US20100293005A1 - Gps-assisted referral of injured or ailing employee during medical triage - Google Patents

Abstract

A method for directing an employee to a treatment center includes receiving with a computer an electronic communication from an employee of a client while the employee is traveling away from a normal location of work, the employee initiating the electronic communication with a GPS-enabled mobile device; determining the location of the employee based on a GPS location of the mobile device with a GPS-tracking system coupled with the computer; performing triage on the employee by a triage operator to determine a level of urgency of a medical condition of the employee, to thereby determine an appropriate disposition for the employee, wherein triage questions are provided to the triage operator by the computer based on a category related to the medical condition; and automatically determining, with the computer, a nearest treatment center to the location of the employee based on the GPS location of the mobile device, the nearest treatment center being adequate to address the level of urgency required by the determined disposition and a designated preferred provider of the client.

Description

RELATED APPLICATIONS
• This application claims the benefit of the filing date of U.S. patent application Ser. No. 10/985,850, filed Nov. 9, 2004, and titled PROVIDING STANDARDIZED MEDICAL TRIAGE, the entire contents of which are incorporated by reference herein.
COPYRIGHT NOTICE
• A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves all copyright rights whatsoever.
BACKGROUND
• Originally, medical triage was a process deployed during wartime or disasters by which a nurse or other medical professional personally performed an initial assessment of patients to group them into one of three categories: those too ill to benefit from immediate medical care, those well enough to survive without immediate care, and those who could benefit from immediate care. In situations in which immediate medical care was a scarce resource, triage methodology helped ensure that such care would be allocated rationally, for maximum aggregate benefit.
• In a broader sense, medical triage is a process for sorting people with medical complaints into groups based on the likelihood of them benefiting from particular levels of medical treatment. For example, most hospital emergency rooms utilize some kind of triage methodology to determine the priority in which patients receive care. The methodology can also include a decision-making strategy for deciding whether a nurse is able to dispense an adequate level of care or a physician is required for a higher level of care. Much of this is done in person, using medical assessments such as blood pressure, pulse, skin color, and general observations of the patient to supplement what the patient describes about his or her condition. The staff then applies hospital triage rules based on that information to determine treatment priority and a level of care, typically aiding those with the most serious conditions first.
• Such medical triage systems exist to ensure that an appropriate level of care is dispensed to all individuals, by evaluating the significance of their self-reported or observed symptoms and matching them with a particular level of care. Accurate triaging means that the patient's medical concerns receive a suitable level of medical attention—neither substantially more nor substantially less than what he or she needs.
• Triage systems can also ensure that the dispensation of care is more economically efficient. In this age of ballooning medical costs, a medical triage system can mean that whoever ultimately pays for the medical services (e.g., government, companies or individuals) does not pay for an unnecessary level of treatment. For example, if someone with a minor injury is accurately triaged, an appropriate level of care can be determined, while expensive services, such as ambulance transport and emergency department care, can be avoided, if unnecessary.
• Some triage systems are focused on controlling and limiting utilization of medical services (i.e., gate keeping). These triage systems are operated by or paid for by insurance companies and/or third party administrators responsible for general health care costs. The system guides callers to medical generalists, rather than to more costly specialists, except when a specialist is necessary. These systems will also direct referrals to in-network (i.e., discounted) medical providers, steering callers away from out-of-network (i.e., non-discounted) providers.
• The spread of telecommunications means that some types of medical triage can be employed by persons who are not on-site with the patient. Advances in triage methods have enabled persons without extensive medical training to conduct some types of triage, so long as they are trained in the triage methods. A common form of triage that is conducted telephonically and by non-medical professionals with specialized training is that used by 911 Emergency Medical System (EMS) dispatching services. However, these services generally operate under the assumption that some emergency medical response will be sent to all callers. The dispatcher typically determines the level of response (e.g., whether basic or advanced life support is dispatched, which ambulance or other responder is closest to the caller, and whichcaller105 gets priority when there are multiple simultaneous calls). EMS dispatchers also provide pre-arrival instructions, guiding callers in simple life saving techniques to help stabilize patients until emergency personnel arrive.
• Medical providers, including clinic and hospital departments, may also utilize a triage service for screening purposes. For example, many expectant mothers and parents call obstetricians' and pediatricians' offices with a variety of medical complaints, concerns and questions. A triage service can play a role in determining which patients need to see a physician and which do not. Many clinics use their own staff for this triage service, but other clinics out-source to call centers. Similarly, many doctors' offices, clinics and hospital departments use call centers to answer their telephones on weekends and after business hours. In addition to handling scheduling and message services, these call centers often use a level of triage to determine which calls warrant paging an on-call doctor.
• Most triage calls begin with a nurse recording the medical condition or injury as stated by the caller, along with the caller's demographic information. This is followed by questioning by the nurse and a short health history. The nurse will assess the symptoms, provide information on seeking care and improving symptoms, and refer the caller to a physician, if necessary. Documentation of the call can be the final part of the triage process.
• Many of the existing services described above provide a triage service in which nurses apply a variation of the free-form triage, answering callers' medical questions using the nurse's own expertise or general guidelines. While sample protocols, risk factors and other information can be provided, these systems do not establish a broadly applicable and consistent decision-making process. Nurses are left to formulate their own questions and direct their own investigations. Even with general guidelines such a system can be rife with inconsistencies and other limitations. Each nurse can have his or her own particular predilections and can steer the inquiry in a direction not warranted by a fuller understanding of a particular patient's condition or optimal practices obtained by methodical study of prior triage cases. The nurse can miss critical points as a result of sloppiness or lack of knowledge and can, as a result, direct more treatment or less treatment than is appropriate. It can be impossible to ensure consistency and quality control with this kind of system.
BRIEF DESCRIPTION OF THE DRAWINGS
• The invention can be better understood with reference to the following drawings and description, with emphasis placed upon illustrating the principles of the invention.
• FIG. 1 is a schematic depiction of a platform for implementing triage.
• FIG. 2 is a block diagram showing the possible hardware components of a computer system for implementing triage.
• FIG. 3 is a block diagram showing possible database components in a computer system for implementing triage.
• FIG. 4 is a schematic depiction of a call process for the triage system.
• FIG. 5 shows a chart depicting for exemplary disposition sets.
• FIG. 6 is another schematic depiction of a call process for the triage system.
• FIG. 7 is a schematic depiction of a call process for the triage system that includes detailed notification procedures.
• FIG. 8 is a schematic depiction of a format for a triage category.
• FIG. 9 is a schematic depiction of one set of tiered triage questions and corresponding dispositions.
• FIG. 10A shows an exemplary triage category for upper extremity injuries, including a set of tiered triage questions and corresponding dispositions.
• FIG. 10B shows exemplary self-care instructions, follow-up criteria and frequently asked questions associated with the triage category inFIG. 10A.
• FIG. 11A shows a schematic depiction of a zigzag-type alternation between sets of triage questions.
• FIG. 11B is a schematic depiction of a step-type alternation between sets of triage questions.
• FIG. 12 is a schematic depiction of a method of alternating between triage questions in one triage category and another set of questions in a triage category added after triage was begun in the original category.
• FIG. 13 shows a sample quantification tool for standardizing and defining triage questions and responses.
• FIGS. 14A-P show various exemplary screen formats for implementing a triage system on a computer.
DETAILED DESCRIPTION THE TRIAGE PLATFORM
• A schematic overview of a platform for implementing a triage system of the invention is shown inFIG. 1. Elements used in supporting and implementing the triage system can be connected through acommunications network100, including, for example, the Internet, an intranet, a local area network and/or a wide area network. Additional elements not shown inFIG. 1 can be included in such a platform. The triage system can also be implemented with fewer elements than shown inFIG. 1.
• The triage system can address the medical inquiries of individuals in any context in which injury management and triage is desirable. Application of the triage system can help reduce utilization of expensive, and often unnecessary, appointments with physicians and emergency room visits. By eliminating unnecessary physician appointments and visits to the emergency room, the system can also reduce unnecessary recordable injuries and unnecessary claims for Workers' Compensation. The triage system can also help ensure prompt, appropriate care, thereby mitigating additional injury, reducing an individual's time away from work and preventing permanent disabilities. There can be direct cost savings by directing an individual to a preferred treatment center (where permitted by law) in which care is more appropriate or better tailored to the individual's condition, and, in some cases, less expensive. The system can also encourage those who are ordinarily reluctant to seek medical care to seek such care when they might benefit from it.
