U.S. patent application number 10/041312 was filed with the patent office on 2002-09-12 for method for automating collection of psychotherapy patient information and generating reports and treatment plans.
Invention is credited to Burke, Phil, Lonski, Michael.
Application Number | 20020128868 10/041312 |
Document ID | / |
Family ID | 23408560 |
Filed Date | 2002-09-12 |
United States Patent
Application |
20020128868 |
Kind Code |
A1 |
Lonski, Michael ; et
al. |
September 12, 2002 |
Method for automating collection of psychotherapy patient
information and generating reports and treatment plans
Abstract
The method and apparatus automatedly generates various reports
for a psychotherapy provider. These reports include Treatment
Plans, progress reports, scheduling reports and billing reports.
The progress reports include a Progress Note which incorporates
various selected data into a report for the insurance company. As
much of the data is selected from menus, the resulting report can
maintain much patient privacy while being satisfactory to the
insurance company. More private information can be stored
separately in Expanded Text. A Treatment Plan is generated using
the various selected data with respect to subsets of emotional
factors, intellectual factors, physical factors, social factors,
and spiritual factors. These subsets may be chosen randomly or with
some periodic selection.
Inventors: |
Lonski, Michael; (Old
Greenwich, CT) ; Burke, Phil; (Wanaque, NJ) |
Correspondence
Address: |
Ronald E. Brown
Pitney, Hardin, Kipp & Szuch LLP
711 Third Avenue, 20th Floor
New York
NY
10017
US
|
Family ID: |
23408560 |
Appl. No.: |
10/041312 |
Filed: |
January 8, 2002 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10041312 |
Jan 8, 2002 |
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09358168 |
Jul 20, 1999 |
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6338039 |
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Current U.S.
Class: |
705/2 ;
705/3 |
Current CPC
Class: |
G16H 70/20 20180101;
G06Q 10/10 20130101; G16H 20/70 20180101; G16H 15/00 20180101; G16H
10/60 20180101 |
Class at
Publication: |
705/2 ;
705/3 |
International
Class: |
G06F 017/60 |
Claims
What is claimed is:
1. An apparatus for providing historic documentation and
prospective treatment advice for a plurality of psychotherapy
patients for a psychotherapy provider comprising: means for
automated collecting and recording of psychotherapy data for the
patients, said psychotherapy data being in a plurality of
categories including historic and prospective information; means
for choosing a subset of categories from said plurality of
categories; means for storing a database comprising textual data
corresponding to a plurality of possible psychotherapy data said
data including prospective treatment advice; means for referencing
into said database by said psychotherapy data in said subset of
categories thereby selecting a portion of said textual data
including prospective treatment advice; means for combining said
portion of said textual data with psychotherapy data including
historic data from said means for automated collecting and
recording thereby automatically generating at least one historical
and one prospective report.
2. The apparatus of claim 1 wherein the automated collecting and
recording of patient psychotherapy data and the automated
generation of the report of claim 1 originates from, and is indexed
to, a list of possible psychotherapeutic problems.
3. The apparatus of claim 1 wherein at least one report includes a
relatively short form patient report and a relatively long term
patient report.
4. The apparatus of claim 1 wherein said at least one report
includes prospective treatment advice.
5. The apparatus of claim 1 wherein said at least one report
includes historic information relating to the psychotherapy
patient.
6. The apparatus of claim 1 wherein said at least one report links
the historical record of at least two psychotherapy patients.
7. The apparatus of claim 1 wherein said database includes a
psychological and psychiatric treatment encyclopedia.
8. The apparatus of claim 7 further including means for updating
said treatment encyclopedia.
9. The apparatus of claim 1 further including means for scheduling
therapy sessions for individual patients and simultaneously for a
group of patients.
10. The apparatus of claim 1 wherein said at least one report
includes a billing report.
11. The apparatus of claim 1 wherein said database is a relational
database.
12. The apparatus of claim 2 wherein said list of possible
psychotherapeutic problems is derived from medical literature and
wherein the apparatus further includes means for revising said list
of possible psychotherapeutic problems.
13 The apparatus of claim 3 wherein generation of at least one
report is automated through menu selections to the psychotherapy
provider.
14. The apparatus of claim 7 wherein said treatment encyclopedia
includes: (a) a list of possible patient problems (b) a list of
possible behavioral definitions (c) a list of possible assessment
criteria (d) a list of possible short term objectives (e) a list of
possible long term goals (f) a list of possible therapeutic
interventions (g) a list of possible physical issues (h) a list of
possible emotional issues (i) a list of possible patient coping
mechanisms (j) a list of possible suggested future treatments (j) a
list of possible related conditions (k) a list of possible patient
responses
15. The apparatus of claim 4 wherein said prospective treatment
advice includes at least one set of assessment data, at least one
short term objective, at least one therapeutic intervention and at
least one long term goal for said at least one report.
16. The apparatus of claim 1 wherein said historic information is
available to psychotherapy providers at any time during operation
of the apparatus.
17. The apparatus of claim 15 wherein said at least one assessment
criteria, said at least one short term objective, said at least one
therapeutic intervention, and said at least one long term goal are
defined in terms of at least emotional factors, physical factors,
intellectual factors, social factors, and spiritual factors.
18. The apparatus of claim 2, wherein entries from said list of
possible psychotherapy problems can be assigned a severity from a
range of severities for each psychotherapy patient.
19. The apparatus of claim 18 wherein said assigned severities
serve as a weighting factor for the selection of prospective
treatment advice.
20. The apparatus of claim 1 wherein said means for selecting said
prospective treatment advice includes pseudo-random selection.
21. The apparatus of claim 1 wherein said means for selecting said
prospective treatment advice includes periodic selection.
22. The apparatus of claim 1 wherein the means for automated
collecting and recording of psychotherapy data is linked to said
database comprising textual data through network means.
Description
BACKGROUND OF THE INVENTION
[0001] This invention relates to the practice of psychotherapy in
an environment whereby insurance companies and HMOs govern, by
their payment rules, how patients are cared for. More particularly,
this invention deals with a method for automating the gathering of
patient information as well as automating documentation, Treatment
Plans, and reports required by insurance companies.
[0002] In the United States, especially in the last eight years
with the explosive growth of managed care and increasingly where
Medicare or Medicaid pays for treatment, the administration of
psychotherapy is driven by insurance companies. These companies
seek to minimize the cost of treatment and demand rigorous
documentation by the care provider. As a result, care providers are
forced to spend less time with patients and to spend more time
generating documentation. As might be expected, patient care has
deteriorated with caregivers increasingly spending more time, money
and energy interacting with managed care companies seeking approval
and providing justification for initial, concurrent and ongoing
treatment.
[0003] Despite time constraints, caregiver is expected to interact
with a patient, and to make and record observations about patients
and their behavior. At some later point, the caregiver must define
patient Treatment Plans and generate detailed patient progress
reports, typically two pages in length Treatment Plans and status
reports are derived from observations made while the caregiver sees
patients. It is not uncommon for a caregiver to see thirty to fifty
patients per day.
[0004] Under these trying circumstances, the pressure on caregivers
is enormous. The caregivers are attempting to provide a high level
of individualized care to a multitude of patients in a very short
period of time, yet are expected to provide extensive documentation
of the progress of each patient. Given the circumstances, patients
tend to blur together making it difficult for the caregiver to
remember enough detail about each patient to adequately report
progress and to devise effective Treatment Plans.
[0005] All three parties, the patient, the caregiver, and the
insurance company are badly served by the above situation. The
patient receives less individualized care than he or she requires.
The caregiver is under pressure to produce results and
documentation in an inadequate period of time. The insurance agency
receives minimal, often generic documentation What is needed is a
method for easing the caregiver's documentation burden so that he
or she might be able to spend more quality, focused, unencumbered
time with patients. The insurance company demands for rigorous
documentation will not change, thus caregivers must be provided
with a method that will enable them to produce the extensive
documentation required in less time.
OBJECTS AND SUMMARY OF THE INVENTION
[0006] It is therefore an object of the invention to provide
psychotherapy caregivers with an apparatus that will enable them to
produce the detailed documentation demanded of them by insurance
companies quickly and with little effort.
[0007] It is a further object of the invention that the above
apparatus should be highly portable allowing caregivers to carry
the invention to patients.
[0008] It is a further object of the invention to provide
caregivers with an apparatus to generate individualized multiple
alternative Treatment Plans for each patient so that the caregiver
might better define an optimal Treatment Plan.
[0009] It is further an object of the invention to construct the
above apparatus so that it is adaptable to individuals and groups
so that patients may be tracked through multiple therapeutic
environments.
[0010] It is further an object of the invention to share, in
appropriate settings where confidentiality can be protected,
information with colleagues so that patient treatment may be
improved and to facilitate teaching of less experienced staff
[0011] It is further an object of the invention to construct the
above apparatus so complete patient histories, including billing,
are complied in a database as the caregiver uses the invention.
