Contextual Inquiry of Enteric Disease Outbreak Investigation

Processes to Improve Visualization Capacity

for Public Health SurveillanceJonathan Anderson, MPH

Bureau of Epidemiology

Utah Department of Health

INTRODUCTION

Inform visualization tool (Epinome) development & implementation

1 - Describe existing work processes (user stories)

2 - Identify:

- decision making milestones

- intervention steps

- wish-list items

- limitations

METHODS

Data collection: Contextual inquiry

Participants:

Domain expert – UDOH Enteric Diseases Epi

Interviewer – UDOH Epi

UDOH Deputy State Epi

CoE Project Manager

Computer Scientist

Other CoE members

CONTEXTUAL INQUIRY APPROACH

RESULTS

61-Step “Work Process” Document:Steps in enteric disease investigation.

Wish list items

Limitations

Possible Intervention Steps

Q & A

Appendices (Artifacts)

Work process stepsWork process steps

Links to AppendicesLinks to Appendices

Wish list itemWish list item

RESULTS

61-step Work Process Document

LHD Involvement 22 steps (36%)

UPHL Involvement 12 steps (20%)

UT-NEDSS data used 13 steps (21%)

Non-NEDSS data used 26 steps (43%)

Manual data entry 15 steps (25%)

Data analysis & visualization 10 steps (16%)

ExampleNEDSS Database Use:

38.The Enteric Disease Epidemiologist uses NEDSS as a record keeping tool, a place to enter/record: a) lab results, b) outbreak names/codes, and c) case status (e.g. Confirmed, Not a Case, Suspect, Probable, etc).The Enteric Disease Epidemiologist enters

information into a spreadsheet (Appendix H) from NEDSS. However, NEDSS is typically not updated with information on risk factors & exposures in the spreadsheet. Therefore, as the investigation progresses the spreadsheet becomes the most current source of data.

ExampleData analysis & visualization:

36. The Enteric Disease Epidemiologist uses the spreadsheet (Appendix H) to analyze the outbreaks. “Analysis” is an ongoing process, beginning as soon

as two cases with matching PFGE patterns are identified.

Analysis in this sense involves searching the spreadsheet (Appendix H) for commonalities.

Variables that are commonly analyzed include: Age, Exposures, Date of onset, Location.

IMPACT Enhanced communication of ideas among

participants

Unique approach/model:

“This approach to design provides an important model for other researchers and practitioners to design usable systems that fit with and expand on existing practice.”

“Academic informatics does not have a good insight into how departments of health function so this paper nicely addresses this gap.”

Created map for development team

Able to compare & validate with other epis

Key Points:

Analysis of PH work processes

Contextual inquiry

Collaborative effort

Detailed (61 step) work process document

Guide software dev to support PH practice

Mapping of additional diseases?