Visualizing Health and Healthcare Data

The only data visualization book written by and for health and healthcare professionals.

In health and healthcare, data and information are coming at organizations faster than they can consume and interpret it. Health providers, payers, public health departments, researchers, and health information technology groups know the ability to analyze and communicate this vast array of data in a clear and compelling manner is paramount to success. However, they simply cannot find experienced people with the necessary qualifications. The quickest (and often the only) route to meeting this challenge is to hire smart people and train them.

Visualizing Health and Healthcare Data: Creating Clear and Compelling Visualizations to "See how You're Doing" is a one-of-a-kind book for health and healthcare professionals to learn the best practices of data visualization specific to their field. It provides a high-level summary of health and healthcare data, an overview of relevant visual intelligence research, strategies and techniques to gather requirements, and how to build strong teams with the expertise required to create dashboards and reports that people love to use. Clear and detailed explanations of data visualization best practices will help you understand the how and the why.

• Learn how to build beautiful and useful data products that deliver powerful insights for the end user
• Follow along with examples of data visualization best practices, including table and graph design for health and healthcare data
• Learn the difference between dashboards, reports, multidimensional exploratory displays and infographics (and why it matters)
• Avoid common mistakes in data visualization by learning why they do not work and better ways to display the data

Written by a top leader in the field of health and healthcare data visualization, this book is an excellent resource for top management in healthcare, as well as entry-level to experienced data analysts in any health-related organization.

