Doccurate: A Curation-Based Approach for Clinical Text Visualization

HistoriView: Implementation and Evaluation of a Novel Approach to Review a Patient Using a Scalable Space-Efficient Timeline without Zoom Interactions

BACKGROUND

 Timelines have been used for patient review. While maintaining a compact overview is important, merged event representations caused by the intricate and voluminous patient data bring event recognition, access ambiguity, and inefficient interaction problems. Handling large patient data efficiently is another challenge.

OBJECTIVE

 This study aims to develop a scalable, efficient timeline to enhance patient review for research purposes. The focus is on addressing the challenges presented by the intricate and voluminous patient data.

METHODS

 We propose a high-throughput, space-efficient HistoriView timeline for an individual patient. For a compact overview, it uses nonstacking event representation. An overlay detection algorithm, y-shift visualization, and popup-based interaction facilitate comprehensive analysis of overlapping datasets. An i2b2 HistoriView plugin was deployed, using split query and event reduction approaches, delivering the entire history efficiently without losing information. For evaluation, 11 participants completed a usability survey and a preference survey, followed by qualitative feedback. To evaluate scalability, 100 randomly selected patients over 60 years old were tested on the plugin and were compared with a baseline visualization.

RESULTS

 Most participants found that HistoriView was easy to use and learn and delivered information clearly without zooming. All preferred HistoriView over a stacked timeline. They expressed satisfaction on display, ease of learning and use, and efficiency. However, challenges and suggestions for improvement were also identified. In the performance test, the largest patient had 32,630 records, which exceeds the baseline limit. HistoriView reduced it to 2,019 visual artifacts. All patients were pulled and visualized within 45.40 seconds. Visualization took less than 3 seconds for all.

DISCUSSION AND CONCLUSION

 HistoriView allows complete data exploration without exhaustive interactions in a compact overview. It is useful for dense data or iterative comparisons. However, issues in exploring subconcept records were reported. HistoriView handles large patient data preserving original information in a reasonable time.

Seeing Your Stories: Visualization for Narrative Medicine

Importance: Narrative medicine (NM), in which patient stories play a crucial role in their diagnosis and treatment, can potentially support a more holistic approach to patient care than traditional scientific ones. However, there are some challenges in the implementation of narrative medicine, for example, differences in understanding illnesses between physicians and patients and physicians' increased workloads and overloaded schedules. This paper first presents a review to explore previous visualization research for narrative medicine to bridge the gap between visualization researchers and narrative medicine experts and explore further visualization opportunities. Highlights: The review is conducted from 2 perspectives: (a) the contexts and domains in which visualization has been explored for narrative medicine and (b) the forms and solutions applied in these studies. Four applied domains are defined, including understanding patients from narrative records, medical communication, medical conversation training in education, and psychotherapy and emotional wellness enhancement. Conclusions: A future work framework illustrates some opportunities for future research, including groups of specific directions and future points for the 4 domains and 3 technological exploration opportunities (combination of narrative and medical data visualization, task-audience-based visual storytelling, and user-centered interactive visualization). Specifically, 3 directions of future work in medical communication (asynchronous online physician-patient communication, synchronous face-to-face medical conversation, and medical knowledge dissemination) were concluded.

Patient Information Summarization in Clinical Settings: Scoping Review

BACKGROUND

Information overflow, a common problem in the present clinical environment, can be mitigated by summarizing clinical data. Although there are several solutions for clinical summarization, there is a lack of a complete overview of the research relevant to this field.

OBJECTIVE

This study aims to identify state-of-the-art solutions for clinical summarization, to analyze their capabilities, and to identify their properties.

METHODS

A scoping review of articles published between 2005 and 2022 was conducted. With a clinical focus, PubMed and Web of Science were queried to find an initial set of reports, later extended by articles found through a chain of citations. The included reports were analyzed to answer the questions of where, what, and how medical information is summarized; whether summarization conserves temporality, uncertainty, and medical pertinence; and how the propositions are evaluated and deployed. To answer how information is summarized, methods were compared through a new framework "collect-synthesize-communicate" referring to information gathering from data, its synthesis, and communication to the end user.

