U.S. patent application number 14/880596 was filed with the patent office on 2016-08-11 for systems and methods for patient health assessment.
The applicant listed for this patent is Aetna, Inc.. Invention is credited to Brian GARCIA, Leonard NAAR, Aaron SKLAR.
Application Number | 20160232299 14/880596 |
Document ID | / |
Family ID | 56565252 |
Filed Date | 2016-08-11 |
United States Patent
Application |
20160232299 |
Kind Code |
A1 |
SKLAR; Aaron ; et
al. |
August 11, 2016 |
SYSTEMS AND METHODS FOR PATIENT HEALTH ASSESSMENT
Abstract
Systems and methods for patient health assessment are disclosed.
A method includes: receiving medical data related to a patient
stored in a database; identifying assessments to be performed by a
case manager for the patient, each including questions to be
answered; displaying, in a user interface of a case manager
terminal, visual indicators that indicate a level of completeness
of the assessments; displaying a listing of questions to be asked
to the patient for a current assessment; receiving, in a data input
field included in the user interface, input data from the case
manager; and, in response to the input data, displaying in the user
interface an updated listing of questions to be asked to the
patient, where the updated listing of questions includes one or
more questions that, when answered by the patient, advance the
progress of completion of at least one of the one or more
assessments.
Inventors: |
SKLAR; Aaron; (Castro
Valley, CA) ; NAAR; Leonard; (London, GB) ;
GARCIA; Brian; (Redding, CT) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Aetna, Inc. |
Hartford |
CT |
US |
|
|
Family ID: |
56565252 |
Appl. No.: |
14/880596 |
Filed: |
October 12, 2015 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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14619440 |
Feb 11, 2015 |
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14880596 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
G16H 10/60 20180101;
G16H 50/20 20180101; G16H 10/20 20180101; G16H 50/30 20180101 |
International
Class: |
G06F 19/00 20060101
G06F019/00 |
Claims
1. A system, comprising: a clinical data database; and a case
manager terminal computing device comprising one or more memories
and one or more processors, wherein the one or more processors are
configured to execute instructions stored in the one or more
memories to perform a patient health assessment, by performing the
steps of: receiving, from a calculation engine module executing on
a health organization server computing device, medical data related
to a patient that is stored in the clinical data database, wherein
the medical data includes one or more of medication data, claims
data, and lab results data for the patient; from the medical data,
identifying plural assessments to be performed by a case manager
for the patient, wherein each assessment includes plural questions
to be answered by the patient; performing a weighted analysis of
the medical data by the calculation engine module, and, based on
the analysis, prioritizing said assessments and questions therein;
selecting a top prioritized assessment, and a top prioritized
question therein, for presentation by the case manager and response
by the patient; and displaying, in an electronic display device,
the selected question from the selected assessment, for
presentation by the case manager and response by the patient.
2. The system of claim 1, wherein the medical data includes each of
medication data, claims data, and lab results data for the
patient.
3. The system of claim 1, wherein performing the patient health
assessment further comprises: receiving a response to the selected
question from the patient; and advancing the progress of completion
of the top prioritized assessment.
4. The system of claim 3, wherein performing the patient health
assessment further comprises: performing a weighted analysis of the
medical data by the calculation engine module based on the response
to the selected question, and, based on the analysis,
reprioritizing said assessments and questions therein.
5. The system of claim 1, wherein performing the patient health
assessment further comprises: receiving in a data input field
displayed in the electronic display device, input data from the
case manager; and in response to the input data, displaying in the
electronic display device an updated listing of questions to be
asked to the patient.
6. The system of claim 1, wherein one visual indicator indicates
that a particular question has been answered by the patient and
another visual indicator indicates that a particular question has
not been answered by the patient.
7. The system of claim 1, wherein each of plural assessments is
indicative of a particular medical condition.
8. A method, comprising: receiving, from a calculation engine
module executing on a health organization server computing device,
medical data related to a patient that is stored in a clinical data
database, wherein the medical data includes one or more of
medication data, claims data, and lab results data for the patient;
from the medical data, identifying plural assessments to be
performed by a case manager for the patient, wherein each
assessment includes plural questions to be answered by the patient;
performing a weighted analysis of the medical data by the
calculation engine module, and, based on the analysis, prioritizing
said assessments and questions therein; selecting a top prioritized
assessment, and a top prioritized question therein, for
presentation by the case manager and response by the patient; and
displaying, in an electronic display device, the selected question
from the selected assessment, for presentation by the case manager
and response by the patient.
9. The method of claim 8, wherein the medical data includes each of
medication data, claims data, and lab results data for the
patient.
10. The method of claim 8, further comprising: receiving a response
to the selected question from the patient; and advancing the
progress of completion of the top prioritized assessment.
11. The method of claim 10, further comprising: performing a
weighted analysis of the medical data by the calculation engine
module based on the response to the selected question, and, based
on the analysis, reprioritizing said assessments and questions
therein.
12. The method of claim 8, further comprising: receiving in a data
input field displayed in the electronic display device, input data
from the case manager; and in response to the input data,
displaying in the electronic display device an updated listing of
questions to be asked to the patient.
13. The method of claim 8, wherein one visual indicator indicates
that a particular question has been answered by the patient and
another visual indicator indicates that a particular question has
not been answered by the patient.
