Deteriorating conditions in hospital patients are a major factor in clinical patient mortality. Currently, timely detection is based on clinical experience, expertise, and attention. However, healthcare trends towards larger patient cohorts, more data, and the desire for better and more personalized care are pushing the existing, simple scoring systems to their limits. Data-driven approaches can extract decision rules from available medical coding data, which offer good interpretability and thus are key for successful adoption in practice. Before deployment, models need to be scrutinized by domain experts to identify errors and check them against existing medical knowledge. We propose a visual analytics system to support health-care professionals in inspecting and enhancing rule-based classifier through identification of similarities and contradictions, as well as modification of rules. This work was developed iteratively in close collaboration with medical professionals. We discuss how our tool supports the inspection and assessment of rule-based classifiers in the clinical coding domain and propose possible extensions.

Clinical Risk Prognosis

Visualizing Rule-based Classifiers for Clinical Risk Prognosis

A major challenge for departments of public health (DPHs) in dealing with the ongoing COVID-19 pandemic is tracing contacts in exponentially growing SARS-CoV-2 infection clusters. Prevention of further disease spread requires a comprehensive registration of the connections between individuals and clusters. Due to the high number of infections with unknown origin, the healthcare analysts need to identify connected cases and clusters through accumulated epidemiological knowledge and the metadata of the infections in their database. Here we contribute a visual analytics dashboard to identify, assess and visualize clusters in COVID-19 contact tracing networks. Additionally, we demonstrate how graph-based machine learning methods can be used to find missing links between infection clusters and thus support the mission to get a comprehensive view on infection events. This work was developed through close collaboration with DPHs in Germany. We argue how our dashboard supports the identification of clusters by public health experts, discuss ongoing developments and possible extensions.

COVID_Cologne

Uncovering chains of infections through spatio-temporal and visual analysis of COVID-19 contact traces

A large number of clinical concepts are categorized under standardized formats that ease the manipulation, understanding, analysis, and exchange of information. One of the most extended codifications is the International Classification of Diseases (ICD) used for characterizing diagnoses and clinical procedures. With formatted ICD concepts, a patient profile can be described through a set of standardized and sorted attributes according to the relevance or chronology of events. This structured data is fundamental to quantify the similarity between patients and detect relevant clinical characteristics. Data visualization tools allow the representation and comprehension of data patterns, usually of a high dimensional nature, where only a partial picture can be projected. In this paper, we provide a visual analytics approach for the identification of homogeneous patient cohorts by combining custom distance metrics with a flexible dimensionality reduction technique. First we define a new metric to measure the similarity between diagnosis profiles through the concordance and relevance of events. Second we describe a variation of the Simplified Topological Abstraction of Data (STAD) dimensionality reduction technique to enhance the projection of signals preserving the global structure of data. The MIMIC-III clinical database is used for implementing the analysis into an interactive dashboard, providing a highly expressive environment for the exploration and comparison of patients groups with at least one identical diagnostic ICD code. The combination of the distance metric and STAD not only allows the identification of patterns but also provides a new layer of information to establish additional relationships between patient cohorts. The method and tool presented here add a valuable new approach for exploring heterogeneous patient populations. In addition, the distance metric described can be applied in other domains that employ ordered lists of categorical data.

ICU_sub

A visual analytic approach for the identification of ICU patient subpopulations using ICD diagnostic codes

Pathogen outbreaks (i.e., outbreaks of bacteria and viruses) in hospitals can cause high mortality rates and increase costs for hospitals significantly. An outbreak is generally noticed when the number of infected patients rises above an endemic level or the usual prevalence of a pathogen in a defined population. Reconstructing transmission pathways back to the source of an outbreak - the patient zero or index patient - requires the analysis of microbiological data and patient contacts. This is often manually completed by infection control experts. We present a novel visual analytics approach to support the analysis of transmission pathways, patient contacts, the progression of the outbreak, and patient timelines during hospitalization. Infection control experts applied our solution to a real outbreak of Klebsiella pneumoniae in a large German hospital. Using our system, our experts were able to scale the analysis of transmission pathways to longer time intervals (i.e., several years of data instead of days) and across a larger number of wards. Also, the system is able to reduce the analysis time from days to hours. In our final study, feedback from twenty-five experts from seven German hospitals provides evidence that our solution brings significant benefits for analyzing outbreaks.

Transmission Pathways in Hospitals

In Search of Patient Zero: Visual Analytics of Pathogen Transmission Pathways in Hospitals

Public health officials dealing with pandemics like COVID-19 have to evaluate and prepare response plans. This planning phase requires not only looking into the spatiotemporal dynamics and impact of the pandemic using simulation models, but they also need to plan and ensure the availability of resources under different spread scenarios. To this end, we have developed a visual analytics environment that enables public health officials to model, simulate, and explore the spread of COVID-19 by supplying county-level information such as population, demographics, and hospital beds. This environment facilitates users to explore spatiotemporal model simulation data relevant to COVID-19 through a geospatial map with linked statistical views, apply different decision measures at different points in time, and understand their potential impact. Users can drill-down to county-level details such as the number of sicknesses, deaths, needs for hospitalization, and variations in these statistics over time. We demonstrate the usefulness of this environment through a use case study and also provide feedback from domain experts. We also provide details about future extensions and potential applications of this work.

COVID-19 CDSS

A Visual Analytics Based Decision Making Environment for COVID-19 Modeling and Visualization

Nowadays, assessing and improving customer experience has become a priority, and has emerged as a key differentiator for business and organizations worldwide. A customer journey (CJ) is a strategic tool, a map of the steps customers follow when engaging with a company or organization to obtain a product or service. The increase of the need to obtain knowledge about customers’ perceptions and feelings when interacting with participants, touchpoints, and channels through different stages of the customer life cycle. This study aims to describe the application of process mining techniques in healthcare as a tool to asses customer journeys. The appropriateness of the approach presented is illustrated through a case study of a key healthcare process. Results depict how a healthcare process can be mapped through the CJ components, and its analysis can serve to understand and improve the patient’s experience.

PatientProcessMining

Mapping the Patient's Journey in Healthcare through Process Mining

Health care delivery processes consist of complex activity sequences spanning organizational, spatial, and temporal boundaries. Care is human-directed so these processes can have wide variations in cost, quality, and outcome making systemic care process analysis, conformance testing, and improvement challenging. We designed and developed an interactive visual analytic process exploration and discovery tool and used it to explore clinical data from 5784 pediatric asthma emergency department patients.

AsthmaEmergencyVA

Understanding variations in pediatric asthma care processes in the emergency department using visual analytics

In modeling infectious diseases, scientists are studying the mechanisms by which diseases spread, predicting the future course of the outbreak, and evaluating strategies applied to control an epidemic. While recent work has focused on accurately modeling disease spread, less work has been performed in developing interactive decision support tools for analyzing the future course of the outbreak and evaluating potential disease mitigation strategies. The absence of such tools makes it difficult for researchers, analysts and public health officials to evaluate response measures within outbreak scenarios. As such, our research focuses on the development of an interactive decision support environment in which users can explore epidemic models and their impact. This environment provides a spatiotemporal view where users can interactively utilize mitigative response measures and observe the impact of their decision over time. Our system also provides users with a linked decision history visualization and navigation tool that support the simultaneous comparison of mortality and infection rates corresponding to different response measures at different points in time.