[0012] It is further an object of the invention to format reports
in such a way that patient privacy is protected while report
recipients, i.e. insurance companies, receive adequate patient
condition documentation.
[0013] These and further objects are attained by a computerized
method and apparatus which automatedly generates various reports
for a psychotherapy provider. These reports include Treatment
Plans, progress reports, scheduling reports and billing reports.
The progress reports include a Progress Note which incorporates
various selected data into a report for the insurance company. As
much of the data is selected from menus, the resulting report can
maintain much patient privacy while being satisfactory to the
insurance company. More private information can be stored
separately in Expanded Text. A Treatment Plan is generated using
the various selected data with respect to subsets of emotional
factors, intellectual factors, physical factors, social factors,
and spiritual factors. These subsets may be chosen randomly or with
some periodic selection
[0014] FIG. 1 shows a block diagram of the basic therapeutic
process. A first step is problem identification. As might be
expected, problem identification is vitally important because a
misstep at this point will waste time and can even lead to an
improper Treatment Plan that might not benefit the patient or could
even harm the patient. Problem identification is difficult because
a patient may have little or no idea of the real nature of his or
her problem(s). It is up to the caregiver to accurately diagnose
the true nature of the patient's problem(s) through interaction and
observation of the patient and by gathering information from
collateral sources.
[0015] A next step is to make an assessment of the identified
problem In assessing the problem, the caregiver win want to define
the problem more concisely, try to find a precipitating event, and
find out what the problem means to the patient. Throughout the
problem identification and assessment steps, the caregiver will
record observations about the patient, typically by taking notes on
a computer, by tape recorder, dictation or by hand.
[0016] As shown in FIG. 1, a next step is to make a formal record
of observations. This usually is performed after seeing a patient,
and may include a reexamination of the problem identification and
assessment steps. At this point, a caregiver must make a decision
to continue or to end treatment. If continued treatment is
indicated, the caregiver will define short-term objectives and
long-term treatment goals then construct Treatment Plans to
accomplish these goals.
[0017] A final step is Treatment Plan implementation. FIG. 1 shows
the therapeutic process as a closed loop system with problem
identification as the next step after treatment implementation.
While this is a simplification, as is the whole of FIG. 1, overall
it is an accurate representation of the process.
[0018] After Treatment Plan implementation, the caregiver must
decide if the Treatment Plan is beneficial and should be continued,
or if it should be modified or abandoned. As shown by FIG. 1, the
effectiveness of the Treatment Plan is determined through repeating
the process of FIG. 1.
[0019] The present invention uses portable devices such as laptop
computers to streamline the caregiver's record keeping throughout
the process of FIG. 1. Additionally, the invention's Treatment Plan
generation facility acts as a panel of experts aiding the caregiver
with expert advice.
BRIEF DESCRIPTION OF THE DRAWINGS
[0020] FIG. 1 is a flowchart delineating the basic actions of the
psychotherapeutic process.
[0021] FIG. 2 is a block diagram depicting the basic elements of
the invention.
[0022] FIG. 3 is a block diagram detailing elements of the
encyclopedia of the invention
[0023] FIG. 4 is a block diagram detailing elements of the
invention's historical database.
[0024] FIG. 5 is a block diagram showing format groups used with
the present invention.
[0025] FIG. 6 is a flowchart showing options from the invention's
main menu.
[0026] FIG. 7 is a flowchart showing the process for generating
Progress Notes.
[0027] FIG. 8 is a flowchart showing the process for generating a
Treatment Plan.
[0028] FIG. 9 is a flowchart showing the various processes for
scheduling and maintaining groups.
[0029] FIG. 9A shows a flowchart for adjusting group attendance and
a flowchart for scheduling group sessions.
[0030] FIG. 9B shows a flowchart for adding or subtracting group
participants and a flowchart for group maintenance.
[0031] FIG. 10 is a flowchart showing the process for scheduling
individual patients.
[0032] FIG. 11 is a flowchart showing the process for maintaining
individual patients.
[0033] FIG. 12 is a flowchart showing the caregiver and physician
maintenance process.
[0034] FIG. 13 is a diagram of the invention as implemented in a
network environment.
[0035] FIGS. 14A, 14B, 14C, and 14D show the fields of a Treatment
Plan Note with sources of information for populating fields
indicated
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT
[0036] Before beginning the description of the drawings, it should
be noted that the invention, as presently configured, is used with
a device such as a computer or a palm corder. The computer includes
all conventional components such as memory, storage, a CPU, a
display, a keyboard and a mouse. As descried hereinafter, the
various selections are preferably made b pull-down menus or similar
devices as is common with WINDOWS.RTM. based programs. As
envisioned, the caregiver will make rounds then use such devices to
generate reports, then dump the reports into a central database.
Wherever possible, the invention uses pull-down menus, option
boxes, and radio buttons to reduce keyboarding and data entry
time.
[0037] As stated earlier, FIG. 1 shows the psychotherapy process as
a feedback loop. Because FIG. 1 is a simplification of the process,
it does not show the caregiver's constant assessment of the
information received directly from the patient or from notes.
Nonetheless, the feedback loop model shown is an accurate
reflection of the basic processes of psychotherapy whatever the
theoretical school. An examination of the role of the present
invention in the process of FIG. 1 aids in an understanding of both
the invention and its utility.
[0038] As per the method of the invention, a caregiver will
typically have begun a Progress Note, the result of the process of
FIG. 7, after a session with the patient. The caregiver selects the
patient and enters the rest of the required bookkeeping data via
pull-down menus. The caregiver will then move onto the problem
identification process 10 as shown in FIG. 1.
[0039] Problems are selected from a pull-down menu of 60 possible
problems, item 75 as shown in FIG. 3, and Item 1 of the appendix
(the appendix delineating a typical problem list). The relatively
small size of the database required to describe a patient's
problems facilitates a compact, fast-running program. Additionally,
by providing a concise list of problems, the method and apparatus
gives the caregiver a global view of possible problems without
overwhelming him or her.
[0040] Before a caregiver selects a problem, the method and
apparatus can provide a history of patient problems from the
Patient Problems Cross-Reference element item 210 as shown in FIG.
4. This feature is helpful in the problem identification and
assessment stages 10 and 15 as shown in FIG. 1. Conceptually, the
role of the method and apparatus is that of an advisor as opposed
to a solution or answer provider. The patient history is meant to
stimulate the caregiver's own thinking about the patient's problem,
not to force caregiver thinking in any single direction.
[0041] As described previously, assessment 15 as shown in FIG. 1
involves direct interaction with, and observation of; the patient.
However, the caregiver constantly assesses the validity of his or
her observations, the validity of treatment goals, and the validity
of Treatment Plans, thus assessment is not limited to item 15.
[0042] Patients are not static. Their problems are often in a state
of flux, thus treatment objectives and Treatment Plans may be
appropriate one day and less relevant the next day. For this
reason, the method and apparatus is designed to stimulate caregiver
thought processes so that the caregiver may better respond to the
changing needs of the patient.
[0043] The next step shown in FIG. 1 is recording observations 20.
The caregiver will typically use the Quick Note format because of
time constraints. Having entered the problem, the caregiver will
then indicate the problem severity by selecting from a scale of one
to five on a pull down menu with one being least severe and five
being most severe. Next the caregiver will select from an Other
Related Conditions pull down menu This information comes from item
165 as shown in FIG. 3 and is keyed to the cited problem, and
describes situations that are typically related to the problem.
Because of the linkage to the problem, those conditions that are
relevant to the problem will appear first in the pull down
menu.
[0044] The caregiver will then select a focus of diagnosis from a
pull down menu. This information comes from item 135 as shown in
FIG. 3 and is not keyed to the problem. The focus of diagnosis
simply defines the type of interaction with the patient. Typically,
these might be an intake interview, a reassessment after
hospitalization, or psychoanalytically informed treatments.
[0045] The caregiver will then select a behavioral definition from
a pull-down menu. The behavioral definition is a global description
of the patient's condition and comes from the treatment
encyclopedia data block 100 as shown in FIG. 3. Behavioral
definitions are keyed to problems; thus the pull-down menu first
displays those behavioral definitions that are relevant to the
problem. The behavioral definitions in the treatment encyclopedia
are culled from medical literature and will be readily accepted and
understood by those reviewing the Progress Note.
[0046] Next, the caregiver will select an emotional issue which the
caregiver deems is a relevant stimulus or precipitant to the
problem(s) being addressed in that session from the treatment
encyclopedia data block 160 as shown in FIG. 3. The emotional issue
is also selected from a pull-down menu, but it is not keyed to the
problem. Like the behavioral definitions, the emotional issue
section of the treatment encyclopedia was collected from medical
literature. The caregiver will then select a physical issue, if
relevant from a pull-down menu. Physical issues, i.e., medical
problems or conditions, are not keyed to any particular problem and
come from the physical issues part of the treatment encyclopedia
140 as shown in FIG. 3. Physical issues are classified by ICD-9
codes.
