U.S. patent application number 11/074053 was filed with the patent office on 2005-07-28 for computer system and method for increasing patients compliance to medical care instructions.
Invention is credited to Karpf, Ronald Steven.
Application Number | 20050165626 11/074053 |
Document ID | / |
Family ID | 34794138 |
Filed Date | 2005-07-28 |
United States Patent
Application |
20050165626 |
Kind Code |
A1 |
Karpf, Ronald Steven |
July 28, 2005 |
Computer system and method for increasing patients compliance to
medical care instructions
Abstract
The Electronic Compliance Promoter is a computer system for
increasing a patient's compliance with medical post-care treatment
instructions. The system permits the patient to review the
treatment instructions that have been entered into a treatment
instructions database by medical personnel at the time of the
examination. The system includes a patient-client computer
interface, a medical person-client interface, a treatment
instructions database, and a compliance-server program. The
database contains the post-visit care instructions and other types
of information that the patient should have to understand and
follow those instructions. The database also has treatment
guideline information to assist the doctor in formulating the
post-care treatment instructions. The patients client-computer
interface provides a knowledge-based means for the patient to
review interactively the Doctor's after care instructions, and
measures compliance by tracking a patients' use of the specific
designated diagnosis related resources. The medical personnel
client-computer interface provides a knowledge-based means to
designate the post-care medical visit instructions the patient is
to follow. The compliance-server program tracks patients compliance
and can send messages to patients reminding them to review the
post-care treatment instructions. The Electronic Compliance
Promoter system provides a means to significantly increase a
patient's compliance with medical care instructions.
Inventors: |
Karpf, Ronald Steven;
(Gaithersburg, MD) |
Correspondence
Address: |
DICKSTEIN SHAPIRO MORIN & OSHINSKY LLP
2101 L Street, NW
Washington
DC
20037
US
|
Family ID: |
34794138 |
Appl. No.: |
11/074053 |
Filed: |
March 8, 2005 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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11074053 |
Mar 8, 2005 |
|
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09372955 |
Aug 12, 1999 |
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Current U.S.
Class: |
705/3 |
Current CPC
Class: |
G16H 40/63 20180101;
Y10S 707/99945 20130101; G06Q 10/10 20130101; G16H 70/60 20180101;
G16H 10/60 20180101 |
Class at
Publication: |
705/003 |
International
Class: |
G06F 017/60 |
Claims
1-18. (canceled)
19. A method of increasing patient compliance, the method
comprising the steps of: (a) receiving treatment information for a
patient; and (b) outputting the treatment information for
display.
20. The method of claim 19, further comprising the step of
measuring compliance of the patient to treatment.
21. The method of claim 20, further comprising the step of
outputting to the patient a measure of compliance of the patient to
treatment.
22. The method of claim 21, wherein said step of outputting a
measure of compliance is performed for each of a plurality of
office visits made by the patient.
23. The method of claim 19, wherein said receiving step (a)
includes the substep of inputting treatment instructions from
medical personnel for the patient in response to a patient office
visit.
24. The method of claim 19, wherein said outputting step (b)
includes the substeps of: determining a patient language
preference; and outputting the treatment information for display in
accordance with the language preference determined.
25. The method of claim 24, wherein said outputting step (b)
includes the substep of outputting treatment information in the
form of treatment instructions for display to the patient, wherein
said outputting substep includes outputting for display a grid
ordered according to a sequence and time order in which the
treatment instructions are to be followed by the patient.
26. An electronic compliance promoter for use in promoting patient
compliance with treatment instructions comprising: a medical
personnel client, wherein said medical personnel client inputs from
medical personnel diagnosis and treatment information regarding a
patient following a medical appointment with the patient; a
treatment server computer, wherein said treatment server computer
receives diagnosis and treatment information from said medical
personnel client; a treatment instructions database, wherein said
treatment instructions database stores the diagnosis and treatment
information received from said treatment server computer; and a
patient client, wherein said patient client accesses said treatment
server computer over a network and views the diagnosis and
treatment information corresponding to the patient.
27. The electronic compliance promoter as set forth in claim 26,
wherein, in response to accessing said treatment server computer
over a network in the form of the Internet, said patient client
displays information including at least one of: diagnosis
information for the patient in the form of a list of links to Web
sites that have relevant diagnosis information; treatment
information for the patient in the form of a list of links to Web
sites that have relevant treatment information; a list of alerts in
the form of patient symptoms that would require immediate medical
attention; and a list of medical followup medical appointments to
be scheduled with medical personnel to continue medical treatment
of the patient.
28. An article of manufacture for use in monitoring patient
compliance with prescribed treatment, the article of manufacture
comprising a machine-readable storage medium having stored therein
indicia of a plurality of machine-executable control program steps,
the control program comprising the steps of: (a) entering treatment
information; (b) determining access of the treatment information by
a patient; and (c) monitoring compliance of the patient based on
access of the treatment information made by the patient in said
determining access step (b).
29. The control program as recited in claim 28, wherein said
entering step (a) includes entering treatment information in the
form of detailed instructions of the treatment to be followed by
the patient.
30. The control program as recited in claim 29, wherein said
entering step (a) further comprises accessing recommended treatment
guidelines to be included as the treatment instructions.
31. The control program as recited in claim 28, wherein said
entering step (a) includes entering treatment information in the
form of a list of resources containing information relevant to the
treatment.
32. The control program as recited in claim 31, wherein the list of
resources includes a list of Web sites containing information
relevant to the treatment generated by a remote database
server.
33. The control program as recited in claim 28, wherein the access
to the treatment information is made by the patient using a
personal computer over the Internet.
34. The control program as recited in claim 32, wherein said
monitoring step (c) is performed by measuring a length of time that
the patient reviews information on a given resource.
35. The control program as recited in claim 28, wherein said
monitoring step (c) is performed by measuring a rate at which the
patient reviews treatment information.
36. The control program as recited in claim 28, further comprising:
(d) issuing a reminder to the patient based on the compliance of
the patient monitored in said monitoring step (c).
37. The control program as recited in claim 36, wherein said
entering step (a) is performed by medical personnel; and wherein
said issuing step (d) is performed by contacting the patient using
at least one of: e-mail, mail, phone, beeper, and cable TV.
Description
FIELD OF THE INVENTION
[0001] This invention relates to a computer system and method for
providing patients with access to the information they need to
understand and follow the post-visit medical care instructions that
arise from a visit with a medical practitioner.
BACKGROUND OF THE INVENTION
[0002] There is a significant problem with patients' failing to
follow a medical practitioners post-examination treatment
instructions. The terminology we use for this is compliance. While
the patient may choose to consciously ignore medically necessary
advice, the greater problem is with patients who leave the medical
practitioners office without being sufficiently cognizant of the
diagnosis or prepared to follow the recommended therapeutic
intervention. This long recognized problem has been intractable,
defying easy solution, but which can now be addressed due to
advances in telecommunications and computer technology. An
associated problem is that health care practitioners often fail to
comply with existing ever-changing treatment guidelines.
[0003] Our awareness of the problem arises in part from experience
with Diabetes. Diabetes Mellitus is the fourth leading cause of
death in the United States and a major cause of blindness and heart
disease. It is the major cause of blindness in person's 24-74 years
of age, with 39,000 new cases each year. Ten percent of patients
with diabetes develop renal disease. Patients with Type-2 diabetes
have a 28-fold increased risk of limb amputation, and approximately
50% of people with diabetes for 25 years have evidence of
neuropathy. Diabetes imposes a 2 to 4-fold lifetime risk of heart
disease, and a 5-fold lifetime risk of a stroke.
[0004] Often, even physicians do not comply with the American
Diabetes Association (ADA) standards of practice. The ADA publishes
standards of practice for comprehensive care of Type-2 Diabetes
Mellitus (DM), including guidelines for optimizing glycemic
control. It is well documented that physicians and other health
care providers often do not comply with the existing ADA
guidelines. And even when the health care provider strictly adheres
to the recommended disease specific intervention, the patient is
likely to depart from the recommended therapy either through
neglect or misunderstanding. There is a clear need for a system
that will assist both the patient and health care practitioner
adhere to recommended therapeutic guidelines. We believe that the
proposed system will enhance the treatment process and outcome of
disease management for diabetic patients and patients with other
diseases.
[0005] Patients may fail to accurately follow doctor's order for a
variety of reasons. All to often they leave the medical encounter
without a clear understanding of the diagnosis or recommended
course of action. Being ill is traumatic--and under the pressures
of a medical examination, patients are often unable to focus on the
instructions for treatment. They may have difficulty understanding
the medical terminology. There is a cognitive difficulty in
remembering instructions for complicated regimens. The age of the
patient or the national origin of the patient or doctor may be a
factor. Older patients may simply have hearing problems. As simple
a distraction as children in the examination room or a loud air
conditioner may make verbal communications difficult.
[0006] For whatever reason, the ability of patients to leave a
medical encounter fully cognizant of the information they need to
continue care is a real problem with serious medical consequences.
The purpose of this system is to significantly assist patients in
their compliance to the post-visit medical care instructions that
arise from a visit to a doctor.
[0007] The current means to address the problem primarily rely on
pamphlets and/or packets of printed information appropriate to the
patient's complaint that is used to supplement the practitioner's
verbal instructions. For instance, lower back pain is a common
complaint, and doctors will often provide patients with a booklet
describing the problem and the appropriate exercise treatments.
[0008] While this has been helpful the approach has serious
problems. The information can only be maintained on a limited
number of the most common complaints, and may not be in the native
language of the patient. Supplies of pamphlets may run out, and
more recent medical advances and treatment guidelines may easily
outdate the information. HMO's and large managed care practices are
beginning to issue medical information books to members that
explain the diagnosis, treatment and prognosis for the most common
ailments. Unlike pamphlets provided to the patient during a medical
visit and addressing the specific patient complaint, these books
are entirely general, and may easily become out-of-date, and may be
lost or otherwise unavailable to the patient. Another problem with
this approach is that it only provides general information that is
meant to supplement the practitioners instructions, but does
nothing to assist the patient with the specific instructions deemed
appropriate to their situation.
SUMMARY OF THE INVENTION
[0009] The main object of the present invention is a computer
system that assists patients to follow or comply with the
post-examination medical treatment that they are to follow. A key
feature of the invention is that the medical personnel may enter
into a treatment instructions database, at the time of the
examination, the precise treatment instructions that the doctor
issues to the patient. Since the treatment instructions database is
accessible to the patient, they may at any time subsequent to the
examination, review the exact instructions that have been provided
to them by the medical practitioner.
[0010] Treatment instructions include both the therapeutic regimen
as well as information about the disease and treatment, since a
patient who understands the disease and treatment is more likely to
be compliant. To aid the medical practitioner to enter the
therapeutic regimen, source materials are provided. The most
current recommended diagnosis specific treatment guidelines are
provided as a starting point in specifying the treatment
instructions. The medical practitioner is not restricted to the use
of the available treatment guidelines but may modify them in part
or full. Other types of treatment instructions include disease and
treatment information, alerts and recommended followup. The system
also allows the medical practitioner to specify which types of
treatment instructions information to include or exclude. We do not
want to overburden patient's with too much information as this may
confuse or otherwise cause them to avoid using the system.
[0011] Treatment guidelines change frequently to reflect new
research and medications, and it is difficult for the health care
practitioner to maintain a comprehensive up-to-date knowledge of
the latest treatment guidelines. Often more specificity may be
added to treatment guidelines to distinguish the treatment
preference for patients depending on age, sex, and ethnicity. An
important feature of the system is that since the treatment
guidelines are accessed over a network, the medical practitioner
will always be prompted with the most up-to-date treatment
guidelines from the source site.
[0012] Another key feature of the system is that the treatment
instructions are available to patients upon demand. Since the
instructions have been entered into a database, patients may access
the database from a computer through a patient program
user-interface, and review the treatment information for any prior
medical examination. A key factor in patient compliance is an
understanding of the therapeutic regimen, as well as an
understanding of the diagnosis and treatment. The system provides
full and clear treatment instructions in a standard format, and
information sources that fully explain the diagnosis and the
recommended treatment. Items of special importance, termed in this
invention `alerts` and `followup` are presented in separate
sections to highlight their importance, to the patient. Alerts are
items of information of special importance, such as possible
medication side effects or symptoms that the patient should be
aware that if they occur, immediate medical attention is required.
Followup refers to future follow-up medical examination.
[0013] To maximize the usability of the system by patients, we make
every attempt to present the information to patients in a manner
that is easy for them to access. Towards this end, the system
allows the user to specify preferences.
[0014] The patient may specify a language preference. Since much of
the information that is presented is from suggested treatment
guidelines and up-to-date information sources, this information can
be presented in a language of their choice. Patients may also
specify the mechanism by which they will receive compliance
reminder messages. A compliance reminder message is sent to a
patient who has not accessed the treatment information. The
mechanism for this can be Email, phone, regular mail, or
beeper.
[0015] Another key feature of the system is to remind patients to
comply with the treatment instructions. This is accomplished by
tracking the patients access to treatment information and using it
to generate a patient's measure of compliance.
[0016] If a patient has not accessed any of the specified treatment
information they are termed non-compliant and they are sent a
reminder message to check the prescribed information sources. If a
patient has accessed some, but not all of the specified treatment
information they are termed partially compliant and they are send a
reminder message to review the information they have not yet
accessed. If a patient has accessed all the specified treatment
information for a medical encounter, then they are termed fully
compliant and no reminder messages are sent.
[0017] Having a measurable index of patient compliance and a means
to take action based on patient lack of full compliance is one of
the key elements of this invention and a primary means to increase
a patients compliance to medical care instructions.
[0018] Another important feature of the system is the ease with
which complex treatment protocols are presented to the patient. A
standard format is utilized, and complex treatment instructions
that require multiple actions followed in a sequence of steps which
may be time dependent, are presented to the patient in a linear
fashion explicitly showing the relationship between the sequence of
steps they must follow.
[0019] Another important object of the invention is the wide
availability of the system. The patient may access all treatment
instructions for all medical examinations from any computer that
has a network connection to the Internet.
[0020] An additional feature is that all these treatment
instructions are now administered in a similar way, so once the
user can successfully understand how to review treatment
instructions for any single examination, they understand the means
to review the treatment instructions for any examination. This
familiarity will reinforce the patient's use of the system and
foster better patient compliance.
