Testing the Conceptual Model

INFORMATION SYSTEM TECHNICAL ANALYSIS

The context level diagram for BST (Figure 4-11) shows the major data inputs and outputs of the accredited breast screening enterprise viewed as a data processing system. Equivalent entities with elements in Model one are the entities PROFESSIONAL NETWORK (“network of practice”), ACCREDITED BREASTSCREENING SYSTEM

(“enterprise organisation” - BST) and BREASTSCREEN AUSTRALIA (“accrediting organisation”).

Pe rfo_rm an_ce an_d co_m plia_nc e R_ep orts

Figure 4-11 Accredited breast-screening system context-level DFD

Screening women for breast cancer involves a range of data collecting and processing activities (Table 4-10). Clinic-based information processing activities by clinicians include recording data from clinical tests and interpreting data, contributing

professional specialised knowledge and skills. The clinic context also involves verbal and written communication activity between staff (e.g. multi-disciplinary discussion; clinical notes) and with clients (informing diagnosis; discussing treatment options).

FUNCTION INFORMATION PROCESSING

ACTIVITIES

DATA

Capturing data Recording clinical data and decisions related to the client, recording equipment data and staff data onto client record

Client record data Equipment data Staff data

Process client data Transferring data on physical client record to digital client information system, checking data entry for quality

Client information system data

• Demographic information • Interaction history (date, staff

member)

• Clinical indicators • Clinician judgment

Monitoring client data

Tracking trends against NAS requirements; meetings to decide actions

Aggregated client record data

Creating reports Monitoring, compliance and explanation reports; feedback for radiologists

Aggregated client record data

Auditing data Internal: QA processes

External: Accreditation site visit

Physical client record completeness Client Information system algorithms Policy and Procedure compliance Staff work practice compliance Table 4-10 Functional decomposition BST activities in relation to BSA requirements

Data support staff members manually enter data collected on the client record onto the client information system. Client data recorded on the paper client record includes:

demographic information; interaction history; breast x-ray films; psychosocial

information; clinical indicators and clinician judgment – cancer diagnosis. Client data is later processed by the Data Manager at population-level (aggregated client records over specified timeframes) and used to generate organisation performance reports for BSA. Table 4-10 is a functional decomposition of BST information activities that generate data used in BSA reports on organisation performance evaluation.

Nine entity-relation (E-R) diagrams were constructed to provide a data view of BST activities. Eight diagrams set out the content of data collected from individual clients onto a paper client record. Figure 4-12 shows that each data element in the client record mapped to a data element used to calculate organisation performance against the NAS that are linked to quantitative measurements. Thus, the E-R diagrams indicated that the technical system was fully integrated for the purposes of organisation accreditation and information support for clinical practice. The client information system and the paper client record were conceptually

equivalent despite the manual data entry activity. Client data generated by members of the clinical practice in the course of client service delivery is the data used to measure the organisation performance against the standards specified in the NAS. It is from the client record data that the Data Manager generates monthly data reports, which are analysed for trends against the NAS, discussed and acted on by the Designated Radiologist, Program Manager and subsequently BST staff members. The IS analysis indicated that some aggregated client data was available to clinicians as feedback and used as information on individual practice performance. Islands of data existed, but organisation-level accreditation did not depend on their integration or boundary maintenance to convert the data into a form suitable for organisation-level accreditation.

Figure 4-13 is an E-R diagram that identifies: 1) data recorded on the paper client record (and on the client information system) that is used for accrediting the organisation and 2) (circled) data that is not recorded on the paper client record and electronic client information system but is required to be collected for accrediting the organisation and checked during an accreditation site visit.

In Figure 4-13 the circled entities represented practice data that was not on the client record but was checked during accreditation site visit. These are summarised in Table 4-11.

DATA FOR ACCREDITATION - required for NAS not on client record

DATA SUPPORTING PRACTICE - not used for NAS and not on client record

• Accreditation of professional clinical staff • Continuing Professional Development

(CPD)

• Mammogram machine calibration and

checking record

• Protocols for and evidence that practice

e.g. infection control and waste disposal

• Multi-disciplinary meetings attendance • _{Customer survey}

• Recruitment plan

• Evaluation of recruitment and education

activities

• Staff rosters and leave

• Mobile bus maintenance schedule • Clinical equipment maintenance schedule • Financial data

• Materials on current best practice for

education and recruitment and for cancer policy development

• Waste disposal

• Contact information for interactions with

relevant people and organisations

Table 4-11 BST data not on the client record: supporting accreditation and practice

Not all data recorded about a client onto the paper client record is transferred onto the client information system and used to measure performance for organisation

accreditation: the physical breast x-ray images and clinical notes are only available from the paper record (the introduction of digital mammography has potential to allow digital breast images to be incorporated into a client information system). Not all data needed for renewing organisation accreditation is recorded on the client record (it is checked during an accreditation site visit). Data is collected that supports the work practices of staff but is not part of the reporting system for organisation-level accreditation (e.g. used to support individual-level accreditation requirements for continuing professional development).