U.S. patent application number 13/340096 was filed with the patent office on 2012-05-10 for clinical collaboration using an online networking system.
This patent application is currently assigned to CERNER INNOVATION, INC.. Invention is credited to CHRISTOPHER S. FINN, DAVID P. McCALLIE.
Application Number | 20120116800 13/340096 |
Document ID | / |
Family ID | 46020462 |
Filed Date | 2012-05-10 |
United States Patent
Application |
20120116800 |
Kind Code |
A1 |
McCALLIE; DAVID P. ; et
al. |
May 10, 2012 |
CLINICAL COLLABORATION USING AN ONLINE NETWORKING SYSTEM
Abstract
Methods are provided for sharing patient information by way of
an online collaboration system. A requesting clinician, through an
online networking system, identifies one or more clinicians with
whom the requesting clinician wishes to collaborate by sending at
least one patient-focused clinical data element. For the clinicians
who have been identified as not being authorized to access
patient-identifying data, the at least one patient-focused clinical
data element is de-identified such that it no longer includes any
patient-identifying data. The de-identified patient-focused
clinical data element is then communicated to the clinicians not
allowed access to the patient-identifying information.
Inventors: |
McCALLIE; DAVID P.;
(STILWELL, KS) ; FINN; CHRISTOPHER S.; (LIBERTY,
MO) |
Assignee: |
CERNER INNOVATION, INC.
OVERLAND PARK
KS
|
Family ID: |
46020462 |
Appl. No.: |
13/340096 |
Filed: |
December 29, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13072248 |
Mar 25, 2011 |
8112294 |
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13340096 |
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11023057 |
Dec 27, 2004 |
7953608 |
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13072248 |
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Current U.S.
Class: |
705/2 |
Current CPC
Class: |
G16H 40/67 20180101;
G16H 10/60 20180101; H04L 63/08 20130101; G06Q 10/10 20130101; G16H
70/20 20180101; G06F 21/6245 20130101 |
Class at
Publication: |
705/2 |
International
Class: |
G06Q 50/22 20120101
G06Q050/22 |
Claims
1. A method in a computer system having a processor and a memory
for providing an online medical collaboration, the method
comprising: receiving from a requesting clinician through an online
networking system for medical clinicians an identification of one
or more clinicians to whom at least one patient-focused clinical
data element is to be communicated; identifying a first subset of
the one or more clinicians to whom the requesting clinician is not
authorized to send the at least one patient-focused clinical data
element that includes patient-identifying data; de-identifying the
at least one patient-focused clinical data element such that it
does not include any of the patient-identifying data; and
communicating the at least one de-identified patient-focused
clinical data element to the first subset of the one or more
clinicians.
2. The method of claim 1, further comprising: identifying a second
subset of the one or more clinicians to whom the clinician is
authorized to send the at least one patient-focused clinical data
element that includes the patient-identifying data; and
communicating the at least one patient-focused clinical data
element to the second subset of the one or more clinicians.
3. The method of claim 2, further comprising communicating a
message from the requesting clinician to the first subset and the
second subset of clinicians.
4. The method of claim 3, wherein the at least one patient-focused
clinical data element provides context in relation to a particular
patient for the message communicated to the one or more
clinicians.
5. The method of claim 1, wherein the requesting clinician is
requesting the one or more clinicians to provide a second opinion
on the medical condition or medical treatment of a patient
corresponding to the at least one patient-focused clinical data
element.
6. The method of claim 1, wherein de-identifying the at least one
patient-focused clinical data element further comprises removing
any of the patient-identifying data to comply with relevant privacy
regulations.
7. The method of claim 1, wherein the at least one de-identified
patient-focused clinical data element is communicated by way of the
online networking system.
8. The method of claim 7, wherein the online networking system is a
medical networking website for medical clinicians.
9. The method of claim 1, wherein communicating the at least one
de-identified patient-focused clinical data element further
comprises posting a message and the at least one de-identified
patient-focused clinical data element on the online networking
system that is accessible only to the first subset of the one or
more clinicians.
10. One or more computer storage media having computer-executable
instructions embodied thereon that, when executed, enable a
computing device to perform a method of providing an online medical
collaboration, the method comprising: receiving a request from a
requesting clinician to share a message and at least one
patient-focused clinical data element with one or more clinicians
by way of an online networking system for medical clinicians;
determining if at least one of the one or more clinicians is not
allowed access to the at least one patient-focused clinical data
element having patient-identifying data; if the at least one of the
one or more clinicians is not allowed access to the at least one
patient-focused clinical data element having patient-identifying
data, (1) de-identifying the at least one patient-focused clinical
data element having patient-identifying data, (2) sharing the at
least one de-identified patient-focused clinical data element with
the at least one of the one or more clinicians, and (3) sharing the
at least one patient-focused clinical data element that has not
been de-identified with the one or more clinicians who are allowed
access to the at least one patient-focused clinical data element
having patient-identifying data; and if the at least one of the one
or more clinicians is allowed access to the at least one
patient-focused clinical data element having patient-identifying
data, sharing the at least one patient-focused clinical data
element having patient-identifying data with the one or more
clinicians.
11. The method of claim 10, wherein the at least one of the one or
more clinicians not allowed access to the patient-identifying data
are not currently associated with a patient corresponding to the at
least one patient-focused clinical data element.
12. The method of claim 11, wherein a clinician is not currently
associated with the patient if the clinician is not currently
treating the patient for a medical condition.
13. The method of claim 10, wherein an amount and a type of data
de-identified from the at least one patient-focused clinical data
element corresponds to a current privacy regulation.
14. The method of claim 10, wherein sharing the at least one
de-identified patient-focused clinical data element further
comprises posting a message and the at least one de-identified
patient-focused clinical data element on the online networking
system accessible only to the at least one of the one or more
clinicians.
15. The method of claim 10, wherein the at least one of the one or
more clinicians allowed access to the patient-identifying data are
either currently treating the patient or are directly associated
with the requesting clinician.
16. The method of claim 10, wherein the at least one
patient-focused clinical data element is located in an electronic
medical record (EMR) associated with the patient.
17. One or more computer storage media having computer-executable
instructions embodied thereon that, when executed, enable a
computing device to perform a method of providing an online medical
collaboration, the method comprising: receiving, from a requesting
clinician through an online networking system for medical
clinicians, a request that includes an identification of at least
one clinician to collaborate in medical care of a particular
patient, wherein the at least one clinician is associated with the
medical care of the patient such that the at least one clinician is
allowed to access patient-identifying data for the patient;
receiving at least one patient-focused clinical data element
associated with the patient, wherein the at least one
patient-focused clinical data element is found in an electronic
medical record associated with the patient and wherein the at least
one patient-focused clinical data element includes the
patient-identifying data; and communicating the request and the at
least one patient-focused clinical data element to the at least one
clinician.
18. The method of claim 17, wherein the request to collaborate in
the medical care of the particular patient is a request for a
second opinion regarding a treatment or a medical diagnosis of the
particular patient.
19. The method of claim 17, wherein communicating the request and
the at least one patient-focused clinical data element to the at
least one clinician further comprises publishing the request and
the at least one patient-focused clinical data element on the
online networking system such that it can be accessed by the at
least one clinician who is registered with the online networking
system.
20. The method of claim 17, further comprising determining that the
at least one clinician is associated with the particular patient in
a way allowed by a privacy regulation such that the at least one
clinician is allowed to view the patient-identifying data.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation-in-part of U.S.
application Ser. No. 13/072,248, filed Mar. 25, 2011, which is a
divisional of U.S. application Ser. No. 11/023,057, filed Dec. 27,
2004, both of which are herein incorporated by reference in their
entirety.
STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT
[0002] Not Applicable.
BACKGROUND
[0003] Modern health care delivery for a given patient involves an
increasingly complex network of clinicians. These clinicians may
include healthcare professionals, such as doctors, nurses, physical
therapists, and others, as well as related staff members.
