Patent Publication Number: US-2010131874-A1

Title: Systems and methods for an active listener agent in a widget-based application

Description:
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     BACKGROUND OF THE INVENTION 
     Healthcare environments, such as hospitals or clinics, include information systems, such as hospital information systems (HIS), radiology information systems (RIS), clinical information systems (CIS), and cardiovascular information systems (CVIS), and storage systems, such as picture archiving and communication systems (PACS), library information systems (LIS), and electronic medical records (EMR). Information stored may include patient medical histories, imaging data, test results, diagnosis information, management information, and/or scheduling information, for example. The information may be centrally stored or divided at a plurality of locations. Healthcare practitioners may desire to access patient information or other information at various points in a healthcare workflow. For example, during and/or after surgery, medical personnel may access patient information, such as images of a patient&#39;s anatomy, that are stored in a medical information system. Radiologist and/or other clinicians may review stored images and/or other information, for example. 
     Using a PACS and/or other workstation, a clinician, such as a radiologist, may perform a variety of activities, such as an image reading, to facilitate a clinical workflow. A reading, such as a radiology or cardiology procedure reading, is a process of a healthcare practitioner, such as a radiologist or a cardiologist, viewing digital images of a patient. The practitioner performs a diagnosis based on a content of the diagnostic images and reports on results electronically (e.g., using dictation or otherwise) or on paper. The practitioner, such as a radiologist or cardiologist, typically uses other tools to perform diagnosis. Some examples of other tools are prior and related prior (historical) exams and their results, laboratory exams (such as blood work), allergies, pathology results, medication, alerts, document images, and other tools. For example, a radiologist or cardiologist typically looks into other systems such as laboratory information, electronic medical records, and healthcare information when reading examination results. 
     Current PACS and/or other reviewing systems provide all available medical information on a screen for a user. However, this information is not organized. In addition, there is currently no way to tell the user which of these data elements are important and which are not. Simply browsing through data is quite problematic as it is a huge disruption in a physician&#39;s workflow and often fails to yield the desired end user results. 
     A variety of clinical data and medical documentation is available throughout various clinical information systems, but it is currently difficult to find, organize, and effectively present the information to physicians and other healthcare providers at a point of care. There are a myriad of difficulties associated with this task. Current systems and methods perform static queries on single data sources, which generally returns information which may or may not be relevant and is typically incomplete. 
     Based on recent studies, computerized physician order entry errors have increased in approximately the last five years. According to the Journal of the American Medical Informatics Association in 2006, unintended adverse consequences from computer entry errors fell into nine major categories (in order of decreasing frequency): 1) more/new work for clinicians, 2) unfavorable workflow issues, 3) never-ending system demands, 4) problems related to paper persistence, 5) untoward changes in communication patterns and practices, 6) negative emotions, 7) generation of new kinds of errors, 8) unexpected changes in the power structure, and 9) and overdependence on technology. Poor usability and user interface design contributes to most if not all of these categories. 
     BRIEF SUMMARY OF THE INVENTION 
     Certain embodiments of the present invention provide systems and methods for providing adaptive, work-centered healthcare services via an adaptive user interface. 
     Certain embodiments provide an adaptive user interface system. The example system includes a user interface including clinical content retrieved from a plurality of clinical information sources for graphical display to a user. The user interface facilitates user interaction with the displayed clinical content, the clinical content including applications and patient data. The example system also includes an active listener agent monitoring the clinical content and user interaction with the clinical content transparently to the user to provide additional clinical content for user interaction via the user interface based on the monitored clinical content and user input. 
     Certain embodiments provide a method for adaptive user interfacing with clinical content. The method includes retrieving clinical content from a plurality of clinical information sources, the clinical content including applications and patient data. The method also includes displaying the clinical content via a user interface for user review and accepting user input in relation to the clinical content via the user interface. The method further includes monitoring, transparent to the user, the clinical content and user input. The method additionally includes providing additional clinical content for user interaction via the user interface based on the monitored clinical content and user input. 
     Certain embodiments provide a machine readable medium having a set of instructions for execution on a computing device. The example set of instructions includes a user interface module including clinical content retrieved from a plurality of clinical information sources for graphical display to a user. The user interface module facilitates user interaction with the displayed clinical content. The clinical content includes applications and patient data. The example set of instructions also includes an active listener module monitoring the clinical content and user interaction with the clinical content transparently to the user to provide additional clinical content for user interaction via the user interface module based on the monitored clinical content and user input. 
    
    
     
       BRIEF DESCRIPTION OF SEVERAL VIEWS OF THE DRAWINGS 
         FIG. 1  illustrates a workflow for providing adaptive, work-centered healthcare services in accordance with certain embodiments of the present invention. 
         FIG. 2  shows an example adaptive user interface in accordance with an embodiment of the present invention. 
         FIG. 3  depicts an example mobile device including a user interface, such as the user interface described in relation to  FIG. 2 . 
         FIG. 4  illustrates an example use case of an adaptive, work-centered user interface in perinatal care in accordance with an embodiment of the present invention. 
         FIG. 5  depicts a user interface architecture in accordance with certain embodiments of the present invention. 
         FIG. 6  depicts an example adaptive user interface system including active listening and response capability in accordance with an embodiment of the present invention. 
         FIG. 7  shows a flow diagram for a method for access to health content via an adaptive, work-centered user interface and supporting architecture in accordance with certain embodiments of the present invention. 
         FIG. 8  shows a block diagram of an example processor system that may be used to implement systems and methods described herein. 
     
    
    
     The foregoing summary, as well as the following detailed description of certain embodiments of the present invention, will be better understood when read in conjunction with the appended drawings. For the purpose of illustrating the invention, certain embodiments are shown in the drawings. It should be understood, however, that the present invention is not limited to the arrangements and instrumentality shown in the attached drawings. 
     DETAILED DESCRIPTION OF THE INVENTION 
     Certain embodiments provide access by an end user to information across enterprise systems. Certain embodiments provide a search-driven, role-based, workflow-based, and/or disease-based interface that allows the end user to access, input, and search medical information seamlessly across a healthcare network. Certain embodiments offer adaptive user interface capabilities through a work-centered interface tailored to individual needs and responsive to changes in a work domain. Certain embodiments introduce an adaptive, work-centered user interface technology software architecture, which embodies two novel concepts. The first concept is to use an ontology modeling approach to characterize a work domain in terms of “work-centered” activities as well as computation mechanisms to achieve an implementation that supports those activities. The second concept is to provide adaptive interaction, both user directed and automated, in work-centered characterization and presentation mechanisms of the user interface to enterprise-level applications. 
     Healthcare information systems are most effective when users are able to find and make use of relevant information across a timeline of patient care. An adaptive user interface can leverage semantic technology to model domain concepts, user roles and tasks, and information relationships, for example. Semantic models enable applications to find, organize and present information to users more effectively based on contextual information about the user and task. Applications can be composed from libraries of information widgets to display multi-content and multi-media information. In addition, the framework enables users to tailor the layout of the widgets and interact with the underlying data. 
     In an example, a new level of adaptive user interface design is achieved by taking advantage of semantic Web technology. Domain concepts and relationships are characterized in a hierarchy of ontologies, associated with upper level ontological constructs that enable adaptive reasoning and extensibility. 
     Thus, certain embodiments offer adaptive user interface capabilities through use of a controller that can “reason” about metadata in an ontology to present users with a work-centered application tailored to individual needs and responsive to changes in a work domain. Targeted information can be delivered from “external” data in an application context-sensitive manner 
     In human-computer interaction, user interface data, events, and frequencies can be displayed, recorded, and organized into episodes. By computing data positioning on the screen, episode frequencies, and implication relations, certain example embodiments can automatically derive application-specific episode associations and therefore enable an application interface to adaptively provide just-in-time assistance to a user. By identifying issues related to designing an adaptive user interface, including interaction tracking, episodes identification, user pattern recognition, user intention prediction, and user profile update, an interface is generated that can act on a user&#39;s behalf to interact with an application based on certain recognized plans. To adapt to different users&#39; needs, the interface can personalize its assistance by learning user profiles and disease-specific workflows, for example. 
