1. Visualizing Temporal Patterns also including… Twinlist for Medication Reconciliation Catherine Plaisant Human-Computer Interaction Lab University Of Maryland, College Park HFES Baltimore – March 12 2013

2. Interdisciplinary research community - Computer Science - Information Studies - Psychology, Sociology, Engineering, etc. in College Park MD ~ www.cs.umd.edu/hcilwww.cs.umd.edu/hcil

3. INFORMATION VISUALIZATION Compact graphical presentation and user interface for manipulating large numbers of items (10 2 - 10 6 ), Enables users to make discoveries, decisions, or explanations about patterns or groups of items Visual bandwidth is enormous Human perceptual skills are remarkable

4. 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. 2006 Methods in Enzymology; 414:1-21.)

5. www.smartmoney.com/marketmap TREEMAP: E.G. SMARTMONEY MARKETMAP

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

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

8. e.g. NCHS data Size = #Deaths per 100 000, in 1998 Color = Rate of change compared to 1981

9. LifeLines – Single Patient [Plaisant 1998] - PAPERS AND VIDEOS at www.cs.umd.edu/hcil/lifelines

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

12. LIFELINES SINGLE RECORD [Plaisant et al. 1998] http://www.cs.umd.edu/hcil/lifelines

13. LIFELINES 2 RECORD [Wang et al. 2008, 2009] http://www.cs.umd.edu/hcil/lifelines2

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

15. Patient ID: 45851737 12/02/2008 14:26Arrival 12/02/2008 14:36Emergency 12/02/2008 22:44ICU 12/05/2008 05:07Floor 12/14/2008 06:19Exit Time Emergency ICU Floor Exit TEMPORAL DATA NUMERICAL VS. CATEGORICAL 04/26/2010 10:0031.03 04/26/2010 10:1531.01 04/26/2010 10:3031.02 04/26/2010 10:4531.08 04/26/2010 11:0031.16 Patient ID: 45851737 Arrival

16. ALIGNMENT E.g. align by arrival Time Patient #45851737Arrival Emergency ICU Floor Exit Patient #43244997 Arrival Emergency ICU Floor Exit JuneJuly August

17. ALIGNMENT E.g. align by arrival Time Patient #45851737Arrival Emergency ICU Floor Exit Patient #43244997 Arrival Emergency ICU Floor Exit 01 M 2 M

18. 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] - www.cs.umd.edu/hcil/lifelines2 Integrated in i2b2 and BTRIS Open source The work of Dave Wang Integrated in i2b2 and BTRIS Open source The work of Dave Wang

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

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

21. blabla

22. 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

23. BACKUP VIDEO www.cs.umd.edu/hcil/eventflow

26. Twinlist Facilitating Medication Reconciliation with Animation and Spatial Layout

27. 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: http://www.ihs.gov/cio/ehr/index.cfm?module=medication_reconciliation

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

29. 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

30. TWINLIST Prototype originally developed by Tiffany Chao Check for newer VIDEOS at www.cs.umd.edu/hcil/sharp or search YouTube for Twinlist (and pick newest version) CODE AVAILABLE ON REQUEST (plaisant@cs.umd.edu)www.cs.umd.edu/hcil/sharp

31. 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 (RC1CA147489-02) Office of the National Coordinator for Health Information Technology (SHARP ~ #10510592) www.cs.umd.edu/hcil www.cs.umd.edu/hcil/eventflow www.cs.umd.edu/hcil/sharp

32. THANK YOU plaisant@cs.umd.edu Join us for HCIL symposium - May 22-23 www.cs.umd.edu/hcil/soh Includes Medical Informatics Workshop Also projects on wrong patient selection, results management, risk communication www.cs.umd.edu/hcil www.cs.umd.edu/hcil/eventflow www.cs.umd.edu/hcil/sharp