Design and architecture of the CARA infrastructure for visualising and benchmarking patient data from general practice

OBJECTIVE

Collaborate, Analyse, Research and Audit (CARA) project set out to provide an infrastructure to enable Irish general practitioners (GPs) to use their routinely collected patient management software (PMS) data to better understand their patient population, disease management and prescribing through data dashboards. This paper explains the design and development of the CARA infrastructure.

METHODS

The first exemplar dashboard was developed with GPs and focused on antibiotic prescribing to develop and showcase the proposed infrastructure. The data integration process involved extracting, loading and transforming de-identified patient data into data models which connect to the interactive dashboards for GPs to visualise, compare and audit their data.

RESULTS

The architecture of the CARA infrastructure includes two main sections: extract, load and transform process (ELT, de-identified patient data into data models) and a Representational State Transfer Application Programming Interface (REST API) (which provides the security barrier between the data models and their visualisation on the CARA dashboard). CARAconnect was created to facilitate the extraction and de-identification of patient data from the practice database.

DISCUSSION

The CARA infrastructure allows seamless connectivity with and compatibility with the main PMS in Irish general practice and provides a reproducible template to access and visualise patient data. CARA includes two dashboards, a practice overview and a topic-specific dashboard (example focused on antibiotic prescribing), which includes an audit tool, filters (within practice) and between-practice comparisons.

CONCLUSION

CARA supports evidence-based decision-making by providing GPs with valuable insights through interactive data dashboards to optimise patient care, identify potential areas for improvement and benchmark their performance against other practices.Supplementary file 1. Graphical abstract.

Designing interactive visualizations for analyzing chronic lung diseases in a user-centered approach

OBJECTIVES

Medical practitioners analyze numerous types of data, often using archaic representations that do not meet their needs. Pneumologists who analyze lung function exams must often consult multiple exam records manually, making comparisons cumbersome. Such shortcomings can be addressed with interactive visualizations, but these must be designed carefully with practitioners' needs in mind.

MATERIALS AND METHODS

A workshop with experts was conducted to gather user requirements and common tasks. Based on the workshop results, we iteratively designed a web-based prototype, continuously consulting experts along the way. The resulting application was evaluated in a formative study via expert interviews with 3 medical practitioners.

RESULTS

Participants in our study were able to solve all tasks in accordance with experts' expectations and generally viewed our system positively, though there were some usability and utility issues in the initial prototype. An improved version of our system solves these issues and includes additional customization functionalities.

DISCUSSION

The study results showed that participants were able to use our system effectively to solve domain-relevant tasks, even though some shortcomings could be observed. Using a different framework with more fine-grained control over interactions and visual elements, we implemented design changes in an improved version of our prototype that needs to be evaluated in future work.

CONCLUSION

Employing a user-centered design approach, we developed a visual analytics system for lung function data that allows medical practitioners to more easily analyze the progression of several key parameters over time.

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.

Visual Analytics for Predicting Disease Outcomes Using Laboratory Test Results

Laboratory tests play an essential role in the early and accurate diagnosis of diseases. In this paper, we propose SUNRISE, a visual analytics system that allows the user to interactively explore the relationships between laboratory test results and a disease outcome. SUNRISE integrates frequent itemset mining (i.e., Eclat algorithm) with extreme gradient boosting (XGBoost) to develop more specialized and accurate prediction models. It also includes interactive visualizations to allow the user to interact with the model and track the decision process. SUNRISE helps the user probe the prediction model by generating input examples and observing how the model responds. Furthermore, it improves the user’s confidence in the generated predictions and provides them the means to validate the model’s response by illustrating the underlying working mechanism of the prediction models through visualization representations. SUNRISE offers a balanced distribution of processing load through the seamless integration of analytical methods with interactive visual representations to support the user’s cognitive tasks. We demonstrate the usefulness of SUNRISE through a usage scenario of exploring the association between laboratory test results and acute kidney injury, using large provincial healthcare databases from Ontario, Canada.

VERONICA: Visual Analytics for Identifying Feature Groups in Disease Classification

The use of data analysis techniques in electronic health records (EHRs) offers great promise in improving predictive risk modeling. Although useful, these analysis techniques often suffer from a lack of interpretability and transparency, especially when the data is high-dimensional. The emergence of a type of computational system known as visual analytics has the potential to address these issues by integrating data analysis techniques with interactive visualizations. This paper introduces a visual analytics system called VERONICA that utilizes the natural classification of features in EHRs to identify the group of features with the strongest predictive power. VERONICA incorporates a representative set of supervised machine learning techniques—namely, classification and regression tree, C5.0, random forest, support vector machines, and naive Bayes to support users in developing predictive models using EHRs. It then makes the analytics results accessible through an interactive visual interface. By integrating different sampling strategies, analytics algorithms, visualization techniques, and human-data interaction, VERONICA assists users in comparing prediction models in a systematic way. To demonstrate the usefulness and utility of our proposed system, we use the clinical dataset stored at ICES to identify the best representative feature groups in detecting patients who are at high risk of developing acute kidney injury.

