WO2002075612A1 - Systeme et procede d'optimisation de la pratique de specialistes medicaux pratiquant dans un environnement multi-site ou de groupes de praticiens generaux multi-site - Google Patents

Systeme et procede d'optimisation de la pratique de specialistes medicaux pratiquant dans un environnement multi-site ou de groupes de praticiens generaux multi-site Download PDF

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Publication number
WO2002075612A1
WO2002075612A1 PCT/AU2002/000284 AU0200284W WO02075612A1 WO 2002075612 A1 WO2002075612 A1 WO 2002075612A1 AU 0200284 W AU0200284 W AU 0200284W WO 02075612 A1 WO02075612 A1 WO 02075612A1
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WO
WIPO (PCT)
Prior art keywords
medical
software application
patient
practice
information
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Application number
PCT/AU2002/000284
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English (en)
Inventor
John Boyages
Steven Constantine Boyages
Howard Paul Gurney
Andrew Peter De La Harpe
Peter Bruce Loder
Owen Allen Ung
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Specialist Information Services Pty Ltd
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Application filed by Specialist Information Services Pty Ltd filed Critical Specialist Information Services Pty Ltd
Priority to AU2002235670A priority Critical patent/AU2002235670B2/en
Publication of WO2002075612A1 publication Critical patent/WO2002075612A1/fr

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Classifications

    • G—PHYSICS
    • G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H40/00—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices
    • G16H40/20—ICT specially adapted for the management or administration of healthcare resources or facilities; ICT specially adapted for the management or operation of medical equipment or devices for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N5/00—Radiation therapy
    • A61N5/10—X-ray therapy; Gamma-ray therapy; Particle-irradiation therapy
    • A61N5/103—Treatment planning systems

Definitions

  • the present invention broadly relates to a computer based management system and/or method for the medical profession, and also to the provision of software facilitating application services and clinical practice services including Internet technologies, relational database population, workflow management and clinical early warning systems to be provided in a manner suited to medical practitioners consulting or treating in multiple sites.
  • a component of presently known practice is recruitment of patients to, and assessment of patients during, clinical trials. This involves trawling though physical records to find suitable criteria (disease type, status, age, sex and other parameters as defined by the trial).
  • Clinical data is written into the medical record (source document).
  • Research staff transcribe selected data from the source documents (medical records, investigation reports) into a case report form (CRF).
  • the CRF is checked by a clinical research associate (CRA) and sent to the central coordinating centre. Data is entered onto a database and checked for discrepancies.
  • a Discrepancy Resolution Form (DRF) is sent back to the study site. The site staff review and complete source verification and return the DRF to the coordinating site for review. This process is repeated until all identified discrepancies are resolved.
  • this process often leads to duplication, discrepancies, redundant query identification points and transcription errors and omissions in the process of undertaking clinical trials.
  • a terminal may be any type of computer or computerised device, a personal computer (PC), a mobile or cellular phone, a mobile data terminal, a portable computer, a personal digital assistant (PDA), a pager, a thin client, or any other similar type of electronic device.
  • the capability of the terminal to request and/or receive information can be provided by an application program, hardware or other such entity.
  • a terminal may be provided with associated devices, for example an information storage device such as a hard disk drive.
  • an information source may be a server or any other type of terminal (for example, a PC computer) coupled to an information storage device (for example, a hard disk drive).
  • the exchange of information ie. the request and/or receipt of information
  • the communication channel can be physically realised via a metallic cable (for example, a telephone line), semi-conducting cable, an electromagnetic signal (for example, a radio frequency (RF) signal), an optical fibre cable, a microwave link, a satellite link or any other such medium or combination thereof connected to a network infrastructure.
  • RF radio frequency
  • the computer network itself may take a variety of forms. It may be located within a local geographic area, such as an office building, and consist of only a limited number of terminals and information sources. This type of computer network is commonly referred to as a Local Area Network (LAN). On a broader scale, it may be larger and support more users over a wider geographic area, such as across a city. This type of network is commonly referred to as a Wide Area Network (WAN). On an even broader scale LAN and WAN networks may be interconnected across a country or globally. An example of a globally connected computer network is the Internet. Files may be stored at various information sources. A user can access files from an information source, if authorised, by connecting to a computer network and requesting the files for viewing or downloading.
  • LAN Local Area Network
  • WAN Wide Area Network
  • the present invention seeks to provide a system and/or method for professional management of medical specialists functioning in a multi-site environment.
  • the present invention seeks to provide a computer readable medium of instructions to facilitate the aforementioned system or method.
  • the present invention seeks to provide a computer readable medium of instructions for professional management of medical specialists functioning in a multi-site environment that facilitates business process outsourcing.
  • the computer readable medium of instructions is a software application which emulates the responsiveness of a traditional client/server application whilst using web technologies that is useable over a conventional dial-up modem.
  • the software application requires no proprietary software to be manually installed by a user (or client or customer) and consequently has a minimal additional entry cost for new users (or clients or customers).
  • the present invention seeks to provide software on one (or multiple) central server(s) with access from a client terminal using commonly available Internet browser applications, without requiring software to be installed or stored on the client terminal.
  • a means to provide support functions such as, but not limited to: multi-site booking including procedure and protocol booking; waiting room management; records collection management, and; accounting functions.
  • the work functions are integrated to workflow, business and clinical logic layers and monitored via a practice manager's module.
  • the present invention seeks to provide a means to view on a terminal aspects of the practice of importance to the clinician, and again from a holistic multi-site perspective, such as, but not limited to, patient histories, clinical contact event recording, resource access, orders entry and results receiving, medical typing interactions, and specific requirements of specialist treatment regimens such as medical oncology, surgery, anaesthesia, radiation oncology and endocrinology.
