Automated diagnostic system and method including synergies

• US 6,767,325 B2
• Filed: 10/22/2002
• Issued: 07/27/2004
• Est. Priority Date: 02/14/2000
• 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): Hindenburg, Max F.
• Assistant Examiner(s): ASTORINO, MICHAEL C
• Application Number:
  US10/278,127
• Publication Number:
  US 20030045782A1
• Time in Patent Office: 644 Days
• Field of Search: 705/2-4, 702/19, 600/300-301, 128/903-904, 128/920-925, 706/2, 706/45
• US Class Current: 600/300
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• 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 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 70/60 relating to pathologies
• 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 128/904 Telephone telemetry
• CPC Class Codes: Y10S 128/92 Computer assisted medical diagnostics
• CPC Class Codes: Y10S 128/925 Neural network

Abstract

Structure-based processing includes a method of diagnosing diseases that works by arranging diseases, symptoms, and questions into a set of related disease, symptom, and question structures, such as objects or lists, in such a way that the structures can be processed to generate a dialogue with a patient. A structure-based processing system organizes medical knowledge into formal structures and then executes those structures on a structure engine to automatically select the next question. Patient responses to the questions lead to more questions and ultimately to a diagnosis. An object-oriented embodiment includes software objects utilized as active, intelligent agents where each object performs its own tasks and calls upon other objects to perform their tasks at the appropriate time to arrive at a diagnosis. Alternative symptoms, synergies, encoding of patient responses, multiple diagnostic modes, disease profiles or timelines, and the reuse of diagnostic objects enhance the processing of the system and method.

Claims

1. A computerized medical diagnostic system, comprising:

means for repetitively asking questions over time to elicit responses from a patient, wherein the responses establish time varying symptoms, and each established symptom contributes a weight to a disease;

means for determining one or more synergistic weights based on the symptoms established over time;

means for accumulating established symptom weights and determined synergistic weights as a cumulative weight for the disease; and

means for determining whether the cumulative weight for the disease reaches or passes a threshold so as to declare a diagnosis.

2. The system defined in claim 1, wherein determining synergistic weights includes establishing a synergistic symptom.

3. The system defined in claim 1, wherein the time varying symptoms are stored in a patient medical record.

36. The system defined in claim 1, wherein the questions are asked during more than one consultation.

37. The system defined in claim 1, additionally comprising determining an onset time for each established symptom and an offset time, if it has occurred.

38. The system defined in claim 1, additionally comprising determining onset characteristics for each established symptom.

4. A computerized medical diagnostic system, comprising:

a computerized device;

a data structure, stored on the computerized device, configured to store values corresponding to time varying symptoms at different times; and

a diagnosis program executing on the computerized device, the program being configured to;

automatically ask questions over time to elicit responses from a patient, the responses establishing time varying symptoms, each established symptom contributing a weight to a disease,

store values corresponding to the established time varying symptoms in the data structure,

determine one or more synergistic weights based on the stored values corresponding to the symptoms established over time,

accumulate established symptom weights and determined synergistic weights as a cumulative weight for the disease, and

determine whether the cumulative weight for the disease reaches or passes a threshold so as to declare a diagnosis.

5. The system defined in claim 4, wherein determining synergistic weights includes establishing a synergistic symptom.

6. The system defined in claim 4, wherein the values corresponding to the time varying symptoms are stored in a patient medical record.

7. The system defined in claim 4, wherein for a particular symptom, the intensity of the symptom varies over time.

8. The system defined in claim 4, wherein for a particular symptom, a symptom attribute cycles or pulses over time.

9. The system defined in claim 4, wherein for a particular symptom, a symptom attribute comes and goes over time.

10. The system defined in claim 4, wherein for a particular symptom, a symptom attribute repeats over time.

11. The system defined in claim 4, wherein determining synergistic weights includes calculating a statistical function of the stored values corresponding to the symptoms established over time.

