WO2011150083A2

WO2011150083A2 - Systems and methods for interactive communication

Info

Publication number: WO2011150083A2
Application number: PCT/US2011/037939
Authority: WO
Inventors: Gregory Luke Larkin; Annette Louise Beautrais
Original assignee: Yale University
Priority date: 2010-05-25
Filing date: 2011-05-25
Publication date: 2011-12-01
Also published as: WO2011150083A3

Abstract

A system, method, and a computer program product for interactive communication are provided. An individual can be discharged from a medical facility. At least one discharge instruction tailored to at least one condition of the individual can be generated. At least one discharge instruction can include information concerning follow up care for the individual. At least one communication to the individual can be generated. The individual can be requested to respond to at least one communication and indicate a condition of the individual. Based on a response by the individual, an instruction to the individual concerning at least one treatment option for the individual can be generated.

Description

SYSTEMS AND METHODS FOR INTERACTIVE COMMUNICATON

CROSS-REFERENCE TO RELATED APPLICATIONS

[0001] The present application claims priority to U.S. Provisional Patent Application N. 61/347,917 to Beautrais and Larkin filed May 25, 2010, and entitled "TXT Rx: Mobile Healthcare Discharge & Patient Support System", and incorporates disclosure of this application herein by reference in its entirety.

TECHNICAL FIELD

[0002] The subject matter described herein relates to data processing and in particular, to enhancing communication between individuals and medical care providers.

BACKGROUND

[0003] Proper and timely treatment as well as effective doctor-patient communication is important to providing adequate healthcare to patients that visit doctors, hospitals, emergency rooms, or other medical facilities. There are millions of clinic, hospital, and emergency room or department discharges that occur every year. At each discharge, it may be the responsibility of physicians or other medical staff to communicate a presumed diagnosis, an expected course of the patient's illness, suggested remedies and prescriptions, and follow-up instructions for further care. Typically, medical staff spend a very limited amount of time in delivering patient discharge instructions, which can include a complete verbal explanation of the patient's diagnosis, expected course of illness, etc. In some situations, a plan for post-discharge care may be provided. However, in view of the limited amount of time that is available to healthcare providers in the hospital emergency room, office, and other medical facilities, discharge planning is effective in less than 65% of the total number of visits. This typically results in both poor compliance and poor patient satisfaction.

[0004] Written discharge instructions are frequently used to enhance limited face-to-face interactions and serve to remind patients of a remote dialogue with their healthcare providers days or weeks after the visit is over. However, in the days following the discharge from the healthcare provider, there is little active listening and interchange with patients. Further, patients' understanding of discharge instructions is often poor and few efforts have successfully improved comprehension or compliance.

[0005] The salience, mode of delivery, clarity and comprehension of discharge instructions affect patients' understanding of their illness and impacts medication adherence and appointment-keeping which, in turn, affect patients' compliance with doctors' recommendations, follow-up behaviors and overall treatment outcomes. Increasingly faced with outpatient care, debilitated, infirm, injured and lonely patients navigate their own discharge planning without proper guidance and often without rapid access to doctors, social services, and concerned family members. In some cases, self-reliance is requested of patients leaving the hospital armed with little more than a ream of generic discharge instructions that are typically too long, too burdensome to carry, too cumbersome to interpret, and/or too time-limited. Other challenges to providing user-friendly discharge instructions include patient comprehension, medical illiteracy, poor recall, fear, anxiety, pain- or sensory-clouding medications. Providers are also challenged with such obstacles as language, culture, patient distrust, poor listening skills and time exigencies.

[0006] Thus, there is a need for an improved way of communication between patients and medical facilities (e.g., hospitals, clinics, emergency rooms/departments, doctors, and/or any other medical facilities) that discharge such patients. Communication should be interactive, allowing for assessment of patient's physical and/or mental conditions, which, in turn, is used to determine an appropriate course of action for the patient.

SUMMARY

[0007] In some implementations, the current subject matter relates to a method for providing interactive communication. The method can include the following: an individual can be discharged from a medical facility; at least one discharge instruction tailored to at least one condition of the individual can be generated; at least one discharge instruction can include information concerning follow up care for the individual; at least one communication to the individual can be generated; the individual can be requested to respond to at least one communication and indicate a condition of the individual. Based on a response by the individual, an instruction to the individual concerning at least one treatment option for the individual can be generated. In some implementations, at least one of the discharging, the generating of at least one discharge instruction, the generating of at least one communication, the requesting of, and the generating of, the instruction is performed on at least one processor.

[0008] In some implementations, the current subject can include the following optional features: at least one communication can include at least one of an appointment reminder, a reminder to take a medication, and a request to determine the condition of the individual; at least one communication can include at least one of an email, a short-message-service message, a text message, an instant message, a multi-media-message-service message, a telephone call, or a combination thereof; the response of the individual can include a numerical response corresponding to the condition of the patient; the method can also include a determination of a condition of the individual based on the numerical response received from the patient; the numerical response corresponding to the lowest number can indicate worst condition of the patient and the numerical response corresponding to the highest number can indicate best condition of the patient; generation of the instruction can include generating, based on the response of the individual corresponding to the lowest number, at least one emergency care instruction for the individual, and providing the at least one emergency care instruction to the individual and/or to at least another individual.

[0009] Articles are also described that comprise a tangibly embodied machine-readable medium embodying instructions that, when performed, cause one or more machines (e.g., computers, etc.) to result in operations described herein. Similarly, computer systems are also described that can include a processor and a memory coupled to the processor. The memory can include one or more programs that cause the processor to perform one or more of the operations described herein.

[0010] The details of one or more variations of the subject matter described herein are set forth in the accompanying drawings and the description below. Other features and advantages of the subject matter described herein will be apparent from the description and drawings, and from the claims.

[0011] Articles are also described that comprise a tangibly embodied machine-readable medium embodying instructions that, when performed, cause one or more machines (e.g., computers, etc.) to result in operations described herein. Similarly, computer systems are also described that can include a processor and a memory coupled to the processor. The memory can include one or more programs that cause the processor to perform one or more of the operations described herein.

[0012] The details of one or more variations of the subject matter described herein are set forth in the accompanying drawings and the description below. Other features and advantages of the subject matter described herein will be apparent from the description and drawings, and from the claims.

BRIEF DESCRIPTION OF THE DRAWINGS

[0013] The accompanying drawings, which are incorporated in and constitute a part of this specification, show certain aspects of the subject matter disclosed herein and, together with the description, help explain some of the principles associated with the disclosed implementations. In the drawings,

[0014] FIG. 1 illustrates an exemplary system, according to some implementations of the current subject matter.

[0015] FIG. 2 illustrates an exemplary system for interactive communication with a patient, according to some implementations of the current subject matter.

[0016] FIG. 3 illustrates a method, according to some implementations of the current subject matter.

[0017] FIGS. 4-8 and 9a-9d illustrate exemplary logs indicating various communications forwarded to and received from individuals, according to some implementations of the current subject matter.

[0018] FIG. 10 is a flowchart illustrating an exemplary individual's medical condition management scheme, according to some implementations of the current subject matter.

[0019] FIG. 1 1 illustrates an exemplary system, according to some implementations of the current subject matter.

[0020] FIG. 12 is a flowchart illustrating an exemplary method, according to some implementations of the current subject matter.

