US20070021984A1 - Interactive patient communication development system for reporting on patient healthcare management - Google Patents

Abstract

A modular interactive system and method for customizing health education to an individual at a remote terminal to induce a modification in a health-related behavior of the individual. The automated system includes a questionnaire generator for questioning the individual to determine his or her motivational drivers and comprehension capacity. The questionnaire generator is a graphical user interface that allows a clinician to graphically attach questions to answer to action. A processor then generates a script program based on what the clinician has attached together. A profile generator receives answers entered by the individual from the remote terminal and generates a motivational driver profile and a comprehension capacity profile of the individual. A translator receives clinical data relating to a current health condition of the individual and translates the clinical data, the motivational driver profile, and the comprehension capacity profile into a profile code. An educational fulfillment bank matches the profile code to matching educational materials and transfers the matched educational materials to the remote terminal. An evaluation program evaluates educational responses of the individual and provides profile updates for targeting subsequent educational material to the individual based on the educational responses.

Description

CROSS-REFERENCE TO RELATED APPLICATIONS
• This is a continuation of co-pending application Ser. No. 09/810,334, filed Mar. 14, 2001, which is herein incorporated by reference.
FIELD OF THE INVENTION
• The present invention relates generally to a modular interactive development system and method for reporting on patient management, and in particular to an automated content delivery program able to connect remote users across independent platforms to a central database of libraries whereby a patient's health can be scored dynamically.
BACKGROUND OF THE INVENTION
• This invention relates to the field of health management, particularly to an automated interactive system and method for reducing the risk associated with a monitored client.
• For example, the know art includes a number of health-management systems for providing outpatient services to patients with chronic health conditions such as asthma and diabetes. However, these systems are incapable of administering a treatment protocol responsive to the patient's current profile and of updating the profile in response to the administered protocol.
SUMMARY OF THE INVENTION
• This invention presents a flexible and scalable system in content development for patient management healthcare. Due to the modular object oriented-structure, individual content modules (“dialogs”) can be mixed into an unlimited number of undatable customized programs, addressing individual as well as co-existing disease states (“co-morbid”) in any combinations, and with automated content variation for improved patient compliance. A dialog is the smallest content object in the FlexCube content structure. Its content addresses issues related to a unique set of symptoms, behaviors or knowledge related to a specific aspect of managing a certain disease referred to as an aspect of care.
• In its basic format, each dialog contains questions related to signs and symptoms, behaviors and knowledge with answers categorized as high, medium or low risk answers. For each answer there is a relevant follow up, which can be a teaching statement, an acknowledgment, a motivational statement or a new question that will explore the patient's condition in more depth. While the logical branching within a dialog is driven by patient answers, no dependency exists between individual dialogs.
• Dialogs are located in a common pool organized by library. From this library each individual dialog is referenced for participation (appearance) in programs and daily sessions. A dialog's behavior in a program (schedule, position, reporting) is defined at the time of the dialog creation or it is custom defined during the program content selection process. In this way dialogs maintain their integrity while being used and re-used in several client programs. They combine freely with other dialogs in user defined program selections, allowing an unlimited combination of aspects of care and co-existing diseases. Finally, they are easily accessible for revisions and updates.
• The present invention provides an object-oriented dialog and modular toolkit structure that enhances quality control options. Also included are the centrally located content objects that offer overview and tracking of the currently active content, global error correction and global update of content to current standards of care. Because the present invention splits up interfaces for content creation and content selection into separate modules, the present invention exercises control over customer's access to content development in compliance with current and future Federal Drug Administration labeling. Finally the system's structure limits logical branching errors to within a dialog, thereby offering a more robust and less error prone system overall.
• Since the content of a dialog and the output of a dialog is related and mapped to a specific aspect of care, the user will have the power and flexibility to model risk evaluation and outcomes reporting around custom selected aspects of care.
BRIEF DESCRIPTION OF THE DRAWINGS
• The foregoing aspects and many of the attendant advantages of this invention will become more readily appreciated as the same becomes better understood by reference to the following detailed description, when taken in conjunction with the accompanying drawings, wherein:
• FIG. 1 is a block diagram depicting a system's compositional and referenced components;
• FIG. 2 is a flow chart diagram depicting the overview of dialog creation;
• FIG. 3 is a block diagram depicting an interdependent characteristics (operators) of a dialog;
• FIG. 4 is flow chart depicting the steps in creating and storing of content data from a dialog;
• FIG. 5 is a flow chart diagram depicting the creation of the programming statements using a Dialog Editor Platform;
• FIG. 6 is a block diagram illustrating the three dimensional aspects of the dynamically determined risk state output scale;
• FIG. 7 is a flowchart depicting the creation of programs using a Program Composer User Interface;
• FIG. 8 is a flow chart depicting a Linker User Interface; and
• FIG. 9 is a flow chart depicting a Reporter User Interface.
