Disease management system and method

• US 6,234,964 B1
• Filed: 03/13/1998
• Issued: 05/22/2001
• Est. Priority Date: 03/13/1997
• Status: Expired due to Term

• Current Assignee: Healthways SC, LLC (Warner Bros. Discovery, Inc.)
• Original Assignee: First Opinion Corporation (Tivity Health, Inc.)
• Inventors: Iliff, Edwin C.
• Primary Examiner(s): Gilbert, Samuel G.
• Application Number:
  US09/042,075
• Time in Patent Office: 1,166 Days
• Field of Search: 128/920, 128/923, 600/300, 705/2, 705/3
• US Class Current: 600/300
• 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 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• 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 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 70/20 relating to practices or guidelines
• CPC Class Codes: G16H 70/60 relating to pathologies
• 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: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation
• CPC Class Codes: Y10S 128/92 Computer assisted medical diagnostics
• CPC Class Codes: Y10S 128/925 Neural network

Abstract

One aspect of the invention is directed to a system and method for automated knowledge-based, long-term patient disease management. Disease management is directed to the continuing medical care of a patient who has been diagnosed with a specified health problem called a disease. The system performs disease management in a fully automated manner, using periodic interactive dialogs with the patient to obtain health state measurements from the patient, to evaluate and assess the progress of the patient'"'"'s disease, to review and adjust therapy to optimal levels, and to give the patient medical advice for administering treatment and handling symptom flare-ups and acute episodes of the disease. One goal of the disease management system is to promote patient health in an automated manner that reduces costly medical intervention. Various features of the system are specifically designed to accumulate and use patient-specific information, so that disease management can be tailored to each individual case. As the system manages a given patient over time, it builds a profile in the form of the frequency and reasons for the patient'"'"'s contacts with the system, the patient'"'"'s subjective understanding of the disease, the patient'"'"'s objective response to various medical treatments, and the patient'"'"'s preferences in treatment. The system performs its contact with patients in the form of disease management sessions, which are regularly scheduled dialogs with the patient.

Claims

1. A computerized disease management method, comprising:

providing at least one interactive dialog to a patient via a computer so as to elicit current health conditions of the patient;

automatically assessing the current health conditions of the patient through the interactive dialog with the patient, wherein the patient has been previously diagnosed with a particular disease; and

automatically optimizing a disease therapy based on the health assessment, which is indicative of a progression of the disease over time, of the patient.

2. The method of claim 1, additionally comprising scheduling a reenter time for the patient.

3. The method of claim 2, wherein the reenter time is a regularly scheduled time.

4. The method of claim 3, wherein the reenter time is different from the regularly scheduled time.

5. The method of claim 2, wherein the acts are repeatedly performed over time.

6. A computerized disease management method, comprising:

retrieving a patient medical record, corresponding to a particular patient having a previously diagnosed medical disease, from a memory;

assessing the health of the patient, comprising;

automatically asking questions of the patient;

automatically receiving answers from the patient so as to obtain health data;

automatically storing the obtained health data into the patient medical record;

automatically selecting a specific health parameter corresponding to a portion of the patient medical record;

automatically calculating changes from prior disease management sessions in the patient'"'"'s health state as indicated by the health parameter, the calculated changes being indicative of a progression of the disease over time;

automatically comparing the health state changes against disease specific changes for the medical disease; and

automatically outputting data indicative of adjusting a disease therapy for the particular patient based on the obtained health data and the comparison.

7. The method defined in claim 6, additionally comprising:

establishing a current disease management session;

determining if the particular patient having the previously diagnosed medical disease has previously registered for a disease management session; and

registering the patient and initializing the patient medical record in the electronic medical database if the patient has not previously registered for a disease management session.

8. The method defined in claim 6, wherein the obtained health data involves subjective health measurements, objective health measurements, and side effects with respect to the patient.

9. The method defined in claim 6, wherein the patient medical record is stored in an electronic medical database.

10. The method defined in claim 6, additionally comprising statistically analyzing the obtained health data, wherein the analyzing comprises:

providing a subjective health measurement in corresponding to the particular patient;

providing an objective health measurement in corresponding to the particular patient; and

calculating a metric based on the subjective health measurement and the objective health measurement, wherein the metric may be used to adjust the disease therapy.

