CA2121245A1 - Health care management system - Google Patents
Health care management systemInfo
- Publication number
- CA2121245A1 CA2121245A1 CA002121245A CA2121245A CA2121245A1 CA 2121245 A1 CA2121245 A1 CA 2121245A1 CA 002121245 A CA002121245 A CA 002121245A CA 2121245 A CA2121245 A CA 2121245A CA 2121245 A1 CA2121245 A1 CA 2121245A1
- Authority
- CA
- Canada
- Prior art keywords
- treatment
- guideline
- health care
- individual
- providing
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
Links
Classifications
-
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
- G16H40/20—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
-
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
- G16H50/20—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems
-
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H50/00—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
- G16H50/70—ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for mining of medical data, e.g. analysing previous cases of other patients
-
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H70/00—ICT specially adapted for the handling or processing of medical references
- G16H70/20—ICT specially adapted for the handling or processing of medical references relating to practices or guidelines
-
- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/20—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for electronic clinical trials or questionnaires
-
- Y—GENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
- Y02—TECHNOLOGIES OR APPLICATIONS FOR MITIGATION OR ADAPTATION AGAINST CLIMATE CHANGE
- Y02A—TECHNOLOGIES FOR ADAPTATION TO CLIMATE CHANGE
- Y02A90/00—Technologies having an indirect contribution to adaptation to climate change
- Y02A90/10—Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation
Abstract
A health care management system for use by hospitals, physicians, insurance companies, health maintenance organizations, and others in the health care field includes a processing unit (302) and health condition guidelines. A user imputs information (304) related to the health condition of an individual and guideline-recommended treatments are identified. The user also inputs (304) actual or proposed treatments for the same individual. The resulting comparative information can be used to modify the actual or proposed treatment, or provide explanatory information as to reasons for the difference between actual/proposed and guideline recommended treatment. Also, the comparative information can be used by a reviewer for evaluation or utilization purposes.
Description
WO 94~00817 2 1 2 1 ~ 4 ~ PCI`/l 'S93/061~4 HEALTH CARE MANAGEMENT SYSTEM
BACKGRO~D OF THE INVENTION
The present invention pertains to the field of data processing systems for health care management. More specifically, ~e present invention pertains to a health care management data pro~essing system hr use by hospitals, physicians, insurance companies, health Ix~tenance organi;zations (HMO's)j and others in the health care field to serve as a diagnostdc, evaluation, and utilization tool for health care pro~nded to individuals. The system is implemented in computer hardware and ~5 software.
.I Due to the ine~ing complexity and cost of providing heal~ care, there is an ever increasing emphasis on managing the health care process.
The process extends ~om an individual presen~ng a health concern to a ~: health eare provide~ and: continues tl~-ough diagnosis" ~erapeu~dc ,' 3û selec~on, resource se~ecticsn, ~eatment, and ~llow-up. T~is process could ,~ : be ~tended further to include proactively identifying or preven~rlg h~alth conce~ns and plar~ing for anticipated resour~e needs at one end of ,~ the p~ocess, and daily nursing management and disability management at `~ th2 o~her e~d of the:process.
:~: 35 Previous ef~orts to manage health care induded manual-historical 'i'``:'!~": systems where indindual files recording actu~l treatment provided were manually reYiewed to collect statistics on general categolies of care or to i `~ i ~3UE~STITUTE SHEET
~VO 94/00817 2 1212 4 a PCI/I,IS93/06104 review the appropriateness of treatment in a g~ven case. Such methods are labor-intensive and inefficient. Efforts have been made to standardize dah collection forms, descriptions of conditions, descriptions of treatment, and treatments in order to more efficiently collect and evaluate hea~th care 5 data. Other efforts have been made to automate the analysis of histor~cal health care data for persons with particular health care conditions. These efforts focus mainly on collecting financial data and serve accounting and administrative functions.
At least one known automated prior art health care management 10 system addresses therapeutic selection by starting with a selected treatment and, based on patient information provided by the user, evaluating whether or not that treatment is appropriate. See "Guideline-bas~d Ulilization Management Program", Benefits Ouarterly (4th Quarter 1991) These systems do not develop a recommended treatment based on various 15 data describing an individual's health condition; the user must first select a predefined treatment. Also, these systems do not have the flexibiliq to modUy or add treatments based on an~ individual's changing health condition. Further, these systems~ do not have an integral component whereby explanatory information is elicited~from the health care provider ; 20 or n:viewer~to fadlltate analysls of the~differenoe between actual or proposed treatment; and recD=ded treatment.
It would be~ a~ decided ~improvement over the prior art to have a health care management data~ prooessing system~ that could be used by various he~lth care partiapants, includirig doctors, nurses, health care 25 adminis~ators, payor~ administrators, employers, and evaluators at multiple stages of ~e healt~i care prooess. It would be a furt~er improvement for such~a system to collect information on individuals ;~- ; having a ~ealth concern, to gu~de the user to a recommended treatment `:: : :
based on the infonna~on collected and to compare an actual or proposed :~ `: ~ : :: :
30 treatment with the recommended trea~nt. The prior art systems also leave an unsatisfied need~ for~explanatory information on differenoes between the actual/proposed treatment and a recommended ~eatment : ~ ~ SUBSTITUTE SHEET
WO 94~00817 2 1 2 1 2 4 5 PCI/US93/06104 3,, and for obta~n~ng sytematic rev~ewer input as to any differences between the actual/proposed treatment and a recommended treatment.
It would be a further improvernent over the prior art for such a system to permit continuous updating and modification of the experience S base, using the information inputed into the prooess for each case. For exarnple, the inhrmation on actual treatment provided can be used to reassess the decision path for recommended treatlnents.
A system implementing the above process should ideally have several qualities. It should be cost-effective, i.e., lead to reducing the total10 cost of health care. It should be usable in real-time, i.e., the information input into the system should be i2~unediately prooessed and available for ,i:! fur~er use. It should be interactive, a~lowing a variety of health care participants (doctors, nurses, administrators, quality evaluators) to , understand and ef~ively use the system. It should be flexible enough to ~`1 15 adapt to changes in and evolution of health care professional knowledge and health care treatment~ methods.
A health care management data processing system designed to manage the health care p~s, using a data base of health care records and health condition guidelines, that includes providing diagnosis, evaluation, and utilization information, would be a decided improvement over the~prior art.
SUMMARY~OF THE ~VI~TION
To overcome these and ~other problerns in the prior art, the present invention provides~a hcalth care management data pro~essing system that is a real-time, interactive system to manage the health care proccss desaibed above. Thè systern can b~ used by hospitals, physicians, insurance comp~es,~ HMO's, and others in the health care field to promote cost-effec~ve~health care.
The present invention builds from a data base of trea~anent guidelines developed~by~ medical professionals and provides a diagnosis-`q;~ based system ~at can be uæd during various steps of the clinical decision process: (1) prospectively, before treatrnent, when an individual presents a ''', ~
J ` ~UBSTITUTE S~EET
wO ~4/008I7 2 1 2 1 2 4 ~ PCr/~'Sg3/06104 health concern; (2) concurrently, at any stage of existing trea'anent; and (3) retrospe~tively, after treatment has been provided. The treatment guidelines are structured to work with an interactive question and answer methodology that ensures that the most appropriate data are collected and 5 guites the user through the complex medical evaluation process. This is done by presenting questions in a logically-structured order, leading to guideline-recommended treatment. The information retained by the system allows for a consistent, efficient review process. Variances between actual or proposed and guideline-reco~runended treatment can be used for 10 quality assurance and audit purposes. Also, cross-speaalty review is hcilitated.
Accor'~ing to the present invention, there is provided a processing unit and software-implemented health condition treatment guidelines. A
user inputs an individual's hedth data into a new or existing case file in 15 response to inq ~iries implemented in a health-condition specific guideline. Through the interactive guideline query-response process, a guideLine-recommended treatment~ (or treatments) is obtained. The user may adopt or accept;the guideline recommended treatment or input an actual or proposed~ treatment that is different. Discrepancies between 20 actual/proposed and guideline-recommended treatment are identified and the user~s choioe Isl documented through interactive queries. Once a treatment is selected, ~e case in ormation is added to the dah base and an additional reviewer can anal~r~e the f e.; The case may be re-opened, and ,' ~ changes may be made at any stage in the process to reflect new conditions, 25 or new or modified ~ treatments.
BRIEF DESCRlPrlON OP THE DR~4W~JGS
Figure 1 is a block diagram of the system of the present invention.
Figure 2 is an excerpt~fr:om~a medical category index to the guideline ;~; database. ~ ~
; ~ igure 3 is an excerpt from a diagnosis code-based index to guidelines.
: :
, ~:
i ~ ~
31JBSTITVTE S~EET
BACKGRO~D OF THE INVENTION
The present invention pertains to the field of data processing systems for health care management. More specifically, ~e present invention pertains to a health care management data pro~essing system hr use by hospitals, physicians, insurance companies, health Ix~tenance organi;zations (HMO's)j and others in the health care field to serve as a diagnostdc, evaluation, and utilization tool for health care pro~nded to individuals. The system is implemented in computer hardware and ~5 software.
.I Due to the ine~ing complexity and cost of providing heal~ care, there is an ever increasing emphasis on managing the health care process.
The process extends ~om an individual presen~ng a health concern to a ~: health eare provide~ and: continues tl~-ough diagnosis" ~erapeu~dc ,' 3û selec~on, resource se~ecticsn, ~eatment, and ~llow-up. T~is process could ,~ : be ~tended further to include proactively identifying or preven~rlg h~alth conce~ns and plar~ing for anticipated resour~e needs at one end of ,~ the p~ocess, and daily nursing management and disability management at `~ th2 o~her e~d of the:process.
:~: 35 Previous ef~orts to manage health care induded manual-historical 'i'``:'!~": systems where indindual files recording actu~l treatment provided were manually reYiewed to collect statistics on general categolies of care or to i `~ i ~3UE~STITUTE SHEET
~VO 94/00817 2 1212 4 a PCI/I,IS93/06104 review the appropriateness of treatment in a g~ven case. Such methods are labor-intensive and inefficient. Efforts have been made to standardize dah collection forms, descriptions of conditions, descriptions of treatment, and treatments in order to more efficiently collect and evaluate hea~th care 5 data. Other efforts have been made to automate the analysis of histor~cal health care data for persons with particular health care conditions. These efforts focus mainly on collecting financial data and serve accounting and administrative functions.
At least one known automated prior art health care management 10 system addresses therapeutic selection by starting with a selected treatment and, based on patient information provided by the user, evaluating whether or not that treatment is appropriate. See "Guideline-bas~d Ulilization Management Program", Benefits Ouarterly (4th Quarter 1991) These systems do not develop a recommended treatment based on various 15 data describing an individual's health condition; the user must first select a predefined treatment. Also, these systems do not have the flexibiliq to modUy or add treatments based on an~ individual's changing health condition. Further, these systems~ do not have an integral component whereby explanatory information is elicited~from the health care provider ; 20 or n:viewer~to fadlltate analysls of the~differenoe between actual or proposed treatment; and recD=ded treatment.
It would be~ a~ decided ~improvement over the prior art to have a health care management data~ prooessing system~ that could be used by various he~lth care partiapants, includirig doctors, nurses, health care 25 adminis~ators, payor~ administrators, employers, and evaluators at multiple stages of ~e healt~i care prooess. It would be a furt~er improvement for such~a system to collect information on individuals ;~- ; having a ~ealth concern, to gu~de the user to a recommended treatment `:: : :
based on the infonna~on collected and to compare an actual or proposed :~ `: ~ : :: :
30 treatment with the recommended trea~nt. The prior art systems also leave an unsatisfied need~ for~explanatory information on differenoes between the actual/proposed treatment and a recommended ~eatment : ~ ~ SUBSTITUTE SHEET
WO 94~00817 2 1 2 1 2 4 5 PCI/US93/06104 3,, and for obta~n~ng sytematic rev~ewer input as to any differences between the actual/proposed treatment and a recommended treatment.
It would be a further improvernent over the prior art for such a system to permit continuous updating and modification of the experience S base, using the information inputed into the prooess for each case. For exarnple, the inhrmation on actual treatment provided can be used to reassess the decision path for recommended treatlnents.
A system implementing the above process should ideally have several qualities. It should be cost-effective, i.e., lead to reducing the total10 cost of health care. It should be usable in real-time, i.e., the information input into the system should be i2~unediately prooessed and available for ,i:! fur~er use. It should be interactive, a~lowing a variety of health care participants (doctors, nurses, administrators, quality evaluators) to , understand and ef~ively use the system. It should be flexible enough to ~`1 15 adapt to changes in and evolution of health care professional knowledge and health care treatment~ methods.
A health care management data processing system designed to manage the health care p~s, using a data base of health care records and health condition guidelines, that includes providing diagnosis, evaluation, and utilization information, would be a decided improvement over the~prior art.
SUMMARY~OF THE ~VI~TION
To overcome these and ~other problerns in the prior art, the present invention provides~a hcalth care management data pro~essing system that is a real-time, interactive system to manage the health care proccss desaibed above. Thè systern can b~ used by hospitals, physicians, insurance comp~es,~ HMO's, and others in the health care field to promote cost-effec~ve~health care.
The present invention builds from a data base of trea~anent guidelines developed~by~ medical professionals and provides a diagnosis-`q;~ based system ~at can be uæd during various steps of the clinical decision process: (1) prospectively, before treatrnent, when an individual presents a ''', ~
J ` ~UBSTITUTE S~EET
wO ~4/008I7 2 1 2 1 2 4 ~ PCr/~'Sg3/06104 health concern; (2) concurrently, at any stage of existing trea'anent; and (3) retrospe~tively, after treatment has been provided. The treatment guidelines are structured to work with an interactive question and answer methodology that ensures that the most appropriate data are collected and 5 guites the user through the complex medical evaluation process. This is done by presenting questions in a logically-structured order, leading to guideline-recommended treatment. The information retained by the system allows for a consistent, efficient review process. Variances between actual or proposed and guideline-reco~runended treatment can be used for 10 quality assurance and audit purposes. Also, cross-speaalty review is hcilitated.
Accor'~ing to the present invention, there is provided a processing unit and software-implemented health condition treatment guidelines. A
user inputs an individual's hedth data into a new or existing case file in 15 response to inq ~iries implemented in a health-condition specific guideline. Through the interactive guideline query-response process, a guideLine-recommended treatment~ (or treatments) is obtained. The user may adopt or accept;the guideline recommended treatment or input an actual or proposed~ treatment that is different. Discrepancies between 20 actual/proposed and guideline-recommended treatment are identified and the user~s choioe Isl documented through interactive queries. Once a treatment is selected, ~e case in ormation is added to the dah base and an additional reviewer can anal~r~e the f e.; The case may be re-opened, and ,' ~ changes may be made at any stage in the process to reflect new conditions, 25 or new or modified ~ treatments.
BRIEF DESCRlPrlON OP THE DR~4W~JGS
Figure 1 is a block diagram of the system of the present invention.
Figure 2 is an excerpt~fr:om~a medical category index to the guideline ;~; database. ~ ~
; ~ igure 3 is an excerpt from a diagnosis code-based index to guidelines.
: :
, ~:
i ~ ~
31JBSTITVTE S~EET
2 1 2 1 2 4 ~ PCrll,'S93/06104 Figure 4 is an excerpt from the guideline data base, showing a guideline question ant navigation structure.
Figu~e 5 is another excerpt from the guideline data bæ, showing another guideline question and navigation structure, illustrating a path to 5 a different guideline.
Figure 6 is another excerpt from the guideline data base, showing a guideline question and navigation structure, illustrating how a previously selected answer can pin with a current answer to identify the next step.
Pigure 7 is an example of a guideline recommendation data base 10 item.
Figure 8 is an excerpt from the guideline procedure file.
Figure 9a is a flow chart of the guideline development process.
Pigure 9b ~s a flow chart of the dinical decision process.
Figure 10 shows the medical category screen menu used to acoess 15 the guidelines.
i Figure l l shows a screen l;.s~ng of titles some of the guidelines for selected medical conditions within the cardiovascular/respiratory medical category. ;
Pigure 12a shows a sneen used to access guidelines by diagnosis code.
j ~ Figure 12b shows a screen used to acoess guidelines by treatment : ~ text. . ; ~
Figure 13 shows a~screen used ~to open a guideline prooess after guideline sel~ don. j ~
Flgure 14 shows a saeen with examples of the question/answer prooess for u~lizing the guideline for the diagnosis of thr~mbophlebitis.
Flgure 15~ shows~ a seen identUying guideline recommended treatment for a ~rombophlebitis case, overlaid with a speaalty review box.
Figure 16 shows a~screen identifying guideline re~mmended trea~nent, pro~ ~ treatrnents, and f~nal recommendation treatrnent for a thrombophleMbs~case.~
:; .
~VBSTITUTE S~IEET
wO 94/008l7 2 1 2 1 2 4 5 PCT/IJS93/06l04 Figure 17 shows a screen used for speaalist's review of a case exhibiting variances between proposed and final recommended treatment.
Pigure 18 is a flow chart of the guideline for treatrnent of thrombophlebitis.
ç S DETAILED DESCRIPIIONOFTHE PREFERRED EMBODIMENT
A. Hardware/Software System Overview The present system is shown in general block-diagram form in Figure 1. As seen there, the system 300 comprises a proceCcing unit or CPU
~, with main memory 302; input means 304, such as a keyboard cormected to the CPU/main memory 302; and two output devioes, a display 306 (such as a CRT or other screen device) and a printer 308, also connected to CPU/main memory. Storage devioe 310 (e.g., a disk drive) communicates with the CPU/main memory 302 and is the memory w~it for storing application software 320 and guideline data bases 330. The system 300 also indudes appropriate~ operating system software ~not shown).
The preferred implementation platfonn of the present invention is a system implemented on an IBM~compatible peKonal computer having at least four megabytès of main memory and an eighty megabyte hard disk drive, with Microsoft Windows as the us~ interfaoe~ and Paradox as the data base management software. Individual personal computers can be networked to give multiple users~ access to a comrnon dah base. The application sof~vare 320~1s written in~Mic~oft C development language.
Figu~e 5 is another excerpt from the guideline data bæ, showing another guideline question and navigation structure, illustrating a path to 5 a different guideline.
Figure 6 is another excerpt from the guideline data base, showing a guideline question and navigation structure, illustrating how a previously selected answer can pin with a current answer to identify the next step.
Pigure 7 is an example of a guideline recommendation data base 10 item.
Figure 8 is an excerpt from the guideline procedure file.
Figure 9a is a flow chart of the guideline development process.
Pigure 9b ~s a flow chart of the dinical decision process.
Figure 10 shows the medical category screen menu used to acoess 15 the guidelines.
i Figure l l shows a screen l;.s~ng of titles some of the guidelines for selected medical conditions within the cardiovascular/respiratory medical category. ;
Pigure 12a shows a sneen used to access guidelines by diagnosis code.
j ~ Figure 12b shows a screen used to acoess guidelines by treatment : ~ text. . ; ~
Figure 13 shows a~screen used ~to open a guideline prooess after guideline sel~ don. j ~
Flgure 14 shows a saeen with examples of the question/answer prooess for u~lizing the guideline for the diagnosis of thr~mbophlebitis.
Flgure 15~ shows~ a seen identUying guideline recommended treatment for a ~rombophlebitis case, overlaid with a speaalty review box.
Figure 16 shows a~screen identifying guideline re~mmended trea~nent, pro~ ~ treatrnents, and f~nal recommendation treatrnent for a thrombophleMbs~case.~
:; .
~VBSTITUTE S~IEET
wO 94/008l7 2 1 2 1 2 4 5 PCT/IJS93/06l04 Figure 17 shows a screen used for speaalist's review of a case exhibiting variances between proposed and final recommended treatment.
Pigure 18 is a flow chart of the guideline for treatrnent of thrombophlebitis.
ç S DETAILED DESCRIPIIONOFTHE PREFERRED EMBODIMENT
A. Hardware/Software System Overview The present system is shown in general block-diagram form in Figure 1. As seen there, the system 300 comprises a proceCcing unit or CPU
~, with main memory 302; input means 304, such as a keyboard cormected to the CPU/main memory 302; and two output devioes, a display 306 (such as a CRT or other screen device) and a printer 308, also connected to CPU/main memory. Storage devioe 310 (e.g., a disk drive) communicates with the CPU/main memory 302 and is the memory w~it for storing application software 320 and guideline data bases 330. The system 300 also indudes appropriate~ operating system software ~not shown).
The preferred implementation platfonn of the present invention is a system implemented on an IBM~compatible peKonal computer having at least four megabytès of main memory and an eighty megabyte hard disk drive, with Microsoft Windows as the us~ interfaoe~ and Paradox as the data base management software. Individual personal computers can be networked to give multiple users~ access to a comrnon dah base. The application sof~vare 320~1s written in~Mic~oft C development language.
3; ~ The application sof:tware ~320 functions as an interactive presentation tool, permitting the user ~to interactively ex~hange information with the system ¦ ~ 25 3QO. Certain session data~ are recorded to allow case audit and analysis of ! ~ s~use At the foundation of the~system 300 is a set of diagnosis-based guide~ines that are denved~from medical professional and healthcare managen~ent e~rtise.~ ~ Each guideline is associated with a particular health~ care condition for which treatment exists. Each guideline is : ~ ~
intended to lead a system user through a sequenoe of interactive data-collec~don quer es based on the spe~fied health care condition observed in :
~UBSTITUTE SHEET
wo 94/00817 2 ~ 2 1 2 4 5 Pcr/US93/06104 an individual patient. The data-collec~on queries are logically structured so that the guidelines user iden~fies pertinent pahent characteristics and is led to an endpoint that is usually one recommended treatment. However, the endpoint may also be two or more alternative treatments, a pointer to 5 a different guideline or a reconunendation for further clinical evaluation before treatment is selected.
As implemented in the system 300, a guideline can be viewed as a deci~sion tree with multiple data collection nodes, most of which have conditional branching to connected nodes based on user-supplied data.
10 The endpoints of navigation through the decision tree are usually embodied in a set of recommended treatments. The path to any recommended treatment involves one or more conditional branches.
Thus, each guideline implemented in the system 300 has a definite algorithmic struchlre that guides the user. The structure and content of 15 and pro~ess for development of guidelines are discussed in greater detail below.
The system 300 presents each guideline in a questioning logic sequence where the res~e to each question drives to the next question or to the appropriate treatment option(s). As defined in the present 20 invention, a treatment option includes an intervention and the corresponding pnmary health care resouroes u~lized in that intervention.
The data for implernenting a guideline indude, in addition to question .
; ~ text, the presentation parameters, such as the presentation order for ~e questions, and the conditional branching logic that is driven by the user's 25 responses to the gwdeline questions. Wi~ each guideline implemented as a set of data hse par~m~ters, the application software is designed as a shell used to access and; present ~e guideline content and control ~e na~ngation through the qufftio~g pro~ess.
!
Once the user reaches one or more guideline-recomended 30 trea~nent options, the system 300 elicits from the uær in~ormation identifying the actual ~eatment already given or, preferably, ~e treatment proposed for the individual that presented the health ca~e condi~on. The `
~:
~3UBSTITUTE S~EET
wo 94/00~l7 PCr/US93/06104 21212~5 system 300 compares the ac~al or proposed treatment against the glaidelin~
recommended treatment option(s). This comparison addresses not only ~, the intervention or procedure that is central to each treatrnent option but ~f also the several health care resource pararneters that are part of each 5 recommended treatment option (and are discussed an greater detail below). T~e system 300 develops a treatment evaluation report based on the comparison to identify discrepancies between the guideline-recommended treatment and the achaal or proposed treatment.
There are four general components to the application software 320:
10 (1) an index component that hcilitates quick access to the correct g~udeline;(2) a question component that presents the questions and controls .- navigation through the guadeline based on the user's responsesi (3) a ,~ treatment component that presents the guideline-defined treatment options, and highlights the appropriate option based on user responses to questions; and (4) ~the clinical decision component that facilitates the collection of data to support analysis of the use and irnpact of the guidelines and the tracking of guideline activity by case.
The index component u~lizes several :different data bases. The main index data bàse,~a por~on of which is shown in Figure 2, inducaes: a field 10 wath two dagit numb0 that identify one or more medical categories; a field ~1 1 containing a textual description for each medical calegy; a field 12 cont~ining two digit numbeK each of which identafies o ne o~ multiple gwdelines withIn a rnedkiil category; a field 13 for a g~deli~e extension identi~ier,;signifying ~at certain guidelines are an extension of other guidelines; and a field 14 containing texhlal des~iiption ~;: for each guideline. Iherefore, each guideline can be identified by a ave digit n:umber: a two digit ~edical caW number, a two digit guideline number,~and a one character extension identifier (optional). For example, i the Thrombophlebitis; Ex~t0sion guideline 15 is id~ntified as 53(23X).
The diagnosis~ code index, a por~ion of which is shown in Flgure 3, cross-references each~guideline number in field 16 wi~ one or more .
WO 94/nO817 2 1212 4 5 PCrlUS93/06l04 s diagnosis codes in field 17. This dah base is an index used to iden~fy a guideline based on a diagnosis code entered by the we~.
The question component also has a data basse. Figure 4 shows a portion of the question and navigation data base. For each guideline S identified by numbers in field 18, there are one o more questions, each identified by number and text in field 19. Associated with each question in one or more of columns 20, 21, 22 is coded navigation information identifying the next step, which may be an additional question, a different Z guideline or a trea~nent. Different paths through ~e guideline are indicated by codes representing each possible answer pr~vided by the us~r.
A two digit code in column 20 or 21, such as the "02" at 23a, identifies the next question to be answered. Two characters, at least one of which is a letter, such as the "4A" at 23b, identifies a treatment. Column 20 shows the ~ode for the next step when the user response to a question is "Pass"
(or "yes"). Column 21 shows~ the~ode for the next step when the user response to a question is "Fail" (or "no"). Column 22 ~ontains infonnation identifying a preoeding question and its responses, if the path from a question depends on the ~us~ responses to both the current and a pre~eding question~ ~(An e~aunple of this appeus u~ Pigure 6 and is explained below.) Figure 5 shows another e3cemplary portion of the question and navigation~ data base. As shown in Figure ~, a four digit code ~i ;; 24 in column 20 ~or~ 21 j~ identifies when another guideline should be applied as the next step. ~
, ~ In impleinenting~a guidel~ne, ~the question/answer combinations are sequenced to yi~d ~the most effi~t route to a trea~nent. Also, the queshon/ansvver combinatdons are isequenced based on *equengr of use, listing ~e most conunon questions first. This sequenang sch~me makes the present invention ~n ore~effiaent in moving ~e user directly to the recommended heatment and collecting only relevant infonnation.
Figure 6, which ~shows~ a furt~ur exemplary portion of the question . ; ~ and navigation dah base,~ provides an example in which the answer to a preceding ques~don together with the answer to the clarrent question ~: ~
: SUBSTITUTE SHEET
, ~
wo 94/0081, 2 1 2 1 2 ~ 5 PCr/~'Sg3/06104 defines the next step. Question/answer 04g under ~ideline 53(03) is illustrative. Under the column 22, labeled "Frm", it is shown that question/answer 04g could have been reached by previously answering question 02 as Pass (code "02P") or by selecting any of answers "a" through S Np- to question 03 (codes "03a" to N03p7, If 02P or 03a through 03e were chosen as the previous answer and response "g" is selected for question 04, then in each case the next step is the trea~nent options of n2A~ or "2C".
However, if response "g" were selected to question û4 after the answer corresponding to code "03f" was selected, then the next step is "PR,"
indicating physician review.
The treatment component also uses data bases. Figure 7 is an example of a guideline reconunendation data base set for the condition corresponding to guideline 53(23). In general, for each gtudeline identified by a five digit number in field 25, there are listed one or more recomended treatments. Each treatment~ is identified br. a two character treatment code in field 26,~a textual treatment description h field 27, and several resouroe utilizatio~n ~indicators ;in colwnns 2~32, laWlet Setting, A/S, WS
, Preop LOS, and~ respectively. (These resource utilization indicators are explained in g~ter ~detail below.) Also, a nurneric procedure code, such~ as a Current~Prooedure ~enninology (~PT) code is provlded in field 33.