14. The method of claim 8, wherein each of plural assessments is
indicative of a particular medical condition.
15. A non-transitory computer-readable storage medium storing
instructions that, when executed by a processor, cause a computer
system to perform the steps of: receiving, from a calculation
engine module executing on a health organization server computing
device, medical data related to a patient that is stored in a
clinical data database, wherein the medical data includes one or
more of medication data, claims data, and lab results data for the
patient; from the medical data, identifying plural assessments to
be performed by a case manager for the patient, wherein each
assessment includes plural questions to be answered by the patient;
performing a weighted analysis of the medical data by the
calculation engine module, and, based on the analysis, prioritizing
said assessments and questions therein; selecting a top prioritized
assessment, and a top prioritized question therein, for
presentation by the case manager and response by the patient; and
displaying, in an electronic display device, the selected question
from the selected assessment, for presentation by the case manager
and response by the patient.
16. The computer-readable storage medium of claim 15, wherein the
medical data includes each of medication data, claims data, and lab
results data for the patient.
17. The computer-readable storage medium of claim 15, wherein the
computer system is further capable to perform the steps of:
receiving a response to the selected question from the patient; and
advancing the progress of completion of the top prioritized
assessment.
18. The computer-readable storage medium of claim 17, wherein the
computer system is further capable to perform the steps of:
performing a weighted analysis of the medical data by the
calculation engine module based on the response to the selected
question, and, based on the analysis, reprioritizing said
assessments and questions therein.
19. The computer-readable storage medium of claim 15, wherein the
computer system is further capable to perform the steps of:
receiving in a data input field displayed in the electronic display
device, input data from the case manager; and in response to the
input data, displaying in the electronic display device an updated
listing of questions to be asked to the patient.
20. The computer-readable storage medium of claim 15, wherein one
visual indicator indicates that a particular question has been
answered by the patient and another visual indicator indicates that
a particular question has not been answered by the patient.
Description
CROSS-REFERENCE TO RELATED APPLICATIONS
[0001] This application is a continuation of U.S. patent
application Ser. No. 14/619,440, filed on Feb. 11, 2015, which is
hereby incorporated by reference herein in its entirety.
FIELD
[0002] This disclosure relates generally to the field of health
care management and, more specifically, to systems and methods for
patient health assessment.
BACKGROUND
[0003] In conventional systems for patient health assessment, a
case manger, such as a registered nurse or nurse practitioner, may
contact a patient (e.g., by telephone) to perform one or more
"assessments" on the patient. In conventional systems, an
assessment includes a predefined series of questions to be asked to
the patient. Some assessments are "linear," meaning that the
questions are asked in a certain order. The case manger typically
asks the patient each question in order to solicit a response from
the patient. Once all of the questions for an assessment have been
answered, the assessment is deemed to be completed. The completed
assessment can then be used by the case manager or other medical
professionals to provide a care plan for the patient. In some
instances, the case manager may have multiple assessments to
complete with a patient.
[0004] However, a problem exists with conventional case manager
assessments when the patient interrupts the linear question list of
an assessment to provide unrelated information or to ask his or her
own questions to the case manager. Such events can derail an
assessment and may cause confusion and unnecessary delays in
completing the assessment. Because the assessment process is
lengthened, patients can get frustrated with the process and may
perceive the case manager as simply reading from a script and not
actually caring about the patient's well-being. Case managers are
often left with incomplete assessments and an array of notes to
reconcile through data entry after a communications session is
completed with the patient. As such, the conventional approach to
case manager assessments is time-consuming and error-prone for the
case manager, which may result in inadequate medical care provided
to the patient.
[0005] Accordingly, there remains a need for systems and methods
for patient health assessment that overcome the drawbacks and
limitations of current approaches.
SUMMARY
[0006] Embodiments of the disclosure provide systems and methods
for patient health assessment. In one embodiment, a system includes
a clinical data database and a case manager terminal computing
device executing one or more processors for performing a patient
health assessment. The case manager terminal computing device is
configured to perform the step of: receiving, from a calculation
engine module executing on a health organization server computing
device, medical data related to the patient that is stored in the
clinical data database; identifying one or more assessments to be
performed by a case manager for the patient, wherein each
assessment includes one or more questions to be answered by the
patient; displaying, in a user interface on a display device,
visual indicators that indicate a level of completeness of each of
the one or more assessments; displaying in the user interface a
listing of questions to be asked to the patient for a current
assessment; receiving in a data input field included in the user
interface, input data from the case manager; and in response to the
input data, displaying in the user interface an updated listing of
questions to be asked to the patient, wherein the updated listing
of questions includes one or more questions that, when answered by
the patient, advance the progress of completion of at least one of
the one or more assessments. The health organization server
computing device can be associated with a health insurance company
or a health care provider, for example.
[0007] Another embodiment of disclosure provides a
computer-readable storage medium, system, or method for performing
assessments that includes: receiving, from a calculation engine
module executing on a server computing device, data related to a
person that is stored in a database; identifying one or more
assessments to be performed for the person, wherein each assessment
includes one or more questions to be answered by the person;
displaying, in a user interface on a display device of an assessor
terminal computing device, visual indicators that indicate a level
of completeness of each of the one or more assessments; displaying,
in the user interface, a listing of questions to be asked to the
person for a current assessment; receiving, in a data input field
included in the user interface, input data from the assessor; and,
in response to the input data, displaying in the user interface an
updated listing of questions to be asked to the person, wherein the
updated listing of questions includes one or more questions that,
when answered by the person, advance the progress of completion of
at least one of the one or more assessments.
