US20020032878A1 - Apparatus for and method of administering a decision procedure - Google Patents

Abstract

A computer system for performing an interactive assessment of the risk of an event, has a computer monitor to present to a user of the system a series of questions and potential responses, and a keyboard or other device to select a response to the question. The system can administer complex inverted tree type decision algorithms, in which the questions that are presented to the user, depend upon the response to the previous question, and an assessment of the risk of an event is presented to the user whenever they reach the terminus point in the decision tree. The risk assessment algorithm is data driven and a risk assessment is defined by entries in a file, which is available over a network. The system provides options so each user may view the path through the sequence of questions and answers, and interact with the risk assessment, in a manner customized for their own interactive session.

Description

• This application is a continuation of U.S. Utility patent application Ser. No. 09/037,165 (Attorney Docket No. K1625.0001/P001), filed on Mar. 9, 1998, which is incorporated herein by reference in its entirety.[0001]
BACKGROUND
• The means to administer a risk assessment have not kept pace with the increasingly complex risk assessment rules that are the result of extensive research and analysis. Particularly in the area of health, data that is collected with the goal of understanding the factors associated with a medical condition, from expensive well-planned epidemiological research studies, may have been analyzed by means of logistic regression, regression trees, discriminant analyses, or other sophisticated statistical methodologies, that result in extremely complicated rules to assess risk. Such rules are too complex to be readily applied.[0002]
• The changing face of health care is, among other things, forcing people to take more responsibility for their own health, and assessing personal risk is an important facet. We see more instances of simple health assessments printed in newspapers, and magazines. By necessity these personal risk assessments must be easy for the reader to apply, since usage rates for complex assessments are low, and error rates are high. The typical personal assessment may require answering a simple set of questions, adding up a point total, and then assessing risk according to the range in which the point total falls. Such simple assessments are about at the level of complexity that can be typically handled without undue chance of error. The problem with such simple assessments is that they are by necessity simplifications from more detailed studies, and subsequently lack the precision of the studies from which they are taken. The tradeoff is that to be usable, they have to be simplified.[0003]
• Even sophisticated users may have difficulty performing a complex risk assessment. The research paper “A computer protocol to predict myocardial infarction in emergency department patients with chest pain”, published in the New England Journal of Medicine, Mar. 31, 1988, Vol 318, pages 797-803, presents a risk assessment that can be used by emergency room medical personnel for triage of patients with symptoms of chest pain. The analysis and procedure is presented without any suggestion for a means by which it may be operationally used in the emergency room. The complexity of the decision rule, possibly requiring the answering of up to 8 questions, and the severity of the consequences should a mistake occur, mandate a careful approach to the means by which the rule is implemented. An embodiment of the invention can be an important element in standard operation procedure by which this rule is applied in the emergency room.[0004]
SUMMARY
• In accordance with an embodiment of the invention, a computer system is provided as an easy means for a user to invoke and perform an interactive risk assessment. A feature of the embodiment is the ease with which extremely complex risk assessment algorithms can be administered. This means that users will have access to, and be able to self administer risk assessments from research studies without having to be concerned with the complexities of the methodologies and implementation. Also risk assessments will no longer have to be simplified in order to be usable. An embodiment of the invention includes administering an interactive risk assessment, which poses one question at a time, recording responses, and presenting to the user either the assessed risk, or the next portion of the risk assessment algorithm that they are to respond to. Also, the risk assessment program has the means to present the risk assessment in a multiplicity of formats, and with customization options to let the user proceed in a manner that they find most useful.[0005]
• An embodiment of the invention provides a system that is able to administer complex decision rules. This includes inverted tree type decision structures in which the path of questions is dependent and determined by the responses to prior questions. Such structures have been heretofore unavailable for personal risk assessments because of their complexity.[0006]
• Embodiments of the invention provide for the wide availability of the system, the ease with which the risk assessment algorithm may be updated and maintained, as well as the scope of risk algorithms that can be available to users. Where the assessment is data driven from a risk assessment definition maintained on a server node of a computer network, all computers that have access to the server can be used to administer a risk assessment. Update of the risk assessment, as more current algorithms become available is achieved by replacing the risk assessment definition with the new definition and are immediately available in all subsequent risk assessments. Also, since any risk assessment that can be defined according to the structure of the risk definition file can be administered by the program, and this structure is general enough to accommodate a wide variety or risk decision structures, a large number of different risk assessments can be maintained in a central location on the same server and made available to users.[0007]
• In an embodiment of the invention, all these risk assessments are now administered in a similar way, so once the user can successfully master the administration of any risk assessment, they have the skills to administer all others.[0008]
• In accordance with an embodiment of the invention, an exemplary system is provided having a client program running on a client node of a computer network, and a server program running on server nodes of a computer network. As a response to a request from the client program for a risk assessment definition, the server can send a response to the client program, that has sufficient information to fully describe the risk assessment that is to be administered. The system can thus be data driven, and can administer any risk assessment that conforms to the structure and criteria of the risk definition file. Each risk definition is easily updateable by replacing the risk definition file with a new file that describes an updated risk assessment decision rule.[0009]
• The system is capable of presenting in a fashion usable to even novice users, even the most complex risk assessments involving deeply nested decision paths, and paths in which the questions that are asked at any level are dependent upon the answers to previous questions, and can implement complicated mathematical risk assessment formulas, in which the values for parameters are provided by the responses to questions presented during the risk assessment.[0010]
• The user interface of the risk assessment program may be event driven, and carefully guides the user through the intricate risk assessment by presenting a series of questions to which the user in turn responds. At the end of a series of questions the risk assessment is presented to the user. The interaction between the user and the risk assessment client program includes not just the ability to respond to questions on the screen, but also provide means for the user to customize the screen presentation in a manner consistent with their personal comfort level. A multiplicity of display modes are available, and the user may choose the display mode with which they are most comfortable, and during the risk assessment switch between display mode. Also, the degree of detail about the previously answered questions and subsequent questions that are displayed is controlled by the user.[0011]
BRIEF DESCRIPTION OF THE DRAWINGS
• The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate an embodiment of the invention, and together with the detailed description of the embodiments, serve to explain the invention.[0012]
• FIG. 1 is a block diagram of an exemplary system in accordance with a preferred embodiment of the invention.[0013]
• FIG. 2 is a block diagram of client program of FIG. 1.[0014]
• FIG. 3 is a block diagram of the server program of FIG. 1.[0015]
• FIG. 4 is an example of risk assessment decision rule.[0016]
• FIG. 5 is a file format for the risk definition file.[0017]
• FIG. 6 is an example of the contents of the risk definition.[0018]
• FIG. 7 is a data structure for maintaining information to administer and display an inverted tree decision rule.[0019]
• FIG. 8 is an example of a risk assessment screen showing the initial display of the risk assessment decision rule in tree display format.[0020]
• FIG. 9 is an example of a risk assessment screen showing a customized view of the risk assessment tree display.[0021]
• FIG. 10 is an example of a risk assessment screen showing the display in tree display format at the conclusion of a risk assessment.[0022]
• FIG. 11 is an example of a risk assessment screen showing the display in text display format at the end of a risk assessment.[0023]
• FIG. 12 is a state diagram describing the operation of the client and server programs.[0024]
• FIG. 13 displays the client/server program message protocols.[0025]
• FIG. 14 is a state table describing the operation of the server program.[0026]
• FIG. 15 is a state table describing the operation of the client program.[0027]
DETAILED DESCRIPTION
• References will now be made in detail to embodiments of the invention, examples of which are illustrated in the accompanying drawings. Wherever possible, the same reference numbers will be used throughout the drawings to refer to the same or like parts.[0028]
• A risk assessment may be a set of steps that is used to assess the risk of an event. The risk assessment may be presented quantitatively as in the expected number of deaths per 100,000 population, or may be qualitative resulting in an assessment such as ‘High risk’ of acute myocardial infarction.[0029]
• A risktree-client program may refer to a computer program running on a computer attached to a computer network, and is a client-node on the computer network. All interactions by the user to perform the risk assessment take place between the user and the risktree-client program.[0030]
• A risktree-server program may refer to a computer program running on a computer attached to a computer network, and is a server-node on the computer network. The risktree-server program responds to requests from a risktree-client program for the information to administer a risk assessment by sending all the information that is required for the risktree-client to administer the risk assessment.[0031]
• A risk definition or risk definition file may refer to the information that is maintained on the risktree-server, and which provides sufficient information for the risktree-client to fully administer a risk assessment.[0032]
• This system can accommodate risk assessment decision rules that follow a complex inverted tree decision structure. An inverted tree decision structure starts with a single initial question to which the user may respond. Depending on the user's response, the risk assessment may terminate with an assessment of the risk or may proceed to another question to which the user must respond, with this process continuing until the decision procedure terminates with sufficient information to calculate and present the risk assessment. Importantly, each ‘next’ question in the risk assessment depends only on the response to the previous question, and different questions may be asked depending on the different responses to a question.[0033]