- A ~pl;ete Dnenu of all treatments that may be referenced in any guideline, i~uding~ trea~ment descriptions and resouroe indicators, is reeained in a~procedure file~;~hat is~uset by all g~udelines. I~e procedure file, an excerpt of ~which ~is shown n Figwe 8, lists the numeric procedure code in field 34, the ~five resource utilization îndicators in fields 3~39, and numeric procedurè~descript~ion text in field 41. A count of ~e number of te~ct lines in ~he nurnenc;~plPoedure description is kept in field 4û.
, , ; ~ ~ The clinical~decision~data collection cornponent is linked to the 30 previous three components to collect data and track guideline activity. Its pUrpO# iS to pro~de a founda~on for moving from ~e individual cases ; ~ ': ' ; 8UBSTITUTE SHEET
wo 94/00817 2 1 2 1 2 ~ 5 Pc~r/US93/o6lo4 prosessed in the systeIn to aggregated statistics for a set of cases. The reports hcilitated by this component are discussed below.
f B. Description of a Dia~nosis-8ased Guideline Magnosis-based guidelines provide a framework to reflect the ' S critical factors in the clinical deasion prooess usually leading to treatment, !.
to define optimal resouroe allocation, and to outline key patient data. A
guideline is not a fixed formula or cookbook, although it must be a definite step by step algorithm that can be coded; rather, a guideline presents a disciplined framework or process to guide ant assist the user, such as a health care provider, in identifying appropriate treatment.
. Application of a guideline to an individual's health condition in the present system 300 consists of four phases: (1) the entry phase; (2) the ` question/dah collection phase; (3) the assessment phase; and (4) the final recormnendation phase. I n~the entry phase, the guideline to be applied is is identified. Generally, a ~guideline is identified by a resognized health ' condition description, which may be stated as a symptom or a diagnosis.
i,f ~: Once the desired guideline is identified among those available in the system, the que~stion/dab coDection phase~begins and the user is !`i~ ` ~ presented with a seriés o f questions. The guideline questions are 20 org nized in a forrnat~ similar ~to a~decision tree or flow cl~ Generally, the next question is identified~o~sed on ~e answer to the current question.
However, some~questions elements may be designed only to elici~
infonnation -and the~ answer does t (at least immediately) influenoe the next question ptesented. The~nu~ of questions presented in a given case valies with the~ guideline selec~Ed and the answers to the questions presented. I
Iri the third phase, the guideline identifies a recommended treatment or o~e~ ~action, based~on the user's answers to the questions presented. As noted~ pre~iously~and shown in Flgures 7 and 8, a recom~nended treatment consists of a textual description, a numeric procedure code, and resource u~lization indicators.
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wo 94/00817 2 1 2 1 2 4 5 Pcr/US93/~
There are a five resource utilization indicators. ~Setting" identifies whether the treatment occurs in an inpatient hcility (IP), outpa~ent hciliq (OP), or physician offlce (OF). "LOS" (Leng~ o Stay) identifies the number of days for inpatient hcilities. "A/S" (Assistant Surgeon) 5 designates whether an assistant surgeon is required. "Preop LOS"
~Preopera~ve Length of Shy) designates the number of inpatient days required prior to elective surge~y. "Flag" indicates special considerations such as }arge case management, physician review, or coordination of services.
More than one recommended treatment may be provided as the outcome of a guideline. Also, a treatment may not be provided; rather, application of a new guideline or further clinical evaluation can be recommended.
As noted above, a guideline is not a fixed formula that, in effect, lS requires the us~ to pursue a given treatment. To the contrary, use of a guideline in the ~present system 300, specifically cont~#nplates that the user may select and~ enter into; the system a proposed or actual treatment that is s ~ ~ ~ not the rea~nu nded treatment indicated by ~e~ guideline If the user sdects a proposed~or~ ~ual ~treatment that is not ~e recommendet 20 treatment~ indicated by the g-udeline, ~then the system calls for specialty review of the case.~ This~ usually imo es; see~ing the opinion of a person different from the person that sdected~ the proposed or actual treatment.
Once the spec~lty ~review is completed, the user enters into the system a final recommendation treatment. This can be the g~ideline 25 recornmended treatment, the proposed or actual treatment previously `' entered by the user, or~ a different treatment reslalting from the specialty review A pmnary purpose of ~e guidelinff is to initiate and facilitate ,~ ~3~ companson and~evaluation, U there is a difference between the the final 30 recommendation treatment and guideline recommended treatment or between the final~recommendation treatment and proposed/actual treatment. This ~comparison and evaluation occurs in d e fourth phase. If 3j ~:
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WO 94/00817 212 I 2 ~ ~ PCI`/l,'S93/061~4 there is a difference between the the final recommendation treatment and guideLine re~omrnended treatment, the system 300 elecits an explanation for each vaAance in the intervention or prooedure, as well as in resource utilization indicators (provided that the differences in the intervention or S procedure permits meaninghl comparisions). If there is a difference between the the final recommendation treatment and proposed/actual treatment, e.g., the user is overriding the proposed/actual treatment of a provider, the system 300 elidts co~unents on the influenoe of the guideline process on the final recommendation, i.e., the manner in which care changed as a result of the guideline process.
The content of a guideline requires that it reflect acoepted clinical practice when forrnulated and also requires (a) ongoing evaluation to ensure appropriateness and (b) assessment of its implementation to ensure consistent application and appropriate sensitivity and speciaaty of its contents. The dinical content of each guideline needs to be based on available evidenoe and refined by result of application. T~us, guidelines are develop~d arst as paper diagnosis and treatrnent models by health care professionals and these models are refined to sufficient definiteness to permit their coding. ~ ~ ~
Figure 9a is a chart outlining the g uteline development process.
At step 1 ~the illness~cabgory that the guideline will cover is identified.
This decision is usuaUy based~ on e~sting patterns, such as the volume of ` ~ cases for an illness category, the extent of valiations in trea~ng an illness, or cost for treating an ~illness. A pa el of people with exp~tise in the selected illness category or in research procedures is established.
At sbp 2, the sa>pe, i e., components of care, of the guideline is identified. The five~ mapr c mponents that a guideline may include are dia~nostic guidelinej~ t~peutic selection, resouroe selection and acute care management. The care componen~s decision is based on the pu.-poses for developing the guideline, understanding how it would be ; implemented, and the financial resources available for guideline development.
SUBSTITUTE SHEET
w~ 94/0~817 2 1 2 1 2 ~ 5 PCr/~S93/06104 At step 3, any subdassifications used to identify severity levels of the illness with a set of treatment options are identified. The subciassifications should be standard groupings whenever possible, so they ,, will be consistent with data used in future analyses.
S At step 4, an evidence chart that defines aspects of the diagnosis or treatment which require specific scientific support or evidenoe is developed. This evidence is necessary to determine the impact on expected clinical outcomes of a spe~ic intervention. It also describes potential adverse affects or outcomes and ~omplications which will need to be considered in evaluating overal! risks and benefits.
At step 5, a literature search is conducted. Prior to conducting the literature search it is important to define the search logic, process, and list of exdusions h order to efficwltly expend time and resources. The evidence chart helps organize the information to complete the l~terature search.
At step 6, evidénoe retrieved for each linhge of the evidence chart is doa~nented in a standard forn~at. l he data abstraction process is completed. The res~lts are summarized to specifically docurnent the results of each study.~ ;
At step 7, ~quantitative ar alysis is used to draw conciusions about a ~particular intervention's effecti~eness. Narrative summaries are created ; ~ ~ of the infolmation~for each~ i~ter rention, descsibing the; impact on expected outcome. ~ l'his~ synthesis of information, inciuding the narrative sumn~, is pro~ided~ to~ knowbdge experts for a decision of clinical ~` 25 impact of interrention on expKtet outcome.
At step 8, a sumn~y of the risks and benefits of interventions appropriate to a~ di~gnosis~is~generated. This summ~ may indude posihve ou~come,~grade of impact, contraindica~on, adverse af ect/mortality, ~adverse affect/morbidity, disability, discomfort and cost impact. At this~ point~ a meeting of the expert panel occurs. During this meeting the nsk sununa~ benefit is reviewed, ~esource selec~on, key . ~ ~3UBSTITVTE S~EET
wo 94/008l7 2 1 2 1 2 4 S PCr/~IS93/061W
management and follow-up guidelines are defined, and consensw on the gu;deline is reached.
At step 9, a clinical appropriateness model is ~eated by the panel that describes by intervention: patient characteristics for which the intervention is indicated and contraindications, with appropriate alternative when present. This inforrnation is then aggregated into a guideline At step 10, for each intervention adopted into the guideline, the panel deterrnines a minimum level of resource required to administer the treatment. This indudes evaluating the setting and potential variables.
At step 11, acute care management is defined For each .. . intervention requiring an inpatient stay, the panel determines the appropriate length of stay.
At step 12, following completion of a guideline, the panel develops guidelines for extended care, which indude the indications, treatments and related resources.
At step 13,~ the panel meets to review the entire guideline for darity and accuracy. Panel members vote formaily for adoption of each I
guideline.
Guidelines ~are continuously updated by re~nng searches by diagnosis ~for newl findings and ~studies. ~ Also each guideline can be reviewed on a pe~lodic~basis,~ such a annually. Wormation from the care management system can be retrieved for that review, induding results of use, Irequency of use,~ frequenq~ of varià~ion by component, type of 2S variations.
C. Using the Syste~
Figure 9b~ shows the basic s~eps of ~e clinical decision process in which the present invention may be used. Initially, an individual presents a health condition to a provider.; Next, the diagnosis process is initiated. The health; care~provider collects information from the individual and perforrns~ tests or o~er prooedures. At this point~ the system user (whether~ it is the provider, assistant, admir~strator, or other) ~ ~ .
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wo 94/008t7 2 1 2 1 2 ~ ~ PCr/US93/06104 may initiate the guideline process leading to a recommended treatrnent.
Also at this po~nt, the user may input an actual or proposed treatment prior to initiating the guideline process.
8roadly viewed in terms of the clinical decision model of Fig.
5 9b, the system 300 can be used to aid diagnostic confirmation and therapeutic selection associated with the diagnosis. The system 300 can also ait resource selection, because the guidelines used in the system conta~n resource recommendation parameters. Thus, the guidelines adtress both the problem of overutilization and its resulting direct costs 10 and underutilization, which usually leads to indirect costs. Using the system in real-time to guide proposed care provides a clinically-sound basis for ongoing quality and outcomes analysis through tracking a specific diagnosis. Potentially inappropriate or les~than-optimal care can be identifed and cone ed. The guideline structure pro~ites a basis for 15 consistent deasion-makin6 while allowing flexibility for complex cacPc requiring care coordination and intensive review.
: ~ `
` To illustrate how~ the system 300 aids diagnostic confi~nation, therapeutic sele~on and~ resource~#lection, it is usefi~l to traoe the actual process followed by a~system user, includulg the saeens presented.
20 1. i~ating a~ Guideline`Process~ - Accessing the Desiret Guideline A~ to the app~opnate g~ideline in a real t~ne mode is a key feature of the~present~ ention. ~lherefore, the index component is struch~ret to a~w, th~user a method of loca~ng the appropriate guideline with tiffering levels of inforn~lation. Por exampie, the guidelines are 25 diagnosis~oased~(that-is, ~y address a spedfied health condition ~at has been realgnized) bùt tliè ~ser (dini~l reviewèr) may only know the procedure being~proposed.~;~ This requuff an efficient search of all of the guidelines that a~ntain~ that p ooedure in order to identify ~e correct guideline for re~iew of the ~cæ
ere are~;~ree ways the user may initiate ~e guideline process.
First, ~e user may~select one category from an alpha index of predefined medic~l categories, as shown in the screen depicted in Figure 10. Each `:: ~ : :
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WO ~4/0081~ 2 1 2 1 2 4 5 PCI`/I,'S93~06104 category leads to an alpha index of guideline titles within that, each title representing a health condition or diagnosis, as shown in Flgure 11. This facilitates quick access to the desired guideline. More than one description may exist for a guideline. To actually select a guideline, the user first S selects one category from a medical catego y list 42 as shown in Figure 10.
For each selected medical category, the system 300 next presents a menu of guideline ldtles 43 as shown in Figure 11. The user then selects the desired guideline 44 which is highlighted as shown in Figure 11.
The guideline process may also be initiated a second way. Once a 10 medical category is selected, the user may move to a screen for inputing a ~! predefined diagnosis code, as shown in Figure 12a. For example, in the preferred embodiment, a code from the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9~M, a standard coding system, may be entered in field 45. One guideline may cover a ` 15 range of diagnosis codes and a diagnosis code may identify more than one guideline. The user selects the desired guideline from the relatively short menu 46 generated hr ~e given diagnosis code. Entry of a 3 digit code will cause ~e system to display a list of all of the guidelines containing that diagnosis code.~ No diagnosis code validation is done. ~Jote that 0 ~ ough the ICD~CM code is ~5 digits, only the first 3 are used to inde~) The guideline process~may also be initiated without identifying a diagnosis. As shown in Fig~e 12b, the user may input text representing a known or proposed~ treatment or procedure inforrnation in field 47. A
procedw or treatment may~ be~found in more than one guideline.
25 Selec~ion is by alpha desiption allowing for a partial string search of 5 characters into the index list. ~he procedure descnptions contain the most s~nificant characters first to~allow a fi~Ged position search. The search is limited to procedure code~ descnptions only, excluding complication descriptions and~;notes. I f matching text is found, the treatment ~on~.aining 30 that text is identified. ~ From that, the guideline~s) containing the identified ,~ treatments are located. Therefore, it is possible that treatment text can lead .
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wo 94/00817 2 1 2 1 2 ~ 5 Pcr/uss3/o6lo4 to more than one guideline. The user then selects the desired guideline from the menu 48 generated in response to the treatment text entered.
After a guideline is selectet, the software calls for identification information to be provided by the user. This is shown in the screen 5 depictet in Figure 13. First, the type of review or file is identifiet. Reviewtype is either initial or extension. Extension review is entered after an initial guideline is used. The extension may be caused by a delayed response or condition in the individual, a complication, a failure of initial trea~nent, or other reason. ~ Next, a case iden~fication nu nber is entered.
10 It is important that a patient have a unique identification number for each admission to ensure all information on the patient is in a single file. As discussed above, extension review allows the user to add inforrnation to an e~asting file. A~ cliniaan or care provider identification nurnber is also entered. Each cliniaan should be identified by a unique nurnber.
15 2. Navigating through a Guideline - the Ouestion/Data Collection Phase Once a guideline is selected, the user proceeds through an interactive process of ~questions~ and answers to reach a recommended treatrnent. Anexamplescreen~s owingpart~oftheprocessisdepictedin Flgure 14. Several~ questions are displayed and a first question 49 is 20 presented to the user by highlighting~ Tl~e are three question formats.
First, the question~ can ~ in ~narrative ~form as at 49 and require a "pass" or ; ~ ~ nfail" (correspon~g to~yes;or~no, respectively) answer 50. The answer is selectedby'pushing"~a~displ~ ed'buttonn. Second,thequestionmay offer multiple answers as~at 52 ~ant pennit selection of only a shgle 25 answer. Response navigation is attached to ea~h multiple~ioice selection (onl,v pass appliesl Third, the question may provide multiple selections as at 51 and all app}icable sele~is~ may be ck~sen. The third type of question is for aboth~na~ngation and data colaeetion and some selections . ~ ~
made do not affen subsequent questions. All questions are presented by 30 highlighting ~e aLnent question and as many questions as possible are displayed on one saeen. Ques~dons ~are numbered to pe~it tracking the : SUBSTITUTE SHEET
WO 94/00817 2 1 2 1 ~ ~ ~ Pcr/uss3/o6lo4 .19 clinical pathway used to arrive at a recommended treatment. A question and any of the responses may extend over more than one line.
Based on the user's answer to the initial question, another question is presented, but it may not be the next question in the numb~ sequenoe.
5 Navigation among questions is dependent on answers and some questions may be skipped. Therefore, the user enters only relevant data and does not have to sift through unnecessary or irrelevant questions.
No backward navigation is allowed in the questioning logic. However, the user may back up to erase and re-enter responses. The number of 10 questions presented to the user varies depending upon the 8t~ideline selec~ed and answers provided.
A question may be arrived at by multiple paths. For example, if question 3 is arrived at from question 1 or 2, then there could be 2 sets of pass~hil navigational options. IJltimately, after navigating through a 15 guideline, the user ~will be provided with at least one recommended treatment, a new guideline or nstructions to seek further clinical evaluation. If questior~ing determinff the need to utilize a different ~deline, then the user is either transferred directly to the new guideline and/or a message~is displaye . A given combination of answers may lead 20 to multiple r_d; treatments as shown by the two highlighted treatments 53,~54 in the~s~een depicted in Figure 15.
Codes are stored that; indicate the path taken through the questior~ulg pr~ ~ (clinical pathway). A "help" menu accessed by a func~on key is available ~at any time to further darify the question, 25 trea~t, or L~stof references. Using the pull-down menu "view"
acoessed~as indicated 56 in Fgure 14, the user may review answers to previous questions.~ ~Howe~rer, exoept in the non directive mode described below, the user may ~not work~ backward or select questions in an arbitrary rnanner. Due to ~the~ nav~gational control built into a guideline, only 30 relevant questions that are required to reach a recommended treatment ;~ SUBSTITUTE SHEET
WO 94/0081~ 2 1 2 1 2 ~ ~ PCl/~lS93/06104i are presented and answered. The user has the ability to exit and suspend review at any time. The review status is stored and the user may continue the review at a later time.
3. Treatment and Review S The guideline question sequence will lead to one or more recommended treatment options, a new guideline, or suggest further clinical evaluation. As shown in Figure 16 all treatment options are displayed to the user with the reconunended treahnent(s) highlighted.
Multiple treatments may be appropriate for a specified combination of answers. A treatrnent option may be displayed with message or note lines.
More than one page of treatments may be present, and the uær can page through all treatments.
A treatment option is displayed in eight fields, as shown in the screen depicted in Figure 16. The first field 57 is a two~uracter treatrnent i; 15 code that hcilitates tracking of treatments within a guideline. The ~de is unique within the selected ~guideline only. Next is a field 58 aontaining a brief description of the treatment, followed by a field 59 for the applicable numeric prooedure ~ode. Multiple prooedure codes may be present if a treatrnent consists~ of more than one prooedure. A procedure code may not always be av~ble for a trea~nent~ option. If it is not available, an internal code will be created~ b~ut not displayed on the screen. The prooedure code can be used in~ reimbursement for the selected treatment.
Next thie résouroe utilization~ indkators are L;sted. The treatment setting field 60, labelled,~"Settingn, identffles inpatient facility (IP), outpatient facili~ OP), or ph~ offioe (OF). The length of stay field 61, iabelled "~OS', provides the nurnberof days fof inpatient facilities. The assistant surgeon ~ d 62,~ elld "AlS", designates whether an assistant surge~)n is requ~ed (y-yes;~n=no; szstandby) l~e preoperative days fielt i ~ ~ 62, labe~ed, "Preop', designates the number of inpatient days required 30 prior to elective surgery. Flag field 64 indicates special considerations such as large case management, physiaan review, or coordination of services.
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As stated previously, the user may enter an actual or proposed keatment prior to or after obtaining the guideline-recommended treatment(s). To enter an actual/proposed treatement after arriving at a guideline recommended treatment, the user utilizes the "Enter" menu 5 and reaches a screen with the fonnat shown h Figure 16. As shown in Figure 16, for the proposediactual treatment the user enters information in five labelled aelds, induding treatment code 69 and the resource utilization indicators of Treatment Sett~ng 65, Length of Stay 66, Preoperative Days 67, and Assistant Surgeon 68. The user norrnally enters 1~ a 2-character treatment code corresponding to one of the treatment options listed above fields 65~9. If the propooed/actual treatment is not listed in that guideline, then a reserved code will be entered and the proposedtactual treatment must be described.
If the proposed/actual treatment is not the same as the guiteline-15 recomrnendet treatment, then the system prompts the user to initiate spe~ality review. ~ Figure~ 17 shows a saeen used in the specialist review process. The spedalist review window is overlald on the treatment options list screen. The foUowu~g fields have data automatically entered:
case ID number ~70, review ID number 71, and~specialist review number n.
20 A five character~lD aeld~73 is user-filbd to identify the spe~alist reviewer.` ~ Four types of review ~with dif~g associated costs and exper~hse can be ;~ selected: clinical review~ (CR) 74; physiaan revlew (PR) 75; independent medical exim (I~) 76; and ~appeal 77. Clinical review is conducted by a licensed professional~with expertise in à par~cular speaalty including the 25 provider or another; on the user staff who has the authority to approve varian~ Physiaan;review is by a consulting physician with authority to approve varianoes.;~ ~IME is a required referral for a second opinion examination. This type of review is chosen based on individual case ments or for a mandatory se ond opinion list. Appeal is a review by a 30 consulting physician generated by an appeals notification.
The reason field in the specialty review window includes seven possible reasons~why the case was carried to a d.Uferent level of review, SUBSTITUTE SHEET
wo 94/008l, 2 1 2 1 2 ~ S Pcr/US93/o6104 including appropriate treatrnent plan 78, partial procedure 79, sefflng 80, LOS 81, preop days 82, assistant surgeon use 83, and diagnosis confirmation 84. For any given case, multiple reasons could be present.
Any varianoe between the proposed/actual and guideline-recommended ~ S treatrnent are automatically designated. Actual consideration of the case !~ by a specialty reviewer occurs off-line. The result of that review is comrnunicated to the user, who is now enters a final re)mmendation, incorporating the condusions reached in specialty review, in the formate required by the screen shown in Figure 16.
With a guideline-recommended treatment identified and a user-selected proposed/actual treatrnent as well as a final reco~unended treatment entered in the systern-defined format, the system 300 per~orms ` comaprisons.
;l ~ Whenever there is a vanance between the treatrnent or a resource lS utilization indicator~for a final rea~nunended treatment and guideline recommended treatment, the system~elicits reasons for the variance(s).
;j The "reason" field ~corresponding to a~ resource utilization indicator where , ~ there is a variance is highlighted. One character standard reason codes are t, used to explain o~erriding~ the guideline recommended treatment.
Reason codes indude the following: I
i A- addibonal diagnosis (cornorbidity) ;~ B - si~cant~cbnical ir~s ~i C -complication D - unavailable infonnation 'r~ 25 E -alternativecareavailaWli~
F - facili~ capability ~ ~ G-geographicdistanoe r~ H- soaal situation surgical sîabilizabon J - contraindication , K- age L - practitioner expenenoe ~, !:
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wo 94/008l7 2 1 2 1 2 4 ~ P~/~'Sg3/0610 : 23 M - patient preference O - system override Z - other For example, "Setting" reason must be completed if the final 5 recommendation treatment Setting is higher than the guideline treatment Setting (IP~OP>OF). "LOS" reason must be completed if the final recommendation LOS is greater than the guideline LOS. "Preop" reason must be compbted if the final recommendation Preop days are greater than the guideline Preop days. Assistant Surgeon reason mwt be 10 completed if the final reconunendation Assistant Surgeon use is greater than the guideline Assistant Surgeon (Y>S>N). Diagnosis confirrnation reason must be completed if a specialty réview reason indicates diagnosis confilmation. [PLEASE CONFIRM]
A final recornmendaaon reason des~iption is enteret if there is no 15 standard reason code for; the final recornrnendation trea~nent or for fur~er explanahon even when a~stan~dard code exists. Por ex~rnple, it is desirable to elicit user comment identiying other diagnosis information that was considered~relevant to treatment xlection and may leat to future modification of the guideline. ~ A ~button" allows access to a free text entry 20 window.
The "Care Ch;mged' fields are used if the final recommendation trea~t is different ~from ~e~ proposed~a~al treatment. Whenever ~` there is a varianoe~betwoen the~treatment or a resouroe utilization ~ndicator for a final recommended treatment and actual/proposed 25 treatment, the system ~eliats rewns for the varianoe(s~. The "reason"
field correspondin~;to~a~ resource uti;lization indicator where there is a rarianoe is highlighted. Treatment "Care Changed"fiel is used if the final rec~mmendation~ different than the proposed/actual treatment. The treating physiaan;indicates whether he agrees ~nth the recommendation 30 (Y, N, U=Unhtown). ~ ;Setting "Care Changed" is used if ~e final re~mendation treatmént ~Setting is different than actual/proposed Treatment Setting. ~The treating physiaan indicates whether he agrePs WO 94/00817 2 1 2 1 2 ~ ~ ~/U593/06104 with the final reconunendation (Y, N, U=Unknown). LOS "Care Changed" is used if the final reconunendation LOS îs difhrent than the actual/proposed LO5. The treating physician indicates whether he agrees with the final reconunendation (Y, N, U). Preop "Care Changed" is uset if S the final recommendation Preop days is different than the actual/proposed Preop days. The treating physician indicates whether he agrees with the final reco~unendation (Y, N, U). Assistant Surgeon "Care Changed" is used if the final reconunendation Assistant Surgeon is different than the actual/proposed Assistant Surgeon. The treating 10 physician indicates whether he agrees with the final reco~runendation (Y, N, U). DX "Care Changed" is used if the case was sent to specialty review fo- diagnosis cVonfirmation~ then the treating physician annohtes whether he agrees with the dedsion (Y, N, U). IPLEASE CONFIRMl D. An Example Guideline - Thrombophlebitis .
An example of the gwdeUne process for a specific health condition is shown in Figure 18, a flow chart for the guiteline, thrombophlebitis, in conk~on with previously discussed s~s shown in Figure 11-16, which represent portions of the implanentation of the flow chart of Pigure 18. I~is flow~chart does~not indude all information presented to 20 the user that would~appear~ on: the té~minal sneen. For example, at step 106 the flow chart shows only the recommended treatment code and treatment text. However,~the~guideline definition for thrombophlebitis indudes ar~d the user would~actually~be presented with a saeen similar to Flgure 16 whkh would include, the~CPI code and resource utilization 25 indicators for each~treatment optwn. Also, the flow chart differs from the ¦ ~ ~ actual saeens in that s~disp~d questions are answered as "pass" or nfailn, which con~spond~to nyes"~or "non, respectively, in the flow chart.
Sbp 100 is the entry point ~ to selection of the , ~ ~ g udelirie based~on~the guideline~title, as shown in Figure 11, or by use of a 30 diagnosis code, as shown in Figure 12, or a treatment text search, as shown in Figure 13 At step 101, the user is asked whether the condition is a superficial or deep vein thrombosis. If the us~ selects "superficialn, at step SUBSTITUTE SHEET
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w~ 94/008l7 2 1 2 1 2 4 5 Pcr/uss3/06l04 : 25 !, 102 the user is asked whether the diagnosis by examination and symptoms includes one of the following: pain, redness, or swelling. If the user selects "no", at step 103 Physician Review is reco~unended. U the user selects "yes", at step 104 the user is asked whether the patient has progressive S symptoms despite appropriate out patient management. If the user selects "no", at step 105 continuing out-patient treatment is the recommended treatrnent option. U the user selects "yes", at step 106 a ~ideline-recomrnended treatrnent identified by code 7D is presented.
If the user selects "deep vein thrombosis" at step 101, at step 107 the 10 user is asked whethel it was diagnosed on doppler/venogram as shown in Figure 14. If the user selects "no," at step 108, Physician Review is recommended. If the user selects "yes," at step 109, the user is aslced whether anticoagulation therapy is contraindicated due to several factors.
If the user selects "no," at step 110 two guideline-recommended treatments ~', 15 identified by a~des 7A and 78 are presented. No preference between the t, :
two treatments is identified. At step 111, the user is asked whether the treatment hiled.~ If the;user selects "no, at step 112 g~udeline indicates that the individual i5~ to be~ discharged. If the user selects "yes", at step 113 a new guidelin_ded treatrnent identified by code 7C is ;~3,; 20 presented.
~; If at step~lO9 the user selec s "yes", at step 114 the user is asked whether there is p~cimal emboiization. If the user selects "no", at step 115 the guideline rff~mme ded treatment identified by code 7C is presented. If the user selects "yes," at step 116 the user is referred to additional medical literature for fur~er diagnosis.
