Erik Sundvalls Research Page

News & updates

• Presentation "Introduktion till Snomed CT" (in Swedish) Lund Apr. 2008
• Student project suggestions, spring 2008

Contact info

Telephone, mail, photo etc available at: http://www.imt.liu.se/mi/Staff/erisu/
If you want to get updated of the research progress (publications etc.), just send me a mail marked [research updates] in the subject line and you'll be informed (at most a couple times a year).

Summary of PhD project:
Overview and Navigation of Electronic Health Records

How can patient information in an electronic health record (EHR) be displayed best in order to gain a quick overview of a patient's history and other important facts? The thesis aims to explore different facets of this question. Requirements vary depending on the user's role and current task, the overview should adjust accordingly.

The need for more structured, computer interpretable and semantically well defined EHR content has this far to a great deal been driven by the desire to use decision support systems and reuse data for follow up purposes. The thesis will also use this improved structure to enhance overview, presentation and navigation of the EHR using various visualization techniques. A hypothesis is that automated reasoning may also be used to better filter/summarize available information before presentation.

Terminology Visualization

The structure of the information in an EHR, and the possibilities to aggregate data for statistical purposes are dependent on data models, terminologies etc. used. Good overview and navigation of those is a related important task that is also explored in the thesis. The first scientific paper thus presented a prototype (TermViz) applying well known methods like "focus+context" and self-organizing layouts from the fields of Information Visualization and Graph Drawing to terminologies like SNOMED CT and ICD-10. The aim was to simultaneously focus on several nodes in the terminologies and then use interactive animated graph navigation and semantic zooming to further explore the terminology systems without loosing context. The prototype, based on Open Source Java components, demonstrated how a number of information visualization methods can aid the exploration of medical terminologies with millions of elements and can serve as a base for further development. Status update: Web/Flash/Flex-based TermViz 2.0 under development, alpha version available.

openEHR & Archetypes

In order to have "semantically well defined EHR content" (needed for advanced EHR overviews) we need a formalized EHR structure and well defined connections to terminology systems etc. Thus I am active in our department's investigation of the archetype/openEHR-approach to EHRs (see http://www.imt.liu.se/mi/ehr/). The second paper describes an Archetype Editor developed by our department that was combined with TermViz and a system for finding terminology bindings to SNOMED CT. 

EHR Visualization

Display of interactive graphical "timelines" showing patient history is an obvious and important part of a patient overview. Work along these lines has already been conducted by others (e.g. the LifeLines project) and is being further explored and expanded in papers and software. Our third paper, entitled Graphical Overview and Navigation of Electronic Health Records in a prototyping environment using Google Earth and openEHR Archetypes, introduces some possible interaction and visualisation techniques suitable for EHR overviews. Evaluation and enhancement of this is one of the current research activities.

The use of graphic languages (pictograms etc.) for quick information overview is another thing expected to be further explored in the thesis.

Reducing redundancy in the EHR?

Finding ways of overviewing and navigating existing EHR content is a main task in the thesis, and an interesting question to discuss in relation to this is the possibility of reducing the amount of redundant information often found in EHRs. Can suitable EHR information structures and user interfaces make it easier to find and refer to already entered information instead of re-entering it? How can patient-specific goals, plans and processes be represented and visualised, and will that be useful for overview purposes and reduced redundancy? Questions like these are likely to be touched upon in the thesis too.

The continued exploration and research depends on what can be concluded by the initial findings.

A PhD thesis at our department is expected to be completed within approximately five years (four years PhD work plus 20% teaching etc). My thesis work begun in August 2004 and will be extended due to parental leaves and department work in projects that are not part of my research.

Main supervisor: Hans Åhlfeldt, co-supervisor: Håkan Örman (formerly Petersson)

Published/available work

• Integration of tools for binding archetypes to SNOMED CT
  BMC Medical Informatics and Decision Making 2008, 8(Suppl 1):S7 (27 October 2008) (Free, open access)
  Erik Sundvall, Rahil Qamar, Mikael Nyström, Mattias Forss, Håkan Petersson, Daniel Karlsson Hans Åhlfeldt, Alan Rector
  This is an extended, updated and revised version of the SMCS 2006 paper (below) since it was selected for BMC publication during SMCS 2006.
• Graphical Overview and Navigation of Electronic Health Records in a prototyping environment using Google Earth and openEHR Archetypes
  MEDINFO 2007, K. Kuhn et al. (Eds), IOS Press, 2007. Pages 1043-1047
  Erik Sundvall, Mikael Nyström, Mattias Forss, Rong Chen, Håkan Petersson, Hans åhlfeldt
  