[0021] FIG. 13 illustrates an exemplary rules engine used by the current subject matter's system, according to some implementations of the current subject matter. DETAILED DESCRIPTION

[0022] To address these and potentially other deficiencies of currently available solutions, one or more implementations of the current subject matter provide methods, systems, articles or manufacture, and the like that can, among other possible advantages, provide systems and methods for providing systems, methods, and computer program products for creating an interactive communication between patients and medical facilities that discharge such patients.

[0023] In some implementations, the current subject matter can be configured to be implemented in a system 100, as shown in FIG. 1. The system 100 can include a processor 1 10, a memory 120, a storage device 130, and an input/output device 140. Each of the components 1 10, 120, 130 and 140 can be interconnected using a system bus 150. The processor 1 10 can be configured to process instructions for execution within the system 100. In some implementations, the processor 1 10 can be a single-threaded processor. In alternate implementations, the processor 1 10 can be a multi -threaded processor. The processor 1 10 can be further configured to process instructions stored in the memory 120 or on the storage device 130, including receiving or sending information through the input/output device 140. The memory 120 can store information within the system 100. In some implementations, the memory 120 can be a computer-readable medium. In alternate implementations, the memory 120 can be a volatile memory unit. In yet some implementations, the memory 120 can be a non-volatile memory unit. The storage device 130 can be capable of providing mass storage for the system 100. In some implementations, the storage device 130 can be a computer-readable medium. In alternate implementations, the storage device 130 can be a floppy disk device, a hard disk device, an optical disk device, a tape device, non-volatile solid state memory, or any other type of storage device. The input/output device 140 can be configured to provide input/output operations for the system 100. In some implementations, the input/output device 140 can include a keyboard and/or pointing device. In alternate implementations, the input/output device 140 can include a display unit for displaying graphical user interfaces.

[0024] In some implementations, the current subject matter can be implemented as a World Wide Web-based or Internet-based application, a platform, collection of applications, etc. whereby a user of the can access functionalities and operations discussed below via user's computing system (e.g., a processor, a keyboard, a mouse, and a monitor). Such applications can be written in various computer languages (e.g., Java, C++, HTML, etc.) and/or can be executed using user's Internet browser program(s) or separately-loadable application(s) that can execute such applications either locally on the user's computer and/or using World Wide Web or any other network. Such World Wide Web-based or Internet-based applications can be configured to provide further interactivity to the functionalities and operations discussed below and allow remote interaction between users of such applications in a variety of environments (e.g., teacher- student, doctor-patient, etc.).

[0025] In some implementations, the current subject matter relates to a communication system configured to monitor at least one physical and/or mental condition of an individual following his or her release from a medical facility. The facility can include a hospital, an emergency care medical facility (or an emergency care department at a hospital), a medical clinic, a doctor's office, a health-fitness facility, a mental institution, a medical laboratory, a medical testing facility, and/or any other medically-related facility and/or a combination of any of the above (hereinafter, "medical facility" or "facility"). The individual can be admitted to the medical facility on an in-patient and/or outpatient basis and/or a combination of both. In some implementations, the individual can be admitted on an outpatient basis and become admitted to the facility on an in-patient basis and vice versa. Upon completion of a treatment or a procedure or a visit to the medical facility, the individual is released and appropriate release instructions can be provided to the individual. Some exemplary instructions can include, but are not limited to, an instruction to take a certain medication at a certain time, an instruction to schedule a follow-up appointment, an instruction to schedule an appointment with a medical facility that may be specializing in a particular problem area related to the condition(s) of the individual, which may be the condition that the individual was treated for at the medical facility releasing the individual, a wellness instruction (e.g., diet regiment, exercise regiment, etc.), and/or any other instruction(s), and/or a combination thereof.

[0026] In some implementations of the current subject matter, subsequent to the release of the individual from the medical facility the individual can be contacted to determine a condition of the individual and/or whether the individual is following the release instructions that the individual was provided with upon release. The condition can include a physical condition, a mental condition, and/or any other condition, and/or any combination thereof. The individual can be contacted via a telephone, an email, a text message, an instant message, a short-message- service ("SMS") message, a multimedia-message-service ("MMS") message, and/or any other type of communication and/or any combination thereof. The individual can be contacted on the individual's mobile telephone, smartphone (e.g., blackberry, Android-type telephone, iPhone, iPad, etc.), a landline telephone, a personal computer, a laptop computer, a PDA, and/or any other wireless, wireline, and/or wired apparatus and/or device. The communications can be received on a periodic basis (e.g., hourly, daily, weekly, monthly, etc.), at random times, or at predetermined times, and/or any combination thereof. The communications can be designed to recommendations that can promote safety, illness/symptom management, and wellness of the individuals that are discharged from a medical facility. An individual can receive a communication that can require him/her to respond to the sender of the communications and based on the individual's response, an appropriate recommendations can be provided that may be designed to address various issues related to the individual's condition (e.g., promoting safety, illness/symptom management, wellness promotion, etc.). In some implementations, the communications can be tailored to a particular individual, his/her illness/condition, preferred coping strategies, activities, favorite type of communications (e.g., SMS, MMS, etc.), and/or any combination thereof.

[0027] In some implementations, the individual can indicate that he/she no longer wishes to continue receiving communications inquiring about individual's state. Such indication can be done by the individual initiating the communication to the sender to stop sending communications, or can respond to a communication from the sender prompting the individual to indicate whether or not further communications are desired, and/or any combination of the above.

[0028] FIG. 2 illustrates an exemplary system 200 for communicating with patients, according to some implementations of the current subject matter. The system 200 includes a hospital facility 210 that communicates with a plurality of patients 235 (a, b, c, n) through a server 220. The hospital facility 210 can be any medical facility, such as a medical clinic, a doctor's office, a rehabilitation center, and or any other type of medically-related facility. The server 220 can be configured to communicate with a plurality of patients 235 and to provide them with a variety of communications (e.g., messages, telephone calls, media messages, etc.), which can include requests for patient's current condition, medication reminders, appointment reminders, and others. The server 220 can be configured to include a plurality of modules 225 (a, b, c, d). Each module 225 can be configured to perform a various forms of communications. In some implementations, one of the modules 225 can be configured to generate various communications requesting patient's current condition (whether physical, mental, and/or otherwise) information. Another module 225 can be configured to provide appointment reminder(s) to patients 235. Yet another module 225 can be configured to provide medication reminder(s) (e.g., when to take a particular medication). Further modules 225 can be configured to send communications to the individuals that provide wellness tips, diet and exercise recommendations, and others. The server 220 can be configured to provide multiple communications directed to the individuals and request a response. In some implementations, the server 220 can be configured to automatically generate communications and send them to individuals based on individual's condition, whether current conditions, condition at the time of release of the individual, and/or combination of both or other condition, individual's diagnosis, individual's release instructions, individual's medical history, and/or any other factors.

[0029] In some implementations, the system can be configured to include a plurality of networked applications and devices configured to support communicate with individuals. In an exemplary implementation, such applications and devices can include an SQL Server database configured to store information, a Web portal configured to provide data administration, data entry, monitoring, data extracts and reporting, and a messaging (e.g., SMS, MMS, etc.) interface to communicate with the individuals' communication devices (e.g., cellular telephones, smartphones, personal computers, iPods, iPads, iPhones, PDAs, telephones, and/or any other devices). Exemplary implementations of the system according to current subject matter can include a Microsoft.NET technology configured to run on a Windows Server. In some implementations, a modem can be configured as a messaging interface, and an SQL server database can be hosted at the same location.

