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Medical Informatics Europe August 30, 2011 Nancy Staggers, PhD, RN, - - PowerPoint PPT Presentation
Medical Informatics Europe August 30, 2011 Nancy Staggers, PhD, RN, - - PowerPoint PPT Presentation
Medical Informatics Europe August 30, 2011 Nancy Staggers, PhD, RN, FAAN University of Maryland Elements of traditional workflow Considering newer models of workflow assessment Technique to elicit workflow for challenging
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Staggers, 2001
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P Naturalistic observation P Interviews P Observation, perhaps with Think
Aloud protocols
P Resulting workflow diagrams
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P Stead and Lin (2009)
P Current systems (US) may actually
worsen healthcare
P Healthcare IT chasm P Work focused on physicians only P Issues apply to nurses, teams,
transitions across settings
P Missing element is
cognitive support
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P “You can’t get the big picture of the
patient.”
ü “We have to jump all over the place to find
the information we need.”
ü “The nursing summary report has about 50%
- f the information we need.”
ü The summary report is organized
differently on the screen than when printed
ü Orders truncated on printed version
without warning or logic
Staggers et al., 2011
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P Being able to obtain the “big picture” of
patients/residents across information sources
P Being able to tell the patient or resident’s
“story”
P Finding pertinent information for a
decision
P For placement P After hospitalization or another trigger
for assessing clients/patients
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P Cognitive task/work analysis
P At least 100 techniques P Critical comparisons available
P Critical incident technique
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ü Useful for ü Gathering facts from domain experts
- r less experienced users
ü Analysis of difficult areas ü Understanding complexities that are
difficult to observe
ü Also a technique for usability testing ü Understanding workflow, requirements
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ü Cognitive support for nurses and
physicians making decisions to place US Veterans into assisted living, home care or nursing homes
ü Must consider at least these elements
ü Functional status ü Mental status ü Social information, social support ü Financial information ü Occupational therapy findings
PI: Weir – study in progress
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ü Originally described by Flanagan (1954) ü More recently ü Beth Crandall ü Working Minds: A Practitioners Guide to
Cognitive Task Analysis
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ü Issue
ü Should we place this person into assisted
living or a skilled nursing facility?
ü Information scattered in electronic
records
ü Buried in clinical notes
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P Interviewed 22 nurse practitioners, physicians
about a difficult transition
P Decisions for placement usually after a trigger
P Critical incident technique
P Several passes at describing the situation P Probes for understanding P “What if” questions
P Qualitative analysis
P Information attributes PI: Weir – study in progress
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ü Some effort for researchers
ü Developing semi-structured interviews ü Inter-interviewer consistency ü Training in interviewing techniques, listening
skills, well-placed and in-depth probes
ü Worked well overall
ü Vivid descriptions of difficult transitions ü Easy to learn and apply ü Cost effective
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ü Disadvantages and puzzles
ü The volume of data ü Time-consuming to analyze ü Differing levels of experience in
research and interviewing of the team
ü The “what if” questions
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