Scenarios, personas and user stories: User-centered evidence-based design representations of communicable disease investigations

PURPOSE Despite years of effort and millions of dollars spent to create unified electronic communicable disease reporting systems, the goal remains elusive. A major barrier has been a lack of understanding by system designers of communicable disease (CD) work and the public health workers who perform this work. This study reports on the application of user-centered design representations, traditionally used for improving interface design, to translate the complex CD work identified through ethnographic studies to guide designers and developers of CD systems. The purpose of this work is to: (1) better understand public health practitioners and their information workflow with respect to CD monitoring and control at a local health agency, and (2) to develop evidence-based design representations that model this CD work to inform the design of future disease surveillance systems. METHODS We performed extensive onsite semi-structured interviews, targeted work shadowing and a focus group to characterize local health agency CD workflow. Informed by principles of design ethnography and user-centered design we created persona, scenarios and user stories to accurately represent the user to system designers. RESULTS We sought to convey to designers the key findings from ethnographic studies: (1) public health CD work is mobile and episodic, in contrast to current CD reporting systems, which are stationary and fixed, (2) health agency efforts are focused on CD investigation and response rather than reporting and (3) current CD information systems must conform to public health workflow to ensure their usefulness. In an effort to illustrate our findings to designers, we developed three contemporary design-support representations: persona, scenario, and user story. CONCLUSIONS Through application of user-centered design principles, we were able to create design representations that illustrate complex public health communicable disease workflow and key user characteristics to inform the design of CD information systems for public health.

[1]  Blaine Reeder,et al.  Scenario-based design: A method for connecting information system design with public health operations and emergency management , 2011, J. Biomed. Informatics.

[2]  T.M. Duffy,et al.  Scenario-Based Design: Envisioning Work and Technology in System Development [Book Review] , 1996, IEEE Transactions on Professional Communication.

[3]  John S. Pruitt,et al.  The Persona Lifecycle: Keeping People in Mind Throughout Product Design , 2006 .

[4]  Frank Drews,et al.  Epinome - a novel workbench for epidemic investigation and analysis of search strategies in public health practice. , 2010, AMIA ... Annual Symposium proceedings. AMIA Symposium.

[5]  DoubleTree Hotel Atlanta.  DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE CENTERS FOR DISEASE CONTROL AND PREVENTION NATIONAL CENTER FOR INJURY PREVENTION AND CONTROL ADVISORY COMMITTEE FOR INJURY PREVENTION AND CONTROL , 2006 .

[6]  Suzanne Bakken,et al.  Review of health information technology usability study methodologies , 2011, J. Am. Medical Informatics Assoc..

[7]  Jonathan Grudin,et al.  Personas, Participatory Design and Product Development: An Infrastructure for Engagement , 2002 .

[8]  Debra Revere,et al.  Reusable design: A proposed approach to Public Health Informatics system design , 2011, BMC public health.

[9]  W. Bodmer.  Principles of Scientific Management , 1993, FASEB journal : official publication of the Federation of American Societies for Experimental Biology.

[10]  David W. Bates,et al.  Primary Care Clinician Attitudes Towards Ambulatory Computerized Physician Order Entry , 2005, AMIA.

[11]  Alan Borning,et al.  Value Sensitive Design and Information Systems , 2020, The Ethics of Information Technologies.

[12]  L. Ohno-Machado.  Journal of Biomedical Informatics , 2001 .

[13]  Barry Kirwan,et al.  A Guide To Task Analysis: The Task Analysis Working Group , 1992 .

[14]  Iain E. Buchan,et al.  Developing visualization-based decision support tools for epidemiology , 2014, Inf. Vis..

[15]  Jakob E. Bardram,et al.  Plans as Situated Action: An Activity Theory Approach to Workflow Systems , 1997, ECSCW.

[16]  Mike Cohn,et al.  Succeeding with Agile: Software Development Using Scrum , 2009 .

[17]  R. Berkelman,et al.  A review of strategies for enhancing the completeness of notifiable disease reporting. , 2005, Journal of public health management and practice : JPHMP.

[18]  Janet Mancini Billson,et al.  Focus Groups: A Practical Guide for Applied Research , 1989 .

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

[20]  State electronic disease surveillance systems --- United States, 2007 and 2010. , 2011, MMWR. Morbidity and mortality weekly report.

[21]  M. Marshall,et al.  The key informant technique. , 1996, Family practice.

[22]  Seonaidh McDonald,et al.  Studying actions in context: a qualitative shadowing method for organizational research , 2005 .

[23]  Dennis F. Galletta,et al.  Human-Computer Interaction and Management Information Systems – Foundations , 2006 .

[24]  K. B. Johnson.  Barriers that impede the adoption of pediatric information technology. , 2001, Archives of pediatrics & adolescent medicine.

[25]  T. Safranek,et al.  Status of state electronic disease surveillance systems--United States, 2007. , 2009, MMWR. Morbidity and mortality weekly report.

[26]  George Demiris,et al.  Building the PHARAOH Framework Using Scenario-Based Design: A Set of Pandemic Decision-Making Scenarios for Continuity of Operations in a Large Municipal Public Health Agency , 2010, Journal of Medical Systems.

[27]  Rebecca A. Hills,et al.  Public Health Practice within a Health Information Exchange: Information Needs and Barriers to Disease Surveillance , 2012, Online journal of public health informatics.

[28]  C. Aydin,et al.  Evaluating Health Care Information Systems: Methods and Applications , 1993 .

[29]  A. Turner,et al.  From the ground up: information needs of nurses in a rural public health department in Oregon. , 2008, Journal of the Medical Library Association : JMLA.

[30]  A. Shepherd,et al.  Guide to Task Analysis , 2003 .

[31]  ReederBlaine,et al.  Scenario-based design , 2011 .

[32]  L. Lee,et al.  Updated guidelines for evaluating public health surveillance systems: recommendations from the Guidelines Working Group. , 2001, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[33]  Karen Holtzblatt,et al.  Contextual design , 1997, INTR.

[34]  Mary Beth Rosson,et al.  Usability Engineering: Scenario-based Development of Human-Computer Interaction , 2001 .

[35]  Tom Rodden,et al.  Proceedings of the Fifth European Conference on Computer Supported Cooperative Work , 1997, Springer Netherlands.

[36]  David W. Bates,et al.  Position Paper: Factors and Forces Affecting EHR System Adoption: Report of a 2004 ACMI Discussion , 2004, J. Am. Medical Informatics Assoc..

[37]  Judy Ramey,et al.  Connecting Public Health IT Systems with Enacted Work: Report of an Ethnographic Study , 2008, AMIA.

[38]  Kenneth T. Anderson,et al.  D ESIGN M ANAGEMENT J OURNAL Design Ethnography , 1999 .

[39]  K. Devers.  How will we know "good" qualitative research when we see it? Beginning the dialogue in health services research. , 1999, Health services research.

[40]  Jakob Nielsen,et al.  Usability engineering , 1997, The Computer Science and Engineering Handbook.