DETAILED DESCRIPTION OF PREFERRED EMBODIMENT
• The present invention includes an object-oriented content structure in which the smallest content object, a care specific dialog, is located in a central library from where its characteristics (operators) are composed and referenced by a modular set of tools located at a client computer.
• FIG. 1 is a block diagram depicting asystem10's compositional and referenced components. Compositionally, thesystem10 relies on four system components for dialog or program creation. Additionally,FIG. 1 illustrates two other system components that interact with the referenced components of the system. Adialog Composer20, further referenced inFIG. 2, which is used to author dialog content by an aspect of care. A Program Composer30, further referenced inFIG. 7, is a user interfaced click and drag assembly platform for composing programs (a virtual content defined collection of dialogs). On a computer desktop, content dialogs are selected (referenced) for use in disease/client specific programs, with program specific tagging of individual dialog attributes related to frequency (scheduling) and reporting. A Program Patient Linker40 is a user interface integrated into the desktop on which patients are assigned to programs. During the assignment process patient identification and patient specific metrics are added to the program. ACare Reporter50, further referenced inFIG. 9, is a user interface for easy patient result lookup, triage and trend reports. Reporting requirements set in theProgram Composer30 determine which reports are displayed.
• Compositional elements of thesystem10 reference either one or both of the two remaining components of the system depicted inFIG. 1. A Program Scheduler60, further referenced inFIG. 8, is an engine for automated scheduling of dialogs based on attributes set in the Program Composer30, and A Dialog Library70. The Dialog Library is the principal central location of dialog content units. Dialogs are organized into body system labeled sub-libraries and stored within theDialog Library70.
• The structure of the system is developed from the integration of the four compositional components as referenced above with the two referenced components and begins with the creation of dialogs in theDialog Composer20 as depictedFIG. 2.
• FIG. 2 is a flow chart diagram depicting the overview of dialog creation and is referenced with more particularity inFIG. 4. Referring toFIG. 2, apatient100 reports on a specific aspect of care110 (i.e., foot care in a Diabetes Structure) that is addressed by a-dialog125, the smallest content structure of the system, from a diseasespecific library120. The basic format of each dialog includesquestions130 related to patient self-management behaviors132, patient-reportable symptoms134, orpatient knowledge136. Each question provides a choice for an answer (“output variable”)140 that falls into one of three risk categories; high142medium144 andlow risk146. For each risk category there is an associated follow up150 which is ateaching statement152, amotivational statement154 or anew question156 that explores the patient's condition in more depth.
• While the logical branching within a dialog depends on output variables, no dependency exists between individual dialogs. Dependencies for dialogs exist outside the dialog structure in related operators.
• FIG. 3 is a block diagram depicting the interdependent characteristics (operators) of adialog300 in the system matrix. The interdependent characteristics include aName Label310 for the aspect of care addressed, aLibrary320 that houses a body systemspecific Localization325, clientspecific Programs330 in which the dialog is being used (referenced), aSchedule frequency340 by which the dialog is being displayed to a patient in a specific program, definition ofReporting requirements350, andPatient Identification information360 and metrics of each individual appliance to which the dialog is assigned.
• The user interface is easy to use due to the simplicity of program structure in which the user is able to interface with the program and dialog composition aspects of the system. Simply using drag and drop content selection procedures based on a medical decision creates a process familiar to the user. The user decides what aspects of care are relevant for a given program or for an individual patient and in most cases simply selects existing content based on that decision. In all steps of dialog composition, certain steps are taken to make available the dialog in a content library.
• FIG. 4 is a flow chart depicting the steps in creating and storing of content data from a dialog, a user's first task is to name the dialog-to-be-created as depicted inblock400. Next, the user defines the library section ofblock410, in which the dialog will reside. The user then identifies an aspect of care atblock420 to which the dialog will primarily refer. Once the naming conventions are assigned and the aspect of care is chosen, the user creates dialog programming statements atblock430, in a graphical programming environment as embodied inFIG. 5. New dialog content is then stored in an appropriate user library atblock440.
• The user who has access to create new content does so using a simple dialog composer as embodied inFIG. 5.FIG. 5 is a diagram depicting the creation components of a dialog Editor Platform. First, a user is presented with apalette500 of programming statements that are represented as graphic symbols (icons) that can be dragged from the palette of available statements into adialog construction platform505. In a typical embodiment of the present invention, the user drags astart question icon510 and a threepronged answer icon520 from an icon palette down to theconstruction platform500. The user then activates a dialog box for each icon by clicking on it with a mouse and specifying a question associated with that particular icon, for example, aStart Question Dialog515. Next, in anAnswer Dialog524, the user enters three answer options relative to the start question and assigns a raw risk value to eachanswer526. The risk values are assigned from high to low with a corresponding text answer. “Yes” equals low risk and “no” equals high risk and “medium” equals somewhere in the middle of low and high risk. Follow upquestions icons530 are dragged onto the construction platform along with an associatedanswer icon540. Ananswer dialog545 is then prepared. Clicking on theoutput icon550, the user activates theoutput dialog box555. Here the user definesrisk state output558 in detail, further depicted with more particularity inFIG. 5, defining the position of the answer relative to the axis of the risk cube. At any time during or after the dialog creation process, the user can review the dialog created, using a simulation interface to an appropriate appliance or in the alternative, the user can review the actual dialog content in a text only overview window. Once all the follow up questions, answers and output dialogs are formulated and put onto the construction platform525, the newly created dialogs are store in auser library560 from where it can be referenced for participation in any user defined care management program or for later updating or editing.
