Veterans Administration Critical Alerts Reengineering
(OIT - Innovation from the Field for Alerts Reengineering)

Situation/Challenge

At the Department of Veterans Affairs (VA) Hospital in Houston, Texas, 50 to 100 cases of prostate, lung and colon cancer go either misdiagnosed or undetected every year. This is largely due to a notification system in which results from critical tests are easily missed or forgotten amongst hundreds of other notifications. As reported in The Wall Street Journal, the VA has recognized this problem and is designing an alert system for warning primary care providers when a patient's chart contains test results that remain addressed.

Normal Modes, LLC and Userworks, Inc. are part of a team supporting the VA's "Innovation from the Field for Alerts Reengineering" project in which Normal Modes is the onsite project team. This ongoing effort aims to develop a means within the Computerized Patient Record System (CPRS) of tracking follow-up actions to critical test results, with the ultimate goal of saving lives via reducing the number of undiagnosed cancers in our nation's veterans. In addition, this effort will help reduce the VA's $150-500 million dollar a year medical liability costs associated with these undiagnosed cancers.

Objectives

The VA recruited us to make certain their new alert system would be designed in a way that would not add extraneous burdens to primary care providers' existing workloads, while at the same time being an effective tool in preventing misdiagnosed or undetected cancers.

In short, our objective is ensuring the VA's new alert system is acceptable, usable and helpful to the primary care providers who will have to use it.

Strategy/Tactics

Over twelve months, we have been working closely with the VA and their primary care providers to ensure the new alert system is as closely aligned with their goals as possible. Working with VA primary care providers, we conducted a series of on-the-fly expert reviews and user interviews on several versions of the prototype alerting system. As the VA's development team built the new alert system, we acted as the voice of the users (i.e., the primary care providers), by providing feedback and design suggestions based on their needs.

Using screen-recording software we watched and measured reactions as primary care providers interacted with both working and non-working prototypes of the new system. We also interviewed primary care providers to better understand how the new alert system would fit into their daily workflow, and how or if improvements could be made.

Message Alignment

According to the Department of Veterans Affairs, the mission of the VA is:

Our work with the VA hospital in Houston is directly related to this mission. By ensuring a usable alert system for the VA's primary care providers, we are directly affecting the quality of care our nation's veterans receive in addition to helping save lives.

Results

Overall, primary care providers responded favorably to the new alert system. Those interviewed quickly realized that the system's reminders would be beneficial in their daily work, helping to reduce the number of missed follow-ups.

Further, every primary care provider felt the alert system would help them manage their daily notifications, largely because it "forces you to address the alert" and "can act as a reminder."

However, there were some aspects of the new alert system that were seen as confusing or vague to the primary care providers we interviewed. For example, shown below, the wording in the dialoged box to the left was seen as vague and confusing to nearly all of the primary care providers we interviewed. While not particularly visually appealing (we were required to work within the existing CPRS software), our recommendations to the VA's development team, featuring enhanced clarity, organization, and salient critical information, are shown in the right dialog box.