System for screening of medical decision making incorporating a knowledge base

• US 6,049,794 A
• Filed: 12/09/1997
• Issued: 04/11/2000
• Est. Priority Date: 12/09/1997
• Status: Expired due to Term

• Current Assignee: Change Healthcare Holdings, LLC (UnitedHealth Group Incorporated)
• Original Assignee: Access Health, Inc. (McKesson Corp.)
• Inventors: Mitus, A. Jacqueline, Lamprey, Josephine A, Baird, David W, Karys, Alec P, Jacobs, Charles M., Upton, Thomas W.
• Primary Examiner(s): Lintz, Paul R.
• Assistant Examiner(s): Khatri, Anil
• Application Number:
  US08/988,368
• Time in Patent Office: 854 Days
• Field of Search: 706/45, 706/46, 706/47, 705/2, 705/3
• US Class Current: 706/45
• 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 70/00 ICT specially adapted for the handling or processing of medical references

Abstract

A System for screening of medical decision making is described. The system runs on a personal computer, and incorporates a knowledge base containing the data required to perform the screening, as well as the rules to be incorporated. The knowledge base is organized into criteria sets subdivided into categories, which include clinical specialties, such as surgery, and imaging, or a level of care, or a body system. The criteria sets are further subdivided into interventions, review types, and levels of care. Finally, within each subdivision, the user selects criteria points which are representations of the patient'"'"'s clinical condition. Upon selection of the criteria points, the system will indicate whether or not a selected method of treatment is medically appropriate or not. The review process is recorded for subsequent examination.

Claims

1. A computer-based medical screening system for use in medical facilities which reviews an intended course of action regarding a patient, accumulates data during the course of action, and provides information as to the utilization of medical resources during said course of action, the system comprising:

a knowledge base of medical information organized into criteria sets, the knowledge base comprising clinical specialties, body systems, procedures,

indications, and criteria points, and wherein each criteria set contains data and

rules for determining when the intended course of action is medically appropriate;

means for inputting patient information;

means for selecting a clinical specialty or body system;

means for selecting a procedure within the selected clinical specialty or body system;

means for selecting an indication within the selected procedure;

means for selecting criteria points within the selected indication based on the patient'"'"'s clinical situation;

means for determining, based on the selected criteria points, whether or not the intended course of action is medically appropriate;

means for displaying the rules governing said determination;

means for recording the steps of the review process;

means for playback of the steps of the review process;

means for including one or more rationale review notes in the criteria sets;

means for associating rationale review notes with procedures, indications, criteria points and rules;

means for outputting the rationale review notes; and

means for outputting one or more resource utilization reports.

2. The system of claim 1, wherein the rationale review notes further comprise mandatory rationale review notes and discretionary rationale review notes, and further comprising, for each type of rationale review notes,

means for associating the rationale review notes with procedures, indications, criteria points and rules;

means for indicating the presence of said rationale review notes in association with a selected procedures, indications, criteria points and rules; and

means for requesting the display of the rationale review notes.

3. The system of claim 2, wherein the criteria sets further comprise:

Intensity of Service, Severity of Illness, and Discharge Screens for adults;

Intensity of Service, Severity of Illness, and Discharge screens for pediatric patients;

Indications for surgery and procedures;

Indications for imaging studies and X-rays;

Indications for Workers'"'"' Compensation;

Indications for primary and specialty care management; and

Surgical indications monitoring.

4. The system of claim 3, wherein the means for inputting patient information comprises linking to an external program, and wherein the means for reporting the steps of the review process further comprises data linking means to a second external program, and further comprising an aggregation data base which contains a history of the reviews performed.

5. The system of claim 4, further comprising means for suspending a review and completing the review at a later time.

6. The system of claim 5, wherein the criteria points comprise "star IS" criteria points, which have a lesser weight in the processing means than other criteria points.

7. A medical screening method for use in medical facilities which comprises:

creating a knowledge base of medical information organized into criteria sets, the knowledge base comprising clinical specialties, body systems, procedures,

indications, and criteria points, and wherein each criteria set contains data and rules for determining when the intended course of action is medically appropriate;

inputting an intended course of action regarding a patient;

inputting and accumulating patient data before and during the course of action;

outputting indications as to whether the intended course of action is appropriate;

outputting rationale review notes;

outputting information as to the utilization of medical resources during said course of action.

8. The method of claim 7, further comprising:

organizing the database into clinical specialty or body system subsets;

organizing the specialty or body system subset into procedure sub-subsets;

organizing the procedure sub-subset into indication sub-subsets; and

organizing the indication sub-subsets into criteria point sub-sub-subsets s sub-subsets.

9. The method of claim 8, wherein the method is implemented by means of computer software.

10. A computer-software-based medical screening method for use in medical facilities, which comprises the following steps, in sequence:

entering patient and case information;

opening a category folder;

selecting a review type from the category folder;

selecting a level of care from the review type folder;

selecting a body system from the level of care folder;

selecting a component from the body system folder;

selecting a component from the body system folder;

inputting criteria points from the body system folder;

opening the case notes folder;

calculating a review outcome from the patient and case information, category folder opened, review type folder opened, level of care folder opened, body system folder opened, component folder opened, and criteria point selected;

opening the case notes folder;

entering referral codes, target review dates, and case notes;

setting an alternative level of care;

entering Variance Days, Reference LOS, and Case notes;

creating an printing a case review report; and

saving the review for future referral.

11. A computer-based medical screening system for use in medical facilities which reviews an intended course of action regarding a patient having a clinical situation, and comprising:

a knowledge base of medical information organized into criteria sets, the knowledge base comprising clinical specialties, body systems, procedures, indications, and criteria points, and wherein each criteria set contains data and rules for determining when the intended course of action is medically appropriate;

means for inputting patient and case information;

means for selecting a review type;

means for selecting a level of care within the review type;

means for selecting a body system within a level of care;

means for selecting a component within a body system;

means for selecting an indication within the selected component;

means for selecting criteria points within the selected indication based on the patient'"'"'s clinical situation;

means for determining, based on the selected criteria points, whether or not the intended course of action is medically appropriate;

means for displaying the rules governing said determination;

means for recording the steps of the review process;

means for playback of the steps of the review process;

means for including one or more rationale review notes in the criteria sets;

means for associating the rationale review notes with procedures, indications, criteria points and rules;

means for outputting the rationale review notes; and

means for outputting one or more resource utilization reports.

12. The system of claim 11, wherein the rationale review notes further comprise mandatory rationale review notes and discretionary rationale review notes, and further comprising, for each type of rationale review notes,

means for associating the rationale review notes with procedures, indications, criteria points and rules;

means for indicating the presence of said rationale review notes in association with a selected procedures, indications, criteria points and rules; and

means for requesting the display of the rationale review notes.

13. The system of claim 12, wherein the criteria sets further comprise Prerequisites, Severity of Illness, Intensity of Service, and Discharge.

14. The system of claim 13, wherein the means for inputting patient information comprises linking to an external program, and wherein the means for reporting the steps of the review process further comprises data linking means to a second external program, and further comprising an aggregation data base which contains a history of the reviews performed.

15. The system of claim 14, further comprising means for suspending a review and completing the review at a later time.

16. The system of claim 15, wherein the criteria points comprise "star IS" criteria points, which have a lesser weight in the processing means than other criteria points.