     In certain embodiments, an adaptive user interface system includes a search engine, a Web server, an active listener, an information composition engine, a query engine, a data aggregator, a document summarizer, a profile context manager, and clinical and administrative dashboards, for example. Certain embodiments offer a complete view of an entire patient medical record in a user-specific, role-specific, disease-specific manner. In certain embodiments, a user interface can also be configured to provide operation views of data, financial views of data, and also serve as a dashboard for any type of data aggregation. 
     Certain embodiments provide an adaptive, work-centered user interface technology software architecture. The architecture uses an ontology modeling approach to characterize a work domain in terms of “work-centered” activities as well as computation mechanisms that achieve an implementation supporting those activities. The architecture also provides adaptive interaction, both user directed and automated, in the work-centered characterization and presentation mechanisms of the user interface to enterprise-level applications. 
     A work-centered solution helps provide an integrated and tailored system that offers support to work in a flexible and adaptable manner by customizing user interaction according to the situated context in which work is accomplished. Under a work-centered approach, an understanding of the overall targeted work domain is developed. For example, questions used to develop an understanding of the work domain can include what the work domain encompasses, what the goals of work are, who participates in the work domain, and how the participants achieve the goals of the work domain, given a local context. The understanding of the work domain can be used to characterize and, thus, support participants&#39; day-to-day activities. 
     In certain embodiments, an active listener agent operates in a foreground and/or background of a computing device and/or software application, such as a user interface, to monitor user and program activity. For example, the active listener agent can gather information related to widgets in a user interface. The active listener agent can gather information related to actions generated by a user with respect to the user interface and its content, for example. 
     In certain embodiments, based on application (e.g., widget) information and user interaction, the active listener agent can identify information and/or functionality important to a user based on a current context. In an embodiment, if the active listener agent detects that one or more data elements displayed on a user interface reach a predetermined threshold, the active listener automatically places one or more widgets on the user interface that include additional relevant information to help enable the user to make a well-informed decision. In another embodiment, the active listener agent can help the user by reacting to the user&#39;s interaction with an application and provide additional insight by displaying additional information in the form of widget(s) and/or other information on a displayed user interface as a result of the user&#39;s actions. For example, if the user drags a certain data element from one widget to another widget (e.g., via cursor selection of the element and movement across a displayed interface using a mousing device), the active listener agent can reposition (e.g., size and/or location) that information on the displayed interface so that an arrangement of data elements signifies a different level of information useful in helping the user arrive at a conclusion (e.g., regarding diagnosis and/or treatment of a patient). The active listener agent can then either place a pre-made relevant widget on the interface that could be helpful a the particular scenario and/or can create a new widget based on the content of the widget the user changed in addition to the data context on the user interface. 
     Rather than focus on pre-determined workflows, the active listener provides a user with additional information helpful to the user in certain situations where there is no known workflow or protocol. Based on historical data and/or other input, the system displays additional information and/or functionality to the user that is relevant to the user to make an informed decision. In the background of an application and/or interface, for example, the active listener can monitor activity of data elements on a displayed interface. When these data elements reach a certain threshold, the active listener places additional information on the displayed interface to help the user make an informed decision. Alternatively or additionally, the active listener can detect when the user makes a change to an application (e.g., by dragging and dropping a data element from on widget to another widget, by conducting a search, by changing a diagnosis, etc.). By combining a context of user interaction with displayed user interface content, relevant information and/or functionality can be provided to a user, for example. 
       FIG. 1  illustrates a workflow  100  for providing adaptive, work-centered healthcare services in accordance with certain embodiments of the present invention. The workflow  100  includes a patient visit  105  to a doctor, hospital, clinic, etc. From the patient visit  105 , a query  110  is generated by a clinician such as an examining physician, a nurse, etc. The query  110  can include a stimulus  112  observed and a patient context  114 , for example. The query  110  is passed to a query driver  115 . The query driver  115  can query one or more data source  120  and/or a knowledge management subsystem  160 , for example. Data source(s)  120  can include one or more of lab results, diagnostic tests (e.g., x-ray, magnetic resonance image, ultrasound, etc.), patient history, insurance information, billing information, etc. 
     In certain embodiments, the query driver  115  can include and/or be in communication with a Query Enhancement Engine (“QUEEN”). Information may be represented in a plurality of formats including text (e.g., reports and papers), tables (e.g., databases), images (e.g., x-ray and computed tomography scans), and video (e.g., surgical procedures). Furthermore, information often reside on different systems and are stored and/or computed in a heterogeneous environment. 
     The Query Enhancement Engine can be used for retrieving information from disparate information sources  120  based on an information need (e.g., a stimulus  112 ) and a context  114 . First, based on the original query  110  and context  114 , QUEEN determines which information source(s)  120  are most appropriate for retrieving the requested information by consulting an information registry. 
     Once candidate information source(s)  120  have been identified, the query  110  is generated (by the Query Enhancement Engine  115 ) and passed to the information source  120  for retrieval. Different data repositories (file systems, databases, etc) utilize different mechanisms for retrieving data within them. The information source  120  encapsulates these retrieval mechanisms. 
     To improve the precision of retrieval results, it is sometimes beneficial to modify the query prior to retrieval. Query enhancement may involve adding additional terms to a query to improve results. Query refinement may involve removing or substituting terms to a query to improve performance. QUEEN  115  may request information using an initial query and then enhance or refine the query to improve performance, for example. 
     The query  110  is combined with data from the one or more data source  120  and provided to an information composition engine (“ICE”)  125  to compile or bundle data from the data source(s)  120  in response to the query  110 . The ICE  125  can bundle information for presentation from multiple, heterogenous data sources  120 . 
     For example, for a given information need, several different types of information may be desirable for the particular task at hand to form a semantically meaningful bundle of information. A bundle includes one or more types of information (e.g., patient history and lab results). Organizing the various informational items into semantic units is referred to as information composition or bundling. The ICE  125  is responsible for composing the retrieved information from the data source(s)  120  together into a bundle that is meaningful to the user. Bundles may be composed based on the semantic needs of the user, and may also be driven by user preferences, and/or other knowledge appropriate to the domain, for example. 
     In certain embodiments, the ICE  125  uses Composers to compose the information retrieved from the data source(s)  120 . Composers employ Composition Decision Logic (“CDL”), for example, to compose the information. Some examples of CDL include aggregation elimination of redundant information, lightweight summarization of information, and fusion of results, for example. 
     A controller, including an active listener component, for example, can manage the interaction between the QUEEN  115  and the ICE  125 . When the QUEEN  115  has retrieved the information, the information is passed to the ICE  125  for composition and bundling before being delivered to the application or user. The active listener component can monitor and react to information retrieved by the QUEEN  115  and passed to the ICE  125 , for example. 
     During composition, it may be determined that some information is missing or insufficient. In this case, the ICE  125  can inform the controller that information is missing/insufficient. The controller can then inform the Query Engine  115  that one or more queries  110  are to be enhanced or refined in order to improve retrieval performance. The query(ies)  110  are performed again and the results are passed back to the ICE  125  for composition and bundling prior to being returned to the user, for example. 
     The ICE  125  then produces a bundle  130  including relevant information composed and tailored for a requesting user based on context information  114  from the query  110 . The bundle  130  is passed to the summarization engine  135 . The summarization engine  135  provides multi-document summarization for the content of the bundle  130 . Summarization will be described further below. 
