Assessment of Information Needs: An Example

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Assessment of Information Needs: An Example

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Title: Assessment of Information Needs: An Example

1
Assessment of Information Needs An Example

Farrokh Alemi, Ph.D.
June 2007

2
Functional Requirements of Electronic Health
records

Focus on future not past
Rely on group and not individual input
Focus on decisions

We want a system that improves future operations.
Building on the past keeps old mistakes.
3
Functional Requirements of Electronic Health
records

Focus on future not past
Rely on group and not individual input
Focus on decisions

EHR must focus on information needed in decision
making not an open list of information
4
Functional Requirements of Electronic Health
records

Focus on future not past
Rely on group and not individual input
Focus on decisions

EHR must focus on information needed in decision
making not an open list of information
5
Functional Requirements of Electronic Health
records

Focus on future not past
Rely on group and not individual input
Focus on decisions

It should focus on what clinicians need and not
what they say they want
6
Proposed Approach

Start with business objective of the EHR
Examine within each use case how EHR changes the
work process
Focus on clinical decisions
Check information needed in these decisions
Check software functionality needed
Aggregate across use cases the information and
functionality needed

7
Proposed Approach

Start with business objective of the EHR
Examine within each use case how EHR changes the
work process
Focus on clinical decisions
Check information needed in these decisions
Check software functionality needed
Aggregate across use cases the information and
functionality needed

8
Proposed Approach

Start with business objective of the EHR
Examine within each use case how EHR changes the
work process
Focus on clinical decisions
Check information needed in these decisions
Check software functionality needed
Aggregate across use cases the information and
functionality needed

9
Proposed Approach

Start with business objective of the EHR
Examine within each use case how EHR changes the
work process
Focus on clinical decisions
Check information needed in these decisions
Check software functionality needed
Aggregate across use cases the information and
functionality needed

10
Proposed Approach

Start with business objective of the EHR
Examine within each use case how EHR changes the
work process
Focus on clinical decisions
Check information needed in these decisions
Check software functionality needed
Aggregate across use cases the information and
functionality needed

11
EHR Systems that Succeed by Design
What We Want?

In design of Electronic Health Records Process
Improvement is often an after thought. We want
to bring these considerations directly to system
design phase.

12
EHR Systems that Succeed by Design

In design of Electronic Health Records Process
Improvement is often an after thought.

13
EHR Systems that Succeed by Design

Not surprising, EHRs often do not lead to the
expected improvements

14
EHR Systems that Succeed by Design

To succeed, system requirements should reflect
the information needed in the new improved
organization

15
EHR Systems that Succeed by Design

We want to bring process improvement
considerations directly to specification of
system requirements.

16
An Example

Design an EHR that will reduce unnecessary visits
while improving quality
Assumptions
A staff model HMO
Both patients and providers have access to email
and Internet
Informed consumers willing to take care of their
own health (not for everyone but for a minority
of patients)

17
An Example

Design an EHR that will reduce unnecessary visits
while improving quality
Assumptions
A staff model HMO
Both patients and providers have access to email
and Internet
Informed consumers willing to take care of their
own health (not for everyone but for a minority
of patients)

18
An Example

Design an EHR that will reduce unnecessary visits
while improving quality
Assumptions
A staff model HMO
Both patients and providers have access to email
and Internet
Informed consumers willing to take care of their
own health (not for everyone but for a minority
of patients)

19
An Example

Design an EHR that will reduce unnecessary visits
while improving quality
Assumptions
A staff model HMO
Both patients and providers have access to email
and Internet
Informed consumers willing to take care of their
own health (not for everyone but for a minority
of patients)

20
An Example

Design an EHR that will reduce unnecessary visits
while improving quality
Assumptions
A staff model HMO
Both patients and providers have access to email
and Internet
Informed consumers willing to take care of their
own health (not for everyone but for a minority
of patients)

Design an EHR to meet these assumptions
21
Describe the Content of Primary Care Visits

General medical examination
Acute upper respiratory infection
Pre- and postnatal care including complicated
pregnancy and abortion
Hypertension
Malignant Neoplasms of skin

Diagnosis Clusters A New Tool for Analyzing the
Content of Ambulatory Medical Care Ronald
Schneeweiss Roger A. Rosenblatt Daniel C.
Cherkin C. Richard Kirkwood Gary Hart Medical
Care, Vol. 21, No. 1. (Jan., 1983), pp. 105-122.
22
Describe the Content of Primary Care Visits

General medical examination
Acute upper respiratory infection
Pre- and postnatal care including complicated
pregnancy and abortion
Hypertension
Malignant Neoplasms of skin

General medical examination
Acute upper respiratory infection
Pre- and postnatal care including complicated
pregnancy and abortion
Hypertension
Malignant Neoplasms of skin

General medical examination
Acute upper respiratory infection
Pre- and postnatal care including complicated
pregnancy and abortion
Hypertension
Malignant Neoplasms of skin

General medical examination
Acute upper respiratory infection
Pre- and postnatal care including complicated
pregnancy and abortion
Hypertension
Malignant Neoplasms of skin

