Using predictive models to continuously update a treatment plan for a patient in a health care location

• US 20060271407A1
• Filed: 05/31/2006
• Published: 11/30/2006
• Est. Priority Date: 06/23/1999
• Status: Active Grant

• Current Assignee: Visicu Incorporated (Koninklijke Philips N.V.)
• Original Assignee: Visicu Incorporated (Koninklijke Philips N.V.)
• Inventors: Breslow, Michael, Rosenfeld, Brian A.
• Granted Patent: US 7,395,216 B2
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: A61B 5/002 Monitoring the patient using a local or closed circuit, e.g. in a room or building A61B5/0017 takes precedence
• CPC Class Codes: A61B 5/0022 Monitoring a patient using a global network, e.g. telephone networks, internet
• CPC Class Codes: A61B 5/0205 Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
• CPC Class Codes: A61B 5/412 Detecting or monitoring sepsis
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G08B 21/0476 Cameras to detect unsafe condition, e.g. video cameras
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 70/20 relating to practices or guidelines

Abstract

A system for determining a treatment plan for a patient comprises a database of patient data elements indicative of a medical condition associated with a patient. A predictive model is applied to patient assessment data and used to prepare a treatment plan. A rules engine applies a patient rule consistent with the treatment plan to selected data elements stored in the database to produce an output indicative of a change in the medical condition of the patient. The output from the rules engine is used to determine if intervention is warranted. The predictive model is applied continuously to determine whether to update the treatment plan and, if necessary, the patient rule.

Claims

1. A system for determining a treatment plan for a patient comprising:

a network;

a datastore accessible via the network, wherein the datastore comprises assessment data elements indicative of a medical condition associated with the patient;

a decision support system connected to the network and comprising a software module,

wherein the software module is adapted for;

continuously applying a predictive model to a first set of selected assessment data elements to produce current health measures for the patient; and

utilizing the health measures to produce a treatment plan for the patient, wherein the treatment plan is continuously updated based on the current health measures; and

a rules generator connected to the network, wherein the rules generator is adapted for establishing a patient-specific rule consistent with the treatment plan for the patient; and

a rules engine connected to the network, wherein the rules generator is adapted for;

applying the patient specific rule to a second set of selected assessment data elements;

determining whether the patient-specific rule for the patient has been contravened; and

issuing an alert if the patient-specific rule for the patient has been contravened.

2. The system of claim 1, wherein the predictive model is selected from the group consisting of an APACHE II algorithm;

an APACHE III algorithm;

a history of present illness (HPI) algorithm;

a review of systems (ROS) algorithm;

a past, family, and/or social history (PFSH) algorithm;

a Sequential Organ Failure Assessment (SOFA) model, and a mortality prediction model (MPM) algorithm.

3. The system of claim 1, wherein the predictive model comprises a guideline selected from the list consisting of:

Acalculous Cholecystitis, Acute Pancreatitis Algorithms, Acute Renal Failure-Diagnosis, Acute Renal Failure-Management &

Treatment, Adrenal Insufficiency. Agitation and Anxiety, Depression &

Withdrawal, Aminoglycoside Dosing and Therapeutic Monitoring, an Amphotericin-B Treatment Guidelines, Analgesia, Antibiotic Classification &

Costs, Antibiograms Algorithm, Antibiotic associated Colitis Algorithm, ARDS;

Hemodynamic Management, ARDS;

Steroid Use, ARDS;

Ventilator Strategies, Asthma, Bleeding Patient, Bloodstream Infections, Blunt Cardiac Injury, Bradyarrhythmias, Brain Death, Bronchodilator Use in Ventilator Patients, Bronchoscopy &

Thoracentesis Guidelines, Candiduria, Cardiogenic Shock, CardioPulmonary Resuscitation Guideline, Catheter Related Septicemia, a Catheter Replacement Strategies, Cervical Cord Injury, Congestive Heart Failure, COPD Exacerbation &

Treatment, CXR (Indications), Dealing with Difficult patients and families, Diabetic Ketoacidosis, Dialysis, Diuretic Use, Drug Changes with Renal Dysfunction, Emergency Cardiac Pacing, Endocarditis Diagnosis and Treatment, Endocarditis Prophylaxis, End of Life Decisions, Endotracheal Tubes &

Tracheotomy, Ethical Guidelines, Febrile Neutropenia, FUO, Fluid Resuscitation, Guillain-Barre Syndrome, Heparin, Heparin-Induced Thrombocytopenia, Hepatic Encephalopathy, Hepatic Failure, HIV+Patient Infections, Hypercalcemia Diagnosis and Treatment, Hyperglycemia Insulin Treatment, Hyperkalemia;

Etiology &

Treatment, Hypematremia;