Clinicians frequently generate a large amount of patient-related
data, at least some of which are stored in the associated patient's
electronic medical record (EMR) stored within a computerized
clinical information system. These data may include (i)
observations made by the clinicians and memorialized in the record,
(ii) results of various tests the patient has undergone, or (iii)
various documents (e.g., in the form of attached files) containing
information related to the patient, as examples.
[0004] A clinician treating a given patient may want to know more
about data within the patient's EMR or other record related to the
patient. For instance, a primary care physician treating a patient
for a particular ailment may want to ask a radiologist about a
diagnosis made based on the results of an x-ray or MRI image for
the patient. One way to accomplish this is to track down the author
of the data, or a clinician of a certain level of expertise that
could help in explaining and/or interpreting the data. These
individuals, however, are often scattered throughout a health
system or institution. In fact, "face-to-face" contact between and
among treating clinicians is decreasing because electronic patient
records may be stored on networked information systems (e.g., LANs,
WANs) and accessed remotely by authorized users. There is not a
strong necessity for clinicians to be physically located within the
same building or even geographic area. Even if data authors are
found, they may be occupied with other tasks that prevent them from
having a discussion with the requesting clinician. Clinicians that
have a certain specific medical expertise, or association with the
data author, are likewise difficult to locate, and identifying
their degree of relevance to the medical issue or data at hand may
be impossible based only on the patient's record.
[0005] Clinicians are, therefore, desiring to more quickly and
effectively locate and engage in collaboration with other
individuals to aid in delivering health care services to a given
patient. It is advantageous for clinicians requesting collaboration
sessions to, at times, have additional contextual information
regarding the patient or relevant data within a record. There is
also a desire for collaboration to take place dynamically and with
the exchange of data that may be embodied in various electronic
forms, such as text, voice and graphical.
BRIEF SUMMARY
[0006] The present invention generally provides a system and
associated methods that enable online collaboration among
clinicians. Specifically, an online networking system is utilized
that is accessible to both the requesting clinician and one or more
clinicians identified by the requesting clinicians with whom the
requesting clinician wishes to collaborate about a particular
patient. For instance, the requesting clinician may wish to
collaborate with a specialist, or to get a second opinion.
Alternatively, the requesting clinician may not have the time to
manage a particular patient's care, or for teaching purposes, may
want another clinician in the office, such as an intern or resident
physician, to make an attempt at diagnosing and treating a patient
under the care of the requesting clinician. There are many
scenarios not described herein, but that are contemplated to be
within the scope of the present invention. Generally, embodiments
of the present invention may be used with any scenario where a
requesting clinician wishes to collaborate with one or more other
clinicians by way of an online networking system.
[0007] In one embodiment, the requesting clinician communicates a
request and at least one patient-focused clinical data element from
the patient's EMR to the online networking system, along with an
identification of one or more clinicians with whom the requesting
clinician wishes to collaborate. This patient information, for
instance, may be posted on a website associated with an online
networking system for medical clinicians. The identified
clinician(s), thus may access this information if he or she is a
registered user of the online networking system. In one instant,
the identified clinician(s) may receive an alert (e.g., e-mail,
text message, telephone call) indicating that he or she has been
sent a message requesting a consultation, second opinion, etc. This
clinician may review the information when he or she has time, and
respond if desired and if requested to respond. In some instance, a
response may not be necessary, such as in the instance of a
resident physician being requested by an attending physician to
review documents and a treatment plan for a particular patient. The
resident physician may not need to respond to the request, but may
simply review the patient information and treat the patient
accordingly.
[0008] One aspect of the present invention is directed to a method
in a computer system having a processor and a memory for providing
an online medical collaboration. The method includes receiving from
a requesting clinician through an online networking system for
medical clinicians an identification of one or more clinicians to
whom at least one patient-focused clinical data element is to be
communicated and identifying a first subset of the one or more
clinicians to whom the requesting clinician is not authorized to
send the at least one patient-focused clinical data element that
includes patient-identifying data. Further, the method includes
de-identifying the at least one patient-focused clinical data
element such that it does not include any of the
patient-identifying data and communicating the at least one
de-identified patient-focused clinical data element to the first
subset of the one or more clinicians.
[0009] Another aspect of the present invention is directed to one
or more computer storage media having computer-executable
instructions embodied thereon that, when executed, enable a
computing device to perform a method of providing an online medical
collaboration. The method includes receiving a request from a
requesting clinician to share a message and at least one
patient-focused clinical data element with one or more clinicians
by way of an online networking system for medical clinicians.
Further, the method includes determining if at least one of the one
or more clinicians is not allowed access to the at least one
patient-focused clinical data element having patient-identifying
data. If the at least one of the one or more clinicians is not
allowed access to the at least one patient-focused clinical data
element having patient-identifying data, the method includes
de-identifying the at least one patient-focused clinical data
element having patient-identifying data, sharing the at least one
de-identified patient-focused clinical data element with the at
least one of the one or more clinicians, and sharing the at least
one patient-focused clinical data element that has not been
de-identified with the one or more clinicians who are allowed
access to the at least one patient-focused clinical data element
having patient-identifying data. If, however, the at least one of
the one or more clinicians is allowed access to the at least one
patient-focused clinical data element having patient-identifying
data, the method includes sharing the at least one patient-focused
clinical data element having patient-identifying data with the one
or more clinicians.
[0010] Another aspect of the present invention is directed to one
or more computer storage media having computer-executable
instructions embodied thereon that, when executed, enable a
computing device to perform a method of providing an online medical
collaboration. The method includes receiving, from a requesting
clinician through an online networking system for medical
clinicians, a request that includes an identification of at least
one clinician to collaborate in medical care of a particular
patient. The at least one clinician is associated with the medical
care of the patient such that the at least one clinician is allowed
to access patient-identifying data for the patient. Further, the
method includes receiving at least one patient-focused clinical
data element associated with the patient. The at least one
patient-focused clinical data element is found in an electronic
medical record associated with the patient and the at least one
patient-focused clinical data element includes the
patient-identifying data. The method additionally includes
communicating the request and the at least one patient-focused
clinical data element to the at least one clinician.
BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWINGS
[0011] In the accompanying drawings which form a part of the
specification and are to be read in conjunction therewith and in
which like reference numerals are used to indicate like elements in
the various views:
[0012] FIG. 1 is a block diagram of a computing system suitable for
use in implementing the present invention;
[0013] FIG. 2 is a flow diagram illustrating a sequential flow
through high-level components;
[0014] FIG. 3 is a flow diagram of one method for roster
generation;
[0015] FIG. 4 illustrates an example of an electronic medical
record;
[0016] FIG. 5 illustrates one example of person-focused clinical
data and a roster;
[0017] FIG. 6 is a flow diagram illustrating a method for
facilitating a collaboration session;
[0018] FIG. 7 is an exemplary graphical interface of a
collaboration session;
[0019] FIG. 8 illustrates a block diagram of an exemplary computing
system environment suitable for use in implementing embodiments of
the present invention;
[0020] FIG. 9 illustrates a flow diagram of a method for enabling
an online medical collaboration, in accordance with an embodiment
of the present invention; and
[0021] FIG. 10 illustrates a flow diagram of another method for
enabling an online medical collaboration, in accordance with an
embodiment of the present invention.
DETAILED DESCRIPTION
[0022] The present invention provides a system and associated
methods that allow for the generation of a roster of potentially
available clinicians for a collaboration session with a requesting
clinician, and then for facilitating such a collaboration session.
This allows for a clinician to better locate others that may
provide helpful medical information and/or context to
patient-focused clinical data of a medical record. The
collaboration session is conducted electronically, enabling the
clinicians to be remotely located with respect to one another.
Further embodiments of the present invention allow for an online
networking system to be used for sharing patient information
between clinicians. Oftentimes, a clinician identified by a
requesting clinician may not have a medical relationship with the
patient, and thus because of relevant privacy regulations, is not
able to access patient-identifying information. Thus, the patient
information may be de-identified prior to being shared with or
accessed by the identified clinician.
