Paul Gorman, MD Lois Delcambre, PhD David Maier, PhD DLI2 Footprints Project: Interim Results Briefing 1

…………..Bundles in captivity Bundles in the wild……….. Observational team: Paul Gorman Joan Ash Mary Lavelle Jason Lyman …………..Bundles in captivity Computer science team: Lois Delcambre Dave Maier Shawn Bowers Longxing Deng Mathew Weaver DLI2 Footprints Project: Interim Results Briefing 2

We cannot know the task until we know what the tools are Edwin Hutchins Cognition in the Wild 2

Information Seeking in Healthcare Finding Medical Knowledge Gathering Patient Data in Clinic Patient Care in ICU DLI2 Footprints Project: Interim Results Briefing 4

The Information Space Large and Growing Diverse Many users and uses Distributed Complex Poorly organized Increasingly but not completely digital DLI2 Footprints Project: Interim Results Briefing 5

Expert Information Seeking Highly focused on patient care problem Task is both generic and unique Uses multiple diverse sources of information Selects small subset, ignores vast majority Time and attention highly constrained DLI2 Footprints Project: Interim Results Briefing 6

What information consumes is attention… A wealth of information produces a poverty of attention Herbert Simon 2

Information Use in Critical Care Question How do clinicians use information to help patients in the ICU? Setting ICU, tertiary care teaching hospital. Subjects Nurses, physicians, pharmacists Methods Ethnographically informed Data collection by participant observation, key informant interviews, focus groups Observation team includes nurse, medical librarian, physician trainee, staff physician DLI2 Footprints Project: Interim Results Briefing 8

The Kardex Most entries in pencil Most info exists elsewhere (not all) Predictable format, flexible content Frequently updated (erase old, add new) Nurse creates, many others use Portable, temporary, task-oriented DLI2 Footprints Project: Interim Results Briefing 9

Resident’s Worksheet Most information found elsewhere (not all) Info from many patients Predictable structure, flexible content Organic, working document Assembled and reused by resident Portable, temporary, task-oriented DLI2 Footprints Project: Interim Results Briefing 10

Messy Bundles Extremely flexible entry, display, content Meaningful organization and annotation High signal-to-noise Portability, immediacy, integration w/ pt care Recording benefit to situation awareness Physical location meaningful (reminding) DLI2 Footprints Project: Interim Results Briefing 11

The Flow Sheet Working document, permanent record Present and recent past states of patient Information exists elsewhere (eventually) Highly structured, still flexible content Selection, organization, annotation by nurse Used by everyone DLI2 Footprints Project: Interim Results Briefing 12

Bundle of Bundles DLI2 Footprints Project: Interim Results Briefing 13

(Wild) Bundles manage information for diverse, complex tasks contain selected, collected, structured, annotated are often used in settings with: high uncertainty low predictability potentially grave outcomes time & attention are highly constrained DLI2 Footprints Project: Interim Results Briefing 14

(Wild) Bundles There is benefit in creating (active processing of information) There is benefit in reusing (trigger memory) There is benefit in sharing (establish collective, situated awareness) DLI2 Footprints Project: Interim Results Briefing 15

Beyond the ICU: Are Bundles Unique to Health Care? DLI2 Footprints Project: Interim Results Briefing 16

Use of Flightstrips in French Air Traffic Control DLI2 Footprints Project: Interim Results Briefing 17

Flightstrips in French Air Traffic Control Controllers use many high tech systems Controllers continue using paper flightstrips Attempts to automate flightstrips have failed No fatalities have ever been attributed to civilian controllers Controllers have final say: if there is an accident, computers (and developers) do not go to jail, controllers do DLI2 Footprints Project: Interim Results Briefing 18

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Visit the ICU at www.cse.ogi.edu/footprints DLI2 Footprints Project: Interim Results Briefing 23

Given…. bundles are everywhere! access to bundles provides access to important information information in bundles is often copied from other information sources we can keep copied/referenced information linked through the use of marks DLI2 Footprints Project: Interim Results Briefing 24

The superimposed and base layers with marks Information Source1 Information Source2 Information Sourcen … DLI2 Footprints Project: Interim Results Briefing 25

(Captive) Bundles SLIMPad - a scratchpad application to create bundles but….with referenced information connected to the underlying source data helping us explore architectural issues for building superimposed applications motivating definition of a metamodel to represent information with mappings to transform inspired by the observational work (but not focused on a specific medical task) DLI2 Footprints Project: Interim Results Briefing 26

SLIMPad demo DLI2 Footprints Project: Interim Results Briefing 27

The SLIMPad Architecture Superimposed Information Management SLIMPad Mark Management user XML Viewer MS Power Point MS Excel IE Explorer PDF Viewer Generic Technology XML Documents PPT Files Excel Spreadsheets Web Pages PDF files DLI2 Footprints Project: Interim Results Briefing 28

The architecture for managing SLIMPad’s superimposed information. Superimposed Information Management Java Objects (ActiveX) SLIMPad TRIM Store (Java) creates and maintains RDF Triples SLIMPad API (ActiveX) DLI2 Footprints Project: Interim Results Briefing 29

