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OUTFLOW
 Visualizing Patients Flow
 by Symptoms & Outcome
  Krist Wongsuphasawat
  David H. Gotz
  IBM T.J. Watson Research Center


                                    mm
Electronic Medical Records
Congestive Heart Failure
                     (CHF)




                             m
Time


Patient #1


    Aug 1998      Oct 1998          Jan 1999
   Ankle Edema   Cardiomegaly       Weight Loss




                                                  m
Many patient records
                                       Time


Patient #1
                     Ankle   Cardio.      Weight

Patient #2
                 Ankle   Cardio.       Rales

Patient #3
                     Ankle                    Rales        Cardio.



Patient #n
                     Ankle Weight Rales               Cardio.
                                                                     m
with outcome
                                   Time


Patient #1                                                       Live (1)
                 Ankle   Cardio.      Weight

Patient #2                                                       Live (1)
             Ankle   Cardio.       Rales

Patient #3                                                       Die (0)
                 Ankle                    Rales        Cardio.



Patient #n                                                       Live (1)
                 Ankle Weight Rales               Cardio.
                                                                     m
information overload!

     6,000 patients


     200,000 symptoms
     6,000,000 medications


                             m
consumable




             m
Overview / Summary



    Millions of records	





                             m
Steps
1.  Aggregation
2.  Visual Encoding
3.  Interactions




                      m
m




Step 1: Aggregation
  Patients   Outflow graph
Patient records


Patient #1

Patient #2
                       Outflow Graph
Patient #3

Patient #4

Patient #5

Patient #6

Patient #7
             …

Patient #n

                               m
Assumption
•  Symptoms are accumulative.

 Patient #1
                  Ankle   Cardio.   Weight



 Patient #1




                                             m
Assumption
•  Symptoms are accumulative.

 Patient #1
                  Ankle   Cardio.   Weight



 Patient #1
                  Ankle   Ankle      Ankle




                                             m
Assumption
•  Symptoms are accumulative.

 Patient #1
                  Ankle   Cardio.   Weight



 Patient #1
                  Ankle   Ankle     Ankle
                          Cardio.   Cardio.




                                              m
Assumption
•  Symptoms are accumulative.

 Patient #1
                  Ankle   Cardio.   Weight



 Patient #1
                  Ankle   Ankle     Ankle
                          Cardio.   Cardio.
                                    Weight




                                              m
Assumption
•  Symptoms are accumulative.

 Patient #1
                  Ankle   Cardio.   Weight



 Patient #1
                  Ankle   Ankle      Ankle
                   [A]    Cardio.    Cardio.
                          [A,C]      Weight
                                    [A,C,W]

      State
                                               m
Select alignment point
  Target patient’s current state




               Ankle
               Cardio.
               Weight	
              [A,C,W]


                                   m
Filter patients
Patient #1
               [A]        [A,C]     [A,C,W]   [A,C,R,W]


Patient #2
              [A]           [A,W]     [A,R,W]    [A,C,R,W]


Patient #3
                    [A]    [A,W]      [A,C,W]   [A,C,D,W]




                                                             m
Select alignment point
            Target patient’s current state




What are the paths                   What are the paths
that led to ?                        after ?

                         Ankle
                         Cardio.
                         Weight	
                        [A,C,W]


                                                          m
Outflow Graph
                      Alignment Point


     [A]      [A,C]




[]

                         [A,C,W]
                                        [A,C,D,W]




                                                    m
Outflow Graph
                      Alignment Point


     [A]      [A,C]




[]            [A,W]

                         [A,C,W]
                                        [A,C,D,W]




                                                    m
Outflow Graph
                      Alignment Point


     [A]      [A,C]
                                        [A,C,R,W]


[]            [A,W]

                         [A,C,W]
                                        [A,C,D,W]




                                                    m
Outflow Graph
                      Alignment Point


     [A]      [A,C]
                                        [A,C,R,W]


[]   [C]      [A,W]

                         [A,C,W]
                                        [A,C,D,W]
     [W]      [C,W]
                        Average outcome = 0.4
                        Average time = 10 days
                        Number of patients = 10

                                                    m
m




Step 2: Visual Encoding
Outflow graph   Outflow visualization
Past                                   Future
                        NOW

                                                          Node’s horizontal position
                                                          shows sequence of states.
                                                   A!
                                                   C!
                                                   W!           End of path
A!

                        A!
                        C!
                             time       link         A!
                                                           Node’s height is
                             edge       edge         C!    number of patients.
                                                     D!
C!



     Color is outcome          Time edge’s width is
     measure.                  duration of transition.                        m
m
m




Step 3: Interactions
 Static vis.   Interactive vis.
Interactions
•    Panning
•    Zooming
•    Brushing + Freezing
•    Tooltip
•    Highlight target




                           m
m




Sample Analysis
What can we learn from it?
Analysis Demo
•  outflow_analysis_demo.mp4




                               m
Steps
1.  Aggregation
  –  Outflow graph
2.  Visual Encoding
  –  Sketch
  –  Visualization
3.  Interactions
  –  Details on demand




                         m
Future Work
•  Evaluation & Design Improvement
•  Use outcome from predictive modeling
•  Similarity measure to select similar patients




                                                   m
Conclusions
•  Electronic Medical Records
   –  Rich information
   –  Large
•  Visualization: Outflow
   –  Visual summary: overview
   –  Interactive exploration: zoom, filter and details
•  Not specific to CHF, or medical domain


                                  Contact me
                                  krist.wongz@gmail.com	

                                  @kristwongz
                                                             m
Soccer Results
                      Alignment Point


      1-0       2-0
                                          2-2


0-0             1-1

                           2-1
                                          3-1
      0-1       0-2
                        Average outcome = win/lose
                        Average time = 10 minutes
                        Number of games = 10

                                                 m
Acknowledgement
•  Charalambos (Harry) Stavropoulos
•  Robert Sorrentino
•  Jimeng Sun




                                      m
Conclusions
•  Electronic Medical Records
   –  Rich information
   –  Large
•  Visualization: Outflow
   –  Visual summary: overview
   –  Interactive exploration: zoom, filter and details
•  Not specific to CHF, or medical domain


                                  Contact me
                                  krist.wongz@gmail.com	

                                  @kristwongz
                                                             m
m




THANK YOU
 ขอบคุณครับ

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Outflow: Visualizing Patients Flow by Symptoms & Outcome