[0047] Next, the caregiver selects a coping mechanism, which is the
patient's defensive or adaptive style. Again, this item is selected
from a pull-down menu. Coping mechanisms come from the treatment
encyclopedia 155 as shown in FIG. 3, and are not keyed to the
problem Finally, the caregiver will select patient responses from
170 as shown in FIG. 3 and select an immediate future treatment(s)
from 150 as shown in FIG. 3. Both the patient response and future
treatment are selected from pull-down menus and are not keyed to a
particular problem.
[0048] Taken alone, the problem, the problem severity, behavioral
definition, emotional issue, physical issue, focus of diagnosis,
other related conditions, coping mechanism, patient response, and
suggested future treatment might seem generic, something like
medical boilerplate. However, when viewed as a group in totality,
these selected items give a complete picture of the patient's
condition and progress while protecting the patient's right to
privacy. Through this means, the caregiver can give an insurance
company or government agency good documentation without betraying
any confidences that are so crucial to the caregiver-patient
relationship.
[0049] To finish the Progress Note, the caregiver has the option of
entering a brief note via the keyboard or by a speech recognition
chip in a palm corder type device. This note, called Expanded Text
in the method of the invention, allows the caregiver to makes
specific comments about sensitive but important data about the
patient. This data is stored separately in the historical record
section, item 250 as shown in FIG. 4. Access to this information is
restricted to the patient's caregiver or to other caregivers.
Outside agencies do not have access to this material, and to
further protect the patient's privacy, this material can be
redacted.
[0050] The caregiver may, particularly after an initial session,
enter formal diagnostic psychological and medical information using
the Formal Progress Note 410 as shown in FIG. 7. This is done via a
pull down list of DSM-IV and ICD-9 codes. Specific medical
problems, procedures, or hospitalizations may be recorded by
selecting the relevant code and entering starting and ending dates.
Similarly, medications may be tracked and updated as necessary
using these codes.
[0051] The generic information described earlier provides excellent
documentation for outside agencies while protecting them from the
liability of inappropriate release of confidential patient
information. Caregivers, on the other hand, need the highly
personal information from the Expanded Text to aid them in their
search for clues to patient behavior.
[0052] The time required to complete the short form Progress Note
is brief. The caregiver need only select nine items from pull down
menus and type or dictate a brief comment to fully document the
session with the patient and present a thorough report on the
patient's condition. These items, (1) problem, (2) severity, (3)
focus of diagnosis, (4) other related conditions, (5) behavioral
definitions, (6) emotional issues, (7) physical issues, (8) patient
response, and (9) future treatment are all accessed via pull-down
menus. Given experience with the method and apparatus, a caregiver
should be able to complete the process in three to five minutes.
The resulting short form Progress Note becomes part of the
patient's history and is stored in that data block 195 as shown in
FIG. 4, except for the Expanded Text which is stored in the
Progress Notes Expanded Text block 250 as shown in FIG. 4.
[0053] After completing the Progress Note, the caregiver would
likely move on to formulating a Treatment Plan, which may be done
manually or automatically. A Treatment Plan includes advice of a
future or prospective nature for the caregiver. However first a
decision must be made to continue or end treatment, items 35 and 30
as shown in FIG. 1 respectively. Most of the time, continuation is
the obvious action to take, but with the pressure on funds for
treatment, caregivers may be forced to spend their time with those
who would benefit most from treatment. The caregiver may consult
the Progress Note patient history 195 as shown in FIG. 4 as an aid
in making this decision.
[0054] If a decision is made to continue treatment, the caregiver
needs to define objectives and goals. At this point, the caregiver
might review behavioral definitions, short term objective,
therapeutic intervention and assessment reference files from the
treatment encyclopedia. Alternatively, the caregiver may opt to
instruct the method and apparatus to automatically generate the
Treatment Plan (process described below) which is then combined
with the "live" data previously entered by the caretaker, resulting
in the "Treatment Plan Note." With the aid of this information and
the Treatment Plan options generated by the method and apparatus as
shown in FIG. 8, the caregiver will define a Treatment Plan 40 as
shown in FIG. 1 that best fits the present needs of the
patient.
[0055] In item 45 as shown in FIG. 1, the caregiver implements the
therapeutic intervention defined in the Treatment Plan of item 40.
As shown by FIG. 1, the therapeutic process begins again after the
therapeutic intervention. The patient's reaction or lack of
reaction to the intervention is assessed and acted upon by the
caregiver through the process of FIG. 1, thus completing the
feedback loop.
[0056] Throughout the process of FIG. 1, the method and apparatus
have aided the caregiver by greatly speeding up the documentation
process. Instead of the burdensome, oftentimes redundant, and time
consuming process of filling out forms by hand or from a keyboard,
the caregiver need only select options from pull-down menus.
Additionally, the caregiver need no longer rack his or her mind for
descriptive terms and language and treatment ideas. The pull-down
menus and Treatment Plans generated by the method and apparatus
provide caregivers with stimulation, structure, and
alternatives.
[0057] FIG. 2 shows the basic data blocks that are used by the
method and apparatus of the present invention. The treatment
encyclopedia 50 contains information used for reference and for
formulating Treatment Plans. The information in the treatment
encyclopedia comes from accepted medical literature and
professional experience. The contents of the treatment encyclopedia
are described more fully in the discussion of FIG. 3.
[0058] Item 55 contains historical data. The various data
sub-groups are described in detail with the discussion of FIG. 4,
but generally, item 55 is the record of the method and apparatus of
the invention. The historic database is added to constantly by the
method of the invention. Any new data such as Progress Notes, new
patients, new caregivers, updated personal or insurance
information, collateral information or contacts or billing records
become part of the data of item 55. Through accessing the data of
item 55, a caregiver can pull up a complete history of a patient or
groups of patients with complete records of Progress Notes and
Treatment Plans and billing records.
[0059] Item 60 contains the algorithms used to formulate Treatment
Plans as well as those algorithms specific to the method and
apparatus of the invention that enable interaction between the
various screens and generation of reports. Item 65 contains the
data required to format screens and reports. The various sub-groups
of item 65 are described in detail with the discussion of FIG.
5.
[0060] The data blocks of FIG. 2 are divided by function and as
such are not dependent on any particular operating system. However,
all the data blocks described are needed for the method and
apparatus of the invention to provide the functional aspects of
data gathering, report generation, and Treatment Plan generation
described in this specification.
[0061] FIG. 3 shows the details of the treatment encyclopedia. This
data block is the primary reference for the method and apparatus of
the invention. Item 70, the problem block, contains two sub groups,
75 the has of 60 problems shown as Item One in the appendix, and a
Diagnostic and Statistical Manual cross reference 80. Problem list
75 describes the problems displayed by patients in the majority of
cases. The problems are denoted with specific code numbers. As an
example amnesia has a code of 100, anger has a code of 200, and
anxiety has a code of 500. Item 80, the DSM cross reference,
defines the problems of item 75 in standard DSM-IV codes so outside
agencies such as insurance companies will find the problems listed
in item 75 acceptable.
[0062] Assessment data block 85, long term goal data block 125,
short term objectives block 120 and therapeutic interventions block
130 are divided into sub groups consisting of emotional factors,
intellectual factors, physical factors, social factors, and
spiritual factors. These five factors along with problem list 75
serve to clarify and simplify the description of the bewildering
number of conditions displayed by patients. The aforementioned five
factors encompass all areas that can effect patients and must be
allowed for when dealing with the patient. By defining assessment
data, short term objectives, long term goals, and therapeutic
interventions in terms of these factors, the method and apparatus
of the invention gives caregivers a vocabulary to define a
patient's condition and treatment options concisely using
easy-to-use pull-down menus thus greatly simplifying the
caregiver's work.
[0063] These data blocks are keyed to the problem data block 75.
Thus, when a caregiver accesses these data blocks, those factors
keyed to the problem being examined appear first in the pull-down
menus. This prioritizing of factors serves to focus the caregiver
and prevents him or her from being overwhelmed by data.
[0064] Assessment step 15 as shown in FIG. 1 is essentially a
refinement and focusing of problem diagnosis step 10 as shown in
FIG. 1. Through the assessment process, the caregiver attempts to
define the exact nature of the problem and its intensity. Data
block 95 as shown in FIG. 3 provides the caregiver with a
vocabulary for assessment in the five dimensions, emotional,
intellectual, physical, social and spiritual. Data block 95 has
been modified and refined so that it reflects an accurate
assessment of a patient in the great majority of cases. Going with
the philosophy of the invention as an advisor and aid to the
caregiver, the invention suggests possibilities, but the caregiver
has the final word in defining the nature of the patient's
problems.
