visual analytics for healthcare - panel at amia 2012 in chicago

Panel onVisual Analytics

for

Healthcare

AMIA 2012 - November 5, 2012Moderator: Adam Perer, IBM Research

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Visual analytics combines automated analysis with interactive visualizations

to understand, reason and make decisions from

big data

De!nition adapted from Daniel Keim, Jörn Kohlhammer,Geoffrey Ellis and Florian Mansmann’s Mastering the Information Age Solving Problems with Visual Analytics

Panelists• Ben

ShneidermanUniversity of Maryland

Pattern Finding in Point & Interval

Event Sequences

PanelistsYuval Shahar

Ben-Gurion University

Visual Analytics for Discovery of Time-Oriented

Clinical Knowledge

PanelistsDavid GotzIBM Research

Visual Analytics for Healthcare

PanelistsDiana MacleanStanford University

Finding What to Look For

Exploratory Visual Analytics for Online Health Communities

Pattern Finding in Point & Interval Event Sequences

!

Ben Shneiderman [email protected] @benbendc

Founding Director (1983-2000), Human-Computer Interaction Lab Professor, Department of Computer Science

Member, Institute for Advanced Computer Studies

University of Maryland College Park, MD 20742

Interdisciplinary research community - Computer Science & Info Studies - Psych, Socio, Poli Sci & MITH (www.cs.umd.edu/hcil)

Patient Histories: Our Research

www.cs.umd.edu/hcil/toolname

Tool Event Types

Records

Display

LifeLines Points, Intervals

One Individual

LifeLines2 Points Many Individual, Summary

Similan Points Many Individual LifeFlow Points Many Individual,

Aggregate EventFlow Points,

Intervals Many

Individual, Aggregate

LifeLines: Patient Histories

www.cs.umd.edu/hcil/lifelines

LifeLines2: Contrast+Creatine


LifeLines2: Align-Rank-Filter & Summarize


LifeLines2: Align-Rank-Filter & Summarize

www.cs.umd.edu/hcil/lifelines2

Similan: Search

www.cs.umd.edu/hcil/similan

LifeFlow: Aggregation Strategy

Temporal Categorical Data (4 records) LifeLines2 format Tree of Event Sequences LifeFlow Aggregation

www.cs.umd.edu/hcil/lifeflow

LifeFlow: Interface with User Controls

EventFlow: Original Dataset

LABA_ICSs Merged

SABAs Merged

Align by First LABA_ICS

Reduce Window Size

Overview + Details

Current Directions

- Motif Simplifications: Find & Replace - Query Features - Menus & Graphical Query - Absence for Points & Intervals - Flexible Temporal Patterns - Scalability - Event types, Events, Records, Query complexity - LP Algorithm - Long-term Case Studies

30th Annual Symposium May 22-23, 2013

www.cs.umd.edu/hcil

@benbendc

Visual Analytics for Discovery of Time-Oriented

Clinical Knowledge or:

You need to Know Something if You Want to Know More

Yuval Shahar, M.D., Ph.D.

Medical Informatics Research Center Department of Information Systems Engineering

Ben Gurion University, Beer Sheva,

Israel [email protected]

Declarative Knowledge in the Medical Domain

•  Many medical tasks, especially those involving chronic patients, require extraction of clinically meaningful concepts from multiple sources of raw, longitudinal, time-oriented data

•  Example: �Modify the standard dose of the drug, if during treatment, the

patient experiences a second episode of moderate anemia that has persisted for at least two weeks�

•  Examples of clinical tasks that require temporal reasoning: –  Therapy

•  Following a treatment plan based on a clinical guideline –  Monitoring and Diagnosis

•  Searching for �a gradual increase of fasting blood-glucose level� –  Quality assessment

•  Comparing observed treatments with those recommended by a guideline –  Research

•  Discovery of hidden dependencies over time between clinical parameters

The Need for Intelligent Mediation: The Gap Between Raw Data and Meaningful Concepts

Clinical databases store raw, time-stamped data BUT: Clinicians and decision-support applications reason in

terms of abstract, clinically meaningful concepts, typically over time periods, AKA Temporal abstractions