[0030] FIG. 3 illustrates another exemplary system 300 for providing communications between entities and individuals, according to some implementations of the current subject matter. The system 300 includes a plurality of clients or individuals 302 that can be configured to communicate with a server 304 via a network 310. In some implementations, the network 310 can be configured to include a local area network ("LAN"), a wide area network ("WAN"), a metropolitan area network ("MAN"), a wireless network, a wired network, a wireline network, a virtual private network ("VPN"), an Asynchronous Transfer Mode ("ATM") network, and/or any other network and/or a combination thereof. The network 310 can also include at least one gateway, at least one modem, and any other communication components that can be configured to provide communications between various components of the network, the server 304, and the clients 302.

[0031] The server 304 can be configured to include a portal 308, a database 312 and a queue 314. The portal 308 can be a web portal, an internet portal, a network portal, or any other portal and can be configured to provide communication capabilities to a plurality of users 306. The users can include system administrators and maintenance workers, professionals that may need to communicate with the clients 302 (for example, in case of medical patients, the users can include physicians, nurses, clinicians, emergency department personnel, psychologists, medical workers, insurance carriers, caregivers, etc.), system evaluation personnel, and/or any other users that may need to access the system for various purposes. The users 306 can also include automatic communication generators that can be configured to automatically generate communications to the client 302 (for example, SMS, MMS, email, telephone calls, and/or any other communications). The portal 308 can be configured to communicate with the queue 314 and the database 312. The queue 314 can be configured to temporarily store communications to and from clients as well as to and from users as well as cause such communications to be sent out at predetermined times and/or instantaneously. The queue 314 can also be configured to receive communications (e.g., SMS, MMS, email, telephone calls, etc.) from clients or individuals 302.

[0032] The database 312 can be configured to store communications sent to and received from clients or individuals 302 as well as users 306. The database 312 can also store information about clients 302. In case of medical patients, the database 312 can store information patients characteristics, i.e., name, address, telephone number, email address, age, height, weight, religious affiliation, race, patient's caretaker information, patient's medical diagnosis, patient's medical conditions, reasons for visiting a particular medical facility, etc. The database 312 can also store information concerning individual's preferred contact times. Further, the database 312 can also be configured to store a plurality of predetermined communications that can be sent to the individuals 302 based on patient information, received patient communications, received user communications and/or instructions, etc. Such communications can be predetermined or automatically generated based on stored and/or supplied information about an individual. For example, in case of a medical patient, such communications can include requests for condition status of a patient (e.g., a communication containing "How are you feeling now?"), appointment reminders (e.g., a communication containing "You have a doctor's appointment at 2 pm today"), medication reminders (e.g., a communication containing "Take your medication at 1 pm today"), safety steps communications (e.g., a communication containing "If you are not feeling well, come to the emergency room"), a wellness-promotion communication (e.g., a communication containing "Go for a walk in the park"), and/or any other communications and/or combination thereof.

[0033] FIG. 1 1 illustrates an exemplary communication system, including an information platform, 1 100, according to some implementations of the current subject matter. The communication system can include a communication device 1 102 that can be configured to communicate with a communication gateway 1 104. The communication gateway 1 104 can be further configured to communication with a system 1 120, which can be a server, a collection of servers, various storage and processing equipment, and/or any combination of the above. The system 1 120 can include a system gateway 1 106, a portal 1 108 (e.g., a Web portal, a network portal, etc.), a database 1 1 10, and a rules engine 1 1 12. Various users 1 1 14 can be configured to communicate with the system 1 120 via the portal 1 108. The users can be administrative professionals, networking professionals, medical staff, analysts, emergency agencies, government agencies, commercial entities, private entities (e.g., survey companies), corporate organizations, non-profit organizations, various subscribers, and/or any combination thereof. In some implementations, access to the portal 1108 can be restricted and/or unrestricted. Users can be charged for accessing the portal, various rates depending on the user and the information that the user is seeking to obtain and/or post via the portal 1 108. The communication device can be a cellular telephone, a smartphone, an iPod, an iPad, a PDA, a PALM device, a personal computer, a telephone, a computing tablet, and/or any other communication device and/or any combination thereof. The communication gateway 1 104 can be any gateway that can be provided by a commercial carrier (e.g., a wireless carrier) and can be configured to send and/or receive signals to/from and to/from the communication device 1 102. The system gateway 1 106 can be configured to receive/send communications from/to the communication gateway 1 104, e.g., messages sent to the communication device 1 102 (e.g., SMS messages sent to patient's cellular telephone) and messages sent by the patient in response to the received messages (e.g., patient's SMS response). The gateway 1 106 can be configured to communicate with the portal 1 108 that can be further configured to communicate with the database 1 1 10. The database 1 1 10 can store communications sent/received to/from the patient, various information about the patient, users 1 1 14, and any other information. The database 1 1 10 can be configured to be used in conjunction with the rules engine 1 1 12 and an exemplary database is illustrated in FIG. 13. The rules engine 1 1 12 can be configured to generate communications to the patient and/or any other third parties based on various inputs, e.g., patient's personal information, medical diagnosis, condition, patient's responses to communications sent to the patient, instructions from medical staff, appointment reminders, medication reminders, wellness instructions, symptom management, etc. The components in system 1100 can be configured to communicate with one another via a bi- direction communication links and/or conduits.

[0034] Referring to FIG. 13, an exemplary rules engine 1 1 12 can include patient's information ("Subject"), which can include name, date of birth, gender, date of visit to the doctor/emergency room, cellular number and carrier, and any other information. The rules engine 1 1 12 can also include information about how the patient wishes to be contacted as well as patient's caregiver contacts ("contact type"). The rules engine 1 1 12 can include information about triggering events (including trigger types, trigger responses, trigger parameters, etc.) that can be used to send various communications to the patient. The rules engine 1 1 12 can further use information about communications/messages forwarded/received to/from the patient, including time of the communication/message, how the communication/message was delivered, and other information. Various blocks inside the rules engine 1 1 12 can be configured to exchange information upon receipt of any updates and can use received updated information to update information within its own block. Information stored and used in the database 1 1 10 and the rules engine 1 1 12 can be tailored to a particular patient and can be used to further manage symptoms, promote wellness, manage care, etc, as discussed below.

[0035] In some implementations, the system 1 100 can include networked applications and devices, which can collectively, support overall needs of multiple stakeholders using the system 1 100. These devices and applications can include: the communication gateway 1 104 (e.g., an SMS gateway), which can provide a conduit for incoming and outgoing messages to individual cellular phones or any other communication devices 1 102. The gateway 1 104 service can be provided by an external commercial carrier (or any other private networking service. The devices can also include the system gateway 1 106 that can provide a connection with the commercial gateway 1 104 as well as a bidirectional conduit of information into and out of the portal 1 108. The portal 1 108 can act for study data administration, data entry, monitoring, data extracts and reporting. The users 1 1 14 of the portal 1 108 can include any entity entering or processing data. In some embodiments, the system 11 10 can include a secure SQL Server (database 1 1 10) which can store encrypted subject and program information. The device can also include a rules engine 1 1 12 that can provides algorithmic, evidence-based, case management and decision support. The rules engine can house specific protocols for each disease entity with adjustable thresholds that, when met, provide tailored, process control feedback streams to individual communication devices 1 102. In some implementations, the system 1 100 can be implemented using Microsoft.NET technologies (IIS, Message Queue services) running in one or more Windows 2008 Servers.