• In accordance with an embodiment of the invention, a computer system is provided having an interactive risk assessment of an event occurring. The system partitions the operation of the system between a risktree-client program which is the program that the user interacts with to perform the risk assessment, and a risktree-server program that stores and provides the risk definition file that defines the risk assessment. The risktree-client program administers a risk assessment that is defined entirely by the information in the risk definition file. In this exemplary system, all communication between the risktree-client and risktree-server use a non-persistent network connection maintained only for the duration of the transaction.[0034]
• FIG. 1 is a block diagram of an exemplary system of an embodiment of the invention. A[0035]system100 of FIG. 1 illustrates the risktree-client computer101, the risktree-service computer102, and thenetwork interface103 over which they establish a connection. In this exemplary system, the network interface protocol that is used is the industry standard network protocol TCP/IP.
• FIG. 2. is a block diagram of the risktree-[0036]client computer101. In this exemplary system, thesystem200 consists of acomputer monitor201, a computer110, acomputer mouse230, and acomputer keyboard220. Thecomputer210 includes amemory213 and a processor (CPU)214, amass storage device216, and a network interface card (NIC)215.Monitor201, thecomputer mouse230, andcomputer keyboard220, are connected tocomputer210 in a manner known to persons of ordinary skill in the art.
• [0037]Computer210 preferably is a Dell OptiPlex XMT, thekeyboard220 is a Dell Quietkey, and monitor201 a Dell Ultrascan 17XE , all manufactured by the Dell Corporation of Austin, Tex.. TheNIC215, is anIntel EtherExpress 16, 16-bit ISA ethernet Adapter card manufactured by the Intel Corporation of Santa Clara, Calif. Thecomputer mouse230, is a Microsoft System Mouse, manufactured by the Microsoft Corporation of Redmond, Wash.
• In this exemplary system,[0038]computer210 is executing under Microsoft Windows 95. The client program is written in a computer language called Microsoft Visual Basic using the Microsoft Visual Basic Version 5.0. This application development tool is from the Microsoft Corporation of Redmond, Washington. Other systems and embodiments may use other hardware and software components.
• FIG. 3. is a block diagram of the risktree-[0039]server computer102. In the exemplary system, thesystem300 consists of acomputer monitor301, acomputer310, acomputer mouse330, and acomputer keyboard320. Thecomputer310 includes amemory313 and a processor (CPU)314, amass storage device316, and a network interface card (NIC)315.Monitor301, thecomputer mouse330, andcomputer keyboard320, are connected tocomputer310 in a manner known to persons of ordinary skill in the art.
• [0040]Computer310 preferably is a Dell OptiPlex XMT, thekeyboard320 is a Dell Quietkey, and monitor301 a Dell Ultrascan 17XE , all manufactured by the Dell Corporation of Austin, Tex. TheNIC315, is anIntel EtherExpress 16, 16-bit ISA ethernet Adapter card manufactured by the Intel Corporation of Santa Clara, Calif. Thecomputer mouse330, is a Microsoft System Mouse, manufactured by the Microsoft Corporation of Redmond, Wash.
• In this exemplary system,[0041]computer310 is executing under Microsoft Windows NT Server 4.0, and is running the Microsoft Internet Information Server, both manufactured by the Microsoft Corporation of Redmond, Wash. Other systems and embodiments may use other hardware and software components. The risk definition files are stored on the risk-server and are accessed by the risktree-client using the industry standard hypertext transport protocol.
• FIG. 4 is a specific example[0042]400 of a complicated inverted tree risk assessment decision rule that the system can handle. The system is not limited to this specific risk assessment, and the example is only used as it will be useful in explaining the operation of an embodiment of the invention. This example is taken from an article ‘A computer protocol to predict myocardial infarction in emergency department patients with chest pain’, by L. Goldman et. al., published in the New England Journal of Medicine, Volume 318,Number 13, on Mar. 31, 1988, pages 797-803. The article presents a risk assessment rule for predicting whether a patient admitted to an emergency room with chest pain has a low or high risk for the presence of myocardial infarction. It is a complicated inverted tree decision rule that is difficult to administer without assistance from some kind of tool.
• The first question in the[0043]decision rule401, asks the question ‘ST elevation or Q waves in 2 or more leads, not known to be old?.’ If the answer to this question is Yes402, then the risk assessment is over and there is a ‘Hi’risk403 that the patient has had a myocardial infarction. If however, the answer is ‘No’404 then the risk assessment proceeds by asking the next question405 ‘Chest pain began more than 48 hours ago?.’ If the answer to this question is ‘Yes’406, then the risk assessment proceeds to the question407 ‘ST-T changes of ischemia or strain, not known to be old?.’ If the response to this question is ‘No’408, then the risk assessment is over and there is a ‘Lo’risk409 that the patient has had a myocardial infarction. If the answer however to question407 is ‘Yes’410, then the risk assessment is terminated by categorizing the patient as having a ‘Hi’risk411 of having had a myocardial infarction.
• If the answer to question[0044]405 is ‘No’412, then the risk assessment proceeds by asking the question413 ‘Prior history of angina or MI?’, and may proceed through as many as 5 more levels of questions before arriving at the assessment of risk.
• All subsequent questions in the risk assessment are operationally evaluated during the process of performing the risk assessment in a manner analogous to that described above. If the user has arrived at the bottom of a branch of the risk assessment tree, then the risk assessment has been completed and the risk can be evaluated and reported. If the user is not at the bottom of the tree then the question has to be considered by the user, and a selection made from the valid responses.[0045]
• FIG. 5 shows the[0046]data structure500 of the risk definition file that describes the risk definition that is maintained on the risktree-server300 of FIG. 3. Every risk assessment that can be defined according to this structure can be displayed and administered by the risktree-client program. The first eightrecords501 of the risk definition provide information about the type of risk assessment. Allsubsequent records502 after the eighth record have a similar format and fully describe the content and structure of the questions and responses for the risk assessment, and have one record for each node of the decision rule.
• Record one[0047]511 of the risk definition file provides a definition of the risk that is to be assessed. Thesecond record512 provides the authoritative reference for the risk assessment. Record three513 is the network location of the risk definition file, and in the case of this exemplary system is the Uniform Resource Location (URL) providing the internet address of the risk definition file. Thefourth record514 provides the maximum depth of the tree structure. This information is used by the risktree-client to display and store the risk definition. Thefifth record515 gives the risk units that will be displayed with the risk assessment. For instance, if the risk assessment calculates a mortality value, the risk units might be 'per 100,000 population.
• Since risk assessments may pertain to life threatening decisions or other important decisions, record six[0048]516 and record seven517 provide dates that bound a period of time during which it is valid to use the decision rule. Record six516 provides a start date in month-day-year format after which the decision rule may be used, and record seven517 provides an end date in month-day-year format after which the risk assessment should not be used. Theeighth record518 provides an internet E-mail address as a contact for further information or questions about the specific risk assessment.
• Following the eighth record are a set of records called node-[0049]descriptor records519 that all have the same format and describe the nodes of the inverted tree structure, the relationship between the nodes, and the associated risk. There will be one entry for each node. In the example FIG. 4.400 of an inverted tree structure for an assessment of the risk of myocardial infarction there are 27 boxes. The risk definition file for that risk assessment would then have 27 node-descriptor records519. The risk definition file corresponds to the rule to assess the risk of myocardial infarction in FIG. 4, and is presented in FIG. 6.
• There are 3 types of nodes in an inverted tree; a start node, question/response node, and terminal nodes. A start node is the first question in the risk assessment, and in the case of FIG. 4, is identified with the question[0050]401 ‘ST elevation or waves in 2 or more leads, not known to be old?’ A question/response node is one that identifies the prior node or immediate predecessor question, the response to the prior question that leads to the node, and the new question associated with the node. In the case of FIG. 4,box405 is an example of a question/response node with thearrow404 indicating the prior question was401, the response was ‘No’404, and the new question that will be asked405 is ‘Chest pain began more than 48 hours ago?’ A terminal node is one that identifies the prior node or immediate predecessor question, the response to the prior question that leads to the terminal node, and the risk assessment. In the case of FIG. 4,box403 is an example of a terminal node with thearrow402 indicating the prior question was401, the response was ‘Yes’402, and the risk assessment is ‘Hi’403 risk of myocardial infarction.
• There are 12 fields in the node-[0051]descriptor519 that give all the information necessary to describe each of the types of nodes in the inverted tree decision structure. Field ‘NodeID’520 provides a unique identifier for the Node. In the exemplary system the NodeIDs are numbered sequentially top-down and left-to-right starting at ‘1’. The NodeID is in character format and the node with NodelD ‘1’ is always the start node in the risk assessment. Field ‘PredNode’521 provides theNodelD520 of the prior or predecessor node. In the case of the start node where there is no predecessor, and this value is blank.Field NodeName522 provides a unique name for the risk description node, and is an alternate identifier to that of theNodeID520 by which a node may be uniquely identified. Field ‘NodeLevel’523 gives a numeric value for the level of the node. The level is the number of questions that the user would have to respond to, in order to reach the current node. The start node is at Nodelevel ‘0’. In FIG. 4, the question in thebox405 is at Nodelevel ‘1’, the question in thebox407 is at Nodelevel ‘2’, and therisk assessment403 is at NodeLevel ‘1’.
• The field ‘NodePos’[0052]524 provides a numeric value with vertical positioning information that will be used by the risktree-client program to give a relative position that the program will use to display the node. Any2 nodes with the same value of NodePos will be displayed with the same vertical alignment by the risktree-client program. The field ‘NumAbove’525 provides a numeric value with the number of predecessor nodes. For an inverted tree rule this will always have the value of ‘1’, though for other types of decision structures that the system can handle, there may be more than a single path leading to the current node. In the case of the start node this value is 0. The field ‘NumBelow’526 gives a numeric value with the number of child nodes. In the case of a terminal node, this value will be ‘0’.
