Hippocrates Hippocrates ArchiveArchive

John Brennan (jbren@wam.umd.edu)John Brennan (jbren@wam.umd.edu)

Hyunyoung Song (hsong@gmail.com)Hyunyoung Song (hsong@gmail.com)

Nima Negahban (nimacn@gmail.com)Nima Negahban (nimacn@gmail.com)

IntroductionIntroduction

Patient Data Management ApplicationPatient Data Management Application– Inherited application “Pattern Finder” Inherited application “Pattern Finder” – Pattern finder was using fake dataPattern finder was using fake data– Conducted usability studies to make Conducted usability studies to make

recommendations on the interfacerecommendations on the interface

MotivationMotivation

Twenty percent of the nations medical Twenty percent of the nations medical spending is on managing patient dataspending is on managing patient data– Paper SystemsPaper Systems

Potential to be an invaluable tool for Potential to be an invaluable tool for doctors and researchersdoctors and researchers

Previous WorksPrevious Works

LifelineLifeline– One of the first applications in this fieldOne of the first applications in this field– Very good at displaying large sets of dataVery good at displaying large sets of data– Lacked the ability to make complex queriesLacked the ability to make complex queries

Previous WorksPrevious Works

KNAVEKNAVE– Robust query systemRobust query system– Poor Visualization System Poor Visualization System

Pattern FinderPattern Finder

Medical History Search Application buiMedical History Search Application built by Jerry Fails, Amy Karlson, Layla Slt by Jerry Fails, Amy Karlson, Layla Shahamet in Spring 2005 CMSC838S tehahamet in Spring 2005 CMSC838S term projectrm project

System SpecSystem Spec– C# program on top of .NET FrameworkC# program on top of .NET Framework– Piccolo api for visualizationPiccolo api for visualization

DatasetDataset

Test - StudentsTest - Students Original DataOriginal Data

– MedicationMedication– TestsTests– VisitsVisits

ValuesValues– Imaginary valuesImaginary values

Test - DoctorsTest - Doctors National Washington National Washington

Hospital Data SetHospital Data Set– Only tests (blood test)Only tests (blood test)– Real values with reference Real values with reference

levellevel

Usability Study: 6 studentsUsability Study: 6 students

3 scenarios with 3 tasks each3 scenarios with 3 tasks each Participants used Pattern Finder with its Participants used Pattern Finder with its

default (phony) datadefault (phony) data Tasks created to test several key Tasks created to test several key

fundamentals of the applicationfundamentals of the application– Understanding eventsUnderstanding events– Creating simple and complex queries using each Creating simple and complex queries using each

of the tools providedof the tools provided Our study gave more focus to the query Our study gave more focus to the query

construction than visualization understandingconstruction than visualization understanding

ObservationObservation

3 tier menu hierarchy3 tier menu hierarchy Understanding full query when more Understanding full query when more

than 3 events have been createdthan 3 events have been created Creating time spans between eventsCreating time spans between events Difficulty querying medication changesDifficulty querying medication changes

(relative values feature)(relative values feature)

User Troubles

Post-Test ResultPost-Test Result

Used Shneiderman’s QUIS model (1-9 semantically anchored radio buttons)Used Shneiderman’s QUIS model (1-9 semantically anchored radio buttons)

RecommendationRecommendation

Create text query window to display Create text query window to display full query user is generatingfull query user is generating

Change editable span text to Change editable span text to NumericUpDown controlsNumericUpDown controls

Change “relative values” text wording to Change “relative values” text wording to “increasing/decreasing values”“increasing/decreasing values”

Those using custom data for the system Those using custom data for the system should use care when developing the event should use care when developing the event drop down menu hierarchy (naming and drop down menu hierarchy (naming and placement)placement)

Usability Test : 2 DoctorsUsability Test : 2 Doctors

No need for scenariosNo need for scenarios 6 Concrete Tasks6 Concrete Tasks

– Desc: one from each query typeDesc: one from each query type– Measurement: Difficulty and UsefulnessMeasurement: Difficulty and Usefulness

Pilot ProfilePilot Profile– Researcher who practiced Neurology 15 years aResearcher who practiced Neurology 15 years a

go => Researcher point of viewgo => Researcher point of view– Gynecology and Obstetrics doctor who practiced Gynecology and Obstetrics doctor who practiced

over 30 years => Pure doctor point of viewover 30 years => Pure doctor point of view

Task 1 – Task 1 – E (Event)E (Event)

Task:

Find Patients who have had 3 WBC (White Blood Cell) measurement.

