Computerized medical diagnostic system including re-enter function and sensitivity factors

• US 5,594,638 A
• Filed: 12/29/1993
• Issued: 01/14/1997
• Est. Priority Date: 12/29/1993
• Status: Expired due to Term

• Current Assignee: Clinical Decision Support, LLC (Tivity Health, Inc.)
• Original Assignee: First Opinion Corporation (Tivity Health, Inc.)
• Inventors: Iliff, Edwin C.
• Primary Examiner(s): Weinhardt, Robert A.
• Assistant Examiner(s): Thomas, Joseph
• Application Number:
  US08/176,858
• Time in Patent Office: 1,112 Days
• Field of Search: 364/413.01, 364/413.02, 364/413.03, 364/413.04, 364/413.12, 364/413.05, 364/401, 364/402, 364/406, 395/10, 395/11, 395/12, 395/20, 395/64, 395/50, 395/51-77, 395/924, 128/670, 128/630, 128/668, 128/695
• US Class Current: 705/3
• CPC Class Codes: G06Q 40/12 Accounting
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• 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 80/00 ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring
• CPC Class Codes: H04M 2201/40 using speech recognition speech recognition per se G10L15/00
• CPC Class Codes: H04M 2203/355 Interactive dialogue design tools, features or methods
• CPC Class Codes: H04M 3/493 Interactive information services, e.g. directory enquiries ; Arrangements therefor, e.g. interactive voice response [IVR] systems or voice portals
• CPC Class Codes: Y10S 128/925 Neural network

Abstract

A system and method for providing computerized, knowledge-based medical diagnostic and treatment advice. The medical advice is provided to the general public over a telephone network. Two new authoring languages, interactive voice response and speech recognition are used to enable expert and general practitioner knowledge to be encoded for access by the public. "Meta" functions for time-density analysis of a number of factors regarding the number of medical complaints per unit of time are an integral part of the system. A semantic discrepancy evaluator routine along with a mental status examination are used to detect the consciousness level of a user of the system. A re-enter feature monitors the user'"'"'s changing condition over time. A symptom severity analysis helps to respond to the changing conditions. System sensitivity factors may be changed at a global level or other levels to adjust the system advice as necessary.

Claims

1. In an automated medical advice system including a computer, and input and output devices, a method of re-entering a diagnosis of a patient'"'"'s medical problem, comprising the steps of:

performing an initial diagnostic consultation with the patient, thereby collecting patient information;

identifying a situation wherein the patient is to consult the system again wherein an indicator associated with programmed re-enter criteria is set in the computer;

automatically instructing the patient to consult the system at a predetermined time in the future based upon the identified situation;

performing one or more additional diagnostic consultations with the patient, thereby collecting and storing additional patient information, wherein the execution path of the additional diagnostic consultation is responsive to the stored patient information and the indicator of satisified re-enter criteria; and

formulating a diagnosis from said collected patient information during a one of the diagnostic consultations.

2. The method defined in claim 1, wherein the step for identifying the situation provides for monitoring the symptoms of the patient over time.

3. The method defined in claim 1, wherein the step for identifying the situation makes an identification when the system fails to make a diagnosis based on the available patient information.

4. The method defined in claim 1, additionally comprising the step of assessing the severity of the problem during at least one of the consultations.

5. The method defined in claim 1, additionally comprising the step of identifying a person consulting the system after the initial consultation as a re-enter patient.

6. The method defined in claim 1, additionally comprising the step of determining that the initial consultation and each additional diagnostic consultation provides patient information for only one medical problem.

7. The method defined in claim 1, wherein the step of performing additional consultations results in adding the additional information to a medical record of the patient.

8. The method defined in claim 1, additionally comprising the step of identifying a patient needing immediate medical attention during any one of the additional diagnostic consultations.

9. The method defined in claim 1, additionally comprising the step of confirming a diagnosis made during one of the consultations based on the additional patient information.

10. The method defined in claim 9, additionally comprising the step of informing the patient when a change in treatment is available for the confirmed diagnosis.

