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Perceptions and attitudes of Canadian orthodontists regarding digital and electronic technology
SHORT COMMUNICATION
Perceptions and attitudes of Canadian orthodontists regarding digital and electronic technology Neal G. Palmer,a James R. Yacyshyn,b Herbert C. Northcott,c Brian Nebbe,a and Paul W. Majord Edmonton, Alberta, Canada Introduction: To plan for future acceptance and implementation of computer-related technology, it is necessary to understand orthodontists’ current perceptions and attitudes toward emerging technologies. Methods: An anonymous, self-administered, mail-out survey of Canadian orthodontists was conducted. The response rate was 45.6% (304/667). Results: Most orthodontists indicated that computer technology could improve current practice efficiency and quality of patient care. Only 15% reported that digital models are quite or very useful; 73.6%, 69.1%, 55%, and 37.4% agreed or strongly agreed with using digital and electronic technology to consult with other dental specialists, other orthodontists, general dentists, and the public, respectively. Cost of the technology was reported as a significant or insurmountable obstacle by 54% of the respondents. Interprovincial legislation, unclear consultation remuneration guidelines, and lack of comfort with the technology were not perceived as significant obstacles. Only 36% reported security or privacy issues as a significant or insurmountable obstacle. Conclusions: Canadian orthodontists seem to view digital and electronic technology as useful and capable of improving their offices’ efficiency and production. Although they are sensitive to some potential obstacles, they are willing to overcome these and incorporate the technology into their practices. (Am J Orthod Dentofacial Orthop 2005;128:163-7)
A
s computers and digital and electronic media become increasingly common in orthodontic offices, practitioners will need to take the initiative in aligning themselves with what the technology has to offer. They must develop the foresight to see not only how their practices will be affected, but also how they can benefit from implementing electronic technology.1 By establishing orthodontists’ current perceptions and attitudes about electronic and digital information, the profession can plan for future acceptance and implementation of the technology. It will assist orthodontists in knowing how they compare with the rest of the profession so that they can investigate continuingFrom the University of Alberta, Edmonton, Alberta, Canada. a Clinical assistant professor, Orthodontic Graduate Program, Department of Dentistry. b Clinical assistant professor, Director of Continuing Dental Education, Department of Dentistry. c Professor, Department of Sociology. d Professor, Director of Orthodontic Graduate Program, Department of Dentistry. Supported by the University of Alberta Fund for Dentistry (#2002-07) and the McIntyre Memorial Research Fund. Reprint requests to: Dr Paul Major, Faculty of Medicine and Dentistry, Room 4051b Dentistry/Pharmacy Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2N8; e-mail, [email protected]. Submitted, September 2004; revised and accepted, February 2005. 0889-5406/$30.00 Copyright © 2005 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2005.02.015
education possibilities and consider technological updates to their practices. The objectives of this study were to determine orthodontists’ (1) perceptions of digital and electronic media’s ability to resolve or improve orthodontic practice issues, (2) attitudes about the usefulness of and willingness to use digital and electronic media, (3) perceived obstacles to the use of digital and electronic media in orthodontic offices, and (4) concerns about Internet privacy issues. METHODS
A research tool (mail-out questionnaire) was developed to survey orthodontists in Canada. The investigators (3 practicing orthodontists, an information technology expert, and a sociologist) developed the initial survey. A draft survey was distributed to a pilot group of 3 practicing orthodontists. Minor revisions were made based on their feedback. The protocol for the study was approved by the Health Research Ethics Board at the University of Alberta. The provincial registries for 2003 were used to compile a list of Canadian orthodontists. Two orthodontists were excluded because they helped to develop the research tool. The remaining 667 orthodontists became the population for the study. A packet was sent consisting of the questionnaire, a return stamped enve163
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Fig 1. Perception of technology’s capabilities to improve current practice issues.
