Revere Debra, Dixon Brian E, Hills Rebecca, Williams Jennifer L, Grannis Shaun J
University of Washington.
Regenstrief Institute.
EGEMS (Wash DC). 2014 Oct 22;2(3):1082. doi: 10.13063/2327-9214.1082. eCollection 2014.
Surveillance, or the systematic monitoring of disease within a population, is a cornerstone function of public health. Despite significant investment in information technologies (IT) to improve the public's health, health care providers continue to rely on manual, spontaneous reporting processes that can result in incomplete and delayed surveillance activities.
Participatory design principles advocate including real users and stakeholders when designing an information system to ensure high ecological validity of the product, incorporate relevance and context into the design, reduce misconceptions designers can make due to insufficient domain expertise, and ultimately reduce barriers to adoption of the system. This paper focuses on the collaborative and informal participatory design process used to develop enhanced, IT-enabled reporting processes that leverage available electronic health records in a health information exchange to prepopulate notifiable-conditions report forms used by public health authorities.
Over nine months, public health stakeholders, technical staff, and informatics researchers were engaged in a multiphase participatory design process that included public health stakeholder focus groups, investigator-engineering team meetings, public health survey and census regarding high-priority data elements, and codesign of exploratory prototypes and final form mock-ups.
A number of state-mandated report fields that are not highly used or desirable for disease investigation were eliminated, which allowed engineers to repurpose form space for desired and high-priority data elements and improve the usability of the forms. Our participatory design process ensured that IT development was driven by end user expertise and needs, resulting in significant improvements to the layout and functionality of the reporting forms.
In addition to informing report form development, engaging with public health end users and stakeholders through the participatory design process provided new insights into public health workflow and allowed the team to quickly triage user requests while managing user expectations within the realm of engineering possibilities.
Engaging public health, engineering staff, and investigators in a shared codesigning process ensured that the new forms will not only meet real-life needs but will also support development of a product that will be adopted and, ultimately, improve communicable and infectious disease reporting by clinicians to public health.
监测，即对人群中的疾病进行系统监测，是公共卫生的一项基石性职能。尽管在信息技术（IT）方面投入巨大以改善公众健康，但医疗服务提供者仍依赖手工的、自发的报告流程，这可能导致监测活动不完整且延迟。
参与式设计原则主张在设计信息系统时纳入实际用户和利益相关者，以确保产品具有高生态效度，将相关性和背景融入设计，减少设计师因领域专业知识不足而产生的误解，并最终减少系统采用的障碍。本文聚焦于用于开发增强型、基于IT的报告流程的协作式和非正式参与式设计过程，该流程利用健康信息交换中可用的电子健康记录来预填充公共卫生当局使用的应报告疾病表单。
在九个多月的时间里，公共卫生利益相关者、技术人员和信息学研究人员参与了一个多阶段的参与式设计过程，其中包括公共卫生利益相关者焦点小组、调查员 - 工程团队会议、关于高优先级数据元素的公共卫生调查和普查，以及探索性原型和最终表单模型的协同设计。
一些州规定的、对疾病调查不太常用或不太需要的报告字段被删除，这使工程师能够将表单空间重新用于所需的和高优先级的数据元素，并提高表单的可用性。我们的参与式设计过程确保了IT开发由最终用户的专业知识和需求驱动，从而显著改进了报告表单的布局和功能。
除了为表单开发提供信息外，通过参与式设计过程与公共卫生最终用户和利益相关者互动，为公共卫生工作流程提供了新的见解，并使团队能够在工程可能性范围内快速分类用户请求并管理用户期望。
让公共卫生人员、工程人员和调查员参与共享的协同设计过程，确保新表单不仅能满足实际需求，还将支持开发出一个会被采用的产品，并最终改善临床医生向公共卫生部门报告传染病和感染性疾病的情况。
