WO2020047639A1

WO2020047639A1 - Method and system for generating an action plan for a user and method for automatic suggestion of an action plan

Info

Publication number: WO2020047639A1
Application number: PCT/BR2019/050376
Authority: WO
Inventors: José Seripieri FILHO
Original assignee: Qualicorp Consultoria E Corretora De Seguros S.A.
Priority date: 2018-09-05
Filing date: 2019-09-05
Publication date: 2020-03-12

Abstract

The present invention describes a means for generating an action plan for a user in a health-management service, wherein this plan is devised together with a health professional on the basis of information on the user that has been provided previously. Said action plan offers health measures and guidelines suggested to the user and shared via a user-accessible viewer tool. The present invention pertains to the fields of health and information technology.

Description

Invention Patent Descriptive Report

USER ACTION PLAN GENERATION METHOD AND SYSTEM AND ACTION PLAN AUTOMATIC SUGGESTION METHOD

Field of the Invention

[0001] The present invention describes a means of generating an action plan for a user in a health management service, where this plan is drawn up with a health professional based on user information previously provided. The present invention is located in the fields of health and information technology.

Background of the Invention

[0002] There are currently several types of health management services offered to users. Some providers tend to market this health management service in a basically uncontrolled manner, which implies a delay in patient / patient care, long queues, different doctors to treat the same health problem, abusive costs, etc.

[0003] Furthermore, current services lack the means to organize medical procedures. There is a lack of a more particular follow-up for each patient, which can hinder the assessment of the patient's health, since a doctor can examine a patient without knowing his history correctly.

[0004] Among the weaknesses presented by the state of the art, there is a lack of a reliable environment that is accessible to professionals to consult relevant information about a patient's health. It can be said that, with current services, doctors do not have due control over their patient, so that a doctor may end up prescribing different types of treatment / medication without even knowing what his patient has had in the past, so way that this can imply serious complications when patient, and can even lead to death.

[0005] In addition to the lack of organization of personal historical episodes that a patient may have, the state of the art also does not consider the family history of the disease. Certain diseases can be more quickly identified if the health professional already had access to information that the occurrence of this disease is common in a certain family.

[0006] Still, there are currently no tools available that make it possible to outline a model of health management for a patient, bringing useful information to the user and carrying out follow-up to treat or prevent some diseases that may be prone to it.

[0007] In the search for the state of the art in scientific and patent literature, the following documents dealing with the topic were found:

[0008] The document CN105975743A describes an interactive intelligent medical detection system, where an application runs on the user's mobile device and several medical data collection modules are made available to be associated with the mobile device. Among the modules are medical equipment for assessing the patient's clinical conditions, such as a body temperature detection device, a blood pressure detection device, a pulse detection device and a vital capacity detection device. These modules collect said data and display it to the user in real time. Thus, the solution proposed by CN105975743A uses software that analyzes the data from these modules, presenting a diagnosis and suggesting treatment automatically to the patient. This solution, however, brings clinical insecurity, since the diagnosis and treatment decisions are offered by software and not by a doctor / health professional. In addition, the CN105975743A solution, in addition to requiring additional modules next to the user's device, aims to address specific problems of the patient, not proposing a way of correcting and preventing the health of the patient. same.

[0009] WO2017075496A1 describes a system for digital health management and support for remote monitoring of patients. This system has a mobile health platform aimed at families to monitor and manage the health conditions of their families. Using this platform, family members can store and organize the health data of each family member. This system also has wearable devices to be used on patients, enabling real-time monitoring. The solution proposed by WO2017075496A1, however, aims exclusively to monitor the patient's health, thus not proposing a correction and / or prevention strategy for the user, in addition to proposing the use of additional technologies for measuring clinical information.

[0010] The document CN102670307A describes a community health monitoring system, proposing a low-cost development and simple implementation solution. In this system, as in WO2017075496A1, a continuous monitoring of patients is proposed, being in this case applied to a community. In this way, a distance physician can request the collection of some health data directly from the patient. However, the solution presented by CN102670307A does not seek a way to propose a service, correction or prevention strategy for the user.