     A revised bundle  140 , annotated with summaries from the summarization engine  135 , is used to generate a presentation  145 . The presentation can include a multimedia bundle of text, video and images returned from a metadata search of the data source(s)  120  and including contextual summaries from the summarization engine  135 . A user can drill down into details through the presentation  145 . A user, such as a physician and/or nurse, can use information from the presentation  145  to further diagnose and/or treat the patient. A user&#39;s reaction and/or other feedback  150  from the presentation  145  information can be provided back to the knowledge management subsystem  160  for subsequent use. In certain embodiments, an active listener component to the knowledge management subsystem  160  updates and/or provides additional content and/or application based on the user reaction/feedback  150 , for example. 
     The knowledge management subsystem  160  will now be described in further detail. The knowledge management subsystem  160  includes one or more tools and/or additional information to assist the query driver  115  to form a query to extract relevant information from the data source(s)  120 . Query  110  information, such as stimulus  112  and context  114 , can be input to the knowledge management subsystem  160  to provide relevant tools and/or information for the query driver  115 . Alternatively and/or in addition, clinician reaction and/or other feedback  150  can be fed back into the subsystem  160  to provide further information and/or improve further results from the knowledge management subsystem  160 . 
     As shown, for example, in  FIG. 1 , the knowledge management subsystem  160  includes one or more dashboards  161 , one or more ontologies  163 , procedures and guidelines  165 , a common data model  167 , and analytics  169 . The knowledge management subsystem  160  can provide a Knowledge and Terminology Management Infrastructure (“KTMI”) to the workflow  100 . An ontology  163  details a formal representation of a set of concepts within a domain and the relationships between those concepts. The ontology  163  can be used to define a domain and evaluate properties of that domain. The common data model  167  defines relationships between disparate data entities within a particular environment and establishes a context within which the data entities have meaning. The common data model  167  provides a data model that spans applications and data sources in the workflow  100  and defines data relationships and meanings within the workflow  100 . Using the analytics  169 , for example, the subsystem  160  can access dashboard(s) content  161 , ontology(ies)  163 , and procedures/guidelines  165  based on a common data model  167  to provide output to the query driver  115 . 
     The activity of summarization engine  135  will now be described in further detail. Multi-document summarization is an automatic procedure aimed at extraction of information from multiple texts written about the same topic (e.g., disease across multiple patients). A resulting summary report allows individual users, such as examining physicians, nurses, etc., to quickly familiarize themselves with information included in a large cluster of documents. Thus, the summarization engine  135  can complement the ICE  125  to summarize and annotate content for ease of reference, for example. 
     Multi-document summarization creates information reports that are more concise and comprehensive than a review of the raw data. Different opinions are put together and outlined to describe topics from multiple perspectives within a single document. While a goal of a brief summary is to simplify an information search and reduce time by pointing to the most relevant source documents, a comprehensive multi-document summary should itself contain the requested information, hence limiting the need for accessing original files to cases when refinement is required. Automatic summaries present information extracted from multiple sources algorithmically, without any editorial touch or subjective human intervention, in an attempt to provide unbiased results. 
     However, multi-document summarization is often more complex than summarizing a single document due to thematic diversity within a large set of documents. A summarization technology aims to combine the main document themes with completeness, readability, and conciseness. For example, evaluation criteria for multi-document summarization developed through Document Understanding Conferences, conducted annually by the National Institute of Standards and Technology, can be used. 
     In certain embodiments, the summarization engine  135  does not simply shorten source texts but presents information organized around key aspects of the source texts to represent a wider diversity of views on a given topic. When such quality is achieved, an automatic multi-document summary can be used more like an overview of a given topic. 
     Multi-document summary criteria can include one or more of the following: a clear structure, including an outline of the main content, from which it is easy to navigate to full text sections; text within sections is divided into meaningful paragraphs; a gradual transition from more general to more specific thematic aspects; good readability; etc. with respect to good readability, the automatic overview can show, for example, no paper-unrelated “information noise” from the respective documents (e.g., web pages); no dangling references to subject matter not mentioned or explained in the overview; no text breaks across a sentence; no semantic redundancy; etc. 
     In certain embodiments, a summarization approach includes three steps: 1) segmentation, 2) clustering/classification, and 3) summary generation. An initial text segmentation is performed by dividing or “chunking” a document into paragraphs based on existing paragraph boundaries. Subtitles and one-line paragraphs can be merged, for example. When no paragraph boundaries are present, then chunking can be done by dividing after ever N words (e.g., every 20 words), for example. 
     For clustering, one or more natural language processing (“NLP”) techniques can be applied to measure similarity between two collections of words, for example. For example, paragraphs including similar strings of words (e.g., N-grams) are identified, and a similarity metric is defined to determine whether two passages are similar. For example, a similarity metric can provide an output resembling a cosine function (e.g., results closer to a value of one indicate greater similarity). Passage similarity scores can be computed for all pairs of passages using these metrics. 
     In certain embodiments, it is computationally expensive to look at all combinations of clusters when there are many passages. Therefore, clustering can be performed in two steps: seed clustering and classification. In seed clustering, a complete-link algorithm can be used until a target number of clusters are found. For example, a target number of clusters can be equal to log(number of documents). In classification, remaining passages are then classified by finding a best matching seed cluster. If a passage has no similarity, it is placed in a trash cluster. 
     For summary generation, a most characteristic paragraph is then taken from each cluster to form a “meta document.” A single document summarizer is then used to create a “summary” for the entire collection. The summary is bundled with the information and provided as the bundle  140 . 
     As an example of the workflow  100  in action, suppose that, prior to performing surgery on a patient, a physician wants to know what allergies a patient has. Information about a patient&#39;s allergies may be stored in different systems using a combination of document repositories, file systems, and databases  120 . Using the ICE  125 , a variety of information about the patent&#39;s allergies is found and bundled and presented to the physician. Some of the information may be buried within paragraphs in some documents, while other information is found in database tables, for example. When a system&#39;s databases have been exposed (e.g., through a Connectivity Framework), the ICE  125  and its QUEEN engine can connect to the database  120  to query for information. When a database is not available for a particular system, the document repository for that system can still be searched. The document summarizer  135  can be used to provide summaries of documents retrieved and to cluster related passages from documents retrieved to pull in related patient information. The information is organized into a bundle  140  before being delivered to the user. The information may be organized based on information type, semantics, information relevance, and the confidence score from the underlying repository, for example. 
     In certain embodiments, the workflow  100  supports a user by continually searching for relevant information from connectivity framework components using a query generation engine  115 . Subsequently, these results are classified and bundled through an information composition engine  125  that transforms the information for appropriate presentation to the user. 
     In certain embodiment, an adaptive user interface (“UI”) design is achieved by taking advantage of semantic web technology. For example, domain concepts and relationships are characterized in a hierarchy of ontologies, associated with upper level ontological constructs that enable adaptive reasoning and extensibility. 
     A core ontology can be derived from one or more work-centered design principles. For example, an effective interface can display information that represents a perspective that a user needs on a situated work domain to solve particular types of problems. As another example, information that is the most important to the user in the current work context can be displayed in a focal area to engage the user&#39;s attention. Referential information can be offered in a periphery of a display to preserve context and support work management. As a further example, a user&#39;s own work ontology (e.g., terms and meaning) should be the primary source for information elements in the interface display. 
     Thus, certain embodiments provide adaptive user interface capabilities through use of a controller that can “reason” about metadata in an ontology to present users with a work-centered application tailored to individual needs and responsive to changes in the work domain. Such user interface capabilities help obviate problems associated with browsing “external” data that a connectivity framework can access by offering an interface to deliver targeted information in an application context-sensitive manner. 
