TimeSpan: Using Visualization to Explore Temporal Multi-dimensional Data of Stroke Patients

Exploring Barriers to Patients' Progression in the Cardiac Rehabilitation Journey From Health Care Providers' Perspectives: Qualitative Study

BACKGROUND

Cardiovascular diseases are one of the leading causes of mortality globally. Cardiac rehabilitation (CR) programs are crucial for patients recovering from cardiac events, as they help reduce the risk of recurrent events and support patient recovery. The patient's journey in CR spans the stages before, during, and after the program. Patients have to progress through each stage of CR programs successfully to complete the entire CR journey and get the full benefits of CR programs, but numerous barriers within this journey can hinder patient progression.

OBJECTIVE

This study aims to explore the barriers to progression at all stages of the CR patient journey from the perspectives of health care providers involved in CR care.

METHODS

This qualitative study involved semistructured interviews with health care providers involved in CR care from July 2023 to January 2024. A purposive maximal variation sampling method was used to target providers with diverse demographics and specialties. Snowball sampling was used to recruit participants, leveraging the existing networks of participants. Each interview lasted between 30 and 45 minutes. Interviews were recorded, transcribed verbatim, and analyzed using an inductive thematic analysis approach. Data analysis was conducted from August 2023 to February 2024.

RESULTS

Ten health care providers, comprising 7 females and 3 males, were interviewed. Their roles included physician, program director, nurse manager, clinical manager, nurse coordinator, nurse, physiotherapist, and kinesiologist. The analysis identified four overarching themes related to barriers to progression in the CR journey: (1) patients not being referred to CR programs, (2) patients not enrolling in CR programs, (3) patients dropping out of CR programs, and (4) patients' lack of adherence to lifestyle changes post-CR programs.

CONCLUSIONS

In light of the growing interest in technological interventions in CR programs, we proposed 4 potential technological solutions to address the barriers to progression identified in our analysis. These solutions aim to provide a foundation for future research to guide the development of effective technologies and enhance patient progression within the CR journey.

PhenoFlow: A Human-LLM Driven Visual Analytics System for Exploring Large and Complex Stroke Datasets

Acute stroke demands prompt diagnosis and treatment to achieve optimal patient outcomes. However, the intricate and irregular nature of clinical data associated with acute stroke, particularly blood pressure (BP) measurements, presents substantial obstacles to effective visual analytics and decision-making. Through a year-long collaboration with experienced neurologists, we developed PhenoFlow, a visual analytics system that leverages the collaboration between human and Large Language Models (LLMs) to analyze the extensive and complex data of acute ischemic stroke patients. PhenoFlow pioneers an innovative workflow, where the LLM serves as a data wrangler while neurologists explore and supervise the output using visualizations and natural language interactions. This approach enables neurologists to focus more on decision-making with reduced cognitive load. To protect sensitive patient information, PhenoFlow only utilizes metadata to make inferences and synthesize executable codes, without accessing raw patient data. This ensures that the results are both reproducible and interpretable while maintaining patient privacy. The system incorporates a slice-and-wrap design that employs temporal folding to create an overlaid circular visualization. Combined with a linear bar graph, this design aids in exploring meaningful patterns within irregularly measured BP data. Through case studies, PhenoFlow has demonstrated its capability to support iterative analysis of extensive clinical datasets, reducing cognitive load and enabling neurologists to make well-informed decisions. Grounded in long-term collaboration with domain experts, our research demonstrates the potential of utilizing LLMs to tackle current challenges in data-driven clinical decision-making for acute ischemic stroke patients.

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.

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.

RASIPAM: Interactive Pattern Mining of Multivariate Event Sequences in Racket Sports

Experts in racket sports like tennis and badminton use tactical analysis to gain insight into competitors' playing styles. Many data-driven methods apply pattern mining to racket sports data - which is often recorded as multivariate event sequences - to uncover sports tactics. However, tactics obtained in this way are often inconsistent with those deduced by experts through their domain knowledge, which can be confusing to those experts. This work introduces RASIPAM, a RAcket-Sports Interactive PAttern Mining system, which allows experts to incorporate their knowledge into data mining algorithms to discover meaningful tactics interactively. RASIPAM consists of a constraint-based pattern mining algorithm that responds to the analysis demands of experts: Experts provide suggestions for finding tactics in intuitive written language, and these suggestions are translated into constraints to run the algorithm. RASIPAM further introduces a tailored visual interface that allows experts to compare the new tactics with the original ones and decide whether to apply a given adjustment. This interactive workflow iteratively progresses until experts are satisfied with all tactics. We conduct a quantitative experiment to show that our algorithm supports real-time interaction. Two case studies in tennis and in badminton respectively, each involving two domain experts, are conducted to show the effectiveness and usefulness of the system.

