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Rising costs, decreasing quality of care, diminishing productivity, and increasing complexity have all contributed to the present state of the healthcare industry. The interactions between payers (e.g., insurance companies and health plans) and providers (e.g., hospitals and laboratories) are growing and are becoming more complicated. The constant upsurge in and enhanced complexity of diagnostic and treatment information has made the clinical decision-making process more difficult. Medical transaction charges are greater than ever. Population-specific financial requirements are increasing the economic burden on the entire system. Medical insurance and identity theft frauds are on the rise. The current lack of comparative cost analytics hampers systematic efficiency. Redundant and unnecessary interventions add to medical expenditures that add no value. Contemporary payment models are antithetic to outcome-driven medicine. The rate of medical errors and mistakes is high. Slow inefficient processes and the lack of best practice support for care delivery do not create productive settings. Information technology has an important role to play in approaching these problems. This paper describes IBM Research's approach to helping address these issues, i.e., the evidence-based healthcare platform. [ABSTRACT FROM AUTHOR]

Background: Some physicians in intensive care units (ICUs) report that electronic health records (EHRs) can be cumbersome and disruptive to workflow. There are significant gaps in our understanding of the physician-EHR interaction., Objective: To better understand how clinicians use the EHR for chart review during ICU pre-rounds through the characterisation and description of screen navigation pathways and workflow patterns., Method: We conducted a live, direct observational study of six physician trainees performing electronic chart review during daily pre-rounds in the 30-bed medical ICU at a large academic medical centre in the Southeastern United States. A tailored checklist was used by observers for data collection., Results: We observed 52 distinct live patient chart review encounters, capturing a total of 2.7 hours of pre-rounding chart review activity by six individual physicians. Physicians reviewed an average of 8.7 patients (range = 5-12), spending a mean of 3:05 minutes per patient (range = 1:34-5:18). On average, physicians visited 6.3 (±3.1) total EHR screens per patient (range = 1-16). Four unique screens were viewed most commonly, accounting for over half (52.7%) of all screen visits: results review (17.9%), summary/overview (13.0%), flowsheet (12.7%), and the chart review tab (9.1%). Navigation pathways were highly variable, but several common screen transition patterns emerged across users. Average interrater reliability for the paired EHR observation was 80.0%., Conclusion: We observed the physician-EHR interaction during ICU pre-rounds to be brief and highly focused. Although we observed a high degree of "information sprawl" in physicians' digital navigation, we also identified common launch points for electronic chart review, key high-traffic screens and common screen transition patterns., Implications: From the study findings, we suggest recommendations towards improved EHR design.

This paper focuses on value sets as an essential component in the health analytics ecosystem. We discuss shared repositories of reusable value sets and offer recommendations for their further development and adoption. In order to motivate these contributions, we explain how value sets fit into specific analytic tasks and the health analytics landscape more broadly; their growing importance and ubiquity with the advent of Common Data Models, Distributed Research Networks, and the availability of higher order, reusable analytic resources like electronic phenotypes and electronic clinical quality measures; the formidable barriers to value set reuse; and our introduction of a concept-agnostic orientation to vocabulary collections. The costs of ad hoc value set management and the benefits of value set reuse are described or implied throughout. Our standards, infrastructure, and design recommendations are not systematic or comprehensive but invite further work to support value set reuse for health analytics. The views represented in the paper do not necessarily represent the views of the institutions or of all the co-authors .

Event sequence data is common to a broad range of application domains, from security to health care to scholarly communication. This form of data captures information about the progression of events for an individual entity (e.g., a computer network device; a patient; an author) in the form of a series of time-stamped observations. Moreover, each event is associated with an event type (e.g., a computer login attempt, or a hospital discharge). Analyses of event sequence data have been shown to help reveal important temporal patterns, such as clinical paths resulting in improved outcomes, or an understanding of common career trajectories for scholars. Moreover, recent research has demonstrated a variety of techniques designed to overcome methodological challenges such as large volumes of data and high dimensionality. However, the effective identification and analysis of latent stages of progression, which can allow for variation within different but similarly evolving event sequences, remain a significant challenge with important real-world motivations. In this paper, we propose an unsupervised stage analysis algorithm to identify semantically meaningful progression stages as well as the critical events which help define those stages. The algorithm follows three key steps: (1) event representation estimation, (2) event sequence warping and alignment, and (3) sequence segmentation. We also present a novel visualization system, ET2, which interactively illustrates the results of the stage analysis algorithm to help reveal evolution patterns across stages. Finally, we report three forms of evaluation for ET2: (1) case studies with two real-world datasets, (2) interviews with domain expert users, and (3) a performance evaluation on the progression analysis algorithm and the visualization design.