[0023] FIG. 1 illustrates an example of a suitable computing system
environment in which the invention may be implemented. The
computing system environment is only one example of a suitable
computing environment and is not intended to suggest any limitation
as to the scope of use or functionality of the invention. Neither
should the computing system environment be interpreted as having
any dependency or requirement to any one or combination of
components illustrated in the exemplary operating environment.
[0024] The present invention is operational with numerous other
general purpose or special purpose computing system environments or
configurations. Examples of well known computing systems,
environments, and/or configurations that may be suitable for use
with the invention include, but are not limited to, personal
computers, server computers, hand-held or laptop devices, cellular
telephones, portable wireless devices, multiprocessor systems,
microprocessor-based systems, programmable consumer electronics,
network PCs, minicomputers, mainframe computers, distributed
computing environments that include any of the above systems or
devices, and the like.
[0025] The present invention may be described in the general
context of computer-executable instructions, such as program
modules, being executed by a computer. Generally, program modules
include routines, programs, objects, components, data structures,
etc. that perform particular tasks or implement particular abstract
data types. The invention may also be practiced in distributed
computing environments where tasks are performed by remote
processing devices that are linked through a communications
network. In a distributed computing environment, program modules
may be located in both local and remote computer storage media
including memory storage devices.
[0026] With reference to FIG. 1, an exemplary system for
implementing the invention includes a general purpose computing
device in the form of a computer or computing system 100. It should
be understood that the terms "computer" or "system" may be used
interchangeably when referring to computing system 100. System 100
serves at least in part as a general medical information system.
Components of system 100 include, but are not limited to, a
processing unit 101, a system memory 102, and a system bus 111 that
couples various system components including the system memory 102
to the processing unit 101. The system bus 111 may be any of
several types of bus structures including a memory bus or memory
controller, a peripheral bus and a local bus using any of a variety
of bus architecture. By way of example, and not limitation, such
architectures include Industry Standard Architecture (ISA) bus,
Micro Channel Architecture (MCA) bus, Enhanced ISA (EISA) bus,
Video Electronics Standard Association (VESA) local bus, and
Peripheral Component Interconnect (PCI) bus also known as Mezzanine
bus.
[0027] System 100 typically includes a variety of computer readable
media. Computer readable media can be any available media that can
be accessed by system 100 and includes both volatile and
nonvolatile media, removable and nonremovable media. By way of
example, and not limitation, computer readable media may comprise
computer storage media and communication media. Computer storage
media includes both volatile and nonvolatile, removable and
nonremovable media implemented in any method or technology for
storage of information such as computer readable instructions, data
structures, program modules or other data. Computer storage media
includes, but is not limited to, RAM, ROM, EEPROM, flash memory or
other memory technology, CD-ROM, digital versatile disks (DVD) or
other optical disk storage, magnetic cassettes, magnetic tape,
magnetic disk storage or other magnetic storage devices, or any
other medium which can be used to store the desired information and
which can be accessed by system 100. Communications media typically
embodies computer readable instructions, data structures, program
modules or other data in a modulated data signal such as a carrier
wave or other transport mechanism and includes any information
delivery media. The term "modulated data signal" means a signal
that has on or more of its characteristics set or changed in such a
manner as to encode information in the signal. By way of example,
and not limitation, communication media includes wired media such
as a wired network or direct wired connection, and wireless media
such as acoustic, radio frequency (RF), infrared and other wireless
media. Combinations of any of the above should also be included
within the scope of computer readable media.
[0028] The system memory 102 includes computer storage media in the
form of a volatile and/or nonvolatile memory such as read only
memory (ROM) 103 and random access memory (RAM) 105. A basic
input/output system (BIOS) 104, containing the basic routines that
help to transfer information between elements within system 100,
such as during start-up, s typically stored in ROM 103. RAM 105
typically contains data and/or program modules that are immediately
accessible to and/or presently being operated on by processing unit
101. By way of example, and not limitation, FIG. 1 illustrates
operating system 106, application programs 107, other program
modules 108, and program data 109.
[0029] The system 100 may also include other
removable/nonremovable, volatile/nonvolatile computer storage
media. By way of example only, FIG. 1 illustrates a hard disk drive
117 that reads from or writes to nonremovable, nonvolatile magnetic
media, a magnetic disk drive 118 that reads from or writes to
removable, nonvolatile magnetic disk 120, and an optical disk drive
119 that reads from or writes to a removable, nonvolatile optical
disk 121 such as a CD ROM or other optical media. Other
removable/nonremovable, volatile/nonvolatile computer storage media
that can be used in the exemplary operating environment include,
but are not limited to, magnetic tape cassettes, flash memory
cards, digital video disks, digital video tape, Bernoulli
cartridges, solid state RAM, solid state ROM, and the like. The
hard disk drive 117, magnetic disk drive 118 and optical disk drive
119 are typically connected to the system bus 111 by a Small
Computer System Interface (SCSI) 112. Alternatively, the hard disk
drive 117, magnetic disk drive 118 and optical disk drive 119 may
be connected to the system bus 111 by a hard disk drive interface,
a magnetic disk drive interface, and an optical drive interface,
respectively.
[0030] The drives and their associated computer storage media
discussed above and illustrated in FIG. 1, provide storage of
computer readable instructions, data structures, program modules
and other data for the system 100. In FIG. 1, for example, hard
disk drive 117 is illustrated as storing operating system 127,
application programs 128, other program modules 129, and program
data 130. Note that these components can either be the same as or
different from operating system 106, application programs 107,
other program modules 108, and program data 109. A user may enter
commands and information into the system 100 through input devices
such as a keyboard 123 and pointing device 122, commonly referred
to as a mouse, trackball or touch pad. Other input devices (not
shown) may include a microphone, joystick, game pad, satellite
dish, scanner, or the like. These and other input devices are often
connected to the processing unit 101 through a user input interface
113 or a serial port interface 114 that is coupled to the system
bus 111, but may be connected by other interface and bus
structures, such as a parallel port, game port or a universal
serial bus (USB). A monitor 116 or other type of display device is
also connected to the system bus 111 via an interface, such as a
video adapter 110. In addition to the monitor 116, computers may
also include other peripheral output devices such as speakers and
printers, which may be connected through an output peripheral
interface.
[0031] The system 100 may operate in a networked environment using
logical connections to one or more remote computers, such as a
remote computer 133 and/or other communications, such as a
communication device 132. The remote computer 133 may be a personal
computer, a server, a router, a network PC, a peer device or other
common network node, and typically includes many or all of the
elements described above relative to the system 100, although only
a memory storage device has been illustrated in FIG. 1. Remote
computer 133 may, for example, be found at a variety of health
system related locations, such as hospitals, other inpatient
settings, pharmacies, a clinician's office, ambulatory settings,
testing labs and a patient's home environment, though other
locations may be chosen as well. The communication device 132 may
be a mobile cellular phone, mobile text-pager or other portable
communications device, and typically includes some of the elements
described above relative to the system 100. The logical connections
depicted in FIG. 1 include a local area network (LAN) 126 and a
wide area network (WAN) 125, but may also include other networks.
Such networking environments are commonplace in offices,
enterprise-wide computer networks, intranets and the Internet.
[0032] When used in a LAN networking environment, the system 100 is
connected to the LAN 126 through a networking interface or adapter
115. When used in a WAN networking environment, the system 100
typically includes a modem 124 or other means for establishing
communications over the WAN 125, such as the Internet. The modem
124, which may be internal or external, may be connected to the
system bus 111 via the serial port interface 114 or other
appropriate mechanism. In a networked environment, program modules
depicted relative to the system 100, or portions thereof, may be
stored in the remote storage device. By way of example, and not
limitation, FIG. 1 illustrates remote application programs 131 as
residing on memory devices 132 and 133. It will be appreciated that
the network connections shown are exemplary and other means of
establishing a communications link between the computers and/or
portable communication devices may be used.
[0033] Although many other internal components of the system 100
are not shown, those of ordinary skill in the art will appreciate
that such components and the interconnection are well known.
Accordingly, additional details concerning the internal
construction of the computer 20 need not be disclosed in connection
with the present invention.
