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Interactive Medical Mind Maps
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Etienne Saliez, version 2018-02-23 /
Introduction
- Up to now many medical record softwares were not much more than
narrative reports of what did happen at some time in the past in some
specific context.
- A large amount of medical knowledge is already available on Internet,
but the challenge is now to learn a "medical methodology" about how to
use it.
- Medical information management was already recommended by Lawrence
Weed in 1968, but at that time the computer technology was still very
limited.
- Excellent data processing and telecommunication technologies are
today available but not yet fully understood and used in a meaningful
way.
- Modern medicine require more and more collaborations between
specialized actors, who are in different locations.
- A project of the working group https://www.isfteh.org/working_groups/category/collaborative_care_team_in_open_source
of the ISfTeH, "International Society for Telemedicine and eHealth", a
not for profit organization with members in about 90 countries, https://isft.org/ .
Objectives
- Evolution to a "task oriented model" in order to help to solve the
"health problems" of the patient. At every step what is known and what
to do.
- Visual support of "Natural Intelligence", presented in a very natural
way as graphs with focus on the relations between concepts.
- Mind synchronization between the members of "Care Teams" across
Internet, as well between group of students and teachers.
- At the current stage an experimental prototype in order to evaluate
the advantages of graphs.
- A subsidiary objective will also be to prepare tools in order to
analyze data for research purposes.
Approaches
- Evolution to a more effective work methodology:
- Old "Descriptive Model":
- Up to now most systems were based on a kind of "Descriptive
Model". Access to large archives of documentation after the
facts, about what did happen in the past. In fact most current
patient record systems do not much more than a simulation of
the work methodology of the paper era.
- New "Task Model":
- Today the question is a migration to a more "Task Oriented
Model", intended to help to solve Health Issues.
- In the management of tasks the relations between concepts
much matter. For example having several Observations it is
important to see to which hypothesis these facts could lead.
These "Problems" need to be clearly formulated and motivated.
- Having identified one or more Problems several Actions will
be proposed and ordered. The relations between Problems and
Action need also to be clearly documented. In both cases N to N
relations.
- A continuous iterative process. Indeed the results of Actions
(investigations and treatments) provide new Observation and the
basis for the next iteration. At any time all these relations
should be maintained up to date.
- At the current stage the goal is only to represent the
logical reasoning in a more explicit way, i.e. by mean graphs
showing weighted relations.
- Information management in general:
- Graphs are a very natural way of thinking. The human brain is
made of a very large set of neurons with many connections to other
neurons. They can be navigated in a kind of N dimensional
information space. Software able to simulate these networks become
today available, in an interactive way.
Remark: From a philosophic point of view " awareness " could be
seen as the current " view " on some selected nodes out of a very
large information space ?
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- Exploration of the potential of graph technologies:
- A prototype is in construction and will be set on the web for
discussions with other members of the ISfTeH Telemedicine
community.
- The current project is experimental in the domain of medical
records, but graph technology is already successful in other
research and industries.
- Medical Model:
- Make the medical reasoning process simply more transparent.
Experienced doctor can work efficiently and quickly in an intuitive
way. Nevertheless weighted explicit representations of the
reasoning are expected to improve the quality of care, particularly
in case of beginners. Today simply more transparency of medical
reasoning. In the future it could help to develop
recommendations.
- Focus on relation between the essential concepts of Observations
---> Health Issues ---> Actions:
- Observations: just the observed facts without any
judgement.
- Health Issues: concerns requiring attention, as well abnormal
findings and hypothesis, as well confirmed diagnoses.
- Actions: decisions about what to do, either more explorations
or treatments.
- Links to medical knowledge, also presented as graph
navigations.
- At any time, starting from available data up to now, the question
is "what to do next". More at http://www.chos-wg.eu/Models/iterative-care-model.html
.
- Clinical Modifiers:
- "Clinical Modifiers" are essential in patient care practice.
Individual patient care require much more weighed precision than
epidemiological surveys. More than "yes" or "no" information, black
or white..
- In this project the challenge is to represent these attributes in
3 ways:
- ( A ) Internally as numeric values, in order to allow
valuable pattern recognition including weighting.