• The triage system can include one ormore triage centers108 in which one ormore triage operators110 communicate with individuals (e.g., a caller105) who have contacted thetriage center108 with medical concerns or questions. Thetriage operator110 can be in contact with thecaller105 through the communications network100 (e.g., using telephones) to allow for a remote triage investigation. Thetriage operator110 can work from anywhere he can connect to thecommunications network100, including from atriage unit126, which can be connected through thecommunications network100 to thetriage center108. Thetriage operator110 can also operate independently, for example, using a non-networked PC.
• In other cases, however, the triage can be implemented in part by acomputer system116, using voice recognition to process the answers offered by thecaller105 and/or using voice generation to present the questions to thecaller105 over the telephone or similar device. Acomputer system116 can also present the questions in written form to thecaller105, as in an Internet Web page, for example. The triage process can be implemented automatically using some of the above-mentioned techniques.
• Thetriage operator110 can be a physician, surgeon, medical resident, physician assistant, nurse practitioner, registered nurse, paramedic, psychiatrist, dentist, pharmacist, other medical professional or other person trained to implement the triage system. In some cases, non-medically trained people can implement the triage system, if they are properly trained to implement the triage system. It can be more efficient to use registered nurses, because they are often trained in general triage practices, can have relevant and useful general medical knowledge and experience to place triage instances into context, and because their services can be less expensive than those of physicians. Someone with credentials less than those of a registered nurse can be utilized as thetriage operator110, although adequate supervision of lesserskilled triage operators110 may be desirable to ensure that the triage process is accurately implemented. Applicable laws and regulations in certain jurisdictions may require minimum licensure or credentials separate from what the triage system requires in order to provide medical advice or triage service in that jurisdiction.
• Thecaller105 can be anyone who makes contact with thetriage operator110 orcomputer system116 for the purposes of medical triage. Thecaller105 can be the injured or ailing person, or anyone with medical questions. Thecaller105 can also be someone who is assisting the injured or ailing person, especially in situations where the injured person is not able to call or communicate over the telephone. For example, a supervisor can help an employee place such a call if the employee is partially incapacitated. A supervisor can also place the call on behalf of someone else when company policy so requires. For simplicity, it can be assumed herein that thecaller105 is the person with the medical issue or complaint.
• Thecaller105 can use a telephone to call thetriage center108 ortriage unit126, such as by using a toll-free (e.g. 1-800) number. Thecaller105 can also use a mobile telephone, satellite telephone, walkie-talkie, computer via the Internet or other network, email, BLACKBERRY (Waterloo, Ontario), facsimile machine, two-way pager or any other system for communicating from a remote location to thetriage operator110.
• In some situations, the triage system is provided to a client organization to serve its employees, customers, and/or those at its facilities104. Acaller106 at the organization facilities104 can be an employee or customer of the client organization, or can have no relation with the client other than being on its property. The client organization can also extend the application of its triage program tocallers105 who are employees, including those off-site and/or not on the job. Additional cost savings can result from improved productivity and morale, as a result of the prompt medical attention available to an employee.
• Employees can be more satisfied with the level of care and thus more likely to comply with self-care instructions, and can be less likely to initiate litigation against the client organization. Furthermore, by shifting the medical decision-making from the client organization to the triage system provider, the risks inherent in medical decision making are shifted away from the client organization. Acaller128 who is mobile can contact atriage operator110 from multiple locations. For example, a long-haul truck driver can have access to the triage system by contacting thetriage center108 ortriage unit126 though thecommunications network100 using any of the devices mentioned above. The position of themobile caller128 can be determined with a tracking system such as the Global Positioning System (GPS)130. This can assist in dispatching medical services to themobile caller128 and/or directing themobile caller128 to anearby treatment center118,120. GPS software employed by thetriage operator110 can help interpret and present GPS-related data for the purpose of locating amobile caller128. For example, the position of themobile caller128 could be displayed on adisplay device160 so that thetriage operator110 orcomputer system116 could help identify routes to atreatment center118, such as the nearest treatment center, or direct an appropriate medical provider to themobile caller128.
• Acaller105 may require emergency assistance, such as assistance provided by an Emergency Medical Service (“EMS”)124. A call to the911call center122 can be made by thecaller105 at the instruction of thetriage operator110 if the triage disposition so warrants. The911call center122 can in turn dispatch an ambulance by contacting theEMS124, which will transport thecaller105 to atreatment center118,120.
• Alternatively, the situation may not require emergency attention. In that case, thetriage operator110 orcaller105 can make an appointment for thecaller105 to see a medical provider (such as a physician, physician's assistant, nurse practitioner, dentist, nurse practitioner, nurse or other medical professional) at one of the treatment centers118,120. Treatment centers118,120 include hospitals, clinics or other locations where medical care can be dispensed. One ormore treatment centers118 can be identified as a preferred treatment center, based on the client specifications, the proximity of thetreatment center118 to thecaller105 or client facility104, the known capabilities of thetreatment center118, etc. However, the system can comport with any applicable laws and regulations that govern (or prohibit) the restriction to, or selection of, preferred treatment centers. Thetriage operator110 orcaller105 can first attempt to use or contact apreferred treatment center118; if that fails, he can then attempt to use or contact anothertreatment center120.
Computer System
• As shown inFIG. 1, thetriage operator110 can use acomputer system116 to help implement the triage system. Alternatively, the triage system can be implemented without computers, such as with books. Thecomputer system116 can be a client-server system, in which one ormore computer clients112 send requests to aserver114 and aserver114 responds to requests from one ormore computer clients112. A “computer client” can be broadly construed to mean computer hardware that requests or receives the file, and “server” can be broadly construed to be the computer hardware that provides or downloads the file. Thecomputer system116 can include a personal computer (PC), laptop computer, server, workstation, and the like, running any one of a variety of operating systems.
• Thecomputer client112 can be any computer hardware, such as a PC, workstation, hand-held device, electronic book, personal digital assistant, peripheral, etc. Thecomputer client112 can also be a software program running on a computer directly or indirectly connected or connectable in any known or later-developed manner to any type of computer network, such as the Internet. The software is also known as instructions stored on a computer-readable storage medium for execution by thecomputer client112. For example, arepresentative computer client112 is a personal computer that is PENTIUM-based (Intel, Santa Clara, Calif.) and includes an operating system such as MICROSOFT WINDOWS (Microsoft Corp., Redmond, Wash.). Thecomputer client112 can also include a Web browser, such as INTERNET EXPLORER (Microsoft Corp., Redmond, Wash.). Acomputer client112 can also be a notebook computer, a handheld computing device (e.g., a PDA), an Internet appliance, a telephone, or any other such device connectable to the computer network or other communications network.
• Theserver114 can be any computer hardware, such as a computer platform, an adjunct to a computer or platform, or any component thereof, such as a program that can respond to requests from acomputer client112. For example, the server can be a PENTIUM-based computer (Intel, Santa Clara, Calif.) runningWINDOWS 2000 SERVER and executing MS SQL (Microsoft Corp., Redmond, Wash.) or ORACLE (Oracle Corp., Redwood Shores, Calif.). Theserver114 can also include a display supporting a graphical user interface (GUI) for management and administration, and an Application Programming Interface (API) that provides extensions to enable application developers to extend and/or customize the core functionality thereof through additional software programs.
• The triage system can be implemented using software running on thecomputer system116. In addition, the triage system can be implemented using a transmission medium, such as one or more carrier wave signals transmitted between thecomputer system116 and another entity, such as another computer system, a server, a wireless network, etc. The triage system can also be implemented using an API or a user interface.
Computer Hardware Components
• A block diagram of thecomputer system116 is shown inFIG. 2, showing a number of different hardware components coupled by adata bus150 to allow communication therebetween. The components can communicate via hardwire or wireless connections. The computer systems embodying the triage system need not include every element shown inFIG. 2, and equivalents to each of the elements are intended to be included within the spirit and scope of the triage system.
• Thecentral processor152 shown inFIG. 2 can run software that assists in triaging thecaller105. Thecentral processor152 can, for example, be used to process information entered by atriage operator110 into thecomputer system116. Thecentral processor152 can be any type of microprocessor, such as a PENTIUM processor (Intel, Santa Clara, Calif.).
