CN110168659A

CN110168659A - For improving clinical effectiveness and reducing the nursing always nursing the CNA of expense and guiding

Info

Publication number: CN110168659A
Application number: CN201780083458.XA
Authority: CN
Inventors: A.L.佩科拉
Original assignee: COTA Inc
Current assignee: COTA Inc
Priority date: 2016-11-14
Filing date: 2017-11-09
Publication date: 2019-08-23
Also published as: CA3042279A1; KR102579786B1; EP3539034A1; JP2020514888A; EP3539034A4; JP7355415B2; KR20190077093A; IL266481A; WO2018089584A1; JP2022119871A; JP7079790B2; IL266481B1

Abstract

Described invention provides a method, system and the non-transitory computer-readable medium for storing computer program instructions, the computer program instructions make the clinical effectiveness communicatedly linked tracking and analysis module carry out operation when being executed on a processor, to improve the clinical effectiveness under particular patient level and reduce total nursing expense under population level using the nursing of CNA guidance.Computer program instructions are made the first clinical effectiveness and tracking module when being executed on the processor for including the tracking of the first clinical effectiveness and analysis module: by counting and biological differences patient's grouping in PATIENT POPULATION up front, to be effectively removed the biological differences as the factor in nursing value, and by being received to personal health information, it sorts and classifies and treatment difference is given over into the leading factor in treatment results, the latter is by generating and distributing multiple clinical effectiveness tracking and analysis node address (CNA), each CNA indicates to include prefix, intermediate and suffix the discrete numeric string to punctuate, the prefix, the each one group of pre-selection variable for indicating for ranked and classification information to be divided into one group of clinically relevant information of intermediate and suffix.The tracking of first clinical effectiveness and analysis (COTA) module tracks therapeutic choice as a result, and reporting and using associated result with these CNA.The nursing of CNA guidance is operated with two sides by the application of CNA, and is formed by the triple of healthcare provider, disburser and the patient with disease.First face, that is mission potency, include provider, include interaction between the tracking of the first clinical effectiveness and the computer of processor, the first client device and disburser of analysis (COTA) module, first client device includes being otherwise communicatively linked to the 2nd COTA module of the first COTA module via network.Disburser covers the service for the health care service under consideration of patient and the information of the other variables selected by disburser, the health plan welfare of the patient to the processor transmission mark for including the first COTA module via the 2nd COTA module.In response, the first COTA module is to the 2nd COTA module transfer: (1) being directed to the clinical outcome data of CNA appropriate, the behavioral difference data of (2) for each medical supplier at CNA appropriate；(3) report on expenses comprising for treating the real-time cost data of each patient in the PATIENT POPULATION for being assigned to CNA appropriate；And nursing expense and clinical effectiveness are mutually related one or more pattern analysis by (4).If the information is enough to confirm: in view of potential welfare and to the injury of patient, medical services are appropriate delivering or the service of level；By improving clinical effectiveness and reducing total nursing expense, medical services are effective in terms of improving healthy result；Compared with the Health intervention of substitution or without intervention, which is cost-effective for just treated medical conditions and clinical effectiveness；And the service follows generally accepted medical practice, then then disburser can be approved as the service to provider payment.Second face, it includes including the computer of the processor of the first COTA module, including interaction between the second client device and patient for being otherwise communicatively linked to the 3rd COTA module of the first COTA module via network, the communication between the processor and the third client device communicatedly linked including the 3rd COTA module for including the first COTA module is provided, the 3rd COTA module provides the complete medical assessment for being enough to obtain patient and the information for distributing CNA to patient.CNA is subsequently used for enabling the patient with situation that standard is arranged to select the optimal care plan of the unfavorable variance risk and medical professional that have reduced based on other patients in geography, clinical effectiveness, expense and CNA.The CNA distributed can be associated with one or more bundles of scheduled patient care service of the treatment for the situation, and one or more of bundles can provide scheduled therapeutic process, expense determination or both.Once patient selects the medical professional for meeting one or more of geography, expense and clinical effectiveness demand of patient, so that it may which the first COTA module is otherwise communicatively linked to the calculating equipment of the office of selected medical professional to promote the arrangement to reservation.

Description

For improving clinical effectiveness and reducing the nursing always nursing the CNA of expense and guiding

Cross reference to related applications

This application claims the equity of the priority for the U.S. non-provisional application number 15/351,099 submitted on November 14th, 2016, The full content of the U.S. non-provisional application is incorporated herein by reference.

Technical field

This disclosure relates to for improving the clinical effectiveness under particular patient level and for reducing total under population level The nursing of the CNA guidance of nursing expense.

Background technique

As ordinary group lives longer, most of medical expenses associated with aging group are all increasing.With it is all As the associated expense of disease of serious the waiting a moment property of cancer etc is just being increased in a manner of it cannot support.For example, cancer expense It is expected that being to increase highest field during health care is spent, without the improvement that matches of result.Only in the U.S., 2010 in cancer About 125,000,000,000 dollars are taken in nursing, and it is unnecessary or uncomfortable to estimate that the cost of about 15-30% can be classified as When nursing as a result, wherein leading to very little or too many nursing of individual patient less than optimal clinical effectiveness and excessively opening Branch (hereinafter referred to as " unfavorable variance (variance) ").

Under present systems, the people of the receiving nursing for every 100 with serious medical situation (condition) comes Say averagely there is 20% unfavorable variance rate, it is meant that deliver very little or too many nursing to individual patient.Thus, 20% Receive to occur causing less than optimal clinical effectiveness in the patient of nursing the total nurse fees of 100% time under population level With increase.

It is usually inefficient for controlling the routine techniques (such as clinical path and disease control) of expense, and does not have now There is the mass substitution scheme being currently present in the market.

(it makes disburser can determine that medical services are the health plans in patient to current prior authorization infrastructure Under the welfare (benefit) that covers) be expensive and spend the too many time, may be unfavorable due to stopping over necessary nursing Ground influences clinical effectiveness.

As the progress in terms of technology and medicine continuously emerges, for disease (such as cancer, cardiovascular disease, lung's disease Disease and behavior health) nursing science and clinical practice quick evolution.Often medical professional is (for example, tumour is cured Teacher) it is difficult to keep up with these progress.These progress, such as next-generation gene sequencing, usually complicated, and may be health meter It draws and significant problem is presented in medical professional.As a result, health plan will likely need more tools and support to manage its doctor (for example, tumour) business for the treatment of.Similarly, medical professional (for example, doctor) will need more decision support tools real It tramples best medicine and maintains business.

Clinical effectiveness tracking and analysis (COTA) module be a kind of tool, for for example make medical professional and/or Other users can practice better medicine, preferably manage and position specific information associated with disease and/or patient, and And promote improved Payment control.

The parameter of clinical effectiveness tracking and analysis includes sequence (sorting), result tracking, east tumour cooperative groups (ECOG) performance status；The toxic reaction (toxicity) of therapy (therapy) and the expense of nursing.In one aspect, method Include COTA module with system, the COTA module from by user's operation client device receive be used to multiple data records into One or more parameters of row sequence, and be ranked up based on the received parameter logistic of institute according to record in response to the reception. It will indicate that the node address of one or more variables is applied to the patient medical records of one group of sequence, it is clinically relevant by one group Patient medical records are determined as meeting the patient medical records of one group of sequence of one or more of variables.COTA module is then Analyze the clinically relevant patient medical records of the group, and by the number of the data record of update and categorized (classify) and sequence Client device is transmitted to for showing according to record at least part.

Each data record include data associated with disease and with the patient currently with the disease or previously had The associated data of the patient of the disease.COTA module can from electronic medical record (EMR), from user, from medical professional people Member receives the data from expert or from any other source.

COTA module can enable a user to execute various analyses to the one or more in data record.For example, It is that COTA module can enable to compare the data or tracking between patient as a result, particular patient can be identified as spy Analysis tool, can be transmitted to client device to promote to for example categorized and ranked number by the candidate of fixed treatment or drug According to the analysis of record, or make it possible to compare Kaplan Meier curve, and can and patient phase determining based on tracking Whether associated particular doctor is treating the patient according to the treatment technology of other medical treatments other (similar) patients.

COTA module can also be transmitted to client device when triggering and remind (alert).Triggering may for example exist When diagnosis, progress when, in dose change, drug change when, in toxic reaction, be intended to and desired result When variant and/or in specific time.

The result of COTA module tracks therapeutic choice is simultaneously reported and to use associated knot with COTA node address (CNA) Fruit.It is by the way that by patient's grouping in PATIENT POPULATION, come (upfront) up front meter and biological differences, this is effectively removed As the biological differences of the factor in the value of nursing, treatment difference is given over into the leading factor in treatment results.COTA The personal health information that module receives, collects and record each patient in PATIENT POPULATION in the database, and to a People's health and fitness information is ranked up.Similar personal health information is classified, and by generating and distributing more in COTA module A node address is grouped based on type of the personal health information to the patient in PATIENT POPULATION.Each CNA is represented as The discrete numeric string to punctuate including prefix, centre and suffix, the prefix, centre and postfix notation will be ranked and classification Information is divided into one group of pre-selection variable of one group of clinically relevant health and fitness information.Multiple CNA are based on each node address of expression The possible arrangement of many trillion is reduced to the clinical significant arrangement for reducing number by the discrete numeric string to punctuate, described to subtract The clinical significant arrangement of a small number of purposes make it possible to remind it is necessary nurse and to unnecessary nursing avoid it is required The first behavioral difference is analyzed from ideal value in necessary time and then analyzes consequential clinical and expense result difference, institute It states ideal value and is expressed as the best clinical effectiveness under minimum opportunity cost, to increase nursing value, it means that most Preferable clinical effectiveness under low opportunity cost；Based on the discrete numeric string to punctuate for indicating each node address and based on arrangement Reduction, reduce processing requirement and for processing time so as to medical supplier performance real time monitoring it is efficient；And Make it possible to predict to occur the material time point of behavioral difference, and interrupt treatment process, to avoid the excessive benefit of nursing Behavioral difference is prevented with/underutilization.

Described invention provides the nursing of CNA guidance.The nursing of CNA guidance has two sides, and the two sides passes through together The triple of healthcare provider, disburser and the patient with disease to be able to achieve through the application of CNA in the U.S. The care delivery based on value.

First face, i.e. mission potency (enabling tool), are included in provider, include first The computer of the processor of COTA module, include be otherwise communicatively linked to via network the first COTA the 2nd COTA module Interaction between one client device and disburser.First face enables disburser via including being otherwise communicatively linked to processor The first COTA module the 2nd COTA module the first client device by network to processor transmit communicate, the communication: Mark is used for the health care service under consideration of patient, and the health plan welfare of the patient covers the service；Instruction should Service is the purpose in order to diagnose or treat medical conditions；And identify the variable of disburser's selection.It should being received from disburser When communication, the first COTA module can include: (i) to be directed to the clinic of each CNA to the 2nd COTA module transfer information, the information Result data, (ii) for the unfavorable variance data of each medical supplier at each CNA comprising the necessary nursing lacked And both unnecessary nursing, material time point needle of the unnecessary nursing to provider during treatment The unfavorable variance of patient at each node address is contributed；(iii) report on expenses comprising be assigned to CNA for treating PATIENT POPULATION in each patient real-time cost data；And (iv) by one of the following or multiple figures that are mutually related Conformal analysis: (1) will expense be nursed and clinical effectiveness is interrelated；(2) by the incidence of toxic reaction and seriousness and nurse fees With interrelated with the clinical effectiveness of nursing；And (3) are interrelated by therapy and quality of life.Based on the information, work as payment Person can confirm (establish) (a) in view of potential welfare and to the injury of patient in material time point, and medical services are suitable When delivering or the service of level；(b) by improving clinical effectiveness and reducing total nurse fees used time, medical services are improving health knot It is effective in terms of fruit；Compared with the Health intervention of substitution or without intervention, the service for just treated medical conditions and It is cost-effective for clinical effectiveness；And the service, when following generally accepted medical practice, disburser can be approved as patient It pays for the medical services to provider.

From the perspective of disburser, which can effectively be eliminated for testing, diagnosing and treating selects Pre-authentication；Eliminate prior authorization；And eliminate the demand changed the place of examination.From the perspective of provider, it is reduced to be good for Health was nursed to the time needed for supplier's payment.Correspondingly, mission potency enables health care to optimize based on service fee Reimbursemen (reimbursement), and (such as passing through bundled services) is changed to from the reimbursemen based on service fee based on wind The nursing reimbursemen of danger.

Second face of the health care of CNA guidance includes the interaction between computer, the second client device and patient, The computer includes the processor of the first COTA module, which includes communicatedly linking via network To the 3rd COTA module of the first COTA module.Pass through a series of communications between the first COTA module and patient, first, CNA The health care of guidance provides the complete medical assessment for being enough that patient is made to obtain his/her situation to patient and is enough to make first COTA module distributes the information of CNA to patient；Second, using CNA, it is based on geography, clinical effectiveness, expense and other patients and sets It sets standard and patient is shown and treats option, the standard allows the patient to the nursing of selection optimization to avoid unfavorable variance；The Three, it is best that it shows having under acceptable nursing expense for the nursing following CNA guidance in his/her region to patient As a result healthcare provider.

Summary of the invention

Described invention provides a method, system and store the non-transitory computers of computer program instructions can Medium is read, the computer program instructions make the first COTA module carry out the shield using CNA guidance when being executed on a processor Reason is to improve the clinical effectiveness under particular patient level and reduce the operation of total nursing expense under population level.

