U.S. patent application number 13/416908 was filed with the patent office on 2012-07-12 for knowledge based electronic clinical record for dentistry.
Invention is credited to Paul Rhodes.
Application Number | 20120179492 13/416908 |
Document ID | / |
Family ID | 40932533 |
Filed Date | 2012-07-12 |
United States Patent
Application |
20120179492 |
Kind Code |
A1 |
Rhodes; Paul |
July 12, 2012 |
KNOWLEDGE BASED ELECTRONIC CLINICAL RECORD FOR DENTISTRY
Abstract
The present invention relates to an electronic records
management system. More specifically, the present invention is a
comprehensive knowledge based clinical records management solution
that encompasses the need for accurate records, while reducing the
time and effort required to enter complete and accurate
information.
Inventors: |
Rhodes; Paul; (Oakland,
CA) |
Family ID: |
40932533 |
Appl. No.: |
13/416908 |
Filed: |
March 9, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12023084 |
Jan 31, 2008 |
8160899 |
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13416908 |
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Current U.S.
Class: |
705/3 |
Current CPC
Class: |
G16H 10/60 20180101;
G16H 40/63 20180101 |
Class at
Publication: |
705/3 |
International
Class: |
G06Q 50/24 20120101
G06Q050/24 |
Claims
1. A computer based patient records system for dental practices,
with the dental practices having a collection of general patient
information and a related collection of dental treatment
information, said dental patient records system comprising a
computer and non-transitory computer readable storage media storing
a plurality of non-transitory instructions for enabling operation
of said computer, said computer comprising: a processor accessing
the computer readable storage media, the computer readable storage
media storing a plurality of non-transitory instructions; said
plurality of instructions including: a. a first plurality of
instructions for execution by the computer to obtain a particular
patient record from a first collection of general patient
information; b. a second plurality of instructions for execution by
the computer to obtain dental treatment information from a second
collection of related dental examination and treatment data that
are specific to the particular patient; and c. a third plurality of
instructions for execution by the computer to display a plurality
of windows on a display of the computer, with a first window
displaying general patient information of the particular patient, a
second window displaying a dental chart, and a third window
displaying an editable window having at least one of dental
examination information and dental treatment information related to
the particular patient, said third window providing a item entry
module including a procedure selection plurality of instructions
for execution by the computer to specify a procedure and a rules
plurality of instructions for execution by the computer to limit
user item selection to a plurality of items based on the specified
procedure.
2. The system of claim 1 further including a sessions data storage
storing a plurality of session, entries comprising dental treatment
and dental examination information related to a particular patient
session, said sessions data storage being accessible to said
processor, each said session entry associated with a particular
patient from the first general patient information collection and
with data in the second collection, wherein the third plurality of
instructions populates information in the first, second, and third
windows based in part on the dental treatment and examination
information stored in a particular one of the session entries.
3. The system of claim 2 further including a session initiation
plurality of instructions stored on the computer readable storage
media, the session initiation instructions for execution by a
computer to allow a user to create a new session entry with the new
session entry inheriting data from the most recent session of a
particular patient.
4. The system of claim 2 wherein the sessions data storage is
configured to prevent editing of a session entry except for a
current session entry.
5. The system of claim 2 further including a form generation
plurality of instructions stored on the computer readable storage
media, the form generation instructions for execution by a computer
to allow a user selection of a form from a plurality of
category/sub-category forms for user selection relating to a
session entry.
6. The system of claim 5 wherein the form generation instructions
further enables user editing of the plurality of
category/sub-category forms.
7. The system of claim 5 wherein the form generation instructions
are for execution by a computer to provide multiple tab data entry
screens for a user.
8. The system of claim 5 wherein the plurality of
category/sub-category forms include categories including at least
one of: examinations, procedures, and surgeries.
9. The system of claim 5 wherein the form generation instructions
for execution by a computer to provide a user data entry screens
having at least one of: check boxes, pull-down selections, and free
text entry.
10. The system of claim 5 wherein the form generation instructions
for execution by a computer to allow user creation of documents
having text relating to data entered on a form.
11. The system of claim 10 wherein the form generation instructions
for execution by a computer to allow user creation of at least one
of a brief narrative text document, and a comprehensive narrative
text document.
12. The system of claim 1 wherein the third plurality of
instructions for execution by a computer to allow user editing of
information displayed in at least one of the first, second, and
third window.
13. The system of claim 1 wherein the second plurality of
instructions for execution by the computer to obtain prior
documents information from the second collection that are specific
to the particular patient, and the third plurality of instructions
for execution by the computer to display a separate window
displaying at least one of (a) prior documents related to the
particular patient; (b) patient alerts and modifiers information
related to the particular patient; (c) general health information
related to the particular patient; and (d) medication prescribed
information related to the particular patient.
14-17. (canceled)
18. A computer based patient records management system for dental
practices, with the dental practices having a collection of general
patient information and a related collection of periodontal
information, said dental patient records system comprising
non-transitory computer readable storage media storing a plurality
of non-transitory instructions for execution by a computer, said
computer comprising: a processor having access to the computer
readable media, the computer readable media storing a plurality of
non-transitory instructions; said plurality of non-transitory
instructions including: a. a first plurality of instructions for
execution by the computer to obtain a particular patient record
from the collection of general patient information; b. a second
plurality of instructions for execution by the computer to obtain
periodontal information from the related periodontal collection
that are specific to the particular patient; and c. a third
plurality of instructions for execution by the computer to display
periodontal information including at least one of dental
examination information and dental treatment information, related
to the particular patient as a plurality of alphanumeric data
associated with each tooth in a spreadsheet format adjacent to a
graphic display of each associated tooth.
19. The system of claim 18 wherein the third plurality of
instructions further enables the computer to display the
alphanumeric data in spreadsheet format around graphics of
individual teeth and implants.
20. The system of claim 18 wherein the third plurality of
instructions further enables the computer to display graphic
depictions of teeth corresponding to the spreadsheet entries.
21. The system of claim 20 wherein the third plurality of
instructions further enables the computer to display an overlay of
one of periodontal supporting bone and gingiva over the graphic
depictions of teeth.
22. The system of claim 20 wherein the third plurality of
instructions further enables the computer to display an overlay of
both periodontal supporting bone and gingiva over the graphic
depictions of teeth.
23. The system of claim 18 further comprising a fourth plurality of
instructions enabling the computer to allow the user to configure
the procedure for entry of periodontal information from one of a
circular entry procedure and a single tooth entry procedure.
24. The system of claim 23 wherein the single tooth entry procedure
involves one of entering a single value on a single tooth and
entering multiple values on a single tooth.