[0034] Those skilled in the art will understand that program
modules such as the operating system 106 and 127, application
programs 107 and 128, and program data 109 and 130 are provided to
the system 100 via one of its memory storage devices, which may
include ROM 103, RAM 105, hard disk drive 117, magnetic disk drive
118 or optical disk drive 119. Preferably, the hard disk drive 117
is used to store program data 130 and 109, application programs 107
and 128, and operating system 106 and 127.
[0035] When the system 100 is turned on or reset, the BIOS 104,
which is stored in the ROM 103 instructs the processing unit 101 to
load the operating system from the hard disk drive 117 into the RAM
105. Once the operating system 127 is loaded in RAM 105, the
processing unit 101 executes the operating system code and causes
the visual elements associated with the user interface of the
operating system 127 to be displayed on the monitor 116. When an
application program 107 and 128 is opened by a user or waken up by
an inbound request for collaboration, the program code and relevant
data are read from the hard disk drive 117 and stored in RAM
105.
[0036] The sequential flow of activity through a set of general
component modules 200, functioning within the system 100, can be
viewed with reference to FIG. 2. Various terminology discussed with
respect to the present invention may have particular meaning as
described below. For instance, the term "clinician" includes, but
is not limited to, a treating physician, specialists such as
surgeons, radiologists and cardiologists, emergency medical
technicians, physician's assistants, nurse practitioners, nurses,
physical therapists, pharmacists, dieticians, microbiologists, and
the like, and aides or assistants thereto. The term "patient"
refers to a person that is receiving or has received
health-care-related services in any location in a medical
environment (e.g., hospitals or other inpatient or outpatient
settings, a clinician's office, ambulatory settings, testing labs,
patient's home environment, or in any other setting). The set of
general component modules 200 interact with various types of
medical records that contain information about patients. As an
example, these medical records may take the form of an electronic
medical record (EMR) for a particular patient. The electronic
medical record is typically designed to contain various types of
information about an individual patient, such as: observed
conditions of the patient (e.g., physiological conditions such as
blood pressure, oxygen saturation levels in blood, or other "vital
signs"); medications taken; current immunizations; food and drug
allergies; diagnoses of various clinicians; listing of clinician
names that are currently providing or that have provided care to
the patient; and may include, directly in the EMR or attached
thereto, other files containing various information/data, such as
image data (e.g., X-ray, MRI image, skin or tissue photos), voice
data (e.g., .wav file or other audio formatted recording of
clinician providing patient-related information), or other textual
information. The information in an EMR or other medical record as
described herein may be referred to generally as patient-focused
clinical data. However, it should be understood that the term
"medical record", or "electronic medical record" in particular,
should not be interpreted to be limited to any type of
computer-readable format or record, but includes any
electronically-stored data structure containing information
relative to at least one specific patient and from which
information may be viewed and/or extracted by the system of the
present invention.
[0037] The general component modules 200 include, in one
embodiment, a receiving component 202, a roster generation
component 204 and an interfacing component 206. Methods for
facilitating collaboration sessions of the present invention
generally involve actions that flow from the receiving component
202, to the roster generation component 204, and on to the
interfacing component 206. The receiving component 202 may be
configured to receive a request for the initiation of a
collaboration session between a requesting clinician and one or
more other clinicians that may potentially be available to
collaborate. Such a collaboration request relates to a piece of the
patient-focused clinical data (also referred to as the "context")
that resides, for example, in a medical record, such the particular
patient's EMR. Selection of the context causes the request for
collaboration session initiation to be generated. Based on the
context related to, or contained within, the request, the roster
generation component 204 begins the building of a roster of
specific potentially available clinicians using a selecting
subcomponent 208 and a ranking subcomponent 210. Certain input from
the requesting clinician and analysis by the roster generation
component 204 and subcomponents thereof may be used to configure
and arrange the roster of potentially available clinicians for
collaboration. Once the roster is complete, the interfacing
component 206 sends invitations for a collaboration session for
those entities on the roster, and subsequently receives replies
from entities interested in joining the session. The interfacing
component may also negotiate the capabilities of all collaborating
entities, including the requesting clinician, and determines which
mode of electronic communication is feasible and/or preferred for
the session.
[0038] One method 300 of roster generation concerning potentially
available clinicians for a collaboration session is presented in
FIG. 3. Reference will also be made to the general component
modules 200 of FIG. 2. The method 300 is capable of implementation
with a particular patient's EMR, such as a medical record 400 shown
in FIG. 4, which will be described and referenced along with the
discussion of FIG. 3.
[0039] A requesting clinician will first initiate a request for a
collaboration session upon a piece of patient-focused clinical data
(i.e., the "context"), in step 302. An example of this context is
shown in FIG. 4 and generally designated 402. The context 402 may
be generally classified into one of two categories. In either
category, the context is preferably hyperlinked for negotiating a
certain access protocol to reach the roster building capabilities
of the roster generation component 204. The hyperlinked context is
selectable with any input device (e.g., a mouse). The first
category of context 402a may include individual caregivers or
clinicians listed in the medical record 400; in other words,
"record related clinicians." In the example shown, the Primary Care
Physician ("PCP") is "Tom Fangman." By selecting the Primary Care
Physician as the record related clinician, other clinicians having
some connection with the Physician may be brought to the attention
of the requesting clinician, as will be explained below.
Alternatively, the second category of context 402b may include
certain types of information or data other than clinicians. For
example, certain information in medical record 400 may be eligible
as something about which to spur a collaboration request, and may
be so identified with certain visual cues, such as a "Collaborate
About" icon next to the context 402b. Context 402b can include, but
is not limited to, information such as vital signs, current
medications, allergies, clinical diagnoses, and problems
articulated by the patient. The receiving component 202 receives
these selections as requests to build a roster, and invokes the
roster generation component 204 to conduct a collaboration
session.
[0040] The method continues at step 304, where the roster
generation component 204 analyzes the received selection relating
to one of the particular pieces of context 402a or 402b to identify
clinicians having some connection with, or relevancy to, the chosen
context. A list of all the clinicians in a given institution that
may be contacted may be maintained, for example, in a searchable
database of the system 100 located on one or more of the storage
devices 117, 118, 119, or at another location in a medical
information system.
[0041] In the case of the context 402a being a clinician (i.e., a
record related clinician), other categories of relevant clinicians
may include, but are not limited to: (i) clinicians associated with
the record related clinician, such as other clinicians in their
practice group or organization (e.g., a primary care physician or
nurse); (ii) clinicians associated with the record related
clinician and the requesting clinician, which may be referred to as
"associates-in-common" (e.g., clinicians in the same practice group
or organization as the record-associated and requesting clinician,
or clinicians frequently utilized by both clinicians); (iii)
clinicians that share the same role as the record related
clinician, such as in the example of medical record 400, Primary
Care Physicians in addition to "Tom Fangman"; or (iv) clinicians in
a "web of care" with the patient whose medical record 400 contains
the context 402a. The concept of web of care relates to a
quantitative measurement of the relationship between the clinician
and patient. This relationship may take into account a number of
factors, including the quality, nature, and frequency of contact or
care given by the clinician for the patient, as is explained in
U.S. patent application Ser. No. 10/860,458, filed Jun. 4, 2004 and
entitled "SYSTEM AND METHOD FOR CREATING A VISUALIZATION INDICATING
RELATIONSHIPS AND RELEVANCE TO AN ENTITY," the teachings of which
are incorporated herein by reference.
[0042] Alternatively, when the initiation of a request for a
collaboration session is through context 402b as data other than
clinician names, various relevant clinicians may include, but are
not limited to: (i) those clinicians that are authors of such
context 402b or initiated an activity to derive the context 402b
(e.g., ordered an X-ray attached with the medical record 400); or
clinicians related to the authors/initiators of the context 402b,
where the relationship involves one of the clinician associations
recited above with respect to the context 402a being a
clinician.
[0043] The activity in step 304 of the method is performing a
merging of various social networks within an institution to find an
initial set of potential clinician collaborators that is at least
partially based on the perceived intent of the requesting
clinician. Thus, the method 300 is working towards finding the
individuals that will have the most relevant information about the
patient-focused clinical data.
