  Socio-technical systems play an important role in public health screening
programs to prevent cancer. Cervical cancer incidence has significantly
decreased in countries that developed systems for organized screening engaging
medical practitioners, laboratories and patients. The system automatically
identifies individuals at risk of developing the disease and invites them for a
screening exam or a follow-up exam conducted by medical professionals. A triage
algorithm in the system aims to reduce unnecessary screening exams for
individuals at low-risk while detecting and treating individuals at high-risk.
Despite the general success of screening, the triage algorithm is a
one-size-fits all approach that is not personalized to a patient. This can
easily be observed in historical data from screening exams. Often patients rely
on personal factors to determine that they are either at high risk or not at
risk at all and take action at their own discretion. Can exploring patient
trajectories help hypothesize personal factors leading to their decisions? We
present Portinari, a data exploration tool to query and visualize future
trajectories of patients who have undergone a specific sequence of screening
exams. The web-based tool contains (a) a visual query interface (b) a backend
graph database of events in patients' lives (c) trajectory visualization using
sankey diagrams. We use Portinari to explore diverse trajectories of patients
following the Norwegian triage algorithm. The trajectories demonstrated
variable degrees of adherence to the triage algorithm and allowed
epidemiologists to hypothesize about the possible causes.
