Decision-centered Design Research Articles

Decision-Centered Design for Post-implementation Analysis of Automation in the Petrochemical Industry

Decision-Centered Design for Post-implementation Analysis of Automation in the Petrochemical Industry

Decision-centered design of a clinical decision support system for acute management of pediatric congenital heart disease

Children with congenital heart disease (CHD), have fragile hemodynamics and can deteriorate due to common childhood illnesses and the natural progression of their disease. During these acute periods of deterioration, these children often present to their local emergency departments (ED) where expertise in CHD is limited, and appropriate intervention is crucial to their survival. Previous studies identified that determining the appropriate intervention for CHD patients can be difficult for ED physicians, particularly since key components of effective decision making are not being met. Although key components of effective decision making for ED physicians have been identified, they have yet to be transformed into actionable guidance. We used decision centered design (DCD) to translate key components of decision making into decision requirements and associated design concepts, that we subsequently incorporated into a prototype clinical decision support system (CDSS). Using framework analysis, transcripts from Critical Decision Method interviews of CHD experts and ED physicians were inductively coded to identify key decision requirements for ED physicians that are currently not well supported, and their associated design concepts. A design workshop was held to refine the identified key decision requirements and design concepts as well as to sketch information that would satisfy the identified requirements. These were iteratively incorporated into a prototype CDSS. Three decision requirements: (1) distinguish the patient's unique physiology based on their unique cardiac anatomy, (2) explicitly consider CHD specific differential diagnoses to allow a more structured reflection of diagnosis, and (3) select CHD appropriate interventions for each patient, were identified. These requirements along with design concepts and information needs identified through the design workshop were incorporated into the CDSS prototype. We identified key decision requirements and associated design concepts, that informed the design of a CDSS to provide actionable guidance for ED physicians when managing CHD patients. Meeting ED physicians' decision components with a CDSS requires the translation of their key decision requirements in its design. If not, we risk creating designs that interfere with clinician performance.

Decision-Centered Design of Patient Information Visualizations to Support Chronic Pain Care.

For complex patients with chronic conditions, electronic health records (EHRs) contain large amounts of relevant historical patient data. To use this information effectively, clinicians may benefit from visual information displays that organize and help them make sense of information on past and current treatments, outcomes, and new treatment options. Unfortunately, few clinical decision support tools are designed to support clinical sensemaking. The objective of this study was to describe a decision-centered design process, and resultant interactive patient information displays, to support key clinical decision requirements in chronic noncancer pain care. To identify key clinical decision requirements, we conducted critical decision method interviews with 10 adult primary care clinicians. Next, to identify key information needs and decision support design seeds, we conducted a half-day multidisciplinary design workshop. Finally, we designed an interactive prototype to support the key clinical decision requirements and information needs uncovered during the previous research activities. The resulting Chronic Pain Treatment Tracker prototype summarizes the current treatment plan, past treatment history, potential future treatments, and treatment options to be cautious about. Clinicians can access additional details about each treatment, current or past, through modal views. Additional decision support for potential future treatments and treatments to be cautious about is also provided through modal views. This study designed the Chronic Pain Treatment Tracker, a novel approach to decision support that presents clinicians with the information they need in a structure that promotes quick uptake, understanding, and action.

Examination of Anesthetic Practitioners’ Decisions for the Design of a Cognitive Tool for Airway Management

The goal of this research was to examine the decisions made by anesthesia providers in emergency and routine clinical situations relating to airway management. A key function of anesthesia is to ensure oxygen can be delivered to the lungs via a patient’s airway. Failure to maintain adequate oxygen levels leads to brain damage and death. The anesthetic work environment is complex. Occasionally, stressful situations occur when difficulties in airway management arise. Members of the anesthesia team must then engage in complex cognitive activities such as rapid, collaborative decision-making. It is suggested that cognitive aids may support decision-making in these situations, although this has not yet been evaluated empirically from a Cognitive Systems Engineering perspective. This ongoing research combined two studies using Cognitive Task Analysis methods as part of a Decision-Centered Design process: observations and Critical Decision Method interviews. These will inform subsequent research phases concerning the development and evaluation of design concepts.

Using Naturalistic Decision Making to Identify Support Requirements in the Traffic Incident Management Work Environment

The road crash environment is a complex, dynamic, and dangerous workplace for responders at the scene. Decisions made by senior officers from responder agencies can alter the survival outcomes of road crash victims and the safety of responder crews. Although no previous studies have utilized naturalistic decision making principles to research traffic incident management, the characteristics of the workplace seem ideally suited to it. This study used critical decision method (CDM) interviews and the recognition-primed decision model to analyze decisions made by experienced senior responders at traffic incidents. CDM interviews were conducted with officers from three agencies: police, emergency services, and road authority traffic officers. The results revealed useful and novel information about the traffic incident management system, for example, interagency coordination issues. The process identified key decision points at incidents as well as countermeasures to the identified issues using decision-centered design. These countermeasures were subsequently validated by subject matter experts.

Designing Colorectal Cancer Screening Decision Support: A Cognitive Engineering Enterprise.