Etiology &

Treatment, Hypertensive Crisis, Hypokalemia;

Etiology &

Treatment, Hyponatremia;

Etiology &

Treatment, Hypothermia, Identification of Cervical Cord Injury, Implantable Cardio-defibrillator, Intra-Aortic Balloon Device, Intracerebral Hemorrhage, Latex Allergy, Magnesium Administration, Management of Hypotension, Inotropes, Management of Patients with Ascites, Empiric Meningitis, Meningitis, a Myasthenia Gravis, Myocardial Infarction, Myocardial Infarction with left bundle branch block, Necrotizing Soft Tissue Infections, Neuromuscular Blockers, Neuromuscular Complications of Critical Illness, Non-Infectious Causes of Fever, Non-Traumatic Coma, Noninvasive Modes of Ventilation, Nutritional Management, Obstetrical Complication, Oliguria, Open Fractures, Ophthalmic Infections, Organ Procurement Guidelines, PA Catheter Guideline and Troubleshooting, Pancreatitis, Penetrating Abdominal Injury, Penetrating Chest Injury, Penicillin Allergy, Permanent Pacemaker and Indications, Pneumonia Community Acquired, Pneumonia Hospital Acquired, Post-Op Bleeding, Post-Op Hypertension, Post-Op Management of Abdominal Post-Op Management of Carotid, Post-Op Management of Open Heart, Post-Op Management of Thoracotomy, Post-Op Myocardial Ischemia (Non-Cardiac Arrhythmias after Cardiac Surgery), Post-Op Power Weaning, Pressure Ulcers, Pulmonary Embolism Diagnosis, Pulmonary Embolism Treatment, Respiratory Isolation, Sedation, Seizure, Status Epilepticus, Stroke, Sub-Arachnoid Hemorrhage, Supra-Ventricular Tachyarrhythmi a, Supra-Ventricular Tachycardi a, Wide Complex QRS Tachycardia, Therapeutic Drug Monitoring, Thrombocytopenia, Thrombolytic Therapy, Transfusion Guidelines, Traumatic Brain Injury, Assessment of Sedation, Sedation, Septic Shock, Bolus Sliding, Scale Midazolam, Short Term Sedation Process, Sinusitis, SIRS, Spinal Cord Injury, Steroid Replacement Strategy, Thyroid Disease, Transplant Infection Prophylaxis, Transplant Related Infections, Treatment of Airway Obstruction, Unknown Poisoning, Unstable Angina, Upper GI Bleeding Stress Prophylaxis, Vancomycin, Upper GI Bleeding Non-Variceal, Upper GI Bleeding Variceal, Use of Hematopoietic Growth Factors, Ventilator Weaning, Ventilator Weaning Protocol, Venous Thrombosis Diagnosis and Treatment, Venous Thromboembolism Prophylaxis, Ventricular Arrhythmia, Warfarin, Warfarin Dosing, and Wound Healing Strategies.

4. The system of claim 1, wherein the decision support system, the rules generator and rules engine are located within a command center and wherein the patient is located at a healthcare location that is remote from the command center.

5. The system of claim 4, wherein the command center is adapted for monitoring a plurality of patients in a plurality of geographically dispersed health cared locations 24 hours per day 7 days per week

6. The system of claim 1, wherein the patient specific rule is applied continuously.

7. The system of claim 1, wherein the alert comprises an instruction to revise the treatment plan.

8. The system of claim 1, wherein the current health measures are indicative of applying medical treatment resources to the patient and wherein the treatment plan comprises applying medical treatment resources to the patient consistent with the medical condition.

9. The system of claim 1, wherein the current health measures are indicative of denying medical treatment resources to the patient, and wherein the treatment plan comprises treating the patient consistent with standards of medical ethics.

10. The system of claim 1, wherein the current health measures are indicative of denying medical treatment resources to the patient, and wherein the treatment plan is modified to withhold further medical treatment resources from the patient and to treat the patient consistent with standards of medical ethics.

11. The system of claim 1, wherein the patient-specific rule for the patient comprises an algorithm.

12. The system of claim 1, wherein the second set of selected assessment data elements comprises a physiological data element of the patient and a clinical data element of the patient.

13. The system of claim 1, wherein the second set of selected assessment data elements comprises a physiological data element of the patient and a medication data element of the patient.

14. The system of claim 1, wherein the second set of selected assessment data elements comprises a physiological data element of the patient and a laboratory data element of the patient.

15. The system of claim 1, wherein the second set of selected assessment data elements comprises a clinical data element of the patient and a laboratory data element of the patient.

16. The system of claim 1, wherein the second set of selected assessment data elements comprise a physiological data element of the patient and another physiological data element of the patient.