• The field ‘Question’[0053]527 gives the text of the question that will be asked and is a character value of length up to 255 characters. In FIG. 4 thebox405 asks the question ‘Chest pain began more than 48 hours ago?’, and this value is found in the ‘Question’field527. The field ‘NodeLabel’528 is a character value of length up to32 characters and gives the text of the response associated with the current node. In FIG. 4 one navigates to thebox405 by answering ‘No’ to theprior question401, and in this example it is this value ‘No’ that is found in the ‘NodeLabel’field528. Field ‘Risk’529 contains a character representation of the risk that will be displayed whenever one reaches a terminal node. In FIG. 4box403 is a terminal node associated with ‘Hi risk’ risk of myocardial infarction, and it is the value ‘Hi’ that is found in the field ‘Risk’529. When displaying the risk for a terminal node in FIG. 4, the assessed value, in this case ‘Hi risk’, is combined with the ‘Risk units’ field ‘of myocardial infarction’ to provide the risk assessment that is presented to the user—‘Hi risk of myocardial infarction’. The field ‘YoungestSib’530 gives the ‘NodeID’520 of the lowest numbered NodeID of all nodes that have the current node as a predecessor, and the field ‘OldestSib’531 gives the ‘NodeID’520 of the highest numbered NodeID of all nodes that have the current node as a predecessor. These values are used by the risktree-client to display the paths between nodes.
• In this exemplary system, the fields ‘NodeLevel’, ‘NodePos’, ‘NumAbove’, ‘NumBelow’, ‘YoungestSib’ and ‘OldestSib’ are provided in the risk definition file, but in other systems and embodiments they may all be calculated from the fields ‘NodeID’, and ‘PredNode’.[0054]
• FIG. 6 is a listing[0055]600 of the risk definition for the example of the risk assessment to predict myocardial infarction in emergency department patients with chest pain of FIG. 4. It is to be understood that the risktree-client can display and administer any risk assessment, not just the assessment of myocardial infarction in emergency room department patients with chest pain. In the risk definition file a caret ‘^ ’ is used as a delimiter for records and fields, and can never occur as the content of an entry in the file.
• The first line[0056]601 ‘Myocardial infarction in Emergency Department Patients with Chest Pain’ is an example of theRecord 1511 of FIG. 5. This information is displayed in therisk assessment display810 of FIG. 8. Thesecond line602 is an example of the ‘Source of the decision rule’512, and gives the journal reference from which the risk assessment was coded, or it may be some other authoritative reference for the risk assessment. Thethird line603 is an example of the ‘Network location of risk definition file’513 and gives the URL of the Internet resource for the myocardial infarction risk definition file. The fourth line604 is an example of the ‘Max depth of the risk decision tree’514, showing that for the myocardial infarction risk assessment the maximum depth of a risk assessment is 8 levels of questions and responses. Thefifth line605 is an example of the ‘Risk units’515 showing that for the myocardial infarction risk assessment the risk assessment will be displayed with the units ‘of myocardial infarction’ appended to the assessment. The myocardial infarction risk assessment always results in a decision that the patient has either ‘High risk’ in which case the risktree-client displays the assessed risk as ‘High risk of myocardial infarction’, or ‘Low risk’ in which case the risktree-client displays the assessed risk as ‘Low risk of myocardial infarction.’
• The[0057]sixth line607 and seventh line608 are examples of thedates516 and517 that bound the period of time during which the myocardial infarction risk assessment is valid. It shows a start date ‘January 1, 1998’ before which the risk assessment should not be used and an end date of ‘December 31, 1998’ after which this risk assessment should not be used. If the date on which the risk assessment is being performed is not within these bounds then the risktree-client will display a message ‘Risk assessment out of date’ and will not administer the risk assessment. This feature assures that the risk assessment must be reassessed on a timely basis. The eighth line608 is an example of the ‘E-mail address’518, and provides a contact point for more information about the risk assessment. The information inlines601,602,603,606,607, and608 are displayed in a popup risk assessment information box that the user may access from the risk assessment display screen of FIG. 8.
• The information in the set of[0058]lines610, correspond to the entries that fully define the myocardial infarction risk assessment of FIG. 4. There are 27 lines in the set, one for each of the 27 boxes in FIG. 4, which represent either a start node, question/response node, or terminal node risk assessment. Each line of the set follows the structure of the node-descriptor519. Line611 is the start node for the myocardial risk assessment, line612 a question/response node, and line613 a terminal risk assessment node. All of the remaining 24 lines of theset610 are either question/response nodes or terminal risk assessment nodes.
• Line[0059]611 describes the first question in the myocardial risk assessment of FIG. 4. There are 12 entries on this line each delimited by a caret ‘^ ’ sign, and correspond to the structure of the node-descriptor519. The ‘NodeID’520 is ‘1’ and indicates that this is the start node or first qusestion in the risk assessment. The ‘PredNode’521 is ‘0’ and identifies that the start node does not have a predecessor—it is the start of the risk assessment procedure. The ‘NodeName’522 is ‘Nodel’ and is an alternative unique identifier for the node. The ‘NodeLevel’523 is ‘0’ since this is the first question of the risk assessment and no questions have yet been answered. The ‘NodePos’524 is ‘11’ and gives the relative vertical position when the node is displayed on the risk assessment display screen. Any node with a value of ‘NodePos’ less than ‘11’ will always be displayed to its left; a node with a value of ‘NodePos’ equal to ‘11’ will always be displayed under it, and a node with a value of ‘NodePos’ greater than 11 will be displayed to its right. The ‘NumAbove’525 is ‘0’ since there are no nodes above the start node, and the ‘NumBelow’526 is ‘2’ since there are2child nodes405 and403 of FIG. 4 which are defined by the lines in the risk defintion612 and613 respectively. The ‘Question’527 entry has the full text of the question for the corresponding node, in this case ‘ST elevation or Q waves in 2 or more leads, not known to be old?.’ The ‘NodeLabel’528 is blank since this is the first node in the risk assessment. For every other node it would have the full text of the question that led to this node from the question identified by ‘PredNode’522. For instance for612 the entry for ‘NodeLabel’ is ‘No’ indicating that this node followed as the answer to the first question in the risk assessment. The ‘Risk’529 is blank since this is not a terminal node in the risk assessment. For every terminal node this field will contain the value of the risk assessment. For instance, for613 the entry for ‘Risk’ is ‘High risk’, indicating that if the user responded to the first question in the risk assessment by choosing the response ‘Yes’, then the risk assessment would be finished and the patient would be categorized as having a ‘High risk of myocardial infarction.’ The ‘YoungestSib’530 and ‘OldestSib’531 entries are ‘1’ and ‘1’ respectively because this is the first node in the risk assessment. For612 the ‘YoungestSib’ and ‘OldestSib’ values are ‘2’ and ‘3’ indicating the range of ‘NodeID's that identify all nodes that are responses to the same question in this case that the nodes identified with NodeIDs ‘2’ and ‘3’ are both responses to the same question in the risk assessment. The ‘YoungestSib’ and ‘OldestSib’ entries for613 are the same as for612, since both identify nodes that are responses to the same question.
• FIG. 7 shows the[0060]structure700 of the risktree data structure that is used by the risktree-client to display and administer the risk assessment. This data structure is saved in the computer memory and is specific for each risk definition. In this exemplary system, the risktree data structure is stored as a collection object. For the example of the myocardial infarction risk assessment of FIG. 4, there are27 entries in the collection, one for each of the nodes of the myocardial infarction risk assessment decision tree.
• The first[0061]12 fields of the risktree data structure, ‘NodeID’710, ‘PredNode’711, ‘NodeName’712, ‘NodeLevel’713, ‘NodePos’714, ‘NumAbove’715, ‘NumBelow’716, ‘Question’717, ‘NodeLabel’718, ‘Risk’719, ‘YoungestSib’720, and ‘OldestSib’721’ have exactly the same definition as the first12 fields520-531 in the definition of the node-descriptor519 for FIG. 5. The values for these fields are taken directly from the risk definition files and saved in the collection. In the example of the myocardial risk assessment of FIG. 4, the nodes in the decision tree, which are coded as27separate records610 in the risk definition file of FIG. 6, are saved in the risktree data structure as27 elements in the collection.
• The remaining[0062]8 fields of the risktree data structure are calculated and provide the information that is needed to display the nodes of the tree in ‘Tree’ display mode. Field ‘Display’740 is a boolean field that determines whether a node will be displayed. In this exemplary system, the nodes that are displayed depend on the level of the current question and the number of levels above and below the current question that are to be displayed. For instance if the risk assessment is at the first question (level=0), and the user has chosen to display 3 levels below the current question, then all nodes that have a ‘NodeLevel’ values of 0, 1, 2, and 3 will be displayed, and any values with a ‘NodeLevel’ with a value greater than ‘3’ will not be displayed. In this case, the boolean field ‘Display’ will be set to ‘True’ for each node that is to be displayed and to ‘False’ for each node that is not to be displayed. As another example, if the current question is a node that is atlevel 3 of the risk assessment decision tree, and the number of levels to be displayed above the current question is set to ‘1’, and the number of levels to be displayed below the current question is set to ‘1’, then just the nodes that have a ‘NodeLevel’ value or 2, 3, or 4 will have their ‘Display’ value set to true. The values of ‘Display’ are recalculated just prior to every redrawing of the risk assessment decision tree on the display monitor. The display is redrawn whenever a response is selected to a question, or a change is made to either of the values for number of levels above or below the current node that are to be displayed.
• For each node, the fields ‘BtnLeft’[0063]741, ‘BtnTop’742, ‘BtnWidth’743, and ‘BtnHeight’744 provide the top left, top width and height of the rectangle that is used to display the associated node on the display monitor. These values are recalculated just prior to every redrawing of the risk assessment decision tree on the display monitor. The values are calculated by taking into account the size of the display area and the nodes that are to be displayed. If the number of levels that are to be displayed is given by ‘nLevel’, the lowest value for a level that is to be displayed is given by the value ‘lLevel’, and the height of the display area is given by ‘DisplayHeight’, then the height of the node rectangle ‘BtnHeight’ value is calculated as ‘DisplayHeight’/(2*nLevel). The ‘BtnTop’ value is calculated as ‘BtnHeight’/2+2*‘BtnHeight’ * (‘NodeLevel’−1Level).
• By scanning the nodes for all levels that are to be displayed we can find the smallest and largest of the values of ‘NodePos’, the vertical positioning of the nodes to be displayed. These are denoted as ‘smallPos’ and ‘largePos’ respectively, and then calculate the value ‘nPos’=‘largePos’−‘smallPos’+1. If the width of the display area is given by ‘DisplayWidth’, then the width of the node rectangle ‘BtnWidth’ is calculated as ‘DisplayWidth’/(2*nPos). The ‘BtnLeft’ value is calculated as ‘Btnwidth’/2+2*‘BtnWidth’*(‘NodePos’−‘smallPos’). These values are also recalculated just prior to every redrawing of the risk assessment decision tree on the display monitor.[0064]
• For each node, the fields ‘BtnMidPnt’[0065]745 is calculated. This is the x-coordinate of the vertical line that is drawn above a node to show the user what question came prior to the current question, and the x-coordinate of the vertical line that is drawn below a node to show the user what question(s) follow a response to the current question. The value for ‘BtnMidPnt’ is calculated as (‘BtnWidth’+‘BtnLeft’)/2, and is recalculated just prior to every redrawing of the risk assessment decision tree on the display monitor.