     In human-computer interaction, user interface data, events, and frequencies can be displayed, recorded, and organized into episodes. By computing data positioned on a display screen, episode frequencies, and implication relations, application-specific episode associations can be automatically derived to enable an application interface to adaptively provide just-in-time assistance to a user. By identifying issues related to designing an adaptive user interface, including interaction tracking, episodes identification, user pattern recognition, user intention prediction, and user profile update, for example, the interface can act on a user&#39;s behalf to interact with an application based on certain recognized plans. To adapt to different users&#39; needs, the interface can personalize its assistance by learning user profiles and disease-specific workflows, for example. 
       FIG. 2  shows an example adaptive user interface (“UI”)  200  in accordance with an embodiment of the present invention. The UI  200  includes a login and user identification area  205 , a patient identification area  210 , an alert  212 , and a widget display area  215 . The user identification area  205  identifies the user currently logged in for access to the UI  200 . The patient identification area  210  provides identification information for a target patient, such as name, identification number, age, gender, date of birth, social security number, contact information, etc. The alert  212  can provide patient information for the attention of the user, such as an indication that the patient has no allergies. The widget display area  212  includes one or more widgets positionable by a user for use via the UI  200 . 
     For example, as shown in  FIG. 2 , the widget display area  212  includes widgets  220 ,  230 ,  240 ,  250 ,  260 ,  280 . Widgets can provide a variety of information, clinical decision support, search capability, clinical functionality, etc. As shown, for example, in  FIG. 2 , the widget  220  is a vitals/labs widget. The vitals widget  220  provides a visual indicator of one or more vital signs and/or lab test results for the patient. For example, indicators can include blood pressure  221 , urinalysis  223 , weight  225 , glucose  227 , and temperature  229 . Each indicator includes a type and a value. For example, the blood pressure indicator  221  includes a type  222  (e.g., blood pressure) and a value  224  (e.g., 200 over 130). Each indicator  221 ,  223 ,  225 ,  227 ,  229  has a certain color and/or a certain size to indicate an importance of the constituent information from the indicator. For example, the blood pressure indicator  221  is the largest sized indicator in the widget  220 , visually indicating to a user the relative importance of the blood pressure reading  221  over the other results. Urinalysis  223  would follow as next in importance, etc. As another example, blood pressure  221  is colored red, urinalysis  223  is colored orange, weight  225  is colored yellow, and both glucose  227  and temperature  229  are colored green. The color can be used to indicate a degree of severity or importance of the constituent value. For example, blood pressure  221 , colored red, would carry the most importance, urinalysis  223 , colored orange, would be next in importance, etc. Thus, indicator size and/or color can be used together and/or separately to provide the user with an immediate visual indication of a priority to be placed on investigation of patient vitals and lab results. In certain embodiments, selection of an indicator retrieves data, results, and/or document(s) used to generate the information for the indicator. 
     Widget  230  provides a list of clinical documents related to the patient, such as encounter summaries, reports, image analysis, etc. Document information can include a document type  231 , a document author  232 , a document date  233 , an evaluation from the document  234 , a document status  235 , and an action for the document  236 . For example, an entry in the document widget  230  can be of visit summary type  231 , generated by author  232  Dr. Amanda Miller, on a date  233  of Mar. 12, 2008, diagnosing  234  possible pre-eclampsia, with a status  235  of signed, and an action  236  of review. A user can select a document entry to retrieve and display the actual document referenced in the widget  230 . 
     Widget  240  provides one or more imaging studies for review by the user. The imaging studies widget  240  includes one or more images  244  along with an imaging type  246  and an evaluation  248 . For example, as shown in  FIG. 2 , the widget  240  includes a head CT evaluated as normal and a fetal ultrasound image evaluated as normal. 
     Widget  250  provides a visual representation of one or more problems  252 ,  254  identified for the patient. Similar to the vitals widget  220 , the problem indicators  252 ,  254  can have a certain color and/or a certain size to indicate an importance of the constituent information from the problem indicator. For example, in the hypertension problem indicator  242  is colored red and is larger than the other problem indicator  254 . Thus, indicator size and/or color can be used together and/or separately to provide the user with an immediate visual indication of a priority to be placed on investigation of patient problems. In certain embodiments, selection of a problem indicator retrieves data, results, and/or document(s) used to generate the information for the indicator. 
     Widget  260  provides one or more reasons for a patient&#39;s visit to the user. The reason for visit widget  260  includes a reason  262  and an icon  264  allowing the user to expand the reason  262  to view additional detail or collapse the reason  262  to hide additional detail. The reasons  262  can be color coded like the indicators from widgets  220 ,  250  to provide a visual indication of priority, significance, severity, etc. 
     Widget  270  provides a listing of medications prescribed to the patient. The medications widget  270  includes a type  272  of medication, a quantity  274  of the medication, and a delivery mechanism  276  for the medication. In certain embodiments, selection of a medication can pull up further detail about the medication and its associated order, for example. 
     As shown, for example, in  FIG. 2 , a user can manipulate a cursor  280  to select a widget and position the widget at a location  285 . Thus, a user can select widgets for display and then arrange their layout in the widget display area  215  of the UI  200 . Alternatively and/or in addition, the user can reposition widgets in the widget display area  215  to modify the UI  200  layout. For example, using the cursor  280 , the user can place the reason for visit widget  260  in a certain spot  285  on the widget display area  215 . 
     The UI  200  can also provide one or more links to other clinical functionality, such as a user dashboard  292 , a patient list  294 , a settings/preferences panel  296 , and the like. 
     Certain embodiments allow healthcare information systems to find and make use of relevant information across a timeline of patient care. For example, a search-driven, role-based interface allows an end user to access, input, and search medical information seamlessly across a healthcare network. An adaptive user interface provides capabilities through a work-centered interface tailored to individual needs and responsive to changes in a work domain, for example. Semantic technology can be leveraged to model domain concepts, user roles and tasks, and information relationships. The semantic models enable applications to find, organize and present information to users more effectively based on contextual information about the user and task. Components forming a framework for query and result generation include user interface frameworks/components for building applications; server components to enable more efficient retrieval, aggregation, and composition of information based on semantic information and context; and data access mechanisms for connecting to heterogeneous information sources in a distributed environment. 
     A variety of user interface frameworks and technologies can be used to build applications including, Microsoft® ASP.NET, Ajax®, Microsoft® Windows Presentation Foundation, Google® Web Toolkit, Microsoft® Silverlight, Adobe®, and others. Applications can be composed from libraries of information widgets to display multi-content and multi-media information, for example. In addition, the framework enables users to tailor layout of the widgets and interact with underlying data. 
     Healthcare information can be distributed among multiple applications using a variety of database and storage technologies and data formats. To provide a common interface and access to data residing across these applications, a connectivity framework (“CF”) is provided which leverages common data and service models (“CDM” and “CSM”) and service oriented technologies, such as an enterprise service bus (“ESB”) to provide access to the data. 
       FIG. 3  depicts example mobile devices including a user interface, such as the user interface described in relation to  FIG. 2 . As shown in  FIG. 3 , a mobile device  310  can include a graphical user interface  320 , a navigation device  330 , and one or more tools  340  for interaction with the content of the interface  320 , for example. The mobile device  310  can include a cellular phone, personal digital assistant, pocket personal computer, and/or other portable computing device. The mobile device  310  includes a communication interface to exchange data with an external system, for example. 
     A combination of mobile services and Web services can be used for delivery of information via the mobile device  310 . Using Mobile Web Technology, portability, ubiquitous connectivity, and location-based services can be added to enhance information and services found on the Web. Applications and various media do not need to reside in separate silos. Instead, applications on these devices  310  can bring together elements of Web 2.0 applications, traditional desktop applications, multimedia video and audio, and the mobile device (e.g., a cell phone), for example. Using an adaptive user interface architecture, widgets can be designed for mobile devices to enable users to create or consume important clinical information whenever and wherever they need it, for example. 