[0036] The systems shown in FIGS. 2-3 can be configured to further provide secure communications between individuals and the server. Some exemplary implementations of the current subject matter can be configured to achieve Health Insurance Portability and Accountability Act ("HIPAA") compliance by: a) placing the server in a secured location; b) restricting access to the server and its database and encrypting all information on two levels: the operating system and the database; c) restricting system access through the Web portal using a Kerberos authentication scheme where only specific users with proper user identification are granted access; d) restricting access to network (e.g., user may have to establish a virtual private network ("VPN") connection with an administrator prior to having access to the system; e) providing user access privileges to allow changing/viewing portions of the information only, as related to their role; f) creating an audit log, where all changes made to the system by users can be logged in the database, which can be used for auditing or quality control purposes, and/or any combination thereof.

[0037] In some implementations, the Web portal and database can be configured to handle a plurality of transactions per second (e.g., millions of transactions). The communication modem can be configured to communicate simultaneously with a plurality of individuals at the same time. In some implementations, back up servers can also be setup to allow for uninterrupted communication between individuals and the system. Other forms of communications can be implemented (e.g., email, calling, etc.) in the event that one form of communication (e.g., SMS messaging) is not available. The systems 200, 300 can also be configured to generate messages to individuals, then receive and log their responses. The systems 200, 300 can generate several types of communications, as discussed below.

[0038] One type of communications can be directed to an ecological momentary assessment mood monitoring of the patient. The ecological momentary assessment ("EMA") methodology can be used to repeatedly sample status of individual's condition (e.g., mental state, physical condition, mood, pain, peak flow (e.g., asthma)) using communication (e.g., messaging) capabilities of the server. During a predetermined time period that the individual is part of a monitoring program (e.g., within certain time frame (e.g., hours, days, weeks, months, etc.) following individual's release from a medical facility), the individual can receive communication(s) from the server on his/her designated communication device (e.g., cellular telephone, iPhone, iPod, iPad, PDA, telephone, personal computer, etc.) that the individual can specify upon his/her release from the medical facility.

[0039] As stated above, the communication(s) can be received automatically, periodically, and/or at random times and can be configured to solicit individual's response to any requests for information that are included in the communication(s). The timing of the communication s) can be algorithmically determined. For example, for depression monitoring, at a predetermined time, the server (220 or 304) can generate and send to an individual's designated communication device (e.g., cellular telephone) a communication (an SMS message) to inquire about individual's status. The communication can be based on various predetermined conditions that can be relevant to the individual, his/her release instructions, etc. The individual can receive a SMS message inquiring about his/her real-time mood. The message can state: "How are you feeling right now? " In the SMS message, the individual can also be asked to indicate how he/she is feeling using a Likert scale that ranges from 1 (corresponding to "never felt worse ") to 9 (corresponding to "never felt better"). This question can prompt the individual to reply by sending a SMS message back to the server using a single number corresponding to the scale description of his/her mood. An exemplary SMS message can be as follows:

"How are you feeling right now? On a scale of 1 ("never felt worse") to 9 ("never felt better") text back now the number corresponding to your mood. "

[0040] Depending on the individual's response, the server (220 or 304) can be configured to provide additional communications to the individual. In some implementations, additional communications from the server can be configured to solicit additional response from the individual. For example, upon receiving a response corresponding to "never felt worse ", the server can generate a communication to the individual asking whether they are in pain, whether they took their medications, etc. In some situations, the server can be configured to send notifications to appropriate personnel indicating condition of the individual, notify individual's caretakers, family, call emergency services, summon authorities, etc., and/or any combination thereof. In some implementations, depending on the individual's response, the server can generate communications that are related to wellness maintenance of the individual, e.g., maintain appropriate diet, exercise routine, etc.

[0041] In some implementations, use of the EMA can allow monitoring patient's status (e.g., mental state, physical condition, etc.) in response to the message intervention with a degree of granularity. It can also provide a degree of dependability, i.e., patient's response to an SMS message can indicate that the patient has received the message and allows medical personnel to monitor the patient with a certain degree of reliability. Such monitoring can be configured to avoid repeated visits to the medical facility from which the patient was released in the event that the patient's condition does not warrant patient's presence in the medical facility (e.g., an emergency room at a hospital). The EMA can provide a feedback loop and process control mechanism to iteratively check patient status and titrate a cascade of responses dynamically.

[0042] In some implementations, the current subject matter can be configured to send communications to various devices of the users that are registered with the system. Such devices can include a user's mobile telephone, a smartphone, an iPod, an iPad, an iPhone, a personal computer, a laptop computer, a PDA, and/or any other device and/or a combination thereof. The devices can also include devices of other users that can be associated with the user for whom the original communication is intended for. As stated above, the communication can be an instant message, an SMS, an MMS, a text communication, or any other communication. The communication can prompt, request, and/or require the user to acknowledge the receipt of the communication by providing a response, an acknowledgement, or any other indication of receipt of the original communication. In some implementations, the systems 200, 300 can include an application programming interface ("API"), such as a Java Mail API, which can be configured to receive and process user's responses. For example, in the instance of an SMS message, a medical patient's response of "3" (i.e., pressing a button corresponding to "3", "d", "e", or "f on the user's mobile telephone) in response to a communication "How are you feeling?" can be interpreted as the patient is feeling "below average." In some implementations, if the user enters more than one number, e.g., "556," by accident, the systems 200, 300 can be configured to recognize a more predominant or more frequently repeating number and process that number as a response, e.g., "5". In some implementations, the user can be configured to enter a text by way of responding to the original communication, e.g., an SMS communication. In this case, the SMS communication can be forwarded to the systems and interpreted appropriately, e.g., it can be transmitted to medical staff that can be assigned to monitor condition of a patient that was recently released from a medical facility (e.g., an emergency room). Such transmission can be in a variety of ways, including at least one of the following: a telephone call (where text-to-voice application can be used to translate patient's text message to voice), an email, an SMS message, an MMS message, a paging communication, and/or any other way of notifying the appropriate personnel, and/or any combination thereof. In some implementations, several entities can be notified of the patient's response. For example, if the patient responded that she or he is feeling chest pain and the patient has been recently treated for a cardiac related illness, emergency personnel can be summoned to patient's location.

[0043] In some implementations, the communications with the individuals can occur in real time, i.e., the systems 200, 300, upon receiving individual's response, can instantly act on it. The system's and, hence, any responses by other entities (e.g., in case of a medical patient, an emergency room personnel, etc.) can depend on the response that is received from the individual. In case of a medical patient, the following types of responses can be provided: safety steps, illness/symptom management, and/or wellness promotion.

[0044] In some implementations, in case of a medical patient, safety tips can be used to ensure well-being of the patient and possibly directed at preventing deterioration of patient's condition, possible trauma, or even death. For example, if upon receiving a communication inquiring about patient's condition, the patient indicates their illness status as severe (e.g., responses corresponding to "1" or "2"), the systems 200, 300 can be configured to send a sequence of messages that can be focused on various, personalized safety steps that can depend on the patient's medical condition, age, native language, religious affiliation, etc. (e.g., call a support person; call their doctor; call translator; if needed, call 91 1). In some implementations, the safety steps that are sent to the patient can be directed by the individualized safety plan developed prior to discharge of the patient from a medical facility. Recognizing that patients who feel very unwell may be unable or reluctant to seek help, or initiate contact, a patient indicating that their illness status is poor or severe automatically can trigger a call to their nominated support person, therapist or doctor; the patient's illness status can be monitored via repeated hourly EMA until these actions have been completed and/or patient's status has improved (for example, the patient responds by sending an SMS containing a "3" using his/her mobile telephone). In some implementations, the systems can automatically and repeatedly check with the support person or agency nominated by the patient to ensure as much as possible that a real person or agency contacts the patient and/or that the patient is feeling better.