• Amain memory unit154 can also be a part of thecomputer system116 Additional storage devices, such as a fixed or harddisk drive unit164, a floppydisk drive unit166, atape drive unit168 and/or optical storage devices such as a CD Rom drive170 or aDVD drive171 can act as adjuncts and/or alternatives to themain memory unit154. The storage devices, such as theDVD drive171, in addition to themain memory unit154, can be used for storing and access to recordings of the conversations between thecaller105 and thetriage operator110, medical and other data related to thecaller105, triage-related software and data used to execute the triage-related software.
• Thenetwork interface158,159 can be any type of a device, card, adapter, or connector that provides thecomputer system116 with network access to a computer or other device, such as a printer. In the triage system, thenetwork interface158,159 can enable thecomputer system116 to connect to a computer network such as the Internet or Ethernet. Software and data can also be loaded into the computer system via thenetwork interface158,159.
• Adisplay device160 can be used to display, to thetriage operator110 or others, any information related to the triage system, such as triage questions to ask of thecaller105. Thedisplay device160 can be any type of display, such as a liquid crystal display (LCD) and the like, capable of displaying, in whole or in part, the triage categories or other outputs generated by thecomputer system116.
• One or more input devices I62 allow thetriage operator110 to enter information into thecomputer system116, such as answers to triage questions. Theinput device162 can be any type of device capable of providing the inputs described herein, such as keyboards, numeric keypads, touch screens, pointing devices, switches, styluses, scanners and light pens. An input/output controller156 can support the input and output devices.
Database and Software Components
• FIG. 3 is a block diagram showing possible database components and supporting architecture in acomputer system200 for implementing the triage system. In the system ofFIG. 3, a user210 can interact with aback end250 of thecomputer system200 via aserver230 and acontent presentation system240. Thecomputer system200 can include one ormore customer databases280, one ormore content databases290, one ormore telephone databases295 and one or moreaudio recordings databases297 and a data warehouse215. Theback end250 can be located in atriage center108 or off-site.
• The user210 can be atriage operator110 capable of interacting with thecomputer system200. The user210 can also be someone who inputs or accesses data or triage-related information, updates the software in thecomputer system200, or otherwise alters thecomputer system200. The software is also known as instructions stored on a computer-readable storage medium for execution by thecomputer system200. The user210 can also be someone who mines the data in thecomputer system200 to generate reports, such as call statistics, injury reports and other reports. The user210 can include a client or representative thereof, who can generate and/or have instant and secure access to statistical reports on employee call characteristics, incident rates and other parameters via thecommunications network100.
• The user210 can access thecomputer system200 through the Internet, a remote server, or a networked device through, for example, aserver230. Users210 may also access thecomputer system200 users using a wide area protocol (WAP), digitized voice signals, interactive television signals, electronic mail systems, voice mail, direct mail, and various messaging systems, including short message service (SMS) systems. The user210 may also interact directly with theback end250. Access to theback end250 can also be provided via one or more carrier wave signals that are accessible to the user210 without requiring aserver230.
• Theback end250 can consist of various elements connected by a LAN. The elements of theback end250 can include a fileserver running WINDOWS 2000 SERVER; a database server running MS SQL (Microsoft Corp., Redmond, Wash.) or ORACLE (Oracle Corp., Redwood Shores, Calif.); phone servers running aWINDOWS 2000 platform; fax servers running aWINDOWS 2000 platform (Microsoft Corp., Redmond, Wash.); an e-mail server running MICROSOFT EXCHANGE; and UNIX-based e-mail server running SENDMAIL (Sendmail, Inc., Emeryville, Calif.) for back-up; a web server running IIS (Microsoft Corp., Redmond, Wash.); a reporting engine running CRYSTAL ENTERPRISE (BusinessObjects, San Jose, Calif.); and a NETSCREEN fire wall device (Juniper Networks, Sunnyvale, Calif.). The system can run 128-bit encryption such as VERISIGN (Verisign, Inc., Mountain View, Calif.) to ensure system security. Other elements and software can be added to thisback end250. Theback end250 can also be implemented with ACCESS (Microsoft Corp., Redmond, Wash.), DEVELOPER 2000 (Oracle Corp., Redwood Shores, Calif.), or other reporting tools, including the replacements or successors to these applications.
• The architecture of theback end250 can be a flexible design that includes real-time, database-resident support, permitting reporting capabilities that can take advantage of E-mail/WAP/Voice-based communication. As content is added to the back end250 (e.g., in content databases290), the attributes of the content can be delivered to the user210 in near real time, using, for example a report generated in the data warehouse215 and presented to the user210 via thecontent presentation system240. Theback end250 can create queries to be provided to a user210 and can receive responses to the queries. Theback end250 can also perform processing based at least in part on the queries and the responses, along with information stored in its databases and lookup tables, and helps determine the triage disposition.
• Thecomputer system200 can also include a business logic processing system (not shown) connected to the server, to form a three-tier computer system. The business logic processing system can receive queries or responses from the user210. That information can be used to update thecustomer databases280, as well as retrieve data and information from both thecustomer databases280 andcontent databases290. The business logic processing system can also provide inputs to and receive outputs from the data warehouse215 and communicate with any rules systems to apply one or more predetermined rules to the user queries. These functions can be accomplished in the absence of a discreet business logic processing system.
• The data warehouse215 communicates with thecustomer databases280 and thecontent databases290 and other databases during the preparation of reports or triage-related queries which can be provided to the user210, such as with an on-screen display. The data warehouse215 can also organize and store data generated using theserver230 and/or a rules system. Thedatabases280,290 can be, for example, SQL relational databases and/or relational online analytical processing databases (ROLAP).
• Thecustomer databases280 can include one or more databases for storing data provided by users210 and/or derived from inputs by users210, including demographic information, answers to triage-related questions, dispositions, follow-up data, plans, or other inputs from the users210. Thecustomer databases280 can have real-time capabilities for support of the data warehouse215. The MedfilesMOL™ database and the telephone system database described below can be components of thecustomer database280.
• Thecontent databases290 can include one or more databases storing content that can be provided to a user210 during operation of the system. Thecontent databases290 can include all of the information of the triage categories, including the tiered triage questions and related information, discussed below. The triage database described below may be a part of thecontent databases290.
• Thecontent databases290 can include the tiered questions, in addition to data that is “scored” in advance for one or more predetermined characteristics. This is also referred to as “derived” data. The scored data can, for example, be maintained as a set of one or more tables of scores. Certain quantitative or qualitative details about a medical condition can be assigned one or more scores based on severity. Derived data can be used in conjunction with look-up tables to accept queries from theserver230 and provide appropriate responses. For example, a given amount of pain, shortness of breath or extent of bums can be matched with a disposition through the lookup tables. Information in lookup tables can be more quickly and conveniently accessed in certain circumstances.
• Thetelephone databases295 store and provide access to telephone numbers, associated names and other telephone-related data. Theaudio databases297 store digitized recordings of the calls.
• Thecomputer system116 can execute dynamic updates to the screen controls to change one or more properties, without having to make coding changes and/or redeploy the triage-related software. Those properties can include position, size, backcolor, forecolor, border style, field input length and tool tip text. The computer system can also execute dynamic updates regarding whether a field receives focus when a Tab key is pressed and/or the order in which fields receive focus when the Tab key is pressed. These changes can be useful for refining the software to improve work flow and ease of use without having to reprogram thecomputer system116.
• In the above description ofFIG. 3, it should be understood that any portion of the functionality provided by thecomputer system200 could be provided by independent systems and/or different groupings of systems than illustrated inFIG. 3.
Triage Process
• As shown schematically inFIGS. 4A-B, users of the triage system (e.g., callers105) can contact atriage operator110 from a remote location. Thecaller105 can, depending on the traffic to thetriage center108, be placed in a telephone system queue (step304) until atriage operator110 is available. The phone system can require thecaller105 to indicate whether the call is for a new injury; those calls are moved ahead of others in the queue who indicate that they are reporting old injuries. Thetriage center108 can be located anywhere atriage operator110 orcomputer116 employs the triage system.
• Thecomputer system116 and software can work together to present thetriage operator110 with information relevant to a caller's medical complaints, prompt for specific questions related to the caller's symptoms, and record the corresponding answers. Thetriage operator110 can employ the information and questions within those categories to determine which disposition (i.e., timing and level of medical care) best suits thecaller105, as described in further detail below. The triage system does not necessarily diagnose the caller's medical condition, although the triage system can be used in conjunction with a diagnosis system.