A Tale of Two Centers: Visual Exploration of Health Disparities in Cancer Care

The annual incidence of head and neck cancers (HNC) worldwide is more than 550,000 cases, with around 300,000 deaths each year. However, the incidence rates and disease-characteristics of HNC differ between treatment centers and different populations, due to undetermined reasons, which may or not include socioeconomic factors. The multi-faceted and multi-variate nature of the data in the context of the emerging field of health disparities research makes automated analysis impractical. Hence, we present a visual analysis approach to explore the health disparities in the data of HNC patients from two different cohorts at two cancer care centers. Our approach integrates data from multiple sources, including census data and city data, with custom visual encodings and with a nearest neighbor approach. Our design, created in collaboration with oncology experts, makes it possible to analyze the patients' demographic, disease characteristics, treatments and outcomes, and to make significant comparisons of these two cohorts and of individual patients. We evaluate this approach through two case studies performed with domain experts. The results demonstrate that this visual analysis approach successfully accomplishes the goal of comparing two cohorts in terms of different significant factors, and can provide insights into the main source of health disparities between the two centers.

THALIS: Human-Machine Analysis of Longitudinal Symptoms in Cancer Therapy

Although cancer patients survive years after oncologic therapy, they are plagued with long-lasting or permanent residual symptoms, whose severity, rate of development, and resolution after treatment vary largely between survivors. The analysis and interpretation of symptoms is complicated by their partial co-occurrence, variability across populations and across time, and, in the case of cancers that use radiotherapy, by further symptom dependency on the tumor location and prescribed treatment. We describe THALIS, an environment for visual analysis and knowledge discovery from cancer therapy symptom data, developed in close collaboration with oncology experts. Our approach leverages unsupervised machine learning methodology over cohorts of patients, and, in conjunction with custom visual encodings and interactions, provides context for new patients based on patients with similar diagnostic features and symptom evolution. We evaluate this approach on data collected from a cohort of head and neck cancer patients. Feedback from our clinician collaborators indicates that THALIS supports knowledge discovery beyond the limits of machines or humans alone, and that it serves as a valuable tool in both the clinic and symptom research.

DPVis: Visual Analytics With Hidden Markov Models for Disease Progression Pathways

Clinical researchers use disease progression models to understand patient status and characterize progression patterns from longitudinal health records. One approach for disease progression modeling is to describe patient status using a small number of states that represent distinctive distributions over a set of observed measures. Hidden Markov models (HMMs) and its variants are a class of models that both discover these states and make inferences of health states for patients. Despite the advantages of using the algorithms for discovering interesting patterns, it still remains challenging for medical experts to interpret model outputs, understand complex modeling parameters, and clinically make sense of the patterns. To tackle these problems, we conducted a design study with clinical scientists, statisticians, and visualization experts, with the goal to investigate disease progression pathways of chronic diseases, namely type 1 diabetes (T1D), Huntington's disease, Parkinson's disease, and chronic obstructive pulmonary disease (COPD). As a result, we introduce DPVis which seamlessly integrates model parameters and outcomes of HMMs into interpretable and interactive visualizations. In this article, we demonstrate that DPVis is successful in evaluating disease progression models, visually summarizing disease states, interactively exploring disease progression patterns, and building, analyzing, and comparing clinically relevant patient subgroups.

Exploring the Design of Streaming Data Interfaces for Emergency Medical Contexts

In this late-breaking work, we describe the design of an interface for displaying streaming vital sign data on a digital checklist used in the emergency medical setting of pediatric trauma resuscitation. We used feedback from interviews and participatory design workshops with clinicians to develop two prototypes of the streaming vital sign interface. We evaluated these prototypes in design-walkthroughs, finding that clinicians preferred the design displaying trend graphs for all four vital signs at once. We discuss how streaming data interfaces on interactive mobile devices can be used to provide situational awareness while unobtrusively supporting different levels of clinical experience.

