Classification Tagging

A few weeks ago we introduced the Circumstances Of Admission field to help you tag your patients with any and all reasons the patient was admitted to your hospital. The reception for this field has been very positive and we thank you for your feed back. However there are still two items we want to address:

  1. How do you tag patients with what’s clinically abnormal?
  2. What if you want to use tags that are not available?

Diagnostic Classification Terminology

Very soon we will be adding two new classification tagging fields: Clinical Classifications and Categorization Of Clinical Signs. The fields will help you tag your patients with the abnormal physical exam findings by body system and what caused the abnormal physical exam findings.

So there will be 3 classification categories:

Circumstances of Admission (ex: Cat interaction, Vehicle collision, …)
— Why did the rescuer bring me this animal?

Clinical Classifications (ex: Physical injury, Neurologic disease, …)
— What are the physical exam findings by body system?

Categorization Of Clinical Signs (ex: Trauma, External parasites, …)
— What caused the abnormal physical exam findings (Clinical Classifications)?

The Clinical Classifications and Categorization Of Clinical Signs fields can be found with the Diagnosis field.

Reminder: If you want to use the Classification Tagging fields, go to Settings and choose Classification Tagging under the WRMD settings box. From the Classification Tagging settings page you can activate these new fields.

As of the date of this blog post, the Clinical Classifications and Categorization Of Clinical Signs fields DO NOT have an automatic tagging feature like the Circumstances Of Admission field does. In the future we will add that feature.

Additionally, if you want to see a list of all the terms for each category and their hierarchical organization, you can view that on the Classification Tagging settings page. We are working on a list of each terms definition that will be made available from the Classification Tagging settings page as well.

Custom Terms

The terms in each category are meant to encompass, at a baseline level, the most common situations encountered in wildlife rehabilitation. For example, the Clinical Classifications category only classifies to the body systems, not to each individual organ or body part. You may use the terms in the classification tagging fields as-is or you may now also add custom terms for specific classifications that your hospital encounters. Your custom terms must be assigned to an existing root or leaf node of the terminology hierarchy. For example, you could use the Circumstances of Admission term “Cat interaction” or add the custom term “Feral cat” under Cat interaction in order to track that detail.

That’s It!

We hope you enjoy the new fields and are having a safe year!

Flexible Analytics

With the release of the new Circumstances of Admission field we are very excited to also release a completely updated Analytics section. The older analytics section was nice but frankly kind-of rigid. It didn’t allow users to modify or tweak the graphs in order to see the information they wanted. In the updated Analytics section, all that changes. Our motivation for a new Analytics section was to answer the question:

Can the analytics be flexible enough to allow users to discover answers to their own questions?”

ps: we think the answer is yes

The Five Ws

The Analytics section has been organized around the Five Ws (Who, What, Where, When and Why). Additionally, all the filters that you can apply are designed to adjust the Five Ws so that you can narrow down the data into only what you want.

Patients (Who)

The Patients sections is all about who your patients are. Such as, what are your most prevalent patients by common name, how many patients were in your care, how many species have been admitted and a whole lot more. There are pages summarizing your patients by many different taxa categories such as, common name, taxonomic class, biological group and endemic status. There are also pages summarizing your patients by many demographic and health indicators such as age, sex, attitude, body condition, dehydration and mucus membranes. The details of each category can be viewed to see their changes in over time. There is also a taxonomy tree map to visualize your patients grouped by their taxonomic ranks.

Origin (Where)

The Origin section is all about where your patients are found at. You can see the most prevalent cities and states you receive patients from and there is now a map page that plots where your patients are found at. The map will cluster patients together within a close geographic area to help you visualize groups.

Circumstances of Admission (Why)

Perhaps the most exciting section is Circumstances of Admission; ie why are your patients brought to your hospital. There is an overview of your patients most frequent circumstances of admission and all your circumstances of admission grouped by their the root circumstance. You can also see the totals of each circumstance of admission as well as the percent of each circumstance of admission compared to each other. And of course, circumstances of admission over time to illustrate their fluctuations seasonally. And, after popular request, there is now a survival rate for each circumstance of admission including their first 24 hours of care compared to after the first 24 hours.