  • Non-clinical functions include practice and clinical key performance indicators, escalation processes, internal action requests and clinical cost tracking for ordered tests and pharmaceuticals.
  • the invention seeks to provide a means to provide aspects of the clinical process to a mobile device, including, for example, clinical diary with patients scheduled, patient medical information, treatment information and letters awaiting sign-off.
  • a means to provide dictated data to typists, facilitate the typist-originator interaction and letter sign-off processes can include a means to incorporate business rules including escalation based on inaction or persistence of the trigger event.
  • Such means may be integrated to workflow, business and clinical logic layers and monitored via a practice manager's module.
  • a means to provide an external parties interface as a means of communicating with external parties via mutually suitable means with, where possible, secure encrypted transmissions which include, but are not limited to: Health Level 7 (HL7), Wireless Application Protocol (WAP), Short Message service (SMS), facsimile or hardcopy printout.
  • HL7 Health Level 7
  • WAP Wireless Application Protocol
  • SMS Short Message service
  • facsimile or hardcopy printout Such means may be integrated to workflow, clinical and business logic layers.
  • a system for use in medical practice the system able to facilitate a medical practitioner to work from multiple sites, the system including: a central server, the central server hosting a software application; a database, the database able to communicate with the software application and the database able to store or produce information or data in response to a request from the software application; at least one client terminal, the at least one client terminal able to communicate with the central server, the at least one client terminal used by the medical practitioner to access functions provided by the software application; whereby, the software application includes at least a user presentation layer, a network services layer, a clinical and business logic layer, and a data access layer for access to the database.
  • a computer readable medium of instructions residing on a host server, a user able to access functions provided by the computer readable medium of instructions from one of a plurality of remote client terminals, the computer readable medium of instructions for use in assisting in the management of a medical practice and including procedures for: allowing the user to remotely access a database of information via one of the client terminals; providing the user with access to clinical functions; and providing the user with access to non-clinical functions.
  • an Internet based software application which resides on a host server, the functions provided by the software application able to be accessed from a Web browser which resides on a remote terminal, the software application for use in assisting to manage a medical practitioner's practice, the software application providing an integrated interface to: front desk functions; practice manager functions; clinical functions; and medical typing functions.
  • a method for use by a medical practitioner to assist in providing medical services to a patient the method assisting the medical practitioner to work from multiple sites, the method including the steps of: the medical practitioner logging into a network based management software application; profile information for the medical practitioner being passed to the management software application; the management software application retrieving and displaying patient lists to the medical practitioner; the medical practitioner selecting a particular patient record from the displayed list, the medical practitioner thereby able to retrieve medical information pertaining to the selected patient from a database associated with the management software application; the medical practitioner able to update the medical information in the patient record on the database.
  • a method for use by a medical practice manager to assist in providing medical services to a patient the method assisting the medical practice manager to work from a site remote to the medical practice, the method including the steps of: the medical practice manager logging into a network based management software application from a terminal remote to a server hosting the management software application; the management software application retrieving and displaying medical practice information to the medical practice manager; the medical practice information including key performance indicators pertaining to the routine functioning of the medical practice.
  • a method for use by a medical practice receptionist to assist in providing medical services to a patient at a medical practice including the steps of: the medical practice receptionist logging into a network based management software application from a terminal remote to a server hosting the management software application; a patient requesting an appointment from the medical practice receptionist; the management software application displaying a booking software tool to the medical practice receptionist; the medical practice receptionist entering patient details into the management software application; the booking software tool presenting medical practitioners and medical practice sites available to the patient; an appointment being made for the patient; at the time of the appointment the medical practice receptionist starting a clinic function of the management software application; and on completion of the clinic post clinic statistics are stored in a database and an end of clinic financial report is generated.
  • a feature of a broad form of an embodiment of the invention is a means to ensure the correct sequencing of data collection and processing from an 'ideal workflow' perspective. Another feature of an embodiment of the invention is a means to ensure clinical rules are applied and enforced, any exceptions being alerted to the responsible clinician. A further feature of an embodiment of the invention is a means to enforce security policy from a patient information perspective.
  • a data source layer that contains the actual data structures that form the repository for system data.
  • the present invention provides that the computer network can be any network of two or more communicating computers or terminals including but not limited to, an internetwork, an intranetwork, a LAN, a WAN, or the Internet.
  • Figure 1 illustrates an embodiment of the present invention wherein, the figure shows a schematic of the general functional design.
  • Figure 2 illustrates an embodiment of the present invention wherein, the figure shows a simple overview of the preferred pre-clinic and post clinic workflow.
  • Figure 3.1 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for preferred flow - Bookings component.
  • Figure 3.2 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for preferred flow - Confirmation component.
  • Figure 3.3 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for preferred flow - Records Gathering component.
  • Figure 3.4 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for preferred flow - Clinic Setup component.
  • Figure 3.5 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for preferred flow - Waiting Room and post clinic functions.
  • Figure 4 illustrates an embodiment of the present invention wherein, the figure shows a management perspective of the simple overview preferred front pre-clinic and post clinic workflow.
  • Figure 5 illustrates an embodiment of the present invention wherein, the figure shows a schematic layout for practice manager providing rapid review of practice status - across sites - for core processes.
  • Figure 6 illustrates an embodiment of the present invention wherein, the figure shows a simple overview of preferred clinical consultation process.
  • Figure 7 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for preferred consultation flow.
  • Figure 8 illustrates an embodiment of the present invention wherein, the figure shows a schematic of the clinician interface with the 'add-note' tab clicked.
  • Figure 9 illustrates an embodiment of the present invention wherein, the figure shows a schematic of clinician interface ('m' - medical record view).
  • Figure 10 illustrates an embodiment of the present invention wherein, the figure shows the Clinical Quality Indicators arising from an embodiment of the invention as illustrated in figures 6, 7 and 8.