- ( B ) Rounded to free speech style (as for example "not to be
excluded", "very probable", "obvious", etc...) in order to
remain compatible with the traditional way of human spoken
communication.
- ( C ) As visual graph, where the numeric values are converted
to color, shape, size, thickness, etc... Visual representations
are expected to provide easier understanding of the patient
situation by the other members of the Care Team of the patient.
Several options are to be experimented in function of the user
preferences.
- Main attributes of items:
- Probability:
- Precision, range of probabilities:
- Degree of belief:
- Handling of both positive and negative assertions:
- Completeness of information:
- Reliability of the sources:
- Current status of Health Issues: Active, Chronic, History
- Expected utility of a recommendation.
- Costs: a multidimensional concept including risk,
disagreement, delay before conclusion, money, availability of
the resource.
- etc...
- Navigation:
- The first screen of a patient record is intended to be a kind of
dash board providing a global overview of the most important Health
Issues. First the current situation, as far as possible, according
to the latest available versions of nodes and relations.
- When the patient arrive in a new environment it is important to
have a first screen showing the most important points about the
patient regardless of any specialism.
- Starting from a given Health Issue, navigation to more details.
Zoom to deeper related details, taking account that a screen can
only show a limited number of information at a time.
- Navigation with Filters on one or more types of nodes as:
- Health Issues,
- Observations,
- Actions
- Anatomical domain,
- Related Medical Knowledge,
- Author. Remark: in a collaborative team some authors could
make different assessment based on the same Observations.
- Encounter and location, including if admitted in hospital. In
fact as the traditional paper records.
- Current Care Plan, scheduled Actions.
- Navigation in the time: at a more advanced stage of software
development, the time could be seen as a 3th dimension of the
graphs.
- etc...
- Access to medical knowledge:
- At lot of medical knowledge sources are available. The challenge
is to find the most relevant information and to make that
information available in a graph minded environment.
- As far as possible make compatibility with existing official
standards, classifications standards and terminologies.
- Education issues:
- On-line exercises on real medical records, but made
anonymous.
- Some medical faculties begin to take a MOOC approach:
- Knowledge:
- Nearly no lectures any more. The student are required to
learn the pure knowledge by mean guided books and
electronic documents.
- Training:
- Training is what most matter and what require much
attention from the teaching staff. Interactive graphs are
expected to be very useful for the training of small groups
of students: "Given all what is know up to now, what to do
next ? "
- Health education in developing regions are an important goal of
the ISFTEH.
- Migration from traditional patient records to
graphs:
- At the initial experimental stage, a few realistic patient
records are created from scratch in a graph way.
- The next step is that graphs could be used as a kind of synthesis
of Global Table of Content of a patient records, while the content
of nodes could still be traditional documents.
- Pattern detection:
- Pattern detection in function of weighted factors.
- Recommendations presented as coming from the experts behind the
system at the same level as other opinions from any care team
Actor.
- For research purposes, graphs can help to discover new
"patterns", using a "Big Data" approach.
- Technical challenges:
Current experimental prototype:
- Objectives:
- Intended to explore the medical advantages and the technical
feasibility of the graph approach.
- Warnings:
- Experimental and still very basic with bugs. The medical content
of the initial version is stupid and only intended for technical
test purposes on only one patient.
- Not to be used for real patients. Security measures not yet
installed.
- Prototype on Internet:
- IMMM-preliminary-prototype/immm.html
. Wait 1/2 a minute for activation.
- User guide:
- To view the content of a node = move the mouse on that
object.
- To move to related nodes = left click on the node.
- To edit a node = right click on the node, but not yet good
working.
- To create new nodes and relations = (not yet easily
possible)
- To request a specific selection in the graph = test are
already possible using the first top line of the screen, but
this require a very specific technical format (cypher).
Call for partners in Open Source:
- Healthcare professionals:
- Interested in medical information management and experimental
graph technologies.
- Informaticians:
- Interested in the challenges of the development on interactive
graphs.
- Sponsors:
- Sponsors willing to support the social goals of the not for
profit International Society for Telemedicine.
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Contacts: