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

2. …………..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

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

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

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. Bundle of Bundles
DLI2 Footprints Project: Interim Results Briefing 13

14. (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

15. (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

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

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

18. 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

19. DLI2 Footprints Project: Interim Results Briefing 19

20. DLI2 Footprints Project: Interim Results Briefing 20

21. DLI2 Footprints Project: Interim Results Briefing 21

22. DLI2 Footprints Project: Interim Results Briefing 22

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

24. 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

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

26. (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

27. SLIMPad demo
DLI2 Footprints Project: Interim Results Briefing 27

28. 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

29. 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

30. 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

31. 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”
referenced
mentioned
“1914”
by painter
DLI2 Footprints Project: Interim Results Briefing 31

32. 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

33. 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

34. 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”,
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

35. 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

36. (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

37. (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

38.
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