Exploring Dental Providers' Workflow in an Electronic Dental Record Environment

Abstract

Background: A workflow is defined as a predefined set of work steps and partial ordering of these steps in any environment to achieve the expected outcome. Few studies have investigated the workflow of providers in a dental office. It is important to understand the interaction of dental providers with the existing technologies at point of care to assess breakdown in the workflow which could contribute to better technology designs.

Objective: The study objective was to assess electronic dental record (EDR) workflows using time and motion methodology in order to identify breakdowns and opportunities for process improvement.

Methods: A time and motion methodology was used to study the human-computer interaction and workflow of dental providers with an EDR in four dental centers at a large healthcare organization. A data collection tool was developed to capture the workflow of dental providers and staff while they interacted with an EDR during initial, planned, and emergency patient visits, and at the front desk. Qualitative and quantitative analysis was conducted on the observational data.

Results: Breakdowns in workflow were identified while posting charges, viewing radiographs, e-prescribing, and interacting with patient scheduler. EDR interaction time was significantly different between dentists and dental assistants (6:20 min vs. 10:57 min, p = 0.013) and between dentists and dental hygienists (6:20 min vs. 9:36 min, p = 0.003).

Conclusions: On average, a dentist spent far less time than dental assistants and dental hygienists in data recording within the EDR.

Keywords: Time and motion studies; dental clinics; dental records; health information systems; process assessment (health care); workflow.

Fig. 1

Data collection tool used for coding the observational data

Fig. 2

Summary of Observation Data. Observation data broken down into dental centers, roles, and type of patient encounter

Fig. 3

Boxplot for distributions of time spent on different activities by dentists

Fig. 4

Time and Motion Analysis of a Dentist’s Workflow During an Initial Visit. In the time and motion plot, the x-axis is measured by seconds and the y-axis is the activities to them. The different colored horizontal bars show the duration of each of the activities as well as the information categories the dentist tried to perform. The gray and white horizontal sections are the categories of different groups of activities: data related, patient related, talking, walking, and miscellaneous

Fig. 5

Time and Motion Analysis of a Dentist’s Workflow During a Planned Visit. In the time and motion plot, the x-axis is measured by seconds and the y-axis is the activities to them. The different colored horizontal bars show the duration of each of the activities as well as the information categories the dentist tried to perform. The gray and white horizontal sections are the categories of different groups of activities: data related, patient related, talking, walking, and miscellaneous

Fig. 6

Time and Motion Analysis of a Dentist’s Workflow During an Emergency Visit. In the time and motion plot, the x-axis is measured by seconds and the y-axis is the activities to them. The different colored horizontal bars show the duration of each of the activities as well as the information categories the dentist tried to perform. The gray and white horizontal sections are the categories of different groups of activities: data related, patient related, talking, walking, and miscellaneous

Fig. 7

Activity Distribution. Distribution of activities for dentists across all dental centers

Fig. 8

Activity (Summary) vs. Information for Dentists at Three Different Visit Types. This shows the heat map analysis for the dentists’ role for three different types of encounters. The key for the correlation 0 to 1 is on the right side of the figure