Proactive and interactive clinical decision support

• US 8,265,948 B2
• Filed: 01/16/2007
• Issued: 09/11/2012
• Est. Priority Date: 09/29/2006
• Status: Active Grant

• Current Assignee: Cerner Innovation, Inc. (Oracle Corporation)
• Original Assignee: Cerner Innovation, Inc. (Oracle Corporation)
• Inventors: Schmitt, Michael D., Huffman, Keith A., Perez, Leo V., Murrish, J. Christopher
• Primary Examiner(s): Koppikar, Vivek
• Assistant Examiner(s): NGUYEN, TRANG T
• Application Number:
  US11/623,584
• Publication Number:
  US 20080082365A1
• Time in Patent Office: 2,065 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/63 for local operation
• 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 70/60 relating to pathologies

Abstract

Proactive and interactive clinical decision support events are provided. When a clinical decision support event is initiated for a patient, relevant stored clinical information associated with the patient is accessed. A user interface is generated using the stored clinical information. A clinician may interact with the user interface by providing user-provided clinical information that may add to and/or modify the stored clinical information in the user interface. Clinical advice is provided based on the stored clinical information and the user-provided clinical information.

Claims

1. A method in a clinical computing environment for providing clinical decision support, the method comprising:

receiving, at a computing device, a clinical order for a patient;

after receiving the clinical order, determining that a clinical decision support event is associated with the clinical order, wherein the clinical decision support event is used to verify that the clinical order is appropriate for the patient;

accessing stored clinical information associated with the patient from a data store;

determining that certain elements of clinical information relevant to the clinical decision support event are not currently available in the stored clinical information;

determining that the stored information does not indicate that the clinical decision support event is needed by performing a preliminary calculation using only the stored information;

determining that initiating the clinical decision support event is appropriate by evaluating the preliminary calculation in combination with possible values for the certain elements that are not currently available in the stored clinical information;

proactively initiating the clinical decision support event based on the stored clinical information even through only partial clinical information for the clinical decision support event is available in the stored clinical information and even though the stored information alone does not indicate that the clinical decision support event is needed;

generating a user interface for the clinical decision support event, the user interface including the plurality of clinical information elements relevant to the clinical decision support event, at least a portion of the clinical information elements being populated with the stored clinical information and requests for the certain elements that are not currently available in the stored clinical information to be provided, wherein the clinical information elements are capable of being modified by a user;

presenting the user interface to a user;

receiving user-provided clinical information from a user via the user interface;

providing clinical advice related to whether the clinical order is appropriate based on the stored clinical information and the user-provided clinical information; and

storing the clinical order and the clinical advice in the patient'"'"'s electronic medical record.

2. The method of claim 1, wherein the clinical order is for a commonly over-prescribed medication.

3. The method of claim 1, wherein the method further comprises:

monitoring stored clinical information associated with the patient;

comparing the stored clinical information against one or more rules associated with the clinical decision support event; and

determining that at least one of the one or more rules associated with the clinical decision support event has been satisfied based on the stored clinical information.

4. The method of claim 1, wherein the data store comprises an electronic medical record for the patient.

5. The method of claim 1, wherein the clinical advice comprises a recommendation to perform at least one clinical action.

6. The method of claim 1, wherein the method further comprises identifying a type of clinical decision support event.

7. The method of claim 6, wherein accessing stored clinical information associated with the patient from a data store comprises accessing stored clinical information relevant to the type of clinical decision support event.

8. The method of claim 6, wherein generating the user interface for presentation using the stored clinical information comprises generating the user interface based on the type of clinical decision support event.

9. The method of claim 1, wherein generating the user interface for presentation using on the stored clinical information comprises determining preliminary clinical advice based on the stored clinical information, and wherein the user interface further includes the preliminary clinical advice.

10. The method of claim 9, wherein providing clinical advice based on the stored clinical information and the user-provided clinical information comprises updating the preliminary clinical advice using the stored clinical advice and the user-provided clinical advice.

11. The method of claim 1, wherein the user interface further includes one or more links to evidence-based medical information regarding the clinical decision support event.

12. The method of claim 1, wherein at least a portion of the user-provided clinical information comprises a modification of at least a portion of the stored clinical information.

13. The method of claim 1, wherein at least a portion of the user-provided clinical information comprises subjective clinical information associated with the patient.

