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ABSTRACT
In our project for the Maryland Department of Juvenile Justice we are developing new techniques to visualize youth records. By showing multiple timelines with selectable markers to retrieve detailed information, overviews are always available even for complex records. Data can be zoomed and filtered, and related events can be highlighted. We show how this technique can be used to visualize medical patient records and other personal histories.
Keywords
Visualization, history, timeline, personal record, justice, medical record, screen design, overview, screen management.
INTRODUCTION
Records of personal histories are needed in a variety of applications. Members of the medical and legal professions examine a record to garner information that will allow them to make an informed decision regarding their patient or case. Decision making critically depends on gleaning the complete story, spotting trends, noting critical incidents or cause-effect relationships and reviewing previous actions. While more attention is now put on developing standards for gathering and exchanging personal records (especially in the medical field), we found that virtually no effort had been made to design visualization and navigation techniques to present and explore personal history records.
Tufte [1] describes timelines as a frequent and powerful form of graphic design. A design using timelines for medical records was proposed by Powsner and Tufte [2] who developed a graphical summary using a table of individual plots of test results and treatment data. In project management Gantt charts and PERT charts display the duration and type of tasks in a project but the overviews do not provide the richness needed for personal histories, which are not carefully planned series of tasks, but mosaics of information that contain a variety of events and relationships.
JUVENILE JUSTICE YOUTH RECORD
We worked with the Maryland Department of Juvenile Justice (previously Department of Juvenile Services, a named in the video) to design a youth record visualization. DJJ is using an information system to process over 50,000 cases of delinquent youth behavior per year. With the current system cryptic codes are used to access screens packed with lists of cases, placements or reviews, and to browse complex forms while searching for detail information in dozens of screens.In response LifeLines was designed to 1) present a visual youth record overview on a single screen, 2) provide direct access to all detailed information from the overview with one or two clicks of the mouse, and 3) promote critical information or alerts to the overview level.
Description of the interface
The facets of the youth record were chosen to be the cases, placements, case worker assignments and reviews (Figure 1). Each facet is distinguished from the next by a change of background color. The dates on the timeline legend show that the youth Bart Simpson has been involved with DJJ for about a year. The first facet of the record shows Bart's cases which are indicated by four lines. Bart was first referred to DJJ for "breaking and entering" (B&E code). The case was handled informally and then closed after 3 months. He was referred again for the same offense, also handled informally and then for a more serious auto theft. That time the case was handled formally (i.e. went to the States Attorney's Office - SAO) and Bart was found guilty. The right end of the timelines area shows Bart's current status: we can see that there is only one case open, an attempted murder case for which a decision has not yet been made. The placement facet shows that Bart is currently at Waxter (a detention center), in relation to the attempted murder case. Last year Bart was placed in a drug abuse program for a while and later at Cheltenham (a residential treatment center) when he was found guilty in the auto theft case. The assignment lines show who has worked on Bart's cases. Currently, Brown is assigned to Bart. The last facet is the set of reviews which are discrete events where the youthÕs needs or progress are assessed. Clicking on a review icon displays the review text in an overlapping window. A click on a worker's name gives that worker's contact information. Similarly details about cases or placement are obtained by clicking on the lines or labels.
Interrelationships between periods or events on the lines can be highlighted. For example one cannot tell by looking at the timelines if the drug abuse program was a result of the auto theft case or the breaking and entering case, but clicking on the drug abuse program highlights the related case (i.e. in this instance the B&E case) and the workers assigned.
Line thickness and color can be used to indicate the severity of the offense and the depth of penetration in the system. At the top of the screen, a set of buttons provides access to Bart's general contact information, aliases used, education information, and medical status. Critical keywords from these screens always appear on the overview (e. g. suicide risk).
KEEPING THE OVERVIEW
LifeLines always begins with an overview of the entire record. Unfortunately, some youth records include so many cases that one page is not enough. Screen size limits the number of lines which can be displayed, and the number of events and periods which can be identified on a line. When all the lines and labels cannot be shown in one screen the lines are brought closer to each other and the labels disappear. In this silhouette, it is still possible to see the number of cases and their severity, the type of placements, and the number and date of the reviews. Once the overview has been appreciated, zooming can be used to expand a desired facet or a particular time period, or focus on a given case.
LIFELINES FOR MEDICAL RECORDS
Because our Visual Basic prototype reads a simple input format it was easy to explore other data sets such as our own personal resumes and sample medical records, which lead to new designs and layouts [2]. For example a medical record overview might show alerts, consultations, letters, xrays, lab tests, etc. as icons, while medical conditions, and treatments would be shown as lines with color and size indicating severity or amounts.
ISSUES
For designers, agreeing on an appropriate data encoding scheme is difficult. Icons, colors and thickness codes have to be carefully chosen to avoid biases. For developers, labeling needs to be optimized and smooth rescaling depends on efficient display algorithms. A complete implementation of the LifeLines will need some data entry mechanism to append or correct existing records. Our previous experience shows that constructing time lines by direct manipulation was an adequate solution in scheduling home automation devices [1].
As a general visualization environment, LifeLines is not computationally demanding, requires only high level data descriptions, and can handle a variety of records. These characteristics suggest that LifeLines could be used as a personal record format and rapidly exchanged or synchronized between multiple services.
CONCLUSION
LifeLines can: 1) reduce the chances of missing information, 2) facilitate the spotting of anomalies and trends (intervals are easier to estimate on a timeline than in a table of dates), 3) streamline the access to details as LifeLines act as large menus, and 4) remain simple and tailorable to various applications.
ACKNOWLEDGMENTS
This work was supported in part by the Maryland Department of Juvenile Justice and by the NSF grant NSF EEC 94-02384.
REFERENCES
©Copyright on this material is held by the authors
plaisant@cs.umd.edu