RSS-Feed abonnieren
DOI: 10.3414/ME12-01-0016
Visualization of Medical Data Based on EHR Standards
Publikationsverlauf
received:
14. März 2012
accepted:
20. Oktober 2012
Publikationsdatum:
20. Januar 2018 (online)
Summary
Background: To organize an efficient interaction between a doctor and an EHR the data has to be presented in the most convenient way. Medical data presentation methods and models must be flexible in order to cover the needs of the users with different backgrounds and requirements. Most visualization methods are doctor oriented, however, there are indications that the involvement of patients can optimize healthcare.
Objectives: The research aims at specifying the state of the art of medical data visualization. The paper analyzes a number of projects and defines requirements for a generic ISO 13606 based data visualization method. In order to do so it starts with a systematic search for studies on EHR user interfaces.
Methods: In order to identify best practices visualization methods were evaluated according to the following criteria: limits of application, customizability, re-usability. The visualization methods were compared by using specified criteria.
Results: The review showed that the analyzed projects can contribute knowledge to the development of a generic visualization method. However, none of them proposed a model that meets all the necessary criteria for a re-usable standard based visualization method. The shortcomings were mostly related to the structure of current medical concept specifications.
Conclusion: The analysis showed that medical data visualization methods use hard-coded GUI, which gives little flexibility. So medical data visualization has to turn from a hardcoded user interface to generic methods. This requires a great effort because current standards are not suitable for organizing the management of visualization data. This contradiction between a generic method and a flexible and user-friendly data layout has to be overcome.
-
References
- 1 Shneiderman B. Designing the User Interface: Strategies for Effective Human-Computer Interaction (3rd edition 1997). MA: Addison-Wesley Publishers; 1997.
- 2 Gigerenzer G, Gaissmaier W, Kurz-Milcke E, Schwartz L, Woloshin S. Helping doctors and patients make sense of health statistics. Psychological Science in the Public Interest 2007; 8: 53-96.
- 3 Brodlie K, Carpenter L, Earnshaw R, Gallop J, Hubbold R, Mumford A, Osland C, Quarendon P. Scientific Visualization, Techniques and Applications. Springer Verlag; 1992.
- 4 Gershon N, Eick SG, Card S. Information visualization. ACM Interactions 1998; 5 (02) 9-15.
- 5 Card S, Mackinlay J. The structure of the information visualization design space. In: Proceedings of the InfoVis’97 IEEE Symposium on Information Visualization. Los Alamitos: IEEE Computer Society Press; 1997: 92-99.
- 6 Green TRG, Petre M. Usability analysis of visual programming environments: A `cognitive dimensions’ framework. Journal of Visual Languages and Computing 1996; 7: 131-174.
- 7 Schönhage B, Eliëns A. A flexible architecture for user-adaptable visualization. In: NPIV ’97: Proceedings of the 1997 workshop on New paradigms in information visualization and manipulation. 8-10.
- 8 Smelcer JB, Miller-Jacobs H, Kantrovich L. Usability of Electronic Medical Records. Journal of Usability Studies 2009; 4 (02) 70-84.
- 9 Riet A, Berg M, Hiddema F, Sol K. Meeting patients’ needs with patient information systems: potential benefits of qualitative research methods. Int J Inf 2001; 64 (01) 1-14.
- 10 Ralston JD, Revere D, Robins LS, Goldberg HI. Electronic Personal Health Records Come of Age. American Journal of Medical Quality 2006; 21 (03) suppl 5-15.
- 11 Ralston JD, Revere D, Robins LS, Goldberg HI. Patients’ experience with a diabetes support program based on an interactive electronic medical record: qualitative study. British Medical Journal 2004; 328 7449 11-59.
- 12 Linder JA, Schnipper JL, Tsurikova R. Barriers to electronic health record use during patient visits. AMIA Annu Symp Proc. 2006: 499-503.
- 13 Schellhase KG, Koepsell TD, Norris TE. Providers’ reactions to an automated health maintenance reminder system incorporated into the patient’s electronic medical record. J Am Board Fam Pract 2003; 16 (04) 312-317.
- 14 Koppel R, Metlay JP, Cohen A. et al Role of computerized physician order entry systems in facilitating medication errors. JAMA 2005; 293 (10) 1197-203.