14. The method of claim 1, wherein the method further comprises receiving a clinical order via the user interface.

15. A system including a computer processor and computer-executable instructions embodied on one or more computer-storage media in a clinical computing environment for providing a clinical decision support event, the system comprising:

an order entry component for receiving a clinical order associated with the patient;

a knowledge base having one or more rules associated with one or more types of clinical decision support events;

an inference engine in communication with the knowledge base and a data store storing clinical information associated with a patient that determines that certain elements of clinical information relevant to a clinical decision support event are not currently available in the stored clinical information, that the stored information for the patient does not indicate that the clinical decision support event is needed by performing a preliminary calculation using only the stored information, and that initiating the clinical decision support event is appropriate by evaluating the preliminary calculation in combination with possible values for certain elements that are not currently available in the stored clinical information; and

a user interface component that generates a user interface for a clinical decision support event even through only partial clinical information for the clinical decision support event is available in the stored clinical information and even though the stored information alone does not indicate that clinical advice is needed, the user interface including a plurality of clinical information elements relevant to the clinical decision support event, at least some of the plurality of clinical information elements being populated with clinical information accessed from the data store, and requests for the certain elements that are not currently available in the stored clinical information to be provided, the user interface being configured to receive user-provided clinical information via the clinical information elements and wherein elements of the user interface are capable of being modified by a user.

16. The system of claim 15, wherein the data store comprises an electronic medical record for the patient.

17. The system of claim 15, wherein the clinical order is for a commonly over-prescribed medication.

18. A method in a clinical computing environment for providing clinical decision support, the method comprising:

accessing, at a computing device, stored clinical information associated with a patient from a data store;

determining that certain elements of clinical information relevant to the clinical decision support event are not currently available in the stored clinical information;

determining that the stored information does not indicate that the clinical decision support event is needed by performing a preliminary calculation using only the stored information;

determining that initiating the clinical decision support event is appropriate by evaluating the preliminary calculation in combination with possible values for the certain elements that are not currently available in the stored clinical information;

proactively initiating the clinical decision support event based on the stored clinical information even through only partial clinical information for the clinical decision support event is available in the stored clinical information and even though the stored information alone does not indicate that clinical decision support event is needed;

generating a user interface for the clinical decision support event, the user interface including the plurality of clinical information elements relevant to the clinical decision support event, at least a portion of the clinical information elements being populated with the stored clinical information and requests for the certain elements that are not currently available in the stored clinical information to be provided, wherein the clinical information elements are capable of being modified by a user;

receiving new clinical information relevant to the certain elements;

determining preliminary clinical advice based on the stored clinical information and the new clinical information;

presenting the stored clinical information and the preliminary clinical advice;

receiving user-provided clinical information describing a medical condition in the patient; and

updating the preliminary clinical advice to generate updated clinical advice based on the stored clinical information and the user-provided clinical information describing the medical condition in the patient; and

presenting the updated clinical advice.

19. A method in a clinical computing environment for providing a clinical decision support event associated with a patient, the clinical decision support event having a plurality of clinical information elements relevant thereto, the method comprising:

monitoring, at a computing device, stored clinical information associated with the patient;

determining that certain elements of clinical information relevant to the clinical decision support event are not currently available in the stored clinical information;

determining that the stored information does not indicate that the clinical decision support event is needed by performing a preliminary calculation using only the stored information;

determining that initiating the clinical decision support event is appropriate by evaluating the preliminary calculation in combination with possible values for the certain elements that are not currently available in the stored clinical information;

proactively initiating the clinical decision support event based on the stored clinical information even through only partial clinical information for the clinical decision support event is available in the stored clinical information and even though the stored information alone does not indicate that the clinical decision support event is needed;

generating a user interface for the clinical decision support event, the user interface including the plurality of clinical information elements relevant to the clinical decision support event, at least a portion of the clinical information elements being populated with the stored clinical information and requests for the certain elements that are not currently available in the stored clinical information to be provided, wherein the clinical information elements are capable of being modified by a user; and

presenting the user interface to a user.

20. The method of claim 19, further comprising:

receiving user-provided clinical information from a user via one or more of the clinical information elements of the user interface; and

providing clinical advice based on the stored clinical information and the user-provided clinical information.