U.S. patent application number 10/276624 was filed with the patent office on 2003-09-25 for methods and apparatus for facilitated, hierarchical medical diagnosis and symptom coding and definition.
Invention is credited to David, Daniel, David, Zipora, Levshin, Alexander, Mikhlin, Mark.
Application Number | 20030181790 10/276624 |
Document ID | / |
Family ID | 26900194 |
Filed Date | 2003-09-25 |
United States Patent
Application |
20030181790 |
Kind Code |
A1 |
David, Daniel ; et
al. |
September 25, 2003 |
Methods and apparatus for facilitated, hierarchical medical
diagnosis and symptom coding and definition
Abstract
Patient pre-screening is facilitated through a system of
hierarchically linked catalogues, each comprising at least one
condition-descriptive entry. The hierarchy of linked catalogues is
essentially tree structure in which the content of the lower-level
catalogues is dependent upon particular entries in upper-level
catalogues. In one embodiment, the uppermost catalogue comprises a
model display of a male or female. In general, a
condition-descriptive entry from an uppermost catalogue is
selected. The selected condition-descriptive entry from the
uppermost catalogue determines at least one lower-level catalogue
that is subsequently displayed By traversing the linked catalogues
in this manner, a concise diagnosis or symptom description may be
quickly and accurately generated. In one embodiment of the present
invention, diagnoses arrived at through the hierarchical structure
include an ICS-9 code, thereby facilitating implementations of
databases.
Inventors: |
David, Daniel; (Ranana,
IL) ; David, Zipora; (Ranana, IL) ; Mikhlin,
Mark; (Yehud, IL) ; Levshin, Alexander;
(Ashdod, IL) |
Correspondence
Address: |
BANNER & WITCOFF, LTD.
TEN SOUTH WACKER DRIVE
SUITE 3000
CHICAGO
IL
60606
US
|
Family ID: |
26900194 |
Appl. No.: |
10/276624 |
Filed: |
November 18, 2002 |
PCT Filed: |
May 18, 2001 |
PCT NO: |
PCT/US01/16044 |
Current U.S.
Class: |
600/300 |
Current CPC
Class: |
A61B 5/1038 20130101;
G16H 30/40 20180101; A61B 5/0013 20130101; A61B 5/002 20130101;
G16H 40/67 20180101; G06V 40/25 20220101; A61B 5/0205 20130101;
G16H 10/60 20180101; A61B 5/112 20130101; G06T 7/20 20130101; A61B
5/4023 20130101; A61B 5/1128 20130101 |
Class at
Publication: |
600/300 |
International
Class: |
A61B 005/00 |
Claims
What is claimed is:
1. A method for facilitating medical pre-screening, the method
comprising steps of: providing an uppermost catalogue of a
plurality of hierarchically linked catalogues, wherein each of the
plurality of hierarchically linked catalogues comprises at least
one medical condition-descriptive entry; receiving an indication of
a selected uppermost condition-descriptive entry from the uppermost
catalogue; and providing at least one additional lower catalogue of
the plurality of hierarchically linked catalogues based on the
selected uppermost condition-descriptive entry.
2. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 1.
3. The method of claim 1, wherein each catalogue of plurality of
hierarchically linked catalogues comprises a menu.
4. The method of claim 1, wherein the uppermost catalogue comprises
a body systems catalogue and the at least one condition-descriptive
entry included therein corresponds to at least one body system
entry.
5. The method of claim 4, wherein the selected uppermost
condition-descriptive entry corresponds to a selected body system
entry, and wherein the at least one additional lower catalogue
comprises a subsystems catalogue and the at least one
condition-descriptive entry included therein corresponds to at
least one subsystem entry based on the selected body system
entry.
6. The method of claim 5, further comprising a step of: receiving
an indication of a selected subsystem entry from the subsystems
catalogue, wherein the step of providing the at least one
additional lower catalogue further comprises providing a diagnosis
catalogue based on the selected subsystem entry, and wherein the at
least one condition-descriptive entry included in the diagnosis
catalogue corresponds to at least one diagnosis entry based on the
selected subsystem entry.
7. The method of claim 6, wherein each of the at least one
diagnosis entry comprises an ICD9 code.
8. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 7.
9. The method of claim 1, wherein the uppermost catalogue comprises
a model display of either a male model or a female model.
10. The method of claim 1, wherein the uppermost catalogue
comprises a body parts catalogue and the at least one
condition-descriptive entry included therein corresponds to at
least one body part entry.
11. The method of claim 10, wherein the selected uppermost
condition-descriptive entry corresponds to a selected body part
entry, and wherein the at least one additional lower catalogue
comprises a symptoms catalogue and the at least one
condition-descriptive entry included therein corresponds to at
least one symptom entry based on the selected body part entry.
12. The method of claim 11, further comprising a step of: receiving
an indication of a selected symptom entry from the symptoms
catalogue, wherein the step of providing the at least one
additional lower catalogue further comprises providing a general
qualifier catalogue based on the selected symptom entry, and
wherein the at least one condition-descriptive entry included in
the general qualifier catalogue corresponds to at least one general
qualifier entry based on the selected symptom entry.