[0065] Assessment criteria are also important in the scheme of the
invention because they factor in the Treatment Plan generation
operation. When the caregiver generates a Treatment Plan FIG. 8,
the basic process is as follows. The invention creates Treatment
Plans through the presentation of behavioral definitions from block
110 as shown in FIG. 3, assessment data from block 95 as shown in
FIG. 3, short-term objectives from block 123 as shown in FIG. 3,
therapeutic interventions from block 127 as shown in FIG. 3, and
long term goals from block 133 as shown in FIG. 3. These elements
are keyed to the problem code. Thus, if the problem code is anger
item 200 in the problem list in the appendix, those elements of
data blocks that refer to anger are selected as possibilities. The
cross reference blocks for assessment 95, short term objectives
123, long term goals 133, and therapeutic interventions 127 refer
to five dimensions of a patient's condition. The five dimensions
are physical, emotional intellectual, social and spiritual.
[0066] As an example, short term objectives 120 as shown in FIG. 3
has two elements, the cross reference section 123 and the Max
section 105. The cross reference section links the short term
objectives data block to problems data block 70 in five different
dimensions, physical, intellectual emotional, social and spiritual.
Thus when a Treatment Plan is created, the short term objectives
section will have problem focused information for all five
dimensions.
[0067] The Max section 105 defines limits for the randomizing
algorithm used in creation of Treatment Plans. Datablocks 85, 100,
125, and 130 also have Max elements in them. The Max elements are
statistical listings of the incidence of particular aspects in
those datablocks. These values were defined originally when setting
up the program. Maxs have been altered over the life of the program
as a database of patient histories has developed. As per the method
of the invention, Maxs serve to inform the algorithm used in
formulating Treatment Plans as to the extent of the possible
information selections linked to any one problem. Thus the problem
of anger may thirty informational selections associated with it,
while different problems will have more or less information
selections. The Max informs the Treatment Plan algorithm about the
extent of the information pool.
[0068] Datablocks physical issues 140, emotional issues 160,
severity 163, coping mechanisms 155, patient responses 170, and
other related conditions 165, focus of diagnosis 135, and future
treatments 150, all of FIG. 3, provide additional information to
the caregiver and are available to the caregiver at anytime. There
is, of course, some overlap. For example, many physical issues,
emotional issues, coping mechanisms and patient responses are
common to those having problems with anger and those having
problems with anxiety.
[0069] To generate the Treatment Plan, the device, via the
relational database program, takes text and "boiler-plate" relating
to various fields from a master table of "Treatment Plan-Additional
Text" 233 FIG. 4 and merges the input entered by the user
(including input data chosen from the menus), as selected by the
randomizing or similar routine, therewith.
[0070] The information presented to the caregiver both serves to
slate the caregiver into thinking along appropriate lines and
prevents the caregiver from being overwhelmed by possibilities.
This last aspect is critical because the problems presented by
patients are complex, with severe time constraints and intense
interactions with colleagues in treatment teams serving to
complicate matters even further. Taken together, these factors can
leave a caregiver feeling blocked and overwhelmed. By presenting a
constrained listing of information to the caregiver, the invention
helps the caregiver to focus and clarifies issues concerning
diagnosis and selection of Treatment Plans.
[0071] In other words, the current or historical data is entered by
the caregiver and combined with prospective advisory data (as
retrieved from the treatment encyclopedia as indexed by the
randomizing or similar function) to generate a Treatment Plan Note
is the most comprehensive and useful end result.
[0072] Moreover, particularly with regard to the Treatment Plan,
the device may be implemented as using artificial intelligence
using the tables and mechanisms described above. In particular, the
"severity" function can be used to delimit the data available to
the randomizing (or similar selection) algorithms in the generation
of the Treatment Plans Further, an internal feedback looping
process can be used to enhance the functionality and usefulness of
this method and apparatus in clinical settings. With the addition
on an "outcome" button (with associated underlying mechanisms and
elements, such as the master table of outcomes for the Treatment
Plan Note, queries, forms, reports, etc.) on the Quick Entry Screen
for individual Progress Notes and the Adjust "Group"
Attendance/Participation screens, the caregiver can provide
feedback to the method and apparatus in the form of; firstly,
results (in quantifiable and analyzable form) of the therapeutic
inventions utilized and, secondly, the specific inventions utilized
in the prior individual or group session.
[0073] By a system of tracking, quantifying and analyzing these
results and methods (that is, therapeutic interventions and future
treatments), the method and apparatus of the invention, with
artificial intelligence implemented, can, in effect, monitor itself
and by accurately recording the entered data and computer generated
Treatment Plan Note, "learn" via artificial intelligence, which
particular strategies (that is, therapeutic interventions, future
treatments) can best address particular "problems of the day" short
term objectives and long term goals.
[0074] FIG. 4 shows the elements of the invention's historical
database. These data blocks are keyed to individual patients so
that the history of each patient can be defined in the context of
these elements. This database evolves with use. Most of the
elements require little in the way of explanation.
[0075] The patient master table 240 contains information about the
patient such as the name, sex, birth date, social security number
as well as the patient's Medicare and Medicaid numbers. The key
element is the social security number because every patient must
have a unique social security number. Billing history 175 is simply
the complete historical record of each patient's billing history.
Caregiver's can access the complete record, the billing history for
any given time period, or the most recent billing. Billing
histories may be accessed via the main menu screen, patient look up
screens, or from Progress Note screens.
[0076] The physician record element 180 is the historical record of
patient medical doctors other than the caregiver. Typically a
patient would have a medical doctor addressing physical problems
while the mental health caregiver supervises patient mental and
emotional problems. With an aging population, many of a patient's
physical problems will have a profound impact on the patient's
mental state and vice versa. Thus, the caregiver and physician need
work closely. Because patients may have multiple physicians or may
change physicians, the caregiver must have access, whenever
feasible, to the complete historic physician record to obtain all
patient data including but not limited to hospital, rehab and
medication information.
[0077] The caregiver record 200 is similar to the physician record
in that a patient may have dealings with different caregivers. It
may be important for the present caregiver to speak with the
caregiver of a previous time so that the caregiver can define a
patient's history in terms outside his or her own experience.
Patients, particularly in nursing homes, retirement communities, or
residential care facilities may have required treatment over the
course of several years. It is important for a new caregiver to
understand the experience of previous caregivers thus the need for
the historical record of caregivers. Additionally, the caregiver
record has links to billing histories thus allowing analysis of
caregiver productivity.
[0078] Facility record 220 and service location record 235 are
simply the historic records of locations where patients are treated
and the location of the caregiver's office respectively. The
facility record comes into play when the caregiver uses the patient
look up screen. The caregiver first selects the facility from then
selects the patient from the record of those patients at the
facility. The patient master table 240 contains those records that
define the patient such as sex, birth date, Medicare and Medicaid
number and social security number. When the caregiver chooses the
patient, those information fields are filled in automatically from
this table. Facility and patient selection use drop down menus and
are rapid and effective way of identifying the patient. The service
location record comes into play when defining caregiver billing
records.
[0079] The patient physical issues cross reference 190 is the
historical record of patient physical problems. Because physical
issues can directly influence a patient's mental state, caregiver's
must have access to a complete history of the physical issues
confronting the patient. Patient problems cross reference 210
contains the history of patient problems recorded from Progress
Notes.
[0080] The Progress Notes section 195 is the historical record of
Progress Notes written throughout the course of the patient's
treatment. This database contains Progress Notes made by all
caregivers not just the current caregiver. This accumulated
collection of notes provides an important record of the course of a
patient's condition and reaction to therapy. The caregiver's ready
access to this material throughout the process of the invention
enables more informed problem selection and assessment as well as
an examination of the progress of the patient's mental state
through the course of treatment.
[0081] As described earlier, the Progress Notes Expanded Text
section 250 as shown in FIG. 4 is that part of a Progress Note
where a caregiver has entered a personal observation and DSMIV
diagnosis focused on the problem of the day. This section is linked
to the Progress Notes section, but is kept as a separate database
so that a caregiver need not fear accidentally making this
information available to an outside agency.
[0082] Progress Notes Additional Text 245 and Treatment Plan
Additional Text 233 contain phrases that are used in conjunction
with elements from the treatment encyclopedia and data from
Progress Notes to fill out fields in reports. This will be
explained in detail with the discussion of FIGS. 14A, 14B, 14C, and
14D.
[0083] The various group histories, group master 185, group
participants 205, group session master 225, and group session
participant Progress Notes 215 are used for scheduling and for
tracking a patient's progress through the group therapy
environment. The caregiver needs to be able to examine these
historical records in detail to understand the patient's behavior
more thoroughly because patient's often react differently in a
group environment than they do one-on-one with the caregiver.