[0021] Other objects and advantages of the invention will be set
forth in part in the description that follows and in part will be
obvious from the description or may be learned by practice of the
invention. The objects and advantages of the invention will be
realized and attained by means of the elements and combinations
particularly pointed out in the appended claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0022] The accompanying drawings, which are incorporated in and
constitute a part of the specification, illustrate the preferred
embodiment of the invention, and together with the detailed
description of the preferred embodiment, serve to explain the
principles of the invention.
[0023] FIG. 1 is a block diagram of the invention.
[0024] FIG. 2 is a block diagram of the computers used in the
system.
[0025] FIG. 3 is an entity-relationship diagram of the treatment
instructions database.
[0026] FIG. 4 is a decision matrix for assigning a measure of
compliance to a patient.
[0027] FIG. 5 is an example of the user-interface logon screen of
the patient program.
[0028] FIG. 6 is an example of the user-interface logon screen of
the patient program with all sections of the user-interface
expanded.
[0029] FIG. 7 is an example of the user-interface screen of the
patient program showing the patient's office visits.
[0030] FIG. 8 is an example of the user-interface screen of the
patient program showing the treatment instructions for a selected
office visit.
[0031] FIG. 9 is an example of the user-interface logon screen of
the medical personnel data entry program
[0032] FIG. 10 is an example of the user-interface screen of the
medical personnel data entry program showing the medical personnel
registration section.
[0033] FIG. 11 is an example of the user-interface of the medical
personnel data entry program used to enter the identity of the
patient.
[0034] FIG. 12 is an example of the user-interface of the medical
personnel data entry program used to enter the patient diagnosis
and treatment instructions.
[0035] FIG. 13 is an example of the user-interface logon screen of
the medical personnel administration program.
[0036] FIG. 14 is and example of the user-interface of the medical
personnel administration program showing the list of all patients,
by visit, who have been seen by the designated medical
personnel.
[0037] FIG. 15 is an example of the user-interface of the medical
personnel administration program showing status of the treatment
instructions for a patient visit.
[0038] FIG. 16 is an example of a compliance reminder message sent
via Email to a patient.
[0039] FIG. 17 is a state diagram describing the operation of the
patient program.
[0040] FIG. 18 is a state table describing the operation of the
patient program.
[0041] FIG. 19 is a state diagram describing the operation of the
medical personnel data entry program.
[0042] FIG. 20 is a state table describing the operation of the
medical personnel data entry program.
[0043] FIG. 21 is a state diagram describing the operation of the
medical personnel administration program.
[0044] FIG. 22 is a state table describing the operation of the
medical personnel administration program.
[0045] FIG. 23 is a state diagram describing the operation of the
treatment instructions server program.
[0046] FIG. 24 is a state table describing the operation of the
treatment instructions server program.
DETAILED DESCRIPION OF THE PREFERRED EMBODIMENT
[0047] References will now be made in detail to the preferred
embodiments of the invention, examples of which are illustrated in
the accompanying drawings. Wherever possible, the same reference
numbers will be used throughout the drawings to refer to the same
or like parts.
[0048] 1. An Electronic Compliance Promoter
[0049] A. Hardware, Operating System and Application Development
Software
[0050] FIG. 1 is a block diagram of the preferred embodiment of the
present invention. A system 100 of FIG. 1 illustrates the
patient-client computer 101, the medical personnel-client computer
102, the treatment server computer 103, the treatment instructions
database 104, and the network interface 105 over which they
establish a connection and communicate. In the preferred embodiment
the network interface protocol that is used is the industry
standard network protocol TCP/IP.
[0051] FIG. 2 is a block diagram of the computers used in the
system. In the preferred embodiment the same computer hardware was
used for the patient-client computer 101, the medical
personnel-client computer 102, and the treatment server computer
103.
[0052] In the preferred embodiment, the system 200 consists of a
computer monitor 201, computer 205, computer mouse 215, and a
computer keyboard 210. The computer 205 includes a memory 206 and a
processor (CPU) 207, a mass storage device 208, and a network
interface card (NIC) 209. Monitor 201, the computer mouse 215, and
computer keyboard 210, are connected to computer 205 in a manner
known to persons of ordinary skill in the art.
[0053] Computer 205 preferably is a Compaq Presario 5280, the
keyboard 210 is a Compaq Easy Access Internet Keyboard, and both
manufactured by the Compaq Corporation. The monitor 201 is an Acer
77 manufactured by the Acer Peripherals America Incorporated of San
Jose, Calif. The NIC 209, is a Linksys Ether16 Lan Card, 16-bit ISA
Ethernet Adapter card manufactured by the Linksys Corporation of
Irvine, Calif. The computer mouse 215 is a Compaq Corporation
2-button Mouse, manufactured by the Compaq Corporation. The
computer network uses a Linksys 5-port workgroup hub manufactured
by the Linksys Corporation of Irvine, Calif. The computers are
connected to the Linksys 5-port Workgroup hub using 10BaseT cable
in a manner known to persons of ordinary skill in the art.
[0054] In the preferred embodiment, the patient-client computer 102
and the medical personnel-client computer 103 are executing under
Microsoft Windows 98. The client programs run under the Microsoft
Internet Explorer Browser 4.0 manufactured by the Microsoft
Corporation of Redmond, Calif., and are written in the industry
standard hypertext markup language (HTML).
[0055] In the preferred embodiment, the treatment instructions
server computer 103 is executing under Microsoft Windows NT Server
4.0, and is running the Microsoft Internet Information Server 4.0.
The treatment instructions database program is written in the
Active Server Page (ASP) language, version 2.0 using Visual Basic
Script, and utilizes the ActiveX Data Objects (ADO) data access
component to communicate with the database using the Microsoft
Access ODBC driver. The treatment instructions database is a
Microsoft Access 97 database. The Microsoft Corporation of Redmond,
Wash. manufactures the six above-mentioned products. Other
embodiments may use other hardware and software components.
[0056] B. Data Structures
[0057] FIG. 3 shows an entity-relationship or ER diagram 300 of the
treatment instruction database. It shows the 10 relational tables
that comprise the treatment instructions database, the fields of
each table, the primary key of each table and the primary-foreign
key relationship between fields of different tables. The discussion
below also provides the attributes of each field of every table. On
the figure, the primary key field is highlighted in bold print.
Relationship lines drawn between the tables identify
primary-foreign key relationships between the tables. The label `1`
and `m` on either side of the relationship line indicates that
tables have a one-to-many relationship, with many records on the
`m` associated table possibly existing for each unique row of the
`1` associated table.
[0058] Table `Patients` 305 contains a single record with
information about every patient that is registered to use the
system. The primary key, `PatientID`, is a unique long integer
generated by Microsoft Access using the counter attribute. The
other fields of table `Patients` 305 include the patients name
stored in the fields `Prefix` a text field of length 8 with the
title of a patient such as `Mr.` or `Mrs.`; `FName` a text field of
length 24 with the first name of the patient; `MI` a text field of
length 1 with the middle initial of the patient; `LName` a text
field of length 24 with the last name of the patient; and `Suffix`
a text field of length 8 with a name suffix such as `Ph.D`, or
`MD`. Still other fields of table `Patients` 305 include patient
identifiers stored in the fields `SSN` a text field of length 11
with the social security number of the patient; `DOB` a date field
with the date of birth of the patient; `Sex` a text field of length
one with either `M` or `F` for `Male` or `Female`; `MaritalStatus`
a field of length 1 with the marital status of the patient coded as
`S`, `M`, `D`, or `W` for `Single`, `Married`, `Divorced`, or
`Widowed` respectively. Other fields of table `Patients` 305 store
the address of the patient in fields `Address` a text field of
length 50 with the address of the patient; `City` a text field of
length 24 with the home city of the patient; `State` a text field
of length 2 with the 2 character postal abbreviation of the home
state of the patient; `Zip` a text field of length 10 with the
postal zip code of the patient, and `Ph` a text field of length 12
with the area code and phone number of the patient. Other fields of
table `Patients` 305 store the Username and Password of the patient
in fields `Username` a text field of length 24 with the Username of
the patient; `Password` a text field of length 24 with the Password
of the patient, and `PIN` a text field of length 24 with the
patient's Password that is used by medical personnel to identify
the patient for data entry of the treatment instructions. The
remaining fields of table `Patients` 305 are `PrefMedLang` a text
field of length 8 used to store the patients language preference
for reviewing treatment instructions; `PrefMeansContact` a text
field of length 8 used to store the means by which a patient
prefers to receive reminder compliance messages; `DateEntered` a
date field with a date and time stamp for when the patient
registered with the system; `DateUpdated` field with the date
attribute with a date and time stamp for when the patient last
updated the registration information, `Email` a text field of
length 124 with the Email address of the patient, and
`MeasCompliance a text field of length 24 with the patient's
overall measure of compliance. When the patient first registers the
`DateEntered` and `DateUpdated` are set to the same value.
[0059] Table `MedPersonnel` 310 contains a single record with
information about every medical practitioner that is registered to
use the system. The primary key, `MedPersID`, is a unique long
integer generated by Microsoft Access using the counter attribute.
The other fields of table `MedPersonnel` 310 include the name
stored in the fields `Prefix` a text field of length 8 with the
title of a patient such as `Dr.` or `Mr`; `FName` a text field of
length 24 with the first name of the medical personnel; `MI` a text
field of length `1` with the middle initial of the medical
personnel; `LName` a text field of length 24 with the last name of
the medical personnel; and `Suffix` a text field of length 8 with a
name suffix such as `Ph.D`, or `MD`. A social security number
identifier for the medical personnel is stored in field `SSN` a
text field of length 11, and their educational level of attainment
or educational degree is stored in the field `Degree` a text field
of length 8. The field `MedPersType` of table `MedPersonnel` 310
has a many-to-one primary-foreign key relationship with the field
`MedPersType` of table `MedPersType` 325 and has the same
attributes. Medical personnel logon validation are stored in fields
`Username` a text field of length 24 with the Username of the
medical personnel, and `Password` a text field of length 24 with
the Password of the medical personnel. The remaining fields of
table `MedPersonnel` 310 are `DateEntered` a date field with a date
and time stamp for when the medical personnel registered with the
system; `DateUpdated` field with the date attribute with a date and
time stamp for when the medical personnel last updated the
registration information, and `Email` a text field of length 124
with the Email address of the medical personnel. Other fields of
table `MedPersonnel` 310 store the address of the patient in fields
`Address` a text field of length 50 with the work address of the
medical personnel; `City` a text field of length 24 with the work
city of the medical personnel; `State` a text field of length 2
with the 2 character postal abbreviation of the work state of the
medical personnel; `Zip` a text field of length 10 with the postal
zip code of the medical personnel, and `Ph` a text field of length
12 with the area code and phone number of the medical
personnel.
[0060] Table `LoginLog` 315 contains information that is a log of
all users that successfully access the system with a valid Username
and Password. The primary key, `LoginID` is a unique long integer
generated by Microsoft Access using the counter attribute. The
other fields of table `LoginLog` 315 include `LoginType`, a field
of length 8 with an encoding of the category of person who has
successfully logged onto the system, and its valid entries are
`patient` for a patient using the patient program to view their
treatment instructions, `medpers` for medical personnel using the
medical personnel data entry program, and `admin` for medical
personnel using the medical personnel administration program. The
field `DateLogin` is a date field with the date and time that the
user logged onto the system. If the value of the field `LoginType`
is `patient` then the field `PersonID` of table `LoginLog` 315 has
a many-to-one primary-foreign key relationship with the field
`PatientID` of table `Patients` 305 and has the same attributes. If
the value of the field `LoginType` is `medpers` or `admin` then the
field `PersonID` of table `LoginLog` 315 has a many-to-one
primary-foreign key relationship with the field `MedPersID` of
table `MedPersonnel` 310 and has the same attributes.
[0061] Table `MedEncounter` 320 contains a single record with
information about every medical encounter or office visit between a
patient and a medical practitioner. The primary key, `EncounterID`,
is a unique long integer generated by Microsoft Access using the
counter attribute. The field `MedPersID` of table `MedEncounter`
320 has a many-to-one primary-foreign key relationship with the
field `MedPersID` of table `MedPersonnel` 310 and has the same
attributes. The field `PatientID` of table `MedEncounter` 320 has a
many-to-one primary-foreign key relationship with the field
`PatientID` of table `Patients` 305 and has the same attributes.
The other fields of this table include `DateEncounter` which has a
date attribute and contains the date of the medical encounter;
`Complaint` a text field of length 255 with the patients complaint
or reason for the medical appointment, and `MeasCompliance` a text
field of length 24 with the system calculated patient measure of
compliance for the associated medical visit.
[0062] Table `MedPersType` 325 is a lookup table that has a single
record for every category of medical personnel describing the type
of medical personnel. The primary key `MedPersType`, is an integer
field and is a numeric coding of a unique type of medical
personnel. The field `MedPersDesc` is a text field of length 50
that has a description of the type of medical personnel
corresponding to the value in the primary key field `MedPersType`.
For instance, the record with a value of `1` for `MedPersType` has
a corresponding record value of `Dr.` for the `MedPersDesc`
field.
[0063] Table `Diagnosis` 330 contains information about the
diagnosis by a medical practitioner of the patients complaint or
reason for the office visit. The field `DiagnosisID` is a unique
long integer generated by Microsoft Access using the counter
attribute. The primary key is the composite index formed by
`DiagnosisID` and `SeqNo`. The field `EncounterID` of table
`Diagnosis` 330 has a many-to-one primary-foreign key relationship
with the field `EncounterID` of table `MedEncounter` 320 and has
the same attributes. Any medical encounter can result in several
different diagnoses so there may be several records in this table
for a single patient medical encounter distinguished by a SeqNo
starting with `1` and incrementing by `1`. The combination of field
`DiaignosisID` and `SeqNo` provides a unique identifier for an
individual diagnosis. The fields `DiagnosisMaj` and `DiagnosisMin`
of table `Diagnosis` 330 have a many-to-one primary-foreign key
relationship with the fields `DiagnosisMaj` and `DiagnosisMin` of
table `Diagnoses` 335 and have the same attributes.
