Experience modeling and analyzing medical processes

Abstract

This paper provides an overview of the UMass/Baystate Medical Safety project, which has been developing and evaluating tools and technology for modeling and analyzing medical processes. We describe the tools that currently comprise the Process Improvement Environment, PIE. For each tool, we illustrate the kinds of information that it provides and discuss how that information can be used to improve the modeled process as well as provide useful information that other tools in the environment can leverage. Because the process modeling notation that we use has rigorously defined semantics and supports creating relatively detailed process models (for example, our models can specify alternative ways of dealing with exceptional behavior and concurrency), a number of powerful analysis techniques can be applied. The cost of eliciting and maintaining such a detailed model is amortized over the range of analyses that can be applied to detect errors, vulnerabilities, and inefficiencies in an existing process or in proposed process modifications before they are deployed.

Dissecting Cardiac Surgery

“…The results of our study can also inform real-time strategies to improve patient safety in the OR. In fact, workflow segmentation through surgical process modeling and cognitive analysis of team-based tasks are being used to inform the design and development of intraoperative cognitive guidance systems, such as Smart checklists and decision support systems in the OR 20,37,38 . By understanding the cognitive demands imposed by specific tasks on specific team members, technology-enabled guidance systems may offer clinical support tailored to specific task demands and OR roles.…”

“…Two cameras (GoPro Hero 4) were set up with a wide and a narrow field of view to record audio and video of an entire CABG surgery from patient OR arrival until departure. As a result of a previous hierarchical task analysis (HTA), 19,20 video of a CABG procedure was decomposed into 14 steps, including a total of 65 descendant substeps, covering the intraoperative phase from arrival of the patient into the OR until departure to ICU. Informed by this HTA, we edited the recording to create 14 video vignettes illustrating each CABG step.…”

“…Previous research from our team on surgical process modeling 20,22 has used HTA 23 to decompose the intraoperative phase of CABG procedures into a 2-level hierarchical view, including surgical steps and substeps. Built upon this hierarchical segmentation, we applied a CTA method 24 in which a human factors researcher conducted in a private office individual semistructured interviews with subjectmatter experts from different OR roles (surgeons, perfusionists, and anesthesiologists) to elucidate the cognitive processes involved during the intraoperative phase of CABG.…”