  • Figure 11 illustrates an embodiment of the present invention wherein, the figure shows a management perspective of the Simple Overview preferred consultation flow.
  • Figure 12 illustrates an embodiment of the present invention wherein, the figure shows a typist perspective of a simple overview of preferred Medical Typing Process.
  • Figure 13 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for preferred medical typing process.
  • Figure 14 illustrates an embodiment of the present invention wherein, the figure shows a management perspective of the simple overview of preferred medical typing process.
  • Figure 15 illustrates an embodiment of the present invention wherein, the figure shows the standard format for the representation of key performance indicators.
  • Figure 16 illustrates a simple overview of a preferred radiation oncology process.
  • Figure 17 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for the preferred radiation oncology workflow.
  • Figure 18 illustrates a simple overview of a preferred medical oncology process.
  • Figure 19 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for the preferred medical oncology workflow.
  • Figure 20 illustrates an embodiment of the present invention wherein, the figure shows the preferred surgical workflow.
  • Figure 21 illustrates an embodiment of the present invention wherein, the figure shows the systematic support for the preferred surgical workflow.
  • the present invention provides a computer based management system and/or method for the medical profession, and/or a computer readable medium of instructions for effecting such.
  • like reference numerals are used to identify like parts throughout the figures. The following modes are described in order to provide a more precise understanding of the subject matter of the present invention. These examples are intended to be merely illustrative and not limiting of the scope of the present invention.
  • Front desk Functions related to the role of front desk/reception within a specialist medical practice.
  • Booking (105) Functions related to the booking process.
  • the booking process in simple process context is shown in figure 2. More detail of how the system and method supports the preferred booking process is shown in figure 3.1.
  • Waiting Room (110) Functions related to the waiting room process.
  • the waiting room process in simple process context is shown in figure 2. More detail of the how the system and method supports the preferred waiting room process is shown in figure 3.5.
  • Billing (115) Functions related to the billing process.
  • the billing process in simple process context is shown in figure 2.
  • Back-office Functions related to non-patient contact related administration a preferred but non-limiting embodiment includes: Clinical Follow ups; Operational; Quality & Performance; Financial; Billing Processes (non-patient payers); Marketing;
  • Medical Typing (140): Functions related to the role of medical typist within a specialist medical practice.
  • Clinical Functions related to the role of medical specialist within a specialist medical practice.
  • Clinical Workspace (150): The primary work area for specialist doctors to view patient records and record clinical events.
  • Library and research (155): On-line access to medical journals such as 'medline' and 'Harrisons' as well as new products and drug information.
  • a preferred embodiment would also include the submission of a 'research request' to a 'librarian'.
  • Specialists lounge (160): A preferred embodiment of the specialist's lounge includes access to non-medical areas of interest. This area is tailored to the specialist's interests but includes common features such as: financial and insurance services.
  • a preferred but non-limiting embodiment of the education services includes video links to cases of interest (eg. Surgical cases), lectures and publications and other datacasting services.
  • Mobile facility The provision of clinical information and access to relevant clinical processes via a personal data assistant (PDA) or mobile phone.
  • PDA personal data assistant
  • User presentation layer (170) The client application (browser) and code that defines what the user sees whether from a standard computer or mobile device.
  • Workflow logic layer (175) The server code that ensures the correct sequencing of workflow events.
  • Clinical and business logic layer (180): The server code and rules that define and monitor actions according to predefined rules and escalation sequences and periods.
  • External parties interface (185): Server code that interfaces and authenticates data extracts and formats data according to rules and protocols defined for the particular party.
  • HIC Australia's health insurance commission, this may be any government payer, from any country /region.
  • Registers (187) Any official register of patient conditions such as the cancer registry.
  • Diagnostics Providers of pathology or medical imaging services.
  • Drug companies (188) Providers and manufacturers of pharmaceuticals.
  • Insurers (189) Private health insurance companies.
  • Data access layer (190): Server code that receives a request for data and returns the requested data.
  • Medical record access security A component of the data access layer that checks record and user status, allows authorised access, stores the fact that a record has been accessed and in the event of record modification records that pre-and-post-modification results.
  • Data source layer (195) The databases that store all system information
  • m-avert A term applied to the code which applies clinical rules and escalates issues in pre-defined periods, to pre-defined people as a component of the clinical and business logic layer.
  • Multi-site design The fundamental system and methods used to enable authorised staff to access other sites from where a clinician works allowing among other features multi-site booking.
  • booking (205): Actions associated with scheduling a patient to see a clinician. As it relates to the present embodiment this allows scheduling of a patient across any site from which the clinician practices for which the user has permission to do so.
  • Confirmation A process step whereby the scheduled patients are contacted and the booking confirmed or cancelled.
  • the appointment vacated by a cancellation may be filled from a waiting list.
  • the embodiment incorporates providing a preferred means of contact (which may be overridden) including various electronic means.
  • Waiting room (225): The functions and process steps from the point that the patient presents at the consulting rooms.
  • Post clinic bookings The scheduling of patients for subsequent visits including complex bookings associated with treatment plans.
  • Billing (235): The calculation of fees, production of invoices and receiving of payments.
  • Debtor follow-up (240): The production and management of account 'reminders' in accordance with preferred periods.
  • Waiting Room (605): Specialists view of the waiting room ('real-time').
  • Clinical consultation (610): The process of information gathering, assessment of data and formation of a plan for the patient's care.
  • Electronic medical record (625): Database and associate controlling functions for the storage of patient related data.
  • Next appointment/Discharge (635): Decision on next treatment steps or discharge from the care of the specialist.
  • Dictation (640): Method for recording voice input from doctor.
  • Electronic dictation system (645): System for managing voice input from doctor.
  • Typing process Physical aspects of medical typing (facilitated by dictation system).
