TWI317507B - Health management system with circular risk references - Google Patents

Description

1317507 IX. Description of invention: 95. 2Γ2Τ月修修(3⁄4正换页 [Technical field of invention] The present invention is a health tube of the reference to the risk cycle. (Health 曰 = status), providing a management reference system based on the immediate risk status. [Prior Art] * Traditionally, the first-line outpatient medical procedures include: registration, waiting, interviews, 4. Inspection, reporting, diagnosis, Prescriptions, referrals, appointments, and prescriptions are described as follows: 刀刀匕刀1 1. Registration: medical institution confirms identity, preparation of secret information, computer dispatched medical treatment number. 2. Waiting: medical institution provides waiting (4), computer _The item number or the name of the staff member. 3. Talk: The doctor listens to the patient and tells the patient about the condition, understands the patient's personal background, and considers the cause and expectation. 4. Consultation: The doctor asks relevant symptoms according to his professional judgment. Clarify the problem and understand the possible causal relationship. 5. Check: Physicians according to their professional experience _ suffering from spider pure, city inspection or laboratory examination (test). 6. Report: physicians judge according to their professionalism The results of the examination are interpreted and the patient is explained or provided with a report. ^Dr. Physicians according to their professional conclusions, including percussion, suspected, called 7507 diagnosis or diagnosis. Prescription. Doctor_专专__立#方或安排进行处理或外科' or further examination. 9. Referral··Physician according to the _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

〇·Appointment. Medical institution: Μ Φ personnel request for patients to pre-arrange the period and number. Pharmacist 4 ik pharmacy staff adjustment, issue prescription drugs and guide patients how to use drugs. From the interaction between the doctors and the doctors in accordance with the traditional medical procedures, the interviews, the examinations, the statistics, the prescriptions, etc. are concentrated in the doctor's office (the clinic): the most important part of the inner valley , including: the professional judge of the doctor> The main complaint of the examination, the background information of the patient, the reason and expectation of the treatment, the possible cause and effect of the symptoms related to the meal, the physical or laboratory examination, the result of the examination and the report, (4) Diagnosing _ The treatment of the thief is transferred. However, in Taiwan, the number of treatments is "three long and two short": the queue is "long", the waiting time is "long", the medicine is waiting for "long", and the time for examination or examination is "short", and the doctor's patient room The talks and talks were "short". Compared with foreign countries or because of the lack of lions (4), "three longs" are at least opaque (a she knows y) and accessibility is relatively good, if the drug-taking time is different from the actual medical division - It’s not too time-consuming to go to the pharmacy to adjust. However, when it comes to "two shorts", 1317507' is a nightmare for both sides of W disease, even medical doctors. Conservative estimates, doctors should look at 50 patients in three or four hours, with an average of 4 per minute. In such a short (four) coffee, the doctor should listen to the patient's statement, check, diagnose, diagnose, write or type a medical record, open a prescription, how can it never go wrong? Secondly, the current health inspection market is extremely active, and the magnitude and speed of the increase in the number of institutions providing services in recent years have shown that its business opportunities are booming. Under the fierce competition of the same industry, the content and equipment of the service have also been continuously improved, and many special inspections or precision inspections have also joined the ranks. ‘All types _ health check _ also waved to people with different health needs. However, in the deep analysis of the market's serviceability, there are several phenomena: service life _ proportion of 0 Cong biased to the laboratory to touch the fine touch, maintenance after the health check, the sexual management mechanism is ugly. Although many health inspectors provide physician-specific interpreting services, “small age-aged screenings are classified as thieves, but strategies and implementations of behavioral counseling, decision analysis, and forward-looking risk assessment are payable. Although there are trends in providing health screening services for different ethnic groups in the market, for example, the whole body fiber is divided into the transfer group, the prime year, the premarital, the child check, etc., and the elderly health check or occupational labor health check provided by the government’s disaster policy. Or, for example, health insurance services for adults over 40 years old, but there is always a lack of a life cycle and a holistic management plan (version _CyClebaSedplam^ng), usually only those with abnormal test results begin to diagnose and treat diseases, and cannot effectively Chasing high-risk diseases and moderately carrying lion rights, ^ this guide is mixed with Kang Lai ^ # segmentation and repetition l3l75〇7 〉 good expense (fragmentation & redundancy) 〇 occasionally a small number of health inspection services involving health risk assessment ApPraisai) 'But its risk assessment tool is purchased from the local data, so it is not limited by the time, race, environment and other differences. It is impossible to break through the definition of the calculator correction parameter. The permission bottleneck of the logical operation formula is not applicable to the decision analysis of management.

