Improving Team-Based Decision Making Using Data Analytics and Informatics: Protocol for a Collaborative Decision Support Design

Background According to the September 2015 Institute of Medicine report, Improving Diagnosis in Health Care, each of us is likely to experience one diagnostic error in our lifetime, often with devastating consequences. Traditionally, diagnostic decision making has been the sole responsibility of an individual clinician. However, diagnosis involves an interaction among interprofessional team members with different training, skills, cultures, knowledge, and backgrounds. Moreover, diagnostic error is prevalent in the interruption-prone environment, such as the emergency department, where the loss of information may hinder a correct diagnosis. Objective The overall purpose of this protocol is to improve team-based diagnostic decision making by focusing on data analytics and informatics tools that improve collective information management. Methods To achieve this goal, we will identify the factors contributing to failures in team-based diagnostic decision making (aim 1), understand the barriers of using current health information technology tools for team collaboration (aim 2), and develop and evaluate a collaborative decision-making prototype that can improve team-based diagnostic decision making (aim 3). Results Between 2019 to 2020, we are collecting data for this study. The results are anticipated to be published between 2020 and 2021. Conclusions The results from this study can shed light on improving diagnostic decision making by incorporating diagnostics rationale from team members. We believe a positive direction to move forward in solving diagnostic errors is by incorporating all team members, and using informatics. International Registered Report Identifier (IRRID) DERR1-10.2196/16047

[1]  Rob Procter,et al.  Supporting informality: team working and integrated care records , 2004, CSCW.

[2]  A. Gramopadhye,et al.  Systematic engineering tools for describing and improving medication administration processes at rural healthcare facilities. , 2014, Applied ergonomics.

[3]  P Coleman,et al.  'Scraps': hidden nursing information and its influence on the delivery of care. , 2000, Journal of advanced nursing.

[4]  C. Chisholm,et al.  A task analysis of emergency physician activities in academic and community settings. , 2011, Annals of emergency medicine.

[5]  Winston Bennett,et al.  Team Task Analysis , 2012, Hum. Factors.

[6]  Toni L. Doolen,et al.  Critical success factors for the sustainability of Kaizen event human resource outcomes: An empirical study , 2011 .

[7]  Monika Kastner,et al.  Usability evaluation of a clinical decision support tool for osteoporosis disease management , 2010, Implementation science : IS.

[8]  Mary Elizabeth Raven,et al.  Using contextual inquiry to learn about your audiences , 1996, ASTR.

[9]  Ingrid M. Nembhard,et al.  The cultural complexity of medical groups , 2012, Health care management review.

[10]  John C. Tang Findings from Observational Studies of Collaborative Work , 1991, Int. J. Man Mach. Stud..

[11]  G. Klein,et al.  Cognitive Task Analysis of Teams , 2000 .

[12]  Andrew Shepherd,et al.  Hierarchical task analysis , 2001 .

[13]  Samina Raza Abidi,et al.  Usability Evaluation of Family Physicians' Interaction with the Comorbidity Ontological Modeling and ExecuTion System (COMET) , 2013, MedInfo.

[14]  Joseph M. Derosier,et al.  Using health care Failure Mode and Effect Analysis: the VA National Center for Patient Safety's prospective risk analysis system. , 2002, The Joint Commission journal on quality improvement.

[15]  Rhona Flin,et al.  The importance of preparation for doctors' handovers in an acute medical assessment unit: a hierarchical task analysis. , 2012, BMJ quality & safety.

[16]  P M Salmon,et al.  Representing situation awareness in collaborative systems: A case study in the energy distribution domain , 2008, Ergonomics.

[17]  N A Stanton,et al.  Distributed situation awareness in dynamic systems: theoretical development and application of an ergonomics methodology , 2006, Ergonomics.

[18]  Dean F. Sittig,et al.  Ebola US Patient Zero: lessons on misdiagnosis and effective use of electronic health records , 2014, Diagnosis.

[19]  Gary Klein,et al.  Working Minds: A Practitioner's Guide to Cognitive Task Analysis , 2006 .

[20]  Adem Karahoca,et al.  Information system design for a hospital emergency department: A usability analysis of software prototypes , 2010, J. Biomed. Informatics.

