U.S. patent application number 16/420778 was filed with the patent office on 2019-09-12 for proactive disease state management system.
This patent application is currently assigned to Huff & Day Enterprises, LLC. The applicant listed for this patent is Huff & Day Enterprises, LLC. Invention is credited to William Glynn Day, Randy Blane Huff.
Application Number | 20190279772 16/420778 |
Document ID | / |
Family ID | 63105404 |
Filed Date | 2019-09-12 |
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United States Patent
Application |
20190279772 |
Kind Code |
A1 |
Huff; Randy Blane ; et
al. |
September 12, 2019 |
Proactive Disease State Management System
Abstract
A proactive disease state management system including network
elements, computer elements and software elements operable to
support a plurality of subscriber devices each under a subscription
plan in which the subscriber device requests the collection of
electronic medical records of a patient for evaluation by a
proactive disease state management engine which interrelates
patient information, patient medical information and patient
laboratory information included in the electronic medical record of
a patient to generate engine result data and populate the fields of
a request reply to the subscriber device.
Inventors: |
Huff; Randy Blane;
(Loveland, CO) ; Day; William Glynn; (Baton Rouge,
LA) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Huff & Day Enterprises, LLC |
Loveland |
CO |
US |
|
|
Assignee: |
Huff & Day Enterprises,
LLC
Loveland
CO
|
Family ID: |
63105404 |
Appl. No.: |
16/420778 |
Filed: |
May 23, 2019 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
|
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15898135 |
Feb 15, 2018 |
10311977 |
|
|
16420778 |
|
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|
62460014 |
Feb 16, 2017 |
|
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
G16H 10/60 20180101;
G16H 50/70 20180101; G16H 50/30 20180101 |
International
Class: |
G16H 50/30 20060101
G16H050/30; G16H 50/70 20060101 G16H050/70; G16H 10/60 20060101
G16H010/60 |
Claims
1-12. (canceled)
13. A method in a computer implemented system, comprising:
retrieving an electronic medical record from an electronic medical
records database; identifying each International Statistical
Classification of Diseases and Related Codes ("ICDC") in said
electronic medical record; comparing each said ICDC in said
electronic medical record to a plurality of disease states in a
disease state database; identifying matches between said ICDC in
said electronic medical record to said plurality of disease states
in a disease state database; scoring said electronic medical record
based upon matches of said ICDC with said plurality of disease
states in said disease state database; attributing a positive score
value to each match of said ICDC in said electronic medical record
to one of said plurality of disease states in said disease state
database; and generating an aggregate health score by aggregating
each said positive score value attributable to each said match of
said ICDC in said electronic medical record to one of said
plurality of disease states in said disease state database.
14. The method of claim 13, further comprising: identifying each
National Drug Code ("NDC") in said electronic medical record;
comparing each NDC in said electronic medical record by reference
to said plurality of disease states in said disease state database;
identifying matches between said NDC in said electronic medical
record to said plurality of disease states in said disease state
database.
15. The method of claim 14, further comprising scoring said
electronic medical record based upon matches of said NDC with said
disease states in said disease state database.
16. (canceled)
17. The method of claim 15, further comprising attributing a null
score value to each failure to match said ICDC in said electronic
medical records to one of said plurality of disease states in said
disease state database.
18. The method of claim 15, further comprising attributing a
positive score value to each match of said NDC to one of said
plurality of disease states in said electronic medical records to
one of said disease states in said disease state database if said
NDC further references to an adverse effect associated to said
disease state.
19. The method of claim 15, further comprising attributing a null
score value to each failure to match said NDC to one of said
plurality of disease states in said disease state database if said
NDC further references to a treatment associated to said disease
state.
20. The method of claim 15, further comprising attributing a
positive score value to each match of said ICDC to one of said
plurality disease states in said disease state database if said NDC
does not further reference to a treatment associated with said
disease state.
21. (canceled)
22. The method of claim 15, further comprising: comparing said
aggregate health score to an average aggregate health score
associated with a plurality of electronic medical records of a
plurality of patients; and assigning said aggregate health score to
a risk level based on said comparison of said aggregate health
score to said average aggregate health score.
23. The method of claim 22, further comprising: associating an
upper tri-tile of said aggregate health scores to a high risk
level; associating a middle tri-tile of said aggregate health
scores to a median risk level; and associating a lower tri-tile of
said aggregate health scores to a nominal risk level.
24. A computer implemented system, comprising: a processor
communicatively coupled to a non-transitory computer readable
media; a disease state database including a plurality of diseases
states, wherein each of said plurality of disease states referenced
to one or more ICDC International Statistical Classification of
Diseases and Related Codes ("ICDC"); a program contained in said a
non-transitory computer readable media, said program including: an
electronic medical record interface executable to access electronic
medical records in one or more medical records databases; an
electronic medical records evaluation module executable to:
identify each said ICDC in said electronic medical records; and
compare each said ICDC identified in said electronic medical
records to one or more said ICDC associated with each of said
plurality of disease states in said disease state database; and
identify matches between said ICDC in said electronic medical
record to said plurality of disease states in a disease state
database; a scoring module executable to: score said electronic
medical record based upon matches of said ICDC with said plurality
of disease states in said disease state database; attribute a
positive score value to each match of said ICDC in said electronic
medical record to one of said plurality of disease states in said
disease state database; and generate an aggregate health score by
aggregating each said positive score value attributable to each
said match of said ICDC in said electronic medical record to one of
said plurality of disease states in said disease state
database.