25. A computer based patient clinical records system for dental
practices, with the dental practices having a collection of general
patient information and a related collection of dental examination
and treatment information, said dental patient clinical records
system comprising a computer and non-transitory computer readable
storage media storing a plurality of non-transitory instructions
for execution by said computer, said computer comprising: a
processor accessing the computer readable storage media, the
computer readable storage media storing a plurality of
non-transitory instructions; said plurality of instructions
including: a. a first plurality of instructions for execution by
the computer to obtain a particular patient record from the
collection of general patient information; b. a second plurality of
instructions for execution by the computer to obtain dental
treatment information from the related dental examination and
treatment collection that are specific to the particular patient;
and c. a third plurality of instructions for execution by the
computer to display a plurality of windows on a display of the
computer, with a first window displaying general patient
information of the particular patient, a second window displaying a
dental chart, and a third window displaying a dental clinical
record, said dental clinical record being editable in said third
window including selection of a procedure and having at least two
of the following template entries selectively accessible according
to a selected procedure: examination information template entries,
treatment information template entries, radiographic information
template entries, laboratory information template entries,
anesthetic information template entries, all such template entries
related to the particular patient and selected procedure, said
template entries being selectively displayed in said third window
based on predetermined rules.
26. A computer based patient clinical records system for dental
practices, with the dental practices having a collection of general
patient information and a related collection of dental examination
and treatment information, said dental patient clinical records
system comprising a computer and non-transitory computer readable
storage media storing a plurality of non-transitory instructions
for execution by said computer, said computer comprising: a
processor accessing the computer readable storage media, the
computer readable storage media storing a plurality of
non-transitory instructions; said plurality of instructions
including: a. a first plurality of instructions for execution by
the computer to obtain a particular patient record from a first
collection of general patient information; b. a second plurality of
instructions for execution by the computer to obtain information
from a second collection of related dental examination and
treatment data that are specific to the particular patient; and c.
a third plurality of instructions for execution by the computer to
display a plurality of windows on a display of the computer, with a
first window displaying general patient information of the
particular patient, a second window displaying a dental chart, and
a third window displaying an editable window having at least one of
dental examination information and dental treatment information
related to the particular patient, said third window having at
least one editable field restricting user item selection to a
predetermined glossary of items dependent on predetermined rules
and the said at least one of dental examination information and
dental treatment information related to a particular patient.
Description
BACKGROUND OF THE INVENTION
[0001] 1. Field of the Invention
[0002] The present invention relates to an electronic records
management system. More specifically, the invention relates to
electronic records management systems generally in the field of
medical records, and has aspects that specifically relate to dental
medical records.
[0003] 2. Description of the Related Art
[0004] The World Health Organization defines Dentistry as `the
science and art of preventing, diagnosing and treating diseases,
injuries and malformations of the teeth, jaws and mouth.` Problems
with teeth and gums have troubled humans for thousands of years.
Ancient Egyptian medical texts, dating back to 3500 BC, refer to
toothaches. Hesi-Re, an Egyptian who lived around 3000 BC, is the
earliest dentist known by name. Organized dentistry began when the
world's first dental school, the Baltimore College of Dental
Surgery, opened in Baltimore, Md. in 1840.
[0005] The first business computer was used for the first time in
1951 to take the United States census. By 1962, there were over
40,000 business computers in the United States. In just one more
year, that number doubled. Since that time businesses have utilized
computers in a variety of ways. One major computer use for many
businesses is records management. Obviously, keeping complete and
accurate records and maintaining them securely is vital to all
medical professionals. Over 160 dental practices lost all of their
physical patient records as a result of Hurricane Katrina. This
loss could have been prevented by offsite secure storage of
electronic copies of records. Electronic records management has
eclipsed physical records management as the preferred option for
most practitioners. Ever-evolving compliance regulations and
statutes have also increased interest in electronic records
management systems among businesses including dental practices.
Dental practitioners constantly strive to make their offices more
efficient, saving time, effort and money. Having a comprehensive
electronic system in place where copious patient records can be
maintained and easily accessed makes the practice run more
efficiently and helps provide patients the best possible care.
[0006] According to the American Dental Association (ADA), the
primary professional organization of dentists, there are more than
175,000 licensed dentists practicing in the United States today.
Nine out of ten are in private practice. Making accurate and
complete record entries is a crucial area of professional
responsibility. A record entry must be made for every patient
interaction that occurs, from a missed appointment to a final
cementation and including all relevant data regarding each
patient's treatment. Dental practitioners are constantly striving
for ways to achieve higher quality, more efficient communication,
reduced administrative time and costs, and to reduce the burden of
keeping up with patient charts, dictation and correspondence. Many
dentists are converting to digital recordkeeping in their quest to
save time, paper and money while maintaining accuracy.
[0007] There are many important reasons for keeping thorough,
accurate records. First, it helps facilitate better patient care.
Referring to descriptions of prior patient care helps the dentist
evaluate the effectiveness of care. Second, a patient may be
treated in several different clinics. To ensure the smooth
transition of a patient from clinic to clinic, information must be
easily transmittable. The patient record is often the sole source
of vital facts concerning patient treatment status. Third, the
patient record is the mechanism by which insurance claims are
filled out, itemized statements prepared, and charges are reviewed
for accuracy. In order to determine charges accurately, the details
of each procedure must be well documented. Fourth, the efficient
use of the time of all involved in patient care is yet another
important reason for making complete and legible record
entries.
[0008] Previous versions of the records management system detailed
below reduced the effort required in creating patient charts by
utilizing a glossary of medical and/or dental specific terms,
organized in an expandable/collapsible hierarchical tree. The user
could select a term or branch node, with each branch node being
expandable to reveal further terms or nodes for selection. The user
could then select a desired term without further data entry. While
this hierarchical structure provided benefits for the dental
practitioner, the inventor of this system continued development of
the system to further enhance the interaction with the dental
practitioner.
SUMMARY OF THE INVENTION
[0009] The present invention is a clinical records management
system that encompasses the need for comprehensive, accurate
records, while reducing the time and effort required to record
complete and accurate information. While the application uses
terminology common to dentistry, the organization of terminology
into procedure specific digital forms is unique and constitutes a
domain specific knowledge base. This organization constitutes
algorithms which are also domain specific knowledge. Additionally,
making selections from these forms and having the application
automatically generate from that the notes which constitute the
clinical patient records The present invention employs a
configurable computer graphical user interfaces (GUI) to effectuate
an efficient and smooth flow of data entry which can then be viewed
in various ways or converted into a variety of documents for
sharing patient clinical information with other treating healthcare
providers. Additionally, the application knowledge base includes a
variety of documents to aid in communications with patients:
procedure specific informed consents, procedure specific
pre-operative and post-operative patient instructions and
instructions for taking specific medications including descriptions
of possible side effects, warnings and risks. There are at least
four different aspects of the present invention and each is
discussed in detail below in relation to embodiments of the
invention.
[0010] One aspect of the present invention is the Main User
Interface (UI). The Main UI consists of eight interrelated,
editable areas. The Main UI's opening view consists of a thumbnail
view of several categories of data, along with a patient identifier
data area and a list of prior sessions (entries) area. The
thumbnail views are `window-panes` each of which can be expanded to
fill the entire main window so associated data can be more easily
viewed and/or edited. The categories may include a dental chart
area, planned treatment area, a list of prior documents generated
area, a list of patient alerts & modifiers area, a summary of
the patient's general health area and a medications prescribed
area. These categories of information to be viewed in this opening
UI may be configured by the end-user.
[0011] Another aspect of the present invention relates to Procedure
Specific Forms which provide the user with the ability to create
chart entries by selecting items from a form instead of typing.
These forms are present in several embodiments of the invention.
