ARBITER SYSTEM AND METHOD OF COMPUTERIZED MEDICAL DIAGNOSIS AND ADVICE

• US 20090007924A1
• Filed: 04/30/2008
• Published: 01/08/2009
• Est. Priority Date: 04/30/2007
• Status: Abandoned Application

• Current Assignee: Clinical Decision Support, LLC (Tivity Health, Inc.)
• Original Assignee: Clinical Decision Support, LLC (Tivity Health, Inc.)
• Inventors: Iliff, Edwin C.
• Application Number:
  US12/113,132
• Publication Number:
  US 20090007924A1
• Time in Patent Office: Days
• US Class Current: 128/898
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• 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

Abstract

A computerized medical diagnostic system and method is described. A computer storage stores a list of candidate disease objects, where each disease object is associated with one or more questions. A computing device is in data communication with the computer storage, and executes instructions associated with an arbiter object. The arbiter object utilizes at least one of multiple evaluation strategies that determine the selection of a next best question to ask of a patient. The disease objects can be separated into a first class that is allowed to vote for the next best question which is to be asked of the patient or into a second class that is not allowed to vote for the next best question. The arbiter object can determine when a next evaluation strategy of the multiple evaluation strategies is to be started.

Claims

1. A computerized arbiter method utilized during an evaluation session in a medical diagnostic system having a computing device, the method comprising:

asking general questions associated with a list of candidate diseases of a patient using a high level mode of inquiry by use of a user interface associated with a computing device;

selecting a set of most likely diseases based on the responses to the general questions;

asking questions focused on the set of most likely diseases using a middle level mode of inquiry;

selecting a most likely disease based on the responses to the questions from the middle level of inquiry; and

asking questions focused on the most likely disease using a low level mode of inquiry,

wherein a sequence of questions corresponds to one of a plurality of evaluation strategies, wherein the set of most likely diseases is divided into one class that is allowed to vote for the next best question which is to be asked of the patient or into another class that is not allowed to vote for the next best question, wherein the diseases that are in the class that cannot vote for the next best question add a weight to a disease score, the weight corresponding to a response for a question asked by another disease, and wherein questions are asked until a goal of the evaluation session has been reached.

2. The method of claim 1, wherein one of the evaluation strategies is intent modulation which eliminates the later stages of urgent diseases from the list of candidate diseases.

3. The method of claim 1, wherein the responses to the questions are stored in a patient electronic medical record and are used to establish patient health items (PHIs), and wherein each candidate disease is associated with one or more PHIs, and each PHI is associated with one or more questions.

4. The method of claim 3, wherein one of the evaluation strategies is mean democratic sine which determines the next best question by a voting process wherein the sine status of a PHI and disease pair is factored into the voting strength of the diseases.

5. The method of claim 3, wherein one of the evaluation strategies is a sequential synergy strategy which gives more voting strength of priority to those PHIs that complete or nearly complete a sequential synergy.

6. The method of claim 1, wherein the diseases that are in the class that are allowed to vote for the next best question add a weight to a disease score.

7. The method of claim 1, wherein the next best question is the question that advances the evaluation session to reach a correct diagnosis at the earliest point in time with the fewest number of questions.

8. The method of claim 1, wherein the number of questions asked of the patient is reduced based on use of the middle level of inquiry where the class that is not allowed to vote for the next best question does not contribute potential questions to be asked of the patient.

9. The method of claim 3, wherein questions corresponding to late stage PHIs of urgent diseases are asked first so as to diagnose or exclude those diseases that have a limited therapeutic window of opportunity.

10. The method of claim 1, wherein a particular one of the plurality of evaluation strategies can be changed responsive to a clinical situation of the patient.

11. The method of claim 3, wherein a particular one of the plurality of evaluation strategies is selected depending upon a past medical history of the patient as stored in the patient electronic medical record.

12. The method of claim 1, wherein a particular one of the plurality of evaluation strategies is selected depending upon the patient'"'"'s previous responses in a consultation.

13. The method of claim 1, additionally comprising selecting from the questions voted on by the diseases in diagnostic consideration.

14. The method of claim 1, wherein the method does not permit diseases of the class not allowed to vote of the set of most likely diseases to suggest questions to ask of the patient during the evaluation session.

15. A computerized medical diagnostic system, the system comprising:

a computer storage storing a list of candidate diseases, each candidate disease associated with one or more questions;

a computing device in data communication with the computer storage, the computing device performing software instructions to;

ask general questions associated with the candidate diseases of a patient using a high level mode of inquiry;

select a set of most likely diseases based on the responses to the general questions;

ask questions focused on the set of most likely diseases using a middle level mode of inquiry;

select a most likely disease based on the responses to the questions from the middle level of inquiry; and

ask questions focused on the most likely disease using a low level mode of inquiry,

wherein the set of most likely diseases is separated into a first class that is allowed to vote for the next best question which is to be asked of the patient or into a second class that is not allowed to vote for the next best question, wherein the diseases that are in the second class add a weight to a disease score, the weight corresponding to a response for a question asked by another disease, and wherein questions are asked until a goal of the evaluation session has been reached.

16. The system of claim 15, wherein the responses to the questions are stored in a patient electronic medical record and are used to establish patient health items (PHIs).

17. The system of claim 16, wherein the diseases in the list of candidate diseases are separated into the first class or the second class based on at least the PHIs.

18. The system of claim 15, wherein the diseases in the first class add a weight corresponding to a response for a question asked by another disease.

19. The system of claim 15, wherein a sequence of questions corresponds to one of a plurality of evaluation strategies.

20. The system of claim 16, wherein the separation of the diseases into the first class and the second class is dynamic and is based in part on a voting strength of each disease in the list of candidate diseases.

