WO1995019604B1 - Medical network management system and process - Google Patents
Medical network management system and processInfo
- Publication number
- WO1995019604B1 WO1995019604B1 PCT/US1995/000537 US9500537W WO9519604B1 WO 1995019604 B1 WO1995019604 B1 WO 1995019604B1 US 9500537 W US9500537 W US 9500537W WO 9519604 B1 WO9519604 B1 WO 9519604B1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- patient
- medical
- stored program
- care
- medical provider
- Prior art date
Links
- 238000000034 method Methods 0.000 title claims 17
- 238000003745 diagnosis Methods 0.000 claims abstract 8
- 239000000203 mixture Substances 0.000 claims 22
- 201000010099 disease Diseases 0.000 claims 10
- 206010022114 Injury Diseases 0.000 claims 9
- 230000004044 response Effects 0.000 claims 3
- 230000001225 therapeutic Effects 0.000 claims 2
- 230000001419 dependent Effects 0.000 claims 1
- 230000001747 exhibiting Effects 0.000 claims 1
- 238000009472 formulation Methods 0.000 claims 1
Abstract
In a medical network management system (NMS) (20), health plan beneficiaries access a team of health care professionals over the telephone to help them assess their health needs and select appropriate care. The NMS (20) has a patient assessment component (22). The patient assessment component consists of a set of information tools which are used by health care professionals to assess patient conditions and assist in the selection of health care services and to help patients find appropriate care at the appropriate time. The tools include a comprehensive, automated set of proprietary assessment algorithms (26) which are based on branched chain algorithms utilizing Bayes theorem. These unique, clinical tools enable a trained nurse or other health care professional to sort patients into different risk categories, safely and effectively without requiring a medical diagnosis. Patients can then be guided to an appropriate level and type of care for their problem(s) based on their level of risk and set of potential needs.
Claims
1. A medical network management system for managing access to medical providers which comprises a data processing system including a memory, a display, and input means, said memory containing a patient assessment stored program and a patient database, said patient assessment stored program including means for checking patient eligibility, means for selecting a branched chain logic algorithm for assessing a patient's level of medical risk and determining an appropriate timing, type, and level of medical care, and a plurality of branched chain logic algorithms, each of said branched chain logic algorithms for assessing the patient's level of medical risk and determining an appropriate timing, type, and level of medical care, said data processing system being configured by said patient assessment stored program when executed on said data processing system to present a first series of questions on said display for checking patient eligibility to receive medical care, to receive a first series of answers responsive to the first series of questions from said input means, to supply the first series of answers to said means for checking patient eligibility which accesses said patient database to check patient eligibility, to present a second series of questions on said display for selecting one of said plurality of branched chain algorithms, and for interactively guiding the patient through the selected one of said plurality of branched chain algorithms and to make a medical care timing and level of medical care recommendation in response to patient answers to questions posed by the selected one of said plurality of branched chain algorithms in order to assess the patient's level of medical risk and thereby determine an appropriate timing, type, and level of medical care, and to provide the timing, type, and level of medical care determination on said display.
2. The medical network management system of claim 1 in which said plurality of branched chain logic algorithms are each configured to present a series of questions answerable with "yes" or "no", answers to said questions being used by said data processing system to categorize the patient as either having a sufficiently low post-test probability of an illness or injury under consideration so as not to justify further medical provider care, or as not having a sufficiently low post-test probability of an illness or injury under consideration so as to eliminate possible need for further medical provider care.
3. The medical network management system of claim 1 in which the appropriate timing, type, and level of medical care include immediate emergency care by a medical provider, urgent care by a medical provider, immediate consultation with a medical provider, an appointment with a medical provider, or self care.
4. The medical network management system of claim 1 in which said patient assessment stored program further includes means for providing a plurality of self-care instructions to the patient, said data processing system further being configured by said patient assessment stored program to provide the plurality of self-care instructions on said display.
5. The medical network management system of claim 1 in which said patient assessment stored program further includes means for scheduling follow-up with the patient, said data processing system further being configured by said patient assessment stored program to provide a follow-up reminder for the patient on said display.
6. The medical network management system of claim 1 in which said plurality of branched chain logic algorithms is organized by clinical codes.
7. The medical network management system of claim 6 in which said plurality of branched chain logic algorithms are further organized by procedural codes.
