In our first study, we surveyed 102 randomly sampled U.S. general dentists who were using a computer at chairside about their use of, opinions about, and attitudes toward their systems.1 A majority of the respondents (80%) had implemented such systems at chairside within the last 10 years. The average age of our respondents was 50 years, with a standard deviation of 10 years. Eighty percent of the respondents used one of four systems: Dentrix (Dentrix Dental Systems, American Fork, UT), EagleSoft (Patterson Dental, St. Paul, MN), SoftDent or PracticeWorks (Carestream Health, Rochester, NY). Seventy percent used at least one other software application e.g., for digital radiology and/or photography, or Invisalign.

Figure 1 shows that most practices store patient information in a mix of paper/hard copy and computer formats. Information strongly associated with billing and practice operations, such as treatment procedures and patient appointments, tended to be most frequently stored on computers, followed by images and intraoral charting. Information that was stored least frequently on the computer included the medical and dental history, progress notes and the chief complaint. The figure also illustrates that a large proportion of information is duplicated on both paper and the computer. Clearly, maintaining information in two places has multiple drawbacks. First, duplicate information storage consumes unnecessary resources. Second, inconsistencies in information between the two types of storage can potentially lead to incomplete diagnosis/treatment, clinical errors and/or legal complications. When asked about the duplication, several respondents indicated that they were in a period of transition, and that they would eliminate paper-based records as soon as they had mastered the corresponding electronic functions and/or felt completely comfortable with the computer as a storage medium. Some also provided another reason; the CPR they used was not able to store all information that the practice wanted to store, and this information therefore remained confined to paper. This finding prompted us to explore the information representation capabilities of CPRs further in the second study we describe below.

Relatively few of the respondents used what would be considered advanced techniques for data entry/retrieval during clinical care: touchscreens and voice input. About 13% each used one of those two technologies. Importantly, while three percent had tried to use a touchscreen and abandoned it, 16% had done so with voice. Judging from these data, voice input does not seem to be mature enough to serve the needs of many practitioners who tried using it. A small fraction of respondents used specialized input devices, such as barcode scanners and electronic dental probes.

In general, respondents appreciated the value and benefits they derived from having adopted CPRs. Charting, treatment planning and imaging functions were seen as particularly useful, and one quarter of respondents could not identify anything in their CPRs that they disliked. Efficiency, convenient information access and patient education were seen as the major advantages of CPRs. Despite this positive view, our study identified several barriers and opportunities for improvement. For instance, usability, functionality and charting were among the main features that respondents disliked, and insufficient operational reliability, program limitations, the learning curve and cost were seen as major barriers to CPR use. Issues with infection control and the need for better user interfaces were recurrent themes.

In sum, our study on chairside computing showed that at present, full adoption of the CPR remains the domain of a small minority of general practitioners. Our survey demonstrated that the dentists who use CPRs tend to derive significant value, but that CPRs as a technology have to mature further in many respects before they will enter the mainstream.