BRIEF DESCRIPTION OF THE DRAWINGS
[0008] FIG. 1 is a conceptual diagram of a system with reference to
an overall healthcare environment, according to one embodiment.
[0009] FIG. 2 is a schematic diagram illustrating an overview of a
system for communicating with a health plan member, according to
one embodiment.
[0010] FIG. 3 is a block diagram of basic functional components for
a server or cluster of servers configured to implement embodiments
of the disclosure.
[0011] FIG. 4 is a conceptual diagram illustrating non-linear
assessments, according to one embodiment.
[0012] FIG. 5 is a conceptual diagram illustrating non-linear
assessments and a data input field for searching for questions to
ask, according to one embodiment.
[0013] FIG. 6 is a conceptual diagram illustrating software modules
included in a calculation engine module to provide non-linear
assessments, according to one embodiment.
[0014] FIG. 7 is a flow diagram of method steps performed by a data
link/merge module, according to one embodiment.
[0015] FIG. 8 is a flow diagram of method steps performed by a
suggestion module, according to one embodiment.
[0016] FIG. 9 is a flow diagram of method steps performed by an
assessment engine module, according to one embodiment.
[0017] FIG. 10 is a flow diagram of method steps of question and
assessment matching, according to one embodiment.
[0018] FIG. 11 is a flow diagram of method steps for linking new
questions to all associated assessments, according to one
embodiment.
[0019] FIGS. 12A-12D are screenshots that illustrate example user
interface screens displayed on a case manager terminal while
performing a patient encounter, according to some embodiments.
DETAILED DESCRIPTION
[0020] Embodiments of the disclosure provide systems and methods
for conducting patient health assessments. According to the
embodiment disclosed herein, a starting point (i.e., a question)
for a case manager (also referred to as an "assessor") to begin an
assessment is suggested by to the case manager by a computer
system. For example, the case manager may be using a computer that
is executing software that provides the suggestion to the case
manager. In other implementations, a software module executing on
another computer system performs the analysis to determine which
question to begin the assessment. While the assessment is taking
place, the computer system dynamically changes the order of the
questions depending on the patient's last statement. The computer
system can also provide follow up questions depending on the
patient's last statement. The computer system also allows the case
manager to search for questions related to the topic of the
conversation.
[0021] Accordingly, embodiments of the disclosure empower the case
manager to use their professional judgment to choose which question
to ask next to the patient. This allows the direction of the
conversation to drive the order of questions, enabling the ability
to fluidly switch from one set of assessment questions to a
completely separate set of questions, depending on the flow of the
conversation. A level of completeness of each assessment can also
be visually represented on a display device of the computer system
operated by the case manager, which enables the case manager to
effortlessly access various assessments to view remaining
questions.
[0022] Turning to FIG. 1, an implementation of a system
contemplated by an embodiment of the disclosure is shown with
reference to an overall healthcare environment, according to one
embodiment. A patient (also referred to as a "subscriber" or
"member" or "consumer") 102 is a member of a health plan 104 of a
health plan organization ("HPO") 106. The patient 102 may subscribe
to the health plan 104 through, for example, his or her employer.
Alternatively, the patient 102 may obtain benefits of the health
plan 104 through a subscriber (e.g., a spouse or child of a
subscriber can be a member of a health plan). The HPO 106 can be a
health insurance company and the health plan 104 can be one of a
number of health insurance or related products, such as a PPO
(Preferred Provider Organization), HMO (Health Maintenance
Organization), POS (Point-of-Service), or the like. The health plan
104 can also be a consumer-directed health plan, such as a high
deductible health plan, health reimbursement arrangement (HRA),
health savings account (HSA), or the like. The patient's health
plan 104 covers various health care services according to one of a
variety of pre-arranged terms. Details for the patient 102 and the
corresponding plan 104 are stored in a member database 108. The
terms of the plan 104 can vary greatly from plan to plan according
to (among other things): what types of services are provided, where
the services are provided, by whom they are provided, the extent to
which the patient is personally responsible for payment, amount of
deductibles, etc. Generally, however, regardless of the specific
plan subscribed to, when a patient 102 obtains health care services
from a provider 110, either the patient 102 or the provider 110 can
submit a claim to the HPO 106 for reimbursement or payment. For
analysis purposes, historical claim data is stored in a claims
database 112.
[0023] A health care services provider 110 may have a contractual
relationship 114 with the HPO 106. Under the contract 114, the
provider 110 typically agrees to provide services to members 102 of
the HPO 106 at scheduled rates. The rates are stored in a fee
schedule 118, preferably stored in a fees database 120 maintained
by the HPO 106. By contracting with the HPO 106, the provider 110
generally increases the amount of business the provider 110
receives from members 102, and members 102 generally receive a less
expensive rate than they would otherwise receive for a health
service provided by the provider 110. The actual amount of
out-of-pocket expense to be paid by a patient 102 may vary
according to the terms of his health plan 104 (e.g., co-payments,
co-insurance or deductibles may apply), but will generally be at
most the contracted rate.