Generic Representation of Information Basic Set of Abstractions Metamodel Model Constructs and Relationships Topic Map XML Schema-Level Data Superimposed Layer Topic Map Defintions DTD Topic Map Instances XML Document Instance-Level Data DLI2 Footprints Project: Interim Results Briefing 30

Topic Map Example Influenced by by painter Painting Painter by painter mentioned critiqued referenced biography by painter influenced by critiqued “Captive” “Paul Klee” biography biography “Francisco de Goya” http://... http://... http://... referenced mentioned “1914” http://... by painter http://... DLI2 Footprints Project: Interim Results Briefing 31

Portion of Structured-Map Model as RDF (instanceOf, “TopicType”, Construct) (instanceOf, “TopicInstance”, Construct) (instanceOf, “ttypename”, Connector) (domain, “ttypename”, TopicType) (range, “ttypename”, String) (domainMult, “ttypename”, “*”) (rangeMult, “ttypename”, “1”) (instanceOf, “topic_instOf”, Conformance) (domain, “topic_instOf”, TopicInstance) (range, “topic_instOf”, TopicType) (domainMult, “topic_instOf”, “*”) (rangeMult, “topic_instOf”, “1”) TopicType ttypename : String 1 <<conformance>> topic_instOf * TopicInstance DLI2 Footprints Project: Interim Results Briefing 32

Representing Schema Topic Types (schema): painting, painter (instanceOf, “painting_tt”, TopicType) (ttypename, “painting_tt”, “painting”) (instanceOf, “painter_tt”, TopicType) (ttypename, “painter_tt”, “painter”) (instanceOf, “byPainter_rt”, TopicRelType) (relType, “byPainter_rt”, “by painter”) (topicType1, “byPainter_rt”, painting_tt) (topicType2, “byPainter_rt”, painter_tt) (instanceOf, “biography_at”, AnchorType) (anchorRole, “biography_at”, “biography”) (topicType, “biography_at”, painter_tt) Topic Types (schema): painting, painter Topic Rel Types (schema): by painter Anchor Types (schema): biography by painter painting painter biography DLI2 Footprints Project: Interim Results Briefing 33

Representing Instance (instanceOf, “painter1”, TopicInstance) (title, “painter1”, “Paul Klee”) (topicInsID, “painter1”, “5”) (topic_instOf, “painter1”, painter_tt) (instanceOf, “painting1”, TopicInstance) (title, “painting1”, “Captive”) (topicInsID, “painting1”, “19”) (topic_instOf, “painting1”, painting_tt) (instanceOf, “byPainter1”, TopicRelInst) (rel_instOf, “byPainter1”, byPainter_rt) (topicIns1, “byPainter1”, painting1) (topicIns2, “byPainter1”, painter1) (instanceOf, “biography1”, AnchorInst) (anchor_instOf, “biography1”, biography_at) (address, “biography1”, a1) (instanceOf, “a1”, Address) (markID, “a1”, “URLMarkManager@954308545”) Topic Instances (instance): Paul Klee, Captive Topic Relationship (instance): a by painter relationship Anchor (instance): a biography anchor Address (instance): mark to url DLI2 Footprints Project: Interim Results Briefing 34

Three Basic Types of Mappings Source Target Model1 Schema1 Instances1 Mapped Model2 Schema1 Instances1 Inter-Model Converted Converted Model1 Schema1 Instances1 Model1 Schema2 Instances1 Inter-Schema Mapped Converted Model1 Schema1 Instances1 Model2 Schema2 Instances Mapped Model-to-Schema Converted Converted DLI2 Footprints Project: Interim Results Briefing 35

(CS Team) Plans “Schema” for bundles: through templates that predefine certain bundles and labels, and possibly predefine scraps. less restrictive than trad. schema. Sharing: a bundle that belongs to multiple pads, a pad with multiple simultaneous users, and interchange of pads and bundles between users. “Scoping” of base layers and marks over those layers. There are several general issues for modeling and management of superimposed information that have emerged from this work and other efforts. DLI2 Footprints Project: Interim Results Briefing 36

(CS Team) Plans (cont.) Distribution: more than a single mark manager. Is there a single space of marks or must applications keep track of which manager handles a particular mark? Mark Maintenance:when base layer changes New Kinds of Sources and Marks: beyond XML, PDF, MS Word, MS Excel, MS PowerPoint and HTML. We are also interested in marks into a “base” layer that is actually superimposed information for another application. Application Interface: try a more query-like API. Also, consider an API generator Superimposed Information Mapping/Conversion: applying and extending our metamodel. DLI2 Footprints Project: Interim Results Briefing 37

www.cse.ogi.edu/footprints demos - including the QTVR of the ICU (with toys) and SLIMPad personnel project description papers “Bundles in the Wild: Tools for Managing Information to Maintain Situation Awareness” “Bundles in Captivity: An Application of Superimposed Information” papers discussing superimposed information DLI2 Footprints Project: Interim Results Briefing 38