[0064] Table `Diagnoses` 335 contains information categorizing
different diagnoses. Each diagnosis has a major and minor category
coding. For instance Diabetes would be a major diagnoses category
and each of the different types of Diabetes would be coded in the
minor category coding. The primary key for this table is a
composite index of two fields `DiagnosisMaj` and `DiagnosisMin` and
each is a text field of length 16. The field `DiagnosisDesc` is a
text field of length 255 with a text description of the diagnosis
record.
[0065] Table `ClinGuidelines` 340 contains information about the
recommended clinical therapeutic guideline for a diagnoses. The
other standard compliance information is contained in the table
`Compliance` 345. Clinical guidelines can consist of several steps
that must be followed in order and or with a specific temporal
relationship. To accommodate this the primary key for this table is
a composite index of the fields `ClinGuidelineID` and `SeqNo. The
field `ClinGuidelineID` is a unique long integer generated by
Microsoft Access using the counter attribute. The field `SeqNo` is
a number field with the value `1` for the first clinical guideline
step. Subsequent guideline steps have an incremental value for the
field `SeqNo`. Each step of a clinical guideline can have a
temporal value associated with it which is stored in the fields
`TimeWhen` which is a long integer field, and `TimeUnits` which is
a text field of length 8. For instance if a medication is to be
taken 3 times per day then the value of `TimeWhen` would be coded
as the `3` and the value of `TimeUnits` would be coded as `times
per day`. The field `GuidelineText` is a text field of length 255
with the text of the step of the clinical guideline. The fields
`DiagnosisMaj` and `DiagnosisMin` of table `ClinGuidelines` 340
have a many-to-one primary-foreign key relationship with the fields
`DiagnosisMaj` and `DiagnosisMin` of table `Diagnoses` 335 and have
the same attributes.
[0066] Table `ClinGuidelines` has a Boolean field `Recommended`.
This is set to `true` if the clinical guideline is the recommended
treatment guideline. This is the guideline that the system will use
when prompting medical personnel to enter treatment instructions.
If the medical practitioner changes the recommended guideline by
editing, adding or deleting or fully changing the recommended
steps, and the new treatment instructions are inserted into the
`ClinGuidelines` table 340, with unique value for
`ClinGuidelineID`, and `SeqNo`, and a value of `false` for the
field `Recommended. In this manner, the table `ClinGuidelines` 340
can have entries for a single `Recommended` treatment guideline for
a diagnosis, and can also contain multiple customized treatment
guidelines for that same diagnosis.
[0067] Table `Compliance` 345 contains standard compliance
information about every diagnosis for the compliance categories
`alerts`, `followup`, `diagnosis information` and `treatment
information`. These are fixed by the system and in the preferred
embodiment may not be edited by the health care practitioner. The
primary key `ComplianceID` is a unique long integer generated by
Microsoft Access using the counter attribute. The field
`ComplianceType` is a text field of length 8 and identifies the
type of compliance information contained in the record. It may take
the values `alerts`, `followup`, `daiginfo`, or `trtmnt` for
`alerts`, `followup`, `diagnosis information` and `treatment
information` respectively. The field `ComplianceText` is a text
field of length 255 and contains compliance specific descriptive
information for the record. The field `ComplianceURL` is a text
field of length 255 and contains the URL of compliance specific
descriptive information for the record. The fields `DiagnosisMaj`
and `DiagnosisMin` of table `Compliance` 345 have the same
definition and attributes as the fields `DiagnosisMaj` and
`DiagnosisMin` of table `Diagnoses` 335.
[0068] The disease specific treatment and diagnosis information
that will be made available to the patient is a URL or Internet
resource. The system allows this information to be presented to the
user according to the language preference of the patient. Table
`Patients` 305 contains a field `PrefMedLang` which records the
patients preferred language. When the patient uses the system to
hyperlink to the disease or treatment information, the link is to
an address that is modified by the language preference so the
information is presented to the patient according to their
preference. As an example, if the patient language preference has a
value of `Spanish` then when the patient hyperlinks to
`Diabetes/Mellitus` treatment information at the URL given in the
Compliance table, the system will hyperlink to URL/Spanish so as to
get the Spanish language version of the associated treatment
information.
[0069] Table `PatCompliance` 350 contains information about the
treatment instructions that have been issued to a patient and the
status of their compliance. The primary key `PatComplIdx` is a
unique long integer generated by Microsoft Access using the counter
attribute. The field `DiagnosisID` of table `PatCompliance` 350 has
a many-to-one primary-foreign key relationship with the field
`DiagnosisID` of table `Diagnosis` 330 and has the same attributes.
The field `EncounterID` of table `PatCompliance` 350 has a
many-to-one primary-foreign key relationship with the field
`EncounterID` of table `MedEncounter` 320 and has the same
attributes. The field `PatComplType` is a text field of length 8
and has a value representing the type of compliance information. It
may take the values `alerts`, `followup`, `diaginfo`, `trtmnt`, or
`inst`. If it has one of the values `alerts`, `followup`,
`diaginfo`, or `trtmnt` then the field `PatComplianceID` of table
`PatCompliance` 350 has a many-to-one primary-foreign key
relationship with the field `ComplianceID` of table `Compliance`
345. If the field `PatComplType` has the value `inst` then the
field `PatComplianceID` of table `PatCompliance` 350 has a
many-to-one primary-foreign key relationship with the field
`ClinGuidelineID` of table `ClinGuidelines` 340. The field
`dateAccessed` is a date field that contains a date and time stamp
for when the patient accessed the treatment instructions and will
be used by the system to calculate the patients measure of
compliance. The field `TrackIt` is a Boolean field. The default
value is `false` but can be set by the Medical Personnel to the
value `true`. If the value is `false` then the system will not
automatically generate reminder messages to the patient about the
associated compliance item, if the patient is non-compliant. If the
value is set to `true` then the system will automatically generate
reminder message if the patient is non-compliant
[0070] FIG. 4 displays the definition of the patient's measure of
compliance. In the preferred embodiment, every patient can be
assigned a `Measure of Compliance` 400 for any specific medical
visit, or for any combination of 2 or more medical visits. For the
one or more visits that are to be measured we count the `Total
items` that the patient is to access and the `Visited items` that
the patient has accessed. In the preferred embodiment compliance is
only measured for medical visits more than one week old. These
numbers can be calculated directly from the `PatEncounter` table
360 of FIG. 3. First get the set of entries for the field
`EncounterID` 361 for the set of patient medical visits more than
one week old that are to be measured. Since each medical visit is
uniquely identified by the field EncounterID 361, the `Total items`
is defined as the number of records in the PatCompliance table 360
with an EncounterID in this set and a `DateEncounter` more than one
week old. The `Visited items` is defined as the number of records
in the PatCompliance table 360 with an EncounterID in this set and
a non-null entry for the dateAccessed field 362 of the table
PatCompliance 360. These two numbers are then compared. If the
`Total items` is equal to the `Visited items` then the `Measure of
compliance` 400 for the patient's visits is `Fully Compliant`. If
the `Visited items` is zero and the `Total items is greater than
zero then the `Measure of Compliance` 400 for the patient's visits
is `Non-compliant`. If the `Visited items` is less than the `Total
items` then the `Measure of Compliance` 400 for the patient's
visits is `Partially compliant`. Other embodiments may use other
means to measure a patient's compliance with medical care
instructions.
[0071] C. User Interface
[0072] In this section we will describe the user interface for the
system, and will display the main screens that the patient and
medical personnel users of the system encounter. We will also
explain the manner in which the user interface operates and the
meaning and purpose of the button, labels, text boxes, check boxes,
and drop-down boxes. A more detailed programmatic design for
building the system is presented in following sections.
[0073] FIG. 5 is an example 500 of the first screen presented to
the patient on the display screen 201 that the patient encounters
when they start the patient program. The purpose of the patient
program is to allow the patient to review online their treatment
instructions. A secondary purpose is to make a record of the
information that is accessed by the patient so the automatic
compliance reminder feature of the system can be invoked.
[0074] This is the logon screen and the patient is not allowed to
view their treatment instructions until they logon with an
authorized Username and Password. It shows the title banner 501 for
the system, `Electronic Compliance Promoter` which will be
displayed on all screens, and the specific program module, `Patient
Program` 502. Other program modules are the Medical Personnel data
entry and administration modules.
[0075] A solid shaded bar 503 across the screen delineates sections
of the module. Each section is labeled, and in this instance is
labeled `Logon` 504. There is another section header on the logon
screen 500 labeled `Register/Update` 510, which the patient uses to
register an authorized Username/Password so they may access the
system or to update their registration information. On the solid
shaded bar is the symbol `<>` 505. System-wide, this is an
indicator for expanding/contracting sections. In this case it means
that by pointing and clicking the mouse anyplace on the solid
shaded bar 503, the section will toggle to either expand or
contract. In this figure the `Logon` section 503 is shown expanded;
i.e. all the fields of the section are displayed, and the
`Register/Update` section 510 is shown contracted with none of the
fields of the section displayed.
[0076] Throughout the modules of the system similar functionality
is employed and will reoccur in FIGS. 6 through 15. Whenever the
symbol `<>` appears on a shaded bar it indicates that the
information displayed in the section appearing immediately below it
can be toggled to either fully display the data fields, or for the
information displayed in the section to be hidden or
contracted.
[0077] The information display items of the `Logon` section 503
appear directly below the section bar. A display banner `Enter
Username and Password` 520 identifies the function of the screen
which is to allow the user to type in the Username and Password and
submit for authorization to review the patient's own treatment
instructions. The label field `Username` 521 identifies the data
entry field 522 in which the patient enters their `Username` and
the label field `Password` 523 identifies the data entry field 524
in which the patient enters their `Password`. The Username and
Password entries are validated against the `Username` and
`Password` fields stored in the patient's record in the table
`Patients` 305 in the fields `Username` and `Password`.
[0078] The `Logon` section has two buttons, `Submit` 531 and
`Reset` 532. The `Submit` button 531 causes the program to submit
the entries in the data entry fields 522 and 524 to the treatment
server program for patient authentication as the proper `Username`
and `Password` respectively, waits for and displays the reply. The
`reset` button 532 causes the program to clear any key entries in
the data entry fields 522 and 524 and set them back to their
initial state.
[0079] In this example screen 500, the section 510
`Register/Update` is shown contracted so the data entry fields are
not displayed. An example of this section in expanded view, caused
by pointing and clicking anywhere in the shaded bar 510, will be
shown in FIG. 6.
[0080] At the bottom of the `Logon` screen is the button `Logoff`
540. This button is selected by the user by pointing and clicking
the mouse-pointing device at the button and causes the program to
back to an initial state prior to any logon. If the patient has
successfully logged in, and then selected the `Logoff` button, they
will not be allowed to review their treatment instructions until
the again `Logon` to the patient program. This `Logoff` button 540
will be repeated on every screen of the Patient Module.
[0081] FIG. 6 is an example 600 of the first screen presented to
the patient on the display screen 201 that the patient encounters
when they start the patient program but with both `Logon` section
504 and the `Register/Update` section expanded to show all data
entry fields. The patient would navigate from the display in FIG. 5
to the display in FIG. 6 by using the mouse pointer to point and
click at the shaded bar 510 that is labeled `Register/Update`. The
program then redisplays the patient program screen as shown in FIG.
6. From FIG. 6 the user could return to the display as it appears
in FIG. 5 by using the mouse pointer to point and click at the
shaded bar 650 which will cause the program to collapse the
`Register/Update` section and hide the data entry fields. The
`Register/Update` data entry section has two purposes for the
patient program. If it is invoked before the patient logs on then
it is used to register the patient as a new user. This same section
will be available to the patient after they have successfully
logged onto the system. In that case, their current registration
information is filled into the data entry fields of the
`Register/Update section and they can update their registration
information by changing the information in a field and selecting
the `Submit` button 631 which causes the program to send the
information to the treatment information server to be used to
update the treatment information database, wait for and display the
reply.
[0082] The data entry fields in the `Register/Update` section
include all of the fields in the Patient Table 305 except
PatientID, DateEntered, DateUpdated, and MeasCompliance, which are
managed by the database program. The data entry fields labeled
Prefix 601, First Name 602, MI 603, Last Name 604, Suffix 605,
Address 606, City 607, State 608, Zip 609, Phone 610, SSN 611,
Email 612, Date of Birth 613, Sex 614 Marital Status 615, Language
616, Contact 617, Username 618, Password 619, and Med-Password 620,
correspond respectively to the data fields, Prefix FName, MI,
LName, Suffix, Address, City, State, Zip, Ph, SSN, Email, DOB, Sex,
MaritalStatus, PrefMedLang, PrefMeansContact Username, Password,
and PIN of the table Patients 305. When the user selects the
`Submit` button 631, the information is sent to the treatment
information server for posting into the treatment information
database, waits for and displays the reply.
[0083] Two of the fields, Language 616 and Contact 617 allow the
patient to enter their preferences as a means of customizing how
the system interacts with them. The choice of language 617
indicates that language by which the patient prefers to view
treatment instructions, and the preferred means of contact 617
indicates the means by which the user prefers to receive reminder
compliance notification.
[0084] Every patient has 2 Passwords. The Password field `Password`
619 is used by the patient to access their treatment instructions
from the patient program. In order for medical personnel to access
a patients records and enter treatment instructions from the
medical personnel data entry program, they have to have
authorization from the patient in the form of the patients
`Username` 618 and `Med-Password` 620 also called a `PIN`. The
`Username` and `Med-Password` field 620 or PIN allows access to the
patient's information in the treatment instructions database from
the medical personnel program but not the patient program. The
`Username` and `Password` field 619 allows access to the patient's
information in the treatment instructions database from the patient
program but not from the medical personnel data entry program. The
use of two Passwords provides a means by which the level of access
and update control to patient's information can be provided for
patients and medical personnel. The user may use the
`Register/Update` section 650 at any time to change the `Username`
618, `Password` 619, or `Med-Password` 620.