! Automated computation of concepts or of temporal

patterns derivable from raw data, using knowledge, supports monitoring, interactive data mining, and automated discovery of meaningful temporal patterns

Bridging the Gap: Knowledge-Based

Monitoring, Exploration, and Discovery •  A distributed architecture that caters for three needs:

–  Automated means for monitoring and recognition of meaningful known patterns, in time-oriented data, by applying temporal-abstraction knowledge from multiple domain-specific knowledge sources to data from multiple data sources

–  Interactive, human-operated means for dynamic visual exploration of a time-oriented data repository, using on-the-fly integration with domain-specific knowledge, to identify new meaningful patterns and add them to the knowledge base

–  Automated analysis, enumeration, and discovery of new meaningful, significant temporal-abstraction patterns (relationships amongst temporal-abstraction intervals)

The Temporal-Abstraction Ontology (Shahar, Artif. Intell. 1997)

• Used by the Knowledge-Based Temporal-Abstraction Method; Includes: • Events (interventions) (e.g., insulin therapy; surgery; irradiation) - part-of, is-a relations • Parameters (measured raw data and derived [abstract] concepts) (e.g., hemoglobin values; anemia levels; liver toxicity grade) - abstracted-into, is-a relations • Patterns (e.g., crescendo angina; paradoxical hyperglycemia) - component-of, is-a relations • Abstraction goals (user views)(e.g., diabetes therapy) - is-a relations • Interpretation contexts (effect of regular insulin; pregnancy; infant) - subcontext, is-a relations • Interpretation contexts are induced by all other entities

Temporal-Abstraction Output Types

• State abstractions (LOW, HIGH) • Gradient abstractions (INC, DEC) • Rate Abstractions (SLOW, FAST) • Pattern Abstractions (CRESCENDO)

- Linear [one-time] patterns - Periodic [repeating] patterns - Fuzzy patterns (partial match)

Temporal-Abstraction Knowledge Types

• Structural (e.g., part-of, is-a relations) - mainly declarative/relational (BMI = ƒ(Wt,Ht))

• Classification (e.g., value ranges; patterns) - mainly functional (BMI = Wt/Ht^2) • Temporal-semantic (e.g., �concatenable��property) - mainly logical (anemia is concatenable; pregnancy is not) • Temporal-dynamic (e.g., interpolation functions) - mainly probabilistic (anemia periods can be bridged)

The IDAN Temporal-Abstraction Mediator [Boaz and Shahar, Artif. Intell. Med 2005]

Temporal- abstraction controller

Knowledge- acquisition tool

Standard medical vocabularies service

Decision support system

Medical knowledge service

Temporal- abstraction service

Medical data Access service

Medical expert

End user (care provider)

The GESHER Knowledge Structuring and Maintenance Tool: Creating a Declarative Knowledge Map from Medical Concepts

[Hatsek et al., OMIJ 2010]

Structured text description

A knowledge map

Constraints on concept values

Overall pattern

Raw clinical data

Intermediate interpretations

Medical knowledge browser

Concept search

The KNAVE-II Single-Subject Browsing and Exploration Interactive Interface [Shahar et al., Artif. Intell. Med 2006]

Evaluation of KNAVE-II (Palo Alto Veterans Administration Health Care System)

(Martins , Shahar, et al., Artif. Intell. Med. 2008)

!  14 clinicians with varying medical/computer use backgrounds !  Each user was given a brief demonstration of the interface !  DB: more than 1000 bone-marrow transplantation patients (2-4yrs) !  Each user asked to answer 10 queries common in oncology protocols !  A cross-over study design compared the KNAVE-II module versus two existing

methods: paper charts and an electronic spreadsheet (ESS) !  (The 2nd phase, using more difficult queries, compared only versus the ESS)

