Method and system for healthcare treatment planning and assessment

• US 6,484,144 B2
• Filed: 09/15/1999
• Issued: 11/19/2002
• Est. Priority Date: 03/23/1999
• Status: Expired due to Term

• Current Assignee: Previser Corporation (Northeast Delta Dental)
• Original Assignee: Dental Medicine International, LLC
• Inventors: Martin, John, Nolf, Randy
• Primary Examiner(s): Trammell, James P.
• Assistant Examiner(s): Elisca, Pierre E
• Application Number:
  US09/396,404
• Publication Number:
  US 20020004725A1
• Time in Patent Office: 1,161 Days
• Field of Search: 705/2, 705/3, 705/4
• US Class Current: 705/2
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/00 ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
• 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

Abstract

Methods and systems consistent with the present invention provide a comprehensive assessment and planning system. Methods and systems consistent with employ a preventive approach to predicting the likelihood of an entity entering a degraded future state by computing a risk value that reflects that likelihood. An embodiment applies to a comprehensive healthcare treatment and planning system. This healthcare system employs a preventive approach to healthcare by basing healthcare decisions on a multi-factorial computation of risk. The risk value is computed by evaluation of a function that considers a variety of historic, environmental, and systemic behaviors and conditions. In addition to considering a risk value, a treatment plan developed in accordance with the healthcare system considers symptoms and objectives of the treatment from the perspective of both the patient and the provider. The outcomes associated with treatment and risk assessment are fed back into the healthcare system to increase its accuracy and subsequent effectiveness in computing risk values over time.

Claims

1. A method in a data processing system for determining an appropriate treatment for a patient, comprising the steps of:

receiving diagnostic data indicating a current state of a patient;

receiving data reflecting treatment objectives of the patient and the provider indicating a preferred treatment outcome;

receiving a plurality of treatment plans for the current state and for preventing the patient from developing a disease;

computing first risk values for the patient associated with respective ones of the treatment plans, each one of the first risk values being based on a subset of the diagnostic data and indicating a likelihood of the patient developing the disease if the associated treatment plan is followed;

computing second risk values for the patient associated with respective ones of the treatment plans, each one of the second risk values being based on a subset of the diagnostic data and indicating a likelihod of the patient being responsive to treatment of the current state if the associated treatment plan is followed;

receiving an indication of a selected one of the treatment plans;

receiving an indication of a degree of success of the selected treatment plan in treating the current state and preventing the development of the disease;

comparing the degree of success with the treatment objectives to assess the effectiveness of the selected treatment plan; and

adjusting the computed first and second risk values for the selected treatment plan based on the effectiveness to increase an accuracy in determining the appropriate treatment.

2. The method of claim 1 further including the step of obtaining insurance pre-authorization for one of the treatment plans based on the risk value therefor.

3. The method of claim 1 wherein the disease under examination is multi-factorial.

4. The method of claim 1 further comprising adjusting the computed risk value consistent with outcomes of prior treatment.

5. A method in a data processing system for determining an appropriate treatment for a current state of a patient, comprising the steps of:

receiving diagnostic data reflecting the current state of the patient and treatment objectives for the patient;

computing a risk value reflecting a likelihood of the patient developing a disease induced by treatment of the current state based on a subset of the diagnostic data;

receiving a proposed treatment plan for the current state that reflects the computed risk value and the treatment objectives; and

analyzing the proposed treatment plan to determine a likelihood that the proposed treatment plan will successfully treat the current state, prevent the patient from developing the disease induced by the treatment, and satisfy the treatment objectives.

6. The method of claim 5 wherein the analyzing step includes:

receiving patient and provider objectives of treatment indicating a preferred treatment outcome; and

determining whether the proposed treatment plan is consistent with the patient and the provider objectives of treatment.

7. The method of claim 5 wherein the analyzing step includes determining whether the proposed treatment plan is appropriate for the diagnostic data.

8. The method of claim 5 wherein the analyzing step includes determining whether the proposed treatment plan is appropriate based upon prior treatment provided.

9. The method of claim 5 further including the step of adjusting the computed risk value based on prior outcomes of treatment to increase an accuracy in determining the appropriate treatment.

