JP2005509218A - 質を堅持するための患者データマイニング - Google Patents

質を堅持するための患者データマイニング Download PDF

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JP2005509218A
JP2005509218A JP2003542948A JP2003542948A JP2005509218A JP 2005509218 A JP2005509218 A JP 2005509218A JP 2003542948 A JP2003542948 A JP 2003542948A JP 2003542948 A JP2003542948 A JP 2003542948A JP 2005509218 A JP2005509218 A JP 2005509218A
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ラオ，アール，バーラト
サンディルヤ，サスヤカマ
ウォーリック，トーマス
シャープビア，ハーム，ジェイ
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Abstract

本発明は、患者の治療の過程における臨床ガイドラインの堅持を自動的に確保するためのシステム及び方法を提供する。データソース（２０２）は治療中の患者の記録を含む患者記録を含んでおり、ガイドライン知識ベース（２０４）は臨床ガイドラインを含み、質堅持エンジン（２０６）は治療中の患者の臨床ガイドラインの堅持をモニターするように構成されている。患者記録の少なくとも一部は、構造化されていない患者データのマイニングにより得られる情報を含む。このシステムは、質堅持情報を出力する出力コンポーネント（２０８）を有する。出力される質堅持情報は、臨床ガイドラインに従って臨床アクションをとる必要があるというような合図を含むことがある。出力される質堅持情報はまた、臨床ガイドラインが守られていないという警告を含むこともある。

Description

本発明は、医療情報処理システムに関し、さらに詳細には、ヘルスケア機関の質を堅持するための情報を提供するコンピュータ化されたシステム及び方法に関する。
ヘルスケア機関は、ケアの質を改善するために証拠に基づくアプローチにますます依存するようになっている。例えば、ヘルスケア機関は通常、利用可能な最善の医学的証拠に基づいて勧告を行う臨床ガイドラインを使用する。ヘルスケアの質は、臨床アクションとガイドラインによる勧告とを比較することにより測定可能である。
ヘルスケア機関は、かかる比較により得られる結果を用いて機関内の改善が必要な領域だけでなく優良の領域を判定することができる。この情報は、計画及び予算の策定のための客観的なベースを提供する。さらに、一般大衆に対する説明責任を果たすと共に質が優良であるという主張の裏付けにこの情報を利用することができる。
現在、ケアの質の問題に対処する解決策には、臨床ガイドラインとの遡及的比較にのみ焦点を当てたものが多い。遡及的比較により価値ある情報が得られるが、一般的に、患者の治療の過程におけるガイドラインの厳守を確保する機構には有効なものはほとんどない。かかる情報は、問題が生じた時に直ちに解決のためのアクションをとれるようにそれらの問題を突き止める上で非常に有用であろう。
ヘルスケア機関が患者のケア管理の大部分の局面が自動化された環境に移行するにつれて、患者情報の収集及び分析が容易になっている。しかしながら、ヘルスケア機関は無数の非構造化及び構造化データソースに情報を維持する傾向がある。例えば、それぞれがそれ自体に特有なフォーマットを有する多種多様なデータベースにアクセスする必要がある。悪いことに、医師のメモをチェックしなければならない場合がある。これらのメモは通常、フリーテキストの口述以上のものでなく、これらのメモを拾い読みして必要な情報を収集するのは容易なことではない。その結果、情報を収集するための努力に時間をとられ、経費が嵩み、エラーが生じ易いのが一般的である。
ケアの質を示す情報を提供する重要性に鑑みて、患者の治療の過程における正確な質堅持情報を発生することは望ましく、また非常に有益なことである。