[0011] The document BR1020170022846 describes a method for stratifying a patient's risk within a population health management, where a system calculates and assigns risk indices based on a patient's health conditions and, thereby, provides a estimated cost of this patient for health management. The solution proposed by BR1020170022846, however, does not provide a way to outline a care, correction or prevention strategy for the patient, performing only the classification within the service. [0012] Thus, from what can be inferred from the researched literature, no documents were found anticipating or suggesting the teachings of the present invention, so that the solution proposed here has novelty and inventive activity in view of the state of the art.

Summary of the Invention

[0013] Thus, the present invention aims to solve the problems of the state of the art from the generation of an action plan for a user in a health management service, where this plan is designed for corrective and preventive actions of the based on information provided and / or obtained. The action plan presents recommended measures for the user to follow, where these measures are planned particularly for the user based on their own information, for example, personal health information, family history, etc. This action plan is evaluated and defined by a health professional who, in possession of user information and other parameters raised by the system, outlines a sequence of measures suggestive to the user, also allowing for the monitoring and evaluation of disease development .

[0014] In a first object, the present invention presents a method of generating an action plan for a user in a health management service, comprising the steps of: receiving, by at least one centralization system, user information provided through previously generated form and storage of user information in a database (DB) included in the centralization system; disease risk assessment, through the centralization system, based on user information received; sending the assessed disease risks to at least one health professional access portal; and definition of the user's health action plan, by the health professional, based on the assessed disease risks.

[0015] In a second object, the present invention presents a system generation of an action plan for a user in a health management service comprising a centralization system, provided with a database (DB), communicating at least with a user access tool and with a professional access portal. health, where:

The. the centralization system comprises:

user information provided through a previously generated form;

algorithm for disease risk assessment, based on user information; and

mechanism for updating the action plan defined by the health professional;

B. the health professional's portal comprises a user information entry tool and updated user information; and

ç. the user access tool comprises a visualization tool for action plans.

[0016] In a third object, the present invention presents a method of automatic suggestion of an action plan for a user in a health management service, being implemented in a centralization system, provided with a database (DB), comprising the stages of : receipt, by the centralization system, of user information provided through a previously generated form; disease risk assessment based on user information received, in which disease risk is assessed using previously defined rules; generation of the user's health action plan, based on the assessed disease risks; and sending the health action plan to at least one health professional.

[0017] These and other objects of the invention will be immediately valued by those skilled in the art and will be described in detail below.

Brief Description of the Figures [0018] In order to better define and clarify the content of this patent application, the following figures are presented:

[0019] Figure 1 shows an implementation of a flow for the definition of the user's action plan in a health management service.

[0020] Figure 2 shows another embodiment of a flow for defining the user's action plan in a health management service, considering the health routine being referred to the automatic suggestion stage.

[0021] Figure 3 shows another embodiment of a flow for the definition of the user's action plan in a health management service, considering the medical return stage.

[0022] Figure 4 shows an example of a flow applicability for the definition of the user's action plan.

Detailed Description of the Invention

[0023] The following descriptions are presented by way of example and are not limited to the scope of the invention and will make the object of the present patent application more clearly understood.

[0024] The present invention provides a solution with systems and methods that are implemented, for example, in health management services, allowing a user contracting the service to be better served, since the solution proposed here aims at the health of the user instead of the disease. In this sense, the solution proposed here proposes an action plan for the user aiming at the user's well-being, bringing corrective and / or preventive actions for the user based on their information, in addition to having a specific and / or specialized service according to the necessity.

[0025] In a first object, the present invention presents a method of generating an action plan for a user in a health management service, comprising the steps of: receiving, by at least one centralization system, user information provided through form previously generated and storage of user information in a database (BD) included in the centralization system; disease risk assessment, through the centralization system, based on user information received; sending the assessed disease risks to at least one health professional access portal; and definition of the user's health action plan, by the health professional, based on the assessed disease risks.

[0026] For the purposes of exemplifying the present invention, without limitation to the scope protected by the patent, the term "user information (s)" includes health data and registration data of a user who joins the health management service. In this sense, registration data, in one embodiment, refer to any type of information capable of identifying a user adept at the health management service. In an example that is not limited to the scope of protection of the invention, registration data is of the type: identification data (name, RG, CPF, etc.), location data (residential, commercial, close relatives address, etc.), data biometric (photo, fingerprint, retina identification, iris recognition, typing pattern, etc.), geolocation data captured by a device, etc.

