Visualizing Temporal Patterns also including… Twinlist for Medication Reconciliation Catherine Plaisant Human-Computer Interaction Lab University Of Maryland, College Park HFES Baltimore – March

Interdisciplinary research community - Computer Science - Information Studies - Psychology, Sociology, Engineering, etc. in College Park MD ~

INFORMATION VISUALIZATION Compact graphical presentation and user interface for manipulating large numbers of items ( ), Enables users to make discoveries, decisions, or explanations about patterns or groups of items Visual bandwidth is enormous Human 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 Methods in Enzymology; 414:1-21.)

TREEMAP: E.G. SMARTMONEY MARKETMAP

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

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

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

LifeLines – Single Patient [Plaisant 1998] - PAPERS AND VIDEOS at

Important issue because of large time range Recursive aggregation mechanism (set of events) --- (summary event) INCLUDE SUMMARIZATION

LIFELINES SINGLE RECORD [Plaisant et al. 1998]

LIFELINES 2 RECORD [Wang et al. 2008, 2009]

LIFEFLOW RECORD AGGREGATE Merge multiple records into tree VISUALIZE Display the aggregation

Patient ID: /02/ :26Arrival 12/02/ :36Emergency 12/02/ :44ICU 12/05/ :07Floor 12/14/ :19Exit Time Emergency ICU Floor Exit TEMPORAL DATA NUMERICAL VS. CATEGORICAL 04/26/ : /26/ : /26/ : /26/ : /26/ : Patient ID: Arrival

ALIGNMENT E.g. align by arrival Time Patient # Arrival Emergency ICU Floor Exit Patient # Arrival Emergency ICU Floor Exit JuneJuly August

ALIGNMENT E.g. align by arrival Time Patient # Arrival Emergency ICU Floor Exit Patient # Arrival Emergency ICU Floor Exit 01 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] - Integrated in i2b2 and BTRIS Open source The work of Dave Wang Integrated in i2b2 and BTRIS Open source The work of Dave Wang

LIFEFLOW RECORD AGGREGATE Merge multiple records into tree VISUALIZE Display the aggregation

within 2 days ICUFloorICU Lifelines2: Specific query “Bounce backs” Lifeflow: Overview of sequences Arrival ICU ? ? ?

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DEMO- LIFEFLOW Data = Patient transfers within hospital ARRIVALArrive the hospital EMERGENCYEmergency room ICUIntensive Care Unit FLOORNormal room EXIT-ALIVELeave the hospital alive EXIT-DEADLeave the hospital dead

BACKUP VIDEO

Twinlist Facilitating Medication Reconciliation with 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:

Intake Hospital -What’s unique? -What’s identical? -What’s equivalent? Medication reconciliation Scenario: Hospital discharge

Levels of equivalences 29 EquivalenceCriteriaExample Form Equivalence Identical except for brand vs. generic Advil = Ibuprofen Senormin = Atenolol Functional Equivalence Same therapeutic intentAtenolol and Propanolol both betablockers Partial Equivalence Form or functional equivalence, but differ in dosage, frequency, or route Advil 100 mg Acetaminophen 200mg No equivalenceUnique 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 Chao Check for newer VIDEOS at or search YouTube for Twinlist (and pick newest version) CODE AVAILABLE ON REQUEST

THANK YOU Acknowledgments 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 (RC1CA ) Office of the National Coordinator for Health Information Technology (SHARP ~ # )

THANK YOU Join us for HCIL symposium - May Includes Medical Informatics Workshop Also projects on wrong patient selection, results management, risk communication