RESULTS

Overall, 128 articles were included, representing various medical fields. Exclusively structured data were used as input in 46.1% (59/128) of papers, text in 41.4% (53/128) of articles, and both in 10.2% (13/128) of papers. Using the proposed framework, 42.2% (54/128) of the records contributed to information collection, 27.3% (35/128) contributed to information synthesis, and 46.1% (59/128) presented solutions for summary communication. Numerous summarization approaches have been presented, including extractive (n=13) and abstractive summarization (n=19); topic modeling (n=5); summary specification (n=11); concept and relation extraction (n=30); visual design considerations (n=59); and complete pipelines (n=7) using information extraction, synthesis, and communication. Graphical displays (n=53), short texts (n=41), static reports (n=7), and problem-oriented views (n=7) were the most common types in terms of summary communication. Although temporality and uncertainty information were usually not conserved in most studies (74/128, 57.8% and 113/128, 88.3%, respectively), some studies presented solutions to treat this information. Overall, 115 (89.8%) articles showed results of an evaluation, and methods included evaluations with human participants (median 15, IQR 24 participants): measurements in experiments with human participants (n=31), real situations (n=8), and usability studies (n=28). Methods without human involvement included intrinsic evaluation (n=24), performance on a proxy (n=10), or domain-specific tasks (n=11). Overall, 11 (8.6%) reports described a system deployed in clinical settings.

CONCLUSIONS

The scientific literature contains many propositions for summarizing patient information but reports very few comparisons of these proposals. This work proposes to compare these algorithms through how they conserve essential aspects of clinical information and through the "collect-synthesize-communicate" framework. We found that current propositions usually address these 3 steps only partially. Moreover, they conserve and use temporality, uncertainty, and pertinent medical aspects to varying extents, and solutions are often preliminary.

ClinicalPath: A Visualization Tool to Improve the Evaluation of Electronic Health Records in Clinical Decision-Making

Physicians work at a very tight schedule and need decision-making support tools to help on improving and doing their work in a timely and dependable manner. Examining piles of sheets with test results and using systems with little visualization support to provide diagnostics is daunting, but that is still the usual way for the physicians' daily procedure, especially in developing countries. Electronic Health Records systems have been designed to keep the patients' history and reduce the time spent analyzing the patient's data. However, better tools to support decision-making are still needed. In this article, we propose ClinicalPath, a visualization tool for users to track a patient's clinical path through a series of tests and data, which can aid in treatments and diagnoses. Our proposal is focused on patient's data analysis, presenting the test results and clinical history longitudinally. Both the visualization design and the system functionality were developed in close collaboration with experts in the medical domain to ensure a right fit of the technical solutions and the real needs of the professionals. We validated the proposed visualization based on case studies and user assessments through tasks based on the physician's daily activities. Our results show that our proposed system improves the physicians' experience in decision-making tasks, made with more confidence and better usage of the physicians' time, allowing them to take other needed care for the patients.

Out with AI, in with the psychiatrist: a preference for human-derived clinical decision support in depression care

Advancements in artificial intelligence (AI) are enabling the development of clinical support tools (CSTs) in psychiatry to facilitate the review of patient data and inform clinical care. To promote their successful integration and prevent over-reliance, it is important to understand how psychiatrists will respond to information provided by AI-based CSTs, particularly if it is incorrect. We conducted an experiment to examine psychiatrists' perceptions of AI-based CSTs for treating major depressive disorder (MDD) and to determine whether perceptions interacted with the quality of CST information. Eighty-three psychiatrists read clinical notes about a hypothetical patient with MDD and reviewed two CSTs embedded within a single dashboard: the note's summary and a treatment recommendation. Psychiatrists were randomised to believe the source of CSTs was either AI or another psychiatrist, and across four notes, CSTs provided either correct or incorrect information. Psychiatrists rated the CSTs on various attributes. Ratings for note summaries were less favourable when psychiatrists believed the notes were generated with AI as compared to another psychiatrist, regardless of whether the notes provided correct or incorrect information. A smaller preference for psychiatrist-generated information emerged in ratings of attributes that reflected the summary's accuracy or its inclusion of important information from the full clinical note. Ratings for treatment recommendations were also less favourable when their perceived source was AI, but only when recommendations were correct. There was little evidence that clinical expertise or familiarity with AI impacted results. These findings suggest that psychiatrists prefer human-derived CSTs. This preference was less pronounced for ratings that may have prompted a deeper review of CST information (i.e. a comparison with the full clinical note to evaluate the summary's accuracy or completeness, assessing an incorrect treatment recommendation), suggesting a role of heuristics. Future work should explore other contributing factors and downstream implications for integrating AI into psychiatric care.