[0027] Furthermore, in one embodiment, health data refer to any type of information related to the health of the user who is adept at the health management service. For purposes of exemplification, in a non-restrictive way to the scope of protection of the invention, health data are of the type: presence of chronic diseases, if you have undergone surgery, health problems in the family, customary and routine actions, life habits, height, weight, different physiological data, etc.

[0028] Thus, initially the user information is provided to the centralization system, where it is obtained by filling out a previously generated health form. The referred health form is composed of questions and fields that direct the user to provide the desired information, so that the centralization system, and the algorithms involved, can perform the respective processing and / or analysis. In one embodiment, said form is a questionnaire that includes questions related to the user's health. Additionally, the questionnaire includes questions related to the user's profile. With this, the said questionnaire aims to obtain, for example, in a clear and simple way, the health data and user registration data. In addition, after filling out the form, the user information obtained is sent to the centralization system and stored in the database (DB).

[0029] In one embodiment, the health form is previously generated by a health professional or by a health specialist and stored in the database (BD). Thus, when integrating the user into the health management service, this form is made available to the user so that he can fill it out and provide his information. In one embodiment, this form is digital and sent to the user from an interaction tool in an electronic application implemented on the user's mobile device, where responses are provided through the mobile device itself. In another embodiment, this form is physical and is filled out manually by the user, in such a way that, later, the user himself or a professional in the health management service is responsible for forwarding this information to the database (BD). In another embodiment, the form is updated based on daily information, for example, updates in the medical field, the emergence of new diseases, etc., where this update can be performed automatically by the centralization system.

[0030] Thus, based on the user information provided, the centralization system performs the risk assessment of diseases, where the centralization system algorithm considers the risks of the user developing certain diseases, that is, from the information of user provided the system is able to identify whether the user already has attributes that can lead him to develop certain diseases. [0031] In one embodiment, the centralization system comprises a calculation engine, or algorithm, that executes rules that have been defined based on medical protocols published in the world literature, for the assessment of disease risks. For example, based on the user's health data, the system calculates the probability of developing some diseases, such as diabetes, hypertension, cardiovascular diseases, etc.

[0032] With this, the risks of diseases assessed by the centralization system are sent to the access portal of the health professional, providing at the same time the calculated risks. In one embodiment, the centralization system sends the risks from a request by the professional through its access portal. For purposes of exemplification, the professional's access portal is any means of interface through which the health professional accesses the centralization system and user information, for example, a web interface, a mobile device application, etc. .

[0033] In one embodiment, in addition to the risks assessed, the health professional also accesses the user information and the completed health form. In this way, the health professional can view the result of the disease risk assessment and check if the results obtained are relevant for the user's analysis and, subsequently, if he understands that the results are not relevant, updates the disease risks evaluated in the database (BD) and the centralization system. In one embodiment, the centralization system comprises a machine learning tool.

[0034] Based on the assessed and validated risks, the health professional is able to define the user's health action plan. The action plan, or a therapeutic plan, defined by the health professional refers to a set of personalized guidelines (or a single one) that is suggested to the user for the treatment or prevention of some disease, where this set of guidelines , for example, can be a sequence of time steps for the user to follow. In one embodiment, the actions is defined by a doctor. In another embodiment, the action plan is defined by a personal physician, who is responsible for managing the user's health, having access to all user information and updating it, storing, for example, in an electronic medical record . In addition, this action plan is updated according to needs viewed by the health professional and, also, from any updates of user information, such as exam results, new medical appointments, etc.

[0035] For the purpose of exemplifying the action plan, without limitations on the scope of the invention, a health professional can recommend a list of guidelines to a user who has diabetes, such as: adequacy of food, carrying out specific tests in a period of time , medical return in a certain period, medication reminders, physical exercise, etc. Still, in the same example, in case the user with diabetes has his or her glycemic index in the desired range, the action plan is updated by the health professional in order to contain preventive actions in an attempt to prevent the index from returning to an abnormal condition . Thus, the present invention makes it possible to model and personify the action plan for each user, based on their past, present and future disease risks.

[0036] In one embodiment, the centralization system additionally performs a step of automatically suggesting the action plan, based on the risks of diseases assessed, and sends this recommended plan to the health professional's access portal. In one embodiment, the centralization system runs an algorithm that systematically suggests an action plan based on the results obtained in the calculation of disease risk. For example, when detecting that the user is at risk for developing a certain disease, the algorithm selects a series of recommended actions for the treatment or monitoring of this disease, from data and known studies stored in the database (BD). [0037] The health professional then receives the action plan recommended by the centralization system and evaluates it in such a way that the health professional can accept this recommended plan, customize the recommended plan or ignore the recommended plan generating a totally personalized one. according to your assessment. In one embodiment, the decision tree algorithm is updated based on the health professional's decision.