The user makes selections from checkboxes, dropdown lists and
multiple choice lists resulting in a compound template made up of
the specific selected items. The application then filters the
entire procedure-specific form for those items selected by the user
and creates a document describing what occurred during a particular
patient session. This component allows the user to easily generate
readable output based on user selections that is then copied to a
separate word processing program and converted into an outline
formatted document, thus reducing the number of keystrokes (and
mouse clicks) necessary to create the desired output.
[0012] A further aspect of the present invention is the mechanism
for building `Procedure Specific Template/Forms. `Template/Forms`
are electronic (digital) `forms` that contain multiple Data Fields
specific to a particular procedure or patient-related event. Using
a domain specific knowledge base, a user can create these
electronic forms each of which contains all areas of information
pertinent to the procedure being described as well as all of the
possible iterations for each of the steps in the procedure. These
complex forms are sub-divided into sections by `Tabs` (pages).
Selection is made by either checking items associated with
Checkboxes, DropDown List boxes or Multiple Choice List boxes, as
well as a variety of custom controls.
[0013] Another aspect of the present invention relates to the
Anesthesia Record. The standard of care for patients receiving
conscious sedation, deep sedation or general anesthesia in a dental
environment calls for the documentation of drugs, gases and other
agents administered as well as the patient's vital signs and oxygen
saturation during anesthesia. While local anesthesia is the most
common form of pain control used by general dentists, sedation,
analgesia and general anesthesia are taught in most dental
specialty residencies and are regularly used by dental specialists
in practice. Therefore, an anesthesia record is a significant
component of an electronic dental patient record. The anesthesia
record in this application is unique in that it contains areas of
information not included in other dental EMR's: pre-anesthesia
physical evaluation, validation of equipment operation and supplies
of gases, a description of the method of administration, the airway
management, the agents administered, the vital signs and the
pre-discharge status of the patient. All of these elements are
important to assuring a safe and conservative anesthesia experience
for the patient. Furthermore, the depth of documentation affords
the practitioner of better risk management. Additionally, the entry
of vital signs (blood pressure, pulse, oxygen saturation of the
blood) may be automatically recorded directly from monitoring
devices thus eliminating errors in entry.
[0014] Another aspect of the present invention relates to a unique
set of data and display (UI) known as the `PerioProfile.` This UI
allows for the collection and display of more elements of data
relevant to the extent of disease as well as evidence of current
disease (inflammatory) activity. In addition to the data values
collected and included on a traditional periodontal chart, the
PerioProfile can collect and simultaneously display data on signs
of inflammatory activity by calculating and displaying indices for
`Bleeding` and `Exudate` activity; collect and display data on a
patient's plaque control effectiveness (a `Plaque Score`), and
other strategic items of dental and periodontal morphologic data
pertinent to periodontal evaluation. Alphanumeric data is displayed
in a `spreadsheet` format so that data for a specific site can be
readily reviewed by scanning down a vertical column. Additionally,
this same data is displayed graphically around graphics of
individual teeth and implants and can include an overlay of
periodontal supporting bone and gingiva to show the relationship
between data items and these anatomic structures. This display of
graphical periodontal data can be viewed with overlays of
supporting bone and or gingiva. This comprehensive spreadsheet and
graphical view of periodontal data including relationships with
alveolar bone and gingiva is a unique design feature of this
application.
BRIEF DESCRIPTION OF THE DRAWINGS
[0015] The above mentioned and other features and objects of this
invention, and the manner of attaining them, will become more
apparent and the invention itself will be better understood by
reference to the following description of an embodiment of the
invention taken in conjunction with the accompanying drawings,
wherein:
[0016] FIG. 1 is a schematic diagrammatic view of the clinical
records management system according to one embodiment of the
present invention.
[0017] FIG. 2 is a screenshot view of the main graphical user
interface of one embodiment of the present invention.
[0018] FIG. 3 is a screenshot window pane view of the Patient
Identifier and Sessions areas of FIG. 2.
[0019] FIG. 4 is a screenshot window pane view of the Dental Chart
area of FIG. 2.
[0020] FIG. 5 is a screenshot window pane view of the Planned
Treatment area of FIG. 2.
[0021] FIG. 6 is a screenshot window pane view of the Alerts &
Modifiers area of FIG. 2.
[0022] FIGS. 7A and 7B are screenshot window pane views of the
General Health Summary area of FIG. 2.
[0023] FIG. 8 is a screenshot window pane view of the Prescribed
Medications area of FIG. 2
[0024] FIGS. 9A-9D are screenshot window pane views of the
Anesthesia Record page according to another embodiment of the
present invention.
[0025] FIG. 10 is a screenshot view of the Vital Signs page
relating to the Anesthesia Record page of FIG. 9.
[0026] FIG. 11 is a schematic diagram of the knowledge base feature
in one embodiment of the present invention.
[0027] FIGS. 12A-12D are screenshot views of a periodontal charting
spreadsheet screen relating to the Dental Chart of FIG. 4.
[0028] FIGS. 13A and 13B are screenshot views of a periodontal
charting input and display relating to the Dental Chart of FIG. 4
according to one embodiment of the present invention.
[0029] FIG. 14 is a schematic relational diagram of the session
entries of FIG. 3.
[0030] FIG. 15 is a screenshot view of a Connective Tissue Graph
session window according to one embodiment of the present
invention.
[0031] FIG. 16 is a screenshot view of a Dentoalveolar Examination
window pane according to one embodiment of the present
invention.
[0032] FIG. 17 is a plan view of a Reconstructive Implant,
Periodontal and Orofacial Surgery bullet point report letter
generated by one embodiment of the present invention.
[0033] Corresponding reference characters indicate corresponding
parts throughout the several views. Although the drawings represent
embodiments of the present invention, the drawings are not
necessarily to scale and certain features may be exaggerated in
order to better illustrate and explain the present invention. The
exemplification set out herein illustrates an embodiment of the
invention, in one form, and such exemplifications are not to be
construed as limiting the scope of the invention in any manner.
DESCRIPTION OF EMBODIMENTS OF THE PRESENT INVENTION
[0034] The embodiment disclosed below is not intended to be
exhaustive or limit the invention to the precise form disclosed in
the following detailed description. Rather, the embodiment is
chosen and described so that others skilled in the art may utilize
its teachings.
[0035] The detailed descriptions which follow are presented in part
in terms of algorithms and symbolic representations of operations
on data bits within a computer memory representing alphanumeric
characters or other information. These descriptions and
representations are the means used by those skilled in the art of
data processing arts to most effectively convey the substance of
their work to others skilled in the art.
[0036] An algorithm is here, and generally, conceived to be a
self-consistent sequence of steps leading to a desired result.
These steps are those requiring physical manipulations of physical
quantities. Usually, though not necessarily, these quantities take
the form of electrical or magnetic signals capable of being stored,
transferred, combined, compared, and otherwise manipulated. It
proves convenient at times, principally for reasons of common
usage, to refer to these signals as bits, values, symbols,
characters, display data, terms, numbers, or the like. It should be
borne in mind, however, that all of these and similar terms are to
be associated with the appropriate physical quantities and are
merely used here as convenient labels applied to these
quantities.
[0037] Some algorithms may use data structures for both inputting
information and producing the desired result. Data structures
greatly facilitate data management by data processing systems, and
are not accessible except through sophisticated software systems.
