Comprehensive Evaluation of the Infectious Disease Bio-Surveillance … · 2011-07-14 · Comprehensive Evaluation of the Infectious Disease Bio-Surveillance System in a County Public

Dey, Tassini, et al.

Introduc4on | Scope | Research | Findings | Conclusion | Future Work

Comprehensive Evaluation of the Infectious Disease Bio-Surveillance System in a County Public Health

Department

Kevin Tassini, Priyanka Shetye, Vedant Mehta,Dr. Anind K. Dey, Dr. Ronald Voorhees, Dr. Michael Wagner


Introduc4on




1 Who We Are

Human Computer Interaction Institute

Carnegie MellonUniversity

Center for Advanced Study of Informatics in Public Health

CASIPH



2 Brief Summary of HCI

DesignBehavioral Science

Computer Science


• Gives us an accurate understanding of the current work process with a focus on technology

• An examina;on of the usability and efficiency of so>ware systems to iden;fy breakdowns and areas of improvement

• A human-‐centered approach allows us to familiarize ourselves with the actual people that need to use the system and be able to design for them

What an HCI perspec4ve offers3



Scope



• Understand the prac;ces of surveillance units• Iden;fy the breakdowns and workarounds in the work

process• Look for opportuni;es for improving these prac;ces• Create new designs, validate them with real users,

and develop prototypes• Evaluate and validate the new designs in terms of

usability and efficiency

Scope4



Research



Research Conducted


5

• “Contextual Inquiry”– Observing work processes in context– Spending 2-‐4 hours observing par;cipants– Pseudo-‐Appren;ce Role


Research Conducted


5

• “Diary Studies”– Leaving forms with prac;;oners to see whom the correspond with and how during ;mes we were not able to observe directly

• Interviews


6

Director of Health Department

Head of Epidemiology

Epidemiologist Epidemiologist

Chief of Infectious Diseases

5 SecretariesSupervisor Nurse

ClerkMaintaining Attendance

Administrator(Public Health

Education)

Travel Consultant

Nurse(Hepatitis B) 4 Nurses

(Dog Bites, Vaccines, Measles, Meningitis, Auditing)

2 NursesFlu Clinic

Coalition Nurse (Spreads

Awareness)

QA Nurse(Orders, Stores,

Monitors Vaccines)

Who We Talked To



7 Who We Talked To

Director of Health Department

Head of Epidemiology

Epidemiologist Epidemiologist

Chief of Infectious Diseases

5 SecretariesSupervisor Nurse

ClerkMaintaining Attendance

Administrator(Public Health

Education)

Travel Consultant

Nurse(Hepatitis B) 4 Nurses

(Dog Bites, Vaccines, Measles, Meningitis, Auditing)

2 NursesFlu Clinic

Coalition Nurse (Spreads

Awareness)

QA Nurse(Orders, Stores,

Monitors Vaccines)




Findings


8


Repor;ng Authority

Pa4ent

Life Cycle of a Case

Lab Database


8


Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.


Dept. of Infec4ous Diseases

NEDSS

Lab Database


8


Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.



NEDSS

Lab Database


8


Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.



NEDSS

Lab Database


8


Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.



Lab Database

NEDSS


8


Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.

State



Lab Database

NEDSS


8


Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.

State



Lab Database

NEDSS


9


Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.

State

Life Cycle of a Case: Annotated


Lab Database

NEDSS

Breakdowns



Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.

State


Lab Database

NEDSS

Cases cannot be submitted electronically due to formatting issues

9 Life Cycle of a Case: Annotated



Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.

State


Lab Database

NEDSSFaxes sent can be illegibleCases can be sent multiple times by accident




Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.

State


Lab Database

NEDSS

The state cannot see all of the information they would like and must follow-up with HD directly




Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.

State


Lab Database

NEDSSThe county has to send request to the state to see activity in surrounding area




Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.