The saeens implementing this guideline include all of the questions and aon~tional branching necessary to navigate through the flowchart of Figure~ 18~ and reach each of the treatment options or o~er ;~ endpoints shown.
For example,~the screens presenting questions would appear similar to Figure 14 with the current question higl~ighted. When the guideline reaches a recommended treatment, the user would be presented with a .
, ~
~UBSTITUTE SHEET
,, WO 94/0081 ~ 2 1 2 1 2 4 ~ PCI~/l,'S93/06104 sae~n similar to Figure 17, without the Specialist Review su~screen, showing g~udeline reconunended treatrnent options with the recommended treatment(s) highlighted. Figure 17 reflects a question/answer path yielding two recommended treatments. Figure 16 S shows one recorded treatrnent reached by a different question/answer path through the guideliné. Figure 16 also differs from Figure 17 in that the user has additionally entered a proposed and final recommendation treatment.
E. Alternative Embodiments of the Invention The above embodiment of the invention is a directive mode whereby the gu~deline process is self-prompting and the user is only required to answer designated questions. In an alternative embodiment invention, the guidelines can be acoessed in a non-directive mode whereby the user can access all questions for a given guideline, to view lS and selectively answer the questions. At any point, the user can shift back to the directive mode and the questions wil~ again be self-prompting with a question appearing based ~on the questions already answered in the non-directive mode. lExplain utility? Can~ d treatments be bound?~
20 F. Reports An important fèature of the~ present invention is its ability to capture key data durmg~ usage for individual patients and cases. This enables the user to tràck~and analyze pattems of care a~oss defined populations in order~to~unterstand trends and variations for planning 25 purpo#s. In addition,~;repor~ can show provider profiles, diagnostic decision outcome profiles,; as well as procedure decision outcome profiles.
On line reports include~adrninistrative reports, summary reports and worksheets. Repor~s mày be used by renewers as work and time rnanagement tools ~and~ by adrninistrators and managers for summary 30 reports and planning tools. Reports may selected for designated time ~UBSTITUTE SHEET
wo 94/00817 2 1 2 1 2 ~ S Pcr/l~S93/06104 D
Reports sort and summarize case review status in several ways.
Case review status includes the following: dosed, i.e. closed (C) by normal review procedures or closed by adn~inistrative closed (A); and open, i.e.
suspended in questioning ~Q), and specialty review (S), or open because S the review process has not been completed (?
There are six types of daily *oductivity Reports: operation manager, supervisor, care manager, specialist reviewer, specialist reviewer productivity, and specialist review worksheet. An example of a operation manager report is shown in Appendix A. This is a general summary 10 report which slummarizes all open case reviews by medical category 200, i.e., reviews with the status of O, Q or S. A total of all open case reviews for all categories 201 is also listed. Initial reviews 202 as well as extension ~ reviews 203 for each category are listed as well as case re~news and specialty $ review 204. This report also summarizes case reviews which are still open and over 30 days old 205 and open reviews which are less than or equal to 30 days from the fnitial review data entry 206.
An example of a~ supervisor report is shown in Appendix B. I~is is a general swnmary report which sununarizes all open case reviews (with status O, Q or S) and ~is~sorted~by~care~manager (reviewer). A total of all 3~ 20 open case reviews for each care nlanager is listed 207. Initial reviews 208 as well as extension reviews 209 are listèd as~ well as cases 210 ant specialty review 2t1. This report~ also summarizes case reviews which are still open and over 30 days old 212~and~open case which are less than or equal to 30 ~3 ~ days from the uutia~ ~ rèview ~data; entry 213.
3 ~ ~ `
An examp1e of the care manager report is shown in Appendix C.
This is a general su~nmary réport which summa~izes all open clse reviews (status O, Q or S) by~indivWual care m~nager (reviewer) 214. This report surnmanzes for each c~re~ manager all open case reviews listing the case ID
215, the most = t review date for the review 216, identifying whe~er the review was initial or extension 217, the speciaL;st review type ~; ; (physician reviewer, Independent medical exam/second opinion appeal) ~` 218, referral reason ~2]9, and the case review guideline name 220. This .~y~
!i~ SUBSTITUTE SHEET
,1 Wo 94/0081t 2 1 2 1 2 ~ 5 Pcr/~s93/o6104 report is generally used by the care manager for follow-up and tracking and by the specialist reviewer as a t~ne management and daily o~ weekly work planning tool.
An exarnple of a specialist reviewer report is shown h Appendix D.
This is a general summary report which s~unarizes open case reviews with specialist status (5) reviewer sorted by reviewer ID, case ID, and review date. This report summdrizes for each specialist reviewer 221 all open case reviews listing the case ID 222, the most current reYiew date for the review 223, identifying whether the review was initial or extension 224, the specialist review type ~dinical reviewer, physician reviewer;
independent medical exam/second opinion, appeal) 225, referral reason 226, and the case review guideline name 227. This report is generally used by the care manager for foliow-up and tracking and as a daily or weeldy planning tool.
An example of the specialist reviewer productivity report is shown in AppendL~c E. This summarizes reviews with a specialist review status (S) sorted by medical categ ry and specialist review type, case ID and review date. For each of these the following are listed: the case ID 228 with the most current~ review date ~for~ the review 229, whether the review was in~tial or extension 230,~ sped~list identification nurnber 231, referral reason 232 ~and the~case review guideline name 233.
An example of a speaal;,st~review work sheet is shown in Appendices F, G.~ ihis~report sumn~ per~nent information for a case review which needs~ a~specialist r~ew. This would most co~unor~y be 2~5 used for physician review although it can be used for clinical review, independent medical exam~#cond opinion or àppeal. The report lists the specialist reviewer 234, the case 235 and clinician ID 236, the proposed treatInent 237 and guidelinè recommended treatment 238 wî~
apropriate resources downloaded with the software. Ques~ns passed and failed are summarized 239 and the reason for the speaalist re~iew 240 is identified. Note~text 241 which has been entered for ~e case is included.
This report is completed bv the care manager (reviewer), printed and .
WO 94/00817 2 1 2 1 2 ~ ~ PCl~/US93/06104 distributed to the appropriate specialist reviewer. The speaalist reviewer would discuss the case with the appropriate resources, complete the inal re~ommendation 242 and outcome and return the worksheet to the care manager who would enter the reason code 243 and text into the case review file.
Information management reports identify overall volume and patterns of care induding diagnosis, therapeu~c selection ant resource use. From these reports, you can determine the level of effectiveness or impact related to each guideliM use. You can also use the reports for quality measurement and planning by identifying where variations are occurring and how they are resolved at the initial guideline level. Reports may be selected by date in either clinician identification number or reviewer identification number or both. They are sorted automatically by specialtyarea. ~; ;
An example of a reporting peri:od sununary shown in Appendix H.
; This report gives an overall surnmary of all cases in reviews. It lists case volume 244 (number of total cases), review volume 245 ~number of individual reviews), the nurnber of physicians 246, and the number of different guidelinesi~used~for initial and extension reviews 247. This report may be sorted for~ a specific t~ne.
An example of a guideline frequency report is showrl in Appendix I.
This report lists ~n how many cases a particular guideline is used 248. The peroent of cases usmg;;each~guideline 249, and the percent of t~tal cases that guidel;ne represents 250 are also listed.
.An example of:a patterns of care report is shown in Appendix J.
This report lists the total ~nu~of cases using the ~rarious guidelines 251.
The propos~d~ trea~ent(s)~for;each guideline 252 are listed with the number of cases for~each~ 253. Proposed average leng~ of stay 254 and recomrnended length of stay 255 are also listed for each guideline proposed treatment. This report can also be~sorted by overall total or cliniaan identification number. ~
~: SUBSTITUTE S~IE~T
:
WO 94/00817 2 1 2 1 2 ~ ~ PCI~ S93/06lW
, An example of a quality mana~ement and planning ~aggregate) report is shown in Apyndix K This is an aggregate report which lists the total number of cases with the requested diagnosis. For each diagnosis guideline requested 256, the following are listed: proposed 257 and final treatment combination 2S8, number of tohl cases with that combination 259, peroent of total cases 260, what peroent went to speaalist review 261, how many varied from the guideline 262, the number with a guideline variance 263, the number of times each variance code was used 264 and the percent of care changed by the treating physician/care provider 265.
An example of a~quality management and planning ~for each component) report is shown in Appendices L, M. This report is sorted by guideline 266, proposed treatment~267, and final recorrunendation 268.
~j This report is a more detailed report and is a subset of the aggregate quality ,¦ management and plalu~ing report. It lists the three categories of setting 269, preoperative days 270 and length of stay 271. The to~l number of cases are listed 272. ~ For each guideline in each~ category, the following are listed: proposed 273 and find recommendation treatment 274, nurnber of cases under each categoq 275, percent :of the cases that carry the ~; propased/final combination 276, p~rcent to specialist review 277, guideline 71 ~ ;20 variations 278, the number with a guideline variance 279, the num~?er of ; times each variance~code;was u~ed 280, and the peroent of care changed by the treating physiaan 281. ~ ~
An exampie of the effecbver~ss report is shown in Appendix N.
This;report provides a breakdown by guideline 282 of the results of its use ~or impact) on the following areas: percentage of reviews where proposed treatmerit selec~orl was impacted 283, percentage of re~riews where propo#d resources werè~impacted ~284, percentage of reviews where both Teatment selection~and~proposed resouroes were impacted 285, and the ,, ~
percentage of total~ cases impacted 286 and total cases 287.
7 ~ 30 Although the~ description of the prefe~ed embodiment has been presented, it is contemplated that various changes could be made without deviating ~rom the spit of the present invention. Accordingly, it is '1 ' ~ ~UBSTITUTE SHEET
wo g4~008l7 2 1 2 1 2 ~ ~ PCr/US93/06104 intended ~at the scope of the present invention be dictated by the appended claims rather than by the descripffon of the pr~erred embodiment.
SUBSTITIITE SHE~ET
W0 94/0081 ~ 2 1 2 1 2 4 ~ PCI/US93/06104 APPENDIX A
_ ._. _. __.. _ _. ._.. ___.____~ _ _ -- . . . .. . ~ _ .. . _ _ __._A_ ____ Date Daiiy Productivity Report Page Operation Manager , 200~ # to ~ ~ ~
Open Specialist Open Open Medicai Category Reviews Review ~=30 days ~30 days __________________________ ________ __________ _________ __________ .
Cardiovascular/Respiratory 202 - Initial 24 4 22 2 Extension 6 1 6 0 203~ Total 30 5 28 2 1 Gynecology I Initial 10 2 10 0 Extension 2 0 2 0 , 201~ Total 12 2 12 0 ! TOTAL Initial 34 6 32 2 ' Extension 8 1 8 0 i Total 42 7 40 2 -i A
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i ~3UBSTITUTE ~;~IEE~
WO 94/00817 2121 2 ~ :3 P~/US93J06104 , ~ 33 ~1 Date Daily Productivity Report Page Supervisor Medical Category: Cardiovascular/ResPiratorY
# t~ 2~ 2~
. Care Review Open specia'ls. Open Open Manager Type Reviews ~eview ~=30 days >30 days :~ _______ __________ ________ __________ _________ _______ __ ~ ABCDE Initia~ 2082~ 4 22 2 ;, 20g Extension 6 ; 6 0 1 20 7~, Total 30 28 2 ;¦ DEFG~ Initial 10 2 10 0 ?~ Extension 2 0 2 0 ~ Total 12 2 12 0 ;~1 TOTAL Initial 34 6 32 2 ~1 Extension 8 1 8 Total 42 7 40 2 '.~
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SUBSTITVTE SHEET
W~ 94/00817 P~/I~S93/0610~
APPENDIX C
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DateDaily Productivity Report Page Ca_e Manager Care Manag r: ABCDE (Na e2l7 21~ 21~ 220 ~ Review Init/ Spec Referral Case ID DateExt Type Reason Guideline _________.. __ ________ _____ ______ ________ ____________________ ___ 0580111}2223 05/01/92 I PR TPLAN Angina, Stable 0580111122Z3 05/05/92 E Angina, Stable 011122223333 05/10/92 I PR SET Degenerative Joint Disea LOS
012333332229 05/01/92 I Degenerative Joint Disea .
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~3lJE~STITUTF S~EE;~T
WO 94/00817 PCI/US93/~6~04 21212~:) APPENDIX D
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Date Daily Productivlty Report Page Specialist Reviewer , Specialist Reviewer: XYZAB "-22! 226~
222 224~ 225~ / 227) 223 Review ~Init/ Spec Referral Case }D ~ Date Ext Type Reason Guideline `~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -- _ _ _ _ _ _ -- -- ~ -- -- -- -- -- -- -- -- A
058011112223 05/01/92 I PR TPLAN Angina, Stable 058011112223 05/05/92 E PR LOS Angina, Stable ! 011122223333 05/10/92 I PR SET Dege~erative Joint Disea LOS
j 012333332229 05/01/92 I PR TPLAN Degenerative Joint Disea ;l .
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' SLIBSTITVTE E;~IEET
W~ 94/00817 PCI/US93~061(~4 APPENDIX E
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Date Daily Productivity Report Page Speci~list Revlewer Productivity Medical Category: Cardiovascular/Respiratory Specialist Type: PR Physician Referral 232 22~) 229 230) 231) / 233) . ~ ~ Review ~Init/ Spec ~ Referral Case ID Date Ext ID Reason Guideline '' ____________ _____________ ______ _______-- ________________________ 058011112223 O5tOlJ92 I XYZAB TPLAN Angina, Stable 058011112223 05/05~92 E XXXXY LOS Angina, Stable 011122223333 05tlO/92 I XYZAB SET ~hrombophlebitis LOS
012333332229 05/01/92 I XYZA~ TPLAN Arterial Occlusive Disea ~31LJBSTITUTE S~EET
WO 9t~tO0817 2 1 2 1 2 ~ S PCI/l,'S93/06104 QPPENDIX F
Date Spec~ s~ Rev~ew Work Sheet Page 1 Specisli5t Rev-ew~r: XY~U ~ 2 3 4 Roturn to:
C~re H~nager: A~CDE f-235 oY Idate~
C~sn Id: 00000510000; i~aVlCW ~: 2 Clinic~an Id: A00100 ~ 2 3 6 Review D~te: 6~05/92 iDiaqnosis: Calculu3 ~sete:Al Proposed Treatment: ~ 2 3 7 Setting LOS Preop A/5 4A) Cystoscopy with re~royrdde stone IP 02 G N
m~nipulat~on Guideline Recommended Tre~tment: ~ 2 3 setting DOS Preop A/S
4AJ Cystoscopy w~th retrograde stone IP 01 0 .
m~nipulaCion
intended to lead a system user through a sequenoe of interactive data-collec~don quer es based on the spe~fied health care condition observed in :
~UBSTITUTE SHEET
wo 94/00817 2 ~ 2 1 2 4 5 Pcr/US93/06104 an individual patient. The data-collec~on queries are logically structured so that the guidelines user iden~fies pertinent pahent characteristics and is led to an endpoint that is usually one recommended treatment. However, the endpoint may also be two or more alternative treatments, a pointer to 5 a different guideline or a reconunendation for further clinical evaluation before treatment is selected.
As implemented in the system 300, a guideline can be viewed as a deci~sion tree with multiple data collection nodes, most of which have conditional branching to connected nodes based on user-supplied data.
10 The endpoints of navigation through the decision tree are usually embodied in a set of recommended treatments. The path to any recommended treatment involves one or more conditional branches.
Thus, each guideline implemented in the system 300 has a definite algorithmic struchlre that guides the user. The structure and content of 15 and pro~ess for development of guidelines are discussed in greater detail below.
The system 300 presents each guideline in a questioning logic sequence where the res~e to each question drives to the next question or to the appropriate treatment option(s). As defined in the present 20 invention, a treatment option includes an intervention and the corresponding pnmary health care resouroes u~lized in that intervention.
The data for implernenting a guideline indude, in addition to question .
; ~ text, the presentation parameters, such as the presentation order for ~e questions, and the conditional branching logic that is driven by the user's 25 responses to the gwdeline questions. Wi~ each guideline implemented as a set of data hse par~m~ters, the application software is designed as a shell used to access and; present ~e guideline content and control ~e na~ngation through the qufftio~g pro~ess.
!
Once the user reaches one or more guideline-recomended 30 trea~nent options, the system 300 elicits from the uær in~ormation identifying the actual ~eatment already given or, preferably, ~e treatment proposed for the individual that presented the health ca~e condi~on. The `
~:
~3UBSTITUTE S~EET
wo 94/00~l7 PCr/US93/06104 21212~5 system 300 compares the ac~al or proposed treatment against the glaidelin~
recommended treatment option(s). This comparison addresses not only ~, the intervention or procedure that is central to each treatrnent option but ~f also the several health care resource pararneters that are part of each 5 recommended treatment option (and are discussed an greater detail below). T~e system 300 develops a treatment evaluation report based on the comparison to identify discrepancies between the guideline-recommended treatment and the achaal or proposed treatment.
There are four general components to the application software 320:
10 (1) an index component that hcilitates quick access to the correct g~udeline;(2) a question component that presents the questions and controls .- navigation through the guadeline based on the user's responsesi (3) a ,~ treatment component that presents the guideline-defined treatment options, and highlights the appropriate option based on user responses to questions; and (4) ~the clinical decision component that facilitates the collection of data to support analysis of the use and irnpact of the guidelines and the tracking of guideline activity by case.
The index component u~lizes several :different data bases. The main index data bàse,~a por~on of which is shown in Figure 2, inducaes: a field 10 wath two dagit numb0 that identify one or more medical categories; a field ~1 1 containing a textual description for each medical calegy; a field 12 cont~ining two digit numbeK each of which identafies o ne o~ multiple gwdelines withIn a rnedkiil category; a field 13 for a g~deli~e extension identi~ier,;signifying ~at certain guidelines are an extension of other guidelines; and a field 14 containing texhlal des~iiption ~;: for each guideline. Iherefore, each guideline can be identified by a ave digit n:umber: a two digit ~edical caW number, a two digit guideline number,~and a one character extension identifier (optional). For example, i the Thrombophlebitis; Ex~t0sion guideline 15 is id~ntified as 53(23X).
The diagnosis~ code index, a por~ion of which is shown in Flgure 3, cross-references each~guideline number in field 16 wi~ one or more .
WO 94/nO817 2 1212 4 5 PCrlUS93/06l04 s diagnosis codes in field 17. This dah base is an index used to iden~fy a guideline based on a diagnosis code entered by the we~.
The question component also has a data basse. Figure 4 shows a portion of the question and navigation data base. For each guideline S identified by numbers in field 18, there are one o more questions, each identified by number and text in field 19. Associated with each question in one or more of columns 20, 21, 22 is coded navigation information identifying the next step, which may be an additional question, a different Z guideline or a trea~nent. Different paths through ~e guideline are indicated by codes representing each possible answer pr~vided by the us~r.
A two digit code in column 20 or 21, such as the "02" at 23a, identifies the next question to be answered. Two characters, at least one of which is a letter, such as the "4A" at 23b, identifies a treatment. Column 20 shows the ~ode for the next step when the user response to a question is "Pass"
(or "yes"). Column 21 shows~ the~ode for the next step when the user response to a question is "Fail" (or "no"). Column 22 ~ontains infonnation identifying a preoeding question and its responses, if the path from a question depends on the ~us~ responses to both the current and a pre~eding question~ ~(An e~aunple of this appeus u~ Pigure 6 and is explained below.) Figure 5 shows another e3cemplary portion of the question and navigation~ data base. As shown in Figure ~, a four digit code ~i ;; 24 in column 20 ~or~ 21 j~ identifies when another guideline should be applied as the next step. ~
, ~ In impleinenting~a guidel~ne, ~the question/answer combinations are sequenced to yi~d ~the most effi~t route to a trea~nent. Also, the queshon/ansvver combinatdons are isequenced based on *equengr of use, listing ~e most conunon questions first. This sequenang sch~me makes the present invention ~n ore~effiaent in moving ~e user directly to the recommended heatment and collecting only relevant infonnation.
Figure 6, which ~shows~ a furt~ur exemplary portion of the question . ; ~ and navigation dah base,~ provides an example in which the answer to a preceding ques~don together with the answer to the clarrent question ~: ~
: SUBSTITUTE SHEET
, ~
wo 94/0081, 2 1 2 1 2 ~ 5 PCr/~'Sg3/06104 defines the next step. Question/answer 04g under ~ideline 53(03) is illustrative. Under the column 22, labeled "Frm", it is shown that question/answer 04g could have been reached by previously answering question 02 as Pass (code "02P") or by selecting any of answers "a" through S Np- to question 03 (codes "03a" to N03p7, If 02P or 03a through 03e were chosen as the previous answer and response "g" is selected for question 04, then in each case the next step is the trea~nent options of n2A~ or "2C".
However, if response "g" were selected to question û4 after the answer corresponding to code "03f" was selected, then the next step is "PR,"
indicating physician review.
The treatment component also uses data bases. Figure 7 is an example of a guideline reconunendation data base set for the condition corresponding to guideline 53(23). In general, for each gtudeline identified by a five digit number in field 25, there are listed one or more recomended treatments. Each treatment~ is identified br. a two character treatment code in field 26,~a textual treatment description h field 27, and several resouroe utilizatio~n ~indicators ;in colwnns 2~32, laWlet Setting, A/S, WS
, Preop LOS, and~ respectively. (These resource utilization indicators are explained in g~ter ~detail below.) Also, a nurneric procedure code, such~ as a Current~Prooedure ~enninology (~PT) code is provlded in field 33.
- A ~pl;ete Dnenu of all treatments that may be referenced in any guideline, i~uding~ trea~ment descriptions and resouroe indicators, is reeained in a~procedure file~;~hat is~uset by all g~udelines. I~e procedure file, an excerpt of ~which ~is shown n Figwe 8, lists the numeric procedure code in field 34, the ~five resource utilization îndicators in fields 3~39, and numeric procedurè~descript~ion text in field 41. A count of ~e number of te~ct lines in ~he nurnenc;~plPoedure description is kept in field 4û.
, , ; ~ ~ The clinical~decision~data collection cornponent is linked to the 30 previous three components to collect data and track guideline activity. Its pUrpO# iS to pro~de a founda~on for moving from ~e individual cases ; ~ ': ' ; 8UBSTITUTE SHEET
wo 94/00817 2 1 2 1 2 ~ 5 Pc~r/US93/o6lo4 prosessed in the systeIn to aggregated statistics for a set of cases. The reports hcilitated by this component are discussed below.
f B. Description of a Dia~nosis-8ased Guideline Magnosis-based guidelines provide a framework to reflect the ' S critical factors in the clinical deasion prooess usually leading to treatment, !.
to define optimal resouroe allocation, and to outline key patient data. A
guideline is not a fixed formula or cookbook, although it must be a definite step by step algorithm that can be coded; rather, a guideline presents a disciplined framework or process to guide ant assist the user, such as a health care provider, in identifying appropriate treatment.
. Application of a guideline to an individual's health condition in the present system 300 consists of four phases: (1) the entry phase; (2) the ` question/dah collection phase; (3) the assessment phase; and (4) the final recormnendation phase. I n~the entry phase, the guideline to be applied is is identified. Generally, a ~guideline is identified by a resognized health ' condition description, which may be stated as a symptom or a diagnosis.
i,f ~: Once the desired guideline is identified among those available in the system, the que~stion/dab coDection phase~begins and the user is !`i~ ` ~ presented with a seriés o f questions. The guideline questions are 20 org nized in a forrnat~ similar ~to a~decision tree or flow cl~ Generally, the next question is identified~o~sed on ~e answer to the current question.
However, some~questions elements may be designed only to elici~
infonnation -and the~ answer does t (at least immediately) influenoe the next question ptesented. The~nu~ of questions presented in a given case valies with the~ guideline selec~Ed and the answers to the questions presented. I
Iri the third phase, the guideline identifies a recommended treatment or o~e~ ~action, based~on the user's answers to the questions presented. As noted~ pre~iously~and shown in Flgures 7 and 8, a recom~nended treatment consists of a textual description, a numeric procedure code, and resource u~lization indicators.
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There are a five resource utilization indicators. ~Setting" identifies whether the treatment occurs in an inpatient hcility (IP), outpa~ent hciliq (OP), or physician offlce (OF). "LOS" (Leng~ o Stay) identifies the number of days for inpatient hcilities. "A/S" (Assistant Surgeon) 5 designates whether an assistant surgeon is required. "Preop LOS"
~Preopera~ve Length of Shy) designates the number of inpatient days required prior to elective surge~y. "Flag" indicates special considerations such as }arge case management, physician review, or coordination of services.
More than one recommended treatment may be provided as the outcome of a guideline. Also, a treatment may not be provided; rather, application of a new guideline or further clinical evaluation can be recommended.
As noted above, a guideline is not a fixed formula that, in effect, lS requires the us~ to pursue a given treatment. To the contrary, use of a guideline in the ~present system 300, specifically cont~#nplates that the user may select and~ enter into; the system a proposed or actual treatment that is s ~ ~ ~ not the rea~nu nded treatment indicated by ~e~ guideline If the user sdects a proposed~or~ ~ual ~treatment that is not ~e recommendet 20 treatment~ indicated by the g-udeline, ~then the system calls for specialty review of the case.~ This~ usually imo es; see~ing the opinion of a person different from the person that sdected~ the proposed or actual treatment.
Once the spec~lty ~review is completed, the user enters into the system a final recommendation treatment. This can be the g~ideline 25 recornmended treatment, the proposed or actual treatment previously `' entered by the user, or~ a different treatment reslalting from the specialty review A pmnary purpose of ~e guidelinff is to initiate and facilitate ,~ ~3~ companson and~evaluation, U there is a difference between the the final 30 recommendation treatment and guideline recommended treatment or between the final~recommendation treatment and proposed/actual treatment. This ~comparison and evaluation occurs in d e fourth phase. If 3j ~:
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WO 94/00817 212 I 2 ~ ~ PCI`/l,'S93/061~4 there is a difference between the the final recommendation treatment and guideLine re~omrnended treatment, the system 300 elecits an explanation for each vaAance in the intervention or prooedure, as well as in resource utilization indicators (provided that the differences in the intervention or S procedure permits meaninghl comparisions). If there is a difference between the the final recommendation treatment and proposed/actual treatment, e.g., the user is overriding the proposed/actual treatment of a provider, the system 300 elidts co~unents on the influenoe of the guideline process on the final recommendation, i.e., the manner in which care changed as a result of the guideline process.
The content of a guideline requires that it reflect acoepted clinical practice when forrnulated and also requires (a) ongoing evaluation to ensure appropriateness and (b) assessment of its implementation to ensure consistent application and appropriate sensitivity and speciaaty of its contents. The dinical content of each guideline needs to be based on available evidenoe and refined by result of application. T~us, guidelines are develop~d arst as paper diagnosis and treatrnent models by health care professionals and these models are refined to sufficient definiteness to permit their coding. ~ ~ ~
Figure 9a is a chart outlining the g uteline development process.
At step 1 ~the illness~cabgory that the guideline will cover is identified.
This decision is usuaUy based~ on e~sting patterns, such as the volume of ` ~ cases for an illness category, the extent of valiations in trea~ng an illness, or cost for treating an ~illness. A pa el of people with exp~tise in the selected illness category or in research procedures is established.
At sbp 2, the sa>pe, i e., components of care, of the guideline is identified. The five~ mapr c mponents that a guideline may include are dia~nostic guidelinej~ t~peutic selection, resouroe selection and acute care management. The care componen~s decision is based on the pu.-poses for developing the guideline, understanding how it would be ; implemented, and the financial resources available for guideline development.
SUBSTITUTE SHEET
w~ 94/0~817 2 1 2 1 2 ~ 5 PCr/~S93/06104 At step 3, any subdassifications used to identify severity levels of the illness with a set of treatment options are identified. The subciassifications should be standard groupings whenever possible, so they ,, will be consistent with data used in future analyses.
S At step 4, an evidence chart that defines aspects of the diagnosis or treatment which require specific scientific support or evidenoe is developed. This evidence is necessary to determine the impact on expected clinical outcomes of a spe~ic intervention. It also describes potential adverse affects or outcomes and ~omplications which will need to be considered in evaluating overal! risks and benefits.
