Checklist-based flow and tracking system for patient care by medical providers
First Claim
1. A method of converting evidence-based clinical decision support guidelines into a prescriptive patient-specific checklist of actions to satisfy process and outcome requirements for care of a specific diagnosis and episode of illness comprising:
- deconstructing a guideline into its constituent symptom, physical exam finding, test, or treatment datum inputs;
subjecting each datum input to Bayesian test characteristic analysis using, when available, the sensitivity and specificity of each datum input with respect to a suspected medical condition, and the prior probability of the suspected medical condition, and calculating post-test probability of a positive or negative result for each datum input;
based upon the test characteristic analysis, creating plurality of protocols, each protocol associated with a prior probability of a patient'"'"'s diagnosis, each protocol representing the optimal number and sequence of datum inputs for the care of the clinical condition through to resolution; and
based on the protocols, extracting the datum input or combination of datum inputs at each decision step of the guideline, and constructing its medical representation, the totality of the medical representations constituting the checklist.
4 Assignments
0 Petitions
Accused Products
Abstract
Interactive methods and systems for directing, integrating, documenting, and tracking steps taken by medical providers during the process of care for a patient'"'"'s given condition. Doctors'"'"' actions are directed by a prescriptive protocol - a checklist of discrete steps designed for efficient or optimal care of an individual patient'"'"'s specific condition. The step-by-step checklist is abstracted from decision tree guidelines for the optimal work up and treatment for the condition using probability-based methodology. The care protocols can be derived from widely available and non-proprietary guidelines and decision trees based on public medical research literature.
In one embodiment, the invention can be employed by a primary care clinician at the point of referral into the specialist sector, and at the specialist level when proposing a risky or expensive or otherwise problematic medical or surgical diagnostic or treatment intervention. At these two critical transaction points in care, the checklist functions like a lock, based on a hidden clinical decision algorithm (an explanation of which can be displayed upon request). The system asks the clinician for data and then generates the patient'"'"'s optimal checklist, displaying it as a point and click form keyed to the stage of care being undertaken by each doctor. As the clinician enters data into the checklist, a decision engine determines whether the checklist data satisfies predetermined criteria for authorization of the proposed action. The system can also document each transaction taken in the process of care to create an electronic record that can be made accessible to all clinicians involved in the process of care.
-
Citations
83 Claims
-
1. A method of converting evidence-based clinical decision support guidelines into a prescriptive patient-specific checklist of actions to satisfy process and outcome requirements for care of a specific diagnosis and episode of illness comprising:
-
deconstructing a guideline into its constituent symptom, physical exam finding, test, or treatment datum inputs;
subjecting each datum input to Bayesian test characteristic analysis using, when available, the sensitivity and specificity of each datum input with respect to a suspected medical condition, and the prior probability of the suspected medical condition, and calculating post-test probability of a positive or negative result for each datum input;
based upon the test characteristic analysis, creating plurality of protocols, each protocol associated with a prior probability of a patient'"'"'s diagnosis, each protocol representing the optimal number and sequence of datum inputs for the care of the clinical condition through to resolution; and
based on the protocols, extracting the datum input or combination of datum inputs at each decision step of the guideline, and constructing its medical representation, the totality of the medical representations constituting the checklist. - View Dependent Claims (2, 3, 4)
-
-
5. A method of managing a patient'"'"'s episode of specialist care through using a temporary, integrated medical episode record that is based upon an algorithmically constructed checklist that specifies and tracks decisions about care comprising:
-
at a referring user interface, selecting a medical specialty;
from a data base, based on the selected medical specialty, returning to the referring user interface a set of condition-specific queries for patient information, the patient information comprising at least one of symptoms, physical exam finding, tests, or treatment data;
at the user interface inputting patient information in response to the queries;
at the data base, receiving the patient information and, based on decision logic, determining the patient'"'"'s probability of a medical condition and comparing this probability to a threshold probability for authorizing or refusing referral to a specialist within the selected medical specialty. - View Dependent Claims (6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25)
-
-
26. A patient referral management data processing system, comprising:
-
a referring user interface by which a medical practitioner identifies a specialty to which he intends to refer a patient and inputs patient information; and
a referral data base process which, based on the selected specialty, returns to the referring user interface a set of condition-specific queries for patient information, the patient information comprising at least one of symptoms, physical exam findings, tests, or treatment data, and, based upon the patient information entered at the referring user interface, determines the patient'"'"'s probability of a medical condition and compares this probability to a threshold probability for authorizing or refusing authorization for a referral to a specialist within the selected medical specialty. - View Dependent Claims (27, 28, 29)
-
-
30. A procedure approval data processing system wherein the intended action is a specialist clinical procedure comprising:
-
a specialist user interface by which a specialist identifies an intended procedure for which he seeks approval and inputs patient information;
a procedure approval data base process which, based on the selected procedure, returns to the referring user interface a set of condition-specific queries for patient information, the patient information comprising at least one of symptoms, physical exam findings, tests, or treatment data, and, based upon the patient information entered at the specialist user interface, determines the patient'"'"'s probability of a medical condition and compares this probability to a threshold probability for authorizing or refusing authorization for the selected procedure. - View Dependent Claims (31, 32, 33)
-
-
34. A method of managing an episode of medical care in a data processing system, comprising:
-
at a user interface, selecting a proposed medical action;
from a database, based upon the selected medical action, returning an interactive checklist of data points for the episode of care, the data points comprising representations of decision nodes of an evidence-based clinical decision support guideline associated with the proposed medical action;
at the user interface, inputting data into a data point of the checklist;
using the data input for the data point, calculating a probability of a medical condition associated with the proposed medical action based upon a prior probability of the condition, the sensitivity of the data point with respect to the condition, and the specificity of the data point with respect to the condition;
comparing the calculated probability of the medical condition to a pre-determined threshold probability of the condition that is associated with the proposed medical action; and
based upon the comparison, authorizing the proposed medical action, refusing authorization of the proposed medical action, or requesting additional data input into the checklist. - View Dependent Claims (35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55)
-
-
56. A medical care data management system comprising:
-
a user interface by which a physician proposes a medical action;
an interactive checklist of data points for the episode of care, the data points comprising representations of decision nodes of an evidence-based clinical decision support guideline associated with the proposed medical action, the checklist permitting the input of data into the data points via the user interface;
a database process which, based on the selected medical action, returns the checklist to the user interface, uses data input into a data point of the checklist to calculate the probability of a medical condition associated with the proposed medical condition, the probability calculation being based upon a prior probability of the condition, the sensitivity of the data point with respect to the condition, and the specificity of the data point with respect to the condition, compares the calculated probability of the medical condition to a pre-determined threshold probability, based upon the comparison, authorizes the proposed medical action, refuses authorization of the proposed medical action, or requests additional data input into the checklist. - View Dependent Claims (57, 58, 59, 60, 61, 62, 63, 64, 65, 66, 67, 68, 69, 70, 71, 72)
-
-
73. A method of managing an episode of medical care in a data processing system, comprising:
-
at a referring user interface, selecting a medical specialty and inputting patient information;
at a database, receiving the selected medical specialty and the patient information, and determining an initial prior probability of a medical condition associated with the selected medical specialty;
from the database, based upon the initial prior probability, returning to the user interface an interactive checklist of data points for the episode of care, the data points comprising representations of decision nodes of an evidence-based clinical decision support guideline associated with the medical specialty;
at the user interface, inputting data into a data points of the checklist; and
at the database, using the data input into the data points of the checklist to determine whether a referral to a specialist physician is authorized. - View Dependent Claims (74, 75, 76, 77, 78, 79, 80, 81, 82, 83)
-
Specification