[0085] Several of the fields have a down pointing arrow 605 on the
right hand side of the data entry field. This indicates that the
field is a drop-down box, and that the program already displays the
only valid entries. The entries are accessed by using the mouse
pointer to point and click at the arrow box 660 and a list of
possible entries for the patient to select with the mouse pointer
will be displayed. The allowable entries in the drop-down box field
`Prefix` 601 are `Mr.`, `Mrs`, `Dr.`, and `Ms.`. The allowable
entries in the drop-down box field `Suffix` 605 are `Ph.D.`, `DVM`,
`Sr`, and `Jr`. The allowable entries in the drop-down box field
`State` 608 are all the 2-character standard abbreviations for the
50 states of the United States. The allowable entries in the
drop-down box field `Sex` 614 are `M` and `F` for male and female
respectively. The allowable entries in the drop-down box field
`Marital Status` 615 are `Married`, `Single`, `Divorced` and
`Widowed`. The allowable entries in the drop-down box field
`Language` 616 are `English` and `Spanish`. The allowable entries
in the drop-down box field `Contact` 617 are `Email`, `Phone`,
`Beeper`, and `Regular mail`.
[0086] The buttons `Submit` 631, `Reset` 632 and `Logoff` 640 have
the same functionality to that shown in the similarly named buttons
`Submit` 531, `Reset` 532 and `Logoff` 540 of FIG. 5.
[0087] FIG. 7 is an example 700 of the list of the patient's
medical appointments on the display screen 201 that are in the
treatment information database and can be reviewed by the patient.
In order to navigate to this screen, the user would have had to
successfully log into the system with their Username and
Password.
[0088] The display shows three shaded section bars, `Logon` 705,
`Register/Update` 706, and `Recent Physician Appointments` 710.
Using the mouse pointer to point and click at any of these shaded
bars will cause the program to collapse the display of the section
if it is expanded, or to expand the display of the section if it is
collapsed. In this example, the `Logon` and `Register/Update`
sections are collapsed hiding their respective data entry fields
and the `Recent Physician Appointments` section 710 is in expanded
mode.
[0089] The `Recent Physicians Appointments` section 710 shows four
recent appointments for the patient. The first appointment 715
shows an appointment with Dr. White on Mar. 29, 1999. Note that the
appointment is underlined. The user can view the compliance
information for that appointment by using the mouse pointer to
point and click at the underlined appointment listing. This will
cause the program to send a message to the treatment information
server to retrieve the compliance information and redisplay the
screen as in FIG. 8, with the specific compliance information from
that appointment.
[0090] The button `Logoff` 740 has the same functionality to that
shown in the similarly named `Logoff` 540 of FIG. 5.
[0091] FIG. 8 is an example 800 of the Patient Program screen on
the display screen 201 that the patient encounters when they have
selected a recent medical appointment to view. The display shows
eight shaded section bars, `Logon` 805, `Register/Update` 806, and
`Recent Physician Appointments` 810, `Treatment Instructions` 815,
`Alert` 820, `Followup` 825, `Diagnosis Information` 830, and
`Treatment Information` 835. Using the mouse pointer to point and
click at any of these shaded bars will cause the program to
collapse the display of the section if it is expanded, or to expand
the display of the section if it is collapsed. In this example, the
`Logon`, `Register/Update`, and `Treatment Information` sections
are collapsed hiding their respective data fields and the `Recent
Physician Appointments`, `Treatment Instructions`, `Alerts`,
`FollowUp` and `Diagnosis Information` sections are in expanded
mode.
[0092] The section `Recent Physician Appointments` 810 shows the
data fields for the recent appointment 811 with Dr. White on Mar.
29, 1999. This section 812 shows appointment data fields that
include the date, physician name, patient's complaint and the
diagnosis. There is a scroll bar 813 that the patient may use to
scroll through other appointments headers. The patient may select
another appointment to view by using the mouse pointer to point and
click at a session identifier 814 which will cause the patient
program to send a request to the server to retrieve the information
session information, wait for and display the reply.
[0093] The treatment instructions are displayed in the section
`Treatment Instructions` 815. The treatment information 816 for the
selected appointment is displayed in a grid ordered according to
the sequence and time order in which the instructions are to be
followed. The alerts are displayed in the section `Alerts` 820, and
are a list of one or more alerts that the patient should be
especially aware of. Alerts may be symptoms that should they occur
the patient should seek immediate medical attention. The followup
information is displayed in the section `FollowUp` 825 and is a
list of the medical followup, if any, that the user should schedule
to continue medical treatment associated with their complaint. The
diagnosis information is displayed in the section `Diagnosis
Information` 830, and in this case is a list of links to web sites
that have relevant diagnosis information. The patient can use the
mouse pointer to point and click at the links and retrieve the
information pages for review. The treatment information is
displayed in the section treatment Information 835. Similarly to
the Diagnosis information, this section has links to web sites that
have relevant treatment information. The diagnosis and treatment
information will be presented to the user according to their
language preference.
[0094] In the example of FIG. 8, the patient has accessed the
instructions and information about their appointment on Mar. 29,
1999. For patient compliance purposes, the system records that the
patient has accessed the treatment information for the March 29
appointment. The system will not record that the patient has
accessed the treatment information for the other appointments until
the patient specifically selects that appointment from the `Recent
Physician Appointment` sections 810 and brings the information up
on the screen of the patient program.
[0095] The button `Logoff` 840 has the same functionality to that
shown in the similarly named `Logoff` 540 of FIG. 5.
[0096] FIG. 9 is an example 900 of the first screen presented to
medical personnel on the display screen 201 that medical personnel
encounter when they start the medical personnel data entry program.
The purpose of the medical personnel data entry program is for
authorized medical personnel to enter the treatment instructions
that are issued after a medical examination.
[0097] This is the logon screen and medical personnel are not
allowed to invoke the patient data entry functions until they logon
with an authorized Username and Password. The screen layout is
entirely similar in layout and functionality to that of the patient
program logon screen 500. For instance it shows the title banner
901 for the system, `Electronic Compliance Promoter` which is the
same as the title banner 501 for the patient program. The only
difference in appearance is the name of the specific program
module, `Medical Personnel Program--Data Entry` 902.
[0098] Functionally this data entry screen is similar to that of
the patient program logon screen 500. The solid shaded bars work as
in all screens--when selected by pointing and clicking the mouse
anyplace on the solid bar, the section will toggle to either expand
and display the data fields or contract to hide the data fields.
The data entry fields `Username` 905 and `Password` 906 are the
fields that the medical personnel use to enter their logon
information to the system. After entering this information,
selecting the `Submit` button 907 sends the Username and Password
to be validated against valid entries in the MedPersonnel table
310, and the program waits and displays the response. If the logon
is validated the program redisplays the screen as shown in FIG. 11,
and if it is not validated then this same logon screen is
redisplayed. The `Reset` button 908 causes the program to clear any
entries from the fields labeled `Username` 905 and `Password` 906.
The Logoff button 990 causes the program to terminate the Medical
Personnel data entry session. If Medical Personnel had logged onto
the system which provided them with access to patients records,
then the Logoff function will deny them access until they again
successfully logon.
[0099] FIG. 10 is an example 1000 of the first screen presented to
the medical personnel on the display screen 201 that the patient
encounters when they start the medical personnel data entry
program. It shows the medical personnel data entry program of FIG.
9 but with the `Logon` section 1005 contracted to hide the data
fields and the `Register/Update` section 1010 expanded to show the
fields used for medical personnel to register to use the system or
to update their logon information. The `Register/Update` section
has two purposes for the medical personnel program. If it is
invoked before the medical personnel logs on then it is used to
register the medical personnel as a new user. This same section
will be available to medical personnel after they have successfully
logged onto the system. In that case, their current registration
information is filled into the data entry fields of the
`Register/Update` section and they can update their registration
information by changing the information in a field and selecting
the `Submit` button 1031 which causes the program to send the
information to the treatment instruction sever to be used to update
the treatment instruction database, wait and display the reply.
[0100] The data entry fields in the `Register/Update` section
include all of the fields in the `MedPersonnel` table 310 except
MedPersID, DateEntered, and DateUpdated that are managed by the
database program. The data entry fields labeled Prefix 1011, First
Name 1012, MI 1013, Last Name 1014, Suffix 1015, Degree 1016,
Medical Practitioner 1017, Address 1018, City 1019, State 1020, Zip
1021, Phone 1022, SSN 1023, Email 1024, Username 1025, and Password
1026, correspond respectively to the data fields, Prefix, Fname,
MI, Lname, Suffix, Degree, MedPersType, Address, City, State, Zip,
Ph, SSN, Email, Username, and Password of the table `MedPersonnel`
310. When the user selects the `Submit` button 1090, the
information is sent to the treatment information server for posting
into the treatment information database, and the program waits and
displays the response. Several of the fields have a down pointing
arrow on the right hand side of the data entry field. This
indicates, as in the patient program, that the field is a drop-down
box, and that the only valid entries are those displayed by the
program. The buttons `Submit` 1031, `Reset` 1032 and `Logoff` 1090
have similar functionality to that shown in the similarly named
buttons `Submit` 907, `Reset` 908 and `Logoff` 990 of FIG. 9.
[0101] FIG. 11 is an example 1100 of the first screen on the
display screen 201 presented to the Medical personnel after they
have successfully logged onto the system. The purpose of this
screen is to allow the medical personnel to identify the patient
for whom they will data enter medical examination compliance
information. The display shows three shaded section bars, `Logon`
1110, `Register/Update` 1120, and `Identify Patient` 1130. Using
the mouse pointer to point and click at any of these shaded bars
will cause the program to collapse the display of the section if it
is expanded, or to expand the display of the section if it is
collapsed. In this example, the `Logon` and `Register/Update`
sections are collapsed hiding their respective data entry fields
and the section `Identify Patient` 1130 is in expanded mode. The
medical personnel would enter the Username and Med-Password or PIN
of the patient into the fields labeled `Username` 1141 and
`Med-Password` 1151. The Med-Password is the Password that is setup
by the patient to allow medical personnel to perform data entry and
administration of their office visit compliance information, and is
provided by the patient to the Medical personnel. The medical
personnel would then select the `Submit` button 1161 which would
send the values in the fields labeled `Username` 1141 and
`Med-Password` 1151 for authorization and wait and display the
results. If the authorization is successful then the screen of FIG.
12 is displayed, but if it is not successful then this screen of
FIG. 11 is redisplayed. If the medical personnel select the reset
button then the entries in the fields labeled `Username` 1141 and
`Med-Password` 1151 would be cleared of their entries. The Logoff
button 1190 has the same functionality as the similarly named
button 990.
[0102] FIG. 12 is an example 1200 of the screen on the display
screen 201 used by the medical personnel to enter the compliance
information for a patient's office visit. The purpose of this
screen is for the medical personnel to enter the treatment
instruction information for the patient's office visit. The display
shows five major sections `Logon` 1205, `Register/Update` 1210,
`Identify Patient` 1215, `Recent Physician Appointments` 1220, and
`Office Visit` 1230. The first three sections have the same
functionality as in FIGS. 10 and 11. Note that by selecting the
`Identify Patient` 1215 section, the medical personnel will be
presented with the `Enter Username and Med-Password` logon screen
of FIG. 11, and can enter the Username and Med-Password to work
with a different patient. They can therefore work with a different
patient without having to go through the Medical Personnel Login
again. The section `Recent Physician Appointments` 1220 lists prior
appointments that have already been recorded in the system. In this
example two prior appointments are shown and both are underlined,
which indicates that by using the mouse pointer to point and click
at the appointment, will bring up a screen that displays the
specifics of that appointment.
[0103] The section `Office Visit` 1230 is the section in which the
treatment instructions are entered. First there is a section 1232
with the date of appointment to be entered, and the Physician, and
the complaint. Below that there is a drop-down box field in which
the diagnosis is entered. For each diagnosis selected the medical
personnel specifies whether to include `Treatment instructions`
1251, `Diagnosis Information` 1252, `Treatment Information` 1253,
`FollowUp` 1254, or `Alerts` 1255. For each of these types of
information the medical personnel can put an `x` in the checkbox
`Include` 1256 to include the associated treatment instruction. If
the checkbox is left blank then the associated information is not
included in the treatment instructions. The medical personnel also
use a checkbox `Compliance Tracking` 1257 in a similar fashion to
indicate to the system whether the treatment instructions included
for the patient should be tracked automatically by the system and
compliance reminders sent if the patient is non-compliant. This
button can only be selected if the associated treatment instruction
has been `included` 1256.
[0104] The treatment instructions can be viewed in the `Treatment
instructions` section 1251. When the user points and clicks at this
section the recommended treatment guidelines are displayed in a
popup dialog window with the sequence of treatment guidelines
displayed in a text grid. Medical personnel can edit these
instructions. Any modification to the treatment guidelines results
in the information being inserted into the ClinGuidelines table 340
with a unique ClinGuidelineID and SeqNo.
[0105] On this screen the Save button 1290 causes the Medical
Personnel data entry program to send the office visit information,
diagnosis, and treatment instruction information to the treatment
instruction server and redisplay the screen as in FIG. 11.
[0106] FIG. 13 is an example 1300 of the first screen presented to
medical personnel on the display screen 201 that medical personnel
encounter when they start the medical personnel administration
program. The purpose of the medical personnel administration
program is to allow authorized medical personnel to review the
compliance of patients with their prescribed medical
instructions.
[0107] This is the logon screen and medical personnel are not
allowed to invoke the administration functions until they logon
with an authorized Username and Password. The screen layout is
entirely similar in layout and functionality to that of the patient
program logon screen 500 and to that of the medical personnel data
entry program 900. For instance we show the title banner 1301 for
the system, `Electronic Compliance Promoter` which is the same as
the title banner 501 for the patient program and as the title
banner 901 for the medical personnel data entry program. The only
difference in appearance is the name of the specific program
module, `Medical Personnel Program--Administration` 1302.
[0108] Functionally this data entry screen is similar to that of
the medical personnel data entry 900. The solid shaded bars work as
in all screens--when selected by pointing and clicking the mouse
anyplace on the solid bar the section will toggle to either expand
and display the fields or contract to hide the fields. The data
entry fields `Username` 1305 and `Password` 1306 are the fields
that the medical personnel use to enter their logon information to
the system. After entering this information, selecting the `Submit`
button 1307 sends the values in the fields labeled `Username` 1305
and `Password` 1306 to be validated against valid entries in the
`MedPersonnel` table 310, and the program waits and displays the
results. If the logon is validated the program redisplays the
screen as shown in FIG. 14. If the logon is not validated then the
screen of FIG. 13 is redisplayed. If the medical personnel select
the `Reset` button 1308 by using the mouse pointing device to point
and click at button, then the data entry fields `Username` 1305 and
`Password` 1306 are cleared of any entries. The `Logoff` button
13990 causes the program to terminate the Medical Personnel
administration session. If Medical Personnel had logged onto the
system which provided them with access to patients records, then
the `Logoff` function will deny them access until they again
successfully logon.
