Digital casts in orthodontics: a comparison of 4 software systems.

INTRODUCTION: The introduction of digital cast models is inevitable in the otherwise digitized everyday life of orthodontics. The introduction of this new technology, however, is not straightforward, and selecting an appropriate system can be difficult. The aim of the study was to compare 4 orthodontic digital software systems regarding service, features, and usability. METHODS: Information regarding service offered by the companies was obtained from questionnaires and Web sites. The features of each software system were collected by exploring the user manuals and the software programs. Replicas of pretreatment casts were sent to Cadent (OrthoCAD; Cadent, Carlstadt, NJ), OthoLab (O3DM; OrthoLab, Poznan, Poland), OrthoProof (DigiModel; OrthoProof, Nieuwegein, The Netherlands), and 3Shape (OrthoAnalyzer; 3Shape, Copenhagen, Denmark). The usability of the programs was assessed by experts in interaction design and usability using the "enhanced cognitive walkthrough" method: 4 tasks were defined and performed by a group of domain experts while they were observed by usability experts. RESULTS: The services provided by the companies were similar. Regarding the features, all 4 systems were able to perform basic measurements; however, not all provided the peer assessment rating index or the American Board of Orthodontics analysis, simulation of the treatment with braces, or digital articulation of the casts. All systems demonstrated weaknesses in usability. However, OrthoCAD and 03DM were considered to be easier to learn for first-time users. CONCLUSIONS: In general, the usability of these programs was poor and needs to be further developed. Hands-on training supervised by the program experts is recommended for beginners.

An example of an application of the semiotic inspection method in the domain of computerized patient record system.

Efficiently navigating through an interface and conducting work tasks in flow is what GUI designers strive for. Dental professionals, who alternate between examination and treatment of a patient and insertion of data into the Computerized Patient Record system, particularly need an interface that would facilitate the workflow. In this paper we present an inspection evaluation of an existing and widely used Computerized Patient Record system. The Semiotic Inspection Method was applied with the expectation that the method could provide evidence that task flow, navigation and wayfinding were major usability issues of the interface. Also expected was that the Semiotic Inspection would reveal the means and strategies used in the interface in order to communicate the flow. The analysis conducted using the Semiotic Inspection Method showed inconsistencies in the communication of the way forward through the interface. In addition, the profile of the users, regarding digital skills, appears to be ambiguous. Finally, the strategies used in the interface for conveying the workflow could be identified as well.

Supporting openEHR Java desktop application developers.

The openEHR community suggests that an appropriate approach for creating a graphical user interface for an openEHR-based application is to generate forms from the underlying archetypes and templates. However, current generation techniques are not mature enough to be able to produce high quality interfaces with good usability. Therefore, developing efficient ways to combine manually designed and developed interfaces to openEHR backends is an interesting alternative. In this study, a framework for binding a pre-designed graphical user interface to an openEHR-based backend is proposed. The proposed framework contributes to the set of options available for developers. In particular we believe that the approach of combining user interface components with an openEHR backend in the proposed way might be useful in situations where the quality of the user interface is essential and for creating small scale and experimental systems.

A migration to an openEHR-based clinical application.

MedView is a suit of clinical applications for recording, retrieving and visualizing patient records, which has been developed and in use for more than ten years. By the introduction of the openEHR architecture, the MedView project started an investigation to migrate from its locally developed framework to openEHR. Issues related to this process, have been discussed in this paper.

SOMWeb: a semantic web-based system for supporting collaboration of distributed medical communities of practice.

BACKGROUND: Information technology (IT) support for remote collaboration of geographically distributed communities of practice (CoP) in health care must deal with a number of sociotechnical aspects of communication within the community. In the mid-1990s, participants of the Swedish Oral Medicine Network (SOMNet) began discussing patient cases in telephone conferences. The cases were distributed prior to the conferences using PowerPoint and email. For the technical support of online CoP, Semantic Web technologies can potentially fulfill needs of knowledge reuse, data exchange, and reasoning based on ontologies. However, more research is needed on the use of Semantic Web technologies in practice. OBJECTIVES: The objectives of this research were to (1) study the communication of distributed health care professionals in oral medicine; (2) apply Semantic Web technologies to describe community data and oral medicine knowledge; (3) develop an online CoP, Swedish Oral Medicine Web (SOMWeb), centered on user-contributed case descriptions and meetings; and (4) evaluate SOMWeb and study how work practices change with IT support. METHODS: Based on Java, and using the Web Ontology Language and Resource Description Framework for handling community data and oral medicine knowledge, SOMWeb was developed using a user-centered and iterative approach. For studying the work practices and evaluating the system, a mixed-method approach of interviews, observations, and a questionnaire was used. RESULTS: By May 2008, there were 90 registered users of SOMWeb, 93 cases had been added, and 18 meetings had utilized the system. The introduction of SOMWeb has improved the structure of meetings and their discussions, and a tenfold increase in the number of participants has been observed. Users submit cases to seek advice on diagnosis or treatment, to show an unusual case, or to create discussion. Identified barriers to submitting cases are lack of time, concern about whether the case is interesting enough, and showing gaps in one's own knowledge. Three levels of member participation are discernable: a core group that contributes most cases and most meeting feedback; an active group that participates often but only sometimes contribute cases and feedback; and a large peripheral group that seldom or never contribute cases or feedback. CONCLUSIONS: SOMWeb is beneficial for individual clinicians as well as for the SOMNet community. The system provides an opportunity for its members to share both high quality clinical practice knowledge and external evidence related to complex oral medicine cases. The foundation in Semantic Web technologies enables formalization and structuring of case data that can be used for further reasoning and research. Main success factors are the long history of collaboration between different disciplines, the user-centered development approach, the existence of a "champion" within the field, and nontechnical community aspects already being in place.

