WO2018002750A1

WO2018002750A1 - Generation of clinical-reasoning cases

Info

Publication number: WO2018002750A1
Application number: PCT/IB2017/053453
Authority: WO
Inventors: Herman STOEVELAAR
Original assignee: Ismar Health Care
Priority date: 2016-06-27
Filing date: 2017-06-12
Publication date: 2018-01-04
Also published as: BE1023816B1

Abstract

According to an embodiment, the invention comprises a method for generating and storing clinical-reasoning cases, CRCs, (100-106) comprising successive steps (131-133), said method comprising the retrieving of a first CRC (100); and the presenting to a user to modify the steps (131, 141) of the first CRC (100); and the obtaining from the user a modification of the first step (131) to a second step (132); and the storing of the CRC with the second step as a separate second CRC (101); and the relating (120) of the first step (131) of the first CRC to the second step (132) of the second CRC; and the searching for relatable CRCs (103) that differ from the second CRC (101) by one different step (133); and the relating (121) of the relatable CRCs (103) to the second CRC via the different step (133).

Description

GENERATION OF CLINICAL-REASONING CASES

Technical Field

[01] The present invention relates to clinical reasoning. More specifically, the invention relates to a computer system for generating clinical-reasoning cases.

[02] In the further description of the invention, a clinical-reasoning case is denoted by the abbreviation CRC.

State of the Art

[03] Clinical reasoning is the process by which observations and interpretations are linked with medical knowledge or insights in order to arrive at a diagnosis or choice of therapy. Clinical reasoning can be tested and practised by running through or solving clinical-reasoning cases.

[04] A clinical-reasoning case typically begins with a clinical problem. The problem defines the most important signs or symptoms for which a patient asks advice from a medical practitioner. A clinical problem may be, for example, a stubborn cough or a severe persistent headache. Subsequently the clinical- reasoning case comprises one or more successive steps that provide more information, in order in this way to confirm or to exclude a possible diagnosis. Such a step may be, for example: further questions and answers with respect to symptomatology or medical history of the patient, physical examination and attendant tests. In this manner, a clinical-reasoning case describes a scenario that ultimately must lead to a particular answer or particular outcome such as a probability of one or more diagnoses or a suitability for a particular therapy.

[05] The generating of clinical-reasoning cases is labour-intensive work, since these cases preferably also ought to be verified by a panel of experts. Furthermore, it is not a simple matter to produce variations on existing clinical- reasoning cases, because each variation in each of the successive steps can lead to a totally different outcome.

[06] In the last decade, various computer-assisted systems have been brought onto the market that are intended to help in drawing up and examining clinical-reasoning cases.

[07] For generating new clinical-reasoning cases, many of these systems follow the complete chain from the formulation of the problem to the ultimate choice of the therapy. In this way, a drafter of a new clinical-reasoning case needs, in each instance, to run through the complete process of evaluating symptoms, medical background, physical examination, interpretation of results, making a diagnosis and choosing a suitable treatment. This may well be useful for beginners, but it quickly becomes inefficient for experienced users.

[08] There is therefore a need for a system that permits a drafter to draft and to manage new clinical-reasoning cases in a rapid and efficient manner, wherein this linear drafting procedure is abandoned.

Summary of the Invention

[09] This is achieved, according to a first aspect of the invention, by a method, implemented on a computer, for generating and storing clinical-reasoning cases, CRCs, comprising one or more successive steps, said method comprising:

- the retrieving of a first CRC from a data-storage means; and

- the presenting to a user to modify the one or more successive steps of the first CRC; and

- the obtaining from the user a modification of the first step to a second step; and

- the storing of the CRC with the second step as a separate second CRC in the data-storage means; and - the relating of the first step of the first CRC to the second step of the second CRC in the data-storage means; and

- the searching of the storage means for relatable CRCs that differ from the second CRC by one different step; and

- the relating of the relatable CRCs to the second CRC via the different step.

[10] The clinical-reasoning cases or CRCs have consequently been stored digitally, for example in a database. The stored CRC comprises, moreover, the one or more successive steps, the formulation of the problem of the clinical case and the solution, i.e. the diagnosis, possibly differentially, possibly with the associated treatment. The steps may, moreover, have been stored as text, figures, video, audio, a link or any combination of the foregoing. In order to generate a new CRC, in accordance with the present invention the user, i.e. the drafter of the new CRC, retrieves an existing CRC from the storage means. The computer system then shows the user the existing CRC and permits the user to change a step in the existing CRC. The user can furthermore also modify the outcome, e.g. the diagnosis or treatment, if the modified step has an influence on this.