[0038] In one embodiment, in addition, the centralization system performs a step of assessing risk factors based on user information provided through the health form. The system then assesses the health risk factors that could become a problem for the user in the future. For purposes of example, risk factors consist of the existence of diseases in the family related to Diabetes, Coronary and Metabolic Diseases.

[0039] Thus, based on the risk factors evaluated, the centralization system automatically generates alerts for the definition of a health routine for the user, based on a developed algorithm. In one embodiment, the centralization system runs an algorithm that issues a series of alerts to a health professional, based on the risk factors assessed on the user's health conditions, where these alerts assist in monitoring the user's health.

[0040] For purposes of example, the health routine comprises a line of actions suggested to the user in an attempt to prevent the development of any disease (s) identified in the risk factor. This line of actions is shared with a health professional who, together with the user, monitors their health and checks whether the suggested line is being followed. In one embodiment, the health routine is sent to a nurse who assists in monitoring the user's health. In one embodiment, the health routine is stored in the user's information and considered in the calculation of the automatic suggestion of the action plan. In another embodiment, the health routine is sent to the personal doctor, where the doctor himself can, according to with your understanding, consider this routine to define the action plan.

[0041] In one embodiment, the generation of the health routine additionally comprises a step of generating preventive actions, for example, indicating vaccines to be taken, medication reminders, climate alerts that can intervene in health, etc.

[0042] In one embodiment, the generation of the routine is performed in parallel or sequentially to the action plan by the centralization system.

[0043] With this, once the action plan and health routine are defined, both are sent and stored in the database (BD), in such a way as to be linked to user information. With this centralization of user information, a health professional has access to the entire clinical and personal profile of the user. In one embodiment, this user information forms an electronic user record.

[0044] Still, in one embodiment, the action plan and health routine are updated based on updated user information. The updated user information is any updates made to the user information history in the health management service, both for registration data and for health data. For the purposes of exemplification, a user is instructed to perform a certain exam and return to the medical consultation, in such a way that the data related to the exam are acquired on medical return and sent to the centralization system. With this, the user information is updated based on the exam data and the medical return data and, thus, the action plan and health routine are updated, if necessary.

[0045] Furthermore, in one embodiment, the user's action plan is updated or redefined with each medical return made by the user.

[0046] In a second object, the present invention presents a system for generating an action plan for a user in a health management service comprising a centralization system, provided with a database (DB), communicating at least with a user access tool and with a health professional access portal.

[0047] For the purposes of the present invention, the centralization system is any computational environment capable of processing, storing, sending and receiving data. In one embodiment, the centralization system is a physical server provided with an interface on which a system administrator is able to access data and manage system configurations. In another embodiment, the centralization system is a cloud server provided with an administrator interface. In another embodiment, the centralization system is a mixed system between a physical server and a cloud server.

[0048] The centralization system receives the user information provided through the health form and stores it in the database (DB), allowing the health professional to consult the user information through its access portal.

[0049] In one embodiment, the centralization system comprises an algorithm for assessing disease risks, based on user information. This algorithm is implemented in the centralization system to execute a sequence of rules that verifies the information provided through the health form and presents an assessment of the risks involved. In one embodiment, the algorithm presents the probabilities that the user will develop certain diseases based on the information provided.

[0050] The assessed risks are stored in the database (BD) linked to user information, in order to be available for access by the health professional. In one embodiment, the assessed risks are stored in the database (BD) and automatically sent to the health professional's access portal, issuing an alert upon receipt.

[0051] Thus, based on the assessed risks, the health professional is able to define the user's action plan and, subsequently, send the plan defined again to the centralization system, where the action plan is stored in the database (DB) and linked to user information.

[0052] The centralization system also comprises a mechanism for updating the action plan defined by the health professional, where this mechanism receives the action plan when it is updated by the health professional and stores the updated action plan in the bank database (BD). In one embodiment, the action plan update mechanism makes a comparison between the previous action plan and the updated action plan and, thus, generates a new file changing only the data that have been updated. In another embodiment, the action plan update mechanism piles up the updated action plans, in order to make it possible to create a history of the user's action plan and store it in the database (DB).

