Kay Miller Job Aid Makeover Overview For my Job Aid Makeover, I am planning to makeover an online training course

on the basics of HIPAA regulations, which protect patient confidentiality. Many employees at the CU Health Science Center and University Hospital are required to take the brief training. I think the standard HIPAA training module currently in use is a good candidate for a makeover because HIPAA violations are frequent and details about the regulations can be forgotten. To my knowledge, CU does not have a job aid that summarizes the information from the training course for easy reference. Should an employee want a refresher, the only way to get it would be to log into the course system and relaunch the module. Audience The audience includes University Medical School and Hospital employees who may handle patient information. There is at least one INFP in the audience. There are also many Extroverts, Sensing, Thinking, Feeling, Judging individuals. The fact that this job aid is meant for private perusal is beneficial to introverts, who will not be required to discuss the content in groups small or large. Extroverts, if they find that they would like to discuss the content of the job aid, may do so with coworkers or with the HIPAA office. Intuitive readers should appreciate the big picture overview at the beginning. Sensing readers will find plenty of details about HIPAA regulations in the content of the job aid. Thinking readers may relate to the factual information about HIPAA regulations, while Feeling readers may relate to the characters who drive the narrative. Judging readers may want to see the main point up front, so an outline is given on the title page. Perceiving readers will want to know that all of the options have been taken into consideration my hope is that their questions will be answered in the dialog between the two characters. Learning Objectives After reading this Job Aid, readers should: 1) Know the four basic principles behind the University of Colorado's approach to HIPAA 2) Be able to identify when PHI and ePHI are not secure, and how to fix the problem by securing the area, or simply rearranging an office. 3) Be able to encrypt an email which includes PHI 4) Be able to create a strong password Problem/Solution Many people assume that HIPAA regulations are common sense. Indeed, many regulations are. However, there are extra layers of security that are applied to patient documents and online information as a matter of necessity.

Another problem, specific to the University of Colorado, is the fact that HIPAA training and certification only occurs once at the time of hire, and the only way to refresh users memories of the information is to relaunch the online course. A job aid would make it easier for employees to access reminders about HIPAA regulations. A good job aid may also replace the online HIPAA training altogether. The regulations are not difficult to learn and a certification test could easily replace the course. Employees could take the test annually (for example) to demonstrate that they have the knowledge without having to take the course. The course could remain available for those who feel they need it. Evidence The job aid should include all relevant HIPAA regulations. In addition, the job aid will give explanations for why the rules are imposed so that they don't seem arbitrary, and show visual demonstrations of what not to do, as well as what to do. Anecdotes Kelly represents the thinking of a generalized employee who thinks that they are safe enough or assumes that everyone can be trusted. Without naming names or pointing to precise situations, the storyline between the two women highlights the need for proper observance of HIPAA regulations. Format I chose a comic book format because I felt that the bulk of the details about HIPAA regulations would be better communicated through demonstration, rather than simply telling what the correct behaviors are. I also thought the narrative format would be more effective at explaining the reasons for the regulations, so they don't seem arbitrary. Sequencing There were two main cycles in this Job Aid based on Abela's SCoRE method: Situation: The University deals with sensitive information that is subject to HIPAA regulations Complication: People often perceive HIPAA regulations as common sense Resolution: Show that, even if that's true, HIPAA violations occur regularly Example: Point out the violations in the fictional office in the Job Aid Complication2: I don't know the laws in detail: what specifically do I have to do? Resolution2: Common sense is a good place to start, but be careful and consistent. Example2: Give an overview of the General HIPAA Security Rule and the four principles.

1) On the title page, I added an overview of the information that will be covered through the rest of the document. This is to satisfy the needs of those who require the big picture up front (Abela, 2008, p. 21). Placing the overview here also helps prepare the short term memory to receive new information (Medina, 2008, p. 116).
2) I followed the introduction with a demonstration of how not to follow the rules.

