Rebecca A. Hills

Reusable design: A proposed approach to Public Health Informatics system design

BackgroundSince it was first defined in 1995, Public Health Informatics (PHI) has become a recognized discipline, with a research agenda, defined domain-specific competencies and a specialized corpus of technical knowledge. Information systems form a cornerstone of PHI research and implementation, representing significant progress for the nascent field. However, PHI does not advocate or incorporate standard, domain-appropriate design methods for implementing public health information systems. Reusable design is generalized design advice that can be reused in a range of similar contexts. We propose that PHI create and reuse information design knowledge by taking a systems approach that incorporates design methods from the disciplines of Human-Computer Interaction, Interaction Design and other related disciplines.DiscussionAlthough PHI operates in a domain with unique characteristics, many design problems in public health correspond to classic design problems, suggesting that existing design methods and solution approaches are applicable to the design of public health information systems. Among the numerous methodological frameworks used in other disciplines, we identify scenario-based design and participatory design as two widely-employed methodologies that are appropriate for adoption as PHI standards. We make the case that these methods show promise to create reusable design knowledge in PHI.SummaryWe propose the formalization of a set of standard design methods within PHI that can be used to pursue a strategy of design knowledge creation and reuse for cost-effective, interoperable public health information systems. We suggest that all public health informaticians should be able to use these design methods and the methods should be incorporated into PHI training.

Public Health Practice within a Health Information Exchange: Information Needs and Barriers to Disease Surveillance

Introduction: Public health professionals engage in frequent exchange of health information while pursuing the objectives of protecting and improving population health. Yet, there has been little study of the information work of public health workers with regard to information exchange. Our objective was to gain a better understanding of information work at a local health jurisdiction before and during the early stages of participation in a regional Health Information Exchange. Methods: We investigated the information work of public health workers engaged in disease surveillance activities at a medium-sized local health jurisdiction by conducting semi-structured interviews and thematically analyzing interview transcripts. Results: Analysis of the information work of public health workers revealed barriers in the following areas: information system usability; data timeliness, accuracy and completeness; and social interaction with clients. We illustrate these barriers by focusing on the work of epidemiologists. Conclusion: Characterizing information work and barriers to information exchange for public health workers should be part of early system design efforts. A comprehensive understanding of the information practice of public health workers will inform the design of systems that better support public health work.

Biosurveillance, Case Reporting, and Decision Support: Public Health Interactions with a Health Information Exchange

This paper describes support for three public health practice domains in demonstrations of a model health information exchange (HIE): biosurveillance, case reporting, and communication from public health to providers through integrated decision support. The model HIE implements interoperability through the use of existing semantic and syntactic standards specified as part of Integration Profiles to support specific data transfer use cases. We implemented these profiles in several public health applications using a service-orientated architecture approach. Methods were validated for each public health domain in national showcase demonstrations. We believe that this work has implications for the integration of public health functions into any HIE, regardless of its architecture, because our informatics methods support a distributed environment. This approach may be extended to strengthen development of the Public Health Grid, a project currently being led by the Centers for Disease Control and Prevention.

Leveraging Health Information Exchange to Improve Population Health Reporting Processes: Lessons in Using a Collaborative-Participatory Design Process

Introduction: Surveillance, or the systematic monitoring of disease within a population, is a cornerstone function of public health. Despite significant investment in information technologies (IT) to improve the public’s health, health care providers continue to rely on manual, spontaneous reporting processes that can result in incomplete and delayed surveillance activities. Background: Participatory design principles advocate including real users and stakeholders when designing an information system to ensure high ecological validity of the product, incorporate relevance and context into the design, reduce misconceptions designers can make due to insufficient domain expertise, and ultimately reduce barriers to adoption of the system. This paper focuses on the collaborative and informal participatory design process used to develop enhanced, IT-enabled reporting processes that leverage available electronic health records in a health information exchange to prepopulate notifiable-conditions report forms used by public health authorities. Methods: Over nine months, public health stakeholders, technical staff, and informatics researchers were engaged in a multiphase participatory design process that included public health stakeholder focus groups, investigator-engineering team meetings, public health survey and census regarding high-priority data elements, and codesign of exploratory prototypes and final form mock-ups. Findings: A number of state-mandated report fields that are not highly used or desirable for disease investigation were eliminated, which allowed engineers to repurpose form space for desired and high-priority data elements and improve the usability of the forms. Our participatory design process ensured that IT development was driven by end user expertise and needs, resulting in significant improvements to the layout and functionality of the reporting forms. Discussion: In addition to informing report form development, engaging with public health end users and stakeholders through the participatory design process provided new insights into public health workflow and allowed the team to quickly triage user requests while managing user expectations within the realm of engineering possibilities. Conclusion: Engaging public health, engineering staff, and investigators in a shared codesigning process ensured that the new forms will not only meet real-life needs but will also support development of a product that will be adopted and, ultimately, improve communicable and infectious disease reporting by clinicians to public health.