10. The method of claim 5 wherein the step of receiving includes accessing the diagnostic data from a remote location.

11. The method of claim 5 wherein the computing step includes adjusting the risk value based on prior outcomes of treatment to increase an accuracy in determining the appropriate treatment.

12. The method of claim 5 further including the step of transmitting the computed risk value to an external source for pre-authorization of a treatment for the patient.

13. The method of claim 12 wherein the transmitting step includes transmitting the computed risk value to an insurance company.

14. The method of claim 12 wherein the transmitting step includes transmitting the computed risk value to an organization that makes policy decisions pertaining to healthcare benefits.

15. A method in a data processing system for determining an appropriate treatment for a current state of a patient, comprising the steps of:

receiving diagnostic data reflecting the current state of the patient;

computing a risk value reflecting a likelihood of the patient being responsive to the treatment of the current state based on a subset of the diagnostic data;

receiving a proposed treatment plan for the current state that reflects the computed risk value; and

analyzing the proposed treatment plan to determine a likelihood that the proposed treatment plan will successfully treat the current state.

16. The method of claim 15 wherein the analyzing step includes:

receiving patient and provider objectives of treatment indicating a preferred treatment outcome; and

determining whether the proposed treatment plan is consistent with the patient and the provider objectives of treatment.

17. The method of claim 15 wherein the analyzing step includes determining whether the treatment plan is appropriate for the diagnostic data.

18. The method of claim 15 wherein the analyzing step includes determining whether the proposed treatment plan is appropriate based upon prior treatment provided.

19. The method of claim 15 further including the step of adjusting the compound risk value based on prior outcomes of treatment to increase an accuracy in determining the appropriate treatment.

20. The method of claim 15 wherein the receiving step includes accessing the diagnostic data from a remote location.

21. The method of claim 15 wherein the computing step includes adjusting the risk value based on prior outcomes of treatment to increase an accuracy in determining the appropriate treatment.

22. The method of claim 15 further including the step of transmitting the computed risk value to an external source for pre-authorization of a treatment for the patient.

23. The method of claim 22 wherein the transmitting step includes transmitting the computed risk value to an insurance company.

24. The method of claim 22 wherein the transmitting step includes transmitting the computed risk value to an organization that makes policy decisions pertaining to healthcare benefits.

25. The method of claim 15 further comprising analyzing the proposed treatment plan to determine a likelihood that the proposed treatment plan will prevent the patient from developing a diseased induced by the proposed treatment plan.

26. A data processing system including a client and a healthcare server, comprising;

a storage device including patient health information that includes data reflecting a current state of the patient and treatment objectives for the patient;

a memory including administrative software and a healthcare system that (1) computes a risk value based on diagnostic data, the risk value reflecting a likelihood of the patient developing a disease induced by treatment of the current state, and (2) that analyzes a proposed treatment plan for the current state to determine a likelihood that the proposed treatment plan will successfully treat the current state, prevent the patient from developing the disease induced by the treatment, and satisfy the treatment objectives; and

at least one processor for executing the healthcare system and the administrative software.

27. A data processing system including a client and a healthcare server, comprising:

means for receiving diagnostic data reflecting a patient'"'"'s current state treatment objectives for the patient;

means for computing a risk value based on a subset of the diagnostic data, the risk value reflecting a likelihood of the patient developing a disease induced by treatment of the current state;

means for receiving a proposed treatment plan for the current state that reflects the computed risk value and the treatment objectives; and

means for analyzing the proposed treatment plan to determine a likelihood that the proposed treatment plan will successfully treat the curernt state, prevent the patient from developing the disease induced by the treatment, and satisfy the treatment objectives.

28. A computer-readable medium containing instructions for controlling a data processing system to perform a method, the data processing system having a healthcare server, the method comprising the steps of:

receiving diagnostic data reflecting a current state of the patient and treatment objectives for the patient;

computing a risk value reflecting a likelihood of the patient developing a disease induced by treatment of the current state based on a subset of the diagnostic data;

receiving a proposed treatment plan for the current state that reflects the computed risk value and the treatment objectives; and

29. The computer-readable medium of claim 28 wherein the analyzing step includes:

receiving patient and provider objectives of treatment indicating a preferred treatment outcome; and

determining whether the treatment plan is consistent with the patient and provider objectives of treatment.