[0024] FIG. 2 is a schematic diagram illustrating an overview of a
system for communicating with a health plan member (e.g., patient
102), according to one embodiment. A health plan organization 106
collects and processes a wide spectrum of medical care information
relating to a patient 102 in order to attempt to mitigate risk of
the patient 102. A personal health record (PHR) 136 of a patient
102 may be configured to solicit the patient's input for entering
additional pertinent medical information, tracking follow-up
actions, and allowing the health plan organization 106 to track the
patient's medical history. In some embodiments, the medical care
information relating to the patient can include health risk
appraisal (HRA) information, also referred to as a health risk
appraisal, or health and well-being questionnaire. In one
embodiment, the HRA is a questionnaire used to gather the pertinent
medical information from the patient 102.
[0025] When the patient 102 utilizes the services of one or more
health care providers 110, a medical insurance carrier collects the
associated clinical data 124 in order to administer the health
insurance coverage for the patient 102. Additionally, a health care
provider 110, such as a physician or nurse, can enter clinical data
124 into one or more health care provider applications pursuant to
a patient-health care provider interaction during an office visit
or a disease management interaction. Clinical data 124 originates
from medical services claims, pharmacy data, as well as from lab
results, and includes information associated with the
patient-health care provider interaction, including information
related to the patient's diagnosis and treatment, medical
procedures, drug prescription information, in-patient information,
and health care provider notes, among other things. The medical
insurance carrier and the health care provider 110, in turn,
provide the clinical data 124 to the health plan organization 106,
via one or more networks 116, for storage in one or more medical
databases 132. The medical databases 132 are administered by one or
more server-based computers associated with the health plan
organization 106 and comprise one or more medical data files
located on a computer-readable medium, such as a hard disk drive, a
CD-ROM, a tape drive, or the like. The medical databases 132 may
include a commercially available database software application
capable of interfacing with other applications, running on the same
or different server based computer, via a structured query language
(SQL). In an embodiment, the network 116 is a dedicated medical
records network. Alternatively, or in addition, the network 116
includes an Internet connection that comprises all or part of the
network.
[0026] In some embodiments, an on-staff team of medical
professionals within the health plan organization 106 consults
various sources of health reference information 122, including
evidence-based preventive health data, to establish and
continuously or periodically revise a set of clinical rules 128
that reflect best evidenced-based medical standards of care for a
plurality of conditions. The clinical rules 128 are stored in the
medical database 132.
[0027] To supplement the clinical data 124 received from the
insurance carrier, the PHR 136 and/or an HRA questionnaire allow
patient entry of additional pertinent medical information that is
likely to be within the realm of patient's knowledge. Examples of
patient-entered data include additional clinical data, such as
patient's family history, use of non-prescription drugs, known
allergies, unreported and/or untreated conditions (e.g., chronic
low back pain, migraines, etc.), as well as results of
self-administered medical tests (e.g., periodic blood pressure
and/or blood sugar readings). Preferably, the PHR 136 facilitates
the patient's task of creating a complete health record by
automatically populating the data fields corresponding to the
information derived from the medical claims, pharmacy data, and lab
result-based clinical data 124. In one embodiment, patient-entered
data also includes non-clinical data, such as upcoming doctor's
appointments. In some embodiments, the PHR 136 gathers at least
some of the patient-entered data via a health risk assessment tool
(HRA) 130 that requests information regarding lifestyle, behaviors,
family history, known chronic conditions (e.g., chronic back pain,
migraines, etc.), and other medical data, to flag individuals at
risk for one or more predetermined medical conditions (e.g.,
cancer, heart disease, diabetes, risk of stroke, etc.) pursuant to
the processing by a calculation engine module 126, which a software
module executed by one or more processors included in a computer
system. Preferably, the HRA 130 presents the patient 102 with
questions that are relevant to his or her medical history and
currently presented conditions. The risk assessment logic branches
dynamically to relevant and/or critical questions, thereby saving
the patient time and providing targeted results. The data entered
by the patient 102 into the HRA 130 also populates the
corresponding data fields within other areas of PHR 136. The health
plan organization 106 aggregates the clinical data 124 and the
patient-entered data, as well as the health reference and medical
news information 122, into the medical database(s) 132 for
subsequent processing via a calculation engine module 126.
[0028] The health plan organization 106 includes a
multi-dimensional analytical software application including a
calculation engine module 126 comprising computer-readable
instructions for performing analysis on the contents of the medical
databases 132 in order to attempt to mitigate risk of the patient
102. In some embodiments, a patient is stratified into one of three
risk tiers, including a high risk tier, a moderate risk tier, and a
low risk tier. Based on the risk tier of a patient and other
engagement factors, the health plan organization can reach out to
the patient 102 via communications medium 134. Example
communications media 134 include telephone, postal mail, email,
text message, or other electronic or non-electronic communication
media. In various embodiments, the type of communication medium 134
used to reach out to or "engage" the patient 102 depends on the
risk tier and/or other engagement factors. Also, the communication
medium 134 allows data transfer between the calculation engine
module 126 and the case manager terminal 160 operated by a case
manager 150. In some examples, the case manager 150 is a registered
nurse or nurse practitioner.