• For each node, the fields ‘TextLeft’[0066]746, and ‘TextTop’747 provide the top left and top respectively of the text of the response that is displayed on the display monitor. The response is positioned just above and to the left of the center of the rectangle displaying the node. The values are calculated by as ‘TextLeft’ ‘BtnMidPnt’+50, and ‘TextTop’=‘BtnTop’−25. The value is recalculated just prior to every redrawing of the risk assessment decision tree on the display monitor.
• These values[0067]741-747 provide sufficient information to redraw all the lines connecting the nodes in a ‘Tree’ display.
• FIG. 8 shows the[0068]main display800 of the risktree-client at the beginning of the assessment for the risk of myocardial infarction in emergency department patients with chest pain, that was given in FIG. 4 The display shows the screen of thecomputer monitor201 of the risktree-client200. In this case the current question is the first question in the risk assessment.
• A[0069]title box810 at the top of the computer monitor of the risktree-client identifies the type of risk that is being assessed; ‘Myocardial Infarction in Emergency Department Patients with Chest Pain’ as given inrecord 1 of the risk definition file. Threequestions811,812,813 are displayed on the screen. The question associated with the start node811 ‘ST elevation or Q waves in 2 or more leads, not known to be old?’ is at the top of the screen. The node812 ‘Chest pain began more than 48 hours ago?’ is a child node ofquestion821 associated with the response ‘No’, and node813 ‘Hi risk’ is a terminal node ofquestion821 associated with the response ‘Yes’. Thequestion buttons811 and812 are shaded darker than theterminal node813 so they may be more readily distinguished. The question811 is highlighted with a darker border to indicate to the user that it is the current question.
• The[0070]lines820 connect the nodes and clearly show the relationship between the questions displayed on the screen.Question821 has no line above it indicating that it is a start node. Theline821 leads fromquestion812 and appears to go right off the screen, indicating that there are more questions below that have not been displayed. Thatquestion813 does not have a line leading down to another question indicating that it is a terminal node.
• The[0071]small boxes831 and832 are associated with the responses ‘No’835 and ‘Yes’836 respectively to question811. Thescreen cursor840 is pointing directly at the small box and the boxed text ‘No’841 is a popup tooltip text that may contain a more complete description of response ‘No’831 to the associated question. Thistooltip841 text is only visible when the cursor is pointing directly in the small box response area.
• Along the left edge of the screen are two icons. The ‘Restart’[0072]icon861 will be used to restart the risk evaluation over at the start node, and the ‘Switch Display Context’ icon862 is used to switch the risk evaluation to ‘Text’ display, but maintaining the same position in the risk assessment.
• Along the right edge of the screen are 4 icons which control the display of the risk tree. The 2 icons near the top right border, control the number of levels above the current node that are displayed.[0073]Icon871 will increase by ‘1’ the number of levels above the current node that are to be displayed, whileicon872 will decrease by ‘1’ the number of levels above the current node that are to be displayed. The current value for the number of levels above the current icon that is to be displayed is itself displayed873 and cannot have a value less than ‘0’. The 2 icons near the bottom right border, control the number of levels below the current node that are displayed.Icon876 will increase by 1 the number of levels below the current node that are displayed, whileicon877 will decrease by 1 the number of levels below the current node that are to be displayed. The current value for the number of levels below the current icon that are to be displayed is itself displayed878 and cannot have a value less than ‘1’.
• The user interacts with the risk assessment displayed on the screen using a mouse, touchscreen or other pointing device. If the user points and clicks the mouse at the ‘Restart’[0074]icon861, then the display will be redrawn to the original display with the start node as the current node. If the user points and clicks the mouse at the ‘Switch Display Context’ icon862 then the display will switch to ‘Text’ mode if it is in ‘Tree’ mode and ‘Tree’ mode if it is in ‘Text’ mode. An example of a risk assessment screen in ‘Text’ mode is given in FIG. 11.
• If the user points the mouse on any of the[0075]boxes811,812, or813 then the text associated with the box is displayed as a popup tooltip text. For instance, if the user points the mouse at box811, then the popup tooltip text will display the ‘fill’ text of the question in box811. This is necessary in cases where because of the number of risk assessment questions that are displayed the fill text of the question cannot be displayed in the text box. An example of this is given in FIG. 9. If the user points at thesmall response boxes831,832 then the associated response is displayed in a popup tooltip text, and is also necessary for large trees where the response cannot be fully displayed on the screen.Tooltip text841 is an example of response tooltip text when the user points the mouse cursor inresponse box831.
• If the user points and clicks the mouse at[0076]question812 or atresponse box831 then the user is selecting ‘No’835 as the response to the current question811. This action will cause the risktree-client to redraw the risk assessment display, identifyingquestion812 as the current question and using a heavier width line to draw the line between questions811 to812 to indicate the question/response path clearly to the user.
• If the user points and clicks the mouse at[0077]icon871 then the number of levels to be displayed above the current question will be increased by ‘1’, the new value displayed873, and the risk display redrawn to reflect the new value. If the user points and clicks the mouse aticon872, and the number of levels to be displayed above the current question is greater than ‘0’, then the number of levels to be displayed above the current question will be decreased by ‘1’, and the new value displayed873, and the risk display redrawn to reflect the new value. Similar actions will ensue if one points and clicks at the icons controlling the number of levels that will be displayed below the current node. If the user points and clicks the mouse at icon878 then the number of levels to be displayed below the current question will be increased by ‘1’, the new value displayed878, and the risk display redrawn to reflect the new value. If the user points and clicks the mouse aticon877, and the number of levels to be displayed below the current question is greater than ‘1’, then the number of levels to be displayed below the current question will be decreased by ‘1’, and the new value displayed878, and the risk display redrawn to reflect the new value.
• The set of responses from which a user may choose, are limited to those responses to the current question. If the user points and clicks at any other response, a message box ‘Invalid selection’ is displayed. The user may point and click at any prior question in the tree to deselect their prior response. The set of question boxes that the user may return to is limited to those questions that they have already responded to and are clearly indicated by their connection with a heavier weight line. If the user points and clicks at any other question box in the display then a message box ‘Invalid selection’ is displayed.[0078]
• Not shown on FIG. 8 is the popup risk assessment information box. If the user of the risk assessment points and clicks the mouse at any place on the display, and clicks with the right mouse button, then a risk assessment information box is displayed. The popup risk assessment information box displays information about the risk assessment and includes the ‘Definition of the risk to be assessed’[0079]511, ‘Source of the risk decision rule’512, ‘Network location of risk definition file’513, ‘E-mail address’518, and thedate range516,517 that the risk assessment is valid.
• FIG. 9 shows the[0080]main display900 of the risktree-client at the beginning of the assessment for the risk of myocardial infarction in emergency department patients with chest pain. The risk assessment is still at the first questions as in FIG. 8, but the number of levels to be displayed below the current question has been set to8, through the use of theicon910, resulting in a display of the entire risk assessment tree. The user interaction with the display operates the same as described for FIG. 8. Thequestion boxes940 is now too small to display the text of the question, so the user may see the fill text by pointing themouse950 at the question box and thepopup tooltip text960 is displayed with the text of the full question.
• FIG. 10 shows the[0081]main display1000 of the risktree-client after the user has responded to four questions in the risk assessment. The ‘Tree’ display mode still has the same functionality described in FIG. 8. This display has the number of levels displayed above the current question set to ‘5’1001 and the number of levels displayed below the current question set to ‘1’1002. Thecurrent node1010 has a highlighted border to make it easier to distinguish. Note that thelines1021 are darker than thelines1022. The heavier weight lines show the user clearly the path that they have taken through the tree to get to the current stage of the interactive risk assessment.
• In this example the user has responded to the[0082]first question1031 with a ‘No’1041; responded to question1032 with a ‘No’1042; responded to question1033 with a ‘Yes’1043, and responded to question1034 with a ‘Yes’1044. This takes the user to the end of the risk assessment atterminal node1010, and the risk assessment is displayed in apopup risk box1050 which displays the result of the risk assessment ‘High risk of myocardial infarction’ on the display monitor. When the user responds to the ‘OK’button1055, the risk assessment is redisplayed at the beginning of the risk assessment as seen in FIG. 8.
• FIG. 11 shows the[0083]main display1100 of the risktree-client if the user had chosen to perform the risk assessment in ‘Text’ mode. The display mode ‘Text’ is chosen when the main display is in ‘Tree’ display mode by pointing and clicking at the ‘Change Display Mode’icon867 of FIG. 8. The display mode ‘Tree’ is chosen when the main display is in ‘Text’ display mode by pointing and clicking at the ‘Change Display Mode’icon1101 of FIG. 11. In each case, selecting the ‘Change Display Mode’ icon causes the display mode to be toggled to the other setting, and the risk assessment display to be redrawn in the new setting. The risk assessment display of FIG. 11 corresponds to the same stage of the risk assessment as is displayed in FIG. 10; i.e. both risk assessments have selected the same responses to all questions.
• A[0084]title box1102 at the top of the computer monitor of the risktree-client identifies the type of risk that is being assessed; ‘Myocardial Infarction in Emergency Department Patients with Chest Pain’ as given inrecord 1 of the risk definition file. Along the left edge of the screen are two icons. The ‘Restart’icon1105 will be used to restart the risk evaluation over at the start node, and the ‘Switch Display Context’icon1102 is used to switch the risk evaluation to ‘Tree’ display mode, but maintaining the same position in the risk assessment.
• In this example the user has responded to the[0085]first question1120, ‘ST elevation or Q waves in 2 or more leads, not known to be old’ with a ‘No’1130; responded to question1121 ‘Chest pain began more than 48 hours ago?’ with a ‘No’1131; responded to question1122 ‘Prior history of angina or MI?’ with a ‘Yes’1132, and responded to question1123 ‘ST-T changes of ischemia or strain, not known to be old?’ with a ‘Yes’1133. This takes the user to the end of the risk assessment, and the risk assessment is displayed in the riskassessment text box1140 at the bottom of the screen which displays the result of the risk assessment ‘High risk of myocardial infarction’ on the display monitor.
• The program displays the user's response to a question by shading the circle just to the left of the response. The response to question[0086]1120 ‘No’1130 was shaded when the user selected that response, while the ‘Yes’response1135 toquestion1120 is left unshaded.
