|Year : 2015 | Volume
| Issue : 1 | Page : 14-18
Evaluation of students' perception in using electronic dental records
Ammar A Abu Mostafa, Faris S Almasari, Khaled W Sadek, Rawad H Alshehri, Salah M Abduljabbar, Yazeed S Alqahtani
Riyadh Colleges of Dentistry and Pharmacy, Riyadh 11681, Kingdom of Saudi Arabia
|Date of Web Publication||2-Feb-2015|
Ammar A Abu Mostafa
Riyadh Colleges of Dentistry and Pharmacy, P.O. Box 84891, Riyadh 11681
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Introduction: The current study was initiated in order to evaluate the students' perception of an electronic dental record (EDR).
Materials and Methods: A digital based survey questionnaire was developed and validated for evaluating the EDR system. The questions covered the demographic data, addressed the perceptions of the students to the system and the extent of students' satisfaction toward the system.
Results: A total of 290 participated with a response rate of 48%. The results indicated that there was a presence of positive attitude among students toward the EDR system leading to an increase in the level of satisfaction with the system. There was a significant difference between the average satisfaction for male and female students for the benefit of male students, with an average satisfaction score of (4.09) compared to average satisfaction score of (3.74) for female students.
Conclusion: The survey has noticed an increase in quality of patient care due to improved oversight of patient management and the ability to more efficiently monitor treatment outcomes. By providing a coordinated delivery of clinical services, the EDR system has been accepted as an enabling technology that allows users to pursue more advanced practices than would be possible with paper-based records.
Keywords: Dental Informatics, evaluation
|How to cite this article:|
Abu Mostafa AA, Almasari FS, Sadek KW, Alshehri RH, Abduljabbar SM, Alqahtani YS. Evaluation of students' perception in using electronic dental records. Saudi J Oral Sci 2015;2:14-8
|How to cite this URL:|
Abu Mostafa AA, Almasari FS, Sadek KW, Alshehri RH, Abduljabbar SM, Alqahtani YS. Evaluation of students' perception in using electronic dental records. Saudi J Oral Sci [serial online] 2015 [cited 2020 Aug 15];2:14-8. Available from: http://www.saudijos.org/text.asp?2015/2/1/14/150585
| Introduction|| |
The electronic dental record (EDR) can be defined as digitally stored healthcare information throughout individual's lifetime with the purpose of supporting continuity of care, education, and research. It helps create legible and organized recordings and to access clinical information about individual patients.  The proliferation of information technology in health care sector has led to tremendous gains in improving healthcare delivery and patient outcomes.  The first use of computation for medicine was in 1968 in dental practice at the National Bureau of Standards.  Dental management programs first began as a system designed to manage dental hygiene recall by alerting when patients are due for recall, then generating reminder cards. The practice management systems soon moved beyond administration of recall systems and started building dental charting capability. The creation of this electronic dental charting shaped the ability of dental practice to more effectively manage patient treatment plans to completion. 
In 2004, the United States Government established the Office of the National Coordinator for Health Information technology with the mission of implementing EDRs across the United States. 
Many leaders in health care industry have been developing computerized clinical record systems to manage huge volumes of clinical, administrative and regulatory information in contemporary healthcare prominent among them being Axi Um (Exan Academic Inc., Canada), QSI (Quality Systems Inc., United States of America), Quick Recovery (General Systems Design, United States of America), Dentrix (Henry Schein Company, United States of America), Softdent (DENTSPLY Infosoft, United States of America), Eaglesoft (Patterson Company, Canada) and Salud (Two-ten Health Systems, Ireland). These systems are viewed as a way of reducing rate of medical errors, complying with regulatory audits and improving quality.  The major disadvantage of these ready-made software systems is a misalignment of the high cost placed on the software and financial reimbursement. An estimate from the council on competitiveness is that the full cost of implementing a fully integrated health information system is 7.5-13.5% of a clinic's annual budgeted revenues. 