12. The system defined in claim 11, wherein the statistical function comprises determining a slope or a trend of a curve.

13. A computerized medical diagnostic method, comprising:

a) repetitively asking questions over time to elicit responses from a patient, the responses establishing a time varying symptom, the established symptom contributing a weight to at least one disease;

b) determining one or more synergistic weights based on the symptom established over time;

c) adding the established symptom weight and the synergistic weight(s) to a total score for each applicable disease, wherein the adding is performed in unison for the applicable diseases; and

d) determining whether the total score for a particular disease reaches or passes a threshold so as to declare a diagnosis.

14. The method defined in claim 13, wherein the time varying symptoms are stored in a patient medical record.

15. The method defined in claim 13, additionally comprising repeating a)-d) for a different symptom.

39. The method defined in claim 13, wherein the questions are asked during more than one consultation.

16. A computerized medical diagnostic method, comprising:

repetitively asking questions over time to elicit responses from a patient, the responses establishing overlapping symptoms which occur over a time period, each established symptom contributing a weight to a disease;

determining one or more synergistic weights based on the overlapping symptoms established over time;

accumulating established symptom weights and determined synergistic weights as a cumulative weight for the disease; and

determining whether the cumulative weight for the disease reaches or passes a threshold so as to declare a diagnosis.

17. The method defined in claim 16, wherein determining synergistic weights includes establishing a synergistic symptom.

18. The method defined in claim 16, wherein the overlapping symptoms are stored in a patient medical record.

19. The method defined in claim 16, wherein determining synergistic weights comprises:

providing an overlap threshold;

computing the length in time that symptoms overlapped in time; and

checking if the computed overlap meets or exceeds the overlap threshold.

20. The method defined in claim 19, additionally comprising providing a selected synergistic weight if the computed overlap meets or exceeds the overlap threshold.

21. The method defined in claim 16, wherein overlapping symptoms are present in the patient at the same time for a specified amount of time.

40. The method defined in claim 16, wherein establishing overlapping symptoms includes determining an onset time and an offset time of each overlapping symptom.

41. The method defined in claim 16, wherein the questions are asked during more than one consultation.

22. A computerized medical diagnostic method, comprising:

repetitively asking questions over time to elicit responses from a patient, the responses establishing symptom values over a time period, each established symptom contributing a weight to a disease;

computing a total symptom value over the time period for a selected established symptom;

determining a synergistic weight based on the total symptom value over the time period;

accumulating established symptom weights and the determined synergistic weight as a cumulative weight for the disease; and

determining whether the cumulative weight for the disease reaches or passes a threshold so as to declare a diagnosis.

23. The method defined in claim 22, wherein the symptom values over time are stored in a patient medical record.

24. The method defined in claim 22, wherein computing the total symptom value over the time period comprises:

plotting the symptom values for the time period; and

integrating the symptom values during the time period.

25. The method defined in claim 24, wherein determining the synergistic weight comprises providing a weight corresponding to the integrated symptom values.

26. The method defined in claim 22, wherein if the symptom is a particular type of pain, the total symptom value over the time period is representative of the total amount of pain suffered by the patient during the time period.

42. The method defined in claim 22, wherein the questions are asked during more than one consultation.

27. A method of computerized medical diagnosis, comprising:

repetitively asking questions over time to elicit responses from a patient, wherein the responses establish a symptom, and the established symptom contributes a weight to a disease;

determining if the established symptom is the first significant symptom for the disease;

providing a synergistic weight based on the determining;

adjusting a disease score for the disease based on the established symptom weight and the synergistic weight; and

calculating whether the disease score for the disease reaches or passes a threshold so as to declare a diagnosis.

28. The method defined in claim 27, wherein the determining comprises:

accessing a list of one or more possible first significant symptoms for the disease; and

identifying whether the established symptom is present on the list.

29. The method defined in claim 28, wherein the providing comprises retrieving a synergistic weight corresponding to the identified first significant symptom.

