A Visual Analytics Framework for Emergency Room Clinical

Encounters

1 Department of Computer Science2 Department of Emergeny Medicine

Zhiyuan Zhang1, Supriya Garg1, Arunesh Mittal1,

Alex Dimitriyadi1, IV Ramakrishnan1, Rong Zhao1,

Klaus Mueller1, Asa Viccellio2

Medical Record

As old as Hippocrates (around 400 BC)• father of Western medicine

Should:• accurately reflect the course of disease• indicate the probable cause of disease

Paper-Based Medical Record

Electronic Medical Record (EMR)

• Transaction-driven: documentation + tables

• Non-intuitive interfaces

• Fragmented display of patient information

Typical Information Flow in the ER

Obtain Patient’s

Information

Current HistoryPast History

Family HistorySocial History

Review of System

Physical Examination

Order Laboratory

Data

Request and obtain

consultation

Take appropriate action within an appropriate time

Reevaluate and readjust therapy and diagnosis

Typical Information Flow in the ER

Obtain Patient’s

Information

Current HistoryPast History

Family HistorySocial History

Review of System

Physical Examination

Order Laboratory

Data

Request and obtain

consultation

Take appropriate action within an appropriate time

Reevaluate and readjust therapy and diagnosis

Obtain Patient’s History

Current HistoryPast History

Family HistorySocial History

Review of System

Physical Examination

Order Laboratory

Data

Request and obtain

consultation

Take appropriate action within an appropriate time

Reevaluate and readjust therapy and diagnosis

Obtain Patient’s History

Current HistoryPast History

Family HistorySocial History

Review of System

Physical Examination

Order Laboratory

Data

Request and obtain

consultation

Take appropriate action within an appropriate time

Reevaluate and readjust therapy and diagnosis

Obtain Patient’s

Information

Current HistoryPast History

Family HistorySocial History

Review of System

Physical Examination

Order Laboratory

Data

Request and obtain

consultation

Take appropriate action within an appropriate time

Reevaluate and readjust therapy and diagnosis

System Objectives

• Support and enhance the clinical decision-making

• Simple Interface to make data and information exploration easier

• Assimilation of data from different sources

• Visualization and visual reasoning is key

• Ease of data and information access is key

System Overview

The 5-W Scheme

• Use a strongly structured paradigm, the 5-W

• WHO : the patient and the history

• WHAT : Symptoms, tests and results, diagnosis, treatments and medications, etc.

• WHERE : locations (when appropriate) of the WHAT on the human body

• WHEN : time and duration of the WHAT

• WHY : cause and effect of the various WHAT constituents

Visualize the 5-W Scheme

• WHO : Basic Info and Vital Signs

• WHAT : Integrated in WHERE, WHEN, and WHY.

• WHERE : Human map

• WHEN : Time line

• WHY : Directed causal graph

Visualize Who, What and Where

(0) Start Screen

Visualize Who, What and Where

(a) Results of triage (name, weight, age, vitals with high fever)

Visualize Who, What and Where

(b) Populating the spatial map with symptoms (head problems)

Visualize Who, What and Where

(c) Adding past history (lung cancer in remission)

Visualize Who, What and Where

(d) Social history indicates patient has a history of smoking

Visualize Who, What and Where

(e) The diagnostic process begins, immediate actions

Visualize Who, What and Where

(e) The diagnostic process begins, using the Diagnostic Sandbox

Visualize Who, What and Where

(f) The diagnostics determines epidural hematoma

Visualizing When

Each entry is classified into:• Symptoms; Tests; Diagnosis; Treatments.

Visualizing When

Each sub-track within one track represents an event.

Visualizing When

Each sub-track has an explanation.

Visualizing When

Abnormal results or severe symptoms are highlighted in red to draw the physician’s attention.

Visualizing When

Brushing operation

Visualizing Why

• Symptom->Test/Data->Diagnosis->Treatment/Medication

• A modified version of the force-directed layout

• All symptoms have incoming edges from a node representing a visit to the physician.

• A convex hull is drawn for each visit.

Visualizing Why

• Enable quick mental analysis

• Help detect errors in diagnoses

Visualize Why

Visualizing Why Case Study

Visualize Why

Conclusions

Implemented an emerging visual analytics system

• For clinical encounters in emergency room scenarios

• Clinician and patient-focused

• Unifies all EMR information fragments into a single interactive visual framework

• Voice and multi-touch interaction capabilities

Current/Future Work

Improvements, fine-tuning, and additional features

• Include more formal user and affordance studies to fine-tune the various modules of our system.

• A more geometrically structured temporal plot for the casual graph.

• Treatment Outcome

• Integrate more analytics in the system.

Thanks For Listening…