発明の概要
本発明は、患者の治療の過程において正確な質堅持情報を作成する方式を提供する。
本発明の種々の実施例では、臨床ガイドラインの堅持を自動的に確保するためのシステムであって、治療中の患者の記録を含む患者記録を有するデータソースと、臨床ガイドラインを含むガイドライン知識ベースと、治療中の患者の臨床ガイドラインの堅持をモニターする質堅持エンジンとより成る臨床ガイドラインの堅持を自動的に確保するシステムが提供される。患者記録の少なくとも一部は、構造化されていない患者データのマイニングにより得られる情報を含む。
このシステムは、質堅持情報を出力する出力コンポーネントを有する。出力される質堅持情報は、臨床ガイドラインに従って臨床アクションをとる必要がある旨の合図のような合図を含むことがある。出力される質堅持情報はまた、臨床ガイドラインが守られていないという警告を含むことがある。
質堅持エンジンは、臨床アクションを臨床ガイドラインと比較することにより臨床ガイドラインの堅持をモニターする。臨床ガイドラインは、勧告される臨床アクションに関連する。質堅持エンジンは、次に勧告される臨床アクションを決定することにより臨床ガイドラインの堅持をモニターすることができる。次に勧告される臨床アクションの合図は、ヘルスケア提供者が勧告をよく守るように出力することができる。
本発明の上記及び他の局面、特徴及び利点は、添付図面を参照して好ましい実施例の以下の詳細な説明を読めば明らかになるであろう。
本発明の明確な理解に資するために、本発明のある特定の局面を説明する実施例が提供される。しかしながら、これらの例には本発明の範囲を限定する意図はなく、本発明のある特定の思想を説明するためのものであることを理解されたい。
本発明は、ハードウェア、ソフトウェア、ファームウェア、特定目的プロセッサまたはこれらの組み合わせを含む種々の形態で実施できることを理解されたい。本発明は、プログラム記憶装置に記憶されたプログラムとしてのソフトウェアで実現するのが好ましい。そのプログラムは任意適当なアーキテクチャーを有するマシーンにアップロードされ、それにより実行される。そのマシーンは、１またはそれ以上の中央処理ユニット（ＣＰＵ）、ランダムアクセスメモリ（ＲＡＭ）及び入出力（Ｉ／Ｏ）インターフェイスのようなハードウェアを備えたコンピュータプラットフォーム上で実現するのが好ましい。コンピュータプラットフォームはまた、オペレーティングシステム及びマイクロ命令コードを有する。本明細書で説明する種々のプロセス及び機能は、オペレーティングシステムにより実行されるマイクロ命令コードの一部またはプログラム（もしくはその組み合わせ）の一部でよい。さらに、別のデータ記憶装置及びプリンタのような他の種々の端末装置をコンピュータプラットフォームに接続することができる。
添付図面に示すシステムの構成要素及び方法ステップの一部はソフトウェアでの実現が好ましいため、システムコンポーネント（またはプロセスステップ）間の実際の接続は本発明がプログラムされる態様により異なることを理解されたい。
図１は、本発明の一実施例に従って本発明が実現されるコンピュータ処理システム１００のブロック図である。このシステム１００は、少なくとも１つのプロセッサ（以下、プロセッサと呼ぶ）１０２がシステムバス１０４を介して他のコンポーネントに作動的に結合されたものである。システムバス１０４には、リードオンリーメモリ（ＲＯＭ）１０６、ランダムアクセスメモリ（ＲＡＭ）１０８、入出力インターフェイス１１０、ネットワークインターフェイス１１２及び外部記憶装置１１４が作動的に結合されている。ディスプレイ装置、ディスク記憶装置（例えば、磁気または光記憶装置）、キーボード及びマウスのような種々の周辺装置を、Ｉ／Ｏインターフェイスまたはネットワークインターフェイス１１２を介してシステムバス１０４に作動的に結合することが可能である。