[0029] For example, a case manager 150 may be notified that a
patient 102 is the highest-risk tier and/or that the patient has
received a poor lab result, via the case manager terminal 160. This
notification is received by the case manager terminal 160 from the
calculation engine module 126.
[0030] The case manager 150 may initiate a communications session
with the patent 102 via the communications medium 134, such as by
placing a phone call to the patient. One goal of the case manager's
interaction with the patient may be to identify the cause of a
health problem with the patient 102. This can be done by performing
one or more "assessments" on the patients. In some embodiments, an
assessment includes a series of questions to be asked to the
patient. Some assessments may be "linear," meaning that the
questions should be asked in a certain order. In some embodiments,
the case manager 150 is provided with multiple recommended
assessments to complete with a given patient 102.
[0031] However, as described above, a problem exists with
conventional case manager assessments when the patient interrupts
the linear question list of an assessment to provide unrelated
information or to ask his or her own questions to the case manager.
Such events can derail an assessment and may cause confusion and
unnecessary delays in completing the assessment. Because the
assessment process is lengthened, patients can get frustrated with
the process and may perceive the case manager as simply reading
from a script and not actually caring about the patient's
well-being. Case managers are often left with incomplete
assessments and an array of notes to reconcile through data entry
after a communications session is completed with the patient. As
such, the conventional approach to case manager assessments is
time-consuming and error-prone for the case manager, which may
result in inadequate medical care provided to the patient.
[0032] Accordingly, embodiments of the disclosure provide for
improved systems and methods for patient health assessment.
According to various embodiments, a case manger 150 opens a
computer program on the case manager terminal 160 to begin a new
encounter with a patient 102. A visual dashboard or user interface
is displayed on a display screen of the case manager terminal 160
that includes a listing of assessments that are incomplete for the
patient 102, where each assessment includes one or more questions
to be answered by the patient 102. For each assessment, a visual
indicator is displayed that indicates a level of completeness of
the assessment (e.g., 0% complete, 25% complete, 100% complete, 3
of 10 questions answered, etc.).
[0033] The case manger 150 begins by asking a question for one of
the assessments that has not yet been answered. The initial
question may be part of a "current assessment" and an initial set
of questions to ask the patient from the current assessment may be
provided to the case manager terminal 160 based on analysis
performed by the calculation engine module 126. In some
embodiments, the calculation engine module 126 is part of the case
manager terminal 160. In other embodiments, the calculation engine
module 126 is in a separate computer system than the case manager
terminal 160, such as in a server of a health plan organization
106.
[0034] When the patient 102 answers a question, the answer is
recorded against the assessments that include that question, such
as the current assessment. One or more recommended questions from
the current may then be prompted to the case manger 150 to ask the
patient 102 (based on analysis performed by the calculation engine
module 126). This process continues until the patient 102 begins to
get off-track, meaning that the patient 102 begins to provide
unsolicited information about things that the case manger 150 has
not asked that may or may not be relevant to the assessments that
are yet to be completed.
[0035] In some embodiments, a data input field may be in displayed
on the case manager terminal 160 that allows the case manger 150 to
search for related question to the patient conversation, e.g., in
situations where the patient 102 has taken the conversation
off-course. Based on the input in the data input field, the case
manager terminal 160, in conjunction with the calculation engine
module 126, may provide new recommendations for questions from one
or more other assessments besides the current assessment to keep
the conversation relevant to the present topic and to carry on with
the progress of completing the assessments. As the new questions
are asked and answered, progress is made towards completing
multiple assessments in parallel while keeping the conversation
relevant to topics that the patient 102 is interested in
discussing.
[0036] While the entity relationships described in FIG. 2 are
representative, those skilled in the art will realize that
alternate arrangements are possible. In one embodiment, for
example, the health plan organization 106 and the medical insurance
carrier are the same entity. Alternatively, the health plan
organization 106 is an independent service provider engaged in
collecting, aggregating, and processing medical care data from a
plurality of sources to provide a personal health record (PHR)
service for one or more medical insurance carriers. In yet another
embodiment, the health plan organization 106 provides PHR services
to one or more employers by collecting data from one or more
medical insurance carriers. In yet another implementation, case
manager terminal 160 is part of health plan organization 106.
[0037] FIG. 3 is a block diagram of basic functional components for
a server or cluster of servers configured to implement embodiments
of the disclosure. For example, server 300 may represent the
computer system that executes the calculation engine module 126
and/or case manager terminal 160 shown in FIG. 2. In some
embodiments, server 300 is configured to be a computer or computers
operated by an insurance carrier and/or case manager.
[0038] The server 300 includes one or more processors 302, memory
304, and network interface 306. In some embodiments, each of the
components including the processor(s) 302, memory 304, and network
interface 306 is interconnected physically, communicatively, and/or
operatively for inter-component communications.
[0039] As illustrated, processors 302 are configured to implement
functionality and/or process instructions for execution within
server 300. For example, processors 302 execute instructions stored
in memory 304. Memory 304, which may be a non-transient,
computer-readable storage medium, is configured to store
information within server 300 during operation. In some
embodiments, memory 304 includes a temporary memory, i.e., an area
for information not to be maintained when the server 300 is turned
off. Examples of such temporary memory include volatile memories
such as random access memories (RAM), dynamic random access
memories (DRAM), and static random access memories (SRAM). Memory
304 also maintains program instructions for execution by the
processors 302.
