AnamneVis: A Framework for the Visualization of Patient History
and Medical Diagnostics Chains 1 Department of Computer Science 2
Department of Emergeny Medicine Zhiyuan Zhang 1, Faisal Ahmed 1,
Arunesh Mittal 1, IV Ramakrishnan 1, Rong Zhao 1, Asa Viccellio 2,
Klaus Mueller 1 Slide 2 Medical History - Anamnesis Includes
patient demographics, problems, symptoms, diagnoses, progress
notes, treatments, medication, vital signs, past medical history,
immunizations, laboratory data, radiology reports, and many others.
Should: accurately reflect the diseases/problems indicate the
probable cause of disease Slide 3 Paper-Based Medical Record Slide
4 Electronic Medical Record (EMR) Full of documentation + tables
Non-intuitive interfaces Fragmented display of patient information
Slide 5 Problems of Current EMR Acceptance of the EMR in clinical
practice lags far behind its expectation and potential. Related
information and overviews are difficult to obtain Severely impedes
a physicians diagnostic reasoning. Possible reason: Inefficient,
fragmented display of patient information Slide 6 Objectives Simple
Interfaces to make data and information exploration easier
Comprehensibly organizing the patient medical history from
different sources Support and enhance the clinical decision-making
Visualization and interaction are the key Provide a suitable visual
mapping for each visual information. Ease of data and information
access is the key AnamneVis Visualization of Anamnesis Slide 7
System Overview Slide 8 The 5-W Scheme Use a strongly structured
paradigm, the 5-W WHO and WHAT : the patient and the history, in
terms of symptoms, tests and results, diagnosis, treatments and
medications, etc. ICD, ICD-procedure. WHERE : locations (when
appropriate) of the WHAT on the human body WHEN, WHY and HOW : show
a case under (doctor) collaborative diagnosis/treatment, or an
entire life span. It demonstrates for each node what, when, why,
and how that node appears. Slide 9 Identify the Five Ws :
Information Extraction Input: Medical reports Doctor-patient
dialogs and other interactive inputs Results from triage, and data
acquired from the patient, such as radiological images, lab
analyses... NLP (Natural Language Processing) engine (cTake) +
online medical ontology server(SNOMED) Extract structured
information and relationships. Formats the extraction results into
the Five W model Passes it on to the visualization engine. Slide 10
Visual Encoding of 5-Ws Two cooperating displays: A hierarchical
radial (patient overview) display with an integrated body outline
primarily for the who and where. A sequential (diagnostic
reasoning) display primarily for the when, why, and how. Slide 11
Visual Encoding of 5-Ws Two cooperating displays: A hierarchical
radial (patient overview) display with an integrated body outline
primarily for the who and where. A sequential (diagnostic
reasoning) display primarily for the when, why, and how. The what
is part of both displays In form of the various nodes
Context-sensitive. The two interfaces are linked operations on
either view will be reflected in the other. Slide 12 Hierarchical
Radial Display Data Model Data Model: Tree data structure to store
the code hierarchy information. Insert each incident into the tree
Node structure: Slide 13 Hierarchical Radial Display Visual Design
Tree Visualization. Node+Edge Hard to show additional info. for
each node and integrate body map Slide 14 Hierarchical Radial
Display Visual Design Tree Visualization. Space filling: Circle
Pack: Size grows very fast. Icicle: Not fully utilize space;
Difficult to integrate body map Slide 15 Hierarchical Radial
Display Visual Design We use the sunburst visualization paradigm.
Space-filling diagram. Fully utilize the space. Easy to integrate
with a body map. Slide 16 Hierarchical Display Examples
Hierarchy-centric Node is sized by how many sub-categories it has
Focus more on the hierarchical information of the medical codes
Serve as an illustration of the complexity of a sub-system and its
composition Slide 17 Hierarchical Display Examples Patient-centric
More radial space is dedicated for diagnoses/procedures the patient
had activities in. Other nodes will be collapsed to save space for
others Slide 18 Hierarchical Display Examples Three predefined code
hierarchies to support multi-scale visualization. Level 1: the
highest code hierarchy level. Level 2: more detailed categories.
Level 3: incident nodes (symptoms/procedures/diagnosis that the
patient has activities in. ) Help users quickly explore these three
levels. Users can expand and collapse the nodes interactively by
their expertise. Slide 19 Typical Diagnostic Information Flow
Patient visits physician Obtain patients information Physical
examination Order laboratory data Request and obtain consultation
Make diagnosis Give treatments A sequential display can show these
reasoning chains very well. Slide 20 Sequential (Causal) Display
Demonstrate the what, when, why and how information. The medical
records are organized by an underlying graph data structure. Each
node corresponds to one incident (medical primitive), which could
be a doctor visit, symptom, test/data, diagnosis or treatment.
Edges represent relationships. Slide 21 Visual Design A node is
displayed as one elongated box Better utilizes the rectangular
screen Better fits the text Better scalability Edges represent
relationships. Edge bundling is used to reduce cluttering. Back
edges May be due to treatments causing new symptoms, or treatments
constituting doctor referrals. Shown in different color (red) to
make them easy to see. Diagnosis Slide 22 Sequential Display
Example Slide 23 Slide 24 Conclusions Implemented a preliminary
framework for clinical visual analytics For clinical scenarios
Patient-focused Unifies all EMR information fragments into a single
interactive visual framework Slide 25 Current/Future Work
Improvements, fine-tuning, and additional features Include more
formal user and affordance studies Potentially used by coding
personnel who work in the hospital billing office to translate
medical records to ICD code. -Better recognize relationships in
medical services. -Perform more accurate billing statements.
Treatment Outcome Google body browser Integrate with current EMR
system. Slide 26 Thanks For Listening! Q&A?
