Six minutes and twenty seconds

Between patients, a dental assistant updates the record. The note goes in one place, the X-rays open in another, and linking a diagnosis to a treatment means another screen. Then billing has to be finished, sometimes back in the office.

Some of that time is the record doing its job. Some is the work of getting from one screen, or one room, to the next.

What the observers timed

Schwei, Cooper, Mahnke, Ye and Acharya observed four community dental clinics in one Wisconsin health system. They recorded 120 encounters (not 120 different professionals) over 88 hours and 35 days of observation. The study was published in 2016; the year of fieldwork is not stated, but it preceded the manuscript's submission in 2015.

In that Wisconsin study (120 observed encounters, published in 2016), the mean time in the electronic dental record per encounter was 6 minutes 20 seconds for the dentist, 10 minutes 57 seconds for the dental assistant and 9 minutes 36 seconds for the hygienist. The discussion describes trips back to the office for billing, moves between the record and the X-rays, scheduling difficulties and the prescription process.

The limits of the Wisconsin study are clear: one organisation, one record system, historical data, and only seven reception encounters observed. Above all, time in the record includes work that has to be done; not all of it could be saved, whatever the software.

Watching the work, testing the screen

In a study published in 2009, Irwin, Torres-Urquidy, Schleyer and Monaco watched rather than timed: 23 comprehensive examination and treatment-planning appointments, over 14 researcher visits to 12 general dental practices in the United States. Most of the process breakdowns they identified were linked to technology that interrupted work and created extra steps and rework.

It is a small, historical study (the paper was accepted in 2008). It counts no minutes, 'most breakdowns' is not most of the working time, and it does not describe today's software.

Usability tests isolate the screen. In a laboratory study published in 2008, Thyvalikakath, Monaco, Thambuganipalle and Schleyer gave 20 people new to the systems (academic staff, dentists and advanced students) nine documentation tasks in demonstration versions of four commercial systems. Correct completion ranged from 16% to 64% across the systems, incorrect completion from 18% to 38%, and 286 usability problems were identified.

Walji and colleagues tested a narrower task at two academic settings, Harvard and UCSF, with 32 participants in usability tests, 36 in interviews and 24 in observations (groups that may overlap). In that study, published online in 2012, only 22% to 41% completed a simple diagnosis-entry task, and nobody completed the complex one. Among 24 major interface problems were truncated terms, limited visibility, and moving between screens to link a diagnosis to a treatment.

Both tests used historical interfaces and set tasks; neither gives an error rate for treatment, or for private practice today. In the 2008 study, the systems predate that year and were used without the training their vendors expected, and its correct and incorrect ranges across systems do not add up to 100%. The Walji team worked with the vendor on fixes.

A 2022 scoping review by Ballester, Bukiet and Dufour describes the same kinds of friction in the dental informatics literature: switching screens for images and notes, awkward navigation, missing feedback to the user, and parallel documentation on paper and computer. It is not a meta-analysis, estimates neither minutes lost nor how common the problems are today, and includes the Schwei study, so it does not confirm it independently.

What the record asks for

These studies do not say that time in the record is wasted, or that today's software fails the way older systems did. What they show is more modest: a record asks for movement between screens, rooms and people, and that movement is part of the working day. It deserves to be seen clearly before anyone promises to remove it.

SoliumOS is built to help quietly with that movement. It prepares the administrative work around care, so information is already where the team needs it, inside the clinic's own cloud; the team approves every step.

Sources

• Schwei, Cooper, Mahnke, Ye and Acharya (2016). Exploring Dental Providers' Workflow in an Electronic Dental Record Environment. Applied Clinical Informatics, 7(2):516–533.
• Irwin, Torres-Urquidy, Schleyer and Monaco (2009). A preliminary model of work during initial examination and treatment planning appointments. British Dental Journal, 206:E1.
• Thyvalikakath, Monaco, Thambuganipalle and Schleyer (2008). A usability evaluation of four commercial dental computer-based patient record systems. JADA, 139(12):1632–1642.
• Walji et al. (2013). Detection and characterization of usability problems in structured data entry interfaces in dentistry. International Journal of Medical Informatics, 82(2):128–138.
• Ballester, Bukiet and Dufour (2022). Current state of dental informatics in the field of health information systems: a scoping review. BMC Oral Health, 22:131.