At step 5, a literature search is conducted. Prior to conducting the literature search it is important to define the search logic, process, and list of exdusions h order to efficwltly expend time and resources. The evidence chart helps organize the information to complete the l~terature search.
At step 6, evidénoe retrieved for each linhge of the evidence chart is doa~nented in a standard forn~at. l he data abstraction process is completed. The res~lts are summarized to specifically docurnent the results of each study.~ ;
At step 7, ~quantitative ar alysis is used to draw conciusions about a ~particular intervention's effecti~eness. Narrative summaries are created ; ~ ~ of the infolmation~for each~ i~ter rention, descsibing the; impact on expected outcome. ~ l'his~ synthesis of information, inciuding the narrative sumn~, is pro~ided~ to~ knowbdge experts for a decision of clinical ~` 25 impact of interrention on expKtet outcome.
At step 8, a sumn~y of the risks and benefits of interventions appropriate to a~ di~gnosis~is~generated. This summ~ may indude posihve ou~come,~grade of impact, contraindica~on, adverse af ect/mortality, ~adverse affect/morbidity, disability, discomfort and cost impact. At this~ point~ a meeting of the expert panel occurs. During this meeting the nsk sununa~ benefit is reviewed, ~esource selec~on, key . ~ ~3UBSTITVTE S~EET
wo 94/008l7 2 1 2 1 2 4 S PCr/~IS93/061W
management and follow-up guidelines are defined, and consensw on the gu;deline is reached.
At step 9, a clinical appropriateness model is ~eated by the panel that describes by intervention: patient characteristics for which the intervention is indicated and contraindications, with appropriate alternative when present. This inforrnation is then aggregated into a guideline At step 10, for each intervention adopted into the guideline, the panel deterrnines a minimum level of resource required to administer the treatment. This indudes evaluating the setting and potential variables.
At step 11, acute care management is defined For each .. . intervention requiring an inpatient stay, the panel determines the appropriate length of stay.
At step 12, following completion of a guideline, the panel develops guidelines for extended care, which indude the indications, treatments and related resources.
At step 13,~ the panel meets to review the entire guideline for darity and accuracy. Panel members vote formaily for adoption of each I
guideline.
Guidelines ~are continuously updated by re~nng searches by diagnosis ~for newl findings and ~studies. ~ Also each guideline can be reviewed on a pe~lodic~basis,~ such a annually. Wormation from the care management system can be retrieved for that review, induding results of use, Irequency of use,~ frequenq~ of varià~ion by component, type of 2S variations.
C. Using the Syste~
Figure 9b~ shows the basic s~eps of ~e clinical decision process in which the present invention may be used. Initially, an individual presents a health condition to a provider.; Next, the diagnosis process is initiated. The health; care~provider collects information from the individual and perforrns~ tests or o~er prooedures. At this point~ the system user (whether~ it is the provider, assistant, admir~strator, or other) ~ ~ .
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wo 94/008t7 2 1 2 1 2 ~ ~ PCr/US93/06104 may initiate the guideline process leading to a recommended treatrnent.
Also at this po~nt, the user may input an actual or proposed treatment prior to initiating the guideline process.
8roadly viewed in terms of the clinical decision model of Fig.
5 9b, the system 300 can be used to aid diagnostic confirmation and therapeutic selection associated with the diagnosis. The system 300 can also ait resource selection, because the guidelines used in the system conta~n resource recommendation parameters. Thus, the guidelines adtress both the problem of overutilization and its resulting direct costs 10 and underutilization, which usually leads to indirect costs. Using the system in real-time to guide proposed care provides a clinically-sound basis for ongoing quality and outcomes analysis through tracking a specific diagnosis. Potentially inappropriate or les~than-optimal care can be identifed and cone ed. The guideline structure pro~ites a basis for 15 consistent deasion-makin6 while allowing flexibility for complex cacPc requiring care coordination and intensive review.
: ~ `
` To illustrate how~ the system 300 aids diagnostic confi~nation, therapeutic sele~on and~ resource~#lection, it is usefi~l to traoe the actual process followed by a~system user, includulg the saeens presented.
20 1. i~ating a~ Guideline`Process~ - Accessing the Desiret Guideline A~ to the app~opnate g~ideline in a real t~ne mode is a key feature of the~present~ ention. ~lherefore, the index component is struch~ret to a~w, th~user a method of loca~ng the appropriate guideline with tiffering levels of inforn~lation. Por exampie, the guidelines are 25 diagnosis~oased~(that-is, ~y address a spedfied health condition ~at has been realgnized) bùt tliè ~ser (dini~l reviewèr) may only know the procedure being~proposed.~;~ This requuff an efficient search of all of the guidelines that a~ntain~ that p ooedure in order to identify ~e correct guideline for re~iew of the ~cæ
ere are~;~ree ways the user may initiate ~e guideline process.
First, ~e user may~select one category from an alpha index of predefined medic~l categories, as shown in the screen depicted in Figure 10. Each `:: ~ : :
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WO ~4/0081~ 2 1 2 1 2 4 5 PCI`/I,'S93~06104 category leads to an alpha index of guideline titles within that, each title representing a health condition or diagnosis, as shown in Flgure 11. This facilitates quick access to the desired guideline. More than one description may exist for a guideline. To actually select a guideline, the user first S selects one category from a medical catego y list 42 as shown in Figure 10.
For each selected medical category, the system 300 next presents a menu of guideline ldtles 43 as shown in Figure 11. The user then selects the desired guideline 44 which is highlighted as shown in Figure 11.
The guideline process may also be initiated a second way. Once a 10 medical category is selected, the user may move to a screen for inputing a ~! predefined diagnosis code, as shown in Figure 12a. For example, in the preferred embodiment, a code from the International Classification of Diseases, 9th Revision, Clinical Modification, or ICD-9~M, a standard coding system, may be entered in field 45. One guideline may cover a ` 15 range of diagnosis codes and a diagnosis code may identify more than one guideline. The user selects the desired guideline from the relatively short menu 46 generated hr ~e given diagnosis code. Entry of a 3 digit code will cause ~e system to display a list of all of the guidelines containing that diagnosis code.~ No diagnosis code validation is done. ~Jote that 0 ~ ough the ICD~CM code is ~5 digits, only the first 3 are used to inde~) The guideline process~may also be initiated without identifying a diagnosis. As shown in Fig~e 12b, the user may input text representing a known or proposed~ treatment or procedure inforrnation in field 47. A
procedw or treatment may~ be~found in more than one guideline.
25 Selec~ion is by alpha desiption allowing for a partial string search of 5 characters into the index list. ~he procedure descnptions contain the most s~nificant characters first to~allow a fi~Ged position search. The search is limited to procedure code~ descnptions only, excluding complication descriptions and~;notes. I f matching text is found, the treatment ~on~.aining 30 that text is identified. ~ From that, the guideline~s) containing the identified ,~ treatments are located. Therefore, it is possible that treatment text can lead .
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wo 94/00817 2 1 2 1 2 ~ 5 Pcr/uss3/o6lo4 to more than one guideline. The user then selects the desired guideline from the menu 48 generated in response to the treatment text entered.
After a guideline is selectet, the software calls for identification information to be provided by the user. This is shown in the screen 5 depictet in Figure 13. First, the type of review or file is identifiet. Reviewtype is either initial or extension. Extension review is entered after an initial guideline is used. The extension may be caused by a delayed response or condition in the individual, a complication, a failure of initial trea~nent, or other reason. ~ Next, a case iden~fication nu nber is entered.
10 It is important that a patient have a unique identification number for each admission to ensure all information on the patient is in a single file. As discussed above, extension review allows the user to add inforrnation to an e~asting file. A~ cliniaan or care provider identification nurnber is also entered. Each cliniaan should be identified by a unique nurnber.
15 2. Navigating through a Guideline - the Ouestion/Data Collection Phase Once a guideline is selected, the user proceeds through an interactive process of ~questions~ and answers to reach a recommended treatrnent. Anexamplescreen~s owingpart~oftheprocessisdepictedin Flgure 14. Several~ questions are displayed and a first question 49 is 20 presented to the user by highlighting~ Tl~e are three question formats.
First, the question~ can ~ in ~narrative ~form as at 49 and require a "pass" or ; ~ ~ nfail" (correspon~g to~yes;or~no, respectively) answer 50. The answer is selectedby'pushing"~a~displ~ ed'buttonn. Second,thequestionmay offer multiple answers as~at 52 ~ant pennit selection of only a shgle 25 answer. Response navigation is attached to ea~h multiple~ioice selection (onl,v pass appliesl Third, the question may provide multiple selections as at 51 and all app}icable sele~is~ may be ck~sen. The third type of question is for aboth~na~ngation and data colaeetion and some selections . ~ ~
made do not affen subsequent questions. All questions are presented by 30 highlighting ~e aLnent question and as many questions as possible are displayed on one saeen. Ques~dons ~are numbered to pe~it tracking the : SUBSTITUTE SHEET
WO 94/00817 2 1 2 1 ~ ~ ~ Pcr/uss3/o6lo4 .19 clinical pathway used to arrive at a recommended treatment. A question and any of the responses may extend over more than one line.
Based on the user's answer to the initial question, another question is presented, but it may not be the next question in the numb~ sequenoe.
5 Navigation among questions is dependent on answers and some questions may be skipped. Therefore, the user enters only relevant data and does not have to sift through unnecessary or irrelevant questions.
No backward navigation is allowed in the questioning logic. However, the user may back up to erase and re-enter responses. The number of 10 questions presented to the user varies depending upon the 8t~ideline selec~ed and answers provided.
A question may be arrived at by multiple paths. For example, if question 3 is arrived at from question 1 or 2, then there could be 2 sets of pass~hil navigational options. IJltimately, after navigating through a 15 guideline, the user ~will be provided with at least one recommended treatment, a new guideline or nstructions to seek further clinical evaluation. If questior~ing determinff the need to utilize a different ~deline, then the user is either transferred directly to the new guideline and/or a message~is displaye . A given combination of answers may lead 20 to multiple r_d; treatments as shown by the two highlighted treatments 53,~54 in the~s~een depicted in Figure 15.
Codes are stored that; indicate the path taken through the questior~ulg pr~ ~ (clinical pathway). A "help" menu accessed by a func~on key is available ~at any time to further darify the question, 25 trea~t, or L~stof references. Using the pull-down menu "view"
acoessed~as indicated 56 in Fgure 14, the user may review answers to previous questions.~ ~Howe~rer, exoept in the non directive mode described below, the user may ~not work~ backward or select questions in an arbitrary rnanner. Due to ~the~ nav~gational control built into a guideline, only 30 relevant questions that are required to reach a recommended treatment ;~ SUBSTITUTE SHEET
WO 94/0081~ 2 1 2 1 2 ~ ~ PCl/~lS93/06104i are presented and answered. The user has the ability to exit and suspend review at any time. The review status is stored and the user may continue the review at a later time.
3. Treatment and Review S The guideline question sequence will lead to one or more recommended treatment options, a new guideline, or suggest further clinical evaluation. As shown in Figure 16 all treatment options are displayed to the user with the reconunended treahnent(s) highlighted.
Multiple treatments may be appropriate for a specified combination of answers. A treatrnent option may be displayed with message or note lines.
More than one page of treatments may be present, and the uær can page through all treatments.
A treatment option is displayed in eight fields, as shown in the screen depicted in Figure 16. The first field 57 is a two~uracter treatrnent i; 15 code that hcilitates tracking of treatments within a guideline. The ~de is unique within the selected ~guideline only. Next is a field 58 aontaining a brief description of the treatment, followed by a field 59 for the applicable numeric prooedure ~ode. Multiple prooedure codes may be present if a treatrnent consists~ of more than one prooedure. A procedure code may not always be av~ble for a trea~nent~ option. If it is not available, an internal code will be created~ b~ut not displayed on the screen. The prooedure code can be used in~ reimbursement for the selected treatment.
Next thie résouroe utilization~ indkators are L;sted. The treatment setting field 60, labelled,~"Settingn, identffles inpatient facility (IP), outpatient facili~ OP), or ph~ offioe (OF). The length of stay field 61, iabelled "~OS', provides the nurnberof days fof inpatient facilities. The assistant surgeon ~ d 62,~ elld "AlS", designates whether an assistant surge~)n is requ~ed (y-yes;~n=no; szstandby) l~e preoperative days fielt i ~ ~ 62, labe~ed, "Preop', designates the number of inpatient days required 30 prior to elective surgery. Flag field 64 indicates special considerations such as large case management, physiaan review, or coordination of services.
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As stated previously, the user may enter an actual or proposed keatment prior to or after obtaining the guideline-recommended treatment(s). To enter an actual/proposed treatement after arriving at a guideline recommended treatment, the user utilizes the "Enter" menu 5 and reaches a screen with the fonnat shown h Figure 16. As shown in Figure 16, for the proposediactual treatment the user enters information in five labelled aelds, induding treatment code 69 and the resource utilization indicators of Treatment Sett~ng 65, Length of Stay 66, Preoperative Days 67, and Assistant Surgeon 68. The user norrnally enters 1~ a 2-character treatment code corresponding to one of the treatment options listed above fields 65~9. If the propooed/actual treatment is not listed in that guideline, then a reserved code will be entered and the proposedtactual treatment must be described.
If the proposed/actual treatment is not the same as the guiteline-15 recomrnendet treatment, then the system prompts the user to initiate spe~ality review. ~ Figure~ 17 shows a saeen used in the specialist review process. The spedalist review window is overlald on the treatment options list screen. The foUowu~g fields have data automatically entered:
case ID number ~70, review ID number 71, and~specialist review number n.
20 A five character~lD aeld~73 is user-filbd to identify the spe~alist reviewer.` ~ Four types of review ~with dif~g associated costs and exper~hse can be ;~ selected: clinical review~ (CR) 74; physiaan revlew (PR) 75; independent medical exim (I~) 76; and ~appeal 77. Clinical review is conducted by a licensed professional~with expertise in à par~cular speaalty including the 25 provider or another; on the user staff who has the authority to approve varian~ Physiaan;review is by a consulting physician with authority to approve varianoes.;~ ~IME is a required referral for a second opinion examination. This type of review is chosen based on individual case ments or for a mandatory se ond opinion list. Appeal is a review by a 30 consulting physician generated by an appeals notification.
The reason field in the specialty review window includes seven possible reasons~why the case was carried to a d.Uferent level of review, SUBSTITUTE SHEET
wo 94/008l, 2 1 2 1 2 ~ S Pcr/US93/o6104 including appropriate treatrnent plan 78, partial procedure 79, sefflng 80, LOS 81, preop days 82, assistant surgeon use 83, and diagnosis confirmation 84. For any given case, multiple reasons could be present.
Any varianoe between the proposed/actual and guideline-recommended ~ S treatrnent are automatically designated. Actual consideration of the case !~ by a specialty reviewer occurs off-line. The result of that review is comrnunicated to the user, who is now enters a final re)mmendation, incorporating the condusions reached in specialty review, in the formate required by the screen shown in Figure 16.
With a guideline-recommended treatment identified and a user-selected proposed/actual treatrnent as well as a final reco~unended treatment entered in the systern-defined format, the system 300 per~orms ` comaprisons.
;l ~ Whenever there is a vanance between the treatrnent or a resource lS utilization indicator~for a final rea~nunended treatment and guideline recommended treatment, the system~elicits reasons for the variance(s).
;j The "reason" field ~corresponding to a~ resource utilization indicator where , ~ there is a variance is highlighted. One character standard reason codes are t, used to explain o~erriding~ the guideline recommended treatment.
Reason codes indude the following: I
i A- addibonal diagnosis (cornorbidity) ;~ B - si~cant~cbnical ir~s ~i C -complication D - unavailable infonnation 'r~ 25 E -alternativecareavailaWli~
F - facili~ capability ~ ~ G-geographicdistanoe r~ H- soaal situation surgical sîabilizabon J - contraindication , K- age L - practitioner expenenoe ~, !:
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wo 94/008l7 2 1 2 1 2 4 ~ P~/~'Sg3/0610 : 23 M - patient preference O - system override Z - other For example, "Setting" reason must be completed if the final 5 recommendation treatment Setting is higher than the guideline treatment Setting (IP~OP>OF). "LOS" reason must be completed if the final recommendation LOS is greater than the guideline LOS. "Preop" reason must be compbted if the final recommendation Preop days are greater than the guideline Preop days. Assistant Surgeon reason mwt be 10 completed if the final reconunendation Assistant Surgeon use is greater than the guideline Assistant Surgeon (Y>S>N). Diagnosis confirrnation reason must be completed if a specialty réview reason indicates diagnosis confilmation. [PLEASE CONFIRM]
A final recornmendaaon reason des~iption is enteret if there is no 15 standard reason code for; the final recornrnendation trea~nent or for fur~er explanahon even when a~stan~dard code exists. Por ex~rnple, it is desirable to elicit user comment identiying other diagnosis information that was considered~relevant to treatment xlection and may leat to future modification of the guideline. ~ A ~button" allows access to a free text entry 20 window.
The "Care Ch;mged' fields are used if the final recommendation trea~t is different ~from ~e~ proposed~a~al treatment. Whenever ~` there is a varianoe~betwoen the~treatment or a resouroe utilization ~ndicator for a final recommended treatment and actual/proposed 25 treatment, the system ~eliats rewns for the varianoe(s~. The "reason"
field correspondin~;to~a~ resource uti;lization indicator where there is a rarianoe is highlighted. Treatment "Care Changed"fiel is used if the final rec~mmendation~ different than the proposed/actual treatment. The treating physiaan;indicates whether he agrees ~nth the recommendation 30 (Y, N, U=Unhtown). ~ ;Setting "Care Changed" is used if ~e final re~mendation treatmént ~Setting is different than actual/proposed Treatment Setting. ~The treating physiaan indicates whether he agrePs WO 94/00817 2 1 2 1 2 ~ ~ ~/U593/06104 with the final reconunendation (Y, N, U=Unknown). LOS "Care Changed" is used if the final reconunendation LOS îs difhrent than the actual/proposed LO5. The treating physician indicates whether he agrees with the final reconunendation (Y, N, U). Preop "Care Changed" is uset if S the final recommendation Preop days is different than the actual/proposed Preop days. The treating physician indicates whether he agrees with the final reco~unendation (Y, N, U). Assistant Surgeon "Care Changed" is used if the final reconunendation Assistant Surgeon is different than the actual/proposed Assistant Surgeon. The treating 10 physician indicates whether he agrees with the final reco~runendation (Y, N, U). DX "Care Changed" is used if the case was sent to specialty review fo- diagnosis cVonfirmation~ then the treating physician annohtes whether he agrees with the dedsion (Y, N, U). IPLEASE CONFIRMl D. An Example Guideline - Thrombophlebitis .
An example of the gwdeUne process for a specific health condition is shown in Figure 18, a flow chart for the guiteline, thrombophlebitis, in conk~on with previously discussed s~s shown in Figure 11-16, which represent portions of the implanentation of the flow chart of Pigure 18. I~is flow~chart does~not indude all information presented to 20 the user that would~appear~ on: the té~minal sneen. For example, at step 106 the flow chart shows only the recommended treatment code and treatment text. However,~the~guideline definition for thrombophlebitis indudes ar~d the user would~actually~be presented with a saeen similar to Flgure 16 whkh would include, the~CPI code and resource utilization 25 indicators for each~treatment optwn. Also, the flow chart differs from the ¦ ~ ~ actual saeens in that s~disp~d questions are answered as "pass" or nfailn, which con~spond~to nyes"~or "non, respectively, in the flow chart.
Sbp 100 is the entry point ~ to selection of the , ~ ~ g udelirie based~on~the guideline~title, as shown in Figure 11, or by use of a 30 diagnosis code, as shown in Figure 12, or a treatment text search, as shown in Figure 13 At step 101, the user is asked whether the condition is a superficial or deep vein thrombosis. If the us~ selects "superficialn, at step SUBSTITUTE SHEET
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w~ 94/008l7 2 1 2 1 2 4 5 Pcr/uss3/06l04 : 25 !, 102 the user is asked whether the diagnosis by examination and symptoms includes one of the following: pain, redness, or swelling. If the user selects "no", at step 103 Physician Review is reco~unended. U the user selects "yes", at step 104 the user is asked whether the patient has progressive S symptoms despite appropriate out patient management. If the user selects "no", at step 105 continuing out-patient treatment is the recommended treatrnent option. U the user selects "yes", at step 106 a ~ideline-recomrnended treatrnent identified by code 7D is presented.
If the user selects "deep vein thrombosis" at step 101, at step 107 the 10 user is asked whethel it was diagnosed on doppler/venogram as shown in Figure 14. If the user selects "no," at step 108, Physician Review is recommended. If the user selects "yes," at step 109, the user is aslced whether anticoagulation therapy is contraindicated due to several factors.
If the user selects "no," at step 110 two guideline-recommended treatments ~', 15 identified by a~des 7A and 78 are presented. No preference between the t, :
two treatments is identified. At step 111, the user is asked whether the treatment hiled.~ If the;user selects "no, at step 112 g~udeline indicates that the individual i5~ to be~ discharged. If the user selects "yes", at step 113 a new guidelin_ded treatrnent identified by code 7C is ;~3,; 20 presented.
~; If at step~lO9 the user selec s "yes", at step 114 the user is asked whether there is p~cimal emboiization. If the user selects "no", at step 115 the guideline rff~mme ded treatment identified by code 7C is presented. If the user selects "yes," at step 116 the user is referred to additional medical literature for fur~er diagnosis.
The saeens implementing this guideline include all of the questions and aon~tional branching necessary to navigate through the flowchart of Figure~ 18~ and reach each of the treatment options or o~er ;~ endpoints shown.
For example,~the screens presenting questions would appear similar to Figure 14 with the current question higl~ighted. When the guideline reaches a recommended treatment, the user would be presented with a .
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,, WO 94/0081 ~ 2 1 2 1 2 4 ~ PCI~/l,'S93/06104 sae~n similar to Figure 17, without the Specialist Review su~screen, showing g~udeline reconunended treatrnent options with the recommended treatment(s) highlighted. Figure 17 reflects a question/answer path yielding two recommended treatments. Figure 16 S shows one recorded treatrnent reached by a different question/answer path through the guideliné. Figure 16 also differs from Figure 17 in that the user has additionally entered a proposed and final recommendation treatment.
E. Alternative Embodiments of the Invention The above embodiment of the invention is a directive mode whereby the gu~deline process is self-prompting and the user is only required to answer designated questions. In an alternative embodiment invention, the guidelines can be acoessed in a non-directive mode whereby the user can access all questions for a given guideline, to view lS and selectively answer the questions. At any point, the user can shift back to the directive mode and the questions wil~ again be self-prompting with a question appearing based ~on the questions already answered in the non-directive mode. lExplain utility? Can~ d treatments be bound?~
20 F. Reports An important fèature of the~ present invention is its ability to capture key data durmg~ usage for individual patients and cases. This enables the user to tràck~and analyze pattems of care a~oss defined populations in order~to~unterstand trends and variations for planning 25 purpo#s. In addition,~;repor~ can show provider profiles, diagnostic decision outcome profiles,; as well as procedure decision outcome profiles.
On line reports include~adrninistrative reports, summary reports and worksheets. Repor~s mày be used by renewers as work and time rnanagement tools ~and~ by adrninistrators and managers for summary 30 reports and planning tools. Reports may selected for designated time ~UBSTITUTE SHEET
wo 94/00817 2 1 2 1 2 ~ S Pcr/l~S93/06104 D
Reports sort and summarize case review status in several ways.
Case review status includes the following: dosed, i.e. closed (C) by normal review procedures or closed by adn~inistrative closed (A); and open, i.e.
suspended in questioning ~Q), and specialty review (S), or open because S the review process has not been completed (?
There are six types of daily *oductivity Reports: operation manager, supervisor, care manager, specialist reviewer, specialist reviewer productivity, and specialist review worksheet. An example of a operation manager report is shown in Appendix A. This is a general summary 10 report which slummarizes all open case reviews by medical category 200, i.e., reviews with the status of O, Q or S. A total of all open case reviews for all categories 201 is also listed. Initial reviews 202 as well as extension ~ reviews 203 for each category are listed as well as case re~news and specialty $ review 204. This report also summarizes case reviews which are still open and over 30 days old 205 and open reviews which are less than or equal to 30 days from the fnitial review data entry 206.
An example of a~ supervisor report is shown in Appendix B. I~is is a general swnmary report which sununarizes all open case reviews (with status O, Q or S) and ~is~sorted~by~care~manager (reviewer). A total of all 3~ 20 open case reviews for each care nlanager is listed 207. Initial reviews 208 as well as extension reviews 209 are listèd as~ well as cases 210 ant specialty review 2t1. This report~ also summarizes case reviews which are still open and over 30 days old 212~and~open case which are less than or equal to 30 ~3 ~ days from the uutia~ ~ rèview ~data; entry 213.
3 ~ ~ `
An examp1e of the care manager report is shown in Appendix C.
This is a general su~nmary réport which summa~izes all open clse reviews (status O, Q or S) by~indivWual care m~nager (reviewer) 214. This report surnmanzes for each c~re~ manager all open case reviews listing the case ID
215, the most = t review date for the review 216, identifying whe~er the review was initial or extension 217, the speciaL;st review type ~; ; (physician reviewer, Independent medical exam/second opinion appeal) ~` 218, referral reason ~2]9, and the case review guideline name 220. This .~y~
!i~ SUBSTITUTE SHEET
,1 Wo 94/0081t 2 1 2 1 2 ~ 5 Pcr/~s93/o6104 report is generally used by the care manager for follow-up and tracking and by the specialist reviewer as a t~ne management and daily o~ weekly work planning tool.
An exarnple of a specialist reviewer report is shown h Appendix D.
This is a general summary report which s~unarizes open case reviews with specialist status (5) reviewer sorted by reviewer ID, case ID, and review date. This report summdrizes for each specialist reviewer 221 all open case reviews listing the case ID 222, the most current reYiew date for the review 223, identifying whether the review was initial or extension 224, the specialist review type ~dinical reviewer, physician reviewer;
independent medical exam/second opinion, appeal) 225, referral reason 226, and the case review guideline name 227. This report is generally used by the care manager for foliow-up and tracking and as a daily or weeldy planning tool.
An example of the specialist reviewer productivity report is shown in AppendL~c E. This summarizes reviews with a specialist review status (S) sorted by medical categ ry and specialist review type, case ID and review date. For each of these the following are listed: the case ID 228 with the most current~ review date ~for~ the review 229, whether the review was in~tial or extension 230,~ sped~list identification nurnber 231, referral reason 232 ~and the~case review guideline name 233.
An example of a speaal;,st~review work sheet is shown in Appendices F, G.~ ihis~report sumn~ per~nent information for a case review which needs~ a~specialist r~ew. This would most co~unor~y be 2~5 used for physician review although it can be used for clinical review, independent medical exam~#cond opinion or àppeal. The report lists the specialist reviewer 234, the case 235 and clinician ID 236, the proposed treatInent 237 and guidelinè recommended treatment 238 wî~
apropriate resources downloaded with the software. Ques~ns passed and failed are summarized 239 and the reason for the speaalist re~iew 240 is identified. Note~text 241 which has been entered for ~e case is included.
This report is completed bv the care manager (reviewer), printed and .
WO 94/00817 2 1 2 1 2 ~ ~ PCl~/US93/06104 distributed to the appropriate specialist reviewer. The speaalist reviewer would discuss the case with the appropriate resources, complete the inal re~ommendation 242 and outcome and return the worksheet to the care manager who would enter the reason code 243 and text into the case review file.
Information management reports identify overall volume and patterns of care induding diagnosis, therapeu~c selection ant resource use. From these reports, you can determine the level of effectiveness or impact related to each guideliM use. You can also use the reports for quality measurement and planning by identifying where variations are occurring and how they are resolved at the initial guideline level. Reports may be selected by date in either clinician identification number or reviewer identification number or both. They are sorted automatically by specialtyarea. ~; ;
An example of a reporting peri:od sununary shown in Appendix H.