The existing electronic medical record system or see-through software (10)) usually only provides the query to print the inspection thread. For the diagnosis of the disease, it is only a categorical list. There is no 妓 一 (C0 side y) _ female, but more lacking for the enchanting The objective risk of concurrent diseases 'Physician's support for the disease is based on the data of the known or known conditions. 'Less can be a forward-looking assessment as a guide to dispose of patients. Therefore, if the information is to be provided by Wei Da Shun Shu, the invention of the Duan Cai (4) system can not only effectively cut the length of time, but also use the time to turn the ship. _, to meet the secret silk, the hospital's shell δ ΐ ΐ system must have the following conditions · · 1. The role of health tube _ role: can cooperate with the disease 电 电 ΛΛ ^ music teacher, turn personnel, medical examination ^, "the mutual Mutong, formed a team of cooperation with Na. The information system in decentralized management needs to have two-library management, which can make each workstation have synchronous update materials. 4. Guidelines for clinical medicine · Clinical decision-making path According to the indications of empirical medicine, the risk of 75〇7 disease and preventive care services, the diagnosis of disease, the condition of the disease, the second phase: the process, the knee structure must be 1" some must be a clear logic and flow Inaccurate 1 or ambiguous possibility, the best solution is to quantify it and calculate it according to the probability formula. (4) Procedures of 1 group · No (4) Groups have different target diseases 2 risks' should be carried out in the following order Gradually narrow the population and give it a different set of risks. (For diseases where metabolic syndrome may have high stress, diabetes, or high menstruation, for those who may develop cardiovascular disease in the future) U Social Demographic Risk Group: Never received health Screeners may have reasons such as: busy green, taking care of preventive health care, conscious risk being too optimistic, rarely seeing doctors, lack of information, and not using services. (2) Biodemographic risk group: age (three or forty years old), gender and The family is known to have high bloodsucking, diabetes, high fat, cardiovascular disease or stroke. Bad behavior Demographic risk group: overworked, overweight, obese, sucking or sparse.

(4) Asymptomatic screening positive population: BMI (greater than 7) or waist circumference (male is greater than 9 cm or female greater than 8 cm), biochemical examination of triglyceride greater than 15 〇 mg/dL, fasting blood glucose For those greater than ii〇mg/dL 1317507 or blood pressure above 130/85, screening for high-density lipoprotein cholesterol (based on men below 40 mg/dL or female below 50 mg/dL). (5) Risk of blood-burden population: The level of cardiovascular risk was assessed by Framin's piracy, and high-risk groups were identified. These estimates are based on known phenomena or conditions, including lifestyle patterns, family history, personal disease history, and some physical characteristics or laboratory data. (6) Disease population: According to the clinical guidelines of JNC-7, NCEP ATP-III and Diabetlc Care, the criteria for hypertension, hyperlipidemia and diabetes are diagnosed, and the subpopulation is classified according to the severity or stage of the disease status assessment. Disease The management of metabolic syndrome in the population has two meanings to further confirm the risk category; (2) the clinical classification of the disease course. (7) Complications Population: The population of heart ▲ tube diseases, peripheral arterial occlusive diseases, strokes and _ urinary bribery, which is the end of a diseased population of the denominator disease population. (8) Persons with disabilities who are disabled or disabled due to the above diseases or complications. It represents the negative indicator of "Quality of Life". 4. The mechanism for determining the underlying disease: according to the cause of death of the generational population of the life cycle or the disease, the treatment of the disease, the early detection and treatment of the disease, the results of the risk calculation, and the disease that the mosquito should manage. 5. Calculator for disease risk of miscellaneous diseases: For the understanding of the disease pathogenesis of the target disease, the risk of disease should be estimated according to the various causal relationships, and the conditional probability, risk right Aspects of action. The latter reviews the past and present medical treatments according to different degrees. It proves that the conditions of the prior art are not mentioned: the treatment of the disease management is also based on it; the staff cannot effectively enter the machine. Zhanyue wants to improve the operation of the poor news system. [Invention] The main purpose of the present invention is to assist the physician in understanding the disease state. And this key is in the instant = now; r use the assessment tool to provide the target disease life cycle classification and = the risk of refining, the practice of preventive medicine, rather than just passive waiting = sexual care perspective : Before it happens, it can be corrected (1=:== disease, to prevent or delay the occurrence of the disease. Yujin's prevention is aimed at the quality of service provided by the New Test, providing clinical medical personnel - recording slaves Ship Management, _ mosquito = = analysis and forward-looking risk assessment strategy and implementation. Physicians in the provision of special f 'can also be objectively quantified, and can be established with the people to the country = then the implementation of health inspection services for many years (four) This risk assessment engine = (4) Health management plan, including setting management objectives, automatic = wind = PB management label, link reminder system and health education information.