[11] When the user stores the new, second, CRC, this second CRC is related to the original CRC via the modified step. In this manner, the CRCs are consequently linked to one another so that a user can always easily see whether variations on existing CRCs exist. Furthermore, not only is the new CRC linked to the original CRC, but the storage means is further searched for existing CRCs that differ from the new CRC by only one step. When such CRCs are found, these CRCs are also linked to the new CRC via the various steps.

[12] In this manner, it is consequently always known which CRCs have been linked to one another or, stated differently, which variations on a particular CRC already exist. This has the advantage that a user can quickly assess whether a particular variant already exists, or which variant he/she is still able to generate. Furthermore, a user also no longer needs to run through the entire linear process for generating a CRC, but he/she can ordinarily adapt one single step of an existing CRC. Optionally, the user can adapt the other steps of the CRC still further, where necessary. By virtue of the fact that CRCs have been related, the retrieving of a CRC can furthermore proceed in an efficient and rapid manner.

[13] According to an embodiment of the invention, the retrieving further comprises:

- the retrieving of the one or more successive steps of the first CRC;

- the retrieving of related steps of related CRCs that differ from the first CRC by one different step;

and wherein the presenting to the user further comprises:

- the displaying of the various related steps to the user.

[14] In the course of the retrieving of a CRC, the computer system consequently shows not only the existing CRC but also which other CRCs are present in the storage system if one particular step were to be modified. As a result of this, a user can easily estimate which new CRCs can yet be generated on the basis of the first CRC. By virtue of the fact that the CRCs have been related to one another in the storage means, the computer system can quickly ascertain the related CRCs.

[15] According to an embodiment of the invention, the data-storage means comprises a graph database, and a CRC has been stored as a nodal point in the graph database and related to other CRCs by means of connections. The relating then further comprises the generating of a connection between nodal points in the graph database.

[16] Graph databases are a type of database that makes use of nodal points or nodes, of connections or edges, and of properties for representing or storing the data in a data-storage means. In contrast to a relational database, the relationships between the data are, moreover, not based on the data themselves but on a separate data type, i.e. the connection, in the database. If information is stored in a graph database, complex searching tasks can be concluded in a rapid manner.

[17] By storing the CRCs in a graph database as nodal points, and by storing the relationships between CRCs that differ only by one step as connections, the computer system can retrieve the related CRCs in a very rapid manner and show them to the user.

[18] According to a second aspect, the invention relates to a computer system adapted to execute one of the methods according to the first aspect.

[19] According to a third aspect, the invention relates to a computer-program product containing instructions capable of being executed on a computer in order to execute the method according to the first aspect if this program is executed on a computer.

[20] According to a fourth aspect, the invention relates to a computer-readable storage means containing the computer-program product according to the third aspect.

[21] According to a fifth aspect, the invention relates to the use of a graph database for storing clinical-reasoning cases, CRCs, wherein a CRC has been stored as a nodal point in the graph database and has been related to other CRCs by means of sides; and wherein a side relates CRCs that differ from one another only by one step.

Brief Description of the Drawings

[22] Figures 1 A, 1 B and 1 C illustrate various steps for the generation of a new CRC on the basis of an existing CRC, according to an embodiment of the invention; and [23] Figures 2A and 2B illustrate various steps in the generation of a new CRC on the basis of an existing CRC, according to an embodiment of the invention; and

[24] Figure 3 illustrates the generation of a CRC via a user interface according to an embodiment of the invention; and

[25] Figure 4 illustrates steps executed by a computer system for generating a CRC, according to an embodiment of the invention; and

[26] Figure 5 illustrates steps executed by a computer system for displaying a CRC to a user, according to an embodiment of the invention; and

[27] Figure 6 illustrates a suitable computer system for executing steps according to embodiments of the present invention.