Participatory Design of an Integrated Information System Design to Support Public Health Nurses and Nurse Managers

OBJECTIVES The objectives of the study were to use persona-driven and scenario-based design methods to create a conceptual information system design to support public health nursing. DESIGN AND SAMPLE We enrolled 19 participants from two local health departments to conduct an information needs assessment, create a conceptual design, and conduct a preliminary design validation. MEASURES Interviews and thematic analysis were used to characterize information needs and solicit design recommendations from participants. Personas were constructed from participant background information, and scenario-based design was used to create a conceptual information system design. Two focus groups were conducted as a first iteration validation of information needs, personas, and scenarios. RESULTS Eighty-nine information needs were identified. Two personas and 89 scenarios were created. Public health nurses and nurse managers confirmed the accuracy of information needs, personas, scenarios, and the perceived usefulness of proposed features of the conceptual design. Design artifacts were modified based on focus group results. CONCLUSION Persona-driven design and scenario-based design are feasible methods to design for common work activities in different local health departments. Public health nurses and nurse managers should be engaged in the design of systems that support their work.

Applying the XForms Standard to Public Health Case Reporting and Alerting

Notifiable condition reporting and alerting are two important public health functions. Today, a variety of methods are used to transfer these types of information. The increasing use of electronic health record systems by healthcare providers makes new types of electronic communication possible. We used the XForms standard and nationally recognized technical profiles to demonstrate the communication of both notifiable condition reports and patient-tailored public health alerts. This demonstration of bi-directional communication took placein a prototypical health information exchange environment. We successfully transferred information between provider electronic health record systems and public health systems for notifiable condition reporting. Patient-specific alerts were successfully sent from public health to provider systems. In this paper we discuss the benefits of XForms, including the use of XML, advanced form controls, form initialization and reduction in scripting. We also review implementation challenges, the maturity of the technology and its suitability for use in public health.

A Lab-EMR interoperability profile as an eHealth architecture component for resource-constrained settings.

Implementation of computerized systems in resource-constrained settings have been gaining traction as a means of improving the delivery of health care, the use and reuse of information, and providing a standards-based capacity for assessing the process and impact of health care. In a resource-constrained environment, systems are often implemented as stand-alone entities focused on specific care activities (for example, delivering antiretroviral therapy). As such, in many countries, taking a generalized approach to linking electronic medical record systems with laboratory information systems (EMR-LIS) is an important area in which to achieve interoperability. In this paper we describe a scenario of use and information interaction interoperability profile based on our experience implementing EMR-LIS integration in two resource-constrained settings. Of significance, the profile emphasizes queued matching in order to avoid mutual dependence while achieving interoperability between systems.

Immunization information and population data sources: the information needs of public health practitioners

Immunizations are an important component of the preventive services provided, managed and promoted by public health. The need to understand the information behaviors of public health practitioners related to immunizations has become more acute as health policy changes encourage the exchange of individual level immunization data between electronic health record (EHR) systems and Immunization Information Systems (IISs). We sought to further that understanding by conducting a series of interviews focused on information needs related to immunization administration and immunization data in Washington State. Interviews were conducted with public health practitioners who represented a variety of roles in local health jurisdictions. Following transcription, interviews were coded using qualitative data analysis software. Here, we will report on the thematic analysis of the interviews and preliminary interpretations and implications of our inquiry.

Understanding optimization processes of electronic health records (EHR) in select leading hospitals: a qualitative study

Background Little is known about optimisation of electronic health records (EHRs) systems in the hospital setting while adoption of EHR systems continues in the United States. Objective To understand optimisation processes of EHR systems undertaken in leading healthcare organisations in the United States. Methods Informed by a grounded theory approach, a qualitative study was undertaken that involved 11 in-depth interviews and a focus group with the EHR experts from the high performing healthcare organisations across the United States. Results The study describes EHR optimisation processes characterised by prioritising exponentially increasing requests with predominant focus on improving efficiency of EHR, building optimisation teams or advisory groups and standardisation. The study discusses 16 types of optimisation that interdependently produced 16 results along with identifying 11 barriers and 20 facilitators to optimisation. Conclusions The study describes overall experiences of optimising EHRs in select high performing healthcare organisations in the US. The findings highlight the importance of optimising the EHR after, and even before, go-live and dedicating resources exclusively for optimisation.