[0044] After an initial set of potential clinician collaborators
relevant to the context is established, and in the case of the
patient-focused clinical data being other than a clinician name,
i.e., context 402b, the roster generation component 204 may analyze
the context 402b for relevant content to share with the requesting
clinician in conjunction with the context 402b, in step 306.
[0045] For instance, this method step may optionally involve
selection of a relevance perspective corresponding to the context
402b. The selected relevance perspective may be used in a clinical
relevance scoring algorithm to rank order the roster of potentially
available clinicians, as will be more fully explained below. In a
sense, the relevance perspective defines a mathematical function
modeling a particular health care treatment scenario for a given
patient.
[0046] One particular example of a relevance perspective involves
identifying the most relevant clinical decision maker for a
patient. In this illustration, an applicable mathematical function
places a higher value on, for example, the number of medication
orders or invasiveness of the procedures undertaken on the patient.
Another example of a relevance perspective involves identifying the
clinician who, in a sense, best knows the patient's current care
plan. This perspective places a higher value on the number of
touches rather than the type of touch. In any case, the relevance
perspective may either be a default selected by the roster
generation component 204 for a particular context 402b, or may also
selected by the requesting clinician from a predefined set of
relevance perspectives stored with system 100.
[0047] Alternatively, the analysis undertaken by the roster
generation component 204 in step 306 may be conducted without
regard to any relevance perspective. For instance, if the
requesting clinician wants to collaborate about a diagnosis or
medication listed in a given patient's medical record 400, it may
be desirable for the requesting clinician and/or any collaborating
clinician to select other patient related data (e.g., demographics,
past diagnoses) for display or quick reference during a
collaboration session. Such additional patient related data may, as
an example, be accessed through a hyperlinked uniform resource
locator (URL) to allow navigation through the medical information
system to a proper file or record location, in accordance with
known security and preference privileges, as those of skill in the
art will appreciate. This additional patient related data will
allow clinicians participating in the collaboration to put into the
proper perspective patient issues that become part of the
collaboration session.
[0048] The method 300 may also include, in step 308, analyzing the
patient-focused clinical data or context 402 to determine if any
software agents should be invited to the collaboration session.
Software agents generally include executable software knowledge
program modules contained within the system 100 that monitor and
give guidance or other information based on the event flow during a
collaboration session. The roster generation component 204 checks
an existing mapping of the context 402 against software agents to
determine which software agents may be appropriate for a
collaboration session. This mapping may be pre-established in a
medical information system (e.g., within a database thereof) based
on the usefulness of information provided by the software agents in
various situations. One example of a software agent is a
question-answer engine that works on-demand for collaboration
participants, retrieving information from a patient's EMR or from
various databases holding medical information (e.g., the MULTUM
database containing drug-drug interactions offered by Cerner
Multum, Inc.), and commanding various medical devices to perform a
task (e.g., take a blood pressure reading). The software agent may
work by using natural language processing to understand requests
logged by any collaborating clinician, whether entered into the
system 100 by text, voice recognition or other means. Other actions
may be taken by software agents to provide useful information in a
collaboration environment, as those of skill in the art will
appreciate. As another example, if the initial set of potential
clinician collaborators include clinicians of a certain area of
practice or specialty, for instance, oncology, then the software
agent may provide information such as the definitions of relevant
terminology within the specialty field, and may link such
information with other information already being presented to the
requesting collaborator and potential collaborators relating to the
patient-focused clinical data.
[0049] There may be certain situations, however, where software
agents may not be invoked even if available. If the processing
burden placed on the medical information system by the software
agent exceeds a given threshold, or if the particular user
interfaces of electronic devices or computers used by the
requesting collaborator and potential collaborators cannot display
a certain type of content, then software agents may not be invoked
at all (e.g., video data on a device displaying text only).
[0050] At this point in the method 300, the roster generation
component 204 aggregates the initial set of potentially available
clinicians from the previous method steps, and any software agents,
into a preliminary roster, in step 310. Thus, at this point, the
entities on the collaboration roster may include both human
clinicians as collaborators and executable program modules.
[0051] Then, in step 312, the roster generation component 204
retrieves presence information for the potentially available
clinicians on the roster. Such presence information may indicate
contact-type information, such as the clinician's current location,
online/offline status, availability, and/or collaboration device
capabilities (e.g., for communications device 132 or remote
computer 133). For instance, a signal requesting a response may be
generated and transmitted by system 100 to the electronic devices
associated with each clinician on the roster. The presence
information on the roster may be updated in real-time and displayed
as part of the roster so that the requesting clinician is informed
of which potential clinician collaborators are, in fact, available
for a collaboration session. During step 312, the component 204 is
continuously acquiring, updating, and displaying availability
information on the roster. Additionally, the presence information
may be displayed in a variety of formats. For example, the color of
an individual's name may represent the presence status of that
individual. The color red may indicate that the individual is
unavailable, yellow may indicate that the individual is busy, and
green may indicate that the individual is available for
collaboration. Other schemes may obviously be implemented,
including other visual or audible cues indicating clinician
availability.
[0052] A selecting subcomponent 208 of the roster generation
component 204 may be used to apply personal preferences of the
requesting clinician, as well as institutional preferences and
policies, to the roster. This ensures that the roster of
potentially available clinicians fully includes all persons that
may be helpful and necessary to a collaboration session.
[0053] Specifically, in step 314, the selecting subcomponent 208
may apply personal preferences of the requesting clinician to the
roster to allow for pre-selection of favorite or preferred
collaborators to be included on the roster. These personal
preferences may be clinicians with which the requesting clinician
frequently collaborates, or software agents that the requesting
clinician requires to monitor the collaboration session, as
examples. As an illustration, a primary care physician may
frequently want to include a particular nurse practitioner in all
collaboration sessions conducted by the physician to ensure the
best possible communication of relevant issues related to the care
of a particular patient discussed in a collaboration session. As
another example, a podiatrist as a requesting clinician may require
a software agent configured to inject surgical diagrams into a
collaboration session where the viewing of video images is
possible. As will be understood, other examples may also be
envisioned for this method step. These personal preferences are
stored within the medical information system and may be edited and
updated as desired by the requesting clinician.
[0054] The selecting subcomponent 208 may also take into account
preferences and policies of an institution with which the
requesting clinician and/or the potentially available clinicians
are associated with in their respective medical practices, in step
316. The roster generation component 204 manages these preferences,
which may include certain clinicians, role groups (e.g., a set of
cardiologists), software agents, and the like, and ensures that
these representative members of these preferential groups are
present on the roster for the collaboration session if possible.
The intent is that if an institution develops evidence that certain
software agents or consultation patterns produce better outcomes in
collaborative exchanges, the medical information system will
support this by requiring the inclusion of the appropriate entities
(i.e., human collaborators and software agents). Another situation
that may necessitate the implementation of institution preferences
and policies is when a requesting user is not a fully-trained
practicing clinician, such as a student or intern in a health
profession. As one example, the institution may require certain
supervising clinicians be on the collaboration roster when the
requesting user is a student nurse or an intern to evaluate or
monitor the collaboration.
[0055] Once this stage of the method 300 has been reached, the
roster now contains all of the entities that may potentially be
part of a specific collaboration session. In step 318, a ranking
subcomponent 210 of the roster generation component 204 is invoked
to rank order entities using a clinical relevance scoring
algorithm. This step may take into account the relevance
perspective of step 304 and any previous rank ordering of
potentially available clinicians.
[0056] The ranking subcomponent 210 preferably uses the clinical
relevance scoring algorithm to take into account the degree of
clinical relevance between the entities on the roster and the piece
of person-focused clinical data or context 402 that was selected by
the requesting clinician in step 302. FIG. 5 shows one exemplary
graphical interface 500 presenting a radiological image 502
selected as the context 402b in step 302, and a roster 504 of
clinicians that have some relevancy to the context (or were
otherwise selected by the requesting clinician and/or associated
institution). Software agents may also be present on the roster
504, though not shown in FIG. 5. Various information about the
clinicians may be provided, as more fully explained in previous
steps of the method 300.