コンピュータシステム１００は、スタンドアロンのシステムかまたはネットワークインターフェイス１１２を介してネットワークにリンクされたシステムである。ネットワークインターフェイス１１２はハードワイヤー接続のインターフェイスでもよい。しかしながら、種々の実施例において、ネットワークインターフェイス１１２は、汎用非同期送受信器（ＵＡＲＴ）、並列デジタルインターフェイス、ソフトウェアインターフェイス、または公知か今後開発されるソフトウェアおよびハードウェアの任意の組み合わせのような、情報を他の装置へ送るか受けるに適した任意の装置を備えることができる。ネットワークインターフェイスは、ローカルエリアネットワーク（ＬＡＮ）、ワイドエリアネットワーク（ＷＡＮ）、イントラネット、仮想私設ネットワーク（ＶＰＮ）及びインターネットを含む種々のタイプのネットワークにリンクすることができる。
外部記憶装置１１４は、プロセッサ１０２により管理されハードディスクのようなメモリ上に常駐するデータベースマネジメントシステム（ＤＢＭＳ）を用いて実現することができる。しかしながら、外部記憶装置１１４は１またはそれ以上のコンピュータシステム上で実現可能なことを理解されたい。例えば、外部記憶装置１１４は別個のコンピュータシステム上に常駐するデータウェアハウスシステムを含むようにしてもよい。
当業者は、本発明の思想及び範囲から逸脱することなく他のコンピュータ環境を利用できることがわかるであろう。
図２を参照して、該図は自動化された質堅持システム２００を示す。この自動化された質堅持システム２００は、患者記録を含むデータソース２０２と、臨床ガイドライン知識ベース２０４と、質堅持エンジン２０６と、出力コンポーネント２０８とを有する。自動化された質堅持システム２００は、治療中の患者について臨床ガイドラインの堅持をモニターするように構成されている。
データソース２０２は、好ましくは、構造化された臨床患者記録（ＣＰＲ）として構成され、全体を本願の一部として引用する米国特許出願（発明者：Rao et al.；発明の名称：患者データマイニング；弁護士事件番号第２００１Ｐ２０９０６ＵＳ０１）に記載されたデータマイニング方式を用いて患者情報を入力されている。
図３に示すように、高品質の構造化臨床情報をマイニングするためのデータマイニングフレームワークの一例は、知識ベース３３０に含まれるドメイン知識を用いてＣＰＲ３１０から情報をマイニングするデータマイナー３５０を有する。データマイナー３５０は、ＣＰＲ３５２から情報を抽出するコンポーネントと、利用可能な証拠を全て原理原則に則って経時的に結合するコンポーネント３５４と、この結合プロセスから推論を導き出すコンポーネント３５６とを有する。マイニングされた情報は構造化ＣＰＲ３８０に蓄積される。
抽出コンポーネント３５２は、患者に関する断片情報を各データソースから拾い集める仕事をするが、これらの情報は特定の時点におけるその患者についての確率論的表明として表される。これらの確率論的表明を「エレメント」と呼ぶ。結合コンポーネント３５４は、同一期間において同一変量に言及する全てのエレメントを結合してその変量に関する１つの統合された確率論的表明を形成する。これらを統合された確率論的表明を「ファクトイド」と呼ぶ。推論コンポーネント３５６は、これらのフォクトイドを同一時点においてそして／または異なる時点において結合することにより、患者の状態の経過を経時的に示す首尾一貫した簡潔な描写を形成する。患者の状態のこの経過を「状態シーケンス」と呼ぶ。
図２を再び参照して、自動化された質堅持システム２００は、例えば、合図のような質堅持情報を出力するように構成可能である。これらの合図は、臨床ガイドラインに従って医師に臨床アクションをとるのを促すために発生される。出力される質堅持情報はまた、臨床ガイドラインが守られていないという警告を含むことがある。
データソース２０２に含まれる患者記録は、患者の治療の間にとられる臨床アクションに関する情報を含む。例えば、臨床記録は患者に対して処方される種々の検査及び治療に関する情報を含む。
質堅持エンジン２０６は、臨床アクションを臨床ガイドラインと比較することにより臨床ガイドラインの堅持をモニターするように構成することができる。臨床アクション情報は、推論の結果得られるものであるため、確率情報の性質を有する。従って、ガイドラインが守られていない可能性のある場合にはこれらの警告が発生される。確率値が各臨床アクションに割り当てられ、ガイドラインが守られなかった確率が所定のしきい値を超えると警告が発せされる。