; This report gives an overall surnmary of all cases in reviews. It lists case volume 244 (number of total cases), review volume 245 ~number of individual reviews), the nurnber of physicians 246, and the number of different guidelinesi~used~for initial and extension reviews 247. This report may be sorted for~ a specific t~ne.
An example of a guideline frequency report is showrl in Appendix I.
This report lists ~n how many cases a particular guideline is used 248. The peroent of cases usmg;;each~guideline 249, and the percent of t~tal cases that guidel;ne represents 250 are also listed.
.An example of:a patterns of care report is shown in Appendix J.
This report lists the total ~nu~of cases using the ~rarious guidelines 251.
The propos~d~ trea~ent(s)~for;each guideline 252 are listed with the number of cases for~each~ 253. Proposed average leng~ of stay 254 and recomrnended length of stay 255 are also listed for each guideline proposed treatment. This report can also be~sorted by overall total or cliniaan identification number. ~
~: SUBSTITUTE S~IE~T
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WO 94/00817 2 1 2 1 2 ~ ~ PCI~ S93/06lW
, An example of a quality mana~ement and planning ~aggregate) report is shown in Apyndix K This is an aggregate report which lists the total number of cases with the requested diagnosis. For each diagnosis guideline requested 256, the following are listed: proposed 257 and final treatment combination 2S8, number of tohl cases with that combination 259, peroent of total cases 260, what peroent went to speaalist review 261, how many varied from the guideline 262, the number with a guideline variance 263, the number of times each variance code was used 264 and the percent of care changed by the treating physician/care provider 265.
An example of a~quality management and planning ~for each component) report is shown in Appendices L, M. This report is sorted by guideline 266, proposed treatment~267, and final recorrunendation 268.
~j This report is a more detailed report and is a subset of the aggregate quality ,¦ management and plalu~ing report. It lists the three categories of setting 269, preoperative days 270 and length of stay 271. The to~l number of cases are listed 272. ~ For each guideline in each~ category, the following are listed: proposed 273 and find recommendation treatment 274, nurnber of cases under each categoq 275, percent :of the cases that carry the ~; propased/final combination 276, p~rcent to specialist review 277, guideline 71 ~ ;20 variations 278, the number with a guideline variance 279, the num~?er of ; times each variance~code;was u~ed 280, and the peroent of care changed by the treating physiaan 281. ~ ~
An exampie of the effecbver~ss report is shown in Appendix N.
This;report provides a breakdown by guideline 282 of the results of its use ~or impact) on the following areas: percentage of reviews where proposed treatmerit selec~orl was impacted 283, percentage of re~riews where propo#d resources werè~impacted ~284, percentage of reviews where both Teatment selection~and~proposed resouroes were impacted 285, and the ,, ~
percentage of total~ cases impacted 286 and total cases 287.
7 ~ 30 Although the~ description of the prefe~ed embodiment has been presented, it is contemplated that various changes could be made without deviating ~rom the spit of the present invention. Accordingly, it is '1 ' ~ ~UBSTITUTE SHEET
wo g4~008l7 2 1 2 1 2 ~ ~ PCr/US93/06104 intended ~at the scope of the present invention be dictated by the appended claims rather than by the descripffon of the pr~erred embodiment.
SUBSTITIITE SHE~ET
W0 94/0081 ~ 2 1 2 1 2 4 ~ PCI/US93/06104 APPENDIX A
_ ._. _. __.. _ _. ._.. ___.____~ _ _ -- . . . .. . ~ _ .. . _ _ __._A_ ____ Date Daiiy Productivity Report Page Operation Manager , 200~ # to ~ ~ ~
Open Specialist Open Open Medicai Category Reviews Review ~=30 days ~30 days __________________________ ________ __________ _________ __________ .
Cardiovascular/Respiratory 202 - Initial 24 4 22 2 Extension 6 1 6 0 203~ Total 30 5 28 2 1 Gynecology I Initial 10 2 10 0 Extension 2 0 2 0 , 201~ Total 12 2 12 0 ! TOTAL Initial 34 6 32 2 ' Extension 8 1 8 0 i Total 42 7 40 2 -i A
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WO 94/00817 2121 2 ~ :3 P~/US93J06104 , ~ 33 ~1 Date Daily Productivity Report Page Supervisor Medical Category: Cardiovascular/ResPiratorY
# t~ 2~ 2~
. Care Review Open specia'ls. Open Open Manager Type Reviews ~eview ~=30 days >30 days :~ _______ __________ ________ __________ _________ _______ __ ~ ABCDE Initia~ 2082~ 4 22 2 ;, 20g Extension 6 ; 6 0 1 20 7~, Total 30 28 2 ;¦ DEFG~ Initial 10 2 10 0 ?~ Extension 2 0 2 0 ~ Total 12 2 12 0 ;~1 TOTAL Initial 34 6 32 2 ~1 Extension 8 1 8 Total 42 7 40 2 '.~
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SUBSTITVTE SHEET
W~ 94/00817 P~/I~S93/0610~
APPENDIX C
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DateDaily Productivity Report Page Ca_e Manager Care Manag r: ABCDE (Na e2l7 21~ 21~ 220 ~ Review Init/ Spec Referral Case ID DateExt Type Reason Guideline _________.. __ ________ _____ ______ ________ ____________________ ___ 0580111}2223 05/01/92 I PR TPLAN Angina, Stable 0580111122Z3 05/05/92 E Angina, Stable 011122223333 05/10/92 I PR SET Degenerative Joint Disea LOS
012333332229 05/01/92 I Degenerative Joint Disea .
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WO 94/00817 PCI/US93/~6~04 21212~:) APPENDIX D
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Date Daily Productivlty Report Page Specialist Reviewer , Specialist Reviewer: XYZAB "-22! 226~
222 224~ 225~ / 227) 223 Review ~Init/ Spec Referral Case }D ~ Date Ext Type Reason Guideline `~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ -- _ _ _ _ _ _ -- -- ~ -- -- -- -- -- -- -- -- A
058011112223 05/01/92 I PR TPLAN Angina, Stable 058011112223 05/05/92 E PR LOS Angina, Stable ! 011122223333 05/10/92 I PR SET Dege~erative Joint Disea LOS
j 012333332229 05/01/92 I PR TPLAN Degenerative Joint Disea ;l .
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W~ 94/00817 PCI/US93~061(~4 APPENDIX E
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Date Daily Productivity Report Page Speci~list Revlewer Productivity Medical Category: Cardiovascular/Respiratory Specialist Type: PR Physician Referral 232 22~) 229 230) 231) / 233) . ~ ~ Review ~Init/ Spec ~ Referral Case ID Date Ext ID Reason Guideline '' ____________ _____________ ______ _______-- ________________________ 058011112223 O5tOlJ92 I XYZAB TPLAN Angina, Stable 058011112223 05/05~92 E XXXXY LOS Angina, Stable 011122223333 05tlO/92 I XYZAB SET ~hrombophlebitis LOS
012333332229 05/01/92 I XYZA~ TPLAN Arterial Occlusive Disea ~31LJBSTITUTE S~EET
WO 9t~tO0817 2 1 2 1 2 ~ S PCI/l,'S93/06104 QPPENDIX F
Date Spec~ s~ Rev~ew Work Sheet Page 1 Specisli5t Rev-ew~r: XY~U ~ 2 3 4 Roturn to:
C~re H~nager: A~CDE f-235 oY Idate~
C~sn Id: 00000510000; i~aVlCW ~: 2 Clinic~an Id: A00100 ~ 2 3 6 Review D~te: 6~05/92 iDiaqnosis: Calculu3 ~sete:Al Proposed Treatment: ~ 2 3 7 Setting LOS Preop A/5 4A) Cystoscopy with re~royrdde stone IP 02 G N
m~nipulat~on Guideline Recommended Tre~tment: ~ 2 3 setting DOS Preop A/S
4AJ Cystoscopy w~th retrograde stone IP 01 0 .
m~nipulaCion
4~1 urethroscopy/ureteropyeloscopy IP 01 0 tl 4CI Cystoscopy wi~h ~ stent p.acemen~ OP N
Ouestions Passed: 239 Dia~nosed by lm~g~ng ~nd one of the following:
fl~nk p~n - severe requir~n~ IM p~n ~eds One of the ~ollowing:
-high grade ob~truction -severe lntract~ble pain -stone ~oo large to p~Sâ
Question5 F2iled:----240 Re~son for Specialist Revlew:
~angth o~ St~y 241 Note Text In~orm~t~on:
cyseo ureehrorcopy stone cxtrAction insert~on stent ~t~e~pted wo success . perc neph done due to ur~ne extr~vas~tion temp po oral ~bs te~ch perc ~ph c~re monitor . ~
_ D~te Spec~ st Rev~ew Work Sheet P~ge .
Speci~list Rev~ewer: XYZA~
f I Case Id: 000005100001 Aev~ew ~: 2 ! Clinici~n Id: A00100 I Revi~w D~te: 6t05/92 243~ ~43a, Diagnos~s: Calculus Ureteral 2 4 2) Re~son C~re Finsl Recommend~t~on ~document ch~nges only~ Code Ch~nged?
Tre~tmen~ Y N U
Sett~ng: IP OP OF _ Y N U
LOS: d--ys Y N U
Preop: _ d~ys Y N U
A~S: Y N S Y N U
DX Conirm Y N Y N U
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SUE~STITUTE S~EET
WO 94/00817 2 1 2 1 2 4 S PCT/IJS93~06104 ( APPE:NDIX G
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.Case Volume: 1,245 244 Review Volume: 1,999 - 24 5 ,~ Physicians: 42 ~2 46 Guidelines: 70 ~247 _ . .. . ... _ .
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WO 94/OOB1 7 2 1212 9 .5 PCl~/VS93/06 104 APPENDIX H
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Medical Category: Cardiovascular/Respiratory ~249 r250 8 % o~ % of Guideline Cases Cases Total Cases _______________________ _____ __________ _______ _ _______ Coronary ~rtery Disease 50 35.0 10.0 Angina, S~able 20 10.0 4.0 Angina, Unstable 20 10.0 4.0 Asthma 105.0 2.0 Pneumonia 14 7.0 2.8 Arterial Occlusive Disease 5 2.5 1.0 SUBTOTAL 200 100.0 40.0 TOTAL . 500 100.0 100.0 .
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SUE~STITVTE SHEE~T
APPENDIX I
Medical Category: Cardiovascular/RespiratorY 25~ 25 Proposed Proposed Avg LOS
Guideline ~ases Treatment Cases Avg LOS Recommended ____________________________ ____~__ _________ ________ __ ______ ____________ Corona~y Artery Disease 50 PTCA 47 3 3 CABG,3 grafts 3 9 8 Angina, Unstabls 20 Telemetry 3 2 2 ~elemetry/
pacemaker 2 3 3 Telemetry/
angiogram 10 4 3 Angiogr~m : WO/CC~ 2 Angiogram WO/CC~ 3 1 0 Arterial Occlusive Disease . 5 kxteriogram 2 2 :Byp2ss 3 8 7 comorbidity :
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W O 94/~0817 PCT/~IS93/06104 21212~S
APPE N DIX J
Guideline: (5310) Coronary Artery Disease ~ 25~ a Cases: 5n - 256 2 60 261 26 s~
2-5--7Treatment-?58 ( 2 5 9 ~ % to J GL Varianc2 Care Changed Proposed Final Cases % Spec Rev Volume Code~ % Known PTCA PTCA 95 90 11 5 A(4) Ktl) CABS/ CABG/ 3 6 33 1 F(l)~
3 graft 3 garft ~ ~ ~ ~2 64 Proposed = final: 48 96 63 PTCA Medical 2 4 100 50 100 Management Proposed ~ Einal: 2 2 ,:
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SU8~TITVTE S~EE~T
WO 94tO0817 2 1 2 1 2 4 5 PCl /US93/lD6104 APPENDIX K
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Guideiine: ~5310) Coronary Artery Disease - 266 Page 1 ---Treatment-2- ,272 % to Ext GL Variance Care Changed Proposed Final ~ases % Spec Rev Rate Volume Code ~ Known ________ _____ _____ _ ___ _____~__ __~___ ______ _______ _____ ___., C269 273 274 275 . ~'2 '277 (278 ( ~281 --SETTING~OP~--------------------------------------------------------IP IP 45 100.0 Pro osed=Final: 45 100.0 0 ~ 43 95.0 0.0 1 1 1 2.5100.0 1 A(1) Proposed=Final: 44 9~.5 J ~280a 1 0 1 2.5 : 100.0 Proposed~Final: 1 2.5 3 3 ,: 3577.8 : ~
4 4 5 11~1 20.0 20.0 5 H(4) Propv~ed=Final: 40 88.9~ ~
4 3 5 11.1 10.0 80.0 50 Proposed~Final: 5 11:.1 ~Xey: ~-Comorbidity ~
H=Social Situation : ::
~3U~3STITUTE SI~EET
~YO 9~0081~ 2 1 2 1 2 4 5 P~/VSg3/061~4 APPENDIX L
..
1 283~ ~ Review % Review ~ 8 4 Reviews 2~ 286 287 Impact Impact impacted ~ ~
282 Proposed Proposed bo~h resources % Cases #
Guideline ~~ Treatment Resources and Treatment Impacted Cases _________ _______ _____ _________________ .I Coronary Artery Disease 4 13 1 14 50 Angina, Unstable 1 25 0 30 20 Arterial Qcclusive Disease 0 40 0 40 5 . ' .
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Ouestions Passed: 239 Dia~nosed by lm~g~ng ~nd one of the following:
fl~nk p~n - severe requir~n~ IM p~n ~eds One of the ~ollowing:
-high grade ob~truction -severe lntract~ble pain -stone ~oo large to p~Sâ
Question5 F2iled:----240 Re~son for Specialist Revlew:
~angth o~ St~y 241 Note Text In~orm~t~on:
cyseo ureehrorcopy stone cxtrAction insert~on stent ~t~e~pted wo success . perc neph done due to ur~ne extr~vas~tion temp po oral ~bs te~ch perc ~ph c~re monitor . ~
_ D~te Spec~ st Rev~ew Work Sheet P~ge .
Speci~list Rev~ewer: XYZA~
f I Case Id: 000005100001 Aev~ew ~: 2 ! Clinici~n Id: A00100 I Revi~w D~te: 6t05/92 243~ ~43a, Diagnos~s: Calculus Ureteral 2 4 2) Re~son C~re Finsl Recommend~t~on ~document ch~nges only~ Code Ch~nged?
Tre~tmen~ Y N U
Sett~ng: IP OP OF _ Y N U
LOS: d--ys Y N U
Preop: _ d~ys Y N U
A~S: Y N S Y N U
DX Conirm Y N Y N U
._ ;
SUE~STITUTE S~EET
WO 94/00817 2 1 2 1 2 4 S PCT/IJS93~06104 ( APPE:NDIX G
. .
.Case Volume: 1,245 244 Review Volume: 1,999 - 24 5 ,~ Physicians: 42 ~2 46 Guidelines: 70 ~247 _ . .. . ... _ .
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WO 94/OOB1 7 2 1212 9 .5 PCl~/VS93/06 104 APPENDIX H
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Medical Category: Cardiovascular/Respiratory ~249 r250 8 % o~ % of Guideline Cases Cases Total Cases _______________________ _____ __________ _______ _ _______ Coronary ~rtery Disease 50 35.0 10.0 Angina, S~able 20 10.0 4.0 Angina, Unstable 20 10.0 4.0 Asthma 105.0 2.0 Pneumonia 14 7.0 2.8 Arterial Occlusive Disease 5 2.5 1.0 SUBTOTAL 200 100.0 40.0 TOTAL . 500 100.0 100.0 .
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:
SUE~STITVTE SHEE~T
APPENDIX I
Medical Category: Cardiovascular/RespiratorY 25~ 25 Proposed Proposed Avg LOS
Guideline ~ases Treatment Cases Avg LOS Recommended ____________________________ ____~__ _________ ________ __ ______ ____________ Corona~y Artery Disease 50 PTCA 47 3 3 CABG,3 grafts 3 9 8 Angina, Unstabls 20 Telemetry 3 2 2 ~elemetry/
pacemaker 2 3 3 Telemetry/
angiogram 10 4 3 Angiogr~m : WO/CC~ 2 Angiogram WO/CC~ 3 1 0 Arterial Occlusive Disease . 5 kxteriogram 2 2 :Byp2ss 3 8 7 comorbidity :
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W O 94/~0817 PCT/~IS93/06104 21212~S
APPE N DIX J
Guideline: (5310) Coronary Artery Disease ~ 25~ a Cases: 5n - 256 2 60 261 26 s~
2-5--7Treatment-?58 ( 2 5 9 ~ % to J GL Varianc2 Care Changed Proposed Final Cases % Spec Rev Volume Code~ % Known PTCA PTCA 95 90 11 5 A(4) Ktl) CABS/ CABG/ 3 6 33 1 F(l)~
3 graft 3 garft ~ ~ ~ ~2 64 Proposed = final: 48 96 63 PTCA Medical 2 4 100 50 100 Management Proposed ~ Einal: 2 2 ,:
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WO 94tO0817 2 1 2 1 2 4 5 PCl /US93/lD6104 APPENDIX K
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Guideiine: ~5310) Coronary Artery Disease - 266 Page 1 ---Treatment-2- ,272 % to Ext GL Variance Care Changed Proposed Final ~ases % Spec Rev Rate Volume Code ~ Known ________ _____ _____ _ ___ _____~__ __~___ ______ _______ _____ ___., C269 273 274 275 . ~'2 '277 (278 ( ~281 --SETTING~OP~--------------------------------------------------------IP IP 45 100.0 Pro osed=Final: 45 100.0 0 ~ 43 95.0 0.0 1 1 1 2.5100.0 1 A(1) Proposed=Final: 44 9~.5 J ~280a 1 0 1 2.5 : 100.0 Proposed~Final: 1 2.5 3 3 ,: 3577.8 : ~
4 4 5 11~1 20.0 20.0 5 H(4) Propv~ed=Final: 40 88.9~ ~
4 3 5 11.1 10.0 80.0 50 Proposed~Final: 5 11:.1 ~Xey: ~-Comorbidity ~
H=Social Situation : ::
~3U~3STITUTE SI~EET
~YO 9~0081~ 2 1 2 1 2 4 5 P~/VSg3/061~4 APPENDIX L
..
1 283~ ~ Review % Review ~ 8 4 Reviews 2~ 286 287 Impact Impact impacted ~ ~
282 Proposed Proposed bo~h resources % Cases #
Guideline ~~ Treatment Resources and Treatment Impacted Cases _________ _______ _____ _________________ .I Coronary Artery Disease 4 13 1 14 50 Angina, Unstable 1 25 0 30 20 Arterial Qcclusive Disease 0 40 0 40 5 . ' .
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Claims (39)
- Claims In a health care management system comprising a processing unit, at least one memory unit and means for interactively exchanging information with a user of the system, a method of analyzing health care treatment for individuals having one or more specified health care conditions by reference to specified health care guidelines, comprising:
(a) defining one or more health care conditions for which treatment exists;
(b) providing to the system one or more diagnosis-based guidelines corresponding to each of said one or more specified health care conditions and including at least one guideline treatment option; and (c) for at least one individual, interactively exchanging with the system information on characteristics of the individual relevant to the observed health care condition, said exchange utilizing data collection nodes and conditional branching in a diagnosis-based guideline, to arrive at an endpoint selected from the group consisting of: a guideline treatment option, an indication to select another one of the diagnosis-based guidelines, or an indication for further clinical evaluation - 2. The method of claim 1, further comprising:
(d) providing to the system information identifying an actual or proposed treatment when said interactive exchange arrives at a guideline treatment option for the at least one individual;
(e) comparing the actual or proposed treatment for the at least one individual against the guideline treatment option corresponding to the defined health care condition observed in that individual; and (f) developing a treatment evaluation based on the comparison of step (e) and including identifying discrepancies between the guideline treatment option and the actual or proposed treatment for the at least one individual provided in step (d). - 3. The method of claim 1 wherein steps (a) and (b) result in the system having more than one diagnosis-based guideline, further comprising:
(g) for at least one individual, selecting at least one of the diagnosis-based guidelines corresponding to a defined health care condition observed in that individual. - 4. The method of claim 3 wherein the step of selecting, for at least one individual, at least one of the diagnosis-based guidelines corresponding to a defined health care condition observed in that individual comprises the system user selecting a name for the health care condition from a list of health care conditions provided by the system.
- 5. The method of claim 3 wherein the step of selecting for at least one individual, at least one of the diagnosis-based guidelines corresponding to a defined health care condition observed in that individual comprises the system user providing text describing a treatment for said health care condition and the system finding any treatment guidelines containing the text provided.
- 6. The method of claim 3 wherein the step of selecting for at least one individual, at least one of the diagnosis-based guidelines corresponding to a defined health care condition observed in that individual comprises the system user providing a predefined diagnosis code for said health care condition.
- 7. The method of claim 6 wherein the step of providing a diagnosis code comprises providing a standardized diagnosis number code.
- 8. The method claim 6 wherein the step of providing a diagnosis code comprises providing a ICD-9-CM code.
- 9. The method of claim 1 wherein the step of providing one or more diagnosis-based guidelines consists of providing guidelines having at least two alternative guideline treatment options linked by at least one test that selects one treatment option as the more appropriate when the test is satisfied.
- 10. The method of claim 1 wherein the step of providing one or more diagnosis-based guidelines comprises providing at least one treatment option having at least one treatment resource limitation parameter.
- 11. The method of claim 10 wherein the at least one treatment resource limitation parameter is based on a resource selected from the group consisting of: treatment setting, inpatient length of stay, requirement for assistant surgeon, and inpatient preoperative stay length.
- 12. The method of claim 1 wherein multiple health care conditions for which treatment exists are defined and for each of the multiple health care conditions there is one corresponding diagnosis-based guideline provided.
- 13. The method of claim 3 further comprising the steps of:
(h) providing to the system information identifying a final recommendation treatment for the at least one individual based on the evaluation of step (f); and (i) for each discrepancy between the guideline treatment option and the final recommendation treatment for the at least one individual provided in step (h), requesting a system user to provide to the system information specifying the basis for selecting the final recommendation treatment causing the discrepancy to arise. - 14. The method of claim 13 further comprising eliciting from a system user information documenting the differences between final recommendation treatment and the actual or proposed treatment.
- 15. The method of claim 1 wherein the step of defining one or more health care conditions comprises defining one or more health care conditions in the nature of a disease or organic dysfunction.
- 16. The method of claim 2 wherein the step of providing information identifying treatment for the at least one individual comprises providing information relating solely to planned treatment.
- 17. The method of claim 2 wherein the step of providing information identifying treatment for the at least one individual comprises providing information relating solely to treatment given.
- 18. The method of claim 2 wherein the step of providing information identifying treatment for the at least one individual comprises providing information relating to both planned treatment and treatment given.
- 19. The method of claim 1 wherein the step of providing one or more diagnosis-based guidelines comprises providing guidelines having at least two alternative guideline treatment options linked by at least one test that selects one treatment option as the more appropriate when the test is satisfied and at step (c) the interactive exchange of information with the system user determines if the test is satisfied.
- 20. The method of claim 19 wherein the at least one test is a question seeking a response selected from among two or more predetermined responses.
- 21. A medical information system for analyzing health care treatment for individuals having a specified health care condition to evaluate such treatment against specified health care guidelines comprising:
(a) a central processing unit;
(b) at least one memory unit connected to said central processing unit;
(c) means for defining one or more health care conditions for which treatment exists;
(d) means for providing to the system one or more diagnosis-based guidelines corresponding to each of said one or more specified health care conditions and including at least one guideline treatment option; and (e) means for interactively exchanging with the system information for at least one individual on characteristics of the individual relevant to the observed, health care condition, said exchange utilizing data collection nodes and conditional branching in a diagnosis-based guideline, to arrive at an endpoint selected from the group consisting of: a guideline treatment option, an indication to select another one of the diagnosis-based guidelines, or an indication for further clinical evaluation. - 22. The medical information system of claim 21, further comprising:
(f) means for providing to the system information identifying a treatment for the at least one individual when the means for interactively exchanging with the system information on characteristics of the individual relevant to the observed health care condition arrives at a guideline treatment option;
(g) means for comparing the treatment identified for the at least one individual against the guideline treatment option corresponding to the defined health care condition observed in that individual; and (h) means for developing a treatment evaluation based on the comparison of element (g) and including identifying discrepancies between the guideline treatment option and the information identifying treatment for the at least one individual provided by element (f). - 23. The medical information system of claim 21 wherein means (c) and (d) provide the system with more than one diagnosis-based guideline, further comprising:
(i) means for selecting, for at least one individual, at least one of the diagnosis-based guidelines corresponding to a defined health care condition observed in that individual - 24. The system of claim 23 wherein the means for selecting, for at least one individual, at least one of the diagnosis-based guidelines corresponding to a; defined health care condition observed in that individual comprises means for the system user selecting a name for a health care condition from a list of health care conditions provided by the system.
- 25. The system of claim 23 wherein the means for selecting, for at least one individual, at least one of the diagnosis-based guidelines corresponding to a defined health care condition observed in that individual comprises means for the system user providing text describing a treatment and the system finding any treatment guidelines containing the test provided.
- 26. The system of claim 23 wherein the means for selecting, for at least one individual, at least one of the diagnosis-based guidelines corresponding to a defined health care condition observed in that individual comprises means for the system user providing a predefined diagnosis code.
- 27, The system of claim 26 wherein the means for providing a diagnosis code comprises means for providing a standardized diagnosis number code,
- 28. The system of claim 26 wherein the means for providing a diagnosis code comprises means for providing an ICD-9-CM code,
- 29. The system of claim 21 wherein the means for providing one or more diagnosis-based guidelines comprises means for providing guidelines having at least two alternative guideline treatment options linked by a test that selects one treatment option as the more appropriate when the test is satisfied.
- 30. The system of claim 21 wherein the means for providing one or more diagnosis-based guidelines comprises means for providing at least one treatment option having at least one treatment resource limitation parameter,
- 31. The system of claim 30 wherein the at least one treatment resource limitation parameter is based on a resource selected from the group consisting of, treatment setting, inpatient length of stay, requirement for assistant surgeon, or inpatient preoperative stay length.
- 32. The system of claim 21 wherein multiple health care conditions for which treatment exists are defined and for each of the multiple health care conditions there is one corresponding treatment guideline provided.
- 33. The system of claim 23 further comprising:
(j) means for providing to the system; information identifying a final recommendation treatment for the at least one individual based on the evaluation of element (h); and (k) means for identifying and requesting a system user to provide to said system, for each discrepancy between the guideline treatment option and the final recommendation treatment for the at least one individual provided in element (j), information specifying the basis for selecting the final recommendation treatment causing the discrepancy to arise. - 34. The system of claim 33 further comprising means for eliciting from a system user information documenting the differences between final recommendation treatment and the actual or proposed treatment.
- 35. The system of claim 21 wherein the means for defining one or more health care conditions comprises means for defining one or more health care conditions in the nature of a disease or organic dysfunction.
- 36. The system of claim 22 wherein the means for providing information identifying treatment for the at least one individual comprises means for providing information relating solely to planned treatment.
- 37. The system of claim 22 wherein the means for providing information identifying treatment for the at least one individual comprises means for providing information relating solely to treatment given.
- 38. The system claim 22 wherein the means for providing information identifying treatment for the at least one individual comprises means for providing information relating to both planned treatment and treatment given.
- 39. The system of claim 21 wherein the means for providing one or more diagnosis-based guidelines comprises means for providing guidelines having at least two alternative guideline treatment options linked by at least one test that selects one treatment option as the more appropriate when the test is satisfied and at step (e) the interactive exchange of information with the system user determines if the test is satisfied.