[0057] The clinical relevance scoring algorithm identifies the most
relevant entities for this piece of context 402 and conducts roster
ranking based on those results. Accordingly, the scoring algorithm
may be implemented by a mathematical function that ranks, for the
example roster 504 shown in FIG. 5, the author of the radiological
image 502 first, followed by clinicians on the roster that have
looked at the image for the particular patient, other clinicians
that have not looked at that particular image but have a certain
expertise in understanding radiological images in general (i.e., a
radiologist), and lastly, other clinicians that have cared for the
particular patient. The mathematical function for this scoring
algorithm places a higher ranking value for individuals on the
roster that have come in contact the most with the particular
patient.
[0058] Generally, the clinical relevance scoring algorithm applies
a mathematical function against data collected about particular
activity types, including frequency of such activities, in order to
rank the collaborators on the roster. The mathematical function may
be a simple linear function or a more complex function applied to
the activity data. In another illustration, the mathematical
function for this scoring algorithm may rank the potentially
available clinicians on the roster according to employment
relationships with the requesting clinician. This may include
clinicians on the roster that are in the same practice/role group
as the requesting clinician, such as cardiologists, or that have
been on the same medical team as the requesting clinician.
[0059] Continuing with step 320, the system 100 presents the rank
ordered and complete roster of potentially available collaborating
entities (i.e., clinicians and software agents) to the requesting
clinician for modification thereof. The display of the complete
roster may be in tabular form, for example, and presents the
collaborator roster as arranged by the clinical relevance scoring
algorithm or other rank order schemes. Additionally, the roster may
contain a display of real-time presence information for each
clinician shown. The requesting clinician can input selections of
specific clinicians and software agents that the requester wishes
to invite for a collaboration session such as by selecting boxes
located next to the name of each potential collaborator. Certain
boxes may already be checked or pre-selected based on the
requesting clinician's stored preferences and the institution's
stored preferences and policies, as described previously for steps
314 and 316. The roster of collaborators may be modified by
selecting or de-selecting the entities on the complete roster.
Optionally, the system 100 may allow the requesting clinician
launch a person-to-person ad-hoc collaboration session with one of
the clinicians on the roster whose presence information indicates
that that individual is available for collaboration. Such an ad-hoc
collaboration may be initiated by, for example, selecting an icon
next to the clinician's name, or by clicking on the name
itself.
[0060] Preferred modalities of collaboration may optionally be
selected by the requesting clinician in step 322. These modalities
refer to types of communications used in computing systems and
other electronic devices. Examples of these modalities include, but
are not limited to, text messaging, voice over internet protocol
(IP), video, shared whiteboard or other real-time communicative
collaboration capabilities, as those of skill in the art will
appreciate. The requesting clinician may select one or more of the
collaboration modalities, and information relating to these
selected modalities may be transmitted as part of the entity
invitation process, as will be more fully explained below.
Additionally, based on the particular type of communication or
computing device to be used by the requesting clinician for the
collaboration session, the system 100 may automatically identify
the capabilities of the device and preclude certain modalities of
collaboration from being presented as an option for the clinician.
Still further, if the particular device used by the requesting
clinician is only capable of one modality of collaboration (e.g., a
pager capable only of text messaging), then step 322 may be
skipped.
[0061] At this point, roster generation is complete and the
requesting clinician is ready to engage in a collaboration session
with at least one of the potentially available clinicians and
software agents on the roster. One method 600 for facilitating a
collaboration session is set forth in FIG. 6 and with continued
reference to the general component modules 200 of the system 100
shown in FIG. 2. In accordance with method 600, the interfacing
component 206 receives the completed roster of entities for a
collaboration session, and manages the collaborative exchange of
information between the requesting clinician and entities that
ultimately participate in the session.
[0062] The interfacing component 206, in step 602, and in view of
selections made by the requesting clinician on the roster, invites
the selected and potentially available clinicians and software
agents (the entities) on the roster to participate in a
collaboration session. Invitations to collaborate are sent to the
entities along with information related to the desired/preferred
collaboration modalities of the requesting clinician. In addition,
the person-focused clinical data, or context, about which the
requesting clinician wishes to collaborate may also be sent as part
of the invitation. The clinical context data may optionally be
presented as a hyperlinked uniform resource locator that the
invited roster entities can invoke to begin a real-time
collaboration session with the requesting clinician.
[0063] Thereafter, in step 604, interfacing component 206
negotiates the capabilities of the responding entities and
initiates the appropriate collaboration mechanisms. The requesting
clinician, the potentially available clinicians and software agents
may be referred to collectively as "collaborators" when invited to,
or currently participating in, a collaborative exchange of
information within a collaboration session.
[0064] As a first action in step 604, the system, through
interfacing component 206, receives replies from the invited
collaborators along with the capabilities (i.e., modalities of
collaboration) they support. For instance, an invited collaborator
may respond by accepting the invitation and indicating that he/she
is capable of collaborating through voice communication only. One
example of a health care delivery situation where this could apply
is with a surgeon presently occupied with a surgical procedure in
an operating room. As to outside requesting clinicians seeking to
collaborate with the surgeon, it may be most appropriate for the
surgeon to provide speaking comments captured by a portable device
or computer, but not for them to type any text or view any video
images. Alternatively, the surgeon or other invited collaborators
may respond by rejecting the invitation or may not respond to the
invitation at all. These responses are noted by the component 206.
The invitations for which no responses have been received may be
left as open requests for collaboration or may be rescinded by the
system or timed-out based on preferences of the system.
[0065] A number of additional rules may control the responding
entities that are allowed to participate in the collaboration
session. In one example, collaborative exchanges within the session
may be conducted between the requesting clinician and one other
clinician, although software agents may simultaneously participate
as well. By limiting the session to two clinicians, the requesting
clinician avoids information overflow in the exchange and is able
to candidly evaluate the information gleaned from the other party
without interference or interruption by other clinicians. At the
same time, it may be desirable in certain circumstances for a given
collaborative session to involve the requesting clinician and
multiple other clinicians so that specific questions can be
answered quickly by those who possess the best knowledge. The
strength of medical opinions (e.g., diagnostic opinions) can also
be verified more easily and thoroughly by multiple collaborating
entities. As another rule, for invitations to role-groups, such as
the "first available cardiologist" or "resident on call", the
system is able to rescind all other invitations to that role group
when any one of the clinician members accepts. This may be done by
sending a notice to the other members in the role group that the
invitation has been rescinded and disabling their ability to enter
the collaboration session.
[0066] A second action of step 604 is, for the invited
collaborators who have accepted the invitation, the interfacing
component 206 establishing the appropriate connections necessary to
initiate the collaboration session. Once the system confirms that
such connections are established, in step 606, the collaboration
session begins using the agreed-upon modalities. During the
collaboration session, the requesting clinician may share some or
all of the current pieces of patient-focused clinical data (e.g.,
context 402) and any other relevant content with the other
collaborators. This may be done by sharing a URL for independent
browsing of the record, with each collaborator having their own
security and preferences applied, or by other sharing schemes. In
one illustration, a requesting clinician may be currently looking
at a clinical flow sheet contained in an electronic medical record,
and desire that other collaborators look at the same sheet
concurrently. The requesting clinician is able to send the URL for
that flow sheet to the other collaborators so that each
collaborator can browse to the correct location and filter it
through their own security and preferences for independent
browsing. Additionally, this may be done through an application
sharing mode involving co-browsing.
[0067] Typically, collaboration in step 606 requires at least one
human collaborator, such as a clinician; however, if a software
agent has sufficient functionality, the agent may provide relevant
information to the requesting clinician based on the context 402
without any human collaborators present.
[0068] One exemplary graphical interface 700 is provided in FIG. 7,
and shows a collaboration session utilizing text message and video
modalities for information exchange. Each collaborator can input
text in text box 702 and view the exchange of textual information
in display area 704. Additionally, the collaborators can see each
other in the camera display area 706. Settings for the
collaboration session are also configurable so that camera video
images, or text messages (i.e., "talking") may be selectably
activated or de-activated during the collaboration session by each
collaborator.