[0040] The server 300 uses network interface 306 to communicate
with external devices via one or more networks, such as the network
116 in FIG. 1. Network interface 306 may also provide a phone or
Internet-enabled voice and/or video connection between a case
manager and a patient. Such networks may include one or more
cellular networks, wireless networks, wired networks, fiber optics
networks, and other types of networks through which communication
between the server 300 and an external device may be established.
Network interface 306 may be a network interface card, such as an
Ethernet card, an optical transceiver, a radio frequency
transceiver, or any other type of device that can send and receive
information.
[0041] FIG. 4 is a conceptual diagram illustrating non-linear
assessments, according to one embodiment. As shown in FIG. 4,
various assessments 402 can be associated with a particular patient
based on or quantified by data inputs 404 for the patient. Example
data inputs 404 include clinical data, administrative data,
question responses, patient updates, personal data, financial data,
among others, that are stored in a medical database. As shown in
FIG. 4, the assessments 402 can be categorized as incomplete,
completed, periodical, or others. As described, each assessment
includes one or more questions to be answered by the patient. When
all the questions of an assessment are answered, the assessment is
deemed "completed." If at least one question remains unanswered,
then the assessment is deemed "incomplete." A "periodical"
assessment, in some embodiments, is an assessment that should be
administered to the patient on a periodic basis, e.g., once a
year.
[0042] When a case manger 150 logs into a case manager terminal 160
to begin a patient encounter 406, a user interface is displayed on
the case manager terminal 160 to the case manager 150. The user
interface may provide visual indications of which assessments are
recommended to complete 414 and may provide a recommendation 408 of
a question to ask the patient. A data input field 410 may also be
provided in the user interface to allow input by the case manager,
e.g., of a patient response to a question that is off-topic. The
data input field 410 may be a text field, a drop-down selection
menu, radio button selection menu, or checkbox-based menu choices,
among others. A notes section 412 of the user interface may provide
an input field where the case manager can input additional notes
about the answer to the question.
[0043] When a patient answers a question, the data is transmitted
from the case manager terminal 160 to be stored in a database as
data inputs 404 (e.g., database 132 in FIG. 2) and is used by a
calculation engine module (e.g., calculation engine module 126 in
FIG. 2) to generate a new question recommendation 408. The
recommendation may be part of the same assessment as the previous
question or from a different assessment.
[0044] Another user interface feature may include a table 416 of
all questions for the recommended assessments 414, with one visual
indicator indicting that a particular question has been answered
and another visual indication indicating that a particular question
has not been answered. For example, the visual indications may be
different colors for questions that been answered and questions
that have not been answered.
[0045] According to some embodiments, the assessments can be
completed in a non-linear manner in which questions from different
assessments can be asked to the patient based on, for example, the
flow of the conversation, as described in greater detail
herein.
[0046] FIG. 5 is a conceptual diagram illustrating non-linear
assessments and a data input field 504 for searching for questions
to ask at patient, according to one embodiment. As shown in FIG. 5,
when a case manager opens a new patient encounter, a visual
indicator 502 may be displayed in a user interface showing which
recommended assessments are to be completed. In the example in FIG.
5, three assessments "A," "B," and "C" are yet to be completed. A
fill-bar visual indicator 502 is shown in FIG. 5, where the
fill-bar is increased when a question for a particular assessment
has been asked and answered until the fill-bar is full, which
indicates that the assessment has been completed.
[0047] The user interface may also include a data input field 504
for searching for questions to ask the patient. In one example
scenario, suppose the case manager asked a particular question to
the patient. The patient, instead of answering the question,
provides some other information that does not answer the question
that was asked. The case manager can input the other information
provided by the patient (e.g., "Condition A" in FIG. 5) in the data
input field 504. The other information is transmitted back to the
calculation engine module 126 that processes the information to
generate a listing 506 of recommended questions (e.g., Questions
1A-6A in FIG. 5) to ask the patient based on the other information
that was provided in the data input field 504. The questions in the
listing 506 may questions that are need to complete the remaining
assessments for the patient, but are also relevant to the flow of
the conversation. As such, as questions are asked and answered,
progress is made towards completing multiple assessments in
parallel. Each question answered in the non-linear assessment may
prompt follow-on questions to further satisfy the assessment
requirements.
[0048] FIG. 6 is a conceptual diagram illustrating software modules
included in a calculation engine module 126 to provide non-linear
assessments, according to one embodiment. As shown, the calculation
engine module 126 includes a data receiver module 602, a data
link/merge module 604, a suggestion module 606, an assessment
engine module 608, and an assessment view module 610. Each of the
modules in FIG. 6 may be a software module comprising
processor-executed instructions that are executed by one or more
computers, such as a server of a health organization and/or a case
manager terminal.
[0049] The data receiver module 602 receives data from a database
132. In one embodiment, the data may be information provided in a
data input field by a case manager during a patient encounter,
where the data was input into the data input field by the case
manager and transmitted from the case manager terminal to the
database 132. The data is transmitted from the data receiver module
602 to the data link/merge module 604.