[0045] In some implementations, the individuals can initiate communications with the systems and not wait to receive a communication inquiring about their status. For example, a patient may be seeking support guidance concerning his/her condition, what medications can be taken for the patient's condition, etc. In this case, the systems can be configured to respond to patient's communications by providing appropriate guidance.

[0046] The systems 200, 300 can be also configured to forward communications relating to illness and/or symptom management. This can be applicable in situations where patient's status is neither low nor high (for example, a patient responds to a request for indication of his/her status with a "3"-"7" using his/her mobile telephone). In this case, the patient can receive messages that may be focused on symptom management and well-being that may be appropriate to patient's illness, physical and/or psychological conditions, etc., and can be consistent with best practice guidelines for that condition and/or that particular patient.

[0047] In some implementations, the patient can be optionally advised and/or alerted of medical appointments, medications, and/or treatment reminders. Such advising/alerting can be based on information that may be stored by the system in a database, where the information can include patient's personal information (e.g., age, height, weight, ethnicity, language, religious affiliation, etc.), patient's medical condition, medications that the patient is instructed to take, patient's treatment physicians and/or specialists, emergency facilities that the patient attended, and/or any other information and/or a combination thereof, and that can be used to populate personalized communications to the patient. The patient can be advised as to appropriate steps, including keeping an appointment with a doctor, taking certain medication at a particular time, performing an exercise routine, etc. [0048] As stated above, the patients can also be reminded to take a particular medication at a particular time. Such reminder can be based on the information that may be stored in the database and that can include a description of a medication, dosage, scheduling, preferred time of day to receive a reminder text, refill due dates, dispensing pharmacy, foods to avoid, conflicting medications, conflicting medical conditions, etc. The systems 200, 300 can be configured to send an automated text message to the patient reminding him/her to take their medication each time it is due. If no response is received, the systems can send a follow-up reminder communication within a predetermined period of time (e.g., within an hour). For example, the communication can include at least the following: "Time to take UR meds @: noon. " ("UR" stands for "your"; "@" stands for "at"; "meds" stands for "medications"). If no response is received by the patient, the next communication can include: "Did U take your meds @ noon? " ("U" stands for "you"). If no response is received to this communication, the systems can be configured to forward a different type communication (e.g., an automated call, a call to the patient's caretaker, etc.). Further, the systems can be configured to send reminder communications to patients reminding them that a medication refill is coming up due shortly. Such reminders can be sent a predetermined period of time within an actual refill date. The systems can be also configured to inquire whether or not the patient has already refilled the medication. The systems can also continue to follow up with the patient until the patient indicates that they have obtained the refill (or that no refill is necessary).

[0049] Based on the patient-related information collected by the systems 200, 300 at the time of patient's discharge, the systems can also provide communications to the patient concerning any medical appointments that may have been scheduled and/or that the patient may want to/need to schedule. The collected information can include date, time, provider, provider phone number for each appointment, etc. The systems can also send appointment reminder communication within a predetermined time frame of the actual appointment. The systems can determine when the appointment is scheduled and forward a reminder indication to the patient within a predetermined time frame of the actual appointment. The systems can send the reminder automatically or manually (e.g., an administrator, a doctor, a nurse, or any other user of the systems can manually send communications) to indicate when the appointment is scheduled. The reminders can be sent repeatedly at predetermined (or random) periods of time, e.g., within two days of appointment, within a day of appointment, within 6 hours of appointment, within an hour of appointment, etc. or any other time that can be designated by the patient, or any other user, and can include at least the following: "Keep Appt: Dr Smith Mon Dec20@ Πηοοη " (i.e., "Keep appointment with Doctor Smith on Monday, December 20 at 12 noon"). In some implementations, the systems can automatically generate a reminder to the doctor that is about to see that patient reminding the doctor that the patient will be coming at a scheduled time. This can be useful for doctors to remind them to obtain necessary medical records (e.g., lab work, hospital records, etc.) for the incoming patient if such records have not been previously forwarded to the doctor. Further, the systems can also be configured to generate a reminder to the patient's caretaker (e.g., a medical transportation service, a car service, a home attendant, etc.) to take the patient to the doctor and/or bring any documentation, items, etc. that may be necessary and/or useful.

[0050] In some implementations, the systems 200, 300 can be configured to provide communications to individuals containing information concerning wellness promotion or well- being of the patient. The systems can send such information when the individual responds to an inquiry concerning patient's status with a "good" response (e.g., the patient responds with "8" or "9" on his/her mobile telephone). The individuals can be provided with messages focused on wellness building and maintenance, including both exercises to promote wellness specific to their illness, and exercises to promote generic health and wellness.

[0051] Health benefits can be derived from enjoying and savoring the positive feelings, emotions and experiences that are part of everyday life (e.g. relationships, hobbies, interests), from becoming immersed and absorbed ("in the flow") with preferred activities from which a sense of accomplishment can be derived, and from deriving a sense of meaning and belonging by participating in something larger than oneself. Experiencing these positive emotions can negate and reverse the deleterious health impacts of exposure to stress. The communications issued by the system according to some implementations of the current subject matter can provide such positive health and wellness communications that encourage positive attitudes and activities (e.g. meditation, walking, stress-reduction exercises, etc.). FIGS. 9a-9d illustrate exemplary positive attitude communications that can be forwarded to the individual.

[0052] In some implementations, the systems 200, 300 can be configured to include a database that can include a plurality of various wellness-promotion and positive communications that can be forwarded to individuals. The communications can be sent to the individuals based on various parameters, including at least one of the following: patient characteristics (e.g., age, gender, hobbies, lifestyle, preferences, etc), patient's condition, etc. Upon receipt of the individual's response that indicates that the individual is doing well, the system can be configured to search the database using information about the individual (e.g., using keywords that correspond to individual's information) and generate personalized communications to be forwarded to the individual.

[0053] In some implementations, the communications that are forwarded over a particular medium (e.g., SMS message, text message, etc.) can be limited in length (e.g., 160 characters for a standard SMS message) and hence, certain abbreviations, nicknames, emoticons, etc. can be used to convey the full length of a desired communication to the individual. In some implementations, the system can be configured to also provide instructions to the individual on how to respond. For example, a communication can include instructions "Did U go to UR Dr. appt. today? Press 1 4 yes, press 2 4 no ". Upon individual's response, the system can determine whether or not to follow up with the individual concerning forward actions (e.g., rescheduling appointment, etc.). In some implementations, individuals can indicate a timeframe within which they would like to receive communications and the system can be configured to send communications at random times during that timeframe. For example, the patients can start receiving personalized communications within one day of discharge from a medical facility, where the communications can be directed to monitoring illness status and providing advice and support. The total number of communications per a predetermined timeframe that can be received by a patient can range from no communications to a plurality of communications (e.g., five communications). The systems 200, 300 can determine whether or not the number of communications that it sends out is intrusive and reduce such number appropriately.