11. The method defined in claim 1, additionally comprising the step of referring the patient to a physician if a diagnosis made during one of the consultations cannot be confirmed based upon any one succeeding consultation.

12. The method defined in claim 1, additionally comprising the step of automatically contacting the patient at preselected times so as to monitor the condition of the patient.

13. In an automated medical advice system including a computer, and input and output devices, a method of symptom severity analysis, comprising the steps of:

performing a first diagnostic consultation with a patient for a problem by a diagnostic process, thereby collecting patient information;

quantizing a severity of a symptom of the patient based upon the first consultation;

identifying a situation wherein the patient is to consult the system again wherein, if a programmed re-enter criteria is satisified, an indicator associated with the programmed re-enter criteria is set in the computer;

automatically instructing the patient to consult the system at a predetermined time in the future based upon the identified situation;

performing a second diagnostic consultation with the patient for the problem by the diagnostic process;

quantizing the severity of the symptom of the patient based upon the second consultation;

analyzing changes in a level of severity and rate of change of severity over time based upon the quantized severities and

providing instructions to the patient based on the analysis of changes in a level of severity and rate of change of severity over time.

14. The method defined in claim 13, additionally comprising the step of providing selected medical advice if the rate of change of severity exceeds a preselected threshold.

15. The method defined in claim 13, additionally comprising the step of requesting the patient to consult with the system at a predetermined later time if the rate of change of severity does not achieve a preselected threshold.

16. The method defined in claim 13, additionally comprising the steps of:

performing a third diagnostic consultation with the patient for the problem by the diagnostic process; and

quantizing the severity of the symptom of the patient based upon the third consultation.

17. The method defined in claim 16, additionally comprising the steps of:

analyzing any change in the rate of change of severity over time; and

providing medical advice if the change of rate of change of severity exceeds a preselected threshold.

18. In an automated medical advice system including a computer, input and output devices, and a set of medical algorithms, a method of modifying sensitivity so as to change the advice of the system, comprising the steps of:

receiving through at least one of said input devices data indicative of physical symptoms of a patient;

establishing a sensitivity factor representative of relative importance of a selective field of interest having a cost/benefit tradeoff recognized by a healthcare organization in at least one medical algorithm;

changing a threshold value in at least one of the medical algorithms by use of the sensitivity factor, wherein the new threshold value affects a branching decision in the medical algorithm and wherein the medical algorithm uses physical symptoms of the patient to generate a diagnosis;

communicating the diagnosis through the output device; and

changing the sensitivity factor over time to affect the sensitivity of the system thereby improving the advice given by the system.

19. The method defined in claim 18, wherein the sensitivity factor comprises a system-wide sensitivity factor affecting all threshold calculations throughout the system.

20. The method defined in claim 18, additionally comprising the steps of:

establishing a problem sensitivity factor; and

changing threshold calculations in a selected one of the medical algorithms by use of the problem sensitivity factor.

21. The method defined in claim 18, wherein the sensitivity factor is selected from the following sensitivity factors:

system-wide, anatomic system, cause, problem, question, organization, or patient, or combinations thereof.

22. The method defined in claim 21, wherein the step of changing the sensitivity factor over time includes changing any combination of the sensitivity factors.

23. The method defined in claim 18, wherein the value of the sensitivity factor is initially set to one.

24. The method defined in claim 18, wherein the changing threshold calculations step includes a multiplication of the sensitivity factor times a threshold value.

25. In an automated medical advice system including a computer, and input and output devices, a method of re-entering a diagnosis of a patient'"'"'s medical problem, comprising the steps of:

performing an initial diagnostic consultation with the patient, thereby collecting patient information;

identifying a situation wherein the patient is to consult the system again, wherein, if a programmed re-enter criteria is satisfied, an indicator associated with the programmed re-enter criteria is set in the computer;

automatically instructing the patient to consult the system at a predetermined time in the future based upon the identified situation;

performing one or more additional diagnostic consultations in response to the indicator of satisfied re-enter criteria such that additional information collected from the patient is associated with one medical problem; and

formulating a diagnosis from said collected patient information during a one of the diagnostic consultations.