•  Direct Ranking comparison: KNAVE-II ranked first in preference by all users •  SUS Usability Scores: KNAVE-II 69, ESS 48, Paper 46 (P=0.006) •  Time: In the first evaluation: Users were significantly faster using KNAVE-II,

up to a mean of 93 seconds difference versus paper, and 27 seconds versus the ESS, for the hardest query (p = 0.0006); In the second evaluation: The comparison with the ESS showed a similar trend for moderately difficult queries (P=0.007) and for hard queries (p=0.002); the two hardest queries were answered a mean of 277 seconds faster when using KNAVE-II rather than ESS

•  Correctness: for KNAVE-II 92% [110/120]; for ESS 57% [69/120], in the second study; scores were significantly higher for all queries (p<0.0001)

Exploration of Subject Populations: The VISITORS System

[Klimov and Shahar, Artif. Intell. Med. 2010; J. Intell. Info. Sys. 2010]

•  VISualizatIon and exploration of Time-Oriented raw data and abstracted concepts for multiple RecordS

–  Knowledge-based time-oriented interpretations of the raw data –  Graphical construction of subject-selection query expressions –  Visual display and interactive exploration –  Use of absolute time as well as relative time (from some event) –  Multiple-record aggregation and association

•  Evaluated for functionality and usability by clinicians and knowledge engineers, with encouraging results

A VISITORS �Select Subject� Query (1) •  Demographic Constraints:

–  Male subjects, who are Young (age≤20) or Old (age≥70)

Query is automatically and incrementally being created from the user�s graphical specification

OR relation

A VISITORS �Select Subjects� Query (2)

•  Knowledge based constraints Hemoglobin state was abstracted as less than Normal, for at least seven days, starting at a time point that is at least two weeks after the allogenic BMT

WBC count was increasing during the same period

A VISITORS �Select Time Intervals� Query •  Find time intervals (in a monthly resolution) during which the

HGB value state was considered lower than “normal” for more than 50% of the subjects

Multiple-subjects raw data

Medical knowledge browser

Subject groups

Distribution of derived patterns over time

Concept search

The VISITORS Multiple-Records Main Interactive-Display Interface

Temporal Association Charts [Klimov and Shahar, Meth. Info. Med. 2010]

The data of each subject are connected by a line

Abstractions for the same subject group are connected; support and confidence are indicated by width and hue

A Temporal-Mediation Application Example: The MobiGuide Project

•  Coordinated by Mor Peleg, Haifa University, Israel •  Funded by the EU; an FP7 Integrated Project •  13 partners from 5 countries •  Monitoring of chronic patients through bodily sensors and a smart phone

–  Cardiac arrhythmia patients in Italy –  Diabetes and high blood pressure in high-risk pregnancy in Spain

•  Provision of alerts to the patients through the mobile phone, and guideline-based decision support to their care providers through the Web

•  Abstraction of raw time-oriented monitored and historical patient data, to support interpretation, alerting, decision support, quality assessment, and mining performed by a temporal mediator

Temporal Data Mining: Mining Temporal Interval Related Patterns

A Temporal Interval Related Pattern (TIRP) is a conjunction of temporal relations among symbolic time intervals (i.e., abstractions)

{A1 o B, A1 o D, A1 m C1, A1 b C2, A1 b A2, B o D, B c C1, B b C2, B b A2, C1 b C2, C1 b A2, C2 o A1 , D c C1,D o C2}

KarmaLego – Fast TIRP Mining [Moskovitch & Shahar, IDAMAP 2009, AMIA 2009]!

*Ri = {Before, After, During, Overlaps…}

A KarmaLego Example: Looking at a Diabetes Dataset

[Moskovitch & Shahar, AMIA 2009]!

•  Contains 2038 diabetic patients� data accumulating over five years (2002-2007) , monitored by a large HMO

•  Includes monthly measurements such as of HbA1c, Glucose, and Cholesterol values, and medications purchased, including diabetic (insulin-based) medications, statins, and beta-blockers, normalized by the Defined Daily Dose (DDD)

•  The laboratory-test values were abstracted using the KBTA method, based on domain expert specifications

•  The medication doses were abstracted, using the Equal- Width Discretization method, into three states!