- 15 Burbeck S. Application Programming in Smalltalk-80: How to use Model-View-Controller (MVC). [Internet]. 1992. Available from http://st-www.cs.illinois.edu/users/smarch/st-docs/mvc.html.
- 16 Cios KJ, Moore GW. Uniqueness of medical data mining. Artificial Intelligence in Medicine 2002; 26: 1-24.
- 17 Martínez-Costa C, Tortosa MM, Fernández-Breis JT. An approach for the semantic interoperability of ISO EN 13606 and OpenEHR archetypes. Proceedings of Journal of Biomedical Informatics. 2010: 736-746.
- 18 EN13606 Association Board meeting protocol. 2011. Available from www.pangea.upv.es.en13606/images/docs/association/MinutesDublin201101.pdf.
- 19 Gaithersburg MD. Common industry specification for usability requirements NISTIR 7432. National Institute of Standards and Technology. 2007.
- 20 Peleg M. Sharable Appropriateness Criteria in GLIF3 Using Standards and the Knowledge-Data Ontology Mapper. Proceedings K4CARE. 2009: 64-75.
- 21 Seffah A, Donyaee M, Kline RB, Padda HK. Usability measurement and metrics: A consolidated model. Software Quality Journal 2006; 14: 159-178.
- 22 Manhas S, Vashisht R, Sandhu PS, Neeru N. Reusability Evaluation Model for Procedure Based Software Systems. International Journal of Computer and Electrical Engineering 2010; 2 (06) 1793-8163.
- 23 Kohl CD, Garde S, Knaup P. Facilitating secondary use of medical data by using openEHR archetypes. Stud Health Technol Inform 2010; 160 (02) 1117-1121.
- 24 Wang TD, Wongsuphasawat K, Plaisant C, Shneiderman B. Extracting Insights from Electronic Health Records: Case Studies, a Visual Analytics Process Model and Design Recommendations. J Med Syst 2011; 35 (05) 1135-1152. Epub 2011 May 4
- 25 Wongsuphasawat K, Guerra Gómez J, Plaisant C, Wang TD, Taieb-Maimon M, Shneiderman B. LifeFlow: Visualizing an overview of event sequences. In: Proc of the 29th ACM Int Conf on Human Factors in Comp Syst. New York: 2011: 1747-1756.
- 26 Plaisant P, Rose A. Exploring Lifelines to Visualize Patient records. Poster summary in 1996 American Medical Informatics Association Annual Fall Symposium Oct. 26–30, 1996. AMIA, Bethesda, MD: AMIA. 1996: 884
- 27 Plaisant C, Shneiderman B, Mushlin R. An information architecture to support the visualization of personal histories. Information processing and management 1998; 34 (05) 581-597.
- 28 Wang TD, Plaisant C, Quinn AJ, Stanchak R, Murphy S, Shneiderman B. Aligning temporal data by sentinel events: discovering patterns in electronic health records. CHI ’08: Proceeding of the twenty-sixth annual SIGCHI conference on Human factors in computing systems. 2008: 457-466.
- 29 http://www.healthinfodesign.com/principles.htm (last accessed 22.06.2011).
- 30 van der Linden H, Talmon J, Tange H, Grimson J, Hasman A. PropeR revisited. Int J Medical Inform 2005; 74 2–4 235-244.
- 31 van der Linden H, Austinb T, Talmon J. Generic screen representations for future-proof systems, is it possible?. There is more to a GUI than meets the eye, Computer methods and programs in biomedicine 2009; 95: 213-226.
- 32 van der Linden H, Schuler T, Chen R, Talmon J. Generic screen representations for future proof systems-is it possible? Two-model approach to a generic GUI. Stud Health Technol Inform 2007; 129 Pt 2 1122-1126.
- 33 van der Linden H, Kalra D, Hasman A, Talmon J. Inter-organizational future proof EHR systems. A review of the security and privacy related issues. Int J Med Inform 2009; 78 (03) 141-160.
- 34 Atalag K, Yang HY. From openEHR Domain Models to Advanced User Interfaces: A Case Study in Endoscopy. 2010 Health Informatics New Zealand Conference, Wellington, November 2–4. 2010.
- 35 Atalag K, Yang HY, Tempero E, Warren J. Model driven development of clinical information sytems using openEHR. Stud Health Technol Inform 2011; 169: 849-853.