• The ‘Text’ display mode does not display the tree structure. Rather, it starts off by displaying only the first question and the set of valid response. The valid responses are drawn without any shading indicating that it is the current question and that no choice has been made. The user may point and click at either of the valid responses to select that response. In FIG. 11 the valid responses to the first question[0087]1120 ‘ST elevation or Q waves in 2 or more leads, not known to be old’ are ‘Yes’1135, and ‘No’1130. Selecting a response has the effect of redrawing the risk assessment screen with the selected response shaded and either adding the next question and its set of valid responses to the display, or if the risk assessment has reached a terminal node, displaying the risk assessment in the riskassessment text box1140.
• Along the right edge of the screen is a single ‘Prior Question’ icon[0088]1108. Pointing and clicking the mouse at this icon deselects the last response in the risk assessment and redraws the display. In the case of FIG. 11, the answer ‘Yes’1133 to the question ‘ST-T changes of ischemia or strain, not known to be old?’ will be deselected and the display screen redrawn without the response shading. The user may also deselect prior responses, and return to any prior question by pointing and clicking at any displayedquestion1120,1121,1122, or1123, in which case the risk assessment screen will be redisplayed showing the selected question, all prior questions and their responses, and with none of the responses to the selected question shaded.
• FIG. 12 is a state diagram[0089]1200 showing the state machines describing the (1) operation of each of the risktree-client, (2) risktree-server, and (3) messaging interface between the components of the system. State tables that provide details of the operation of the risktree-client, and risktree-server are presented in FIG. 14, and15, respectively, and details of the message protocols in FIG. 13.
• FIG. 12 has 3 separate regions. The region labeled risktree-[0090]client1210 shows the state machine for the operation of the risktree-client; the region labeled risktree-server1229 shows the state machine for the operation of the risktree-server; and the region labeled ‘NetworkMessage FIG. 13’1230 is the network message interface between the risktree-client and the risktree-server and is described in detail in FIG. 13. The state machine diagrams show the different states of the program, and the actions which cause them to change state. Arrows pointing to-and-from the NetworkMessage regions show the interprocess communication over the network between the different components of the system, and in particular show which states may send/receive network messages.
• The risktree-[0091]client state machine1210 has 7 states. In the state ‘START’ the program is started and after initialization of program variables transfers to the state ‘IDLE’. In state ‘IDLE’ the risktree client waits for a request from the user. If the requested action is to end the risk assessment, then the program transitions to the ‘END’ state and halts execution. If the requested action is to get a risk definition then the program checks for the validity of the URL that specifies the risk definition and if it is valid, transitions to the state ‘GET_RISDKDEF’ to start the processing to retrieve and parse the risk definition. If it is an invalid URL then display the message ‘Illegal name’ and wait in the state ‘IDLE’ for another request.
• The risk definition file is specified by a URL which gives the location, either local or on the network for the risk definition. State ‘GET_RISIDEF’ first checks to see if there is a copy of the risk assessment on the local machine. If there is copy of the risk definition file on the local machine, then the file is retrieved and the program transitions to the state ‘PARSE_RISKDEF’ to continue processing. If there is not a copy of the risk definition file on the local machine then (1) format a request for the risk assessment (2) connect with the risktree-server (3) request the risk definition (4) wait and retrieve the response from the risktree-server, and (5) disconnect with the server. If the response is a risk definition then transition to the state ‘PARSE_RISKDEF’, but if the response is an error message then display the error message and transition to the ‘IDLE’ state. All network communication for the risktree-client is performed in the state ‘GET_RISKDEF’.[0092]
• State ‘PARSE_RISKDEF’ parses the risk definition file, saves all the fields[0093]511-518 in the risk definition file in variables in the program, as well as the node-descriptor variables for each node in the risk definition node tree. The maximum depth of the risk assessment is also set and saved. If there is an error during the parsing then display the error message ‘Error in Parse’ and transition to the state ‘IDLE’, else transition to the state ‘INIT’ to continue processing.
• In the state ‘INIT’ several variables are initialized that will be required during each risk assessment session. This includes setting the display mode to ‘Tree’ and setting the current question to the first question in the risk assessment. After this initialization is performed the program transition to state ‘ADMIN_RISK’ to administer the risk assessment to the user.[0094]
• IN the state ‘ADMIN_RISK’ there are[0095]3 types of actions that cause the program to transfer to another state. The user may request that the risk assessment be restarted in which case the program transfers to the state ‘INIT’ to reinitialize the risk assessment to its initial state. The user may choose to end the risktree-client, in which case the program transitions to the state ‘END’ and the program terminates execution, or the user may request that a new risk assessment be administered in which case the program transitions to the state ‘IDLE’ so the program can acquire the risk definition file for the new risk assessment. All other actions in the ‘ADMIN_RISK’ state result in the program remaining in the state ‘ADMIN-RISK’, and relate to the interactions between the user and the risktree-client as the user responds to questions and chooses different customization options to assist them in the risk assessment. The details of these actions will be described in FIG. 15.
• The risktree-[0096]server state machine1210 has5 states. In the state ‘START’ the program is started and after initialization of program variables transfers to the state ‘IDLE’. In state ‘IDLE’ the risktree-server waits for a request for service. The request may be an operator request to terminate the risktree-server in which case the program transitions to the state ‘END’ and terminates execution, or the request may be a network request message. If the request is a network request then a connection is established with the requesting program and the request message is parsed. If the request is for an available risk definition then the program transitions to the state ‘SEND_RISKDEF’ to retrieve and send the file, and then terminates the connection and transitions back to the state ‘IDLE’ to await another request. Any other request will cause the risktree-server to transition to the state ‘SEND_ERROR’ to send an error message, and then terminate the connection and transition back to the state ‘IDLE to await another request.
• There are three types of[0097]network messages1230 that are used to communicate between the client and server portions of the system. All communication on the client side is performed in the state ‘GET_RISKDEF’ which sends a request for a file and receives the response. The communication on the server side is performed in the ‘IDLE’ state that receives requests, and the ‘SEND_RISKDEF’ and ‘SEND_ERROR’ state the process and fulfill the request. The network messages are described in further detail in FIG. 13.
• This exemplary embodiment uses an industry standard ethernet and an industry standard TCP/IP network protocol for its computer network. A conversation between the risktree-client and the risktree-server is implemented by establishing a connection between the computers over the computer network. To minimize computer resources to maintain the connection between the risktree-server and the risktree-client, this exemplary system uses a non-persistent network connection; i.e., a network connection is established between the interview-client and the interview-server only for the length of time necessary to perform a specific transaction. In the exemplary system the connection is implemented using the industry standard hypertext transport protocol (http). In other systems and embodiments the non-persistent connection may be implemented using another industry standard protocol, or a special protocol may be implemented specifically to address the operation of the risk assessment. If either the risktree-client or the risktree-server program terminates their connection with the other program, either by design or another reason, such as a network outage, the other program also terminates its connection state.[0098]
• FIG. 13 is a diagram[0099]1300 of the network message protocols for communications between the risktree-client and the risktree-server. It shows the risktree-client states on the left side of the figure and the risktree-server states on the right hand side of the figure. The messages that are sent from each state of the risktree-client and their response from the risktree-server are indicated on the diagram.
• From state ‘GET_RISKDEF’ a request may be made to the risktree-server for a specific risk definition that the risktree-server maintains. After the request is sent the risktree-client waits in the state ‘GET_RISKDEF’ to receive the response from the risktree-server.[0100]
• The risktree-server responds by establishing the connection, retrieving and parsing the message. If the message is valid and the risk definition is available then the risktree-server transitions to state ‘SEND_RISKDEF’ and sends the risk definition file to the risktree-client.[0101]
• If the message is not valid, or the message is valid but the risk definition is not available, for whatever reason, then the risktree-server transitions to the state ‘SEND_ERROR’ and sends the error message to the risktree-client. After the risktree-client receives the risk definition or an error message from the risktree-server, the risktree-client terminates the connection with the risktree-server.[0102]
• FIG. 14 is a diagram[0103]1400 with a state table describing the operation of the risktree-server program. Upon initialization of the risktree-server it enters theSTART state1401, performs initialization, and transitions to theIDLE state1402.
• In the[0104]IDLE state1402, the server waits for a request for a connection from a risktree-client. When a request for a connection is received the risktree-client establishes the connection with the risktree-client. If the request is for a risk assessment definition, then the program transitions to thestate SEND_RISKDEF1403 to fulfill the request. All other request messages are invalid and the program transitions to thestate SEND_ERROR1404 to send an error message.
• Termination of the risktree-server occurs in response to a system or operator request to terminate the execution of the risktree-server program. During the[0105]IDLE state1402, the risktree-server can receive a system or operator request to terminate the risktree-server processing, in which case the program transitions to thestate END1405, performs shut-down processing, and terminates the execution of the risktree-server program.
• [0106]State SEND_RISKDEF1403 is used to process a request for a risk assessment definition. When the program enters this state, a connection is already established with the risktree-client. The risktree-server program parses the name of the risk assessment definition that has been requested, and checks for the availabity of the risk assessment definition. If the risk assessment definition is available then it retrieves the file, and transmits this file to the risktree-client program using the industry standard hypertext transport protocol. At the successful completion of the transmission, the connection is terminated by the risktree-server, and the program transitions back to thestate IDLE1402 to await the next service request. If the risk definition is not available, then the risktree-server transitions to the state ‘SEND_ERROR’1404.