Collaboration patterns in an online community of practice in oral medicine.

SOMWeb is an online collaboration system based on Semantic Web technologies, which is used for knowledge sharing and dissemination within an oral medicine community in Sweden. Based on a previous study of the use of SOMWeb, general patterns of interaction and communicative activities involved in community collaboration have been identified. The patterns for one such activity, distance consultation, are described and modeled using techniques from the Pragmatic Web. It is also shown how patterns could inform system design.

mGen--An Open Source Framework for Generating Clinical Documents.

As formalised electronic storage of medical data becomes more and more wide spread the possibility and need for creating human readable presentations for various purposes increases. This paper presents the mGen framework - a general framework for text generation, written in Java and in the process of being open-sourced, that has been developed within the MedView projectThe work presented in this paper was supported by the Swedish Agency for Innovation Systems (VINNOVA).. The framework has been used for several years to generate literally thousands of clinical documents at an oral medicine clinic in Sweden.

SOMWeb - Towards an Infrastructure for Knowledge Sharing in Oral Medicine.

In a net-based society, clinicians can come together for cooperative work and distance learning around a common medical material. This requires suitable techniques for cooperative knowledge management and user interfaces that are adapted to both the group as a whole and to individuals. To support distributed management and sharing of clinical knowledge, we propose the development of an intelligent web community for clinicians within oral medicine. This virtual meeting place will support the ongoing work on developing a digital knowledge base, providing a foundation for a more evidence-based oral medicine. The presented system is founded on the use and development of web services and standards for knowledge modelling and knowledge-based systems. The work is conducted within the frame of a well-established cooperation between oral medicine and computer science.

mVisualizer: Easily Accessible Data Exploration for Clinicians.

In medical research and clinical work, having direct access to a large knowledge base of information about patients is very useful. Software for information visualisation can help the user browse, analyse and learn from such knowledge, thus providing new insights and accelerating research. However, when introducing new software to clinicians, who may have limited computer knowledge, adoption can be hindered by the complexity of the applications and the time investments necessary to learn them. By involving clinicians directly in the design process, we have developed mVisualizer, an application that provides a hands-on workspace to visualise and explore patient data. mVisualizer was designed for accessibility and simplicity, and to encourage users to explore the data in order to make discoveries and pose new questions relevant for knowledge gathering and research. The user-centered approach helped ensure that mVisualizer is understandable and easy to learn for clinicians. The application is in use by clinicians today, and its use has led to new discoveries and theories that will be the subject of future medical research. This leads to the conclusion that information visualisation software for exploring patient data can help clinicians and researchers by making the data more accessible, which stimulates research and learning.

MedView: an instrument for clinical research and education in oral medicine.

The etiology for many of the mucosal lesions we encounter in clinical practice is frequently uncertain or unknown and there is reason to believe that multicausality plays an important role. To detect multicausal relationships, the analysis must include multiple variables and large amounts of data. A traditional retrospective analysis is often based on a limited number of variables and frequently entails methodological errors where vital information may be missing. Prospective studies may be hampered by the fact that the prevalences of many conditions are relatively low. The search for new knowledge in oral medicine should therefore be facilitated by prospective use of formalized information gathered in multicenter studies. MedView is a computer program that is based on formalized input and registration of all clinical information. The output applications are focused on visualization and statistical analysis. MedView is aimed at clinical research and is well suited for multicenter studies. It also contains applications for education and distant consultations.

Using text generation to access clinical data in a variety of contexts.

MedView is a joint project with participants from oral medicine and computer science. The aim of the project is to build a large database from patient examinations and produce computerised tools to access data in various ways. One way to access data is to read case descriptions generated from stored cases. We give a description of how documents are generated from data and how these are used in a variety of contexts to supply useful information.

MedView: a declarative approach to evidence-based medicine.

MedView is a project that meets the challenges of evidence-based oral medicine by providing a formalisation of clinical examination data and clinical procedures. Tools are provided for knowledge acquisition, knowledge generation, visualisation and analysis of data, and knowledge sharing. The formal declarative model constitutes the main governing principle in MedView, not only in the formalisation of clinical terms and concepts, but in visualisation models and in the design and implementation of individual tools and the system as a whole as well.