[0109] FIG. 14 is an example 1400 of the screen presented to the
medical personnel on the display screen 201 when they have first
successfully logged into the system. The display shows five shaded
section bars. The sections `Logon` 1410 and `Register/Update` 1420
are the same as described in FIGS. 12 and 13. There is a new
section `Patients` 1430 which lists all patients that the Medical
Personnel may review. This section has its own sections--one for
every patient listed. In this example there are just two patients
John Doe and Jane Doe. The office visits for John Doe are listed in
the section `John Doe` 1440 and the office visits for Jane Doe are
listed in the section `Jane Doe` 1450. The data fields for the
patient specific sections are the list of office visits for that
patient. Each entry 1441 in the list is underlined which indicates
that by using the mouse device to point and click at the office
visit entry, compliance information for that office visit will be
displayed. The `Logoff` button 1490 has the same functionality as
the similarly named button 1390.
[0110] FIG. 15 is an example 1500 of the compliance status screen
presented to the medical personnel on the display screen 201 when
they have selected a patient for review. In this case the medical
personnel has selected to review the compliance information for the
patient Jane Doe. The display shows seven shaded section bars. The
sections `Logon` 1505 and `Register/Update` 1510 are the same as
described in FIGS. 13 and 14. There is a new section
`Patients`--Jane Doe` 1520 under which the compliance information
for the patient Jane Doe will be displayed. Each office visit
(1530,1531) is presented as its own section in descending
chronological order. Within each office visit, there is a section
displaying the compliance information for each diagnosis 1540. If
there are multiple diagnoses at an office visit then each diagnoses
is displayed in its own section. The compliance information that is
presented is for five categories of compliance
information--`Treatment instructions` 1550, `Diagnosis Information`
1555, `Treatment Information` 1560, `Alerts` 1565 and `FollowUp`
1570. For each category the information about whether the patient
has accessed the information is contained in a checkbox `Accessed`
1541. If the checkbox has an `x` in it then the patient has
accessed the corresponding type of information. If the checkbox is
empty then the patient has not accessed the corresponding type of
information. The medical personnel uses the checkbox `Send
reminder` 1542 to explicitly request the system to send a reminder
compliance message to the patient. If the medical personnel places
and `x` in the checkbox, by using the mouse pointing device to
point and click at the checkbox, then a reminder compliance message
will be sent by the treatment server program to the patient. The
`Back` button 1580 will cause the program to redisplay the prior
screen with a list of the visits for all patients as shown in FIG.
14. The `Logoff` button 1590 has the same functionality as the
similarly named button 1390.
[0111] D. Compliance Reminders
[0112] Compliance reminders are one of the key features of the
invention. The "Measure of Compliance` 400 provides a reasonable
surrogate measure for actual compliance, and is used by the system
to track a patients access to the treatment information resources.
All patients that are not fully up-to-date in reviewing the
treatment information are automatically sent reminders.
[0113] FIG. 16 is an example 1600 of an Email reminder that is sent
automatically by the treatment information database program to a
patient who is not fully compliant with the post-examination
treatment instructions as measured by the `Measure of Compliance`
400. It is a standard Email message addressed to the patient in the
`To` Email address 1610, sent by the Electronic Compliance Promoter
identified in the `From` Email address 1620, and with a subject
line 1630 indicating to the patient that this is a reminder about
the Mar. 29, 1999 office visit. The body of the E-mail further
references the patient's medical examination by listing the
complaint 1640 at the time of the office visit and the diagnosis
1650. A short message 1660 reminds the patient to check information
relevant to the referenced office visit.
[0114] E. Communication Protocol
[0115] The preferred embodiment uses an industry standard Ethernet
and an industry standard TCP/IP network protocol for its computer
network. A computer network conversation between the patient
program and the treatment database program is implemented by
establishing a connection between the computers over the computer
network. Similarly, a computer network conversation between the
medical personnel program and the treatment database program is
implemented by establishing a connection between the computers over
the computer network. Similarly, a computer network conversation
between the medical personnel administration program and the
treatment database program is implemented by establishing a
connection between the computers over the computer network.
[0116] To minimize the computer resources utilized to maintain
these connections, this invention uses a non-persistent network
connection; i.e. a network connection is established between the
client and server computers only for the length of time necessary
to perform a specific transaction.
[0117] In the preferred embodiment the connections are implemented
using the industry standard hypertext transport protocol (http). In
other embodiments the non-persistent connection may be implemented
using another industry standard protocol, or a special
non-persistent protocol may be implemented specifically to address
the operation of this system. If any of the client programs
(patient program, medical personnel program or medical personnel
administration program) or the treatment database program
terminates their connection with the other program, either by
design or another reason, such as a network outage, the other
program also terminates its connection state.
[0118] F. Patient Program
[0119] In this preferred embodiment of the program the client
programs all execute as industry standard hypertext markup language
(html) pages in a Microsoft Internet Explorer Web Browser Version
4.0. The treatment instructions database server program executes as
Microsoft Active Server Pages running under the Microsoft Internet
Information Server 4.0 web server. The writing of client side html
code that implements functionality within a web browser is
well-known to those skilled in the arts, as is the writing of
Active Server Page to generate the content of these pages
dynamically based on input from the user and information contained
within a database. Thus both the client and server programs utilize
the services of standard well-known and well-used web systems
programs to implement their functionality. The operation of these
system programs are well known to those skilled in the art and will
not be further described in this specification.
[0120] In the preferred embodiment the specific language protocol
versions that are used are the Hypertext Markup Language 4.0
standard and the Cascading Style Sheet (CSS) 1.0 standard. The
Microsoft Internet Explorer is using Active Server Pages 2.0 to
generate html pages dynamically, and the ActiveX Data Objects
Component (ADO) to access data in the treatment instructions
database. An example of how these standards are utilized may be
helpful.
[0121] The operation of the preferred embodiment of the client
programs all rely heavily on sections of information that are
toggled to expand and contract when the user points and click with
the mouse pointer device at the section header. For instance FIG. 5
show a `Register/Update` section 510 in collapsed mode. In FIG. 6
this same `Register/Update section 650 is shown in expanded mode.
Throughout the specification of the client programs, expanding and
collapsing of sections is implemented using specific features of
the HTML 4.0/CSS 1.0 standards. Expanding a section displays the
information for the user and collapsing has the opposite effect.
Since the client programs are running under a web browser, and are
written in HTML 4.0 and CSS 1.0, the expand/collapse functionality
is implemented using the HTML DIV start and end tags to define
screen sections, and then setting the properties of the style
attribute to cause the browser to either display or hide the
section. Thus the expand/collapse function is standard
functionality that can be employed in any web page that is written
in HTML 4.0/CSS 1.0 and operates within the confines of the
Microsoft Internet Explorer Web Browser Version 4.0. This is
standard html programming that is well known to any person skilled
in the art.
[0122] Similarly, after the client program is first displayed there
will be one or more `Submit` buttons displayed. Selecting a
`Submit` button by pointing and clicking with the mouse pointer
device will cause the Web browser to access and display on the
display screen a new page associated with a URL. This is
implemented in all client programs by use of the html FORMS tags
with the value of the action attribute set to the URL of the client
program and name-value pairs of the QueryString set by the web
browser when the user select a `Submit` button. This too is
standard html programming understood and well known to those
skilled in the art. The `Reset` button is also used throughout the
client programs, always in tandem with the `Submit` button. The
`Reset` button resets all fields contained within the FORMS tag to
their initial values, and is standard html programming understood
and well known to those skilled in the art.
[0123] Finally, throughout the client programs we use hyperlinks.
This is indicated by underlined test. By pointing and clicking with
the mouse pointer device at a hyperlink, will cause the web browser
to display the URL referenced by the hyperlink. Hyperlinking is
central to the notion of web programming, is standard html
programming understood and well known to those skilled in the art.
In some instances the hyperlink information will be displayed in a
new window that `floats` on top of the client program. This too is
a general facility of web programming that is well known to those
skilled in the art.
[0124] Similarly with other functionality of the client programs,
the means by which the functionality is implemented are standard
html/css coding and are well known to those skilled in the art. The
specification will therefore focus on the logic of the systems and
the algorithms employed to implement the systems. For each of the
three client programs, Patient, Medical Personnel data entry, and
Medical Personnel administration programs, we provide the
description by means of the standard systems design tools--state
diagrams and state tables.
[0125] FIG. 17 is a state diagram 1700 showing the state machine
describing the logical operation of the patient program. The state
diagram shows the different states that the program may occur in,
and the actions that cause them to change to another state.
[0126] Since the patient program is operating under the Microsoft
Internet Explorer Web Browser 4.0, after starting the Patient
Program the patient program is either waiting for a response from
the server program or waiting for input from the user. State
`START` 1701 represents the program state when the Web Browser is
started and a request is sent via http to the server program for
the patient logon page. After sending the request the program
immediately transfers to the `WAIT_FOR_REPONSE` 1710 state,
awaiting the receipt via http of the html file that will display
the requested logon page of the Patient program on the display
screen of the Web Browser. When the html file is received it is
displayed or rendered by the browser on the display screen and then
processing transfers to the `WAIT_FOR_INPUT` 1720 state in which
the Patient Program awaits user keyboard or computer mouse
input.
[0127] There are two distinct type of actions that may occur in the
`WAIT_FOR_INPUT` 1720 state. The user may interact with the screen
as when they use the mouse to point-and-click at a section to
expand or contract it, or key enter information in one of the data
entry fields displayed on the screen. This type of interaction
between the user and the program results in changes to the
currently displayed screen but does not cause a request to be sent
to the server program for a new page. In this case the program
processes the user input and remains in the state `WAIT_FOR_INPUT`
1720.
[0128] The second type of action that may occur is when the user
initiates an action, such as pressing the `Submit` button 540 of
FIG. 5, which causes a http request message to be sent to the
server requesting a new page. In this case the message is sent and
the program transfers to the state `WAIT_FOR_REPSONSE`, awaiting
the reception of a new page. When that page is received, it is
displayed on the display screen of the Web Browser and the program
transfers to the state `WAIT_FOR_INPUT` awaiting action from the
user.
[0129] The state machine for the Patient Program 1700 clearly shows
the reliance on the browser and the server programs for the
operation of this module of the system. The browser is the
operational platform that displays html pages and interacts with
the user. The user may initiate actions that will result in a
message to the server to formulate a new html page, wait for the
response from the server, and display a new page of the patient
system according to the specifics of the message request.
[0130] FIG. 18 is a state table 1800 for the operation of Patient
Program. It has 3 states, START 1801 which corresponds to the state
1701 of FIG. 17, WAIT_FOR_RESPONSE 1810 which corresponds to the
state 1710 of FIG. 17, and WAIT_FOR_INPUT 1820 which corresponds to
the state 1720 of FIG. 17. The state table provides more detail on
the operation of the Patient Program.
[0131] When the Patient Program is started it immediately enters
the logical state START 1801 in which the Internet Explorer Web
Browser program is started in the `StartUp` operation 1802. The Web
Browser uses the Universal Resource Locator (URL) of the Patient
Program to request the html file with the logon screen for the
Patient Program. In this case the URL is only the name of the
Network Resource with the Patient Program ASP file and has no
`QueryString` associated with it. After requesting the file, the
program transfers to the state WAIT_FOR_RESPONSE 1810 and when the
file is received, performs the operation `Display web page` 1811
and displays the Patient program logon screen, sets the focus to
the `Logoff` button 540 of FIG. 5, and transfers to the state
`WAIT_FOR_INPUT` 1820.
[0132] The state `WAIT_FOR_INPUT` 1820 is the state in which the
user interacts with the Patient Program and so it is in this state
that most of the html/css programming is done. There are 10
different operations that the program must be capable of
handling.
[0133] If the operation is to `Expand or Collapse` a section 1821
then if the selected section is in collapsed mode then the screen
is redisplayed with the selected section in expanded mode. If the
selected section is in expanded mode then the screen is redisplayed
in collapsed mode. In the preferred embodiment the sections are set
to their respective modes by programming the DHTML `onclick` event
to set the style property display attribute of the sections html
DIV tag to `NONE` to collapse the section and `BLOCK` to display
it.
[0134] If the operation is to `Change focus` 1827 then the browser
resets the focus to the selected field. This will most often occur
with the data entry fields. For instance if the user is entering a
Username into the Username field 522 of FIG. 5, then the focus of
the browser has to be on this data entry field so the browser will
update the Username data entry field with the keyed values. The web
browser changes the focus when the user points and clicks at a data
entry field or uses the `Tab` key to navigate to a new field. If
the operation is `Key-Entry` 1828, then the key entered is appended
to the values in the data entry field that has the focus. This
operation is handled by the web browser and includes support for
`Backspace` and `Del` to remove previously keyed characters.
[0135] If the operation is to `Submit Logon` 1823 then the Web
Browser submits a request to the server program to validate the
Username and Password of the user. The Web Browser uses the
Universal Resource Locator (URL) of the Patient Program with the
`QueryString` set to name-value pairs with the Username and
Password. This URL request is sent to the server and the program
enters the state `WAIT_FOR_REPONSE` 1810 waiting to receive and
display a new page of the Patient Program. If the treatment
database server program can validate the Username and Password then
it will respond with a screen containing Patient Information
including recent appointments. If the treatment database server
program cannot validate the Username and Password then it will
respond with the Patient Program logon screen.
[0136] If the requested operation is to `Submit SignUp/Update` 1824
then the Web Browser submits a request to the server program to
either sign-up a new patient or to update the patient's information
in the treatment instructions database. The Web Browser uses the
URL of the Patient Program with the QueryString set to the
name-value pairs of the `Register/Update` section 650 of FIG. 6.
