# Presentation: 797563

## www.cse.ogi.edu/footprints

**Paul Gorman, MD **
**Lois Delcambre, PhD**
**David Maier, PhD**

## Bundles in the wild...........

- Observational team:Paul GormanJoan AshMary LavelleJason Lyman

- ..............Bundles in captivity

- Computer science team:Lois DelcambreDave MaierShawn BowersMathew Weaver
-     Rupa Tummala
- 	Sun Murthy

- Oregon Health
- Sciences University

- Oregon Graduate
- Institute of
- Science &
- Technology

## Slide 3

## (Wild) Bundles

## (Wild) Bundles

- There is benefit in creating (active processing of information)
- There is benefit in reusing (trigger memory)
- There is benefit in sharing (establish collective, situated awareness)

## Bundles in the Wild: Managing Information to Solve Problems and Maintain Situation Awareness

- Library Trends, 2000, Volume 49, Number 2
- Paul Gorman, Joan Ash, Mary Lavelle, Jason Lyman, Lois Delcambre, David Maier
- Division of Medical Informatics and Outcomes Research
- Oregon Health Sciences University
- Database and Object Technology Lab
- Computer Science and Engineering Department
- Oregon Graduate Institute

## Bundles: Meeting Clinical Information Needs

- Bulletin of the Medical Library Association
- 2001 (in press)
- Joan Ash, Paul Gorman, Mary Lavelle, Jason Lyman,
- Lois Delcambre, David Maier
- Division of Medical Informatics and Outcomes Research
- Oregon Health Sciences University
- Database and Object Technology Lab
- Computer Science and Engineering Department
- Oregon Graduate Institute

## Following Experts at Work in Their Own Information Spaces: Using Observational Methods to Develop Tools for the Digital Library

- Submitted to the Journal of the American Society of Information Science and Technology 2001
- Paul Gorman, Mary Lavelle, Lois Delcambre, and David Maier
- Division of Medical Informatics and Outcomes Research
- Oregon Health Sciences University
- Database and Object Technology Lab
- Computer Science and Engineering Department
- Oregon Graduate Institute

## Given....

- bundles are everywhere!
- access to bundles provides access to important information
- information in bundles is often copied from other information sources
- We can create bundles in a superimposed application.
- We can keep referenced information linked through the use of marks

## Bundles are superimposed information

- Superimposed
- Layer

- Base
- Layer

*Information Source*1

*Information Source*2

*Information Source*n

*...*

- marks

- Focus on building generic technology

- Superimposed information:
- highlights
- annotates
- elaborates
- selects
- collects
- organizes
- connects
- reuses
- information elements

## Resident’s Worksheet

## SLIMPad

## Slide 13

## Bundles in Captivity: An Application of Superimposed Information

- Lois Delcambre, David Maier, Shawn Bowers, Mathew Weaver, Longxing Deng, Paul Gorman, Joan Ash, Mary Lavelle, Jason Lyman
- Database and Object Technology Lab
- Computer Science and Engineering Department
- Oregon Graduate Institute
- Division of Medical Informatics and Outcomes Research
- Oregon Health Sciences University

- International Conference on Data Engineering
- ICDE 2001
- Heidelberg, Germany

## Representing and Transforming Model-based Information

- Shawn Bowers and Lois Delcambre
- Computer Science Department
- Oregon Graduate Institute
- Invited for submission to a journal

- Semantic Web Workshop
- held in conjunction with the
- European Conference on Digital Libraries
- Lisbon, Portugal

## Uni-level Description of Computer Information

- Patent Application: April 2001
- Lois Delcambre and Shawn Bowers
- A patent describing the generic representation and the transformation techniques
- presented in the Semantic Web Workshop

## What’s the point?

- Information seeking is secondary (problem solving/patient care is primary).
- Expert problem solvers are implicitly making information selections as they work.
- We set out to “reuse human attention” ...
- We set out to explore superimposed information and superimposed applications.

## Results

- Use of bundles is ubiquitous.
- Sharing/reusing bundles is of high benefit.
- Superimposed applications can be built from generic components.
- Easily “clicking through” to the underlying context is of high benefit.

## Serendipitous Results

- Free-form nature of SLIMPad/bundle/scrap model captures human expertise (much like Google mines human expertise – the links placed by humans).
- SLIMPad does not understand the human expertise ... implicit in the SLIMPad content.
- Such work appears in a broad range of applications.
- We are extending SLIMPad.
- We are exploring and validating these findings in a specific medical application.

## Current Investigation:Can SLIMPad Help a Real Task?

**Task**: Hospital Discharge Summary
- Brief summary dictated & transcribed at discharge
- Flexible content/Standard structure
- Chore to create/Highly valued once created
**Problem**: MDs complain about new system
- Like distributed access to (scanned) record, but
- Much more difficult to do discharge summary
- Overwhelming impetus to make everything digital
**Data**: Invite MDs to be videotaped doing work
- First two respondents: Dr. M and Dr. P

## Dr. M. Discharge Summary: Paper Hospital Record

**Tools Available**
- Telephone
- Paper hospital record
- Outline reminder
- Personal notes
- PC (not used)
**Time Elapsed**
- 4 min 31 sec

## Dr. P. Discharge Summary: Electronic Hospital Record

**Tools Available**
- Telephone
- PC # 1: scanned paper record system
- PC # 2: legacy system w/ labs, transcribed rpts
- Blank sheet of paper
**Time Elapsed**
- 19 min 16 sec

## Scanned Hospital Record

## Dueling Residents

## Observations

- Much faster with paper record
- MD creates bundle as part of task
- Selection, organization, and annotation
- Information from disparate sources
- Questions
- Will tool that enables bundle creation (SLIMPad) help MDs perform discharge summary task?
- What if MD were able to create and maintain bundle throughout hospital stay?

## Fertile Ground

- Boeing Service Engineering
- Collaborative Knowledge Management
- Oregon Clinic Cardiologists
- Saturday rounds “handover”
- Intel Corporation
- Consumer Health Information
- NASA Johnson Space Center
- Anomoly response, ? Other applications
- Forest Service Digital Government Project
- Watershed assessment

## http://www.cse.ogi.edu/footprints

## Annotation

## Resident’s Worksheet

- Most information found elsewhere (not all)
- Info from many patients
- Predictable structure, flexible content
- Organic, working document
- Assembled and reused by resident
- Portable, temporary, task-oriented

## Messy Bundles

- Extremely flexible entry, display, content
- Meaningful organization and annotation
- High signal-to-noise
- Portability, immediacy, integration w/ pt care
- Recording benefit to situation awareness
- Physical location meaningful (reminding)

## The Flow Sheet

- Working document, permanent record
- Present and recent past states of patient
- Information exists elsewhere (eventually)
- Highly structured, still flexible content
- Selection, organization, annotation by nurse
- Used by everyone

## Bundle of Bundles

## Use of Flightstrips in French Air Traffic Control

## Information Seeking in Healthcare

- Gathering Patient Data in Clinic

- Patient Care in ICU

- Finding Medical Knowledge

## What information consumes is attention...  A wealth of information produces a poverty of attention

- What information consumes is attention...  A wealth of information produces a poverty of attention

- Herbert Simon

## Beyond the ICU:Are Bundles Unique to Health Care?