8. The medical network management system of claim 6 in which said memory additionally contains a medical provider information stored program and a medical provider database, said data processing system further being configured to link said patient assessment stored program and said patient database to said medical provider information stored program and said medical provider database with said clinical codes and with patient information from said database when said patient assessment stored program and said medical provider stored program are executed on said data processing system.
9. The medical network management system of claim 8 in which said medical provider information stored program includes a means for selecting a medical provider for the patient, said data processing system further being configured by said medical provider information stored program to make a medical provider selection for the patient from said medical provider database based on said clinical codes and the patient information and to provide the medical provider selection on said display screen.
10. The medical network management system of claim 9 in which said medical provider information stored program further includes a means for referring the patient to the medical provider.
11. The medical network management system of claim 1 in which said memory additionally comprises a stored program editor for generating branched chain logic algorithms.
12. The medical network management system of claim 11 in which each of said plurality of branched chain logic algorithms is configured to present a series of questions answerable with "yes" or "no", said stored program editor for generating branched chain logic algorithms includes a yes-no logic block for generating the questions answerable with "yes" or "no" and an endpoint logic block for generating endpoints in said plurality of branched chain logic algorithms.
13. The medical network management system of claim 12 in which said stored program editor for generating said plurality of branched chain logic algorithms further includes a means for integrating new branched chain logic algorithms generated with said stored program editor with said plurality of branched chain logic algorithms.
14. In a data processing system including a display and input means, a process for managing health care, which comprises presenting a first series of questions on said display to select one of a plurality of branched chain logic algorithms which assess the patient's level of medical risk and determine an appropriate timing, type, and level of medical care, receiving a first series of answers responsive to the first series of questions from the input means, using the first series of answers to select one of said plurality of branched chain logic algorithms, presenting in accordance with the selected branched chain logic algorithm a second series of questions on said display, receiving a second series of answers responsive to the second series of questions from the input means so as to guide the patient through the selected one of said plurality of branched chain algorithms and determine from answers to questions posed by the selected one of the plurality of branched chain algorithms an appropriate timing, type, and level of medical care.
15. The process of claim 14 additionally comprising the steps of: presenting further questions to the display determined by the second series of answers, receiving further answers from the input means, assessing the patient's level of risk, categorizing the patient either as having a sufficiently low post-test probability of an illness or injury under consideration so as not to justify further medical provider care, or as not having a sufficiently low post-test probability of an illness or injury under consideration so as to eliminate possible need for further medical provider care, and presenting a third series of questions on said display for checking patient eligibility to receive medical care, entering a third series of answers responsive to the third series of questions from the input means, and using the third series of answers to determine patient eligibility to receive medical care .
16. The process of claim 14 in which the second series of questions are answerable with "yes" or "no", answers to said questions being used by said data processing system to categorize the patient either as having a sufficiently low post-test probability of an illness or injury under consideration so as not to justify further medical provider care, or as not having a sufficiently low post-test probability of an illness or injury under consideration so as to eliminate possible need for further medical provider care.
17. The process of claim 14 in which the appropriate timing, type, and level of medical care include immediate emergency care by a medical provider, urgent care by a medical provider, immediate consultation with a medical provider, an appointment with a medical provider, or self care.
18. The process of claim 17 in which the process includes making a self care recommendation to the patient, and providing a plurality of self-care instructions on said display.
19. The process of claim 14 in which the process includes scheduling follow-up with the patient, and providing a follow-up reminder for the patient on said display.
20. The process of claim 19 in which in which the plurality of branched chain logic algorithms are organized by clinical codes.
21. The process of claim 20 in which the plurality of branched chain logic algorithms are further organized by procedural codes.
22. The process of claim 19 in which the process further includes making a medical provider selection for the patient from said medical provider database based on said clinical codes and the recommendation.
23. In combination, a data processing system having a memory, a patient assessment stored program in said memory utilizing a plurality of branched chain logic algorithms, and a stored program editor in said memory for generating branched chain logic algorithms when executed in said data processing system, said plurality of branched chain logic algorithms each being configured to present a series of questions answerable with "yes" or "no", said stored program editor for generating branched chain logic algorithms including a yes-no logic block for generating the questions answerable with "yes" or "no" and an endpoint logic block for generating endpoints in said plurality of branched chain logic algorithms.