Task 2 – E-FTTask 2 – E-FT(Event - (Event - Fixed Time spanFixed Time span))

Task:

Find Patients whose HGB (Hemoglobin) measurement was between 10 ~ 14 Gm/dl (normal person reference level) but 2 day later it increased over 14 Gm/dl.

Task 3 – E-VTTask 3 – E-VT(Event – (Event – VariableVariable Time span) Time span)

Task:

Find Patients whose HGB measurement was under 14 Gm/dl, but within 3 days it decreased under 14 Gm/dl.

Task 4 – E*-VTTask 4 – E*-VT

((MultipleMultiple Event – Variable Time span) Event – Variable Time span)

Task:

Find Patients whose WBC measurement is above 8.50 K/ul and BASO (basophilia ) lab test after 2 days

Task:

Find patients who had 5 or more HGB within 3 days followed by MCH measurement.

Task 5 - E*WC-VT Task 5 - E*WC-VT (Multiple Event with (Multiple Event with Window ConstraintWindow Constraint – – Variable Time span)Variable Time span)

Task 6 – (Task 6 – (E*WC)F-VT E*WC)F-VT (Multiple Event with (Multiple Event with FunctionalFunctional Window Window ConstraintConstraint – Variable Time span) – Variable Time span)

Task:

Find patients who had 2 or more HGB test within 2 days that are less than the reference level (10~14 Gm/dl) within a range of 3 Gm/dl .

Results Results

ComponentsComponents– Most Intuitive (1)(7)Most Intuitive (1)(7)– Confusing but useful (2)(3)(6)Confusing but useful (2)(3)(6)– Not much useful (4)(5)Not much useful (4)(5)

ResultsResults

Query Query

TypeType

DifficultyDifficulty UsefulnessUsefulnessPracticePractice ResearchResearch

EE (1+1)/2(1+1)/2 55 11E-FTE-FT (3+4)/2=3.5(3+4)/2=3.5 88 22E-VTE-VT (3+5)/2=4(3+5)/2=4 88 88E*-VTE*-VT (3+5)/2=4(3+5)/2=4 77 77E*WC-VTE*WC-VT (9+9)/2=9(9+9)/2=9 22 77(E*WC)F-VT(E*WC)F-VT (9+9)/2=9(9+9)/2=9 44 77

ConclusionConclusion

VisualizationVisualization– Combinatorial display of results are redundantCombinatorial display of results are redundant

Query PowerQuery Power– 33rdrd, 4, 4thth query are the most useful query are the most useful– Consumes exponential time when query Consumes exponential time when query

becomes complicatedbecomes complicated Medical UseMedical Use

– Potential for Patient monitoring system in ERPotential for Patient monitoring system in ER

FutureworkFuturework

Need for centralized patient dataNeed for centralized patient data– Data from emergency room was only Data from emergency room was only

result of blood, urine and cerebral spinal result of blood, urine and cerebral spinal fluid result for a month period.fluid result for a month period.

Add various filters (currently the Add various filters (currently the system has just two) to the search system has just two) to the search systemsystem

Special Thanks To..Special Thanks To..

Professor Ben Shneiderman Professor Ben Shneiderman Professor James Reggia, Doctor Yong Professor James Reggia, Doctor Yong

Song for the Usability StudySong for the Usability Study Doctor Mike Gillam for providing the eDoctor Mike Gillam for providing the e

mergency room patient dataset and usmergency room patient dataset and useful informationeful information

The EndThe End

John Brennan (John Brennan (jbren@wam.umd.edujbren@wam.umd.edu)) Hyunyoung Song (Hyunyoung Song (hsong@cs.umd.eduhsong@cs.umd.edu)) Nima Negaban (nimacn@gmail.com)Nima Negaban (nimacn@gmail.com)