QualDash: Adaptable Generation of Visualisation Dashboards for Healthcare Quality Improvement

Adapting dashboard design to different contexts of use is an open question in visualisation research. Dashboard designers often seek to strike a balance between dashboard adaptability and ease-of-use, and in hospitals challenges arise from the vast diversity of key metrics, data models and users involved at different organizational levels. In this design study, we present QualDash, a dashboard generation engine that allows for the dynamic configuration and deployment of visualisation dashboards for healthcare quality improvement (QI). We present a rigorous task analysis based on interviews with healthcare professionals, a co-design workshop and a series of one-on-one meetings with front line analysts. From these activities we define a metric card metaphor as a unit of visual analysis in healthcare QI, using this concept as a building block for generating highly adaptable dashboards, and leading to the design of a Metric Specification Structure (MSS). Each MSS is a JSON structure which enables dashboard authors to concisely configure unit-specific variants of a metric card, while offloading common patterns that are shared across cards to be preset by the engine. We reflect on deploying and iterating the design of OualDash in cardiology wards and pediatric intensive care units of five NHS hospitals. Finally, we report evaluation results that demonstrate the adaptability, ease-of-use and usefulness of QualDash in a real-world scenario.

Facilitating the Development of Deep Learning Models with Visual Analytics for Electronic Health Records

Electronic health record (EHR) data are widely used to perform early diagnoses and create treatment plans, which are key areas of research. We aimed to increase the efficiency of iteratively applying data-intensive technology and verifying the results for complex and big EHR data. We used a system entailing sequence mining, interpretable deep learning models, and visualization on data extracted from the MIMIC-IIIdatabase for a group of patients diagnosed with heart disease. The results of sequence mining corresponded to specific pathways of interest to medical staff and were used to select patient groups that underwent these pathways. An interactive Sankey diagram representing these pathways and a heat map visually representing the weight of each variable were developed for temporal and quantitative illustration. We applied the proposed system to predict unplanned cardiac surgery using clinical pathways determined by sequence pattern mining to select cardiac surgery from complex EHRs to label subject groups and deep learning models. The proposed system aids in the selection of pathway-based patient groups, simplification of labeling, and exploratory the interpretation of the modeling results. The proposed system can help medical staff explore various pathways that patients have undergone and further facilitate the testing of various clinical hypotheses using big data in the medical domain.

MetricsVis: A Visual Analytics System for Evaluating Employee Performance in Public Safety Agencies

Evaluating employee performance in organizations with varying workloads and tasks is challenging. Specifically, it is important to understand how quantitative measurements of employee achievements relate to supervisor expectations, what the main drivers of good performance are, and how to combine these complex and flexible performance evaluation metrics into an accurate portrayal of organizational performance in order to identify shortcomings and improve overall productivity. To facilitate this process, we summarize common organizational performance analyses into four visual exploration task categories. Additionally, we develop MetricsVis, a visual analytics system composed of multiple coordinated views to support the dynamic evaluation and comparison of individual, team, and organizational performance in public safety organizations. MetricsVis provides four primary visual components to expedite performance evaluation: (1) a priority adjustment view to support direct manipulation on evaluation metrics; (2) a reorderable performance matrix to demonstrate the details of individual employees; (3) a group performance view that highlights aggregate performance and individual contributions for each group; and (4) a projection view illustrating employees with similar specialties to facilitate shift assignments and training. We demonstrate the usability of our framework with two case studies from medium-sized law enforcement agencies and highlight its broader applicability to other domains.

Dementia Patient Segmentation Using EMR Data Visualization: A Design Study

(1) Background: The Electronic Medical Record system, which is a digital medical record management architecture, is critical for reliable medical research. It facilitates the investigation of disease patterns and efficient treatment via collaboration with data scientists. (2) Methods: In this study, we present multidimensional visual tools for the analysis of multidimensional datasets via a combination of 3-dimensional radial coordinate visualization (3D RadVis) and many-objective optimization (e.g., Parallel Coordinates). Also, we propose a user-driven research design to facilitate visualization. We followed a design process to (1) understand the demands of domain experts, (2) define the problems based on relevant works, (3) design visualization, (4) implement visualization, and (5) enable qualitative evaluation by domain experts. (3) Results: This study provides clinical insight into dementia based on EMR data via visual analysis. Results of a case study based on questionnaires surveying daily living activities indicated that daily behaviors influenced the progression of dementia. (4) Conclusions: This study provides a visual analytical tool to support cluster segmentation. Using this tool, we segmented dementia patients into clusters and interpreted the behavioral patterns of each group. This study contributes to biomedical data interpretation based on a visual approach.

Using Dashboard Networks to Visualize Multiple Patient Histories: A Design Study on Post-Operative Prostate Cancer

In this design study, we present a visualization technique that segments patients' histories instead of treating them as raw event sequences, aggregates the segments using criteria such as the whole history or treatment combinations, and then visualizes the aggregated segments as static dashboards that are arranged in a dashboard network to show longitudinal changes. The static dashboards were developed in nine iterations, to show 15 important attributes from the patients' histories. The final design was evaluated with five non-experts, five visualization experts and four medical experts, who successfully used it to gain an overview of a 2,000 patient dataset, and to make observations about longitudinal changes and differences between two cohorts. The research represents a step-change in the detail of large-scale data that may be successfully visualized using dashboards, and provides guidance about how the approach may be generalized.

