Medical network management system and process
First Claim
1. An article of manufacture for use with a data processing system with an attached display and input means comprising:
- (a) software that presents a first series of questions on aid display to select one of a plurality of branched chain logic algorithms which assess the patient'"'"'s level of medical risk and determine an appropriate tog, type, and level of medical care;
(b) software that receives a first series of answers responsive to the first series of questions from the input means;
(c) software that uses the first series of answers to select one of said plurality of branched chain logic algorithms;
(d) software that presents in accordance with the selected branched chain logic algorithm a second series of questions from the input means,(e) software that receives a second series of answers responsive to the second series of questions from the input means;
(f) software that presents further questions to the display determined by the second series of answers;
(g) software that receives further answers from the input means;
(h) software that assesses the patient'"'"'s level of risk;
(i) software that categories the patient either as having a sufficiently low post-test probability of an illness or injury under consideration so as not to justify further medical provider care, or as not having a sufficiently low post-test probability of an illness or injury under consideration so as to eliminate possible need for further medical provider care; and
(j) software that determines an appropriate timing, type, and level of medical care.
4 Assignments
0 Petitions
Accused Products
Abstract
In a medical network management system (NMS) (20), health plan beneficiaries access a team of health care professionals over the telephone to help them assess their health needs and select appropriate care. The NMS (20) has a patient assessment component (22). The patient assessment component consists of a set of information tools which are used by health care professionals to assess patient conditions and assist in the selection of health care services and to help patients find appropriate care at the appropriate time. The tools include a comprehensive, automated set of proprietary assessment algorithms (26) which are based on branched chain algorithms utilizing Bayes theorem. These unique, clinical tools enable a trained nurse or other health care professional to sort patients into different risk categories, safely and effectively without requiring a medical diagnosis. Patients can then be guided to an appropriate level and type of care for their problem(s) based on their level of risk and set of potential needs.
340 Citations
50 Claims
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1. An article of manufacture for use with a data processing system with an attached display and input means comprising:
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(a) software that presents a first series of questions on aid display to select one of a plurality of branched chain logic algorithms which assess the patient'"'"'s level of medical risk and determine an appropriate tog, type, and level of medical care; (b) software that receives a first series of answers responsive to the first series of questions from the input means; (c) software that uses the first series of answers to select one of said plurality of branched chain logic algorithms; (d) software that presents in accordance with the selected branched chain logic algorithm a second series of questions from the input means, (e) software that receives a second series of answers responsive to the second series of questions from the input means; (f) software that presents further questions to the display determined by the second series of answers; (g) software that receives further answers from the input means; (h) software that assesses the patient'"'"'s level of risk; (i) software that categories the patient either as having a sufficiently low post-test probability of an illness or injury under consideration so as not to justify further medical provider care, or as not having a sufficiently low post-test probability of an illness or injury under consideration so as to eliminate possible need for further medical provider care; and (j) software that determines an appropriate timing, type, and level of medical care. - View Dependent Claims (2, 3, 4, 5, 6, 7, 8, 9)
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10. An article of manufacture for use with a data processing system including an attached display and input means, comprising a storage medium having stored therein a computer program for managing access to medical providers, said computer program including a patient assessment stored program and said data processing system including a patient database, said patient assessment stored program including:
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(a) software that checks patient eligibility by accessing said patient database; (b) software that selects a branched chain logic algorithm for assessing a patient'"'"'s level of medical risk and determining an appropriate timing, type, and level of medical care; (c) software that defines a plurality of branched chain logic algorithms, each of said branched chain logic algorithms for assessing the patient'"'"'s level of medical risk and determining an appropriate timing, type, and level of medical care, each of said plurality of branched chain logic algorithms being configured to present a series of questions answerable with "yes" or "no", answers to said questions being used by said data processing system to categorize the patient either as having a sufficiently low post test probability of an illness or injury under consideration so as not to justify further medical provider care, or as not having a sufficiently low post-test probability of an illness or injury under consideration so as to eliminate possible need for further medical provider care; (d) software that presents a first series of questions on said display for checking patient eligibility to receive medical care; (e) software that receives a first series of answers responsive to the first series of questions from said input means; (f) software that supplies the first series of answers to said software that checks patient eligibility; (g) software that presents a second series of questions on said display for selecting one of said plurality of branched chain algorithms; (h) software that receives a second series of answers responsive to the second series of questions from said input means; (i) software that supplies the second series of answers to said software that selects a branched chain logic algorithm for selecting one of said plurality of branched chain logic algorithms; and (j) software that uses the selected branched chain logic algorithm to present questions to the display, receive answers from the input means, present further questions to the display based on the answers, receive further answers from the input means, assess the patient'"'"'s level of medical risk, and determine an appropriate timing, type, and level of medical care, and to provide the timing, type, and level of medical care determination on said display. - View Dependent Claims (11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21)
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- 22. An article of manufacture for use with a data processing system, comprising a storage medium having stored therein a patient assessment stored program utilizing a plurality of branched chain logic algorithms, and a stored program editor in said storage medium for generating branched chain logic algorithms when executed on said data processing system, said plurality of branched chain logic algorithms each being configured to present a series of questions answerable with "yes" or "no" when executed on said data processing system, said stored program editor for generating branched chain logic algorithms including a yes-no logic block for generating the questions answerable with "yes" or "no" and an endpoint logic block for generating endpoints in said plurality of branched chain logic algorithms.
