title: Detection and characterization of usability problems in structured data entry interfaces in dentistry.
abstract: BACKGROUND
  Poor usability is one of the major barriers for optimally using electronic health records (EHRs). Dentists are increasingly adopting EHRs, and are using structured data entry interfaces to enter data such that the data can be easily retrieved and exchanged. Until recently, dentists have lacked a standardized terminology to consistently represent oral health diagnoses.
  
  
  OBJECTIVE
  In this study we evaluated the usability of a widely used EHR interface that allow the entry of diagnostic terms, using multi-faceted methods to identify problems and work with the vendor to correct them using an iterative design method.
  
  
  METHODS
  Fieldwork was undertaken at two clinical sites, and dental providers as subjects participated in user testing (n=32), interviews (n=36) and observations (n=24).
  
  
  RESULTS
  User testing revealed that only 22-41% of users were able to successfully complete a simple task of entering one diagnosis, while no user was able to complete a more complex task. We identified and characterized 24 high-level usability problems reducing efficiency and causing user errors. Interface-related problems included unexpected approaches for displaying diagnosis, lack of visibility, and inconsistent use of UI widgets. Terminology related issues included missing and mis-categorized concepts. Work domain issues involved both absent and superfluous functions. In collaboration with the vendor, each usability problem was prioritized and a timeline set to resolve the concerns.
  
  
  CONCLUSIONS
  Mixed methods evaluations identified a number of critical usability issues relating to the user interface, underlying terminology of the work domain. The usability challenges were found to prevent most users from successfully completing the tasks. Our further work we will determine if changes to the interface, terminology and work domain do result in improved usability.
authors: The University of Texas Health Science Center at Houston, USA. Muhammad.F.Walji@uth.tmc.edu
authors: Muhammad F
authors: MF
authors: Walji
authors: Elsbeth
authors: E
authors: Kalenderian
authors: Duong
authors: D
authors: Tran
authors: Krishna K
authors: KK
authors: Kookal
authors: Vickie
authors: V
authors: Nguyen
authors: Oluwabunmi
authors: O
authors: Tokede
authors: Joel M
authors: JM
authors: White
authors: Ram
authors: R
authors: Vaderhobli
authors: Rachel
authors: R
authors: Ramoni
authors: Paul C
authors: PC
authors: Stark
authors: Nicole S
authors: NS
authors: Kimmes
authors: Meta E
authors: ME
authors: Schoonheim-Klein
authors: Vimla L
authors: VL
authors: Patel
mesh_terms: D003813:Dentistry / Q000706:statistics & numerical data*; D003945:Diagnosis, Oral / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D055991:Health Records, Personal; D009323:Natural Language Processing; D009626:Terminology as Topic; D014481:United States; D014584:User-Computer Interface; D014600:Utilization Review; D018875:Vocabulary, Controlled