Clinical database of classified out-patients for tracking primary care outcome
First Claim
1. A computerized out-patient primary care medical system for the entry of clinical data stored into a database, said medical system includes;
- means for documenting up to three chronic, long term diagnosis in an out-patient office visit record, said record created during said entry of data and said diagnosis represented on a source document by a partial code that consists of the last 4 digits of a full six digit chronic diagnosis code,means for determining the primary reason for an office visit through the use of either of two single letter codes obtained from said source document, said codes representing either a chronic, long term diagnosis or an acute short term diagnosis,means for documenting the primary reason for an office visit, said primary reason represented on a source document as a partial code that consists of the last 4 digits of a full six digit chronic or acute diagnosis code,means for documenting any physical data noted during an office visit, said physical data consisting of signs and symptoms and represented on a source document as partial codes that consist of the last 3 digits of a full 5 digit physical data code,means for documenting office visit type, said type being either scheduled or unscheduled and represented by either of two single letter codes present on a source document,means for documenting the clinical status of an out-patient during said office visit, said status being represented by one of five possible single digits that include a 1 indicating normality or baseline, 2 indicating mild instability, 3 indicating serious instability, 4 indicating improvement from the out-patient'"'"'s most recent office visit, and 5 indicating that hospitalization was ordered during that office visit,means for checking entry of said clinical status according to a set of requirements listed on a screen during entry, said requirements consisting of entering a clinical status of 4 for any improvement in said clinical status of an out-patient in comparison to that out-patient'"'"'s most recent visit and the mandatory entering of at least one physical data item for any clinical status other than 1,means for updating a related out-patient record during creation and said entry of office visit record, said updating reflecting any changes in any of an out-patient'"'"'s chronic diagnosis and said related record is an out-patient master medical record,means for identification of an out-patient master medical record, said identification being by entry of an out-patient last name and full first name present on a master medical record source document,means for dating the creation of a master medical record,means for documenting up to three chronic diagnosis of an out-patient in said master medical record, alternate data sets used by said documenting means consisting of either a partial code that consists of the last 4 digits of a full six digit chronic diagnosis code as a direct entry means or a clinical group indicator and a full diagnostic text of said chronic diagnosis with or without a diagnostic category indicator as an indirect entry means of said documenting,means for identifying an out-patient laboratory test record that will store test results, said identification being a nine digit number,means for documenting the date when laboratory tests were taken, said tests numbering up to fourteen for each out-patient lab test record,means for assigning a special number to said lab test record, said special number being an invoice and the most unique aspect of identification of said lab test record,means for linking said lab test record to either of two related out-patient records, said records being either an office visit record or an emergency room record of said out-patient depending upon the location from which the lab tests were ordered,means for entering parameter or historical data with each current lab test result, said parameter or historical data is in encoded form and represents a compilation of past results of any single lab test including chronicity of abnormality and a most recent result of that test whether normal or abnormal,means for recalling prior test results from different aspects for each current lab test result, said prior aspects include date and value of first abnormality, date and value of last abnormality, consistency of prior results, and the most recent result for a particular test normal or abnormal.
0 Assignments
0 Petitions
Accused Products
Abstract
A computerized medical database system for the standardized recording and tracking of out-patient care by the simulation through existing software of multiple facets of a typical primary care clinical environment.
Central to the system'"'"'s data processing are office visit records as the primary vehicle for encoded data input and a chronic diagnosis classification table for ranking out-patients into separate, prioritized diagnostic categories. Integrated with both in a relational database are other files storing distinct but related clinical attributes of both the transactional and inventory type. The former, as event-based, include emergency room, medicine activity, specialist, lab tests and an office visit-derived or intermediary file while the latter type, as a fixed pool of clinically descriptive data elements, include long and short-term diagnosis, physical signs and symptoms and a generic medication list.
The data processing is of three kinds; data entry of office visit, one master medical for each out-patient and lab test result records, data query for obtaining summary-type, narrowly focused information for a single or group of related out-patients and, thirdly, the compilation of data from office visits for reporting various clinical results.
Some of the latter type processing, using sets of clinical criteria including diagnostic category for specific record selection, include detecting and justifying excessive office visits, determining lab test overusage, monitoring physician activity during episodes of protracted illnesses of differing severity and the printing of physical, medication and lab test results from the same office visit.