13. The method of claim 12, wherein the step of providing the at
least one additional lower catalogue further comprises providing a
special qualifier catalogue based on the selected symptom entry,
and wherein the at least one condition-descriptive entry included
in the special qualifier catalogue corresponds to at least one
special qualifier entry based on the selected symptom entry.
14. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 13.
15. In a computer system comprising a display and a user interface
selection device, a method for facilitating medical record
generation, the method comprising steps of: providing, on the
display, a plurality of hierarchically linked catalogues, wherein
each of the plurality of hierarchically linked catalogues comprises
at least one medical condition-descriptive entry; receiving, via
the user interface selection device, selection information
corresponding to user selections from a portion of the plurality of
hierarchically linked catalogues, wherein the at least one
condition-descriptive entry included in each lower-level catalogue
of the portion of the plurality of hierarchically linked catalogues
is based on the user selections relative to at least one
higher-level catalogue of the portion of the plurality of
hierarchically linked catalogues; and providing, on the display, a
diagnosis based on the user selections.
16. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 15.
17. The method of claim 15, wherein each catalogue of plurality of
hierarchically linked catalogues comprises a menu.
18. The method of claim 15, wherein the diagnosis comprises an ICD9
code.
19. The method of claim 15, further comprising steps of: providing,
on the display, a problem input mechanism; receiving, via the user
interface selection device, an indication of user selection of the
problem input mechanism; and providing, on the display and
responsive to the indication of user selection of the problem input
mechanism, a patient problem list comprising the diagnosis.
20. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 19.
21. The method of claim 19, wherein the patient problem list
comprises a severity field, the method further comprising steps of:
receiving severity level information relative to the diagnosis; and
providing, on the display, the patient problem list comprising the
severity level information for the diagnosis.
22. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 21.
23. The method of claim 19, wherein the patient problem list
comprises an onset date field, the method further comprising steps
of: receiving onset data information relative to the diagnosis; and
providing, on the display, the patient problem list comprising the
onset date information for the diagnosis.
24. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 23.
25. In a computer system comprising a display and a user interface
selection device, a method for facilitating medical record
generation, the method comprising steps of: providing, on the
display, a plurality of hierarchically linked catalogues, wherein
each of the plurality of hierarchically linked catalogues comprises
at least one medical condition-descriptive entry; receiving, via
the user interface selection device, selection information
corresponding to user selections from a portion of the plurality of
hierarchically linked catalogues, wherein the at least one
condition-descriptive entry included in each lower-level catalogue
of the portion of the plurality of hierarchically linked catalogues
is based on the user selections relative to at least one
higher-level catalogue of the portion of the plurality of
hierarchically linked catalogues; and providing, on the display, a
qualified symptom description based on the user selections.
26. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 25.
27. The method of claim 25, wherein at least one catalogue of the
plurality of hierarchically linked catalogues comprises a model
display of either a male model or a female model.
28. The method of claim 27, further comprising a step of:
receiving, via the user interface selection device, an indication
of a selected portion of the model display.
29. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 28.
30. The method of claim 28, further comprising a step of:
providing, on the display, an enlarged display of the selected
portion.
31. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 30.
32. The method of claim 25, further comprising steps of: providing,
on the display, a symptom input mechanism; receiving, via the user
interface selection device, an indication of user selection of the
symptom input mechanism; and providing, on the display and
responsive to the indication of user selection of the symptom input
mechanism, a patient complaint list comprising the qualified
symptom description.
33. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 32.
34. The method of claim 32, wherein the patient problem list
comprises a severity field, the method further comprising steps of:
receiving severity level information relative to the qualified
symptom description; and providing, on the display, the patient
complaint list comprising the severity level information for the
qualified symptom description.
35. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 34.
36. The method of claim 32, wherein the patient problem list
comprises an onset date field, the method further comprising steps
of: receiving onset data information relative to the qualified
symptom description; and providing, on the display, the patient
complaint list comprising the onset date information for the
qualified symptom description.
37. A computer-readable medium comprising computer-executable
instructions for performing the steps recited in claim 36.
38. The method of claim 1, 15 or 25 in combination with a method
for remote monitoring of a subject including the steps of acquiring
the medical condition entry from a remote monitoring site and
transmitting information from a subject located at the information
to a central record keeping site.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] Related subject matter is found in U.S. Pat. No. 5,441,047,
and U.S. Pat. No. 5,544,649, the teachings of which patents are
hereby incorporated by this reference. This is a patent application
based upon previously filed U.S. provisional application Serial No.
60/205,186 filed May 18, 2000, for Method and Apparatus for
Facilitating Medical Pre-Screening for which priority is
claimed.
TECHNICAL FIELD
[0002] The present invention relates to techniques for medical
diagnosis, symptom coding and definition.
BACKGROUND OF THE INVENTION
[0003] Before the advent of electronic data processing, clinical
medical records were generally either handwritten or transcribed.