• When the caller's turn has arrived, atriage operator110 can answer the telephone and implement the triage system. All telephone conversations can be digitized and stored digitally on a hard drive and then transferred to DVD; a call can also be stored on analog tape. The call recording and the triage operator's computer inputs can both have a running time-stamp so that they can be linked and/or synchronized to better enable one to understand the basis for the triage operator's decisions or the effectiveness of the triage questions, when analyzed at a later date.
• Upon receiving a call, thetriage operator110 can begin by finding and confirming the caller's location (step308), so that thetriage operator110 can dispatch medical services to the caller's location if necessary. Thetriage operator110 can also use the location information to determine if thecaller105 is eligible for services (step310), e.g. a pre-existing client, employed by a pre-existing client, a customer of a pre-existing client, or otherwise entitled to services. An exemplary computer screen layout shown inFIG. 14A can be suitable for recording such information.
• Services can be denied to acaller105 who is not eligible. If thecaller105 is not eligible for services, he will be notified (step312). However, if it is apparent that thecaller105 is in need of emergency medical attention, thetriage operator110 can instruct thecaller105 to contact the EMS and provide interim self-care instructions. If thetriage operator110 wishes to contact the EMS on the caller's behalf, it can be important to get an accurate description of the exact location of thecaller105 and information on the appropriate EMS, which thetriage operator110 may not have in the database. Other demographic information such as the caller's social security number or name can be used to determine if thecaller105 is eligible for triage services or has called before, so that his medical records can be accessed, if they exist.
• Thetriage operator110 can establish whether or not thecaller105 already exists in the triage system database (step316) using personal data. If thecaller105 does not exist in the database, basic caller data are solicited by thetriage operator110 and entered (step322) via any appropriate devices, such as a keypad, mouse, light pen, touch screen, scanner, etc. The information can enable the system to follow-up with thecaller105 or allow triage reports to be generated, as described below.
• Thecaller105 may already be listed in the database. If so, the caller's information is accessed. The exemplary computer screen layout shown inFIG. 14A can be suitable for accessing such information. Once the caller data are entered (step322) or accessed, thetriage operator110 determines if the call is a report call only (step324). A report call is a call in which no medical treatment is desired by thecaller105, but merely establishes the caller's data for future contact and for more complete data records of injuries and reporting statistics for triage client organizations. For a report call, intervening triage-related steps are skipped (step342) and the data collection process is initiated, as described below. The call type can be selected using radio buttons, as described in reference toFIG. 14C, below.
• If the call is not a report only call, then the process is continued (step340), as shown inFIG. 4B, by determining if the call is a follow-up call (step344). A follow-up call is a call based on a medical condition that was previously addressed by the triage system. If it is a follow-up call, the system is set up as a follow-up call (step350) by accessing the data related to the original incident, which can be associated with the caller's personal data. This can enable the follow-up call data and the original incident data to be linked within the database, and can help thetriage operator110 understand the earlier incident or condition. A follow-upcaller396 can also contact thetriage operator110 and directly commence follow-up (step350).
• If it is not a follow-up call, the call is set up as an original call (step352), enabling an initial inquiry into the caller's condition and personal data. The caller's age can be collected in order to determine a suitable level of care for thecaller105. For example, chest pains in a 65-year-old can suggest a heart attack, while they might not for an 18-year-old. If acaller105 is identified as a minor, a “Pre-Triage for Minors” frame can become enabled, as further described in reference toFIG. 14C, which can give the option of selecting a type of legal consent. Legal consent criteria can be required before the call can progress, in order to prevent the unauthorized triage of minors. A parental consent form on file with the triage center, over-the-phone consent from a parent, or an agreement on file with the client organization can generally allow minors to make full use of the triage system. The triage system can, however, allow for Emergent-911 and Emergent triage of minors under the legal principle of implied consent. Triaging can be discontinued following the Emergent-911 or Emergent questions for minors, as it can become harder to claim that implied consent applies to a less urgent situation. For particular clients, the “Pre-Triage for Minors” frame can be disabled.
• Next, thetriage operator110 can select the relevant triage categories (step354). The categories can correspond to body parts and/or injury types that can be the focus of the triage inquiry. The categories can be generally symptom-based. Each category contains both tiered triage questions and related information. The tiered triage questions, described below, are related questions that can lead to one of a set of possible dispositions, depending on the answers provided. An exemplary computer screen layout that allows selection of relevant categories is shown inFIG. 14C.
• The categories that relate to particular body parts can include “abdominal injury,” “abdominal pain without injury,” “chest pain without injury,” “chest injury,” “dental injury,” “upper extremity pain without injury,” “upper extremity injury,” “lower extremity pain without injury,” “lower extremity injury,” “ eye injury,” “eye chemical exposure,” “red eye,” “groin strain,” “headache, typical,” “headache, new onset/atypical,” “head injury,” “low back injury with direct trauma,” “low back injury without direct trauma,” “low back pain without injury,” “neck injury,” “pregnancy,” “shortness of breath,” etc.
• The triage categories that are not necessarily related to a particular body part can include “bites,” “blood-borne pathogen exposure,” “bums,” “electric shock,” “frostbite,” “general complaint,” “heat illness,” “insect bite or sting,” “insecticide exposure,” “open wound/laceration,” “psychiatric conditions/stress,” “rash,” etc.
• As shown inFIG. 4B, thetriage operator110 can ask thecaller105 one or more questions about his complaints to ascertain the origin or cause of the caller's inquiry and allow thetriage operator110 to select the relevant categories (step354). For example, if thecaller105 states that he fell off a ladder, thereby bumping his head and cutting his arm, thetriage operator110 can select the “head injury” and “laceration” categories. Both the supporting information and tiered triage questions in those two categories—laceration and head injury—can be applied by thetriage operator110 as further described below. If more than one relevant triage category is selected, the categories can be prioritized (step355). They can be prioritized based on the description thecaller105 provides or rules implemented by thetriage operator110. Such a rule can provide, for example, that the “chest pain” category always has a higher priority than the “groin strain” category.
• Both the category selection and the body part selection can be accomplished in the exemplary screen layout displayed inFIG. 14C, where the body part (e.g., foot, neck, hand, torso),body part location1 and2 (e.g., left/right/lateral/dorsal) are selected using combo-box fields672-676, and thecategory678 is selected from a list. When the “Add”button680 is selected, the combination of category and body part are recorded and displayed in awindow682. The same category can be applied multiple times to different areas of the body by selecting the same category a second time while selecting different body parts. For example, the laceration category can be applied to both the hand and the elbow, as primary and secondary body parts. Likewise, different categories can be applied to the same body part, if, for example, there is both a bum and an open wound at the same place. When all or some of the categories and body parts are selected, thetriage operator110 can use thearrow buttons684 to prioritize the selections, as shown inFIG. 14C.
• As shown inFIG. 4B, the information and questions within each of the relevant triage categories are applied to triage the caller's complaints (step356), i.e., to determine a suitable triage disposition for thecaller105. The possible gradations of disposition can correspond to urgency, as described below, especially with respect toFIG. 5.FIG. 4B shows that thetriage operator110 determines either that a referral is required (step358) as a result of the triage process (step356) or not. Thus, there are two basic dispositions shown in FIG.4B—“requiring a referral” and “not requiring a referral.”
• If the triage inquiry results in a referral, thetriage operator110 can search for and refer thecaller105 to a preferred medical provider (step366), including any preferred treatment centers. If there is no preferred medical provider designated by the client, or if the preferred medical provider cannot adequately address the caller's medical condition, thecaller105 can be referred to any other suitable medical provider. Alternatively, thecaller105 can be presented with a list of treatment centers to choose from for referral, or can be allowed to select his own referral clinic, depending on the client policy and applicable laws and regulations. If the triage process does not result in a referral, self-care instructions (step364) can be given to the caller. An exemplary screen format for displaying triage questions and enabling access to supporting information, including self-care instructions, is shown inFIGS. 14D-E.
• If the caller's condition allows, thetriage operator110 can collect more information (step368) about thecaller105, beyond that requested at the beginning of the call. This information can include demographic data, incident criteria, and other information. An exemplary computer screen format for entering this information is shown inFIG. 14.
• Thetriage operator110 can also inquire into other data that is of special interest to the client organization, i.e. the special client requirements (step370). For example, the client can require that everycaller105 with a back injury be asked if he or she was wearing a company-supplied back-belt at the time of injury. Other clients can require that everycaller105 with a laceration be asked whether he or she was wearing safety gloves. An exemplary computer screen format for entering this information is shown inFIGS. 14M-N.
