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      Usability assessment of an electronic health record in a comprehensive dental clinic

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          Abstract

          In this paper we present the development and usability of an electronic health record (EHR) system in a comprehensive dental clinic.The graphic user interface of the system was designed to consider the concept of cognitive ergonomics.The cognitive task analysis was used to evaluate the user interface of the EHR by identifying all sub-tasks and classifying them into mental or physical operators, and to predict task execution time required to perform the given task. We randomly selected 30 cases that had oral examinations for routine clinical care in a comprehensive dental clinic. The results were based on the analysis of 4 prototypical tasks performed by ten EHR users. The results showed that on average a user needed to go through 27 steps to complete all tasks for one case. To perform all 4 tasks of 30 cases, they spent about 91 min (independent of system response time) for data entry, of which 51.8 min were spent on more effortful mental operators. In conclusion, the user interface can be improved by reducing the percentage of mental effort required for the tasks.

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          Most cited references26

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          Methods and dimensions of electronic health record data quality assessment: enabling reuse for clinical research

          Objective To review the methods and dimensions of data quality assessment in the context of electronic health record (EHR) data reuse for research. Materials and methods A review of the clinical research literature discussing data quality assessment methodology for EHR data was performed. Using an iterative process, the aspects of data quality being measured were abstracted and categorized, as well as the methods of assessment used. Results Five dimensions of data quality were identified, which are completeness, correctness, concordance, plausibility, and currency, and seven broad categories of data quality assessment methods: comparison with gold standards, data element agreement, data source agreement, distribution comparison, validity checks, log review, and element presence. Discussion Examination of the methods by which clinical researchers have investigated the quality and suitability of EHR data for research shows that there are fundamental features of data quality, which may be difficult to measure, as well as proxy dimensions. Researchers interested in the reuse of EHR data for clinical research are recommended to consider the adoption of a consistent taxonomy of EHR data quality, to remain aware of the task-dependence of data quality, to integrate work on data quality assessment from other fields, and to adopt systematic, empirically driven, statistically based methods of data quality assessment. Conclusion There is currently little consistency or potential generalizability in the methods used to assess EHR data quality. If the reuse of EHR data for clinical research is to become accepted, researchers should adopt validated, systematic methods of EHR data quality assessment.
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            The impact of electronic health records on time efficiency of physicians and nurses: a systematic review.

            A systematic review of the literature was performed to examine the impact of electronic health records (EHRs) on documentation time of physicians and nurses and to identify factors that may explain efficiency differences across studies. In total, 23 papers met our inclusion criteria; five were randomized controlled trials, six were posttest control studies, and 12 were one-group pretest-posttest designs. Most studies (58%) collected data using a time and motion methodology in comparison to work sampling (33%) and self-report/survey methods (8%). A weighted average approach was used to combine results from the studies. The use of bedside terminals and central station desktops saved nurses, respectively, 24.5% and 23.5% of their overall time spent documenting during a shift. Using bedside or point-of-care systems increased documentation time of physicians by 17.5%. In comparison, the use of central station desktops for computerized provider order entry (CPOE) was found to be inefficient, increasing the work time from 98.1% to 328.6% of physician's time per working shift (weighted average of CPOE-oriented studies, 238.4%). Studies that conducted their evaluation process relatively soon after implementation of the EHR tended to demonstrate a reduction in documentation time in comparison to the increases observed with those that had a longer time period between implementation and the evaluation process. This review highlighted that a goal of decreased documentation time in an EHR project is not likely to be realized. It also identified how the selection of bedside or central station desktop EHRs may influence documentation time for the two main user groups, physicians and nurses.
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              Applied cognitive task analysis (ACTA): a practitioner's toolkit for understanding cognitive task demands.

              Cognitive task analysis (CTA) is a set of methods for identifying cognitive skills, or mental demands, needed to perform a task proficiently. The product of the task analysis can be used to inform the design of interfaces and training systems. However, CTA is resource intensive and has previously been of limited use to design practitioners. A streamlined method of CTA, Applied Cognitive Task Analysis (ACTA), is presented in this paper. ACTA consists of three interview methods that help the practitioner to extract information about the cognitive demands and skills required for a task. ACTA also allows the practitioner to represent this information in a format that will translate more directly into applied products, such as improved training scenarios or interface recommendations. This paper will describe the three methods, an evaluation study conducted to assess the usability and usefulness of the methods, and some directions for future research for making cognitive task analysis accessible to practitioners. ACTA techniques were found to be easy to use, flexible, and to provide clear output. The information and training materials developed based on ACTA interviews were found to be accurate and important for training purposes.
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                Author and article information

                Contributors
                siriwan.suebnukarn@gmail.com
                lollipui@gmail.com
                t.budsara@gmail.com
                kbcaninek@gmail.com
                mansuangdent@yahoo.com
                arm.panu@gmail.com
                Journal
                Springerplus
                Springerplus
                SpringerPlus
                Springer International Publishing AG (Cham )
                2193-1801
                12 May 2013
                12 May 2013
                2013
                : 2
                : 220
                Affiliations
                Faculty of Dentistry, Thammasat University, Pathumthani, Thailand
                Article
                291
                10.1186/2193-1801-2-220
                3667354
                23741651
                6ae899f6-6bc0-496d-985a-bd4c91b29f30
                © Suebnukarn et al.; licensee Springer. 2013

                This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 13 February 2013
                : 30 April 2013
                Categories
                Research
                Custom metadata
                © The Author(s) 2013

                Uncategorized
                electronic oral health record,cognitive ergonomics,cognitive task analysis,usability study

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