[0053] In one embodiment, the centralization system additionally comprises an algorithm for automatic suggestion of the user's health action plan, where this algorithm receives the health risks assessed and performs decision steps to generate the recommended action plan. This recommended action plan is sent to the health professional to be validated, where the health professional can accept, customize or ignore the recommended action plan.

[0054] In one embodiment, the centralization system additionally comprises an algorithm for assessing risk factors identified in the user information provided through the health form. Said algorithm, in one embodiment, performs a probabilistic assessment of usual factors and / or user history, based on the information provided, and provides the results identified. In addition, the centralization system comprises an algorithm for the automatic generation of the user's health routine, which, based on the risk factors evaluated, generates a line of preventive actions for the user. In one embodiment, the action routine is shared between the user and a nurse, who assists in monitoring of routine actions.

[0055] The health professional's access portal comprises a tool that allows user information to be entered and updated. In one embodiment, the health professional's access portal is a web platform, operable on different types of electronic devices, where the health professional can send and receive data from the centralization system, in addition to being able to use this platform during a consultation with the user.

[0056] The user has an access tool capable of sending and receiving data from the centralization system, where this access tool comprises a tool for viewing the action plan defined by the health professional. In one embodiment, the user access tool is an application, operable on mobile devices, which comprises a series of tools with access to information from the health management service hired by the user. In this application, the user has access to the medical guidelines defined in the action plan and, optionally, has an interface to inform compliance with these guidelines. In one embodiment, the access tool is also operable on a web platform.

[0057] In one embodiment, the action plan visualization tool is a timeline that has all the medical guidelines defined in the action plan. In another embodiment, the action plan visualization tool is a calendar with the guidelines to be followed indicated on the days and, eventually, times indicated by the health professional. In another embodiment, the action plan visualization tool presents a screen with the guidelines defined by the health professional in a sequence of steps, which can be temporal or timeless.

[0058] In a third object, the present invention presents a method of automatic suggestion of action plan for user in management service of health being implemented in a centralization system, provided with a database (DB), comprising the steps of: receiving, through the centralization system, user information provided through a previously generated form; disease risk assessment based on user information received, in which disease risk is assessed using previously defined rules; generation of the user's health action plan, based on the assessed disease risks; and sending the health action plan to at least one health professional.

[0059] In one embodiment, the action plan generation step is performed based on an algorithm that selects a series of recommended actions for the treatment or monitoring of a disease that has been detected in the risks of evaluated diseases. Thus, the algorithm selects from the database (BD) the set of recommendations, which the system has previously been trained, most appropriate for the treatment, monitoring or prevention of the detected disease.

[0060] In one embodiment, the algorithm for generating the action plan is previously trained in a supervised manner considering relevant clinical information, epidemiological data and guidance from specialist doctors. In one embodiment, the database (BD), which is used as the basis for the automatic suggestion algorithm to operate, is updated based on at least one among: user information; updated user information; updated user health data imputed by a health professional; health action plan defined by the health professional; everyday data; or a combination of them. The database update is performed manually or automatically.

Example 1. Care Plan and Care Line in the Health Management Service

[0061] The examples shown here are intended only to exemplify one of the countless ways of carrying out the invention, however without limiting, the scope.

[0062] When joining the plan, the user downloads and installs a health management service application and performs an initial registration providing his registration data, such as name, RG, CPF, address (es), biometric data (which are collected by the user's own mobile device), etc., and enables the user's geolocation function, where the application can automatically inform the user's current location. This location can be used for various purposes, such as indicating hospitals and clinics closest to the user.

[0063] Once this registration is made, the system creates a user profile and, optionally, performs a big data analysis to assess whether there are other profiles linked to the same user. In cases where a user tries to perform more than one type of registration in the unitary registration system described here, the big data analysis is able to identify these multiple registration attempts and cross this user information, generating the profile data for the creation a unique profile for the user subscribed to the health management service. Nevertheless, the creation of a unique user profile allows the creation of a unique electronic medical record for this user.

[0064] With this, the user is provided with a health questionnaire, through the application itself, with questions directed to the evaluation of the user's health, such as age, height, weight, lifestyle, existing known diseases, history of diseases, if you have undergone surgery, surgeries performed, medications currently taken, if you have a disability, etc. When filling in this information, the user completes the form and submits the responses to the centralization system.