• FIG. 6 is a block diagram illustrating the three dimensional aspects of the dynamically determined risk state output scale which in the Dialog Composer,FIG. 5, is referenced atblock558. TheX-axis610 scales whether the answer to a question dialog sets the risk at a certain risk level on a9 point risk scale or whether the answer moves the patient risk state in a certain direction and by how much, thereby creating an accumulated risk profile. Additionally, the answer to a dialog is incorporated as a value in a mathematically calculated risk state that may incorporate other answers as well, creating a composite, weighted risk state. The Y-axis620 refers to the actual aspect of care in which the risk will be incorporated. The Z-axis630 incorporates the expression ofrisk530, i.e, whether the risk is assigned to a sign orsymptom632, abehavior634, or aknowledge expression636. This dynamic model allows for very sophisticated risk profiling including risk trend alerts, composite risk profiling by aspects of care and profiling by risk expression. The dynamic risk “foot prints” available at any time can serve as triggers for automated content selection.
• Once dialogs are named, created and assigned to an aspect of care and the risk output is assigned to the appropriate dialog, a user of the system can then use theProgram Composer30 to create the program that eventually is assigned to a patient.
• FIG. 7 is a flowchart depicting the creation of “programs” using the Program Composer User Interface (“UI”) . The UI is a platform for selecting library resident Dialogs created as depicted inFIG. 6, for participation in user-defined care management programs. In a typical embodiment of the present invention, the first step is to name thefuture program block700. Next, atblock710, a user selects the disease libraries from which the program dialogs are created. Simultaneously, atblock720, the user checks the Utilities Library to add dialogs to the program that are not disease specific like generic greetings. This gives the user access to the detailed content of both of these libraries organized by aspects of care and their respective dialogs. Creating the program is now a simple task of adding dialogs to the program list, seeblock730, and atblock740 to define the delivery of the dialogs as a user can choose specific delivery of the dialogs on a daily750, weekly752, or any other754 programmed timed basis. Additionally, atblock742, a user checks the priority of dialogs to set parameters necessary for the correct scheduling of the dialogs in the program. Options are to force the scheduler to include thedialog block744, or to assign dialogs as fillers, block746. The later could be the case, for example, with trivia type dialogs, entertainment dialogs etc. Also, the user has the opportunity to decide the placement of dialogs in daily sessions. Greetings, for example, should be checked as “always first.” The user can review the complete created program using the “View Selection” link, block760. Using a very simple interface, the user has now created a totally custom made program. Atblock770, the program is now available for assignment to any of the user's patients or for later modification by the user by adding or deleting dialogs. The present invention embodies the assignment by way of a Linker User Interface (“Linker UI”) as depicted inFIG. 8.
• FIG. 8 is a flow chart depicting the Linker UI, which is a platform for assigning or “linking” care management programs to patient populations or to individual patients. The first step atblock800 is to retrieve patient's name(s) to be used on the work platform through a filtering or sorting procedure defined by the user. Next, atblock810, the user marks the patient(s) and the care management program to be assigned. Finally the user creates the “Link” to activate a dialog box that allows the user to specify a time frame in which the program will run for the selected patient(s), block820. Should the user wish to link the patient to other programs all that is needed is to repeat the process. To process the linking of an entire population or part of a population a user selects all patients, block800, and assigns all of them, block810, to a program.
• The last step in the creation of a system program is the creation of a Reporter User Interface (“Reporter UI”) which creates patient reports specific to patient results that in turn can initiate program actions based on those results.FIG. 9 is a flow chart depicting the Reporter UI and the creation of reports. The layout of the Reporter UI is completely consistent with that of the Linker UI depicted inFIG. 8. First a user retrieves patient names through a filtering process, block902. The user filters, atblock900, names through the programs by either risk search, block904, the aspects of care, block905, within each program, or the risk expression, block906, as defined as a symptom, behavior or knowledge, block908, factor. This is done to allow a user to trend a risk profile, block910, for the patient in the aspect of care where the patient has scored, for example, a high-risk profile as depicted inFIG. 6. A user can configure the Reporter UI to display block920 the actual answers or results that led to the exampled high-risk profile. Lastly, atblock930, a patient is assigned to a program based on the risk profile or Aspect of Care. Reports assigned to patients can now for example, allow the user to see details for each aspect of care, order a report printed or write a note that will be associated with a linked event.
• While this invention has been described in terms of several preferred embodiments, there are alterations, permutations, and equivalents that fall within the scope of this invention. It is therefore intended that the following appended claims be interpreted as including all such alterations, permutations, and equivalents as fall within the true spirit and scope of the present invention.