VISEMURE: A Visual Analytics System for Making Sense of Multimorbidity Using Electronic Medical Record Data

Multimorbidity is a growing healthcare problem, especially for aging populations. Traditional single disease-centric approaches are not suitable for multimorbidity, and a holistic framework is required for health research and for enhancing patient care. Patterns of multimorbidity within populations are complex and difficult to communicate with static visualization techniques such as tables and charts. We designed a visual analytics system called VISEMURE that facilitates making sense of data collected from patients with multimorbidity. With VISEMURE, users can interactively create different subsets of electronic medical record data to investigate multimorbidity within different subsets of patients with pre-existing chronic diseases. It also allows the creation of groups of patients based on age, gender, and socioeconomic status for investigation. VISEMURE can use a range of statistical and machine learning techniques and can integrate them seamlessly to compute prevalence and correlation estimates for selected diseases. It presents results using interactive visualizations to help healthcare researchers in making sense of multimorbidity. Using a case study, we demonstrate how VISEMURE can be used to explore the high-dimensional joint distribution of random variables that describes the multimorbidity present in a patient population.

Technology Recommendations to Support Person-Centered Care in Long-Term Care Homes during the COVID-19 Pandemic and Beyond

The COVID-19 pandemic has exposed persistent inequities in the long-term care sector and brought strict social/physical distancing distancing and public health quarantine guidelines that inadvertently put long-term care residents at risk for social isolation and loneliness. Virtual communication and technologies have come to the forefront as the primary mode for residents to maintain connections with their loved ones and the outside world; yet, many long-term care homes do not have the technological capabilities to support modern day technologies. There is an urgent need to replace antiquated technological infrastructures to enable person-centered care and prevent potentially irreversible cognitive and psychological declines by ensuring residents are able to maintain important relationships with their family and friends. To this end, we provide five technological recommendations to support the ethos of person-centered care in residential long-term care homes during the pandemic and  in a post-COVID-19 pandemic world.

Visual Analytics for Electronic Health Records: A Review

The increasing use of electronic health record (EHR)-based systems has led to the generation of clinical data at an unprecedented rate, which produces an untapped resource for healthcare experts to improve the quality of care. Despite the growing demand for adopting EHRs, the large amount of clinical data has made some analytical and cognitive processes more challenging. The emergence of a type of computational system called visual analytics has the potential to handle information overload challenges in EHRs by integrating analytics techniques with interactive visualizations. In recent years, several EHR-based visual analytics systems have been developed to fulfill healthcare experts’ computational and cognitive demands. In this paper, we conduct a systematic literature review to present the research papers that describe the design of EHR-based visual analytics systems and provide a brief overview of 22 systems that met the selection criteria. We identify and explain the key dimensions of the EHR-based visual analytics design space, including visual analytics tasks, analytics, visualizations, and interactions. We evaluate the systems using the selected dimensions and identify the gaps and areas with little prior work.

Predicting Acute Kidney Injury: A Machine Learning Approach Using Electronic Health Records

Acute kidney injury (AKI) is a common complication in hospitalized patients and can result in increased hospital stay, health-related costs, mortality and morbidity. A number of recent studies have shown that AKI is predictable and avoidable if early risk factors can be identified by analyzing Electronic Health Records (EHRs). In this study, we employ machine learning techniques to identify older patients who have a risk of readmission with AKI to the hospital or emergency department within 90 days after discharge. One million patients’ records are included in this study who visited the hospital or emergency department in Ontario between 2014 and 2016. The predictor variables include patient demographics, comorbid conditions, medications and diagnosis codes. We developed 31 prediction models based on different combinations of two sampling techniques, three ensemble methods, and eight classifiers. These models were evaluated through 10-fold cross-validation and compared based on the AUROC metric. The performances of these models were consistent, and the AUROC ranged between 0.61 and 0.88 for predicting AKI among 31 prediction models. In general, the performances of ensemble-based methods were higher than the cost-sensitive logistic regression. We also validated features that are most relevant in predicting AKI with a healthcare expert to improve the performance and reliability of the models. This study predicts the risk of AKI for a patient after being discharged, which provides healthcare providers enough time to intervene before the onset of AKI.