[0065] Based on the responses provided, the centralization system executes a sequence of rules that are applied in the responses to assess the risks of diseases that the user has. In this example, the centralization system provides the degree of risk for the user to develop the following diseases: Risk for developing Diabetes (DM), Risk for developing Hypertension (SAH), Risk for developing Cardiovascular Disease (CV), Risk for developing Metabolic diseases and Risk for developing depression. Thus, the rules used in this example were defined based on medical protocols published in the world literature, as indicated in the table below:

Table 1 - Basis for developing rules

[0066] Thus, the following table shows an example with a simulation for assessing the risks for the user to develop diabetes.

Table 2 - Risk for Development of Diabetes

[0067] In the calculation provided in Table 2, the partial risk for each of the parameters is calculated from the multiplication of the "Score" and "OR" values, which are coefficients defined in the literature. Thus, Total Risk is calculated from a sum of partial risks. Having the Total Risk, the algorithm verifies the degree of risk of the user within a scale, which follows: <7 “The risk for you to have type 2 diabetes is very low, in the next 10 years”; 7 - 11 "There is a small risk that you will have type 2 diabetes in the next 10 years."; 12 - 14 “There is a moderate risk that you will have type 2 diabetes in the next 10 years”; 15 - 20 “One in three people with a similar profile to yours will develop type 2 diabetes in the next 10 years.”; > 20 “One in three people with a profile similar to yours already has type 2 diabetes and still has no diagnosis. One in two people with this profile will develop type 2 diabetes in the next 10 years. ”

[0068] Table 3 below shows a simulation for risk assessment to develop hypertension.

Table 3 - Risk for the Development of Hypertension

[0069] In order to determine the user's risk of developing hypertension, the use of equation (1) below is proposed in the literature:

[0070] Where q is obtained using equation (2) below, where b is a tabulated coefficient for each parameter:

[0071] Table 4 below shows a simulation for the definition of risks for developing cardiovascular diseases in men.

Table 4 - Risk for the development of Cardiovascular Diseases

[0072] To calculate the estimated risk of the male user developing cardiovascular diseases in 10 years, the following equation (3) is proposed:

[0073] In addition, a simulation was also carried out to define the risks of a user developing metabolic diseases, as indicated in the table below.

Table 5 - Risk of Development of Metabolic Diseases

[0074] In Table 5, the indices in the Results are based on the user's responses, which relate to the fact that the user has answered whether or not he has that parameter. The responses for the parameters grouped according to the relationship between them are added and, based on the sum, a conclusion is reached if the user presents criteria for metabolic syndrome.

[0075] In addition, a questionnaire is also proposed to assess the risk of the user developing depression, where in this example the questionnaire used was based on the PHQ-9, as indicated in the table below:

Table 6 - Risk of Depression Development

[0076] Thus, based on the answers provided by the user, a summation of the daily frequencies in which the user felt those symptoms related to depression is performed. From this sum, the degree of depression of the user is evaluated, being in this example: 0 = "No signs of depression"; <5 = "Minimal Depression"; <10 = “Mild Depression”; <15 = "Moderate Depression"; <20 = "Moderately Severe Depression"; otherwise “Severe Depression”. In addition, the system is also able to verify, from the responses, if the user has major depression or another depressive disorder.

[0077] As can be noted, the parameters indicated in the tables are responses provided by the user in the health questionnaire. In addition, these calculations can consider the results of examination data obtained later.

[0078] After calculating the risks, the user is directed to a first consultation with the personal physician, who is the physician responsible for carrying out the health management of this user during the term of the health management service. The doctor accesses the risks of evaluated diseases and defines a care plan / therapeutic plan for the user, containing guidelines for treating or preventing any of these evaluated diseases, in addition to scheduling routine tests to check the current condition of the user. In the first consultation, the personal physician is already able to define the risk-related care plan for developing Diabetes (DM) according to the medical criteria, suggesting a sequence of guidelines for the user, in case the patient has diabetes or a high degree of risk to develop this disease. As for the care plan for Hypertension (SAH) and Cardiovascular Disease (CV), the personal physician directs the user to perform specific tests or awaits the results of the routine tests scheduled to conclude the degree of risk of developing these diseases. Thus, in a return visit, with the results of the examination, the personal physician is able to define the care plan for Hypertension (SAH) and Cardiovascular Disease (CV).