25. The system of claim 24, wherein each of said plurality of
disease states in said disease state database further referenced to
one or more National Drug Codes ("NDC"), and wherein said
electronic medical records evaluation module further executable to:
identify each said NDC in said electronic medical records; and
compare each said NDC identified in said electronic medical records
to said one or more NDC associated with each of said plurality of
disease states in said disease state database; and identify matches
between said NDC in said electronic medical record to said
plurality of disease states in said disease state database.
26-27. (canceled)
28. The system of claim 25, wherein each failure to match said ICDC
in said electronic medical records to one of said plurality of
disease states in said disease state database generates a null
score value.
29. The system of claim 25, wherein each match of said NDC to one
of said plurality of disease states in said electronic medical
records to one of said disease states in said disease state
database generates a positive score value if said NDC references to
an adverse effect associated to said disease state.
30. The system of claim 25, wherein each match of said NDC to one
of said plurality of disease states in said electronic medical
records to one of said disease states in said disease state
database generates a null score value if said NDC references a
treatment associated to said disease state.
31. The system of claim 25, wherein each match of said ICDC to one
of said plurality of disease states which does not have a
corresponding match to said NDC to treat said disease state
generates a positive score value.
32. (canceled)
33. The system of claim 25, further comprising a patient risk level
assignment module executable to compare said aggregate health score
to an average aggregate health score associated with a plurality of
electronic medical records of a plurality of patients.
34. The system of claim 33, wherein said patient risk level
assignment further executable to: associate an upper tri-tile of
said aggregate health scores to a high risk level; associate a
middle tri-tile of said aggregate health scores to a median risk
level; and associate a lower tri-tile of said aggregate health
scores to a nominal risk level.
Description
[0001] This United States Non-Provisional Patent Application claims
the benefit of U.S. Provisional Patent Application No. 62/460,014,
filed Feb. 16, 2017, hereby incorporated by reference herein.
I. FIELD OF THE INVENTION
[0002] A proactive disease state management system which correlates
data included in the electronic medical record of a patient to a
plurality of disease states contained in a disease state database
and calculates a score attributable to each one of the plurality of
disease states contained in the disease state database based on
correlations made between the data in the electronic medical record
and the plurality of disease states, and further calculates an
aggregate score for all correlations to the disease states
contained in the disease state database which can by comparison of
the aggregate score to an average aggregate score be assigned a
risk level attributable to the electronic medical record of the
patient.
II. SUMMARY OF THE INVENTION
[0003] A broad object of embodiments of the invention can be to
provide a proactive disease state management system including
network elements, computer elements and software elements operable
to support a plurality of subscriber devices each under a
subscription plan in which the subscriber device requests the
collection of electronic medical records of a patient for
evaluation by a proactive disease state management program which
correlates International Statistical Classification of Diseases and
Related Codes ("ICDC") or National Drug Codes ("NDC") included in
the electronic medical record of a patient to a plurality of
disease states included in a disease state database and calculates
a score attributable to each one of the plurality of disease states
contained in the disease state database, and further calculates an
aggregate score for all the correlations made to disease states
contained in the disease state database which can be by comparison
of the aggregate score to an average aggregate score can be
assigned a risk level attributable to the electronic medical record
of the patient.
[0004] Another broad object of embodiments of the invention can be
to provide a method in a computer implemented proactive disease
state management system including one or more of: retrieving an
electronic medical record from an electronic medical records
database and evaluating the medical record by identifying each ICDC
or NDC in the electronic medical record and identifying matches
between the ICDC or the NDC to said plurality of disease states in
a disease state database and scoring said electronic medical record
of a patient by aggregating the positive score values associated
with each of the plurality of disease states in the disease state
database and assigning the aggregate health score to a risk level
based on said comparison of the aggregate score to an average
aggregate score.
[0005] Naturally, further objects of particular embodiments of the
invention are disclosed throughout other areas of the
specification, drawings, and claims.
III. A BRIEF DESCRIPTION OF THE DRAWINGS
[0006] FIG. 1 is a block diagram of a particular embodiment of a
proactive disease state management system.
[0007] FIG. 2 is an enlarged portion of FIG. 1 showing a processor
communicably coupled to a non-transitory computer readable media
containing a particular embodiment of the proactive disease state
management program.
[0008] FIG. 3 is a block flow diagram illustrating a method in the
proactive disease state management system of evaluating and scoring
the data in an electronic medical record.
[0009] FIG. 4 is a block diagram of a proactive disease state
management engine executable to evaluate and score the data in an
electronic medical record and output engine results.
[0010] FIG. 5 is an illustration of a subscriber device having a
display surface on which menus of a graphical user interface
downloadable from the proactive disease state management engine can
be displayed.
IV. DETAILED DESCRIPTION OF THE INVENTION
[0011] Proactive Disease State Management System. Generally
referring to FIGS. 1 through 5, the proactive disease state
management system (1)("PDSMS") includes network elements, computer
elements and software elements operable to support a plurality of
subscriber devices (2) each under a subscription plan (3) in which
the subscriber device (2) requests the collection of electronic
medical records (4)("EMR") of a patient (5) and evaluation of the
EMR (4) by a proactive disease state management
engine(s)(6)("PDSME" or "engine") which interrelates one or more of
patient information (7), patient medical information (8) and
patient laboratory information (9) included in the EMR (4) to
generate engine result data (10) and populate the fields of a
request reply (11) to the subscriber device (2).