[0054] FIGS. 4-8 illustrate exemplary logs of communications with patients that have been recently discharged from an emergency department at a hospital. Such messages can include welcome messages, requests for health status, instructions as to what should be done in an emergency, appointment reminders, medication reminders, wellness-promotion messages, and/or any other messages and/or combination thereof. For example, "Hello from the ED: Remember to take your Augmentin 3 three times today", as shown in FIG. 4, can correspond to a reminder to take certain medication; "Hello from the ED: Remember you need to make an appt to see your GP tomorrow ", as shown in FIG. 5, can correspond to a reminder to make an appointment with patient's general practice physician; "Hi from the ED: On scale of 1 (never felt worse) to 9 (never felt better) how are doing today? Text yr answer now ", as shown in FIG. 6, can correspond to communication requesting patient's current health status; or "Keep yr behaviors positive, because yr behaviors become yr habits", as shown in FIG. 7, or "Do your favorite activity to improve yr mood", as shown in FIG. 8, can correspond to wellness-promotion messages. In some implementations, the system can record patient's response to the communication, e.g., a patient texted "7" in response to a request in FIG. 6.

[0055] FIGS. 9a-9d illustrate additional examples of various communications concerning depression monitoring that can be forwarded to an individual. These can include wellness promotion messages (FIGS. 9a-9b), illness/symptom management (FIG. 9c), and safety tips (FIG. 9d).

[0056] In some implementations, an individual can be requested to respond on the basis of a color-coordinated scheme. For example, in case of asthma condition management method 1000 that can be implemented by systems 200, 300, as shown in FIG. 10, a color "red" can correspond to safety steps instructions that can be forwarded to an asthma patient to treat acute asthma, a color "yellow" can correspond to asthma symptom management, and color "green" can correspond to wellness-promotion communications. Each of these categories is illustrated at 1016. As shown in FIG. 10, a patient can be admitted for treatment of acute asthma at a medical facility, e.g. a hospital, a clinic, an emergency department, etc., at 1004-1006. The patient can be admitted, at 1002, for a short stay, at 1008, and/or discharged, at 1010-1012. Once the patient is discharged from the medical facility treating his/her asthma, the medical facility (or any third party) can begin monitoring the patient, at 1014. The patient can receive a communication stating "How is your asthma now? Text 1 for RED, 2 for YELLOW, 3 for GREEN", where colors can correspond to the scale shown at 1016. The patient can be advised as to the color scheme at the time of discharge from the medical facility. The patient can also be asked to text patient's peak flow, at 1018. If the patient's response corresponds to "RED", at 1020, the patient is advised to take his/her medication and if it does not work proceed to go to a hospital (or any other medical facility) for immediate treatment, at 1038-1040. Additionally, other parties can be notified of the patient's condition, e.g., emergency services, patient's caretakers, hospital facilities, patient's physicians, etc. These parties can provide requisite assistance to the patient and/or the medical facility that will be treating the patient. [0057] If the patient indicates that the condition is "YELLOW", at 1022, the patient can be provided with various asthma symptom management steps, at 1042-1046. For example, the patient can be advised to take relief medication, avoid asthma-causing conditions (e.g., dust, pollen, animals, foods, etc.). At a predetermined time (or at any time), the patient can be again prompted to provide status of his/her asthma condition on the basis of the previously described color-coded scheme, at 1048.

[0058] If the patient indicates that the condition is "GREEN", at 1024, the patient can be provided with various wellness promotion steps, such as, asthma medication, management of asthma, medication and appointment reminders, etc., at 1026- 1036.

[0059] FIG. 12 illustrates an exemplary method 1200, according to some implementations of the current subject matter. The method 1200 can be implemented by systems 200, 300, and 1 100. At 1202, an individual can be discharged from a medical facility. At least one discharge instruction tailored to at least one condition of the individual can be generated, at 1204. At least one discharge instruction can include information concerning follow up care for the individual. At 1206, at least one communication to the individual can be generated. At 1208, the individual can be requested to respond to at least one communication and indicate a condition of the individual. Based on a response by the individual, an instruction to the individual concerning at least one treatment option for the individual can be generated, at 1210. In some implementations, at least one of the discharging, the generating the at least one discharge instruction, the generating the at least one communication, the requesting, and the generating the instruction is performed on at least one processor.

[0060] In some implementations, the current subject can include the following optional features. At least one communication can include at least one of an appointment reminder, a reminder to take a medication, and a request to determine the condition of the individual. At least one communication can include at least one of an email, a short-message-service message, a text message, an instant message, a multi-media-message-service message, a telephone call, or a combination thereof. The response of the individual can include a numerical response corresponding to the condition of the patient. The method can also include a determination of a condition of the individual based on the numerical response received from the patient. The numerical response corresponding to the lowest number can indicate worst condition of the patient and the numerical response corresponding to the highest number can indicate best condition of the patient. Generation of the instruction can include generating, based on the response of the individual corresponding to the lowest number, at least one emergency care instruction for the individual, and providing the at least one emergency care instruction to the individual and/or to at least another individual.

EXAMPLES

[0061] Effective patient discharge instructions require careful, thoughtful, personalized communication using modalities acceptable and familiar to the patient. Novel interventions using health information technology ("IT") may yield significant benefits including: improved compliance with medication regimens, improved appointment-keeping, enhanced self-efficacy, self-management and social support; improved patient satisfaction and brand loyalty while reducing medication errors, return ED/PCP visits, medico-legal complaints and overall healthcare costs.

[0062] The inventors of the current subject matter conducted various experiments, discussion of which is presented below. The inventors concluded that simple, low-cost, IT-based discharge intervention and support can be feasible, acceptable to patients and can reduce the risk of subsequent unhealthy behaviors. The inventors conducted various pilot and feasibility studies which revealed that more than 90% of emergency room/department ("ED") patients are able to send and retrieve cell phone SMS texts for post-discharge safety steps, mood monitoring, symptom self-management, treatment recommendations, appointment reminders, individual support, and tailored wellness-building strategies. The inventors further developed a generically extensible software application framework that can have the capacity to interact with subjects via communication devices such as cell phones. The framework included several components for creating, administering, executing and evaluating a variety of protocols that can be used in several domains of human interaction. In the clinical realm, one of these protocols can be used for patient discharge instructions program, which can include six elements: safety steps, appointment keeping, medication adherence, symptom self-management, wellness promotion and education. Using these elements, this program has been adapted for multiple patient conditions including asthma/COPD, smoking cessation, diabetes, depression, pain syndromes (e.g., headache, back pain, arthritis, etc.) CHF, HIV/AIDS, hypertension and alcohol abuse. By enhancing patient satisfaction, adherence, safety, self-management and wellness after discharge the inventors have realized an improved customer satisfaction and expect reduced hospital visits and healthcare costs over time.

Example 1

[0063] Cell phone text messaging for patient-centered healthcare: A feasibility study.

[0064] The inventors of the current subject matter conducted a prospective cohort study of 1 1 12 general ED patients to explore the feasibility and acceptability of using cell phone text messaging to provide post ED discharge support. A random sample of 301 of these 1 1 12 non- major trauma patients (age range 16-94 years; median, 46 years, mean 47.9 years; 49.8% male) attending a general ED (serving 79 660 patients per year) completed a more intensive survey. Of these, 80% owned cell phones which they used daily. Patients indicated a strong willingness to receive by cell phone the following types of free text messages as part of their health care: reminders of medical appointments (62%), reminders to take medication (45%), ideas for coping with stress (45%), messages which build optimism (37%), provide support (30%), provide motivation to take care of themselves (e.g. to exercise, meditate) (35%), encourage them to commit to goals (35%), reminders to be grateful or to savor life experiences (29%), jokes of the day (43%o), inspirational quotes (38%) and messages of hope (33%). More generally, this study suggested that cell phone ownership was common and the use of text messages to provide healthcare was both feasible and acceptable to most ED patients.