1317507 Another object of the present invention is to respond to the government's active reform and planning of the second generation of health insurance, emphasizing ★ people's pay and improving medical quality: the disease management secret of the present invention uses the target disease as the management target, compared with the current disease as the management target. The system is more pragmatic. It is based on the gp-time conditional probability to refer to the leading indicators of future risks. It is easier to grasp the rule than to directly make decisions based on current disease conditions (backward indicators). The policy can be used to analyze process quality and results. Quality, the logic of adjusting medical content with risk also helps to control the waste of medical resources. Another object of the present invention is to personally record the personal health of the data: for the structure _ 'instant analysis management system' can output the risk of a certain target disease and its danger = sub-conditional scale 'provided a seam fresh (prc_test (10) 趟y) As a customer's testimony of self-administration symptoms, all social records can provide a future analysis of the disease, and truly become (4) self-management of personal health records - JL 〇 [Implementation] -, II® 'The invention mainly includes a health manager system

医 统 统 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽 纽The surface device includes at least a database for storing the aforementioned electronic data, 'selecting the number of the identification number or the identity card number: the management steps include ··, ° the library, the knowledge (closed system 1. storing the patient's electronic basic data in the The computer system ID code can be selected from the medical record number (used by the closed system) or the ID card number or open system): 12 • 1317507 Depending on the age and gender, the computer will automatically generate the generation population and the code to which the patient belongs. Based on the generational population code, the computer automatically generates a clinical classification code for the disease-related disease. 2 · For each clinical classification code, the computer system will generate the problem model of the "problem characteristic model": After the patient responds according to the indicator key, the patient will gradually reduce the population of the population to which the clinical classification codes belong. The recorded population d, the biological population, the unintentional exposed population and the disease population are sequentially screened to the smallest population group that can be confirmed. (For example, the life cycle is determined by gender age. The basic data is 56 years old, then the generation population code is the winner. The database of the disease code is td_4U and its pre-occurrence rate p. 414__ 689. If the minimum population of the confirmed population can be confirmed by the sociological population, the rate of the target disease td-414 should be 1245 per 100,000 according to the table. The clinical refractory code is used to query the conditional probability of the final screening group. These probabilities f-stocks are based on the epidemiological value of the invention = research funding, and the subject matter of the disease is __ parameter is the default financial 2 with the gradual reduction of the population group, the system will answer the conditions according to the patient's answer The automatic judgment determines the preset value of the minimum identifiable population. 3. The computer is sorted according to the condition of the condition of each disease, and according to the preset 1317507 before the disease, the secret will go to the thief · package disease (4), such as: in accordance with the syndrome group, the purpose (4) H1 Diabetes Dp, hyperlipidemia (L2), high-risk future-risk disease (eg, cardiovascular disease risk 21%), and important health-related behaviors such as: [Brib·· /CS], [Overweight: / Bw], [insufficient exercise: such as], and actively choose the symptom questionnaire to be tested, the science examination project and the laboratory related test items