Data structures are not the information content of a memory; rather
they represent specific electronic structural elements which impart
a physical organization on the information stored in memory. More
than mere abstraction, the data structures are specific electrical
or magnetic structural elements in memory which simultaneously
represent complex data accurately and provide increased efficiency
in computer operation.
[0038] Further, the manipulations performed arc often referred to
in terms, such as comparing or adding, commonly associated with
mental operations performed by a human operator. No such capability
of a human operator is necessary, or desirable in most cases, in
any of the operations described herein which form part of the
present invention; the operations are machine operations. Useful
machines for performing the operations of the present invention
include general-purpose digital computers or other similar devices.
In all cases the distinction between the method operations in
operating a computer and the method of computation itself should be
recognized. The present invention relates to a method and apparatus
for operating a computer in processing electrical or other (e.g.,
mechanical, chemical) physical signals to generate other desired
physical signals.
[0039] The present invention also relates to an apparatus for
performing these operations. This apparatus may be specifically
constructed for the required purposes or it may comprise a
general-purpose computer as selectively activated or reconfigured
by a computer program stored in the computer. The algorithms
presented herein are not inherently related to any particular
computer or other apparatus. In particular, various general-purpose
machines may be used with programs written in accordance with the
teachings herein, or it may prove more convenient to construct more
specialized apparatus to perform the required method steps. The
required structure for a variety of these machines will appear from
the description below.
[0040] The present invention deals with `object-oriented` software,
and particularly with an `object-oriented` operating system. The
`object-oriented` software is organized into `objects`, each
comprising a block of computer instructions describing various
procedures (`methods`) to be performed in response to `messages`
sent to the object or `events` which occur with the object. Such
operations include, for example, the manipulation of variables, the
activation of an object by an external event, and the transmission
of one or more messages to other objects.
[0041] Messages are sent and received between objects having
certain functions and knowledge to carry out processes. Messages
are generated in response to user instructions, for example, by a
user activating an icon with a `mouse` pointer generating an event.
Also, messages may be generated by an object in response to the
receipt of a message. When one of the objects receives a message,
the object carries out an operation (a message procedure)
corresponding to the message and, if necessary, returns a result of
the operation. Each object has a region where internal states
(instance variables) of the object itself are stored and where the
other objects are not allowed to access. One feature of the
object-oriented system is inheritance. For example, an object for
drawing a `circle` on a display may inherit functions and knowledge
from another object for drawing a `shape` on a display.
[0042] A programmer `programs` in an object-oriented programming
language by writing individual blocks of code each of which creates
an object by defining its methods. A collection of such objects
adapted to communicate with one another by means of messages
comprises an object-oriented program. Object-oriented computer
programming facilitates the modeling of interactive systems in that
each component of the system can be modeled with an object, the
behavior of each component being simulated by the methods of its
corresponding object, and the interactions between components being
simulated by messages transmitted between objects. Objects may also
be invoked recursively, allowing for multiple applications of an
objects methods until a condition is satisfied. Such recursive
techniques may be the most efficient way to programmatically
achieve a desired result.
[0043] An operator may stimulate a collection of interrelated
objects comprising an object-oriented program by sending a message
to one of the objects. The receipt of the message may cause the
object to respond by carrying out predetermined functions which may
include sending additional messages to one or more other objects.
The other objects may in turn carry out additional functions in
response to the messages they receive, including sending still more
messages. In this manner, sequences of message and response may
continue indefinitely or may come to an end when all messages have
been responded to and no new messages are being sent. When modeling
systems utilizing an object-oriented language, a programmer need
only think in terms of how each component of a modeled system
responds to a stimulus and not in terms of the sequence of
operations to be performed in response to some stimulus. Such
sequence of operations naturally flows out of the interactions
between the objects in response to the stimulus and need not be
preordained by the programmer.
[0044] Although object-oriented programming makes simulation of
systems of interrelated components more intuitive, the operation of
an object-oriented program is often difficult to understand because
the sequence of operations carried out by an object-oriented
program is usually not immediately apparent from a software listing
as in the case for sequentially organized programs. Nor is it easy
to determine how an object-oriented program works through
observation of the readily apparent manifestations of its
operation. Most of the operations carried out by a computer in
response to a program are `invisible` to an observer since only a
relatively few steps in a program typically produce an observable
computer output.
[0045] In the following description, several terms which are used
frequently have specialized meanings in the present context. The
term `object` relates to a set of computer instructions and
associated data which can be activated directly or indirectly by
the user. The terms `windowing environment`, `running in windows`,
and `object oriented operating system` are used to denote a
computer user interface in which information is manipulated and
displayed on a video display such as within bounded regions on a
raster scanned video display. The terms `network`, `local area
network`, `LAN`, `wide area network`, or `WAN` mean two or more
computers which are connected in such a manner that messages may be
transmitted between the computers. In such computer networks,
typically one or more computers operate as a `server`, a computer
with large storage devices such as hard disk drives and
communication hardware to operate peripheral devices such as
printers or modems. Other computers, termed `workstations`, provide
a user interface so that users of computer networks can access the
network resources, such as shared data files, common peripheral
devices, and inter-workstation communication. The computers have at
least one processor for executing machine instructions, and memory
for storing instructions and other information. Many combinations
of processing circuitry and information storing equipment are known
by those of ordinary skill in these arts. A processor may be a
microprocessor, a digital signal processor (`DSP`), a central
processing unit (`CPU`), or other circuit or equivalent capable of
interpreting instructions or performing logical actions on
information. Memory includes both volatile and non-volatile memory,
including temporary and cache, in electronic, magnetic, optical,
printed, or other format used to store information. Users activate
computer programs or network resources to create `processes` which
include both the general operation of the computer program along
with specific operating characteristics determined by input
variables and its environment.
[0046] The terms `desktop`, `personal desktop facility`, and `PDF`
mean a specific user interface which presents a menu or display of
objects with associated settings for the user associated with the
desktop, personal desktop facility, or PDF. When the PDF accesses a
network resource, which typically requires an application program
to execute on the remote server, the PDF calls an Application
Program Interface, or `API`, to allow the user to provide commands
to the network resource and observe any output. The term `Browser`
refers to a program which is not necessarily apparent to the user,
but which is responsible for transmitting messages between the PDF
and the network server and for displaying and interacting with the
network user. Browsers are designed to utilize a communications
protocol for transmission of text and graphic information over a
worldwide network of computers, namely the `World Wide Web` or
simply the `Web`. Examples of Browsers compatible with the present
invention include the Internet
[0047] Explorer program sold by Microsoft Corporation (Internet
Explorer is a trademark of Microsoft Corporation), the Opera
Browser program created by Opera Software ASA, or the Firefox
browser program distributed by the Mozilla Foundation (Firefox is a
registered trademark of the Mozilla Foundation). Although the
following description details such operations in terms of a graphic
user interface of a Browser, the present invention may be practiced
with text based interfaces, or even with voice or visually
activated interfaces, that have many of the functions of a graphic
based Browser.
