2014.ISDS.Abstracts.Final.pdf


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ISDS 2014 Conference Abstracts

Assessing the Work Practices and Information Needs 
of Disease Investigators

Neil Abernethy*, Lauren Carroll, Alan Au and Tsung-Chieh Fu

Biomedical Informatics and Medical Education, University of Washington, Seattle, WA, USA

Objective
The goal of this work is to identify specific work practices in 

disease investigation that would be supported by data visualization, 
such as identifying exposure, contact, and spatiotemporal clustering.

Introduction
Investigation of cases, clusters, and outbreaks of infectious disease 

is a complex process requiring substantial support from protocols, 
distributed and cooperative work, and information systems. We 
set out to identify public health information needs, the types of 
data required to meet these needs, and the potential alignment with 
visualizations of this data.

Methods
We used mixed methods to identify common high-level themes 

and low-level data elements required during disease investigation. We 
first studied disease investigation protocols and contact investigation 
data forms from 31 jurisdictions in the context of tuberculosis case 
investigations.

To provide further insight into the disease investigation process, 
we conducted qualitative research with a public health department 
to identify work practices, protocols, paper forms, electronic tools, 
visualizations, and information needs encountered during case and 
outbreak investigations. This research consisted of two focus groups 
with different divisions of a public health department, attendance of 
daily meetings, and participant observation of investigators, nurses, 
and epidemiologists in the Communicable Disease Section.

Results
We obtained 25 data forms and 21 protocols from 31 states 

representing contact investigation practices. Both forms and protocols 
were available from 15 states, allowing comparison of the data fields in 
these artifacts. Of 82 data elements recorded, only 10 were commonly 
represented in both data forms and protocols. This suggests that not all 
work practices were encoded in these protocols, that some protocol-
driven activities are not reflected in the forms we analyzed, and that 
the functions of these artifacts are not well coordinated.

Disease investigation practices vary widely by jurisdiction, however 
as expected some data fields (e.g. demographics, transmission risk, 
and clinical/case management variables) are more common across 
jurisdictions. Similarly, some common functionality is required 
of information systems, such as patient identification and search, 
diagnosis, treatment monitoring, tracking trends, and identifying or 
plotting links between cases and those at risk.

We used qualitative methods to obtain a more complete picture of 
disease investigation work practices that emerged from state protocols. 
Focus groups were used to explore several themes, including the 
use of information tools and how well they satisfied public health 
information needs. Participants routinely used information tools 
to record data during the disease investigation process, although 
existing tools were not as well-suited for data retrieval and analysis. 
Variations in data reporting requirements between local/state systems 
also affected work practices involving data entry. Participants made 

use of free-text data fields to record case-specific information, but this 
complicated extraction and analysis of these data.

Direct observation sessions reiterated the use of information systems 
for data management in conjunction with paper records. Consistent 
with findings from the data form and protocol analysis, investigators 
used systems to check for common risk factors that might indicate that 
cases were related and to track case status. Visualization might benefit 
such data management tasks; however most visualizations observed 
were not routinely available. Information systems were also used 
for process-related tasks, such as de-duplicating entries, accessing 
health records from partnering agencies, and conducting workload 
management tasks.

Conclusions
This research helps establish that 1) potential users of information 

systems have diverse workflow needs and data requirements that 
should be considered in system design; 2) gaps exist between the 
current capacity of health programs and the functions of information 
tools; 3) greater levels of standardization of public health data 
are needed within and between jurisdictions; and 4) coordinated 
development of data standards, infectious disease protocols, and 
information tools (including user interfaces and visualizations) is 
needed. Coordination of what public health workers should do, what 
they actually do, and what they could do with case data will improve 
future public health surveillance and response activities.

Keywords
Outbreak management; Contact investigation; Data standards; 
Qualitative methods; Comparison

Acknowledgments

This research was supported by NLM grant #R01 LM011180-02. We are 
grateful for the participation of staff from Public Health Seattle & King 
County.

*Neil Abernethy

E-mail: neila@uw.edu    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * (1):e99, 201