• State ‘SEND_ERROR’[0107]1404 is used to indicate that no risk assessment definition can be provided by the risktree-server. The risktree-server formats a one line error response message “ERROR-NO RISK DEFINITION” and transmits the response to the risktree-client program using the industry standard hypertext transport protocol. At the successful completion of the transmission, the connection is terminated by the risktree-server, and the program transitions back to thestate IDLE1402, to await the next service request.
• State ‘END’[0108]1405 stops the execution of the risktree-server program.
• FIG. 15 is a diagram[0109]1500 with a state table describing the operation of the risktree-server program. Upon initialization of the risktree-server it enters theSTART state1510, performs initialization, and transitions to theIDLE state1520.
• In the ‘IDLE’[0110]state1520, the risktree-client program waits for a user requested action. The user may either request that the program be terminated in which case the program transitions to state ‘END’ for termination processing or the user may request that a risk assessment be performed by specifying the URL of the risk definition that is to be administered. The program then validates the URL of the risk definition. If the URL is a valid resource, then the program transitions to the state ‘GET_RISKDEF’ to continue processing. If the URL is invalid then the program displays the error message ‘Invalid name’ and continues in the ‘IDLE’ state.
• In the ‘GET_RISKDEF’[0111]state1530, the risktree-client program first parses the name of the risk definition file from the URL and checks to see if there is a copy of the risk definition file on the client machine. If there is then retrieve it and transition to the state ‘PARSE_RISKDEF’1540. If the risk definition is not resident on the client machine, then (1) format the network request for the risk definition file (2) connect with the risktree-server (3) request the risk assessment from the risktree-server, and (4) wait for a response. When the response is received from the risktree-server check to see if it is an error message, and if it is then display the error ‘No risk definition’ to the user and transtion to the state ‘IDLE’. If the response is the risk definition file then store it, and transition to the state ‘PARSE_RISKDEF’1550.
• In the state ‘PARSE_RISKDEF’[0112]1550 parse the risk definition. If during parsing an error is encountered, then display the error message ‘Risk definition error’ and transition to the state ‘IDLE’1520. If the parse is completed without error, then the values from the parsing will have been saved in risktree-client program memory, and will include all the information in the risk definition structure of FIG. 5, which is saved in the internal data structure described in FIG. 7. Then the program will transition to the ‘INIT’state1550, to initialize the risk assessment interactive program.
• In the state ‘INIT’[0113]1550, the risktree-client is initialized to the first question in the risk assessment, the risk assessment displayed to the user, and the interface enabled to accept user input from the mouse pointing device. The display mode is set to ‘Tree’ indicating that the initial display mode is ‘Tree’ mode, and the currentQuestion is set to the ‘NodeID’710 of the first node in the risk assessment decision tree. The value for the number of levels to be shown above and below the current question are both set to ‘1’, and then the risk assessment is displayed to the user. Then transition to the state ‘ADMIN_RISK’ to begin the interactive self administered risk assessment.
• State ‘ADMIN_RISK’[0114]1560 administers the risk assessment to the user. The program waits until the user interacts with the interactive risk assessment by pointing and clicking with themouse pointing device230, performs the requested action, and continues processing. The user can choose to restart the risk assessment by using the mouse to point and click at the ‘Restart’ icon (861 in ‘Tree’ mode’ and1105 in ‘Text mode’). This will cause the program to immediately terminate the current risk assessment and transfer to the state ‘INIT’1550 to reinitialize and restart the risk assessment. The user can choose to terminate the risk assessment program in either ‘Tree’ or ‘Text’ display mode, by using the right mouse button to bring up a context sensitive popup menu and choosing the ‘EXIT’ option. This will cause the program to immediately terminate the current risk assessment and transfer to the state ‘END’1590 to terminate the execution of the risktree-client program.
• In ‘Tree’ display mode, the user controls the number of levels above and below the current question that are displayed. The user can choose to ‘Increase levels shown above’[0115]1574, by pointing and clicking the mouse at the ‘Increase levels above’icon871, which causes the program to check if the current value is less than the maximum number of levels and if it is then increase it by ‘1’, redraw the risk assessment screen to reflect the new value, and continue processing in the state ‘ADMIN_RISK’. The user can choose to ‘Decrease levels shown above’1575, by pointing and clicking the mouse at the ‘Decrease levels above’icon872, which causes the program to check if the current value is greater than ‘1’, and if it is then decrease the parameter by ‘1’, redraw the risk assessment screen to reflect the new value, and continue processing in the state ‘ADMIN_RISK’. The user can choose to ‘Increase levels shown below’1576, by pointing and clicking the mouse at the ‘Increase levels below’icon877, which causes the program to check if the current value is less than the maximum number of levels and if it is then increase it by ‘1’, redraw the risk assessment screen to reflect the new value, and continue processing in the state ‘ADMIN_RISK’. The user can choose to ‘Decrease levels shown below’1577, by pointing and clicking the mouse at the ‘Decrease levels below’icon876, which causes the program to check if the current value is greater than ‘1’, and if it is then decrease the parameter by ‘1’, redraw the risk assessment screen to reflect the new value, and continue processing in the state ‘ADMIN_RISK’.
• The user can choose to ‘Change display mode’[0116]1578, by pointing and clicking at the ‘Toggle display’ icon (‘Tree’display mode867, ‘Text’ display mode1101). If the display is in ‘Tree’ mode then the display is redrawn in ‘Text’ mode and the processing continues in the state ‘ADMIN_RISK’. If the display is in ‘Text’ mode then the display is redrawn in ‘Tree’ mode and the processing continues in the state ‘ADMIN_RISK’. In ‘Text’ display mode the user can choose the action ‘Prior question’1579, by pointing and clicking the mouse pointer on the prior question icon1108 causing the risk assessment display to be redrawn in ‘Text’ display mode, with the prior question as designated as the current question, and then continuing the processing in the state ‘ADMIN_RISK’.
• In ‘Tree’ display mode, the action ‘MouseOver Question’[0117]icon1580 is initiated whenever the user moves the position of themouse950 over a ‘Question’icon940, causing the full text of the question to be displayed in a popup text box, and which disappears when the mouse pointer is moved out of the text box.
• Also in ‘Tree’ display mode, the action ‘MouseOver Response’[0118]icon1581 is initiated whenever the user moves the position of themouse840 over a ‘Response’icon831, causing the full text of the response to be displayed in a popup text box, and which disappears when the mouse pointer is moved. In either case the processing continues in the state ‘ADMIN_RISK’.
• The user can choose to answer a[0119]risk assessment question1582 by pointing and clicking the mouse (1) on a response icon, or (2) at a question icon, which causes the selection of the associated response icon. If the chosen answer is not in a branch of the current question then display the error message ‘Illegal choice’, and continue processing in the state ‘ADMIN_RISK’. If the chosen answer is in the branch of the tree of the current question and the level of the selected response is less than the level of the current question, then reset the current question, redisplay the risk assessment, and continue processing in the state ‘ADMIN_RISK’. If the chosen answer is in the branch of the tree of the current question and the level of the selected response is more than ‘1’ greater than the level of the current question, indicating the user has skipped a question, then display the error message ‘Illegal choice’, and continue processing in the state ‘ADMIN_RISK’. In all other cases, set the current question to the question associated with the selected response. If the current question is a terminal node of the risk assessment then display the estimated risk assessment and continue processing by reinitializing the risk assessment in the state ‘IDLE’, but if it is not a terminal node the, display the risk assessment in the current display mode and continue processing in the state ‘ADMIN_RISK’.
• The user can choose to run a ‘New assessment’[0120]1584, in either ‘Tree’ or ‘Text’ display mode, by using the right mouse button to bring up a context sensitive popup menu and choosing the ‘NEW’ option. This will cause the program to immediately terminate the current risk assessment and transfer to the state ‘IDLE’1520 so the user may specify another type of risk assessment to be administered by the risktree-client program. Another action, in either ‘Tree’ or ‘Text’ display mode, that the user can initiate is to view the additional ‘Information ‘1585’ that is provided in the risk definition file about the risk assessment. This includes the source of therisk decision rule512, network location of therisk definition file513, date range during which the risk assessment is valid (516,517), and anE-mail contact address518. This information is accessed by the user by using the right mouse button to bring up a context sensitive popup menu and choosing the ‘HELP’ option. This will cause the program to display this information on the screen with a screen button with the label ‘Okay’ that when depressed will remove the information screen from the display monitor, and continue processing in the state ‘ADMIN_RISK’.
• In the ‘END’[0121]state1590, the risktree-client terminates execution of the risktree-client program.
• Other exemplary systems and embodiments of the invention may use the same principles to implement a system to perform a self administered interactive risk assessment. In an embodiment there may be customization options to control the amount of information that is displayed and the manner in which the risk assessment is presented. This can be further enhanced with other customization options that further assist the user to understand and operate the risk assessment, and other display formats. Also other kinds of information may be made available to give further explanations of the questions and responses.[0122]
• In other embodiments there may be other means to calculate the risk. In the exemplary system described above, a risk value is associated with each terminal node. Other means to calculate the risk might include summing values based on the response to each question, and translating that value into a risk when a terminal node is reached.[0123]
• In other exemplary systems and embodiments the risk assessment decision procedure may follow formats other than that of an inverted tree. Decision structures in which the sequence of questions is entirely predetermined and not dependent upon the response to the prior question, or structures in which responses to different questions can lead to the same question may be accommodated by the system.[0124]
• In still other embodiments the structure of the risk definition file may be extended to include other decision algorithms that may not be able to be coded by the current scheme.[0125]
• In still other embodiments, the system may be used to assign group membership. The risk assessment process of answering questions until a terminal node is reached and a risk assigned is one of deciding that a person belongs in a group based on their responses to questions, and then giving a risk of occurrence of an event associated with membership in that group. The system could be used equally well if the decision at a terminal node is to assign the person to a group without necessity of inferring a risk value.[0126]
• Other embodiments will be apparent to those skilled in the art from consideration of the specification and practice of the invention disclosed herein. It is intended that the specification and examples be considered as exemplary only, with a true scope of the invention being indicated by the following claims.[0127]