This offered almost no ability to search for and analyze clinical
information. Further exacerbating this situation, patient
complaints often differ widely even when describing the same
condition, thus making such complaints most difficult to capture in
a structured manner.
[0004] To achieve at least a basic level of commonality, structure
and accessibility, codes to be used when performing patient
diagnosis, such as the International Classification of Diseases,
9th Revision, Clinical Modification (ICD-9-CM, hereinafter
"ICD-9"), were established. However, codebooks are long and
cumbersome to use, thus making codification a very time-consuming
and error-prone task. A system is needed to simplify and expedite
their application. Moreover, in the process of monitoring patients
and/or interviewing patients for subsequent physician examinations,
a method for obtaining more consistent and standardized patient
information (i.e., problem definitions and complaint
formalizations) is required. Such a technique will be crucial in
creating a database that can be used for future statistical
analysis and decision support.
[0005] U.S. Pat. Nos. 5,441,047 and 5,544,649 ("the '047 and '649
patents"), incorporated by reference, disclose an interactive,
two-way audio-visual communication system for use in monitoring
ambulatory (at home) patients. In particular, the '047 and '649
patents describe a system wherein a health care worker at a central
station monitors and/or examines the patient, while the patient is
at a remote location. The patient may be a person having a specific
medical condition being monitored or may be an elderly person
desiring general medical surveillance in the home environment.
Cameras are provided at the patient's remote location and at the
central station such that the patient and the health care worker
are in interactive visual and audio communication. A communications
network such as an interactive cable television is used for this
purpose. Various medical condition sensing and monitoring equipment
are placed in the patient's home, depending on the particular
medical needs of the patient. The patient's medical condition is
measured or sensed in the home and the resulting data is
transmitted to the central station for analysis and display. The
health care worker then is placed into interactive visual
communication with the patient concerning the patient's general
well being, as well as the patient's medical condition. Thus, the
health care worker can make "home visits" electronically,
twenty-four hours a day.
[0006] A technique combining the monitoring techniques of the '047
and '649 patents with an improved method of patient medical
diagnosis, consistent, standardized record keeping and symptom
coding would be an advancement of the art.
SUMMARY OF THE INVENTION
[0007] The present invention provides a technique for facilitating
the acquisition of standardized patient medical information through
a system of hierarchically linked catalogues, each comprising at
least one condition-descriptive entry. The hierarchy of linked
catalogues is essentially a tree structure in which the content of
the lower-level catalogues is dependent upon particular entries in
upper-level catalogues. In one embodiment, the uppermost catalogue
comprises a model display of a male or female. In general, a user
of the system selects a condition-descriptive entry from an
uppermost catalogue. The selected condition-descriptive entry from
the uppermost catalogue determines at least one lower-level
catalogue that is subsequently displayed to the user. By traversing
the linked catalogues in this manner, the user of the system can
arrive at a concise diagnosis or symptom description. Because the
condition-descriptive entries in each catalogue are predetermined,
commonality of problem descriptions is inherent. In one embodiment
of the present invention, diagnoses arrived at through the
hierarchical structure include an ICD-9 code, thereby facilitating
implementations of databases. These and other advantages and
features of the subject invention will become apparent from the
detailed description of the invention that follows.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] In the detailed description of presently preferred
embodiments of the present invention which follows, reference will
be made to the drawings comprised of the following figures, wherein
like reference numerals refer to like elements in the various views
and wherein:
[0009] FIG. 1 is a more detailed functional block diagram of the
data analysis and display center of the central station of FIG.
2;
[0010] FIG. 2 an illustration of one possible arrangement of the
health monitoring and telecommunications equipment in the central
stations;
[0011] FIG. 3 an illustration of one possible arrangement of the
medical condition measuring, sensing and telecommunications
equipment in a patient's home environment;
[0012] FIG. 4 illustrates an exemplary hierarchy in accordance with
the present invention;
[0013] FIG. 5 illustrates an exemplary first embodiment of a
plurality of hierarchically linked catalogues each comprising at
least one condition-descriptive entry in accordance with the
present invention;
[0014] FIGS. 6A and 6B illustrate an exemplary second embodiment of
a plurality of hierarchically linked catalogues each comprising at
least one condition-descriptive entry in accordance with the
present invention; and
[0015] FIG. 7 illustrates an exemplary problems/complaints list in
accordance with the present invention.
DETAILED DESCRIPTION OF THE INVENTION
[0016] The system of the present invention may use or incorporate
inexpensive home medical monitoring equipment that includes a
camera, sensors and measuring devices for the particular medical
parameters to be monitored. The patient's home equipment is simple
to use and modular to allow for the accommodation of the monitoring
device to the specific needs of each patient. To reduce production
costs and to avoid complex maintenance problems, the home unit
includes only the sensor part of the measuring device. The raw
data, including video image data, is transmitted to the central
station, which includes all of the needed sophistication to allow
for the storage, transformation, display and interpretation of the
data. The need for expensive equipment in the home is thus avoided.