17. The system of claim 1, wherein the second set of selected assessment data elements comprises at least two data elements of the patient selected from the group consisting of a physiological data element, a clinical data element of the patient, a medication data element of the patient, and a laboratory data element of the patient.

18. The system of claim 1, wherein the alert comprises a patient intervention protocol and order.

19. The system of claim 1, wherein the rules engine is further adapted for:

determining whether the patient requires monitoring by the remote command center; and

issuing a stop monitoring order in the event the patient does not require monitoring by the remote command center.

20. The system of claim 1, wherein the network is selected from the group consisting of a wired network, a wireless network, a satellite network, a public switched telephone network, an IP network, a packet switched network, a cell phone network, a cable network, and a coax network, a hybrid fiber coax network.

21. A method for determining a treatment plan for a patient comprising:

accessing a first set of assessment data elements indicative of a medical condition associated with the patient;

continuously applying a predictive model to a first set of selected assessment data elements to produce current health measures for the patient; and

utilizing the health measures to produce a treatment plan for the patient, wherein the treatment plan is continuously updated based on the current health measures; and

establishing a patient-specific rule consistent with the treatment plan for the patient;

applying the patient-specific rule to a second set of selected assessment data elements;

determining whether the patient-specific rule for the patient has been contravened; and

issuing an alert if the patient-specific rule for the patient has been contravened.

22. The method for determining a treatment plan for a patient of claim 21, wherein the predictive model is selected from the group consisting of an APACHE II algorithm;

an APACHE III algorithm;

a history of present illness (HPI) algorithm;

a review of systems (ROS) algorithm;

a past, family, and/or social history (PFSH) algorithm; and

a mortality prediction model (MPM) algorithm.

23. The method for determining a treatment plan for a patient of claim 21, wherein the predictive model comprises a guideline selected from the list consisting of:

Acalculous Cholecystitis, Acute Pancreatitis Algorithms, Acute Renal Failure-Diagnosis, Acute Renal Failure-Management &

Treatment, Adrenal Inisufficiency. Agitation and Anxiety, Depression &

Withdrawal, Aminoglycoside Dosing and Therapeutic Monitoring, an Amphotericin-B Treatment Guidelines, Analgesia, Antibiotic Classification &

Costs, Antibiograms Algorithm, Antibiotic associated Colitis Algorithm, ARDS;

Hemodynamic Management, ARDS;

Steroid Use, ARDS;

Ventilator Strategies, Asthma, Bleeding Patient, Bloodstream Infections, Blunt Cardiac Injury, Bradyarrhythmias, Brain Death, Bronchodilator Use in Ventilator Patients, Bronchoscopy &

Thoracentesis Guidelines, Candiduria, Cardiogenic Shock, CardioPulmonary Resuscitation Guideline, Catheter Related Septicemia, a Catheter Replacement Strategies, Cervical Cord Injury, Congestive Heart Failure, COPD Exacerbation &

Treatment, CXR (Indications), Dealing with Difficult patients and families, Diabetic Ketoacidosis, Dialysis, Diuretic Use, Drug Changes with Renal Dysfunction, Emergency Cardiac Pacing, Endocarditis Diagnosis and Treatment, Endocarditis Prophylaxis, End of Life Decisions, Endotracheal Tubes &

Tracheotomy, Ethical Guidelines, Febrile Neutropenia, FUO, Fluid Resuscitation, Guillain-Barre Syndrome, Heparin, Heparin-Induced Thrombocytopenia, Hepatic Encephalopathy, Hepatic Failure, HIV+Patient Infections, Hypercalcemia Diagnosis and Treatment, Hyperglycemia Insulin Treatment, Hyperkalemia;

Etiology &

Treatment, Hypernatremia;

Etiology &

Treatment, Hypertensive Crisis, Hypokalemia;

Etiology &

Treatment, Hyponatremia;

