Andrea Mahnke

The Role of Nonverbal and Verbal Communication in a Multimedia Informed Consent Process

OBJECTIVE Nonverbal and verbal communication elements enhance and reinforce the consent form in the informed consent process and need to be transferred appropriately to multimedia formats using interaction design when re-designing the process. METHODS Observational, question asking behavior, and content analyses were used to analyze nonverbal and verbal elements of an informed consent process. RESULTS A variety of gestures, interruptions, and communication styles were observed. CONCLUSION In converting a verbal conversation about a textual document to multimedia formats, all aspects of the original process including verbal and nonverbal variation should be one part of an interaction community-centered design approach.

Farm Mapping to Assist, Protect, and Prepare Emergency Responders: Farm MAPPER

ABSTRACT Responders such as firefighters and emergency medical technicians who respond to farm emergencies often face complex and unknown environments. They may encounter hazards such as fuels, solvents, pesticides, caustics, and exploding gas storage cylinders. Responders may be unaware of dirt roads within the farm that can expedite their arrival at critical sites or snow-covered manure pits that act as hidden hazards. A response to a farm, unless guided by someone familiar with the operation, may present a risk to responders and post a challenge in locating the victim. This project explored the use of a Web-based farm-mapping application optimized for tablets and accessible via easily accessible on-site matrix barcodes, or quick response codes (QR codes), to provide emergency responders with hazard and resource information to agricultural operations. Secured portals were developed for both farmers and responders, allowing both parties to populate and customize farm maps with icons. Data were stored online and linked to QR codes attached to mailbox posts where emergency responders may read them with a mobile device. Mock responses were conducted on dairy farms to test QR code linking efficacy, Web site security, and field usability. Findings from farmer usability tests showed willingness to enter data as well as ease of Web site navigation and data entry even with farmers who had limited computer knowledge. Usability tests with emergency responders showed ease of QR code connectivity to the farm maps and ease of Web site navigation. Further research is needed to improve data security as well as assess the program’s applicability to nonfarm environments and integration with existing emergency response systems. The next phases of this project will expand the program for regional and national use, develop QR code–linked, Web-based extrication guidance for farm machinery for victim entrapment rescue, and create QR code–linked online training videos and materials for limited English proficient immigrant farm workers.

P092 Algorithmic approach to injured workers: designed for dairy and pork, applicable across industries

Background Agriculture has again been listed as the most dangerous U.S. industry in 2015. Like other large animal production, dairy and pork operations consistently account for serious, restrictive, non-fatal injuries. This project was designed to develop a return to work software application to produce applicable light duty job assemblies based on worker limitations and available tasks on the farm. Methods Farm task data were collected by physical and occupational therapists at dairy and pork farms in Minnesota and „Wisconsin. The collection included heights, weights, and environmental considerations such as slippery surfaces. Narrative data from therapist collection had to be converted to a structured format to make most use of algorithmic functionality. Results The system, in prototype form, has been tested with workers, employers and clinicians. The application outputs suggested job tasks based on the limitations entered. Rather than a typical proscriptive output from physician to patient and employer, this application provides a prescriptive recommendation allowing the injured worker to get back to work sooner and safer. Farmers/employers still have the discretion to adjust the recommended tasks so long as they stay within the physical limitations outlined by the physician (e.g. cannot lift more than 10 lbs.). Conclusions The tool in prototype appears to be appealing to Insurance companies that offer Workers’ Compensation coverage and Farmers/employers who appreciate the guidance it offers in navigating a safe return to work of injured employees. Though few farmers realise the financial ramifications of keeping someone on time-loss, they quickly discern the value of the system, and often request more information about farm safety and injury prevention.

Exploring Dental Providers’ Workflow in an Electronic Dental Record Environment

BACKGROUND A workflow is defined as a predefined set of work steps and partial ordering of these steps in any environment to achieve the expected outcome. Few studies have investigated the workflow of providers in a dental office. It is important to understand the interaction of dental providers with the existing technologies at point of care to assess breakdown in the workflow which could contribute to better technology designs. OBJECTIVE The study objective was to assess electronic dental record (EDR) workflows using time and motion methodology in order to identify breakdowns and opportunities for process improvement. METHODS A time and motion methodology was used to study the human-computer interaction and workflow of dental providers with an EDR in four dental centers at a large healthcare organization. A data collection tool was developed to capture the workflow of dental providers and staff while they interacted with an EDR during initial, planned, and emergency patient visits, and at the front desk. Qualitative and quantitative analysis was conducted on the observational data. RESULTS Breakdowns in workflow were identified while posting charges, viewing radiographs, e-prescribing, and interacting with patient scheduler. EDR interaction time was significantly different between dentists and dental assistants (6:20 min vs. 10:57 min, p = 0.013) and between dentists and dental hygienists (6:20 min vs. 9:36 min, p = 0.003). CONCLUSIONS On average, a dentist spent far less time than dental assistants and dental hygienists in data recording within the EDR.

Facilitating Return to Work for Injured and Ill Animal Agriculture Workers

Iris Anne Reyes,1 MPH; Nancy Bellendorf,2 OTR; Tami Meehan,3 PT, DPT, OCS; Ron Wenger,3 PT, DPT, OCS, MTC; Christopher Kadolph4; Shaun Halstead4; Andrea Mahnke,4 MS; Bryan Weichelt,4 MS, MBA, PMP; William Ray,4 BS; Matthew Keifer,1 MD, MPH 1National Farm Medicine Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA 2Work Safe Therapy & Ergonomics, Medford, Wisconsin, USA 3Wenger Physical Therapy, North Mankato, Minnesota, USA 4Biomedical Informatics Research Center, Marshfield Clinic Research Foundation, Marshfield, Wisconsin, USA

Integration of Cognitive Modeling into the Evaluation of Electronic Health Records

Previous research has consistently cited the importance of a usable interface in the successful adoption of the electronic health record (EHR). Among the most time intensive EHR activities is Computerized Physician Order Entry (CPOE) a method of creating and modifying orders through an electronic interface. The Marshfield Clinic, a non-profit, regional health care organization in Wisconsin, is in the process of implementing a new CPOE system. As a part of early evaluation, cognitive and behavioral modeling was coupled with formative usability testing to better understand the potential use of a new CPOE design. Participants consisted of 11 medical residents. Results suggest that participants were able to complete the majority of task scenarios in less than 20 seconds per task. Additionally, the integration of a cognitive and behavioral tool provided new evaluation information to help aid in future design efforts.

Broader Considerations of Medical and Dental Data Integration

Dental health insurance coverage in the United States is either nonexistent (Medicare and the uninsured), spotty (Medicaid) and limited (most employer-based private benefit plans). Perhaps as a result, dental health in the United States is not good. What public policy makers may not appreciate is that this may well be impacting medical care costs in a way that improved dental benefits would produce a substantial return to investment in expanded dental insurance coverage.