[0048] Browsers display information which is formatted in a
Standard Generalized Markup Language (`SGML`) or a HyperText Markup
Language (`HTML`), both being scripting languages which embed
non-visual codes in a text document through the use of special
ASCII text codes. Files in these formats may be easily transmitted
across computer networks using a hypertext transfer protocol
(`HTTP`) or a secure HTTP (`SHTTP`), including global information
networks like the Internet, and allow the Browsers to display text,
images, and play audio and video recordings. The Web utilizes these
data file formats to conjunction with its communication protocol to
transmit such information between servers and workstations.
Browsers may also be programmed to display information provided in
an eXtensible Markup Language (AMU) file, with XML files being
capable of use with several Document Type Definitions (`DTD`) and
thus more general in nature than SGML or HTML. The XML file may be
analogized to an object, as the data and the stylesheet formatting
are separately contained (formatting may be thought of as methods
of displaying information, thus an XML file has data and an
associated method).
[0049] The terms `personal digital assistant` or `PDA`, as defined
above, means any handheld, mobile device that combines computing,
telephone, fax, e-mail and networking features. The terms `wireless
wide area network` or `W WAN` mean a wireless network that serves
as the medium for the transmission of data between a handheld
device and a computer. The term `synchronization` means the
exchanging of information between a handheld device and a desktop
computer either via wires or wirelessly. Synchronization ensures
that the data on both the handheld device and the desktop computer
are identical.
[0050] In wireless wide area networks, communication primarily
occurs through the transmission of radio signals over analog,
digital cellular, or personal communications service (`PCS`)
networks. Signals may also be transmitted through microwaves and
other electromagnetic waves. At the present time, most wireless
data communication takes place across cellular systems using second
generation technology such as code-division multiple access
(`CDMA`), time division multiple access (`TDMA`), the Global System
for Mobile Communications (`GSM`), personal digital cellular
(`PDC`), or through packet-data technology over analog systems such
as cellular digital packet data (CDPD`) used on the Advance Mobile
Phone Service (`AMPS`).
[0051] The terms `wireless application protocol` or `WAP` mean a
universal specification to facilitate the delivery and presentation
of web-based data on handheld and mobile devices with small user
interfaces.
[0052] The term `Session` means a specific patient related
encounter. Some sessions will be related to a patient visit to the
dentist's office. Others sessions will be to document something
else related to the patient (for example, phoned in a prescription,
phone call to the patient, documents mailed to the patient,
etc.).
[0053] The term `Procedure` relates to a specific patient related
event such as a Periodontal Exam or an Implant Surgery. A procedure
is based on a `Type` and a `Sub-specialty.`
[0054] The term `Type` means the type of process being performed
and documented during a particular patient session. For example,
Exam, Treatment, Progress, Outcomes, etc.
[0055] The term `Template` means an electronic (digital) `form`
which contains multiple Data Fields specific to a particular
procedure or process. Templates are based on a specific combination
of a `Type` and a `Sub-specialty.` A Template may be an editable
document having certain information already present and predefined
sections for data entry, or may be a rule based document generator
as described in more detail below.
[0056] The terms `Record` and `Chart` relate to a patient's
clinical documentation (i.e., the clinical record or the clinical
chart).
[0057] The present invention generally involves a knowledge based
clinical records management solution which employs a configurable
computer graphical user interface (GUI) to effectuate an efficient
and smooth flow of data from the end-user to the clinical records.
The embodiments of the present invention provide for the creation,
management, use and sharing of clinical patient information in a
dental practice, although many aspects of the present invention are
applicable in the general medical field. There are at least four
aspects of the present invention and each is discussed in detail
below in discussions of the associated embodiments of the
invention. FIG. 1 depicts a schematic representation of clinical
records management system 102. Main User Interface (UI) 104 is
capable of obtaining and displaying patient-related from a
plurality of databases. Main UI also accesses non-patient related
data that is needed to operate a Dental Office. Dental Office
Systems 130 may include Billing 132, Scheduling 134 and other
systems 136 that may be used in the office of a dental practice.
Records Management System 102 includes Main UI 104 which reads and
updates patient data in Dental Specific database 120, General
Patient database 122 and Anesthesia Record database 124. User input
is facilitated and made easier using Knowledge Base 108, discussed
in detail below. Records Management System 102 may be implemented
as a stand alone program, including all the programming necessary
to interact with databases 120, 122, and 124. Alternatively,
Records Management System 102 may interact with existing database
programs that manage databases 120, 122, and 124.
[0058] One embodiment of the present invention includes Main UI 104
which is depicted in FIG. 2. Main UI 104 is divided into vertical
columns on the computer screen which includes, in this exemplary
embodiment, an upper box in the left most column having patient ID
information. Below that is a window pane which has a list of
sessions for the patient, as sessions are described in greater
detail with regards to FIGS. 3 and 14. To the right of this is the
`Main Window` for the application. These thumbnail views are
`window-panes,` each of which can be expanded to fill the entire
main window so that they can be more easily viewed or read. The
Main UI, in this exemplary embodiment, consists of eight areas. The
exact number of areas, and the selection and arrangement of such
areas, may be modified for accommodating various desired data
displays and/or hardware configurations of the displaying device.
For example, additional data viewing may be provided depending on
the amount and character of patient data maintained by records
management system 102. Alternatively, the shape and size of the
areas may be adapted to smaller screens generally available on
hand-held devices or to larger display screen than conventionally
used in a dental practitioner's office.
[0059] Patient identifier area 1 comprises, in the exemplary
embodiment, patient-related data as depicted more particularly in
FIG. 3. The data may include, but is not limited to, full legal
name, address, other contact information (e.g., phone, mobile
phone, instant messaging, e-mail), date of birth, age in years,
primary health care provider (dentist and/or doctor), social
security number (SSN), health insurance information (policy issuer
and policy number), name of the patient's primary care dentist, and
a photo or portrait of the patient. For Health Insurance
Portability and Accountability Act (HIPAA) compliance, the SSN is
not readily viewable on the screen and only displays in a `popup`
when the mouse `hovers` over the `SSN` icon. The exact information
displayed may be configured by the user for personal or office
preferences and procedures.
[0060] Shown in FIG. 2, Sessions List area 2 includes a list of
prior data entries relating to treatment sessions of the patient
prior to any current windows. FIG. 3 shows this in greater detail,
with the lower portion of the window pane as including a list of
sessions. Each session is a collection of information about a
particular patient visit. The selection of a particular session
results in the population of the other window panes of Main UI 104.
This allows the practitioner/user to view in one screen a summary
of the relevant patient data available electronically, and the
practitioner/user may drill down any of the other window panes (as
described in greater detail below) to obtain the full data from any
of these summaries. Further, the practitioner/user may initiate a
new session. When a new session is initiated, the data record or
object associated with the new session inherits the information
from the immediately prior session, allowing the practitioner/user
to avoid having to enter duplicative data, so that only the entry
of new data and/or the deletion of old data is required. In the
exemplary embodiment, only session information in the current
session may be edited and prior session information is available in
read-only mode. However, it is possible to configure the software
to provide permission based editing features, so that a user and/or
super-user may be able to modify certain prior session data.