State


Lab Database

NEDSS

NEDSS does is not capable of supporting all of the types of cases the county tracks (Ex: MRSA)

Slow server response causes frustration, delays entry of information

Forms are redundant, do not help to prevent errors, and do not make it easy to “undo”




Repor;ng Authority

Pa4ent

County HD

Epidemiology Dept.

State


Lab Database

NEDSS



The Unsimplified Version...10


County HD

LabDatabase

Analysis and Report

Link Reports

IDE Reports

IDE Reports and Results Cube

Settings ToggleDey, Tassini, et al.

11 Major Findings: Limita4ons and Workarounds


Users do not have a way of going back to intermediate steps of genera;ng a report once it is created

Location Set County

Time Set Year

Time Set Quarter

Time Set Month

Generate Report

Confirm Generation

Generation Complete




Users do not have a way of going back to intermediate steps of genera;ng a report once it is created




There is no way to pull out detailed informa;on from the IDE(Infec;ous Disease) reports in NEDSS

NEDSS Generated Report Workaround: Excel Report




•MRSA -‐ This version of NEDSS does not support inves;ga;ons of cases not mee;ng state criteria, thus they must create their own systems to support monitoring these instances

• Hepa;;s -‐ A nurse worked 45 minutes on a case only to find out that it had already been reported by the department... in 2005


12


• Nurses have to check exis;ng cases before entering a new case in NEDSS to ensure that it is not a duplicate... but some;mes this is not always in effec;ve in preven;ng duplicate inves;ga;ons

• Labs are received via fax that leads to legibility problems• Same pa;ent assigned to different nurses because of a

spelling mistake in the name

Major Findings: Duplica4on of Work


12


• Large amounts of valuable informa;on is gathered during an inves;ga;on, but it is not reported.

• Nurses print screens from NEDSS, annotate on them and then enter the informa;on back into NEDSS.



12


• Nurses have to fill in the same informa;on mul;ple ;mes while crea;ng a case.

-‐ Lab Codes: “I only use one lab and every ;me I have to search it up from the hundred labs that come up here.”

-‐ Server Delay: “It’s frustra;ng to use because it takes such a long ;me to enter everything”



13


Role of NEDSS in the decision making process:• NEDSS is used to generate reports on cases• NEDSS is used to get the ques;onnaire data related to a

case, on a case by case basis• NEDSS tells about the risk factors, but not about the people

who came into contact with the infected people• NEDSS can help by providing contact informa;on, dates of

onset, and care site outcome

Major Findings: NEDSS in Decision Making Process



Conclusion


14 Conclusion

• Localized NEDSS system does not make easy enough for different users to get the informa;on they need -‐ and so they have developed parallel systems to help compensate

• Provide incen;ve for staff to put in informa;on promptly through improved feedback and tools support (i.e., VOIP, decision making support tools)

• Help staff be`er handle large amounts of contact informa;on and actually assist with the inves;ga;on process and provide incen;ve to use




Future Work


15 Future Work

✓ Duplicate research methods with a different county, different popula;on type, and different NEDSS-‐based system

✓ Run design workshops with epidemiologists and nurse inves;gators to brainstorm design solu;ons and iden;fy promising ones

✓ Wireframe ini;al design schemas and walk through them with epidemiologists and staff to ensure validity



15 Future Work

• Prototype and develop new so>ware support:-‐ Integra;on inves;ga;on support tools:

‣ Ex: Case Management Assistance, Automized Duplica;on Checks, Contact Management

-‐ Improved usability with changes to interface and selec;on menus (less codes)

• Evaluate changes to work process and evaluate efficiency post-‐implementa;on of prototype



Thank You

Center for Advanced Study of Informatics in Public Health(CASIPH)

University of PittsburghDepartment of Biomedical Informatics



Thank You


Kevin Tassini, Priyanka Shetye, Vedant Mehta,Dr. Anind K. Dey, Dr. Ronald Voorhees, Dr. Michael Wagner

Documents

Comprehensive Evaluation of the Infectious Disease Bio-Surveillance … · 2011-07-14 · Comprehensive Evaluation of the Infectious Disease Bio-Surveillance System in a County Public