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Families Citing this family (526)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US20010011224A1 (en) | 1995-06-07 | 2001-08-02 | Stephen James Brown | Modular microprocessor-based health monitoring system |
US8078431B2 (en) | 1992-11-17 | 2011-12-13 | Health Hero Network, Inc. | Home power management system |
US8027809B2 (en) | 1992-11-17 | 2011-09-27 | Health Hero Network, Inc. | Home power management system |
WO2001037174A1 (en) | 1992-11-17 | 2001-05-25 | Health Hero Network, Inc. | Method and system for improving adherence with a diet program or other medical regimen |
US8078407B1 (en) | 1997-03-28 | 2011-12-13 | Health Hero Network, Inc. | System and method for identifying disease-influencing genes |
US8626521B2 (en) | 1997-11-21 | 2014-01-07 | Robert Bosch Healthcare Systems, Inc. | Public health surveillance system |
US7624028B1 (en) | 1992-11-17 | 2009-11-24 | Health Hero Network, Inc. | Remote health monitoring and maintenance system |
US5307263A (en) | 1992-11-17 | 1994-04-26 | Raya Systems, Inc. | Modular microprocessor-based health monitoring system |
US5951300A (en) | 1997-03-10 | 1999-09-14 | Health Hero Network | Online system and method for providing composite entertainment and health information |
US8095340B2 (en) | 1992-11-17 | 2012-01-10 | Health Hero Network, Inc. | Home power management system |
US7970620B2 (en) | 1992-11-17 | 2011-06-28 | Health Hero Network, Inc. | Multi-user remote health monitoring system with biometrics support |
US9215979B2 (en) | 1992-11-17 | 2015-12-22 | Robert Bosch Healthcare Systems, Inc. | Multi-user remote health monitoring system |
US5832448A (en) | 1996-10-16 | 1998-11-03 | Health Hero Network | Multiple patient monitoring system for proactive health management |
US6330426B2 (en) | 1994-05-23 | 2001-12-11 | Stephen J. Brown | System and method for remote education using a memory card |
US6968375B1 (en) | 1997-03-28 | 2005-11-22 | Health Hero Network, Inc. | Networked system for interactive communication and remote monitoring of individuals |
US5660176A (en) | 1993-12-29 | 1997-08-26 | First Opinion Corporation | Computerized medical diagnostic and treatment advice system |
US6206829B1 (en) | 1996-07-12 | 2001-03-27 | First Opinion Corporation | Computerized medical diagnostic and treatment advice system including network access |
USRE43433E1 (en) | 1993-12-29 | 2012-05-29 | Clinical Decision Support, Llc | Computerized medical diagnostic and treatment advice system |
US5935060A (en) | 1996-07-12 | 1999-08-10 | First Opinion Corporation | Computerized medical diagnostic and treatment advice system including list based processing |
US5471382A (en) * | 1994-01-10 | 1995-11-28 | Informed Access Systems, Inc. | Medical network management system and process |
US8015033B2 (en) | 1994-04-26 | 2011-09-06 | Health Hero Network, Inc. | Treatment regimen compliance and efficacy with feedback |
US7222079B1 (en) * | 1994-06-23 | 2007-05-22 | Ingenix, Inc. | Method and system for generating statistically-based medical provider utilization profiles |
US5557514A (en) | 1994-06-23 | 1996-09-17 | Medicode, Inc. | Method and system for generating statistically-based medical provider utilization profiles |
US7072840B1 (en) * | 1994-10-28 | 2006-07-04 | Cybear, L.L.C. | Prescription management system |
AU4525596A (en) * | 1994-12-19 | 1996-07-10 | University Of Medicine And Dentistry Of New Jersey | An interactive system using a graphical interface for assisting medical professionals in the diagnosis, treatment and management of surgical and trauma patients |
WO1996027163A1 (en) * | 1995-02-28 | 1996-09-06 | Clinicomp International, Inc. | Clinical critical care path system and method of using same |
US5946659A (en) * | 1995-02-28 | 1999-08-31 | Clinicomp International, Inc. | System and method for notification and access of patient care information being simultaneously entered |
US6434531B1 (en) * | 1995-02-28 | 2002-08-13 | Clinicomp International, Inc. | Method and system for facilitating patient care plans |
US5842175A (en) * | 1995-04-28 | 1998-11-24 | Therassist Software, Inc. | Therapy system |
GB2301685A (en) * | 1995-06-03 | 1996-12-11 | Simmon Hill | Patient database for hospital records |
US6177940B1 (en) * | 1995-09-20 | 2001-01-23 | Cedaron Medical, Inc. | Outcomes profile management system for evaluating treatment effectiveness |
WO1997011635A1 (en) * | 1995-09-28 | 1997-04-03 | Grail Sven F H | Medical record system |
US5786816A (en) * | 1995-10-20 | 1998-07-28 | Araxsys, Inc. | Method and apparatus for graphical user interface-based and variable result healthcare plan |
US5850221A (en) * | 1995-10-20 | 1998-12-15 | Araxsys, Inc. | Apparatus and method for a graphic user interface in a medical protocol system |
US5826237A (en) * | 1995-10-20 | 1998-10-20 | Araxsys, Inc. | Apparatus and method for merging medical protocols |
US6426759B1 (en) | 1995-10-20 | 2002-07-30 | Confer Software, Inc. | Apparatus and method for managing changes of computerized medical protocols |
US6037940A (en) * | 1995-10-20 | 2000-03-14 | Araxsys, Inc. | Graphical user interface in a medical protocol system having time delay rules and a publisher's view |
US5924073A (en) * | 1995-11-14 | 1999-07-13 | Beacon Patient Physician Association, Llc | System and method for assessing physician performance using robust multivariate techniques of statistical analysis |
CA2240188A1 (en) * | 1995-12-12 | 1997-06-19 | Deroyal Industries, Inc. | Method for the prescription and administration of health care resources |
US5778345A (en) * | 1996-01-16 | 1998-07-07 | Mccartney; Michael J. | Health data processing system |
EP1011419B1 (en) * | 1996-03-01 | 2002-05-02 | Medicomp Systems, Inc. | Method and apparatus to assist a user in creating a medical protocol |
US5740800A (en) * | 1996-03-01 | 1998-04-21 | Hewlett-Packard Company | Method and apparatus for clinical pathway order selection in a medical information system |
US20050277908A1 (en) * | 1996-04-10 | 2005-12-15 | Bertolero Arthur A | Methods and devices for performing minimally invasive cardiac surgery and methods for coronary artery disease management |
US5970463A (en) * | 1996-05-01 | 1999-10-19 | Practice Patterns Science, Inc. | Medical claims integration and data analysis system |
AU3140897A (en) * | 1996-05-22 | 1997-12-09 | Medical Science Systems, Inc. | Pharmaceutical process system for creating and analyzing information |
US6108635A (en) * | 1996-05-22 | 2000-08-22 | Interleukin Genetics, Inc. | Integrated disease information system |
US6725447B1 (en) * | 1996-05-31 | 2004-04-20 | Nellcor Puritan Bennett Incorporated | System and method for graphic creation of a medical logical module in the arden syntax file format |
WO1997048059A1 (en) * | 1996-06-11 | 1997-12-18 | Yeong Kuang Oon | Iterative problem solving technique |
AU710599B2 (en) * | 1996-06-11 | 1999-09-23 | Yeong Kuang Oon | Iterative problem solving technique |
US7725328B1 (en) * | 1996-10-30 | 2010-05-25 | American Board Of Family Practice, Inc. | Computer architecture and process of patient generation evolution, and simulation for computer based testing system |
US6032119A (en) | 1997-01-16 | 2000-02-29 | Health Hero Network, Inc. | Personalized display of health information |
CN1252877A (en) | 1997-03-13 | 2000-05-10 | 第一咨询公司 | Disease management system |
US6394811B2 (en) | 1997-03-20 | 2002-05-28 | Terese Finitzo | Computer-automated implementation of user-definable decision rules for medical diagnostic or screening interpretations |
US5991728A (en) * | 1997-04-30 | 1999-11-23 | Deroyal Industries, Inc. | Method and system for the tracking and profiling of supply usage in a health care environment |
US6108665A (en) * | 1997-07-03 | 2000-08-22 | The Psychological Corporation | System and method for optimizing behaviorial health care collection |
US6067523A (en) * | 1997-07-03 | 2000-05-23 | The Psychological Corporation | System and method for reporting behavioral health care data |
US6029138A (en) * | 1997-08-15 | 2000-02-22 | Brigham And Women's Hospital | Computer system for decision support in the selection of diagnostic and therapeutic tests and interventions for patients |
US6012034A (en) * | 1997-08-18 | 2000-01-04 | Becton, Dickinson And Company | System and method for selecting an intravenous device |
US6014633A (en) * | 1997-09-24 | 2000-01-11 | Deroyal Business Systems, L.L.C. | Method for the analysis and standardization of bills of resources |
EP1019802A4 (en) * | 1997-09-29 | 2002-02-06 | Edgar L Ross | Method and system for pain management |
US6697783B1 (en) * | 1997-09-30 | 2004-02-24 | Medco Health Solutions, Inc. | Computer implemented medical integrated decision support system |
US6266675B1 (en) | 1997-10-07 | 2001-07-24 | Phycom Corporation | System and method for using a relational database to enable the dynamic configuration of an application program |
US5991701A (en) * | 1997-10-13 | 1999-11-23 | Kinex Iha Corp. | Method for improved instantaneous helical axis determination |
US5891060A (en) * | 1997-10-13 | 1999-04-06 | Kinex Iha Corp. | Method for evaluating a human joint |
US5954674A (en) * | 1997-10-13 | 1999-09-21 | Kinex Iha Corporation | Apparatus for gathering biomechanical parameters |
US6314556B1 (en) * | 1997-11-07 | 2001-11-06 | Deroyal Business Systems, Llc | Modular health care information management system utilizing reusable software objects |
US5995937A (en) * | 1997-11-07 | 1999-11-30 | Deroyal Industries, Inc. | Modular health-care information management system utilizing reusable software objects |
US6049794A (en) * | 1997-12-09 | 2000-04-11 | Jacobs; Charles M. | System for screening of medical decision making incorporating a knowledge base |
US6047259A (en) * | 1997-12-30 | 2000-04-04 | Medical Management International, Inc. | Interactive method and system for managing physical exams, diagnosis and treatment protocols in a health care practice |
BE1013121A6 (en) * | 1998-02-11 | 2001-10-02 | Curame | Method for implementing orders. |
US6546545B1 (en) | 1998-03-05 | 2003-04-08 | American Management Systems, Inc. | Versioning in a rules based decision management system |
US6601034B1 (en) | 1998-03-05 | 2003-07-29 | American Management Systems, Inc. | Decision management system which is cross-function, cross-industry and cross-platform |
US8364578B1 (en) | 1998-03-05 | 2013-01-29 | Cgi Technologies And Solutions Inc. | Simultaneous customer/account strategy execution in a decision management system |
US6609120B1 (en) | 1998-03-05 | 2003-08-19 | American Management Systems, Inc. | Decision management system which automatically searches for strategy components in a strategy |
US6694298B1 (en) | 1998-04-02 | 2004-02-17 | Medco Health Solutions, Inc. | Computer implemented patient medication review system and process for the managed care, health care and/or pharmacy industry |
US6014631A (en) * | 1998-04-02 | 2000-01-11 | Merck-Medco Managed Care, Llc | Computer implemented patient medication review system and process for the managed care, health care and/or pharmacy industry |
CN1198901A (en) * | 1998-04-06 | 1998-11-18 | 马正方 | Nutritive diet guiding device and method |
US6148297A (en) * | 1998-06-01 | 2000-11-14 | Surgical Safety Products, Inc. | Health care information and data tracking system and method |
US6282531B1 (en) | 1998-06-12 | 2001-08-28 | Cognimed, Llc | System for managing applied knowledge and workflow in multiple dimensions and contexts |
US6064968A (en) * | 1998-08-25 | 2000-05-16 | Schanz; Stephen J. | Systems, methods and computer program products for identifying unique and common legal requirements for a regulated activity among multiple legal jurisdictions |
US6872187B1 (en) | 1998-09-01 | 2005-03-29 | Izex Technologies, Inc. | Orthoses for joint rehabilitation |
US8521546B2 (en) | 1998-09-25 | 2013-08-27 | Health Hero Network | Dynamic modeling and scoring risk assessment |
US6954802B2 (en) | 1998-09-29 | 2005-10-11 | Tdk Electronics Corporation | Removable media recording station for the medical industry |
US6584445B2 (en) * | 1998-10-22 | 2003-06-24 | Computerized Health Evaluation Systems, Inc. | Medical system for shared patient and physician decision making |
US6149585A (en) * | 1998-10-28 | 2000-11-21 | Sage Health Management Solutions, Inc. | Diagnostic enhancement method and apparatus |
AU768947B2 (en) * | 1998-11-30 | 2004-01-08 | Health Hero Network, Inc. | System and method for improving a risk for a monitored client |
US6381576B1 (en) * | 1998-12-16 | 2002-04-30 | Edward Howard Gilbert | Method, apparatus, and data structure for capturing and representing diagnostic, treatment, costs, and outcomes information in a form suitable for effective analysis and health care guidance |
US20020087358A1 (en) * | 1998-12-16 | 2002-07-04 | Gilbert Edward H. | System, method, and computer program product for processing diagnostic, treatment, costs, and outcomes information for effective analysis and health care guidance |
US6393404B2 (en) * | 1998-12-23 | 2002-05-21 | Ker Bugale, Inc. | System and method for optimizing medical diagnosis, procedures and claims using a structured search space |
US6385589B1 (en) | 1998-12-30 | 2002-05-07 | Pharmacia Corporation | System for monitoring and managing the health care of a patient population |
US20040034686A1 (en) * | 2000-02-22 | 2004-02-19 | David Guthrie | System and method for delivering targeted data to a subscriber base via a computer network |
US6581038B1 (en) | 1999-03-15 | 2003-06-17 | Nexcura, Inc. | Automated profiler system for providing medical information to patients |
US7647234B1 (en) * | 1999-03-24 | 2010-01-12 | Berkeley Heartlab, Inc. | Cardiovascular healthcare management system and method |
US6529876B1 (en) * | 1999-03-26 | 2003-03-04 | Stephen H. Dart | Electronic template medical records coding system |
US6290646B1 (en) | 1999-04-16 | 2001-09-18 | Cardiocom | Apparatus and method for monitoring and communicating wellness parameters of ambulatory patients |
US8419650B2 (en) | 1999-04-16 | 2013-04-16 | Cariocom, LLC | Downloadable datasets for a patient monitoring system |
US6371123B1 (en) * | 1999-06-11 | 2002-04-16 | Izex Technology, Inc. | System for orthopedic treatment protocol and method of use thereof |
US20020007285A1 (en) * | 1999-06-18 | 2002-01-17 | Rappaport Alain T. | Method, apparatus and system for providing targeted information in relation to laboratory and other medical services |
US20030204426A1 (en) * | 1999-06-18 | 2003-10-30 | American Management Systems, Inc. | Decision management system which searches for strategy components |
US7739123B1 (en) * | 1999-06-18 | 2010-06-15 | Microsoft Corporation | Method, apparatus and system for providing health information |
US7416537B1 (en) | 1999-06-23 | 2008-08-26 | Izex Technologies, Inc. | Rehabilitative orthoses |
US6277071B1 (en) * | 1999-06-25 | 2001-08-21 | Delphi Health Systems, Inc. | Chronic disease monitor |
US6708155B1 (en) * | 1999-07-07 | 2004-03-16 | American Management Systems, Inc. | Decision management system with automated strategy optimization |
US6754883B2 (en) | 1999-08-24 | 2004-06-22 | Ge Medical Systems Information Technologies, Inc. | Modular analysis and standardization system |
US6581204B2 (en) | 1999-08-24 | 2003-06-17 | Ge Medical Systems Information Technologies, Inc. | Modular tracking and profiling system |
US7171371B2 (en) | 1999-09-03 | 2007-01-30 | Smg Trust | Method and system for providing pre and post operative support and care |
US6640212B1 (en) * | 1999-09-30 | 2003-10-28 | Rodney L. Rosse | Standardized information management system for long-term residence facilities |
US7877492B2 (en) * | 1999-10-12 | 2011-01-25 | Webmd Corporation | System and method for delegating a user authentication process for a networked application to an authentication agent |
US7305475B2 (en) | 1999-10-12 | 2007-12-04 | Webmd Health | System and method for enabling a client application to operate offline from a server |
US7519905B2 (en) * | 1999-10-12 | 2009-04-14 | Webmd Corp. | Automatic formatting and validating of text for a markup language graphical user interface |
US6527711B1 (en) | 1999-10-18 | 2003-03-04 | Bodymedia, Inc. | Wearable human physiological data sensors and reporting system therefor |
US6738754B1 (en) * | 1999-10-22 | 2004-05-18 | Intermap Systems, Inc. | Apparatus and method for directing internet users to health care information |
US7076437B1 (en) * | 1999-10-29 | 2006-07-11 | Victor Levy | Process for consumer-directed diagnostic and health care information |
US6876991B1 (en) | 1999-11-08 | 2005-04-05 | Collaborative Decision Platforms, Llc. | System, method and computer program product for a collaborative decision platform |
US20050028171A1 (en) * | 1999-11-12 | 2005-02-03 | Panagiotis Kougiouris | System and method enabling multiple processes to efficiently log events |
US20040034833A1 (en) * | 1999-11-12 | 2004-02-19 | Panagiotis Kougiouris | Dynamic interaction manager for markup language graphical user interface |
US20040260577A1 (en) * | 1999-11-15 | 2004-12-23 | Recare, Inc. | Electronic healthcare information and delivery management system with an integrated medical search architecture and capability |
JP2001142967A (en) * | 1999-11-17 | 2001-05-25 | Hitachi Ltd | Welfare information providing method, device for executing the same and recording medium with recorded processing program therefor |
CA2391985A1 (en) * | 1999-11-25 | 2001-05-31 | Yeong Kuang Oon | A unitary language for problem solving resources for knowledge based services |
US20020007284A1 (en) * | 1999-12-01 | 2002-01-17 | Schurenberg Kurt B. | System and method for implementing a global master patient index |
US7464040B2 (en) * | 1999-12-18 | 2008-12-09 | Raymond Anthony Joao | Apparatus and method for processing and/or for providing healthcare information and/or healthcare-related information |
US7490048B2 (en) | 1999-12-18 | 2009-02-10 | Raymond Anthony Joao | Apparatus and method for processing and/or for providing healthcare information and/or healthcare-related information |
US6980958B1 (en) * | 2000-01-11 | 2005-12-27 | Zycare, Inc. | Apparatus and methods for monitoring and modifying anticoagulation therapy of remotely located patients |
US20020068857A1 (en) | 2000-02-14 | 2002-06-06 | Iliff Edwin C. | Automated diagnostic system and method including reuse of diagnostic objects |
US8712792B2 (en) * | 2000-02-24 | 2014-04-29 | Webmd, Llc | Personalized health communication system |
US8612245B2 (en) * | 2000-02-24 | 2013-12-17 | Webmd Llc | Personalized health history system with accommodation for consumer health terminology |
US8775197B2 (en) * | 2000-02-24 | 2014-07-08 | Webmd, Llc | Personalized health history system with accommodation for consumer health terminology |
US20040049408A1 (en) * | 2000-03-03 | 2004-03-11 | Voss Anne Coble | Process for reducing the cost associated with the prevention and treatment of pressure ulcers |
US6968503B1 (en) | 2000-03-09 | 2005-11-22 | Quovadx, Inc. | XML user interface for a workflow server |
US7379885B1 (en) * | 2000-03-10 | 2008-05-27 | David S. Zakim | System and method for obtaining, processing and evaluating patient information for diagnosing disease and selecting treatment |
US6957218B1 (en) | 2000-04-06 | 2005-10-18 | Medical Central Online | Method and system for creating a website for a healthcare provider |
US20010037215A1 (en) * | 2000-04-07 | 2001-11-01 | Emilie Sparks | Multi-user distribution system and center for diagnosis-related educational information and home medical tests and devices |
US8140357B1 (en) | 2000-04-26 | 2012-03-20 | Boesen Peter V | Point of service billing and records system |
US20010039503A1 (en) * | 2000-04-28 | 2001-11-08 | Chan Bryan K. | Method and system for managing chronic disease and wellness online |
WO2001084444A1 (en) * | 2000-05-02 | 2001-11-08 | Comedex, Inc. | Medical product selection apparatus |
WO2001088810A1 (en) * | 2000-05-12 | 2001-11-22 | Opsion Medical, Inc. | Networked medical information system for clinical practices |
US9427520B2 (en) | 2005-02-11 | 2016-08-30 | Carefusion 303, Inc. | Management of pending medication orders |
US11087873B2 (en) | 2000-05-18 | 2021-08-10 | Carefusion 303, Inc. | Context-aware healthcare notification system |
US7860583B2 (en) | 2004-08-25 | 2010-12-28 | Carefusion 303, Inc. | System and method for dynamically adjusting patient therapy |
US9741001B2 (en) * | 2000-05-18 | 2017-08-22 | Carefusion 303, Inc. | Predictive medication safety |
US10353856B2 (en) | 2011-03-17 | 2019-07-16 | Carefusion 303, Inc. | Scalable communication system |
US10062457B2 (en) | 2012-07-26 | 2018-08-28 | Carefusion 303, Inc. | Predictive notifications for adverse patient events |
US9069887B2 (en) | 2000-05-18 | 2015-06-30 | Carefusion 303, Inc. | Patient-specific medication management system |
AU6172301A (en) | 2000-05-18 | 2001-11-26 | Alaris Meidical Systems Inc | Distributed remote asset and medication management drug delivery system |
US20020010597A1 (en) * | 2000-05-19 | 2002-01-24 | Mayer Gregg L. | Systems and methods for electronic health management |
US7739124B1 (en) | 2000-06-02 | 2010-06-15 | Walker Digital, Llc | System, method and apparatus for encouraging the undertaking of a preventative treatment |
JP2002024409A (en) * | 2000-06-16 | 2002-01-25 | Pfizer Prod Inc | Health care system for patient |
US20060122474A1 (en) | 2000-06-16 | 2006-06-08 | Bodymedia, Inc. | Apparatus for monitoring health, wellness and fitness |
US7689437B1 (en) * | 2000-06-16 | 2010-03-30 | Bodymedia, Inc. | System for monitoring health, wellness and fitness |
US7261690B2 (en) * | 2000-06-16 | 2007-08-28 | Bodymedia, Inc. | Apparatus for monitoring health, wellness and fitness |
WO2005029242A2 (en) | 2000-06-16 | 2005-03-31 | Bodymedia, Inc. | System for monitoring and managing body weight and other physiological conditions including iterative and personalized planning, intervention and reporting capability |
MXPA02012643A (en) * | 2000-06-23 | 2004-09-10 | Bodymedia Inc | System for monitoring health, wellness and fitness. |
GB2363954A (en) * | 2000-06-24 | 2002-01-09 | Ncr Int Inc | Displaying a visual decision tree and information buttons |
US20020019749A1 (en) * | 2000-06-27 | 2002-02-14 | Steven Becker | Method and apparatus for facilitating delivery of medical services |
ATE438338T1 (en) * | 2000-06-30 | 2009-08-15 | Becton Dickinson Co | HEALTH AND SICKNESS MANAGEMENT SYSTEM FOR IMPROVED PATIENT CARE |
US20020013716A1 (en) * | 2000-07-19 | 2002-01-31 | Dunham Michael H. | Network based integrated system of care |
US20140122110A1 (en) * | 2000-08-01 | 2014-05-01 | Logical Images, Inc. | System and method for problem-oriented patient-contextualized medical search and clinical decision support to improve diagnostic, management, and therapeutic decisions |
JP2002073822A (en) * | 2000-08-30 | 2002-03-12 | Fujitsu Ltd | Medical information system |
AU2001275020A1 (en) | 2000-09-21 | 2002-04-02 | Theradoc.Com, Inc. | Systems and methods for manipulating medical data via a decision support system |
US7447643B1 (en) | 2000-09-21 | 2008-11-04 | Theradoc.Com, Inc. | Systems and methods for communicating between a decision-support system and one or more mobile information devices |
US20020095313A1 (en) * | 2000-09-28 | 2002-07-18 | Haq Mohamed M. | Computer system for assisting a physician |
US20020091687A1 (en) * | 2000-09-29 | 2002-07-11 | Thor Eglington | Decision support system |
US6988088B1 (en) * | 2000-10-17 | 2006-01-17 | Recare, Inc. | Systems and methods for adaptive medical decision support |
EP1358615A2 (en) * | 2000-11-01 | 2003-11-05 | Staged Diabetes Management, Llc. | A system and method for integrating data with guidelines to generate displays containing the guidelines and data |
US7558738B1 (en) * | 2000-11-06 | 2009-07-07 | Flatt Jerrold V | Software article, system and method for physician referral services |
US20020077864A1 (en) * | 2000-11-17 | 2002-06-20 | Samuel Cavallaro | Fully integrated critical care workstation |
US20020077860A1 (en) * | 2000-12-18 | 2002-06-20 | Earnest Jocelyn Branham | Method and system for assisting in determining when to order supplemental medical information about a patient |
US20020082863A1 (en) * | 2000-12-21 | 2002-06-27 | Kleinke John D. | Systems and methods for obtaining approval for medical reimbursements |
US20020082825A1 (en) * | 2000-12-22 | 2002-06-27 | Ge Medical Systems Information Technologies, Inc. | Method for organizing and using a statement library for generating clinical reports and retrospective queries |
US7162439B2 (en) * | 2000-12-22 | 2007-01-09 | General Electric Company | Workstation configuration and selection method and apparatus |
US20030097185A1 (en) * | 2000-12-29 | 2003-05-22 | Goetzke Gary A. | Chronic pain patient medical resources forecaster |
US20020128866A1 (en) * | 2000-12-29 | 2002-09-12 | Goetzke Gary A. | Chronic pain patient care plan |
US20060095457A1 (en) * | 2001-01-12 | 2006-05-04 | Glasspool David W | Interactive tool for knowledge-based support of planning under uncertainty |
US7130805B2 (en) * | 2001-01-19 | 2006-10-31 | International Business Machines Corporation | Method and apparatus for generating progressive queries and models for decision support |
US20020108620A1 (en) * | 2001-02-13 | 2002-08-15 | Carl Lauryssen | Informed consent system and method therefor |
US7376576B2 (en) * | 2001-03-16 | 2008-05-20 | Portblue Corporation | Decision making and implementation system |
US7401027B2 (en) * | 2001-03-19 | 2008-07-15 | The Jasos Group, Llc | Methods for collecting fees for healthcare management group |
US7398217B2 (en) * | 2001-03-19 | 2008-07-08 | The Jasos Group, Llc | Methods and systems for healthcare practice management |
JP2004528643A (en) * | 2001-04-05 | 2004-09-16 | インスツルメンタリウム コーポレイション | Method and system for detecting differences in a tracking environment |
US7957986B1 (en) | 2001-04-09 | 2011-06-07 | Trover Solutions, Inc. | System and method for managing account processing |
US20020188466A1 (en) * | 2001-04-18 | 2002-12-12 | Barrette Pierre Philip | Secure digital medical intellectual property (IP) distribution, market applications, and mobile devices |
US7542961B2 (en) * | 2001-05-02 | 2009-06-02 | Victor Gogolak | Method and system for analyzing drug adverse effects |
US6789091B2 (en) | 2001-05-02 | 2004-09-07 | Victor Gogolak | Method and system for web-based analysis of drug adverse effects |
US20020188467A1 (en) * | 2001-05-02 | 2002-12-12 | Louis Eke | Medical virtual resource network |
US7925612B2 (en) * | 2001-05-02 | 2011-04-12 | Victor Gogolak | Method for graphically depicting drug adverse effect risks |
US6778994B2 (en) | 2001-05-02 | 2004-08-17 | Victor Gogolak | Pharmacovigilance database |
US20020183965A1 (en) * | 2001-05-02 | 2002-12-05 | Gogolak Victor V. | Method for analyzing drug adverse effects employing multivariate statistical analysis |
AU2002312066A1 (en) * | 2001-05-29 | 2002-12-09 | Becton, Dickinson And Company | Health care management system and method |