[0050] FIG. 7 is a flow diagram of method steps performed by a data
link/merge module, such as data link/merge module 604 in FIG. 6,
according to one embodiment. As shown, the method 700 begins at
step 702, where the data link/merge module receives data
identifiers. The data identifiers may include identifiers for the
data received from the data receiver module 602. In some
embodiments, patient data is sorted in categories (e.g., clinical,
financial, demographic, etc.) and is merged with reference data.
This combined "patient object" is then associated with the
appropriate assessment. At step 704, the data link/merge module
sorts the data identifiers to data categories. At step 706, the
data link/merge module links data sources to relevant identifiers.
At step 708, the data link/merge module merges data sources
relevant to the data identifiers. At step 710, the data link/merge
module generates a data object for a patient state. At step 712,
the data link/merge module links the data object to the current
assessment.
[0051] FIG. 8 is a flow diagram of method steps performed by a
suggestion module, such as suggestion module 606 in FIG. 6,
according to one embodiment. As shown, the method 800 begins at
step 802, where the suggestion module evaluates a search text from
the case manager. For example, the search text may be input into
the data input field 504 described above. As such, when the
conversation between the patient and the case manager shifts to a
new topic, the case manager can type free text into the data input
field 504. The suggestion module associates the free text with
available assessments and generates the next set of questions to
present to the case manager. At step 804, the suggestion module
evaluates a current assessment being administered to the patient.
At step 806, the suggestion module identifies all linked data
sources for the current assessment. At step 808, the suggestion
module generates a new question list based on the search context.
At step 810, the suggestion module links the new questions to all
the associated assessments.
[0052] FIG. 9 is a flow diagram of method steps performed by an
assessment engine module, such as assessment engine module 608 in
FIG. 6, according to one embodiment. The assessment engine module
is configured to select the next assessment and select the next set
of questions to present to the case manager. As shown, the method
900 begins at step 902, where the assessment engine module receives
a current assessment identifier and patient identifier. At step
904, the assessment engine module identifies new assessment content
for a current assessment position. At step 906, the assessment
engine module prioritizes new assessment questions and reduces a
total number of questions by relevance to the current context. At
step 908, the assessment engine module links new questions to all
relevant assessments. At step 910, the assessment engine module
assigns new priority questions to the current assessment.
[0053] Referring back to FIG. 6, new priority questions from the
assessment engine module are transmitted to the assessment view
module 610. The assessment view module 610 communicates with the
case manager terminal to display the new priority questions in the
case manager terminal user interface to the case manager.
[0054] FIG. 10 is a flow diagram of method steps of question and
assessment matching, according to one embodiment. In some
implementations, based on free text entry by the case manager,
different assessments can be selected as being relevant to the free
text entry. Certain questions can then the selected as being the
appropriate questions to present. FIG. 10 is a visual
representation of the background logic presented in FIGS. 8 and 9.
As shown, the method 1000 begins at step 1002, where the assessment
engine module performs an initial matching of new content to the
pool of possible assessment questions. The initial matching may be
performed by executing any technically feasible matching algorithm,
including deterministic or probabilistic matching algorithms. If
exactly one match is found, then the method 1000 proceeds to step
1004, where the assessment engine module returns the one match
question.
[0055] If at step 1002, zero matches are found, then the method
1000 proceeds to step 1006, where the assessment engine module
performs probabilistic matching to determine which remaining
assessment questions are left to be answered based on the new
content. At step the 1008, the assessment engine module performs a
weighted priority sort of the remaining assessment questions are
left to be answered. The matches are then returned at step
1004.
[0056] If at step 1002, more than one match is found, then the
method 1000 proceeds to step 1010, where the assessment engine
module performs further matching of the new content to assessment
questions. The further matching may be any technically feasible
matching algorithm, including deterministic or probabilistic
matching. If, at step 1010, exactly one match is found, the method
proceeds to step 1004 where the match is returned. If, at step
1010, more than one match is found, then the method 1000 proceeds
to step 1008, described above.
[0057] FIG. 11 is a flow diagram of method steps for linking new
questions to all associated assessments, according to one
embodiment. In one implementation, FIG. 11 provides the logic for
updating the next set of questions to be presented to the case
manager. The intention of this process is to support the case
manager in staying on task, making progress towards completing an
assessment. As shown, the method 1100 begins at step 1102, where
the calculation engine module evaluates a current assessment
position for a patient 1102. At step 1104, the calculation engine
module merges the assessment position with patient data to create
an updated state for the patient. At step 1106, the calculation
engine module generates a new question list for all relevant
assessments for the patient. At step 1108, the calculation engine
module reduces the total questions by a weighted priority for the
patient and the current encounter. At step 1110, the calculation
engine module links new questions to all associated
assessments.
[0058] FIGS. 12A-12D are screenshots that illustrate example user
interface screens displayed on a case manager terminal while
performing a patient encounter, according to some embodiments. As
shown in FIG. 12A, a user interface 1200 includes an indicator of a
current assessment 1202 (e.g., "Diabetes--Adult") and next
questions 1206 to ask the patient for the current assessment 1202.