According on one side, described invention provides a kind of for improving the clinical effectiveness under particular patient level simultaneously For reducing the method for total nursing expense under population level, which comprises A. provider, comprising packet Include the friendship between the computer, the first client device and disburser of the processor of the tracking of the first clinical effectiveness and analysis module Mutually, first client device includes being otherwise communicatively linked to the first clinical effectiveness tracking and analysis module via network The second clinical effectiveness tracking and analysis module；And B it is described include the first clinical effectiveness tracking and analysis module Interaction between the computer of processor, the second client device and patient, second client device includes via described Network and be otherwise communicatively linked to first clinical effectiveness tracking and the third clinical effectiveness tracking of analysis module and analysis module, It is described include the first clinical effectiveness tracking and analysis module processor computer it is described include the first clinical effectiveness Execute step on the processor of tracking and analysis module, the step include: (a) by by patient's grouping in PATIENT POPULATION come Meter and biological differences up front, to be effectively removed the biological differences as the factor in nursing value, and lead to It crosses the following leading factor given over to treatment difference in treatment results: (i) receives, collects and recorded described in the database The personal health information of each patient in PATIENT POPULATION, the personal health information include characterize it is every in the PATIENT POPULATION Each parameter of a patient and the information that existence, prognosis or treatment are influenced based on newest scientific knowledge or medical guide； (ii) the personal health information for each patient in the PATIENT POPULATION is arranged using collated filter (filter) Sequence, to provide one group of ranked personal health information for the group and to identify the satisfaction in the PATIENT POPULATION every The patient of a parameter；(iii) classify to similar personal health information, and by being tracked in first clinical effectiveness With the tracking of multiple clinical effectiveness and analysis node address (CNA) are generated and distributed in analysis module, is based on and the PATIENT POPULATION Associated personal health information is grouped the type of the patient in the PATIENT POPULATION, wherein the generation and distributing The multiple node address include: (1) each CNA is expressed as include prefix, centre and suffix the discrete number to punctuate Ranked and classification information is divided into one group of clinically relevant health and fitness information by string, the prefix, centre and postfix notation One group of pre-selection variable；(2) the discrete numeric string to punctuate based on each CNA of expression subtracts the possible arrangement of many trillion Few to arrive the clinical significant arrangement for reducing number, the significant arrangement of the clinic for reducing number makes it possible to must in prompting The nursing wanted and to unnecessary nursing avoid analyze the first behavioral difference and so from ideal value in required necessary time The consequential clinical and expense result difference of post analysis, the ideal value are expressed as preferably facing under minimum opportunity cost Bed is as a result, to increase nursing value, it means that the preferable clinical effectiveness under minimum opportunity cost；(3) every based on expression The discrete numeric string to punctuate of a CNA and the reduction based on arrangement, reduce processing requirement and for processing time with So that being efficient to the real time monitoring of medical supplier's performance；And (4) make it possible to predict that behavioral difference may occur Material time point, and interrupt treatment process prevents the behavioral difference to avoid excessive use/underutilization of nursing； (iv) the clinical effectiveness for each CNA is measured by following: for patients one or more in the subset of the PATIENT POPULATION The one group clinically relevant personal health information of the analysis for the subset of the PATIENT POPULATION；And (v) by Treatment, follow-up, abides by prescription medicine (prescribed medicine) and is assigned to the patient population of each CNA at test Compare the difference between a provider and another provider in terms of the expense of each patient in body It is different, come measure each patient in the PATIENT POPULATION for being assigned to each CNA each provider behavior Difference；(b) via including first client device of second clinical effectiveness tracking and analysis module from the branch Pay person's communication for receiving under consideration health care service and the variable that by the disburser is selected of the mark for patient When, the tracking of the second clinical effectiveness of Xiang Suoshu and analysis module transmit information, and the health plan welfare of the patient covers the doctor Service is treated, the information includes, (1') the clinical outcome data for each CNA in (iv)；(2') being directed in (v) The behavioral difference data of each medical supplier at each CNA；(3') report on expenses comprising be assigned to for treating The real-time cost data of each patient in the PATIENT POPULATION of CNA in (iii)；And it (4') will nursing expense and clinic As a result be mutually related one or more pattern analysis；Wherein the information is enough to make the disburser in the material time point Confirm that (a') considers that potential welfare and the injury to the patient, the medical services are appropriate delivering or the service of level； (b') by improving clinical effectiveness and reducing total nursing expense, the medical services are effective in terms of improving healthy result； (c') compared with the Health intervention of substitution or without intervention, the service is for just treated medical conditions and the clinical knot It is cost-effective for fruit；And (d') described service follows generally accepted medical practice, and is approved as the disburser The medical services are paid to the provider；(c) via including third clinical effectiveness tracking and analysis When second client device of module exchanges a series of communications with the patient, provides and be enough to obtain the complete of the patient Medical assessment is simultaneously determined for the information to patient distribution CNA, and using the CNA with reduced unfavorable variance The nursing of the optimum level of risk；And come the nursing for selecting the CNA of healthcare provider and aspiration level to guide, described one Sequence of communications includes: (i'') in response to the first communication from the patient, is faced to described in computer server including first The processor of the tracking of bed result and analysis module reports health problem (health concern), as answer, to including described Third clinical effectiveness tracks and second client device of analysis module sends the second communication, and second communication includes will The list of test needed for the health problem is diagnosed as medical conditions；(ii'') in response to including from the patient (i'') third communication of the result of test needed for the diagnosis health problem in faces as answer to including the third Second client device of bed result and analysis module sends fourth communication, and the fourth communication includes the medical conditions Diagnosis and list for required additional testing of further classifying to the medical conditions；(iii'') in response to coming from institute State the fifth communication of the result comprising the additional testing in (i'') of patient, examining in result, (ii'') based on the test Disconnected and the additional testing in (ii'') list, (a'') obtainable multiple CNA from (iii) are distributed to the patient CNA, the CNA distributed include one group of clinically relevant health and fitness information for the patient；And (b'') to include institute The 6th communication of second client device transmission of third clinical effectiveness tracking module is stated, the 6th communication includes: (1'') The CNA distributed；And the medical professional's of patient of (2'') treatment in the CNA distributed is geographically organized List, wherein the list of medical professional is classified by the one or more in geographical, clinical effectiveness or expense； (iv'') in response to the 7th communication from the patient, the 7th communication selection include reduced unfavorable variance risk and Meet at least one of geography, expense and result demand of the patient or the optimal care meter of multiple medical professionals It draws, is otherwise communicatively linked to the meter including third clinical effectiveness tracking and analysis module in the office of selected medical professional Equipment is calculated, to promote the arrangement to the patient and the reservation of selected medical professional.

In some embodiments of the method, the parameter of the sequence of (a) in (a) (ii) include one of the following or Multiple: gender, the age, race, complication, Tobacco, insurance source, medical record number, primary care physician, change the place of examination doctor Teacher, hospital, approved service supplier, the specific clinical molecular phenotype of disease, therapy intention, the phase of therapy, biological marker Object and nursing expense；Or (b) one group of pre-selection variable in (a) (iii) (1) includes the specific clinical molecular phenotype of disease, The numeric string for indicating the phenotype is wherein determined based on digraph；Or (c) in step (a) (iii) (4) and step (b) (i') (4') in material time point when being included in diagnosis, in progress, in dose change；When drug changes；Having When toxic reaction and one or more of when being intended to variant with desired result；Or (d) (b) (1') (4') the step that nursing expense is interrelated with clinical effectiveness in include by the incidence of toxic reaction, toxic reaction it is tight Principal characteristic；Therapy；And one or more of quality of life and nursing expense and nurse result it is interrelated；Or (e) at (b) Or (c) in from the client device receive it is described transmission via human user or technical process；Or (f) at (c) (iii'') CNA distributed in (b'') (1'') and the one of the scheduled patient care service of the treatment for the situation A or multiple bundles (bundle) are associated；Or (g) clinical effectiveness in (c) (iii'') (b'') (2'') include with It is one or more of lower: received therapeutic agent, the dose intensity of delivering, spacing of doses, dosage duration, quality of life degree Amount, the toxic reaction of therapy, progression free survival phase, Overall survival, reaction measurement and death；Or (h) in step (c) (iii'') list of the medical professional in (b'') (2'') is visually classified by clinical effectiveness.

In some embodiments, one or more bundles of the scheduled patient care service provide scheduled treatment Process, for the situation treatment expense determine or both.

In some embodiments, the method further includes: by one of the scheduled patient care service Or ranking is carried out to both clinical effectiveness and nursing expense in multiple bundles, mark is in minimum nursing expense at the CNA Under best clinical effectiveness.

It in some embodiments, include: (a) green by vision sorter of the clinical effectiveness to the list of medical professional Color table shows better than average clinical effectiveness；(b) yellow indicates average clinical effectiveness；And (c) red is indicated than average clinical effectiveness Difference.

In some embodiments, the method further includes having from the patient and selected medical professional License in the case where: by the personal health information of the patient from first clinical effectiveness tracking and analysis module pass The calculating equipment including the 4th clinical effectiveness tracking and analysis module of the defeated office in selected medical professional.

In some embodiments, the behavioral difference data for each medical supplier at each CNA in (c) Including both the necessary nursing lacked and unnecessary nursing, the unnecessary nursing exists to the provider The material time point during treating is contributed for the unfavorable variance of the patient at each CNA.

In some embodiments, the method further includes: indicate in step (d) the service be for diagnose or The purpose for treating medical conditions.

In some embodiments, the report on expenses includes: in doctor compared between the average cost of each income； Or the hospital's contributrion margin (contribution margin) compared with dollar and percentage；Or the hospital of each patient Average income；Or hospital's average cost of each patient；Or it is same for the average cost of every an example of each doctor, weighting Row is average；Or the average cost of imaging, laboratory work, assessment and management；Or the drug, medical for each doctor Product and other spendings；Or their combination.

In some embodiments, the variable of disburser's selection includes: by the certain of the personal health information Attribute-bit is the variable of one group of desired characteristic；Mark is added to the personal health information by the disburser with will be each The personal health information of patient, which is identified as, is in of equal importance with other health and fitness informations in PATIENT POPULATION's database The variable of one or more attributes in level, or both.

According on the other hand, described invention provides a kind of clinical effectiveness for improving under particular patient level And for reducing the system of total nursing expense under population level, the system comprises: the processor of (A) computer server, Comprising: database, the database includes the personal health information and data for human experimenter group；Communicatedly link To the tracking of the first clinical effectiveness of the database and network and analysis module；And for storing depositing for computer program instructions Reservoir；(B) the first client device comprising: processing unit；Memory, and it is otherwise communicatively linked to the Computer Service The first clinical effectiveness tracking of the processor of device and the second clinical effectiveness tracking of analysis module and analysis module；And (C) Two client devices comprising: processing unit, memory, and it is otherwise communicatively linked to the processor of the computer server The first clinical effectiveness tracking and analysis module third clinical effectiveness tracking and analysis module；(A) computer program instructions The first clinical effectiveness tracking and analysis module is set to carry out operation when executing on the processor, the operation includes: (a) By counting and biological differences patient's grouping in PATIENT POPULATION up front, to be effectively removed as nursing value In factor biological differences, and by below will treatment difference give over to the leading factor in treatment results: (i) receive, Collect and record in the database the personal health information of each patient in the PATIENT POPULATION, the personal health letter Breath include characterize each patient in the PATIENT POPULATION each parameter and based on newest scientific knowledge or medical guide come Influence the information of existence, prognosis or treatment；(ii) using collated filter to for each patient's in the PATIENT POPULATION Personal health information is ranked up, to provide described in one group of ranked personal health information and mark for the group The patient for meeting each parameter in PATIENT POPULATION；(iii) classify to similar personal health information, and by institute State generate and distribute in the tracking of the first clinical effectiveness and analysis module the tracking of multiple clinical effectiveness and analysis node address (CNA), The type of the patient in the PATIENT POPULATION is grouped based on personal health information associated with the PATIENT POPULATION, The wherein generation and to distribute the multiple CNA include: that each CNA is expressed as including the discrete of prefix, centre and suffix by (1) The numeric string to punctuate, the prefix, centre and postfix notation by it is ranked and classification information be divided into one group it is clinically relevant Health and fitness information one group of pre-selection variable；(2) the discrete numeric string to punctuate based on each CNA of expression is a by many trillion Possible arrangement is reduced to the significant arrangement of clinic for reducing number, the significant arrangement of the clinic for reducing number so that Necessary nursing can reminded and unnecessary nursing is being avoided in required necessary time from ideal value analysis the first row For difference and then consequential clinical and expense result difference is analyzed, the ideal value is expressed as in minimum possible expense Best clinical effectiveness under, to increase nursing value, it means that the preferable clinical effectiveness under minimum opportunity cost； (3) it based on the discrete numeric string to punctuate for indicating each CNA and based on the reduction of arrangement, reduces processing requirement and is used for The time of processing is so that be efficient to the real time monitoring of medical supplier's performance；And (4) make it possible to predict possible hair The material time point of raw behavioral difference, and interrupt treatment process, to avoid nursing excessive use/underutilization to prevent State behavioral difference；(iv) the clinical effectiveness for each CNA is measured by following: being one in the subset of the PATIENT POPULATION Or multiple patient analysis are for one group of clinically relevant personal health information of the subset of the PATIENT POPULATION；And (v) by treatment, test, follow-up, in accordance with each trouble in prescription medicine and the PATIENT POPULATION for being assigned to each CNA Compare the difference between a provider and another provider in terms of the expense of person, is divided to measure It is fitted on the behavioral difference of each provider of each patient in the PATIENT POPULATION of each CNA；(b) via First client device including second clinical effectiveness tracking and analysis module receives mark from the disburser and uses When the health care service under consideration of patient and the communication of the variable selected by the disburser, Xiang Suoshu second faces The tracking of bed result and analysis module transmit information, and the health plan welfare of the patient covers the medical services, the information It include: the clinical outcome data for each CNA (1') in (iv)；In (v) for every at each CNA The behavioral difference data of a medical supplier；(3') report on expenses comprising for treating the institute for the CNA being assigned in (iii) State the real-time cost data of each patient in PATIENT POPULATION；And nursing expense and clinical effectiveness are (4') mutually related one A or multiple pattern analysis；Wherein the information is enough that the disburser is made to confirm (a') in view of latent in the material time point In welfare and injury to the patient, the medical services are appropriate delivering or the service of level；(b') clinical by improving As a result and total nursing expense is reduced, the medical services are effective in terms of improving healthy result；(c') with substitution health Intervene or compared without intervention, the service is cost-effective for just treated medical conditions and the clinical effectiveness； And (d') described service follows generally accepted medical practice, and the disburser is made to be approved as the medical services to institute State provider payment；(c) via second visitor for including third clinical effectiveness tracking and analysis module When family end equipment exchanges a series of communications with the patient, provide the complete medical assessment for being enough to obtain the patient and for The patient distributes the information of CNA, and the optimum level with reduced unfavorable variance risk is determined using the CNA Nursing；And come the nursing for selecting the CNA of healthcare provider and aspiration level to guide, a series of communications include: (i'') in response to from the patient first communication, Xiang Suoshu computer server include first clinical effectiveness with Track and the processor of analysis module report health problem, as answer, to including third clinical effectiveness tracking and analysis mould Second client device of block sends the second communication, and second communication is comprising being diagnosed as medical shape for the health problem The list of test needed for condition；(ii'') in response to including the diagnosis health problem institute in (i'') from the patient The third communication of the result of the test needed, as answer, to described second including the third clinical effectiveness and analysis module Client device sends fourth communication, and the fourth communication includes the diagnosis of the medical conditions and is used for the medical conditions The further list of additional testing needed for classification；(iii'') in response to including the additional survey in (i'') from the patient The fifth communication of the result of examination, the result based on the test, the diagnosis in (ii'') and the additional testing in (ii'') List, (a'') obtainable multiple CNA from (iii) to the patient distribute CNA, and the CNA distributed includes to be directed to the trouble One group of clinically relevant health and fitness information of person；And (b'') to include the third clinical effectiveness tracking module described in The 6th communication of second client device transmission, the 6th communication include: the CNA that (1'') is distributed；And (2'') treatment exists The geographically organized list of the medical professional of the patient in CNA distributed, wherein medical professional's is described List is classified by the one or more in geographical, clinical effectiveness or expense；(iv'') in response to from the patient's 7th communication, the 7th communication selection there is reduced unfavorable variance risk and meet the geography of the patient, expense and As a result the optimal care plan of at least one of demand or multiple medical professionals, is otherwise communicatively linked in selected medical treatment The office of professional include third clinical effectiveness tracking and analysis module calculating equipment, with promote to the patient with The arrangement of the reservation of selected medical professional.

In some embodiments, the parameter of the sequence of (a) in (a) (ii) includes one of the following or multiple: gender, Age, race, complication, Tobacco, insurance source, medical record number, primary care physician, the doctor that changes the place of examination, hospital, warp The service supplier of approval, the specific clinical molecular phenotype of disease, therapy intention, the phase of therapy, biomarker and nurse fees With；Or (b) one group of pre-selection variable in (a) (iii) (1) includes the specific clinical molecular phenotype of disease, wherein based on having The numeric string for indicating the phenotype is determined to figure；Or (c) in step (a), (iii) (4) and step (b) (i') be (4') In material time point when being included in diagnosis, in progress, in dose change；When drug changes；In toxic reaction, And one or more of when being intended to variant with desired result；Or (d) (b) (1') (4') in will nursing Expense and the interrelated step of clinical effectiveness include by the incidence of toxic reaction, the seriousness of toxic reaction；Therapy；And One or more of quality of life and nursing expense and nursing result are interrelated；Or (e) at (b) or (c) in from institute It states client device and receives the transmission via human user or technical process；Or (f) at (c) (iii'') (b'') (1'') In the CNA distributed to for one or more bundles of scheduled patient care service for the treatment of of the situation it is related Connection；Or (g) clinical effectiveness in (c) (iii'') (b'') (2'') includes one of the following or multiple: received treatment Agent, the dose intensity of delivering, spacing of doses, dosage duration, quality of life is measured, the toxic reaction of therapy, get nowhere life Deposit phase, Overall survival, reaction measurement and death；Or (h) the medical professionalism people in step (c) (iii'') (b'') (2'') The list of member is visually classified by clinical effectiveness.

