1. Enhancing Timely Management of Workflow with Interactive Visual Displays & Actions for Situation Awareness Processing Sureyya Tarkan UMD Dept. of Computer Science & HCIL sureyya@cs.umd.edu http://www.cs.umd.edu/hcil/sharpc/ Supervised by Ben Shneiderman & Catherine Plaisant

2. Situation Awareness ( Endsley, 2004 ) 1 Shared SA of a teamTemporal dynamic environment 1. Perception 2. Comprehension 3. Projection

3. Interruptions & Notifications October 8, 2015 2

4. ‘Missed Results’ Problem Mishandling of abnormal results & no follow-up (Wahls, 2007) Most common missing information: lab test results (Dovey, 2002) Delay in care, time/financial loss, pain/suffering, adverse clinical consequence (Hickner, 2008) 3 October 8, 2015

5. Test Process Steps 1. Pre-analytic a. Ordering the test b. Implementing the test 2. Analytic a. Performing the test 3. Post-analytic a. Reporting results to the clinician b. Responding to the results c. Notifying the patients of the results d. Following-up to ensure the patient took the appropriate action based on test results 4 Lab technician Patient & Physician Physician Specimen lost Specimen mislabeled in office Physician on vacation Results misplaced Specimen damaged during transport No documentation on record Nurse Patient doesn’t go

6. Medical Informatics Applications 5 VA View Alert Window Alert arrived results in chronological order Patient list Pending tests in patient chart

7. October 8, 2015 6 Motivation: Package Tracking Clear expectation Constant feedback Explicit responsibility

8. 7 Motivation: Lists & Actions October 8, 2015

9. Approach for Reducing Missed Results Model user actions within workflow specification Assign temporal responsibility Derive an interactive display from the model From order time to until all follow-up actions are taken Support actor action sheets as part of tracking Provide retrospective analyses for manager to identify common problems and compare performance 8 October 8, 2015

10. Laboratory Test Result Management Workflow Schedule Exam (4 days) Accept Patient (1 hour) Confirm Appointment Update Patient Info Draw Sample (21 hours) Prepare Equipment Ship with Carrier Transport by self Examine Specimen (1 day) Access Patient Sample Conduct Test Write Results Analyze Results (1 day) Access Report Inform Patient Schedule Visit Repeat Test Order New Test 9 October 8, 2015

11. Modeling Actions 10

12. October 8, 2015 Multi-Step Task Analyzing, Reporting, Tracking (MSTART) Prototype 11

13. Rich Tabular Displays October 8, 2015 12

14. October 8, 2015 Generating Actor Action Sheets: Result Review 13

15. 14 October 8, 2015 Order

16. 15 October 8, 2015 Retrospective Analysis

17. Proposed Work: Actions for Situation Awareness Processing (ASAP) October 8, 2015 16 More information Edit/Annotate Marking

18. October 8, 2015 17 Actions, Groups, and Values

19. Evaluation Plans for ASAP Iterative Design Reviews with Medical Professionals Usability Test 10 subjects, 25 tasks (1 hour) Inform design Feedback: Interview, Questionnaire Controlled Experiment Test whether ASAP reduces the amount of missed and delayed results Busy s imulation environment where multiple distracting factors are in place Compare to a plain list ordered by time of arrival 20 participants, 50 tasks (2 hours) October 8, 2015 18

20. Summary Model user actions within workflow specification Allow actions as part of display Integrate review of results with possible actor actions from within same screen Tracking shows how much time has passed since last action Acknowledgments Zach Hettinger, Daniel Murphy, Archana Laxmisan, Hardeep Singh, Dean Sittig Strategic Health-IT Advanced Research Projects (SHARPC) Contact: sureyya@cs.umd.edusureyya@cs.umd.edu Website: http://www.cs.umd.edu/hcil/sharp/http://www.cs.umd.edu/hcil/sharp/ 19 October 8, 2015