       FIG. 4  illustrates an example use case of an adaptive, work-centered user interface  400  in perinatal care in accordance with an embodiment of the present invention. In the example of  FIG. 4 , Patricia Smith, a 35-year old pregnant female, is in her 34th week of her third pregnancy. Throughout the course of her care, Patricia has had the typical workup, including initial lab studies, vitals, a three-dimensional (“3D”) fetal ultrasound, and other routine tests. With the exception of her gestational diabetes, Patricia has had a normal pregnancy, and all indications are that she&#39;ll deliver a healthy baby boy at full term. 
     At her 34-week appointment, however, Patricia&#39;s obstetrician/gynecologist becomes somewhat concerned at her blood pressure, which is high compared to previous readings, at 145/95. Dr. Amanda Miller orders an electrocardiogram (“EKG”) and a urinalysis (“UA”) test. Although Patricia&#39;s EKG shows a normal sinus rhythm, her UA comes back with trace amounts of Albumin, suggestive of pre-eclampsia. Dr. Miller asks Patricia to set up her next appointment for one week from today to monitor her blood pressure and kidney function. 
     The following week, Patricia&#39;s blood pressure is higher than the previous value (150/98) and Dr. Miller orders another urinalysis. The UA comes back positive again, but at about the same level as before. Dr. Miller feels it&#39;s prudent to continue the weekly visits until her blood pressure comes down to normal levels. She also mentions to Patricia that one warning sign of eclampsia is a sudden, severe headache, and, if she experiences one, she should go directly to the Emergency Department for care. 
     At her son&#39;s fifth birthday party over the weekend, Patricia comes down with a severe headache. Tom, her husband, immediately takes her to the Emergency Department (“ED”) at the local hospital. The ED staff access all of Patricia&#39;s medical records via a longitudinal timeline record, for example, and become informed about all of the aspects of her case. With Patricia&#39;s blood pressure (“BP”) skyrocketing at 200/130, the ED doc orders a series of tests—UA, EKG, Chem Panel, and a Head CT. Both the Chem Panel and Head CT come back normal but, just as Dr. Miller feared, the UA shows and elevated level of Albumin (2+). Given the result of the tests and Patricia&#39;s condition, the ED doc and Dr. Miller decide the best course of action is to deliver the baby via a C-section as soon as Patricia&#39;s blood pressure comes under control. She is administered Hydralazine (through her IV) to control the hypertension and Tylenol  3  for her headache, and is transported to surgical holding. 
     The C-section was a success, and Patricia and Tom are the proud parents of Evan, a six-pound, four-ounce healthy baby boy. After a week&#39;s stay, both Patricia and Evan are discharged from the hospital. Both Patricia and Evan are examined a week later at Dr. Miller&#39;s office. Patricia&#39;s albumin and blood pressure have returned to normal, as has her blood glucose level. 
     Using the user interface  400 , Dr. Miller can easily review, enter, and modify Patricia&#39;s progress, lab results, vitals, etc., based on an identification of the patient  405 . The UI  400  shows Patricia&#39;s vitals  410  and visually indicates through a large, red icon  415  that Patricia&#39;s blood pressure is of concern. Additionally, abnormal urinalysis results  417  are visually highlighted to the physician. Clinical details  410  of the urinalysis can be easily reviewed, with key results highlighted to indicate positive  425  or negative  427  results. Dr. Miller can review the radiology  430  and cardiology  440  studies she ordered for Patricia and can check documents  450 , including previous progress notes  455  to evaluate Patricia&#39;s progress. Dr. Miller (and/or an assisting nurse, for example) can also enter and review Patricia&#39;s reasons for visiting the hospital  460 . After prescribing the Hydralazine and Tylenol  3 , Dr. Miller can verify the dosage and delivery methods and modify them following the C-section via a Medications widget  470 . If Dr. Miller has further questions and/or wants to search for additional information, a search field  480  allows her to do so. 
       FIG. 5  depicts a user interface architecture  500  in accordance with certain embodiments of the present invention. The architecture  500  includes a user interface transformation engine  502 , a query generation/expansion engine  503 , an information composition engine  509 , a multi-document summarization engine  514 , and one or more connectors  519  to a connectivity framework  545 . The components of the architecture  500  are accessible by a user via a user interface  501  on a processing device, such as a computer or handheld device. The user can submit a query for information via the user interface  501 , for example. 
     The query generation/expansion engine  503  includes a stimulus  504 , one or more query generators  505 , and one or more access mechanisms  506  to search one or more data source  507  to produce a query and collected documents  508 . The query and collected documents  508  are passed to the information composition engine  509  that includes applications  510 ,  511 ,  512 ,  513  that process and apply cognitive reasoning, for example, to organize the query and collected documents  508  into one or more units meaningful to a requesting user based on one or more of semantic guidelines, user preferences, and domain-related information, for example. A toolset including composers can employ Composition Decision Logic (“CDL”), such as aggregation, elimination of redundant information, lightweight summarization of information, and fusion of results, to compose the information. Applications can include one or more data driven applications  510 , enterprise application interfaces  511 , task/process driven applications  512 , and data structure specific applications  513 , for example. The applications  510 ,  511 ,  512 , and/or  513  can include one or more templates related to new data types, new data structures, domain specific tasks/processes, new application interfaces, etc. Composition and processing of the query and collected documents  508  produces a bundle  550  of information in response to a user query. 
     The multi-document summarization engine  514  receives the bundle  550  of documents and segments the documents into passages  515 . The passages  515  are clustered based on similar concepts  516 . A meta-document  517  is then formed from the concepts  516 . A summary  518  is generated from the meta-document  517 . Query results  550 , the meta-document  517 , and/or the meta-document summary  518  can be provided to the user via the user interface  501 . 
     Via connectors  519  to a connectivity framework  545 , the user interface  501  and its engines  503 ,  509 ,  514  can send and receive information in response to user query via the interface  501 , for example. For example, the query engine  503  can access the connectivity framework  545  to query one or more data sources  507 . 
     The connectivity framework  545  includes a client framework  520 . The client framework  520  includes a context manager  521  for one or more products  522 , a patient search  523 , a registry navigator  524 , and a viewer  525 . Thus, in certain embodiments, the connectivity framework  520  can facilitate viewing and access to information via the user interface  501  and apart from the user interface  501 . Via the connectivity framework  545 , the query engine  503  and/or other parts of the user interface  501  can access information and/or services through a plurality of tiers. 
     Tiers can include a client framework tier  526 , an application tier  528 , and an integration tier  530 , for example. The client framework tier  526  includes one or more client web servers  527  facilitating input and output of information, for example. The applicant tier  528  includes one or more applications  529  related to enterprise and/or departmental usage such as business applications, electronic medical records, enterprise applications, electronic health portal, etc. The integration tier  530  includes a consolidated interoperability platform server  535  in communication with customer information technology (“IT”)  543  via one or more factory  536  and/or custom  537  interfaces, such as default and/or customized interfaces using a variety of message formats such as a web service (“WS”), X12, Health Level Seven (“HL7”), etc. The consolidated interoperability platform  535  can communicate with the one or more applications  529  in the application tier  528  via a common service model (“CSM”), for example. 