In some embodiments, the system further comprises: by one of the scheduled patient care service Or ranking is carried out to both clinical effectiveness and nursing expense in multiple bundles, mark is in minimum nursing at the CNA distributed Best clinical effectiveness under expense.

In some embodiments, the system further comprises having from the patient and selected medical professional License in the case where: by the personal health information of the patient from first clinical effectiveness tracking and analysis module pass The calculating equipment including the 4th clinical effectiveness tracking and analysis module of the defeated office in selected medical professional.

In some embodiments, the system further comprises: the instruction service is for diagnosing or treating medical shape The purpose of condition.

In some embodiments, the report on expenses includes: in doctor compared between the average cost of each income； Or the hospital's contributrion margin compared with dollar and percentage；Or hospital's average income of each patient；Or each patient Hospital's average cost；Or it is average for the average cost of every an example of each doctor, weighting colleague；Or imaging, experiment The average cost of room work, assessment and management；Or the drug for each doctor, medical supplies and other spendings；Or it Combination.

According on the other hand, described invention provides a kind of non-transitory calculating for storing computer program instructions Machine readable medium, the computer program instructions for promote provider, include the first clinical effectiveness with Interaction (A) between the computer of track and the processor of analysis module, the first client device and disburser, and in the packet Computer, the second client device containing the processor for including the tracking of the first clinical effectiveness and analysis module and the friendship between patient Mutually (B), first client device include being otherwise communicatively linked to the first clinical effectiveness tracking and analysis via network Second clinical effectiveness of module tracks and analysis module, second client device include communicating ground chain via the network It is connected to the first clinical effectiveness tracking and the third clinical effectiveness tracking of analysis module and analysis module, the computer program Instruct it is described include the first clinical effectiveness tracking and analysis module processor on execute when make first clinical effectiveness and Tracking module carries out operation, and the operation includes: (a) by counting patient's grouping in PATIENT POPULATION up front and biology Difference is learned, to be effectively removed the biological differences as the factor in nursing value, and by the way that difference will be treated below It gives over to the leading factor in treatment results: (i) receives, collects and recorded in the database from each of described PATIENT POPULATION The personal health information of patient, the personal health information include each parameter for characterizing each patient in the PATIENT POPULATION And the information of existence, prognosis or treatment is influenced based on newest scientific knowledge or medical guide；(ii) collated filter is used Personal health information for each patient in the PATIENT POPULATION is ranked up, to provide one group that is directed to the group Ranked personal health information and identify the patient for meeting each parameter in the PATIENT POPULATION；(iii) to similar Personal health information is classified, and by generating and distributing multiple in first clinical effectiveness tracking and analysis module Clinical effectiveness tracking and analysis node address (CNA), based on personal health information associated with the PATIENT POPULATION come to institute The type for stating the patient in PATIENT POPULATION is grouped, wherein it is described generation and distribute the multiple node address include: (1) will Each CNA be expressed as include prefix, centre and suffix the discrete numeric string to punctuate, the prefix, centre and postfix notation Ranked and classification information is divided into one group of pre-selection variable of one group of clinically relevant health and fitness information；(2) every based on expression The possible arrangement of many trillion is reduced to and reduces the clinical significant of number by the discrete numeric string to punctuate of a CNA Arrangement, the significant arrangement of the clinic for reducing number make it possible to reminding necessary nurse and to unnecessary nursing It avoids analyzing the first behavioral difference from ideal value in required necessary time and then analyzes consequential clinical and expense Result difference, the ideal value is expressed as the best clinical effectiveness under minimum opportunity cost, thus increase nursing value, this Mean the preferable clinical effectiveness under minimum opportunity cost；(3) based on the discrete number to punctuate for indicating each CNA String and the reduction based on arrangement reduce processing requirement and the time for processing so that the real-time prison showed medical supplier Control is efficient；And (4) make it possible to predict to occur the material time point of behavioral difference, and interrupt treatment process, The behavioral difference is prevented to avoid excessive use/underutilization of nursing；(iv) measured by following for each section The clinical effectiveness of dot address: the institute of the PATIENT POPULATION is directed to for patient analysis one or more in the subset of the PATIENT POPULATION State one group of clinically relevant personal health information of subset；And (v) by treatment, test, follow-up, abide by prescription medicine And compare a provider in terms of the expense for each patient being assigned in the PATIENT POPULATION of each CNA With the difference between another provider, to measure each of the PATIENT POPULATION for being assigned to each CNA The behavioral difference of each provider of patient；(b) via including second clinical effectiveness tracking and analysis mould First client device of block from the disburser receive mark for patient health care service under consideration with And the variable selected by the disburser communication when, the tracking of the second clinical effectiveness of Xiang Suoshu and analysis module transmit information, institute The health plan welfare for stating patient covers the medical services, the information include: (1') in (iv) for each CNA Clinical outcome data；(2') the behavioral difference data for each medical supplier at each CNA in (v)；(3') Report on expenses comprising the real-time expense of each patient in the PATIENT POPULATION for treating the CNA being assigned in (iii) Data；And (4') nursing expense and clinical effectiveness are mutually related one or more pattern analysis；The wherein information foot So that the disburser confirms the injury of (a') in view of potential welfare and to the patient, the doctor in the material time point The service for the treatment of is appropriate delivering or the service of level；(b') by improving clinical effectiveness and reducing total nursing expense, the medical treatment clothes Business is effective in terms of improving healthy result；(c') compared with the Health intervention of substitution or without intervention, the service is for just It is cost-effective for treated medical conditions and the clinical effectiveness；And (d') described service follows generally accepted doctor Practice is treated, and so that the disburser is approved as the medical services and pays to the provider；(c) via packet Second client device for including the third clinical effectiveness tracking and analysis module exchanges a series of communications with the patient When, the complete medical assessment for being enough to obtain the patient and the information for distributing CNA to the patient are provided, and use institute CNA is stated to determine the nursing of the optimum level with reduced unfavorable variance risk；And come select healthcare provider and The nursing of the CNA guidance of aspiration level, a series of communications include: that (i'') is communicated in response to first from the patient, Health problem is reported to the processor for described in computer server including the tracking of the first clinical effectiveness and analysis module, as answering It is multiple, the second communication is sent to second client device for including third clinical effectiveness tracking and analysis module, it is described Second list of the communication comprising test needed for the health problem is diagnosed as medical conditions；(ii'') in response to from described The third communication of the result comprising test needed for the diagnosis health problem in (i'') of patient, as answer, to including The third clinical effectiveness and second client device of analysis module send fourth communication, and the fourth communication includes institute State the diagnosis of medical conditions and the list for required additional testing of further classifying to the medical conditions；(iii'') it rings The fifth communication of result of the Ying Yu from the patient comprising the additional testing in (i''), result based on the test, (ii'') diagnosis in and the list of the additional testing in (ii''), (a'') from (iii) obtainable multiple CNA to institute It states patient and distributes CNA, the CNA distributed includes one group of clinically relevant health and fitness information for the patient；And (b'') it is communicated to second client device transmission the 6th for including the third clinical effectiveness tracking module, the described 6th Communication includes: the CNA that (1'') is distributed；And the medical professionalism people of patient of (2'') treatment in the node address distributed The geographically organized list of member, wherein the list of medical professional is by by geographical, clinical effectiveness or expense One or more is classified；(iv'') in response to the 7th communication from the patient, the 7th communication selection, which has, to be subtracted At least one of small unfavorable variance risk and the geography, expense and the result demand that meet the patient or multiple medical treatment The optimal care plan of professional, be otherwise communicatively linked to selected medical professional office include third clinic knot The calculating equipment of fruit tracking and analysis module, to promote the arrangement to the patient and the reservation of selected medical professional.

In some embodiments, the non-transitory computer-readable medium further comprises: by described scheduled Ranking is carried out to both clinical effectiveness and nursing expense in one or more bundles of patient care service, what is distributed Best clinical effectiveness of the mark under minimum nursing expense at CNA.

In some embodiments, the non-transitory computer-readable medium further comprises having from the patient In the case where license with selected medical professional: the personal health information of the patient is tied from first clinic Fruit tracking and analysis module be transferred to selected medical professional office include the 4th clinical effectiveness track and analyze The calculating equipment of module.

In some embodiments, the non-transitory computer-readable medium further comprises: the instruction service is to use In the purpose for diagnosing or treating medical conditions.

In some embodiments, by the variable that the variable that disburser selects includes: disburser selection include: by Certain attribute-bits of the personal health information are the variable of one group of desired characteristic；Mark is added to institute by the disburser Personal health information is stated so that the personal health information of each patient to be identified as and its in PATIENT POPULATION's database Its health and fitness information is in the variable of one or more attributes in level of equal importance, or both.

With reference to features as discussed above, these and other aspects and embodiment will for those of ordinary skill in the art It is obvious.

Detailed description of the invention

In the accompanying drawings, not to scale (NTS), and wherein identical appended drawing reference runs through the identical element of several views instruction:

Fig. 1 illustrates the exemplary block diagrams of some pressure and some potential solutions in tumour market；

It is logical by network and one or more subscriber computers that Fig. 2 illustrates server computer according to an embodiment of the present disclosure Letter is to provide the block diagram of clinical effectiveness tracking and analysis (COTA) module to one or more of subscriber computers；

Fig. 3 is the block diagram of several functions according to an embodiment of the present disclosure of illustrating and provided by COTA module；

Fig. 4 A be it is according to an embodiment of the present disclosure diagram using COTA module come to data associated with colorectal cancer patients into The block diagram of row sequence；

Fig. 4 B is the process that COTA module according to an embodiment of the present disclosure is ranked up data by specific node creation Figure；

Fig. 4 C is diagram according to an embodiment of the present disclosure for determining the numeric string of the expression phenotypic characteristic for node address Digraph block diagram；

Fig. 5 A is the flow chart for the step of diagram according to an embodiment of the present disclosure is executed by COTA module；

Fig. 5 B is diagram according to an embodiment of the present disclosure for enabling the patient for the situation of being diagnosed with to optimize treatment choosing The flow chart of the step of item；

Fig. 6 illustrates the flow chart that COTA module according to an embodiment of the present disclosure transmits prompting in response to triggering；

Fig. 7 be it is according to an embodiment of the present disclosure diagram mobile device tissue received prompting graphical representation；

Fig. 8 shows the graphical representation of the disease incident of cancer subtypes according to an embodiment of the present disclosure；

Fig. 9 is the graphical representation of the search according to an embodiment of the present disclosure refined by the variable being input in COTA module；

Figure 10 shows the list of multiple variables relevant to specified disease according to an embodiment of the present disclosure；

It includes the real-time Kaplan with the confidence interval for cancer of pancreas that Figure 11, which is shown according to an embodiment of the present disclosure, The graphical representation of Meier curve；

Figure 12 is the graphical representation according to an embodiment of the present disclosure that show Kaplan Meier curve by progression of disease；

Figure 13 is the figure of the real-time reference test (benchmarking) of the result between two side according to an embodiment of the present disclosure Shape indicates；

Figure 14 is the graphical representation of report on expenses according to an embodiment of the present disclosure；

Figure 15 A and 15B are the graphical representations at treatment interface according to an embodiment of the present disclosure；

Figure 16 is the graphical representation of result screen according to an embodiment of the present disclosure；

Figure 17 is the graphical representation for the treatment of details report screen according to an embodiment of the present disclosure；

Figure 18 is the graphical representation of the relatively analysis screen of toxic reaction and expense according to an embodiment of the present disclosure；

Figure 19 is the graphical representation of the relatively analysis screen of therapy and quality of life according to an embodiment of the present disclosure；

Figure 20 is the flow chart that the feedback according to an embodiment of the present disclosure for being supplied to medical professional is supported；

Figure 21-23 shows the figured embodiment according to an embodiment of the present disclosure for different diagnostic-types；

Figure 24 shows diagram COTA module according to an embodiment of the present disclosure for tumor of breast --- breast cancer was from 2008 Data to the histology (histology) with invasive ductal carcinoma in 2013 generate and the graphical representation of sequence；

Figure 25 shows diagram COTA module according to an embodiment of the present disclosure for tumor of breast --- breast cancer was from 2008 The graphical representation for generating and sorting to the data of tumor grades in 2013 and phase (stage)；

Figure 26 shows diagram COTA module according to an embodiment of the present disclosure for breast cancer --- the IIB phase from 2008 to Data in 2013 generate and the graphical representation of sequence；

Figure 27 shows diagram according to an embodiment of the present disclosure for the graphical representation of the overall survival result of patient with breast cancer；

Figure 28 shows result --- the figure of the comparison between two sides that diagram according to an embodiment of the present disclosure is directed to breast cancer Shape indicates；

Figure 29 depicts an example of the schematic diagram of diagram client device according to an embodiment of the present disclosure；And

Figure 30 is the block diagram of the inside structure of diagram computer according to an embodiment of the present disclosure.

Figure 31 is the patient of the nursing according to an embodiment of the present disclosure for showing the CNA guidance for the patient for having breast cancer The flow chart in face.

Figure 32 is block diagram the advantages of illustrating the two sides of the nursing of CNA guidance.Supplier-disburser face makes it possible to eliminate For testing, diagnosing and treating selection pre-authentication；The demand eliminating prior authorization and changing the place of examination optimizes based on service fee It repays and makes it possible to be changed to the reimbursemen based on risk from the reimbursemen based on service fee.Use the CNA nursing guided Do three things in the patient face of patient: first, it provides information to patient, so patient obtains the full assessment of his/her situation (for example, physical assessment；Laboratory Evaluation；Imaging etc.) CNA is assigned；Second, it shows for the situation Patient treats option, which treats option optimization and nurse and reduce the risk of unfavorable variance；And third, it shows to patient The nursing for following CNA guidance in his/her region and under the acceptable nursing expense with the doctor of best result.

Specific embodiment

Embodiment is discussed in more detail referring now to the figure with the application.It is identical and/or corresponding in adjoint figure Element be indicated by the same numbers.

There is disclosed herein various embodiments；It should be understood, however, that: the disclosed embodiments and user interface as shown It is only the explanation for the disclosure that can be embodied in a variety of manners.In addition, each purport in the example provided in conjunction with various embodiments It is being illustrative and be not restrictive.In addition, each figure is not necessarily to scale, some features may be extended to show specific group The details (and each any size shown in figure, material and similar details are intended to be illustrative and be not restrictive) of part. Therefore, the details of specific structure disclosed herein and function is not necessarily to be construed as restrictive, and only as instructing Those skilled in the art differently use the representative basis of the disclosed embodiments.

Referring to the block diagram and operation diagram of the method and apparatus for selecting and presenting media related with specific subject Show to describe the present invention.It should be appreciated that being realized block diagram or behaviour by means of analog or digital hardware and computer program instructions The combination of the frame in each frame and block diagram or operational illustration yet to illustrate.These computer program instructions can be provided to logical With the processor of computer, special purpose computer, ASIC or other programmable data processing units, so that via computer or other The function of being specified in the instruction realization block diagram or one or more operation boxes that the processor of programmable data processing unit executes/ Movement.

In some replacement implementations, the function action pointed out in frame can not be by the order pointed out in operational illustration yet Occur.For example, two frames continuously shown can actually be performed substantially simultaneously or the frame sometimes can by with Inverted order executes, this depends on related functionality/movement.In addition, being presented and being described as flow chart in the disclosure The embodiment of method is provided as example, in order to provide the more complete understanding to the technology.Disclosed method is not limited to The operation and logic flow presented herein.Imagine alternate embodiment, wherein change the order of various operations and wherein solely On the spot execute the sub-operation for being described as a part as larger operation.

Although being described about cancer condition, described clinical effectiveness Treatment analysis can be used for any clinic Situation is (for example, cardiovascular disease, metabolic disease (diabetes), immune-mediated disease are (for example, lupus, rheumatoid joint It is scorching), organ transplant；Neurodegenerative disease；Pulmonary disease, infectious disease, hepatic disease；Behavior health).Practitioner will be appreciated by The parameter of each such situation.