LargeNetVis: Visual Exploration of Large Temporal Networks Based on Community Taxonomies

Temporal (or time-evolving) networks are commonly used to model complex systems and the evolution of their components throughout time. Although these networks can be analyzed by different means, visual analytics stands out as an effective way for a pre-analysis before doing quantitative/statistical analyses to identify patterns, anomalies, and other behaviors in the data, thus leading to new insights and better decision-making. However, the large number of nodes, edges, and/or timestamps in many real-world networks may lead to polluted layouts that make the analysis inefficient or even infeasible. In this paper, we propose LargeNetVis, a web-based visual analytics system designed to assist in analyzing small and large temporal networks. It successfully achieves this goal by leveraging three taxonomies focused on network communities to guide the visual exploration process. The system is composed of four interactive visual components: the first (Taxonomy Matrix) presents a summary of the network characteristics, the second (Global View) gives an overview of the network evolution, the third (a node-link diagram) enables community- and node-level structural analysis, and the fourth (a Temporal Activity Map - TAM) shows the community- and node-level activity under a temporal perspective. We demonstrate the usefulness and effectiveness of LargeNetVis through two usage scenarios and a user study with 14 participants.

ChartWalk: Navigating large collections of text notes in electronic health records for clinical chart review

Before seeing a patient for the first time, healthcare workers will typically conduct a comprehensive clinical chart review of the patient's electronic health record (EHR). Within the diverse documentation pieces included there, text notes are among the most important and thoroughly perused segments for this task; and yet they are among the least supported medium in terms of content navigation and overview. In this work, we delve deeper into the task of clinical chart review from a data visualization perspective and propose a hybrid graphics+text approach via ChartWalk, an interactive tool to support the review of text notes in EHRs. We report on our iterative design process grounded in input provided by a diverse range of healthcare professionals, with steps including: (a) initial requirements distilled from interviews and the literature, (b) an interim evaluation to validate design decisions, and (c) a task-based qualitative evaluation of our final design. We contribute lessons learned to better support the design of tools not only for clinical chart reviews but also other healthcare-related tasks around medical text analysis.

The Validity, Generalizability and Feasibility of Summative Evaluation Methods in Visual Analytics

Many evaluation methods have been used to assess the usefulness of Visual Analytics (VA) solutions. These methods stem from a variety of origins with different assumptions and goals, which cause confusion about their proofing capabilities. Moreover, the lack of discussion about the evaluation processes may limit our potential to develop new evaluation methods specialized for VA. In this paper, we present an analysis of evaluation methods that have been used to summatively evaluate VA solutions. We provide a survey and taxonomy of the evaluation methods that have appeared in the VAST literature in the past two years. We then analyze these methods in terms of validity and generalizability of their findings, as well as the feasibility of using them. We propose a new metric called summative quality to compare evaluation methods according to their ability to prove usefulness, and make recommendations for selecting evaluation methods based on their summative quality in the VA domain.

Criteria for Rigor in Visualization Design Study

We develop a new perspective on research conducted through visualization design study that emphasizes design as a method of inquiry and the broad range of knowledge-contributions achieved through it as multiple, subjective, and socially constructed. From this interpretivist position we explore the nature of visualization design study and develop six criteria for rigor. We propose that rigor is established and judged according to the extent to which visualization design study research and its reporting are INFORMED, REFLEXIVE, ABUNDANT, PLAUSIBLE, RESONANT, and TRANSPARENT. This perspective and the criteria were constructed through a four-year engagement with the discourse around rigor and the nature of knowledge in social science, information systems, and design. We suggest methods from cognate disciplines that can support visualization researchers in meeting these criteria during the planning, execution, and reporting of design study. Through a series of deliberately provocative questions, we explore implications of this new perspective for design study research in visualization, concluding that as a discipline, visualization is not yet well positioned to embrace, nurture, and fully benefit from a rigorous, interpretivist approach to design study. The perspective and criteria we present are intended to stimulate dialogue and debate around the nature of visualization design study and the broader underpinnings of the discipline.