[21]  V. Payne,et al.  Using voluntary reports from physicians to learn from diagnostic errors in emergency medicine , 2015, Emergency Medicine Journal.

[22]  Kim M. Unertl,et al.  Research Paper: Describing and Modeling Workflow and Information Flow in Chronic Disease Care , 2009, J. Am. Medical Informatics Assoc..

[23]  Kimberly A Davis,et al.  Information Loss in Emergency Medical Services Handover of Trauma Patients , 2009, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[24]  W. Klein,et al.  Handbook of Imagination and Mental Simulation , 2008 .

[25]  Cynthia C. Hull,et al.  Educational Resources Information Center (ERIC) File Partition Study: Final Report. , 1972 .

[26]  Sterling L. Wiggins,et al.  ARA Design Directions for Support of Submarine Commanding Officer Decision Making , 2006 .

[27]  Chris Kenaszchuk,et al.  Measuring teamwork in health care settings: A review of survey instruments , 2012 .

[28]  Judith Bishop,et al.  A survey and comparison of CSCW groupware applications , 2006 .

[29]  Kabir Yadav,et al.  Designing Real-time Decision Support for Trauma Resuscitations. , 2015, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[30]  M. Gokhale,et al.  Tracking Abnormal Cervical Cancer Screening: Evaluation of an EMR-Based Intervention , 2010, Journal of General Internal Medicine.

[31]  Chauniqua Kiffin,et al.  Enhancing patient safety in the trauma/surgical intensive care unit. , 2009, The Journal of trauma.

[32]  Hardeep Singh,et al.  Editorial: Helping health care organizations to define diagnostic errors as missed opportunities in diagnosis. , 2014, Joint Commission journal on quality and patient safety.

[33]  Cathleen Wharton,et al.  Testing a walkthrough methodology for theory-based design of walk-up-and-use interfaces , 1990, CHI '90.

[34]  S. Weisband Maintaining Awareness in Distributed Team Collaboration: Implications for Leadership and Performance , 2002 .

[35]  Vimla L. Patel,et al.  The multitasking clinician: Decision-making and cognitive demand during and after team handoffs in emergency care , 2007, Int. J. Medical Informatics.

[36]  Kevin R. Weaver,et al.  Differential Diagnosis Generators: an Evaluation of Currently Available Computer Programs , 2012, Journal of General Internal Medicine.

[37]  J. C. Flanagan Psychological Bulletin THE CRITICAL INCIDENT TECHNIQUE , 2022 .

[38]  Kimberly A. Neuendorf,et al.  The Content Analysis Guidebook , 2001 .

[39]  Steven E. Stemler,et al.  An Overview of Content Analysis. , 2001 .

[40]  Hardeep Singh,et al.  Advancing the research agenda for diagnostic error reduction , 2013, BMJ quality & safety.

[41]  David F. Feldon,et al.  Cognitive task analysis , 2009 .

[42]  Catherine Yoon,et al.  Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from 4 liability insurers. , 2007, Annals of emergency medicine.

[43]  Sallie J. Weaver,et al.  Team-training in healthcare: a narrative synthesis of the literature , 2014, BMJ quality & safety.

[44]  Robert R. Hoffman,et al.  Human Factors Contributions to Knowledge Elicitation , 2008, Hum. Factors.

[45]  Robert El-Kareh,et al.  Use of health information technology to reduce diagnostic errors , 2013, BMJ quality & safety.

[46]  Geraldine Fitzpatrick,et al.  Integrated care and the working record , 2004, Health Informatics J..

[47]  Regan L. Mandryk,et al.  Direct intentions: the effects of input devices on collaboration around a tabletop display , 2006, First IEEE International Workshop on Horizontal Interactive Human-Computer Systems (TABLETOP '06).

[48]  Vaninha Vieira,et al.  Sanar: A Collaborative Environment to Support Knowledge Sharing with Medical Artifacts , 2012, 2012 Brazilian Symposium on Collaborative Systems.

[49]  Jeanmarie Mayer,et al.  Feasibility of population health analytics and data visualization for decision support in the infectious diseases domain , 2016, Appl. Clin. Inform..