Disposition (What)

The disposition section is about what happened to your patients at the end of their care. There’s an overview page with the totals of each disposition as well as graphs illustrating when each disposition occurred. There are also specific graphs for released and transferred patients, include the type of release (or transfer) and the release (or transfer) rate of your survived patients. Of course you can see the survival rate of your patients and the percentage of each disposition. There is also a map that plots where your patients are released (or transferred) at.

Dates (When)

We’ve also greatly expanded your ability to modify the date range to render the analytics within. Not only can you change the date range but you can also compare to previous date ranges and group your data by different time frequencies; ie Day, Week, Month, Quarter, Year. (Grouping dates by bigger time frequencies is perfect when looking at data over large time periods)

Segment the Data

Analytic Segments

By default the graphs show data for all your patients, but what if you want to see analytics for a unique segment of your patients? For example, what if you only want to see data for your birds, or raptors, or perhaps all patients from a particular city, or even only patients that were poisoned? No problem!

Just click on the box labeled All Patients and choose which segment of your patients you wan to see.

Want to compare multiple segments of patients? Again no problem. You can choose up to three segments to create your graphs with.

Future Plans

In all honesty it is difficult to describe all the features and functionality of the new Analytics section, simply because of how much you can do with it. Even with this amazing release we are already planning improvements. Soon, we hope to allow you to save favorite graphs into one convenient place. We also want to create the ability to have even more specific segmentation; for example, render the charts for only “songbirds that also had an interaction with a cat”

We are very interested in any charts that you may generate at your own hospital. If there are any useful charts that you think we are missing PLEASE TELL US and share your charts with us ([email protected])! Additionally if you are not able to “discover answers to your own questions” PLEASE TELL US. There may be some tweaking that we need to do.

A Word of Caution

Looking at your analytics can be extremely fun and interesting, however I would like to express a word of caution. It is very easy to read to far into what the analytics are showing you. In other words, don’t let the analytics let you jump to conclusions. Let the analytics confirm, deny or improve your questions. If you see anomalies in the analytics that might indicate something important, or maybe just the result of bad data that needs correcting.

Other than that enjoy the new Analytics!

Circumstances Of Admission Tagging

Our First Goal: Keeping WRMD Simple

When we first conceptualized WRMD we set some very basic rules and milestones that we wanted to stick to. The first was that WRMD must be as simple as possible so that any wildlife rehabilitator could use it no matter their background or resources. Every time we make a change or add a new feature we still ask our selves “will this benefit our community of users or slow them down? ie: is this the WRMD way.”

Very soon we will be introducing a new feature in WRMD that officially takes WRMD into our second goal; benefitting from all the incredible data you collect on your patients!

Our Second Goal: Benefitting From The Data

In WRMD, you can collect information about who your patients are, where your patients come from, what condition they were in when admitted and what their final outcome was. However, although there are ways to record why a patient was found and admitted, it has always been a little bit difficult to do that. Definitely not in the “WRMD way.” In a forthcoming update, that will change. We are introducing a new field called Circumstances Of Admission that will allow you to tag your patients using predefined terms for any and all reasons the animal was brought in.

The new Circumstances Of Admission field can be found underneath the Reasons for Admission field with all the other Intake related data. Additionally, with each term you choose you can indicate if the circumstance is suspected or confirmed.

But That’s Not All!

You may be excited by this new field but also concerned that you now need to record in multiple places why your patients are admitted. Additionally you may be concerned that you need to go back and update all your past patients. If that’s how you feel then we agree with you.

In keeping with the “will this benefit our community of users or slow them down?” spirit, we wanted to make this new field as powerful as possible but also as simple as possible. With that being said, over the past year we have been developing and training a machine learning application to interpret what is written on your patient records in order to automatically tag your Circumstances Of Admission for you, so you don’t have to.

You and your users can still describe the reason for admission in regular human language. After you have admitted your patient, the Circumstances Of Admission classifier application will use the patients Common Name, Reasons For Admission, Notes About Rescue and Care By Rescuer fields to predict which Circumstances Of Admission tags best fit. You may still manually add or remove terms if needed.

