1. DLI2 Footprints Project: Interim Results Briefing1 Paul Gorman, MD Lois Delcambre, PhD David Maier, PhD

2. DLI2 Footprints Project: Interim Results Briefing2 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

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

4. DLI2 Footprints Project: Interim Results Briefing4 Information Seeking in Healthcare Gathering Patient Data in Clinic Patient Care in ICU Finding Medical Knowledge

5. DLI2 Footprints Project: Interim Results Briefing5 The Information Space Large and Growing Diverse Many users and uses Distributed Complex Poorly organized Increasingly but not completely digital

6. DLI2 Footprints Project: Interim Results Briefing6 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

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

8. DLI2 Footprints Project: Interim Results Briefing8 Information Use in Critical Care Question How do clinicians use information to help patients in the ICU? Setting ICU, tertiary care teaching hospital. SubjectsNurses, physicians, pharmacists MethodsEthnographically informed –Data collection by participant observation, key informant interviews, focus groups –Observation team includes nurse, medical librarian, physician trainee, staff physician

9. DLI2 Footprints Project: Interim Results Briefing9 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

10. DLI2 Footprints Project: Interim Results Briefing10 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

11. DLI2 Footprints Project: Interim Results Briefing11 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)

12. DLI2 Footprints Project: Interim Results Briefing12 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

13. DLI2 Footprints Project: Interim Results Briefing13 Bundle of Bundles

14. DLI2 Footprints Project: Interim Results Briefing14 (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

15. DLI2 Footprints Project: Interim Results Briefing15 (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)

16. DLI2 Footprints Project: Interim Results Briefing16 Beyond the ICU: Are Bundles Unique to Health Care?

17. DLI2 Footprints Project: Interim Results Briefing17 Use of Flightstrips in French Air Traffic Control

18. DLI2 Footprints Project: Interim Results Briefing18 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

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23. DLI2 Footprints Project: Interim Results Briefing23 Visit the ICU at www.cse.ogi.edu/footprints

24. DLI2 Footprints Project: Interim Results Briefing24 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

25. DLI2 Footprints Project: Interim Results Briefing25 The superimposed and base layers with marks Superimposed Layer Base Layer Information Source 1 Information Source 2 Information Source n … marks

26. DLI2 Footprints Project: Interim Results Briefing26 (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)

27. DLI2 Footprints Project: Interim Results Briefing27 SLIMPad demo

28. DLI2 Footprints Project: Interim Results Briefing28 The SLIMPad Architecture XML Viewer user MS Power Point MS Excel IE Explorer XML Documents PPT Files Excel Spreadsheets Web Pages Superimposed Information Management Mark Management Generic Technology PDF Viewer PDF files SLIMPad

29. DLI2 Footprints Project: Interim Results Briefing29 The architecture for managing SLIMPad’s superimposed information. Superimposed Information Management SLIMPad Java Objects (ActiveX) SLIMPad API (ActiveX) TRIM Store (Java) RDF Triples creates and maintains

30. DLI2 Footprints Project: Interim Results Briefing30 Generic Representation of Information Topic Map Topic Map Defintions Topic Map Instances XML DTD XML Document Metamodel Superimposed Layer Basic Set of Abstractions Model Constructs and Relationships Schema-Level Data Instance-Level Data

31. DLI2 Footprints Project: Interim Results Briefing31 Topic Map Example PaintingPainter by painter Influenced by “Captive”“Paul Klee” by painter influenced by “Francisco de Goya” “1914” by painter mentioned biographyreferenced http://... biography http://... critiqued mentioned http://...

32. DLI2 Footprints Project: Interim Results Briefing32 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 TopicInstance * 1 > topic_instOf

33. DLI2 Footprints Project: Interim Results Briefing33 (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) Representing Schema Topic Types (schema): painting, painter Topic Rel Types (schema): by painter Anchor Types (schema): biography paintingpainter by painter biography

34. DLI2 Footprints Project: Interim Results Briefing34 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”, “URLMarkManager@954308545”) Topic Instances (instance): Paul Klee, Captive Topic Relationship (instance): a by painter relationship Anchor (instance): a biography anchor Address (instance): mark to url

35. DLI2 Footprints Project: Interim Results Briefing35 Three Basic Types of Mappings Model 1 Schema 1 Instances 1 SourceTarget Mapped Converted Mapped Converted Mapped Converted Inter-Model Inter-Schema Model-to- Schema Model 2 Schema 1 Instances 1 Model 1 Schema 1 Instances 1 Model 1 Schema 1 Instances 1 Model 1 Schema 2 Instances 1 Model 2 Schema 2 Instances

36. DLI2 Footprints Project: Interim Results Briefing36 (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.

37. DLI2 Footprints Project: Interim Results Briefing37 (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.

38. DLI2 Footprints Project: Interim Results Briefing38 www.cse.ogi.edu/footprints 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