Modeling Patient Treatment With Medical Records: An Abstraction Hierarchy to Understand User Competencies and Needs

Background Health care is a complex sociotechnical system. Patient treatment is evolving and needs to incorporate the use of technology and new patient-centered treatment paradigms. Cognitive work analysis (CWA) is an effective framework for understanding complex systems, and work domain analysis (WDA) is useful for understanding complex ecologies. Although previous applications of CWA have described patient treatment, due to their scope of work patients were previously characterized as biomedical machines, rather than patient actors involved in their own care. Objective An abstraction hierarchy that characterizes patients as beings with complex social values and priorities is needed. This can help better understand treatment in a modern approach to care. The purpose of this study was to perform a WDA to represent the treatment of patients with medical records. Methods The methods to develop this model included the analysis of written texts and collaboration with subject matter experts. Our WDA represents the ecology through its functional purposes, abstract functions, generalized functions, physical functions, and physical forms. Results Compared with other work domain models, this model is able to articulate the nuanced balance between medical treatment, patient education, and limited health care resources. Concepts in the analysis were similar to the modeling choices of other WDAs but combined them in as a comprehensive, systematic, and contextual overview. The model is helpful to understand user competencies and needs. Future models could be developed to model the patient’s domain and enable the exploration of the shared decision-making (SDM) paradigm. Conclusion Our work domain model links treatment goals, decision-making constraints, and task workflows. This model can be used by system developers who would like to use ecological interface design (EID) to improve systems. Our hierarchy is the first in a future set that could explore new treatment paradigms. Future hierarchies could model the patient as a controller and could be useful for mobile app development.

[1]  Catherine M. Burns,et al.  Using Comparative Cognitive Work Analysis to Identify Design Priorities in Complex Socio-Technical Systems , 2015 .

[2]  Simon de Lusignan,et al.  What is primary care informatics? , 2003, Journal of the American Medical Informatics Association : JAMIA.

[3]  A. Majeed.  Sources, uses, strengths and limitations of data collected in primary care in England. , 2004, Health statistics quarterly.

[4]  Kathryn Momtahan,et al.  Applications of ecological interface design in supporting the nursing process. , 2004, Journal of healthcare information management : JHIM.

[5]  Catherine H. Yu,et al.  Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care - systematic decision aid development and study protocol , 2014, Implementation Science.

[6]  Catherine M. Burns,et al.  Modeling a medical environment: an ontology for integrated medical informatics design , 2001, Int. J. Medical Informatics.

[7]  W. Weston,et al.  Informed and shared decision-making: the crux of patient-centered care. , 2001, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[8]  Marcus Watson,et al.  Work domain analysis for the evaluation of human interaction with anaesthesia alarm systems , 1998, Proceedings 1998 Australasian Computer Human Interaction Conference. OzCHI'98 (Cat. No.98EX234).

[9]  Gregory Makoul,et al.  An integrative model of shared decision making in medical encounters. , 2006, Patient education and counseling.

[10]  Alex Mihailidis,et al.  Twenty Years of Cognitive Work Analysis in Health Care , 2014 .

[11]  Juha Mikkonen,et al.  Social determinants of health: Canadian facts , 2010 .

[12]  David Barber,et al.  Utility of linking primary care electronic medical records with Canadian census data to study the determinants of chronic disease: an example based on socioeconomic status and obesity , 2016, BMC Medical Informatics and Decision Making.

[13]  Pascale Carayon,et al.  State of science: human factors and ergonomics in healthcare , 2013, Ergonomics.

[14]  K. J. Vicente,et al.  Cognitive Work Analysis: Toward Safe, Productive, and Healthy Computer-Based Work , 1999 .

[15]  T. Jason Hall,et al.  Fixation and Attention Allocation in Anesthesiology Crisis Management: An Abstraction Hierarchy Perspective , 2006 .

[16]  R. Thomson,et al.  Shared Decision Making: A Model for Clinical Practice , 2012, Journal of General Internal Medicine.

[17]  Marcus Watson,et al.  Designing for Attention With Sound: Challenges and Extensions to Ecological Interface Design , 2007, Hum. Factors.

[18]  P. Buckle,et al.  Work Domain Analysis for understanding medication safety in care homes in England: an exploratory study , 2016, Ergonomics.

[19]  Catherine M. Burns,et al.  Using Cognitive Work Analysis and a Persuasive Design Approach to Create Effective Blood Pressure Management Systems , 2014 .

[20]  Justin St-Maurice,et al.  User Perception of Data and Medical Record Personalities , 2014 .

[21]  Karin C. VanMeter,et al.  Gould's Pathophysiology for the Health Professions , 2014 .

[22]  Catherine M. Burns,et al.  A Work Domain Analysis of Patient Monitoring in the Operating Room , 1998 .

[23]  Catherine M. Burns,et al.  Ecological Interface Design , 2004 .

[24]  C. Charles,et al.  Decision-making in the physician-patient encounter: revisiting the shared treatment decision-making model. , 1999, Social science & medicine.

[25]  Anne Holbrook,et al.  Views on health information sharing and privacy from primary care practices using electronic medical records , 2011, Int. J. Medical Informatics.

[26]  Judith A. Effken,et al.  Clinical information displays to improve ICU outcomes , 2008, Int. J. Medical Informatics.

[27]  S de Lusignan,et al.  Managers See the Problems Associated with Coding Clinical Data as a Technical Issue whilst Clinicians also See Cultural Barriers , 2003, Methods of Information in Medicine.

[28]  Glyn Elwyn,et al.  Inside the black box of shared decision making: distinguishing between the process of involvement and who makes the decision , 2006, Health expectations : an international journal of public participation in health care and health policy.

[29]  France Légaré,et al.  Implementation of an electronic medical record in family practice: a case study. , 2010, Informatics in primary care.

[30]  Greg A. Jamieson,et al.  From Work Domains to Worker Competencies: A Five-Phase CWA , 2016 .

[31]  G. Elwyn,et al.  Advancing theories, models and measurement for an interprofessional approach to shared decision making in primary care: a study protocol , 2008, BMC health services research.

[32]  S. de Lusignan,et al.  The use of routinely collected computer data for research in primary care: opportunities and challenges. , 2006, Family practice.

[33]  H. Witteman,et al.  Shared decision making: examining key elements and barriers to adoption into routine clinical practice. , 2013, Health affairs.

[34]  Catherine M. Burns,et al.  Using team cognitive work analysis to reveal healthcare team interactions in a birthing unit , 2014, Ergonomics.

[35]  Anne Miller,et al.  A work domain analysis framework for modelling intensive care unit patients , 2004, Cognition, Technology & Work.

[36]  Alissa L. Russ,et al.  Current Challenges and Opportunities for Better Integration of Human Factors Research with Development of Clinical Information Systems , 2009, Yearbook of Medical Informatics.

[37]  M. Labrecque,et al.  Prevalence of clinically significant decisional conflict: an analysis of five studies on decision-making in primary care , 2016, BMJ Open.

[38]  J. St-Maurice,et al.  A Proof of Concept for Assessing Emergency Room Use with Primary Care Data and Natural Language Processing , 2012, Methods of Information in Medicine.

[39]  Ann M. Bisantz,et al.  Work Domain Analysis Using the Abstraction Hierarchy: Two Contrasting Cases , 2016 .