Because of the automatic tagging, the Circumstances Of Admission field will be hidden by default. This way everything will appear the same and you won’t need train your volunteers or staff on the changes.

If you want to manually use the Circumstances Of Admission field, there is a setting under General WRMD Settings to show the Circumstance of Admission field.

Retroactive Tagging

As part of training and validating the Circumstances Of Admission classifier application, we have already tagged the majority of all patients admitted in WRMD over the past year and plan to retroactively tag past patients so that you don’t have to. The Circumstances Of Admission classifier application is not only a huge timesaver for you in realtime, it also has the amazing benefit of going back in time and automatically tagging your older patients. Additionally any imported patients can be automatically tagged in a matter of seconds.

It Gets Better!

With the introduction of the Circumstances Of Admission field we are also releasing a major update to the entire Analytics section of WRMD. One blog post is not enough to describe how powerful the new Analytics section is, but to give you an idea of our motivation, we want to answer the question: “Can the analytics be flexible enough to allow the user to discover answers to their own questions?”

In the new Analytics section you can see what your most frequent circumstances of admission are, what their survival rate is and how often they occur over time. To learn all about the new Analytics section read this blog post.

Thanks!

We really hope you use and appreciate the Circumstances Of Admission field. This was an important missing part of WRMD and one that we have been working long and hard on to make simple and amazing.

Just Some Foot Notes
  • The Circumstances Of Admission terms are based of the Clinical Wildlife Health Initiative terminology with some modification and additions.
  • A complete list of all the Circumstances Of Admission terms and their definitions will be made available.
  • The Circumstances Of Admission classifier application is still learning and it may occasionally make incorrect predictions. Please do your part and correct any mistakes for us and help teach the classifier.
  • We know that the data that you collect is amazing and powerful but we are not in the business of taking, selling or using that data without your permission and understanding.

Features and Upgrades Planned for WRMD

First off, we would like to thank all our users and their flexibility in adapting their organization to use Wildlife Rehabilitation MD. From our travels to other facilities we have seen many different ways to record and disseminate information. It is not easy to change procedures within any wildlife rehabilitation organization, yet our users have done it! Wildlife will benefit greatly, from your actions.

One of our goals has been to incorporate the best ideas from what individuals and organizations have shared with us, and to add them into WRMD. We want to share with you what new features and upgrades are planned for WRMD. Below is our to do list for the next year. Our list is endless, but we are trying to keep to a development plan. Our hope  is to have accomplished many of the items before the end of 2014. Some features will be added very soon. Others will be added during the 2014-2015 change over.

Features and Upgrades to Come Sooner Than Later

  1. Add the ability to choose which fields you see in the “List Records” screen (done).
  2. Allow users to log into multiple accounts with the same credentials (done).
  3. Allow users to search for records across all years (done).
  4. Add Lab and Prescription rechecks which will show up in the recheck reports.
  5. Create a more useful husbandry extension.
  6. A complete redesign of the analytics section with more user control of what data is being reported.

Features and Upgrades That Will Occur at the End of the Year

  1. Add the ability to identify siblings and/or foster families.
  2. Add the ability to transfer records to another facility.
  3. Allow homecare users, sub-permitted and satellite rehabers to login and only see their records as well as allow other accounts to see and collaborate on their records.
  4. Update how enclosure’s are recorded to better track where an animal is and where it has been.
  5. Add the ability to identify feathers and anatomical locations of concern on body map images.
  6. Update the age terms to standardized terminology.
  7. Adoption of the Clinical Wildlife Health Initiative terminology.

Many of the above features will require user input before being adopted into WRMD. As we begin to work on a new feature we will be reaching out to our users for their input as well as presenting our ideas of how a new feature might work.

We continue to appreciate feedback from our users. If you think you have an amazing idea that would benefit WRMD and our community please do not hesitate to let us know.

