case study

Medical Consults


FUNDED BY: U.S Department of Veterans Affairs

PROBLEM: Consultations are a critical part of healthcare. Consultations occur when primary care providers refer patients to specialists.  Unfortunately, in some cases, the consultation process breaks down. There may be long delays before the patient sees the specialist, or the consultation may never occur. The goal of this project was to identify barriers and facilitators to effective consultations and deliver recommendations for mitigating barriers and preventing delays in care. One objective was to provide design concepts to aid referring physicians in appropriately requesting and tracking consultations.

APPROACH: Applied Decision Science led a cognitive task analysis with primary care providers in the Veterans Health Administration. We traveled around the country interviewing and observing providers as they submitted consultations. We then analyzed the qualitative data to identify cognitive demands associated with requesting and tracking consultations. From this analysis, we designed an interactive prototype of a new interface aimed at supporting primary care providers in managing consultations.

IMPACT: Consultations are notoriously difficult to track. Coordination between primary care and specialty clinics is challenging because information must be shared across clinics, roles, and time. We designed a prototype interface aimed at overcoming these challenges. Results from an evaluation demonstrated that our prototype was more useful and usable for referring physicians than an implemented user interface at a major Midwestern medical facility. The prototype we designed has the potential to reduce breakdowns in the consultation process and prevent delays in patient care.

Savoy, A., Militello, L. G., Patel, H., Flanagan, M. E., Russ, A. L., Daggy, J. K., … & Saleem, J. J. (2018). A cognitive systems engineering design approach to improve the usability of electronic order forms for medical consultation. Journal of biomedical informatics, 85, 138-148.
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Savoy, A., Militello, L., Diiulio, J., Midboe, A. M., Weiner, M., Abbaszadegan, H., & Herout, J. (2019). Cognitive requirements for primary care providers during the referral process: Information needed from and interactions with an electronic health record system. International Journal of Medical Informatics, 129, 88-94.
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Militello, L. G., Savoy, A., Porter, B., Flanagan, M., Wu, J., Adams, J., … & Weiner, M. (2018). Hidden complexities in information flow between primary and specialty care clinics. Cognition, Technology & Work, 1-10. 
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