     As shown, for example, in  FIG. 5 , the consolidated interoperability platform  535  includes an enterprise service bus (“ESB”)  531 , a collection of registries, data, and services  532 , configuration information  533 , and a clinical content gateway (“CCG”) interface engine  534 , for example. The ESB  531  can be a Java business intelligence (“JBI”) compliant ESB, for example. The ESB  531  can include one or more endpoints or locations for accessing a Web service using a particular protocol/data format, such as X12, HL7, SOAP (simple object access protocol), etc., to transmit messages and/or other data, for example. Using a CSM, the ESB  531  facilitates communication with the applications  529  in the application tier  528 , for example. Via the ESB  531 , information in the registries, data and services repository  532  can be provided to the applicant tier  531  in response to a query, for example. Configuration information  533  can be used to specify one or more parameters such as authorized users, levels of authorization for individual users and/or groups/types of users, security configuration information, privacy settings, audit information, etc. The CCG interface engine  531  receives data from the customer IT framework  543  and provides the data to the registries  532  and/or applications  529  in the application tier  531 , for example. 
     As shown, for example, in  FIG. 5 , the customer IT  543  includes support for a third party electronic message passing interface (“eMPI”)  538 , support for a regional health information organization (“RHIO”)  539 , one or more third party applications  540 , support for a cross-enterprise document sharing (“XDS”) repository  541 , support for an XDS registry  542 , and the like. Using customer IT  543  in conjunction with the interoperability platform  535 , a RHIO gateway and third party application integration can be provided via one or more interfaces to the connectivity framework  545  and/or the query generation/expansion engine  503  of the user interface  501 . 
     The customer IT framework  543  can be organized to provide storage, access and searchability of healthcare information across a plurality of organizations. The customer IT framework  543  may service a community, a region, a nation, a group of related healthcare institutions, etc. For example, the customer IT framework  543  can be implemented with the RHIO  539 , a national health information network (“NHIN”), a medical quality improvement consortium (“MQIC”), etc. In certain embodiments, the customer IT  543  connects healthcare information systems and helps make them interoperable in a secure, sustainable, and standards-based manner. 
     In certain embodiments, the customer IT framework  543  provides a technical architecture, web applications, a data repository including EMR capability and a population-based clinical quality reporting system, for example. The architecture includes components for document storage, querying, and connectivity, such as the XDS registry  542  and repository  541 . In certain embodiments, the XDS registry  542  and repository  541  can include an option for a subscription-based EMR for physicians, for example. In certain embodiments, the XDS registry  542  and repository  541  are implemented as a database or other data store adapted to store patient medical record data and associated audit logs in encrypted form, accessible to a patient as well as authorized medical clinics. In an embodiment, the XDS registry  542  and repository  541  can be implemented as a server or a group of servers. The XDS registry  542  and repository  541  can also be one server or group of servers that is connected to other servers or groups of servers at separate physical locations. The XDS registry  542  and repository  541  can represent single units, separate units, or groups of units in separate forms and may be implemented in hardware and/or in software. The XDS registry  542  and repository  541  can receive medical information from a plurality of sources. 
     Using an XDS standard, for example, in the customer IT framework  543 , document querying and storage can be integrated for more efficient and uniform information exchange. Using the customer IT  543 , quality reporting and research may be integrated in and/or with an RHIO  539  and/or other environment. The customer IT  543  can provide a single-vendor integrated system that can integrate and adapt to other standards-based systems, for example. 
     Via the customer IT framework  543 , a group of EMR users may agree to pool data at the XDS registry  542  and repository  541 . The customer IT framework  543  can then provide the group with access to aggregated data for research, best practices for patient diagnosis and treatment, quality improvement tools, etc. 
     XDS provides registration, distribution, and access across healthcare enterprises to clinical documents forming a patient EMR. XDS provides support for storage, indexing, and query/retrieval of patient documents via a scalable architecture. Certain embodiments, however, support multiple affinity domains (defined as a group of healthcare enterprise systems that have agreed upon policies to share their medical content with each other via a common set of policies and a single registry) such that each affinity domain retains its autonomy as a separate affinity domain but shares one instance of hardware and software with the other involved affinity domains. The XDS registry  542  and repository  541  can maintain an affinity domain relationship table used to describe clinical systems participating in each affinity domain. Once a request for a document is made, the source of the request is known and is used to determine which document(s) in the repository  541  are exposed to the requesting user, thus maintaining the autonomy of the affinity domain. 
     In certain embodiments, the XDS registry  542  and repository  541  represent a central database for storing encrypted update-transactions for patient medical records, including usage history. In an embodiment, the XDS registry  542  and repository  541  also store patient medical records. The XDS registry  542  and repository  541  store and control access to encrypted information. In an embodiment, medical records can be stored without using logic structures specific to medical records. In such a manner the XDS registry  542  and repository  541  is not searchable. For example, a patient&#39;s data can be encrypted with a unique patient-owned key at the source of the data. The data is then uploaded to the XDS registry  542  and repository  541 . The patient&#39;s data can be downloaded to, for example, a computer unit and decrypted locally with the encryption key. In an embodiment, accessing software, for example software used by the patient and software used by the medical clinic performs the encryption/decryption. 
     In certain embodiments, the XDS registry  542  and repository  541  maintain a registration of patients and a registration of medical clinics. Medical clinics may be registered in the XDS registry  542  and repository  541  with name, address, and other identifying information. The medical clinics are issued an electronic key that is associated with a certificate. The medical clinics are also granted a security category. The security category is typically based on clinic type. In certain embodiments, the requests and data sent from medical clinics are digitally signed with the clinic&#39;s certificate and authenticated by the XDS registry  542  and repository  541 . Patients may be registered in the XDS registry  542  and repository  541  with a patient identifier and password hash. Patients may also be registered in the XDS registry  542  and repository  541  with name, address, and other identifying information. Typically, registered patients are issued a token containing a unique patient identifier and encryption key. The token may be, for example, a magnetic card, a fob card, or some other equipment that may be used to identify the patient. A patient may access the XDS registry  542  and repository  541  utilizing their token, and, in an embodiment, a user identifier and password. 
     In certain embodiments, design of the user interface architecture  500  is guided by a plurality of factors related to the interactive nature of the system. For example, one factor is visibility of system status. The system can keep users informed about what is going on through appropriate feedback within reasonable time. Additionally, another factor is a match between the system and the “real world.” The system can speak the user&#39;s language, with words, phrases and concepts familiar to the user, rather than system-oriented terms. For example, information can follow real-world conventions and appear in a natural and logical order. Additionally, with respect to consistency and standards, users should not have to wonder whether different words, situations, or actions mean the same thing. The interface architecture can follow platform conventions, for example. 
     Another example factor relates to user control and freedom. Users often choose system functions by mistake and need a clearly marked “emergency exit” to leave the unwanted state without having to go through an extended dialogue. Certain embodiments support undo and redo operations related to configuration of system parameters and information query, for example. 
     Another factor is error prevention. Error-prone conditions can be eliminated, or the system can check for error conditions and present users with a confirmation option before a remedial action is executed. Additionally, certain embodiments can help users recognize, diagnose, and recover from errors. Error messages can be expressed in plain language (e.g., no codes), precisely indicate the problem, and constructively suggest a solution, for example. Even though it is better if the system can be used without documentation, it may be necessary to provide help and documentation. Any such information can be easy to search, focused on the user&#39;s task, list concrete steps to be carried out, and not be too large, for example. 
     With respect to ease of user interaction, the system can reduce or minimize the user&#39;s memory load by making objects, actions, and options visible. The user should not have to remember information from one part of the dialogue to another. Instructions for use of the system can be visible or easily retrievable whenever appropriate. Further, accelerators, often unseen by a novice user, can often speed up interaction for an expert user such that the system can cater to both inexperienced and experienced users. In certain embodiments, users can tailor frequent actions. Additionally, displayed dialogues can be configured not to include information that is irrelevant or rarely needed. Every extra unit of information in a dialogue competes with the relevant units of information and diminishes their relative visibility. 