• If there are no such client requirements, or once special client requirements are collected (step376), the data acquired during the triage process can be saved to a database (step377). The data can include the identification of thecaller105 andtriage operator110, cause of injury, symptoms, answers to questions, triage disposition, instructions given by thetriage operator110 and the results fromcaller105 follow-up, in addition to other information discussed elsewhere.
• The databases for saving the post-triage data and the other acquired data include theMedfilesMOL™ database389, thetriage database390 and thetelephone system database391. Thetriage database390 is used for storage and organization of the information obtained during a triage call, and is implemented using an application interface which allows real-time updating and modification of the database. TheMedfilesMOL™ database389 is implemented using a post-call processing software interface that allows the development and editing of the triage software, as well as the investigation of particular call histories. The data in the three databases can be saved for long-term storage in the data warehouse repository392 (i.e., a data warehouse). Data warehouse users393 can access the data to prepare reports, study aggregate caller data and study the long-term efficacy of the triage system or elements thereof. Thedatabases389,390,391 and thewarehouse392 can have security features to prevent the unauthorized access to the confidential medical records or proprietary client information contained therein.
• Once all of the selected information is saved to one or more of the databases (step377), a report is generated and sent (step378) to predetermined recipients. The recipients can include particular contact persons at the client or others, as detailed below.
• The system can present an opportunity to maintain the call record (step379). The client can have instructions not to save such information; if so, the call can be terminated at this point, because the call can be considered complete. If there are instructions to maintain the call record, then the records are saved (step384) using theMedfilesMOL™ application382. TheMedfilesMOL™ application382 can be used to maintain demographic information, details about the call and any incident, or other information.
• Application of the triage system can result in the selection of a particular disposition from a set of dispositions. A disposition is, generally, the action or actions to be taken by thetriage operator110 orcaller105 to resolve the caller's condition. A particular disposition within a disposition set can be identified by generalized indicia such as numbers or letters to express the selected level of care. For example, a “#1” disposition can indicate the most urgent level of care, indicating to thetriage operator110 that whatever actions are associated with the “#1” level (e.g., calling 911) should be executed. In the same disposition set, a “#5” disposition can indicate the least urgent level of care, indicating to thetriage operator110 that self-care instructions, for example, should be communicated to thecaller105. When general indicia are employed, the specific set of instructions associated with each of the indicia can be modified. Dispositions can also be expressed as the disposition instructions themselves (e.g., “call 911,” “see doctor within 24 hours,” etc).FIG. 5 shows that the triage system can use a number of triage exemplary disposition sets396,397,398,399, with varying stratification and level of specificity. These disposition sets398 can account for differing levels of urgency, from someone who needs immediate medical attention to someone who can treat himself.
• FIG. 6 is a schematic depiction of the triage system, and offers a more detailed description of the dispositions that can be assigned to acaller105 based on the answers given to the triage questions. As shown inFIG. 6, an injured employee (step400) is directed to notify the supervisor (step402) so they can call the triage center together (step404); this step reflects a common corporate policy requiring supervisor involvement following an injury. Otherwise, the employee (step400) can call the triage center directly (step404). Once the triage center is contacted, atriage operator110 can begin to inquire into the details of the injury. This allows thetriage operator110 to select and apply the triage categories (step406) to assign a disposition.
• FIG. 6 shows six possible dispositions, but more or fewer could be used. The first four dispositions (steps408,410,412,414) are variations on self-care; self-care instructions can be given over the telephone or sent by e-mail or faxed to thecaller105 and his supervisor. For example, one possible disposition is that the employee would require assurance that his condition is not serious and/or information, but would return to work (step408), after which thetriage operator110 would follow up (step416) using the particular follow-up information associated with the relevant categories of the previous call. Alternatively, the employee is sent home with self-care instructions and can return to work for the next shift (step414). If a follow-up is indicated, the system can schedule the follow-up automatically and thecaller105 can be informed to expect a follow-up at a certain date and time. The triage system can be integrated with the calendar function MICROSOFT OUTLOOK (Microsoft Corp., Redmond, Wash.) to automatically schedule and/or document follow-up calls.
• If the medical condition of thecaller105 is sufficiently serious, one of the more urgent dispositions (steps418,420) is assigned. Thecaller105 can be directed to a designated medical facility for further evaluation and/or care (step418). Also, acaller105 can be directed to an alternative medical provider if that designated or preferred medical provider is unavailable or cannot effectively address the caller's condition (step420). The client can specify reasons for which a medical provider is preferred and conditions suitable for overriding that preference, consistent with applicable rules and regulations. For the six dispositions detailed inFIG. 6, the client's claim manager can be contacted about the inquiry (step424) and updated (step426), as needed. The software can generate reports that are suited to updating the claim manager and others. The employee will ideally return to work (step428).
• FIG. 7 shows another schematic depiction of the triage system. The triage process can be initiated with a telephone call to the triage center when an employee has an injury or medical concern (step430). In this scheme, the supervisor can be notified (step432) before a toll-free telephone call is placed (step434). Thetriage operator110 triages the caller (step436). The triage process can result in an on-site resolution (step438), wherein thecaller105 is given on-site treatment or instructions for self-care without visit to an off-site provider. There may be no Workers' Compensation claims (step438) when the employee returns to work (“RTW”) after being given medical information (step442), when on-site self-care is provided (step444), or when an alternative duty is assigned to the employee (step446). With these dispositions (steps442,444,446), thetriage operator110 follows up with the caller, as indicated by the relevant triage categories (step448).
• Alternatively, thecaller105 will be referred to a medical provider (step440). This can happen for any of the following dispositions: Emergent-911 disposition (step458), Emergent disposition (step456), Urgent disposition (step454), or Non-Urgent disposition (step452), as determined by the instructions associated with each of these dispositions. Care is then transferred to the off-site provider (step460) per the selected disposition.
• The triage center can update the data warehouse and then notify the client organization of the particular injury and resolution (steps450,452). Work sites, regional offices, franchise offices, division offices, etc. can be the recipients of such a report, or receive other communications regarding the injury or issue. Each of those levels can have a particular interest in safety, human resources issues, Workers' Compensation issues, or other relevant issues. Likewise, a third-party administrator, insurance carrier, insurance broker, or other entity can be contacted when the client so requests (step452). Ultimately, it is hoped that the employee returns to work (step454).
Triage Categories
• Within the triage system, different triage categories are applied based on the caller's complaints. The triage categories aggregate different types of supporting information and germane inquiries that apply to the particular conditions targeted by the categories.FIG. 8 shows a schematic representation of the various sections of an exemplary triage category480:Critical Considerations482,Clinical Frame484,Tiered Triage Questions486,Question Rationale488, Self-care490 (including an overview, self-care instructions, prevention advice and follow-up questions), Frequently Asked Questions (“FAQ”)492 andGeneral Information494. An exemplary screen format for accessing these sections is described with regard toFIGS. 14E-F.
• Any of these sections can be accessed at any time by opening up frames, or can be automatically presented to thetriage operator110 when acertain category480 is called up. For example, one or more of the sections482-494 could open as a frame automatically as soon as aparticular category480 is accessed, while others are available at the option of the triage operator, by selecting a button, drop-down menu or other selection modality. The categories do not necessarily have all of these sections, and can have additional sections not listed here.
• TheCritical Considerations482 section generally guides the triage operator's questioning of thecaller105. TheCritical Considerations482 section can be used to flag important information or safety concerns for consideration during application of thetiered triage questions486 and alert thetriage operator110 to other important information related to the tiered triage questions486. For example, when thetriage operator110 decides to apply the abdominal injury triage category, theCritical Considerations482 window appears on-screen before any questions are asked. TheCritical Considerations482 can alert thetriage operator110 to the fact that an abdominal injury can result in potentially life-threatening conditions, including the rupture of solid or hollow viscera and that an abdominal injury in a pregnant woman can result in uterine abruption or rupture. If this were not known by atriage operator110, he or she might incorrectly discount the level of danger that thecaller105 faces. The software can automatically present the relevantCritical Consideration482 on screen when thecategory480 is selected, or it can be presented upon selection of an icon on the computer screen.
• AClinical Frame section484 in atriage category480 can be accessed by the triage operator. Unlike theCritical Considerations section482, this section can be structured as a text box in which thetriage operator110 can type a short description of the mechanism, location and time of injury and any treatment attempted and corresponding results. Atext box662 for entering the clinical frame is shown inFIG. 14C. Alternatively, this section can actively request information, and such requests can be tailored to each triage category.