21. The system of claim 20, wherein the voting strength of a particular disease is related to the changing probability that the particular disease is the diagnosis for the patient.

22. The system of claim 20, wherein the voting strength of a particular disease is dependent upon the number of PHIs the patient has of the particular disease.

23. The system of claim 20, wherein the voting strength depends upon aspects of the PHI being established for the patient.

24. The system of claim 20, wherein a particular disease is dynamically transferred between the first and second classes upon reaching or exceeding a threshold.

25. The system of claim 15, wherein the system does not permit diseases of the class not allowed to vote to suggest questions to ask of the patient during an evaluation session based at least in part on the disease score.

26. The system of claim 15, wherein each candidate disease is associated with one or more patient health items (PHIs), and each PHI is associated with one or more questions.

27. The system of claim 16, wherein the computing device additionally performs software instructions to check the patient electronic medical record for responses to questions or PHIs prior to asking questions of the patient.

28. A computerized medical diagnostic system, the system comprising:

a computer storage storing a list of disease objects, each disease object associated with one or more questions; and

a computing device in data communication with the computer storage, the computing device executing instructions associated with

an arbiter object, wherein the arbiter object, in conjunction with a plurality of evaluation strategies, determines the selection of a next best question to ask of a patient.

29. The system of claim 28, wherein the arbiter object determines when the next evaluation strategy of the plurality of evaluation strategies is to be started.

30. The system of claim 29, wherein the determination of when the next evaluation strategy is to be started is based on a rule set.

31. The system of claim 29, wherein the determination of when the next evaluation strategy is to be started depends on the completion of the current evaluation strategy.

32. The system of claim 28, additionally comprising a patient ombudsman object that interfaces with the arbiter object and suggests one or more general questions, wherein answers to the general questions causes a decrease in the number of questions asked of the patient.

33. The system of claim 28, wherein an evaluation strategy is intent modulation in which the late stage of urgent diseases are established or ruled out before proceeding to other diseases.

34. The system of claim 28, wherein an evaluation strategy is intent modulation in which critical curve patient health items (PHIs) of urgent diseases are established after evaluating late stage symptoms.

35. The system of claim 28, wherein an evaluation strategy comprises excluding or establishing serious diseases before diagnosing other diseases.

36. The system of claim 28, wherein the evaluation strategies can be changed as often as after every question asked of the patient.

37. The system of claim 28, wherein certain PHIs of a disease are designated as late stage PHIs of a disease.

38. The system of claim 28, wherein certain PHIs of a disease are designated as critical curve PHIs.

39. The system of claim 28, wherein the arbiter object does not permit disease objects of a class not allowed to vote from the list of disease objects to suggest questions to ask of the patient during an evaluation session.

40. The system of claim 28, wherein each disease object is associated with one or more PHIs, and each PHI is associated with one or more questions.

41. The system of claim 28, wherein the arbiter object interfaces the disease objects with the patient.

42. The system of claim 28, wherein selected ones of the disease objects suggest questions to ask of the patient, and wherein the arbiter object selects the next best question to ask the patient based at least on a voting strength of the selected disease objects.

43. The system of claim 42, wherein the arbiter object selects the next best question to ask the patient additionally based at least on a weight of the question, a sine status of a patient health item associated with the question, the diseases in diagnostic consideration, and data in an electronic medical record of the patient.

44. The system of claim 28, additionally comprising an interface in data communication with an output device to ask questions of the patient and with an input device to receive responses from the patient.

45. The system of claim 28, wherein the arbiter object can change the axis of inquiry based on certain criteria.

46. A computerized arbiter method associated with an evaluation session in a medical diagnostic system, the method comprising:

providing a plurality of modes of inquiry, each mode including at least one evaluation strategy, including one mode of inquiry wherein a plurality of disease objects are separated into a first class that is allowed to vote for the next best question which is to be asked of a patient or into a second class that is not allowed to vote for the next best question to be asked; and

asking the next best question of the patient.

47. The method of claim 46, additionally comprising:

asking general questions of the patient associated with a list of diseases using a high level mode of inquiry;

selecting a set of most likely diseases based on the responses to the general questions;

asking questions focused on the set of most likely diseases using a middle level mode of inquiry;

selecting a most likely disease based on the responses to the questions from the middle level of inquiry; and

asking questions focused on the most likely disease using a low level mode of inquiry,

wherein the evaluation strategies include at least one diagnostic strategy, wherein each of the diseases that has not been excluded from diagnostic consideration adds a weight to a disease score based on a response to each question asked, and wherein questions are asked until a goal of the evaluation session has been reached.

48. The method of claim 46, wherein the evaluation strategies include a non-diagnostic strategy.

49. The method of claim 47, wherein the method does not permit diseases of a non-voting class from the set of most likely diseases to suggest questions to ask of the patient during the evaluation session.

50. The method of claim 47, wherein a disease is excluded if weights for the patient health items for which questions have not been asked yet and weights with associated synergies cannot cause the disease score to reach or exceed a diagnostic threshold.

51. A computerized medical diagnostic system, the system comprising:

a computer storage storing a list of candidate disease objects, each disease object associated with one or more questions; and

a computing device in data communication with the computer storage, the computing device executing instructions associated with

an arbiter object, wherein the arbiter object utilizes at least one of a plurality of evaluation strategies that help determine the selection of a next best question to ask of a patient, wherein the disease objects are separated into a first class that is allowed to vote for the next best question which is to be asked of the patient or into a second class that is not allowed to vote for the next best question.

52. The system of claim 51, wherein the arbiter object determines when a next evaluation strategy of the plurality of evaluation strategies is to be started.