LifeLines for Visualizing Patient Records

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Project description:

(updated 06/2018)

The Lifelines project started in 1994 with research grant from the Maryland Department of Juvenile Services . We started developing a new technique called Life-Lines to visualize personal history records. In 1995 we started working with IBM Watson Research Center and Kaiser Permanente Colorado to extend the technique to medical records. At the time IBM's Kaiser system was one of very rare computerized system combining data from diverse sources (e.g. notes, pharmacy data, test results, etc.).

LifeLines provided a novel general visualization environment for personal histories. A one screen overview of the record using timelines provides direct access to the data. For a patient record, medical problems, hospitalization and medications can be represented as horizontal lines, while icons represent discrete events such as physician consultations, progress notes or tests. Line color and thickness can illustrate relationships or significance. Semantic zooming and filters allow users to focus on part of the information, revealing more details.

LifeLines are easy to understand with no or limited training and can facilitate the spotting of anomalies and trends, streamline the access to details (as LifeLines act as large menus) and reduce the chances of missing information.

We believe that LifeLines have applicability to a number of the health care projects. Computerized medical records pose tremendous problems to system developers. Infrastructure and privacy issues need to be resolved before physicians can even start using the records. Non-intrusive hardware is required for physicians to do their work (e.g. interview patients) away from their desk. But all the efforts to solve these problems will only succeed if appropriate attention is also given to the user interface design. Long lists to scroll, clumsy searches, endless menus and lengthy dialogs will lead to user frustration. Techniques are being developed to summarize, filter and present large amounts of information, leading us to believe that rapid access to needed data is possible with careful design.

Influence: Examples of commercial or operational systems using some of the principles demonstrated in the Lifelines prototypes:

1: 2: 3: 4:
5: 6: 7: 8:

1) Harvard I2B2 (screenshot ~1997)
2) PatientLikeMe, e.g. Fig.2 from Frost and Massagli, 2008
3) Southampton EPR, from " Rew, D.A. Indian J Surg Oncol (2011)
4) Wand Timeline view of a patient record in Allscripts ambulatory EHR iPad application Used with permission of Allscripts. (screenshot 11/2012)
5) HealthTronics UroChartEHR (Screenshot accessed 07/2014)
6) iSALUS EHR (Screenshot accessed 02/2015) See also the nice Vitals screen)
7) UHR Rennes PEP platform. Screens from 2017 presentation.
8) VIP from Baudel and Brochard paper at Visu 2018 (IBM Fance Lab)

Participants:

Catherine Plaisant, Assistant Research Scientist
Ben Shneiderman, Professor Computer Science
Anne Rose, Faculty Research Assistant
Jia Li, Graduate Student Computer Science
Diane Lindwarm (Alonzo), Graduate Student Psychology
Dan Heller, Undergraduate Student
Partha Ghosh, Graduate Student ISR
Richard Mushlin, IBM Watson Research Center
Aaron Snyder, Kaiser Permanente Colorado
and we thank John Karat (IBM) for his leadership and support

Related Publications:

Plaisant, C., Mushlin, R., Snyder, A., Li, J., Heller, D., Shneiderman, B. http://www.cs.umd.edu/localphp/hcil/tech-reports-search.php?number=
LifeLines: Using Visualization to Enhance Navigation and Analysis of Patient Records
Revised version appeared in 1998 American Medical Informatic Association Annual Fall Symposium (Orlando, Nov. 9-11, 1998) AMIA, Bethesda MD, pp. 76-80

Plaisant, C., Shneiderman, B., Mushlin, R.
An Information Architecture to Support the Visualization of Personal Histories
CS-TR-3855, UMIACS-TR-97-87. Revised version appeared in Information Management and Processing, 34, 5, pp. 581-597, 1998.

Lindwarm D., Rose, A., Plaisant, C., Norman, K. (May 1997)
Viewing personal history records: A comparison of tabular format and graphical presentation using LifeLines
CS-TR-3795, UMIACS-TR-97-45. Revised version appeared in Behavior and Information Technology, 17, 5, 1998, 249-262

Plaisant, C., Rose, A. (March 1996)
Exploring LifeLines to visualize patient records , CS-TR-3620, CAR-TR-819
A short version of this report appeared as a poster summary in 1996 American Medical Informatic Association Annual Fall Symposium (Washington, DC, Oct. 26-30, 1996), pp 884, AMIA, Bethesda MD.

Plaisant, C., Milash, B., Rose, A., Widoff, S., Shneiderman, B. (Sept. 1995)
Life Lines: Visualizing personal histories
ACM CHI '96 Conference Proc. (Vancouver, BC, Canada, April 13-18, 1996) 221-227, color plate 518. See ACM digital library

Videos:

A 1998 video demonstratating LifeLines for Medical Patient Records is available as part of the 1998 HCIL Video Report, 103 MB

YouTube version:

An older video demonstrates LifeLines in the Maryland department of Juvenile Justice application. It is available from HCIL (HCIL 1996 Video Report , 86 MB) or through ACM-SIGCHI as part of the CHI'96 video.
 

Prototypes:

Source Code: The very old java 1.0 code of LifeLines is open source, DownLoad Source Code

Live prototypes Note: they were planned for 1024x768 minimum resolution and 32 MB memory
Last compiled in 1998!

As of June 2014 those old demos still work (yeah!), but you may have to adjust your security settings (e.g. by adding us www.cs.umd.edu as a safe server), and switch internet browser to make sure you can run Java (e.g. on a Mac you may need to switch to Firefox or Safari).
Note that with newer versions of Java some bugs have appeared over the years. For example with Java 1.4, the area representing the future had become transparent...
If anyone is interested in modernizing this old code, let us know :)

Example based on real patient data (developed with the assistance of Aaron Snyder, Kaiser Permanente Colorado)
Demo with imaginary samples - uses richer display attributes

Older demos: Fall 1997 , Summer 1997 , May 1997

Screen prints of underlying data LLD format documentation Screen samples of early explorations of patient record visualization. And in a different domain: a customer record for ebusiness (!!Attention sample data only - Chauffeured demo!!) and a screenshot of it

Sponsors and Partners:

Related pages

Other HCIL projects on visualization of temporal data, e.g. Eventflow for exploring temporal patterns

The original DJJ project where LifeLines was "born".

Related HCIL workshops:

(1997) Visualizing Personal Histories: a Workshop (July 21-22, 1997)
(2004) Personal Medical Devices Workshop: Increasing Patient Healthcare Participation (June 3, 2004)
(2008) Interactive Visual Exploration of Electronic Health Records (May 30, 2008);
and many more, e.g.
(2014) Workshop on Exploring Temporal Patterns in Electronic Health Record Data (Thursday, May 29, 2014)
See also: HealthInfoDesign Resources on design and medical informatics.

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