This URL request is sent to the server and the program enters the
state `WAIT_FOR_RESPONSE` 1810 waiting to receive and display a new
page of the Patient Program. If the SignUp is successful then the
user will be able to further use the system. However at the time of
registration there will be no medical appointments in the system so
there will be no treatment instruction information to review. If
the update is successful, then they will be logged into the system,
if not already logged in, and the server will respond with the same
screen as after a successful `Submit Logon` 1823.
[0137] If the requested operation is `Submit Recent Appointment`
1825, then the patient is requesting to review the treatment
information for a selected appointment. The Web Browser uses the
URL associated with the underlined (hyperlink) appointment 715 of
FIG. 7 to request a new Patient Program screen with the appointment
information. The URL request is sent to the server and the program
enters the state `WAIT_FOR_RESPONSE` 1810 waiting to receive and
display a new page, similar to FIG. 8, with the patient's treatment
instruction information for the specified medical appointment.
[0138] For both the patient `Logon` section and the `SignUp/Update`
section there is a `Reset` button. If the selected operation is
`Reset` 1822, then the data entry fields associated with the
respective sections are cleared to their initial state with no
entries.
[0139] If the requested operation is `Display Diagnosis Info` 1829,
then the patient has selected a hyperlink to a website that
contains diagnosis information. The Web browser opens a new browser
window and displays the hyperlink URL with the diagnosis
information. This will cause the system to hyperlink to the
resource in the language preference of the patient by linking to a
subdirectory of the URL with the language specific information. For
instance if the value of the Patients language preference is
`Spanish` then the system may access information about
Diabetes/Mellitus at the network site
URL/Spanish/DiabetesMellitus.html. The window will `float` on top
of the Patient program window and will remain displayed until the
Patient closes it. The Patient Program remains fully operational
even while the web browser manages the second diagnosis information
window.
[0140] If the requested operation is `Display Treatment Info` 1830,
then the patient has selected a hyperlink to a website that
contains treatment information. The Web browser opens a new browser
window and displays the hyperlink URL with the treatment
information. Analogously to disease information, treatment
information is displayed in the language preference of the patient.
The window will `float` on top of the Patient program window and
will remain displayed until the Patient closes it. The Patient
remains full operational even while the web browser manages the
second treatment information window.
[0141] If the requested operation is `Submit Logoff` 1826, then the
Web Browser submits a request to the server program to log the
patient out of the system. The program uses the URL of the Patient
Program with the QueryString indicating `Logoff`. The URL request
is sent to the server and the program enters the state
`WAIT_FOR_RESPONSE` 1810 waiting to receive and display a new
`Logon` pages just as if it had transitioned from the `Start` state
1801.
[0142] G. Medical Personnel Program
[0143] FIG. 19 is a state diagram 1900 showing the state machine
describing the logical operation of the Medical Personnel Data
Entry Program. Since the Medical Personnel Data Entry Program is
operating under the Microsoft Internet Explorer Web Browser 4.0,
after invocation the program is either waiting for a response from
the server program or waiting for input from the user. State
`START` 1901 represents the program state when the Web Browser is
started and a request is sent via http to the server program for
the Medical Personnel logon page. After sending the request the
program immediately transfers to the `WAIT_FOR_REPONSE` 1910 state,
awaiting the receipt via http of the html file that will display
the requested logon page of the Medical Personnel Data Entry
Program on the display screen of the Web Browser. When the html
file is received it is displayed or rendered by the browser on the
display screen and then processing transfers to the
`WAIT_FOR_INPUT` 1920 state in which the Medical Personnel Data
Entry Program awaits user keyboard or computer mouse input.
[0144] There are two distinct type of actions that may occur in the
`WAIT_FOR_INPUT` 1920 state. The user may interact with the screen
as when they use the mouse to point-and-click at a section to
expand or contract it, or key enter information in one of the data
entry fields displayed on the screen. This type of interaction
between the user and the program results in changes to the
presently displayed screen but does not cause a request to be sent
to the browser for a new page. In this case the program processes
the user input and remains in the state `WAIT_FOR_INPUT` 1920.
[0145] The second type of action that may occur is when the user
initiates an action, such as pressing the `Submit` button 907 of
FIG. 9, which causes a http request message to be sent to the
server requesting a new page. In this case the message is sent and
the program transfers to the state `WAIT_FOR_REPSONSE` 1910,
awaiting the reception of a new page. When that page is received,
it is displayed on the display screen of the Web Browser and the
program transfers to the state `WAIT_FOR_INPUT` awaiting action
from the user.
[0146] The state machine for the Medical Personnel Program 1900
clearly shows the reliance on the Web Browser and the Web Server
for the operation of this module of the system. The browser is the
operational platform that displays html pages and interacts with
the user. The user may initiate actions that will result in a
message to the server to formulate a new html page, wait for the
response from the server, and display a new page of the Medical
Personnel Data Entry system according to the specifics of the
message request.
[0147] FIG. 20 is a state table 2000 for the operation of Medical
Personnel Data Entry Program. It has 3 states, START 2001 which
corresponds to the state 1901 of FIG. 19, WAIT_FOR_RESPONSE 2010
which corresponds to the state 1910 of FIG. 19, and WAIT FOR INPUT
2020 which corresponds to the state 1920 of FIG. 19. The state
table provides more detail on the operation of the Medical
Personnel Data Entry Program.
[0148] When the Medical Personnel Data Entry Program is started it
immediately enters the logical state START 2001 in which the
Internet Explorer Web Browser program is started in the StartUp
operation 2002. The Web Browser uses the Universal Resource Locator
(URL) of the Medical Personnel Data Entry Program to request the
html file with the logon screen. In this case the URL is the
network resource of the Medical Personnel Data Entry ASP file and
has no QueryString associated with it. After requesting the file,
the program transfers to the state WAIT_FOR_RESPONSE 2010 and when
the file is received, performs the operation `Display web page`
2011 and displays the Medical Personnel Data Entry program logon
screen, sets the focus to the `Logoff` button 990 of FIG. 9, and
transfers to the state `WAIT_FOR_INPUT` 2020.
[0149] The state `WAIT_FOR_INPUT` 2020 is the state in which the
user interacts with the Patient Program and so it is in this state
that most of the html/css programming is done. There are 14
different operations that the program must be capable of
handling.
[0150] If the operation is to `Expand or Collapse` a section 2021
then if the selected section is in collapsed mode then the screen
is redisplayed with the selected section in expanded mode. If the
selected section is in expanded mode then the screen is redisplayed
in collapsed mode. In the preferred embodiment the sections are set
to their respective modes by programming the DHTML `onclick` event
to set the style property display attribute of the sections html
DIV tag to `NONE` to collapse the section and `BLOCK` to display
it.
[0151] If the operation is to `Change focus` 2030 then the browser
resets the focus to the selected field. This will most often occur
with the data entry fields. For instance if the user is entering a
Username into the Username field 905 of FIG. 9, then the focus of
the browser has to be on this data entry field so the browser will
update the Username field. The web browser changes the focus when
the user points and clicks at a data entry field-or uses the `Tab`
key to navigate to a new field. If the operation is `Key-Entry` 20,
then the key entered is appended to the values in the data entry
field that has the focus. This operation is handled by the web
browser and includes support for `Backspace` and `Del` to remove
previously keyed characters.
[0152] If the operation is to `Submit MedPersonnel Logon` 2023 then
the Web Browser submits a request to the server program to validate
the Username and Password of the Medical Personnel. The Web Browser
uses the Universal Resource Locator (URL) of the Medical Personnel
Data Entry Program with the QueryString set to name-value pairs
with the Username and Password. This URL request is sent to the
server and the program enters the state `WAIT_FOR_REPONSE` 2010
waiting to receive and display a new page of the Medical Personnel
Data Entry Program. If the treatment database server program can
validate the Username and Password then it will respond with a
screen requesting patient logon information. If the treatment
database server program cannot validate the Username and Password
then it will respond with the Medical Personnel Data Entry Program
logon screen.
[0153] If the operation is to `Submit Patient Logon` 2024 then the
Web Browser submits a request to the server program to validate the
Username and PIN of the Patient so the Medical Personnel may enter
treatment instruction information associated with the current
medical appointment. The Web Browser uses the Universal Resource
Locator (URL) of the Medical Personnel Data Entry Program with the
QueryString set to name-value pairs with the Username and PIN. This
URL request is sent to the server and the program enters the state
`WAIT_FOR_REPONSE` 2010 waiting to receive and display a new page
of the Medical Personnel Data Entry Program. If the treatment
database server program can validate the Username and PIN then it
will respond with a screen similar to FIG. 12 in which the medical
personnel may enter the treatment instruction information
associated with the medical appointment. If the treatment database
server program cannot validate the Username and PIN then it will
respond with a screen similar to FIG. 11, in which the medical
personnel has been validated but still requesting patient
validation.
[0154] If the requested operation is to `Submit SignUp/Update` 2025
then the Web Browser submits a request to the server program to
either sign-up a new medical personnel or to update the medical
personnel's information in the treatment instructions database. The
Web Browser use the URL of the Medical Personnel Data Entry Program
with the QueryString set to the name-value pairs of the
`Register/Update` section 1010 of FIG. 10. This URL request is sent
to the server and the program enters the state `WAIT_FOR_RESPONSE`
2010 waiting to receive and display a new page of the Medical
Personnel Data Entry Program. If the Signup or update is successful
then they will be logged into the system, if not already logged in,
and the server will respond with the same screen as after a
successful `Submit MedPersonnel Logon` 2023.
[0155] For both the Medical Personnel `Logon` section, the Medical
Personnel Program `Enter Patient Username and Pin` section, and the
`SignUp/Update` section there is a `Reset` button. If the selected
operation is `Reset` 2022, then the data entry fields associated
with the respective sections are cleared to their initial state
with no entries.
[0156] If the requested operation is `Display Recent Appointment`
2032, then the Medical Personnel has selected to display the
treatment information for a specific patient's appointment in a new
web browser window. The Web browser opens a new browser window and
displays the patient appointment. The window will `float` on top of
the Medical Personnel Data Entry program window and will remain
displayed until it is closed. The Medical Personnel Data Entry
Program remains fully operational even while the web browser
manages the new patient appointment information window.
[0157] If the requested operation is `Enter Diagnosis` 2026, then
the Medical Personnel will use the mouse pointer device to open the
drop-down diagnosis field 1235 of FIG. 12, and select a diagnosis
for the patient. Scrolling down to other diagnoses and treatment
instructions data entry fields enters additional diagnoses. These
diagnoses will be entered into the treatment instruction database
for the patient's medical visit when the medical personnel select
the `Save` button 1290.
[0158] If the user requested operation is `Enter Include Treatment
Information` 2027, then the Medical Personnel has selected to
toggle a checkbox 1256 of FIG. 12, indicating that the patient
should be instructed to use the associated information. Only if the
checkbox is checked will the instructions be entered into the
database. The posting of the indicated information to the treatment
instruction database for a patient's medical visit occurs when the
medical personnel select the `Save` button 1290.
[0159] If the requested operation is `Enter Track Treatment
Information` 2028, then the Medical Personnel has selected to
toggle a checkbox 1257 of FIG. 12, indicating that the system
should track and automatically notify the patient about compliance
to the associated treatment instructions. This checkbox can only be
selected if the corresponding `Include` checkbox 1256 has been
checked. The posting of the indicated information to the treatment
instruction database for a patient's medical visit occurs when the
medical personnel select the `Save` button 1290.
[0160] If the requested operation is `Submit Logoff` 2029, then the
Web Browser submits a request to the server program to log the
Medical Personnel out of the system. The program uses the URL of
the Medical Personnel Data Entry Program with the QueryString
indicating `Logoff`. This has the effect of nullifying the Medical
personnel logon to the system and displaying the screen as in FIG.
8.
[0161] If the requested operation is `Save` 2033 then the medical
personnel has entered the appointment specific information and is
requesting that it be saved in the treatment instructions database.
If treatment instruction information has been entered, then the
values from the office visit section of FIG. 12 are included in the
QuerySring name-value pairs that are sent to the server. The URL
request is sent to the server and the program enters the state
`WAIT_FOR_RESPONSE` 2010 waiting to receive and display a patient
login page as in FIG. 11.
[0162] If the requested operation is `Enter Treatment Instructions`
2034 then the medical personnel has chosen to modify the recommend
treatment guidelines for the associated diagnosis. The section
`1251` will redisplay as a popup dialog box with the recommended
treatment guidelines in an editable text grid. The medical
personnel can edit, delete and change the treatment instructions
and close the popup dialog box. Making any change has the effect of
changing the value of the html TreatmentEdit field to `true`. The
default value is `false`. This html field is hidden from the user
but its value is sent to the server along with other name-value
pairs when the `Save` button 1290 is invoked. The server will use
this value as the means to either use the recommended and default
value for the treatment guidelines (value=false) or to insert the
edited values into the ClinGuidelines table 340 (value=true).
[0163] H. Medical Personnel Administration Program
[0164] FIG. 21 is a state diagram 2100 showing the state machine
describing the logical operation of the Medical Personnel
Administration Program. Since the Medical Personnel Administration
Program is operating under the Microsoft Internet Explorer Web
Browser 4.0, after invocation the program is either waiting for a
response from the server program or waiting for input from the
user. State `START` 2101 represents the program state when the Web
Browser is started and a request is sent via http to the server
program for the Medical Personnel logon page. After sending the
request the program immediately transfers to the `WAIT_FOR_REPONSE`
2110 state, awaiting the receipt via http of the logon html file
that will display the requested page of the Medical Personnel
Administration Program on the display screen of the Web Browser.
When the logon file is received it is displayed or rendered by the
browser on the display screen and then processing transfers to the
`WAIT_FOR_INPUT` 2120 state in which the Medical Personnel
Administration Program awaits user keyboard or computer mouse
input.
[0165] There are two distinct types of actions that may occur in
the `WAIT_FOR_INPUT` 2120 state. The user may interact with the
screen as when they use the mouse to point-and-click at a section
to expand or contract it, or key enter information in one of the
data entry fields displayed on the screen. This type of interaction
between the user and the program results in changes to the
presently displayed screen but does not cause a request to be sent
to the browser for a new page. In this case the program processes
the user input and remains in the state `WAIT_FOR_INPUT` 2120.