278 Citations
11 Claims
-
1. A computerized out-patient primary care medical system for the entry of clinical data stored into a database, said medical system includes;
-
means for documenting up to three chronic, long term diagnosis in an out-patient office visit record, said record created during said entry of data and said diagnosis represented on a source document by a partial code that consists of the last 4 digits of a full six digit chronic diagnosis code, means for determining the primary reason for an office visit through the use of either of two single letter codes obtained from said source document, said codes representing either a chronic, long term diagnosis or an acute short term diagnosis, means for documenting the primary reason for an office visit, said primary reason represented on a source document as a partial code that consists of the last 4 digits of a full six digit chronic or acute diagnosis code, means for documenting any physical data noted during an office visit, said physical data consisting of signs and symptoms and represented on a source document as partial codes that consist of the last 3 digits of a full 5 digit physical data code, means for documenting office visit type, said type being either scheduled or unscheduled and represented by either of two single letter codes present on a source document, means for documenting the clinical status of an out-patient during said office visit, said status being represented by one of five possible single digits that include a 1 indicating normality or baseline, 2 indicating mild instability, 3 indicating serious instability, 4 indicating improvement from the out-patient'"'"'s most recent office visit, and 5 indicating that hospitalization was ordered during that office visit, means for checking entry of said clinical status according to a set of requirements listed on a screen during entry, said requirements consisting of entering a clinical status of 4 for any improvement in said clinical status of an out-patient in comparison to that out-patient'"'"'s most recent visit and the mandatory entering of at least one physical data item for any clinical status other than 1, means for updating a related out-patient record during creation and said entry of office visit record, said updating reflecting any changes in any of an out-patient'"'"'s chronic diagnosis and said related record is an out-patient master medical record, means for identification of an out-patient master medical record, said identification being by entry of an out-patient last name and full first name present on a master medical record source document, means for dating the creation of a master medical record, means for documenting up to three chronic diagnosis of an out-patient in said master medical record, alternate data sets used by said documenting means consisting of either a partial code that consists of the last 4 digits of a full six digit chronic diagnosis code as a direct entry means or a clinical group indicator and a full diagnostic text of said chronic diagnosis with or without a diagnostic category indicator as an indirect entry means of said documenting, means for identifying an out-patient laboratory test record that will store test results, said identification being a nine digit number, means for documenting the date when laboratory tests were taken, said tests numbering up to fourteen for each out-patient lab test record, means for assigning a special number to said lab test record, said special number being an invoice and the most unique aspect of identification of said lab test record, means for linking said lab test record to either of two related out-patient records, said records being either an office visit record or an emergency room record of said out-patient depending upon the location from which the lab tests were ordered, means for entering parameter or historical data with each current lab test result, said parameter or historical data is in encoded form and represents a compilation of past results of any single lab test including chronicity of abnormality and a most recent result of that test whether normal or abnormal, means for recalling prior test results from different aspects for each current lab test result, said prior aspects include date and value of first abnormality, date and value of last abnormality, consistency of prior results, and the most recent result for a particular test normal or abnormal. - View Dependent Claims (2, 3, 4)
-
-
5. A computerized out-patient primary care medical database system for the processing and reporting of clinical data includes;
-
means for creating by a set of intermediary routines new, office visit-derived intermediary records for the storage of office based clinical data in compiled form; and
said creating means includes,means for detecting by out-patient diagnostic category early and possibly unnecessary scheduled office visits, said diagnostic category established and defined by either an individual chronic diagnosis or the combined value of up to three chronic diagnosis of an out-patient present in a said office visit-derived record in reference to a table of chronic diagnosis sorted in descending order by clinical urgency or prognosis, means for detecting by diagnostic category consecutive unscheduled out-patient office visits, means for determining whether or not said early scheduled office visits were clinically justifiable, said justification being either absolute or tentative, means for detecting by diagnostic category 3 types of protracted illnesses, said illnesses represented by a continuous string of office visit-derived records of an out-patient that all contain a clinical status indicator other than 1 and each of said three types of protracted illnesses differing by initial level of severity, means for determining if any, and type of, physician intervention or action occured during each office visit included in any of 3 said types of protracted illness processing for an out-patient, said types of actions include new medication, medication changes, specialty referrals, lab tests ordered and office injections of medication including by what route, intramuscular or intravenous, and said reporting of clinical data includes, means for printing by said diagnostic category from said office visit-derived records the physical, medication change and laboratory test results separately but from the same office visit, means for printing of clinical data that may reveal the overusage of office visit based lab tests ordering, said overusage because of the absence of any documented problems during those office visits when said tests were ordered, and said reporting of clinical data further includes;
means for querying of said out-patient database summary-type and narrowly formulated out-come based clinical data for computer screen display. - View Dependent Claims (6, 7, 8, 9, 10)
-
-
11. For use in a computerized out-patient primary care medical database system
means for the automatic classification of out-patients into one of three chronic diagnosis-based clinical diagnosis categories through the use of a predefined consensus-based reference table of chronic diagnosis arranged according to the relative prognosis or clinical urgency of each, said reference table divided into three diagnostic categories with each ranked hierarchically in relation to the other two and for classifying said out-patients depending upon the diagnostic category location of up to three chronic diagnosis any out-patient may have in relation to said reference table, and said means for the automatic classification further includes, means for creating an out-patient master medical or first office visit record, said record creation occuring during a data entry routine for either of said record type which then immediately confers upon an out-patient of that record the attribute of classification into one of said diagnostic categories, and means for recognizing said classification of each out-patient by said database system during the execution of data processing instructions, said instructions identify each out-patient record, master medical or office visit, as belonging to one of three said diagnostic categories depending upon the combined value of up to three chronic diagnosis found in said record types determined by thier relative position in said reference table of chronic diagnosis, and said recognizing means includes, means for checking by said data processing instructions an encoded letter present in each chronic diagnosis that is present in any out-patient record of prior said types, said encoded letter present in a fixed position in each chronic diagnosis and for indicating to which of three said diagnostic categorys of said chronic diagnosis reference table that chronic diagnosis belongs to.
Specification