Evidence-based checklist flow and tracking system for patient care by medical providers

• US 7,693,727 B2
• Filed: 05/16/2003
• Issued: 04/06/2010
• Est. Priority Date: 05/16/2002
• Status: Expired due to Fees

• Current Assignee: Cerylion Incorporated
• Original Assignee: Cerylion Incorporated
• Inventors: Moore, Gordon T.
• Primary Examiner(s): Morgan; Robert W
• Assistant Examiner(s): SOREY, ROBERT A
• Application Number:
  US10/440,465
• Publication Number:
  US 20040044546A1
• Time in Patent Office: 2,517 Days
• Field of Search: 705/2
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• 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 70/20 relating to practices or guidelines
• 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

Abstract

Interactive methods and systems for directing, integrating, documenting, and tracking steps taken by medical providers during the process of care for a patient'"'"'s given condition. Doctors'"'"' actions are directed by a prescriptive protocol—a checklist of discrete steps designed for efficient or optimal care of an individual patient'"'"'s specific condition. The step-by-step checklist is abstracted from decision tree guidelines for the optimal work up and treatment for the condition using probability-based methodology. The care protocols can be derived from widely available and non-proprietary guidelines and decision trees based on public medical research literature.

In one embodiment, the invention can be employed by a primary care clinician at the point of referral into the specialist sector, and at the specialist level when proposing a risky or expensive or otherwise problematic medical or surgical diagnostic or treatment intervention. At these two critical transaction points in care, the checklist functions like a lock, based on a hidden clinical decision algorithm (an explanation of which can be displayed upon request). The system asks the clinician for data and then generates the patient'"'"'s optimal checklist, displaying it as a point and click form keyed to the stage of care being undertaken by each doctor. As the clinician enters data into the checklist, a decision engine determines whether the checklist data satisfies predetermined criteria for authorization of the proposed action. The system can also document each transaction taken in the process of care to create an electronic record that can be made accessible to all clinicians involved in the process of care.

Claims

1. A computer-implemented method of managing health care provided to a patient, comprising:

creating, by at least one computer, a plurality of checklists each associated with a prior probability level of a medical condition, wherein said creating includes transforming at least one stored evidence-based decision guideline into each of said plurality of checklists by using a Bayesian analysis to construct an optimal sequence of steps to reach a predetermined probability threshold indicating approval for a major transition in the care process;

storing, by said at least one computer, said plurality of checklists in a checklist database;

receiving, by said at least one computer, patient information entered by a first physician including a suspected medical condition and patient insurance information;

responsive to said patient information being received from said first physician, calculating, by said at least one computer, an initial prior probability of said suspected medical condition from said received patient information based on accumulated information from a plurality of other patients stored on an accessible system wide database;

selecting, by said at least one computer from said checklist database, a first checklist associated with a prior probability level of a medical condition matching said calculated initial prior probability of a suspected medical condition for said patient;

displaying, by said at least one computer, said first checklist to said first physician;

receiving, by said at least one computer, responses to said first checklist from said first physician;

calculating, by said at least one computer, a cumulative probability of said suspected medical condition based on said received responses to said first checklist from said first physician;

determining, by said at least one computer, that said cumulative probability of said suspected medical condition exceeds a predetermined probability threshold associated with said first checklist in said checklist database;

responsive to said predetermined probability threshold being met, determining, by said at least one computer, a first major transition in the care process including that said patient is to be referred to a second eligible physician with regard to said suspected medical condition based on said patient insurance information and physician identifying information from an insurance database;

responsive to said determining said first major transition in the care process, transmitting, by said at least one computer, a referral note to said second physician;

receiving, by said at least one computer, a proposed medical action selected by said second physician from a list of possible medical actions;

responsive to receiving said proposed medical action from said second physician, calculating, by said at least one computer, a subsequent prior probability of said suspected medical condition from said received patient information and said received proposed medical action based on accumulated information from a plurality of other patients stored on said accessible system wide database;

selecting, by said at least one computer from said checklist database, a second checklist associated with a prior probability level matching said calculated subsequent prior probability for said patient;

displaying, by said at least one computer, said second checklist to said second physician;

receiving, by said at least one computer, responses to said second checklist from said second physician;

calculating, by said at least one computer, a cumulative probability of said medical condition based on said received responses to said second checklist from said second physician;

determining, by said at least one computer, that said cumulative probability exceeds a predetermined probability threshold associated with said second checklist in said checklist database;

responsive to said predetermined threshold being met, determining, by said at least one computer, a second major transition in the care process including that said proposed medical action is to be performed on said patient with regard to said suspected medical condition;

responsive to said determining that said medical action is to be performed on said patient, generating, by said at least one computer, an approval of said proposed medical action; and

responsive to said generating of said approval of said proposed medical action, automatically reporting to said first physician, by said at least one computer, said approval of said proposed medical action together with said responses to said second checklist received from said second physician.