This demonstration is exaggerated from real offices on campus for humorous effect and for greater contrast with the improved office at the end. This decision comes from McCloud (2006, p. 12-21) and Medina (2008, p. 83) who says that emotional arousal focuses attention on the 'gist' of an experience.
3) Also following the introduction, I give people-centered reasons for observing the

regulations (there are more reasons for following the regulations given throughout the story). This is to reinforce the importance of the rules, that they are not just meaningless regulations for which an institution can be punished if violated. This is to benefit the Feeling personalities (Abela, 2008, p. 24-25) and to create interest to bring in attention (Medina, 2008, p. 76). Graphics
1) The most significant choice was the decision to go with a hand drawn comic

instead of computer-generated effects. I did this mainly because I felt drawing would give me more flexibility to manipulate the design the way I wanted, and would show more emotion and humor. This is inspired by McCloud (2006, p. 1820) and Roam (2008, p. 25) who says that audiences respond better to handdrawn images...than to polished graphics.
2) Another choice was to have the words especially when stored and transmitted

electronically (Slide 5) appear in a 1996 style computer. This was done to break up a lengthy bit of historical text and to associate those words with the picture (McCloud, 2006, p. 26). This creates more visual interest and the 1996 computer highlights the history HIPAA. Tufte (2006, p. 136) states that design devices and gimmicks cannot salvage failed content. So, while the computer image may be a design device in this case, it is done to reinforce the content, rather than to decorate nonsense.
3) Another choice was to frame some of the details of Defense in Depth in a

computer monitor. Doing so freed me of the panels somewhat so that I could use a diagram inspired by Duarte (2008, p. 53). It also, similar to the decision to use the 1990s computer before, used visual association of the computer with the tasks one would be doing on the computer to protect ePHI. (McCloud, 2006, p. 26).

Text
1) I decided to stick with the traditional upper-case lettering associated with comics.

This would lend it some consistency with the comic book format. (Bliss, 2002, website). The drawback to this is that all-capital lettering can be difficult to read (Lang, 2007, conference session) and so I was particularly careful to do my lettering carefully and make each letter distinct. 2) The names of the four principles are written in bold print when they are first introduced and again when Kelly reviews them. This is done to create contrast with the text that surrounds the principles (Williams, p. 166) and to draw attention to them (Medina, 2008, p. 88).
3) The title text is designed to look like a traditional comic title. (idrawdigital, 2009,

website). The size and style create contrast with the rest of the text on the page and grab attention (Williams, 2008, p. 166.). Layout 1) On Slide 6, I created what I call a Duarte-inspired diagram to display as much information as possible in one visual plane (Duarte, 2008, p. 53). I thought that a linear demonstration would bore the audience, but a diagram would condense information without losing meaning (Reynolds, 2008, video). 2) I started with a template of nine frames per page. Though none of the pages actually use all nine frames, the template lends consistency throughout the job aid (Duarte, 2008, p.172). The title page and the final page are the only two that do not use the template. This is justified because a) the first page is not part of the narrative, and b) the last page stands out in order to draw attention to the contact information and make it more memorable (Medina, 2008, p. 88).
3) The frames have a landscape orientation so that they could be read easily on a

computer they're adapted to (their) environment (McCloud, 2005, online video). This orientation allows the reader to take in the structure and make sense of it as a whole before reading the text (Duarte, 2008, p. 100). Measurement Ideally I would employ brief, regular assessments of employees' understanding of HIPAA regulations. Employees would have the choice of retaking the original online course, or relying on their memory or using the job aid. The assessment could consist of a timed test requiring employees to identify HIPAA violations in a photo, a strong password, or name the correct procedure for handling different kinds of PHI. Employees would be allowed to retake the test as many times as necessary to pass at 80% or higher.

Other learning materials and assessment methods may be made available for employees who have difficulty with the materials and methods described here.