[0012] The Network. Now referring primarily to Figures land 2, the
PDSMS (1) (also referred to as the "system") can be distributed on
one or more servers (12) (along with associated databases 12' and
30) having a server network interface (13) operably coupled to a
plurality of subscriber devices (2) by a public network (14), such
as the Internet (15), a cellular-based wireless network(s) (16), or
a local network (17)(individually or collectively the "network"
(18)).
[0013] The network (18) supports a plurality of communication
resources (19)(along with other communication resources made
available in the future) to afford as illustrative examples:
recording, transmission, or reproduction of images (whether still
or moving images), sound relating to acoustical, mechanical or
electrical frequencies, electronic mail, instant messaging, text
messaging (such as short message service) multimedia messaging
(such as multimedia message service) attributable to the execution
of self-contained programs or pieces of software designed to
fulfill particular purposes (also referred to as "applications"
(20)), as illustrative examples: web applications, online
applications, mobile applications, downloadable by a subscriber
device (2).
[0014] Remote Patient Medical Information Databases. A patient's
EMR (4) can be stored in one or more medical records databases
(21). The term "electronic medical record (EMR)" refers to the
record of patient encounters and medical services received by one
of a plurality of patients (5) from one or more care delivery
organizations (22) which can each occur in a common format using a
common clinical data repository (23) or can be an accumulation of
EMR (4) of a plurality of unaffiliated care delivery organizations
(24) which in turn utilize unaffiliated clinical data repositories
(25) which may not be in a common format. The EMR (4) of a patient
(5) includes, but need not necessarily be limited to, patient
information (7) such as date of birth, weight, sex; patient medical
information (8) such as current diagnosis, prescribed medications
and allergy indications; and patient laboratory information (9)
such as performed laboratory tests and laboratory test values.
[0015] Health Level 7 Data Files. Typically, the transfer of EMR
(4) between software applications used by care delivery
organizations (22)(24) occurs in accordance with a set of
international standards referred to as the Health Level 7 ("HL7")
standards. These standards focus on the application layer, which is
"layer 7" in the Open Systems Interconnection Model ("OSI model").
The HL7 standards are produced by Health Level Seven International,
an international standards organization, and are adopted by other
standards issuing bodies such as American National Standards
Institute and International Organization for Standardization.
[0016] HL7 specifies a number of flexible standards, guidelines,
and methodologies by which a plurality of healthcare delivery
organizations (23)(24) can communicate with each other. HL7
guidelines or data standards are a set of rules that allow
information to be shared and processed in a uniform and consistent
manner. These data standards are meant to allow health care
delivery organizations to easily share clinical information.
[0017] HL7 I considers the following standards to be its primary
standards: [0018] Version 2.x Messaging Standard--an
interoperability specification for health and medical transactions.
[0019] Version 3 Messaging Standard--an interoperability
specification for health and medical transactions. [0020] Clinical
Document Architecture (CDA)--an exchange model for clinical
documents, based on HL7 Version 3. [0021] Continuity of Care
Document (CCD)--a US specification for the exchange of medical
summaries, based on CDA. [0022] Structured Product Labeling
(SPL)--the published information that accompanies a medicine, based
on HL7 Version 3. [0023] Clinical Context Object Workgroup
(CCOW)--an interoperability specification for the visual
integration of user applications.
[0024] PDSMS Web Application Program Interface. Embodiments of the
PDSMS includes a PDSMS Web application program interface ("PDSMS
Web API") (26). The PDSMS Web API (26) includes an PDSMS web
interface program (27) contained in a non-transitory computer
readable media (28)(also referred to as a memory element)
communicatively coupled to a processor (29). Upon execution, the
PDSMS Web API (26) routes hypertext transfer protocol ("HTTP")
requests to the one or more medical records databases (21) to
transfer the requested EMR (4) of a patient (5) to the PDSME
database (12'), (30) for evaluation by the PDSME (6).
[0025] The Engine. Embodiments of the PDSMS (1) can include a
proactive disease state management engine ("PDSME" or "program")
(6) contained in the memory element (28) communicatively coupled to
the processor (29). The PDSME includes computer-executable
instructions in the form of a program and modules that utilize
routines, objects, components, data structures, or the like, to
perform particular functions or tasks or implement particular
abstract data types, or the like, being executed by the computer
elements and network elements, it is not intended that embodiments
of the invention be limited to a particular set of
computer-executable instructions or protocols.
[0026] The HL7 Translation Module. Embodiments of the PDSME (6) can
include an HL7 translation module (31) executable to translate HL7
data files (32) contained in the EMR (4) of a patient (5) retrieved
from one or more medical records databases (21) of one or more
common clinical data repositories (23), or one or more unaffiliated
clinical data repositories (24) (or a combination thereof) into a
common format which can be downloaded to a PDSME database (30).
Similarly, the HL7 translation module (31) can be executed to
translate the result data (10) from the PDSME (6), or contained in
the PDSME database (30), from the common format of the PDSME
database (30) to HL7 data files (32) for transmission to one or
more subscriber devices (2).