[0084] To better understand the patient's reaction to these
differing environments, the caregiver must know the participants in
each group. It is possible that a patient reacts badly to a certain
individual or a certain type of behavior displayed by other
individuals. A patient might be outgoing and vocal in a sheltered
setting, but may be withdrawn or aggressive in the more stressful
group environment. Unless the caregiver has access to detailed
histories of a patient's group participation, he or she will be
unable to understand and treat the fill range of the patient's
problems in the context of their known strengths and abilities.
[0085] FIG. 5 shows the collection of formats used by the invention
to define screen layout and interaction with other elements of the
invention. All formats are designed so that the caregiver can move
from screen to screen as quickly as possible and to minimize
caregiver data entry chores. Drop-down menus are used wherever
possible, i.e. for patient selection or for reference and review of
histories. Additionally, formats such as Progress Notes are
designed with as much "boilerplate" as possible so that caregivers
need only fill in the blanks to give a complete and accurate
description of a patient's condition
[0086] The Progress Note formats 255 FIG. 5 and Progress Notes
Additional Text 245 FIG. 4 are designed to work in concert to
minimize caregiver data entry. The Progress Note format section 255
defines the overall structure of the Progress Note with the
Progress Note Additional Text section 245 serving to provide the
boilerplate language for the Quick Note and the four page Formal
Progress Note input screens and reports. As in descriptions of
other data block sections of the invention, the actual formatting
structures are dependent on the chosen operating system, thus this
specification will include a generic description of those data
blocks needed to implement the invention.
[0087] Assessment reference format 280, short term objective
reference format 290, and therapeutic intervention reference format
285 are designed to present those elements in five dimensions:
emotional, intellectual, physical, social and spiritual, cross
referenced to the problem being worked on. As presently configured,
the invention presents this information in a pull-down menu format
so that the caregiver may browse through the possible selections
easily and make selections by a single action such as a mouse
click.
[0088] The Treatment Plan format 260 defines the Treatment Plan
screen layout and also defines the linkages of the Treatment Plan
screen to other parts of the invention. The Treatment Plan by Date
format 265 defines screen layout and links so that the caregiver
can call up the historic record of Treatment Plans and access any
time period desired. Patient history format 270 and billing history
format 275 are similar to the Treatment Plan by Date format in that
these formats are designed to let the caregiver access a patient's
history and billing history for any time period quickly and
easily.
[0089] FIG. 6 is a block diagram of the options available to
caregivers from the main menu screen of the invention. From the
main menu screen 295, the caregiver has four options, enter data
300, generate reports 302, transfer files 305, and examine
reference files 310. The Enter Data option 300 is the take off
point for most of the caregiver's work. From this option, the
caregiver deals with individual patients 315, works with groups
320, schedules patient therapy sessions 325, and updates physician
or caregiver information 330.
[0090] The Generate Reports option 302 allows the caregiver to
generate reports such as a semi-annual review of a patient's
problems 316, lists of patients seen by a caregiver over a specific
time period 322, and a review of patient intakes over a given time
period 326.
[0091] The Transfer Files option 305 allows caregivers to transfer
files from one device to another. Typically, a caregiver would use
this option when downloading work done on a laptop or a palm corder
to a network at the end of a shift. Another typical use is
accessing and downloading records from a network server to a
caregiver's laptop. The transfer files option is not only a
convenience, but is necessary for historical database compilation
purposes. As mentioned previously, caregivers need complete access
to patient histories. The file transfer option enables automatic
construction of the patient histories through downloading of
progress reports and other current records.
[0092] The Examine Reference Files option 310 allows caregivers to
move directly to Assessment Reference Files 335, Short Term
Objective Reference Files 340, and Therapeutic Intervention
Reference Files 345. Typically, a caregiver might access these
files to gain insight about a particular behavior or problem
displayed by a patient. As mentioned previously, these datablocks
are referenced to particular problems and are defined in five
aspects, emotional, intellectual, physical, social, and spiritual.
Thus, for nearly any type of problem, a caregiver can quickly pull
up and examine a compilation of assessment criteria, short term
goals and therapeutic interventions keyed specifically to that
problem. The value of this rapid access to complete information
cannot be overstated given the time constraints faced by
caregivers. In those situations where the caregiver is blocked and
needs stimulation or where the caregiver needs to verify an
assumption, this aspect of the invention is invaluable.
[0093] FIG. 7 shows the process of the Progress Note. As mentioned
previously, there are two Progress Note forms, the Quick Note and
the Formal Progress Note. The Quick Note is the standard caregiver
working note. This form of Progress Note contains sufficient data
to be an excellent source of information for the caregiver and
other caregivers who might treat the patient. The Formal Progress
Note provides more detailed documentation and is meant for use by
outside agencies such as insurance companies, or for detailed
record keeping in medical hospital or clinical settings.
Additionally, the formal note might be used for research or
educational purposes. The format of the Formal Progress Note
combines readily accepted medical boilerplate with
"fill-in-the-blank" information from pull-down menus to define a
patient's status and progress in a manner that will be complete and
useful to outside agencies and for internal record keeping.
[0094] FIG. 7 describes the process for both types of notes, the
difference in the two being primarily length, type of boilerplate,
and resulting pull-down menus used for the two. The caregiver
begins from the main menu screen 295 and moves from there to the
select patient look-up option 355. The caregiver selects the
facility from a pull-down menu 360, then selects the patient from a
pull-down menu showing the patients at the facility 365.
[0095] In item 370, the caregiver selects the Progress Notes
option, then selects a problem of the day. In most cases, the
caregiver will have already determined the problem when interacting
with the patient. Nonetheless, the caregiver may want to review a
history of the patient's problems to get a historic perspective on
the patient's progress. Item 375 indicates the option to review the
patient's historical problems 380 or to move straight to problem
selection 385.
[0096] At this point, the caregiver must decide whether to proceed
to the Quick Note 395 or the Formal Progress Note 390. After the
caregiver chooses the desired format, the process is basically the
same for both formats. With the quick form, the caregiver enters
data 395 using pull-down menus for various "f-in-the-blank"
questions and might enter a more personal observation in the
expanded notes section. Typically, the caregiver would first
indicate problem severity, select other related conditions, and
focus of diagnosis, and then select a behavioral definition(s). As
previously described, Behavioral Definitions, item 100 as shown in
FIG. 3, are global descriptions of a behavior and are keyed to
selected problems. Thus, those behavioral definitions keyed to the
problem selected at item 385 will appear first in the pull-down
menu.
[0097] Next, the caregiver would select a relevant emotional issue
from a pull-down menu originating from data block 160 as shown in
FIG. 3. Emotional issues are not linked to any particular problem
because a problem may or may not be a direct manifestation of an
emotional issue. However, emotional issues and precipitating events
that lead to emotional issues, are important clues to a patient's
behavior thus should be included in a Progress Note. Next, the
caregiver might select a physical issue from a pull-down menu. The
physical issue data originates from the Physical Issues datablock
140 as shown in FIG. 3. So that the physical issue data is
universally acceptable, physical issues are expressed in terms of
standard ICD-9 definitions and codes. For convenience, colloquial
descriptions are used as well, i.e. arthritic, diabetic, and/or
cardiac conditions. As with emotional issues, physical issues are
not linked to any particular problem. A patient problem may or may
not be a direct manifestation of a physical issue. However, as with
emotional issues, physical issues are vital to an understanding of
a patient's behavior.
[0098] The caregiver might then select a coping mechanism,
(adaptive style), displayed by the patient from a pull down menu.
This information originates in data block 155 as shown in FIG. 3,
and is not keyed to the problem selected at item 385. As with the
emotional and physical issues selection, a patient's coping
mechanism can be an important clue to a patient's progress, yet may
or may not be a direct manifestation of the problem selected at
385.
[0099] At this point the care giver might select a patient response
to treatment and a possible future treatment. Both items are
selected from pull-down menus and originate from items 170 and 150
as shown in FIG. 3 respectively. Again, neither item is linked to
the problem of 385 yet both items are important records for the
therapy process.
[0100] The items just described, problem severity, focus of
diagnosis, other related conditions, behavioral definitions,
emotional issues, physical issues, coping mechanism, patient
responses, and suggested future treatments are all options
available in the Quick Note. Taken together these items form an
effective snapshot of the patient at the time of the evaluation. If
these items are combined with a caregiver personal observation in
the Expanded Note section of the Quick Note, the resulting record
is &detailed description of the patient that becomes an
invaluable reference for the caregiver and any other caregivers
entrusted with the care of that particular patient. With very
little practice, the caregiver will be able to create this precise
record in a matter of three to five minutes.
[0101] After completing the Progress Note 395, the next step is to
decide whether or not to print the report 415. If printing is
desired, the caregiver selects the Print Report option 420. If not,
the caregiver moves directly to the decision to select another
patient 425.
