Visualizing Temporal Patternsalso including… Twinlist for Medication Reconciliation

Catherine PlaisantHuman-Computer Interaction Lab University Of Maryland, College Park

HFES Baltimore – March 12 2013

Interdisciplinary research community - Computer Science - Information Studies - Psychology, Sociology, Engineering, etc. in College Park MD ~ www.cs.umd.edu/hcil

INFORMATION VISUALIZATION

Compact graphical presentation and user interface for manipulating large numbers of items (102 - 106), Enables users to make

discoveries, decisions, or explanations about patterns or groups of items

Visual bandwidth is enormousHuman perceptual skills are remarkable

SPOTFIRE: E.G. RETINOL’S ROLE IN EMBRYOS & VISION

Revealed the previously unknown involvement of the retinol binding protein RBP1 in cell cycle control.(Stubbs S, & Thomas N. 2006 Methods in Enzymology; 414:1-21.)

www.smartmoney.com/marketmap

TREEMAP: E.G. SMARTMONEY MARKETMAP

e.g. Market falls 311 points, with a few exceptions

e.g. Market mixedEnergy & Technology up, Financial & Health Care down

e.g. NCHS data Size = #Deaths per 100 000, in 1998 Color = Rate of change compared to 1981

LifeLines – Single Patient[Plaisant 1998] - PAPERS AND VIDEOS at www.cs.umd.edu/hcil/lifelines

• Important issue because of large time range

• Recursive aggregation mechanism (set of events) --- (summary event)

INCLUDE SUMMARIZATION

LIFELINES

SINGLE RECORD

[Plaisant et al. 1998]http://www.cs.umd.edu/hcil/lifelines

LIFELINES 2

RECORDRECORDRECORD

RECORD

RECORD

[Wang et al. 2008, 2009]http://www.cs.umd.edu/hcil/lifelines2

LIFEFLOW

RECORD

RECORD

RECORD

RECORD

RECORD

RECORD

RECORD

RECORD

AGGREGATEMerge multiple records into

tree

VISUALIZEDisplay the aggregation

Patient ID: 4585173712/02/2008 14:26 Arrival12/02/2008 14:36 Emergency12/02/2008 22:44 ICU12/05/2008 05:07 Floor12/14/2008 06:19 Exit

Time

EmergencyICU

FloorExit

TEMPORAL DATA NUMERICAL VS. CATEGORICAL

04/26/2010 10:00 31.0304/26/2010 10:15 31.0104/26/2010 10:30 31.0204/26/2010 10:45 31.0804/26/2010 11:00 31.16

Patient ID: 45851737

Arrival

ALIGNMENT• E.g. align by arrival

Time

Patient #45851737 ArrivalEmergency

ICUFloor

ExitPatient #43244997 Arrival

EmergencyICU

FloorExit

June July August

ALIGNMENT• E.g. align by arrival

Time

Patient #45851737 ArrivalEmergency

ICUFloor

ExitPatient #43244997 Arrival

EmergencyICU

FloorExit

0 1 M 2 M

LIFELINES2• Introduce powerful combination of simple operators Align, Rank, Filter, and Summarize

• Multiple records simultaneously visible• Align by key events• Rank by frequency• Filter by events sequences• Provide summaries

[Wang et al. 2008, 2009] - www.cs.umd.edu/hcil/lifelines2

Integrated in i2b2 and BTRISOpen source

The work of Dave Wang

LIFEFLOW

RECORD

RECORD

RECORD

RECORD

RECORD

RECORD

RECORD

RECORD

AGGREGATEMerge multiple records into

tree

VISUALIZEDisplay the aggregation

within 2 days

ICU Floor ICU

• Lifelines2: Specific query “Bounce backs”

• Lifeflow: Overview of sequencesArrival

ICU

?

??

blabla

DEMO- LIFEFLOW• Data = Patient transfers within hospital

ARRIVAL Arrive the hospitalEMERGENCY Emergency roomICU Intensive Care UnitFLOOR Normal roomEXIT-ALIVE Leave the hospital aliveEXIT-DEAD Leave the hospital dead

www.cs.umd.edu/hcil/eventflow

Twinlist Facilitating Medication Reconciliationwith Animation and Spatial Layout

Medication reconciliation

• Develop list of current medications• Develop list of medications to be prescribed• Compare lists• Make clinical decision based on comparison• Communicate the new list to

appropriate caregivers and to patient

One definition from: http://www.ihs.gov/cio/ehr/index.cfm?module=medication_reconciliation

Intake Hospital

- What’s unique?- What’s identical?- What’s equivalent?

Medication reconciliationScenario: Hospital discharge

Levels of equivalences

29

Equivalence Criteria Example

Form Equivalence

Identical except for brand vs. generic

Advil = IbuprofenSenormin = Atenolol

Functional Equivalence

Same therapeutic intent Atenolol and Propanolol both betablockers

Partial Equivalence

Form or functional equivalence, but differ in dosage, frequency, or route

Advil 100 mgAcetaminophen 200mg

No equivalence

Unique in form and function

“Automated medication reconciliation and complexity of care transitions”Bozzo Silva, Bernstam, Markowitz, Johnson, Zhang and Herskovic, AMIA 2011

TWINLIST Prototype originally developed by Tiffany ChaoCheck for newer VIDEOS at www.cs.umd.edu/hcil/sharp or search YouTube for Twinlist (and pick newest version)CODE AVAILABLE ON REQUEST (plaisant@cs.umd.edu)

THANK YOUAcknowledgments Ben Shneiderman Students past and present:

Megan Monroe, Rongjian Lan, Tiffany Chao, Johnny Wu Krist Wongsuphasawat, David Wang

Clinicians/Partners Zach Hettinger (MI2),Seth Powsner (Yale); Tamra Meyer (ARMY PharmacoVigilance Center)

Elmer V. Bernstam, Jorge Herskovic, Todd R. Johnson (SharpC), and many more Sponsors Oracle Health Science National Institutes of Health (RC1CA147489-02) Office of the National Coordinator for Health Information Technology (SHARP ~ #10510592)

www.cs.umd.edu/hcil www.cs.umd.edu/hcil/eventflow www.cs.umd.edu/hcil/sharp

THANK YOU

plaisant@cs.umd.edu

Join us forHCIL symposium - May 22-23www.cs.umd.edu/hcil/soh Includes Medical Informatics WorkshopAlso projects on wrong patient selection, results management, risk communication

www.cs.umd.edu/hcil

www.cs.umd.edu/hcil/eventflow www.cs.umd.edu/hcil/sharp