[0069] Collaboration session activity in step 606 may involve
parallel activities of specific software agents that were present
on the collaboration roster generated. As a first parallel activity
606a within the collaboration session facilitated by the
interfacing component 206, software agents monitor the
communicative exchange between clinicians in the collaboration
session for specific triggering events of interest. If such a
triggering event is realized, a second parallel activity 606b is
invoked where the software agent may perform one of a range of
clinically relevant tasks. Illustrations of triggering events of
interest may include a spoken word, a typed phrase, a call to the
agent by name, user actions such as the sharing a newly created
piece of patient-focused clinical data, or other type of event. As
an example, during a collaboration session, the requesting
clinician may call for a software agent called "OrderBot" to order
a specific medication, in this case Acetaminophen 375 mg. OrderBot
will then take action to order the prescribed medication for that
particular patient. Another example may be a natural language
processing agent that is aware of medical terminology that
highlights words in text messages or voice transcripts, hyper
linking them to their definitions or to related clinical actions
from an evidence-based medicine standpoint. Still further, another
example of a triggering event response may be software agents that
act as question-answer systems on demand from collaborators, or
agents that passively monitor the collaboration session and build
annotated and conceptually abstracted transcripts. All of these
software agents are capable of injecting the results into the
events stream of the collaboration session.
[0070] The general component module 200 may additionally include a
storing component 212 for storage any transcript or log of events
and data streams built by the software agent or other system
component during the collaboration session. Each transcript may be
stored within the given patient's electronic medical record (i.e.,
the patient associated with the context 402) as a clinical
document. Such transcripts may also take the form of the preferred
modality of the collaboration session, such as text messaging,
voice, or other modalities as previously explained. Additionally,
each transcript may be stored in a personal clinician record as a
clinical document. Personal clinician records may be secure
documents that can only be accessed by authorized users (e.g., may
be password protected, etc.). Such personal clinician records are
preferred when a collaboration session: (i) involves a general
private conversation that is not to be accessed or reviewed by
everyone who has authorized access to a given patient's record; or
(ii) a specific private conversation based on the fact that the
collaboration session spanned multiple patients and multiple pieces
of context 402.
[0071] Once a transcript is embedded in or electronically attached
to a patient record, it may be retrieved and viewed or played back
in much the same way that a piece of patient-focused clinical data
is chosen when initiating a request for a collaboration session. An
example of a transcript may be the clinical document 506 displayed
in the roster list shown in FIG. 5. In this way, the transcript
itself may function as the context 402 about which the requesting
clinician desires to have a communicative collaborative exchange
with another clinician.
[0072] Therefore, the present invention can be seen to achieve
increased efficiencies in the delivery of health care related
services. These efficiencies are realized because, with the present
invention, clinicians can more quickly and completely understand
patient-focused clinical data in a respective electronic medical
record by collaborating with other clinicians and software agents
that have some level of specific knowledge and/or expertise to
lend. Furthermore, since certain changes may be made in the above
invention without departing from the scope hereof, it is intended
that all matter contained in the above description or shown in the
accompanying drawing be interpreted as illustrative and not in a
limiting sense.
[0073] Referring now to FIG. 8, a block diagram is provided
illustrating an exemplary computing system environment 800 suitable
for use in implementing embodiments of the present invention. It
will be understood and appreciated by those of ordinary skill in
the art that the computing system environment 800 shown in FIG. 8
is merely an example of one suitable computing system environment
and is not intended to suggest any limitation as to the scope of
use or functionality of embodiments of the present invention.
Neither should the computing system environment 800 be interpreted
as having any dependency or requirement related to any single
module/component or combination of modules/components illustrated
therein. Among other components not shown, the system 800 includes
a requesting computing device 802, a receiving computing device
803, a data store 806, and an online networking system, that
communicate with each other by way of a network 804. The network
804 may be, in one embodiment, one or more local area networks
(LANs). Alternatively, the network 804 may take the form of a wide
area network, which may include, without limitation, one or more
wide area networks (WANs), such as the Internet. Such networking
environments are commonplace in offices, enterprise-wide computer
networks, intranets, and the Internet. Accordingly, the network 804
is not further described herein.
[0074] In some embodiments, one or more of the illustrated
components/modules may be implemented as stand-alone applications.
In other embodiments, one or more of the illustrated
components/modules may be integrated directly into other
components. It will be understood by those of ordinary skill in the
art that the components/modules illustrated in FIG. 8 are exemplary
in nature and in number and should not be construed as limiting.
Any number of components/modules may be employed to achieve the
desired functionality within the scope of embodiments hereof.
Further, components/modules may be located on any number of
servers, client devices, or the like.
[0075] With continued reference to FIG. 8, each of the computing
devices 802 and 803 and the online networking system 808 may be any
type of computing device, such as computing device 100 described
with reference to FIG. 1, for example. A computing device as used
herein may include a laptop, smart phone device, a tablet, PDA, a
personal computer, or any other device that can communicate by way
of the network 804. The requesting computing device 802 and the
receiving computing device 803 may communicate with one another
indirectly, such as when the requesting computing device 802
communicates a message and a patient-focused clinical data element
to the online networking system 808, and the receiving computing
device 803 accessed that patient data through the online networking
system 808. In one embodiment, a user of the requesting computing
device 802 sends a request through the online networking system 808
that includes an identification of one or more other clinicians
with whom the requesting clinician would like to collaborate. This
collaboration may include a request for a second opinion regarding,
for instance, treatment options or a diagnosis of a particular
patient.
[0076] Alternatively, the requesting clinician may simply want to
share patient information with another clinician for that
clinician's information, such as if the other clinician may also be
involved in the treatment of the patient. The other clinician, in
one embodiment, is a resident physician or a nurse who works
directly with the requesting clinician such that the patient
information may be relevant to the other clinicians. This is a
convenient way of sharing information if the clinicians are
physically located in the same geographical area (e.g., same
building or complex) or if the clinicians are located in different
geographical areas. In yet another embodiment, the requesting
clinician may not be sending a request to another clinician, but
may like to send certain pieces of information from a patient's EMR
to review at a later time. The patient information may thus be
uploaded onto the online networking system and reviewed at a later
time. There may be more than one clinicians identified by the
requesting clinician, and as such there may be multiple receiving
computing devices 803, although one is shown in FIG. 8 for
simplicity. As such, it should be understood that any number of
computing devices may be employed within the system 800 within the
scope of the present invention. Each may comprise a single device
or multiple devices cooperating in a distributed environment.
Additionally, other components not shown may also be included
within the system 800, while components shown in FIG. 8 may be
omitted in some embodiments.
[0077] The online networking system 808 may include various
components including a requesting component 810, a determining
component 812, a data de-identifying component 814, and a
communicating component 816. While four components are illustrated
in FIG. 8, other components may be utilized in various embodiments
and are contemplated to be within the scope of the present
invention. As mentioned, the online networking system 808 generally
functions as an interactive system for clinicians in the medical
field. It may take the form of a website or multiple websites that
are accessible to clinicians who are registered with the system. As
such, one clinician may share or request a consultation (e.g.,
second opinion) with another clinician who is also registered with
the system. As such, a clinician may access the online networking
system 808 by way of, for example, the Internet and may use a user
interface on a website to make requests and send patient
information, such as patient-focused clinical data elements from a
patient's EMR to other clinicians.
[0078] The requesting component 810 is generally responsible for
receiving requests from requesting clinicians and processing the
requests in the system. The requesting component 810 may determine
whether the one or more clinicians identified in the request are
registered with the online networking system 808. If a clinician is
not registered, an attempt may be made the online networking system
808 to contact that clinician and ask if he or she would like to
register with the system, as there is a message or request pending
from another clinician. The requesting component 810 also may
analyze the request to determine what type of request is being
made, such as if the request is to share information or if the
request is to ask for assistance, in which case the receiving
clinician would be asked to respond to the request by the
requesting clinician and likely provide information to the
requesting clinician via the online networking system 808.
