1. Temporal Data Analysis and Electronic Health Records Ben Shneiderman, Catherine Plaisant, Taowei David Wang, Kris Wongsuphasawat

2. LifeLines: Patient Histories

3. Lifelines and Improvements
Plaisant CHI 96, AMIA 98
I2b2 (Murphy AMIA 07)

4. Lifelines and Improvements
Plaisant CHI 96, AMIA 98
Bade CHI 2004
I2b2 (Murphy AMIA 07)

5. Specification of Temporal Abstractions
Shahar 1999
Powsner & Tufte, 1994
Post 2007

6. PatternFinder in Amalga

7. 1) LifeLines2: Align-Rank-Filter
Multiple records simultaneously visible
Align by sentinel events
Rank by frequency
Filter by events

8. LifeLines2: Contrast+Creatinine
Contrast and Creatinine dataset
In some diagnostic radiology procedures, patients are injected contrast material. However, some patients develop adverse side
effects to the contrast material. One serious side effect is renal failure, which is detected by high creatinine levels in a patient's blood.
This adverse effect usually occur within two weeks after the radiology contrast. WHC is interested in finding the proportion
of patients who exhibit this condition in historical records.
Screenshots
1-aligned-ranked.png:
We align by the 1st occurrence of radiology contrast and rank by the number of creatinine high (CREAT-H) events to bring
the most severe patients to the top. We realize two things: (1) some patients have more than 1 "Radiology Contrast" events,
and (2), some patients have consistently high creatinine readings (chronic kidney failure).
2-aligned(all)-distribution-selected.png
We align by all occurrences of raiology contrast, and then show the temporal summary of CREAT-H events.
The patients are presented in 4 exclusive sets in the summary: those who have CREAT-H only before alignment, only after
alignment, both before and after, and neither. We then select from the "only after" summary the patients who have
at least one CREAT-H event within 2 weeks of any "Radiology Contrast" event. There are 421 patients.

9. LifeLines2: Contrast+Creatinine
VIDEO

10. LifeLines2: Heparin-Induced Thrombocytopenia
Heparin induced thrombocytopenia dataset
Heparin is used for anticoagulation when abnormal blood clotting occurrs in a patient.
However, Heparin induced thrombocytopenia can occur, usually within 4-14 days after
heparin administration. WHC wishes to find how many patients may exhibit these signs.
Screenshots
1-ranked.png:
The dataset is loaded and ranked by the number of platelet "Low or Critical" events.
First, we notice that many patients have more than 1 administrations of heparin. We also see that,
serendipitously, that some patients, after being admitted to trauma center, some patients stayed in the hospital for months.
2-aligned(all)-ranked-selected.png
We then align by all occurrences of "Heparin Administration", and then select, from the temporal summary, patients who have at least
one "Low or Critical" platelet event within 4-14 days after any heparin administration. We see that there are 1094 patients selected.

11. LifeLines2: Heparin-Induced Thrombocytopenia

12. 2) Similan: Find similar patients
In terms of ?
Not in terms of demographic information
Age, gender, etc.
But in terms of patient histories
Events
time
Patient#1
Patient#1
Stomach Pain
Vomitting
Diarrhea

13. Similan: Find similar patients
How?
Similarity Measure
Between pairs of patients
Score ranges from 0 to 1. (Most similar = 1)
Users select one target patient

14. Similan: Find similar patients
(target)
Patient #2
0.80
0.63
0.96
0.77
Patient #3
Patient #4
Patient #5

15. Similan: Find similar patients
(target)
similar
Patient #4
0.96
Patient #2
0.80
Patient #5
0.77
Patient #3
0.63 15

16. Challenge What is “similar”? depends on users/tasks Patient#1 (target)B C
Patient#2
swapping A C B B
missing
Patient#3 A C
Patient#4
Time difference A B C
time

17. } Mix&Match Measure User customizable similarity measure Total Score
Missing Event
Patient#1
(target)
Matched Events A C B C
Extra Event
Patient#2 A B C B }
Total Score
0 to 1
Match Score = F(∆ time)
Number of Mismatches = Missing + Extra
Number of Swapping*

18. Similan: Find Similar Patients
VIDEO
Trauma Admission-hematocrit dataset
Hematocrit is the proportion of blood volume that is occupied by red blood cells. Low or critical levels of hematocrit indicate
significant hemorrhaging. WHC is interested in what proportion of trauma patients who have low or critical levels of hematocrit within 24 hours trauma admission.
Screenshots
1-defualt.png:
This screen shows the data that is loaded into Lifelines2. The patients are scattered on the calendar time, forcing users to scan horizontally as well as scrolling vertically.
2-aligned(first)-ranked-selected.png
We align the data by the first Trauma Admission, and rank the patients by the number hematocrit low or critical events
to bring the most 'severe' patients on top. Finally, we show the distribution of "HCT Low or Critical", and select the
patients who have "HCT Low or Critical" within 24 hours of Trauma Admission. The blue number 4514 on top shows how many patients satisfy the selection.

19. Take Away Messages Medical Record & other temporal event
exploration is possible for:
1) pattern discovery
2) comparison of groups
3) similar event records
Thanks for collaboration with Washington Hospital Center