[0102] If the caregiver decides to continue with another patient,
the process loops back to the Select Facility option 360. If the
caregiver chooses to end the Progress Note process, he or she
returns to the main menu 295 for other options such as patient
scheduling 325 as shown in FIG. 6.
[0103] If at decision point 390, the caregiver had chosen to select
a Formal Progress Note, the process is exactly the same except that
the format of the formal note is more detailed and contains a
lengthy section on assessment data, short term objectives, long
term goals, and therapeutic interventions. Because the assessment
data, short term objectives, and therapeutic interventions are
keyed to the problem, those assessment criteria related to the
problem appear first in the pull-down menus.
[0104] As described earlier, the assessment data originate from
data block 85 as shown in FIG. 3, and are expressed in five
dimensions, emotional, intellectual, physical, social and
spiritual. The Formal Progress Note allows the caregiver to make
selections in all five areas. The Formal Progress Note also permits
selections in all five areas for short term objectives and
therapeutic interventions. As with the asses t data section, short
term objectives and therapeutic interventions are keyed to the
selected problem. If the selected problem were anger, the caregiver
would have the opportunity to select comments about assessment
data, short-term objectives, and therapeutic interventions in all
five areas for anger (physical, emotional, intellectual, social and
spiritual).
[0105] After completion of the Formal Progress Note, the caregiver
moves through the process as described earlier. Decisions are made
concerning printing the report 415 or selecting another patient
425. Thus, other than differences in report length, the Formal
Progress Note process mirrors the Quick Note process.
[0106] The Treatment Plan process of FIG. 8 is a vital component of
the therapeutic loop of FIG. 1. With the creation of the Progress
Note, the caregiver has defined the patient's current state. With
the Treatment Plan, the caregiver defines the nature of hoped for
patient improvement and a suggested method for achieving
progress.
[0107] In going with the philosophy of the invention as an advisor
rather than a solution provider, the process of FIG. 8 provides
suggested Treatment Plans for the caregiver to review. The
caregiver is not expected to take Treatment Plan suggestions as
instructions to be followed exactly. Instead, the caregiver uses
the suggested Treatment Plans as a stimulus to define an optimal
treatment program. In the process of FIG. 8, the caregiver may look
at several alternative Treatment Plan suggestions before deciding
on a course of action.
[0108] The process of the invention for generating Treatment Plans
involves selecting assessment data, short term goals, therapeutic
interventions and long term goals keyed to problems defined in
Progress Note reports. If, as would be typical, the caregiver
generates the Treatment Plan in concert with a Progress Note, the
problem so defined would be the focus of the Treatment Plan, and
the result of the process defined as a Treatment Plan Note. If the
caregiver decides to skip the Treatment Plan step, the invention
automatically generates a Treatment Plan for any Progress Note that
does not have an attendant Treatment Plan when the caregiver next
accesses the Treatment Plan option.
[0109] Additionally, the invention will generate a Treatment Plan
for each of the problems associated with the patient defined in a
Progress Note. Thus, if the caregiver identified anger and
depression as problems for a given session, the invention would
generate one Treatment Plan for anger and one for depression for
that given therapy session.
[0110] Treatment Plan generation begins when the caregiver selects
the Treatment Plan option from the main menu screen 435 as shown in
FIG. 8. The next step in FIG. 8 is to select the problem that is to
be the focus of the Treatment Plan 440. If the caregiver is
operating out of the main menu after completing a group of Progress
Notes, the invention automatically defaults to the problem already
selected in the Progress Note for that given session. With items
445, 450, 455, and 460, the invention retrieves assessment data,
short term objectives, therapeutic interventions, and long term
goals that are keyed to the selected problem. This collection of
data is gathered from data blocks 85, 120, 130, and 125
respectively, all from the therapeutic encyclopedia of FIG. 3.
[0111] As previously described, assessment data, short term
objectives, therapeutic interventions, and long term goals are
defined in emotional, intellectual, physical social and spiritual
terms. As presently configured, a randomizing algorithm 465 as
shown in FIG. 8 selects two items from each of the five factors
from items 445, 450, and 455 then selects two factors from 460. The
invention then displays that result as Treatment Plan options 470.
Alternatively, the randomizing algorithm could be replaced with
systematic, periodic or manual selection of a subset of emotional
intellectual, physical, social and spiritual terms.
[0112] After reviewing the treatment options offered in item 470,
the caregiver must decide if the options are acceptable 475. At
this point the caregiver has three choices. The options may be
deemed acceptable, the caregiver may selectively edit out
irrelevant or inappropriate material or the caregiver may opt to
define an entirely new Treatment Plan by cycling through the
randomization algorithm again. If the caregiver decides to edit the
plan, he or she will optimize the Treatment Plan then save it 485
and return to the main menu screen 295. If the caregiver has
decided to opt for a new Treatment Plan, the process loops around
to item 445.
[0113] Experience has shown the process of FIG. 8 to be an
effective method for generating Treatment Plan Notes. All options
presented in 470 are keyed to the problem thus are relevant.
Additionally, patient problems are complex and there is never one
correct Treatment Plan. Many treatment approaches are valid and
caregivers have found the many options suggested by the process of
FIG. 8 to be helpful in defining an optimum Treatment Plan for
patients. Additionally, patients are not static. Their problems can
change dramatically from day to day, and the limitless number of
Treatment Plan options offered by the invention can aid caregivers
in their attempts to stay abreast of changing patient conditions
and anticipated events or reactions to treatment.
[0114] As a refinement of the invention, a severity factor has been
incorporated into the invention as a problem modifier . When a
caregiver selects a problem for a Progress Note, he or she
indicates the severity of the problem on a scale of one to five.
This has the effect of weighting the linkages between a problem and
the items selected for Treatment Plan generation. As a result of
this process, the range of items selected during the process of
445, 450, 455, and 460 is narrowed and are more closely aligned to
the patient profile. This is not to say that the philosophy of the
invention has changed. The options presented in item 470 should be
only regarded as suggested options. It is up to the caregiver to
decide on the course of treatment. However, the narrowed spectrum
of possibilities allows the invention to present a more tightly
focused group of options to the caregiver.
[0115] FIG. 9 details the courses open to caregivers when choosing
from the groups option 320 as shown in FIG. 3. From the main menu
screen 295 as shown in FIG. 9, caregivers can select from the group
maintenance option 520, the add group participants option 510, the
schedule group sessions/group Progress Notes option 505, or the
adjust group attendance option 500. Taken together, these four
options provide al the tools needed for caregivers to create,
maintain and schedule therapy groups.
[0116] The group maintenance option 520 is used to set up and
decommission groups. With option 520, the structure of the group is
set up. The group is populated with patients using option 510, add
group participants. The caregiver begins the process of option 520
by selecting the chosen facility from a pull down menu 525 as shown
in FIG. 9B. The caregiver names the group entering the name in the
data entry screen 530 FIG. 9B, then decides if another group is to
be entered 535 FIG. 9B. If so, the process loops around to the
select facility option 525. If the caregiver wishes to exit the
process of 520, he or she selects to return to the main menu 540
FIG. 9B.
[0117] At this point, the caregiver would populate the group just
created using the add group participants option 510 FIG. 9B. The
caregiver begins this process by selecting a facility and the group
name from pull-down menus 545 as shown in FIG. 9B, then selects the
name of the group participant by selecting a facility and patient
name from pull-down menus 550 as shown in FIG. 9B. The reason the
facility must be selected a second time is that patients from one
location may take part in groups at another location.
[0118] The caregiver then moves on to the add or delete option 555
as shown in FIG. 9B. Since the process of 510 is used both to add
and delete patients from groups, the caregiver must indicate his or
her intention on the screen of item 555. At this point, the
caregiver indicates if another patient is to be added or deleted
from a group. If the caregiver wants to continue the process of
510, there are two options. The caregiver can continue to work with
the present group by moving to the select patient option 550. If
work with a different group is desired, the caregiver moves to the
select facility and group option 545. If the caregiver wishes to
exit the process of 510, he or she returns to the main menu 565 as
shown in FIG. 9B.
[0119] After populating a group with patients, the caregiver moves
on to the process scheduling the group by selecting option 505 as
shown in FIG. 9A. Option 505 serves a double duty as it is used to
set group schedules and as an entry to the Group Progress Note
option. The process of 505 as shown in FIG. 9A begins with the
caregiver selecting the facility 570 as shown in FIG. 9A and the
group 575 through the use of pull down menus. At this point 580 as
shown in FIG. 9A, the caregiver indicates whether the objective is
to start a Group Progress Note by selecting the Group Progress Note
option 585 or to move to the scheduling option 590.