Inexpensive sensors are placed in the patients' homes, and the more
costly analytic equipment for all the patients is located at the
central station.
[0017] The central station includes a computer-based multi-channel
data analysis and display unit that enables the interpretation,
display, and storage of the transmitted data. This central station
is preferably equipped with alarm mechanisms to alert the staff to
any aberration from the expected. The central station further
includes apparatus for the communication of data to all authorities
involved in the wide spectrum of the patient's needs, e.g.,
emergency care agencies, the patient's physician, nursing services,
social workers, etc.
[0018] The central station is preferably provided with the
capability of automatically scanning predesignated patient home
units at predetermined intervals to provide continuous supervision
of specific parameters. In some instances, the central station may
monitor continuously one or more parameters, e.g., ECG, blood
pressure, respiration, etc., for hours or even days, thereby
creating a semi-intensive-care capability. The embodiment disclosed
enables one highly trained nurse or patient monitoring personnel
located at the control center to supervise and monitor a multitude
of patients either seriatim or substantially simultaneously.
Whereas a visiting nurse may only be able to visit 5 or 6 homes per
day in person, a nurse at the central station may be able to visit
5 or 6 patients per hour by making electronic "home visits".
[0019] Cable television provides an already existing, widespread
and ideal system for interactive visual communication with most
residential units in densely populated urban areas. The ambulatory
patient monitoring system integrating the latest advances in
biomedical technology with cable television provide safe and
accurate general and medical supervision for the
geriatric/homebound population in their own, natural
environment.
[0020] Using such an interactive system, a direct visual uni- or
bi-directional contact between the elderly person monitored and the
supervision is established at any time, day or night. This contact
can be initiated, at will, by the patient monitor or by the
patient. Moreover, this communication system is used to transfer
general data as well as medical data from sensors to monitor the
various medical and non-medical parameters. Further, a health
practitioner may be able to have "classes" with many remotely
located patients.
[0021] Cable television networks provide a useful mode of
communication between the patient's remote location and the central
station at the present, and is a presently preferred means for
transmission of the audio-visual signal from the patient to the
central station and for transmission of the audio-visual signal of
a health practitioner to the patient's remote location. Further,
the measured medical data can be displayed in the patient's remote
location and the parameters picked up by the camera. The
transmission of the measured medical data may also be by cable
television, or may be through another communication network such as
the telephone system. The data transmission could also be by
microwave, cable, or other transmission means. It will be
appreciated that as advances in telecommunications develop, other
techniques for transmission of video signals between a central
station and the home may be desirable and economically feasible.
For example, satellite and radio transmission of the video signal
and/or monitored medical data, or transmission via modem through
the telephone lines, may also prove satisfactory.
[0022] Communication between the patient's remote location and the
central station can be initiated by a variety of techniques. One
method is by manually or automatically placing a call on the
telephone to the patient's home or to the central station. When the
call is received, a responsive switch is thrown, turning on the
camera in the patient's home or at the central station.
Alternatively, the patient and central station could agree on times
or time intervals in which communication would take place. Ideally,
a remote control button on the patient's chair is installed which,
when activated, turns on the equipment in the home and alerts the
health practitioner at the central station.
[0023] Referring now to FIG. 1. Data indicating the medical
condition of the patient is sensed in the patients' remote location
and may be sent via the telephone lines to the central station 20.
The data is in turn relayed on a data bus 68 into a central
computer 70. The central computer 70 has both a data storage center
72 (including volatile and/or non-volatile memory, as known in the
art), and a central processing unit (CPU) 74. The data storage
center 72 stores incoming patient data for a given period of time,
which may be over 24 hours, so that a physician or health
practitioner can go back through the patient's medical data, during
the previous 24 hours for example, and ascertain what the patient's
health or condition was at a certain period of time. This
capability is important for diagnostic purposes because it allows
the physician to monitor and analyze the patient's medical
condition prior to a given event such as a cardiac arrest. The
physician can simply enter commands into the keyboard 76 to access
particular data from a particular period of time and display the
information. For example, the physician may have the patient
monitored for electrical activity in the heart. The patient will
have a set of electrodes attached to his chest and the electrical
potentials are measured on the surface of the chest. The data
analysis and display unit 28 may further include a means for
transferring the medical data onto high storage capacity media 77
such as optical disks, which can then be retrieved at a later point
in time. The diagnostic tools provided by this data analysis and
display center significantly enhances the ability to monitor
patients in the home and to diagnose precise medical conditions
based on the collected data. Because the present invention provides
a technique amenable to the use of standardized codes in diagnosing
patients and describing their symptoms, the stored data may be
readily searched and analyzed in a coherent manner.
