Expert system for providing interactive assistance in solving problems such as health care management

• US 5,517,405 A
• Filed: 10/14/1993
• Issued: 05/14/1996
• Est. Priority Date: 10/14/1993
• Status: Expired due to Term

• Current Assignee: Aetna Life & Casualty Co. (CVS Health Corporation)
• Original Assignee: Aetna Life & Casualty Co. (CVS Health Corporation)
• Inventors: Higgins, Brian, McAndrew, Peter D., Wayand, Jeff, Potash, David L., Held, Joe
• Primary Examiner(s): Weinhardt, Robert A.
• Application Number:
  US08/136,649
• Time in Patent Office: 943 Days
• Field of Search: 364/413.01, 364/413.02, 364/419.19, 364/402, 364/406, 364/401, 395/12, 395/51, 395/911, 395/924, 395/925, 395/934
• US Class Current: 706/45
• CPC Class Codes: G09B 7/04 characterised by modifying the teaching programme in response to a wrong answer, e.g. repeating the question, supplying a further explanation
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 40/63 for local operation
• 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: Y10S 706/924 Medical

Abstract

A problem solving expert system is provided which is particularly useful in managing the health care of individual patients. A description of a problem (e.g., medical condition) and a proposed solution therefor (e.g., medical procedure) is entered via a user interface. A topical library is searched to identify information relevant to the problem and proposed solution. Access to the identified information is available in either a full text or synopsis format, to assist a user in assessing the appropriateness of the proposed solution. An inference engine provides a recommendation to the user as to the appropriateness of the proposed solution based on information entered via the user interface and rules associated with the inference engine. A user can interact with the inference engine in either a structured or guided mode. The structured mode is directed to inexperienced users and dynamically generates questions in response to previous answers provided by the user to enable the inference engine to make its recommendation. The guided mode is directed to experienced users and provides a predefined questionnaire enabling the user to decide which questions to answer in order to obtain a recommendation.

Claims

1. A computer system for use in medical case management comprising:

a user interface selectively operable in a guided mode for experienced users and a structured mode for inexperienced users, said user interface enabling the input of information identifying a patient, a description of at least one medical condition of said patient and a proposed treatment for said medical condition;

a database for storing a topical library of medical information;

means for searching said topical library to identify medical information relevant to the medical condition and proposed treatment entered via said user interface;

means for enabling a user to access, via said user interface, medical information identified by said searching means to assist the user in assessing the appropriateness of said proposed treatment; and

an expert system including a rules database for supplementing the assistance provided by said searching means, said expert system being accessible by said user interface for providing a recommendation as to the appropriateness of said proposed treatment based on information entered via said user interface and rules recovered from said rules database;

said expert system facilitating the input of information via said user interface in said structured mode by dynamically generating questions in response to previous answers provided by the user to enable the expert system to make said recommendation; and

said expert system facilitating the input of information in said guided mode by providing a predefined questionnaire enabling the user to decide which questions to answer to obtain said recommendation.

2. A computer system in accordance with claim 1, wherein said expert system is responsive to the information entered via said user interface and rules recovered from said rules database for providing a recommendation as to whether said proposed treatment should be certified for coverage by an insurer.

3. A computer system in accordance with claim 2 wherein said expert system includes means for analyzing a plurality of different medical conditions entered via said user interface, said expert system factoring each of said medical conditions into a recommendation as to whether or not the proposed treatment should be certified for coverage by said insurer.

4. A computer system in accordance with claim 2 wherein said expert system includes means for providing said user with an explanation of the logic it used to make a recommendation.

5. A computer system in accordance with claim 1 wherein said expert system includes means for providing said user with an explanation of the logic it used to make a recommendation.

6. A computer system in accordance with claim 1 wherein said expert system includes means for suggesting alternatives to said proposed treatment.

7. A computer system in accordance with claim 1 further comprising:

means for providing a user interaction file that maintains a record of the medical condition and proposed treatment entered by said user, the medical information identified by said searching means and accessed by said user, and the recommendation made by said expert system means.

8. A computer system in accordance with claim 7 further comprising:

means for retrieving said user interaction file during a subsequent session involving the case management of a patient to which said user interaction file relates;

wherein said expert system considers information in the retrieved user interaction file before making a recommendation as to a new proposed treatment for said patient.

9. A computer system in accordance with claim 1 further comprising:

means for providing a user interaction file that includes a record of a guided or structured dialog with said user, including the medical condition and proposed treatment entered by said user, the medical information identified by said searching means and accessed by said user, and the recommendation made by said expert system means.

10. A computer system in accordance with claim 9 further comprising:

means for retrieving said user interaction file during a subsequent session involving the case management of a patient to which said user interaction file relates;

wherein said expert system considers information in the retrieved user interaction file before making a recommendation as to a new proposed treatment for said patient.

11. A computer system in accordance with claim 1 wherein said searching means include means for providing context sensitive assistance to said user by generating a key word search through said topical library in response to information entered by the user.

12. A computer system in accordance with claim 11 wherein said topical library contains synopses of said medical information, said system further including means for enabling a user to access either a synopsis or a full record of medical information identified by said searching means.

13. A computer system for use in medical case management comprising:

a user interface for enabling the input of information identifying a patient, a description of at least one medical condition of said patient and a proposed treatment for said medical condition;

a database for storing a topical library of medical information;

means for searching said topical library to identify medical information relevant to the medical condition and proposed treatment entered via said user interface;

means for enabling a user to access, via said user interface, medical information identified by said searching means to assist the user in assessing the appropriateness of said proposed treatment; and

an expert system including a rules database and being accessible by said user interface for providing recommendations as to the appropriateness of said proposed treatment and as to whether said proposed treatment should be certified for coverage by an insurer, based on information entered via said user interface and rules recovered from said rules database.

14. A computer system in accordance with claim 13 wherein said expert system includes means for analyzing a plurality of different medical conditions entered via said user interface, said expert system factoring each of said medical conditions into a recommendation as to whether or not the proposed treatment should be certified for coverage by said insurer.

15. A computer system in accordance with claim 14 wherein said expert system includes means for providing said user with an explanation of the logic it used to make a recommendation.

16. A computer system in accordance with claim 13 wherein said expert system includes means for providing said user with an explanation of the logic it used to make a recommendation.

17. A computer system in accordance with claim 13 wherein said expert system includes means for suggesting alternatives to said proposed treatment.

18. A computer system in accordance with claim 13 further comprising:

means for providing a user interaction file that maintains a record of the medical condition and proposed treatment entered by said user, the medical information identified by said searching means and accessed by said user, and the recommendation made by said expert system means.

19. A computer system in accordance with claim 18 further comprising:

means for retrieving said user interaction file during a subsequent session involving the case management of a patient to which said user interaction file relates;

wherein said expert system considers information in the retrieved user interaction file before making another recommendation.

20. A computer system in accordance with claim 13 wherein said searching means include means for providing context sensitive assistance to said user by generating a key word search through said topical library in response to information entered by the user.

21. A computer system in accordance with claim 20 wherein said topical library contains synopses of said medical information, said system further including means for enabling a user to access either a synopsis or a full record of medical information identified by said searching means.