  • a patient is selected by one of the means in the left of the page.
  • Add note method is a means of collecting clinical information in a very flexible format. The method supports the subjective, objective, assessment and plan consultation structure, 'progress note' format, simple contact recording (eg. phone call, email or other). Supports the electronic health summary. Entry may be specifically tailored to the requirements of a clinical trial.
  • Clinical logic layer sorts input information to appropriate data target for storage. Security standards are applied to the record, as it is stored.
  • Medication chart function allows an order by doctor of medication for administration by a second party (eg nurse).
  • (722) The clinical layer encodes the diagnosis into ICD-10 code format.
  • Reminders or actions may be entered and sent to the specialist (self- reminder) or to any other person in the system.
  • Modes for selecting the patient to work on include Waiting room; All patients in system; List by diagnosis/disease code; List by interested party.
  • Order Test A method and process for ordering pathology including the innovative steps of allowing multiple providers, storing and updating the most common tests ordered by the specialist for 'quick request' .
  • Business logic layer calculating the value of tests ordered and storing with the medical record and clinic statistics.
  • a further feature is the system and method for Point-Of-Care (POC) pathology services.
  • POC Point-Of-Care
  • buttons Button selection of actions on the selected patient. These buttons, in many cases provide rapid access to a sub-item on the tabs described in (870).
  • the buttons include but are not limited to the following actions:
  • Order Test As per (870) Order test.
  • Make appointment Allows selection of criteria to make an appointment but pass the task of actually scheduling the appointments to the front desk or actually creating the appointments for the patient at that point in time.
  • Billing Allows viewing of intended billing policy for this patient and allow changes that are passed back to the front desk to actually receive payment.
  • Dictation Provides a view of interested parties and the option to dictate now or later.
  • the dictate now option launches the electronic dictation system.
  • the dictate later adds a reminder task for the specialist. When the reminder is clicked a summary of all actions taken during the consultation are displayed by way of reminder for the specialist while dictating.
  • Reminder As per (870) Reminder.
  • An embodiment of the present invention includes access to historical (recorded at some stage in the past) information, a preferred but non-limiting embodiment of the history functions as shown in figure 9 are as follows:
  • Patient Workload (1010) Monthly patient numbers split by type and procedure.
  • Electronic dictation system (645): System for managing voice input from doctor. Work pending (1210): List of dictation waiting and in progress.
  • Type (1220) System and method for typing reports including pre-defined preferred templates for specialists and a method where desired to have the input elements entered into the medical record.
  • the originating specialist may listen to the dictation while viewing the typed information. They may choose to complete the typing themselves or dictate the clarification.
  • Mould room staff may view patients scheduled for moulds on the day selected via the 'mould waiting room'. A fitting date may be applied/altered. If the simulator is required at that time it may also be scheduled. (1723): Clinical information is filtered such that only information required for the mould room processes is available.
  • Simulation waiting room shows patient lists for the selected day. By clicking on the patient name relevant information can be displayed.
  • Electronic Dictation system (2050): Optional use of dictation system or direct recording in standard format.
  • the present invention in one particular embodiment, is a system or method for professional management of medical specialists functioning in a multi-site environment.
  • a preferred, but non-limiting, embodiment of the present invention is herein disclosed with reference to figures 1 through 21 inclusive.
  • the present invention also provides a computer readable medium of instructions for effecting the system and/or method.
  • the invention encompasses process re-design as depicted in figures 2, 6 and 12 and underlying systematic support for the preferred process.
  • the general design depicted in figure 1 shows the overall components.
  • Figures 3.1 to 3.5, 7 and 13 show the systems support for the preferred process in a structure that demonstrates the tiers depicted in figure 1.
  • An important aspect to an embodiment of the invention is the introduction of practice key performance indicators that are shown from a process perspective in figures 4, 11 and 14.
  • the preferred system uses Internet and health standards to establish a model that enables business process outsourcing, an important feature in the health care industry.
  • the system comprises a database (figure 1 : data source layer).
  • Data requests pass through the data access layer, if the data access layer deems access is allowed then the requested information returned to the browser (user presentation layer).
  • Actions and the order of display of process steps within the user presentation layer are managed by the workflow logic layer.
  • Each action is checked by the clinical and business logic layer to ensure rule compliance.
  • a novel feature is the control provided by the clinical and business logic layer with the ability to manage within defined rules and encourage compliance by escalation due to inaction within predefined periods.
  • a preferred, but non-limiting, embodiment in respect of each key process follows.
  • the various processes are accessed by the various 'roles' within a practice.
  • the role of front desk performs process functions that support the specialist in pre and post clinical functions shown in figure 2.
  • the practice manager role is one of control and monitoring the business.
  • the present invention facilitates this by key performance indicators shown in figures 4, 11 and 14.
  • the role of typist performs process functions shown in figure 12.
  • the role of specialist medical doctor performs clinical functions a simplified representation of which is shown in figure 6.
  • caller information is collected (301). If the information contains a patient identification number information pertaining to that patient is retrieved (302 and 303) and presented for confirmation. Caller information is then stored (303) in a newly created booking record.
  • the workflow logic manager presents the clinicians and sites for the booking (304) based on the clinicians and sites to which the user has been granted access (305) and the clinician selected.
  • the booking record is updated with the clinician and location information (306).
  • the workflow manager displays appointment types and triage (307). If a procedure is selected gather the procedures performed by this specialist at the selected site (308) and store the selected type, triage and procedure (309).
  • workflow manager requires a patient identification number (following a check by the clinical and business logic layer (312) then allow entry of search criteria for patient (311) and store the selected patient against the booking record and set the booking from tentative to booked (313). If the workflow manager requires a referring doctor identifier (following a check by the clinical and business logic layer the referrer search page is presented and the database updated with the referrer identifier.