[0024] Still referring to FIG. 1, the audio-visual signal from the
patient is fed on cable 84 to a video storage unit 86. Again, a
health care practitioner or physician may enter commands at the
keyboard 76 for the central computer 70 and retrieve the
audio-visual signal stored in the video storage unit 86 such that
he or she can see the picture of the patient on a TV screen 88
either simultaneous with its transmission from the patients' remote
location 10, or during a previous period of time. For example, if
the patient was experiencing chest pains at 3:00 a.m. the previous
day, the physician may want to see the picture of the patient at
3:00 a.m. The physician enters a command into the keyboard 76, or
manipulates the video data storage device 86, such as a VCR, to
retrieve the video picture of the patient 16 at 3:00 am. The
picture of the patient 16 is displayed on the screen 88 together
with a time field 90. The physician can then have the display units
82 or 78 display the electrocardiograms in a one or two-dimensional
image to correspond with the patient's picture at that period of
time so he can match up the medical data with the video image of
the patient.
[0025] Also depicted in FIG. 1 is a computer monitor 150 of the
type well known in the art. The computer monitor 150 is used, in
one embodiment of the present invention, as part of a user
interface along with a user interface selection device (such as a
mouse, touch screen, voice recognition interface, etc.) to allow
the health care practitioner to operate software programs stored in
memory 72 and executed by the processor 74. In particular, the
healthcare practitioner can use the two-way, audio visual
communication capabilities of the present invention to perform
medical pre-screening on diagnostic record keeping using software
programs running on the computer 70. As described herein.
[0026] Referring now to FIG. 2, there is illustrated one possible
arrangement of the health monitoring and telecommunications
equipment at the central station 20 surrounding the health
practitioner or nurse 112. The nurse 112 enters via keyboard 76 of
the central computer 70 commands to call up on the TV screen 88 the
patient 16 of interest. The commands may also include commands to
start up the camera in the patients home. The central computer 70
is linked with the switching center 34 (FIG. 2) such that any of
the subscriber patients can be accessed. Preferably, the patient's
medical records and history are entered into the computer 22 such
that when the particular patient is selected, the history is
displayed either on the display 150 of computer 70 or on a separate
screen 152. This enables the nurse 112 to rapidly familiarize
herself with the patient. If the patient's data is being
simultaneously transmitted to the central station 20, the patient's
ECG or cardiac activity can be displayed on displays 78 and 82,
respectively. Alternatively, the patient's oximetry data may be
displayed for a given period of time on a separate display 154. The
nurse 112 also has a camera 22 oriented towards her which generates
an audio-visual signal for transmission to the patient's remote
location 10.
[0027] The patient depicted in FIG. 3 may be examined for various
ambulatory and other physical characteristics useful in the
diagnosis of patient health, for example the predisposition to
fall. For example, gait and mobility of the patient may be examined
and analyzed using the system of the invention. Specifically, the
video camera 22 may include a lens having a wide angle vision
field. The patient 16 can be orally instructed by the health
practitioner to position himself at a start position in the vision
field, for example, standing erect at the center of the vision
field at a specified distance from the camera 22. The practitioner
112 will direct the patient 12, having been positioned at the start
position, to conduct specific physical activities such as specific
arm movements, walking, bending, etc.
[0028] The video image data generated in this manner is transmitted
to the central station where it can be recorded for subsequent
analysis. As described in greater detail below, the video image
data can then be used to generate motion characteristics data for
comparison with previously stored standard data or previously
recorded data for that patient. Also the recorded visual signal may
be reviewed by the practitioner for purposes of diagnosis and
advice to the patient. Thus, the predisposition of a patient to
fall and the potential reasons for a fall can be predicted and
preventive intervention can be attempted. For example, a change in
medication can be prescribed or physical therapy may be instituted.
The system may then be utilized to monitor the results of the
prescribed medication or therapy.
[0029] Thus, the video image data alone may be relied upon to
provide a medical signal or diagnostic information relating to
specific body parts or functions, just as physicians and medical
practitioners regularly rely upon visual diagnosis. The system of
the invention permits such diagnosis. As another, rather than using
a wide angle video input to view the entire patient in an
ambulatory condition to study gait, etc., a narrow field or angle
signal can be utilized to conduct, for example, an eye examination.
Such an examination could focus on eye movement, pupil size under
differing conditions, eye reaction time, eye condition in view of a
regimen of medication, and numerous other diagnostic matters. The
condition and color of skin can also be examined using a narrow
field visual technique. Again, the visual condition of a patient is
an important diagnostic tool and reaction to medication, growth of
moles, and skin disturbances can be recorded, compared to standards
and prior data in an ongoing manner to facilitate patient
treatment.
[0030] Building upon the interactive audio-visual communication
system described above, the present invention facilitates patient
diagnosis and record keeping through the use of hierarchically
linked catalogues comprising condition-descriptive entries. FIG. 4
illustrates an exemplary hierarchy 700 in accordance with the
present invention. In particular, the hierarchy 700 comprises a
well-known tree structure. As shown, a topmost element "A" is
linked to lower level elements, here labeled "B" and "C". Elements
"B" and "C", in turn, are linked to still-lower elements "D", "E",
"F" and "G", respectively. Even lower elements "H", "I", "J", "K"
and "L" are linked to higher level elements "D" and "F",
respectively. An arbitrary number of levels may be provided. If
successively lower levels of elements are considered as increasing
specific descriptions of medical diagnoses and/or symptoms, it
becomes readily evident that the tree structure may be traversed
from top to bottom to efficiently arrive at such diagnoses or
symptom descriptions. The present invention builds upon this
principle, as described in greater detail below.