[50]  Paul M. Taylor,et al.  Research Paper: Measuring the Impact of Diagnostic Decision Support on the Quality of Clinical Decision Making: Development of a Reliable and Valid Composite Score , 2003, J. Am. Medical Informatics Assoc..

[51]  Toni L. Doolen,et al.  The impact of organizational context on work team effectiveness: a study of production team , 2003, IEEE Trans. Engineering Management.

[52]  Jan Florin,et al.  Interruptions in emergency department work: an observational and interview study , 2013, BMJ quality & safety.

[53]  Wolfgang Gaissmaier,et al.  Disrupting diagnostic reasoning: do interruptions, instructions, and experience affect the diagnostic accuracy and response time of residents and emergency physicians? , 2015, Academic medicine : journal of the Association of American Medical Colleges.

[54]  Hong-In Cheng,et al.  Icon and user interface design for emergency medical information systems: A case study , 2012, Int. J. Medical Informatics.

[55]  Gregory N. Larsen,et al.  Techniques for Cyber Attack Attribution , 2003 .

[56]  G Del Fiol,et al.  Clinical Complexity in Medicine: A Measurement Model of Task and Patient Complexity , 2015, Methods of Information in Medicine.

[57]  Daniel Dajun Zeng,et al.  Next-Generation Team-Science Platform for Scientific Collaboration , 2011, IEEE Intelligent Systems.

[58]  Guilherme Del Fiol,et al.  Heuristics in Managing Complex Clinical Decision Tasks in Experts' Decision Making , 2014, 2014 IEEE International Conference on Healthcare Informatics.

[59]  Neville A Stanton,et al.  Command and control in emergency services operations: a social network analysis , 2006, Ergonomics.

[60]  Ingrid M. Nembhard,et al.  Behaviors of successful interdisciplinary hospital quality improvement teams. , 2011, Journal of hospital medicine.

[61]  Cathleen Wharton,et al.  Cognitive Walkthroughs: A Method for Theory-Based Evaluation of User Interfaces , 1992, Int. J. Man Mach. Stud..

[62]  Carl Gutwin,et al.  A review of groupware evaluations , 2000, Proceedings IEEE 9th International Workshops on Enabling Technologies: Infrastructure for Collaborative Enterprises (WET ICE 2000).

[63]  J. B. Brooke,et al.  SUS: A 'Quick and Dirty' Usability Scale , 1996 .

[64]  Ashley N. D. Meyer,et al.  The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations , 2014, BMJ quality & safety.

[65]  Jill M. Purdy,et al.  THE IMPACT OF COMMUNICATION MEDIA ON NEGOTIATION OUTCOMES , 2000 .

[66]  Yunan Chen,et al.  Documenting transitional information in EMR , 2010, CHI.

[67]  Gerry Stahl,et al.  Studying and Supporting Collaborative Care Processes , 2005 .

[68]  John Annett Hierarchical Task Analysis , 2003 .

[69]  Neville A Stanton,et al.  Hierarchical task analysis: developments, applications, and extensions. , 2006, Applied ergonomics.

[70]  G. Pravettoni,et al.  Interprofessional team dynamics and information flow management in emergency departments. , 2014, Journal of advanced nursing.

[71]  R. Peterson,et al.  Task Conflict snd Relationship Conflict in Top Management Teams:The Pivotal Role of Intragroup Trust. , 1998 .

[72]  James E Andrews,et al.  Information seeking and intentions to have genetic testing for hereditary cancers in rural and Appalachian Kentuckians. , 2007, The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association.

[73]  Neville A Stanton,et al.  From ethnography to the EAST method: A tractable approach for representing distributed cognition in Air Traffic Control , 2010, Ergonomics.

[74]  Neville A. Stanton,et al.  Distributed situation awareness in an Airborne Warning and Control System: application of novel ergonomics methodology , 2007, Cognition, Technology & Work.

[75]  M. Demirbag,et al.  Modeling quality commitment in service organizations: an empirical study , 2012 .

[76]  Neville A. Stanton,et al.  Up periscope: understanding submarine command and control teamwork during a simulated return to periscope depth , 2017, Cognition, Technology & Work.