General medical examination
Acute upper respiratory infection
Pre- and postnatal care including complicated
pregnancy and abortion
Hypertension
Malignant Neoplasms of skin

63 clusters of diagnoses explain 80 of primary
care
Diagnosis Clusters A New Tool for Analyzing the
Content of Ambulatory Medical Care Ronald
Schneeweiss Roger A. Rosenblatt Daniel C.
Cherkin C. Richard Kirkwood Gary Hart Medical
Care, Vol. 21, No. 1. (Jan., 1983), pp. 105-122.
27
Describe the Content of Primary Care Visits

General medical examination
Acute upper respiratory infection
Pre- and postnatal care including complicated
pregnancy and abortion
Hypertension
Malignant neoplasms of skin

Each cluster is a use case, a scenario, under
which we can examine impact of EHR
Diagnosis Clusters A New Tool for Analyzing the
Content of Ambulatory Medical Care Ronald
Schneeweiss Roger A. Rosenblatt Daniel C.
Cherkin C. Richard Kirkwood Gary Hart Medical
Care, Vol. 21, No. 1. (Jan., 1983), pp. 105-122.
28
Describe the Content of Primary Care Visits

General medical examination
Acute upper respiratory infection
Pre- and postnatal care including complicated
pregnancy and abortion
Hypertension
Malignant neoplasms of skin

In each cluster, ask internal external
experts how EHR will reduce visits
Diagnosis Clusters A New Tool for Analyzing the
Content of Ambulatory Medical Care Ronald
Schneeweiss Roger A. Rosenblatt Daniel C.
Cherkin C. Richard Kirkwood Gary Hart Medical
Care, Vol. 21, No. 1. (Jan., 1983), pp. 105-122.
29
Describe the Content of Primary Care Visits

General medical examination
Acute upper respiratory infection
Pre- and postnatal care including complicated
pregnancy and abortion
Hypertension
Malignant neoplasms of skin

In each cluster, trace decisions and see what
information is useful
Diagnosis Clusters A New Tool for Analyzing the
Content of Ambulatory Medical Care Ronald
Schneeweiss Roger A. Rosenblatt Daniel C.
Cherkin C. Richard Kirkwood Gary Hart Medical
Care, Vol. 21, No. 1. (Jan., 1983), pp. 105-122.
30
For General Medical Examination Cluster

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

31
For General Medical Examination Cluster

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

32
For General Medical Examination Cluster

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

33
For General Medical Examination Cluster

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

34
For General Medical Examination Cluster

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

What impact will EHR have on our
business objective in this use case?
35
For General Medical Examination Cluster

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

Experts Reduces time for a well visit from 1
hour to ½ hour in 70 of the cases
36
For General Medical Examination Cluster

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

Given this use case what information is needed
to carryout the necessary decisions?
37
For General Medical Examination Cluster
Information needed exercise, weight, smoking,
etc.

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

38
For General Medical Examination Cluster
Information needed key findings and thoroughness
of self exam

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

39
For General Medical Examination Cluster

Patients will visit lab before scheduled
appointment
Patients will complete a health risk assessment
online. Computer will provide feedback.
Computer will guide patient in doing self
examination.
Computer will help patient plan questions they
want to ask during the visit.

Information needed clients questions
40
List of Decisions Information Items
41
List of Decisions Information Items
Lets look at Information needed in other use
cases
42
For Acute Upper Respiratory Infection Cluster

Patients contact clinicians by phone or email
Clinicians reviews the symptoms and asks the
patients to come in next day if symptoms get
worst
System follows up with the patient to see if
symptoms have gotten worse

43
For Acute Upper Respiratory Infection Cluster

Patients contact clinicians by phone or email
Clinicians reviews the symptoms and asks the
patients to come in next day if symptoms get
worst
System follows up with the patient to see if
symptoms have gotten worse

44
For Acute Upper Respiratory Infection Cluster

Patients contact clinicians by phone or email
Clinicians reviews the symptoms and asks the
patients to come in next day if symptoms get
worst
System follows up with the patient to see if
symptoms have gotten worse

45
For Acute Upper Respiratory Infection Cluster

Patients contact clinicians by phone or email
Clinicians reviews the symptoms and asks the
patients to come in next day if symptoms get
worst
System follows up with the patient to see if
symptoms have gotten worse

What impact will EHR have on our
business objective in this use case?
46
For Acute Upper Respiratory Infection Cluster

Patients contact clinicians by phone or email
Clinicians reviews the symptoms and asks the
patients to come in next day if symptoms get
worst
System follows up with the patient to see if
symptoms have gotten worse

Experts Reduces visits in 60 of cases, where
patient gets better after resting
47
For Acute Upper Respiratory Infection Cluster

Patients contact clinicians by phone or email
Clinicians reviews the symptoms and asks the
patients to come in next day if symptoms get
worst
System follows up with the patient to see if
symptoms have gotten worse

Given this use case what information is needed
to carryout the necessary decisions?
48
For Acute Upper Respiratory Infection Cluster
Information needed patients signs and symptoms