Adoption of clinical decision support has been limited. Important barriers include an emphasis on algorithmic approaches to decision support that do not align well with clinical work flow and human decision strategies, and the expense and challenge of developing, implementing, and refining decision support features in existing electronic health records (EHRs). We applied decision-centered design to create a modular software application to support physicians in managing and tracking colorectal cancer screening. Using decision-centered design facilitates a thorough understanding of cognitive support requirements from an end user perspective as a foundation for design. In this project, we used an iterative design process, including ethnographic observation and cognitive task analysis, to move from an initial design concept to a working modular software application called the Screening & Surveillance App. The beta version is tailored to work with the Veterans Health Administration's EHR Computerized Patient Record System (CPRS). Primary care providers using the beta version Screening & Surveillance App more accurately answered questions about patients and found relevant information more quickly compared to those using CPRS alone. Primary care providers also reported reduced mental effort and rated the Screening & Surveillance App positively for usability.

Eliciting User Decision Requirements for Designing Computerized Diagnostic Support for Family Physicians

Despite its 40-year history, computerized diagnostic support is not used in routine clinical practice. As part of a European project to develop computerized diagnostic support for family physicians, we identified user decision requirements and made design recommendations. To this end, we employed multiple data types and sources. All data were elicited from U.K. family physicians and pertained to consultations with patients, either real or simulated. To elicit user requirements, we conducted in situ observations and interviews with eight physicians and performed a hierarchical task analysis of the diagnostic task. We also analyzed 34 think-aloud transcripts of 17 family physicians diagnosing detailed patient scenarios on a computer and 24 interview transcripts of 18 family physicians describing past cases of intuitive diagnoses from their experience. All transcripts were coded using the situation assessment record (SAR) method. We report our methods and results using the decision-centered design framework. Studies employing multiple human factors techniques and data types in order to elicit user requirements are rare. Our approach enabled us to propose interface design recommendations that go beyond existing “differential diagnosis generators,” with the aim to improve physicians’ performance and acceptance of the resulting tool.

Employing Decision-Centered Design to Develop Decision Support for Colorectal Cancer Screening (Extended Abstract)

This paper describes a project employing decision-centered design to develop a decision support application called the Screening & Surveillance App (SSA) to aid primary care providers in tracking and managing colorectal cancer (CRC) screening for their patients. This paper details the path from cognitive task analysis (CTA) to a decision support application. We conducted ethnographic observations and CTA interviews to identify common elements of clinical workflow across health systems and articulate decision requirements. We describe three design iterations that emerged over the course of CTA and software development. Findings from a beta test evaluating the SSA suggest that it saves time, increases accuracy in responding to CRC-related patient-specific questions, and is perceived to reduce workflow as compared to participants’ current electronic health records (EHR). Usability and usefulness ratings for the SSA as measured by the Health ITUES were above 4 on a 5-point scale where 5 was most positive.

Design and Implementation of a Cognitive Command and Control System for Tower Controllers

This article describes a Cognitive Systems Engineering (CSE) practitioner's approach to the preliminary design and implementation of a C2 system, focusing on how the CSE approach guided the system design features. The Virtual Assistants and Persistent Sentinels project was built as a concept demonstrator to investigate the efficacy of a CSE approach to building C2 systems. The project team adopted the Decision-Centered Design (DCD) Methodology (Crandall, Klein, & Hoffman, 2006). Guided by the DCD process, from preparation to application design, this article describes 3 examples of transitions from macrocognitive challenges to design prototypes. Preliminary evaluation was conducted using cognitive indicators (Long & Cox, 2007) to evaluate if system features hindered cognitive performance as well as by obtaining feedback from subject matter experts through a cognitive wall walk.

Once More, Into the Soup

In one of the earlier essays in this department, we discussed a number of acronyms all having to do with system design, and all having the form x-centered The purpose of that essay was to demonstrate a broad framework within which to understand human-centered computing (HCC), and also to show the various convergences and divergences of the communities of practice that have introduced their own x-centered-design designations. Among them are learner-centered design, client-centered design, designer-centered design, decision-centered design, and work-oriented design.

Applying Decision-Centered Design to Damage Control for the Navy

Decision-Centered Design (DCD) was created so that the users of information technology (IT) have an advocate in the design cycle. DCD was created to increase the value of IT for the decision maker. It is a cognitive engineering approach to design that uncovers and models the cognitive expertise of users and conveys these insights to IT developers. DCD ensures that cognitive challenges are addressed in IT designs so that cognitive performance is improved. Other cognitive enginering approaches share these same goals, but DCD also has principles and processes that other cognitive engineering approaches may not share. This paper will use a Damage Control decision support system to illustrate the application of DCD.

The Development of Cognitive Analysis Methods to Aid Interface Design

The goal of any human factors implementation is to optimize the interface between technological systems and the humans operating within them. As technological systems continue to grow in capability and complexity, knowledge of how performers operate within these systems has become more deeply embedded within the system and in the head of the operator. In high-technology, high-complexity systems used in military, nuclear power, air traffic control, and aerospace operations, demands imposed by the system interface are predominantly cognitive in nature. Techniques for uncovering the cognitive demands associated with operating these complex systems have become increasingly necessary for understanding, predicting, and optimizing human performance within them. This paper illustrates how the application of Cognitive Task Analysis (CTA) and Decision-Centered Design techniques can be used to uncover and aid the cognitive processes involved with operating complex systems, and in turn, enhance human performance in complex systems. The design of a prototype display for Landing Signal Officers aboard U.S. aircraft carriers will illustrate the application of these methods. The utility of these principles, however, can be applied to any domain or environment in which humans must interface with complex technology.