1. Project 4: Cognitive Information Design and Visualization Presented by Dr. Ben ShneidermanCatherine Plaisant Jorge Herskovic Todd JohnsonSurreya Tarkan Elmer BernstramTiffany Chao Elis Markovitz Chitra Shriram

2. Human-Computer Interaction has Strong Structures 3. Human-Computer Interaction has Strong Structures 4. History of EHR Interfaces &Tech TransferLifelines (AMIA 1998) www.cs.umd.edu/hcil/lifelines Lifelines2 (CHI 2009 - IHI 2010) www.cs.umd.edu/hcil/lifefines2Now Integrated with i2b2 & BTRISLifeFlow (CHI 2011, IHI 2011 with Mayo) www.cs.umd.edu/hcil/lifeflow 5. Overall Goals of Project 4Create framework & guidelines for designinginteractive information visualizations that providepatient-centered cognitive support by enhancingaccessibility & understanding of patient data.Short Term Goals:Focus on clinician-centered visualization tools thataddress national priorities.Lab & study tracking to ensure completionMedication Reconciliation 6. Initial effortsSurvey EHR visualizationsBuild relationshipsWorkshops with partners & vendorsCreate national interest in EHR usability ACM, UPA, HIMSS, InfoVis article by Steve LohrSee: www.cs.umd.edu/hcil/sharp 7. Lab & study tracking to ensure completionSureyya TarkanDefine tracking processes Assign temporal responsibility Define possible actions Predict expected durationGenerate User Interface from processesEnhance situation awarenessIntegrate follow-up actions with resultsSimplify rapid operationsProvide retrospective analysis 8. Medication ReconciliationA complex process: Develop a list of current medications; Develop a list of medications to be prescribed; Compare the medications on the two lists Make clinical decisions based on the comparison Communicate the new list to appropriate caregivers and to the patient.http://www.ihs.gov/cio/ehr/index.cfm?module=medication_reconciliation 9. Example of Medication ListsWhat is unique?What is identical? What is equivalent? 10. Existing toolsLimitations: 1. No or limited assistance 2. Increases workload for the clinician. 3. Usability problems 11. Levels of Equivalence 12. Levels of EquivalenceBozzo Silva, P., Bernstam, E., S87Automated medication reconciliation and complexity of careMarkowitz, E., Johnson, T.,Zhang, J.,Wednesday, Oct. 26 Lincoln WesttransitionsHerskovic, J.8:50 9:10 AM 13. Two Designs - DemosTabular layout Spatial LayoutGrouped rows = similarityCloseness = similarityMedRecon TwinList 14. MedRecon: semi automatic reconciliationEliz Markowitz, Elmer V. Bernstam, Jorge Herskovic, Jiajie Zhang, Todd R. JohnsonVideo demoUn-reconciledmedicationsrequire cliniciansselection or rejectionIdentical medicationsautomatically reconciled 15. MedRecon:Compatibility with hand helddevices ? 16. MedRecon: semi automatic reconciliationEliz Markowitz, Elmer V. Bernstam, Jorge Herskovic, Jiajie Zhang, Todd R. JohnsonVideo demoUn-reconciledmedicationsrequire cliniciansselection or rejectionIdentical medicationsautomatically reconciled Markowitz, E., Bernstam, E.,S87 Herskovic, J., Zhang, J., Medication Reconciliation: Work Domain Ontology,Wednesday, Oct. 26 Lincoln West Paper Shneiderman, B, Plaisant, C., Prototype Development, and a Predictive Model8:30 8:50 AM Johnson, T. 17. TwinlistTiffany Chao, Catherine Plaisant, Ben ShneidemanBased on class project of : Leo Claudino, Sameh Khamis, Ran Liu, Ben London, Jay PujaraStudents of CMSC734 Information Visualization class Presentations:HCIL symposium (200+ attendees)AMIA WISH tomorrow Best reconciliation app I have ever seenDr. Shawn Murphy, PartnersHealthcare & Harvard Medical 18. TwinlistTiffany Chao, Catherine Plaisant, Ben ShneidermanBased on class project of : Leo Claudino, Sameh Khamis, Ran Liu, Ben London, Jay Pujara UMD CMSC734 Information Visualization Presentations:HCIL symposium (200+ attendees)AMIA WISH tomorrow Best reconciliation app I have ever seenDr. Shawn Murphy, PartnersHealthcare & Harvard Medical 19. Systematic Yet Flexible HIT Eliz Markowitz Need balance between Systematicity to ensure consistency, efficiency & safety Flexibility to accommodate variability Hypothesis: Matching task & interface systematicity &flexibility improves efficiency & usability Goal: design guidelinesEliz Markowitz, MS, Jiajie Zhang, PhD, Elmer V. Bernstam, MD, PhD, and Todd R. Johnson, PhD 20. Systematic Yet Flexible HITEliz Markowitz PhD ThesisExample: SYF & Catheter Insertion 384 total states 286 goal states 13,004 paths to any state in whichthe central line is inserted 1,680 paths to the ideal goal state Only 2 paths contain the appropriate sequence of 9 actions 21. Reducing Wrong Patient Errors Meirav Taieb, Jyothi Vinjumur, Catherine Plaisant, Ben ShneidermanWith long lists, users may choose wrong item Poor visual design Inadequate feedback Lack of error preventionWrong