lope, and a letter to explain the research topic and obtain informed consent from the participating orthodontists. Reminder cards were mailed 1 week and 2 weeks after the initial mail-out. The reminder cards thanked the orthodontists for their participation or reminded them to complete and return the survey. Responses were entered into spreadsheets and coded for data analysis. The data were cleaned by checking for entries outside the legitimate range or inconsistent codes; the necessary corrections were made by manually rechecking the surveys. SPSS for Windows (SPSS, Chicago, Ill) was used to enter and analyze the data. Twenty percent of the surveys were selected by using a random number generator to be hand-checked by a blinded evaluator to determine the rate of data entry errors. The data entry error rate was 0.103% (12 of 11,651 points). This was considered to be accurate enough for data analysis, and further manual confirmation was foregone. Descriptive statistics were used to analyze the data. RESULTS
From the population of 667, a total of 304 surveys were returned for data collection—a response rate of
45.58%. Of the respondents, 9 were in full-time academic positions, 17 were not practicing, and 278 were currently practicing. The 17 nonpracticing respondents were excluded, leaving 287 surveys for analysis. Ninety percent or more of the orthodontists indicated that computer technology could improve current practice by: reducing radiation exposure, reducing time to transfer records, increasing practice efficiency, increasing practice production, improving doctor-to-doctor communication, improving doctor-to-patient communication, improving record quality, reducing record storage requirements, and increasing access to shared patient information. Furthermore, 83.4% believed that computer technology could improve case diagnosis and treatment planning, 84% thought it could increase patient satisfaction, and 71.9% indicated that it could decrease office expenses and increase the number of case starts. Finally, 67.0% of orthodontists thought that computer technology could reduce appointment times. Comprehensive descriptive data are presented in Figure 1. Figure 2 shows that 4% percent or less of the orthodontists considered digital photography, digital radiography, and orthodontic imaging software not at all useful. Over three fourths of the respondents said
Palmer et al 165
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Fig 2. Perception of usefulness of various information technologies.
that digital photography was quite useful or very useful. With regard to electronic or virtual models and electronic referral forms, two thirds believed that they were somewhat useful or useful, and about 15% said they were quite or very useful. Most orthodontists (86.8%) believed that paperless charting had at least some usefulness. The orthodontists were asked about their willingness to use digital and electronic media in various communication settings. Their responses are shown in Figure 3. Almost three fourths of the respondents (73.6%) agreed or strongly agreed with using digital and electronic technology to consult with other dental specialists such as oral surgeons, periodontists, or prosthodontists Slightly less (69.1%) agreed with using it to consult with other orthodontists, and over one half (55%) would use it to consult with general practicing dentists. Only 37.4% were willing to consult with patients using digital and electronic technology. Figure 4 shows how orthodontists rate various obstacles to the general use of electronic and digital media in their practices. Cost or expense of the technology was the most important; over half of the respondents (54.4%) reported it to be a significant or insurmountable obstacle. More than one third said that security or privacy, scheduling for videoconferencing, lack of face-to-face communication, and incompatible hardware or software were significant or insurmount-
able obstacles. Furthermore, 21.8% thought that need for technical training was a significant or insurmountable obstacle, and 27.0% believed that lack of interdoctor cooperation was a significant or insurmountable obstacle. Approximately one third of the respondents considered interprovincial legislation, unclear consult remuneration guidelines, and lack of comfort with technology to be not an obstacle at all. DISCUSSION
Although the respondents thought that digital and electronic technology was generally useful in orthodontics, a substantial minority did not believe that it could improve certain aspects of their practices. These aspects pertain to some of their main sources of stress and concern, including office expenses, appointment times, case starts, diagnosis and treatment planning, and patient satisfaction. These are related to time management, patient cooperation, practice management, and lack of personal time, all of which are related to orthodontists’ stress and personal satisfaction.2 Nevertheless, 95.9% of the respondents reported that technology was at least somewhat capable of increasing practice efficiency, and 90.0% thought that it was at least somewhat capable of increasing practice production. Research to investigate how information technology might benefit specific practice issues such as increasing case starts, reducing appointment times, and
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Fig 3. Willingness to use information technology for consultations.
Fig 4. Obstacles to use of information technology.
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reducing office expenses would probably motivate orthodontists to actively integrate the technologies. By and large, orthodontists consider digital and electronic technology to be useful in their orthodontic practices. Digital photography is the most useful. Only 2 respondents considered it not at all useful. Digital photography has a generalized perception of value to the orthodontic community. Digital radiography and imaging software are also perceived as useful to most of the profession. Orthodontists were generally open to using telecommunications in their practices. This reflects other research that shows that practitioners are leery about using digital and electronic technology to communicate with the public but are quite open to using it to communicate with colleagues.3 The willingness to consider electronic consultation is somewhat surprising, since previous research has shown that the time to prepare a case for a teledentistry conference is longer than conventional means.4,5 Cost, lack of face-to-face communication, incompatible software or hardware, security and privacy, and time seemed to be the major obstacles to the general incorporation of digital and electronic technology for both the general dental and orthodontic communities.6,7 In contrast to previous studies based on general dentists, remuneration guidelines and lack of comfort with technology did not seem to be considered as important in the orthodontic community as one might have thought.