Through specification and claims, except the meaning being expressly recited, term, which can also have in context, to be built View or the meaning for having nuance implied.Similarly, the phrase " in one embodiment " as used in this article is different Surely refer to the same embodiment, and as used in this article phrase " in another embodiment " be not necessarily meant to refer to it is different Embodiment.Such as, it is intended that theme claimed includes the combination of example embodiment in whole or in part.

Generally, can use at least partly from the context understand term.For example, as used in this article The term of such as "and", "or" or "and/or" etc may include a variety of meanings, which can at least partly take Certainly in the context using such term.If such as A, B or C are then intended to mean that in general, "or" is used for linked list: A, B and C, this, which is in inclusive meaning, uses and A, B or C, this, which is in exclusiveness meaning, uses.In addition, at least partly Ground depends on context, and term " one or more " as used in this article can be used in singular meaning describing any Feature, structure or characteristic, or can be used for the combination of Expressive Features, structure or characteristic on plural references.Similarly, this Outside, the term of such as "a", "a" or "the" etc is construed as conveying singular usage or conveys plural usage, until Partially depend on context.In addition, term "based" is construed as being not necessarily intended to convey one group of exclusive sexual factor, And instead can permit the presence for the additive factor being not necessarily expressly recited, again, this depends, at least partially, on context.

It is to dominate the extraordinary chemical combination of classification that most of its research and development (R & D) investment is put into tumour by pharmaceuticals industry In object.For example, the about 30-35% of 3 pipeline of stage is tumour.These compounds are the height targetings based on newest scientific progress Special therapy, and the business and development model different from existing business now and development model will likely be needed.System The current structure of medicine company is usually inefficiency, and may not be able to be supported by its future products.

For the new adjoint diagnostic test of therapy of new generation exploitation diagnostic companies will need new mode educate doctor with And efficient marketing and distribution channel.

The reimbursemen model in the U.S. will likely be changed to the payment model based on value from by services pay model." par doctor Therapy case " has accelerated this certain elements (for example, during responsibility medical organization (ACO) & for primary care with patient is Family (PCMH) model of the medical treatment of the heart), and have the disburser's activity paid towards binding in professional (such as orthopaedy).It is right In government, employer, other disbursers and/or for doctor, current may be by the payment model of services pay can not Lasting.Many doctors are it has also been found that be unsustainable by the economic conditions of services pay model.As indicated on, government can It can change towards the payment model based on value.

Fig. 1 illustrates the exemplary block diagrams of some pressure and some potential solutions in such as tumour market.It is swollen Tumor doctor 105 faces financial pressure, it is many cannot be using their current models come continuous business, and many is look for thick stick Bar acts on the new paragon of (leverage).Potential tumour doctor solution 110 includes polymerization and new payment model, such as Bundle.Drugmaker (being illustrated as " drugmaker ") 115 usually has its largely or entirely tumour pipeline, as height target To therapy.In addition, the epoch of heavy bomb drugs may finish.In addition, " old world " business model may be no longer appropriate for, and And it may be too expensive.Possible drug solution 120 includes Patient identification and its business model of change.Health plan 125 is logical Often with the increased demand for having " management " tumour.Moreover, executing the management without believable tool or ability in inside.Separately Outside, the medical professional of such as doctor etc may not buy health plan.Potentially health plan solution 130 includes New payment model (for example, bundle) and control expense.

Fig. 2, which is illustrated, is hereinafter also referred to as server 205 according to the server computer 205(of one embodiment) pass through network 215 (referred to herein as calculate and set with subscriber computer (referred to herein as client device) 210 and subscriber computer It is standby) 230 communications to be to provide clinical effectiveness tracking and analysis (COTA) module to subscriber computer 210 and/or subscriber computer 230 220 block diagram.Server 205 can be generated and/or provide for example will be by subscriber computer 210 and/or subscriber computer 230 The web page that browser (not shown) is shown by the network 215 of such as internet etc.In one embodiment, COTA mould Block 220 is web page (or a part of web page), and therefore by subscriber computer 210 and/or subscriber computer 230 user accesses via web browser.In another embodiment, COTA module 220 is software application, such as Mobile " app ", which can be downloaded to subscriber computer 210 from server computer 205 and/or user counts Calculation machine 230.In another embodiment, COTA module 220 is provided for so that being able to achieve functionality described herein User interface.

The calculating equipment of such as server computer 205, subscriber computer 210 and subscriber computer 230 etc may energy It is enough such as to send or receive signal via wired or wireless network, or it may be capable of handling or store signal, such as by signal In memory as the storage of physical storage state.As an example, the equipment that can be operated as server can wrap Include dedicated rack-mount server, desktop computer, laptop computer, set-top box, various feature (such as aforementioned devices of combination Two or more features) integrated equipment etc..Server may in terms of configuration or ability difference it is very big, but server It generally may include one or more central processing unit and memory.Server can also include that one or more large capacities are deposited Store up equipment, one or more power supply, one or more wired or wireless network interfaces, one or more input/output interfaces or Person's one or more operating system, such as Windows server, Mac OS X, Unix, Linux, FreeBSD Deng.

Server 205 may include equipment, which includes for providing matching for content to another equipment via network It sets.Server 205 can such as trustship such as social network sites etc website, the example of the website can include but is not limited to Flickr, Twitter, Facebook, LinkedIn or personal user's website (blog, videoblog etc.). Server 205 can be with a variety of other websites of trustship, and including but not limited to commerce site, educational site, dictionary website, encyclopaedia is complete Book website, Wiki, financial website, governmental site etc..

Server 205 can further provide for a variety of services, which includes but is not limited to web services, third party Service, audio service, Video service, E-mail service, Transit time flow meter (IM) service, SMS service, MMS service, FTP Service passes through voice (VOIP) service, row's schedule service, photo service of IP etc..The example of content may include text, figure Picture, audio, video etc. can be handled in the form of such as physical signal of such as electric signal etc, or can be by Such as it is stored in memory as physical state.The example that can be used as the equipment that server is operated includes desk-top meter Calculation machine, multicomputer system, microprocessor type or programmable consumer electronics etc..

In one embodiment, it 205 managed database 240 of server or is communicated with database 240.Database 240 can be with It is stored locally or remote from server 205.In one embodiment, COTA module 220 is to the data stored in database 240 It accesses or searches for or sort.COTA module 220 can also be by network 215(for example, from internet) retrieval information.Data Library 240 can store patient data or other relevant medical informations.For example, being input in database or COTA module 220 Data can come from the expert in its corresponding field (for example, having the tumour doctor of the experience more than the years such as 5,10,15,20,30 Teacher).It can manually or automatically enter data into database 240 and/or COTA module 220.

Network can be with Coupling device, so that communication can be exchanged, such as in server and client device or other classes The exchanged between equipment of type, including being exchanged between the wireless device for example via wireless network coupling.Network can also include Large capacity reservoir, such as the calculating of such as network-attached reservoir (NAS), storage area network (SAN) or other forms Machine or machine readable media.Network may include internet, one or more Local Area Network, one or more wide area networks (WAN), wire type connection, wireless type connection or any combination thereof.Similarly, subnet such as can using different frameworks or Person can abide by different agreement or compatible with different agreement, can interoperate in bigger network.For example, can make various types of The equipment of type can be used for providing the ability of interoperable for different frameworks or agreement.As an illustrated example, router can To provide link between separation and independent LAN in other ways.

Communication link or channel may include such as analog of telephone line, such as twisted pair, coaxial cable, including T1, T2, T3 Or all or part of digital line of T4 type line, Integrated Service Digital Network, digital subscriber line (DSL), including satellite chain The Radio Link on road or other communication links or channel, such as may be known to those skilled in the art.It is set in addition, calculating Standby or other related electronic equipments can be remotely coupled to network, such as such as be remotely coupled to net via telephone wire or link Network.

Wireless network can couple client device with network.Wireless network can using independent self-organizing network, Mesh network, Wireless LAN (WLAN) network, cellular network etc..Wireless network may further include through wireless radio chain The system of terminal, gateway, the router of the couplings such as road etc., the terminal, gateway, router etc. freely, can be moved randomly Or themselves is arbitrarily organized, so that network topology can change, even can quickly change sometimes.Wireless network can be with Further use multiple network access technology, including long term evolution (LTE), WLAN, wireless router (WR) net or second Generation, the third generation or forth generation (2G, 3G or 4G) cellular technology etc..Network access technique can be able to achieve to equipment (for example, Such as with different degrees of ambulant client device) wide area covering.

For example, network can be able to achieve the RF or wireless type communications via one or more network access techniques, Such as global system for mobile communications (GSM), General Packet Radio Service (GPRS), increases Universal Mobile Telecommunications System (UMTS) Strong type data GSM environment (EDGE), 3GPP long term evolution (LTE), LTE be advanced, wideband code division multiple access (WCDMA), bluetooth, 802.11b/g/n waiting.Wireless network almost may include that in such as client device or can calculate equipment etc by it Any kind of wireless communication mechanism of signal is transmitted between equipment, between networks or in network etc..

In one embodiment and such as described herein, subscriber computer 210 and/or subscriber computer 230 It is smart phone.In another embodiment, subscriber computer 210 and/or subscriber computer 230 are tablet computers.User's meter Calculation machine 210 and/or subscriber computer 230 can also be computer, music player, set-top box, intelligence TV or can transmit letter Any other calculating equipment of breath.

COTA module 220 can establish the effective means of managing patient, lead to the more preferable result under controlled expense.? In one embodiment, COTA module 220 is connector between third party and medical professional (for example, tumour doctor) or connects Mouthful.In one embodiment, COTA module 220 is that cancer is ordered into clinic and the molecule fidelity of highest level (fidelity) analysis tool.COTA module 220 and then real-time tracking are as a result, such as Overall survival (overall Survival, OS), progression free survival phase (Progression free survival, PFS) and expense.

Overall survival can be test endpoint, be generally expressed as a period of time (existence duration), such as with the moon For unit.Continually, using intermediate value, so that once 50% subject has reached terminal, so that it may calculate test endpoint.Example DFS phase, be commonly used for analysis for local disease treatment as a result, it is described treatment cause patient obviously disease-free, It such as performs the operation or performs the operation and add complementary therapy.It is interim in disease-free survival, event be recurrence rather than it is dead.The people of recurrence is still raw It deposits, but they are no longer considered disease-free.

Progression free survival phase is the length of time during and after drug or treatment, during the drug or treatment just Treated disease (for example, cancer) will not get worse.It is sometimes used as the healthy measurement that research has the people of disease, to taste Examination determines that new treatment work is much good.

As used in this article, term " real-time " or " real-time " mean it is no it is appreciable delay or immediately in The information collected or delivered after handling.These terms further include the time introduced by (for example, near real-time) automatic processing Delay.

In one embodiment, COTA module 220 can remind subscriber computer 210 and/or user's meter at crucial moment The user (for example, medical professional) of calculation machine 230 provides relevant information.COTA module 220 is it is also possible that be able to achieve medical treatment Communication and cooperation and (for example, by medical professional's progress) content between professional are issued.In one embodiment In, COTA module 220 can make medical professional be able to carry out the contract taken risks with disburser (for example, binding branch It pays).

Although describing COTA module 220 herein with respect to cancer, COTA module 220 can be advantageously employed Manage any disease or situation.

In one embodiment, the descriptive elements of COTA include sequence, result tracking, performance status/quality of life degree Amount, the expense of the toxic reaction of therapy and nursing.

Fig. 3 is the block diagram for the function 300 of being provided according to the diagram of one embodiment by COTA module 220.

In one embodiment, COTA module 220 execute COTA sequence 310, the COTA sequence 310 mark meet one or The patient of multiple parameters.Parameter may include such as demographic parameters, such as gender, age, race (ethnicity), conjunction And disease, Tobacco, medical record number, insurance source, primary care medical professional, the medical professional that changes the place of examination, doctor Institute, the service supplier (for example, pharmacy) of approval, the specific clinical and molecular phenotype of disease, therapy are intended to, about progression of disease Therapy phase and biomarker.Parameter can be simple indicator (for example, positive, negative, do not access), be based on Parameter (for example, tumor size), the measured parameter (for example, tumor grade) etc. of number.Parameter can be by as user The input of selection is received by COTA module 220.By the clinic of patient's sequence 310 to highest level and/or it can divide in diagnosis Sub- fidelity, because each patient has the different death rates, disease incidence, treatment and expense.Term " the clinic of highest level And/or molecule fidelity " refer to according to as receive in its related fields it is newest science and/or medical guide obtained by most High-caliber patient information.For example, in the case where there is such as 10 to can be used for the test of lung cancer, the result table of this 10 tests Show the fidelity of the highest level for lung cancer.COTA module 220 can be with any combination of that 10 results to there is lung cancer Patient is ranked up.COTA module 220 can it is additional science and/or medical guide received in its related fields when packet Include them.In one embodiment, COTA module 220 collects the life for influencing patient based on newest science and/or medical guide It deposits and/or all information of prognosis and/or treatment.

In addition, the tracking of 220 implementing result of COTA module and analysis 320.The tracking result in real time of COTA module 220.One In a embodiment, element result tracking includes parameter progression free survival phase, Overall survival, performance status/quality of life measurement, poison Property incidence/seriousness (for example, degree that substance or drug can damage individual) of reaction, dead and drug utilization (for example, The duration of the dose intensity of delivering, spacing of doses and therapy).It is also contemplated within other types of result.

Element ECOG performance status/quality of life measurement refers to the side that can be used to track the quality of life of patient at any time Method.It is demographic parameters --- a part of the specific clinical molecular phenotype of disease, i.e., when therapy starts patient it is strong The phase of health, and in sequence.For example, the ECOG(when therapy starts is for example, ECOG 3) with therapy after ECOG(example Such as, ECOG 2) comparison reflect the effect of the therapy.

In one embodiment, the exemplary parameter of the toxic reaction of element therapy is incidence and seriousness.At one In embodiment, COTA to be able to achieve the finance taken risks between disburser and supplier and concludes a bargin, so each side can be reduced Changeability, waste and poor efficiency, but still carry out expected result.

COTA module 220 can also such as change in diagnosis, in progress, in dose change/drug in key point When change/toxic reaction and/or when being intended to variant with desired result, in real time to medical professional (for example, doctor Teacher) (or in another embodiment, to the insurance company of patient or any other entity) transmission such as prompting 330 etc Communication.In one embodiment, COTA module 220 provides prompting, warning banner medical professional to medical professional The particular patient searched for.For example, COTA module 220 can be applied in real time to particular patient is look for it is specific (for example, It is new) drugmaker of drug or drug candidate provides prompting.It is good candidate that the prompting, which can identify for certain drug, Particular patient.

Fig. 4 A is the block diagram being ranked up according to the diagram of one embodiment to data associated with colorectal cancer patients.Though It is so described about cancer (for example, colon cancer), but describes to can be adapted for any kind of cancer with attached drawing, or another In one embodiment, it can be adapted for any kind of disease for the data associated with patient for having for it.

It collects for all cancers (or in another embodiment, for the cancer of more than one type, or at it In its embodiment, for all cardiovascular diseases, pulmonary disease, gastrointestinal disease, neurological disease etc.) data 410, and the number According to 410 constrictions to the Cancer-Related subset 420 of such as colon.In one embodiment, it is then analyzed and is arranged by COTA module 220 The subset 420 of sequence and the Cancer-Related data of colon, to generate the colon cancer data set 430 of sequence.The colon cancer data set of sequence 430 may include one or more packets, wherein each grouping includes patient's phase with the specific colon cancer with same type Associated data.Thus, COTA module 220 makes it possible to for cancer being ordered into the fidelity of highest level.