patients, medications, lab testsTest: 100 subjects with 4 treatmentsPhotos (Y/N) & Animation (Y/N) 22. University Health Service Provider: Smead, JohnRegisterYour patient list:Sex Age MedRec Birth Date Admission Date Attending DrReport Culbertson, GeorgeM 77 9845722 EMM 3/4/19346/11/2011Connors, GregRequest Culbertson, Susan F 24 9887333 JDC 5/22/1987 6/11/2011Schneider, BenCensus History Donder, BillM 21 9823244 EMM 6/4/19906/102011 Tabibi, Mary Discuss Harris, Emily F 24 9828970 DRD 5/22/1987 6/12/2011Tabibi, MaryFeedback Isaacson, ThomasM 53 9845722 EMM 7/11/19586/11/2011 Connors, Greg Training Burchard, Susan F 24 9887333 JDC 5/22/1987 6/12/2011Schneider, Ben PrivacyAboutCulbertson, GeorgeM 77 9823244 EMM 3/4/19346/11/2011Connors, Greg Contact Culbertson, Susan F 24 9828970 DRD 5/22/1987 6/12/2011Franks, GeorgeText sizeAlbertson, George M 77 9845722 EMM 3/4/19346/11/2011Schneider, Ben +-Burchard, Susan F 24 9887333 JDC 5/22/1987 6/12/2011Schneider, Ben ~espagnol Albertson, George M 77 9823244 EMM 3/4/19346/11/2011Tabibi, Mary Burchard, Susan F 24 9828970 DRD 5/22/1987 6/12/2011Schneider, Ben 23. University Health Service Patient: Culbertson, GeorgeRegisterReportRounds ReportRequestPT#: 0897709870987Census Sex:MMR#: 9845722 History Birth date: 3/4/1934 Admit: 6/11/2011 Discuss Rm/Bed: EMMAttending: Connors, GregFeedback Training PrivacyBlood Test Electrocardiogram MRI CT ScanAbout ContactText size +- ~espagnol 24. University Health Service Patient: Culbertson, GeorgeRegisterReportRounds ReportRequestPT#: 0897709870987Census Sex:MMR#: 9845722 History Birth date: 3/4/1934 Admit: 6/11/2011 Discuss Rm/Bed: EMMAttending: Connors, GregFeedback Training PrivacyBlood Test Electrocardiogram MRI CT ScanAbout ContactText size +-Blood Test Confirmed: Due back in 6 hours ~espagnol 25. University Health Service Patient: Culbertson, GeorgeRegisterReportRounds ReportRequestPT#: 0897709870987Census Sex:M MR#: 9845722 History Birth date: 3/4/1934Admit: 6/11/2011 Discuss Rm/Bed: EMM Attending: Connors, GregFeedback Training PrivacyBlood TestBlood Test ElectrocardiogramMRIMRI CT ScanCT ScanAbout Electrocardiogram ContactText size +- ~espagnol 26. University Health Service Patient: Culbertson, SusanRegisterReportRounds ReportRequestPT#: 0897709870987Census Sex:FMR#: 9845758 History Birth date:Admit: 6/11/2011 Discuss Rm/Bed: EMMAttending: Connors, GregFeedback Training PrivacyBlood Test Electrocardiogram MRI CT ScanAbout ContactText size +- ~espagnol 27. University Health Service Provider: Smead, JohnRegisterYour patient list:Sex Age MedRec Birth Date Admission Date Attending DrReport Culbertson, GeorgeM 77 9845722 EMM 3/4/19346/11/2011Connors, GregRequest Culbertson, Susan F 24 9887333 JDC 5/22/1987 6/11/2011Schneider, BenCensus History Donder, BillM 21 9823244 EMM 6/4/19906/102011 Tabibi, Mary Discuss Harris, Emily F 24 9828970 DRD 5/22/1987 6/12/2011Tabibi, MaryFeedback Isaacson, ThomasM 53 9845722 EMM 7/11/19586/11/2011 Connors, Greg Training Burchard, Susan F 24 9887333 JDC 5/22/1987 6/12/2011Schneider, Ben PrivacyAboutCulbertson, GeorgeM 77 9823244 EMM 3/4/19346/11/2011Connors, Greg Contact Culbertson, Susan F 24 9828970 DRD 5/22/1987 6/12/2011Franks, GeorgeText sizeAlbertson, George M 77 9845722 EMM 3/4/19346/11/2011Schneider, Ben +-Burchard, Susan F 24 9887333 JDC 5/22/1987 6/12/2011Schneider, Ben ~espagnol Albertson, George M 77 9823244 EMM 3/4/19346/11/2011Tabibi, Mary Burchard, Susan F 24 9828970 DRD 5/22/1987 6/12/2011Schneider, Ben 28. University Health Service Provider: Smead, JohnRegisterYour patient list:Sex Age MedRec Birth Date Admission Date Attending DrReportRequestCensus History DiscussFeedback Training PrivacyAboutCulbertson, GeorgeM 77 9823244 EMM 3/4/19346/11/2011Connors, Greg ContactText size +- ~espagnol 29. Culbertson, GeorgeRegisterReportRequestCensus History DiscussFeedback Training PrivacyAbout ContactText size +- ~espagnol 30. University Health Service Patient: Culbertson, GeorgeRegisterReportRounds ReportRequestPT#: 0897709870987Census Sex:MMR#: 9845722 History Birth date: 3/4/1934 Admit: 6/11/2011 Discuss Rm/Bed: EMMAttending: Connors, GregFeedback Training PrivacyBlood Test Electrocardiogram MRI CT ScanAbout ContactText size +- ~espagnol 31. Student spinoff projectsMoodTracker 32. Next? Two PhD theses emerging - Lab tracking & Systematic Yet Flexible Framework Nov/Dec special section of ACM Interactions- Includes paper by Siemens/Allscripts Presentations to corporate designers Users studies & clinician reviews Comparative analyses & guidelines 33. Project 4: Cognitive Information Design and Visualization Thanks for support (#10510592) from: Office of the National CoordinatorStrategic Health IT Advanced Research ProjectsPre-doctoral training fellowship:Agency for Healthcare Research and Quality