Description of Embodiments

[28] The present invention relates to the generating of clinical-reasoning cases, abbreviated as CRC. A clinical-reasoning case typically begins with a clinical problem. The problem defines the most important signs or symptoms for which a patient asks advice from a medical practitioner. A clinical problem may be, for example, a stubborn cough or a severe persistent headache. Subsequently the clinical-reasoning case comprises one or more successive steps that provide more information, in order to confirm or to exclude a possible diagnosis. For instance, such a step may be: further questions and answers with respect to symptomatology or medical history of the patient, physical examination and attendant tests. In this manner, a clinical-reasoning case describes a scenario that ultimately must lead to a particular answer or particular outcome, such as a probability of one or more diagnoses or a suitability for a particular therapy. [29] Fig. 4 illustrates steps executed by a computer system for generating a CRC, according to an embodiment of the invention. Fig. 1A, Fig. 1 B and Fig. 1 C illustrate schematically CRCs 100, 101 , 103 during the execution of these steps. Prior to the execution of the steps, CRCs 100 and 103 have been stored on the computer system. CRC 100 comprises a formulation of the problem P1 , a first step 131 (A1 ), a second step 141 (B1 ), and a diagnosis D1 . CRC 103 comprises the same formulation of the problem P1 , a different step 133 (A3), one and the same following step 141 (B1 ) as in CRC 100, and a different diagnosis D3. CRC 103 consequently differs from CRC 100 only by the first step A3. Therefore CRCs 100 and 103 have been related to each other by means of a link 123 which relates step A1 of CRC 100 to step A3 of CRC 103.

[30] At a given moment a user wishes to generate a new CRC on the basis of the existing CRC 100. In step 401 , CRC 100, i.e. the first CRC, is then retrieved from a data-storage means on the computer system where all the CRCs have been stored. Subsequently, in step 402, the user is presented the possibility to make a modification to one of steps A1 and B1 , in order thereby to create a new CRC. In this case, the user modifies, for example, step A1 to A2 132. As a result of this, the possible diagnosis also changes, and consequently the user also changes this from D1 to D2. The modifying of a step in a CRC together with the associated diagnosis is sometimes also called a 'what if in the literature. Upon receipt of the modification by the user in step 402, a new CRC 101 is generated which is subsequently stored in the data-storage means in step 403.

[31] At this moment, the new CRC 101 has not yet been related to the already existing CRC 103. Since the new CRC 101 was generated from CRC 100, in the following step 404 CRC 101 is related to CRC 100 by means of link 120 between step A1 of CRC 100 and step A2 of CRC 101 , as illustrated in Fig. 1 B.

[32] Through the creation of the new CRC 101 , however, it is also possible that yet other CRCs are present in the system that also differ from CRC 101 just by one step but have not yet been directly related to CRC 101 . Therefore in the following step 405 a search is then made for other CRCs, i.e. relatable CRCs, that differ from CRC 101 just by one single step. In the case of Fig. 1 , this is the case for CRC 103, for example. When such a CRC is found, this is then related in step 406 to the new CRC 101 by means of link 121 which connects step A2 of CRC 101 to step A3 of CRC 103.

[33] Fig. 2A and Fig. 2B illustrate a similar situation. CRCs 100, 101 , 103, 104 and 105 as indicated in Fig. 2A form an existing situation wherein all the CRCs have already been related to one another. Fig. 2B then illustrates the situation wherein a user creates CRC 106 on the basis of CRC 104. In this connection, step A3 is modified into step A2, and step 142 (B2) remains unmodified. During step 404, CRC 106 is then related to CRC 104 by means of link 127 which connects steps A2 and A3 to one another, i.e. relates them to one another. During step 405, CRC 101 is then identified, which differs from CRC 106 only by step B1 . After this, CRC 101 is related to CRC 106 during step 406.

[34] Figure 5 illustrates further steps 501 -503 which, for example, can be executed for retrieving 401 and offering 402 a CRC. These steps are further illustrated on the basis of Fig. 3. Fig. 3 shows, on the one hand, CRCs 100 to 108 as stored and/or generated by the computer system and, on the other hand, a screen display 305 of CRC 105 as shown to a drafter of a CRC during the executing of the steps of Fig. 5.

[35] During the retrieving of a CRC in step 401 , for example CRC 105 in the example shown in Fig. 3, all the steps of CRC 105 are also retrieved in step 501 , i.e. steps 331 (A3) and 341 (B3). After the retrieving of the CRC and all the steps, these are displayed to the user via the screen print 305. Besides steps 331 and 341 , the clinical problem P1 and the diagnosis D5 are also displayed, i.e. the complete content of the existing CRC 105 is shown to the user.