In general, patient information is stored in electronic medical record (EMR).However, EMR usually includes too many information, and And therefore medical professional is difficult to position interested specific information from the bulk information being stored in EMR.In addition, EMR In most of information it is unrelated with the information that medical professional is searching for.It is capture and the office for entering doctor with target The EMR wholly or largely of patient and the associated data of the patient for the office for leaving doctor it is different, COTA module 220 It is targeting, because module 220 allows users to positioning specific data associated with particular patient.Correspondingly, COTA mould Block 220 can be ranked up data to position specific special information.The received data of COTA module 220 usually via Web page, and be discrete (for example, usually by user in drop-down menu or via one or more check boxes selection one A or multiple selections are to provide).

The grouping of the type of patient is classified to patient based on these variables, sorts and promoted to COTA module, causes The appointment of unique COTA node address (CNA), unique COTA node address embody those classified variables.In one embodiment In, data are absorbed into system via human user or technical process (for example, API), the layer in application program (means to hold A part of the application program of row specific function) information is checked and assesses, such as whether it is correct, whether it damages, what has Information, lack loophole in what information // information, how to format it, spelling etc., correct so far it detects that pass CNA is distributed in any problem of the information, and to that group information.In one embodiment, CNA be for similar data into The address of row classification.In one embodiment, the relationship between the different characteristics in the grouping of COTA module id, this allows COTA Classify to the information about any patient in grouping.In one embodiment, group information quilt in database Allocate CNA in advance.In one embodiment, COTA module obtains the bulk information comprising many different attributes, allows user will Certain attribute-bits are one group of characteristic, and add (one or more) attribute to the information to indicate that the information is similar to database In other information segment, i.e. the information and other information type/value having the same.Correspondingly, node address be so that with The number that family can specially compare similar patients and similar patients.This specificity allows the biological variability of result is minimum Change, and therefore the higher precision of the influence about therapeutic agent to result is provided.

In one embodiment, user wants personal health information (PHI) of the verifying from patient, it is ensured that it is in all respects All it is correct, and then distributes CNA appropriate.As used in this article, personal health information (PHI) refers to medical treatment Can be used for identifying individual patient and the health for such as diagnosing or treating etc be provided in record or the record set assigned During care creation, using or disclosed any information.The example of personal identifier in PHI includes but is not limited to Name；Less than all geographical subdivisions in state comprising street address, city, county, area, postcode；It is directly related with individual For all date elements (except the time) on date comprising the date of birth, admission date, discharge the date, date of death and 89 years old or more institute's has ages and all date elements (including time) for indicating such age；Telephone number；Fax number Code；E-mail address；Social security number, medical record number；Health plan beneficiary's number；Account number；Certificate/licensing Number；Delivery vehicle identifier and sequence number comprising license plate number；Device identifier and sequence number；Web uniform resource locator (URL)；Internet Protocol (IP) address digit；Biometric identifier comprising fingerprint and vocal print；Full face photographs and appoint What comparable image；And any other unique identification number, characteristic or code (but be not by investigator are to data encoding And the unique code distributed).The PHI is input in browser for patient A.PHI is sent to classification layer and CNA is divided Match, which defines the attribute of the record of patient A.And then into database, that is, the patient for being included into such CNA belongs to Property set is added into the CNA.Once this is completed, when next user logs on to application program accesses database, database is just The CNA of all information and distribution of patient A will be returned.Correspondingly, how user should handle the symptom of the patient if immediately appreciating that/ Attribute, that is, user obtains patient's snapshot how related with other patients of its information in the database of the type (snapshot).

Fig. 4 B is to carry out COTA classification and sequence as described above by specific node creation according to one embodiment Flow chart.As shown in Figure 4 B, select expert variable gender or property category (gender) 440(variables A), ethnic 445(variable B) ... and KRAS 450(variable G).K-Ras is the protein encoded in the mankind by KRAS gene.Normal KRAS gene Protein product executes necessary function in normal tissue signaling, and the mutation of KRAS gene is the weight in many cancer developments Want step.

COTA module 220 analyzes categorized and ranked data about these variables (for example, variable 440,445,450) 430 to generate unique COTA node 455.COTA module 220 can apply these nodes to mention in categorized and ranked data For more clinically relevant results.The node is created as one group of pre-selection variable, which preselects variable by application with further mistake Filter categorized and ranked data.The node is represented as the node address of instruction pre-selection variable.The variable may include Such as diagnosis, consensus data, result, phenotype etc..Phenotype is the mentioned observable property of people or the compound of character, such as its shape State, development, biochemistry or physiological property, phenological phenomenon, behavior and behavior product.Phenotype by people gene expression and ring Interaction between the influence and the two of border factor causes.In one embodiment, by the select expert in related fields The variable of the node, so that data are divided into clinically relevant result.

COTA node 455 is represented as the node address in COTA module 220.In one embodiment, node address quilt It is expressed as the list (function of the number as the selection in the letter and expression variable for indicating variable) of selected variable.For example, As shown in Figure 4 B, node 455 includes the A1-2(A table shown in frame around both the women of gender variables A and male's variable Show gender or property category variable, and 1-2 indicates women and male patient).Node 455 further includes B1-4, because node 455 includes Ethnic variable, wherein all sub- variables are selected and (shown around all ethnic variables with frame).Node 455 further includes G1, because For about KRAS variable, only Mut+ is selected (vanning).Thus, node 455 has node address A1-2, B1-4 ... G1.

In another embodiment, node address is represented as the multiple numeric strings separated by fullstop, wherein each number String indicates one or more variables (for example, disease, phenotype, therapy type, progress/tracking, gender etc.).For example, the first number String can indicate that specified disease, the second numeric string can indicate the type of disease, and third numeric string can indicate the hypotype of disease, And the 4th numeric string can indicate phenotype.Thus, in this example, the first numeric string, which can be, indicates the 01 of cancer, second Numeric string can be the 02 of instruction tumor of breast, and third numeric string can be the 01 of instruction breast cancer, and the 4th numeric string can Be indicate phenotype specific feature 1201 so that node address be 01.02.01.1201.It is understood that node address can To include any number of numeric string, and it is not limited to four strings.

In one embodiment, the number for indicating phenotype can be provided by the way that the property list of phenotype is shown as digraph String.Fig. 4 C has been illustratively depicted the digraph 460 according to one embodiment, which shows the characteristic of phenotype to mention For indicating the numeric string of phenotype.Digraph 460 includes the node for indicating phenotype and the side for indicating the relationship between node.From root " beginning " node starts to track the figure to the node for selected phenotype.Each edge all joins with digital correlation.For node The numeric string of the expression phenotype of location is provided as several combinatorics on words.For example, being directed to the phenotype of selected male and white man The numeric string of characteristic will be represented as 11.Other types of combination can also be used.Advantageously, the property list of phenotype is shown with Allow to add other nodes without changing total to figure.The appearance of screen be CNA as a result, and its appearance can change Become, however it is expected to that the information is presented.

Node 455 provides the prompting and resource matched in relevant situation specific to each phenotype to COTA module 220 Ability.Resource can be information, content, to the link of real-time support etc..Each patient is classified into one or more nodes Address.One or more nodes can also be associated with each disease.In one embodiment, with interdependent node appropriate " mark Note " resource.In one embodiment, node is interchangeable at any time, with synchronous with science/medical treatment progress holding.

Each node address can be with one or more bundles of scheduled patient care service (for example, treatment plan) It is associated.Each bundle can also be associated with one or more nodes.The service for including in each bundle can be by one A or multiple medical professionals, hospital, group, insurance company etc. determine, to optimize patient care and/or expense.Show at one In example, bundle can indicate the number of image scanning, the selection of drug or drug, the timetable for when applying drug, operation Or program, the number of follow-up and frequency etc..The binding of patient care service may conclude a bargin to risk particularly useful.For example, corresponding Can have in each bundle of (associated with specified disease) node address allows user (for example, doctor, patient etc.) Select the predetermined payout of bundle appropriate.It can be based on historical data associated with the specified disease or node address come really Fixed or Charges negotiable.Advantageously, for specified disease, the binding of service provides expense to insurance company and/or hospital and determines.This Decrease the expense of processing and maintenance record.In addition, medical professional will know scheduled therapeutic process in advance, this is to doctor Teacher provides the excitation that better result is obtained with lower expense.

The 10th revision (ICD-10) of international statistical classification of diseases and related health problems is such as by the World Health Organization (WHO) volume of the external cause of disease, S&S, anomaly, complaint, social condition and the injury or disease classified Code.It is considered as these code sets of classification code collection than some other medical codes as Systematized Nomenclature of Medicine (SNOMED) Collect at higher information level, which is used for the electron exchange of clinical health information by federal government's system. In an advantageous embodiment, the process for the treatment of is identified using node address, rather than uses the world ICD-10(disease point Class, the 10th revision) code identifies and treats disease.For example, this allows than the conventional ICD-10 code for planned treatment More effective therapeutic process, especially in the case where such as patient is by mistaken diagnosis.

Fig. 5 A is flow chart the step of execution according to the diagram of one embodiment by COTA module 220.In step 505 Place, COTA module 220 collect data record.Data record each includes data associated with disease (for example, cancer).Number It may include the patient data for being directed to the patient or previously had with the disease according to record.For example, data record may include Diagnosis, consensus data, result, expense or other relevant informations.Data record can be from electronic databank (for example, electronics Medical records) in collect, by user (for example, medical professional, expert, specialist etc.) provide, or from it is any its Its source.In one embodiment, data record is stored in database 240 by COTA module 220.

At step 510, COTA module 220 receives the one or more parameters for being used to be ranked up to data record.It can To receive the input that one or more of parameters are selected as user from subscriber computer 210.One or more of parameters It may include such as diagnosis, consensus data, result, expense or any other parameter.

At step 515, COTA module 220 is based on one or more of parameter logistics and is ranked up according to record.Sequence Mark meets the patient of one or more of parameters.It, will based on the newest science received in related fields and/or medical guide Patient is ordered into clinic and/or the molecule fidelity of highest level.In one embodiment, sequence is executed in real time.

At step 520, categorized and ranked data record is filtered according to node address.Node address is indicated by user It pre-selects to provide the variable of one group of clinically relevant patient.In one embodiment, the variable of node address is by this field Select expert.Node address can be represented as multiple numeric strings, and each numeric string is separated by fullstop.Each numeric string can be with Indicate one or more variables (for example, disease, the type of disease, the hypotype of disease, phenotype or any other correlated variables).Also Imagine other expressions of node address.

At step 525, analysis is directed to the data record of clinically relevant patient.Analysis data record may include (for example, The clinical effectiveness of patient associated with disease is tracked in real time).The result may include the dose intensity of such as delivering, be connect Therapeutic agent, dosage, spacing of doses and the dosage duration of receipts, the incidence of toxic reaction and seriousness, expense, get nowhere life Deposit the phase (PFS), Overall survival (OS), reactivity etc..COTA module 220 can compare tracked result between patients. Whether the associated particular doctor of the patient that COTA module 220 is also based on the tracking to determine with tracked is according to it The treatment technology of other (similar) patients of his medical treatment treats the patient.In one embodiment, COTA module 220 is based on The result of many patients determines this point.

In another embodiment, analysis data record may include based on the result tracked come (for example, in real time) More at least some of new data records.For example, COTA module 220 can determine that patient ABC has colon cancer, prescription has been opened And XYZ is taken drugs 2 years, and be in the paracmasis in past 3 years now.If COTA module 220 is to patient The information is determined in the tracking of ABC, then module 220 can use information update data record associated with patient ABC.

In other embodiments, analysis data record includes executing analysis to determine survival, is such as passed through Create Kaplan Meier curve.Kaplan Meier curve is that show can be for example for single doctor (or medical professionalism people Member) or for one group of doctor (or medical professional) development five year survival rate curve.Can for Overall survival and/or Progression free survival phase creates Kaplan Meier curve.It is contemplated that other types of analysis.

In order to promote to analyze, analysis tool can also be included to subscriber computer 210 and/or user by COTA module 220 Computer 230.The analysis tool can be via the addressable user interface of web page, the label on existing web page, Software application, app etc..As the user interface described in attached drawing herein is exemplary.The analysis tool can be with It allows users to compare, analyze data record or be further ranked up data record.

At step 530, COTA module 220 provides communication based on analysis.Communication can take the prompting to user Form.In one embodiment, COTA module 220 can be to subscriber computer 210 and/or the transmission of subscriber computer 230 through dividing The data record of the data record and/or update of class and sequence.For example, the transmission of COTA module 220 allows users to access warp Sequence or table, chart, list, the link of the data record that update etc..In another embodiment, COTA module 220 can be with There is the advertisement of data record (for example, associated therewith) to subscriber computer 210 and/or the transmission of subscriber computer 230.Other In embodiment, particular patient can be identified as by COTA module 220 is used for the specifically candidate for the treatment of or drug.The information for Such as drugmaker, health plan, management formula nursing alliance, insurance company etc. may be valuable.COTA module 220 can be with (for example, via network 215) is communicated to subscriber computer 210, subscriber computer 230 or any other entity transmission.

COTA module 220 can be used by many people, professional and/or company and it is made to be benefited.Such as and as above It is described, the pipeline of the highly-specialised of drugmaker may need for permitted various new business models (e.g., including 4 tests of stage/post-market surveillance, the marketing, sale, the exploitation fixed a price and concluded a bargin).In one embodiment, in pharmacy public affairs COTA module 220 can be used to promote this new business model in the professional of department.For example, COTA module 220 can incite somebody to action Correct patient matches with correct drug.COTA module 220 can make it possible to reality via its sequence and node address ability Now accurate Patient identification.In one embodiment, COTA module 220 provides matching feature, which makes user's (example Such as, drugmaker) it can be positioned (for example, in real time) and be or will be that needle drugmaker is issued or particular drug being developed One or more patients of the good candidate of object.

In addition, COTA module 220 can make health plan be benefited.As indicated on, cancer nursing will likely become more Add complexity, and it will likely not be efficient for continuing directly management for health plan.In one embodiment, health meter It draws and the nursing of their cancer is contracted out to COTA module 220(what has done previously with respect to pharmacy interests similar to health plan). This can reduce their expense, such as be offset by reducing the total cost nursed and providing expense for them, such as by replacing Path is changed, expensive prior authorization infrastructure is reduced, reduces the other staff of " management cancer ".In addition, American parity is medical Clause regulation in bill: compared with administrative expense, 85% premium (premium) must go to work relevant to clinical care It is dynamic.In one embodiment, COTA module 220 provides the connection to Claim Data to assay surface, to manage its tumour doctor Health plan is supported when teacher.

In one embodiment, COTA module 220 can make the tissue for participating in diagnostic method or tool be benefited.Participate in diagnosis The tissue of method or tool, such as those of involved in the next-generation gene sequencing, it would be possible to need efficient education, market battalion Pin and sale/distribution channel.Because COTA module 220 can accurately sort with identified patient and to doctor (or other doctor Treat professional) time-based prompting is sent, so its use can make such tissue be benefited.

Fig. 5 B is diagram according to the embodiment for enabling the patient for the situation of being diagnosed with to optimize his/her treatment The flow chart of the step of option.The step of Fig. 5 B, can be carried out by the COTA module 220 executed on server computer 205. The COTA module 220 executed on server computer 205 can be via the COTA module executed on subscriber computer 210 220 interact and/or can be by network 215 via the COTA mould executed on subscriber computer 230 with user (for example, patient) Block 220 is interacted with user (for example, medical professional).COTA module 220 may include for server computer 205, Multiple examples of the COTA module 220 executed on subscriber computer 210 and subscriber computer 230.