[0031] Referring now to FIG. 5, an exemplary first embodiment of a
plurality of hierarchically linked catalogues 802-806 (each
comprising at least one condition-descriptive entry) is
illustrated. In particular, the example illustrated in FIG. 5
allows a health care practitioner to arrive at a diagnosis through
increasingly specific condition-descriptive entries. Generally, the
plurality of hierarchically linked catalogues is generated using
software routines executed by a suitable computing platform and
displayed on a monitor or similar device. For example, with
reference to FIG. 2, the catalogues are displayed on the monitor
150 based on software executed by the computer 80.
[0032] In the example illustrated in FIG. 5, three catalogues
802-806 are illustrated. A topmost or uppermost catalogue 802 is
logically positioned at the top of the hierarchy. In accordance
with the present invention, the uppermost catalogue 802 generally
comprises the most general condition-descriptive entries.
Successively lower catalogues 804-806 comprise correspondingly more
specific condition-descriptive entries. In particular, the
catalogues 802-806 are organized according to a
System-Subsystem-Diagnosis hierarchy, as described below. Although
only three catalogues are illustrated in FIG. 5, it is understood
that a greater or lesser number of catalogues could be used and
arranged in this manner.
[0033] Each condition-descriptive entry within a given catalogue
preferably comprises a medically acceptable term or group of terms
useful in aiding a health care practitioner to describe a patient's
symptoms and/or categorize a portion of the patient's body. Within
a given catalogue, each condition-descriptive entry preferably
describes the symptoms/body portion at a given level of
abstraction, with successively lower categories corresponding to
successively lower levels of abstraction, i.e., increasingly
specific entries. A feature of the present invention is the
hierarchical linking of the catalogues such that selection of an
entry in a given catalogue automatically determines which lower
level catalogues are displayed. By asking the patient to describe
his or her condition at each catalogue level, a health care
practitioner may select a condition-descriptive entry and
continually narrow the diagnosis/symptom description until a final
level of abstraction or description is achieved.
[0034] For example, the uppermost catalogue 802 in FIG. 5 comprises
"Systems" entries descriptive of general body systems, e.g.,
digestive, respiratory, etc. By selecting an uppermost
condition-descriptive entry 808, in this case "Digestive", a lower
level catalogue 804, listing various "Organs" logically grouped
together underneath the "Digestive" system, is automatically
displayed. Likewise, selection of another condition-descriptive
entry 812, in this case "Stomach/Duodenum", causes a further lower
level catalogue 806, listing various diagnoses applicable to the
"Stomach/Duodenum", to be automatically displayed. Because the
lowest level catalogue comprises the most specific
condition-descriptive entries, selection of a final condition
descriptive entry 816 is equivalent to a final diagnosis; in this
case, a diagnosis calling for "Diagnostic procedures on stomach
(including gastroscopy)." Throughout this selection process,
selection windows 810, 814, 818 display the selected
condition-descriptive entries 808, 812, 816 thereby allowing the
health care practitioner to quickly confirm entries as they are
selected. Note that although specific condition-descriptive entries
(i.e., ICD-9 codes) are shown in FIG. 5, it is understood that the
present invention is not limited in this regard. Indeed, a large
number of condition-descriptive entries may be included in each
catalogue thereby requiring the use of scroll-bars or similar
mechanisms.
[0035] In one embodiment of the present invention, specific codes
822 are included with the diagnosis entries in the diagnosis
catalogue 806, which codes are uniquely descriptive of the selected
diagnosis. In a preferred embodiment, the codes 822 comprise ICD-9
codes. The use of specific codes provides uniformity across
diagnoses and further facilitates database implementations,
including efficient searching and data analysis. To further
facilitate the process, definitions (diagnoses) in the diagnosis
catalog 806 are dynamically sorted according to frequency of use.
In such doing, most frequent definitions (diagnoses) are always
shown on the first panel and are therefore easily accessible.
[0036] An "Add to problems list" button 820 is also illustrated in
FIG. 5. The problems button 820 allows the health care
practitioner, once he or she is satisfied with the completeness and
accuracy of the diagnosis, to have data representative of the
selected diagnosis 816 (and, optionally, the higher-level
condition-descriptive entries 808, 812) stored in a database or
other long term memory. Techniques for capturing data in this
manner are well-known in the art. By maintaining a list of such
data, a complete history of each patient's problems/diagnoses may
be provided, as described in greater detail below with reference to
FIG. 7.
