National Center for Cognitive Informatics & Decision Making at The UT Health Science Center at Houston (UTHealth)

Project 4: Cognitive Information Design and Visualization: Enhancing Accessibility and Understanding of Patient Data

Leaders: Todd Johnson, Ben Shneiderman, Catherine Plaisant

The goal of the project is to create a framework and guidelines for designing advanced interactive information visualizations that provide patient-centered cognitive support by enhancing the accessibility and understanding of patient data, thus addressing key clinical tasks that are currently the source of substantial errors and inefficiency.

Project 4 is exploring - and proposing novel interfaces for:

Medication Reconciliation

Two prototypes were completed in the 1st first year that presented two completely different user interfaces and ways for clinicians to address medication reconciliation (i.e. reconciling two lists of medications into a single reconciled list) in two different use-case scenarios. These interfaces (Twinlist and Multilist) were built on the substratum of a novel medication reconciliation algorithm that removes the tediousness of a fully manual reconciliation without diminishing the decision making power of the clinician.

Our medication reconciliation algorithm and the user interfaces are part of the Pan-Sharp project now run on the SMArt platform currently under active development by Harvard’s SHARP project.

Results Management (focusing on how to avoid missing results)

A prototype had been developed in the early part of the project to illustrate designs that facilitate the management of orders to reduce the problem of “missed labs”.

Our design makes use of a hierarchy of process definitions, which when combined with a database of actors and organizations, provides input for an Interface Generator. The software architecture produces a domain independent system that can be widely used and easily modified. A set of principles ensures that lab results are returned and acted on: (1) definition of agent temporal responsibilities, (2) generation of actor action sheets that offer appropriate choices at each step of the process, integrated in the result viewing screens, and (3) use of predictions of estimated time of completion for each step to increase awareness of delays and better prioritization of actions.

Our visual approach to retrospective analysis uses visualization to review the performance of different actors involved in multistep processes.

Interface Improvements to Reduce Wrong Patient Selection Problem.

Wrong patient selection is a severe problem in patient safety; from ordering medication to performing surgery. CPOE systems can sometimes even increase the rate of wrong patient selection. We reviewed the origin of wrong patient errors, and suggested user interface remedies; we built a prototype system to demonstrate them.

Framework for Systematic Yet Flexible Systems Analysis (SYFSA) -- For Information please contact Todd Johnson

Our research on the Systematic Yet Flexible Systems Analysis (SYFSA) framework guides interface design even as it is continuously refined by our practical experience in applying it. We expect that SYFSA will enable the creation of Healthcare IT systems that encourage best practices while simultaneously accommodating the tremendous variety of real-world healthcare workflow. Systematic Yet Flexible Systems can provide visual and other cues to encourage evidence-based best practices along with visual feedback of progress while simultaneously supporting the need to deviate from these standards in some cases.

Pan-SHARP Project: a collaboration between all Sharp projects, demonstrating interoperability in a SmartApp

The medication reconciliation project was selected as the focus and showcase of a Pan-SHARP collaboration. The Pan-SHARP collaboration, under Project 4’s lead, incorporates innovations from all four SHARP projects and MD PnP to deliver an innovative medication reconciliation solution with state-of-the-art technology. Project 4 members are leading this project.

For the source code for Twinlist and other Univeristy of Maryland products, please contact Catherine Plaisant or plaisant@cs.umd.edu.

For the MedRec reconciliation algorithm and the interface source code, please go to https://github.com/jherskovic

Publications

General Reviews:

Saitwal H, Qing D, Jones S, Bernstam EV, Chute CG & Johnson TR. Cross-terminology mapping challenges: A demonstration using medication terminological systems. J Biomed Inform. 2012; 45: 613–625. doi:10.1016/j.jbi.2012.06.005
Rind A, Wang T, Aigner W, Miksch S, Wongsuphasawat K, Plaisant, C, & Shneiderman B. Interactive Information Visualization for Exploring and Querying Electronic Health Records: A Systematic Review. 2010.

Review Medication Reconciliation / Twinlist:

Detailed description of Twinlist - for potential implementers - 1st release January 2012 - regular updates: Chao T, Plaisant C, & Shneiderman B. Twinlist: Overview and general implementation description
Description of Twinlist: Chao T. Visual techniques for medication reconciliation: spatial metaphor, animated explanation, and flexible decision-making (Undergrad Honor Project report - Dec 2011)
Early prototypes: Markowitz E, Bernstam E, Herskovic J, Zhang J, Shneiderman B, Plaisant C, & Johnson T. Medication Reconciliation: Work Domain Ontology, Prototype Development, and a Predictive Model (AMIA Fall 2011)
Early Twinlist prototype description (Infovis class project): Claudino L, Khamis S, Liu R, London B, Pujara J, Plaisant C, & Shneiderman B. Facilitating Medication Reconciliation with Animation and Spatial layout Proceedings of the Workshop on Interactive Healthcare Systems (WISH2011)

Results Management (once called "missed labs"):

Tarkan, S., Plaisant, C., Shneiderman, B., Hettinger, A. Z., Improving Timely Clinical Lab Test Result Management: A Generative XML Process Model to Support Medical Care [UPDATE VERSION UNDER PREPARATION]
Tarkan, S., Plaisant, C., Shneiderman, B., Hettinger, A. Z., Reducing Missed Laboratory Results: Defining Temporal Responsibility, Generating User Interfaces for Test Process Tracking, and Retrospective Analyses to Identify Problems (AMIA Fall 2011)

SYFSA: Systematic Yet Flexible Systems Analysis:

Johnson TR, Markowitz E, Bernstam E, Herskovic J, Thimbleby H. SYFSA: A Framework for Systematic Yet Flexible Systems Analysis. Journal of Biomedical Informatics. (Under review) Contact Todd Johnson for access.

Presentations

Project 4 Overview from SHARPC 2012 Annual Meeting (by Dr. Ben Shneiderman)
Pantazos K, Tarkan S, Plaisant C, & Shneiderman B. Promoting Timely Completion of Multi-Step Processes -- A Visual Approach to Retrospective Analysis. 2012.