Claims (42)

What is claimed is:

1. A computer system for performing a self administered interactive assessment of the risk of an event, comprising:

(a) a client program;

(b) a server program;

(c) a computer network;

(d) in which the client program can establish and terminate a connection over the computer network to the server program and send and receive data;

(e) in which the server program can establish and terminate a connection over the computer network to the client program and send and receive data.

2. A system according toclaim 1, wherein the computer program on the client computer can communicate with the server computer by;

(a) opening a network connection with the server;

(b) requesting the definition of a risk assessment that is to be administered;

(c) receiving and storing the definition of the risk assessment to be administered;

(d) closing the network connection with the server.

3. A system according toclaim 1, wherein the computer program on the server computer can communicate with the client computer by;

(a) responding to requests from the client program for the definition of a risk assessment by opening a connection with the client;

(b) sending the risk assessment definition to the client;

(c) closing the connection.

4. A system according toclaim 1 in which the risk evaluation definition defines;

(a) The type of risk that is being assessed;

(b) Each question in the risk assessment;

(c) The first question in the risk assessment;

(d) The set of responses associated with each question in the risk assessment;

(e) The action to be taken to a response to a question during the interactive risk, where the action is either the specification of the next question to be displayed, or that the risk assessment is completed;

(f) A means to assess risk based upon the responses to questions in the risk assessment.

5. A system according toclaim 2, further comprising;

(a) means to select which risk assessment is to be administered;

(b) means to administer the selected risk assessment to a user of the system based on the information in the risk assessment definition.

6. A system according toclaim 5 wherein the said means to administer the risk assessment includes;

(a) means to display the risk assessment questions, associated responses, and actions that may be taken;

(b) means for the user to select an action from the risk assessment display;

(c) means to update the risk assessment display based on the action that the user selects from the risk assessment display;

(d) means to evaluate the risk of an event based upon the users responses to the sequence of questions in the risk assessment;

(e) means for presenting the risk of an event to a user of the system.

7. A system according toclaim 6, wherein the said means to display the risk evaluation questions and answers further includes;

(a) computer monitor or other device to display the questions and associated responses;

(b) one or more display formats of the risk assessment;

(c) a current format for the display presentation format;

(d) means to display the risk assessment in the current display format.

8. A system according toclaim 7, wherein the said display presentation further includes;

(a) a means to display the questions and associated responses in a risk assessment;

(b) a means to indicate the current question in the risk assessment;

(c) a means to display the path through the sequence of risk assessment questions and responses that led to the present question;

(d) a means to display the choice of actions that the use may take.

9. A system ofclaim 8, wherein the display of the choice of actions that the user may take further includes;

(a) a means to choose at least one of the associated responses to the current question;

(b) a means to choose to move back to a prior question in the risk evaluation;

(c) a means to choose another display format;

(d) a means to choose customization options for the current display presentation format;

(e) a means to choose to restart the risk assessment.

