title: Advancing cognitive engineering methods to support user interface design for electronic health records.
abstract: BACKGROUND
  Despite 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.
  
  
  OBJECTIVE
  In 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Dentists 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.
  
  
  CONCLUSIONS
  This 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.
authors: Dental Informatics Core, Indiana University School of Dentistry, 1121 W Michigan Street, S316, Indianapolis, IN, USA; Center for Biomedical Informatics, Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN, USA. Electronic address: tpt@iu.edu.
authors: Thankam P
authors: TP
authors: Thyvalikakath
authors: Office of Faculty Affairs, School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Michael P
authors: MP
authors: Dziabiak
authors: School of Dental Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Raymond
authors: R
authors: Johnson
authors: Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Miguel Humberto
authors: MH
authors: Torres-Urquidy
authors: Biomedical Informatics Research Center, Marshfield Clinic, Marshfield, WI, USA.
authors: Amit
authors: A
authors: Acharya
authors: Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
authors: Jonathan
authors: J
authors: Yabes
authors: Center for Biomedical Informatics, Regenstrief Institute, Inc., 410 West 10th Street, Suite 2000, Indianapolis, IN, USA.
authors: Titus K
authors: TK
authors: Schleyer
mesh_terms: D001698:Biomedical Engineering / Q000379:methods*; D003071:Cognition / Q000502:physiology*; D003657:Decision Making; D003815:Dentists; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D055094:Evidence-Based Dentistry; D006801:Humans; D008490:Medical Informatics; D020380:Needs Assessment; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D013647:Task Performance and Analysis; D013673:Technology Assessment, Biomedical / Q000379:methods*; D014584:User-Computer Interface
keywords: Cognitive engineering; Cognitive task analysis; Electronic dental records; Electronic health records; System design; Usability