Portinari: A Data Exploration Tool to Personalize Cervical Cancer Screening

Socio-technical systems play an important role in public health screening programs to prevent cancer. Cervical cancer incidence has significantly decreased in countries that developed systems for organized screening engaging medical practitioners, laboratories and patients. The system automatically identifies individuals at risk of developing the disease and invites them for a screening exam or a follow-up exam conducted by medical professionals. A triage algorithm in the system aims to reduce unnecessary screening exams for individuals at low-risk while detecting and treating individuals at high-risk. Despite the general success of screening, the triage algorithm is a one-size-fits all approach that is not personalized to a patient. This can easily be observed in historical data from screening exams. Often patients rely on personal factors to determine that they are either at high risk or not at risk at all and take action at their own discretion. Can exploring patient trajectories help hypothesize personal factors leading to their decisions? We present Portinari, a data exploration tool to query and visualize future trajectories of patients who have undergone a specific sequence of screening exams. The web-based tool contains (a) a visual query interface (b) a backend graph database of events in patients' lives (c) trajectory visualization using sankey diagrams. We use Portinari to explore diverse trajectories of patients following the Norwegian triage algorithm. The trajectories demonstrated variable degrees of adherence to the triage algorithm and allowed epidemiologists to hypothesize about the possible causes.Comment: Conference paper published at ICSE 2017 Buenos Aires, at the Software Engineering in Society Track. 10 pages, 5 figure

PatientExploreR: an extensible application for dynamic visualization of patient clinical history from electronic health records in the OMOP common data model.

MotivationElectronic health records (EHRs) are quickly becoming omnipresent in healthcare, but interoperability issues and technical demands limit their use for biomedical and clinical research. Interactive and flexible software that interfaces directly with EHR data structured around a common data model (CDM) could accelerate more EHR-based research by making the data more accessible to researchers who lack computational expertise and/or domain knowledge.ResultsWe present PatientExploreR, an extensible application built on the R/Shiny framework that interfaces with a relational database of EHR data in the Observational Medical Outcomes Partnership CDM format. PatientExploreR produces patient-level interactive and dynamic reports and facilitates visualization of clinical data without any programming required. It allows researchers to easily construct and export patient cohorts from the EHR for analysis with other software. This application could enable easier exploration of patient-level data for physicians and researchers. PatientExploreR can incorporate EHR data from any institution that employs the CDM for users with approved access. The software code is free and open source under the MIT license, enabling institutions to install and users to expand and modify the application for their own purposes.Availability and implementationPatientExploreR can be freely obtained from GitHub: https://github.com/BenGlicksberg/PatientExploreR. We provide instructions for how researchers with approved access to their institutional EHR can use this package. We also release an open sandbox server of synthesized patient data for users without EHR access to explore: http://patientexplorer.ucsf.edu.Supplementary informationSupplementary data are available at Bioinformatics online

Exploiting the potential of large databases of electronic health records for research using rapid search algorithms and an intuitive query interface.

Objective: UK primary care databases, which contain diagnostic, demographic and prescribing information for millions of patients geographically representative of the UK, represent a significant resource for health services and clinical research. They can be used to identify patients with a specified disease or condition (phenotyping) and to investigate patterns of diagnosis and symptoms. Currently, extracting such information manually is time-consuming and requires considerable expertise. In order to exploit more fully the potential of these large and complex databases, our interdisciplinary team developed generic methods allowing access to different types of user. Materials and methods: Using the Clinical Practice Research Datalink database, we have developed an online user-focused system (TrialViz), which enables users interactively to select suitable medical general practices based on two criteria: suitability of the patient base for the intended study (phenotyping) and measures of data quality. Results: An end-to-end system, underpinned by an innovative search algorithm, allows the user to extract information in near real-time via an intuitive query interface and to explore this information using interactive visualization tools. A usability evaluation of this system produced positive results. Discussion: We present the challenges and results in the development of TrialViz and our plans for its extension for wider applications of clinical research. Conclusions: Our fast search algorithms and simple query algorithms represent a significant advance for users of clinical research databases

DPVis: Visual Analytics with Hidden Markov Models for Disease Progression Pathways

