Web Application Dashboards: From Intelligence

Web Application Dashboards: From Intelligence Analysis to Health Care Applying the Open-Source OZONE Widget Framework to Health IT Todd C. Hughes, Tina Coleman Next Century Corporation 7075 Samuel Morse Drive Columbia, MD David Benjamin Hellar, Laurian C. Vega Next Century Corporation

Emily S. Patterson School of Health and Rehabilitation Sciences College of Medicine Ohio State University Columbus, OH

The Ozone Widget Framework (OWF) is a dashboard environment that enables users to select and arrange web applications in a highly customized way. OWF is available as Free Open Source Software and has been deployed in a variety of defense and intelligence analysis environments ranging from real-time analytics, cyber-situational awareness, to strategic and operational planning. These environments share characteristics with the information analysis and workflow needs of health care. This paper discusses those similarities and the current and future possibilities for OWF usage in health care. INTRODUCTION In hospital and clinical settings, patient care requires the fusion of rich heterogeneous data received from medical instruments and manual input from at the point of care as well as historical data from the patient’s health records. These sources of information offer the provider situational awareness for real-time decision making as well as contribute to long-term medical interactions involving numerous providers.

centered fusion activities applied in warfare and intelligence analysis environments. The OWF and OMP are designed as a presentation layer toolkit that can be rapidly deployed in a variety of mission contexts. Today OWF and OMP support strategic planning, real-time common operational picture, situation awareness, and other applications for defense and intelligence organizations [2] [3]. In the future they may empower innovations in patient care interaction and other health information technology. OZONE WIDGET FRAMEWORK

As Hall et al. suggest in their Human-Centered Fusion model, humans serve multiple roles ranging from contributing inputs as “soft sensors” to performing highlevel overviews and supporting visual analytics and automated reasoning [1]. In the domain of Human-Centered Fusion, the graphical user interface is the means by which humans perform many of these functions. Limited patient interaction time, competing with the desire of the clinical practitioner to address the full health needs of the patient, necessitates that human computer interfaces support users to analyze data streams quickly whose data may be provided from a variety of devices and distributed enterprise environments. The challenge from a software engineering perspective is to create systems that integrate multiple data streams of varying timeliness and pedigree. The challenge from a human factors engineering perspective is to create a meaningful interface that allows users to visually parse and interpret a massive amount of data. Any health information technology system needs to support real-time visual analytics while avoiding information and cognitive overload. This paper discusses the OZONE family of open source products, including the popular OZONE Widget Framework (OWF) and the OZONE Marketplace (OMP). These products were built to fit the needs of human-

OWF is an open-source rich internet application that facilitates the customization of interaction between reusable web applications—called “widgets”—and offers flexible layout options for organizing larger collections in highly customized ways—called “dashboards” [4]. OWF is build on a lightweight web architecture that allows users access it through their normal web browsers. Figure 1 shows an example of an OWF session with a dashboard consisting of several widgets.

Figure 1: OWF dashboard applications, or "widgets."

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OWF was originally designed to address a tension in the intelligence analysis realm between data security and innovative analytical workflows. Intelligence organizations are understandably protective if their data. Users gain access to data through stove-piped systems that restrict access to the underlying data and confine their analysis to workflows prescribed by their software applications or system designers. Although these architectures are adjusting with the advent of widespread cloud initiatives, useful data is often most readily accessible by opening up multiple applications or web browser windows, searching for the information of interest from various sources, and copying it into a spreadsheet or other intermediate data repository. Users would thus spend the better part of each day running queries and integrating results before starting their “real” work, and none of that intermediate work is available to other analysts working similar problems. OWF provides two primary means of solving this dilemma. First, OWF’s presentation tier integration allows users to bring their data together in a single dashboard to let them visually recognize and correlate it. Although the ability to see information on the same page would seem to be a simple matter, before OWF those users had no mechanisms at hand better than toggling between multiple browser tabs. Second, OWF enables data sharing within the browser through multiple means of inter-widget communications, including “eventing,” drag-and-drop, widget intents, and remote procedure calls. All of these provide a means of sharing context across the widgets in a dashboard and thus allow them to filter and retrieve information relative to the context of import to the user. Although configuring widgets to share data does require some software development skill, the OWF SDK provides a simple JavaScript library that integrates with most common web application development technologies. These two techniques support greater freedom for analysts without requiring their underlying applications themselves to change their server-side interactions and flow. Through correlation via visual proximity and integration of the data by sharing it across components within the browser, OWF has proven to be an effective approach for flexible interaction with protected information. With OWF users no longer need to launch multiple browser windows across different screens to perform a single function. Instead, OWF lets users build multiple dashboard applications accessible from a single window. OWF also provides state management so users can always return to their dashboards as they last left them. When an ideal layout is designed, users can export the dashboard with its widgets and share it with other team members or other OWF instances.