Etiology &

Treatment, Hypothermia, Identification of Cervical Cord Injury, Implantable Cardio-defibrillator, Intra-Aortic Balloon Device, Intracerebral Hemorrhage, Latex Allergy, Magnesium Administration, Management of Hypotension, Inotropes, Management of Patients with Ascites, Empiric Meningitis, Meningitis, a Myasthenia Gravis, Myocardial Infarction, Myocardial Infarction with left bundle branch block, Necrotizing Soft Tissue Infections, Neuromuscular Blockers, Neuromuscular Complications of Critical Illness, Non-Infectious Causes of Fever, Non-Traumatic Coma, Noninvasive Modes of Ventilation, Nutritional Management, Obstetrical Complication, Oliguria, Open Fractures, Ophthalmic Infections, Organ Procurement Guidelines, PA Catheter Guideline and Troubleshooting, Pancreatitis, Penetrating Abdominal Injury, Penetrating Chest Injury, Penicillin Allergy, Permanent Pacemaker and Indications, Pneumonia Community Acquired, Pneumonia Hospital Acquired, Post-Op Bleeding, Post-Op Hypertension, Post-Op Management of Abdominal Post-Op Management of Carotid, Post-Op Management of Open Heart, Post-Op Management of Thoracotomy, Post-Op Myocardial Ischemia (Non-Cardiac Arrhythmias after Cardiac Surgery), Post-Op Power Weaning, Pressure Ulders, Pulmonary Embolism Diagnosis, Pulmonary Embolism Treatment, Respiratory Isolation, Sedation, Seizure, Status Epilepticus, Stroke, Sub-Arachnoid Hemorrhage, Supra-Ventricular Tachyarrhythmia, Supra-Ventricular Tachycardia, Wide Complex QRS Tachycardia, Therapeutic Drug Monitoring, Thrombocytopenia, Thrombolytic Therapy, Transfusion Guidelines, Traumatic Brain Injury, Assessment of Sedation, Sedation, Septic Shock, Bolus Sliding, Scale Midazolam, Short Term Sedation Process, Sinusitis, SIRS, Spinal Cord Injury, Steroid Replacement Strategy, Thyroid Disease, Transplant Infection Prophylaxis, Transplant Related Infections, Treatment of Airway Obstruction, Unknown Poisoning, Unstable Angina, Upper GI Bleeding Stress Prophylaxis, Vancomycin, Upper GI Bleeding Non-Variceal, Upper GI Bleeding Variceal, Use of Hematopoietic Growth Factors, Ventilator Weaning, Ventilator Weaning Protocol, Venous Thrombosis Diagnosis and Treatment, Venous Thromboembolism Prophylaxis, Ventricular Arrhythniia, Warfarin, Warfarin Dosing, and Wound Healing Strategies.

24. The method for determining a treatment plan for a patient of claim 21, wherein the steps are performed by a command center and wherein the patient is located at a healthcare location that is remote from the command center.

25. The method for determining a treatment plan for a patient of claim 24, further comprising monitoring a plurality of patients in a plurality of geographically dispersed health cared locations 24 hours per day 7 days per week

26. The method for determining a treatment plan for a patient of claim 21, wherein applying the patient-specific rule to a second set of selected assessment data elements comprises applying the patient-specific rule to a second set of selected assessment data elements patient specific rule continuously.

27. The method for determining a treatment plan for a patient of claim 21, wherein the alert comprises an instruction to revise the treatment plan.

28. The method for determining a treatment plan for a patient of claim 21, wherein the current health measures are indicative of applying medical treatment resources to the patient and wherein the treatment plan comprises applying medical treatment resources to the patient consistent with the medical condition.

29. The method for determining a treatment plan for a patient of claim 21, wherein the current health measures are indicative of denying medical treatment resources to the patient, and wherein the treatment plan comprises treating the patient consistent with standards of medical ethics.

30. The method for determining a treatment plan for a patient of claim 21, wherein the current health measures are indicative of denying medical treatment resources to the patient, and wherein the treatment plan is modified to withhold further medical treatment resources from the patient and to treat the patient consistent with standards of medical ethics.

31. The method for determining a treatment plan for a patient of claim 21, wherein the patient-specific rule for the patient comprises an algorithm.

32. The method for determining a treatment plan for a patient of claim 21, wherein the second set of selected assessment data elements comprises a physiological data element of the patient and a clinical data element of the patient.

33. The method for determining a treatment plan for a patient of claim 21, wherein the second set of selected assessment data elements comprises a physiological data element of the patient and a medication data element of the patient.

34. The method for determining a treatment plan for a patient of claim 21, wherein the second set of selected assessment data elements comprises a physiological data element of the patient and a laboratory data element of the patient.

35. The method for determining a treatment plan for a patient of claim 21, wherein the second set of selected assessment data elements comprises a clinical data element of the patient and a laboratory data element of the patient.

36. The method for determining a treatment plan for a patient of claim 21, wherein the second set of selected assessment data elements comprises a physiological data element of the patient and another physiological data element of the patient.

37. The method for determining a treatment plan for a patient of claim 21, wherein the second set of selected assessment data elements comprises at least two data elements of the patient selected from the group consisting of a physiological data element, a clinical data element of the patient, a medication data element of-the patient, and a laboratory data element of the patient.

38. The method for determining a treatment plan for a patient of claim 21, wherein the alert comprises a patient intervention protocol and order.

39. The method for determining a treatment plan for a patient of claim 21, the method further comprising:

making a determination whether the patient requires monitoring by the remote command center; and

in the event the patient does not require monitoring by the remote command center, issuing a release protocol and order.