  • the forms are displayed after first checking the components required by this specialist. Any changes are stored in the patient demographic database.
  • the comprehensive registration forms include such data as religion or the like which may not be required by some specialists.
  • System set-up parameters allow these segments to be bypassed using the workflow management layer. Display feedback on the booking and check for additional feedback items for the specialist and location selected. Store the fact that the information has been provided to the caller.
  • the location selected may have specific parking instructions
  • the specialist have specific billing requirements at that site and the procedure being carried out may require specific instructions such as fasting.
  • the workflow manager displays the quotation information. Quick quote items are retrieved based on prior inputs and displayed in the browser. Billing rules are applied to the selected billing items and the quote stored in the database.
  • the user selects the date and location for which to confirm bookings (315).
  • Scheduled appointments are retrieved (316). All scheduled patients and contact information is displayed (317) such that the user can call the patient to confirm the booking. If accepted, confirmation logic is applied (318) and the booking status is updated to 'confirmed' (319). If cancelled, cancellation logic is applied (318) and the status is updated to 'cancelled' (319).
  • appointment slots vacated by cancellations allow selection from wait listed patients (320) following checking to which wait lists the user has access to. The vacated appointment is replaced with the one selected from the wait list (322).
  • the user selects the date and location of clinics for which they require records (323), the business logic layer checks user permissions as to which clinics they are allowed to request records (324). Appointments lists, requesting sites and preferred modes of requesting records are gathered from the database (325) and returned to the browser (326). The user may modify the requesting method, if required (326). Rules for requesting records are carried out (327) according to selected criteria and requests are sent via the external parties interface (329) following the gathering of transmission requirements (330). Once requested the status is updated in the database (328). Once records arrive in the location they may be received into the systems (as a means of record tracking) (331) at which point the record received status is updated. With reference to figure 3.4, a list of specialists and locations is display (334) according to the permissions granted to the user (335). Clinician preferences for room set up are retrieved (336) and displayed (334).
  • the user selects manage current waiting room option from the menu (337) and the user identification and location information is used (338) to retrieve current waiting room information (339).
  • Detailed room information is gathered for each clinic (340) and the status of each aspect is interpreted (341) and passed to the browser for display (342).
  • the business logic layer gathers the clinic statistics for commencement of the clinic (344), stores it (345) and sends the statistics ID (344) back to browser. Modifications are stored in the database (350) and the new status displayed. Patients are 'received' into the waiting room at which point their arrival time and status is recorded and displayed. Non-scheduled patients may also be received into the waiting room. For each patient the status of registration information is displayed (346) and allows on-click access to print (349) and receive registration forms. Data 'refreshes' after each modification showing 'real-time' status. Modifications are stored in the database (350) and the new status displayed.
  • the information is passed to the database to retrieve available appointment dates for selection (353). Modifications are stored in the database (353) and the new status displayed. Typically payments would then be received for the consultation (354). The amount payable is determined following the application of billing rules either from quote and/or input by the clinician during the consultation (355). Apply rules for receiving payments of various types (355) and an invoice receipt printed (355). All changes are stored in the database (356). On completion of the clinic the clinic is finalised for the specialist (357) required post clinic statistics are gathered (358) and stored in the database (359). An end of clinic financial report is printed (358) and provided to the specialist with any monies received. Any rules such as 'did-not-attend' rules are auto- sent to the referring doctor via the external parties interface.
  • the role of clinical specialist is supported in an embodiment of the invention as follows: With reference to figure 7, the specialist logs into system and profile information is passed to the business logic layer (701). The clinicians workspace is opened with links to patient data. The entire workspace is opened as per figure 8. Prior to opening the system checks if the specialist currently has a clinic and requests clinic information from data source layer (702). Specialist patient lists are retrieved (703) and made available in the left frame of the browser ( Figure 8: 810).
  • Patient information is retrieved (706) for 'each tab' (fig 8: 870) and passed back to the browser.
  • Common data elements are sorted for display by the clinical logic layer (705).
  • an embodiment of the invention can provide multiple means of accessing similar functions for ease of use by the clinician.
  • the inputs are designed in a manner that the specialist may choose to what extent they wish to use the software/system.
  • Fig 8: 830 On selection key patient demographics (Fig 8: 830), current medications (Fig 8: 840), allergies and alerts (Fig 8: 850), and reminder status (Fig 8: 860) is displayed at all times. If any of these parameters are updated during the consultation the change is reflected (visually) immediately. Whenever a record is accessed the date, time and person accessing the record is recorded. If a modification is made, a pre and post modification 'snapshot' is taken and stored. This information is not accessible by any user of the system.
  • the medical record overview (Fig 9 9) displays record access permission (Fig 9: 910), permission to participate in, for example, the NSW and Commonwealth electronic health record(Fig 9: 915), key reasons for treating the patient (Fig 9: 920), a summary of clinical events (Fig 9: 925) and 'sticky notes' (Fig 9: 930). In addition access is provided to histories within the record.
  • Figure 9 915 allows the specialist to record whether the patient wishes to participate in the NSW electronic health record program, or other regional program. Information about the program is also available.
  • the 'sticky notes' (Fig 9: 930) allows the specialist to record any non-clinical information that may be of interest and with a simple click delete items that are no longer relevant.
  • the specialist may record the fact that the patient was taking a holiday in June.
  • the specialist may record the information such that it can be recalled as a discussion point to ease the stresses of the consultation or procedure. Once the information is no longer relevant it is removed.
  • the progress note (Fig 9: 935) lists all progress notes and allows modification of previous and addition of new notes. This may be added by the doctor or dictated for entry by the typist.
  • the medical history and problem list (Fig 9: 940) lists and allows modification of previous and addition of new medical histories and problems.
  • the family history (Fig 9: 945) lists and allows modification of previous and addition of new family histories. This embodiment includes the ability to click a family tree and condition lists for rapid recording.