In addition, developers can build OWF widgets using the web development toolkit of their choice. Widgets have been built on a variety of technologies including JavaScript, Java, .NET and scripting languages such as Perl and Ruby on Rails. Developers can include data-sharing across their widgets and implement other container-aware behaviors (e.g., drag and drop) through OWF JavaScript APIs, which provide lightweight client-side inter-widget interactions. System administrators enjoy OWF’s deployment flexibility because it can be deployed across a variety of application server and database combinations. It also works seamlessly with whatever web applications are also deployed throughout the enterprise. HISTORY AND USAGE The Intelligence Community transformed its infrastructure and began including OWF in key system designs as its budgets were shrinking while the importance of delivering timely information and collaborating across agencies was growing. OWF was first released in 2009, began collaborative development across multiple agencies in 2010, and was open-sourced in December 2012 after Congressional legislative recognition in the National Defense Authorization Act of 2012 [5]. OWF has enjoyed broad adoption across the intelligence organizations within the Department of Defense. It is difficult to quantify the installed instances or end users of OWF, since OWF is deployed within agencies whose networks are disconnected from public networks. A few data points, however, demonstrate some measure of magnitude of impact: • Agencies using or participating in the development of OWF include, but are not limited to, the National Security Agency, DARPA, the US Army, the Defense Information Systems Agency, Navy SPAWAR, the National Geographic Agency, and the US Coast Guard. [6, 7, 8, 9, 10, 11, 12] • Moderated Google Groups associated with the software, prior to its open-source release, had 1700+ users and developers seeking information as to upcoming features or asking questions related to their usage of the software. Since the software has been made available open source, that list has waned to approximately 1500 members, with message traffic now more active on public Google Groups. • The public GitHub repository for OWF is ‘watched’ by over 100 users, ‘starred’ by more than 200, and ‘forked’ by nearly 100.[13]

CLINICAL REMINDERS OWF DEMONSTRATION Health information technology is in the midst of a transformation similar to that experienced by the Intelligence Community at the time OWF was conceived. OWF was designed for intelligence analysts, but many of its features may be applicable to health information technology. For example, healthcare providers are constantly searching through various information sources—from unstructured text (patient visit notes) to structured demographic and medication data—to discover actionable indications and warnings of health-related threats as well as prescribe courses of action with the patient for near-term action and preventative care. As a demonstration of OWF in the health information technology domain, we developed a prototype “clinical reminders dashboard” that combines several sources of data and proactively suggests interactions for a patient. Although computerized clinical reminders systems are in use in many clinical settings, research indicates that improved interfaces, significantly improve learn-ability, efficiency, usability, and workload for preventive care screening clinical reminders used by intake nurses in ambulatory care [14, 15]. Figure 2 shows the prototype clinical reminders dashboard comprised of three widgets. The top pane shows a timeline, in which our sample patient, John Doe, shows two reminders of recommended interactions in November of 2013. The left bottom pane shows the patient roster for the authorized health care provider, and the right bottom pane shows a reminder widget featuring information specific to our selected patient, including further details of the reminders shown in the timeline, as well as a means of data entry for the specific selected reminder. The text entered for the reminder resolution may itself become part of the system’s data ingest for recommendations.

roster publishes a message which sets a context that the other widgets respond to. The reminder widget uses that context to retrieve the data it needs to accomplish its responsibility of providing reminder data. The timeline widget is an even more generic-use component which plots events it is given. It can also provide additional detail on events, as shown in Figure 3.

Figure 3: Detail in Timeline Widget.

Now, suppose that after deployment our compliance team indicates that showing other patient names on the screen is a privacy violation. Without making any changes to the widget components, users or administrators can adjust the dashboard’s layout, such that the patient roster widget now exists with the reminders widget within an collapsible “accordion” layout. Our sample user has also moved the timeline widget to a bottom pane (see Figure 4). All of the data exchange interactions between the widgets still operate correctly and the clinician can continue to be prompted to make appropriate recommendations to their patients.

Figure 4: Alternate dashboard layout.

ENTERPRISE ENVIRONMENT SUPPORT

Figure 2: OWF Clinical Reminders Dashboard.

Note that in the dashboard the patient roster widget is not aware of (“coupled to”) the timeline widget or the reminder widget. Through inter-widget communications, the patient

Given OWF’s genesis and usage within large government agency programs, it already handles certain aspects important for use for large health information technology systems. Integration with existing user sign-on systems. The authentication and authorization module for OWF is built as a plug-in on top of industry-standard Spring security. OWF

systems using user authorization schemes ranging from username/password combinations stored in databases or LDAP systems to certificates embedded in plastic identification cards are supported and deployed today. Multiple examples of these security plugins are provided with the OWF distribution. Branding, theming, and customization support. OWF is meant to underpin an enterprise system, not necessarily be its front-face. Thus, it supports a range of configuration items to support branding the system.

adding new help files or videos to the system to provide additional assistance. Future mobility. The Government body that that prioritizes the roadmap for OWF has identified mobility as one of its near-term technical objectives. This will allow the platform to have a user experience optimized for tablet and smartphone devices. Because the code is available opensource, this capability could be escalated by a contributor. OZONE MARKETPLACE OZONE Marketplace (see Figure 6) is a related software application which serves as the application registry for OWF widgets, akin to the Apple Appstore or Google Play. OWF users can browse Marketplace instances from within their OWF instance or through Marketplace directly as a website. When browsed from within OWF, users can add widgets to their OWF instance directly, allowing them to become familiar with and choose to use new widgets in a manner analogous to how they might add an application to their smartphone today. As with commercial application registries, Marketplace allows users to provide comments and ratings. These then inform potential new users as to the fitness or usefulness of new widgets for their purposes, as well as allow enterprise providers to make portfolio decisions as to which widgets to refine or build.

Figure 5: OWF Black on White theme (above) and White on Black theme (below).

Figure 5 shows and example of OWF theming. An OWF instance can have one or more themes, which are available to the end-user to toggle between to adjust their own user experience. The last theme setting is saved, such that when the user returns to the application, it reappears with the look and feel to which they are accustomed. Widgets are provided the setting for the current theme to allow them to participate in adjusting their presentation. Images, colors, and fonts can all be updated through either editing an existing theme or adding a new theme folder to the system. Other customization elements include: adding new buttons with associated actions to the toolbar, changing the sets of items available to the end-user based on a profile, and

Figure 6: Ozone Marketplace.

OZONE Marketplace is listed as a “sister project” of OWF, and described as available for release to government agencies today, with an anticipated open-source release [4]. REFERENCES 1.

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