[0166] The second type of action that may occur is when the user
initiates an action, such as pressing the `Submit` button 1307 of
FIG. 13, which causes a http request message to be sent to the
server requesting a new page. In this case the message is sent and
the program transfers to the state `WAIT_FOR_RESPONSE`, awaiting
the reception of a new page. When that page is received, it is
displayed on the display screen of the Web Browser and the program
transfers to the state `WAIT_FOR_INPUT` awaiting action from the
user.
[0167] The state machine for the Medical Personnel Administration
Program 2100 clearly shows the reliance on the Web Browser and the
Web Server for the operation of this module of the system. The
browser is the operational platform that displays html pages and
interacts with the user. The user may initiate actions that will
result in a message to the server to formulate a new html page,
wait for the response from the server, and display a new page of
the Medical Personnel Administration system according to the
specifics of the message request.
[0168] FIG. 22 is a state table 2200 for the operation of Medical
Personnel Administration Program. It has 3 states, START 2201 which
corresponds to the state 2101 of FIG. 21, WAIT_FOR_RESPONSE 2210
which corresponds to the state 2110 of FIG. 21, and WAIT_FOR_INPUT
2020 which corresponds to the state 2120 of FIG. 21. The state
table provides more detail on the operation of the Medical
Personnel Administration Program.
[0169] When the Medical Personnel Administration Program is started
it immediately enters the logical state START 2201 in which the
Internet Explorer Web Browser program is started in the StartUp
operation 2202. The Web Browser uses the Universal Resource Locator
(URL) of the Medical Personnel Administration Program to request
the file with the logon screen. In this case the URL is the network
resource of the Medical Personnel Data Entry ASP file and has no
QueryString associated with it. After requesting the file, the
program transfers to the state WAIT_FOR_RESPONSE 2210 and when the
file is received, performs the operation `Display web page` 2211,
displays the Medical Personnel Administration program logon screen,
sets the focus to the `Logoff` button 1390 of FIG. 13, and
transfers to the state `WAIT_FOR_INPUT` 2220.
[0170] The state `WAIT_FOR_INPUT` 2220 is the state in which the
user interacts with the Patient Program and so it is in this state
that most of the html/css programming is done. There are 9
different operations that the program must be capable of
handling.
[0171] If the operation is to `Expand or Collapse` a section 2221
then if the selected section is in collapsed mode then the screen
is redisplayed with the selected section in expanded mode. If the
selected section is in expanded mode then the screen is redisplayed
in collapsed mode. In the preferred embodiment the sections are set
to their respective modes by programming the DHTML onclick event to
set the style property display attribute of the sections html DIV
tag to `NONE` to collapse the section and `BLOCK` to display
it.
[0172] If the operation is to `Change focus` 2226 then the browser
resets the focus to the selected field. This will most often occur
with the data entry fields. For instance if the user is entering a
Username into the `Username` field 1305 of FIG. 13, then the focus
of the browser has to be on this data entry field so the browser
will update the `Username` data entry field with the keyed values.
If the operation is `Key-Entry` 2227, then the key entry is
appended to the values in the data entry field that has the focus.
This operation is handled by the web browser and includes support
for `Backspace` and `Del` to remove keyed characters.
[0173] If the operation is to `Submit Logon` 2223 then the Web
Browser submits a request to the server program to validate the
Username and Password of the user. The Web Browser uses the
Universal Resource Locator (URL) of the Medical Personnel
Administration Program with the QueryString set to name-value pairs
with the Username and Password. This URL request is sent to the
server and the program enters the state `WAIT_FOR_REPONSE` 2210
waiting to receive and display a new page of the Medical Personnel
Administration Program. If the treatment database server program
can validate the Username and Password then it will respond with a
screen containing a list of all Patients seen by the Medical
Personnel and all medical appointments by each patient. If the
treatment database server program cannot validate the Username and
Password then it will respond with the Patient Program logon
screen.
[0174] If the requested operation is to `Submit SignUp/Update` 2224
then the Web Browser submits a request to the server program to
either sign-up a new medical personnel or to update the medical
personnel's information in the treatment instructions database. The
Web Browser uses the URL of the Medical Personnel Administration
Program with the QueryString set to the name-value pairs of the
`Register/Update` section 1010 of FIG. 10. This URL request is sent
to the server and the program enters the state `WAIT_FOR_RESPONSE`
2210 waiting to receive and display a new page of the Medical
Personnel Administration Program. If the SignUp or update is
successful then they will be logged into the system, if not already
logged in, and the server will respond with the same screen as
after a successful `Submit Logon` 2223.
[0175] For both the Medical Personnel `Logon` section and the
`SignUp/Update` section there is a `Reset` button. If the selected
operation is `Reset` 2222, then the data entry fields associated
with the respective sections are cleared to their initial state
with no entries.
[0176] If the requested operation is to `Display Office Visit` 2228
then the Web Browser submits a request to the server program to
display the status of the treatment information for all
appointments by the selected patient. The Web Browser uses the URL
of the Medical Personnel Administration Program with the
QueryString set to a name-value pair containing the patient's
unique PatientID. The URL is sent to the server and the program
enters the state `WAIT_FOR_RESPONSE` 2210 waiting to receive and
display a page similar to of FIG. 15.
[0177] The screen button `Back` 1580 of FIG. 15 is displayed if the
Medical Personnel Administration program is displaying the
treatment instruction information for a selected patient. If the
selected operation is `Back Button` 2229, then the Web Browser uses
the Universal Resource Locator (URL) of the Medical Personnel
Administration Program with the QueryString set to a name-value
pair with the value `back`. This URL request is sent to the server
and the program enters the state `WAIT_FOR_REPONSE` 2210 waiting to
receive and display a new page of the Medical Personnel
Administration Program. The program responds with the `prior
screen`; i.e. a screen containing a list of all Patients seen by
the Medical Personnel and all medical appointments by each
patient.
[0178] If the requested operation is `Submit Logoff` 2225, then the
Web Browser submits a request to the server program to log the
Medical Personnel out of the system. The program uses the URL of
the Medical Personnel Administration Program with the QueryString
indicating `Logoff`. The URL request is sent to the server and the
program enters the state `WAIT_FOR_RESPONSE` 2210 waiting to
receive and display a new `Logon` pages just as if it had
transitioned from the `Start` state 2201. This nullifies the
medical personnel login and results in the redisplay of the logon
screen FIG. 13.
[0179] I. Server Program
[0180] The treatment instructions database server program executes
as Microsoft Active Server Pages running under the Microsoft
Internet Information Server 4.0 web server. Among other things, the
web server handles session management for a multiplicity of
simultaneous client programs, memory management, object management,
receipt and parsing of http message requests, dispatch of files to
the client in response to an http request, and processing of Active
Server Pages. The writing of server side Active Server pages to
dynamically generate html files based on input from the user and
information contained within a database is well known to those
skilled in the art. The specification will therefore focus on the
logic and algorithms employed to implement the server system.
[0181] FIG. 23 is a state diagram 2300 for the operation of the
treatment database server program. It shows the logical operation
of the treatment instructions database server. At server startup
`Start` 2310 the program attempts to open the treatment
instructions database. If it cannot be opened then it sends a
message to the operator and immediately ends execution by
transferring to the `End` state 2380. The server program cannot run
if the central treatment instructions database is not available. If
the database is available then the server application program is
started and the program transfers to the `Wait for Request` state
2320, and waits for service requests from the client or to examine
patients compliance and send reminders to non-compliant
patients.
[0182] Logically, there are three different types of client service
requests that the server program may receive, one each from the
three different client programs. While service requests from
different clients may be handled very similarly, for clarity in the
specification, the requests are categorized by the client program
that forwarded the service request to the server. If the service
request is from the patient program then the server processes the
request in the `Patient Response` state 2330. If the service
request is from the Medical Personnel Data Entry Program then the
server processes the request in the `MedPersonnel Data Entry` state
2340. If the service request is from the Medical Personnel
Administration Program then the server processes the request in the
`MedPersonnel Administration` state 2350. In each case when a
service request message is received, the program transfers to the
appropriate state, parses the message, processes the response and
constructs the appropriate html response file, and passes the file
back to the web server to send on to the client.
[0183] Periodically, the treatment server program initiates
execution of a compliance calculation and reminders program. The
purpose of this program is to calculate compliance for each patient
and for each patient session, store the calculated compliance in
the database and send reminder messages to non-compliant patients.
Compliance is calculated according to the definition rule of FIG.
4, in which a patient is only compliant if they have used the
Patient Program to check all the treatment instructions specified
by their medical practitioner, but limited to the set of medical
appointments more than 1 weeks old and to treatment instructions
that have the TrackIT boolean field of table PatCompliance 350 set
to `true`. In the preferred embodiment, the treatment server
program initiates execution of the compliance calculation and
reminders program at Sunday morning. Reminders are sent to all
patients that are non-compliant according to their preferential
means of contact as entered in their registration information 617
of FIG. 6. Every Sunday morning at 1 am, the server program is
started and the treatment instructions database server program
enters the `Auto-Calc Compliance` state 2360, and initiates
execution of the compliance calculation and reminders program. In
the preferred embodiment the compliance calculation and reminders
program is executed once a week and compliance only considers those
appointments more than one week old and for whom the practitioner
has expressly requested the patients compliance be tracked; i.e.
the TrackIt field of table PatCompliance 350 is set to `true`.
These are parameterized settings and different setting can be
utilized in the preferred embodiment. For instance, compliance
calculation and reminder messages could be generated every evening
rather than once a week.
[0184] All four states rely heavily on interaction with the
treatment instruction database. In the preferred embodiment, the
server accesses the database by use of the Microsoft ActiveX Data
Objects component. The database may reside on the treatment server
computer, or on another database server computer on the computer
network. In either case it uses the Microsoft ODBC database driver
to access the treatment instructions database from the server
program.
[0185] The preferred embodiment of the program uses a Microsoft
Access 97 database. This is a SQL compliant database and all
communications between the server program and the database are
through the industry standard SQL language. Programming database
access using he SQL language is well known to those skilled in the
art.
[0186] The operator may terminate the execution or shutdown the
treatment server database program in which case the program first
transfers to the state `Logoff` 2370 to normally shut-down the
database and then transfer to the state `End` 2380 to terminate the
treatment server database program.
[0187] FIG. 24 is a state table 2400 for the execution of the
Treatment Instructions Database Server Program. It has 8 states,
`START` 2410 which corresponds to the state 2310 of FIG. 23;
`WAIT_FOR_RESPONSE` 2420 which corresponds to the state 2320 of
FIG. 23; `PATIENT_RESPONSE` 2430 which corresponds to the state
`Patient Response` 2330; `MEDPERSONNEL DATA_ENTRY` 2440 which
corresponds to the state 2340 of FIG. 23; `MEDPERSONNEL
ADMINISTRATION` 2450 which corresponds to the state 2350 of FIG.
23; `AUTO-CALC COMPLIANCE` 246 which corresponds to the state 2360
of FIG. 23; `LOGOFF` 2470 which corresponds to the state 2370 of
FIG. 23, and `END` 2480 which corresponds to state 2380 of FIG. 23.
The state table provides more detail on the operation of the
Treatment Instructions Database Server Program.
[0188] There is only one operation in state `START` 2410, which is
`StartUp` 2411. The purpose of this state is to start the execution
of the server program. The server program cannot be started if the
database is unavailable, so immediately after starting execution
the first operation that is performed is to open the treatment
instructions database. If the treatment instructions database
cannot be opened or is otherwise unavailable, then a message is
sent to the operator that the `Database cannot be opened` and
immediately transfer to the state `END` 2480 to terminate the
execution of the program. If the treatment instructions database is
available and can be opened then processing transitions to the
state `WAIT_FOR_REQ` 2420 to wait for service requests from client
programs.
[0189] In the state `WAIT_FOR_REQ` 2420, the server program idles,
awaiting a network service request from one of the client programs.
When it receives a network request it can determine which client
has made the request from the http message body. An http message
from the Patient Program will reference the ASP patient program
that processes the Patient program and transfer to the state
`PATIENT_RESPONSE 2430; an http message from the Medical Personnel
Data Entry program will reference the ASP program that processes
the Medical Personnel Data Entry Program and transfer to the state
`MEDPERSONNEL DATA_ENTRY` 2440, and an http message from the
Medical Personnel Administration Program will reference the ASP
program that processes the Medical Personnel Administration Program
and transfer to the state `MEDPERSONNEL ADMINISTRATION` 2450.
[0190] Within any of these states the processing will follow a
similar pattern. First the QueryString of the message will be
parsed to identify the type of message and user input. Then the ASP
program will perform operations (SELECT, UPDATE, INSERT) with the
treatment instructions database based on the user input, following
which the ASP program will formulate the html page as a response to
the client program. The response web page will be sent to the
client, and finally the server will transfer back to the state
`WAIT_FOR_REQ` 2420.
[0191] In the state that processes client requests from the Patient
Program, `PATIENT_RESPONSE` 2430, there are 6 possible operations
or message requests. If the message request is to start a Patient
session `Start` 2431 then the processing will proceed by generating
a response page with a Patient Logon, and Register/Update sections,
sending the page to the client and then transfer to the state
`WAIT_FOR_REQ` 2420. This will only allow the patient to either
register for the system or logon to the system with their
registered Username and Password. If the message request is for a
Patient Logon 2432 then the processing will proceed by parsing the
Username and Password from the QueryString, and checking if the
Username and Password are in the database table `Patients` 305. If
it is, then the user is validated, and the program inserts a record
in the LoginLog table 315 recording the successful login, generates
a response page with a Patient Logon, Register/Update screens and
recent appointments sections. The Register/Update section will have
all data fields filled in with the current information from the
database. The patient is now logged onto the system will be able to
view compliance information for their medical appointments.
[0192] Even though the Patient has successfully logged into the
system the Logon section is still generated. This is so another
Patient may log into the system without having to start up a new
browser session.