11. The method of claim 10, wherein the acts are repeatedly performed over time.

12. The method of claim 11, wherein a plurality of metrics are statistically analyzed.

13. The method of claim 10, wherein the metric is a ratio.

14. The method of claim 10, additionally comprising adjusting the disease therapy for the patient based on the metric.

15. The method defined in claim 6, wherein adjusting the disease therapy minimizes medical side effects for the patient.

16. The method of claim 6, additionally comprising scheduling a next disease management session for the particular patient.

17. The method of claim 16, wherein the next disease management session for the particular patient is at a regularly scheduled time.

18. The method of claim 17, wherein the next disease management session for the particular patient is at a time that is different than the regularly scheduled time.

19. The method of claim 16, wherein the acts are repeatedly performed over time.

20. The method of claim 6, wherein the disease therapy is adjusted for the particular patient if a threshold is reached during the comparing.

21. The method of claim 6, wherein a medical recommendation for the particular patient is made if a threshold is reached.

22. The method of claim 6, wherein the health parameter is a plurality of health parameters including an objective parameter.

23. The method of claim 6, wherein the health parameter is a plurality of health parameters including a subjective parameter.

24. The method of claim 6, wherein adjusting the disease therapy comprises:

determining the availability of objective health measurements and subjective health measurements for the particular patient having the previously diagnosed medical disease; and

adjusting therapy for the patient based on available objective health measurements, or adjusting therapy for the patient based on unavailable objective health measurements and available subjective health measurements.

25. The method of claim 24, wherein the questions relate to objective health measurements.

26. The method of claim 24, wherein the questions relate to subjective health measurements.

27. The method of claim 24, wherein the subjective health measurements include measurements of side effects relating to the patient'"'"'s therapy.

28. The method of claim 6, wherein the obtained health data includes a patient'"'"'s subjective perception of pain.

29. The method of claim 28, additionally comprising encoding the patient'"'"'s subjective perception of pain into a pain code.

30. The method of claim 29, wherein the pain code comprises subcodes representative of provocative, quality, region, severity and timing of the pain.

31. The method of claim 29, wherein the pain code is stored in the patient medical record.

32. The method of claim 29, additionally comprising identifying the patient'"'"'s medical disease by indexing a database of diseases with the pain code.

33. The method of claim 6, wherein adjusting the disease therapy comprises:

providing a therapeutic alterations permission level corresponding to the particular patient having the previously diagnosed medical disease;

automatically determining a therapy adjustment for the patient; and

recommending the therapy adjustment to the patient as allowed by the therapy alterations permission level.

34. The method of claim 33, wherein the therapy adjustment comprises starting a new therapy.

35. The method of claim 33, wherein the therapy adjustment comprises discontinuing an existing therapy.

36. The method of claim 33, wherein the therapy adjustment comprises adding a new therapy to an existing therapy.

37. The method of claim 33, wherein the determining the therapy adjustment is limited by the therapeutic alterations permission level.

38. The method of claim 6, wherein automatically asking questions of the patient comprises:

setting a preview mode for a disease management medical script comprising a plurality of questions;

asking a one of the plurality of questions in the script related to the health of the particular patient;

allowing the patient to receive information relating to the consequence of having answered the question; and

resetting the medical script as if the question had not been answered.

39. The method of claim 6, wherein automatically asking questions of the patient comprises:

providing a plurality of health parameters;

asking a selected question from a disease management medical script comprising a plurality of questions;

waiting a preset time for a response to the question; and

performing an action based on the health parameters after the preset time expires with no response.

40. The method of claim 39, wherein the health parameters include information in the patient medical record.

41. The method of claim 6, wherein assessing the health of the patient further comprises:

filtering any significant symptoms of the particular patient having the previously diagnosed medical disease;

obtaining and storing initial health measurements from the patient if the patient has not been previously assessed; and

obtaining and storing subsequent health measurements from the patient if the patient has been previously assessed.

42. The method of claim 6, wherein assessing the health of the patient further comprises:

determining a severity of a significant symptom obtained from the particular patient having the previously diagnosed medical disease;

continuing assessing the health of the patient if the severity level is sufficiently low; and

taking a predetermined action if the severity level is sufficiently high.