[0079] Furthermore, at each user visit to the personal physician, also scheduled and defined in the generated care plan, the care plan is redesigned according to the patient's clinical evolution.

[0080] The user, through his application, can view all consultations or exams requested by the doctor, either by the personal doctor or by a specialist doctor. The management of the examinations and consultations provided for in the user's care plan, but pending a request, are viewed only by the personal physician in the user's electronic medical record, avoiding any type of confusion by the user.

[0081] At the same time, the centralization system also calculates and evaluates the user's health risk factors, even if it presents a low risk of develop the diseases mentioned above, that is, if the user does not present evident risks to develop these diseases, but has a family history that may become a trend in the future. These risk factors are also assessed using an algorithm implemented in the centralization system. This algorithm checks the health questionnaire fields that are related to the user's family history and, based on the answers, highlights these factors to the centralization system.

[0082] In the case of the existence of such risk factors, the system generates one or a series of alerts to a nurse who is responsible for monitoring the user's health. Thus, this nurse, based on the care plan defined by the personal doctor, creates in the centralization system a line of care for monitoring the health of the user, in which they understand the nurse's tasks, such as asking the client to schedule an appointment. consultation with a personal doctor every 6 months, in this example, when it comes close to the end of the six-month period, if there is no appointment scheduled for this patient with the personal doctor, the system alerts the nurse, who in turn must enter into contact the patient for a health assessment and then decide whether to schedule an appointment with the personal physician.

[0083] This line of care is available both in the patient's application and in a portal where a nurse has access, where routine actions are shared between both. For example, if a user has a family history of a disease, but does not have any apparent risk of developing it, this line of care is designed for monitoring, proposing specific tests at a pre-defined interval, in addition to routine actions , such as improvements in eating habits, physical exercise, etc.

[0084] Optionally, the care line also has a risk prevention mechanism and a health promotion mechanism, which operate based on risk factors. This risk prevention mechanism allows the user to receive information relevant to health prevention, for example, by sending processed data about alert regions to which the user can pass, infections, epidemiology data, food tips, healthy behavior tips, vaccine reminders, etc. The risk prevention mechanism is also associated with the user's application to capture georeferencing data through, for example, the GPS system. With the information from the GPS, the mechanism allows the user to indicate regions close to him to carry out health prevention actions, such as, for example, indicating places for the application of a vaccine against epidemiological diseases.

[0085] The health promotion mechanism presents health tips to the user, for example, indicating about running or walking events that occur close to him. Also, in cases where the user is part of groups of people, for example, in social networks, who go through the same health conditions as him, the promotion mechanism monitors the group as a whole, promoting actions to improve the habit of health of these people.

[0086] The information obtained in the generation of the care line can also be accessed by the personal doctor and, if necessary, can be considered in the definition of the care plan. Thus, both the care plan and the care line are stored in the database and linked to user information.

[0087] Automatic suggestion of the care plan

[0088] In another example, the centralization system suggests to the personal doctor a care plan based on the assessed disease risks. Observing the degrees of risk for the user to develop diseases such as Diabetes (DM), Hypertension (SAH) and Cardiovascular Diseases (CV) and the user's health data, the algorithm assesses whether the user already has attributes that can lead him to develop certain diseases, such as weight, age, lifestyle, etc. [0089] Based on this, the algorithm selects a series of recommended actions for the treatment or monitoring of a disease that has been detected in the risks of diseases evaluated. Thus, the algorithm selects from the database (BD) the set of recommendations, which the system has previously been trained, most appropriate for the treatment, monitoring or prevention of the detected disease. For example, in case the user is at risk of developing diabetes, a series of actions for the prevention or treatment of diabetes is already known and stored in the database (BD), with this, the algorithm selects these actions and indicates to the personal doctor .

[0090] Table 7 below indicates an example of a care plan, containing therapeutic goals, for a user who has diabetes mellitus 2.

Table 7 - Care plan for users with diabetes

[0091] As illustrated in figure 1, the care plan recommended by the centralization system is sent to the personal physician. With this, the personal doctor can accept the recommended plan, customize the recommended plan including or excluding consultations and exams, or the personal doctor can ignore the system's suggestion and set up a fully personalized care plan according to his own evaluation after physical exams.