[0193] If the message request is for `SignUp` 2433, then the
Patient is requesting authorization to use the system. The server
parses the QueryString for all the SignUp information and inserts
the information into the `Patient` Table of the treatment
instruction database. The program inserts a record in the LoginLog
table 315 recording the successful login, and then generates a
response page with the Patient Logon, Register/Update and Recent
Appointment sections, sends the page to the client and transfers to
the state `WAIT_FOR_REQ` 2420. The `Update` message 2434 is handled
similarly. The QueryString is parsed for the Update information and
the Patient table of the treatment instruction database is updated
with the information. The program then generates a response page
with the Patient Logon, Register/Update and Recent Appointment
sections, sends the page to the client and transfers to the state
`WAIT_FOR_REQ` 2420.
[0194] If the message request is for the Patient's recent
appointments 2435 then the QueryString is parsed for the patient
and appointment identification information. The patient,
appointment, diagnosis, medical personnel, and patient compliance
information are retrieved from the treatment instruction database
and a response page is generated with sections for the Patient
Logon, Register/Update, Recent Physician Appointments, and for the
selected appointments treatment instructions, alerts, followup,
diagnosis and treatment information. Before the page is returned to
the client the `dateAccessed` field of the PatCompliance table of
the treatment instructions database is updated with current date
for each of the compliance records for the requested medical
encounter. The page is then sent to the client and processing
continues in the state `WAIT_FOR_REQ` 2420. If the message request
is to `Logoff` 2436 then the processing will proceed by generating
a response page with a Patient Logon, and Register/Update sections,
sending the page to the client and then transfer to the state
`WAIT_FOR_REQ` 2420. This has the effect of nullifying the
patient's logon, as they cannot again view appointment or
compliance specific information until they again use the logon
function of the patient program.
[0195] In the state that processes client requests from the Medical
Personnel Data Entry Program, `MEDPERSONNEL DATE_ENTRY` 2440, there
are 7 possible operations or message requests. If the message
request is to start a Medical Personnel Data Entry session `Start`
2441 then the processing will proceed by generating a response page
with a Logon, and Register/Update sections, and sending the page to
the client and then transitioning to the state `WAIT_FOR_REQ` 2420.
If the message is a MedPersonnel Logon 2442, then the Username and
Password are parsed from the QueryString and the program checks if
the Medical Personnel is registered to use the system by checking
the Username and Password in the MedPersonnel table 310 of the
treatment instructions database. If the Username and Password are
validated then processing will proceed by inserting a record in the
LoginLog table 315 recording the successful login, generating a
response page with a Logon, Register/Update and Identify Patients
sections, sending the page to the client and then transitioning to
the state `WAIT_FOR_REQ` 2420.
[0196] If the message request is for `SignUp` 2433, then the
Medical Personnel is requesting authorization to use the system.
The server parses the QueryString for all the SignUp information
and inserts the information into the `MedPersonnel` Table 310 of
the treatment instruction database. The program then inserts a
record in the LoginLog table 315 recording the successful login,
generates a response page with the Medical Personnel Logon,
Register/Update and Identify Patients sections, sends the page to
the client and transfers to the state `WAIT_FOR_REQ` 2420. The
`Update` message 2444 is handled similarly. The QueryString is
parsed for the Update information and the MedPersonnel table 310 of
the treatment instruction database is updated with the information.
The program then generates a response page with the Medical
Personnel Logon, Register/Update and Identify Patients sections,
sends the page to the client and transfers to the state
`WAIT_FOR_REQ` 2420.
[0197] If the message request is a Patient Logon 2445 then the
program parses the QueryString for the Username and Med-Password or
PIN of the patient. The Username and PIN are validated against the
Patients Table, and if valid the program generates a response page
with the Medical Personnel Logon, Register/Update, Identify
Patients, and Recent Physician Appointment sections. If the
Username and Pin cannot be validated in the database then the
program generates a response page with the Medical Personnel Logon,
Register/Update, and Identify Patients sections. The generated page
is then sent to the client and the program transitions to the state
`WAIT_FOR_REQ` 2420.
[0198] If the message request is a `Save` 2446 message then this
indicates that the Medical Personnel have finished entering the
information for the patient. The program parses the QuerySting for
all appointment-related information including appointment date,
diagnosis, complaint, and patient compliance information. The
program updates the database with this information. For each
diagnosis and for every type of treatment instructions, `Treatment
instruction` 1251, Diagnosis information 1252, `Treatment
information` 1253, `Followup` 1254, and `Alerts` 1255, if the
`Include` checkbox `1256` is checked then the program will insert a
record into the PatCompliance table of the treatment instruction
database to reflect that this is treatment information specified by
the medical practitioner. If the corresponding compliance tracking
checkbox is selected 1257, then the TrackIt field of the
PatCompliance field will be set to the value `Yes` so the system
will automatically monitor the patients usage and send compliance
messages.
[0199] For each diagnosis the QueryString has a value for the
hidden HTML field Recommended. This field has a value of `false` if
the medical personnel have in anyway edited or modified the
recommended treatment guideline. If the value of the field is
`true` then the practitioner has accepted and is using the
recommended treatment guidelines, and the treatment instructions
for the encounter, patient and diagnosis use the ClinGuidelineID
key in the primary-foreign key relationship between the
ClinGuidelines table 340 and the PatCompliance table 350. If the
value is `false`, then the practitioner has modified the
recommended treatment guidelines and the values of each step of the
treatment guideline are inserted into the ClinGuidelines table 340
of the treatment instructions database, and a new value for the
index key ClinGuidelineID is generated and will be used in the
primary-foreign key relationship with the PatCompliance table
350.
[0200] After the database has been updated, the system generates a
response page with the Medical Personnel Logon, Register/Update,
and Identify Patients sections and the program transitions to the
state `WAIT_FOR_REQ` 1240. The system is now ready for the Medical
personnel to process the next patients' appointment.
[0201] If the response message is `Logoff` 2447 then the Medical
Personnel is finished using the data entry program. Processing
proceeds by generating a response page with the Logon and
Register/Update sections. The response page is sent back to the
client and the program transitions to the state `WAIT_FOR_REQ`
2420. This has the effect of nullifying the medical personnel's
login, as they must login again to the system to use any of the
data entry options.
[0202] In the state that processes client requests from the Medical
Personnel Administration Program, `MEDPERSONNEL ADMINISTRATION`
2450, there are 7 possible operations or message requests. If the
message request is to start a Medical Personnel Administration
session `Start` 2451 then the processing will proceed by generating
a response page with a Medical Personnel Logon, and Register/Update
sections, and sending the page to the client and then transfer to
the state `WAIT_FOR_REQ` 2420. If the message request is for a
Medical Personnel Logon 2452 then the processing will proceed by
parsing the Username and Password from the QueryString. If the
Username and Password can be validated against the MedPersonnel
table, then processing proceeds by inserting a record in the
LoginLog table 315 recording the successful login, generating a
response page with the Logon, Register/Update, and Patient
sections. If the Username and Password cannot be validated then
processing proceeds by generating a response page with the Logon
and Register/Update sections. The response page is sent back to the
client and the program transitions to the state `WAIT_FOR_REQ`
2420. If a Patient section is generated it will have a section for
every patient that has been seen by the Medical Personnel that is
logged on, and each Patient section will in turn have a listing of
all office visits by the patient with the medical personnel.
Retrieving from the MedEncounter table 320 all appointments for
each patient with the Medical Personnel that is logged onto the
system generates the information in the Patient section.
[0203] If the message request is for `SignUp` 2453, then the
Medical Personnel is requesting authorization to use the system.
The server parses the QueryString for all the SignUp information
and inserts the information into the `MedPersonnel` Table of the
treatment instruction database. The program then inserts a record
in the LoginLog table 315 recording the successful login, generates
a response page with the Medical Personnel Logon, Register/Update
and Patient sections, sends the page to the client and transfers to
the state `WAIT_FOR_REQ` 2420. The `Update` message 2454 is handled
similarly. The QueryString is parsed for the Update information and
the MedPersonnel table of the treatment instruction database is
updated with the information. The program then generates a response
page with the Medical Personnel Logon, Register/Update and Patients
sections, sends the page to the client and transfers to the state
`WAIT_FOR_REQ` 2420.
[0204] If the message request if to `Get Office Visit 2455 then the
Medical Personnel has requested to see the details of the
compliance information for the patient. The QueryString is parsed
for the identifier of the patient, and a response page is generated
with Logon, Register/Update, and Patient sections. The patient
section has subsections for each office visit, and each office
visit has sections for each diagnosis. In this case the Patient
section only has information for the single selected patient--not
all patients as in the prior screens. The response page is sent to
the client and the program transitions to the state `WAIT_FOR_REQ`
1240 to wait on the next message request.
[0205] If the message request is `Back` 2456, then the Medical
personnel is finished examining the detailed compliance information
for a patient and the program returns to the same state displayed
in FIG. 14. While medical personnel are examining the patients
compliance information they may choose to instruct the system to
send a compliance message to the patient. They do this by checking
the `Send Reminder` checkbox 1542 of FIG. 15. They may send
reminder messages even for those treatment instructions that have
not been flagged with a value of `true` in the `TrackIt` field of
the PatCompliance Table 350. Processing proceeds by parsing the
QueryString which will identify any treatment instructions that the
medical personnel have requested compliance reminders be sent to
the patient. If there are any then the system will invoke the
procedures to send reminder messages according to the preference of
the patient. For instance if the patients preference is to use
Email then a MAPI component will be invoked by the server to send
an Email message, similar to that in FIG. 16, to the patient.
Processing continues by generating a response page with the Logon,
Register/Update, and Patient sections, sending the response page to
the user, and transitioning to the state `WAIT_FOR_REQ` 2420.
[0206] If the response message is `Logoff` 2457 then the Medical
Personnel has finished using the administration program. Processing
proceeds by generating a response page with the Logon and
Register/Update sections. The response page is sent back to the
client and the program transitions to the state `WAIT_FOR_REQ`
2420.
[0207] A key feature of the system is its ability to identify
patients that are non-compliant with treatment instructions and
send them compliance reminders. This is implemented in the
preferred embodiment by a server program that is executed Sunday
each week at lam in the morning and calculates for every patient
and for every patient session their measure of compliance. If a
patient is non-compliant then a reminder message is sent to
them.
[0208] When the enters the `AUTO_CALC_COMPLIANCE` state 2460, it
performs a sequence of steps to calculate compliance according to
the algorithm depicted in FIG. 4, and for non-compliant patients
send reminder messages. Processing proceeds by first calculating
according to the algorithm described in FIG. 4, and storing a
measure of compliance for each appointment more than 2 weeks old
and for each patient. The compliance measure is stored in the
database in the MeasCompliance field for MedEncounter. Next a
compliance measure is calculated for each patient in the database.
This is done by considering only those appointments in the database
more than 1 weeks old and calculating according to the algorithm
described in FIG. 4 a measure of compliance and then updating the
MeasCompliance field of the Patients Table with the value. The last
step is to retrieve from the database the calculated measure of
compliance for each patient and for those that are non-compliant
sending them a reminder message, by means of their preferred means
of contact, as stored in the PrefMeansContact field of the Patients
Table. Compliance messages are only sent if there are items in the
PatCompliance table with the field `TrackIt` set to `true`
indicating that the Medical Personnel have specifically requested
the system to track the Patients compliance for the respective
information and send reminder messages. After the reminder message
have been processed, processing continues by transitioning to the
state `WAIT_FOR_REQ` 2420.
[0209] In the state `LOGOFF` 2370 there is only one operation
`CloseDB` 2371 to finish and commit all transactions to the
treatment instructions database and shutdown the database in a
normal fashion. After the database is closed processing transitions
to the state `End` 2380, and the execution of the treatment
instruction database server program is terminated.
[0210] 2. Other Embodiments
[0211] Other embodiments of the inventions use the same principles
to implement a system for increasing a patient's compliance to
medical care instructions. In the preferred embodiment medical
compliance is measured by classifying a patients access to
treatment information into one of 3 categories. In other
embodiments, there may be more complicated algorithms to measure
and classify patients into compliance groups. In the present
embodiment, non-compliant and partially compliant patients may be
reminded to follow treatment instructions. In other embodiments, a
multiplicity of means may be used to remind severely non-compliant
patients to follow the treatment instructions.
[0212] In the present embodiment, once a patient accesses a
treatment instruction source they are not subsequently issued
reminders. In another embodiment, the user may be sent a reminder
message in the case that the information is updated. For instance,
in the case of drug alerts, if a new alert is issued, then the
system can automatically determine which users are using that drug
in treatment and send the new alert to them.
[0213] In still other embodiments the messaging and prompting of
non-compliant or partially compliant patients to remind them about
treatment instructions may be by other means including but not
limited to mail, phone, beeper, or via cable TV.
[0214] The preferred embodiment uses a simple scheme to track
patient compliance. If a patient accesses the medical appointment
information from the patient program then they are assumed to be
compliant. In other embodiments more complicated means may be used
to measure compliance. For instance we may measure the length of
time that patients review a page, and rate as more compliant those
patients that spend more time reviewing a page that those who spend
less time reviewing a page. Also, in the preferred embodiment we do
not capture the information about whether the patient has
hyperlinked to recommended diagnosis and/or treatment information.
In other embodiments we may capture that information and use it to
calculate a patient's compliance. This could be implemented by one
skilled in the art either by maintaining patient session
information on the server in session specific variables, or by
using hidden html fields to accumulate and store user interactions
as the user views different web pages, by a combination of both, or
by some other means known to those skilled in the art.
[0215] In the present embodiment the list of diagnoses is contained
within a single drop-down box with diagnoses identified by major
and minor English language coding. If other embodiments of the
invention, standard-coding definitions of diagnoses may be
utilized.
[0216] In other embodiments compliance messages will be sent not
just to the patient's medical practitioner but may also be sent to
a supervisor and/or medical personnel who have a responsibility for
compliance followup. In the preferred embodiment compliance is
calculated and messages sent once each week. In other embodiments
compliance may be calculated on a different schedule, and the
algorithm for sending reminders may take into account when and
whether prior reminder messages have been send to the patient.
[0217] Other embodiments will be apparent to those skilled in the
art from consideration of the specification and practice of the
invention disclosed herein. It is intended that the specification
and examples be considered as exemplary only, with a true scope of
the invention being indicated by the following claims.
[0218] In the present embodiment the Email address of the medical
personnel is captured but is not made available in any fashion to
the patient as a means to contact the practitioner. Other
embodiments could provide functionality as part of the patient
program to send Email to the practitioner.
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