     Certain embodiments provide visualization strategies with a graphical user interface for disparate data types across large clinical datasets across an enterprise. Thus, design elements can include, for example, institutional components, a single point of access search, one or more components/widgets, one or more medical records grids/forms, scheduling, clinical data results, graphs, task lists, messaging/collaboration components, multi-scale images (e.g., deep zoom), one or more external components, mail, RSS feeds, external Web-based clinical tools (e.g., WebMD), etc. Server components can include, for example, a search engine, a Web server, an active listener, an information composition engine, a query engine, a data aggregator, a document summarizer, profile context management, one or more dashboards (e.g., clinical and administrative), etc. 
       FIG. 6  depicts an example adaptive user interface system  600  including active listening and response capability in accordance with an embodiment of the present invention. The system  600  includes an active listener agent  610 , a user interface  620 , content  630 , and input  640 , for example. Components of the system  600  can be implemented in software, hardware, and/or firmware in various separate and/or integrated combinations, for example. 
     Content  630  is displayed to a user via the user interface  620 . Content  630  can include one or more widgets, such as widgets described above in relation to  FIGS. 2 and 4 , applications, data displays, images, etc. Via the user interface  620 , a user can provide input  640  to affect content  630  displayed on the interface  620 . The active listener agent  610  monitors displayed content  630  and user input  640  in the background of the user interface  620 . In response to user input  640  based on content  630 , the active listener agent  610  can provide further content  630  related to existing content  630  and input  640  via the user interface  620 . The active listener agent  610  can find, organize, and present information to users based on contextual information about the user and the user&#39;s task, for example. 
     For example, as shown in  FIG. 2 , the user interface  200  displays content  630  such as a vitals widget  220  and a patient problems widget  250 . When a user inputs  640  a patient&#39;s reason for visit  250 , the active listener agent  610  determines that the patient&#39;s current medication would be of interest to the physician reviewing her problems and reason for visit and provides additional content  630  in the form of the medication information widget  270 . 
     As another example, turning to  FIG. 4 , the user interface  400  displays content  630  such as a vitals/labs widget  410 , a medications widget  470 , an a reason for visit widget  460 , among others. The active listener agent  610  can monitor the content  630  and user input  640 . Based on the urinalysis information  417  from the vitals/labs widget  410 , the active listener agent  610  determines that the user may likely be interested in further clinical detail  420  regarding the urinalysis and related lab results. Thus, the clinical lab detail panel  420  can be provided via the interface  400 , for example. 
     In certain embodiments, in addition to displaying additional  630  that are retrieved from a library of widget/application and patient information, for example, the active listener agent  610  can generate new content  630  based on existing content  630  and/or input  640 . For example, if a user drags patient medication information from a medication widget or application (such as the medications widget  270  shown in  FIG. 2 ) and brings it into a patient problems widget or application (such as the problems widget  250  shown in  FIG. 2 ), a new widget can be generated (and/or the problems widget can be modified) to show a correlation between a patient problem, such as hypertension and a medication being taken by the patient, such as hydralazine, to combat the problem. 
     In certain embodiments, a modified and/or newly created widget and/or other application can be saved for later use. For example, a user can save the widget, and/or the system can automatically save the widget. For example, the widget can be generally saved and/or saved in connection with a particular user, mode, group, etc. 
       FIG. 7  shows a flow diagram for a method  700  for adaptive user interfacing with clinical content in accordance with certain embodiments of the present invention. 
     At  710 , content is displayed for user review. For example, clinical content related to a patient can be displayed to a user via a user interface in response to a user request, such as access to a patient&#39;s electronic medical record information. 
     At  720 , user input is accepted. For example, via the user interface, the user can modify displayed information, interact with a displayed application, add information, request further information, etc. For example, user input can include a request for information about a patient, activation of a widget, positioning of information in a user interface display, etc. User input can include information regarding a patient encounter such as a stimulus and a context. User input can be provided directly by a user and/or extracted via another application or widget displayed for the user via the interface, for example. 
     At  730 , content and input are monitored. For example, an active listener can “listen” or monitor content and activity via the user interface to identify patterns of use, subject matter of interest, changes to displayed applications and/or content, etc. 
     At  740 , additional content is provided. For example, based on displayed content and user interaction with that content, the active listener provides additional content that may be of use to the user. 
     At  750 , content is modified. For example, based on user interaction with displayed content (e.g., applications and data), the content can be modified. For example, patient data can be updated by a user via the interface. As another example, a user can input and/or transfer information from one application to another application to create a new application (e.g., a new user interface widget) and/or modify an existing application. 
     At  760 , modified content is provided to the user. For example, the updated patient data, new application, modified application, etc., are provided to the user via the user interface. For example, thumbnails, links, summaries, and/or other representations of data can be graphically provided to the user via the user interface. Selection of a thumbnail, link, summary, etc., may generate a further level of detail for review by the user and/or retrieval and display of source documents, for example. Additionally, a new widget can be selected and displayed from a library based on monitored content and/or action. Alternatively or in addition, a new widget can be created from existing widget and/or other information for use by the user via the interface. Modified information can be saved for later use, for example. 
     One or more of the steps of the method  700  may be implemented alone or in combination in hardware, firmware, and/or as a set of instructions in software, for example. Certain examples may be provided as a set of instructions residing on a computer-readable medium, such as a memory, hard disk, DVD, or CD, for execution on a general purpose computer or other processing device. 
     Certain examples may omit one or more of these steps and/or perform the steps in a different order than the order listed. For example, some steps may not be performed in certain examples. As a further example, certain steps may be performed in a different temporal order, including simultaneously, than listed above. 
     Thus, certain embodiments provide a plurality of benefits including a single point of access, cross-modality data access, XDS compliance, push and pull capability, consensus building, transparency, knowledge management enhanced by use, cross platform (Web, mobile, etc.) accessibility, and a system level view of a user&#39;s information space, for example. 
     Certain embodiments provide an architecture and framework for a variety of clinical applications. The framework can include front-end components including but not limited to a Graphical User Interface (GUI) and can be a thin client and/or thick client system to varying degree, which some or all applications and processing running on a client workstation, on a server, and/or running partially on a client workstation and partially on a server, for example. 
     The example user interface systems and methods described herein can be used in conjunction with one or more clinical information systems, such as a hospital information system (“HIS”), a radiology information system (“RIS”), a picture archiving and communication system (“PACS”), a cardiovascular information system (“CVIS”), a library information system (“LIS”), an enterprise clinical information system (“ECIS”), an electronic medical record system (“EMR”), a laboratory results/order system, etc. Such systems can be implemented in software, hardware, and/or firmware, for example. In certain implementations, one or more of the systems can be implemented remotely via a thin client and/or downloadable software solution. Furthermore, one or more components can be combined and/or implemented together. 
     In certain embodiments, an active listener agent operates in a foreground and/or background of a computing device and/or software application, such as a user interface, to monitor user and program activity. For example, the active listener agent can gather information related to widgets in a user interface. The active listener agent can gather information related to actions generated by a user with respect to the user interface and its content, for example. 
     In certain embodiments, based on application (e.g., widget) information and user interaction, the active listener agent can identify information and/or functionality important to a user based on a current context. In an embodiment, if the active listener agent detects that one or more data elements displayed on a user interface reach a predetermined threshold, the active listener automatically places one or more widgets on the user interface that include additional relevant information to help enable the user to make a well-informed decision. In another embodiment, the active listener agent can help the user by reacting to the user&#39;s interaction with an application and provide additional insight by displaying additional information in the form of widget(s) and/or other information on a displayed user interface as a result of the user&#39;s actions. For example, if the user drags a certain data element from one widget to another widget (e.g., via cursor selection of the element and movement across a displayed interface using a mousing device), the active listener agent can reposition (e.g., size and/or location) that information on the displayed interface so that an arrangement of data elements signifies a different level of information useful in helping the user arrive at a conclusion (e.g., regarding diagnosis and/or treatment of a patient). The active listener agent can then either place a pre-made relevant widget on the interface that could be helpful a the particular scenario and/or can create a new widget based on the content of the widget the user changed in addition to the data context on the user interface. 