The implementation of EDR systems has allowed a more effective management of a larger patient base while improving the level of service within dental practice. The study was conducted at the Riyadh Colleges of Dentistry and Pharmacy, which has adopted a novel project to come up with an EDR system, tailor made to cater to the needs of the college. Dentoplus (Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Saudi Arabia), which has been in place since 2013, has become an integral part of the clinics' quality assurance and student education programs.
The current study was initiated in order to evaluate student's performance on the EDR. The study also attempted to evaluate system efficiencies, satisfaction level to the system and student perception of how the system has impacted patient care.
| Materials and Methods|| |
This study was conducted at a Dental College in Riyadh, Saudi Arabia over a period of 2 weeks. The study was approved by Research Ethics Committee of the Riyadh Colleges of Dentistry and Pharmacy. A digital based survey questionnaire comprising of a list of 15 questions was developed and validated for evaluating the EDR system of the Colleges.
Questionnaires are frequently used as a quantitative evaluation method in medical informatics, and measures of validity indicate whether an item measures to its intended purpose. It is a significant tool to obtain an insight into what people consider and feel. 
The criteria for inclusion in the above-mentioned study were all the students who use the Dentoplus software.
The questionnaire was sent through colleges E-mail to all the students from level 7 to level 12 (4 th , 5 th and 6 th year) comprising a total of 604 students (328 female and 276 male). The outcomes of the questionnaire were analyzed using SPSS © V17.0 software. The results were analyzed under six sections; namely:
- Preliminary results of data.
- Results related to trends of students toward Dentoplus system.
- Extent of student's satisfaction to Dentoplus system.
- Degree of satisfaction toward system's interface.
- Relationship between attitudes of both male and female students toward Dentoplus system.
- The differences in the level of satisfaction of students to the different variables of Dentoplus system.
| Results|| |
Overall mean rank for the general attitude of students toward EDR system was 3.72 with a standard deviation of ± 0.86. This result indicated that there was a generalized positive attitude to the newly installed software.
The skills and attitude were calculated using the study's instrument. There was a significant direct correlation medium of statistically significant trends between male and female students about EDR system and satisfaction with the system, as the value of Pearson correlation coefficient (0.631) level of significance (0.000).
There was a significant difference between the average satisfaction for male and female students on EDR system, for the benefit of male students, with an average satisfaction score (4.09) compared to (3.74) the female students.
A total of 604 questionnaires were distributed, of which 290 participated with a response rate of 48%. Males constituted 62.1% [Table 1].
Of the 290 respondents, 20% (n = 58) were from level 10 while 19.3% (n = 56) were from students of level 8. Levels 7, 9, 11 and 12 are almost evenly distributed with a percentage of 14.5, 14.1, 16.9 and 15.2% respectively as shown in [Table 2].
|Table 2: Distribution of respondents according to the variable of the academic level|
Click here to view
Asked about their experience with computer usage, a clear majority of the research sample 97.9% (n = 284) responded that they have experience with the computer while 2.1% (n = 6) had no experiences with computers.
With a mean rank of 4.22 ± 0.79, most of the students agreed that the EDR was readily accessible for their daily clinical use.
A significant number of students agreed to the fact that the EDR was better than the earlier paper file system with a mean of 4.12 ± 1.10.
There was seen to be consent among the respondents that the list of procedures programmed into the system covered all the procedures intended to be performed by the students in the clinic (4.02 ± 0.97).
With the new system in place, students noted that there was an improved communication between the Departments in the College with a mean average of 4.01 and a standard deviation of ±0.94.
A high percentage of respondents claimed that the EDR system was practical with a mean arithmetic average of 4.0 ± 0.82.
The EDR system was seen to have made a positive impact on improving data accuracy (3.93 ± 0.94).
Students were seen to have got used to the new EDR system very quickly as the majority of respondents had previous experience with computer handling. The arithmetic mean average to this variable was 3.91 with a standard deviation of ±1.04.