CONCLUSIONS
● Digital and electronic technology is generally viewed as useful to the orthodontic profession. ● Orthodontists believe technology can increase office efficiency and production. ● Most orthodontists are more willing to implement digital and electronic technology for consulting with colleagues than for consulting with patients. ● The major obstacles to the general use of the technology are related to cost, security or privacy, and time management. REFERENCES 1. Bauer JC, Brown WT. The digital transformation of oral health care. Teledentistry and electronic commerce. J Am Dent Assoc 2001;132:204-9. 2. Roth SF. Occupational stress and job satisfaction among Canadian orthodontists [thesis]. Edmonton, Alberta, Canada: University of Alberta; 2002. 3. Stephens CD, Cook J. Attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients. J Orthod 2002;29:137-42. 4. Cook J, Edwards J, Mullings C, Stephens C. Dentists’ opinions of an online orthodontic advice service. J Telemed Telecare 2001;7: 334-7. 5. Cook J, Mullings C, Vowles R, Ireland R, Stephens C. Online orthodontic advice: a protocol for a pilot teledentistry system. J Telemed Telecare 2001;7:324-33. 6. Mitchell E, Sullivan F. A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97. BMJ 2001;322:279-82. 7. Bodenheimer T, Grumbach K. Electronic technology: a spark to revitalize primary care? JAMA 2003;290:259-64.
BOUND VOLUMES AVAILABLE TO SUBSCRIBERS Bound volumes of the American Journal of Orthodontics and Dentofacial Orthopedics are available to subscribers (only) for the 2004 issues from the Publisher, at a cost of $96.00 ($115.56 Canada and $108.00 international) for Vol. 125 (January-June) and Vol. 126 (July-December). Shipping charges are included. Each bound volume contains subject and author indexes. The binding is durable buckram, with the journal name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact Elsevier Inc., Subscription Customer Service, 6277 Sea Harbor Dr, Orlando, FL 32887; phone 800-654-2452 or 407-345-4000. Subscriptions must be in force to qualify. Bound volumes are no available in place of a regular Journal subscription.
Perceptions and attitudes of Canadian orthodontists regarding digital and electronic technology Neal G. Palmer,a James R. Yacyshyn,b Herbert C. Northcott,c Brian Nebbe,a and Paul W. Majord Edmonton, Alberta, Canada Introduction: To plan for future acceptance and implementation of computer-related technology, it is necessary to understand orthodontists’ current perceptions and attitudes toward emerging technologies. Methods: An anonymous, self-administered, mail-out survey of Canadian orthodontists was conducted. The response rate was 45.6% (304/667). Results: Most orthodontists indicated that computer technology could improve current practice efficiency and quality of patient care. Only 15% reported that digital models are quite or very useful; 73.6%, 69.1%, 55%, and 37.4% agreed or strongly agreed with using digital and electronic technology to consult with other dental specialists, other orthodontists, general dentists, and the public, respectively. Cost of the technology was reported as a significant or insurmountable obstacle by 54% of the respondents. Interprovincial legislation, unclear consultation remuneration guidelines, and lack of comfort with the technology were not perceived as significant obstacles. Only 36% reported security or privacy issues as a significant or insurmountable obstacle. Conclusions: Canadian orthodontists seem to view digital and electronic technology as useful and capable of improving their offices’ efficiency and production. Although they are sensitive to some potential obstacles, they are willing to overcome these and incorporate the technology into their practices. (Am J Orthod Dentofacial Orthop 2005;128:163-7)
A
s computers and digital and electronic media become increasingly common in orthodontic offices, practitioners will need to take the initiative in aligning themselves with what the technology has to offer. They must develop the foresight to see not only how their practices will be affected, but also how they can benefit from implementing electronic technology.1 By establishing orthodontists’ current perceptions and attitudes about electronic and digital information, the profession can plan for future acceptance and implementation of the technology. It will assist orthodontists in knowing how they compare with the rest of the profession so that they can investigate continuingFrom the University of Alberta, Edmonton, Alberta, Canada. a Clinical assistant professor, Orthodontic Graduate Program, Department of Dentistry. b Clinical assistant professor, Director of Continuing Dental Education, Department of Dentistry. c Professor, Department of Sociology. d Professor, Director of Orthodontic Graduate Program, Department of Dentistry. Supported by the University of Alberta Fund for Dentistry (#2002-07) and the McIntyre Memorial Research Fund. Reprint requests to: Dr Paul Major, Faculty of Medicine and Dentistry, Room 4051b Dentistry/Pharmacy Centre, University of Alberta, Edmonton, Alberta, Canada, T6G 2N8; e-mail, [email protected]. Submitted, September 2004; revised and accepted, February 2005. 0889-5406/$30.00 Copyright © 2005 by the American Association of Orthodontists. doi:10.1016/j.ajodo.2005.02.015