- 24. An article of manufacture for use with a data processing system, comprising a storage medium having stored therein a patient assessment stored program, said patient assessment stored program including a plurality of patient complaint based branched chain logic algorithms, said plurality of patient complaint based branched chain logic algorithms each being configured to present a series of questions answerable with "yes" or "no" when said patient assessment stored program is executed by said data processing system, answers to said questions being used by said data processing system when said patient assessment stored program is executed by said data processing system to categorize the patient as either having a sufficiently low post-test probability of a specific illness or injury under consideration so as not to justify further medical provider care for the specific illness or injury, or as not having a sufficiently low post-test probability of an illness or injury under consideration so as to eliminate possible need for further medical provider care for the specific illness or injury.
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37. An article of manufacture for use with a data processing system, comprising a storage medium having stored therein a patient assessment stored program, said patient assessment stored program including a plurality of patient complaint based branched chain logic algorithms, each of said plurality of patient complaint based branched chain logic algorithms being configured to present a series of questions answerable with "yes" or "no" when said patient assessment stored program is executed by said data processing system, each of the answers to said questions being used by said data processing system when said patient assessment stored program is executed by said data processing system to make a categorization of the patient as either:
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(a) having a sufficiently low post-test probability of a specific illness or injury under consideration so as to eliminate possible need for further investigation, medical care, or other health care, for the specific illness or injury under consideration;
or(b) not having a sufficiently low post-test probability of the specific illness or injury under consideration so as to eliminate possible need for further investigation, medical care, or other health care, for the specific illness or injury under consideration; the answers further being used with the categorization to recommend an appropriate intervention for the specific illness or injury under consideration. - View Dependent Claims (38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49)
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50. An article of manufacture for use with a data processing system, comprising a storage medium having stored therein a patient assessment stored program, said patient assessment stored program including a plurality of branched chain logic algorithms based on patient complaints, symptoms, and needs, each of said plurality of complaint branched chain logic algorithms being configured to present a series of questions answerable with "yes" or "no" when said patient assessment stored program is executed by said data processing system, each of the answers to said questions being used by said data processing system when said patient assessment stored program is executed by said data processing system to make a categorization of the patient as either:
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(a) having a sufficiently low post-test probability of a specific illness, injury, condition, or etiology under consideration so as to clinically eliminate possible need for further investigation, medical care, or other health care, for the specific illness, injury, condition, or etiology under consideration;
or(b) not having a sufficiently low post-test probability of the specific illness, injury, condition, or etiology under consideration so as to clinically eliminate possible need for further investigation, medical care, or other health care, the specific illness, injury, condition, or etiology under consideration; the answers further being used with the categorization to identify a set of appropriate interventions for injuries and illnesses which cannot be clinically eliminated, wherein an appropriate intervention in the set of appropriate interventions has at least one characteristic selected from the group consisting of level of intervention, timing of intervention, place of intervention, nature of intervention, type of provider, specific characteristics required of the provider, and specific individual provider.
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Specification