Contextual Inquiry of Air Force Medical Service (AFMS) Pathology: Identify the Unique Needs and Work Practices Prior to Implementing a Digital Pathology System
Jonhan Ho, Orly Aridor, David Glinski, Chris Saylor, Dale M Selby, Joseph P Pelletier, Steven W Davis, Christopher B Gerlach, Leslie Anthony, Anil V Parwani. University of Pittsburgh School of Medicine, Pittsburgh, PA; UPMC, Pittsburgh; Wilford Hall Ambulatory Surgical Center, San Antonio, TX; David Grant Medical Center, Fairfield, CA; 81st Medical Group Hospital, Biloxi, MS
Background: Recent advances in whole slide imaging are initiating a move towards wide spread adoption and implementation of digital pathology (DP) in anatomic pathology practices. The Air Force Medical Service (AFMS) is exploring efforts to implement DP into its pathology practice. Prior to designing a new DP system, the unique needs and preferences of AFMS pathologists and their pathology system should be identified. Contextual Inquiry (CI) is a social tool for understanding and capturing in-detail aspects of work from the perspective of the person performing the work, and is used to help identify the worker's needs. CI is commonly used by software developers, and was previously used to help design other hospital information systems.
Design: A research team composed of an academic pathologist and 3-5 trained observers interviewed pathology/histology personnel at 3 AFMS pathology labs following CI guidelines by Holtzblatt et al. Notes representing user-provided data from all sites were documented during the observation sessions. These notes were arranged into an affinity diagram, a hierarchal organization of the notes based on common themes in the data. Five models were created to help visualize the data: sequence, flow, artifact, physical, and cultural models.
Results: A total of 22 pathologists, 4 residents and 7 histotechs were observed. A total of 1132 affinity notes were documented. Notes were generalized into 74 statements and grouped into 27 second level, 9 first level and finally 5 main level categories--Workflow and Workload Distribution, Quality, Communication, Military Culture, and Technology. AFMS pathologists work flow needs were similar to civilian pathologists, including need to deliver accurate diagnosis in a timely manner, conduct quality assurance, consult with other pathologists, communicate effectively with clinicians, and track and manage cases. Unlike their civilian counterparts, AFMS pathology system has unique staffing limitations and need to serve a large patient population distributed across the globe.
Conclusions: Based on findings, AFMS pathology has more to gain from DP and is better positioned to implement DP than civilian pathology practices.
Tuesday, March 20, 2012 1:00 PM
Poster Session IV # 224, Tuesday Afternoon