  • the medications and allergies (Fig 9: 950) lists and allows modification of previous and addition of new medications and allergies.
  • the social history and alerts (Fig 9: 955) lists and allows, subject to security and access status, modification of previous and addition of new social histories and alerts.
  • This embodiment includes the ability to rapidly record common social factors of smoking and alcohol consumption.
  • the measures (Fig 9: 960) lists and allows recording of pre-clinic measures.
  • the tests option (Fig 9: 965) lists tests ordered and their status. It allows graphical display of selected pathology analyses and the display of images from medical imaging.
  • Interested parties (Fig 9: 980) lists and allows modification to any person or group interested in the case and whether they are to receive correspondence.
  • the preferred embodiment encompasses the following items that are presented as a preferred, but non-limiting, example of function available when a patient is selected. Any changes via these features are recorded in the database and subsequently appear in the appropriate section of the history described above.
  • the 'add note' method is a means of collecting clinical information in a very flexible format.
  • the method supports: subjective, objective, assessment and plan consultation structure, 'progress note' format, simple contact recording (eg. Phone call, email or other).
  • the Clinical logic layer sorts input information to appropriate data target for storage. Security standards are applied to the record, as it is stored. Specific components are stored into the events and histories tables in the electronic medical record and summary information is stored.
  • the prescribe method allows prescriptions to be added or topped in the standard prescription structure or a quick format in the case of history. Pricing information on all drugs ordered is extracted, cross reactions checked and a physical prescription printed. The order details are recorded in the patients electronic health record as is the drug pricing.
  • the information and consents tab contains a list of consents that may be selected and printed. In addition, information provided to patients including choices and risks is also entered. Requested information and consents are printed and recorded in the patients electronic medical record.
  • the principle diagnosis tab allows entry of the diagnosis via a graphical means whereby the specialist 'mouses-over' and area of the body, a list of aliments is presented in a popup menu style with sub-menus to select in more detail.
  • the clinical logic layer encodes the diagnosis into ICD-10 code format and both the textual and codified versions of the principle diagnosis are stored in the patients electronic medical record.
  • the treatment reports tab provides access to treatment reports tailored to the specific specialty or clinical trial.
  • the clinical logic as defined by the trial or specialist is applied and events triggered and information entered via the report is stored in the patients electronic medical record.
  • the specialist may enter a reminder that may be entered sent to the specialist themselves (self-reminder) or to any other person in the system.
  • the reminder status is tracked and inaction alerted via the m-avert method.
  • Reminder details are stored in the database.
  • the finalize consultation event tab provides sequenced events at the end of a consultation in a logical clinical flow.
  • the events include: making a new appointment, Billing and dictation. These events are described as:
  • Make appointment Allows selection of criteria to make an appointment but pass the task of actually scheduling the appointments to the front desk or actually creating the appointments for the patient at that point in time.
  • Billing Allows viewing of intended billing policy for this patient and allows changes that are passed back to the front desk to actually receive payment.
  • Dictation Provides a view of interested parties and the option to dictate now or later.
  • the 'dictate now' option launches the electronic dictation system.
  • the dictate later adds a reminder task for the specialist.
  • When the reminder is clicked a summary of all actions taken during the consultation are displayed by way of reminder for the specialist while dictating.
  • a clinical trials module will be incorporated into the medical record.
  • Study protocol data such as eligibility, investigation and treatment schedules, toxicity and response criteria can be held in a table and which can be cross-referenced with the patient's record.
  • An 'eligibility alert' will be displayed on the clinical workspace if the patient is found eligible for the study.
  • Appropriate Patient Information and consent forms can be printed off.
  • Investigations and clinic visits for the clinical trial will be determined by the protocol. History, examination, adverse events and treatment records will be recorded and stored as per Figure 9.
  • Research nurse can record entries in the progress notes.
  • p a tient data can be de-identified and then made available for electronic transfer to an external clinical reporting form (CRF) made available by the monitoring company.
  • Data transfer can be in the Clinical Data Interchange Standards (CDISC) format.
  • Study monitors can review the CRF and patients electronic medical record before electronically transferring the CRF to the Trial Centre.
  • the standard statistics include, but are not limited to:
  • Patient Workload Monthly patient numbers split by type and procedure.
  • Ad-Hoc Contacts Monthly numbers of non-scheduled contacts.
  • the role of medical typist is supported in an embodiment of the invention as follows:
  • the structure and design of the system facilitates outsourcing (optionally) of the medical typing processes.
  • the physical location of the typists is not a factor in the systems operation.
  • This feature allows for business models where the specialist may still have access to medical typing services where they may not be able to justify the expense on their own.
  • a specialist seeking to establish a new practice could benefit from typing services they may otherwise not justify or want the additional distractions of hiring and managing staff.
  • the electronic dictation system is an important feature of a particular embodiment of the invention. It manages voice input from a doctor and associates that with a patient.
  • the typist enters the system and is presented with a list of all outstanding typing including originator, referring doctor, patient, priority, status, date and time dictated, length of dictation and status (1310). Double clicking the record opens the word processor and the dictation file. On opening the preferred template for that specialist is opened (1320) and data retrieved from the database populating pre-defined components of the template (1330). Typing status is updated and any request for clarification is sent to the business rules layer (1350) and on to the originating specialist (1340).
  • the originating specialist may listen to the dictation while viewing the typed information (1340). They may choose to complete the typing themselves or dictate the clarification. Rules are applied (1350) according to the action undertaken by the specialist. When typing is complete it is queued for final approval by the specialist. Typing status is updated and any changes to dictation or the letter or record entry are stored (1360). All completed work is sent to the specialist for approval (1370) before printing or storing in record. The specialist may accept or change the information including the recipients. Any changes are stored (1380) and the letter submitted to the business logic layer and to the external parties interface or in the case of record entry to the patients electronic medical record.
