9 Design & Solution Definition

9.1 Design & Solution Definition / Intervention Design

With requirements defined, we move to designing the solution. In business analysis, this is Solution Design or Design Definition. In public health, it parallels Intervention Design and Implementation Planning. Both involve translating requirements into a blueprint for action.

9.1.1 The Dual Framework

BA Perspective	PH Perspective
Solution Architecture	Intervention Framework
System Design	Program Design
Interface Design	Service Delivery Model
Integration Design	Health Information Exchange
Change Management Plan	Implementation Strategy (CFIR)

9.1.2 Architecture and Framework

9.1.2.1 Solution Architecture

BA solution architecture defines:

• System components and their relationships
• Technology stack selection
• Integration points with existing systems
• Data flow between components
• Security architecture

9.1.2.2 Intervention Framework

PH intervention design defines:

• Core intervention components
• Delivery mechanisms
• Target populations
• Adaptable vs. core elements
• Contextual considerations

NoteCancerSurv Example

Solution Architecture (BA):

┌─────────────────────────────────────────────────────────┐
│                    CancerSurv Platform                   │
├──────────────┬──────────────┬──────────────┬────────────┤
│  Web UI      │  API Layer   │  Analytics   │  Reporting │
│  (React)     │  (REST/FHIR) │  (R/Python)  │  Engine    │
├──────────────┴──────────────┴──────────────┴────────────┤
│                    Core Services                         │
│  Case Management │ Data Quality │ User Management        │
├─────────────────────────────────────────────────────────┤
│                    Data Layer                            │
│  PostgreSQL │ Document Store │ Data Warehouse           │
└─────────────────────────────────────────────────────────┘

Intervention Framework (PH):

CancerSurv delivers the surveillance intervention through:

• Core components: Case abstraction, data quality, NPCR reporting (non-negotiable)
• Adaptable elements: Dashboard customization, local report templates
• Delivery mechanism: Cloud-based SaaS with local training support
• Target population: State cancer registries, hospital tumor registrars

9.1.3 Design Patterns

9.1.3.1 User Interface Design

Both domains emphasize user-centered design:

BA UI/UX Approach:

• Wireframes and mockups
• User journey mapping
• Usability testing
• Accessibility compliance (WCAG)

PH Service Design Approach:

• Patient journey mapping
• Cultural competency review
• Health literacy assessment
• Equity impact analysis

9.1.3.2 Key Design Principles

Principle	BA Application	PH Application
Simplicity	Minimize clicks, clear navigation	Reduce complexity for adoption
Consistency	Standard UI patterns	Consistent with clinical workflows
Feedback	Visual confirmation of actions	Clear outcome indicators
Error Prevention	Validation before submission	Built-in clinical decision support
Flexibility	Customizable views, workflows	Adaptable to local context

9.1.4 Integration Design

9.1.4.1 Connecting Systems

Health IT projects require extensive integration:

flowchart LR
    subgraph External["External Systems"]
        H[Hospital EHRs]
        L[Lab Systems]
        V[Vital Records]
        N[NPCR/CDC]
    end
    
    subgraph CancerSurv["CancerSurv Platform"]
        API[Integration Layer]
        Core[Core System]
    end
    
    H -->|HL7 FHIR| API
    L -->|HL7 v2| API
    V -->|Batch| API
    API --> Core
    Core -->|XML| N

Figure 9.1: CancerSurv Integration Landscape

9.1.4.2 Integration Standards

Standard	Use Case	Design Consideration
HL7 FHIR	Real-time EHR integration	REST APIs, JSON payloads
HL7 v2.x	Legacy lab interfaces	Message parsing, acknowledgments
NAACCR XML	Cancer registry exchange	Schema validation, field mapping
Direct Protocol	Secure health messaging	Certificate management

9.1.5 Implementation Readiness Assessment

9.1.5.1 CFIR for Design Validation

The Consolidated Framework for Implementation Research (CFIR) provides a lens for evaluating design decisions:

CFIR Domain	Design Questions
Intervention Characteristics	Is the design evidence-based? Is it adaptable?
Outer Setting	Does it meet regulatory requirements? Does it connect to external systems?
Inner Setting	Does it fit organizational workflows? Is infrastructure adequate?
Individuals	Will users accept it? What training is needed?
Process	How will it be implemented? Who champions it?

NoteCancerSurv Example

CFIR-Informed Design Review:

CFIR Construct	CancerSurv Design Decision	Rationale
Relative Advantage	Modern UI, mobile access	Clear improvement over mainframe
Complexity	Phased rollout, role-based views	Reduce cognitive load
Adaptability	Configurable data fields	Support local registry needs
Available Resources	Cloud-hosted, vendor support	Minimize IT infrastructure burden
Self-Efficacy	Embedded training, help system	Build user confidence

9.1.6 Prototyping and Validation

9.1.6.1 Iterative Design

Design should be validated before full development:

BA Prototyping:

• Low-fidelity wireframes for concept validation
• High-fidelity mockups for detailed feedback
• Interactive prototypes for workflow testing
• MVP (Minimum Viable Product) for market validation

PH Piloting:

• Formative research with target population
• Pilot testing in representative sites
• Rapid cycle evaluation (PDSA)
• Fidelity assessment

9.1.6.2 Prototype Fidelity Levels

Level	BA Artifact	PH Artifact	Purpose
Low	Paper sketches, Balsamiq	Concept paper, draft protocol	Concept validation
Medium	Clickable mockups	Pilot at 1-2 sites	Workflow validation
High	Working prototype	Multi-site pilot	Full process validation

9.1.7 Change Management Planning

9.1.7.1 Preparing for Transition

Design must include plans for organizational change:

BA Change Management:

• Stakeholder impact analysis
• Communication plan
• Training plan
• Resistance management
• Transition strategy

PH Implementation Planning:

• Capacity building
• Technical assistance model
• Sustainability planning
• Scale-up strategy

NoteCancerSurv Example

Change Management Elements:

Element	Plan
Training	3-tier approach: super-users (in-person), all users (webinar), ongoing (self-paced modules)
Communication	Monthly newsletters, demo sessions at registrar conferences
Support	Help desk during business hours; online knowledge base; user community forum
Rollout	Phase 1: High-volume hospitals; Phase 2: Remaining facilities; Phase 3: Full operation

9.1.8 Design Documentation

9.1.8.1 What to Document

Design documentation bridges requirements and implementation:

Document	BA Content	PH Content
Architecture Document	System components, technology stack	Intervention components, delivery model
Interface Specifications	Screen layouts, navigation flows	Service user touchpoints
Integration Specifications	APIs, message formats	Data exchange protocols
Data Design	Database schema, data flows	Data collection instruments
Security Design	Access controls, encryption	Privacy protections, consent
Transition Plan	Deployment, training, support	Implementation, capacity building

9.1.9 Deliverables from This Phase

BA Deliverable	PH Deliverable	Purpose
Solution Architecture	Intervention Framework	Define solution structure
UI/UX Design	Service Delivery Model	Specify user experience
Integration Design	HIE Specifications	Define system connections
Prototype	Pilot Protocol	Validate design
Change Management Plan	Implementation Strategy	Prepare organization

9.1.10 Moving Forward

With design complete, the next phase focuses on Implementation: building, deploying, and rolling out the solution while managing the organizational change required for adoption.