Exploration Strategies for Discovery of Interactivity in Visualizations

We investigate how people discover the functionality of an interactive visualization that was designed for the general public. While interactive visualizations are increasingly available for public use, we still know little about how the general public discovers what they can do with these visualizations and what interactions are available. Developing a better understanding of this discovery process can help inform the design of visualizations for the general public, which in turn can help make data more accessible. To unpack this problem, we conducted a lab study in which participants were free to use their own methods to discover the functionality of a connected set of interactive visualizations of public energy data. We collected eye movement data and interaction logs as well as video and audio recordings. By analyzing this combined data, we extract exploration strategies that the participants employed to discover the functionality in these interactive visualizations. These exploration strategies illuminate possible design directions for improving the discoverability of a visualization's functionality.

RegressionExplorer: Interactive Exploration of Logistic Regression Models with Subgroup Analysis

We present RegressionExplorer, a Visual Analytics tool for the interactive exploration of logistic regression models. Our application domain is Clinical Biostatistics, where models are derived from patient data with the aim to obtain clinically meaningful insights and consequences. Development and interpretation of a proper model requires domain expertise and insight into model characteristics. Because of time constraints, often a limited number of candidate models is evaluated. RegressionExplorer enables experts to quickly generate, evaluate, and compare many different models, taking the workflow for model development as starting point. Global patterns in parameter values of candidate models can be explored effectively. In addition, experts are enabled to compare candidate models across multiple subpopulations. The insights obtained can be used to formulate new hypotheses or to steer model development. The effectiveness of the tool is demonstrated for two uses cases: prediction of a cardiac conduction disorder in patients after receiving a heart valve implant and prediction of hypernatremia in critically ill patients.

Novel Interactive Data Visualization: Exploration of the ESCAPE Trial (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) Data

BACKGROUND AND PURPOSE

The ESCAPE (Endovascular Treatment for Small Core and Anterior Circulation Proximal Occlusion With Emphasis on Minimizing CT to Recanalization Times) randomized clinical trial collected a large diverse data set. However, it is difficult to fully understand the effects of the study on certain patient groups and disease progression. We developed and evaluated an interactive visualization of the ESCAPE trial data.

METHODS

We iteratively designed an interactive visualization using Python's Bokeh software library. The design was evaluated through a user study, which quantitatively evaluated its efficiency and accuracy against traditional modified Rankin Scalegraphic. Qualitative feedback was also evaluated.

RESULTS

The novel interactive visualization of the ESCAPE data are publicly available at http://escapevisualization.herokuapp.com/. There was no difference in the efficiency and accuracy when comparing the use of the novel with the traditional visualization. However, users preferred the novel visualization because it allowed for greater exploration. Some insights obtained through exploration of the ESCAPE data are presented.

CONCLUSIONS

Novel interactive visualizations can be applied to acute stroke trial data to allow for greater exploration of the results.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT01778335.

Visualizing High-Dimensional Data: Advances in the Past Decade

Massive simulations and arrays of sensing devices, in combination with increasing computing resources, have generated large, complex, high-dimensional datasets used to study phenomena across numerous fields of study. Visualization plays an important role in exploring such datasets. We provide a comprehensive survey of advances in high-dimensional data visualization that focuses on the past decade. We aim at providing guidance for data practitioners to navigate through a modular view of the recent advances, inspiring the creation of new visualizations along the enriched visualization pipeline, and identifying future opportunities for visualization research.

Exploring the Possibilities of Embedding Heterogeneous Data Attributes in Familiar Visualizations

Heterogeneous multi-dimensional data are now sufficiently common that they can be referred to as ubiquitous. The most frequent approach to visualizing these data has been to propose new visualizations for representing these data. These new solutions are often inventive but tend to be unfamiliar. We take a different approach. We explore the possibility of extending well-known and familiar visualizations through including Heterogeneous Embedded Data Attributes (HEDA) in order to make familiar visualizations more powerful. We demonstrate how HEDA is a generic, interactive visualization component that can extend common visualization techniques while respecting the structure of the familiar layout. HEDA is a tabular visualization building block that enables individuals to visually observe, explore, and query their familiar visualizations through manipulation of embedded multivariate data. We describe the design space of HEDA by exploring its application to familiar visualizations in the D3 gallery. We characterize these familiar visualizations by the extent to which HEDA can facilitate data queries based on attribute reordering.