2. The method of claim 1, further comprising:

storing, by said at least one computer system, said patient information received from said first physician, said suspected medical condition, said calculated initial prior probability for said patient with regard to said first major transition in the care process, said first checklist, said responses to said first checklist received from said first physician, said referral note, said proposed medical action selected by said second physician, said second checklist, said responses to said second checklist received from said second physician, and said approval of said proposed medical action, into a temporary episode record contained in a temporary episode record database.

3. The method of claim 2, further comprising:

storing, by said at least one computer system, said temporary episode record in said system wide database.

4. The method of claim 3, further comprising:

purging, by said at least one computer system, said temporary episode record of patient identification information prior to storing said temporary episode record in said system wide database.

5. The method of claim 1, further comprising:

wherein said reporting said approval of said proposed medical action to said first physician comprises displaying a progress report in a graphical user interface, wherein said progress report summarizes the status of all of the first physician'"'"'s patients currently undergoing active care by specialists.

6. The method of claim 5, further comprising:

wherein said progress report that summarizes the status of all of the first physician'"'"'s patients displays color codes representing the status of each of said patients currently undergoing active care by specialists.

7. The method of claim 1, further comprising:

wherein said information stored in said system wide database regarding said plurality of other patients comprises data from temporary episode records of said plurality of other patients.

8. The method of claim 7, further comprising:

wherein said calculating of said calculated prior probability for said patient with regard to said first major transition in the care process and said calculating of said calculated prior probability for said patient with regard to said second major transition in the care process are responsive to said data from said temporary episode records of said plurality of other patients.

9. The method of claim 1, further comprising:

wherein said initial prior probability level comprises one of the set consisting of high probability, medium probability, and low probability.

10. The method of claim 1, further comprising:

wherein said first physician comprises a primary care physician; and

wherein said second physician comprises a specialist.

11. The method of claim 1, further comprising:

wherein said proposed medical action comprises a test.

12. The method of claim 1, further comprising:

wherein said proposed medical action comprises a medical procedure.

13. The method of claim 1, further comprising:

wherein said proposed medical action comprises a medical treatment.

14. The method of claim 1, further comprising:

determining, by said at least one computer system, that said responses to said first checklist received from said first physician do not satisfy evidence-based clinical decision criteria for referring said patient to said second physician; and

responsive to said determination that said responses to said first checklist received from said first physician do not satisfy said evidence-based clinical decision criteria for referring said patient to said second physician, generating, by said at least one computer system, a notification to said first physician.

15. The method of claim 1, further comprising:

determining, by said at least one computer system, that said responses to said second checklist received from said second physician do not satisfy evidence-based clinical decision criteria for approval of said proposed medical action; and

responsive to said determination that said responses to said second checklist received from said second physician do not satisfy said evidence-based clinical decision criteria for approval of said proposed medical action, generating, by said at least one computer system, a notification to both said first physician and said second physician.

16. A system for managing health care provided to a patient, said system including at least one computer and at least one database, comprising:

a decision engine in at least one computer system configured to create a plurality of checklists each associated with a prior probability level of a medical condition, wherein said creation includes transforming at least one stored evidence-based decision guideline into each of said plurality of checklists by using a Bayesian analysis to construct an optimal sequence of steps to reach a predetermined probability threshold indicating approval for a major transition in the care process;

a checklist database configured to store said plurality of checklists;

an accessible system wide database configured to store information regarding a plurality of other patients;

an insurance database configured to store physician identifying information;

said computer system, via a first user interface, configured to receive patient information entered by a first physician including a suspected medical condition and patient insurance information;

said computer system, responsive to said patient information being received from said first physician, configured to calculate an initial prior probability of said suspected medical condition from said received patient information based on accumulated information from a plurality of other patients stored on an accessible system wide database;

said computer system configured to select from said checklist database, a first checklist associated with a prior probability level of a medical condition matching said calculated initial prior probability of a suspected medical condition for said patient;

said computer system, via said first user interface, configured to display said first checklist to said first physician;

said computer system, via said user interface, configured to receive responses to said first checklist from said first physician;

said computer system configured to calculate a cumulative probability of said suspected medical condition based on said received responses to said first checklist from said first physician;

said computer system configured to determine that said cumulative probability of said suspected medical condition exceeds a predetermined probability threshold associated with said first checklist in said checklist database;