[0120] If the caregiver chooses the scheduling option, he or she
enters a starting time and date and the invention automatically
schedules a preset number of group meetings at that time slot. With
item 595, the caregiver indicates whether another group is to be
scheduled, in which case the invention loops back to item 570. If
the other option is selected at 595, the caregiver goes back to the
main menu 600.
[0121] The process of the Group Progress Note 585 is slightly
different from an individual Progress Note. The dynamics of a
group's interaction are complex compared to reactions of
individuals within the group. Thus, data entry 588 consists of the
caregiver moving directly to an expanded note section where the
behavior of the group, (including process notes and therapeutic
group issues), as well as significant individual patient reactions
are noted.
[0122] When the note is saved 592, it automatically is placed in
the record of all patients who are scheduled to participate in a
group. Typically, a caregiver then returns to the main menu 600 to
record individual Progress Notes for all members of the group
through selection of adjust group attendance option 500 as shown in
FIG. 9. Thus, a patient record will contain the Group Progress Note
delineating the dynamics of the group and the group's reaction to
the group discussion in an individual Progress Note detailing the
patient's reaction to the dynamics of the group and his or her
progress in dealing with specific problems within the context of
the group therapeutic experience. This information is contained in
a second Expanded Text section. Thus the Progress Note for a
patient attending a group will have the general Expanded Text note
common to all who attended the group and an individualized Progress
Note focusing on the patient. The invention is structured so that
the group expanded note is saved then automatically added to each
individual Progress Note as the caregiver writes the note.
[0123] The adjust group attendance option 500 as shown in FIG. 9A
is accessed from the main menu. After selecting option 500, the
caregiver will select the facility and the group from pull-down
menus 605. Next, the caregiver selects the patient from a pull down
menu displaying patients in the group 610, and enters the data for
the Progress Note. The Progress Note follows the quick Progress
Note process of FIG. 7 including identification and selection of
assessment data, patient's participation level, participation
quality, "at risk" status, overall theme of the group and the type
of interventions specifically directed towards the patient with
most of the input coming from pull down menus. The problem selected
for the individual Progress Note reflects the problem presented by
the patient to the group on that given day and time of treatment
and/or the patient's reaction to the group and its dynamics.
[0124] For example the group discussion may be about a sense of
loss, but an individual patient's reaction to the group might well
be anger. Thus, the caregiver would select anger for the individual
Progress Note. The information from the pull-down menus will
describe the patient's reaction to the group in general terms, and
the expanded note section will document details and possible
explanations for the patient's behavior from the caregiver's point
of view.
[0125] This note taken together with the Group Progress Note
provides a detailed picture of the patient's reaction to the
complex dynamics of the group. Because the time required to produce
the Group Progress Note is divided by the number of participants,
the composite time required to create a Group Progress Note and an
individual Progress Note should be only slightly more than three to
five minutes.
[0126] FIG. 10 shows the process for scheduling appointments for
individual patients. The process begins from the main menu screen
295 with the selection of the individual scheduler option 630. Next
the caregiver selects the facility and the patient from pull-down
menus 635, then enters the desired schedule data 690. As with the
group scheduling data entry screen 590 as shown in FIG. 9, the
invention permits automated scheduling of appointments after
entering an initial date.
[0127] With item 645, the caregiver decides to schedule another
patient or to return to the main menu 650. If the caregiver decides
to schedule another patient, the process loops around to item 635
so that the caregiver can select another facility and patient.
[0128] FIG. 11 shows the process for patient enrollment. The
process begins with the main menu screen 295. The caregiver then
selects the patient maintenance option 652, and moves on to
entering patient identification data 655. Patient identification
data typically will consist of entering the patient's name, social
security number, date of birth, gender and may include the
patient's Medicare and Medicaid number. Additional, identification
data will include date of entry into facility or treatment, marital
status, past hospitalizations, relevant medical history, and
involved family members or friends.
[0129] Next, the caregiver enters the patient's address and the
location of facility where the patient will be housed 660. Although
pull-down menus are used whenever possible throughout the actions
represented by 655 and 660, most of the data will have to be
entered by keyboard. The caregiver then moves on to entering the
initial assessment data 665. This section makes fill use of
pull-down menus to describe the patient's condition and select the
proper diagnostic code. A final step is to enter data on relevant
physical issues 670. Here again, pull down menus are used to speed
data entry. From this point, the caregiver moves on to item 675
where a decision is made to return to the main menu 680 or to
enroll another patient. If the latter option is chosen, the process
loops around to patient maintenance option 652.
[0130] The process of FIG. 12, the caregiver or physician
maintenance option is similar to the process of FIG. 11. The
process starts from the main menu screen 295 with the next step
being selection of the caregiver/physician maintenance option 685.
For the enter identification information step 690, most of the
information is entered via the keyboard, but pull-down menus are
used where possible to speed up the process. The next steps,
entering the address 695, access numbers 700, and credentials 705
are made via keyboarding as there is little opportunity to use
pull-down menus. With item 710, the caregiver returns to the main
menu 715 or enters data for a new caregiver/physician 690.
[0131] The processes of FIGS. 11 and 12 are the most keyboard
intensive tasks experienced with the invention. However, these are
one time efforts and should not take longer than five to ten
minutes per person. Thus, these aspects of the invention will not
compromise the overall time savings offered by the invention.
[0132] The invention may be used in a stand-alone mode or, as shown
by FIG. 13, a central server could be used as a database in a local
or wide area network application. The main advantage to this
approach is the rapid compilation of a large historical database. A
database compiled by multiple caregivers becomes an invaluable tool
for doing research.
[0133] FIG. 13 shows a central server 800 acting as a database, a
workstation 830 connected via a local area network 825, as well as
a laptop computer 810 connected via a modem. Both the workstation
and the laptop would be independent of the server 800 except for
downloading data at the end of the day or accessing data on an
irregular basis. Device 820 represents a terminal in a network
environment wherein the terminal is interacting in real time with
the server 800. In this case only the application is on the
terminal. All records are accessed via the server. The advantage to
this is that different users my be granted different access
privileges.
[0134] The invention is presently configured as a relational
database using a series of tables with common fields to implement
the relational functionality. This configuration was selected for
ease of implementation, flexibility and for the amenability to
statistical and other types of inquiries. The product used as a
base for the database is MICROSOFT ACCESS.RTM.. This is not to say
that the invention is tied to the relational database model any
more than it is tied to any particular operating system. That said,
the invention works very smoothly and quickly as presently
configured.
[0135] FIGS. 14A, B, C, and D show the fields that make up a
Treatment Plan Note report and the sources for the data populating
the fields. This report first identifies the patient 827 FIG. 14A,
displays a history of past problems 831 FIG. 14A, displays symptoms
displayed by the patient during the session being reported on 832
FIGS. 14A and 14B, then ends with the Treatment Plan
recommendations 833 FIGS. 14B, 14C, and 14D. FIG. 14A shows the
first part of a Treatment Plan Note. The word "patient" 802 comes
from the Treatment Plan format element 260 FIG. 5 and is always
displayed with a Treatment Plan Note. The accompanying name of the
patient AAANestor AAATestor 803 comes from the patient master table
240 FIG. 4 as does much of the basic patient identification data.
As shown, the patient's social security number 809, gender 804,
Medicare and Medicaid numbers 807, date of birth 811, and facility
name 806 all come from the patient master table 240. All these
elements are keyed to the social security number which is
referenced by the session ID number 812 which comes from the
Progress Notes table 195 FIG. 4.
[0136] Thus when a Treatment Plan Note is generated, for a
particular session, the social security number of the patient
linked to that secession ID number implements the relationship
between the two tables and facilitates the population of the
previously discussed patient information fields. This also includes
the problem DSM-IV Codes 814 and 816 that come from the patient
master table as well as the attendant verbal descriptions 817 and
818, that come from the problem master table 75 FIG. 3.
[0137] The caregiver code 821 and the name of the caregiver 823
come from the Progress Note table 195 and the caregiver table 200
respectively both of FIG. 4. Thus when this treatment report is
generated, the caregiver code related to the session ID number from
the Progress Note table 195 provides the link to the caregiver name
from table 200 FIG. 4, thus completing the patient identification
section 827 FIG. 14A.
[0138] The patient history section 831 receives data from two
sources, the patient problem cross-reference table 210 FIG. 4 and
the problem table 75 FIG. 3. Item 210 contains the problem codes,
100.001 item 837 being an example, for any problems reported in a
Progress Notes. These problems are linked to the patient's social
security number, thus are accessed and displayed when the Treatment
Plan Note is generated. Item 839 is an example of a verbal
description of a problem linked to the problem codes. These
descriptions come from the problem table 75 FIG. 3.
