Multiple Scale Visualization of Electronic Health Records to Support Finding Medical Narratives

Electronic Health Records (EHRs) contain rich medical information about patients, possibly hundreds of notes, lab results, images and other information. Doctors can easily be overwhelmed by this wealth of information. For their daily work, they need to derive narratives from all this information to get insights into the main issues of their patients. Standard solutions show all the information in linear lists, often leading to cognitive overload; research solutions provide timelines and relations between the notes but provide too much fragmented information. We propose MEDeNAR, a system for enabling medical professionals to obtain insights from EHRs based on the different tasks in their workflow. The key aspects of our system are the introduction of an intermediate level that summarizes the information using clustering and NLP methods. The results are visualized along a timeline and provide easy access to the detailed descriptions in notes and lab results at the EHR level. We designed the system using an iterative design process in collaboration with 18 doctors, two nurses and 14 domain experts. During the final evaluation, the doctors ranked our system higher than a standard baseline solution and a variation for the used NLP methods. CCS Concepts • Human-centered computing → Visualization toolkits; User interface toolkits;

[1]  Nils Gehlenborg,et al.  ThreadStates: State-based Visual Analysis of Disease Progression , 2022, IEEE Transactions on Visualization and Computer Graphics.

[2]  F.R.H. Zijlstra,et al.  Efficiency in work behaviour: A design approach for modern tools , 1993 .

[3]  Denise R. Aberle,et al.  TimeLine: Visualizing Integrated Patient Records , 2007, IEEE Transactions on Information Technology in Biomedicine.

[4]  Catalina Hallett,et al.  Multi-modal presentation of medical histories , 2008, IUI '08.

[5]  Jinwook Choi,et al.  V-model: a new innovative model to chronologically visualize narrative clinical texts , 2012, CHI.

[6]  Lena Mamykina,et al.  CareView: analyzing nursing narratives for temporal trends , 2004, CHI EA '04.

[7]  Hongfang Liu,et al.  Salience of Medical Concepts of Inside Clinical Texts and Outside Medical Records for Referred Cardiovascular Patients , 2019, J. Heal. Informatics Res..

[8]  Daniel A. Keim,et al.  Semantic Concept Spaces: Guided Topic Model Refinement using Word-Embedding Projections , 2019, IEEE Transactions on Visualization and Computer Graphics.

[9]  Bongshin Lee,et al.  Timelines Revisited: A Design Space and Considerations for Expressive Storytelling , 2017, IEEE Transactions on Visualization and Computer Graphics.

[10]  Daniel J. Wigdor,et al.  More Text Please! Understanding and Supporting the Use of Visualization for Clinical Text Overview , 2018, CHI.

[11]  Noémie Elhadad,et al.  Automated methods for the summarization of electronic health records , 2015, J. Am. Medical Informatics Assoc..

[13]  Rui Zhang,et al.  Impact of a prototype visualization tool for new information in EHR clinical documents. , 2012, Applied clinical informatics.

[14]  Krista E. DeLeeuw,et al.  A Comparison of Three Measures of Cognitive Load: Evidence for Separable Measures of Intrinsic, Extraneous, and Germane Load , 2008 .

[15]  Cynna Selvy,et al.  Unified Medical Language System (UMLS) , 2015 .

[16]  Shiaofen Fang,et al.  Visualization of unstructured text sequences of nursing narratives , 2006, SAC '06.

[17]  Ricky K. Taira,et al.  Context-Based Electronic Health Record: Toward Patient Specific Healthcare , 2012, IEEE Transactions on Information Technology in Biomedicine.

[18]  Tamara Munzner,et al.  A Multi-Level Typology of Abstract Visualization Tasks , 2013, IEEE Transactions on Visualization and Computer Graphics.

[19]  Alexandra Pomares Quimbaya,et al.  HTL Model: A Model for Extracting and Visualizing Medical Events from Narrative Text in Electronic Health Records , 2016, ICT4AgeingWell.

[20]  Peter Szolovits,et al.  MIMIC-III, a freely accessible critical care database , 2016, Scientific Data.

[21]  Jessica López Espejel Automatic summarization of medical conversations, a review , 2019, JEPTALNRECITAL.

[22]  Jeffrey Dean,et al.  Scalable and accurate deep learning with electronic health records , 2018, npj Digital Medicine.

[23]  Hooshang Kangarloo,et al.  Problem-centric organization and visualization of patient imaging and clinical data. , 2009, Radiographics : a review publication of the Radiological Society of North America, Inc.

[24]  Chris North,et al.  Toward measuring visualization insight , 2006, IEEE Computer Graphics and Applications.

[25]  Claus Bossen,et al.  Factors affecting physicians' use of a dedicated overview interface in an electronic health record: The importance of standard information and standard documentation , 2016, Int. J. Medical Informatics.

[26]  J. Sweller,et al.  Cognitive load theory in health professional education: design principles and strategies , 2010, Medical education.

[27]  Ann Blandford,et al.  Making sense of personal health information: Challenges for information visualization , 2013, Health Informatics J..

[28]  Jo-Anne LeFevre,et al.  Cognitive load in hypertext reading: A review , 2007, Comput. Hum. Behav..

[29]  David K. Vawdrey,et al.  HARVEST, a longitudinal patient record summarizer , 2014, J. Am. Medical Informatics Assoc..

[30]  Chris North,et al.  An insight-based methodology for evaluating bioinformatics visualizations , 2005, IEEE Transactions on Visualization and Computer Graphics.