• TheClinical Frame484 can be important in determining the severity of the complaint. Answers to the questions provided in this section can help define the context for the injury or condition and alert thetriage operator110 to important issues, as well as any other categories that ought to be applied in a given inquiry. For example, symptoms resulting from a fall can be treated differently depending on whether the fall was from a 10-foot ladder or on level ground. A fall from a 10-foot ladder can alert thetriage operator110 to an increased potential severity of the condition and add to the list of, or cause the software to automatically access, applicable triage categories and/or dispositions.
• One of the basic features of thetriage category480 is thetiered triage questions486, which, when applied, can determine the disposition of the caller. Thetiered triage questions486 are discussed below, in reference toFIG. 9.
• For each prompted question in thetriage questions486, thetriage operator110 can access theQuestion Rationale488 section. TheQuestion Rationale488 section can help triageoperators110 understand the process and provide guidance for real world situations that do not fit neatly into tiered triage questions486. This section can also be helpful fortriage operators110 who are in training or who are using a new triage category or a triage category with which they are not familiar.
• The Self-care section490 provides category-specific self-care instructions to thecaller105 and a brief explanation of the condition, including measures thecaller105 might take to prevent a similar medical condition in the future. For example, the self-care instructions for the upper extremity injury category shown inFIG. 10 include: the administration of acetaminophen, aspirin, or ibuprofen; that the affected area be elevated; that ice and/or heat be applied to the affected area; and that work is modified to restrict lifting or forced grasp. Thissection490 can include a list of symptoms that can develop and for which follow-up and reevaluation is necessary (i.e., “red flags”). For example, in the “bite wounds” triage category, any sign of infection or loss of sensation can suggest that thecaller105 should contact a medical provider immediately. The Self-Care section490 can include general information about the category, discharge instruction, and a definition of all possible dispositions. This section can include both self-care as the ultimate treatment and interim self-care instructions which are applied in the time before a medical facility can be reached or other medical help arrives.
• If thecaller105 asks questions about his condition, thetriage operator110 can choose to answer the questions using his or her own knowledge. In some cases, thetriage operator110 can find it helpful to refer to a Frequently AskedQuestions section492 of the triage category for a brief explanation of the medical condition and answers to common concerns. For example, those being triaged for animal bite wounds often ask if HIV can be transmitted to them as a result; the answer provided in the Frequently AskedQuestions section492 is that animals do not transmit HIV.
• TheGeneral Information section494 can contain additional information about the condition or information not suited for the other sections. For example, hyperlinks to Internet sites, Local Area Network, or other data sources containing more detailed medical information can be put in this section.
Tiered Triage Questions
• As stated before, the triage questions can be tiered. That is, there are groups of questions in each tier and the tiers are ranked by urgency level. For each tier there is a corresponding disposition that is appropriate for the urgency level of the tier. An exemplary format of the tiered triage questions is shown inFIG. 9.Tiers500,508,514,522 are shown inFIG. 9. In this example, the highest urgency tier is the Emergent-911tier500. Each of the tiers can have acorresponding disposition506,514,518,526, as shown inFIG. 9. An exemplary screen format for displaying the tiered triage questions and accepting answer inputs from thetriage operator110 is shown inFIGS. 14D-F.
• In the Emergent-911tier500, for example, there can be at least one yes/no question. If any of the questions are answered “yes,” then the corresponding disposition for thatcaller105 is the Emergent-911disposition506. The Emergent-911disposition506 can include instructions for immediate referral to an ER by the local EMS, and, like some of the other dispositions, can include condition-specific interim care instructions. The Emergent-911disposition506 can be modified to include other instructions. The Emergent-911tier500 can be designed so that it can select thosecallers105 who need quick transport, severe pain relief and/or special emergency medical services, such as cardiac monitoring and defibrillation capability. Emergent-911 is typically the highest urgency disposition. Interim care instructions can be provided for all categories when triaging results in an Emergent-911disposition506,Emergent disposition514,Urgent disposition518 orNon-Urgent disposition526.
• If all of the questions of the Emergent-911 tier are answered “no,” then thetriage operator110 moves to theEmergent tier508. In theEmergent tier508, there can also be a number of questions, for which any “yes” answer results in thecorresponding Emergent disposition514. AnEmergent disposition514 can indicate that there should be an immediate referral to a medical provider, but not by an EMS. However, if all of the questions in the Emergent tier are answered “no,” then thetriage operator110 can move down to theUrgent tier514.
• If any of theUrgent tier514 questions are answered “yes,” then theUrgent disposition518 is warranted. AnUrgent disposition518 can require a referral to a medical provider on the day of the complaint or within 24 hours. If all of the answers to the Urgent tier questions are “no,” then thetriage operator110 should move to theNon-Urgent tier522. Any “yes” answers to any of the Non-Urgent tier522 questions should result in the selection of theNon-Urgent disposition526, which can require a referral to a medical provider within three days of the complaint.
• In the example shown inFIG. 9, if there is a “yes” answer for an Urgent tier question, all remaining questions can still be asked of thecaller105, including those in the Non-Urgent522 or Self-Care tiers. This can be in contrast to a “yes” answer for anEmergent tier508 or Emergent-911tier500 question, for which the entire triage process can be halted, and the disposition immediately implemented. The cut-off point in the triage process in which a disposition is selected but questions of a lesser urgency are still asked can be set at any particular tier.
• The self-care disposition534 can be automatically selected (530) if all of the answers to the preceding triage questions are “no.” Thus, no tiered triage questions are shown in this particular example, and the self-care disposition functions as a catch-all for those who do not fit in the other tiers. Alternatively, there may be triage questions in a self-care tier in order to assist in customizing the self-care instructions for the caller's condition, or if there is a lower urgency tier, among other reasons. This Self-Care disposition534 can require self-care that is distinguishable from interim self-care, discussed above. If there is an on-site triage operator110, such as a nurse, this nurse can help implement the Self-Care disposition.
• As shown inFIG. 9, the triage questions from higher urgency tiers can be asked before those of lower urgency. Within the “abdominal pain” category, for example, the question about shortness of breath is in the Emergent-911 tier and precedes the question about blood in the urine which is in the Emergent tier. There can be any number of questions in each tier. Whether a “yes” or “no” answer is provided, thetriage operator110 can record comments made by thecaller105 or the triage operator's observations or thoughts. In some situations, the triage questions can be answered by thetriage operator110 instead of thecaller105.
• For consistency, the triage system can be designed, as shown inFIG. 9, so that any “yes” answer to a question within a specific tier (typically indicating the presence of particular symptoms) results in the selection of the disposition that corresponds to that tier. This ensures consistency and prevents error. The software can present the triage questions as a list, grouped according to tier, and each having yes and no buttons. The selection of a “yes” answer using a button or drop-down menu could immediately bring up a frame that contains the disposition information. However, it is not necessary to require “yes” answers for selecting a disposition; “no” answers and combinations of “yes” and “no” answers can result in the selection of a particular disposition. Similarly, qualitative or quantitative information given by thecaller105 can result in one of the possible dispositions, such as with the quantification tool described below. Any question that does not lead to a disposition can be excluded from any of the triage questions.
• The questions can be symptom-based. That is, the questions can relate to what thecaller105 can sense. This can allow a quicker and more consistent disposition of thecaller105 because it does not require an attempt at quantification or objectivity. This can also be a requirement for selection of suitable triage questions. However, quantified details of the actual incident, if there was one, can also be used to determine a suitable disposition. The questions can also be history-based, that is, addressing family history (e.g., family history of heart disease), social history (e.g., whether or not thecaller105 ever smoked) and past history (e.g., whether thecaller105 has a history of heart disease).
• One aspect of the triage system can include its flexibility. It can be beneficial to allow thetriage operator110 to revisit any of the questions to review the answers or associated comments. Thetriage operator110 also has the ability to navigate between unanswered triage question groups within the same tier. Using a “Triage Navigator” screen, thetriage operator110 can jump directly to specific categories or specific tiers within the triage questions. The Triage Navigator can take the form of a drop-down list, or a pop-up window with links to the other categories, as shown inFIG. 14D. The system can also utilize the responses to questions in other triage categories if the same question appears again later in another triage category. The system can also determine and consider the variation in responses to the same or similar questions that are asked more than once during the triage process and, for example, alert thetriage operator110 to that fact.