[0139] The information of section 832 FIGS. 14A and 14B comes from
the Progress Notes table 195 FIG. 4. This material is inked to this
report with the session HD code 812. When a problem code is saved
for the problem of the day in the Progress Note table 195, it
results in the population of fields 841 and 843. As an aside, if no
data were save in the problem of the day section of the Progress
Note table 195, fields 841 and 843 would not be populated and the
area in the report would remain blank As shown in FIG. 14A, item
841 comes from the Progress Notes Additional Text table 245 FIG. 4
and the attendant problem description 843 comes from problem table
75 FIG. 3.
[0140] The caregiver's detailed comments 844 come from the Progress
Notes Expanded Text table 250. Again these items are linked to the
session ID code 812. Boilerplate 846 comes from the Progress Notes
extended text table 245 FIG. 4, while the attendant behavioral
definition 847 comes from the table of behavioral definitions 100
FIG. 3. Boilerplate statement 849 concerning related conditions
comes from the Progress Notes Additional Text table 245 FIG. 4 and
the attendant condition comes from the other related conditions
table 165 FIG. 3. As in earlier cases, the code for item 851 is
stored in the Progress Notes record 195 FIG. 4 and is linked to the
session ID 812.
[0141] Moving to FIG. 14B, the emotional issue boilerplate 851
comes from the Progress Note Additional Text table 245, as does the
physical issues boilerplate 852. The emotional issue entry 853
comes from the emotional issue table 160 FIG. 3 while the physical
condition description 864 comes from the physical issues table 140
FIG. 3. These entries complete item 832, that section of the report
dealing the patient's condition as observed by the caregiver at the
time of the 10 treatment session.
[0142] Item 833 FIGS. 14B, 14C, and 14D contains the Treatment
Plan. As described earlier, the Treatment Plan is based on the
problem observed and noted by the caregiver on the Progress Note.
For this report, the problem of the day is depression 843 FIG. 14A.
The first section of the Treatment Plan deals with assessment data.
This material is displayed in terms of the five dimensions
expressed earlier, physical, emotional, intellectual, social and
spiritual. The section is headed by boilerplate 856 that comes from
the Treatment Plan Additional Text element 233 FIG. 4. The
assessment issues displayed 857, 858, 859, 861, and 862, all of
FIG. 14B, come from the assessment cross reference table item 95
FIG. 3. Two items are described for each assessment issue. As the
invention is configured presently, these issues are chosen at
random from the pool of data linked to depression in the assessment
cross-reference table 95 FIG. 3.
[0143] The rest of the Treatment Plan deals with long term goals,
short term objectives, therapeutic interventions, and suggested
future treatment. As descried earlier, the process for populating
the data field for long term goals, short term objectives, and
therapeutic interventions is keyed to the problem of the day, in
this case depression. As is the case for the assessment section
above, a randomizing algorithm selects two items from the data pool
linked to depression for each category.
[0144] Long term goal boilerplate 863 comes from Treatment Plan
Additional Text 233 FIG. 4 with the attendant data 864 FIG. 14C
coming from the long-term goal cross-reference table 133 FIG. 3.
The next section, short term objectives, proceeded by boilerplate
866 which comes from Treatment Plan Additional Text 233 FIG. 4, is
displayed in the five dimensions. This data, physical 867,
emotional 868, intellectual 869, social 872, and spiritual 871
comes from the short-term objective cross-reference table 123 FIG.
3. As with the process above a randomizing element pulls two
selections from the pool linked to each dimension from table
123.
[0145] Therapeutic intervention boilerplate 873 comes from the
Treatment Plan Additional Text table 233 FIG. 4. As with the
short-term objectives, two data selections are made for each of the
five dimensions. Physical data 874 FIG. 14C comes from the
therapeutic interventions cross-reference table 127 FIG. 3 as does
emotional data 876, intellectual data 877, social data 878, and
spiritual data 879, all of FIG. 14D. The final section future
treatment, is headed by boiler plate 881 from the Progress Notes
Additional Text table 245 FIG. 4 with the attendant data 882 coming
from the future treatment table 150 FIG. 3.
Ramifications of the Invention
[0146] The ramifications of the invention are both obvious and
subtle. It should be obvious from reading the specification that
the invention saves caregivers a great deal of time and energy.
What may not be so obvious is the quality of record keeping and
report generation possible based on data analysis enabled by the
invention. When caregivers must keep records without the simulation
and aid of the present invention, records often become generic
because caregivers do not or cannot take time to record relevant
observations resulting in records for one patient tending to be
similar to another. The focused pull-down menus offered by the
present invention relieve caregivers of generating descriptive text
while providing them with stimulating multiple choices.
[0147] When a caregiver makes a Progress Note entry using the
invention, the effect is that of having a panel of experts
presenting various possibilities. The caregiver quickly discards
those choices that seem inappropriate and selects that which seem
reasonable. This multiple choice approach is swift and much less
draining than trying to generate descriptive material from scratch.
Caregivers get tired, discouraged and/or demoralized but the
structure of the invention forces a caregiver to generate a sharply
focused well articulated record.
[0148] One must also take into account the pressure to reduce
treatment costs in the mental health field. A course often taken is
to use either less experienced individuals and or those with lower
levels of training as caregivers. As an example, a nurse, a social
worker, or some other non-doctoral level treatment professional
might replace a doctor as a caregiver. In this environment, the
present invention, with its multiple choice, panel of experts
approach is effective for training and can help caregivers to
become highly effective.
[0149] The automatic combination of a group note linked to an
individual note in a relational database structure is extremely
significant. Patients are complex and the ability to draw on the
entire record of a patient's experience and reaction to a group
setting provides caregivers with a tool that facilitates defining
the real nature of a patient's problems. Additionally, the ability
to access a complete, detailed patient history at any time plus the
ability to generate Treatment Plan alternatives automatically can
only enhance a caregiver's ability to provide more effective
patient treatment. Furthermore, because this invention is based on
quantitative data, even though it has a textual presentation, it
permits unlimited data analysis. These analyses are customizable,
detailed, flexible and personalized reports determined solely by
the caregiver's and/or institution's clinical requirements and
interests. Analysis can be performed against any recorded data.
Examples of these reports and data analysis possible include:
patients seen by date range, by location and by caregiver; reports
of individual and group sessions conducted by caregiver by
location; analysis of procedure codes utilized by caregiver by
location; and periodic reports including all problems addressed in
treatment for patients, all physical and emotional issues, all
medications, and hospitalizations.
[0150] When all is considered, the present invention simplifies and
speeds up the process of patient record keeping, report generation,
data and trend analysis while aiding caregivers in their search for
optimum Treatment Plans. The records accumulated in the invention's
historical database provide a rich source for measuring caregiver
and Treatment Plan effectiveness. The information generated by this
invention also allows for education and supervision, clinical
research and program planning and advanced cost analysis. In short,
not only does the present invention increase the efficiency of
caregiver record keeping, but also it aids them in their attempts
to practice more effective therapy.
[0151] Thus the several aforementioned objects and advantages are
most effectively attained. Although a single preferred embodiment
of the invention has been disclosed and described in detail herein,
it should be understood that this invention is in no sense limited
thereby and its scope is to be determined by that of the appended
claims.
1 Appendix -- Example of Problem List Code Problem 100 Amnesia 200
Anger 300 Anorexia and Bulimia Nervosa 400 Antisocial Behavior 500
Anxiety 600 Alcohol/Chemical Dependence 700 Alcohol/Chemical
Dependence-Relapse 800 Childhood Traumas 900 Chronic Pain 1000
Cognitive Deficits/Confusion 1100 Compulsions 1200 Confusion 1300
Conversions 1400 Crisis 1500 Delusions 1600 Denial 1700 Dependency
1800 Depression 1900 Dissocation 2000 Eating Disorders 2100
Education Deficits 2200 Family Conflicts 2300 Female Sexual
Dysfunction 2400 Grief/Loss Unresolved 2500 Guilt 2600
Hallucinations 2700 Hyperactivity in Children 2800 Hypochondriacal
Behavior 2900 Impulse Control Disorder 3000 Intimate Relationship
Conflicts 3100 Legal Conflicts 3200 Loneliness/Isolation 3300 Low
Self-Esteem 3400 Male Sexual Dysfunction 3500 Malingering 3600
Mania or Hypomania 3700 Manic Behavior 3750 Manipulation 3800
Medical Issues 3900 Negative Self-Concept 4000 Negativism 4100
Noncompliance 4200 Obesity 4300 Obsessions 4400 Paranoid Ideation
4500 Passive-Aggressive Behavior 4550 Personality Disorders 4600
Phobias 4700 Psychoticism 4800 Rape Trauma Syndrome 4850
Schizophrenia 4900 Sexual Abuse 5000 Sleep Disorders 5100 Social
Discomfort 5200 Somatization 5300 Spiritual Confusion 5400 Suicidal
Ideation 5500 Suspiciousness 5600 Vocational Stress 5700 Withdrawn
Behavior
* * * * *