     Rather than focus on pre-determined workflows, the active listener provides a user with additional information helpful to the user in certain situations where there is no known workflow or protocol. Based on historical data and/or other input, the system displays additional information and/or functionality to the user that is relevant to the user to make an informed decision. In the background of an application and/or interface, for example, the active listener can monitor activity of data elements on a displayed interface. When these data elements reach a certain threshold, the active listener places additional information on the displayed interface to help the user make an informed decision. Alternatively or additionally, the active listener can detect when the user makes a change to an application (e.g., by dragging and dropping a data element from on widget to another widget, by conducting a search, by changing a diagnosis, etc.). By combining a context of user interaction with displayed user interface content, relevant information and/or functionality can be provided to a user, for example. 
       FIG. 8  is a block diagram of an example processor system  810  that may be used to implement systems and methods described herein. As shown in  FIG. 8 , the processor system  810  includes a processor  812  that is coupled to an interconnection bus  814 . The processor  812  may be any suitable processor, processing unit, or microprocessor, for example. Although not shown in  FIG. 8 , the system  810  may be a multi-processor system and, thus, may include one or more additional processors that are identical or similar to the processor  812  and that are communicatively coupled to the interconnection bus  814 . 
     The processor  812  of  FIG. 8  is coupled to a chipset  818 , which includes a memory controller  820  and an input/output (“I/O”) controller  822 . As is well known, a chipset typically provides I/O and memory management functions as well as a plurality of general purpose and/or special purpose registers, timers, etc. that are accessible or used by one or more processors coupled to the chipset  818 . The memory controller  820  performs functions that enable the processor  812  (or processors if there are multiple processors) to access a system memory  824  and a mass storage memory  825 . 
     The system memory  824  may include any desired type of volatile and/or non-volatile memory such as, for example, static random access memory (SRAM), dynamic random access memory (DRAM), flash memory, read-only memory (ROM), etc. The mass storage memory  825  may include any desired type of mass storage device including hard disk drives, optical drives, tape storage devices, etc. 
     The I/O controller  822  performs functions that enable the processor  812  to communicate with peripheral input/output (“I/O”) devices  826  and  828  and a network interface  830  via an I/O bus  832 . The I/O devices  826  and  828  may be any desired type of I/O device such as, for example, a keyboard, a video display or monitor, a mouse, etc. The network interface  830  may be, for example, an Ethernet device, an asynchronous transfer mode (“ATM”) device, an 802.11 device, a DSL modem, a cable modem, a cellular modem, etc. that enables the processor system  810  to communicate with another processor system. 
     While the memory controller  820  and the I/O controller  822  are depicted in  FIG. 8  as separate blocks within the chipset  818 , the functions performed by these blocks may be integrated within a single semiconductor circuit or may be implemented using two or more separate integrated circuits. 
     Thus, certain embodiments provide for access by an end user to information across enterprise systems. Certain embodiments provide a technical effect of a search-driven, role-based, workflow-based, and/or disease-based interface that allows the end user to access, input, and search medical information seamlessly across a healthcare network. Certain embodiments offer adaptive user interface capabilities through a work-centered interface tailored to individual needs and responsive to changes in a work domain. Certain embodiments introduce an adaptive, work-centered user interface technology software architecture, which uses an ontology modeling approach to characterize a work domain in terms of “work-centered” activities as well as computation mechanisms to achieve an implementation that supports those activities and provides adaptive interaction, both user directed and automated, in work-centered characterization and presentation mechanisms of the user interface to enterprise-level applications. 
     Certain embodiments provide an adaptive user interface that leverages semantic technology to model domain concepts, user roles and tasks, and information relationships, for example. Semantic models enable applications to find, organize and present information to users more effectively based on contextual information about the user and task. Applications can be composed from libraries of information widgets to display multi-content and multi-media information. In addition, the framework enables users to tailor the layout of the widgets and interact with the underlying data. 
     Certain embodiments contemplate methods, systems and computer program products on any machine-readable media to implement functionality described above. Certain embodiments may be implemented using an existing computer processor, or by a special purpose computer processor incorporated for this or another purpose or by a hardwired and/or firmware system, for example. 
     One or more of the components of the systems and/or steps of the methods described above may be implemented alone or in combination in hardware, firmware, and/or as a set of instructions in software, for example. Certain embodiments may be provided as a set of instructions residing on a computer-readable medium, such as a memory, hard disk, DVD, or CD, for execution on a general purpose computer or other processing device. Certain embodiments of the present invention may omit one or more of the method steps and/or perform the steps in a different order than the order listed. For example, some steps may not be performed in certain embodiments of the present invention. As a further example, certain steps may be performed in a different temporal order, including simultaneously, than listed above. 
     Certain embodiments include computer-readable media for carrying or having computer-executable instructions or data structures stored thereon. Such computer-readable media may be any available media that may be accessed by a general purpose or special purpose computer or other machine with a processor. By way of example, such computer-readable media may comprise RAM, ROM, PROM, EPROM, EEPROM, Flash, CD-ROM or other optical disk storage, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to carry or store desired program code in the form of computer-executable instructions or data structures and which can be accessed by a general purpose or special purpose computer or other machine with a processor. Combinations of the above are also included within the scope of computer-readable media. Computer-executable instructions comprise, for example, instructions and data which cause a general purpose computer, special purpose computer, or special purpose processing machines to perform a certain function or group of functions. 
     Generally, computer-executable instructions include routines, programs, objects, components, data structures, etc., that perform particular tasks or implement particular abstract data types. Computer-executable instructions, associated data structures, and program modules represent examples of program code for executing steps of certain methods and systems disclosed herein. The particular sequence of such executable instructions or associated data structures represent examples of corresponding acts for implementing the functions described in such steps. 
     Embodiments of the present invention may be practiced in a networked environment using logical connections to one or more remote computers having processors. Logical connections may include a local area network (LAN) and a wide area network (WAN) that are presented here by way of example and not limitation. Such networking environments are commonplace in office-wide or enterprise-wide computer networks, intranets and the Internet and may use a wide variety of different communication protocols. Those skilled in the art will appreciate that such network computing environments will typically encompass many types of computer system configurations, including personal computers, hand-held devices, multi-processor systems, microprocessor-based or programmable consumer electronics, network PCs, minicomputers, mainframe computers, and the like. Embodiments of the invention may also be practiced in distributed computing environments where tasks are performed by local and remote processing devices that are linked (either by hardwired links, wireless links, or by a combination of hardwired or wireless links) through a communications network. In a distributed computing environment, program modules may be located in both local and remote memory storage devices. 
     An exemplary system for implementing the overall system or portions of embodiments of the invention might include a general purpose computing device in the form of a computer, including a processing unit, a system memory, and a system bus that couples various system components including the system memory to the processing unit. The system memory may include read only memory (ROM) and random access memory (RAM). The computer may also include a magnetic hard disk drive for reading from and writing to a magnetic hard disk, a magnetic disk drive for reading from or writing to a removable magnetic disk, and an optical disk drive for reading from or writing to a removable optical disk such as a CD ROM or other optical media. The drives and their associated computer-readable media provide nonvolatile storage of computer-executable instructions, data structures, program modules and other data for the computer. 
     While the invention has been described with reference to certain embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the scope of the invention. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from its scope. Therefore, it is intended that the invention not be limited to the particular embodiment disclosed, but that the invention will include all embodiments falling within the scope of the appended claims.