24. The combination of claim 23 in which said stored program editor for generating said plurality of branched chain logic algorithms further includes a means for integrating new branched chain logic algorithms generated with said stored program editor with said plurality of branched chain logic algorithms.
25. In combination, a data processing system having a memory and a patient assessment stored program in said memory, said patient assessment stored program including a plurality of branched chain logic algorithms, said plurality of branched chain logic algorithms each being configured to present a series of questions answerable with "yes" or "no" when said patient assessment stored program is executed by said data processing system, answers to said questions being used by said data processing system when said patient assessment stored program is executed by said data processing system to categorize the patient as either having a sufficiently low post-test probability of an illness or injury under consideration so as not to justify further medical provider care, or as not having a sufficiently low post-test probability of an illness or injury under consideration so as to eliminate possible need for further medical provider care.
26. The combination of claim 25 in which said patient assessment stored program is further configured to make a medical care timing and level of medical care recommendation in response to patient answers to the questions.
27. The combination of claim 26 in which the appropriate timing and level of medical care include immediate emergency care by a medical provider, urgent care by a medical provider, immediate consultation with a medical provider, an appointment with a medical provider, or self care.
28. The combination of claim 27 in which said patient assessment stored program further includes means for providing a plurality of self-care instructions to the patient.
29. The combination of claim 26 in which said patient assessment stored program further includes means for scheduling follow-up with the patient.
30. The combination of claim 25 in which said plurality of branched chain logic algorithms are organized by clinical codes.
31. The combination of claim 30 in which said plurality of branched chain logic algorithms are further organized by procedural codes.
32. The combination of claim 30 in which said data processing system additionally includes a medical provider information stored program, a medical provider database and a patient database in said memory, said data processing system further being configured to link said patient assessment stored program and said patient database with said medical provider information stored program and said medical provider database with said clinical codes and with patient information from said patient database when said patient assessment stored program and said medical provider stored program are executed on said data processing system.
33. The combination of claim 32 in which said medical provider information stored program includes a means for selecting a medical provider for the patient, said data processing system further being configured by said medical provider information stored program to make a medical provider selection for the patient from said medical provider database based on said clinical codes and the patient information when said medical provider stored program is executed on said data processing system.
34. The combination of claim 33 in which said medical provider information stored program further includes a means for referring the patient to the medical provider when said medical provider stored program is executed on said data processing system.
35. The combination of claim 25 in which said data processing system additionally includes a stored program editor in said memory for generating branched chain logic algorithms when said stored program editor is executed on said data processing system.
36. The combination of claim 35 in which said plurality of branched chain logic algorithms are each configured to present a series of questions answerable with "yes" or "no" when said patient assessment stored program is executed by said data processing system, said stored program editor for generating branched chain logic algorithms including a yes-no logic block for generating the questions answerable with "yes" or "no" and an endpoint logic block for generating endpoints in said plurality of branched chain logic algorithms when said stored program editor is executed on said data processing system.
37. The combination of claim 36 in which said stored program editor for generating branched chain logic algorithms further includes a means for integrating new branched chain logic algorithms generated with said stored program editor with said plurality of branched chain logic algorithms when said stored program editor is executed on said data processing system.
38. In combination, a data processing system having a memory and a medical provider information stored program, a medical provider database and a plurality of clinical codes stored in said memory, said data processing system being configured by said medical provider information stored program when executed by said data processing system to link said medical provider information stored program and said medical provider database with said clinical codes.
39. The combination of claim 38 in which a patient assessment stored program and a patient database including patient information are additionally stored in said memory, said data processing system further being configured by said patient assessment stored program when executed by said data processing system to link said patient assessment stored program and said patient database to said medical provider information stored program and said medical provider database with said clinical codes.
40. The combination of claim 39 in which said medical provider information stored program includes a means for selecting a medical provider for the patient, said data processing system further being configured by said medical provider information stored program when executed by said data processing system to make a medical provider selection for the patient from 1 8 4
said medical provider database based on said clinical codes and the patient information.
41. The combination of claim 40 in which said medical provider information stored program further includes a means for referring the patient to the medical provider.
42. The combination of claim 39 in which said patient assessment stored program is configured to make a medical care recommendation and said medical care provider information stored program is configured to make a medical provider selection for the patient based on the medical care recommendation using the clinical codes when said patient assessment stored program and said medical provider stored program are executed on said data processing system.
