An Intelligent Patient Data Review Assistant (IPDRA) Jim Ong, MS LTC Trinka Coster, MD Matthew Medlock, MD LTC Joseph Parker, MD Jane Dowling, MS Stephen Porter, MD Seth Powsner, MD Ida Sim, MD PhD Stottler Henke Walter Reed Army Institute of Research Uniformed Services Univ. of the Health Sciences Walter Reed Army Medical Center NYU Medical Center Harvard Medical School Yale University School of Medicine UC San Francisco School of Medicine AMIA Medinfo 2004 This research was funded by the U.S. Department of Defense.

AMIA MedInfo An Intelligent Patient Data Review Assistant IPDRA Mission. Help clinicians review patient data more effectively before, during, and after patient encounters Current state-of-the-art Limitations Web application server Relational database Source-oriented queries Modest use of graphics Time-consuming to query related patient data from different parts of the database Hard to mentally integrate data spanning multiple pages and data sources

AMIA MedInfo An Intelligent Patient Data Review Assistant IPDRA Approach Patient data views Information- dense displays Visual view authoring Testing and debugging Present integrated, clinically-meaningful subsets of each patient’s records (by problem, body system, demographic). Compact, coordinated timelines and time- series graphs with traditional text, tables. Users specify view logic by drawing and configuring hierarchical flow charts. Desktop application lets users test and debug view definitions and upload them to the server.

AMIA MedInfo An Intelligent Patient Data Review Assistant Key Questions Effectiveness Feasibility How should we design patient views to enable effective and efficient data review by clinicians? What software tools and processes can enable practical design and development of large libraries of views?

AMIA MedInfo An Intelligent Patient Data Review Assistant Cardiac View (ICDB) Reference ranges Show/hide module Graph Module Timeline roll over  short text notes mouse click  html detail in normal range high

AMIA MedInfo An Intelligent Patient Data Review Assistant Diabetes View (ICDB) Datetime reference line Reference value

AMIA MedInfo An Intelligent Patient Data Review Assistant Normal range / grid lines Selecting a time- stamped note draws a datetime reference line

AMIA MedInfo An Intelligent Patient Data Review Assistant Hypertension View (ICDB)

AMIA MedInfo An Intelligent Patient Data Review Assistant DataMontage mockup

AMIA MedInfo An Intelligent Patient Data Review Assistant IPDRA Architecture View Generation View Authoring View authoring tool (SimBionic) View logic specifications View test/debug application or Web application server SimBionic run-time system Primitive functions: query database DataMontage API generate HTML, XML DoD Clinical database (ICDB, M2, CHCS II) Object templates (DataMontage XML, HTML, SQL queries) View files: HTML, XML

AMIA MedInfo An Intelligent Patient Data Review Assistant IPDRA View Authoring Tool (SimBionic) Flow-chart drawing area Catalog of flow charts, primitive functions, variables

AMIA MedInfo An Intelligent Patient Data Review Assistant IPDRA Status Prototyped IPDRA view server and test/debug application Developed initial set of views using ICDB Evaluation and refinement of views planned for fall 2004 using DoD M2 clinical database IPDRA subsystems released as products Java SimBionic visual authoring tool (Feb 2004) DataMontage graph library (Sept 2004)