[36] After the retrieving of CRC 105, the steps of the related CRCs are also retrieved in step 502. In the example shown in Fig. 3, no CRC has yet been related to step 331 , and CRCs 103 and 104 have been related at step 341. In other words, CRC 104 differs from CRC 105 by step B2, and CRC 103 differs from CRC 105 by step B1 . These steps B1 and B2 are then also shown or made displayable in step 503 by means of the screen print 305, more specifically by means of the image 352. Step 503 can furthermore be executed together with step 402 by also giving a user the possibility to generate a new step by means of a clickable option 351 or 352.

[37] By means of the above steps, a user can consequently generate a new CRC in a simple manner. In this connection, he/she has only to select and open an existing CRC. After this, he/she can see directly which related CRCs already exist, and decide upon the step on the basis of which he/she wishes to generate a new CRC. After the generating of the CRC, the new CRC is then stored and linked to the CRC on the basis of which it was generated, and to other existing and related CRCs.

[38] CRCs are preferably stored in a database. In one embodiment in this connection, use is made of a relational database. According to a preferred embodiment, the CRCs are stored together with the links in a graph database.

[39] A graph database is a type of database that makes use of nodal points or nodes, of connections or edges, and of properties for representing or storing the data in a data-storage means. In contrast to a relational database, the relationships between the data are, moreover, not based on the data themselves but on a separate data type, i.e. the connection, in the database. If information is stored in a graph database, complex searching tasks can be concluded in a rapid manner. Adapted to the present invention, CRCs can be stored as nodal points in the graph database, and the links and consequently the relationship between related CRCs can be stored as edges. Each edge then describes in each instance how one CRC has been related to another CRC, i.e. by which step the CRCs differ from one another. [40] During the retrieving of a CRC in step 401 and the searching for related steps in step 502, it is then sufficient to retrieve the relevant CRC and to follow the links to the related CRCs. Consequently, no further complex processing is necessary wherein various tables need to be merged, as would be the case if the CRCs had been stored in a relational database.

[41] The above steps can be executed on a computer system as part of a computer application. In this connection, the interaction with the user can take place on the same computer system, i.e. the user environment 305 is shown on a display of the computer system, the CRCs are stored on a storage system of the computer system, and the steps themselves are executed by a processor of the computer system. Other implementations as known in the state of the art are also possible. In this way, the user can also generate and manage CRCs remotely. For instance, the steps can be executed in the cloud, and both storage and execution can be spread over various computer systems, i.e. on a distributed computer system.

[42] Fig. 6 shows an example of a suitable computer system 600 for executing the steps according to the above embodiments. The computer system 600 may in general have been implemented as a suitable computer for general purposes and may comprise a bus 610, a processor 602, a local memory 604, one or more optional input interfaces 614, one or more output interfaces 616, a communication interface 612, a storage-element interface 606 and one or more storage elements 608. The bus 610 may comprise one or more conductors which make communication possible between the components of the computer system 600. The processor 602 may comprise any type of conventional processor or microprocessor that interprets and executes program instructions. The local memory 604 may comprise a random-access memory (RAM) or another type of dynamic-storage device that stores information and instructions for execution by the processor 602, and/or a read-only memory (ROM) or another type of static-storage device that stores static information and instructions for use by the processor 602. The input interface 614 may comprise one or more conventional mechanisms that enable a user to input information into the computer device 600, such as a keyboard 620, a mouse 630, a pen, voice recognition and/or biometric mechanisms, etc. The output interface 616 may comprise one or more conventional mechanisms that emit information to the user, such as a display 640, a loudspeaker, etc. The communication interface 612 may comprise a transceiver-like mechanism - such as, for example, one or more Ethernet interfaces - that enables the computer system 600 to communicate with other devices and/or systems, for example mechanisms for communicating with the telecommunication apparatus 621 . The communication interface 612 of the computer system 600 may have been connected to another such computer system by means of a local-area network (LAN) or a wide-area network (WAN) such as the Internet, for example. The storage-element interface 606 may comprise a storage interface - such as, for example, a serial advanced-technology attachment (SATA) interface or a small- computer-system interface (SCSI) - for connecting the bus 610 to one or more storage elements 608 such as one or more local discs, for example SATA disc stations, and may control the reading and writing of data to and/or from these storage elements 608. Although the storage elements 608 have been described heretofore as a local disc, in general any other suitable computer-readable medium, such as a removable magnetic disc, optical storage media such as a CD or DVD, ROM disc, solid-state drives, flash-memory cards, could be used. The system 600 described above can also act as a virtual machine above the physical hardware.