- 36 Hanzlicek P, Spidlen J, Heroutova H, Nagy M. User interface of MUDR electronic health record. Int J Med Inform 2005; 74: 221-227.
- 37 Hanzlicek P, Spidlen J Nagy. Universal electronic health record MUDR. MStud Health Technol Inform 2004; 105: 190-201.
- 38 Spidlen J, Hanzlícek P, Ríha A. Zvárová. Flexible information storage in MUDR(II) EHR. Int J Med Inform 2006; 75 3–4 201-208.
- 39 Garde S, Hovenga E, Buck J, Knaup P. Expressing Clinical Data Sets with openEHR Archetypes: A Solid Basis for Ubiquitous Computing. Int J Med Inform 2007; 76: S3
- 40 Beale T. Archetypes: Constraint-based domain models for future-proof information systems. In: Eleventh OOPSLA Workshop on Behavioral Semantics: Serving the Customer. Seattle, Washington, USA: Northeastern University; 2002: 16-32.
- 41 ASTM E2369, Standard Specification for Continuity of Care Record (CCR).
- 42 Nygren E, Hendriksson P. Reading the medical record 1 and 2. Computer Methods and Programs in Biomedicine. 1992: 1-39.
- 43 Pyper C, Amery J, Watson M, Crook C. Access to Electronic health records in primary care - a survey of patients’ views. Best Paper Selection for: IMIA Yearbook of Medical Informatics 2006; Assessing Information Technologies for Health. Haux R, Kulikowski C. editors Methods Inf Med 2006; 45 Suppl (Suppl. 01) 41
- 44 Ammenwerth E, Schnell-Inderst P, Hö rbst A. Patient Empowerment by Electronic Health Records: First Results of a Systematic Review on the Benefit of Patient Portals. In Stoicu-Tivadar L, Blobel B, Marcun T, Orel A. (eds.) E-health Across Borders without Boundaries. Studies in Health Technology and Informatics Volume 165. Amsterdam: IOS Press; 2011: 63-67.
- 45 Pare G, Jaana M, Sicotte C. Systematic review of home telemonitoring for chronic diseases: the evidence base. J Am Med Inform Assoc 2007; 14 (03) 269-277.
- 46 Bird LJ, Goodchild A, Sue H. Describing Electronic Health Records Using XML Schema, XML Asia Pacific. 2000. Sydney, Australia:
- 47 Rinner C, Janzek-Hawlat S, Sibinovic S, Duftschmid G. Semantic validation of standard based electronic health record documents with W3C XML Schema. Methods Inf Med 2010; 49 (03) 271-280.
- 48 Hansen CD, Johnson C. Visualization Handbook. Academic Press; 2004.
- 49 Aigner W, Miksch S, Schumann S, Tominski C. Visualization of Time-Oriented Data. Human-Computer Interaction Series. Springer: 2011.
- 50 López DM, Blobel B. Architectural approaches for HL7-based health information systems implementation. Methods Inf Med 2010; 49 (02) 196-204. Epub 2010 Mar 8
- 51 Hoerbst A, Ammenwerth E. Electronic health records. A systematic review on quality requirements. Methods Inf Med 2010; 49 (04) 320-336. Epub 2010 Jul 6
- 52 Poissant L, Pereira J, Tamblyn R, Kawasumi Y. The impact of electronic health records on time efficiency of physicians and nurses: a systematic review. J Am Med Inform Assoc 2005; 12 (05) 505-516.
- 53 Bettencourt-Silva J, De La Iglesia B, Donell S, Rayward-Smith V. On Creating a Patient-centric Database from Multiple Hospital Information Systems. Methods Inf Med 2011; 50 (05) 210-220.
- 54 Klimov D, Shahar Y, Taieb-Maimon M. Intelligent interactive visual exploration of temporal associations among multiple time-oriented patient records. Methods Inf Med 2009; 48 (03) 254-262. Epub 2009 Apr 20
- 55 McKinlay A, McVittie C, Reiter E, Freer Y, Sykes C, Logie R. Design issues for socially intelligent user interfaces. A discourse analysis of a data-to-text system for summarizing clinical data. Methods Inf Med 2010; 49 (04) 379-387. Epub 2009 Dec 21