Claims (22)

1. A method for managing a condition of an individual, comprising the steps of:

(A) selecting a plurality of dialogs from one or more libraries;

(B) assembling said dialogs; and

(C) defining a delivery schedule for said dialogs as assembled to one or more of said individuals.

2. The method according toclaim 1, wherein said dialogs comprise a plurality of content objects.

3. The method according toclaim 1, further comprising the step of:

generating a prioritization for said dialogs.

4. The method according toclaim 3, wherein said prioritization comprises an option to include said dialogs in said delivery schedule.

5. The method according toclaim 3, wherein said prioritization comprises an option to include one or more filler types of said dialogs in said delivery schedule.

6. The method according toclaim 1, wherein said delivery schedule comprises (i) a daily schedule, (ii) a weekly schedule or (iii) a custom schedule.

7. The method according toclaim 1, further comprising the step of:

generating a presentation defined by said dialogs as assembled.

8. The method according toclaim 1, further comprising the steps of:

generating one or more management programs for said dialogs related to said condition;

marking a particular individual among a plurality of said individuals for an assignment; and

linking said particular individual with said management programs per said assignment.

9. The method according toclaim 1, further comprising the steps of:

identifying a particular individual among a plurality of said individuals by filtering said individuals using at least one of a plurality of factors for said condition;

generating a profile for said particular individual based on a plurality of responses received from said particular individual responding to a plurality of questions sent to said particular individual; and

generating a report for said profile.

10. The method according toclaim 1, wherein said management of said condition comprises a disease management, said one or more libraries comprise one or more of (i) a disease specific library and (ii) a non-disease specific library and said dialogs concern a plurality of aspects of health care.

11. The method according toclaim 1, further comprising a storage medium storing a computer program comprising the steps ofclaim 1.

12. A method for managing a condition, comprising the steps of:

(A) generating one or more management programs for a plurality of dialogs related to said condition;

(B) marking a particular individual among a plurality of individuals for an assignment; and

(C) linking said particular individual with said management programs per said assignment.

13. The method according toclaim 12, further comprising the step of:

generating a time frame in which said management programs will run for said particular individual.

14. The method according toclaim 12, further comprising the step of:

identifying said particular individual by filtering a plurality of names of said individuals.

15. The method according toclaim 12, wherein said management of said condition comprises a disease management and said management programs concern a plurality of aspects of health care.

16. The method according toclaim 12, further comprising a storage medium storing a computer program comprising the steps ofclaim 12.

17. A method for managing a condition, comprising the steps of:

(A) identifying a particular individual among a plurality of individuals by filtering said individuals using at least one of a plurality of factors for said condition;

(B) generating a profile for said particular individual based on a plurality of responses received from said particular individual responding to a plurality of questions sent to said particular individual; and

(C) generating a report for said profile.

18. The method according toclaim 17 wherein said report comprises said responses and is readable by a human.

19. The method according toclaim 17, wherein said factors comprise at least one among (i) a plurality of factors related to a level at risk (ii) a plurality of factors related to an aspect of care and (iii) a plurality of factors related to an expression of risk.

20. The method according toclaim 19, wherein said factors related to said expression of risk comprises at least one among (i) a plurality of symptom factors reportable by said individuals, (ii) a plurality of behavior factors of said individuals and (iii) a plurality of knowledge factors of said individuals.

21. The method according toclaim 17, further comprising the step of:

assigning said particular individual to a healthcare program based on said report, wherein said management of said condition comprises a disease management.

22. The method according toclaim 17, further comprising a storage medium storing a computer program comprising the steps ofclaim 17.

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