WO2002099585A2 (en) * | 2001-06-06 | 2002-12-12 | Lenhard William R | System and method for operating a long term care facility |
US7493264B1 (en) | 2001-06-11 | 2009-02-17 | Medco Health Solutions, Inc, | Method of care assessment and health management |
US20050010447A1 (en) * | 2001-07-06 | 2005-01-13 | Katsuyuki Miyasaka | Patient information management apparatus and method |
US20030050801A1 (en) * | 2001-08-20 | 2003-03-13 | Ries Linda K. | System and user interface for planning and monitoring patient related treatment activities |
US20030036927A1 (en) * | 2001-08-20 | 2003-02-20 | Bowen Susan W. | Healthcare information search system and user interface |
US20030061065A1 (en) * | 2001-08-24 | 2003-03-27 | Keeley Damon A.J. | Evidence-based outcomes system |
US7461006B2 (en) * | 2001-08-29 | 2008-12-02 | Victor Gogolak | Method and system for the analysis and association of patient-specific and population-based genomic data with drug safety adverse event data |
US20030046113A1 (en) * | 2001-08-31 | 2003-03-06 | Johnson Ann Mond | Method and system for consumer healthcare decisionmaking |
JP4029593B2 (en) * | 2001-09-11 | 2008-01-09 | 株式会社日立製作所 | Process analysis method and information system |
DE10151029A1 (en) * | 2001-10-16 | 2003-04-30 | Siemens Ag | System for parameter configuration of multimodal measuring devices |
DE10247459A1 (en) * | 2001-10-31 | 2003-07-03 | Caterpillar Inc | Health information analysis method and system |
US8224663B2 (en) * | 2002-05-24 | 2012-07-17 | Becton, Dickinson And Company | System and method for assessment and corrective action based on guidelines |
US20030097278A1 (en) * | 2001-11-19 | 2003-05-22 | Mantilla David Alejandro | Telephone-and network-based medical triage system and process |
US20030125983A1 (en) * | 2001-12-27 | 2003-07-03 | Flack John M. | Computer-implemented method and system for managing patient healthcare and evaluating patient kidney function |
FI20012593A0 (en) * | 2001-12-28 | 2001-12-28 | Pertti Laehteenmaeki | A method and system for providing a nutrition information service |
US6991464B2 (en) * | 2001-12-28 | 2006-01-31 | Expert Clinical Systems, Inc. | Web-based medical diagnostic and training system |
US20030144885A1 (en) * | 2002-01-29 | 2003-07-31 | Exscribe, Inc. | Medical examination and transcription method, and associated apparatus |
US10173008B2 (en) | 2002-01-29 | 2019-01-08 | Baxter International Inc. | System and method for communicating with a dialysis machine through a network |
US8775196B2 (en) | 2002-01-29 | 2014-07-08 | Baxter International Inc. | System and method for notification and escalation of medical data |
US20030163348A1 (en) * | 2002-02-27 | 2003-08-28 | Stead William W. | Method and system for clinical action support |
WO2003077142A1 (en) * | 2002-03-04 | 2003-09-18 | Medstory.Com | Method, apparatus, and system for data modeling and processing |
US7840422B1 (en) * | 2002-04-09 | 2010-11-23 | Trover Solutions, Inc. | Systems and methods for managing insurance claims |
US7716072B1 (en) | 2002-04-19 | 2010-05-11 | Greenway Medical Technologies, Inc. | Integrated medical software system |
US8606593B1 (en) | 2009-02-25 | 2013-12-10 | Greenway Medical Technologies. Inc. | System and method for analyzing, collecting and tracking patient data across a vast patient population |
US8738396B2 (en) * | 2002-04-19 | 2014-05-27 | Greenway Medical Technologies, Inc. | Integrated medical software system with embedded transcription functionality |
US20110301982A1 (en) * | 2002-04-19 | 2011-12-08 | Green Jr W T | Integrated medical software system with clinical decision support |
US20030233253A1 (en) * | 2002-04-30 | 2003-12-18 | Peth Thomas C. | Point-of-care clinical documentation software system and associated methods |
US8234128B2 (en) | 2002-04-30 | 2012-07-31 | Baxter International, Inc. | System and method for verifying medical device operational parameters |
GB0209937D0 (en) * | 2002-05-01 | 2002-06-05 | Univ Glasgow | Simulation model generation |
US6898462B2 (en) | 2002-05-08 | 2005-05-24 | Koninklijke Philips Electronics N.V. | Defibrillator/monitor with patient specific treatment algorithms |
AU2003234402A1 (en) * | 2002-05-10 | 2003-11-11 | Duxlink, Inc. | Management of information flow and workflow in medical imaging services |
US20030216937A1 (en) * | 2002-05-14 | 2003-11-20 | Jorg Schreiber | System and method for providing on-line healthcare |
US20030216943A1 (en) * | 2002-05-15 | 2003-11-20 | Mcphee Ron | Interactive system and method for collecting and reporting health and fitness data |
US20050131738A1 (en) * | 2002-05-15 | 2005-06-16 | Morris Tommy J. | System and method for handling medical information |
JP2006511851A (en) | 2002-05-15 | 2006-04-06 | ユー.エス. ガバメント アズ リプレゼンテッド バイ ザ セクレタリー オブ ジ アーミー | Medical information processing system and method |
AU2003241484A1 (en) * | 2002-05-16 | 2003-12-31 | Gordon T. Morre | Checklist-based flow and tracking system for patient care by medical providers |
US20030229512A1 (en) * | 2002-06-06 | 2003-12-11 | Lenhard William R. | System and method for operating a long term care facility |
JP2005528967A (en) * | 2002-06-06 | 2005-09-29 | インストルメンタリウム コーポレーション | Method and system for selectively monitoring activity in a tracking environment |
US7225131B1 (en) * | 2002-06-14 | 2007-05-29 | At&T Corp. | System and method for accessing and annotating electronic medical records using multi-modal interface |
WO2004017297A1 (en) * | 2002-08-19 | 2004-02-26 | Amirsys, Inc. | An electronic medical reference library device |
US7020508B2 (en) | 2002-08-22 | 2006-03-28 | Bodymedia, Inc. | Apparatus for detecting human physiological and contextual information |
US20040073460A1 (en) * | 2002-10-01 | 2004-04-15 | Erwin W. Gary | Method for managing the healthcare of members of a population |
CA2817028A1 (en) * | 2002-10-09 | 2004-04-22 | Bodymedia, Inc. | Method and apparatus for auto journaling of continuous or discrete body states utilizing physiological and/or contextual parameters |
US9842188B2 (en) | 2002-10-29 | 2017-12-12 | Practice Velocity, LLC | Method and system for automated medical records processing with cloud computing |
US11361853B2 (en) | 2002-10-29 | 2022-06-14 | Practice Velocity, LLC | Method and system for automated medical records processing with telemedicine |
US8606594B2 (en) * | 2002-10-29 | 2013-12-10 | Practice Velocity, LLC | Method and system for automated medical records processing |
US10714213B2 (en) | 2002-10-29 | 2020-07-14 | Practice Velocity, LLC | Method and system for automated medical records processing with patient tracking |
US7624027B1 (en) | 2002-10-29 | 2009-11-24 | Practice Velocity, LLC | Method and system for automated medical records processing |
US20050283386A1 (en) * | 2002-11-20 | 2005-12-22 | Aventis Pharmaceuticals Inc. | Method and system for marketing a treatment regimen |
US11335446B2 (en) | 2002-12-06 | 2022-05-17 | Quality Healthcare Intermediary, Llc | Method of optimizing healthcare services consumption |
US7711577B2 (en) * | 2002-12-06 | 2010-05-04 | Dust Larry R | Method of optimizing healthcare services consumption |
US20140200907A1 (en) | 2013-01-16 | 2014-07-17 | American Health Data Institute, Inc. | Method of optimizing healthcare services consumption |
US20040153341A1 (en) * | 2002-12-09 | 2004-08-05 | Brandt Samuel I. | System for analyzing and processing orders related to healthcare treatment or services |
US7230529B2 (en) * | 2003-02-07 | 2007-06-12 | Theradoc, Inc. | System, method, and computer program for interfacing an expert system to a clinical information system |
WO2004081842A1 (en) * | 2003-03-10 | 2004-09-23 | Siemens Medical Solutions Health Services Corporation | A preventive care health maintenance information system |
US7840509B1 (en) | 2003-03-26 | 2010-11-23 | Edmund Messina | Computer-based system for interrogating a user and generating a result |
US7949544B2 (en) * | 2003-04-02 | 2011-05-24 | Starwriter, Llc | Integrated system for generation and retention of medical records |
US7182738B2 (en) | 2003-04-23 | 2007-02-27 | Marctec, Llc | Patient monitoring apparatus and method for orthosis and other devices |
US20050004814A1 (en) * | 2003-04-29 | 2005-01-06 | Seltzer Jonathan H. | Method and system for distributing medical safety information |
US20040225529A1 (en) * | 2003-05-06 | 2004-11-11 | Snyder Bernard M. | Method and apparatus for monitoring and treating medical signs and symptoms |
US20040249674A1 (en) * | 2003-05-06 | 2004-12-09 | Eisenberg Floyd P. | Personnel and process management system suitable for healthcare and other fields |
US7399276B1 (en) | 2003-05-08 | 2008-07-15 | Health Hero Network, Inc. | Remote health monitoring system |
US7780595B2 (en) | 2003-05-15 | 2010-08-24 | Clinical Decision Support, Llc | Panel diagnostic method and system |
DE10322685A1 (en) * | 2003-05-20 | 2004-12-23 | Siemens Ag | Process for processing a data set comprising therapy instructions for medical treatments |
US20040260576A1 (en) * | 2003-06-20 | 2004-12-23 | Dongwen Wang | Guideline execution task ontology (GETO) |
US20050038675A1 (en) * | 2003-08-12 | 2005-02-17 | Siekman Jeffrey A. | Methods and systems for at-home and community-based care |
US20070061168A1 (en) * | 2003-08-12 | 2007-03-15 | Emily Hamilton | Method and apparatus for evaluating variations between health care service providers |
US20050043966A1 (en) * | 2003-08-19 | 2005-02-24 | Harnsberger Hugh F. | Electronic medical reference library device |
US20050065438A1 (en) * | 2003-09-08 | 2005-03-24 | Miller Landon C.G. | System and method of capturing and managing information during a medical diagnostic imaging procedure |
KR101084554B1 (en) * | 2003-09-12 | 2011-11-17 | 보디미디어 인코퍼레이티드 | Method and apparatus for measuring heart related parameters |
US7460652B2 (en) | 2003-09-26 | 2008-12-02 | At&T Intellectual Property I, L.P. | VoiceXML and rule engine based switchboard for interactive voice response (IVR) services |
US20060111933A1 (en) * | 2003-10-09 | 2006-05-25 | Steven Wheeler | Adaptive medical decision support system |
GB2424103A (en) * | 2003-11-21 | 2006-09-13 | Agency Science Tech & Res | Method and system for validating the content of technical documents |
US8020564B2 (en) * | 2003-12-01 | 2011-09-20 | Carefusion 303, Inc. | System and method for analyzing medical treatment data |
US20050149353A1 (en) * | 2003-12-30 | 2005-07-07 | Ladd Nichols | Selecting apparel for surgical procedures |
US7356475B2 (en) | 2004-01-05 | 2008-04-08 | Sbc Knowledge Ventures, L.P. | System and method for providing access to an interactive service offering |
US20060143022A1 (en) * | 2004-01-13 | 2006-06-29 | Betty Bird | Consumer care management method and system |
US7282031B2 (en) * | 2004-02-17 | 2007-10-16 | Ann Hendrich & Associates | Method and system for assessing fall risk |
US8340981B1 (en) | 2004-03-02 | 2012-12-25 | Cave Consulting Group, Inc. | Method, system, and computer program product for physician efficiency measurement and patient health risk stratification utilizing variable windows for episode creation |
US7739126B1 (en) | 2004-03-02 | 2010-06-15 | Cave Consulting Group | Method, system, and computer program product for physician efficiency measurement and patient health risk stratification |
US20050203775A1 (en) * | 2004-03-12 | 2005-09-15 | Chesbrough Richard M. | Automated reporting, notification and data-tracking system particularly suited to radiology and other medical/professional applications |
US20110004635A1 (en) * | 2004-03-12 | 2011-01-06 | Chesbrough Richard M | Automated reporting, notification and data-tracking system particularly suited to radiology and other medical/professional applications |
CA2560323C (en) | 2004-03-22 | 2014-01-07 | Bodymedia, Inc. | Non-invasive temperature monitoring device |
US7379946B2 (en) | 2004-03-31 | 2008-05-27 | Dictaphone Corporation | Categorization of information using natural language processing and predefined templates |
US20050251428A1 (en) * | 2004-05-06 | 2005-11-10 | Dust Larry R | Method and system for providing healthcare insurance |
US7069180B1 (en) * | 2004-05-11 | 2006-06-27 | Cisco Technology, Inc. | Method and apparatus for availability measurement of complex networks |
GB2415273A (en) * | 2004-06-19 | 2005-12-21 | Foster Ltd Dr | Real time monitoring system |
US7835922B2 (en) * | 2004-07-08 | 2010-11-16 | Astrazeneca Ab | Diagnostic system and method |
US7936861B2 (en) | 2004-07-23 | 2011-05-03 | At&T Intellectual Property I, L.P. | Announcement system and method of use |
US8165281B2 (en) | 2004-07-28 | 2012-04-24 | At&T Intellectual Property I, L.P. | Method and system for mapping caller information to call center agent transactions |
US8313433B2 (en) * | 2004-08-06 | 2012-11-20 | Medtronic Minimed, Inc. | Medical data management system and process |
EP1779281A1 (en) * | 2004-08-10 | 2007-05-02 | Koninklijke Philips Electronics N.V. | System and method for configuring clinical care setting for a patient according to clinical guidelines |
US7580837B2 (en) | 2004-08-12 | 2009-08-25 | At&T Intellectual Property I, L.P. | System and method for targeted tuning module of a speech recognition system |
US7602898B2 (en) | 2004-08-18 | 2009-10-13 | At&T Intellectual Property I, L.P. | System and method for providing computer assisted user support |
US20080172214A1 (en) * | 2004-08-26 | 2008-07-17 | Strategic Health Decisions, Inc. | System For Optimizing Treatment Strategies Using a Patient-Specific Rating System |
US20060059145A1 (en) * | 2004-09-02 | 2006-03-16 | Claudia Henschke | System and method for analyzing medical data to determine diagnosis and treatment |
US20090083075A1 (en) * | 2004-09-02 | 2009-03-26 | Cornell University | System and method for analyzing medical data to determine diagnosis and treatment |
US20060053035A1 (en) * | 2004-09-09 | 2006-03-09 | Eisenberg Floyd P | Healthcare personnel management system |
US20060062375A1 (en) * | 2004-09-23 | 2006-03-23 | Sbc Knowledge Ventures, L.P. | System and method for providing product offers at a call center |
US7197130B2 (en) | 2004-10-05 | 2007-03-27 | Sbc Knowledge Ventures, L.P. | Dynamic load balancing between multiple locations with different telephony system |
US20060078867A1 (en) * | 2004-10-08 | 2006-04-13 | Mark Penny | System supporting acquisition and processing of user entered information |
US9081879B2 (en) | 2004-10-22 | 2015-07-14 | Clinical Decision Support, Llc | Matrix interface for medical diagnostic and treatment advice system and method |
US7668889B2 (en) | 2004-10-27 | 2010-02-23 | At&T Intellectual Property I, Lp | Method and system to combine keyword and natural language search results |
US20060095294A1 (en) * | 2004-10-29 | 2006-05-04 | Compton David L | Computerized method and system for documentation-based coding |
US8082280B2 (en) * | 2004-10-29 | 2011-12-20 | Cerner Innovation, Inc. | Computerized method and system for coding-based navigation |
US7657005B2 (en) | 2004-11-02 | 2010-02-02 | At&T Intellectual Property I, L.P. | System and method for identifying telephone callers |
US8308794B2 (en) | 2004-11-15 | 2012-11-13 | IZEK Technologies, Inc. | Instrumented implantable stents, vascular grafts and other medical devices |
EP1819278A4 (en) | 2004-11-15 | 2009-04-08 | Izex Technologies Inc | Instrumented orthopedic and other medical implants |
US7724889B2 (en) | 2004-11-29 | 2010-05-25 | At&T Intellectual Property I, L.P. | System and method for utilizing confidence levels in automated call routing |
US7864942B2 (en) | 2004-12-06 | 2011-01-04 | At&T Intellectual Property I, L.P. | System and method for routing calls |
US7242751B2 (en) | 2004-12-06 | 2007-07-10 | Sbc Knowledge Ventures, L.P. | System and method for speech recognition-enabled automatic call routing |
US20060126808A1 (en) * | 2004-12-13 | 2006-06-15 | Sbc Knowledge Ventures, L.P. | System and method for measurement of call deflection |
US7885823B2 (en) * | 2004-12-30 | 2011-02-08 | Cerner Innovation, Inc. | Computerized system and method for managing personnel data in a healthcare environment |
US20060149592A1 (en) * | 2004-12-30 | 2006-07-06 | Doug Wager | Computerized system and method for providing personnel data notifications in a healthcare environment |
US7751551B2 (en) | 2005-01-10 | 2010-07-06 | At&T Intellectual Property I, L.P. | System and method for speech-enabled call routing |
US7443303B2 (en) | 2005-01-10 | 2008-10-28 | Hill-Rom Services, Inc. | System and method for managing workflow |
US7450698B2 (en) | 2005-01-14 | 2008-11-11 | At&T Intellectual Property 1, L.P. | System and method of utilizing a hybrid semantic model for speech recognition |
US7627096B2 (en) | 2005-01-14 | 2009-12-01 | At&T Intellectual Property I, L.P. | System and method for independently recognizing and selecting actions and objects in a speech recognition system |
US20060173713A1 (en) * | 2005-01-26 | 2006-08-03 | Alan Petro | Integrated medical device and healthcare information system |
US8296162B1 (en) | 2005-02-01 | 2012-10-23 | Webmd Llc. | Systems, devices, and methods for providing healthcare information |
US7627109B2 (en) | 2005-02-04 | 2009-12-01 | At&T Intellectual Property I, Lp | Call center system for multiple transaction selections |
US7682308B2 (en) * | 2005-02-16 | 2010-03-23 | Ahi Of Indiana, Inc. | Method and system for assessing fall risk |
US20060188087A1 (en) * | 2005-02-18 | 2006-08-24 | Sbc Knowledge Ventures, Lp | System and method for caller-controlled music on-hold |
US8130936B2 (en) * | 2005-03-03 | 2012-03-06 | At&T Intellectual Property I, L.P. | System and method for on hold caller-controlled activities and entertainment |
US8223954B2 (en) | 2005-03-22 | 2012-07-17 | At&T Intellectual Property I, L.P. | System and method for automating customer relations in a communications environment |
US7933399B2 (en) * | 2005-03-22 | 2011-04-26 | At&T Intellectual Property I, L.P. | System and method for utilizing virtual agents in an interactive voice response application |
US7636432B2 (en) | 2005-05-13 | 2009-12-22 | At&T Intellectual Property I, L.P. | System and method of determining call treatment of repeat calls |
US7657020B2 (en) | 2005-06-03 | 2010-02-02 | At&T Intellectual Property I, Lp | Call routing system and method of using the same |
US8005204B2 (en) | 2005-06-03 | 2011-08-23 | At&T Intellectual Property I, L.P. | Call routing system and method of using the same |
US8503641B2 (en) | 2005-07-01 | 2013-08-06 | At&T Intellectual Property I, L.P. | System and method of automated order status retrieval |
US8175253B2 (en) * | 2005-07-07 | 2012-05-08 | At&T Intellectual Property I, L.P. | System and method for automated performance monitoring for a call servicing system |
US20070021977A1 (en) * | 2005-07-19 | 2007-01-25 | Witt Biomedical Corporation | Automated system for capturing and archiving information to verify medical necessity of performing medical procedure |
CA2630962A1 (en) * | 2005-07-27 | 2007-02-01 | Medecision, Inc. | System and method for health care data integration and management |
US8392213B2 (en) * | 2005-07-28 | 2013-03-05 | Roberto Beraja | Medical claims fraud prevention system including historical patient locating feature and associated methods |
US8392211B2 (en) * | 2005-07-28 | 2013-03-05 | Roberto Beraja | Medical claims fraud prevention system including patient call initiating feature and associated methods |
US8392210B2 (en) * | 2005-07-28 | 2013-03-05 | Roberto Beraja | Medical claims fraud prevention system and associated methods |
US8751264B2 (en) | 2005-07-28 | 2014-06-10 | Beraja Ip, Llc | Fraud prevention system including biometric records identification and associated methods |
US8583454B2 (en) | 2005-07-28 | 2013-11-12 | Beraja Ip, Llc | Medical claims fraud prevention system including photograph records identification and associated methods |
US20160328812A9 (en) * | 2005-07-28 | 2016-11-10 | Roberto Beraja | Medical decision system including question mapping and cross referencing system and associated methods |
US8392212B2 (en) * | 2005-07-28 | 2013-03-05 | Roberto Beraja | Medical claims fraud prevention system including patient identification interface feature and associated methods |
US7464042B2 (en) * | 2005-07-28 | 2008-12-09 | Roberto Beraja | Medical professional monitoring system and associated methods |
US7685000B1 (en) | 2005-08-10 | 2010-03-23 | Matria Healthcare, Inc. | Predictive modeling system and method for disease management |
US8526577B2 (en) | 2005-08-25 | 2013-09-03 | At&T Intellectual Property I, L.P. | System and method to access content from a speech-enabled automated system |
US8548157B2 (en) | 2005-08-29 | 2013-10-01 | At&T Intellectual Property I, L.P. | System and method of managing incoming telephone calls at a call center |
US7894993B2 (en) * | 2005-09-08 | 2011-02-22 | The Invention Science Fund I, Llc | Data accessing techniques related to tissue coding |
US7743007B2 (en) * | 2005-09-08 | 2010-06-22 | Invention Science Fund I | System for graphical illustration of a first possible outcome of a use of a treatment parameter with respect to body portions based on a first dataset associated with a first predictive basis and for modifying a graphical illustration to illustrate a second possible outcome of a use of a treatment parameter based on a second dataset associated with a second predictive basis |
US20070055541A1 (en) * | 2005-09-08 | 2007-03-08 | Jung Edward K | Accessing predictive data |
US20070055450A1 (en) * | 2005-09-08 | 2007-03-08 | Searete Llc, A Limited Liability Corporation Of State Of Delaware | Data techniques related to tissue coding |
US20070055540A1 (en) * | 2005-09-08 | 2007-03-08 | Searete Llc, A Limited Liability Corporation | Data techniques related to tissue coding |
US10460080B2 (en) * | 2005-09-08 | 2019-10-29 | Gearbox, Llc | Accessing predictive data |
US10016249B2 (en) * | 2005-09-08 | 2018-07-10 | Gearbox Llc | Accessing predictive data |
US20070055547A1 (en) * | 2005-09-08 | 2007-03-08 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Data techniques related to tissue coding |
US20070055460A1 (en) * | 2005-09-08 | 2007-03-08 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Filtering predictive data |
US20070123472A1 (en) * | 2005-09-08 | 2007-05-31 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Filtering predictive data |
US20070093967A1 (en) * | 2005-09-08 | 2007-04-26 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Accessing data related to tissue coding |
US20070055452A1 (en) * | 2005-09-08 | 2007-03-08 | Jung Edward K | Accessing data related to tissue coding |
US20070055546A1 (en) * | 2005-09-08 | 2007-03-08 | Searete Llc, A Limited Liability Corporation Of State Of Delawre | Data techniques related to tissue coding |
US20070055548A1 (en) * | 2005-09-08 | 2007-03-08 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Accessing data related to tissue coding |
US20070168223A1 (en) * | 2005-10-12 | 2007-07-19 | Steven Lawrence Fors | Configurable clinical information system and method of use |
US20070083849A1 (en) * | 2005-10-12 | 2007-04-12 | General Electric Company | Auto-learning RIS/PACS worklists |
US7818181B2 (en) * | 2005-10-31 | 2010-10-19 | Focused Medical Analytics Llc | Medical practice pattern tool |
DE102005055657A1 (en) * | 2005-11-22 | 2007-05-24 | Siemens Ag | Medical diagnostic unit e.g. computer tomography unit, operating method, involves determining examination processes with required examination steps based on additional information that are assigned to each examination step |
DE102005056081A1 (en) * | 2005-11-24 | 2007-06-06 | Siemens Ag | Workflow generating method for medical treatment, involves evaluating medical investigation for answering generated diagnostic question, and generating workflows based on initial symptom list of patient and/or answer |
US20070129967A1 (en) * | 2005-12-05 | 2007-06-07 | Thompson Stephen C | Automated method for medical care management |
US7911348B2 (en) * | 2005-12-09 | 2011-03-22 | Bee Cave, LLC. | Methods for refining patient, staff and visitor profiles used in monitoring quality and performance at a healthcare facility |
US20080021731A1 (en) * | 2005-12-09 | 2008-01-24 | Valence Broadband, Inc. | Methods and systems for monitoring patient support exiting and initiating response |
US20070288263A1 (en) * | 2005-12-09 | 2007-12-13 | Valence Broadband, Inc. | Methods and systems for monitoring quality and performance at a healthcare facility |
US7786874B2 (en) * | 2005-12-09 | 2010-08-31 | Samarion, Inc. | Methods for refining patient, staff and visitor profiles used in monitoring quality and performance at a healthcare facility |
US7761310B2 (en) * | 2005-12-09 | 2010-07-20 | Samarion, Inc. | Methods and systems for monitoring quality and performance at a healthcare facility |
US20070132597A1 (en) * | 2005-12-09 | 2007-06-14 | Valence Broadband, Inc. | Methods and systems for monitoring patient support exiting and initiating response |
US20070136090A1 (en) * | 2005-12-12 | 2007-06-14 | General Electric Company | System and method for macro-enhanced clinical workflow |
US20070162310A1 (en) * | 2005-12-30 | 2007-07-12 | Health Systems Technology, Inc. | Medical office electronic management system and method |
US20070156032A1 (en) * | 2006-01-04 | 2007-07-05 | Gordon Linda S | Electronic disease management system |
WO2007089814A2 (en) * | 2006-01-30 | 2007-08-09 | Daniel Ronnie C | Referral coordination systems and methods |
US20080021854A1 (en) * | 2006-02-24 | 2008-01-24 | Searete Llc, A Limited Liability Corporation Of The State Of Delaware | Search techniques related to tissue coding |
US20070260631A1 (en) * | 2006-03-09 | 2007-11-08 | Microsoft Corporation | Embedded decision support |
CN101400298A (en) * | 2006-03-13 | 2009-04-01 | 皇家飞利浦电子股份有限公司 | Display and method for medical procedure selection |
US7949538B2 (en) * | 2006-03-14 | 2011-05-24 | A-Life Medical, Inc. | Automated interpretation of clinical encounters with cultural cues |
US20070219824A1 (en) * | 2006-03-17 | 2007-09-20 | Jean Rawlings | System and method for identifying and analyzing patterns or aberrations in healthcare claims |
EP1998840A4 (en) * | 2006-03-23 | 2012-02-29 | Becton Dickinson Co | System and methods for improved diabetes data management and use employing wireless connectivity between patients and healthcare providers and repository of diabetes management information |
US8731954B2 (en) | 2006-03-27 | 2014-05-20 | A-Life Medical, Llc | Auditing the coding and abstracting of documents |
US20070239488A1 (en) * | 2006-04-05 | 2007-10-11 | Derosso Robert | Computerized dental patient record |
US20070244714A1 (en) * | 2006-04-12 | 2007-10-18 | Aetna, Inc. | Reducing Cost and Improving Quality of Health Care Through Analysis of Medical Condition Claim Data |
US8112292B2 (en) * | 2006-04-21 | 2012-02-07 | Medtronic Navigation, Inc. | Method and apparatus for optimizing a therapy |
