comprehensive evaluation of the infectious disease bio-surveillance … · 2011-07-14 ·...
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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
Dey, Tassini, et al.
Introduc4on
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
1 Who We Are
Human Computer Interaction Institute
Carnegie MellonUniversity
Center for Advanced Study of Informatics in Public Health
CASIPH
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
2 Brief Summary of HCI
DesignBehavioral Science
Computer Science
Dey, Tassini, et al.
• 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
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
Scope
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
• 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
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
Research
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
Research Conducted
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
5
• “Contextual Inquiry”– Observing work processes in context– Spending 2-‐4 hours observing par;cipants– Pseudo-‐Appren;ce Role
Dey, Tassini, et al.
Research Conducted
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
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
Dey, Tassini, et al.
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
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
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)
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Findings
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8
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
Life Cycle of a Case
Lab Database
Dey, Tassini, et al.
8
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
Life Cycle of a Case
Dept. of Infec4ous Diseases
NEDSS
Lab Database
Dey, Tassini, et al.
8
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
Life Cycle of a Case
Dept. of Infec4ous Diseases
NEDSS
Lab Database
Dey, Tassini, et al.
8
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
Life Cycle of a Case
Dept. of Infec4ous Diseases
NEDSS
Lab Database
Dey, Tassini, et al.
8
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
Life Cycle of a Case
Dept. of Infec4ous Diseases
Lab Database
NEDSS
Dey, Tassini, et al.
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Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
State
Life Cycle of a Case
Dept. of Infec4ous Diseases
Lab Database
NEDSS
Dey, Tassini, et al.
8
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
State
Life Cycle of a Case
Dept. of Infec4ous Diseases
Lab Database
NEDSS
Dey, Tassini, et al.
9
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
State
Life Cycle of a Case: Annotated
Dept. of Infec4ous Diseases
Lab Database
NEDSS
Breakdowns
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
State
Dept. of Infec4ous Diseases
Lab Database
NEDSS
Cases cannot be submitted electronically due to formatting issues
9 Life Cycle of a Case: Annotated
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
State
Dept. of Infec4ous Diseases
Lab Database
NEDSSFaxes sent can be illegibleCases can be sent multiple times by accident
9 Life Cycle of a Case: Annotated
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
State
Dept. of Infec4ous Diseases
Lab Database
NEDSS
The state cannot see all of the information they would like and must follow-up with HD directly
9 Life Cycle of a Case: Annotated
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
State
Dept. of Infec4ous Diseases
Lab Database
NEDSSThe county has to send request to the state to see activity in surrounding area
9 Life Cycle of a Case: Annotated
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
State
Dept. of Infec4ous Diseases
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”
9 Life Cycle of a Case: Annotated
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Repor;ng Authority
Pa4ent
County HD
Epidemiology Dept.
State
Dept. of Infec4ous Diseases
Lab Database
NEDSS
9 Life Cycle of a Case: Annotated
Dey, Tassini, et al.
The Unsimplified Version...10
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
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
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
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
Dey, Tassini, et al.
11 Major Findings: Limita4ons and Workarounds
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Users do not have a way of going back to intermediate steps of genera;ng a report once it is created
Dey, Tassini, et al.
11 Major Findings: Limita4ons and Workarounds
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
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
Dey, Tassini, et al.
11 Major Findings: Limita4ons and Workarounds
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
•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
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Introduc4on | Scope | Research | Findings | Conclusion | Future Work
• 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
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Introduc4on | Scope | Research | Findings | Conclusion | Future Work
• 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.
Major Findings: Duplica4on of Work
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Introduc4on | Scope | Research | Findings | Conclusion | Future Work
• 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”
Major Findings: Duplica4on of Work
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Introduc4on | Scope | Research | Findings | Conclusion | Future Work
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
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Conclusion
Dey, Tassini, et al.
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
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Future Work
Dey, Tassini, et al.
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
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
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
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
Thank You
Center for Advanced Study of Informatics in Public Health(CASIPH)
University of PittsburghDepartment of Biomedical Informatics
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Dey, Tassini, et al.
Thank You
Introduc4on | Scope | Research | Findings | Conclusion | Future Work
Kevin Tassini, Priyanka Shetye, Vedant Mehta,Dr. Anind K. Dey, Dr. Ronald Voorhees, Dr. Michael Wagner