0.26 0.18 0.22 0.28

0.25 0.23 0.33 0.42 0.29

Exploration of Diabetes TIRPs: An Example of discovered Patterns

[Moskovitch & Shahar, AMIA 2009]

Shown : Levels of [vertical] support; [No. cases/Horizontal support] D.inc, D.dec, De.stab: drug dose gradient; H.dec, H.inc, H.stab: HbA1C gradient F = Finishes; M = Meets; S = Starts (temporal relations)

The KarmaLego Visualization Tool (I)!

The KarmaLego Visualization Tool (II)!

Automated Classification: Using TIRPs as Features

[Moskovitch & Shahar, IDAMAP 2009]

•  The TIRPs discovered by KarmaLego can be used as features for classification •  Classification was rigorously evaluated in several medical domains

•  Example: An ICU dataset of patients who underwent cardiac surgery at the Academic Medical Center in Amsterdam during April 2002-May 2004

•  Static data include details such as age, gender, surgery type •  Temporal data (HR, BP, FiO2…) measured each minute during first 12

hours • Classification task: Determine whether the patient was mechanically

ventilated more than 24 hours during her postoperative ICU stay •  664 patients; 196 patients were mechanically ventilated for more than

24hrs (29.5%) • Multiple aspects were investigated: The temporal-relations fuzziness

factor value, the discretization method, the feature selection method… • Overall accuracy: 79.6% for most combinations involving 5 discrete

states using a very simple equal-width discretization method

Summary: Intelligent Abstraction, Exploration, and Discovery

of Time-Oriented Data and Their Abstractions •  It takes knowledge to obtain even more knowledge!

•  Distributed integration of time-oriented clinical data and knowledge •  Faster identification of new patterns

•  Goal-directed: By supporting intelligent, interactive visual exploration, by a domain expert, of the contents of the accumulating time-oriented database

•  Data-driven: by automated discovery of frequent temporal patterns •  Quick adaptation to new patterns, by enabling human experts to easily

modify the knowledge base •  Visualization provides concise, meaningful summaries of large amounts of

time-oriented data in terms familiar to the clinicians •  Temporal abstractions can also be used for generation of natural language summaries

•  Suggests an iterative process in which new discovered and validated knowledge is added to the knowledge base and is exploited for the discovery of further medical knowledge

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Finding What to Look For Exploratory Visual Analytics for

Online Health Communities

Diana MacLean, PhD Candidate

Advised by Je!rey Heer Computer Science Dept.

Stanford University [email protected]

Exploratory Visual Analytics

•  Start of research cycle (rinse, repeat) • Goals • Create a mental map of the data • Drive hypotheses generation

•  Useful for • Big(ish) data • Researchers with partial/full domain expertise

FORUM CONTENT

What do users talk about? Do forums contain novel, useful information? Can online health forum participation help patients?

The Raw Data

Creating a Co-Occurrence Graph

Wgat allergy that might trigger asthma? And she has had allergy and asthma problems since birth. It could be asthma, or you could have a heart condition.



asthma allergy



asthma allergy

heart condition

Pain Forum

Pain Forum

Hypothesis: A common discussion pattern in the Pain Management forum is, “I took [DRUG X] after having surgery on [BODY PART Y].”

Pain Forum : Body Parts


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Hypothesis 1: A data-driven derivation of “pain types” from health forum data would closely mirror an expert-derived categorization. Hypothesis 2: We can use data-driven categorization to map out symptom types for conditions that are less understood (e.g. Lyme Disease).

Asthma Forum

Asthma Forum

Hypothesis: Forums related to specific conditions have smaller vocabularies of medically-relevant terms.

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Summary

•  First: figure out what to look for •  Exploratory visual analytics can help us

marshal hypotheses – Quickly – Even with big (ish) data – But without accuracy /completeness guarantees

•  Visualizations can be playful – Fun/accuracy trade-o! – Can we engage non-experts (users), too?

visual analytics for healthcare - panel at amia 2012 in chicago

Health & Medicine

temporalabstraction

raw data

oriented clinical knowledge

timeoriented data example

timeoriented data repository

temporalabstraction

temporal patterns derivable

temporal reasoning