education possibilities and consider technological updates to their practices. The objectives of this study were to determine orthodontists’ (1) perceptions of digital and electronic media’s ability to resolve or improve orthodontic practice issues, (2) attitudes about the usefulness of and willingness to use digital and electronic media, (3) perceived obstacles to the use of digital and electronic media in orthodontic offices, and (4) concerns about Internet privacy issues. METHODS
A research tool (mail-out questionnaire) was developed to survey orthodontists in Canada. The investigators (3 practicing orthodontists, an information technology expert, and a sociologist) developed the initial survey. A draft survey was distributed to a pilot group of 3 practicing orthodontists. Minor revisions were made based on their feedback. The protocol for the study was approved by the Health Research Ethics Board at the University of Alberta. The provincial registries for 2003 were used to compile a list of Canadian orthodontists. Two orthodontists were excluded because they helped to develop the research tool. The remaining 667 orthodontists became the population for the study. A packet was sent consisting of the questionnaire, a return stamped enve163
164 Palmer et al
American Journal of Orthodontics and Dentofacial Orthopedics August 2005
Fig 1. Perception of technology’s capabilities to improve current practice issues.
lope, and a letter to explain the research topic and obtain informed consent from the participating orthodontists. Reminder cards were mailed 1 week and 2 weeks after the initial mail-out. The reminder cards thanked the orthodontists for their participation or reminded them to complete and return the survey. Responses were entered into spreadsheets and coded for data analysis. The data were cleaned by checking for entries outside the legitimate range or inconsistent codes; the necessary corrections were made by manually rechecking the surveys. SPSS for Windows (SPSS, Chicago, Ill) was used to enter and analyze the data. Twenty percent of the surveys were selected by using a random number generator to be hand-checked by a blinded evaluator to determine the rate of data entry errors. The data entry error rate was 0.103% (12 of 11,651 points). This was considered to be accurate enough for data analysis, and further manual confirmation was foregone. Descriptive statistics were used to analyze the data. RESULTS
From the population of 667, a total of 304 surveys were returned for data collection—a response rate of
45.58%. Of the respondents, 9 were in full-time academic positions, 17 were not practicing, and 278 were currently practicing. The 17 nonpracticing respondents were excluded, leaving 287 surveys for analysis. Ninety percent or more of the orthodontists indicated that computer technology could improve current practice by: reducing radiation exposure, reducing time to transfer records, increasing practice efficiency, increasing practice production, improving doctor-to-doctor communication, improving doctor-to-patient communication, improving record quality, reducing record storage requirements, and increasing access to shared patient information. Furthermore, 83.4% believed that computer technology could improve case diagnosis and treatment planning, 84% thought it could increase patient satisfaction, and 71.9% indicated that it could decrease office expenses and increase the number of case starts. Finally, 67.0% of orthodontists thought that computer technology could reduce appointment times. Comprehensive descriptive data are presented in Figure 1. Figure 2 shows that 4% percent or less of the orthodontists considered digital photography, digital radiography, and orthodontic imaging software not at all useful. Over three fourths of the respondents said
Palmer et al 165
American Journal of Orthodontics and Dentofacial Orthopedics Volume 128, Number 2
Fig 2. Perception of usefulness of various information technologies.
