Advancing cognitive engineering methods to support user interface design for electronic health records |
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| Affiliation: | 1. Dental Informatics Core, Indiana University School of Dentistry, 1121 W Michigan Street, S316, Indianapolis, IN, USA;2. Office of Faculty Affairs, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA;3. School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA;4. Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA;5. Biomedical Informatics Research Center, Marshfield Clinic, Marshfield, WI, USA;6. Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA;7. Center for Biomedical Informatics, Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN, USA;1. Faculty of Pharmacy, The University of Sydney, Pharmacy and Bank Building (A15), Sydney, NSW 2006, Australia;2. School of Healthcare, University of Leeds, Baines Wing, Leeds LS2 9JT, UK;1. Department of Clinical Pharmacology and Pharmacoepidemiology, University of Heidelberg, Heidelberg, Germany;2. Cooperation Unit Clinical Pharmacy, University of Heidelberg, Heidelberg, Germany;3. Department of Internal Medicine V, Hematology, Rheumatology, and Oncology, University of Heidelberg, Heidelberg, Germany;4. Division of Nephrology, Renal Clinic, University of Heidelberg, Heidelberg, Germany;1. Department of Biomedical Informatics, Columbia University, New York, NY, USA;2. Department of Anesthesiology, Columbia University, New York, NY, USA;3. Department of Medicine, Division of Cardiology, Columbia University, New York, NY, USA;4. The Clinical Trials Office, Columbia University, New York, NY, USA;5. School of Nursing, Columbia University, New York, NY, USA;6. The Irving Institute for Clinical and Translational Research, Columbia University, New York, NY, USA;1. Feinberg School of Medicine, Northwestern University, Chicago, IL, United States;2. Group Health Research Institute, Seattle, WA, United States;3. Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States;4. Marshfield Clinic Research Foundation, Marshfield, WI, United States;5. Sigfried and Janet Weis Center for Research, Geisinger Health System, Danville, PA, United States;6. Departments of Biomedical Informatics and Medicine, Vanderbilt University, Nashville, TN, United States;7. Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, IL, United States |
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| Abstract: | BackgroundDespite many decades of research on the effective development of clinical systems in medicine, the adoption of health information technology to improve patient care continues to be slow, especially in ambulatory settings. This applies to dentistry as well, a primary care discipline with approximately 137,000 practitioners in the United States. A critical reason for slow adoption is the poor usability of clinical systems, which makes it difficult for providers to navigate through the information and obtain an integrated view of patient data.ObjectiveIn this study, we documented the cognitive processes and information management strategies used by dentists during a typical patient examination. The results will inform the design of a novel electronic dental record interface.MethodsWe conducted a cognitive task analysis (CTA) study to observe ten general dentists (five general dentists and five general dental faculty members, each with more than two years of clinical experience) examining three simulated patient cases using a think-aloud protocol.ResultsDentists first reviewed the patient's demographics, chief complaint, medical history and dental history to determine the general status of the patient. Subsequently, they proceeded to examine the patient's intraoral status using radiographs, intraoral images, hard tissue and periodontal tissue information. The results also identified dentists’ patterns of navigation through patient's information and additional information needs during a typical clinician–patient encounter.ConclusionThis study reinforced the significance of applying cognitive engineering methods to inform the design of a clinical system. Second, applying CTA to a scenario closely simulating an actual patient encounter helped with capturing participants’ knowledge states and decision-making when diagnosing and treating a patient. The resultant knowledge of dentists’ patterns of information retrieval and review will significantly contribute to designing flexible and task-appropriate information presentation in electronic dental records. |
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| Keywords: | Cognitive task analysis Electronic health records Usability Cognitive engineering System design Electronic dental records |
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