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Acknowledgements
- Scientific team
– Charlene Weir – Frank Drews Bruce Bray – Bruce Bray
- Operations Team
– Patient Care Services Medical Informatics – Paul Nichol Paul Nichol
- Funding
New Directions for VHA Cognitive Support g pp Jonathan R. Nebeker - - PDF document
New Directions for VHA Cognitive Support g pp Jonathan R. Nebeker - - PDF document
7/6/2010 New Directions for VHA Cognitive Support g pp Jonathan R. Nebeker MS MD VHA University of Utah 1 7/6/2010 Acknowledgements Scientific team Charlene Weir Frank Drews Bruce Bray Bruce Bray Operations Team
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VA EHR Way Forward
- A renaissance?
- Modular extensible architecture?
- Open source community?
- Value behavioral sciences?
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Decision vs. Cognitive Support
- Decision support
– Here’s the right decision/task – Sometimes consider Workflow Rarely consider Cognition – Rarely consider Cognition
- Cognitive support
– Give rich information environment that supports cognition in context of problem and pp g p workflow
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Translating frameworks for Cognitive Support
- Moving away from
– Paper-based-chart metaphor (13 years) – Event-driven decision support Human factors as usability analysis – Human factors as usability analysis
- Moving towards
– Information rich environments – Cognitive Systems Engineering Cognitive Systems Engineering
- Using theory to inform design
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Theoretical Foundation
- Cognitive System Engineering
– Joint Cognitive Systems – Contextual Control Model
Mi d t & G l it
- Mindsets & Goal pursuits
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Contextual Control Model
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Control Characteristics
- Breadth
– Time – Data space
R l ti hi ( l it )
- Relationships (complexity)
– What is related – Implications of relationships
- Adapting to uncertainty and unusual
- Adapting to uncertainty and unusual
– Data gathering strategies – Decision-making strategies
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COCOM + Action Phases
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CCOCM + Mindsets
Updating (Breadth) Sensmaking (Complexity and Uncertainty) Planning
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Goals
- Reduce cognitive load (make it easier) to:
– Consider breadths of data – Complexity of relationships Deal with uncertainty – Deal with uncertainty
- Improve shared cognition
– Targets clinicians and teams
- Facilitate mindset transitions and focus on
- Facilitate mindset transitions and focus on
appropriate goals
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New EHR Paradigm
- Reduce to basic concepts
– Conditions, Interventions, Observations
- Annotate observations
- Relate
– Terminologies, Knowledge bases, Ad hoc
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Example of Integrated Control
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Status and Goals
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Design Principles
- Maximize ease of attaining high levels of
control characteristics.
– Breath, relationships, decision strategies
Make information present or rapidly
- Make information present or rapidly
accessible (for rapid cognitive cycling)
- At each step, ask what information is
needed for task and mindset needed for task and mindset.
- Not “only right information at right time”
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Integrated Documentation & Quality Measurement
- Update observations
- Orders write plan
- Plan satisfied quality measures
- Assistance from terminology
– NDF-RT – Clinical Enterprise Terminology
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Planning
- Medication reconciliation in context
– Change in medications – Conditions (acute and chronic), Status of conditions (observations) – Status of conditions (observations)
- Feed forward control
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Access to Free Text
- Need to break up documentation and link
to key concepts.
- Allows focus on one one type of
information across time information across time.
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