At step 550, the subscriber computer 210 of the COTA module 220 that is executed on server computer 205 from patient Receive communication.For example, the communication may include that patient is look for the instruction for the treatment of option, medical professional or any other Instruction.The COTA module 220 executed on server computer 205 be otherwise communicatively linked to include for PATIENT POPULATION individual it is strong The database 240 of health information, the personal health information may include or may not include the health and fitness information of patient.In server meter The COTA module 220 executed on calculation machine 205 is configured to analyze the personal health information being stored in database 240.This can be with It is executed before receiving communication from patient as pre-treatment step.For example, the COTA executed on server computer 205 Module 220 can be by each patient to personal health information sequence and classification and into PATIENT POPULATION with distributing multiple nodes Location, each medical treatment and nursing for being assigned to each node address for each node address measurement clinical effectiveness and measurement mention The behavioral difference of donor, to analyze such as personal health information described herein.

At step 555, the health and fitness information of patient is received.It can be from the COTA module executed on subscriber computer 210 220 receive health and fitness information.The health and fitness information of patient may include the situation that patient is diagnosed with.In one embodiment, suffer from Person with specificity via the COTA module 220 executed on subscriber computer 210 from the database 240 of computer server 205 In available situation list and sublist select the situation.22 0 base of COTA module executed on server computer 205 In the health and fitness information of received patient determine the test list for further classifying to situation.

At step 560, as needed for the COTA module 220 executed on server computer 205 for situation into The test list of one step classification is sent to the COTA module 220 executed on subscriber computer 210.

At step 565, the result of test is received from the COTA module 220 executed on subscriber computer 210.It can be Test is sent from patient to medical professional after completion initial treatment and in the case where there is the license from patient As a result, the result of test to be supplied to the COTA module 220 executed on server computer 205.

At step 570, based on the result of test to patient's distribution node address.Can from during pre-treatment step by Divide in multiple node address that the COTA module 220 executed on server computer 205 is generated for PATIENT POPULATION The node address matched.The node address distributed include one group of pre-selection variable, the group preselect variable effectively will it is ranked and divide The personal health information of class is divided into one group of clinically relevant health and fitness information.In one embodiment, the node address distributed It is associated with one or more bundles of scheduled patient care service (for example, treatment plan) for the situation for the treatment of.In advance Fixed patient care service can be determined by the one or more in medical professional, hospital, medical team or insurance company.In advance The bundle of fixed patient care service can provide scheduled therapeutic process.The bundle of scheduled patient care service can be with The expense provided for the situation determines.

At step 575, the COTA module 220 executed on server computer 205 is by the node address of distribution and controls The geographically organized list for treating the medical professional of the patient in the node address of distribution is transferred to be calculated in user The COTA module 220 executed on machine 210.It can be by clinical effectiveness visually to the geographically organized of medical professional List is classified.In one embodiment, clinical effectiveness can be pressed according to color visually to the ground of medical professional Organized list is classified in reason.For example, can be visually to the geographically organized list of medical professional Classify so that green indicates better than average clinical effectiveness, yellow indicate it is average clinical as a result, and red instruction than average Clinical effectiveness is poor.

At step 580, the selection to candidate medical professional is received.The candidate medical professional of selection can be by Patient's selection is to meet geographical limitation, clinical effectiveness standard and by one or more of expense standard of patient's setting.One It is further based on nursing expense after receiving to the selection of candidate medical professional by the option of patient in a embodiment Each medical professional is sorted in the group of candidate medical professional.For example, each medical professional can by into One step is classified as more than the candidate medical professional of selection, few or essentially identical with it.

In one embodiment, the subscriber computer 210 of patient is otherwise communicatively linked to (for example, in candidate's medical treatment of selection The office of professional) subscriber computer 230 of medical professional, with promote to selected candidate medical treatment specially The arrangement of the reservation of industry personnel.In another embodiment, the COTA module 220 executed on server computer 205 will be suffered from The personal health information of person is transferred to the COTA module 220 executed on the subscriber computer 230 of medical professional.

Advantageously, the step of Fig. 5 B enable the patient for the situation of being diagnosed be based on geographical limitation, clinical effectiveness and The expense standard of patient optimizes treatment option.

Fig. 6 illustrates the flow chart 600 of the prompting according to the embodiment provided by COTA module 220.In one embodiment In, doctor or other medical professionals are changed based on their preference.These preferences can be by medical professional/doctor Setting, and may include for example for the triggering of prompting 610 and/or for providing the technology reminded.For the triggering of prompting It may include for example: the 615, update of diagnosis, the event, the change (example of group membership that arrange in real time in new patient diagnosis Such as, the possibility that is identified change the new gene of grouping, and/or leave grouping someone), toxic reaction and/or dose intensity change Become 620, in progression of disease the application of 625, certain drug, be intended to desired result variant 630, and/or it is expected when Between or period relevant prompting 635(for example, side effect prompting and/or diagnostic test are reminded).Prompting may include being sent to use The text message 640 or Email 645 of family computer 210.It is contemplated that other types of prompting, such as user is calculated The call of machine 210, the update on web page, social media update, using such as Twitter, Facebook or its The message that its social media site is sent adds content to software library or web page, and/or be sent to subscriber computer 210 or Any other message or communication accessed by subscriber computer 210.Although being described above as providing prompting, triggering can be with It is any movement for causing COTA module 220 to execute any other movement.

Fig. 7 is the diagram mobile device 705(according to one embodiment for example, subscriber computer 210) tissue is by equipment 705 Received prompting graphical representation.As shown in Figure 7, the received COTA prompting of institute is listed by title or theme, such as New colon cancer 710, new clear-cell carcinoma 715, dosage adjustment 720, the 725, new progress 730 that is discontinued, new breast cancer 735, The 3rd periodic reminder 740 of CHOP, neutropenia risk prompting 745 and clinical test can use 750.Being of CHOP The abbreviation title of pharmaceutical composition used in treatment comprising cyclophosphamide (Cytoxan/Neosar), adriamycin (or sub- Baudrillard Mycin), vincristine (vincaleukoblastinum) and prednisolone, and for for example treating non-Hodgkin lymphoma.

COTA module 220 can provide specified disease data set, the hair including such as disease (for example, on demand and in real time) Raw rate (for example, sorting by COTA), by the progression free survival phase, and/or Overall survival of state of progress.In one embodiment, COTA module 220 can provide drug utilization data set, such as change with complete or partial therapy, toxic reaction and/or therapy Covert associated data.

Fig. 8 is shown to be occurred according to the disease by cancer subtypes that can be provided by COTA module 220 of one embodiment The graphical representation 800 of rate.Herein, COTA Figure 80 0 is for the lymthoma from 2010 to 2013 year.User can use graph search The information of constriction graphically is carried out in importation 810.Graph search importation 810 may include the content for example to be reported (for example, Diagnosis with Minimum Cost, complete diagnosis and/or the patient being reviewed, diagnostic-type, cancer location/hypotype, the world ICD9(disease Classification, the 9th revision) code, complication, progression of disease, property category, age, date range, race, diabetes, Tobacco History, the past chemotherapy or radiation history etc.) selection.

Fig. 9 show it is according to one embodiment based on the variable being input in COTA module 220, can by COTA mould The graphical representation 900 for the sequence that block 220 provides.Graphical representation 900 is shown from 2010 to 2013 year by male and female point The COTA for Hodgkin lymphoma opened schemes.Graphical representation 900 show indicate 900 in graphically had the disease The statistics 910 of the different patients of disease.Figure 10 shows multiple variables 1005 relevant to specified disease according to one embodiment The exemplary lists of (variable shown in herein, is directed to lymthoma).

It includes that can be provided by COTA module 220 with for cancer of pancreas that Figure 11, which is shown according to one embodiment, The graphical representation 1100 of the real-time Kaplan Meier curve of confidence interval.As described above, Kaplan Meier curve is Showing can be for example for single doctor (or medical professional) or for the development of one group of doctor (or medical professional) The curve of five year survival rate.Kaplan Meier curve can be created for Overall survival and/or progression free survival phase.User exists Variable of the instruction for his graph search in graph search importation 1110.

Figure 12 is to show the Kaplan for progression of disease that can be provided by COTA module 220 according to one embodiment The graphical representation 1200 of Meier curve.Line 1205 is directed to all cancers of pancreas, and thick line 1210 is directed to that with the first progress A bit.

Figure 13 be according to one embodiment can be by the real-time reference for the bipartite result that COTA module 220 provides The graphical representation 1300 of test.Figure 130 0 includes the curve for the result of John Doe doctor (doctor for the treatment of cancer of pancreas) 1305, and the curve 1310 of the result for remaining doctor for treating cancer of pancreas.Figure 13 further includes instrument 1320, the instrument 1320 measurement John Doe doctor's the result is that positive tracking or passive tracking.

Figure 14 is the expense according to (for example, being provided by COTA module 220) associated with COTA module 220 of one embodiment With the graphical representation of report 1400.The appearance of screen be CNA as a result, and its appearance can be changed, however it is expected to The information is presented.Report on expenses 1400 can be associated with the expense label 1220 of Figure 12.Such as in estimation (one or more) Medical expense, capture knowledge and/or by knowledge transformation at specific implementation when, report on expenses 1400 can be used.At one In embodiment, the expense of the various treatments of 220 real-time tracking of COTA module, doctor, hospital etc..As shown in Figure 14, report on expenses 1400 illustrate the comparison between doctor and the average cost of each income.Report on expenses 1400 can also include other comparisons, Such as, hospital's contributrion margin for being indicated with dollar and percentage, hospital's average income and expense are (for example, each patient Average income, the average cost of each patient), doctor's average cost of every an example is (for example, for every an example of each doctor Average cost, weighting colleague are average), doctor's average cost of each income is (for example, imaging, laboratory work, assessment and pipe The average cost of reason, drug, medical supplies, and other spendings for each doctor) etc..

Figure 15 A and 15B are according to the associated with COTA module 220 (for example, being mentioned by COTA module 220 of one embodiment For) with the graphical representation for promoting the treatment interface 1500 of the relationship between result and treatment.As shown in figure 15 a, it treats Interface 1500 may include the list that the different types for the treatment of of (or being refused by it) is applied to the patient for having breast cancer, such as example Such as operation, anti-tumor drug, cell therapy, radiotherapy.It can arrange to treat according to progression of disease.For example, usually all The drug in terms of tumour is given to phase property, and any number of drug can be given in any a cycle.In a reality It applies in example, user can choose progress (for example, being represented as progress 0 to progress 4), wherein progress 0 is in first time diagnosis, period Later, and drug can be selected in multiple classifications or from multiple classifications.

In Figure 15 B, in another embodiment, treatment interface 1510 may include controlling for one or more therapies Treatment scheme is expressed as label 1515 on treatment interface 1510 in graphical form.Treatment interface 1510 may include that instruction is directed to The beginning and end data of scheme, dose intensity, the description for the treatment of, drug particular brand etc. field.Therapeutic scheme can be with Summarized or be expressed as in graphical form the treatment list in table 1520.Table 1520 may include for the dynamic of each treatment Make icon 1505.Movement icon 1505 can promote to act, such as edit, close, checking component etc..In one embodiment In, movement icon 1505 can be and executed with single choice (for example, it is desired to repeatedly click or select) shortcut of complex task. For example, the icon in diagnostics lines can take user to diagnostic screen.

Figure 16 is the graphical representation according to the result screen 1600 for promoting result to track of one embodiment.Result screen Curtain 1600 can promote from such as diagnosis (that is, progress zero), the first progress, the second result tracking being in progress to the 4th, In it is each progress be considered as different diseases.Result screen label can be (for example, in one or more drop-down menus or other words In section) it include diagnosis date, treatment beginning and end date, the reaction (for example, complete, part, stable) to treatment With date of reaction, for the annotation about reaction input field (for example, the negative field of part field, CR-RA-Pet, CR word Section etc.) and tracking end data, it may include for last connection and dead field which, which terminates data,.As a result Screen 1600 can also include other fields, such as the toxic reaction of drug therapy, make it possible to input what has occurred The number of the input area of (for example, stop, continuing, without change, drug dose change and how many times), the number of delay, drug The number of change and/or reduction.In one embodiment, the user of COTA module 220 can indicate patient.

Figure 17 is to be shown in treatment details report screen of the expense compared between result according to one embodiment 1700 graphical representation.Treat details report screen 1700 expense of nursing and clinical effectiveness is interrelated with optimizing care valence Value.Expense and financial data can by hospital, by being collected and analyzed in doctor etc. at a given time period (for example, 5 years).It can be with Expense and financial data are indicated with one or more cost ranges.In one embodiment, cost range includes being directed to be greater than The range 1705 of 25000 dollars of expense, for the expense from 10000 dollars to 25000 dollar range 1710 and be directed to The range 1715 of expense less than 10000 dollars.When in conjunction with clinical data, COTA module 220 can be faced based on different Bed sorts and provides the cost data for being directed to different treatments in given time period.

Figure 18 is being illustrated between toxic reaction and expense by what COTA module 220 provided according to one embodiment The graphical representation of the analysis screen 1800 compared.The appearance of screen be CNA as a result, and its appearance can be changed, however It is expected to that the information is presented.Analysis screen 1800 is by the incidence of toxic reaction and seriousness and nursing expense and nurses result It is interrelated.Toxic reaction can be indicated with digital (for example, with range), by standard (for example, grade) etc..For example, as schemed Shown in 18, classified based on the generic term standard (CTCAE) for adverse events, toxic reaction is represented as toxic reaction etc. Grade 1-4.The grade of toxic reaction is compared with expense in graphical form.Analysis screen 1800 can be used for optimizing care Value and effect, wherein value is effect/expense.In one embodiment, COTA module 220 attempts to obtain high effect and low expense With.

Figure 19 is being illustrated between therapy and quality of life by what COTA module 220 provided according to one embodiment The graphical representation of the analysis screen 1900 compared.Therapy can be indicated by the therapeutic agent in analysis screen 1900.However, also Imagine the therapy of other forms, such as operation, program etc..In one embodiment, therapy include incidence, seriousness and The toxic reaction of therapy.Can be based on the average east ECOG(tumour cooperative groups) scale measures quality of life, and range is from grade 0 It is (i.e. fully active) to arrive class 5 (i.e. dead).Quality of life can also be measured using any suitable measurement.Analysis screen 1900 can promote how to be in progress on the disease of patient, how disease influences the activity of daily living of patient and appropriate Treatment and prognosis evaluation.

Figure 20 is the flow chart 2000 that the system for prompting of medical professional is supplied to according to the diagram of one embodiment.Screen The appearance of curtain be CNA as a result, and its appearance can be changed, however it is expected to that the information is presented.In one embodiment In, the information in prompting just helps user to make decision in the future.In one embodiment, the information in prompting is just being provided in mistake The one group of attribute occurred in the period gone.In one embodiment, it is influencing the decision of user but also reactive not only proactively Ground provides healthcare givers/doctor summary report how done in past one week, one month, season etc..In a reality It applies in example, for different users there are different promptings, each prompting may influence the decision that user makes.Such as In the case where the therapy of application deviates desired result, prompting can be used for real-time course corrections to drive best values.? In frame 2005, definition is triggered based on clinical data.Any standard can be used to trigger definition, such as new disease is examined Disconnected, progression of disease, patient's reaction, the change of Patient Characteristics, dose change/drug toxicity reaction change, towards with desired knot Discrepant trend of fruit etc..The standard can be adjusted based on disease and its parameter.Based on the definition being triggered, transmission is reminded 2010-A, 2010-B, 2010-C(are referred to as prompting 2010).It is understood that reminding 2010 may include any number of prompting. Reminding 2010 may include the interior link for perhaps arriving content.Responsible doctor, other medical professionalisms can be transferred to by reminding 2010 Personnel, hospital, drugmaker or any other people or entity.

Such as show that content 2015-A, 2015-B, 2015-C(are referred to as content 2015 using subscriber computer 210) with It provides and reminds.Content 2015 may include with remind 2010 associated patient datas, compared with or any other related content.? In one embodiment, compare can for example between doctor, between the patient and entire PATIENT POPULATION of a doctor, at one Between doctor and all doctors of specific location etc..Compare can be shown based on trending analysis treatment tend to where with it be It is no just at offset direction (that is, result not as good as standard good).Comparing can be graphically displayed as one or more curve on figure. In one embodiment, COTA module 220 is utilized together with calculating based on cloud.COTA module 220 is it is also possible that can be real Connectivity that is existing or using hospital record.