said computer system, responsive to said predetermined probability threshold being met, configured to determine first major transition in the care process including that said patient is to be referred to a second eligible physician with regard to said suspected medical condition based on said patient insurance information and physician identifying information from an insurance database;

said computer system, responsive to said determining said first major transition in the care process, configured to transmit a referral note to said second physician;

said computer system, via a second user interface, configured to display to said second physician said referral note to a second physician and a list of possible medical actions;

said computer system, via said second user interface, configured to receive a proposed medical action selected by said second physician from said displayed list of possible medical actions;

said computer system, responsive to receiving said proposed medical action from said second physician, configured to calculate a subsequent prior probability of said suspected medical condition from said received patient information and said received proposed medical action based on accumulated information from a plurality of other patients stored on said accessible system wide database;

said computer system configured to select from said checklist database, a second checklist associated with a prior probability level matching said calculated subsequent prior probability for said patient;

said computer system, via said second user interface, configured to display said second checklist to said second physician;

said computer system, via said second user interface, configured to receive responses to said second checklist from said second physician;

said computer system configured to calculate a cumulative probability of said medical condition based on said received responses to said second checklist from said second physician;

said computer system configured to determine that said cumulative probability exceeds a predetermined probability threshold associated with said second checklist in said checklist database;

said computer system, responsive to said predetermined threshold being met, configured to determine a second major transition in the care process including that said proposed medical action is to be performed on said patient with regard to said suspected medical condition;

said computer system, responsive to said determining that said medical action is to be performed on said patient, configured to generate, by said at least one computer, an approval of said proposed medical action; and

said computer system, responsive to said generating of said approval of said proposed medical action, configured to automatically report to said first physician, via said at first user interface, said approval of said proposed medical action together with said responses to said second checklist received from said second physician.

17. The system of claim 16, further comprising:

a temporary episode record in a temporary episode record database configured to store said patient information received from said first physician, said suspected medical condition, said calculated initial prior probability for said patient with regard to said first major transition in the care process, said first checklist, said responses to said first checklist received from said first physician, said referral note, said proposed medical action selected by said second physician, said second checklist, said responses to said second checklist received from said second physician, and said approval of said proposed medical action.

18. The system of claim 17, further comprising:

a system wide database configured to store said temporary episode record.

19. The system of claim 18, further comprising:

wherein temporary episode record is purged of patient identification information prior to said temporary episode record being stored in said system wide database.

20. The system of claim 16, further comprising:

wherein said information stored in said system wide database regarding said plurality of other patients comprises data from temporary episode records of said plurality of other patients.

21. The system of claim 20, further comprising:

wherein said calculating of said calculated prior probability for said patient with regard to said first major transition in the care process and said calculating of said calculated prior probability for said patient with regard to said second major transition in the care process are responsive to said data from said temporary episode records of said plurality of other patients.

22. The system of claim 16, further comprising:

wherein said initial prior probability level comprises one of the set consisting of high probability, medium probability, and low probability.

23. The system of claim 16, further comprising:

wherein said first physician comprises a primary care physician; and

wherein said second physician comprises a specialist.

24. The system of claim 16, further comprising:

wherein said proposed medical action comprises a test.

25. The system of claim 16, further comprising:

wherein said proposed medical action comprises a medical procedure.

26. The system of claim 16, further comprising:

wherein said proposed medical action comprises a medical treatment.

27. The system of claim 16, further comprising:

wherein said at least one computer system is further configured to determine that said responses to said first checklist received from said first physician do not satisfy evidence-based clinical decision criteria for referring said patient to said second physician; and

responsive to said determination that said responses to said first checklist received from said first physician do not satisfy said evidence-based clinical decision criteria for referring said patient to said second physician, generate a notification to said first physician.

28. The system of claim 16, further comprising:

wherein said at least one computer system is further configured to determine that said responses to said second checklist received from said second physician do not satisfy evidence-based clinical decision criteria for approval of said proposed medical action; and

responsive to said determination that said responses to said second checklist received from said second physician do not satisfy said evidence-based clinical decision criteria for approval of said proposed medical action, generate a notification to both said first physician and said second physician.

29. The system of claim 16, further comprising:

wherein said reporting said approval of said proposed medical action to said first physician comprises displaying a progress report in a graphical user interface, wherein said progress report summarizes the status of all of the first physician'"'"'s patients currently undergoing active care by specialists.

30. The system of claim 16, further comprising:

wherein said progress report that summarizes the status of all of the first physician'"'"'s patients displays color codes representing the status of each of said patients currently undergoing active care by specialists.