Example 2

[0065] SMS messages with ED-assessed suicidal ideation patients

[0066] The inventors of the current subject matter conducted a pilot study of the feasibility, acceptability and practicality of using SMS messages to provide patient-tailored health care and support to patients identified at ED visits as having suicidal ideation or suicidal behavior. Each patient received one text daily: message content varied from reminders of appointments and medications, to reminding patients of coping strategies, to messages of hope and humor. The inventors also used Ecological Momentary Assessment ("EMA") methodology via cell phone messaging each day to assess mood: prior to receiving the text message, each patient received a text inquiring about their real-time mood state, requesting that they assess their current mood on a Likert scale ranging from 1 ("never felt worse") to 9 ("never felt better") and requesting that they text the number corresponding to their mood state back to the researcher. At the conclusion of the study, an interviewer contacted each individual to conduct a telephone interview to assess the acceptability of the intervention, and patient preferences for different types of messages, frequency and duration of SMS support. Patients were willing participants and all suicidal ED patients consented and complied with the study protocol, acknowledged receiving messages, and EMA mood monitors, which attest strongly to the feasibility of the intervention. The following outcomes were assessed over the 6-month duration of the intervention: appointment keeping post-discharge (rates of failure to attend appointments reduced by 40% from 56% prior to the text intervention to 16% at the completion of the intervention); medication compliance, measured by a. getting prescriptions filled at pharmacies which improved by 21% from 49% in the 6 months prior to the intervention to 70% at the completion of the 6-month intervention) and b. daily self-reported taking of medications as directed, which improved by 26%, from 43% in the two weeks prior to the initiation of the intervention to 69% during the intervention); improved mood (measured via EMA monitoring); amongst patients who did not get text messages mood ratings were, on average, 39% higher in those who were sent text messages; repeat visits to the ED during the 6-month follow-up period (assessed by self-report and verified by check of the ED log) reduced by 32% from 46% to 14%; patient satisfaction ratings with continued care after the index ED visit (compared to patients who did not get text messages) which were higher by 13% (93% vs. 80%). Qualitative feedback was uniformly positive; representative comments from subjects included: "it makes me feel wanted and appreciated" ; "makes me feel loved"; "means you are in contact with someone "; "Keeps me distracted. Stops me from harming myself; "Helps me to put things into focus "; "This would keep me stable ". "Someone outside my circle was able to connect with me in a non- judgmental way ".

Example 3

[0067] Use of cell phone text messaging in an outpatient mental health service.

[0068] The inventors of the current subject matter also conducted a study of the use of cell phone text messages in an outpatient mental health clinic. All patients had histories of suicidal behavior. Clerical and clinical staff sent texts to patients to remind them of appointments, maintain contact and provide support. Both staff and patients were highly enthusiastic about the innovative service. Qualitative interviews with over 50 patients revealed few reservations or barriers to technology uptake, except in older patients (over 70 years of age) who in some cases had difficulty reading the SMS text. Follow up evaluation generated results consistent with, and of the same order as, those found in the study of ED suicidal patients, above. Specifically, during the intervention period, the rate of missed appointments reduced by 37%, patient satisfaction with follow-up care improved by 14%>, self-reported daily adherence with antidepressant medications improved by 23%, self-reported mood ratings (via daily EMA reports) improved by 26% compared to the two week period prior to the initiation of the intervention. Qualitative evaluations from clinic secretarial staff were positive and highlighted the advantages of reduced missed appointments and better use of medical staff time, and reduced time spent trying to contact and reschedule patients who had failed to attend appointments. Qualitative reports from clinical psychologists tended to focus on the advantages of keeping in touch with patients by text messaging: their patients tended to respond to, and heed advice in text messages, whereas they typically did not respond to telephone calls or voice messages. In the views of the clinical psychologists maintaining contact with patients in this way averted crises and likely reduced crisis presentations to the psychiatric emergency department.

Example 4

[0069] Use of cell phone text messaging in an ED clinic to promote antibiotic adherence

[0070] The inventors of the current subject matter conducted a study of the use of cell phone text messages in an Emergency Department ("ED") to promote adherence to medication regimens relating to prescribed oral and topical antibiotics, and to remind patients of follow up medical appointments. All patients discharged from the ED who were prescribed antibiotics and owned cell phones, and did not object to the additional cost of text messages for up to 10 days post-discharge, were eligible for the study. Patients were enthusiastic participants and the response rate was 94%. Text messages reminding patients to take or apply their antibiotics were sent the day following discharge, and daily until the end of the prescribed course. Each evening patients were sent a reminder text asking if they had remembered to take their medications for that day. Patients prescribed multiple antibiotics were sent reminders which included reference to all medications and the number of times they were to take each medication daily. Patients were sent separate text messages to remind them of appointments; these reminders were sent the day prior to and the day of the appointment. Once the course(s) of antibiotics was/were completed subjects were telephoned and asked a series of questions which assessed patient satisfaction with their treatment in the ED during their visit, which had occurred, typically, a week earlier. They were also asked for their views on the text reminder program. Patients were very enthusiastic about the intervention; many had texted replies immediately in response to text message reminders saying "Thanks - have just taken the meds " or "have just made appt for tomorrow " and similar appreciative messages.

[0071] The inventors of the current subject matter concluded that the following population groups can benefit from the current subject matter system:

1. At-risk patients (case management, including risk mitigation and safety steps);

2. Inpatients, outpatients and ED patients discharged from healthcare facilities (medication adherence and appointment reminders; strategies to promote self- management of diseases, both acute and chronic). This intervention can also be extended to institutions beyond health facilities including for example, people discharged from correctional or welfare facilities); and

3. Special populations (texting for activities such as public health messaging, wellness for enrollees of insurance plans, quality assurance /patient or client satisfaction surveys, employee health campaigns, military/ veterans, and universities who would use the emergency notification function or related mass announcements for blood drives, disasters, civil defense, etc).

[0072] The systems and methods disclosed herein can be embodied in various forms including, for example, a data processor, such as a computer that also includes a database, digital electronic circuitry, firmware, software, or in combinations of them. Moreover, the above-noted features and other aspects and principles of the present disclosed implementations can be implemented in various environments. Such environments and related applications can be specially constructed for performing the various processes and operations according to the disclosed implementations or they can include a general-purpose computer or computing platform selectively activated or reconfigured by code to provide the necessary functionality. The processes disclosed herein are not inherently related to any particular computer, network, architecture, environment, or other apparatus, and can be implemented by a suitable combination of hardware, software, and/or firmware. For example, various general-purpose machines can be used with programs written in accordance with teachings of the disclosed implementations, or it can be more convenient to construct a specialized apparatus or system to perform the required methods and techniques.

[0073] The systems and methods disclosed herein can be implemented as a computer program product, i.e., a computer program tangibly embodied in an information carrier, e.g., in a machine readable storage device or in a propagated signal, for execution by, or to control the operation of, data processing apparatus, e.g., a programmable processor, a computer, or multiple computers. A computer program can be written in any form of programming language, including compiled or interpreted languages, and it can be deployed in any form, including as a stand-alone program or as a module, component, subroutine, or other unit suitable for use in a computing environment. A computer program can be deployed to be executed on one computer or on multiple computers at one site or distributed across multiple sites and interconnected by a communication network.