More than 75% of the users of the system agreed to the fact that they had no problems whatsoever in following the sequences of the screens (3.82 ± 0.98).
A total of 66% (n = 189) of the study group thought that the system had enhanced their productivity than when using the paper file system, but 21% (n = 61) were not sure. This attitude of the respondents had an arithmetic mean of 3.75 with a standard deviation of ±0.98.
Although more than ½ of the students (58%; n = 166) reported that the entry of patient data into the system did not increase their workload when comparing with the paper file system, a significantly high percentage of 31% (n = 89) found it more difficult in data entry with a mean average of 3.36 ± 1.22.
Another hindrance felt by the respondents was the speed of the system wherein 61% (n = 175) perceived that the system was slow and affected their output. This variable had an arithmetic mean of 3.36 with a standard deviation of ±1.18.
Though a Dentoplus tutorial video was uploaded for the students to get familiar with the system, a sizable number of candidates (38% n = 109) felt that it was not sufficient for a beginner user of the system.
With 34% of the students complaining that they could not get all patients' data entered without assistance (3.22 ± 1.31) this was one of the least favored factors found by the respondents to the EDR software system.
[Table 3] shows an overview of how the participants responded to all questions in the questionnaire.
|Table 3: Arithmetic mean and SD of the attitudes of students toward dentoplus system|
Click here to view
As illustrated in [Table 4], more than ½ of the sample size (51.4% n = 149) were satisfied while 29% (n = 84) was very satisfied with Dentoplus system. On the contrary, 28 students (9.8%) were not satisfied, and a negligible number of five students were very unhappy about Dentoplus system. 8.3% of the total students preferred to stay neutral to this question.
|Table 4: Distribution of respondents according to degree of satisfaction toward Dentoplus|
Click here to view
On analyzing the differences in the level of satisfaction of the students toward different variables of Dentoplus system like the study level and gender, there are no statistically significant differences in the level of satisfaction of students for system Dentoplus depending on the variable-level of study as the value of the significance level is 0.05. However, there was a significant difference between the average satisfaction for male and female students toward the EDR system, with an average satisfaction score (4.09) for male students compared to (3.74) for female students. This means that the level of male students' satisfaction toward the EDR system was higher than the level of satisfaction of female students [Table 5].
|Table 5: The differences in the level of satisfaction of students in different variables (study level and gender)|
Click here to view
Mann-Whitney test was used to identify whether there was a significant difference in students' satisfaction based on their previous experience in dealing with computer. The result of this test showed that the students with previous experience in using computer are more satisfied; however, this difference was insignificant as the P > 0.05 [Table 6].
|Table 6: Student's satisfaction based on their previous experience in dealing with computer|
Click here to view
| Discussion|| |
The results of the current study demonstrated that nearly all participants have very good experience with the use of computers and thus got used to the system quickly. This can be attributed to the fact that the Kingdom of Saudi Arabia is well on its way to becoming an information-based society. The thrust from the government and the availability of affordable computers has led to an increase in computer penetration among individuals from 30.5% in 2007 to 53% in 2009. According to the Communications and IT Commission, there are 53.1 million mobile subscriptions and 15.2 million internet users at the end of the third quarter of 2012 in the Kingdom. 
The students had a very positive attitude toward the implementation of the Dentoplus software system. This satisfaction is justifiable as the availability and access to computers is sufficient, and each dental station is equipped with one. Most of the students who had experience with both paper file system as well as the EDR system (Levels 9-12) found the latter to be far better and practical to use. However, this study showed that the male students are significantly more satisfied than the female students, the thing that is frequently encountered in higher education whenever satisfaction rate is compared between male and female students. 
Most of the respondents were unsatisfied with the statement of "The system decreases data security and confidentiality of patient details", this means high satisfaction rate with the level of security of the EDR system. Security of the patients' data has become a major IT concern at most institutions. Ensuring that the users are appropriately using the system might involve surveillance of student EDR entries via IT electronic surveillance. 