In one embodiment, content 2015 may include to the anti-with the traffic lights on display of medical professional The feedback for presenting indicator (not shown) is supported.For example, blue might mean that extraordinary performance (that is, better than standard), green It might mean that standard performance, yellow might mean that enough performances but may be noted that red might mean that user The something about medical professional to the method for the disease may be needed to pay attention to.Other realities of feedback indicator can also be used Existing mode.

Figure 21-24 shows the graphical representation for different diagnostic-types according to one or more embodiments.Figure 21 shows The diagnostic screen 2100 for stomach and intestine tumor (for example, colon cancer) is gone out.Figure 22 is shown for tumor of breast (for example, mammary gland Cancer) diagnostic screen 2200.Figure 23 shows the diagnostic screen 2300 for breast tumor (for example, lung cancer).Diagnostic screen 2100,2200,2300 include many different parameters, the test or aspect of such as disease.Parameter can be represented as simply referring to Show symbol, the parameter based on numerical value, measured parameter etc..

Figure 24 shows the report screen 2400 that diagram COTA module 220 is generated and sorted for the data of tumor of breast Graphical representation.Report screen 2400 is shown by histology (that is, histology with invasive ductal carcinoma) to be implemented according to one The breast cancer from 2008 to 2013 year of example.Report screen 2400 license based on phase, age, progress or any other parameter come Real-time selection patient with breast cancer.Advantageously, report screen 2400 allows the classification in a manner of clinically relevant.

Figure 25 shows the report screen 2500 that diagram COTA module 220 is generated and sorted for the data of tumor of breast Graphical representation.Report screen 2500 shows all 2 grades of year tumour from 2008 to 2013 according to one embodiment by stages Breast cancer.

Figure 26 shows the figure for the report screen 2600 that diagram COTA module 220 is generated and sorted for the data of breast cancer Shape indicates.All IIB primary breast cancers that report screen 2600 is shown according to one embodiment from 2008 to 2013 year.Report The Figure 26 05 accused on screen 2600 shows all IIB primary breast cancers by progesterone receptor status.

Figure 27 shows the analysis screen that the overall survival result of patient with breast cancer is directed to according to the diagram of one embodiment 2700 graphical representation.Figure 28, which is shown, will be illustrated as John Doe for the existence result of breast cancer according to one embodiment Graphical representation 2800 of doctor's (thick line) compared between polymerization (non-thick line) side.

In one embodiment, " node " described above indicate in one or more of graphical representation (for example, In one or more of Figure 21-27) the possible arrangement of each of the variable that shows.

As shown in the example of Figure 29, client device 2905 may include that one or more processing units are (herein Also referred to as CPU) 2922, one or more of processing units 2922 are docked at least one computer bus 2925 (interface).Client device 2905 can be such as subscriber computer 210.Memory 2930 can be lasting reservoir And it is docked with computer bus 2925.Memory 2930 includes RAM 2932 and ROM 2934.ROM 2934 includes BIOS 2940.Memory 2930 is docked with computer bus 2925, so as in such as operating system 2941, application program 2942, equipment It is stored in during the execution of the software program of driver and software module 2943,2945 etc to the offer of CPU 2922 Information in reservoir 2930, the software module 2943,2945 is including program code and/or is incorporated herein described function One or more of process steps, such as process flow described herein can be performed in the computer of energy property.CPU 2922 first from reservoir (for example, memory 2932, one/multiple data storage mediums 2944, removable media drive And/or other storage equipment) the executable process steps of load computer.Then CPU 2922 can execute the process step of storage Suddenly, so that process steps can be performed in the computer for executing load.During the execution of process steps can be performed in computer, storage Data (such as the data stored by storage equipment) can be accessed by CPU 2922.

One/multiple persistent storage mediums 2944 can be used for storage software and data (for example, operating system and one Or multiple application programs) (one or more) computer readable storage medium.One/multiple persistent storage mediums 2944 may be used also Device driver for storage, such as digital camera driver, printed driver, are swept watchdog driver Retouch one in instrument driver or other device drivers, web page, content file, playlist and other files Or it is multiple.One/multiple persistent storage mediums 2206 may further include used to implement the present disclosure one or more implement The program module and data file of example.

For purposes of this disclosure, for computer-readable medium with machine-readable form storing computer data, which can To include the computer program code that can be performed by computer.As an example, not a limit, computer-readable medium may include: It is explained for tangible or fixed storage the computer readable storage medium of data, or to contain the transient state of the signal of code Communication media.As used in this article, computer readable storage medium refers to physics or tangible reservoir (with signal phase It instead), and include but is not limited to be used for information (such as computer readable instructions, data structure, program module or other numbers According to) tangible storage the volatile and non-volatile realized of any method or technique, removable and immovable medium. Computer readable storage medium include but is not limited to RAM, ROM, EPROM, EEPROM, flash memory or other solid-state memory technologies, It CD-ROM, DVD or other optical storages, cassette, tape, magnetic disk storage or other magnetic storage apparatus or can use In any other physics that visibly stores desired information or data or instruction and can be accessed by computer or processor Or material medium.

Client device 2905 can also include power supply 2926, network interface 2950, audio interface 2952, display 2954 (for example, monitor or screen), keypad 2956, luminaire 2958, I/O interface 2960, haptic interface 2962, GPS 2964, Microphone 2966, video camera, TV/ radio tuner, audio/video capture card, sound card, the analog audio with A/D converter Frequency input, modem, Digital Media input (HDMI, optical link), the number port I/O (RS232, USB, FireWire, Thunderbolt), one or more of expansion slot (PCMCIA, ExpressCard, PCI, PCIe).

For purposes of this disclosure, module is (in the case where being with or without human interaction or enhancing) to execute or promote Process described herein, the software of feature and/or function, hardware or firmware (or combinations thereof) system, process or functionality Or its component.Module may include submodule.The component software of module can be stored on computer-readable medium.Module can It can be indispensable to one or more servers, or be loaded and executed by one or more servers.It is one or more Module can be grouped into engine or application program.

Figure 30 is calculated according to the diagram such as server computer 205, user of one or more other embodiments of the present disclosure The block diagram of the exemplary inside structure of the computer of machine 210 and/or subscriber computer 230 etc.Such as the meter mentioned herein Calculation machine refers to any equipment with the processor for being able to carry out logic or encoded instruction, and can be server, a People's computer, set-top box, tablet computer, smart phone, tablet computer or media device only lift several such equipment.Such as Shown in the example of Figure 30, inside structure 3000 includes one or more processing units (referred to herein as CPU) 3012, institute One or more processing units 3012 are stated to dock at least one computer bus 3002.Also it is docked with computer bus 3002 One/multiple persistent storage mediums 3006, network interface 3014, memory 3004(for example, random-access memory (ram), Transient storage, read-only memory (ROM) etc. when operation), as driver (its can read and/or be written to including Removable medium (media such as floppy disk, CD-ROM, DVD)) interface medium disk drive interface 2308, as supervising Visual organ or it is other display equipment interface display interface 3010, as the keyboard interface 3016 of the interface for keyboard, conduct For the pointing device interface 3018 of mouse or the interface of other pointing devices and not separately shown various other Interface, parallel and serial port interface, universal serial bus (USB) interface etc..

Memory 3004 is docked with computer bus 3002, so as in such as operating system, application program, device drives journey The information being stored in memory 3004 is provided during the execution of the software program of sequence and software module etc to CPU 3012, it should Software module includes program code and/or the executable process steps of computer for being incorporated herein described function, example Such as, one or more of process flow described herein.CPU 3012 is first from reservoir (for example, memory 3004, one/multiple storage mediums 3006, removable media drive and/or other storage equipment) load computer is executable Process steps.Then CPU 3012 can execute the process steps of storage, process step can be performed to execute the computer of load Suddenly.During the execution of process steps can be performed in computer, the data (for example, the data stored by storage equipment) of storage can be with It is accessed by CPU 3012.

As described above, one/multiple persistent storage mediums 3006 can be used for storage software and data (for example, Operating system and one or more application program) (one or more) computer readable storage medium.One/multiple persistently deposit Storage media 3006 can be also used for storage device driver, such as digital camera driver, watchdog driver, printing Machine driver, scanner driver or other device drivers, web page, content file, playlist and its One or more of its file.One/multiple persistent storage mediums 3006 may further include used to implement the present disclosure The program module and data file of one or more embodiments.

The inside structure 3000 of computer can (as described above) include microphone, video camera, TV/ radio tuner, Audio/video capture card, sound card, the analog audio input with A/D converter, modem, Digital Media input (HDMI, optical link), the number port I/O (RS232, USB, FireWire, Thunderbolt), and/or expansion slot (PCMCIA, ExpressCard, PCI, PCIe).

The nursing of CNA guidance has two sides, and the two sides passes through healthcare provider, disburser and together with disease The triple of patient makes the care delivery based on value in the U.S. for being able to achieve the application by CNA.

First face, i.e. mission potency, including provider, include the first COTA module processor Computer includes being otherwise communicatively linked to the first client device of the 2nd COTA module of the first COTA via network and paying Interaction between person.First face enable disburser via include be otherwise communicatively linked to processor the first COTA module the First client device of two COTA modules is transmitted to processor by network and communicated, the communication: mark is being examined for patient's The health plan welfare of health care service in worry, the patient covers the service；Indicating the service is to diagnose or control Treat the purpose of medical conditions；And identify the variable of disburser's selection.When receiving the communication from disburser, the first COTA module It can include: the clinical outcome data for being (i) directed to each CNA to the 2nd COTA module transfer information, the information, (ii) for every The unfavorable variance data of each medical supplier at a CNA comprising the necessary nursing and unnecessary nursing two lacked Person, the unnecessary nursing is to provider in the material time point during treatment at each node address The unfavorable variance of patient contributes；(iii) report on expenses comprising for treating each of the PATIENT POPULATION for being assigned to CNA The real-time cost data of patient；And (iv) by one of the following or multiple pattern analysis that are mutually related: (1) by nurse fees With interrelated with clinical effectiveness；(2) by the clinical effectiveness of the incidence of toxic reaction and seriousness and nursing expense and nursing It is interrelated；And (3) are interrelated by therapy and quality of life.Based on the information, when disburser can be in material time point Confirm that (a) considers that potential welfare and the injury to patient, medical services are appropriate delivering or the service of level；(b) by changing Kind clinical effectiveness simultaneously reduces total nurse fees used time, and medical services are effective in terms of improving healthy result；With the health of substitution Intervene or compared without intervention, which is cost-effective for just treated medical conditions and clinical effectiveness；And it should When service follows generally accepted medical practice, disburser can be approved as patient and be directed to medical services to provider Payment.

It is discribed in example as in Fig. 31, the CNA according to an embodiment of the present disclosure for the patient for having breast cancer Second face of the health care of guidance includes the interaction between computer, the second client device and patient, the computer packet Containing the processor including the first COTA module, which includes being otherwise communicatively linked to the first COTA via network 3rd COTA module of module.Via the second client device and the patient for including third clinical effectiveness tracking and analysis module When exchanging a series of communications, the first COTA module does three things: it provides information to patient, so that patient obtains his/her shape The complete medical assessment of condition is (for example, physical assessment；Laboratory Evaluation；Imaging etc.) so that CNA can be distributed；Use distribution CNA, it shows patient's treatment option for situation, and the patient treats option optimization and nurses and reduce the wind of unfavorable variance Danger；And it to patient show in his/her geographic area following CNA guide nursing and in acceptable nursing expense Down with the doctor of best result, so that patient can choose the nursing of the CNA guidance of healthcare provider and aspiration level.

As depicted in figure 32, from the perspective of disburser, mission potency can be eliminated effectively for testing, examining Disconnected and therapeutic choice pre-authentication；Eliminate prior authorization；And eliminate the demand changed the place of examination.Come from the angle of provider It sees, it is reduced to health care to the time needed for supplier's payment.Correspondingly, mission potency enables health care to optimize Reimbursemen based on service fee, and (such as passing through bundled services) is changed to from the reimbursemen based on service fee based on risk Nursing reimbursemen.From the perspective of patient, three things are done in the nursing of CNA guidance: it provided to patient be enough to make patient obtain he/ The complete medical assessment of her situation and the information that CNA is distributed for patient；Second, using CNA, it is based on geographical, clinical As a result, expense and other patients are arranged standard and show patient and treat option, and the standard allows the patient to selection optimization Nursing is to avoid unfavorable variance；Third, it shows can connecing for the nursing that CNA is guided of following in his/her region to patient With the healthcare provider of best result under the nursing expense received.

It will be appreciated by those skilled in the art that disclosed method and system can be achieved in many ways, and shine This is not by foregoing example embodiment and exemplary limitation.In other words, in the various combinations of hardware and software or firmware just by The function element and independent function that single or multiple components execute can be distributed in user calculating equipment or server or both Among the software application at place.In this respect, any number of feature of different embodiments described herein can be with It is combined into single or multiple embodiments, and there is feature more less or more than all features described herein Alternate embodiment is possible.It is functional to be distributed in a manner of currently known or to become known in whole or in part Among multiple components.Thus, in realizing function described herein, feature, interface and preference, a large amount of software/hardwares/ Firmware combinations are possible.In addition, the scope of the present disclosure covers for executing the normal of described feature and function and interface Known way is advised, and those of can make variation to hardware or software described herein or fastener components and repair Change, it such as will be by now and from now on understood by one of ordinary skill in the art.

Although describing system and method according to one or more embodiments, it is understood that the disclosure does not need It is limited to the disclosed embodiments.It is intended to cover various modifications being included in spirit and scope of the claims and similar Arrangement, range should be given broadest interpretation so as to comprising all such modifications and similar structure.Disclosure packet Include any and all embodiments of following following claims.