[77]  P. Pirolli,et al.  The Sensemaking Process and Leverage Points for Analyst Technology as Identified Through Cognitive Task Analysis , 2007 .

[78]  B. Miller,et al.  Improving Diagnosis in Health Care. , 2016, Military medicine.

[79]  Guy H. Walker,et al.  Event analysis of systemic teamwork (EAST): a novel integration of ergonomics methods to analyse C4i activity , 2006, Ergonomics.

[80]  Jeanmarie Mayer,et al.  Supporting novice clinicians cognitive strategies: System design perspective , 2016, 2016 IEEE-EMBS International Conference on Biomedical and Health Informatics (BHI).

[81]  P. Westesson,et al.  Opportunities in IT Support of Workflow & Information Flow in the Emergency Department Digital Imaging Process , 2010, Proceedings of the Human Factors and Ergonomics Society ... Annual Meeting. Human Factors and Ergonomics Society. Annual Meeting.

[82]  Joseph L. Kannry,et al.  Integrating usability testing and think-aloud protocol analysis with "near-live" clinical simulations in evaluating clinical decision support , 2012, Int. J. Medical Informatics.

[83]  Terri L. Griffith,et al.  The phenomenology of conflict in virtual work teams , 2002 .

[84]  Carl Gutwin,et al.  Workspace Awareness in Real-Time Distributed Groupware: Framework, Widgets, and Evaluation , 1996, BCS HCI.

[85]  D O'Hare,et al.  Cognitive task analyses for decision centred design and training. , 1998, Ergonomics.

[86]  Nick Sevdalis,et al.  The Impact of Operating Room Distractions on Stress, Workload, and Teamwork. , 2015, Annals of surgery.

[87]  C. Cramton Attribution in distributed work groups. , 2002 .

[88]  Steve Cisler Computer-supported cooperative work and groupware , 1988 .

[89]  Vimla L. Patel,et al.  Understanding the nature of information seeking behavior in critical care: Implications for the design of health information technology , 2013, Artif. Intell. Medicine.

[90]  Douglas G. Altman,et al.  Practical statistics for medical research , 1990 .

[91]  G. Stoddard,et al.  Identifying complexity in infectious diseases inpatient settings: An observation study. , 2017, Journal of biomedical informatics.

[92]  Richard J Holden,et al.  Interruptions in the wild: Development of a sociotechnical systems model of interruptions in the emergency department through a systematic review. , 2015, Applied ergonomics.

[93]  Maarten van Someren,et al.  The Think Aloud Method: A Practical Guide to Modelling Cognitive Processes , 1994 .

[94]  Matthew H. Samore,et al.  Big-Data Based Decision-Support Systems to Improve Clinicians' Cognition , 2016, 2016 IEEE International Conference on Healthcare Informatics (ICHI).

[95]  Guilherme Del Fiol,et al.  Understanding complex clinical reasoning in infectious diseases for improving clinical decision support design , 2015, BMC Medical Informatics and Decision Making.

[96]  Kimberly M. Kelly,et al.  Communication in Genetic Counseling: Cognitive and Emotional Processing , 2011, Health communication.

[97]  Pedro Antunes,et al.  Evaluation Methods for Groupware Systems , 2007, CRIWG.

[98]  Pamela J. Hinds,et al.  CONFLICT AND SHARED IDENTITY IN GEOGRAPHICALLY DISTRIBUTED TEAMS , 2001 .

[99]  Eduardo Salas,et al.  Does Team Building Work? , 2009 .

[100]  S. Cross,et al.  LISA: a web‐based decision‐support system for trial management of childhood acute lymphoblastic leukaemia , 2005, British journal of haematology.

[101]  David W. Bates,et al.  Usability of a novel clinician interface for genetic results , 2012, J. Biomed. Informatics.

[102]  Susanne Kvarnström,et al.  Difficulties in collaboration: A critical incident study of interprofessional healthcare teamwork , 2008, Journal of interprofessional care.

[103]  Joseph A Cafazzo,et al.  Technological aspects of hospital communication challenges: an observational study. , 2015, International journal for quality in health care : journal of the International Society for Quality in Health Care.