US20070260479A1 (en) * | 2006-05-02 | 2007-11-08 | David Duckert | Method and system for consolidating diverse clinical data to facilitate medication titration |
US20080021739A1 (en) * | 2006-07-19 | 2008-01-24 | Brock David L | Internet browser based electronic medical record database management system and method |
US20080033752A1 (en) * | 2006-08-04 | 2008-02-07 | Valence Broadband, Inc. | Methods and systems for monitoring staff/patient contacts and ratios |
US20080051770A1 (en) * | 2006-08-22 | 2008-02-28 | Synergetics, Inc. | Multiple Target Laser Probe |
US20070005405A1 (en) * | 2006-09-12 | 2007-01-04 | Dust Larry R | Insurance system and method |
US20080081322A1 (en) * | 2006-09-29 | 2008-04-03 | Susan Anne Fosbrook | Teaching method for health assessment |
US8589185B2 (en) * | 2006-10-06 | 2013-11-19 | Cerner Innovation, Inc. | Acknowledgement of previous results for medication administration |
US8775208B2 (en) * | 2006-10-06 | 2014-07-08 | Cerner Innovation, Inc. | Patient outcomes in context of documentation |
US8560335B2 (en) * | 2006-10-06 | 2013-10-15 | Cerner Innovation, Inc. | Viewing clinical activity details within a selected time period |
US8423384B2 (en) * | 2006-10-06 | 2013-04-16 | Cerner Innovation, Inc. | Providing multidisciplinary activities in context of clinician's role relevant activities |
US8355924B2 (en) * | 2006-10-06 | 2013-01-15 | Cerner Innovation, Inc. | Patient activity coordinator |
US20080086329A1 (en) * | 2006-10-06 | 2008-04-10 | Cerner Innovation, Inc. | Resceduling clinical activities in context of activities view |
US8050946B2 (en) * | 2006-10-06 | 2011-11-01 | Cerner Innovation, Inc. | Clinical activity navigator |
US20080086333A1 (en) * | 2006-10-06 | 2008-04-10 | Cerner Innovation, Inc. | Documentation of medication activities in context of mar |
US20080086327A1 (en) * | 2006-10-06 | 2008-04-10 | Qmed, Inc. | System and method for determining and verifying disease classification codes |
US20080086334A1 (en) * | 2006-10-06 | 2008-04-10 | Cerner Innovation, Inc. | Providing clinical activity details in context |
US20080091472A1 (en) * | 2006-10-11 | 2008-04-17 | Steven Hoppe | Treatment monitoring tool |
US20080103815A1 (en) * | 2006-10-31 | 2008-05-01 | Sap Ag | System and method for estimating cost of medical treatment |
WO2008064258A2 (en) * | 2006-11-20 | 2008-05-29 | Mckesson Information Solutions Llc | Interactive viewing, asynchronous retrieval, and annotation of medical images |
US20080120142A1 (en) * | 2006-11-20 | 2008-05-22 | Vivalog Llc | Case management for image-based training, decision support, and consultation |
US8185458B2 (en) * | 2006-11-30 | 2012-05-22 | Schmotzer Theresa M | Occupational therapy and ergonomic system |
US20080154642A1 (en) * | 2006-12-21 | 2008-06-26 | Susan Marble | Healthcare Core Measure Tracking Software and Database |
US8380530B2 (en) | 2007-02-02 | 2013-02-19 | Webmd Llc. | Personalized health records with associative relationships |
US20090006457A1 (en) * | 2007-02-16 | 2009-01-01 | Stivoric John M | Lifeotypes |
US8527293B2 (en) * | 2007-03-30 | 2013-09-03 | General Electric Company | Method and system for supporting clinical decision-making |
WO2008127627A1 (en) * | 2007-04-12 | 2008-10-23 | Warren Pamela A | Psychological disability evaluation software, methods and systems |
US8682823B2 (en) | 2007-04-13 | 2014-03-25 | A-Life Medical, Llc | Multi-magnitudinal vectors with resolution based on source vector features |
US7908552B2 (en) | 2007-04-13 | 2011-03-15 | A-Life Medical Inc. | Mere-parsing with boundary and semantic driven scoping |
US20080255875A1 (en) * | 2007-04-16 | 2008-10-16 | General Electric Company | Systems and Methods for Managing Patient Preference Data |
US7966195B2 (en) * | 2007-07-11 | 2011-06-21 | Intercede Health | System and method for providing optimized medical order sets |
US9946846B2 (en) | 2007-08-03 | 2018-04-17 | A-Life Medical, Llc | Visualizing the documentation and coding of surgical procedures |
US20090044334A1 (en) * | 2007-08-13 | 2009-02-19 | Valence Broadband, Inc. | Automatically adjusting patient platform support height in response to patient related events |
US20090044332A1 (en) * | 2007-08-13 | 2009-02-19 | Valence Broadband, Inc. | Height adjustable patient support platforms |
US8654139B2 (en) * | 2007-08-29 | 2014-02-18 | Mckesson Technologies Inc. | Methods and systems to transmit, view, and manipulate medical images in a general purpose viewing agent |
US20090132285A1 (en) * | 2007-10-31 | 2009-05-21 | Mckesson Information Solutions Llc | Methods, computer program products, apparatuses, and systems for interacting with medical data objects |
US8520978B2 (en) * | 2007-10-31 | 2013-08-27 | Mckesson Technologies Inc. | Methods, computer program products, apparatuses, and systems for facilitating viewing and manipulation of an image on a client device |
US7987069B2 (en) | 2007-11-12 | 2011-07-26 | Bee Cave, Llc | Monitoring patient support exiting and initiating response |
KR100966590B1 (en) * | 2007-12-11 | 2010-06-29 | 한국전자통신연구원 | Method and system for collaborating of physiological signal measure devices |
US20090157427A1 (en) * | 2007-12-12 | 2009-06-18 | Capel Winston T | Method of personalized, independent medical evaluation |
US20090171695A1 (en) * | 2007-12-31 | 2009-07-02 | Intel Corporation | System and method for interactive management of patient care |
US20090216557A1 (en) * | 2008-02-24 | 2009-08-27 | Kyle Lawton | Software System for Providing Access Via Pop-Up Windows to Medical Test Results and Information Relating Thereto |
US20090276246A1 (en) * | 2008-05-01 | 2009-11-05 | Siemens Medical Solutions Usa, Inc. | Automated Interdisciplinary Plan of Care Generation System |
US9342320B2 (en) * | 2008-05-16 | 2016-05-17 | Mckesson Technologies Inc. | Method for facilitating cooperative interaction between software applications |
US20090307006A1 (en) * | 2008-06-04 | 2009-12-10 | International Business Machines Corporation | Method of collaborative evaluation infrastructure to assess the quality of healthcare clnical decision actors |
US20100004948A1 (en) * | 2008-07-01 | 2010-01-07 | Mckesson Financial Holdings Limited | Apparatus, method, system and computer program product for creating, individualizing and integrating care plans |
US8311854B1 (en) | 2008-07-01 | 2012-11-13 | Unicor Medical, Inc. | Medical quality performance measurement reporting facilitator |
WO2010005908A2 (en) * | 2008-07-07 | 2010-01-14 | Agamatrix, Inc. | Integrated blood glucose measurement device |
US8057679B2 (en) | 2008-07-09 | 2011-11-15 | Baxter International Inc. | Dialysis system having trending and alert generation |
US10089443B2 (en) | 2012-05-15 | 2018-10-02 | Baxter International Inc. | Home medical device systems and methods for therapy prescription and tracking, servicing and inventory |
US10922651B2 (en) * | 2008-07-10 | 2021-02-16 | T-System, Inc. | Systems and methods for improving medical order entry for high volume situations |
US8301464B1 (en) | 2008-07-18 | 2012-10-30 | Cave Consulting Group, Inc. | Method and system for producing statistical analysis of medical care information |
US11244416B2 (en) | 2008-07-18 | 2022-02-08 | Cave Consulting Group, Inc. | System, method, and graphical user interface for identifying medical care providers outside a process-of-care standard |
US8554579B2 (en) | 2008-10-13 | 2013-10-08 | Fht, Inc. | Management, reporting and benchmarking of medication preparation |
US20100145722A1 (en) * | 2008-12-05 | 2010-06-10 | Edward Zalta | System and method for transferring data associated with an electronic medical records system |
US8725530B2 (en) | 2008-12-08 | 2014-05-13 | Mastodon, Llc | Systems, methods, and apparatus for use in gathering and providing healthcare information |
US20100211407A1 (en) * | 2009-02-13 | 2010-08-19 | Duke David O | Method and system for providing a patient therapeutic plan |
US20100145726A1 (en) * | 2008-12-08 | 2010-06-10 | Duke David O | Method and System for Providing a Patient Therapeutic Plan |
US20100223071A1 (en) * | 2009-03-02 | 2010-09-02 | Mckesson Financial Holdings Limited | Systems, methods, apparatuses, and computer program products for organizing patient information |
WO2010101898A2 (en) | 2009-03-02 | 2010-09-10 | Florida Atlantic University | Apparatus and method for managing interaction-based services |
US20100249965A1 (en) * | 2009-03-31 | 2010-09-30 | Agamatrix, Inc. | Integrated Blood Glucose Measurement Device |
US20130035959A1 (en) * | 2009-07-07 | 2013-02-07 | Sentara Healthcare | Methods and systems for tracking medical care |
US20110077970A1 (en) * | 2009-09-30 | 2011-03-31 | Andrew Mellin | Method, apparatus and computer program product for providing a patient quality monitor |
US8165897B2 (en) * | 2009-11-09 | 2012-04-24 | Roberto Beraja | Medical decision system including interactive protocols and associated methods |
US20110112850A1 (en) * | 2009-11-09 | 2011-05-12 | Roberto Beraja | Medical decision system including medical observation locking and associated methods |
US20110137670A1 (en) * | 2009-12-04 | 2011-06-09 | Mckesson Financial Holdings Limited | Methods, apparatuses, and computer program products for facilitating development and execution of a clinical care plan |
US8977574B2 (en) * | 2010-01-27 | 2015-03-10 | The Invention Science Fund I, Llc | System for providing graphical illustration of possible outcomes and side effects of the use of treatment parameters with respect to at least one body portion based on datasets associated with predictive bases |
CN102859527B (en) * | 2010-02-05 | 2017-03-22 | 皇家飞利浦电子股份有限公司 | Treatment plan creation workflow tracking |
US7983935B1 (en) * | 2010-03-22 | 2011-07-19 | Ios Health Systems, Inc. | System and method for automatically and iteratively producing and updating patient summary encounter reports based on recognized patterns of occurrences |
US8781852B2 (en) * | 2010-03-25 | 2014-07-15 | Rl Solutions | Systems and methods for creating a form for receiving data relating to a health care incident |
US20120053957A1 (en) * | 2010-05-18 | 2012-03-01 | Lorri Atkins | Tool for detecting inconsistencies and omissions in documented justification for medical services |
US8620625B2 (en) | 2010-07-30 | 2013-12-31 | Hill-Rom Services, Inc. | Above bed sensor |
US8655679B2 (en) * | 2010-08-06 | 2014-02-18 | Sunjay Berdia | System and methods for an intelligent medical practice system employing a learning knowledge base |
WO2012024450A2 (en) | 2010-08-17 | 2012-02-23 | Wisercare Llc | Medical care treatment decision support system |
US8688477B1 (en) | 2010-09-17 | 2014-04-01 | National Assoc. Of Boards Of Pharmacy | Method, system, and computer program product for determining a narcotics use indicator |
US20120109689A1 (en) * | 2010-10-28 | 2012-05-03 | Jason Lee | Support System for Improved Quality Healthcare |
US8907287B2 (en) * | 2010-12-01 | 2014-12-09 | Hill-Rom Services, Inc. | Patient monitoring system |
US20120173285A1 (en) * | 2011-01-05 | 2012-07-05 | Suresh Muthukrishnan | Proactive Clinical Evidence at Point of Care and Genomic Data Integration through Cloud EMR Media |
US8799021B2 (en) | 2011-02-18 | 2014-08-05 | Nuance Communications, Inc. | Methods and apparatus for analyzing specificity in clinical documentation |
US10460288B2 (en) * | 2011-02-18 | 2019-10-29 | Nuance Communications, Inc. | Methods and apparatus for identifying unspecified diagnoses in clinical documentation |
US10032127B2 (en) | 2011-02-18 | 2018-07-24 | Nuance Communications, Inc. | Methods and apparatus for determining a clinician's intent to order an item |
CN102651051A (en) * | 2011-02-28 | 2012-08-29 | 国际商业机器公司 | System and method for identifying clinical pathway implementation deviation |
US20120239430A1 (en) * | 2011-03-14 | 2012-09-20 | Nvoq Incorporated | System and Method to Provide Metrics Regarding a Physician's Performance to Protocol and Real-Time Alerts When Performance Deviates |
US20130035956A1 (en) * | 2011-08-02 | 2013-02-07 | International Business Machines Corporation | Visualization of patient treatments |
WO2013029026A1 (en) * | 2011-08-24 | 2013-02-28 | Acupera, Inc. | Remote clinical care system |
US10140420B2 (en) * | 2011-10-12 | 2018-11-27 | Merge Healthcare Incorporation | Systems and methods for independent assessment of image data |
US20170344726A1 (en) * | 2011-11-03 | 2017-11-30 | Omada Health, Inc. | Method and system for supporting a health regimen |
JP2014533860A (en) * | 2011-11-17 | 2014-12-15 | ザ クリーブランド クリニック ファウンデーションThe Cleveland ClinicFoundation | Graphic tool for managing longitudinal episodes of patients |
US20130218596A1 (en) * | 2012-02-16 | 2013-08-22 | dbMotion Ltd. | Method And System For Facilitating User Navigation Through A Computerized Medical Information System |
US20130218598A1 (en) * | 2012-02-21 | 2013-08-22 | Medicomp Systems, Inc. | Electronic medical coding systems |
US9295390B2 (en) | 2012-03-02 | 2016-03-29 | Hill-Rom Services, Inc. | Facial recognition based monitoring systems and methods |
WO2013142493A1 (en) * | 2012-03-19 | 2013-09-26 | Mayo Foundation For Medical Education And Research | Analyzing and answering questions |
US20130268286A1 (en) * | 2012-04-06 | 2013-10-10 | Cerner Innovation, Inc. | Providing protocol variances from standard protocols |
US20140058742A1 (en) * | 2012-05-16 | 2014-02-27 | Dynamic Health Initiatives | Methods and systems for interactive implementation of medical guidelines |
EP2856372A2 (en) * | 2012-06-01 | 2015-04-08 | Koninklijke Philips N.V. | System and method for matching patient information to clinical criteria |
CN104254857A (en) * | 2012-06-08 | 2014-12-31 | 惠普发展公司,有限责任合伙企业 | Patient information interface |
NZ723391A (en) | 2012-08-31 | 2018-01-26 | Baxter Corp Englewood | Medication requisition fulfillment system and method |
WO2014037872A2 (en) * | 2012-09-06 | 2014-03-13 | Koninklijke Philips N.V. | Guideline-based decision support |
US20140100863A1 (en) * | 2012-09-10 | 2014-04-10 | Constantine Mantz | Medical Benefits Determination System and Related Methods |
US10496788B2 (en) | 2012-09-13 | 2019-12-03 | Parkland Center For Clinical Innovation | Holistic hospital patient care and management system and method for automated patient monitoring |
US10593426B2 (en) | 2012-09-13 | 2020-03-17 | Parkland Center For Clinical Innovation | Holistic hospital patient care and management system and method for automated facial biological recognition |
US20140081659A1 (en) | 2012-09-17 | 2014-03-20 | Depuy Orthopaedics, Inc. | Systems and methods for surgical and interventional planning, support, post-operative follow-up, and functional recovery tracking |
WO2014049527A2 (en) | 2012-09-28 | 2014-04-03 | Koninklijke Philips N.V. | Personalizing patient pathways based on individual preferences, lifestyle regime, and preferences on outcome parameters to assist decision making |
US20140108024A1 (en) * | 2012-10-15 | 2014-04-17 | Mckesson Financial Holdings | Systems and methods for medical treatment plan verification and implementation compliance |
US20140114671A1 (en) * | 2012-10-19 | 2014-04-24 | International Business Machines Corporation | Mapping a care plan template to a case model |
US9489489B2 (en) | 2012-10-26 | 2016-11-08 | Baxter Corporation Englewood | Image acquisition for medical dose preparation system |
EP3453377A1 (en) | 2012-10-26 | 2019-03-13 | Baxter Corporation Englewood | Improved work station for medical dose preparation system |
US20140129246A1 (en) * | 2012-11-07 | 2014-05-08 | Koninklijke Philips Electronics N.V. | Extension of clinical guidelines based on clinical expert recommendations |
WO2014074913A1 (en) | 2012-11-08 | 2014-05-15 | Alivecor, Inc. | Electrocardiogram signal detection |
US9395234B2 (en) | 2012-12-05 | 2016-07-19 | Cardiocom, Llc | Stabilizing base for scale |
US11182728B2 (en) | 2013-01-30 | 2021-11-23 | Carefusion 303, Inc. | Medication workflow management |
US10430554B2 (en) | 2013-05-23 | 2019-10-01 | Carefusion 303, Inc. | Medication preparation queue |
AU2014241019A1 (en) | 2013-03-13 | 2015-09-03 | Carefusion 303, Inc. | Patient-specific medication management system |
WO2014159286A1 (en) * | 2013-03-13 | 2014-10-02 | Carefusion 303, Inc. | Healthcare communication system |
EP2973370A4 (en) * | 2013-03-13 | 2016-08-17 | Carefusion 303 Inc | Predictive medication safety |
US10360343B2 (en) * | 2013-03-15 | 2019-07-23 | Adityo Prakash | Facilitating integrated behavioral support through personalized adaptive data collection |
US9254092B2 (en) | 2013-03-15 | 2016-02-09 | Alivecor, Inc. | Systems and methods for processing and analyzing medical data |
US20140288964A1 (en) * | 2013-03-22 | 2014-09-25 | Siemens Aktiengesellschaft | Method And System For Supporting An Acquisition Of Clinical Data |
US20140297297A1 (en) * | 2013-03-29 | 2014-10-02 | Mckesson Specialty Care Distribution Corporation | Generating models representative of clinical guidelines and providing treatment/diagnostic recommendations based on the generated models |
US10628555B1 (en) * | 2013-04-02 | 2020-04-21 | Collaborative Network 4 Clinical Excellence, Inc. | System and methods for disease management |
WO2014194118A2 (en) * | 2013-05-29 | 2014-12-04 | Revon Systems, Llc | Schedule-based electronic medical record modules, applications, and uses thereof |
US11183300B2 (en) | 2013-06-05 | 2021-11-23 | Nuance Communications, Inc. | Methods and apparatus for providing guidance to medical professionals |
US9247911B2 (en) | 2013-07-10 | 2016-02-02 | Alivecor, Inc. | Devices and methods for real-time denoising of electrocardiograms |
US20150032681A1 (en) * | 2013-07-23 | 2015-01-29 | International Business Machines Corporation | Guiding uses in optimization-based planning under uncertainty |
US10541053B2 (en) | 2013-09-05 | 2020-01-21 | Optum360, LLCq | Automated clinical indicator recognition with natural language processing |
US9734478B2 (en) | 2013-09-26 | 2017-08-15 | Ali Alhimiri | Rating system, process and predictive algorithmic based medium for treatment of medical conditions in cost effective fashion and utilizing management pathways for customizing or modifying of a base algorithm by an accountable care organization or other payor in order to establish best treatment protocols and financial assessment tools for incentivizing care providers and for achieving improved clinical/functional outcomes |
US10133727B2 (en) | 2013-10-01 | 2018-11-20 | A-Life Medical, Llc | Ontologically driven procedure coding |
US20160063211A1 (en) * | 2014-08-27 | 2016-03-03 | Chen Technology, Inc. | Systems and methods for modeling medical condition information |
US11610677B2 (en) | 2013-10-08 | 2023-03-21 | Chen Technology, Inc. | Patient health monitoring system |
US20160239621A1 (en) * | 2013-10-23 | 2016-08-18 | Koninklijke Philips N.V. | System and method enabling the efficient management of treatment plans and their revisions and updates |
US9974512B2 (en) | 2014-03-13 | 2018-05-22 | Convergence Medical, Llc | Method, system, and computer program product for determining a patient radiation and diagnostic study score |
US11587688B2 (en) | 2014-03-27 | 2023-02-21 | Raymond Anthony Joao | Apparatus and method for providing healthcare services remotely or virtually with or using an electronic healthcare record and/or a communication network |
WO2015153127A1 (en) * | 2014-04-04 | 2015-10-08 | Omada Health, Inc. | Systems and methods that administer a health improvement program and an adjunct medical treatment |
US9311804B2 (en) | 2014-04-11 | 2016-04-12 | Hill-Rom Services, Inc. | Patient-need prediction system |
NZ727697A (en) | 2014-06-30 | 2022-05-27 | Baxter Corp Englewood | Managed medical information exchange |
US10755369B2 (en) | 2014-07-16 | 2020-08-25 | Parkland Center For Clinical Innovation | Client management tool system and method |
US11575673B2 (en) | 2014-09-30 | 2023-02-07 | Baxter Corporation Englewood | Central user management in a distributed healthcare information management system |
US11107574B2 (en) | 2014-09-30 | 2021-08-31 | Baxter Corporation Englewood | Management of medication preparation with formulary management |
US20160117456A1 (en) * | 2014-10-27 | 2016-04-28 | International Business Machines Corporation | Criteria Conditional Override Based on Patient Information and Supporting Evidence |
US10423717B2 (en) * | 2014-11-26 | 2019-09-24 | International Business Machines Corporation | System and method for analyzing and deducing criteria-related content for evaluation |
WO2016090091A1 (en) | 2014-12-05 | 2016-06-09 | Baxter Corporation Englewood | Dose preparation data analytics |
CN107004242B (en) * | 2014-12-09 | 2021-02-26 | 庆熙大学校产学协力团 | Mobile communication terminal-based life guide method, mobile communication terminal, and computer-readable recording medium recording the method |
JP6347755B2 (en) * | 2015-02-27 | 2018-06-27 | 富士フイルム株式会社 | Medical support device, operating method and program of medical support device, medical support system |
AU2016226164A1 (en) | 2015-03-03 | 2017-10-19 | Baxter Corporation Englewood | Pharmacy workflow management with integrated alerts |
JP2018524718A (en) | 2015-06-25 | 2018-08-30 | ガンブロ・ルンディア・エービーGambro Lundia Ab | Medical device system and method with distributed database |
US10839943B2 (en) * | 2015-09-01 | 2020-11-17 | Amino, Inc. | Gathering information from a healthcare consumer using context-based questions, and progressively presenting information associated with a ranked list of suggested healthcare providers |
US20170255752A1 (en) * | 2016-03-03 | 2017-09-07 | Artificial Medical Intelligence, Inc. | Continuous adapting system for medical code look up |
EP3223181B1 (en) | 2016-03-24 | 2019-12-18 | Sofradim Production | System and method of generating a model and simulating an effect on a surgical repair site |
US11547616B2 (en) * | 2016-04-27 | 2023-01-10 | Zoll Medical Corporation | Portable medical triage kit |
JP7153017B2 (en) | 2016-12-21 | 2022-10-13 | ガンブロ・ルンディア・エービー | A medical device system that includes an information technology infrastructure with a secure cluster domain that supports external domains |
US11355221B2 (en) * | 2017-01-09 | 2022-06-07 | Mahdis MANSOURI | Classification systems, and methods of collecting, associating, storing, searching, and providing healthcare information, and connecting healthcare participants globally |
US10449670B2 (en) | 2017-07-17 | 2019-10-22 | Bank Of America Corporation | Event processing using robotic entities |
US20210233661A1 (en) * | 2018-08-31 | 2021-07-29 | Koninklijke Philips N.V. | System and method for creating guideline-based summaries for imaging exams |
AT524707A1 (en) | 2021-01-28 | 2022-08-15 | Blockhealth Gmbh | Procedures for organizing health data |
US20230060235A1 (en) * | 2021-08-27 | 2023-03-02 | Biocanic Inc. | Multi-stage workflow processing and analysis platform |
Family Cites Families (29)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US1988634A (en) * | 1933-08-31 | 1935-01-22 | David D Stonecypher | Diagnosticum |
US3186111A (en) * | 1961-12-06 | 1965-06-01 | Reed C Lawlor | "peek-a-boo" retrieval system |
US3566370A (en) * | 1969-06-10 | 1971-02-23 | Searle Medidata Inc | Automated medical history taking system |
US3934226A (en) * | 1971-11-17 | 1976-01-20 | International Health Systems, Inc. | Automated audio health history acquisition system |
US3810102A (en) * | 1972-03-31 | 1974-05-07 | Telserv Inc | System for transmission and analysis of biomedical data |
US3794982A (en) * | 1972-04-17 | 1974-02-26 | Pelam Inc | Data acquisition device |
JPS5335422B2 (en) * | 1973-02-28 | 1978-09-27 | ||
US4290114A (en) * | 1976-07-01 | 1981-09-15 | Sinay Hanon S | Medical diagnostic computer |
US4315309A (en) * | 1979-06-25 | 1982-02-09 | Coli Robert D | Integrated medical test data storage and retrieval system |
US4360345A (en) * | 1980-07-14 | 1982-11-23 | American Heart Association, Inc. | Health education system |
JPS57211338A (en) * | 1981-06-24 | 1982-12-25 | Tokyo Shibaura Electric Co | Tatal image diagnosis data treating apparatus |
US4489309A (en) * | 1981-06-30 | 1984-12-18 | Ibm Corporation | Pipelined charge coupled to analog to digital converter |
US4489387A (en) * | 1981-08-20 | 1984-12-18 | Lamb David E | Method and apparatus for coordinating medical procedures |
US4464122A (en) * | 1982-12-02 | 1984-08-07 | Berkeley Fuller | Health potential summary and incentive system |
US4667292A (en) * | 1984-02-16 | 1987-05-19 | Iameter Incorporated | Medical reimbursement computer system |
JPS6176144A (en) * | 1984-09-21 | 1986-04-18 | オリンパス光学工業株式会社 | Medical image file apparatus |
US4583524A (en) * | 1984-11-21 | 1986-04-22 | Hutchins Donald C | Cardiopulmonary resuscitation prompting |
US4733354A (en) * | 1984-11-23 | 1988-03-22 | Brian Potter | Method and apparatus for automated medical diagnosis using decision tree analysis |
US4899758A (en) * | 1986-01-31 | 1990-02-13 | Regents Of The University Of Minnesota | Method and apparatus for monitoring and diagnosing hypertension and congestive heart failure |
WO1988004450A1 (en) * | 1986-12-11 | 1988-06-16 | Sun Alpha Incorporated | Bioenergy control system |
US5018067A (en) * | 1987-01-12 | 1991-05-21 | Iameter Incorporated | Apparatus and method for improved estimation of health resource consumption through use of diagnostic and/or procedure grouping and severity of illness indicators |
US4858126A (en) * | 1987-02-26 | 1989-08-15 | Croce Jr Pasquale W | Method and apparatus for quantitative evaluation of back health |
US4872122A (en) * | 1987-06-19 | 1989-10-03 | University Of Pennsylvania | Interactive statistical system and method for predicting expert decisions |
US4839822A (en) * | 1987-08-13 | 1989-06-13 | 501 Synthes (U.S.A.) | Computer system and method for suggesting treatments for physical trauma |
US5025374A (en) * | 1987-12-09 | 1991-06-18 | Arch Development Corp. | Portable system for choosing pre-operative patient test |
US4945476A (en) * | 1988-02-26 | 1990-07-31 | Elsevier Science Publishing Company, Inc. | Interactive system and method for creating and editing a knowledge base for use as a computerized aid to the cognitive process of diagnosis |
US5084819A (en) * | 1988-11-10 | 1992-01-28 | Response Technologies Inc. | Data collection, analysis, and response system and method |
US5088037A (en) * | 1990-03-23 | 1992-02-11 | Anthony Battaglia | Portable rescue administration aid device |
US5301105A (en) * | 1991-04-08 | 1994-04-05 | Desmond D. Cummings | All care health management system |
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- 1993-06-18 CA CA002121245A patent/CA2121245A1/en not_active Abandoned
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1996
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WO1994000817A1 (en) | 1994-01-06 |
NZ254452A (en) | 1996-04-26 |
US5583758A (en) | 1996-12-10 |
AU4652293A (en) | 1994-01-24 |
AU6550096A (en) | 1996-10-31 |
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US5953704A (en) | 1999-09-14 |
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