Each test has a status label showing that it is [Checked], [Inspected], and [Completed], respectively, representing different stages such as "not yet executed", "not yet executed report" and "entered report". The results of these risk assessments will result in two standard reports, one for the history test, the known disease of the patient, the health-related behavior and the pre-existing rate of the important target disease. Systematic Suggested Symptom Questionnaire, Science Examination Project and Experiment Room inspection project' and the stage strategy of behavior change. Another part of the reference to the disease, the known disease of the pot, the change of the stalk of the behavior of the acid and the behavior of the future may occur = the relative risk of the disease (standard disease), the system recommended self-symptoms evaluation project, etc. 0 (4) after the completion of the tea 'The patient will be treated at the time of treatment = ^ '[__ read the lion's shirt 2 / month early' including the appointment of outpatient time, patient self-recording project, the t-listed Guardian ^ course, Ying Silk's questionnaire , should be traced to the body joy -, should be traced to the laboratory check, should remind the physician to reorganize the place or doctor's advice 1317507; special scheduling. ^ 5 · The patient enters the clinic, and the patient will appear in the computer system as a message that meets the "three generations of the syndrome" and displays the health management label' (eg. Mh4.H1DpL2/cs /bw/pi), the auxiliary physician performs the following actions: (1) The physician can inquire about the data generated in the aforementioned steps 1.3: the current management quality indicators of the disease, important health-related behaviors, symptom questionnaires to be tested, and science % Check items and labs_test items. After the doctor performs the symptom questionnaire and the examination item, the result value can be directly input, and the information system provides the statistical analysis function to provide the doctor to compare or judge the previous data. Assist the physician to determine the laboratory-related inspection items in the medical order, and open the inspection application form. Here, the status of the shaft Guan Yi Li Xue _ [wire], the laboratory inspection items • The state of the target is [inspection]. (2) 歹1J Printed Doctor's Risk Assessment Report: Background information of the patient (the smallest population group with disease-recognized disease and its pre-occurrence rate) > History of known diseases: current health-related behavior Pre-existing rate with important target diseases, as well as system-suggested symptom questionnaires, physical examination items, laboratory examination items, and stage strategies for behavioral changes, etc. (3) 2-infected patient risk assessment report··Can be supplemented with _ post-printed or According to the pre-satisfaction report, directly print the information about the known diseases, the skills to change the relevant health behaviors, the relative risks of possible diseases in the future, and the self-symptoms assessment project, as a reference for the auxiliary materials of the education, and