The students in level 9 up to level 12 who participated in this study have experienced the paper-based files before the EDR, the results showed a significant preference of the EDR over the paper-based files. This is because they used to suffer of losing radiographs and pages from the paper-based files, in addition to the delay of getting the files from the filing room. Moreover, a study conducted by McAndrew et al. pointed out that the documentation in the EDR systems is significantly more accurate than in the paper-based files. 
In addition to recording the patients' data and making it accessible whenever needed, the EDR systems have a utility in dental school strategic planning. The stored data in the EDR system can be utilized to analyze the caries risk assessment and patient demographics, including gender and age, which provides the regulatory bodies with important information for their future plans.  Furthermore, the EDR systems can capture and allow the comparative analysis of patients or groups of providers for quality assurance purposes. The use of quality indicators will enable outcome-based quality improvement. For example, the system could be used to generate a report indicating missing radiographs, patients still in active treatment that who have not been seen in their respective appointments and overdue recalls. The system could also be used to collect patient satisfaction surveys while waiting for their appointments.
Patient education for informed decision-making could be a component of the EDR system. Showing small videos or clips of the treatment to the patient prior to the treatment will not only alleviate the fear and anxiety of the patient toward the treatment but also increase his confidence - in the student treating him. The system could also have a link to the library and books like management of medical emergencies and medical drug index.
| Conclusion|| |
Although Dentoplus system has been used for just over a year, the vast majority of the respondents were satisfied with it barring a few glitches, which can be rectified within a period. Due to the survey an increase in quality of patient care there has been improved oversight of patient management and the ability to more efficiently track down treatment outcomes.
There is no better place to begin this learning curve regarding the importance and utilization of EDR systems than in dental schools, where dental health professional students can acquire a comfort level with the system in an academic environment that they may then implement in their future practice.
| References|| |
Rhodes P. Electronic clinical records: Having the right data to navigate through the perfect storm. J Calif Dent Assoc 2014;42:119-23.
Schleyer T, Song M, Gilbert GH, Rindal DB, Fellows JL, Gordan VV, et al
. Electronic dental record use and clinical information management patterns among practitioner-investigators in The Dental Practice-Based Research Network. J Am Dent Assoc 2013;144:49-58.
Schleyer TK. Dental informatics: A work in progress. Adv Dent Res 2003;17:9-15.
Chan KS, Fowles JB, Weiner JP. Review: Electronic health records and the reliability and validity of quality measures: A review of the literature. Med Care Res Rev 2010;67:503-27.
Bush GW. Executive Order: 13335: Incentives for the use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator; 2004.
Meeks DW, Smith MW, Taylor L, Sittig DF, Scott JM, Singh H. An analysis of electronic health record-related patient safety concerns. J Am Med Inform Assoc 2014;21:1053-9.
Hersh W. Health care information technology. J Am Med Assoc 2004;292:2273-4.
Laerum H, Faxvaag A. Task-oriented evaluation of electronic medical records systems: Development and validation of a questionnaire for physicians. BMC Med Inform Decis Mak 2004;4:1.
A Comprehensive Study on the State of ICT Market Development in Saudi Arabia. Available from: http://www.citc.gov.sa/English/Reportsandstudies/Studies/Pages/TheStateofICTMarketDevelopmentinSaudiArabia.aspx. [Last accessed on 2014 Aug 06].
Johan DJ, Gbolahan G. Predicting students satisfaction through service quality in higher education. Int J Manage Educ 2013;11:107-18.
Cederberg RA, Valenza JA. Ethics and the electronic health record in dental school clinics. J Dent Educ 2012;76:584-9.
McAndrew R, Ban J, Playle R. A comparison of computer- and hand-generated clinical dental notes with statutory regulations in record keeping. Eur J Dent Educ 2012;16:e117-21.
Filker PJ, Cook N, Kodish-Stav J. Electronic health records: A valuable tool for dental school strategic planning. J Dent Educ 2013;77:591-7.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]