[0092] In figure 2, it is proposed, alternatively, that the centralization system consider the results of the health routine defined in the line of care for a new calculation and, with this, improve the suggestion of the care plan.

[0093] Figure 3 considers the data obtained in the medical return, such as the examination data or any additional information that the personal physician has identified, providing an update of the user's information. Thus, based on the updated user information, the centralization system calculates and suggests a new care plan for the user and sends it to the personal physician. This flow makes it possible to recalculate the risks of diseases at each user's medical visit and, consequently, the recommended care plan is recalculated, allowing the personal physician to replan the care plan, if necessary.

[0094] In the same direction, figure 4 illustrates a flow for the definition of the user care plan considering the risks of developing Diabetes (DM), Hypertension (SAH) and Cardiovascular Diseases (CV), where in a first consultation the doctor is already able to provide a care plan for the risk of developing Diabetes (DM) ). For Hypertension (SAH) and Cardiovascular Diseases (CV) the personal physician requests the user to perform specific tests and, based on the results of these tests that are sent to the database (BD), the centralization system suggests and sends the doctor the care plan for Hypertension (SAH) and for Cardiovascular Diseases (CV), so that the personal physician can define the respective care plans.

[0095] Those skilled in the art will value the knowledge presented here and will be able to reproduce the invention in the modalities presented and in other variants, covered by the scope of the attached claims.

Claims

1. Method of generating an action plan for a user in a health management service, characterized by the fact of understanding the steps of:

The. receiving, by at least one centralization system, user information provided through a previously generated form and storing user information in a database (BD) included in the centralization system;

B. disease risk assessment, through the centralization system, based on user information received;

ç. sending the assessed disease risks to at least one health professional access portal; and

d. definition of the user's health action plan, by the health professional, based on the risks of diseases assessed.

2. User action plan generation method, according to claim 1, characterized by the fact that it additionally comprises the steps of:

The. assessment of risk factors, by the centralization system, based on user information received;

B. automatic generation of risk factor alerts, based on the risk factors assessed;

ç. sending alerts to a health professional access portal and defining the health routine by the health professional.

3. User action plan generation method, according to claim 1, characterized by the fact that it additionally comprises the steps of:

The. automatic suggestion of the user's health action plan, through the centralization system, based on the assessed disease risks; and b. sending the recommended health action plan to the health professional access portal.

4. User action plan generation method, according to claims 1 and 2, characterized by the fact that the action plan and the health routine are sent to the database (BD).

5. User action plan generation method, according to claim 4, characterized by the fact that the action plan and the health routine are updated based on updated user information.

6. Action plan generation system for users in health management services, characterized by a centralization system, provided with a database (DB), communicating at least with a user access tool and with a portal health professional access, where:

The. the centralization system comprises:

user information provided through a previously generated form;

algorithm for disease risk assessment, based on user information; and

mechanism for updating the action plan defined by the health professional;

B. the health professional's access portal includes a user information entry tool and updated user information; and

ç. the user access tool comprises a visualization tool for action plans.

7. User action plan generation system, according to claim 6, characterized by the fact that the centralization system additionally comprises at least one among:

algorithm for assessing risk factors, based on user information received, and algorithm for automatic generation of alerts for the definition of user health routine, based on the risk factors evaluated; algorithm for automatic suggestion of the user's health action plan, based on the assessed disease risks; or

a combination between them.

8. Method of automatic suggestion of an action plan for a user in a health management service, characterized by being implemented in a centralization system, provided with a database (DB), comprising the steps of:

The. receiving, through the centralization system, user information provided through a previously generated form;

B. disease risk assessment based on user information received, in which disease risk is assessed using previously defined rules;

ç. generation of the user's health action plan, based on the assessed disease risks; and

d. sending the health action plan to at least one health professional.

9. Method of automatic suggestion of user action plan, according to claim 8, characterized by the fact that the user's health action plan is generated based on an algorithm that selects actions, based on the risks for evaluated diseases, in which the actions are previously stored in the database (BD).

10. Method of automatic suggestion of an action plan for the user, according to claim 9, characterized by the fact that it comprises a step for updating the actions in the database (BD) based on at least one among:

user information;

updated user information;

updated user health data imputed by a health professional;

health action plan defined by the health professional; everyday data; or

a combination between them.