Peer Review Results These are the questions I asked my reviewers: 1) How well does this comic work as instruction? What could I add or remove to make it a better job aid? 2) The "story line" is pretty cheesy. Does it work, or would you recommend that I cut out the first three pages (after the title page) and jump right to the HIPAA rules? Where do you think this job aid should "start"? 3) Are any aspects of the layout confusing? What frames specifically should be changed and what should I change about them? 4) On slide #6, the main image is the "computer screen" with the open windows. I was trying to condense all of the rules for using electronic PHI and display them in a Duarteinspired diagram. Do you think it works? Can you recommend a better way to display those rules? 5) I cut back on verbiage as much as I though possible, but I still think my Job Aid looks overly "texty". What bits do you think I can cut back even more without sacrificing meaning? Both my reviewers thought that the human element of the storyline and the characters emphasized the importance of following the HIPAA regulations. They responded to different aspects of it, but the response was similar. Both also thought that the starting point worked and that I shouldn't remove any part of the storyline. Collin thought that Slide #6 with what Im calling the Duarte-Inspired diagram was confusing he didn't know where to look. I realized that the boxes in the upper left and lower right corners were drawing attention away from the more important diagram in the center. I removed the boxes and integrated their content into the larger diagram for coherence. I also made the diagram more like Duarte's by bringing the windows closer together and highlighting the radial pattern. I added a radial background design to increase this effect. Both reviewers gave some character direction, as well. Collin suggested lightening up Kellys response to being lectured from ohif we must which made the following content appear to be less engaging. I changed it to oh all right then. I hope this is a better segue than the original dialogue, while still keeping the sort of rhythm that I had in mind. Suzie recommended softening Junes demeanor in the first section so that getting instruction feels like less of a lecture. To deal with this, I changed Junes expression from outright anger to a combination of shock and concern.

References Abela, A. (2008). Advanced Presentations by Design: Creating Communication That Drives Action. San Fransisco: Pfeifer. Bliss, P. (2002, May). Hopelessly Lost but Making Good Time #25. Retrieved March 9, 2010 from Sequential Tart website: http://www.sequentialtart.com/archive/apr03/art_0403_2.shtml. Duarte, N. (2008). slide:ology: the art and science of creating great presentations. Sebastopol: O'Reilly. Idrawdigital. (2009, November 20). Drawing Comics-Lettering Techniques Retrieved from: http://www.idrawdigital.com/2009/11/drawing-comics-lettering-techniques. Lang, T. A. (2007, June ). Writing and Designing Materials for Patient Education. Session presented by the American Medical Writers Association Conference, Rocky Mountain Chapter. Niwot, CO. McCloud, S. (2006). Making Comics: Storytelling Secrets of Comics, Manga and Graphic Novels. New York: Harper. McCloud, S. (2005, February). Scott McCloud on Comics [online video].Retrieved from: http://www.ted.com/talks/view/id/432. Medina, J. (2008). Brain Rules: 12 principles for surviving and thriving at work, home, and school. Seattle: Pear Press. Reynolds, G. (2008, March 28). Authors @ Google: Garr Reynolds [online video]. Retrieved from http://www.youtube.com/watch?v=DZ2vtQCESpk&feature=player_embedded Roam, D. (2008). The Back of the Napkin: Solving Problems and Selling Ideas with Pictures. New York: Portfolio/Penguin Group. Tufte, E. (2006). Beautiful Evidence. Cheshire, CT: Graphics Press. Williams, R. (2008). The Non-Designer's Design Book (Third ed.). Berkeley: Peachpit Press.

Abela Worksheets
Worksheet A.1a. Audience Personality Type
Audience The majority of University Medical School and Hospital employees anyone involved in research involving human subjects, or anyone who may potentially handle patient information. Personality Type There is at least one INFP in the audience. There are several Extroverts, Sensing, Thinking, Feeling, Judging individuals

Worksheet A.1b. Audience Personality Implications

Instructional Product (presentation or job aid) Implications
The fact that this job aid is meant for private perusal is beneficial to introverts, who will not be required to discuss the content in groups small or large. Extroverts, if they find that they would like to discuss the content of the job aid, may do so with coworkers. Intuitive readers should be able to see the big picture towards the beginning, as the overview will be given; there are also a few dense content displays that will allow Intuitives to see how elements of concept relate to each other. Sensing readers will find plenty of details, both in the panel-to-panel content of the job aid and in the dense content displays contained within. Thinking readers may find the facts about HIPAA regulations appealing (such as they are), while Feeling readers may relate to the comic characters who drive the narrative Judging readers may want to see the main point up front, and they will not be disappointed. Perceiving readers will want to know that all of the options have been taken into considerations my hope is that they will find their questions answered in the dialog between the two characters.

Worksheet A.2. From-To Think-Do Matrix

From Think
What is HIPAA? Why so much concern for handling paperwork? Im not going to share information with anyone. I can just use common sense when deciding what to do with patient information. Information is safe enough.