1 8 5
STATEMENT UNDER ARTICLE 19
By this amendment the claims have been modified so as to more clearly define the inventive medical network management system. For example, claim 14 is now more specifically drawn to a "process" rather than a system, as are its dependent claims 15-22. In addition, claim 23 has been rewritten to specify a combination of physical elements and to specify that the patient assessment stored program and the stored program editor operate in certain ways when executed on the data processing system. Similarly, claim 1 now provides that the patient assessment stored program configures the data processing system in a particular manner during program execution.
As defined by amended claims 1 and 3-22 and new claims 25-37, Applicants' invention is directed toward managing access to medical providers. Specifically, the present invention determines the timing, type, and level of medical intervention by efficiently applying the speed, efficiency, and consistency of computerized analysis to a triage-like model of managed health care. In this way the present invention serves to obviate the need for unnecessary test or formulation of diagnoses for patients exhibiting less than predefined risk.
The mode of analysis contemplated by the invention is different from that used in conventional systems disposed to formulate a medical diagnosis or evaluate a proposed diagnosis. In such conventional systems the data is examined, after the decision for intervention by a health care provider has been made, to determine which diseases or medical condition are most likely present in the patient. That is, these systems are directed toward diagnosis and treatment of medical conditions; i.e. after the decision to intervene medically has already been made. Specifically, medical analysis techniques are employed to determine an underlying condition from a set of symptoms, as well as to suggest treatment, i.e. , to perform a diagnosis.
The cited international Application having Publication Number WO 94/00817), exemplifies a medical diagnosis system concerned with identifying a treatment guideline after the decision to seek the assistance of a health care provider has been made. The system is disposed to provide a diagnosis in response to an identified health condition, or to evaluate a proposed procedure using such a treatment guideline. As stated at page 16, lines 5-6, "the system 300 can be used to aid diagnostic confirmation and therapeutic selection" (italics added). See also, page 16, lines 24-26, "the guidelines are diagnosis-based (that is, they address a specified health condition that has been recognized)" (italics added). A "guideline process" used to aid therapeutic and resource selection is initiated only after it has been decided to seek medical intervention. The guidelines are described as being "associated with a particular health care condition for which treatment exists". No similar type of association exists with respect to the claimed "branched chain algorithms", which are intended to determine, inter alia, whether or not a patient may be categorized as having a sufficiently low probability of an illness or injury under consideration so as not to justify further medical provider care.
In view of the foregoing, the pending claims are thus believed to define patentable subject matter.
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
AU22267/95A AU689575B2 (en) | 1994-01-10 | 1995-01-10 | Medical network management system and process |
CA002180653A CA2180653C (en) | 1994-01-10 | 1995-01-10 | Medical network management system and process |
NZ283830A NZ283830A (en) | 1994-01-10 | 1995-01-10 | Management system; network system and process to help patients with health care |
EP95915368A EP0739519A1 (en) | 1994-01-10 | 1995-01-10 | Medical network management system and process |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US08/180,090 | 1994-01-10 | ||
US08/180,090 US5471382A (en) | 1994-01-10 | 1994-01-10 | Medical network management system and process |
Publications (4)
Publication Number | Publication Date |
---|---|
WO1995019604A2 WO1995019604A2 (en) | 1995-07-20 |
WO1995019604A3 WO1995019604A3 (en) | 1995-08-10 |
WO1995019604A9 WO1995019604A9 (en) | 1995-09-08 |
WO1995019604B1 true WO1995019604B1 (en) | 1995-10-05 |
Family
ID=22659163
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/US1995/000537 WO1995019604A2 (en) | 1994-01-10 | 1995-01-10 | Medical network management system and process |
Country Status (6)
Country | Link |
---|---|
US (3) | US5471382A (en) |
EP (1) | EP0739519A1 (en) |
AU (1) | AU689575B2 (en) |
CA (1) | CA2180653C (en) |
NZ (1) | NZ283830A (en) |
WO (1) | WO1995019604A2 (en) |
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- 1995-01-10 WO PCT/US1995/000537 patent/WO1995019604A2/en active Application Filing
- 1995-01-10 AU AU22267/95A patent/AU689575B2/en not_active Expired
- 1995-01-10 NZ NZ283830A patent/NZ283830A/en not_active IP Right Cessation
- 1995-01-10 EP EP95915368A patent/EP0739519A1/en not_active Withdrawn
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