質堅持エンジン２０６はまた、次に勧告される臨床アクションを決定することにより臨床ガイドラインの堅持をモニターすることができる。次に勧告される臨床アクションの合図は、ヘルスケア要員が勧告をよく守ることができるように出力される。
例えば、ヘルスケア機関の認定合同委員会（ＪＣＡＨＯ）により公表された急性心筋梗塞の治療のためのガイドラインは、アスピリン禁忌症のない或る特定のＡＭＩ患者が病院到着の前または後の２４時間以内にアスピリンを受けることを要求している。このケースでは、質堅持エンジン２０６は、データソース２０２からＡＭＩ患者の患者記録を選択し、それらの患者のうちの或る特定のものにアスピリン投与の必要性があるという合図を発生することができる。ＡＭＩ患者にアスピリンを投与することなく２４時間が経過した場合、警告が出力される。
出力コンポーネント２０８は、これらの合図と、場合によっては警告とを、他の質堅持情報と共に出力することができる。出力コンポーネント２０８は、この情報を、印刷したレポート、コンピュータのディスプレイ装置などにより出力するように実現することができる。しかしながら、他の種々の実施例では、この質堅持情報は医師のカレンダー／スケジューリングシステムに一体化することができる。
図４を参照して、該図は患者の治療の過程における臨床ガイドラインの堅持を自動的に確保する方式の一例を略示する流れ図である。ステップ４０２でスタートすると、患者記録がデータソースから得られる。得られた患者記録の少なくとも一部は、例えば、医師のメモ、医療画像及び波形情報のような構造化されていない情報から導出された治療情報を含んでいる。この情報は、好ましくは、全体を本願の一部として引用する米国特許出願（発明者：Rao et al.；発明の名称：患者データマイニング；弁護士事件番号第２００１Ｐ２０９０６ＵＳ０１）に記載されたように、マイニングされた非構造化患者情報を用いて入力された構造化データレポジトリ内に常駐している。
ステップ４０４において、臨床ガイドラインは臨床ガイドライン知識ベースから検索される。例えば、臨床ガイドラインは、データベースに蓄積され、対象となる種々の疾患について勧告されている臨床アクションを含む。これらの臨床ガイドラインは、認定機関（ＪＣＡＨＯのような）、政府機関、及び消費者ヘルスケア機関により公表された勧告を含むことがある。さらに、臨床ガイドラインは、内部で使用するために（例えば、病院がケアの質を測定するために）作成することがある。一般的に、臨床ガイドラインは勧告された臨床アクションの何らかのリストを含んでいる。
次に、ステップ４０６において、臨床ガイドラインの堅持がモニターされる。これは、現在の患者の診断を判定し、その患者に対してとられた臨床アクションを関連のガイドラインと比較することより成る。勧告された臨床アクションが守られていない場合、医師及び他の医療機関に警告が発せられることがある。この患者について次に勧告される臨床アクションが決定され、合図が発生されることもある。
ステップ４０８において、合図及び警告のような質堅持情報は、レポート、コンピュータディスプレイにより出力されるか、カレンダーまたはスケジューリングシステムに統合されることがある。
図１−４に示すように、本発明は、汎用コンピュータシステムを用いて実現するのが好ましい。しかしながら、本発明のシステム及び方法は、１またはそれ以上のプログラム式汎用コンピュータ、プログラムしたマイクロプロセッサまたはマイクロコントローラ、または端末集積回路要素、ＡＳＩＣまたは他の集積回路、デジタル信号プロセッサ、個別素子回路のようなハードワイヤー電子または論理回路、ＰＬＤ、ＰＬＡ、ＦＰＧＡまたはＰＡＬなどのようなプログラム可能論理デバイスなどの任意の組み合わせを用いて実現することができる。
本発明の実施例を添付図面を参照して説明したが、本発明はそれらの実施例に限定されず、本発明の範囲または思想から逸脱することなく当業者により他の実施例または変形例が想到されることを理解されたい。
本発明の一実施例に使用するコンピュータ処理システムのシステム図である。 本発明の一実施例による質確保システムの一例である。 構造化された臨床情報をマイニングするためのデータフレームワークの一例である。 患者の処置の過程において臨床ガイドラインの堅持を自動的に確保するための方式の一例を略示する流れ図である。