  • Full Paper - Author-preview version (PDF, 5 pages) (better graphis resolution, but no page headers/footers) or Full Paper - IOS Press version (PDF, 5 pages)
  • Presentation (PDF) given (15 minutes) at the Medinfo 2007 Conference, Brisbane, Australia, August 20 to the 24th, 2007
  • GooglEHR-20071030a.kmz A Google Earth file fairly similar to the one used for demo at Medinfo 2007
  • References used in the paper:  http://www.citeulike.org/user/erisu/tag/usedinmedinfo2007
  • If there is demand for it (mail me) I might try to create and upload a short video presetation of the approach.
• Integration of Tools for Binding Archetypes to SNOMED CT
  Proceedings of SMCS2006; 1-3 Oct, Copenhagen, Denmark, p 64-68;
  Erik Sundvall, Rahil Qamar, Mikael Nyström, Mattias Forss, Håkan Petersson, Hans Åhlfeldt, Alan Rector
  http://www.hiww.org/smcs2006/proceedings/12SundvallSMCS2006final.pdf
  Local backup: http://www.imt.liu.se/~erisu/2006/SMCS2006SundvallArchetypeEditor.pdf
  Presentation file (Powerpoint): http://www.hiww.org/smcs2006/talks/Sundvall.ppt
• Interactive Visualization and Navigation of Complex Terminology Systems, Exemplified by SNOMED CT.
  Proceedings of MIE2006; 27-30 Aug, Maastricht, The Netherlands, p 851-856;
  Sundvall E, Nyström M, Petersson H, Åhlfeldt H.
  http://www.imt.liu.se/~erisu/2006/MIE2006SundvallTermViz.pdf
• Master thesis: A Diabetes Data Browser using Java and Semantic Web; LiU-IMT-EX-353, 2003-12-17; Erik Sundvall
  http://ehealth.sf.net/thesis2003/ (or a local copy: erik_thesis_v031_press.pdf)

Publications co-authored

• Archetype-based conversion of EHR content models: pilot experience with a regional EHR system
  BMC Medical Informatics and Decision Making 2009, 9:33 (1 July 2009)
  Chen R, Klein GO, Sundvall E, Karlsson D, Åhlfeldt H
  http://www.biomedcentral.com/1472-6947/9/33
• Requirements and prototyping of a home health care application based on emerging JAVA technology.
  International Journal of Medical Informatics 68 (2002) 129-139;
  Leili Lind, Erik Sundvall, Daniel Karlsson, Nosrat Shahsavar, Hans Åhlfeldt.
• Experiences from Development of Home Health Care Applications based on Emerging Java Technology;
  Proceedings of MEDINFO 2001; September, 2001; L. Lind, E. Sundvall, H. Åhlfeldt
  http://www.imt.liu.se/mi/Publications/Publications/PaperInfo/lind01.html

Selected other presentations

• "Introduktion till Snomed CT" vid "Seminarium om gemensamt fackspråk för vård och omsorg i morgondagens informationssystem" på Scandic Star i Lund 9 - 10 april 2008. Arrangerat av Socialstyrelsen m.fl.(in Swedish) Uppdatering: Videoinspelning av föredraget finns nu tillgänglig.

Press

• "Synsinnet nyckel till journal som anpassar sig efter läsare" (in Swedish)
  http://www.dagensmedicin.se/Article.jsp?article=39487
  Dagens Medicin (Tryck 2006-03-08, Web 2006-03-09)

Current work

• TermViz, terminology visualization prototype developed, also included in an Archetype Editor. A new web accessible version is underway.
• EHR Overviews, see Medinfo 2007 paper above.
• Exploration of openEHR and the archetype approach, see http://www.imt.liu.se/mi/ehr
• Member of IHTSDO Technical Committee
• Universitetets "Tredje uppgift", samverkansuppgiften; Kontakter med hälso- & sjukvårdsorganisationer nationellt (termkonferenser, SFMI-arrangemang), företag m.m. Se seminarer etc: http://www.imt.liu.se/mi/ehr

Teaching 

I have been involved in the teaching of the courses:

• TBMI17 (2005-2006) changed into TBMI19 2007
• TBMI19 (2007-2009)
• TBMT06 (2006)
• TDDC10 / TDDC79 (2006-2009)
• TDDC79 Student project - Visualization of Health Records Using Google Earth. Results: 2007, 2008, 2009 (ongoing)
• TBMI27 (2006)

I am and have been supervising some master thesis projects:

• Java-based archetype editor, by Johan Hjalmarsson & Mattias Forss; LiTH-IMT/MI20-EX--06/423--SE.
• EHR-portal for patients (web & archetype based), by Joakim Fredriksson & Jonas Andersson; LiTH-IMT/MI20-EX--06/425--SE
• Användbarhetsutvärdering av en grafiskt visualiserad patientjournal (Usability evaluation of a graphically visualized medical record), by Henrik Särnbrink &
  Klas Johansson, LiU-ITN-TEK-G--08/032--SE
  
• Warning information / EHR overviews, by Jenny Wihlborg & Mattias Pettersson [Printed. Awaiting electronic publication link.]
• Archetype based EHR GUI, by Carl Magnus Alfon [currently running]
• Cinical Decision support..., by Hanna Karlsson & Herman Viklund [Printed. Awaiting electronic publication link.]
• Development of an API for creating and editing openEHR archetypes, by Filip Klasson & Patrik Väyrynen; LiTH-IMT/MI30-A-EX--09/472--SE

Public tutorials etc.

• Several public, open tutorials at IMT
• Medinfo 2007 workshop
• MIE 2008 openEHR tutorial
• Snomed CT tutorial in Lund

Notes

Various notes & information in wiki-style (Created using http://www.tiddlywiki.com/)

• My graduate (PhD) course list.
• Teaching: TDDC10

Links

• Short information visualisation intro: http://www.infovis.net/printMag.php?num=179&lang=2
• One of my favourite visualisation toolkits: http://prefuse.org/ (java) and http://flare.prefuse.org/ (flash/flex)
• Famous previous EHR-overview research: http://www.cs.umd.edu/hcil/lifelines/
• Clinergy - an interesting system including (visual) structured EHR data entry.  
• Some timeline-relateded links: http://del.icio.us/emcs/timeline  
• A recently started bibliography tracking list http://www.citeulike.org/user/erisu/