that digital photography was quite useful or very useful. With regard to electronic or virtual models and electronic referral forms, two thirds believed that they were somewhat useful or useful, and about 15% said they were quite or very useful. Most orthodontists (86.8%) believed that paperless charting had at least some usefulness. The orthodontists were asked about their willingness to use digital and electronic media in various communication settings. Their responses are shown in Figure 3. Almost three fourths of the respondents (73.6%) agreed or strongly agreed with using digital and electronic technology to consult with other dental specialists such as oral surgeons, periodontists, or prosthodontists Slightly less (69.1%) agreed with using it to consult with other orthodontists, and over one half (55%) would use it to consult with general practicing dentists. Only 37.4% were willing to consult with patients using digital and electronic technology. Figure 4 shows how orthodontists rate various obstacles to the general use of electronic and digital media in their practices. Cost or expense of the technology was the most important; over half of the respondents (54.4%) reported it to be a significant or insurmountable obstacle. More than one third said that security or privacy, scheduling for videoconferencing, lack of face-to-face communication, and incompatible hardware or software were significant or insurmount-
able obstacles. Furthermore, 21.8% thought that need for technical training was a significant or insurmountable obstacle, and 27.0% believed that lack of interdoctor cooperation was a significant or insurmountable obstacle. Approximately one third of the respondents considered interprovincial legislation, unclear consult remuneration guidelines, and lack of comfort with technology to be not an obstacle at all. DISCUSSION
Although the respondents thought that digital and electronic technology was generally useful in orthodontics, a substantial minority did not believe that it could improve certain aspects of their practices. These aspects pertain to some of their main sources of stress and concern, including office expenses, appointment times, case starts, diagnosis and treatment planning, and patient satisfaction. These are related to time management, patient cooperation, practice management, and lack of personal time, all of which are related to orthodontists’ stress and personal satisfaction.2 Nevertheless, 95.9% of the respondents reported that technology was at least somewhat capable of increasing practice efficiency, and 90.0% thought that it was at least somewhat capable of increasing practice production. Research to investigate how information technology might benefit specific practice issues such as increasing case starts, reducing appointment times, and
166 Palmer et al
American Journal of Orthodontics and Dentofacial Orthopedics August 2005
Fig 3. Willingness to use information technology for consultations.
Fig 4. Obstacles to use of information technology.
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reducing office expenses would probably motivate orthodontists to actively integrate the technologies. By and large, orthodontists consider digital and electronic technology to be useful in their orthodontic practices. Digital photography is the most useful. Only 2 respondents considered it not at all useful. Digital photography has a generalized perception of value to the orthodontic community. Digital radiography and imaging software are also perceived as useful to most of the profession. Orthodontists were generally open to using telecommunications in their practices. This reflects other research that shows that practitioners are leery about using digital and electronic technology to communicate with the public but are quite open to using it to communicate with colleagues.3 The willingness to consider electronic consultation is somewhat surprising, since previous research has shown that the time to prepare a case for a teledentistry conference is longer than conventional means.4,5 Cost, lack of face-to-face communication, incompatible software or hardware, security and privacy, and time seemed to be the major obstacles to the general incorporation of digital and electronic technology for both the general dental and orthodontic communities.6,7 In contrast to previous studies based on general dentists, remuneration guidelines and lack of comfort with technology did not seem to be considered as important in the orthodontic community as one might have thought.
CONCLUSIONS
● Digital and electronic technology is generally viewed as useful to the orthodontic profession. ● Orthodontists believe technology can increase office efficiency and production. ● Most orthodontists are more willing to implement digital and electronic technology for consulting with colleagues than for consulting with patients. ● The major obstacles to the general use of the technology are related to cost, security or privacy, and time management. REFERENCES 1. Bauer JC, Brown WT. The digital transformation of oral health care. Teledentistry and electronic commerce. J Am Dent Assoc 2001;132:204-9. 2. Roth SF. Occupational stress and job satisfaction among Canadian orthodontists [thesis]. Edmonton, Alberta, Canada: University of Alberta; 2002. 3. Stephens CD, Cook J. Attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients. J Orthod 2002;29:137-42. 4. Cook J, Edwards J, Mullings C, Stephens C. Dentists’ opinions of an online orthodontic advice service. J Telemed Telecare 2001;7: 334-7. 5. Cook J, Mullings C, Vowles R, Ireland R, Stephens C. Online orthodontic advice: a protocol for a pilot teledentistry system. J Telemed Telecare 2001;7:324-33. 6. Mitchell E, Sullivan F. A descriptive feast but an evaluative famine: systematic review of published articles on primary care computing during 1980-97. BMJ 2001;322:279-82. 7. Bodenheimer T, Grumbach K. Electronic technology: a spark to revitalize primary care? JAMA 2003;290:259-64.
BOUND VOLUMES AVAILABLE TO SUBSCRIBERS Bound volumes of the American Journal of Orthodontics and Dentofacial Orthopedics are available to subscribers (only) for the 2004 issues from the Publisher, at a cost of $96.00 ($115.56 Canada and $108.00 international) for Vol. 125 (January-June) and Vol. 126 (July-December). Shipping charges are included. Each bound volume contains subject and author indexes. The binding is durable buckram, with the journal name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact Elsevier Inc., Subscription Customer Service, 6277 Sea Harbor Dr, Orlando, FL 32887; phone 800-654-2452 or 407-345-4000. Subscriptions must be in force to qualify. Bound volumes are no available in place of a regular Journal subscription.