30. A computerized medical diagnostic system, comprising:

a computerized device;

a data structure, stored on the computerized device, configured to store synergistic weights; and

a diagnosis program executing on the computerized device, the program being configured to;

automatically ask questions over time to elicit responses from a patient, wherein the responses establish a symptom, and the established symptom contributes a weight to a disease selected from a plurality of diseases,

determine if the established symptom is the first significant symptom for the disease,

provide a one of the synergistic weights based on the determination,

adjust a disease score for the disease based on the established symptom weight and the synergistic weight, and

calculate whether the disease score for the disease reaches or passes a threshold so as to declare a diagnosis.

31. The system defined in claim 30, wherein the data structure comprises a list of one or more possible first significant symptoms for the disease and a synergistic weight for each possible first significant symptom.

32. The system defined in claim 31, wherein the value of the synergistic weight for each possible first significant symptom corresponds to the relative importance of each symptom in the list.

33. The system defined in claim 31, wherein the determination includes identifying whether the established symptom is present on the list.

34. The system defined in claim 33, additionally including retrieving a synergistic weight corresponding to the identified symptom on the list.

35. The system defined in claim 31, wherein the data structure additionally comprises a list of one or more possible first significant symptoms and a synergistic weight for each possible first significant symptom for each of the plurality of diseases.

43. A method of computerized medical diagnosis, comprising:

repetitively asking questions over time to elicit responses from a patient, wherein the responses establish symptoms, each established symptom contributing a weight to a disease;

detecting if at least a portion of the established symptoms are present in a predetermined time order sequence;

providing a synergistic weight according to the detecting results;

adjusting a disease score for the disease based on the established symptom weights and the synergistic weight; and

calculating whether the disease score for the disease reaches or passes a threshold so as to declare a diagnosis.

44. The method defined in claim 43, additionally comprising setting a start time for each established symptom.

45. The method defined in claim 43, additionally comprising storing the established symptom weights and the synergistic weight in a patient medical record.

46. The method defined in claim 43, additionally comprising storing a plurality of the symptom predetermined time order sequences and the corresponding synergistic weights in a data structure.

47. The method defined in claim 46, wherein providing a synergistic weight includes retrieving the synergistic weight from the data structure.

48. A computerized medical diagnostic method, comprising:

repetitively asking questions over time to elicit responses from a patient, the responses establishing symptom levels, each established symptom contributing a weight to a disease;

determining a synergistic weight for a selected established symptom based on the symptom level;

accumulating established symptom weights and the determined synergistic weight as a cumulative weight for the disease; and

determining whether the cumulative weight for the disease reaches or passes a threshold so as to declare a diagnosis.

49. The method defined in claim 48, additionally comprising storing a plurality of symptom levels and corresponding synergistic weights for selected symptoms in a data structure.

50. The method defined in claim 49, wherein determining a synergistic weight includes retrieving the synergistic weight from the data structure.

51. A method of computerized medical diagnosis, comprising:

repetitively asking questions over time to elicit responses from a patient, wherein the responses establish a symptom, and the established symptom contributes a weight to a disease;

determining if an onset of the established symptom has a synergistic weight;

providing a synergistic weight according to the determining results;

adjusting a disease score for the disease based on the established symptom weight and the synergistic weight; and

calculating whether the disease score for the disease reaches or passes a threshold so as to declare a diagnosis.

52. The method defined in claim 51, wherein the providing comprises:

plotting the onset of the established symptom;

calculating an onset slope based on the plotting; and

comparing the onset slope to a predefined slope threshold.

53. The method defined in claim 52, wherein the providing further comprises obtaining a synergistic weight based on the comparing.

54. The method defined in claim 52, additionally comprising storing a plurality of onset slope values and corresponding synergistic weights in a data structure.

55. The method defined in claim 54, wherein providing the synergistic weight further includes retrieving the synergistic weight from the data structure.