[0079] The determining component 812 determines whether the
identified clinician(s) is allowed access to the
patient-identifying data included in the request. As mentioned, the
request may include a patient-focused clinical data element which,
in one embodiment, is pulled directly from the patient's EMR, and
thus may include information that identified the patient. Depending
on the applicable privacy regulation, patient-identifying
information may not be allowed to be shared with clinicians not
associated with the patient, such as clinicians who are not
currently treating the patient or clinicians who work directly with
the treating clinician (e.g., nurse, physician's assistant,
resident physician). In this case, the patient-identified
information would need to be removed prior to being sent to the
identified clinician. A data store 806 may be accessed by the
determining component 812 to determine whether the identified
clinician(s) is allowed access to the patient-identifying
information.
[0080] In one embodiment, the determining component 812 utilizes a
rules-based authentication subsystem or an equivalent system that
is able to automatically determine, given names and other
identifying information of both the patient and the receiving
clinicians, whether the receiving clinicians are allowed access to
the patient-identifying information of a particular patient. For
exemplary purposes only, XACML is one type of rules-based
authentication subsystem that may be used to make these types of
determinations. The rules used by the rules-based authentication
subsystem may include, for example, that any clinician listed below
has an ongoing professional, medical relationship with the patient,
and thus is allowed access to the patient-identifying data. As
such, the subsystem would understand that any other clinician not
listed is not granted access to the identifying information.
[0081] Even further, in one embodiment, the communication of
de-identified patient data to the receiving clinicians may act as
an initial inquiry to determine if there are any clinicians who are
interested in responding to the collaboration request sent by the
requesting clinician. As such, a receiving clinician may decide to
act as a consultant, and thus may eventually be granted access to
the full set of data, including patient-identifying information.
This may happen, for instance, with the requesting clinician and
the patient's consent. Joining the collaboration as a consultant
enables a deeper collaboration with a full set of patient data
accessible by the new consultant. In one instance, the initial
request with de-identified data may act as a "fishing expedition"
to identify the most qualified specialists in a particular area,
and to further identify those who are interested in joining the
medical team
[0082] The data de-identifying component 814 de-identifies the data
by removing all forms of data that may contribute to identification
of the patient. For example, current HIPAA privacy standards
mandate that eighteen specific identifiers would need to be removed
prior to sharing the patient information. These identifiers include
names, geographic subdivisions smaller than a state, all elements
of dates (except year) related to an individual (including dates of
admission, discharge, birth, death and, for individuals over 89
years old, the year of birth must not be used), telephone numbers,
FAX numbers, electronic mail addresses, Social Security numbers,
medical record numbers, health plan beneficiary numbers, account
numbers, certificate/license numbers, vehicle identifiers and
serial numbers including license plates, device identifiers and
serial numbers, web URLs, Internet protocol addresses, biometric
identifiers (including finger and voice prints), full face photos
and comparable images, and any unique identifying number,
characteristic or code. The removal of patient-identifying
information may be done manually, or alternatively may be done
automatically using an algorithm that recognizes words and numbers
that would need to be removed. While patient-identifying
information, in compliance with HIPPA, for example, may be removed
before being sent to a receiving clinician, the de-identified data
retains sufficient clinical detail to enable the collaboration to
proceed. As such, the de-identification process will preserve
sufficient clinical information to enable the responding clinician
to make a decision whether or not to collaborate.
[0083] In one embodiment, a requesting clinician may wish to share
patient information in a collaborative environment, such as in an
online networking system, but may not have a particular clinician
in mind with which the requesting clinician wishes to share
information. In this case, the patient information may be published
onto the online networking system for many clinicians to see. Here,
the patient information would be de-identified to remove all
patient-identifying information, This type of online sharing and
collaboration allows a larger set of clinicians to review the
patient information and respond to the requesting clinician with
ideas for diagnosis and treatment of the patient. De-identifying
data allows many different clinicians to be able to review the
patient's information in a social networking setting. For instance,
a generic message may be sent to all neurologists by a requesting
clinician who has a patient with a potential neurological disorder.
One or more neurologists may then review the information and
provide feedback to the requesting clinician regarding a possible
diagnosis. Even further, embodiments of the present inventions may
be used similar to social networking sites where a message with
de-identified patient information is broadcast to a group of
clinicians who are in the network of the requesting clinician.
[0084] The communicating component 816 communicates the message and
patient-focused clinical data elements to the identified or
receiving clinician(s). While this communication may comprise
sending an electronic communication directly to the identified
clinician(s), it may also or alternatively publish or post the
information on the online networking system 808, such as a website
associated therewith, and alert the clinician that information is
ready to be viewed. The receiving clinician(s) may then access the
message and patient information by signing on to the online
networking system 808 to view the information and request. If the
request and patient are posted online, it may be accessible only to
the receiving clinicians and not any other clinician that has
access to the online networking system 808.
[0085] In one embodiment, any communications between the requesting
clinician and the receiving clinician(s) may be archived and saved
to the patient's EMR for future reference. This may occur no matter
if the receiving clinician was given access to the full EMR or
de-identified data associated with the patient's EMR. For example,
if the requesting clinician asked a particular receiving clinician
with expertise in a particular heart condition to consult on a
case, the information received back from the receiving clinician,
or specialist, may be needed in the future care of the patient, and
thus archiving this information may be extremely helpful in the
future. Further, having a record of what information was sent, what
was received, etc. may also prove to be helpful in the future,
especially with ongoing privacy concerns regarding what information
is made available to clinicians who are not authorized to have
access to patient identifying information. While in one embodiment
this collaboration information is archived to the patient's EMR, in
another embodiment, this information may be archived in a different
location, such as in a separate database that stores all of the
collaboration information for a particular hospital, medical
office, etc.
[0086] Turning now to FIG. 9, a flow diagram of a method 900 for
enabling an online medical collaboration is illustrated, in
accordance with an embodiment of the present invention. Initially,
an identification of a clinician(s) and a patient-focused clinical
data element is received from a requesting clinician at step 910.
As mentioned, the patient-focused clinical data element may be a
portion of the patient's EMR, and is retrieved and sent to the
online networking system to be shared with other clinicians. At
step 912, it is determined whether the receiving or identified
clinician is allowed access to the patient-identifying data that is
contained within the patient-focused clinical data element or other
patient information sent through the system. As mentioned, a
clinician may be allowed access to patient-identifying information
if the clinician is within a network of clinicians responsible for
treating the patient. This may include a clinician within the same
office as the requesting clinician or a clinician not associated
with the requesting clinician, but who currently treats the
patient. If it is determined that the clinician is allowed access
to the patient-identifying data, the patient-focused clinical data
element with patient-identifying data is shared with the identified
clinician at step 914. If the clinician, however, is not allowed
access to the patient-identifying data associated with the
particular patient, the patient-focused clinical data element is
de-identified at step 916 and the de-identified information is
shared with the clinician at step 918. As such, for a clinician who
is not treating the patient or who is not otherwise associated with
the medical care of the patient, this clinician would only receive
the patient's medical information with all patient-identifying data
having been removed.
[0087] Referring to FIG. 10, a flow diagram is shown of a method
1000 for enabling an online medical collaboration, in accordance
with an embodiment of the present invention. At step 1010, a
request is received that includes an identification of a clinician
who is allowed to access patient-identifying data. As such, this
clinician may be associated with the treatment of the patient, or
for some other reason is allowed to access the patient's
identifiable information. At step 1012, a patient-focused clinical
data element is received from the patient's EMR. In one embodiment,
more than one patient-focused clinical data element is received at
the online networking system. The requesting clinician, for
example, may need a second opinion or need assistance from a
specialist to determine the best treatment option for the patient,
and thus may send relevant patient information to the online
networking system so that another clinician can access the patient
information and assist in this determination. In one embodiment, if
the patient information is being sent to a clinician who also
treats the patient, the information may not need to be
de-identified prior to being accessed by the clinician. At step
1014, the request and the patient-focused clinical data element is
communicated to the clinician. In one embodiment, this information
is communicated by being posted on a website associated with the
online networking system so that the identified clinician(s) is
able to access the data and respond to the request.
* * * * *