• FIG. 10 shows anexemplary triage category480 for triaging upper extremity injuries including a set of triage questions. The elements of thecategory480 can be displayed as shown, or elements or portions thereof can be presented by computer frames automatically or on command. Thecategory480 includes supporting information such asCritical Considerations482 in addition to the tiered triage questions486. Thetiered triage questions486 are set up similarly to those inFIG. 9, in that any “yes” answer indicates the presence of a symptom and leads to the selection of a corresponding disposition. There are fourquestion tiers500,508,514,522 shown inFIG. 10. No questions are associated with the Self-Care disposition534.
• The triage questions486 andcategories480 can be drafted and organized so that they satisfy a particular set of rules or so that they have a particular set of characteristics, including those rules and characteristics discussed above. Having thetriage questions486 and/orcategories480 standardized in this way throughout the triage system can help streamline the triage process and make the triage process more predictable and/or consistent for thetriage operator110 and thecaller105, thereby helping to ensure consistent results.
• In an example of a set of rules, reflected in thetriage category480 ofFIG. 10, thetriage questions486 and/or categories are symptom-based. The triage questions486 are organized according to urgency. Applying thetriage questions486 results in one of five dispositions: Emergent-911, Emergent, Urgent, Non-Urgent or Self-care, corresponding to each of thetiers500,508,514,522,490. Emergent-911 referrals may be based on a caller's need for speed of transport by an EMS, pain relief and/or special emergency medical services, such as cardiac monitoring and defibrillation capability. Emergent referrals are immediate referrals to a medical provider when the user does not need the specialized services of EMS, but requires an immediate evaluation. An urgent referral is a referral to a medical provider within about two days of the disposition being selected. A Non-Urgent referral is a referral to a medical provider within several days of the disposition being selected. A Self-care disposition includes providing self-care instructions to thecaller105 so that he can care for his illness or injury. Additional dispositions can be “interim self-care” which relates to providing information before an eventual visit to a medical provider and “report only” which can be appropriate when there is no need for any level of medical care but the call is still reported. These dispositions are discussed further with reference toFIG. 9.
• Further describing an exemplary set of rules, the questions are answered “yes” or “no” and can be answered by thetriage operator110, and are not necessarily the answers given by thecaller105. Any questions that are not yes/no questions can be eliminated from the set of tiered triage questions. The rule set can require that “yes” answers always result in the selection of the corresponding disposition. Thequestions486 are tiered such that the first group of questions leads to an Emergent-911 disposition, the second group of questions leads to an Emergent disposition, and so on. For example, the question about significant gross deformity, which, if positive, leads to an Emergent-911 disposition, precedes the question about swelling over joints, which, if positive, leads to an Emergent disposition. One of the dispositions is selected when all of thetriage questions486 are asked. Triagequestions486 that do not add to the disposition are not included in thecategory480. Aclinical frame484 can be requested via a prompt, as described above, which can include information related to the time, place and mechanism of injury.
Multiple Relevant Triage Categories
• Often, for a given inquiry, more than one category can apply. When dealing with multiple categories, the software can facilitate the presentation of all relevant categories on-screen, including the tiered triage questions and supporting information. Additionally, the software can prompt for answers to the highest urgency questions from all of the relevant categories before prompting for answers to the questions that are of a lower urgency. For example, a user can call with symptoms that, following a brief consultation, are categorized as “abdominal pain without injury” and “chest pain without injury.” The software would ensure that all of the questions that result in an “Emergent-911” disposition from both the “abdominal pain without injury” and “chest pain without injury” categories are answered before moving on to the questions that result in an Emergent disposition. Although it could be possible to ask all of the abdominal pain questions before moving on to the chest pain questions, this may cause an unnecessary delay of a 911 call or other action if the subsequent triage of the chest pain resulted in a higher urgency disposition.
• One way of applying two sets of triage questions simultaneously is presented inFIG. 11A. This is termed a zigzag-type alternation. In the zigzag-type alternation, the questions in the Emergent-911 tier544 from afirst category522 are asked, then the Emergent-911 questions566 from thesecond category522 are asked. Thereafter, the questioning returns to thefirst category550, and the process is repeated at the next tier, as shown inFIG. 11A. Any “yes” answers for theCategory1triage questions550 can result in a selection of a corresponding disposition. Likewise, any “yes” answers, for theCategory2triage questions552 can result in a selection of a corresponding disposition. If “no” answers are given to all questions in the Emergent-911 and Emergent tiers, then the questions of the remainingtiers576,580,588,590,592,594 in both categories can be asked, without terminating the triage process at the first “yes” answer.
• FIG. 11B shows a step-type alternation for applying two sets of triage questions simultaneously. In FIG.1IB, the Emergent-911 questions are asked from afirst triage category550; then the Emergent-911 questions are asked from thesecond category552. Instead of switching back to thefirst category550, thetriage operator110 then asks theEmergent question568 from thesecond category552. Any “yes” answer for theCategory1triage questions550 can result in a selection of a corresponding disposition. Likewise, any “yes” answer for theCategory2triage questions552 can result in a selection of a corresponding disposition. If “no” answers are given to all questions in the Emergent-911 and Emergent tiers, then the questions of the remainingtiers576,580,588,590,592,594 in both categories can be asked, without terminating the triage process at the first “yes” answer.
• The zigzag-type alternation depicted inFIG. 11A can be better for asking triage questions of two different categories when it is established that one of the categories is more important of the two. However, the scheme illustrated inFIG. 11B can be superior in some cases because there is less switching between different subject matters, thereby streamlining the flow of the conversation and minimizing the potential for either thecaller105 ortriage operator110 to become confused. However, regardless of the type of alternation scheme applied, thetriage operator110 can decide which category to apply first; this ordering can be more important in situations where there are more than two relevant categories and when thetriage operator110 suspects that a particular category or categories are more likely to yield a more urgent disposition.
• In the course of conducting a triage, atriage operator110 can determine that an additional triage category is warranted. It is not uncommon to discover information about the injury and its cause that leads thetriage operator110 to suspect additional, perhaps more severe, injuries. If thetriage operator110 determines that an additional category is relevant, the software allows him or her to apply the triage questions of that category at any time in the triage process.
• For example, a triage for a “laceration” can reveal that the laceration extended into the eye. Thus, the “eye injury” category may need to be triaged along with the original laceration. Being able to immediately add the additional triage categories increases the likelihood that a more urgent disposition can be found sooner. Furthermore, the higher-priority questions of the after-added category can be posed to thecaller105 first before alternating between the two categories as shown inFIGS. 11A and 11B.
• An example of a scheme for asking questions of after-added triage categories is shown inFIG. 12. As shown, the Emergent-911 (554) andEmergent questions564 were asked of Category1 (550), and “no” answers were offered to all of the yes/no questions in those two tiers. Then in the midst of the questions of theUrgent tier576, it was discovered that a second category applies, so thetriage operator110 can immediately skip654 to the Emergent-911 (556) questions of that new category, Category2 (552). If all of the questions of the Emergent-911tier556 are “no” then thetriage operator110 continues to the Emergent tier questions568. Again, if all of the answers are “no,” theUrgent tier580 questions can then be asked. At this point, if theUrgent tier580 questions ofCategory2 are all “no”, then thetriage operator110 can continue with whateverUrgent tier576 questions of Category1 (550) have not been answered. If the answers to theUrgent tier576 questions are “no,” then thetriage operator110 can alternate between the remainingtriage tiers588,590,592,594, as shown above. This can help ensure that any of the more urgent dispositions can be identified first before alternating between the lower-urgency tiers.
Record-Keeping, Reporting and Data Mining
• The triage system can collect andstore caller105 data, including all data acquired during the triage process. The data is stored so that it can be selectively accessed for the purposes of record-keeping, reporting and data mining. Standard software reporting tools, such as BUSINESSOBJECTS 6.5 or subsequent versions (BusinessObjects, San Jose, Calif.), or the MedfilesMOL™ application described above can be used to access data that conform to any of a variety of parameters, including dates, locations, individuals, company, corporate divisions, job type, age, etc. The record-keeping and reporting procedures can be customized to meet a client's specific needs, including by having reports tailored to particular state and/or industry requirements.
• For example, the MedfilesMOL™ application can assist in Occupational Safety & Health Administration—(“OSHA”) and state-mandated record-keeping. This can include generating First Report of Injury and OSHA log updates. The application can identify recordable incidents by comparing injury type and treatments to OSHA's recording criteria. The MedfilesMOL™ application then tracks recordable cases and automatically updates the OSHA log. The client can be given partial access to a database so that a current OSHA log can be printed or viewed at any time, and, at year end, the OSHA-A summary can be generated.