1?, 1317507 Delivery of patients to participate. 6 · When the remaining money is reduced, the status of the laboratory inspection project is changed to [Complete] when the bribe is reported to the value of the electricity job. Completion of the Symptom Questionnaire, = Academic Examination and various Wei's enrollment __, through the "Disease Grading Guidelines", the system automatically corrects the existing disease label [Hypertension: Η〇'ΗΡ, Η1, Η2], [Diabetes: D〇, Dp, m, D2], [hyperlipid: L〇, Lp, Ll, L2]. 7. In addition to the result of 7 in the "Disease and Test Project _ Module", the probability of the conditional condition of the target disease is simultaneously synchronized, so that the result is automatically calculated by the data. The target disease risk, complete the case cycle operation. /·, patients who have been managed by the case's system will automatically prompt the patient's health education content, the items to be tracked, and the time to be missed. Physicians can check the management indicators of body mass, blood pressure, blood pressure, blood glucose, triglyceride, sputum hemoglobin, high-density lipoprotein, low-density lipoprotein, etc., which are compared by the system to the last-time test. The target value is generated, and the disease risk of the target can be automatically reminded, and the outpatient doctor can make corrections to the prescription or the female squad of the course. When the physician confirms the information, the system will repatriate the data back to the [case manager system] to generate a work list, and provide the case manager with follow-up management. Please refer to the third and fourth figures. After all the relevant target diseases have been calculated and their chances are calculated, the risk assessment is based on the database. The steps are as follows: 16. 1317507 (1) Query to generate each target disease (example: D1, D2, D3) The risk factor associated with it (for example, [Finance + [R2, R5, R6] + [R3, R6, R7]), list all factors in a union [R1, R2, R3 , R4, R5, R6, R7]). (2) Each risk factor has several questionnaire items. The different answer results of each “question item” will produce different conditional probability, and will be stored in the database in a certain calculation parameter. 'Content is to ask past medical history, current medical history, family History, health > behavior, environmental occupation factors, etc. (3) Disease and risk factors are many-to-many relationships, so the combination of each risk factor and different diseases has a coefficient that determines its weight. (4) For a target disease, the similarity ratio (LikelihoodRatio) of the answers to all the risk factors is multiplied by the weight coefficient of the corresponding target disease, and finally the "combined multiplier" is calculated by the conditional probability method (c〇 Mp〇site muitipHer, 1 CMR_Rn). CMR-Rn= 〇_D414RkX LR_R〇(5) Each target disease is conditioned by conditional probability. The anchoring of the previous pre-occupation rate is the result of the risk assessment and can be based on the preset threshold (cut- Off) is labeled, its formula: pr(td_414_M07B)=P〇(td_414_M07B)x CMR.Rn The computer generates a management label according to the results of the disease health risk assessment, and its system operation is 17 1317507. The following is the management label package Diseases and weights that have been red and silky.// Health-related behavioral labels [smoking: /cs], [overweight: /bw], [insufficient exercise: ./pl] and actively choose to be tested Symptoms, scientific examination items and laboratory-related inspection items' are stored in the database in the status attribute of [to be checked]. The management label of the disease according to the standard generates health requirements, which is automatically selected by the database according to the management label: • (1) The results of these risk assessments will generate a list of health needs for the physician to refer to the second known disease and health of the patient. The relevant behavior and the important target disease rate (absolute risk;), the system automatically built the proposed symptom questionnaire, the scientific examination face and experiment recording project, and the behavior change continuation strategy. (7) In addition, the system will produce a preliminary report for the patient to record information about the known disease, the skills to change the relevant health behavior and the relative risk of future disease (standard disease), and the system recommended self-symptom assessment r' Health needs clear nD medical mail can be noticed by the system during the visit, the operation is as follows: 7 = material connection into the [Physician System], computer system produces symptom items, laboratory examination items and behavior changes The stage of the strategy. —Tian: When the mother r is precious, the system can remind the doctor to perform these check items. Once the mother and the target are executed, the status attribute is changed, and the database is instantly saved.

18,13 ϊ 7507 [Yuancheng] when the system will automatically generate two customs clearances for the W division to refer to, the patient's known disease, health phase examination check = 1 version of the pre-existing rate, the system recommended symptoms 渺 ^ - a copy of the project to read the project's and the stage of behavior change strategy.

Behavior 彳Qiu Qi 6 knows the phase of the 11 dragons, changes the relative health and the relative risks of the disease (standard disease) that may occur in the future, is the self-symptom evaluation project of Jianye. T-visiting doctors can misunderstand the above reports as a reference for clinical treatment: (1) The “disease grading guidelines” are automatically corrected by the system for existing diseases. (Example: [高血丽·· H0, Hp, H1, called [diabetes: D〇, arsenic m [hyperlipid · L0, Lp, L1, L2]) and the similarity of the test results to correct the risk of the original disease (re-typing, for example : The density of the wax protein is low. After calculation, the cardiovascular risk is changed from 〇.16 to (4), and the risk label is changed from Mh3 to Mh4). (7) After the patient is managed by the case, the system will automatically remind the patient about the content of the education, the time to be followed and the time to be arranged. The body mass coefficient, blood pressure, cholesterol, blood sugar, tri-acid Glycerin, glycosylated hemoglobin, high-density lipoprotein, low-density lipoprotein, etc., which is generated by systematic comparison of the last-time test record and target value, and can automatically indicate the disease risk of the target The outpatient doctor made a prescription to correct the disease of the disease 浐 = illness 1317507. When the physician confirms the information, the system will revert the data back to the [case manager system] to generate a work list, and the case manager will arrange follow-up tracking management. The result will affect the above data and form a circular reference.

