The main aim of this thesis was to trial the use of ‘Locales Framework' as proposed by Geraldine Fitzpatrick, in her PhD Thesis and later her book (Fitzpatrick 1998; Fitzpatrick 2003).
The other aim of this thesis was to determine the current interactions of the users of Decision Support Software (DSS) in the health arena with particular emphasis on Pathology in the determination and notification of notifiable diseases. Even in the area of Bioinformatics, where the bulk of the current research appears focused upon Human genome research; there was no direct literature that related to medical pathology. In the area of DSS, there has been research carried out in the fields of Nursing and Clinical, as recently as 2002, but it would appear that there is not any current research being undertaken in the arena of medical pathology.
There was only one paper that actually mentioned Medical Pathology and DSS, by Kaplan and Fitzpatrick (Kaplan and Fitzpatrick 1997), and even this paper only mentioned Medical Pathology in passing.
Although I have reviewed a relatively large quantity of literature relating to the individual areas of my Master’s Thesis, I have been unable to find any that relates completely to the topic. I have attempted to make my own research as detailed and exacting as possible in the short time frame available.
Using Locales Framework and its five aspects of locale as a principled approach in the development of shared abstractions among stakeholders:
2. Civic structures,
3. Individual view,
4. Interaction trajectory,
The whole premise of ‘Locales Framework’ is that of one of a metaphor of place, with ‘locale’ as its primary unit of analysis. ‘Locale’ can function as a shared abstraction because of it’s being constituted in the relationship between the interactional needs of a social world - a group of people with shared purpose - and the ‘sites and means’ it uses to meet those needs. Hence, ‘locale’ only makes sense when we understand both the social and the technical aspects.
Due to the numerous areas of interest originally envisaged for this study, the study was designed so that it would be implemented in stages:
1. Stage 1 - Which was undertaken as part of this Master’s thesis, will have a strictly limited scope, and will be focused upon the Computer Supported Cooperative Workplace (CSCW) processes and the volume of information being forwarded to the requesting Doctors.
2. Stage 2 - Possible PhD thesis - concentrating of a specific item(s) of interest uncovered during Stage 1.
The significance of this study is important, as ‘Information Overload’ is affecting not just Doctors, but also everyone in modem day society. A segment of this study will be concentrating upon, at which point, Doctors consider that they are being ‘swamped’ with too much information from the Pathology service provider .
There are two problems, which need to be resolved by this thesis:
1. The investigation proposed for this thesis: ‘Interactions in an Medical Environment’.
2. There is the purely physical one of designing a software solution suitable for the pathology service provider.
In my favour, I have over six years of experience in that area of Laboratory Information Systems with particular interest in the Pathology arena, with minor emphasis upon its decision support features.
In this the first stage of the investigation, I will undertake studies into the interactions in the use of Decision Support Systems within the medical environment with particular focus on ‘Locales Framework’.
From the data gathered in the first stage, I will develop a number of medium-fidelity prototypes artefacts of a software application called ‘SIGPATH’, to be use in the Contextual Inquires being held in the second stage. SIGPATH was the name that I had given to the software, and stands for "Significant Pathology. ’’ These artefacts are:
Data Extraction - A routine, which will interact with the shadowed database of the pathology provider, and will extract sufficient data to develop the data warehouse or data cube
Web Application - A web application to display a visual representation of the data, highlighting points of interest to the pathologists
Email - A routine to generate emails to the referring Doctors highlight cases of interest within their geographical area of interest. The email will contain links to a number of relevant articles (where appropriate) highlighting new treatment or research.
From these artefacts, I will undertake a contextual inquiry into the viability of the use of the Locales Framework to help in the design of a Decision Support System (DSS), focused on the Medical Environment (Pathology). Sullivan and Nicolaides Pathology (S & N Pathology), a pathology service provider, in Brisbane, Queensland, has developed a requirement for an expert / decision support system, based upon business intelligence rules. This requirement has developed from both inside (peer review & research) and outside (legislative) requirement.
The core of the DSS is the data warehouse, which is based upon medical data dating back to the early 1990’s. The Bioinformatics data has been restricted to the specific area of significant pathology as defined by and relating to the specific pathology service provider.
Significant pathology are those tests which have been deemed ‘significant’ either to the provider, i.e. Rare, unusual, the requesting referrers, the state Department of Health, or tests that the local department of health has deemed reportable.
Each week the Queensland Department of Health issues reports to the Medical community, reporting instances of all notifiable diseases that occur within its area of responsibility. A Senior Pathologist within the service provider wishes to emulate and enhance on this idea. Along with these facts, the current system can no longer provide the breadth or depth of information required in a 21st Century Pathology practice.
The purposed solution for the service provider is to develop an internal expert / decision support system based upon business intelligence rules and data warehousing processes. The only technical restraint is that it must be based upon their existing software skills (Caché from InterSystems Pty. Ltd.), Microsoft and Macromedia.