To
Even if I think that patient information wont get lost or stolen or misused, it is still possible for mistakes to happen. If I am careful, I wont commit any security mistakes I have to be especially careful where patient confidentiality is concerned. Common sense only goes so far. I must employ extra safeguards to protect patient confidentiality.

Do

Worksheet A.3. Audience Problem

As I mentioned in the matrix in A.2, many people assume that HIPAA regulations are common sense. Indeed, many of them are. However, there are extra layers of security that are applied to patient documents and online information as a matter of necessity. If all HIPAA regulations were really common sense, then patient confidentiality would never be breeched. This is clearly not the case, necessitating the creation of HIPAA regulations in the first place, and continued reminders to people who handle patient information. Another problem, specific to the University of Colorado, is the fact that HIPAA training and certification only occurs once at the beginning of ones hire, and the only way to refresh users memories of the information is to relaunch the (rather tedious) online course. A job aid would make it easier for employees to access refreshers about HIPAA regulations. I can also envision a good job aid replacing the online HIPAA training altogether. The regulations are not difficult to learn and a certification test could easily replace a course. Employees could take the test once a year or on some regular schedule to demonstrate that they have the knowledge without having to take the course, unless they feel they need it (currently the assessment is only accessible at the end of the online course). The job aid could serve as a refresher (or even the complete study document) for the test.

Worksheet A.4. Spectrum of Solution Contributions

1) Help recognize that there is a problem: HIPAA regulations are important for protecting patient safety. many 2) Help define the problem: Patient confidentiality has been violated at hospitals and research institutions, possibly even our own.

3) Help define the solution space: CU has implemented an online training module and assessment about HIPAA regulations. 4) Solve part of the problem: The current training and assessment is only required for new hires who may come in contact with patient information. There are no reminders, job aids or regular refresher courses or assessments. 5) Solve the whole problem: To ensure patient safety and confidentiality, a job aid should be readily available as a reference for employees who have taken the initial online training. Brief, regular assessments of the regulations could be required for the employee's files, and employees would have the choice of retaking the original online course, or relying on their memory or the job aid.

Worksheet A.5. Solution Evaluation

Option 1 Keep current training requirements Will remain the same Option 3 Make a job aid available, in addition to the current course module, but don't add regular assessment Unknown depends on Violations may whether employee's will decrease because the bother to retake the job aid will be easier to course before access than the online assessment course Employees may feel compelled to review the course material, or keep the regulations in mind for the sake of the test General knowledge may improve because of the availability of the job aid as a reference tool, but without assessment, it will be difficult to be sure. Option 2 Implement regular testing, but don't add to current instructional material Option 4 Make a job aid available, in addition to the course module, and require annual assessment Violations will likely decrease because the job aid will be available, and assessment will compel employees to review the material. Knowledge should improve because of the availability of reference material and the requirement to keep the information fresh.

Evaluation Criteria Reduction in HIPAA violations

Improvement in employee knowledge of regulations, determined by assessment testing

Will remain the same

Worksheet A.6. List of Evidence

Evidence
Include all relevant HIPAA regulations In addition to the rules, give explanations for why the rules are imposed so they don't seem arbitrary Show visual demonstrations of what not to do, as well as what to do

Worksheet A.7 Stakeholder Analysis

Who will be impacted by the success or failure of this instructional product? What is their role in the success or failure of this instructional product? University of Colorado and the University of Colorado Hospital The university and hospital have a responsibility to ensure that employees have the knowledge and behave accordingly If the product is successful, risks to the reputation of the school and hospital are diminished The university and hospital exist in a competitive environment, so any dents in their reputation may result in losses of funding, quality students, patient trust, etc. Employees and researchers The Regents of the University of Colorado The Regents are responsible for providing funding for the training and instructional materials and assessments If the product is successful, the Regents are spared the financial burden that may result from lawsuits due to violations. If the product is unsuccessful, the Regents will likely have to deal with budget shortfalls due to lawsuits and reductions in extrainstitutional funding

How will they be impacted if the instructional product is a success (i.e., learners achieve learning objectives)? How will they be impacted if the instructional product is a failure (i.e., learners do not achieve learning objectives)?

Researchers and staff are responsible for their own acquisition of knowledge and behavior in accordance with the regulations Researchers and staff are spared the shame of transgressing, which could result a halt to research Repeated violations may result in a halt to research and even a loss of jobs, if the product is unsuccessful