  • practice manager The role of practice manager is supported in an embodiment of the invention as follows: Again the structure and design of the system facilitates outsourcing (optionally) of the practice management function. In this model the physical location of the practice manager is not a factor in the systems operation. This feature allows for business models where the specialist may still have access to practice management services where they may not be able to justify the expense on their own. Similarly in another specific, but non-limiting, example a specialist seeking to establish a new practice could benefit from practice management services they may otherwise not justify or want the additional distractions of hiring and managing staff. In yet another, non-limiting, specific example practice groups may benefit by hiring fewer practice managers that have the ability to
  • the external parties interface absolute numbers and detailed status allow '5 viewing of hold-ups or potential problems in the external interface processes.
  • the detail option allows the practice manager to see more information for an informed intervention.
  • the absolute numbers at various stages of diagnostics orders/results (Fig 5 550). Provides a view on the status of diagnostic tests, the detail function allows specific patient instances to be viewed. Displaying contact information of the provider allows for 0 ease of contact of the provider.
  • the absolute numbers at various stages of the medical typing process (Fig 5: 560) provide a view of workload and how the typing function is coping. The detail function allows specific patient instances to be viewed.
  • Fig 5 : 570 The absolute numbers at various stages of the accounting process (Fig 5 : 570) provide a view of the accounting process, the detail function allows specific patient instances to be viewed. 5
  • the status of system reports manual or automatic (Fig 5: 580) allow the practice manager to monitor if tasks have been performed and intervene if necessary.
  • the scrolling message of critical KPIs (Fig 5: 590) provide key information for maximising practice revenue and efficiency.
  • the number of appointment slots available in the next 'x' days may be scrolled. This may prompt action by the practice manager to have front desk staff use the waiting list function to fill the vacant appointment slots. Thus being pro-active in maximising the revenue event.
  • Financial report of daily controls including: receipts, banking, write-offs, reversals, and movements (Fig 4: 445).
  • the front desk/ reception staff select manage current waiting room option from the menu information is selected from the database based on the user profile and location and current waiting room information is retrieved from the database.
  • the waiting room functions are the same as those in figure 3.5 and related commentary.
  • the Radiation oncology specialist uses the standard clinical functions (figures 6 to 10) with additional radiation oncology data collection. Within this embodiment the specialist may select a treatment plan for radiation oncology that may involve other aspects such as chemotherapy. Among other Radiation Oncology specific information the specialist would indicate whether the treatment requires a mould.
  • the standard clinical rules described in figures 6 to 10 are applied and the consultation information stored in database.
  • Radiation Oncology services are queried to select available appointments slots that are displayed and may be selected to establish bookings. Treatment requirements are passed to the business logic layer and defined rules applied in retrieving the available slots.
  • the booked appointment information is stored in the database.
  • the waiting room may apply appropriate billing in the manner described in figure 3.5 and associated descriptions in addition Radiation Oncology specific billing may also be applied.
  • These associate billings are processes using standard billing logic and billing data is stored in the database.
  • mould room staff may view patients scheduled for moulds on the day selected via the 'mould waiting room' .
  • a fitting date may be applied/altered and if the simulator is required at that time it may also be scheduled.
  • Mould room status is recorded and a date input for fitting.
  • the mould waiting room also displays patients for fitting. By clicking on the patient all previous work up information may be displayed.
  • Clinical information is filtered such that only information required for the mould room processes is available and the mould status is updated.
  • Simulation waiting room shows patient lists for the selected day. By clicking on the patient name relevant information can be displayed. Relevant clinical information is retrieved. Any updates to simulation data are stored making information available to the planning room. Patients awaiting planning are displayed. Planning information for the specialist may be recorded and business & clinical logic associated with planning applied.
  • Planning information is stored in the database.
  • the clinician reviews and signs-off the plan and creates a request for the treatment to be booked.
  • the reception staff query outstanding treatment booking lists. Accelerator diaries are queried to provide booking dates and the selected booking dates are stored in the database and the patient notified.
  • the application has the ability to book patients for daily radiotherapy excluding weekends and machine service days. Treatment occasions of service will be linked to standardised billing rules.
  • the treatment room may check treatments. Any breaks in the treatment or 'did-not-attends' trigger action to specialist. Data related to treatments is stored and billing generated. At the completion of treatment, a standardised treatment summary will be generated, with the ability of the doctor to sign this off electronically. Standard QA statistics can be collected and standardised treatment QA can be recorded for each patient.
  • the specialist may perform a review during the treatment phase and adjust treatment. Standard rules are applied to outputs from treatment review, letters generated and updates stored.
  • the initial chemotherapy booking is created (1910) as a series of bookings spaced according to the requirements of the protocol (1911) and may interact with orders for diagnostic services (1911), radiation oncology (figures 16 & 17) or surgery (figures 20 & 21).
  • the series is requested (1911) from the database and suitable appointment slots returned (1912) from all calendars, appointments booked (1910) and the bookings saved to the database (1912).
  • the chemotherapy review group recalls all patients booked for chemotherapy that have not yet had write-up for their next administration of therapy (1913, 1914 & 1915). All relevant decision information is displayed (Weight, Height, BSA, Pathology results, tumour measures, toxicity information) (1913, 1914 & 1915) along with a standard chemotherapy medication chart (1913). The medications are formulated and notes taken by the group using (optionally) the clinical teaming workflow software (1913 & 1914). Updates via the interaction tool are stored to the database and the status is updated (1915).
  • the specialist writes up the prescription using the standard prescription writing software while viewing the medication chart information (1916). Internal checks may occur with the protocol (1917) and discrepancies alerted (1916). Prescription information is stored to the database and record status updated (1918).