[0027] EMR Evaluation Module. Embodiments of the PDSME (6) further
include a EMR evaluation module (33). The EMR evaluation module
(33) can be executed to evaluate the EMR (4) of a patient (5) to
identify International Statistical Classification of Diseases and
Related Codes (34) ("ICDC") the ("Diagnosis Evaluation") (38) and
to identify National Drug Codes (35) ("NDC") (the "Medication
Evaluation") (39). The ICDC (34) includes more than 14,400
different codes each associated with and allows tracking of
diagnosis of the corresponding disease state (36). The NDC (34) is
a ten digit, three-segment identifier associated with and allows
the tracking of each medication (37) listed under Section 510 of
the US Federal Food, Drug, and Cosmetic Act. While embodiments of
the invention may describe the use of ICDC and NDC as practiced in
the United States; it is not intended to preclude embodiments which
use classification systems similar to the ICDC or NDC in foreign
countries.
[0028] The EMR evaluation module (33) operates on the PDSME
database (30) in which each of a plurality of disease states (36)
can be associated with one or more ICDC (34) or NDC (35). In part,
the EMR evaluation module (33) operates to perform a Diagnosis
Evaluation (38) in which the one or more ICDC (34) identified in
the EMR (4) of a patient (5) can be compared against each of a
plurality of disease states (36) contained in the PDSME database
(30) and by comparison can be matched to a disease state (36) to
trigger a "YES" indicator (40) or not matched to a diseases state
to trigger a "NO" indicator (41) associated with each disease state
(36). The "YES" indicator (40) establishes that either a diagnosis
for the disease state (36) occurs as a ICDC (34) in the EMR (4) of
the patient (5) or other diagnoses occur as a ICDC (34) in the EMR
(4) of the patient (5) that could contribute to exacerbation or
generation of the disease state (34). Also in part, the EMR
evaluation module (33) operates on the PDSME database (30) to
perform the Medication Evaluation (39) in which the one or more of
the NDC (35) identified in EMR (4) of a patient (5) can be compared
against the plurality of disease states (36) and by comparison can
be matched to a disease state (36) to trigger a "Yes" indicator
(40) or not matched to trigger a "NO" indicator (41).
[0029] As one illustrative example, the relational PDSME database
(30) can contain a plurality of disease states (36) each associated
with a plurality of ICDC (34) or NDC (35) (collectively referred to
as "triggers" (42) that match to the ICDC (34) or NDC (35) (or
both) occurring in the EMR (4) of a patient (5). As one
non-limiting example, an embodiment of the PDSME database (30) can
include: [0030] Sleep Disorder--having an associated total of 84
triggers [0031] Stroke having an associated total of 23 triggers
[0032] Urinary Tract Infections having an associated total of 48
triggers [0033] Parkinson's having an associated total of 43
triggers [0034] Pain having an associated total of 34 triggers
[0035] Osteoporosis having an associated total of 36 triggers
[0036] Heart Failure having an associated total of 25 triggers
[0037] Gastrointestinal having an associated total of 53 triggers
[0038] Falls having an associated total of 35 triggers [0039]
Depression having an associated total of 35 triggers [0040]
Dehydration having an associated total of 28 triggers [0041] COPD
having an associated total of 42 triggers [0042] Altered
Nutritional Status having an associated total of 80 triggers [0043]
Diabetes having an associated total of 83 triggers
[0044] As one particular example, the disease state (36) "Altered
Nutritional Status" can be contained in the PDSME database (30).
The administrator of the PDSME (6) can associate a plurality of
ICDC (34) and a plurality of NDC (35) with the disease state (36)
"Altered Nutritional Status" as triggers (42). The ICDC (34) or NDC
(35) associated with the disease state (36) as triggers (42) can be
identified by the administrator using appropriate clinical
guidelines. The Institute of Medicine defines clinical practice
guidelines as "statements that include recommendations, intended to
optimize patient care, that are informed by a systematic review of
evidence and an assessment of the benefits and harms of alternative
care options." One source of clinical guidelines can be American
College of Physicians. Accordingly, the ICDC (34) and the NDC (35)
associated with a disease state (36) can be greater or lesser in
based on changes in clinical guidelines over time. Accordingly, the
total number of triggers (42) associated with each disease state
(36) can vary over time.
[0045] The Scoring Module. Embodiments of the PDSME (6) further
include a EMR scoring module (43) communicatively coupled to the
EMR evaluation module (33). The EMR scoring module (43) can be
executed to calculate and attribute a score (44) to each one of the
plurality of disease states (36) contained in the PDSME database
(30), and can calculate an aggregate score (45) for all the disease
states (36) contained in the PDSME database (36) (also referred to
as the "health score" (45). The health score (45) provides a
clinician a ready reference regarding the health level of each
patient (5).
[0046] As to particular embodiments, including the Diagnosis
Evaluation (38), if the EMR evaluation module (33) matches an ICDC
(34) to a disease state (36) contained in the PDSME database (30)
and associates a disease state indicator of "Yes" (40) to the
disease state (36), then the EMR scoring module (43) associates a
score value (46) of "one" with that listed disease state (36), and
if the EMR evaluation module (33) fails to match an ICDC (34) to a
disease state (36) contained in the PDSME database (30) and
associates a disease state indicator "No" (41) to the disease state
(36), then the EMR scoring module (43) associates a score value
(46) of "zero" (also referred to as a "null score value") or with
that listed disease state (36).
[0047] As to particular embodiments, including the Medication
Evaluation (39), if the EMR evaluation module (33) matches an NDC
(35) to a disease state (36) contained in the PDSME database (30)
and associates a disease state indicator of "Yes" (30) with that
listed disease state (36), and if, the EMR evaluation module (33)
further matches the medication (37) associated with the NDC (35) to
an adverse effect on the disease state (36), or if the medication
(37) associated with the NDC (35) contributes or potentiates in the
development of the disease state (36) (collectively "an adverse
effect"), then the EMR scoring module (43) associates a score value
(46) of "one" with the disease state (36), if in the alternative,
the EMR evaluation module (33) further matches the medication (37)
associated with the NDC (35) to a treatment for an ICDC (34) also
matched to the disease state (36), then the EMR scoring module (43)
associates a score value (46) of "zero" with the disease state
(36), if however, the EMR evaluation module (33) does not match a
NDC (35) to a disease state (36) contained in the PDSME database
(30) and associates a disease state indicator of "No" (41) with the
disease state (36), then the EMR scoring module (43) associates a
score value (46) of "zero" to the disease state (36), if however,
if the EMR evaluation module (33) matches an ICDC (34) to the
disease state (36), and if the EMR evaluation module (33) does not
match an NDC (35) to the disease state (36) and associates a
disease state indicator "Yes" (40) to the disease state (36), then
the EMR scoring module (43) associates a score value (46) of "one"
to the disease state (36) for not treating the disease state
(36).
[0048] As to the particular embodiments above described, due to the
complexity of individual physiological response to medications (37)
and other existing disease states (36), there are no other factors
weighed in assigning the score values (46) as described above.
[0049] The Rules Engine. The above illustrative examples of the EMR
evaluation module (33) and the EMR scoring module (43) are not
intended to preclude other rule-based embodiments which allow the
EMR (4) of a patient (5) to be evaluated based on other EMR data
(47) that in accordance with the general hierarchy of the rules
(48) contained the knowledge base (49) of the rules engine
(50).
[0050] As to embodiments, the rules engine (50) has a hierarchy as
follows:
[0051] 1. Disease State(s) contained in the PDSME database (30).
[0052] A. Trigger Rule--a disease state(s)(36) is determined if an
ICDC (34) is contained in the EMR (4) of a patient (5). [0053] B.
Groups--groupings/roll-ups of similar rules (the sub-headings
within the documents) [0054] 1) "Risk" if EMR data (47) in the EMR
(4) is associated with a health risk (51) of a disease state (36),
then that hit is assigned a score value (46) which is positive (the
above illustrative embodiments assign one "1"); [0055] 2) "Therapy"
if a EMR data (47) in the EMR (4) is associated with a therapy (52)
of a disease state (36), then that hit is assigned a score value
(46) which is negative (the above illustrative embodiments assign
minus one "-1").
[0056] As an example, for the disease state (36) "Altered
Nutritional Status" the rules engine (50) includes the follow
rules:
[0057] I. Disease State: Altered Nutritional Status ("ANS"). [0058]
A. Trigger Rule: EMR (4) of patient (5) includes the ICDC (34) for
ANS [0059] Group: "Altered Nutritional Status Dysphagia Side Effect
Meds" [0060] Rule: "ACE Inhibitors" (37); "Risk" (51); "Score"=1
[0061] Group: "Altered Nutritional Status Acceptable Meds" [0062]
Rule: "Megace" (37); "Therapy" (52); "Score"=-1
[0063] The PDSME Report. Now referring primarily to the
illustrative example of Table 1, the EMR evaluation module (33) can
be executed to evaluate the EMR (4) of a patient (5) to compare
ICDC (34) and NDC (35) against fifteen disease states (36)(as shown
in Table 1, Column 1--Disease States; however, the example of the
fifteen disease states (36) listed in Table 1 is not intended to
preclude embodiments which include a greater or lesser number of
disease states (36). One or more "triggers (42)" can be associated
with each disease state (36) (as shown in Table 1, Column 2--Actual
Risk Factor Trigger Totals) and in the example of Table 1 there are
a total of 695 triggers (42) associated with the fifteen disease
states (36); however, this is not intended to preclude embodiments
have a greater or lesser number of triggers (42) for each disease
state (36) or in aggregate total for all the disease states (36)
listed. The EMR evaluation module (33) scores the disease state
indicators (40)(41) (as shown in Table 1, Column 3--Patient Total)
and then calculates the score (44) for each disease state
(36)(Patient Total For Disease State/by Risk Factor Trigger Total
For Disease State.times.100) and in the aggregate for the listed
plurality of disease states (36)(Patient Total For All Disease
States/by Risk Factor Trigger Total for All Disease
States.times.100) to generate the health score (45). In the example
of Table 1 the aggregate health score (45) is calculated by the EMR
scoring module (43) (695/467.times.100=67).
TABLE-US-00001 TABLE 1 EXAMPLE HEALTH SCORE REPORT. Actual Risk
Factor Health Trigger Patient SCORE Disease States (36) Totals(RF)
Total (PT) (100X PT/RF) Sleep Disorder 84 23 27 Stroke 23 18 78
Urinary Tract Infection 48 41 85 Parkinson's 43 34 79 Pain 34 21 62
Osteoporosis 36 31 86 Heart Failure 25 13 52 Gastrointestinal
Disorder 53 45 85 Fall 35 23 66 Depression 35 21 60 Dementia 46 43
93 Dehydration 28 11 39 COPD 42 33 79 Altered Nutritional Status 80
65 81 Diabetes 83 45 54 Total Overall 695 467 67 (Health Score)
[0064] The Patient Risk Level Assignment Module. Embodiments of the
PDSME (6) further include a patient risk level assignment module
(53) which operates to assign each of a plurality of patients (5)
to a risk level (54) of: a high risk level (55), a median risk
level (56), or a nominal risk level (57). The segregation of
patients (5) into risk levels (54) applies to those patient's (5)
identified by the EMR evaluation module (33) as having a "YES"
indicator (40) indicating an ICDC (34) in the EMR (4) for any one
of the plurality of disease states (36) contained in the PDSME
database (30). The patients (5) can then be allocated to a risk
level (54) based comparison of the aggregate health score (45) to
the average aggregate health score (58) of all patients (5) in a
bell curve format divided into one-thirds with the higher third
comprising high risk level (55), the middle third comprising the
median risk level (56) and the lower third comprising the nominal
risk level (57). Patients (5) not having a ICDC (34) in the EMR (4)
for all of the plurality of disease states (36) contained in the
PDSME database (36) are assigned to the nominal risk level (57).
All patients that have an existing ICDC (34) in the EMR (4) are
automatically assigned to the high risk level (55).
[0065] Counseling Engine. Embodiments of the PDSME (6) can, but
need not necessarily, further include a counseling engine (59)
executable to assist clinicians in counseling the patient (5), with
a corresponding set for the professional. It can serve as both a
reminder and a reliable reference resource for clinicians with only
important information highlighted.
[0066] Min/Max Dose Engine. Embodiments of the PDSME (6) can, but
need not necessarily, include a minimum-maximum dose engine (60)
executable to provide drug-dosing information to clinicians on the
most frequently prescribed drugs. This five-engine set offers an
easy to implement resource for quick-check information on the usual
range of daily doses for adult, pediatric, and geriatric
patients.
[0067] Dosage Range Check Engine. Embodiments of the PDSME (6) can,
but need not necessarily, include a dosage range check engine (61)
executable to monitor the appropriateness of medication dosing. It
uses age, route of administration, indications, and organ function
data to identify safe dosage levels based on certain
patient-specific parameters. It provides renal dose screening,
hepatic adjustment indicators, and lifetime maximum dose. Dosing
information also accommodates the narrow therapeutic window for
neonates and infants.
[0068] Drug-Disease Contraindications Engine. Embodiments of the
PDSME (6) can, but need not necessarily, include a drug-disease
contraindications engine (62) executable to create warnings
concerning the use of certain medications in patients with specific
conditions and diseases, or patients who have had certain
procedures or diagnostic tests. Clinicians may use these warnings
to make informed decisions about altering a patient's drug therapy
when these conditions exist.
[0069] Prioritized Warnings Engine. Embodiments of the PDSME (6)
can, but need not necessarily, include a prioritized warnings
engine (63) executable to provide auxiliary labels and establishes
label priority for a particular drug product based on the relative
clinical importance of the message for that particular clinical
formulation. These label warnings enable clinicians to provide
patients with essential information by affixing the labels to the
medication vial, or printing them separately for reference.
[0070] Indications Engine. Embodiments of the PDSME (6) can, but
need not necessarily, include an indications engine (64) executable
to assessing the appropriateness of drug therapy for a specific
medical condition, based on current medical evidence. This engine
provides clinicians information to make informed decisions
regarding medication therapy and may also be used to help identify
potentially inappropriate drug treatment for a given disease. The
engine includes both FDA-approved and certain "off-label"
indications substantiated by primary medical literature.
[0071] Drug Information Engine. Embodiments of the PDSME (6) can,
but need not necessarily, include a drug information engine (65)
executable to provide an evidence-based foundation for safe and
effective drug therapy. These full-text monographs have been
officially designated as a federal standard on drug therapy, based
on accepted medical practice, and are used by pharmacists,
physicians, nurses, and other clinicians in a wide range of
healthcare environments.
[0072] High Risk Medication Engine. Embodiments of the PDSME (6)
can, but need not necessarily, include a high risk medication
engine (66) executable to provide risk evaluation and mitigation
strategy (REMS) and boxed warning information of prescription drugs
directly within the user's workflow. The engine reviews REMS and
boxed warnings, captures important and actionable content and
presents it in a format that is flexible and easy to integrate,
eliminating the manual effort it takes to monitor REMS and boxed
warning changes from the manufacturer. The engine also maintains
historical Information to support retrospective analysis or audit
functions. This engine helps ensure patient safety and regulatory
compliance set forth by the FDA by presenting actionable messages
to the right user at the right time.
[0073] Medication Guide Engine. Embodiments of the PDSME (6) can,
but need not necessarily, include a medication guide engine (67) is
a convenient source for all currently available Medication Guides
submitted by manufacturers through the FDA Structured Product Label
(SPL) file and subsequently posted to the National Library of
Medicine's (NLM) "Daily Med" website. Through validated links to
the National Drug Code (NDC) in the engine provides a notification
to pharmacists when a Medication Guide is required for a drug
product and provides automated access to all electronic Medication
Guides filed with the FDA, in PDF and XML.
[0074] Drug-Lab Interference Engine. Embodiments of the PDSME (6)
can, but need not necessarily, include a drug-lab interference
engine (68) executable identify drugs that may falsely alter
laboratory test results. A drug can falsely alter a laboratory test
result by causing an analytic interference in a laboratory test.
This engine can be used by clinicians to screen patient lab and
drug therapy data, and to look up reference information on in-vitro
drug-lab conflicts.
[0075] Duplicate Therapy Engine. Embodiments of the PDSME (6) can,
but need not necessarily, include a duplicate therapy engine (69)
helps clinicians prevent patients from receiving duplicate drug
therapies through the deployment of a highly-specific clinical
screening of duplicate drug therapies with clinical relevance. The
engine helps detect potentially problematic duplications--not
simply two drugs in the same therapeutic class, which may be
valid.
[0076] Allergens Engine. Embodiments of the PDSME (6) can, but need
not necessarily, include a drug allergy engine (70) executable to
identify and consolidate information about drugs known to cause
significant allergic reactions, cross-sensitivities, and drug
intolerances by identifying and helping to avert drug-allergy
issues. Drug-allergy screenings also look at certain inactive
medication ingredients such as latex and peanuts. A specially
developed Allergen Pick List streamlines workflow by giving the
user a convenient way to quickly and easily record a patient's
allergy, enabling fast and convenient allergy profiling.
[0077] Subscriber Device. Now referring to primarily to FIG. 1, as
above described, one or more subscriber devices (2) can be connect
with one or more servers (12) of the system (1) through the network
(18). In particular embodiments, the subscriber device (2) can take
the form of a limited-capability computer designed specifically for
communications over the network (18). Alternatively, the subscriber
devices (2) might be a set-top box, an intelligent television
connected to receive data through an entertainment medium such as a
cable television network or a digital satellite broadcast, a
hand-held device such as a smart phone, a slate or pad computer, a
personal digital assistant or camera/cell phone, or a
multiprocessor system, a microprocessor-based or programmable
consumer electronic, a network personal computer, a minicomputer, a
mainframe computer, or the like. Each of the one or more subscriber
devices (2) can further include other peripheral output devices
(71) such as speakers and printers; although the peripheral output
devices (71) are not so limited. Each subscriber devices (2) can
include an Internet browser (72) such as Microsoft's INTERNET
EXPLORER.RTM., GOOGLE CHROME.RTM., MOZILLA.RTM., FIREFOX, or the
like, which functions to download and render multimedia content
that is formatted in "hypertext markup language" (HTML).
[0078] The Subscription Plan. Subscriber devices (2) used with the
network (18) operate under a subscription plan (3) that define the
terms, features, and fees under which network (18) use is granted.
For example, a subscription plan (3) might allow a predefined
number of requests of the PDSME (6).
[0079] Graphical User Interface Module. Now referring primarily to
FIGS. 1 and 5, embodiments of the PDSME (6) further include a
graphical user interface module (73). The graphical user interface
module (73) can be resident in the one or more servers (12) of the
system (1) (as shown in the example of FIG. 1) and, as to
particular embodiments, the subscriber device (2) can use the
Internet browser (72) to simply display downloaded a graphical user
interface (74) on the display surface (75) of the subscriber device
(2) and to relay user inputs back to the one or more servers (12).
The server (12) would respond by formatting or populating one or
more graphical user interface menus (76) (see for example FIG. 4)
and downloading them for display on the display surface (77) of the
subscriber device (2).
[0080] In other embodiments, the one or more servers (12) can be
used primarily as sources of images and data, with primary
responsibility for implementing the graphical user interface (74)
being placed upon each of the one or more subscriber devices (2)(as
shown in the example FIG. 4). As to these embodiments, each of the
one or more subscriber devices (2) can run the graphical user
interface module (73) implementing the graphical user interface
(74), to retrieve images and data from the one or more servers
(12). While illustrative examples in this description attribute
images and data to one or more servers (12) for clarity, it is to
be understood that various types of images and data may reside in
one server computer (12) or can be distributed among a plurality of
server computers (12).
[0081] It can be appreciated that the PDSME (6) or portion of the
PDSME (6) such as the graphical user interface module (73) can be
contained and provided on a computer-readable media (78) that can
store data that is accessible by the subscriber device (2), such as
magnetic cassettes, flash memory cards, digital video disks,
Bernoulli cartridges, random access memories (RAMs), read only
memories (ROMs), and the like.
[0082] A subscriber (79) can enter commands and information into
the subscriber device (2) through the graphical user interface (74)
through input devices (79) such as a keyboard or a pointing device
such as a mouse; however, any method or device that converts
subscriber (79) action into commands and information can be
utilized including, but not limited to: a microphone, joystick,
game pad, touch screen, or the like.
[0083] A "click event" occurs when the subscriber (80) operates an
PDSME (6) function through the use of a command which for example
can include pressing or releasing the left mouse button while a
pointer is located over a control icon (or other interactive field
which activates a function) displayed in the graphic user interface
(74). However, it is not intended that a "click event" be limited
to the press and release of the left button on a mouse while a
pointer (is located over a control icon (or field), rather, a
"click event" is intend to broadly encompass a command by the user
through which a function of PDSME (6)(or other program,
application, module or the like) including the graphical user
interface module (73) which implements the graphic user interface
(74) can be activated or performed, whether through selection of
one or a plurality of control icon or fields, or by user voice
command, keyboard stroke, mouse button, touch on a touch screen, or
otherwise.
[0084] Again, referring primarily to FIG. 4, showing an exemplary
embodiment of the graphic user interface (74) which can be
implemented using various technologies and different devices,
depending on the preferences of the designer and the particular
efficiencies desired for a given circumstance. By click event the
subscriber (80) can operate the functionalities of the graphical
user interface module (73) to display an interactive graphic user
interface (74) on a display surface (77) of the subscriber device
(2).
[0085] As can be easily understood from the foregoing, the basic
concepts of the present invention may be embodied in a variety of
ways. The invention involves numerous and varied embodiments of a
computer implemented proactive disease state management system and
methods for making and using such computer implemented proactive
disease state management system including the best mode.
[0086] As such, the particular embodiments or elements of the
invention disclosed by the description or shown in the figures or
tables accompanying this application are not intended to be
limiting, but rather exemplary of the numerous and varied
embodiments generically encompassed by the invention or equivalents
encompassed with respect to any particular element thereof. In
addition, the specific description of a single embodiment or
element of the invention may not explicitly describe all
embodiments or elements possible; many alternatives are implicitly
disclosed by the description and figures.
[0087] It should be understood that each element of an apparatus or
each step of a method may be described by an apparatus term or
method term. Such terms can be substituted where desired to make
explicit the implicitly broad coverage to which this invention is
entitled. As but one example, it should be understood that all
steps of a method may be disclosed as an action, a means for taking
that action, or as an element which causes that action. Similarly,
each element of an apparatus may be disclosed as the physical
element or the action which that physical element facilitates. As
but one example, the disclosure of a "trigger" should be understood
to encompass disclosure of the act of "triggering"--whether
explicitly discussed or not--and, conversely, were there
effectively disclosure of the act of "triggering", such a
disclosure should be understood to encompass disclosure of a
"trigger" or even a "means for triggering." Such alternative terms
for each element or step are to be understood to be explicitly
included in the description.
[0088] In addition, as to each term used, it should be understood
that unless its utilization in this application is inconsistent
with such interpretation, common dictionary definitions should be
understood to be included in the description for each term as
contained in the Random House Webster's Unabridged Dictionary,
second edition, each definition hereby incorporated by
reference.
[0089] All numeric values herein are assumed to be modified by the
term "about", whether or not explicitly indicated. For the purposes
of the present invention, ranges may be expressed as from "about"
one particular value to "about" another particular value. When such
a range is expressed, another embodiment includes from the one
particular value to the other particular value. The recitation of
numerical ranges by endpoints includes all the numeric values
subsumed within that range. A numerical range of one to five
includes for example the numeric values 1, 1.5, 2, 2.75, 3, 3.80,
4, 5, and so forth. It will be further understood that the
endpoints of each of the ranges are significant both in relation to
the other endpoint, and independently of the other endpoint. When a
value is expressed as an approximation by use of the antecedent
"about," it will be understood that the particular value forms
another embodiment. The term "about" generally refers to a range of
numeric values that one of skill in the art would consider
equivalent to the recited numeric value or having the same function
or result. Similarly, the antecedent "substantially" means largely,
but not wholly, the same form, manner or degree and the particular
element will have a range of configurations as a person of ordinary
skill in the art would consider as having the same function or
result. When a particular element is expressed as an approximation
by use of the antecedent "substantially," it will be understood
that the particular element forms another embodiment.
[0090] Moreover, for the purposes of the present invention, the
term "a" or "an" entity refers to one or more of that entity unless
otherwise limited. As such, the terms "a" or "an", "one or more"
and "at least one" can be used interchangeably herein.
[0091] Thus, the applicant(s) should be understood to claim at
least: i) each of the systems or engines herein disclosed and
described, ii) the related methods disclosed and described, iii)
similar, equivalent, and even implicit variations of each of these
devices and methods, iv) those alternative embodiments which
accomplish each of the functions shown, disclosed, or described, v)
those alternative designs and methods which accomplish each of the
functions shown as are implicit to accomplish that which is
disclosed and described, vi) each feature, component, and step
shown as separate and independent inventions, vii) the applications
enhanced by the various systems or components disclosed, viii) the
resulting products produced by such systems or components, ix)
methods and apparatuses substantially as described hereinbefore and
with reference to any of the accompanying examples, x) the various
combinations and permutations of each of the previous elements
disclosed.
[0092] The background section of this patent application provides a
statement of the field of endeavor to which the invention pertains.
This section may also incorporate or contain paraphrasing of
certain United States patents, patent applications, publications,
or subject matter of the claimed invention useful in relating
information, problems, or concerns about the state of technology to
which the invention is drawn toward. It is not intended that any
United States patent, patent application, publication, statement or
other information cited or incorporated herein be interpreted,
construed or deemed to be admitted as prior art with respect to the
invention.
[0093] The claims set forth in this specification, if any, are
hereby incorporated by reference as part of this description of the
invention, and the applicant expressly reserves the right to use
all of or a portion of such incorporated content of such claims as
additional description to support any of or all of the claims or
any element or component thereof, and the applicant further
expressly reserves the right to move any portion of or all of the
incorporated content of such claims or any element or component
thereof from the description into the claims or vice-versa as
necessary to define the matter for which protection is sought by
this application or by any subsequent application or continuation,
division, or continuation-in-part application thereof, or to obtain
any benefit of, reduction in fees pursuant to, or to comply with
the patent laws, rules, or regulations of any country or treaty,
and such content incorporated by reference shall survive during the
entire pendency of this application including any subsequent
continuation, division, or continuation-in-part application thereof
or any reissue or extension thereon.
[0094] Additionally, the claims set forth in this specification, if
any, are further intended to describe the metes and bounds of a
limited number of the preferred embodiments of the invention and
are not to be construed as the broadest embodiment of the invention
or a complete listing of embodiments of the invention that may be
claimed. The applicant does not waive any right to develop further
claims based upon the description set forth above as a part of any
continuation, division, or continuation-in-part, or similar
application.
* * * * *