Additional recommended assessments 1204 that are recommended to
complete with the patient are also shown in the user interface
1200. Visual indicators 1210 indicate to the case manager a level
of completeness (e.g., completion percentage) of the various
assessments to be completed and/or recommended to be completed.
[0059] Also shown in the user interface 1200 is a data input field
1208 for the case manager to input information to find new
questions to ask the patient. As described, the information
provided in the data input field 1208 may be information provided
by the patient.
[0060] In some embodiments, during an assessment, the case manager
can follow the scripted next questions 1206 or type a new topic
into the data input field 1208 in order to follow the patient's
diversion "off-script."
[0061] As shown in FIG. 12B, the case manager has input the text
1212 "blood pressure" into the data input field 1208. In response,
the user interface is updated to display a listing 1214 of
recommended questions to ask the patient based on the text 1212. In
some embodiments, the questions displayed in the listing 1214 are
helpful toward completing one or more of the assessments being
administered or recommended for the patient.
[0062] In the example in FIG. 12B, the case manager may select the
recommended question 1216 (i.e., "Do you know your most recent
blood pressure?"), which causes the user interface shown in FIG.
12C to be displayed. In FIG. 12C, a listing of questions 1218
related to "recent blood pressure" are provided. Once the answers
are complete, the case manager can click "Submit" 1220, which
causes the user interface shown in FIG. 12D to be displayed.
[0063] As shown in FIG. 12D, the answer to the blood pressure
question(s) increase the completion progress of one of the
recommended assessments 1204, namely the "Chronic Obstructive
Pulmonary Disease (COPD)" assessment 1222. The current assessment
1202, however, remains as "Diabetes--Adult."
[0064] In sum, embodiments of the disclosure disclose dynamically
changing the order of questions, providing follow-up questions
based on a patient's response, and/or visually representing the
level of completeness of numerous assessments that are
simultaneously being completed based on the conversational flow of
the assessment. By providing a data input field that can generate
new questions to ask the patient, multiple assessments can be
completed in parallel, while keeping the conversation relevant to
the patient, which keeps the patient engaged and provides for
better and faster assessment completion.
[0065] Although embodiments of the disclosure provide for a
calculation engine module 126 as part of a health plan organization
106, other embodiments may include the calculation engine module
126 as part of a server executed by a health care provider. In some
embodiments, any entity that has access to clinical data from the
patient's medical record may implement the calculation engine
module 126 to perform the features and functions disclosed herein.
In still further embodiments, the assessment workflow described
herein may implemented outside of the health care industry and is
applicable to any industry that involves assessments, such as, for
example, the financial assessments (e.g., assessments to determine
a person's financial status, credit worthiness, level of credit to
offer, set of terms to provide the customer, etc.), academic
assessments, online dating or matchmaking assessments, and
employment assessments, among others.
[0066] All references, including publications, patent applications
and patents, cited herein are hereby incorporated by reference to
the same extent as if each reference were individually and
specifically indicated to be incorporated by reference and were set
forth in its entirety herein.
[0067] The use of the terms "a" and "an" and "the" and similar
referents in the context of describing the disclosure (especially
in the context of the following claims) are to be construed to
cover both the singular and the plural, unless otherwise indicated
herein or clearly contradicted by context. The terms "comprising,"
"having," "including," and "containing" are to be construed as
open-ended terms (i.e., meaning "including, but not limited to,")
unless otherwise noted. Recitation of ranges of values herein are
merely intended to serve as a shorthand method of referring
individually to each separate value falling within the range,
unless otherwise indicated herein, and each separate value is
incorporated into the specification as if it were individually
recited herein. All methods described herein can be performed in
any suitable order unless otherwise indicated herein or otherwise
clearly contradicted by context. The use of any and all examples,
or exemplary language (e.g., "such as") provided herein, is
intended merely to better illuminate the disclosure and does not
pose a limitation on the scope of the disclosure unless otherwise
claimed. No language in the specification should be construed as
indicating any non-claimed element as essential to the practice of
the disclosure.
[0068] One embodiment of the disclosure may be implemented as a
program product for use with a computer system. The program(s) of
the program product define functions of the embodiments (including
the methods described herein) and can be contained on a variety of
computer-readable storage media. Illustrative computer-readable
storage media include, but are not limited to: (i) non-writable
storage media (e.g., read-only memory devices within a computer
such as CD-ROM disks readable by a CD-ROM drive, flash memory, ROM
chips or any type of solid-state non-volatile semiconductor memory)
on which information is permanently stored; and (ii) writable
storage media (e.g., floppy disks within a diskette drive or
hard-disk drive or any type of solid-state random-access
semiconductor memory) on which alterable information is stored.
[0069] Preferred embodiments of this disclosure are described
herein, including the best mode known to the inventors for carrying
out the disclosure. Variations of those preferred embodiments may
become apparent to those of ordinary skill in the art upon reading
the foregoing description. The inventors expect skilled artisans to
employ such variations as appropriate, and the inventors intend for
the disclosure to be practiced otherwise than as specifically
described herein. Accordingly, this disclosure includes all
modifications and equivalents of the subject matter recited in the
claims appended hereto as permitted by applicable law. Moreover,
any combination of the above-described elements in all possible
variations thereof is encompassed by the disclosure unless
otherwise indicated herein or otherwise clearly contradicted by
context.
* * * * *