Preface xiii

Section I Establishing a Framework and Process 1

Chapter 1 Health and Healthcare Data Visualizations of Historical Importance 3

Chapter 2 Stop Hunting Unicorns and Start Building Teams and Know The Data 9

Search for Characteristics and Core Competencies 10

Get to Know the Data 11

Classifications, Intent, Purpose, and Lineage 12

Two Types of Data 14

Qualitative/Categorical Data 14

Quantitative/Numerical Data 14

Scales/Levels of Measure 15

Nominal 15

Ordinal 16

Interval 17

Ratio 18

Summary 19

Chapter 3 Requirements-Gathering and Design Methods 21

Design Thinking Foundational Concepts 22

Design Methods 23

Contextual Inquiry 23

Mental Models 24

Personas 26

Persona Creation Guide 27

Graphic Organizers 29

Guided Analytics Framework 29

Summary Overview Dashboard 30

Supporting Focused Reports 30

Details 31

Multidimensional Exploratory Displays (MEDs™) 31

Sketching 32

Prototyping 33

Testing 34

Summary 36

Section II Perceiving the Best Practices of Data Visualization 37

Chapter 4 The Research 39

Research Informs Data Visualization Best Practices 39

Preattentive Attributes 41

Preattentive Attributes at Work 43

Gestalt Principles 46

Color Theory 48

The Power of White Space 53

Where People Look 54

Summary 54

Chapter 5 Table Design Checklist 55

Fundamentals of Table Design 55

Organization/Categorization 55

Non-Data Ink 56

Fonts 56

Number Alignment and Formatting 56

Labels 58

Summary 58

Chapter 6 Powerful Visualizations in Four Shapes 59

Bars, Lines, Points, and Boxes 59

Shape One: Bars 61

Bar Basics 61

Using Bars To: See How You’re Doing 63

Distributions 63

Histograms 63

Population Pyramid (Paired Bars) 65

Ranking 67

Change over Time 68

Comparing Multiple Data Points 70

Proportions | Part-to-Whole 71

Challenging the 100% Myth 73

Deviation (Difference, Variation) 73

Ranges and Comparative Values 74

Displaying the Vital Few: Pareto Charts 77

Bars Are Not Boring 78

Shape Two: Lines 79

Line Basics 79

Using Lines To: See How You’re Doing 83

As a Reference | Comparison 83

Change over Time 84

Change over Time | Sparklines 86

Change over Time | Deviation Graphs 87

Distributions 88

Distributions | The Empirical Rule and Control Charts 88

Statistical Process Control Charts (SPCs) and Geometric (G) Charts 90

Relationships | Correlations 91

Shape Three: Points 92

Point Basics 92

Using Points To: See How You’re Doing 94

Distributions 94

Revealing Details 95

Change over Time 96

Correlation 96

Hierarchy Quadrant 97

Location Details 98

Shape Four: Boxes 98

Box Basics 99

Using Boxes To: See How You’re Doing 99

Distribution 99

Multiple Values 100

Change over Time and Utilization Rates 101

Hierarchical Data 101

Other Shapes 102

Summary 103

Chapter 7 Maps 105

Using Maps to Gain Insights 105

Geographic Maps 105

Choropleth Maps 106

Hex-Tile Maps 109

Symbol/Dot-Density Maps 110

Proportional Symbol Maps 112

When Not to Use a Map 113

Summary 114

Chapter 8 Graphs and Charts to Never Use or Use with Caution 115

When “Cool Displays” Are Anything But 115

Pie and Donut Charts 117

Why People Use Them 117

Characteristics 118

Challenges 118

Best Practice Alternative 119

Multiples of Several-Part Stacked Bar Charts (MSPSBCs) 121

Why People Use Them 121

Characteristics 121

Challenges 121

Best Practice Alternative 124

Bubble Charts 124

Why People Use Them 124

Characteristics 125

Challenges 125

Best Practice Alternative 126

Treemaps 128

Why People Use Them 128

Characteristics 129

Challenges 129

Best Practice Alternative 130

Marimekko (Mekko or Mosaic) Charts 132

Why People Use Them 132

Characteristics 132

Challenges 134

Best Practice Alternative 134

Radial Bar and Petal Charts 134

Why People Use Them 134

Characteristics 135

Challenges 135

Best Practice Alternative 136

Radar Charts 138

Why People Use Them 138

Characteristics 138

Challenges 138

Best Practice Alternative 139

Sankey Diagrams 141

Why People Use Them 141

Characteristics 141

Challenges 142

Best Practice Alternative 144

One More Thing: 3-D 145

Summary 146

Chapter 9 Making Accessible Visualizations 149

Accessible Design is Good Design 149

Accessibility in Data Visualization 150

Ways to Make Accessible Data Visualizations 151

Summary 158

Section III Creating Compelling Data Displays 159

Chapter 10 Dashboards, Reports, and Multidimensional Exploratory Displays (MEDs™) 161

Definitions Matter 161

Dashboards 162

Dashboards Defined 162

Purpose/Objective 162

Data/Information 163

Design 164

Example Dashboards 165

Dashboard Summary 169

Reports 170

Reports Defined 170

Purpose/Objective 170

Design 170

Example Reports 171

Report Summary 176

Multidimensional Exploratory Displays (MEDs™) 176

MEDs™ Defined 177

Purpose/Objective 177

Design 177

Example MED™ 177

MEDs™ Summary 184

Summary 184

Chapter 11 Infographics 185

"No Tobacco Day" Infographic 186

Measles and Vaccinations Infographic 188

Infographic vs. Infoposter 191

Summary 194

Section IV Closing Thoughts and Recommended Reading and Resources 195

Closing Thoughts 197

Fluency and Mastery 197

Bitten by the Viz Bug | Recommended Reading and Resources 199

Recommended Reading 199

Resources 201

Accessibility Resources 202

Author Bios 203

References 207

Index 211

Kathy Rowell is a nationally recognized health, healthcare, and data visualization expert, lecturer, and author specializing in helping leading organizations analyze, design, and present visual displays of data to inform their decisions and stimulate effective action. She is the co-author of the Best Boring Book Ever (BBBE) of Healthcare Classification Systems and Databases, and BBBE of Tableau for Healthcare Professionals, which are used by numerous colleges and universities and professional organizations to teach and train students and professionals.
Kathy is the Co-founder and Principal of HealthDataViz (HDV) where she has led innovative and ground-breaking projects and data visualization training initiatives for leading organizations such as Memorial Sloan Kettering Cancer Center, the Centers for Medicare and Medicaid Services, and the Children’s Hospital Association. A graduate of the University of NH and Dartmouth Medical School, Kathy lives in Maine and loves being on the water and cruising the coast with her family on their boat "Visualize."