Aim: This study was performed to better characterize accessibility to electronic health records (EHRs) among informatics professionals in various roles, settings, and organizations across the United States and internationally., Background: The EHR landscape has evolved significantly in recent years, though challenges remain in key areas such as usability. While patient access to electronic health information has gained more attention, levels of access among informatics professionals, including those conducting usability research, have not been well described in the literature. Ironically, many informatics professionals whose aim is to improve EHR design have restrictions on EHR access or publication, which interfere with broad dissemination of findings in areas of usability research., Methods: To quantify the limitations on EHR access and publication rights, we conducted a survey of informatics professionals from a broad spectrum of roles including practicing clinicians, researchers, administrators, and members of industry. Results were analyzed and levels of EHR access were stratified by role, organizational affiliation, geographic region, EHR type, and restrictions with regard to publishing results of usability testing, including screenshots., Results: 126 respondents completed the survey, representing all major geographic regions in the United States. 71.5 percent of participants reported some level of EHR access, while 13 percent reported no access whatsoever. Rates of no-access were higher among faculty members and researchers (19 percent). Among faculty members and researchers, 72 percent could access the EHR for usability and/or research purposes, but, of those, fewer than 1 in 3 could freely publish screenshots with results of usability testing and half could not publish such data at all. Across users from all roles, only 21 percent reported the ability to publish screenshots freely without restrictions., Conclusions: This study offers insight into current patterns of EHR accessibility among informatics professionals, highlighting restrictions that limit dissemination of usability research and testing. Further conversations and shared responsibility among the various stakeholders in industry, government, health care organizations, and informatics professionals are vital to continued EHR optimization.

Patients' medical conditions often evolve in complex and seemingly unpredictable ways. Even within a relatively narrow and well-defined episode of care, variations between patients in both their progression and eventual outcome can be dramatic. Understanding the patterns of events observed within a population that most correlate with differences in outcome is therefore an important task in many types of studies using retrospective electronic health data. In this paper, we present a method for interactive pattern mining and analysis that supports ad hoc visual exploration of patterns mined from retrospective clinical patient data. Our approach combines (1) visual query capabilities to interactively specify episode definitions, (2) pattern mining techniques to help discover important intermediate events within an episode, and (3) interactive visualization techniques that help uncover event patterns that most impact outcome and how those associations change over time. In addition to presenting our methodology, we describe a prototype implementation and present use cases highlighting the types of insights or hypotheses that our approach can help uncover., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Disease progression is often complex and seemingly unpredictable. Moreover, patients often respond in dramatically different ways to various treatments, and determining the appropriate intervention for a patient can sometimes be difficult. In this paper, we describe an interactive visualization-based system for intervention analysis and apply it to patients at risk of developing congestive heart failure (CHF). Text analysis techniques are used to extract Framingham criteria data from clinical notes. We then correlate the progression of these criteria with intervention data. A visualization-based user interface is provided to allow interactive exploration. We present an overview of the system and share clinician feedback regarding the prototype implementation.

The identification of high-risk patients is a critical component in improving patient outcomes and managing costs. This paper describes the Intelligent Care Delivery Analytics platform (ICDA), a system which enables risk assessment analytics that process large collections of dynamic electronic medical data to identify at-risk patients. ICDA works by ingesting large volumes of data into a common data model, then orchestrating a collection of analytics that identify at-risk patients. It also provides an interactive environment through which users can access and review the analytics results. In addition, ICDA provides APIs via which analytics results can be retrieved to surface in external applications. A detailed review of ICDA's architecture is provided. Descriptions of four use cases are included to illustrate ICDA's application within two different data environments. These use cases showcase the system's flexibility and exemplify the types of analytics it enables.