[0061] Dental Chart area 3, shown in FIG. 2 and particularly in
FIG. 4, includes an occlusal view of the teeth in the upper
(maxillary) and lower (mandibular) arches (jaws). Occlusal relates
to the grinding or biting surface of a tooth. Dental chart area 3
makes use of color-coding to depict missing teeth, the presence of
crowns, implants and other dental treatments. Dental Chart area 3
gives the end-user a quick, yet informative way of viewing the
patient's teeth. In addition, more detailed periodontal charting
may be invoked from this area 3 as described in greater detail
below in the discussion of FIGS. 12 and 13.
[0062] Treatment Planned area 4, depicted in FIG. 2 and
particularly in FIG. 4, lists treatments that are planned for the
patient and may make use of color-coding to show which treatments
had been carried out and which treatments still need to be carried
out. Color-coding allows the data to be presented in a way that
allows the end-user an easy way to quickly determine what planned
treatments have been carried out and which are still needed.
Billing codes and descriptions of all parts of the treatment plan
that are billable items are passed to Dental Office Systems 130.
This eliminates duplicate entries and the possibility of
errors.
[0063] Depicted in FIG. 2, Treatment area 5 includes a list of
prior patient encounters that had been documented in the patient's
clinical record (treatments and other patient interaction events
relevant to a treatment plan). The display, in this exemplary
embodiment, is by date of the treatment. Double-clicking on any
treatment date brings up the details of that treatment in either of
the following ways: (a) the narrative notes as displayed below in
section; or (b) the form used to enter notes allowing modification
of the notes. The display, in another embodiment, may be by date
and title of the treatment.
[0064] Alerts & Modifiers area 6 of FIG. 2 is shown more
particularly in FIG. 6. A&M area 6 includes listings of the
current significant risk factors or modifiers that had been added
to the patient's record that should be `flagged` and brought to the
practitioner's attention because they were associated with
highlighted risk or required specific needs when examining or
treating the patient. The contents of A&M 6 display recently
updated listings and the contents of this category arc
automatically copied forward from the prior session as soon as a
new session is created. This helps provide the best patient care by
ensuring the practitioner does not miss any significant risk
factors or modifiers.
[0065] General Health Summary area 7 of FIG. 2 is depicted in
particularity in FIGS. 7A and 7B. General Health Summary area 7 of
FIG. 7A includes current health status of the patient including
terms entered from the glossary (long-term medical conditions which
are still of significant concern, allergies, medications, etc.).
General Health Summary area 7 displays updated listings and
contents that may be automatically copied forward from the prior
session as soon as a new session is created. Current medications
prescribed by others (medical doctors, etc.) are also shown in
General Health Summary area 7. When expanded, as depicted in FIG.
7B, the full General Health Summary is available for review and
editing. In this exemplary embodiment, tabs are provided for the
following items: Current Medications, Allergies, Vital Signs, Drug
Idiosyncrasies, Medical History, Personal-Social Conditions or
Habits, A.S.A. Classification.
[0066] Medications Prescribed area 8 of FIG. 2 is depicted in
particularity in FIG. 8. Medications Prescribed area 8, as
particularly shown in FIG. 8, lists medications (prescribed and
over-the-counter) that may have been prescribed for the patient by
anyone in the end-user's practice. Medications Prescribed area 8
includes a listing of prescribed items which are, in the exemplary
embodiment, sorted by date. Each item is a summary of an underlying
prescription record, which by the practitioner/user activating an
item a more detailed record associated with the particular
prescription.
[0067] Records Management System 102 thus includes a database
comprised of a collection of chart entries representing the
patient's clinical dental health history record. These records may
be organized into rows and columns referencing the totality of the
patient clinical dental health history. Chart entries are collected
into charts. Each chart may represent a particular aspect of a
session between the patient and the practitioner.
[0068] Yet another novel aspect of this invention is the concept of
a chart view configuration. Chart views define the patient chart
content and organization used for viewing or printing. These
include specialized reports, letters, presentations, and
statistical graphs. Chart views are pre-defined by a knowledge base
for immediate use by a practitioner, and are fully configurable for
customization if desired. Chart views may be used to define
specific data elements of the patient chart (columns), filter for
specific data (queries), and organize data into groups, order data
(sort), and dynamically format data (fonts/color/style). Any
combination of information may be obtained using configurable chart
views. Configuring each Patient Chart is optional, and the
practitioner or administrator may specify certain default views for
general use.
[0069] The specific types of chart view configurations are
provided, in the exemplary embodiment, as Chart Filter(s), Chart
Graph(s) or Chart Report(s). Chart Filters allow the user to
quickly find specific chart entries by selecting a term from a
listing of categories or sub-categories, and then activating the
chart filter (view) mode. This feature adds the ability to filter
the patient charts on multiple category terms at the same time as
well as applying chart views to better organize the result
presentation.
[0070] Chart Graphs supports the ability to view patient chart
information in many different graphical formats. The user may
combine Chart Filters with Chart Graphs to produce trend
information on just about anything related to the patient chart
records.
[0071] Chart Reports are based on similar principles as Chart
Filters. Any patient chart information may be sent to a local
printer for report generation using all of the same configuration
features offered by chart views. A difference between a chart view
and a chart report is that grouped terms are organized as blocks
and sub-blocks in the report output. Additionally, any application
display may be sent to the local printer using the built-in web
browser print function.
[0072] The view configuration provides dynamic formatting to a
particular view (i.e. Chart Filter, Chart Graph, Chart Report). For
example a particular view may highlight terms that are more
important than other terms such as medical alerts or a particular
treatment plan as differentiated from the actual treatment
provided. This is called dynamic formatting because each column or
data item is evaluated against specific configuration criteria and
configuration formatting styles are applied to the data as it is
displayed in a current view. The formatting styles include font,
coloration, and other types of text and graphics formatting. In
this way the practitioner or administrator of this invention can
customize how the Patient Chart is displayed according to his/her
own preferences. Dynamic value based formatting configurations can
be defined for each patient view listing rows or graphics for
patient clinical chart history with value based formatting
styles.
[0073] The view configuration is used to present information
according to view configuration rules for (Reports, Graphic Charts,
and Letters), and takes the dynamic information returned from the
view configuration and inputs into the predefined presentations. In
the exemplary embodiment, standard `views` are defined in the
initial setup. The practitioner/user, however, can add new `views`
to sort and view the data from the Patient Chart(s) as s/he finds
most useful. Such views may be configured for different viewing
devices, so that hand-held devices such as PDA and/or telephones
(either cellular, radio, or VoIP) may receive, display, and receive
input on such views. Thus, a practitioner's office may be
configured to provide such views on multiple types of devices,
adapting to the style and parameters of the individuals in the
office. Thus, a practitioner might in one circumstance view and
edit a patient record in the middle of an examination or procedure
using such a hand-held device. In other circumstances, a
practitioner may use a full computer and display to examine, make
notes, and plan further procedures remotely from the patient.
[0074] Another aspect of the present invention relates to a Dental
(or Medical) Smart Procedure-Specific Forms Generator. In the
exemplary embodiment, this component involves a rules-based dental
record entry system in which the current context provides a
specific template form associated with a selected category or
sub-category. The selected template form is used to fill in data
fields relating to the patient and to guide the creation of forms
narratives. After starting a new session, a dialog box is displayed
with choices of Specialty Type (`Type`) and Sub-Category Type
(`Sub-Category`) and depending on the Sub-category Type selected,
it may include another choice: `Procedures`. `Procedures` is
selected from a dropdown list that would be specific to the
selected `Sub-category.` Appendix A provides a sample of dropdown
lists containing dental-specific terms for Types, Sub-Categories
and Procedures.