10. A system according toclaim 6, wherein the said means for the user to select an action includes;

(a) one or more of a computer keyboard, mouse, touchscreen or other device by which the user can select an action;

(b) means to select an answer to the set of associated responses to the current question;

(c) means to select a prior question in the risk evaluation;

(d) means to select another display presentation;

(e) means to select a customization option for the current display format presentation;

(f) means to select to restart the risk assessment.

11. A system according toclaim 6, wherein the said means to update the risk assessment display based on the action that the user selects from the risk assessment display includes;

(a) means to update the risk assessment display presentation based on the selection of a response to the current question;

(b) means to update the risk assessment display with a new display presentation if the user chooses to change the format of the display presentations;

(c) means to assess the risk and display the results of the risk assessment if the user is at the end of the risk evaluation;

(d) means to re-display the risk assessment for the current question according to selected display format presentation customization options;

(e) means to restart the risk evaluation at the first question.

12. A method for performing a self administered interactive assessment of the risk of an event, comprising:

(a) a client program;

(b) a server program;

(c) a computer network;

(d) in which the client program can establish and terminate a connection over the computer network to the server program and send and receive data;

(e) in which the server program can establish and terminate a connection over the computer network to the client program and send and receive data.

13. A method according toclaim 12, wherein the computer program on the client computer can communicate with the server computer by;

(a) opening a network connection with the server;

(b) requesting the definition of a risk assessment that is to be administered;

(c) receiving and storing the definition of the risk assessment to be administered;

(d) closing the network connection with the server.

14. A method according toclaim 12, wherein the computer program on the server computer can communicate with the client computer by;

(a) responding to requests from the client program for the definition of a risk assessment by opening a connection with the client;

(b) sending the risk assessment definition to the client;

(c) closing the connection.

15. A method according toclaim 12 in which the risk evaluation definition defines;

(a) The type of risk that is being assessed;

(b) Each question in the risk assessment;

(c) The first question in the risk assessment;

(d) The set of responses associated with each question in the risk assessment;

(e) The action to be taken to a response to a question during the interactive risk, where the action is either the specification of the next question to be displayed, or that the risk assessment is completed;

(f) A means to assess risk based upon the responses to questions in the risk assessment.

16. A method according toclaim 13, further comprising;

(a) means to select which risk assessment is to be administered;

(b) means to administer the selected risk assessment to a user of the system based on the information in the risk assessment definition.

17. A method according toclaim 16 wherein the said means to administer the risk assessment includes;

(a) means to display the risk assessment questions, associated responses, and actions that may be taken;

(b) means for the user to select an action from the risk assessment display;

(c) means to update the risk assessment display based on the action that the user selects from the risk assessment display;

(d) means to evaluate the risk of an event based upon the users responses to the sequence of questions in the risk assessment;

(e) means for presenting the risk of an event to a user of the system.

18. A method according toclaim 17, wherein the said means to display the risk evaluation questions and answers further includes;

(a) computer monitor or other device to display the questions and associated responses;

(b) one or more display formats of the risk assessment;

(c) a current format for the display presentation format;

(d) means to display the risk assessment in the current display format.

19. A method according toclaim 18, wherein the said display presentation further includes;

(a) a means to display the questions and associated responses in a risk assessment;

(b) a means to indicate the current question in the risk assessment;

(c) means to display the path through the sequence of risk assessment questions and responses that led to the present question;

(d) a means to display the choice of actions that the use may take.

20. A method ofclaim 19, wherein the display of the choice of actions that the user may take further includes;

(a) a means to choose at least one of the associated responses to the current question;

(b) a means to choose to move back to a prior question in the risk evaluation;

(c) a means to choose another display format;

(d) a means to choose customization options for the current display presentation format;

(e) a means to choose to restart the risk assessment.

21. A method according toclaim 17, wherein the said means for the user to select an action includes;

(a) one or more of a computer keyboard, mouse, touchscreen or other device by which the user can select an action;

(b) means to select an answer to the set of associated responses to the current question;

(c) means to select a prior question in the risk evaluation;

(d) means to select another display presentation;

(e) means to select a customization option for the current display format presentation;

(f) means to select to restart the risk assessment.

22. A method according toclaim 17, wherein the said means to update the risk assessment display based on the action that the user selects from the risk assessment display includes;

(a) means to update the risk assessment display presentation based on the selection of a response to the current question;

(b) means to update the risk assessment display with a new display presentation if the user chooses to change the format of the display presentations;

(c) means to assess the risk and display the results of the risk assessment if the user is at the end of the risk evaluation;

(d) means to re-display the risk assessment for the current question according to selected display format presentation customization options;

(e) means to restart the risk evaluation at the first question.

23. A method of displaying an interactive decision structure, the method comprising the steps of:

(a) controlling an amount of information regarding the decision structure that is to be visualized;

(b) receiving interactive responses corresponding to the decision structure visualized; and

(c) displaying at least a portion of the decision structure based on said controlling step (a) and the interactive responses received in said receiving step (b).

24. The method of displaying as recited inclaim 23, the method further comprising the step of:

(d) highlighting a decision path through the decision structure based on the received interactive responses.

25. The method of displaying as recited inclaim 23, wherein the decision structure comprises a series of questions and potential responses associated with each question;

wherein said receiving step (b) comprises the step of allowing a user to input a response to a given question; and

wherein said displaying step (c) redraws the displayed portion of the decision structure based on the response input by the user.

26. The method of displaying as recited inclaim 25, wherein the decision structure comprises a predetermined sequence of questions, wherein individual questions are sequentially displayed as part of the decision structure after each interactive response received in said receiving step (b).

27. The method of displaying as recited inclaim 25, wherein the decision structure permits interactive responses to different questions to lead to the same subsequent question in the decision path.

28. The method of displaying as recited inclaim 25, wherein the decision structure may be alternatively displayed in a text mode and a tree mode.

29. The method of displaying as recited inclaim 28, wherein, when the decision structure is displayed in a text mode, a series of questions and associated responses are displayed in full text.

30. The method of displaying as recited inclaim 28, wherein, when the decision structure is displayed in a tree mode, a series of question blocks representing questions are arranged in an inverted tree structure connected by lines representing associated responses to respective questions.

31. The method of displaying as recited inclaim 30, wherein, in a tree mode, said controlling step (a) comprises the step of inputting preference data from a user to control the number of levels that are to be displayed above and below a current question block as the displayed portion of the decision structure; and

wherein the decision structure represents an assessment of a risk of an event occurring.

32. The method of displaying as recited inclaim 24, wherein said highlighting step (d) comprises: highlighting a border of a current question in the decision structure; and

displaying the decision path using heavy weighted lines relative to the remaining lines of the portion of the decision structure displayed.

33. A computer system for administering a decision procedure, the computer system comprising:

a first computer having a monitor, wherein said first computer administers a decision procedure to a user; and

a second computer, wherein said second computer transfers to said first computer a decision procedure definition file that defines the decision procedure to be administered by the client program at said first computer;

wherein a program executed on said first computer comprises the steps of:

(i) visually displaying on the monitor at least a portion of the decision procedure as an inverted tree structure;

(ii) allowing the user to input responses to said first computer; and

(iii) updating the decision procedure to reflect the most recent response by the user.

34. The computer system as recited inclaim 33, further comprising a computer network, wherein both said first and second computers are coupled to said computer network, and wherein said second computer transfers the decision procedure definition file to said first computer over said computer network using a hypertext transfer protocol (HTTP).

35. The computer system as recited inclaim 34, wherein a non-persistent connection is initiated between said first and second computers until the definition file is transferred to said first computer.

36. The computer system as recited inclaim 33, wherein the decision procedure is a self-administrated risk assessment based on a series of questions and responses to such questions.

37. The computer system as recited inclaim 36, wherein the risk assessment is a medical risk assessment for predicting whether a patient admitted to an emergency room with chest pain has a risk of presenting myocardial infarction.

38. The computer system as recited inclaim 36, wherein the definition file includes:

(a) a description of the risk that is being assessed;

(b) text of each question in the risk assessment;

(c) identification of the first question in said risk assessment;

(d) text of the allowable responses associated with each question; and

(e) action to be taken in response to a question during the risk assessment, wherein the action is either the specification of a subsequent question to be displayed or that the risk assessment is completed.

39. The computer system as recited inclaim 33, wherein said second computer is a network server comprising a mass storage device for storing a plurality of decision procedure definition files, and wherein said first computer is one of a plurality of client computers requesting a selected one of the plurality of decision procedure definition files stored in the mass storage device.

40. A method of using a computer system to administer an assessment, wherein a user inputs a request to initiate administration of the assessment, a local search for an assessment definition file is made, an assessment definition file is retrieved from a remote location if the definition file is not found in the local search, administration of the assessment is begun with display of a question, receipt of user input response associated with the question, and display of a series of questions is made based on user input responses to a previous question until the series of questions terminates, and an assessment value is output associated with the termination of the series of questions.

41. The method recited in claim40, wherein the administered assessment categorizes the user as belonging to a group based on the input responses received from the user during administration of the assessment.

42. The method recited in claim41, wherein the administered assessment value indicates a risk of occurrence of an event associated with membership in the group.

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