  • Formulation tags may be printed (formulation tags contain a unique tag number - see chemotherapy nurse step) and applied to the syringes.
  • Chemotherapy reception selects manage current waiting room option from the menu (1922) and the user identification and location information is used (1923) to retrieve current waiting room information (1924). Patients are 'received' into the waiting room at which point their arrival time and status is recorded and displayed. For each patient the status of pre-clinic measures is displayed (1922). Clicking the status indicator displays those measures required (1923) prior to administering of chemotherapy and allows direct access to record measures. Any calculations required during the entry of measures are performed on entry (1923) and displayed in the browser.
  • Modifications are stored in the database (1924) and the new status displayed.
  • Chemotherapy nurse selects manage current waiting room and receives a 'nursing view' (1925) including: medication formulations, formulation checking (record tag number which is crosschecked (1926), pathology results (1926 - if available), and administered formulation record. All entries are checked (1926) and stored in the database (1927). Any patients that failed to attend or have a 'not-completed' entry by the nurse are flagged as a protocol breach and alerted to the specialist for action.
  • the specialist accesses 'Post therapy' consultation information via the standard clinical module and applies chemotherapy information by selecting the 'post-chemotherapy' note type (1928).
  • This note type allows entry of toxicity and tumour measures and allows changes to the planned therapy (1929 and 1930). If changes are made options to continue with the current schedule or re-schedule the protocol are allowed (1928, 1929, and 1930). Flags are then set and the process continues from the chemotherapy write-up stage until the protocol is complete, breached or the patient otherwise discharged.
  • Embodied in the prescribe function is a medication order for a medication is to be administered by a second party such as a nurse.
  • the medication chart is a four-step procedure.
  • Step one is the doctors order which incorporates prescribed drugs and includes the patient demographics and protocol names. Drugs are entered directly from the prescription field or typed manually by the doctor. Doses of medication must be added manually. A previous medication chart can be duplicated and then checked by the doctor. Selected investigation results are displayed.
  • Step two allows a second party such as a pharmacist to check the drug order, send a query to the doctor if required and then confirms the order.
  • Step three allows a second party such as a nurse to record that the medication has been administered. All steps are subject to security and access rights for each party.
  • Step four is the completed medication chart that cannot be edited.
  • the medication chart is stored in the patients electronic medical record and can be printed off for manual use. QA statistics can be reported each month by chemotherapy type, user and cost.
  • the surgeon accesses the system either via direct connection or mobile link (2110).
  • the theatre list is retrieved (2120)
  • any standard rules for that specialist, location and operation combination are applied (2115) and the list presented (2110) to the surgeon.
  • the surgeon may select any patient to record operation notes (2125) in a format preferred for that specialist, operation and location combination (2130).
  • the surgeon may also select 'interested parties' (2125) to whom reports are to be sent (2130).
  • the network as referenced in this specification should be taken to include all forms of connected or communicating computers or terminals having at least two terminals connected or communicating as hereinbefore described. That is, the term network should be taken to include any type of terminal as hereinbefore defined, computer, computerised device, peripheral computer equipment, computerised accessory, mobile or cellular phone, digital electronic device or other similar type of computerised electronic device or part thereof which is rendered such that it is capable of communicating with at least one of any of the aforementioned entities. Said communication of information or data can occur over any data communications network, computer network, wireless network, internetwork, intranetwork, local area network
  • LAN local area network
  • WAN wide area network
  • Internet the Internet and developments thereof, transient or temporary network, combinations of the above or any other type of network providing for computerised, electronic or digital devices.
  • references to the terms connecting, communicating, transmitting, requesting, receiving, exchanging and the like, and permutations thereof, as applied to the term computer network and/or components thereof should be taken to pertain to the transfer of information or data.
  • Such transfers of information or data can be facilitated for by any form of entity /entities for facilitating such, including, but not limited to, metallic wires or cables, semi-conducting wires or cables, optical fibres and optical devices, wireless means, electromagnetic waves and the like and modulations thereof, acoustic waves and the like and modulations thereof, control of electric and/or magnetic fields, and/or the transportation of all forms of memory devices.
  • the invention may also be said broadly to consist in the parts, elements and features referred to or indicated in the specification of the application, individually or collectively, in any or all combinations of two or more of said parts, elements or features, and where specific integers are mentioned herein which have known equivalents in the art to which the invention relates, such known equivalents are deemed to be incorporated herein as if individually set forth.

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Abstract

La présente invention concerne un système et/ou un procédé de gestion professionnelle de spécialistes médicaux pratiquant dans un environnement multi-site, ainsi qu'un support lisible par ordinateur d'instructions destinées à faciliter lesdits système et procédé. Selon l'invention, il est possible de mettre en oeuvre une gestion professionnelle de spécialistes médicaux pratiquant dans un environnement multi-site, facilitant l'externalisation de processus commerciaux. Des logiciels peuvent être fournis à un ou plusieurs serveurs centraux accessibles par l'intermédiaire d'un terminal abonné au moyen d'applications de navigateur Internet courantes, sans nécessiter l'installation ou l'enregistrement desdits logiciels sur le terminal abonné. Le système selon l'invention fait également intervenir un moyen destiné à la mise en oeuvre de fonctions d'assistance telles que par exemple commande multi-site, notamment commande de procédure et de protocole ; gestion de salle d'attente ; gestion de récupération d'informations ; et, fonctions de comptabilité. Les fonctions de travail sont intégrées à des couches logiques de flux de travail, commerciales, et cliniques, et contrôlées par l'intermédiaire d'un module de gestionnaire de pratique.
PCT/AU2002/000284 2001-03-16 2002-03-18 Systeme et procede d'optimisation de la pratique de specialistes medicaux pratiquant dans un environnement multi-site ou de groupes de praticiens generaux multi-site WO2002075612A1 (fr)

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