[0075] The end-user is able to make multiple selections from Type
`Specialty`, Sub-category `Type` and Procedure lists resulting in a
compound template made up of the specific items that had been
selected but always in the order of Types, Sub-categories, and then
Procedures. The Smart Form Generator filters the entire glossary
and displays only those items that pertain to the specific tasks
being performed and documented during a particular session. Each
general type of form (Examination, Non-surgical care, Surgical
care) provides a default set of tabs for individual pages relating
to information relevant for the overall form. For example, in the
exemplary embodiment the Examination includes at least the
following tabs: Chief Complaint, History, Health Summary, Clinical
Findings, Radiographic & Lab Findings, Diagnoses, and Treatment
Plan. As another example, the exemplary embodiment of the
Non-surgical care form includes at least the following tabs: Chief
Complaint, POH (personal oral hygiene), Clinical Findings,
Radiographic Findings, Treatment (performed), Intra-op Findings,
Local Anesthetic, Further Needs. The exemplary embodiment of the
Surgical care form includes at least the following tabs: Pre-op
(including Indications and Goals of the Procedure), Procedure
(description), lntra-op Findings, Suturing & Coverage, Local
Anesthetic, Pre-discharge Summary, and Analgesia. The
practitioner/user may select from a brief form (standard data
entry), comprehensive form (enhanced standard data entry), and a
customized form (specific user defined selection of possible data
entry). Presenting the specific terms on each page in something
similar to a paper-based form only requires mouse clicking on check
boxes, selecting a single item from a dropdown list or selecting
multiple items from an options list. Unusual comments arc typed
into a text field.
[0076] One example present in FIG. 15 and Appendix A involves a
scenario in which Surgical care is selected as the category of the
form, and-Periodontal is then selected as the Sub-Category. A list
of Procedures for the selected Type/Sub-Category is then displayed.
For example, `Connective Tissue Graft` may be selected to lead the
user to the template shown in FIG. 15 and Appendix B. In
particular, FIG. 15 depicts the particular screen displayed to the
practitioner/user when the tab "Site Prep Harvest & Placement"
is activated. Template forms are discussed below in relation to a
third component of an embodiment of the present invention.
[0077] A further aspect of the present invention involves an Input
Mechanism for Building Session Content from `Templates/Forms.`
After selecting a Type/Sub-Category/Procedure combination, a
particular Template is displayed for the user. `Templates` are
electronic forms that contain multiple data fields specific to a
particular procedure or process, typically in a screen having
multiple tabs and data entry locations. They give a familiar look
and functionality to inputting data. In one embodiment, Templates
are pre-existing documents stored in Template Library 108, which
when invoked from a current session, inheriting the information
from the patient and session. In an alternative embodiment,
Templates are created dynamically based on the selected
combination, a Template rule, and initial data entries relating to
the patient and the session. User selections define input prompts
for accepting selectable patient-related data. The user is
presented terms in a template or electronic form from which he/she
will (1) click on check boxes, (2) make single selections from
dropdown list boxes, (3) make multiple selections from multiple
options boxes or (4) write in blank text fields. FIG. 16 shows an
exemplary input screen for a procedure, in this case a
Dentoalveolar Examination. Each form may have several tabs each
with several data entry fields.
[0078] When the user finishes making selections from the template,
he/she clicks a button (Save) which re-compiles the selected items
along with their appropriate parent terms to display in prose
format or bulleted format. Some or all of the tabs of a particular
form may be completed. The display may create documents that are
editable (e.g., using a word processor) to allow the addition of
comments or further details at any location within the document, or
may create an image file suitable for direct printing. Appendix C
shows a sample of prose-formatted output in such a document.
Appendix D shows a sample of output in bulleted format.
[0079] Clinical records management system 102 is based on Knowledge
Base 108 (FIG. 1). FIG. 11 depicts further details of the Knowledge
Base feature. Main GUI 1120 effectuates an efficient and smooth
flow of data entry by utilizing Knowledge Base 1102. Knowledge Base
1102 houses terminology common to several dental specialties and
rules to guide the creation of Templates and Forms. In building
session content, the user selects a specific
Type/Sub-Category/Procedure combination matching the procedure
being administered to patient. Template Generator 1118 dynamically
creates a template/form using the user-selected combination,
Glossary Library 1212 and Rules 1214. Rules 1114 define how
Glossary Library 1112 is organized, associations between terms and
procedures, and how Procedure-specific Forms and Templates are
generated and displayed. Each Form has various tabs that display
specific areas of information related to the specific procedure
selected and covered in the form. Glossary Library 1112 and Rules
1114 may be updated by an administrator via a software update or
`patch` (either locally or remotely) or manually using Knowledge
Base editor 1102. Knowledge Base editor 1102 may be used by a
practitioner/user to hide certain data elements in particular
forms, either in the data entry or the report/letter generation.
Another aspect of Knowledge Base 1102 involves the translation of
entered data into either text suitable for a letter or a bullet
point report. For example, the bullet point report of FIG. 17
includes textual information relating to several forms, from
patient general data, to a session examination, treatment, and
anesthesia.
[0080] Main UI 104 also includes access points for Glossary
Explorer 1122 and Patient Chart Editor 1124 of FIG. 11. In
addition, and as part of the user interface, there is a method of
creating and editing the Glossary Library 1112 called Glossary
Management Tool 1104, configuring user interface layouts, and
predefining various organizational aspects of the Glossary Library
1112 by the administrator of knowledge based clinical records
management system 102. Rule Editor 1106 is used to update rules
governing the relationship between procedures and terms, including
the form and content of procedure forms and documents. Glossary
Management Tool 1104 and Ruled Editor 1106 are components of
Knowledge Base Editor 106 (FIG. 1). Glossary Library 112 also
includes information on specific types of data so that multiple
levels of detail may be easily navigated by the practitioner/user.
For example, in the exemplary embodiment, certain types of dental
materials may be specified in a cascading fashion so that once a
practitioner/user selects a particular company, the various styles
available from the company are displayed for selection, then the
applicable diameters for the style are displayed for selection.
Similarly, when entering a suture material, a practitioner/user may
first specify the actual material being used in the procedure and a
drop-down menu of related diameters is then displayed.
[0081] In addition to selecting items from pull-down menus, the
typing feature matches the initial few letters entered by the user
with the glossary terms relevant to that portion of the patient
record. Thus, if the user attempts to type in a glossary term that
is inappropriate to the current entry information of the record, no
match would be found. This allows a practitioner/user to enter
information that is not in the predefined glossary if appropriate,
and also provides a tool to check the spelling and appropriate use
of a free text term. A further embodiment of the invention also
provides a pop-up window with a message that explains why the
typing is inappropriate to the current entry and/or suggests
alternatives that the knowledge engine determines may be the
intention of the user.