20. 1317507 [Simple description of the drawings] The first figure is a flow chart of the present invention. The second figure is the target disease location and population location query table of the present invention. The third figure is the main content list of the metabolic syndrome case of the present invention. The fourth figure is the calculation chart of the target disease condition probability of the present invention. The fifth graph is a test similarity calculation diagram for the target disease of the present invention. [Main component symbol description]

Claims (1)

4 4 Wen,. ~ ------ J, the moon day repair (from the original 1317507 ten, the scope of the patent application 1 · - a kind of test reference to the health of the m-track containing storage, suffering from electronic basic information, and can call the code Selecting the ship or identity card 5 Tiger's equipment that automatically generates the clinical classification code of the disease-related disease of the patient's computer device contains at least the information for storing the aforementioned electronic basic data, and selects the identification of the medical record number or the identity card number. The management system includes the following steps: a · The electronic content of the patient is stored in the _ system (four) library 'automatically generated by the computer to the generation of the patient's population _ clinical classification code eye-catching and patient-related targets The disease b is prompted by the problem of each clinical classification code 'computer model', and the patient responds according to the indicator key === narrows the patient's clinical classification code belongs to the generation & automatic step-by-step Group C's clinical classification disease code, query the most relevant minimum person d · computer according to the condition of the disease conditional risk factor modulo t and self-wind rr associated module" and "wind by the patient according to the" button and then answer , H's disease Pre-operating rate, and generate management label. Different '^ disease%, various standard test, describe e, f step generation & part standard report, one for medical fine * machine rate, system recommended symptom questionnaire, = == Important "The disease before the second phase and the behavioral change stage strategy, the other laboratory, the knowledge of the disease phase (four) news, change the detailed reference, call the relative risk of (the disease), Department: Recommendation 22 1317507 The Department of Health refers to the health management number or the identity card number of the reference to the risk cycle, and its identification code can be selected as the health record of the risk cycle referenced by the medical record _ ^申^(4)1; =, =, the patient enters the answer according to the instruction "Problem characteristic model" 2 i The clinical classification code of the small patients is the lips of the world. ΪΑ 、, biological population, bad behavior exposed people (10) disease population group sequencer filtered to the smallest population group that can be confirmed. The health management condition of the risk cycle referenced in the first paragraph of the scope of the patents of the human rights department H is the case of the epidemiological and problem characteristics. The risk cycle described Kang Guan = According to the indicator key, after answering the electronic questionnaire, the computer automatically calculates the pre-incidence rate of the disease, and the system will generate the tube label, including the disease with high risk in the future and the important health = representative has not been executed, has been executed Has not yet entered the report and has been lost; ^ Same as ^ · If / / t to turn the first health check system reference, which also includes the risk assessment of the target disease, the steps are to list the disease The associated risk factors, (four) set mode b. Each risk factor has Xuan exposure items, each questionnaire back. 'The results will produce the probability of inactive, all stored in a certain calculation parameters ^ 23 1317507 database The content is to ask about past medical history, current medical history, family history, health behaviors, environmental occupation factors, etc.; the parameters of the answers to each item of all risk factors are calculated into combined multipliers by conditional probability, each risk factor and different diseases. The combination has another number to determine its weight; md · each target disease is calculated by conditional probability to re-evaluate the previous pre-uprate rate, and can be preset Threshold be tagged, J △ formula ^ (td_414-M07B) = Pd (tcL4Uji〇7B) x ⑽ Hong pong e. The computer produces management rods based on the results of the disease health risk assessment. twenty four