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

DLI2 Footprints Project: Interim Results Briefing 1

Paul Gorman, MD Lois Delcambre, PhDDavid Maier, PhD


Bundles in the wild………..Observational team:

Paul GormanJoan AshMary LavelleJason Lyman

…………..Bundles in captivityComputer science team:

Lois DelcambreDave MaierShawn BowersLongxing DengMathew Weaver

We cannot know the task until we know what the tools are

Edwin Hutchins

Cognition in the Wild


Information Seeking in Healthcare

Gathering Patient Data in Clinic

Patient Care in ICU

Finding Medical Knowledge


The Information Space

• Large and Growing• Diverse• Many users and uses• Distributed• Complex• Poorly organized• Increasingly but not

completely digital


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

What information consumes is attention…

A wealth of information produces a poverty of attention

Herbert Simon


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


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


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


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)


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


Bundle of Bundles


(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


(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)


Beyond the ICU:Are Bundles Unique to Health Care?


Use of Flightstrips in French Air Traffic Control


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






Visit the ICU atwww.cse.ogi.edu/footprints


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


The superimposed and base layers with marks

Superimposed Layer

BaseLayer

Information Source1

Information Source2

Information Sourcen

…

marks


(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)


SLIMPad demo


The SLIMPad Architecture

XMLViewer

userMS

PowerPoint

MSExcel

IEExplorer

XML Documents

PPT Files

Excel Spreadsheets

Web Pages

Superimposed Information Management

Mark Management

Generic Technology

PDFViewer

PDF files

SLIMPad


The architecture for managing SLIMPad’s superimposed information.

Superimposed Information Management

SLIMPad

Java Objects(ActiveX)

SLIMPadAPI

(ActiveX)

TRIM Store(Java) RDF

Triples

creates andmaintains


Generic Representation of Information

Topic Map

Topic Map Defintions

Topic Map Instances

XML

DTD

XML Document

Metamodel

SuperimposedLayer

Basic Set of Abstractions

Model Constructs and Relationships

Schema-LevelData

Instance-LevelData


Topic Map Example

Painting Painterby painter

Influenced by

“Captive” “Paul Klee”by painter influenced by

“Francisco de Goya”

“1914”by painter

mentioned biographyreferenced

referencedhttp://...

biography biography

http://...http://...

critiqued

critiqued

mentioned

http://...

http://...


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

<<conformance>>

topic_instOf


(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 SchemaTopic Types (schema):painting, painter

Topic Rel Types (schema):by painter

Anchor Types (schema):biography

painting painterby painter

biography


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


Three Basic Types of Mappings

Model1

Schema1

Instances1

Source Target

Mapped

Converted

Converted

Mapped

Converted

Mapped

Converted

Converted

Inter-Model

Inter-Schema

Model-to-Schema

Model2

Schema1

Instances1

Model1

Schema1

Instances1

Model1

Schema1

Instances1

Model1

Schema2

Instances1

Model2

Schema2

Instances


(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.


(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.


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