With seven years wholly immersed in healthcare data visualization, following ten years as a licensed marriage and family therapist, Lindsay brings a wealth of direct care experience and an unbridled passion and nationally recognized expertise for visualizing health and healthcare data. A Tableau Zen Master and member of the HealthDataViz (HDV) team, Lindsay is an enthusiastic creator of effective, intuitive, and beautiful dashboards that people love to use and make the story and opportunities buried in the data clear. Her passion for health and healthcare data knows no bounds evidenced by her establishment of #ProjectHealthViz, a community of passionate data visualizers that create displays of health and healthcare data each month to tell our health stories.
Lindsay has a B.A. from Bucknell University and an M.A. from the University of Connecticut. She currently lives in Pennsylvania with her husband and two boys.

Cambria Brown has over ten years of experience analyzing and visualizing health and healthcare data, and is a Tableau Desktop Certified Professional. With a background in public health, survey design, advanced biostatistics, and quality improvement, Cambria understands the full data use cycle and is passionate about helping organizations use data to improve health.
As a member of the HealthDataViz team, she has developed beautiful, user-friendly, and high impact dashboards for a variety of clients including the New York City Dept. of Health and Mental Hygiene, the Colorado Dept. of Public Health and Environment, and the Urban Indian Health Institute. Cambria holds a Master of Public Health in Epidemiology and Biostatistics from Oregon Health & Science University. She lives in Colorado where, when not data vizzing, she enjoys going on adventures with her husband and two children.

Praise for visualizing health and healthcare data

"Reading this book, I've been recalling our data visualization journey at Memorial Sloan Kettering. Since 2017, we've been guided by HealthDataViz (HDV) through every step of gaining and maturing our ability to tell stories, answer questions, and make decisions through the visualization of our data. This book is a guide from the HDV masters generously and comprehensively sharing their craft, covering the science behind it, methodology, process, human element, data, design, visualization techniques, use cases and do's and don'ts. It's also a fun and easy read. I highly recommend it to anyone as a guide for their health and healthcare data visualization journey."
—Rimma Belenkaya, MA, MS, Knowledge Management, Data Modeling, and Data Quality Assurance, Memorial Sloan Kettering Cancer Center

"Easily the most practical and accessible book on visualizing data! It has all the do's and don'ts of visual presentation in one easy-to-absorb book!"
—Jennifer Daley, MD, FACP, Market Medical Executive, Cigna

"This latest book builds upon HealthDataViz's legacy of sharing the type of leading-edge training in data visualization and design thinking that are often reserved for consulting engagements, while still offering so much more via in-person engagements. Having watched them guide current and prior companies on their data visualization and executive dashboarding journeys, I highly recommend this book and the HealthDataViz team."
—Thomas White, MD, MS, CHIE, Clinical Data Science and Insights, MedStar Health

"This is a fantastic book chock full of data visualization best practices and fundamental concepts. The clean design, thoughtful use of color, well-made charts, and specific advice make it helpful for any professional. I especially appreciate the foundation in design thinking and user-centric approach. The healthcare-specific examples should really bring it home for anyone in that industry seeking to do a better job communicating with data."
—Bill Shander, Information Designer; LinkedIn Learning Instructor of Data Storytelling and Visualization; Board Member, Data Visualization Society

"Visualizing Health and Healthcare Data does exactly that. If you work with data in the healthcare sector, then this book will be a valuable resource, not only to read and study, but to have nearby when you are visualizing your data. This book covers the basics, provides a solid framework, and offers real-world examples, while focusing on the most important part, the reader of the visualizations."
—Jeffrey Shaffer, author, Big Book of Dashboards; adjunct professor, University of Cincinnati; Chief Operating Officer, Unifund