Patients contact clinicians by phone or email
Clinicians reviews the symptoms and asks the
patients to come in next day if symptoms get
worst
System follows up with the patient to see if
symptoms have gotten worse

49
For Acute Upper Respiratory Infection Cluster
Information needed Pt verification, permission
to contact, preferred contact time, change in
symptoms

Patients contact clinicians by phone or email
Clinicians reviews the symptoms and asks the
patients to come in next day if symptoms get
worst
System follows up with the patient to see if
symptoms have gotten worse

50
List of Decisions Information Items
New information items added in
51
List of Decisions Information Items
Lets look at Information needed in other use
cases
52
For Pre and Postnatal Care Cluster

Some prenatal visits avoided for patients with
positive laboratory tests
Some post-partum visits avoided by the system
triaging depressed patients to specialists

53
For Pre and Postnatal Care Cluster

Some prenatal visits avoided for patients with
positive laboratory tests
Some post-partum visits avoided by the system
triaging depressed patients to specialists

54
For Pre and Postnatal Care Cluster

Some prenatal visits avoided for patients with
positive laboratory tests
Some post-partum visits avoided by the system
triaging depressed patients to specialists

What impact will EHR have on our
business objective in this use case?
55
For Pre and Postnatal Care Cluster

Some prenatal visits avoided for patients with
positive laboratory tests
Some post-partum visits avoided by the system
triaging depressed patients to specialist

Experts Reduces visits in 10 of cases
56
For Pre and Postnatal Care Cluster

Some prenatal visits avoided for patients with
positive laboratory tests
Some post-partum visits avoided by the system
triaging depressed patients to specialist

Given this use case what information is needed
to carryout the necessary decisions?
57
For Pre and Postnatal Care Cluster

Some prenatal visits avoided for patients with
positive laboratory tests
Some post-partum visits avoided by the system
triaging depressed patients to specialist

Information needed items used in triage protocol
58
List of Decisions Information Items
New information added in
59
List of Decisions Information Items
Note that risk assessment was also needed in a
previous use case
60
List of Decisions Information Items
Lets look at Information needed in other use
cases
61
For Hypertension Cluster

Patients measure blood pressure at home
Patient calls in or is called by the system
regarding control of their hypertension
Clinician available by email to change
prescription, explain progress and evaluate
patient condition

62
For Hypertension Cluster

Patients measure blood pressure at home
Patient calls in or is called by the system
regarding control of their hypertension
Clinician available by email to change
prescription, explain progress and evaluate
patient condition

63
For Hypertension Cluster

Patient measure blood pressure at home
Patient calls in or is called by the system
regarding control of their hypertension
Clinician available by email to change
prescription, explain progress and evaluate
patient condition

64
For Hypertension Cluster

Patient measures blood pressure at home
Patient calls in or is called by the system
regarding control of their hypertension
Clinician available by email to change
prescription, explain progress and evaluate
patient condition

What impact will EHR have on our
business objective in this use case?
65
For Hypertension Cluster

Patient measures blood pressure at home
Patient calls in or is called by the system
regarding control of their hypertension
Clinician available by email to change
prescription, explain progress and evaluate
patient condition

Experts Reduces visits in 70 of cases, adds in
cost of home equipment
66
For Hypertension Cluster

Patient measures blood pressure at home
Patient calls in or is called by the system
regarding control of their hypertension
Clinician available by email to change
prescription, explain progress and evaluate
patient condition

Given this use case what information is needed
to carryout the necessary decisions?
67
For Hypertension Cluster

Patients measures blood pressure at home
Patient calls in or is called by the system
regarding control of their hypertension
Clinician available by email to change
prescription, explain progress and evaluate
patient condition

Information needed patient reported BP
68
For Hypertension Cluster
Information needed patient verification, side
effects, change in blood pressure

Patients measures blood pressure at home
Patient calls in or is called by the system
regarding control of their hypertension
Clinician available by email to change
prescription, explain progress and evaluate
patient condition

69
List of Decisions Information Items
70
List of Decisions Information Items
As more use cases are examined more information
items are added to the list.
71
List of Decisions Information Items
When the list is complete, experts need to rate
the relative importance of each item in each
decision
72
Rate The Relative Importance of the Information

On a scale from 1 to 7, where 7 is a piece of
information absolutely necessary for the visit
and 1 is a piece of information you can live
without, rate the importance of each piece of
information in each decision.

73
Rate The Relative Importance of the Information

On a scale from 1 to 7, where 7 is a piece of
information absolutely necessary for the visit
and 1 is a piece of information you can live
without, rate the importance of each piece of
information in each decision.

See a possible set of ratings
74
List of Decisions Information Items
75
Analysis of Ratings
First calculate the average rating across use
cases
76
Analysis of Ratings
Then calculaterange of ratings
77
Analysis of Ratings
Next assign information Items to data collection
categories based on the Average and range
78
Analysis of Ratings
High average low range
79
Analysis of Ratings
High average high range
80
Analysis of Ratings
Low average high range
81
Analysis of Ratings
Low average, low range items not as relevant
82
Why Do This?