Claims (24)

  1. 臨床ガイドラインの堅持を自動的に確保するためのシステムであって、
    治療中の患者の記録を含む患者記録を有するデータソースと、
    臨床ガイドラインを含むガイドライン知識ベースと、
    治療中の患者の臨床ガイドラインの堅持をモニターする質堅持エンジンとより成る臨床ガイドラインの堅持を自動的に確保するシステム。
  2. 少なくとも一部の患者記録は、構造化されていない患者データのマイニングにより得られる情報を含む請求項１のシステム。
  3. 質堅持情報を出力する出力コンポーネントをさらに備えた請求項１のシステム。
  4. 出力される質堅持情報は合図を含む請求項３のシステム。
  5. 合図は、臨床ガイドラインに従って臨床アクションをとるための合図を含む請求項４のシステム。
  6. 出力される質堅持情報は、臨床ガイドラインが守られていないという警告を含む請求項３のシステム。
  7. 出力される質堅持情報は、臨床ガイドラインが守られていない可能性があるという警告を含む請求項３のシステム。
  8. データソースに含まれる患者記録は、患者の治療中にとられる臨床アクションに関する情報を含む請求項１のシステム。
  9. 質堅持エンジンは、臨床アクションを臨床ガイドラインと少なくとも部分的に比較することにより臨床ガイドラインの堅持をモニターする請求項８のシステム。
  10. 臨床ガイドラインは勧告された臨床アクションに関するものである請求項９のシステム。
  11. 質堅持エンジンは、次に勧告される臨床アクションを少なくとも一部決定することにより臨床ガイドラインの堅持をモニターする請求項１０のシステム。
  12. 質堅持エンジンは、次に勧告される臨床アクションの合図を少なくとも部分的に出力することにより臨床ガイドラインの堅持をモニターする請求項１１のシステム。
  13. 患者の治療の過程における臨床ガイドラインの堅持を自動的に確保する方法であって、
    構造化されていないデータソースからの、少なくとも一部がマイニングされた情報を含む、治療中の患者の患者記録を得、
    ガイドライン知識ベースから臨床ガイドラインを検索し、
    治療中の患者の臨床ガイドラインの堅持をモニターするステップより成る臨床ガイドラインの堅持を自動的に確保する方法。
  14. 質堅持情報を出力するステップをさらに含む請求項１３の方法。
  15. 出力される質堅持情報は合図を含む請求項１４のシステム。
  16. 合図は臨床ガイドラインに従って臨床アクションを行うための合図を含む請求項１５の方法。
  17. 出力される質堅持情報は、臨床ガイドラインが守られていないという警告を含む請求項１４の方法。
  18. 出力される質堅持情報は、臨床ガイドラインが守られていない可能性があるという警告を含む請求項１４の方法。
  19. 得られた患者記録は、患者の治療中にとられる臨床アクションに関する情報を含む請求項１４の方法。
  20. 臨床ガイドラインの堅持をモニターするステップは、臨床アクションと臨床ガイドラインとを比較することを含む請求項１９の方法。
  21. 臨床ガイドラインは、勧告された臨床アクションに関するものである請求項２０の方法。
  22. 臨床ガイドラインの堅持をモニターするステップは、次に勧告される臨床アクションを決定することを含む請求項２０の方法。
  23. 臨床ガイドラインの堅持をモニターするステップはさらに、次に勧告される臨床アクションの合図を出力することを含む請求項２２の方法。
  24. 臨床ガイドラインの堅持を自動的に確保する方法ステップを実行するためにマシーン上で実行可能な命令のプログラムを含み、そのマシーンにより読み取り可能なプログラムの記憶装置であって、それらの方法ステップは、
    構造化されていないデータソースからの、少なくとも一部がマイニングされた情報を含む、治療中の患者の患者記録を得、
    ガイドライン知識ベースから臨床ガイドラインを検索し、
    治療中の患者の臨床ガイドラインの堅持をモニターするステップより成る記憶装置。
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