[0074] As used herein, the term "user" can refer to any entity including a person or a computer.

[0075] Although ordinal numbers such as first, second, and the like can, in some situations, relate to an order; as used in this document ordinal numbers do not necessarily imply an order. For example, ordinal numbers can be merely used to distinguish one item from another. For example, to distinguish a first event from a second event, but need not imply any chronological ordering or a fixed reference system (such that a first event in one paragraph of the description can be different from a first event in another paragraph of the description).

[0076] The foregoing description is intended to illustrate but not to limit the scope of the invention, which is defined by the scope of the appended claims. Other implementations are within the scope of the following claims.

[0077] These computer programs, which can also be referred to programs, software, software applications, applications, components, or code, include machine instructions for a programmable processor, and can be implemented in a high-level procedural and/or object- oriented programming language, and/or in assembly/machine language. As used herein, the term "machine-readable medium" refers to any computer program product, apparatus and/or device, such as for example magnetic discs, optical disks, memory, and Programmable Logic Devices (PLDs), used to provide machine instructions and/or data to a programmable processor, including a machine-readable medium that receives machine instructions as a machine-readable signal. The term "machine-readable signal" refers to any signal used to provide machine instructions and/or data to a programmable processor. The machine-readable medium can store such machine instructions non-transitorily, such as for example as would a non-transient solid state memory or a magnetic hard drive or any equivalent storage medium. The machine-readable medium can alternatively or additionally store such machine instructions in a transient manner, such as for example as would a processor cache or other random access memory associated with one or more physical processor cores.

[0078] To provide for interaction with a user, the subject matter described herein can be implemented on a computer having a display device, such as for example a cathode ray tube (CRT) or a liquid crystal display (LCD) monitor for displaying information to the user and a keyboard and a pointing device, such as for example a mouse or a trackball, by which the user can provide input to the computer. Other kinds of devices can be used to provide for interaction with a user as well. For example, feedback provided to the user can be any form of sensory feedback, such as for example visual feedback, auditory feedback, or tactile feedback; and input from the user can be received in any form, including, but not limited to, acoustic, speech, or tactile input.

[0079] The subject matter described herein can be implemented in a computing system that includes a back-end component, such as for example one or more data servers, or that includes a middleware component, such as for example one or more application servers, or that includes a front-end component, such as for example one or more client computers having a graphical user interface or a Web browser through which a user can interact with an implementation of the subject matter described herein, or any combination of such back-end, middleware, or front-end components. The components of the system can be interconnected by any form or medium of digital data communication, such as for example a communication network. Examples of communication networks include, but are not limited to, a local area network ("LAN"), a wide area network ("WAN"), and the Internet.

[0080] The computing system can include clients and servers. A client and server are generally, but not exclusively, remote from each other and typically interact through a communication network. The relationship of client and server arises by virtue of computer programs running on the respective computers and having a client-server relationship to each other. [0081] The implementations set forth in the foregoing description do not represent all implementations consistent with the subject matter described herein. Instead, they are merely some examples consistent with aspects related to the described subject matter. Although a few variations have been described in detail above, other modifications or additions are possible. In particular, further features and/or variations can be provided in addition to those set forth herein. For example, the implementations described above can be directed to various combinations and sub-combinations of the disclosed features and/or combinations and sub-combinations of several further features disclosed above. In addition, the logic flows depicted in the accompanying figures and/or described herein do not necessarily require the particular order shown, or sequential order, to achieve desirable results. Other implementations can be within the scope of the following claims.

Claims

What is claimed:

1. A computer-implemented method, comprising:

discharging an individual from a medical facility;

generating at least one discharge instruction tailored to at least one condition of the individual, wherein the at least one discharge instruction includes information concerning follow up care for the individual;

generating at least one communication to the individual;

requesting the individual to respond to the at least one communication and indicate a condition of the individual;

generating, based on a response by the individual, an instruction to the individual concerning at least one treatment option for the individual;

wherein at least one of the discharging, the generating the at least one discharge instruction, the generating the at least one communication, the requesting, and the generating the instruction is performed on at least one processor.

2. The method according to claim 1, wherein the at least one communication includes at least one of an appointment reminder, a reminder to take a medication, and a request to determine the condition of the individual.

3. The method according to claim 1, wherein the at least one communication includes at least one of an email, a short-message-service message, a text message, an instant message, a multi-media-message-service message, a telephone call, or a combination thereof.

4. The method according to claim 1 , wherein the response of the individual includes a numerical response corresponding to the condition of the patient.

5. The method according to claim 4, further comprising

determining condition of the individual based on the numerical response received from the patient.

6. The method according to claim 5, wherein the numerical response corresponding to the lowest number indicates worst condition of the patient and the numerical response corresponding to the highest number indicates best condition of the patient.

7. The method according to claim 6, wherein generating the instruction further comprises

generating, based on the response of the individual corresponding to the lowest number, at least one emergency care instruction for the individual; and

providing the at least one emergency care instruction to the individual and/or to at least another individual.

8. A system, comprising:

at least one programmable processor; and

a machine-readable medium storing instructions that, when executed by the at least one programmable processor, cause the at least one programmable processor to perform operations comprising:

discharging an individual from a medical facility;

generating at least one communication to the individual;

requesting the individual to respond to the at least one communication and indicate a condition of the individual; and

generating, based on a response by the individual, an instruction to the individual concerning at least one treatment option for the individual.

9. The system according to claim 8, wherein the at least one communication includes at least one of an appointment reminder, a reminder to take a medication, and a request to determine the condition of the individual.

10. The system according to claim 8, wherein the at least one communication includes at least one of an email, a short-message-service message, a text message, an instant message, a multi-media-message-service message, a telephone call, or a combination thereof.

1 1. The system according to claim 8, wherein the response of the individual includes a numerical response corresponding to the condition of the patient.

12. The system according to claim 1 1 , wherein the operations further comprise determining condition of the individual based on the numerical response received from the patient.

13. The system according to claim 12, wherein the numerical response corresponding to the lowest number indicates worst condition of the patient and the numerical response corresponding to the highest number indicates best condition of the patient.

14. The system according to claim 13, wherein generating the instruction further comprises

15. A computer program product comprising a machine-readable medium storing instructions that, when executed by at least one programmable processor, cause the at least one programmable processor to perform operations comprising: discharging an individual from a medical facility;

generating at least one communication to the individual; requesting the individual to respond to the at least one communication and indicate a condition of the individual; and

16. The computer program product according to claim 15, wherein the at least one communication includes at least one of an appointment reminder, a reminder to take a medication, and a request to determine the condition of the individual.

17. The computer program product according to claim 15, wherein the at least one communication includes at least one of an email, a short-message-service message, a text message, an instant message, a multi-media-message-service message, a telephone call, or a combination thereof.

18. The computer program product according to claim 15, wherein the response of the individual includes a numerical response corresponding to the condition of the patient.

19. The computer program product according to claim 18, wherein the operations further comprise

20. The computer program product according to claim 19, wherein the numerical response corresponding to the lowest number indicates worst condition of the patient and the numerical response corresponding to the highest number indicates best condition of the patient.

21. The computer program product according to claim 20, wherein generating the instruction further comprises

generating, based on the response of the individual corresponding to the lowest number, at least one emergency care instruction for the individual; and providing the at least one emergency care instruction to the individual and/or to at least another individual.