[0082] The right clicking function allows the user the ability to
filter the patient's records and present only those sessions
containing information on the user-selected category or term and
within each such session only the information included in the
selected topic. Glossary filters allow users to limit the glossary
content to a specific category or terms that contain a specific
phrase. This reduces the time spent browsing the glossary for
specific terms, and reduces the time a dentist would need to spend
finding a data record relevant to the glossary term selected.
[0083] An additional aspect of the present invention relates to the
Anesthesia Record depicted in FIG. 9. Anesthesia Record data is
stored in Database 114. Each Anesthesia Record contains data
related to the administration of an anesthetic modality, for
example such modalities such as: local anesthesia, orally
administered conscious sedation, I.V. administered conscious or
deep sedation, I.V. Administered general anesthesia or Inhalation
General Anesthesia. Each Anesthesia Record is broken down into
several sections, with this exemplary embodiment including: (1)
Pre-Anesthesia Evaluation, (2) Monitors and Equipment, (3) Orally
Administered Drugs, (4) Anesthetic Technique, (5) Airway
Management, (6) I.V. Antibiotics Administered, (7) Anesthetic
Agents Administered, (8) Vital Signs and (9) Pre-Discharge
Evaluation and Status. An exemplary embodiment of a Vital Signs
page, in one form, is depicted in FIG. 10. The Vital Signs page
provides information from a device monitoring at least one of the
patient's blood pressure, heart rate and blood oxygen saturation
during a dental procedure, with the example of FIG. 10 showing the
tracking of blood pressure heart rate and oxygen saturation.
However, other vital signs may be monitored and included in a Vital
Signs page. Multiple Vital Sign pages may be associated with a
anesthesia record, for example, a patient may have heart rate,
blood pressure, temperature, and galvanic skin response measured
during an anesthesia event and recorded on separate Vital Signs
pages. The anesthesia record may be adjusted to the time duration
of the procedure, showing all data on one page or zooming in a
specific time block to show data in greater size for ease of
accurate viewing. Also back and forward buttons allow for the view
to move forward or reverse to view different time blocks of
data.
[0084] The layout of the Anesthesia Record page is determined based
on the anesthesia type. Different types will hide different
categories and sub-categories. Thus, each Anesthesia Record
includes information about dosages of anesthesia delivered to the
patient and data related to the patient's response to the
anesthesia. Having a distinct Anesthesia Record allows for
disparate medical and/or dental practices to share information
about a specific patient's reaction to anesthesia. An exemplary
collection of Anesthesia Record screen shots are provided in FIGS.
9A-9E illustrating various aspects of the Anesthesia Record. FIG.
9A represents a pre-examination record with the ability to record
the patient statistics prior to dispensing anesthesia. FIG. 9B
illustrates the charting ability to include specific medications
and dosages at various times administered during a procedure. FIG.
9C illustrates a monitored vital sign such as blood pressure being
monitored across the time domain. FIG. 9D illustrates a similar
view as FIG. 9C except with the temporal domain being graphically
compressed. FIG. 9E illustrates a discharge record relating to the
anesthesia event.
[0085] The variations of the Anesthesia Record may be dynamically
created once the modality is specified. For example, a record of
Local Anesthesia may include sections (1) and (6) (2); section (3)
excluding anything dealing with General Anesthesia or Conscious
Sedation; section (4) including only Nasal Mask and Nasal Cannula
choices; omitting sections (5) and (6), including section (7) and
section (8) except omitting the Aldrete Recovery Score and adding
the notations `Patient discharged to escort . . . .` As another
example, an Anesthesia Record relating to Orally Administered
Conscious Sedation may include sections (1) and (2); section (3)
and section (9), excluding anything dealing with General Anesthesia
or I.V. Conscious Sedation, but include a list of orally
administered analgesic agents including the times they are
administered; section (4) including only Nasal Mask and Nasal
Cannula choices; omitting section (5) and (6), and including
sections (7) and (8). With the example of I.V. Administered
Conscious Sedation, such an Anesthesia Record may include sections
(1) (2) (4) (5) (6) (7) (8) and (9); section (3) excluding anything
dealing with General Anesthesia; section (4) including only Nasal
Mask and Nasal Cannula choices; omitting section (5) and including
sections (6), (7) and (8). With an Anesthesia Record relating to
I.V. Administered Deep Sedation/I.V. or Inhalation General
Anesthesia all sections are included.
[0086] Another aspect of the present invention relates to a unique
set of data and display (UI) known as the `PerioProfile.`
Periodontal charting involves the collection of multiple parameters
of site specific information. It can be done either one tooth at a
time or more commonly it is done one parameter at a time by making
a circuit through the mouth for each parameter. The PerioProfile
allows for three different ways of entering data: (1) a circuit
approach which follows the user defined path through the dentition
to put in a single data parameter for all teeth at a time; (2)
enter a single parameter on a single tooth; or (3) enter all
parameters of data at once on a single tooth. FIG. 13A depicts how
the user would enter a single data parameter on a single site-while
FIG. 13B depicts a periodontal charting input for all data
parameters for one tooth. The parameters entered on the screens of
FIGS. 13A and 13B result in the Perio chart format shown in FIGS.
12A-12D. In addition to the data values collected and included on a
traditional periodontal chart, the PerioProfile may collect and
simultaneously display data on signs of inflammatory activity and
produce indices for `Bleeding` and `Exudate` activity; collect and
display data on a patient's plaque control effectiveness (a `Plaque
Score`), and other strategic items of dental and periodontal
morphological data pertinent to periodontal evaluation such as
including the display of normal supporting bone and extent of
gingival tissue overlaying the graphical periodontal data display
to allow the viewing of the relationships between anatomic
structures and the extent of periodontal destruction also shown in
FIGS. 12A-12D.
[0087] Traditionally, the display of periodontal charting has been
arranged around a graphic of the teeth and has utilized numbers as
well as universally recognized symbols (for example, Roman numerals
for tooth modalities). In one embodiment of the present invention,
the display of periodontal charting is done by displaying
alphanumeric data in a `spreadsheet` format so that data for a
specific site can be readily reviewed by scanning down a vertical
column. FIGS. 12A-12D depict periodontal charting spreadsheet
screens. Additionally, this same data is display graphically around
graphics of individual teeth and implants and may include an
overlay of periodontal supporting bone (FIG. 12B) and/or gingiva
(FIG. 12D, both supporting bone and gingiva in FIG. 12C) to show
the relationship between data items and these anatomic structures.
This comprehensive spreadsheet and graphical view of periodontal
data is a unique design feature of this application.
[0088] While this invention has been described as having an
exemplary design, the present invention may be further modified
within the spirit and scope of this disclosure. This application is
therefore intended to cover any variations, uses, or adaptations of
the invention using its general principles. Further, this
application is intended to cover such departures from the present
disclosure as come within known or customary practice in the art to
which this invention pertains. The following Appendices provide
examples of aspects of the present invention, which may be altered
and adapted in various forms.
[0089] Appendix A shows a List of Type-Sub-Category-Procedure
combinations for development of procedure-specific templates used
in the present invention.
[0090] Appendix B shows a sample template used in the present
invention.
[0091] Appendix C shows sample output of the present invention
presented in prose format.
[0092] Appendix D shows sample output of the present invention
presented in bulleted format.
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