43. The method of claim 42, wherein the predetermined action is referral to a physician.

44. The method of claim 42, wherein the predetermined action is transfer to a diagnostic process.

45. A computerized disease management system, comprising:

a computerized device having a data storage;

a patient medical record stored in the data storage, the patient medical record corresponding to a particular patient having a diagnosed medical disease; and

a disease management program executing on the computerized device, the program configured to assess the current health conditions of the patient, store health data in the patient medical record based on the health assessment, and automatically output data indicative of adjusting a disease therapy for the particular patient based on the stored health data, which is indicative of a progression of the disease over time.

46. The system defined in claim 45, wherein the health assessment includes computer code configured to:

automatically ask questions of the patient;

automatically receive answers from the patient so as to obtain the health data;

automatically select a specific health parameter corresponding to a portion of the patient medical record;

automatically calculate changes from prior disease management sessions in the patient'"'"'s health state as indicated by the health parameter; and

automatically compare the health state changes against disease specific changes for the medical disease.

47. The system defined in claim 45, wherein the computerized device executes computer code configured to:

establish a current disease management session;

determine if the particular patient having the diagnosed medical disease has previously registered for a disease management session; and

register the patient and initialize the patient medical record in the data storage if the patient has not previously registered for a disease management session.

48. The system defined in claim 45, wherein the data storage includes an electronic medical database.

49. A computerized disease management method, comprising:

providing a database of disease-specific changes over time for a plurality of diseases;

providing at least one interactive dialog to a patient via a computer so as to elicit current health conditions of the patient;

automatically assessing the current health conditions of the patient through the interactive dialog with the patient, wherein the patient has been previously diagnosed with a particular disease; and

automatically optimizing a disease therapy based on a comparison of the health assessment of the patient and the database, which are indicative of a progression of the disease over time.

50. The method of claim 49, additionally comprising scheduling a time for a new interactive dialog with the patient.

51. The method of claim 50, wherein the acts are repeatedly performed over time.

52. The method of claim 50, wherein the time is a regularly scheduled time.

53. The method of claim 52, wherein the time is different from the regularly scheduled time.

54. A computerized disease management system, comprising:

a computerized device having a data storage;

a database of disease-specific changes over time for a plurality of diseases;

a patient medical record stored in the data storage, the patient medical record corresponding to a particular patient having a diagnosed medical disease; and

a disease management program executing on the computerized device, the program configured to assess the current health conditions of the patient, store health data in the patient medical record based on the health assessment, and automatically output data indicative of adjusting a disease therapy for the particular patient based on the stored health data and functions of the database, which are indicative of a progression of the disease over time.

55. The system defined in claim 54, wherein the health assessment includes computer code configured to:

automatically ask questions of the patient;

automatically receive answers from the patient so as to obtain the health data;

automatically select a specific health parameter corresponding to a portion of the patient medical record;

automatically calculate changes from prior disease management sessions in the patient'"'"'s health state as indicated by the health parameter; and

automatically compare the health state changes against the disease specific changes for the medical disease.

56. The system defined in claim 54, wherein the computerized device executes computer code configured to:

establish a current disease management session;

determine if the particular patient having the diagnosed medical disease has previously registered for a disease management session; and

register the patient and initialize the patient medical record in the data storage if the patient has not previously registered for a disease management session.

57. The system defined in claim 54, wherein the data storage includes an electronic medical database.

58. A computerized disease management method, comprising:

retrieving a patient medical record, corresponding to a particular patient having a previously diagnosed medical disease, from a memory;

assessing the health of the patient, comprising;

automatically asking questions of the patient, comprising;

providing a plurality of groups of questions indicative of assessing the health of the patient, each group being related to a linguistic level of understanding;

identifying the linguistic level of understanding of the particular patient;

selecting one of the question groups based on the identified linguistic level; and

asking a question of the patient from the selected group;

automatically receiving answers from the patient so as to obtain health data;

automatically storing the obtained health data into the patient medical record;

automatically selecting a specific health parameter corresponding to a portion of the patient medical record;

automatically calculating changes from prior disease management sessions in the patient'"'"'s health state as indicated by the health parameter, the calculated changes being indicative of a progression of the disease over time;

automatically comparing the health state changes against disease specific changes for the medical disease; and

automatically outputting data indicative of adjusting a disease therapy for the particular patient based on the obtained health data and the comparison.

59. The method of claim 58, wherein the method additionally comprises modifying a sensitivity factor based on the identified linguistic level, wherein the disease therapy adjustment depends on the sensitivity factor.