[0037] Referring now to FIGS. 6A and 6B, an exemplary second
embodiment of a plurality of hierarchically linked catalogues 902,
908, 914-922 (each comprising at least one condition-descriptive
entry) is illustrated. In particular, the example illustrated in
FIGS. 6A and 6B allows a health care practitioner to arrive at a
symptom description through increasingly specific
condition-descriptive entries. Generally, the plurality of
hierarchically linked catalogues is generated using software
routines executed by a suitable computing platform and displayed on
a monitor or similar device. For example, again with reference to
FIG. 5, the catalogues are displayed on the monitor 150 based on
software executed by the computer 80. As before, the specific
number of catalogues shown in FIGS. 6A and 6B are for illustrative
purposes only; any number of catalogues may be provided as a matter
of design choice.
[0038] In contrast to the strictly text based catalogues
illustrated in FIG. 5, FIG. 6A illustrates catalogues 902, 908
based on model displays 904, 910. In particular, a male model
display 904 and a zoom display 910 are shown. Of course, female
model displays may be chosen depending on the gender of the patient
under consideration. When using the model displays 904, 910, the
condition-descriptive entries correspond to predetermined regions
of the model display. Thus, a health care practitioner, through a
user interface selection device such as a mouse-cursor combination,
for example, can select a given region on the model display
corresponding to a problem region described by a patient. (This
mode of data entry is particularly useful where interactive
audio-visual communication with the patient is possible, for
example, when using the system described above relative to FIGS.
1-3.) In the example shown in FIG. 6A, a head region 906 has been
selected. Any number of specific regions may be defined as a matter
of design choice, which regions can be overlapping or
non-overlapping. Preferably, the model display may be rotated
around at least one axis (preferably, at least a vertical axis) to
provide a complete display of all possible regions. Techniques for
providing and manipulating such displays are well known in the
art.
[0039] Once a region 906 has been selected, the zoom display 910
may be optionally provided. The zoom display 910 corresponds to a
lower level catalogue relative to the male model display 904, with
the various sub-regions depicted therein corresponding to
lower-level condition-descriptive entries. For example, within the
head region 906, the zoom display 910 allows selection of a sinuses
sub-region 912. Because the contents of the zoom display 910 are
dictated by the particular region 906 selected in the larger model
display 904, the hierarchical catalogue structure provided through
the use of text-only catalogues is maintained.
[0040] More conventional text-based catalogues 914-916 may be
provided as an alternative to, or in addition to, the model
displays 904, 910. Where provided, such catalogues operate in the
manner described above relative to FIG. 5. That is, various
condition-descriptive entries 924, 928 may be selected, thereby
allowing the user to traverse the hierarchical catalogue structure.
Regardless, selection of a given region and, optionally, sub-region
automatically causes a further catalogue 918, in this case a
"Symptoms" catalogue, to be displayed. The "Symptoms" catalogue 918
list one or more condition-descriptive entries appropriate to the
selected region/sub-region combination. In the example illustrated
in FIG. 6B, only a single "Pain" entry 932 is displayed. Selection
of this entry automatically causes additional lower-level
catalogues 920, 922 to be displayed based on the particular entry
932 selected. Where only a single entry 932 is provided in a higher
level catalogue, one or more lower level catalogues dependent on
the single entry may be provided before the single entry is
selected. In the example illustrated in FIG. 6B, a "General
Qualifiers" catalogue 920 and a "Special Qualifiers" catalogue 922
are provided relative to the selected entry 932. Particular
condition-descriptive entries 936, 940 may be selected from the
respective qualifiers catalogues 920, 922. The resulting symptom
description is therefore the collection of condition-descriptive
entries selected from the various lower level catalogues, in this
case "acute sinus pain resulting from an injury." As in the example
of FIG. 5, the text-based catalogues 914-922 provide selection
windows 926, 930, 934, 938 942 such that a user of the catalogues
may verify the selections as they are made. Once again, scroll bars
may be used with any of the text-based catalogues 914-922 in those
instances where the number of condition-descriptive entries is
relatively large. Although particular condition-descriptive entries
are illustrated in FIGS. 6A and 6B, it is understood that the
present invention is not limited in this regard.
[0041] Finally, a "Save Complaints" button 944 is also illustrated
in FIG. 6B. The complaints button 944 allows the health care
practitioner, once he or she is satisfied with the completeness and
accuracy of the symptom description, to have data representative of
the described symptom stored in a database or other long term
memory. Techniques for capturing data in this manner are well-known
in the art. By maintaining a list of such data, a complete history
of each patient's problems/diagnoses may be provided, as described
in greater detail below with reference to FIG. 7.
[0042] Referring now to FIG. 7, an exemplary problems/complaints
list in accordance with the present invention is illustrated.
Generally, the list comprises problems/diagnoses and/or
complaints/symptoms generated when a health care practitioner
traverses the hierarchically linked catalogues, as described above,
and saves the results to a database. The accumulated results can
then be displayed as shown in FIG. 7. Techniques for storing and
later processing such data for display are well known in the art.
In particular, the list comprises a current problems/diagnoses
section 1002 and a current complaints/symptoms section 1014. The
data shown in the problems/diagnoses section 1002 results from
traversal of, for example, catalogues of the type described above
relative to FIG. 5. Similarly, the data shown in the
complaints/symptoms section 1014 results from the traversal of, for
example, catalogues of the type described above relative to FIGS.
