This paper presents a unified framework of EHR usability, called TURF, which is (1) a theory for describing, explaining, and predicting usability differences; (2) a method for defining, evaluating, and measuring usability objectively; (3) a process for designing built-in good usability; and (4) once fully developed, a potential principle for developing EHR usability guidelines and standards. TURF defines usability as how useful, usable, and satisfying a system is for the intended users to accomplish goals in the work domain by performing certain sequences of tasks. TURF provides a set of measures for each of the useful, usable, and satisfying dimensions of usability. TURF stands for task, user, representation, and function, which are the four components that determine the usability of an EHR system. These four components are described with theoretical descriptions along with examples of how usability is measured in several case studies. How TURF can be used to improve usability through redesign is also demonstrated in a case study. In summary, this paper states that usability can not only be defined scientifically under a coherent, unified framework, it can also be measured objectively and systematically.

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Objective To estimate bias associated with partial mouth periodontal examination (PMPE) protocols regarding estimates of prevalence, severity and extent of clinical attachment loss (CAL), pocket depth (PD) and gingival recession (REC). Material and Methods A search was made for articles published in English, from 1946–2012, which compared PMPE vs. full mouth periodontal examination (FMPE) protocols for CAL or PD ≥ 4mm or REC ≥ 3mm thresholds. PMPE protocols were evaluated for sensitivity of estimates of periodontitis prevalence, relative biases for severity and extent estimates. Results A review of the literature identified 12 studies which reported 32 PMPE protocols. Three PMPE protocols which had sensitivities ≥ 85% and relative biases ≤ 0.05 in absolute values for severity and extent estimates were: 1) half mouth six-sites, 2) diagonal quadrants six-sites and 3) full mouth mesiobuccal-midbuccal-distobuccal (MB-B-DB). Two other PMPE protocols (full mouth and half mouth mesiobuccal-midbuccal-distolingual) performed well for prevalence and severity of periodontitis; however, their performance in estimates of extent was unknown. Conclusions Among the 32 PMPE protocols listed, the half-mouth six-sites and full-mouth MB-B-DB protocols had the highest sensitivities for prevalence estimates and lowest relative biases for severity and extent estimates.

Objective To evaluate bias associated with nine identified partial-mouth periodontal examination (PMPE) protocols in estimating periodontitis prevalence using the periodontitis case definition given by the Centers of Disease Control and Prevention and American Academy of Periodontology (CDC/AAP). Material and Methods Prevalence from full-mouth examination was determined in a sample of 3,667 adults ≥30 years old from the National Health and Nutrition Examination Survey (NHANES) 2009-2010. Prevalence, absolute bias, relative bias, sensitivity and inflation factor were derived for these protocols according to the CDC/AAP definition and half-reduced CDC/AAP definition as ≤50% of sites were measured. Results Bias in moderate and severe periodontitis prevalence ranged between 11.1% to 52.5% and 27.1% to 76.3% for full-mouth mesiobuccal-distolingual protocol and half-mouth mesiobuccal protocol respectively; according to the CDC/AAP definition. With half-reduced CDC/AAP definition, half-mouth four sites protocol provided small absolute bias (3.2%) and relative bias (9.3%) for the estimates of moderate periodontitis prevalence; corresponding biases for severe periodontitis were -1.2% and -10.2%. Conclusion Periodontitis prevalence can be estimated with limited bias when a half-mouth four sites protocol and a half-reduced CDC/AAP case definition are used in combination.