Claims

1. a kind of for improving the clinical effectiveness under particular patient level and for reducing total nursing expense under population level Method, comprising:

A. provider, include the tracking of the first clinical effectiveness and analysis module processor computer, the Interaction between one client device and disburser, first client device includes being otherwise communicatively linked to institute via network State the tracking of the first clinical effectiveness and the second clinical effectiveness tracking of analysis module and analysis module；And

B it is described include the first clinical effectiveness tracking and analysis module processor computer, the second client device Interaction between patient, second client device include being otherwise communicatively linked to first clinic via the network As a result it tracks and the third clinical effectiveness of analysis module tracks and analysis module:

It is described include the first clinical effectiveness tracking and analysis module processor computer it is described include first clinic As a result it tracks on the processor with analysis module and executes step, the step includes:

(a) by counting and biological differences patient's grouping in PATIENT POPULATION up front, to be effectively removed conduct The biological differences of factor in nursing value, and by the way that treatment difference is given over to the leading factor in treatment results below:

(i) the personal health information for receiving, collecting and recording each patient in the PATIENT POPULATION in the database, institute Stating personal health information includes characterizing each parameter of each patient in the PATIENT POPULATION and based on newest scientific knowledge Or medical guide come influence existence, prognosis or treatment information；

(ii) the personal health information for each patient in the PATIENT POPULATION is ranked up using collated filter, with One group of ranked personal health information for the group is provided and is identified in the PATIENT POPULATION and meets each ginseng Several patients；

(iii) classify to similar personal health information, and by tracking and analyzing mould in first clinical effectiveness Generate in block and distribute multiple clinical effectiveness tracking and analysis node address (CNA), be based on it is associated with the PATIENT POPULATION Personal health information is grouped the type of the patient in the PATIENT POPULATION, wherein the generation and distributing the multiple Node address includes:

(1) by each CNA be expressed as include prefix, centre and suffix the discrete numeric string to punctuate, the prefix, centre and Ranked and classification information is divided into one group of pre-selection variable of one group of clinically relevant health and fitness information by postfix notation；

(2) the possible arrangement of many trillion is reduced to reduction by the discrete numeric string to punctuate based on each CNA of expression The significant arrangement of the clinic of number, the significant arrangement of the clinic for reducing number make it possible to reminding necessary nursing With to unnecessary nursing avoid in required necessary time from ideal value analyze the first behavioral difference and then analyze with Generation clinic and expense result difference, the ideal value is expressed as the best clinical effectiveness under minimum opportunity cost, To increase nursing value, it means that the preferable clinical effectiveness under minimum opportunity cost；

(3) based on the discrete numeric string to punctuate for indicating each CNA and based on the reduction of arrangement, reduce processing requirement and Time for processing is so that be efficient to the real time monitoring of medical supplier's performance；And

(4) make it possible to the material time point for predicting that behavioral difference may occur, and interrupt treatment process, to avoid nursing Excessive use/underutilization prevents the behavioral difference；

(iv) the clinical effectiveness for each CNA is measured by following:

For described in the subset of the patient analysis one or more in the subset of the PATIENT POPULATION for the PATIENT POPULATION One group of clinically relevant personal health information；And

(v) by treatment, test, follow-up, in accordance with every in prescription medicine and the PATIENT POPULATION for being assigned to each CNA Compare the difference between a provider and another provider in terms of the expense of a patient, to measure It is assigned to the behavioral difference of each provider of each patient in the PATIENT POPULATION of each CNA；

(b) via including first client device of second clinical effectiveness tracking and analysis module from the payment When person receives the communication for the variable that mark is selected for the health care service under consideration of patient and by the disburser, Information is transmitted to second clinical effectiveness tracking and analysis module, the health plan welfare of the patient covers the medical treatment clothes Business, the information includes,

(1') the clinical outcome data for each CNA in (iv)；

(2') the behavioral difference data for each medical supplier at each CNA in (v)；

(3') report on expenses comprising each patient's in the PATIENT POPULATION for treating the CNA being assigned in (iii) Real-time cost data；And

(4') nursing expense and clinical effectiveness are mutually related one or more pattern analysis；

Wherein the information is enough

Confirm the disburser in the material time point,

(a') consider that potential welfare and the injury to the patient, the medical services are appropriate delivering or the service of level；

(b') by improving clinical effectiveness and reducing total nursing expense, the medical services are effective in terms of improving healthy result 's；

(c') compared with the Health intervention of substitution or without intervention, the service is for just treated medical conditions and described faces It is cost-effective for bed result；And

(d') service follows generally accepted medical practice, and

Make the disburser be approved as the medical services to pay to the provider；

(c) via second client device and the patient for including third clinical effectiveness tracking and analysis module When exchanging a series of communications,

The complete medical assessment for being enough to obtain the patient and the information for distributing CNA to the patient are provided, and

The nursing of the optimum level with reduced unfavorable variance risk is determined using the CNA；And to select healthy shield The nursing of the CNA guidance of supplier and aspiration level is managed,

It is described it is a series of communication include:

(i'') in response to from the patient first communication, to described in computer server include the first clinical effectiveness with Track and the processor of analysis module report health problem,

As answer, second is sent to second client device for including third clinical effectiveness tracking and analysis module Communication, the list of second communication comprising test needed for the health problem is diagnosed as medical conditions；

(ii'') in response to the result comprising test needed for the diagnosis health problem in (i'') from the patient The third communication,

As answer, four-way is sent to second client device for including the third clinical effectiveness and analysis module Letter, the fourth communication include the diagnosis of the medical conditions and for adding needed for further classify to the medical conditions The list of test；

(iii'') in response to the fifth communication of the result comprising the additional testing in (i'') from the patient, based on described The result of test, the diagnosis in (ii'') and the list of the additional testing in (ii''),

(a'') obtainable multiple CNA to the patient distribute CNA from (iii), and the CNA distributed includes to be directed to the trouble One group of clinically relevant health and fitness information of person；And

(b'') described to the 6th communication of second client device transmission for including the third clinical effectiveness tracking module 6th communication include:

The CNA that (1'') is distributed；And

The geographically organized list of the medical professional of patient of (2'') treatment in the CNA distributed, wherein medical treatment The list of professional is classified by the one or more in geographical, clinical effectiveness or expense；

(iv'') in response to the 7th communication from the patient, the 7th communication selection includes reduced unfavorable variance risk And at least one of geography, expense and result demand for meeting the patient or the best shield of multiple medical professionals Reason plan,

It is otherwise communicatively linked in the office of selected medical professional include the tracking of third clinical effectiveness and analysis module Equipment is calculated, to promote the arrangement to the patient and the reservation of selected medical professional.

2. method as described in claim 1, wherein

(a) parameter of the sequence in (a) (ii) includes one of the following or multiple: gender, age, race, complication, cigarette Grass uses, insures source, medical record number, primary care physician, the doctor that changes the place of examination, hospital, approved service supplier, disease Sick specific clinical molecular phenotype, therapy intention, the phase of therapy, biomarker and nursing expense；Or

(b) one group of pre-selection variable in (a) (iii) (1) includes the specific clinical molecular phenotype of disease, wherein being based on digraph To determine the numeric string for indicating the phenotype；Or

(c) step (a) (iii) (4) and step (b) (i') (4') in material time point be included in diagnosis when, when being in progress, In dose change；When drug changes；In in toxic reaction and when being intended to variant with desired result It is one or more；Or

(d) (b) (1') (4') in include by the hair of toxic reaction by nursing expense and the interrelated step of clinical effectiveness Raw rate, the seriousness of toxic reaction；Therapy；And one or more of quality of life and nursing expense and nurse result it is mutual Association；Or

(e) at (b) or (c) in from the client device receive it is described transmission via human user or technical process；Or

(f) the scheduled patient of the CNA distributed in (c) (iii'') (b'') (1'') and the treatment for the situation One or more bundles of care are associated；Or

(g) clinical effectiveness in (c) (iii'') (b'') (2'') includes one of the following or multiple: received therapeutic agent, The dose intensity of delivering, spacing of doses, dosage duration, quality of life measurement, the toxic reaction of therapy, Progression free survival Phase, Overall survival, reaction measurement and death；Or

(h) list of the medical professional in step (c) (iii'') (b'') (2'') is pressed clinical effectiveness in vision On classify.

3. the method as described in claim 2(f), wherein one or more bundles of the scheduled patient care service There is provided scheduled therapeutic process, for expense determination for the treatment of of the situation or both.

4. the method as described in claim 2(f), further comprises: by the one of the scheduled patient care service Ranking is carried out to both clinical effectiveness and nursing expense in a or multiple bundles, mark is in minimum nurse fees at the CNA Best clinical effectiveness under.

5. the method as described in claim 2(h), wherein by clinical effectiveness to the vision of the list of medical professional Classification includes:

(a) green indicates better than average clinical effectiveness；

(b) yellow indicates average clinical effectiveness；And

(c) red to indicate poorer than average clinical effectiveness.

6. method as described in claim 1, further comprises, having from the patient and selected medical professional In the case where license:

The personal health information of the patient is transferred to from first clinical effectiveness tracking and analysis module selected The calculating equipment including the 4th clinical effectiveness tracking and analysis module of the office of medical professional.

7. the method as described in claim 1 step (d) (2), wherein each doctor being directed at each CNA in (c) The behavioral difference data for treating supplier include both the necessary nursing lacked and unnecessary nursing, the unnecessary nursing Have in the material time point during treatment for the unfavorable variance of the patient at each CNA to the provider Contribution.

8. the method as described in claim 1 step (d), further comprises: the instruction service is for diagnosing or treating The purpose of medical conditions.

9. as claim 1 step (d) (3') described in method, wherein the report on expenses includes:

In doctor compared between the average cost of each income；Or

The hospital's contributrion margin compared with dollar and percentage；Or

Hospital's average income of each patient；Or

Hospital's average cost of each patient；Or

It is average for the average cost of every an example of each doctor, weighting colleague；Or

The average cost of imaging, laboratory work, assessment and management；Or

For the drug of each doctor, medical supplies and other spendings；Or

Their combination.

10. the method as described in claim 1 step (b) (i'), wherein the variable of disburser selection include: by Certain attribute-bits of the personal health information are the variable of one group of desired characteristic；Mark is added to institute by the disburser Personal health information is stated so that the personal health information of each patient to be identified as and its in PATIENT POPULATION's database Its health and fitness information is in the variable of one or more attributes in level of equal importance, or both.

11. a kind of for improving the clinical effectiveness under particular patient level and for reducing total nursing expense under population level System, comprising:

(A) processor of computer server comprising:

Database, the database include the personal health information and data for human experimenter group；

It is otherwise communicatively linked to the tracking of the first clinical effectiveness and analysis module of the database and network；And

For storing the memory of computer program instructions；

(B) the first client device comprising: processing unit；Memory, and it is otherwise communicatively linked to the computer server Processor the first clinical effectiveness tracking and analysis module the second clinical effectiveness tracking and analysis module；And

(C) the second client device comprising: processing unit, memory, and it is otherwise communicatively linked to the computer server Processor the first clinical effectiveness tracking and analysis module third clinical effectiveness tracking and analysis module；

(A) computer program instructions make the first clinical effectiveness tracking and analysis module when being executed on the processor Operation is carried out, the operation includes:

(iii) classify to similar personal health information, and by tracking and analyzing mould in first clinical effectiveness Generate in block and distribute multiple clinical effectiveness tracking and analysis node address (CNA), be based on it is associated with the PATIENT POPULATION Personal health information is grouped the type of the patient in the PATIENT POPULATION, wherein the generation and distributing the multiple CNA includes:

(iv) the clinical effectiveness for each CNA is measured by following:

(b) via including first client device of second clinical effectiveness tracking and analysis module from the payment When person receives the communication for the variable that mark is selected for the health care service under consideration of patient and by the disburser, Information is transmitted to second clinical effectiveness tracking and analysis module, the health plan welfare of the patient covers the medical treatment clothes Business, the information include:

(1') the clinical outcome data for each CNA in (iv)；

Wherein the information is enough

Confirm the disburser in the material time point,

(d') service follows generally accepted medical practice, and

It is described it is a series of communication include:

(i'') in response to the first communication from the patient, Xiang Suoshu computer server includes the described first clinical knot The processor of fruit tracking and analysis module reports health problem,

The CNA that (1'') is distributed；And

(iv'') in response to the 7th communication from the patient, the 7th communication selection has reduced unfavorable variance risk And at least one of geography, expense and result demand for meeting the patient or the best shield of multiple medical professionals Reason plan,

12. system as described in claim 11, wherein

13. the system as described in claim 12(f), wherein one or more bindings of the scheduled patient care service Packet provides scheduled therapeutic process, for expense determination for the treatment of of the situation or both.

14. the system as described in claim 12(f), further comprises: by the scheduled patient care service Ranking is carried out to both clinical effectiveness and nursing expense in one or more bundles, mark is minimum at the CNA distributed Best clinical effectiveness under nursing expense.

15. the system as described in claim 12(h), wherein by clinical effectiveness to the view of the list of medical professional Feel that classification includes:

(a) green indicates better than average clinical effectiveness；

(b) yellow indicates average clinical effectiveness；And

(c) red to indicate poorer than average clinical effectiveness.

16. system as described in claim 11, further comprises, having from the patient and selected medical professional License in the case where:

17. the system as described in claim 11 step (d) (2), wherein being directed to each of at each CNA in (c) The behavioral difference data of medical supplier include both the necessary nursing lacked and unnecessary nursing, the unnecessary shield Manage the unfavorable variance to the provider in the material time point during treatment for the patient at each CNA It contributes.

18. the system as described in claim 11 step (d), further comprises: the instruction service is for diagnosing or controlling Treat the purpose of medical conditions.

19. the system as described in claim 11 step (d) (3), wherein the report on expenses includes:

In doctor compared between the average cost of each income；Or

The hospital's contributrion margin compared with dollar and percentage；Or

Hospital's average income of each patient；Or

Hospital's average cost of each patient；Or

The average cost of imaging, laboratory work, assessment and management；Or

For the drug of each doctor, medical supplies and other spendings；Or

Their combination.

20. the system as described in claim 11 step (b) (i'), wherein the variable of disburser selection includes: It is the variable of one group of desired characteristic by certain attribute-bits of the personal health information；Mark is added to by the disburser The personal health information with by the personal health information of each patient be identified as in PATIENT POPULATION's database Other health and fitness informations are in the variable of one or more attributes in level of equal importance, or both.

21. a kind of non-transitory computer-readable medium for storing computer program instructions, the computer program instructions are used for Promote provider, include the first clinical effectiveness tracking and analysis module processor computer, first Interaction (A) between client device and disburser, and it is described include the first clinical effectiveness tracking and analysis module The computer of processor, the interaction (B) between the second client device and patient, first client device include via Network and be otherwise communicatively linked to first clinical effectiveness tracking and the second clinical effectiveness tracking of analysis module and analysis module, Second client device includes being otherwise communicatively linked to the first clinical effectiveness tracking and analysis mould via the network The third clinical effectiveness of block tracks and analysis module, the computer program instructions by it is described include that the first clinical effectiveness tracks It is operated with carrying out first clinical effectiveness and tracking module when executing on the processor of analysis module, the operation includes:

(iv) the clinical effectiveness for each node address is measured by following:

(1') the clinical outcome data for each CNA in (iv)；

Wherein the information is enough

Confirm the disburser in the material time point,

(d') service follows generally accepted medical practice, and

It is described it is a series of communication include:

The CNA that (1'') is distributed；And

The geographically organized list of the medical professional of patient of (2'') treatment in the node address distributed, The list of middle medical professional is classified by the one or more in geographical, clinical effectiveness or expense；

22. the non-transitory computer-readable medium as described in claim 21, wherein

23. the non-transitory computer-readable medium as described in claim 22(f), wherein the scheduled patient care clothes One or more bundles of business provide scheduled therapeutic process, for expense determination for the treatment of of the situation or both.

24. the non-transitory computer-readable medium as described in claim 22(f), further comprises: by described pre- Ranking is carried out to both clinical effectiveness and nursing expense in one or more bundles of fixed patient care service, is being distributed CNA at best clinical effectiveness of the mark under minimum nursing expense.

25. the non-transitory computer-readable medium as described in claim 2(h), wherein by clinical effectiveness to medical professionalism The vision sorter of the list of personnel includes:

(a) green indicates better than average clinical effectiveness；

(b) yellow indicates average clinical effectiveness；And

(c) red to indicate poorer than average clinical effectiveness.

26. the non-transitory computer-readable medium as described in claim 21, further comprises, having from the patient In the case where license with selected medical professional:

27. the non-transitory computer-readable medium as described in claim 21 step (d) (2), wherein being directed in (c) The behavioral difference data of each medical supplier at each CNA include the necessary nursing and unnecessary nursing two lacked Person, the unnecessary nursing are directed to each CNA to the material time point of the provider during treatment The unfavorable variance of the patient at place contributes.

28. the non-transitory computer-readable medium as described in claim 21 step (d), further comprises: described in instruction Service is the purpose for diagnosing or treating medical conditions.

29. the non-transitory computer-readable medium as described in claim 21 step (d) (3), wherein the report on expenses Include:

In doctor compared between the average cost of each income；Or

The hospital's contributrion margin compared with dollar and percentage；Or

Hospital's average income of each patient；Or

Hospital's average cost of each patient；Or

The average cost of imaging, laboratory work, assessment and management；Or

For the drug of each doctor, medical supplies and other spendings；Or

Their combination.

30. according to non-transitory computer-readable medium described in claim 21 step (b) (i'), wherein the disburser selects The variable selected includes: the variable by certain attribute-bits of the personal health information for one group of desired characteristic；Mark By the disburser be added to the personal health information with by the personal health information of each patient be identified as with it is described Other health and fitness informations in PATIENT POPULATION's database are in the variable or two of one or more attributes in level of equal importance Person.