30. The computer-readable medium of claim 28 wherein the step of analyzing includes determining whether the treatment plan is appropriate for the patient'"'"'s diagnostic data.

31. The computer-readable medium of claim 28 wherein the analyzing step includes determining whether the proposed treatment plan is appropriate based upon prior treatment provided.

32. The computer-readable medium of claim 28 further including instructions for adjusting the compound risk value based on prior outcomes of treatment.

33. The computer-readable medium of claim 28 wherein the receiving step includes accessing diagnostic data stored at a remote location.

34. The computer-readable medium of claim 28 wherein the computing step includes adjusting the risk value based on prior outcomes of treatment.

35. The computer-readable medium of claim 28 further including instructions for transmitting the computed risk value to an external source for pre-authorization of a treatment for the patient.

36. The computer-readable medium of claim 28 wherein the transmitting step includes transmitting the computed risk value to an insurance company.

37. The computer-readable medium of claim 28 wherein the transmitting step includes transmitting the computed risk value to an organization that makes policy decisions pertaining to healthcare benefits.

38. A method in a data processing system, comprising the steps of:

receiving information reflecting a current state of an entity and objectives for the entity;

computing a risk value that indicates a likelihood of the entity entering an undesirable state induced by treatment of the current state based on a subset of the information;

receiving a proposed strategy for the current state that reflects the computed risk value and the objectives; and

analyzing the proposed strategy to determine the likelihood that the proposed strategy will successfully treat the current state, prevent the entity from entering the undesirable state induced by the treatment, and satisfy the objectives.

39. The method of claim 38 further including the step of:

requesting authorization from an external source before employing the proposed strategy.

40. The method of claim 38 further including the step of receiving objectives of the entity and determining whether the proposed strategy is consistent with the objectives of the entity.

41. The method of claim 38 wherein the analyzing step includes determining whether the proposed strategy is appropriate for the diagnostic information.

42. The method of claim 41 wherein the determining step includes determining whether the proposed strategy is appropriate based upon prior results of executed strategies.

43. The method of claim 38 further including the step of adjusting the computed risk value based on prior results of strategy invocations.

44. The method of claim 38 wherein the receiving step includes accessing the diagnostic information from a remote location stored on a remote location.

45. The method of claim 38 wherein the computing step includes adjusting the computed risk value based on prior results of executed strategies.

46. The method of claim 38 wherein the receiving step includes receiving information reflecting a current state of a healthcare patient.

47. A data processing system including a client and healthcare server, comprising:

means for receiving diagnostic data indicating a current state of a patient;

means for receiving data reflecting treatment objectives of the patient and the provider indicating a preferred treatment outcome;

means for receiving a plurality of treatment plans for the current state and for preventing the patient from developing a disease;

means for computing first risk values for the patient associated with respective ones of the treatment plans, each one of the first risk values being based on a subset of the diagnostic data and indicating a likelihood of the patient developing the disease if the associated treatment plan is followed;

means for computing second risk values for the patient associated with respective ones of the treatment plans, each one of the second risk values being based on a subset of the diagnostic data and indicating a likelihod of the patient being responsive to treatment of the current state if the associated treatment plan is followed;

means for receiving an indication of a selected one of the treatment plans;

means for receiving an indication of a degree of success of the selected treatment plan in treating the current state and preventing the development of the disease;

means for comparing the degree of success with the treatment objectives to access the effectiveness of the selected treatment plan; and

means for adjusting the computed first and second risk values for the selected treatment plan based on the effectiveness to increase an accuracy in determining the appropriate treatment.

48. A data processing system including a client and a healthcare server, comprising:

means for receiving diagnostic data reflecting a current state of the patient;

means for computing a risk value reflecting a likelihood of the patient being responsive to the treatment of the current state based on a subset of the diagnostic data;

means for receiving a proposed treatment plan for the current state that reflects the computed risk value; and

means for analyzing the proposed treatment plan to determine a likelihood that the proposed treatment plan will successfully treat the current state.