A project to rethink the paper-based process in which clinical providers do reporting for public health surveillance helped ensure that IT development was driven by users' workflow needs.
The project, carried about by researchers from the University of Washington and the Regenstrief Institute, took a participatory design approach to converting the burdensome and often incomplete reporting process, reports eGEMS (Generating Evidence & Methods to improve patient outcomes.)
The proposed new system would take a process that previously involved faxing paper forms to the public health agency to one in which electronic reporting forms were pre-populated with relevant data available from the electronic health record system used by the Indiana Health Information Exchange (IHIE).
Based in Marion County, Indiana, reporting for the study was required for two distinct working groups: sexually transmitted infections (STIs) and non-STIs. It focused on seven targeted conditions: hepatitis B, chronic hepatitis C, chlamydia, gonorrhea, histoplasmosis, salmonella, and syphilis.
The process involved six phases: team brainstorming; public health focus groups to refine ideas; a technical feasibility assessment; a public health stakeholder survey on system functionality; forms prototyping; and a public health focus group form review.
"By involving public health end users in the process of form redesign, we were made aware of important differences between policy needs (e.g., state-mandated fields on the forms) and actual workflow needs," the authors wrote, stressing that by improving usability, they hoped public health agencies would receive more complete and accurate data.
"Rather than recreating a paper form using IT software, we redesigned the form to respond to the realities and goals of the work being done, and the context of its use by clinicians and policymakers," they said.
A similar project by the New York City Public Health Department, called NYC Macroscope, compiles EHR data from primary care practices involved in New York's Primary Care Information Project to monitor conditions such as obesity and hypertension, as well as smoking rates and flu vaccinations.
Public health surveillance also is a core function of the District of Columbia Health Information Exchange program. Its population includes a high percentage of residents who live in poverty and are on Medicaid, and it has a large homeless population.
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