[43] The steps shown by the above embodiments can be implemented as program instructions that have been stored in the local memory 604 of the computer system 600 for execution by the processor 602 thereof. As an alternative, the instructions can be stored in the storage element 608 or may be accessible from another computer system via the communication interface 612.

[44] Although the present invention was illustrated on the basis of specific embodiments, for a person skilled in the art it will be clear that the invention is not limited to the details of the foregoing illustrative embodiments, and that the present invention can be implemented with various modifications and adaptations without thereby departing from the field of application of the invention. The present embodiments must therefore be regarded in all aspects as illustrative and not restrictive, the field of application of the invention being described by the appended claims and not by the foregoing description, and all the modifications that fall within the meaning and the scope of the claims being consequently incorporated herein. In other words, it is assumed that all modifications, variations or equivalents are covered thereby that fall within the field of application of the underlying basic principles and that have essential attributes that are claimed in this patent application. In addition, the reader of this patent application will understand that the words 'comprising' and 'comprise' do not exclude other elements or steps, that the word 'a/an' does not exclude a plural, and that a singular element - such as a computer system, a processor or another integrated unit - can perform the functions of various aids that are mentioned in the claims. Possible modifications in the claims may not be interpreted as a limitation of the claims in question. The terms 'first', 'second', 'third', 'a', 'b', 'c' and such like, when used in the description or in the claims, are used in order to make the distinction between elements or steps of the same kind, and do not necessarily describe a successive or chronological sequence. In the same way, the terms 'top side', 'bottom side', 'over', 'under' and such like are used for the sake of the description, and they do not necessarily refer to relative positions. It should be understood that those terms are mutually interchangeable under the right circumstances, and that embodiments of the invention are able to function in accordance with the present invention in sequences or orientations other than those described or illustrated in the above.

Claims

1 . Method, implemented on a computer, for generating and storing clinical- reasoning cases, CRCs, (100-106), comprising one or more successive steps (131 -133, 141 -143), said method comprising:

- the retrieving of a first CRC (100, 105) from a data-storage means; and

- the presenting to a user to modify the one or more successive steps (131 , 141 , 331 , 341 ) of the first CRC (100, 105); and

- the obtaining from the user a modification of the first step (131 , 331 ) to a second step (132, 332); and

- the storing of the CRC with the second step as a separate second CRC (101 , 107) in the data-storage means; and

- the relating (120, 151 ) of the first step (131 , 331 ) of the first CRC to the second step (132, 332) of the second CRC in the data-storage means; and

- the searching of the storage means for relatable CRCs (103, 106) that differ from the second CRC (101 ) by one different step (133, 341 ); and

- the relating (121 , 152, 153) of the relatable CRCs (103, 101 , 106) to the second CRC via the different step (133, 341 ).

2. Method according to Claim 1 , wherein the retrieving further comprises:

- the retrieving of the one or more successive steps (331 , 341 ) of the first CRC;

- the retrieving of related steps of related CRCs (103, 104) that differ from the first CRC (101 ) by one different step (341 );

and wherein the presenting to the user further comprises:

- the displaying of the various related steps to the user.

3. Method according to one of the preceding claims, wherein the data-storage means comprises a graph database; and wherein a CRC has been stored as a nodal point in the graph database and has been related to other CRCs by means of sides; and wherein the relating further comprises the generating of a connection between nodal points in the graph database.

4. Computer system (600) adapted to execute the method according to one of Claims 1 to 3.

5. Computer-program product containing instructions, executable on a computer, in order to execute the method according to one of Claims 1 to 3 if this program is executed on a computer.

6. Computer-readable storage means containing the computer-program product according to Claim 5.

7. Use of a graph database for storing clinical-reasoning cases, CRCs, wherein a CRC has been stored as a nodal point in the graph database and has been related to other CRCs by means of sides; and wherein a side relates CRCs that differ from one another only by one step.