The Clinical Wildlife Health Initiative (CWHI)

The Clinical Wildlife Health Initiative (CWHI) is a group of wildlife rehabilitation hospitals across North America, organized to develop a list of agreed upon standardized terminology used to described the Circumstances of Admission, Clinical Signs and Diagnosis of wildlife rehabilitation patients. The CWHI was organized and chaired by The Raptor Center of the University of Minnesota College of Veterinary Medicine. Its creation was a collaborative effort of more than a dozen wildlife care and conservation organizations including Wildlife Center of Virginia (WCV), the creators of Wild-One.

How the CWHI is Organized

The CWHI is organized primarily into three main groups of terminology:

  1. Circumstances of Admission – Why did the finder bring me this animal?
  2. Clinical Signs – What are the abnormal physical exam findings?
  3. Diagnosis – What caused the abnormal physical exam findings

Within each group there are many subgroups of definition terms, some of which contain a third subgroup of terms. As you traverse the terms down the tree, the terms become more and more specific. The definitions only go at most three levels deep in order to simplify the selection of an appropriate term(s) to use.

The Status of the CWHI

Recently the University of Minnesota Raptor Center has begun hosting a series of conference calls to re-examine the existing terms and enhance the terminology. Organizations from across North American, including Wildlife Rehabilitation MD, are contributing to the cause.

Wildlife Rehabilitation MD and the CWHI Terminology

We absolutely support the CWHI. We feel that regardless of which rehabilitation database one chooses, a standardized terminology shared by all is essential to the wildlife rehabilitation community’s growth. However, we also are realistic and know that rehabbers are short on staff, time, money and other resources. We don’t have the time to think about and choose the most appropriate term(s) for a case from lists within lists. We just want to write down observations and notes in sentences that make sense to us and our co-rehabers. Rehabilitators and veterinary staff that use Wildlife Rehabilitation MD really like the flexibility allowed by Wildlife Rehabilitation MD to describe the circumstances of admission, clinical signs and diagnosis of their patients in commonly used language or medical terminology. This creates a very interesting dilemma, we want standardized terminology, but we also need our record keeping to be quick and easy.

Imagine a scenario during the middle of summer when you’re admitting over 50 animals a day. You have a line of people out the door, each holding a box with a stressed-out suffering patient. This scenario isn’t that uncommon for wildlife rehabilitation centers throughout the country. Those people in line and especially the animals need to be taken care of as quickly as possible. Wildlife Rehabilitation MD was designed by people who have endured summers like this and made it a point to be able to admit our cases quickly and all on one screen. Using common language to describe why the animal(s) were brought to our facility, it is a much easier way to record information.

Part of the Problem

Online behavioral studies have shown repeatedly that while online, people loose interest quickly if the answers they are seeking are not immediate. Choosing from a list of dozens of terms can be time consuming and is akin to taking a survey. It’s human nature to want things to be quick and easy—once a survey taker loses interest they simply abandon the task or fudge the answers simply to get it finished. This would be disastrous and counter productive for standardized terminology’s cause.

Part of the Solution

Wildlife Rehabilitation MD is a database run on a server in the internet. All three of those words mean that any hard or time consuming work can and should be done by a computer. We think that we should let the computers (ie: Wildlife Rehabilitation MD) do the computing and let the rehabbers (ie: us) do the rehabbing. We simply use the fields in Wildlife Rehabilitation MD per normal to admit our patients, describe their injuries and record thier treatments and Wildlife Rehabilitation MD will (behind the scenes) analyze our records for keywords/phrases and determine which CWHI terms best fit. Think this sounds crazy? Try it on Google. They perform this same logic every second of the day, calculating webpage probability based in keyword search. It may seem like magic but in actuality it is simply people typing their words and letting computers do their jobs.

All that said, we will also soon be including a list of the CWHI terms in Wildlife Rehabilitation MD so that if in fact you do want to choose the most appropriate term(s) you can.

The Next Steps for the CWHI and WRMD

As the University of Minnesota Raptor Center host more conference calls, terms are revised and important decisions are made, we’ll make sure to keep you posted on the progress. In time, all this hard work being conducted by rehabilitation hospitals across North America, as well as all the major wildlife rehabilitation databases, will have a tremendously positive impact on our community and the patients we serve. This is a very exciting time going forward for our profession!