6A and 6B.
[0043] A shown, the problems/diagnoses section 1002 comprises a
problems/diagnosis name field 1004, an onset data field 1006, a
severity field 1008, a change severity button 1010 and an old
problems display button 1012. The problems/diagnoses name filed
1004 is where textual data descriptive of each particular
problem/diagnosis is displayed. In a preferred embodiment, the
textual data for each problem/diagnosis is a predetermined
character string selected in accordance with the ICD-9 coding
system. Although not shown, the corresponding ICD-9 code may also
be displayed. The onset date field 1006 sets forth the date the
particular problem began according to the patient. The dates
illustrated in FIG. 7 are shown in a day/month/year format. The
date data may be entered directly into the onset date field for
each problem. The severity field 1008 sets forth the severity of
the particular problem. In a preferred embodiment, severity of a
problem is limited to Chronic, Active and Not Active, as shown. Of
course, other severity descriptors may be used as a matter of
design choice. The severity change button 1010 allows the severity
for a given problem to be changed as necessary. In one embodiment,
the severity change button 1010 is in the form of a pull down menu,
although other embodiments will be readily evident to those having
ordinary skill in the art. Alternatively, the severity data may be
directly entered directly into to the severity field for each
problem. Finally, the old problems display button 1012 allows one
or more previously entered, but no longer current, problems to be
displayed along with the most recently entered problem. Note that
where a relatively large number of problems/diagnoses need to be
displayed, scroll bars or similar mechanisms may be employed.
[0044] The complaints/symptoms section 1014 is similarly structured
and comprises an onset date field 1016, a complaint/symptom
description field 1018, a move to old complaints button 1020 and a
show old complaints button 1022. The onset date filed 1016, like
its counterpart in the complaints/diagnoses section 1002, sets
forth the date, according to the patient, a given symptom first
manifested itself. Using an alternative representation, the dates
illustrated in the date fields 1016 are shown in a month/day/year
format. As before, the date data for a given complaint/symptom may
be entered directly into the onset date fields 1016. The
complaint/symptom description field 1018 comprises the descriptions
resulting from the traversal of the hierarchically linked
catalogues, as described above. The descriptions are preferably
standardized descriptions according to an accepted standard such as
ICD-9, for example. As complaints/symptoms are alleviated or
otherwise go away, they may be archived using the move to old
complaints button 1020. That is, once it is determined that a given
complaint/symptom is no longer relevant, it may be selected and, by
activating the move to old complaints button 1020, it is no longer
displayed with the current complaints/symptoms, but the data is
archived in long term memory. When activated, the show old
complaints button 1022 causes the archived complaint/symptom data
to be recalled and displayed.
[0045] The present invention facilitates medical prescreening and
coding by providing for the quick, efficient and reliable capture
of patient diagnoses and/or symptom descriptions as well as other
coding systems and definitions such as procedures, diagnostic
tests, medical billing codes (HCFA, Medicare etc.) and more. The
use of a hierarchy of previously defined catalogues limits reduces
and places structure upon the data capture steps. It minimizes the
time required to enter information into the system by drastically
reducing search time, standardizing the input of data and
eliminating the need for writing or typing in the problem
description. By incorporating the use of ICD-9 codes, a user has no
need to worry about looking up or entering the required code. This
does away with an important source of conflict among concerned
parties: the adequate codification of problems that for billing
purposes has to comply with the mentioned code. The use of
standardized terms to capture patient data makes possible the
implementation of database queries for statistical analysis and
decision support. Data from years of patient observation acquires
renewed significance and relevance, as it becomes available for use
by a larger segment of the population. Furthermore, by enabling the
physician or medical worker to use a human body model to link
regions of the body to the patients' complaint, and by the use of a
hierarchy of catalogues, the present invention allows medical
workers to pinpoint a patient's complaint more precisely. Further
still, the catalogues may be customized to meet the particular
requirements of a given practitioner or practice. Finally, because
the hierarchy of catalogues is quickly and easily traversed, the
patient is easily and reliably prescreened by a medical worker who
does not necessarily need to entire skill set of a physician,
thereby allowing physicians to be concentrate their efforts on
those patients who are most in need of them.
[0046] While the foregoing detailed description sets forth
preferably preferred embodiments of the invention, it will be
understood that many variations may be made to the embodiments
disclosed herein without departing from the true spirit and scope
of the invention. For example, three other embodiments possible in
the recognition of body parts for complaint formalization: (1) the
patient points to a body part relevant to his/her complaint and the
medical worker at the central station recognizes the region by
clicking on it in the patients' image on the screen in front of
him; (2) the patient points to the part of his body that is
relevant to his complaint and image recognition software
automatically recognizes the region; and (3) verbally, the patient
recognizes the body part relevant to his complaint and the relevant
region is recognized automatically using speech recognition
methods. Other such modifications within the scope of the present
invention may be readily devised by those having ordinary skill in
the art. Nevertheless, the scope of the present invention is
defined by the appended claims, to be interpreted in light of the
foregoing specifications.
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