In the PICTE project we identify ways to evaluate the impact of new health ICT on healthcare workers very early in the system development process. We are taking Queensland Health's forthcoming eHealth system as a case study.
PICTE Research Leader: Prof Penelope Sanderson
Pictured: Michael Muthukrishna (20%), Clinton Freeman, Stephen Whitcher, Penny Sanderson,
Wendy Broxham, Tania Xiao (25%), Hai-Ning Liang
For more information, see the COSE People pages.
What will PICTE achieve?
In healthcare systems worldwide, there is currently a huge rush to develop and install advanced health information systems, such as shared electronic health records. Unfortunately, once installed, new health ICT nearly always has unintended consequences that compromise its effectiveness. If we had better ways of modelling the impact of the ICT on healthcare work systems and work practices much earlier in system development, we could make better decisions about how to design, configure and implement such systems.
In the PICTE project we are developing cognitive systems engineering methods that allow envisionment and evaluation of the impact of health ICT much earlier in system development than is usually possible. Our approach differs from approaches based in requirements engineering, use cases, workflow modelling, usability studies, and technology acceptance, all of which have been only partially successful in healthcare.
Who will benefit?
Our end-users will be health system executives and senior clinicians who are responsible for improving healthcare system quality, productivity, and safety by making evolutionary or revolutionary changes in health ICT. Such executives and clinicians will benefit from features that the PICTE technique and tools provide, such as the breadth of the analysis performed, the exploration of boundary cases, and the decision support tools provided to assist decision making. End-users will have a record of the process by which decisions about are achieved and the criteria used, which can be updated and adjusted as needs develop.
Key features
PICTE techniques and supporting tools will include the following:- A representational framework plus ontologies for capturing affordances of new ICT at different levels of detail (top thread in diagram below)
- An analytic framework for representing information and coordination needs at different organisational levels, and for envisioning ICT-enabled work (bottom thread in diagram below)
- "Convolution" methods for evaluating ICT affordances against information and coordination needs (cycle at centre right of diagram below)
The more detailed steps, and their outputs, are shown in the diagram below.
Progress
We have initial projects in progress at several departments in Queensland Health tertiary hospitals. These projects are small-scale testbeds for the process to be used in the forthcoming eHealth initiative. We are developing methods for capturing ICT and workplace properties, identifying the comparison processes needed, and exploring suitable software support for the methods.
Much of our work will involve observation of healthcare work practices. We are therefore contributing significantly to the development of OpenSHAPA, a software tool for performing analysis of video, audio, and electronic records of people at work. OpenSHAPA will be used to examine healthcare work activity, to capture ICT decisionmaking processes, and to help analyse the results of empirical tests of new health information systems in prototype form.
Publications
Saleem, J. J., Russ, A. L., Sanderson, P. M., Johnson, T. R., Zhang, J., & Sittig, D. F. (in press). Current challenges and opportunities for better integration of human factors research with development of clinical information systems. Methods of Information in Medicine, 48. (Supplement 2009 IMIA Yearbook of Medical Informatics). [abstract]
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