Clinical researchers use disease progression models to understand patient status and characterize progression patterns from longitudinal health records. One approach for disease progression modeling is to describe patient status using a small number of states that represent distinctive distributions over a set of observed measures. Hidden Markov models (HMMs) and its variants are a class of models that both discover these states and make inferences of health states for patients. Despite the advantages of using the algorithms for discovering interesting patterns, it still remains challenging for medical experts to interpret model outputs, understand complex modeling parameters, and clinically make sense of the patterns. To tackle these problems, we conducted a design study with clinical scientists, statisticians, and visualization experts, with the goal to investigate disease progression pathways of chronic diseases, namely type 1 diabetes (T1D), Huntington's disease, Parkinson's disease, and chronic obstructive pulmonary disease (COPD). As a result, we introduce DPVis which seamlessly integrates model parameters and outcomes of HMMs into interpretable and interactive visualizations. In this study, we demonstrate that DPVis is successful in evaluating disease progression models, visually summarizing disease states, interactively exploring disease progression patterns, and building, analyzing, and comparing clinically relevant patient subgroups.Comment: to appear at IEEE Transactions on Visualization and Computer Graphic

Analyzing User Behavior Patterns in Adaptive Exploratory Search Systems with LifeFlow

Adaptive exploratory search is a method that can provide user-centered personalized search results by incorporating interactive user interfaces. Analyzing the user behavior pat- terns of these systems can be complicated when they sup- port transparent and controllable open user models. This paper suggests to use a visualization tool to address the problem, as a complement to the typical statistical analy- sis. By adopting an event sequence visualization tool called LifeFlow, we were able to easily find out user interesting behavior patterns, especially regarding the open user model exploration

Visual Exploration and Cohort Identification of Acute Patient Histories Aggregated from Heterogeneous Sources

How can we use information visualization to support retrospective, exploratory analysis of collections of histories for patients admitted to acute care? This paper describes a novel design for visual cohort identification and exploration. We have developed a tool that integrates multiple, heterogeneous clinical data sources and allows alignment, querying and abstraction in a common workbench. This paper presents results from two projects and a review of related work in the field of information visualization including both presentation and interactive navigation of the information. We have developed an interactive prototype and present the visualization aspect of this prototype and a brief demonstration of its use in a research project with a large cohort of patients. The prototype represents and reasons with patient events in different OWL-formalizations according to the perspective and use: One for integration and alignment of patient records and observations; Another for visual presentation of individual or cohort trajectories. Health researchers have successfully analyzed large cohorts (over 100,000 individuals) using the tool. We have also used the tool to produce interactive personal health time-lines (for more than 10,000 individuals) on the web. Utility, usability and effect have been tested extensively and the results so far are promising. We envision that clinicians who want to learn more about groups of patients and their treatment processes will find the tool valuable. In addition, we believe that the visualization can be useful to researchers looking at data to be statistically evaluated, in order to discover new hypotheses or get ideas for the best analysis strategies. Our main conclusion is that the tool is usable, but it can be challenging to use for large data sets.Postprint version. © 2016 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other users, including reprinting/ republishing this material for advertising or promotional purposes, creating new collective works for resale or redistribution to servers or lists, or reuse of any copyrighted components of this work in other works

Visualisation of Integrated Patient-Centric Data as Pathways: Enhancing Electronic Medical Records in Clinical Practice

Routinely collected data in hospital Electronic Medical Records (EMR) is rich and abundant but often not linked or analysed for purposes other than direct patient care. We have created a methodology to integrate patient-centric data from different EMR systems into clinical pathways that represent the history of all patient interactions with the hospital during the course of a disease and beyond. In this paper, the literature in the area of data visualisation in healthcare is reviewed and a method for visualising the journeys that patients take through care is discussed. Examples of the hidden knowledge that could be discovered using this approach are explored and the main application areas of visualisation tools are identified. This paper also highlights the challenges of collecting and analysing such data and making the visualisations extensively used in the medical domain. This paper starts by presenting the state-of-the-art in visualisation of clinical and other health related data. Then, it describes an example clinical problem and discusses the visualisation tools and techniques created for the utilisation of these data by clinicians and researchers. Finally, we look at the open problems in this area of research and discuss future challenges