The electronic dental record (EDR) represents a powerful tool with the potential to facilitate incorporating best practice guidelines into dental treatments and improve quality of care. Studies of how professionals interact with EDRs are needed to maximize these potentials.
Objectives : To: 1) understand EDR utilization in the context of patient care; 2) determine common patterns of EDR interaction and problematic issues, 3) identify practitioners attitudes towards EDRs, and 4) identify opportunities to implement elements that support clinical decision-making.
Methods : Observations were carried out in a convenience sample of 15 hygienists and 12 dentists employed at 9 HealthPartners Dental Group (HPDG) locations. The principal investigator and study coordinator served as observers. We used contextual inquiry, an ethnographic research method, to document work sequence, information acquisition and documentation, work process breakdowns, and verbal feedback. Coded field notes were analyzed using Qualrus©.
Results : Twenty-five observations were conducted. Work flow through EDR screens was fairly consistent. Most providers had favorable attitudes towards EDRs; although, they wish that electronic dental- and medical records could interact. Hygienists bore most of the information acquisition and documentation responsibilities. Single monitor use prevented EDR access while viewing radiographs resulting in duplication of data recording. EDR breakdowns were limited but seriously interrupted workflow. Adjunct features, such as patient education resources, were seldom utilized compared to features that must be completed to “charge-out” the patient. While hygienists actively asked patients about tobacco use, most did not assess patients' desire to quit. Practitioners expressed a willingness to utilize the EDR to assist in incorporating best practice guidelines, including tobacco cessation interventions.
Conclusions : Practitioners' attitudes are generally positive about EDR usage and incorporation of best practice guidelines strategies to support clinical decision-making. Practitioner compliance with these strategies will be highest when elements are required rather than optional.