Clustering as a fundamental data analysis technique has been widely used in many analytic applications. However, it is often difficult for users to understand and evaluate multidimensional clustering results, especially the quality of clusters and their semantics. For large and complex data, high-level statistical information about the clusters is often needed for users to evaluate cluster quality while a detailed display of multidimensional attributes of the data is necessary to understand the meaning of clusters. In this paper, we introduce DICON, an icon-based cluster visualization that embeds statistical information into a multi-attribute display to facilitate cluster interpretation, evaluation, and comparison. We design a treemap-like icon to represent a multidimensional cluster, and the quality of the cluster can be conveniently evaluated with the embedded statistical information. We further develop a novel layout algorithm which can generate similar icons for similar clusters, making comparisons of clusters easier. User interaction and clutter reduction are integrated into the system to help users more effectively analyze and refine clustering results for large datasets. We demonstrate the power of DICON through a user study and a case study in the healthcare domain. Our evaluation shows the benefits of the technique, especially in support of complex multidimensional cluster analysis., (© 2011 IEEE)

Electronic health records (EHRs) contain a wealth of information about patients. In addition to providing efficient and accurate records for individual patients, large databases of EHRs contain valuable information about overall patient populations. While statistical insights describing an overall population are beneficial, they are often not specific enough to use as the basis for individualized patient-centric decisions. To address this challenge, we describe an approach based on patient similarity which analyzes an EHR database to extract a cohort of patient records most similar to a specific target patient. Clusters of similar patients are then visualized to allow interactive visual refinement by human experts. Statistics are then extracted from the refined patient clusters and displayed to users. The statistical insights taken from these refined clusters provide personalized guidance for complex decisions. This paper focuses on the cluster refinement stage where an expert user must interactively (a) judge the quality and contents of automatically generated similar patient clusters, and (b) refine the clusters based on his/her expertise. We describe the DICON visualization tool which allows users to interactively view and refine multidimensional similar patient clusters. We also present results from a preliminary evaluation where two medical doctors provided feedback on our approach.

Providing near-term prognostic insight to clinicians helps them to better assess the near-term impact of their decisions and potential impending events affecting the patient. In this work, we present a novel system, which leverages inter-patient similarity for retrieving patients who display similar trends in their physiological time-series data. Data from the retrieved patient cohort is then used to project patient data into the future to provide insights for the query patient. The proposed approach and system were tested using the MIMIC II database, which consists of physiological waveforms, and accompanying clinical data obtained for ICU patients. In the experiments we report the effectiveness of the inter-patient similarity measure and the accuracy of the projection of patients' data. We also discuss the visual interface that conveys the near-term prognostic decision support to the user.

Documents in rich text corpora usually contain multiple facets of information. For example, an article about a specific disease often consists of different facets such as symptom, treatment, cause, diagnosis, prognosis, and prevention. Thus, documents may have different relations based on different facets. Powerful search tools have been developed to help users locate lists of individual documents that are most related to specific keywords. However, there is a lack of effective analysis tools that reveal the multifaceted relations of documents within or cross the document clusters. In this paper, we present FacetAtlas, a multifaceted visualization technique for visually analyzing rich text corpora. FacetAtlas combines search technology with advanced visual analytical tools to convey both global and local patterns simultaneously. We describe several unique aspects of FacetAtlas, including (1) node cliques and multifaceted edges, (2) an optimized density map, and (3) automated opacity pattern enhancement for highlighting visual patterns, (4) interactive context switch between facets. In addition, we demonstrate the power of FacetAtlas through a case study that targets patient education in the health care domain. Our evaluation shows the benefits of this work, especially in support of complex multifaceted data analysis.

Online health information portals provide valuable content to casual consumers. However, the page-oriented nature of these resources makes it difficult for users to understand the overall information space and navigate the complex relationships between various diseases. We have developed a visual analytic system named DiseaseAtlas that helps users navigate a large set of disease-related documents and understand multi-dimensional relationships for key semantic concepts such as symptoms and treatments. This paper describes several unique aspects of DiseaseAtlas and demonstrates its capabilities through a case study.