• The triage system can also improve the client's claim process system by providing more timely, accurate, complete and consistent reporting of injury incidents. The system can also collect and manage information with which to investigate and/or challenge, defend against, or settle such a claim.
• Details about particular calls can be kept on file at thetriage center108 or elsewhere for auditing purposes. The triage software can automatically generate short narrative reports about each call orcaller105; these can be based on a pre-formatted report template. Reports, including narrative reports, can be automatically faxed, emailed, or otherwise communicated to the client or any interested division or entity listed above.
• Users210 can analyze the data to create reports, study injury trends, identify hazards, and compare one facility or department with another or with industry benchmarks, pre-determined goals, or projected outcomes. The data gathered can also contribute to the maintenance of complete and accurate company records, accessible to authorized company personnel and/or others. Other reports can be automatically generated and sent to a company's safety officer, risk manager and/or insurance carrier to trigger accident investigation and preventive measures. The database of the system can be securely accessible to designated client managers via the Internet or other means so that the client can have access to these reports and other reporting options on demand. An exemplary computer screen format for accomplishing these reporting functions is shown inFIG. 140.
• Allowing the compilation and analysis of injury statistics can be helpful in situations where it is suspected that a small percentage of employees of a client can account for a large or disproportionate percentage of injury claims and costs. Users210 can monitorparticular callers105 who use the triage system at higher rates and/or are more accident-prone. For example, the triage system can be designed to notify a user210 when acertain caller105 has reached a predetermined threshold for use of the triage system or injury rate.
• The user210 can mine the existing injury data to discover injury patterns or safety issues, including locations, job tasks, supervisors, or other criteria that may contribute to injuries. The system also allows users210 to set injury threshold rates or other parameters for automatic notification via the system. The parameters can include a date range, site (e.g., “Store 315”), location (e.g., the loading dock), city and state, call type, caller gender, triage category applied, triage disposition, referral and/or treatment.
• The user210 can analyze the data to identify preventive measures, improve work safety rules and monitor compliance with work safety rules. For example, user210 can assess whether any required safety equipment has an overall health or cost benefit. If the data reveal that wearing back-belts has no effect on back injury rates or costs over time, then client organizations can abandon the belts in favor of other preventative measures. Similarly, a manager can measure the rate of compliance with the safety measures. Customizing and automating this process can further help loss-prevention. The client can also monitor the performance of and cost-savings of the client's injury management service and the triage system itself.
• The triage-related data can also be routinely mined to test the effectiveness of and fine-tune the instructions or other information dispensed by thetriage operator110. Various statistical methods can help pinpoint potential areas for improvement. This can help ensure optimal, evidence-based care. For example, if the follow-up for allcallers105 assigned to the Urgent disposition show unfavorable aggregate outcomes, the Emergent tier questions could be edited so that the Emergent tier captures a greater proportion ofcallers105 or so that the questions better select those for whom that disposition is most appropriate. Triage questions and supporting information can be modified, supplemented or removed. Such undesirable outcomes can include both adverse health-related results of the applied disposition (e.g., when care is inadequate) and also when a level of care is excessive, resulting in unneeded expenditures. Alternatively, for example, the Urgent disposition could be modified, setting a smaller window of time in which to see a medical providers.
• A threshold level of undesirable aggregate triage outcomes can be set. When the threshold level is exceeded, a user210 can be alerted to modify the triage system to reduce the level of undesirable aggregate triage outcomes. Following any changes, the triage-related data can be again analyzed to determine the efficacy of any modification that was made to the system.
Additional Features of the Triage System
• The triage system can be adapted to a client's specifications. The triage inquiry can be tailored to individual divisions, location of the incident, or job type. Likewise, the triage system can be specially configured for a particular U.S. state, call type, patient gender, category, disposition, referral, impression, and/or treatment. To accomplish this, the system can include, exclude or modify certain triage questions provided to thecaller105 ortriage operator110. Supporting information can also be included, excluded or modified. The particular client variations are identified and accessed as thecaller105 is identified. These variations can also be keyed to the place or business from which thecaller105 is calling. The triage system can, for example, suppress any data from being collected.
• In a triage center, there can be triage operators answering the telephones and performing triage, and, in addition, a manager who monitors the center. An additional feature of the triage system can be a “Flag Review” button, which allows thetriage operator110 to flag a call for review by a manager. The “Flag Review” button can be used to identify a problem with thecaller105 or the way the triage category functions during the call. It can be used for immediate assistance, or for identifying possible areas for long-term improvements.
• The triage system can allow for different types of system overrides. One kind of override is the 911 Override, which allows thetriage operator110 to immediately bypass the remaining triage process and call 911 or direct thecaller105 or the caller's supervisor to call 911. If thetriage operator110 feels the caller's condition has become dangerous and requires EMS dispatch, clicking this button by-passes triage and expedites the 911 referral. The 911 Override can be employed at any time in the triage process. The 911 Override can be accessed by a single button that is always present on the computer screen. The user can see a pop-up screen requesting entry of a caller's name, and a call-back telephone number.
• Another kind of override, Triage Operator Override (“TO Override”), allows atriage operator110 the ability to immediately bypass the remaining triaging of a caller. This TO Override feature also allows thetriage operator110 to automatically navigate to the Provider Search (Referral) screen at any point during the call flow. This allows thetriage operator110 to use his own discretion and professional judgment to, if desired, substitute a disposition that he feels is more prudent than that provided by the triage system. While a computerized triage system provides a valuable framework for triage, it is recognized that the software cannot anticipate the infinite number of variables and situations that atriage operator110 can face. The TO Override feature helps thetriage operator110 address a situation in which he believes there is a more logical: safe or appropriate response than what the software has indicated. TO Override can also be used when, for example, the triage disposition is Self-care, but thecaller105 insists on a referral. Selection of the TO Override feature can prompt the display of the Provider Search (i.e., Referral) screen.
• A system override can prompt thetriage operator110 to provide the reason for the override and flag the call for manager review. The reason for the override can be indicated in an electronic record linked to the call record, but can be excluded from reports to the client organizations or government agencies, consistent with applicable laws and agreements with clients.
• With some conditions, it can be important to obtain from thecaller105 quantitative details about the symptoms or cause of the ailment. Quantification tools supported by the software can be used by thetriage operator110 to quantify symptoms. Quantification tools can deal with the extent of bleeding, the amount of pain, shortness of breath, extent of burns, time of a possible rabies-infecting bite, and tetanus status. A quantification tool can, for example, help thetriage operator110 decide if bleeding can be considered “severe” bleeding.FIG. 13 shows anexemplary quantification tool597 for determining whether a wound is deep or not. Thetriage operator110 can ask some of thequestions598 within thequantification tool597 and thereby choose the proper yes/noconclusion598 about the wound depth. An icon can appear to the left of any triage question involving one of these symptom patterns, and can open a document with quantifying information to aid in answering the accompanying question. The information can assist in the selection of triage categories or selection of a disposition within a triage category. The quantification tools also provide standardization between the triage operators so triage results are consistent.
• The time elapsed between an injury and the time the injured person contacts thetriage operator110 can be a factor—in the triage analysis. For example, if acaller105 is concerned about the possibility of a broken bone, a call immediately after the incident may not reveal some of the more important symptoms—whether there is swelling or bruising, for example. Therefore, the system can alert thetriage operator110 to the elapsed time and its relevance, modify questions based on the elapsed time (including eliminating questions that would not have relevance at a particular time and/or automatically adding others), have questions automatically answered in certain ways based on the time elapsed and indicate whether it is important for thecaller105 to follow-up at a later time. The elapsed time can otherwise be used to determine a disposition, such as, for example, when the incident was so long ago that nothing more than self-care is needed. The system can also make note of what time the event occurred in the caller's time zone, which will then be adjusted for a correct calculation of the elapsed time. This information can become part of the recorded triage-related data and stored in the database with the answers to the triage questions.
Screen Formats and Selection Modalities
• FIGS. 14A-P show various exemplary computer screen formats and selection modalities that can be used to help implement the triage system on a computer.
• FIG. 14A shows ascreen600 that enables the identification of thecaller105 so that the triage-related data, including any information related to triage outcomes, can be associated with his demographic or personal information and so that client preferences can be applied to the call. When thetriage operator110 answers the call from thecaller105, thetriage operator110 can select the “Start Call”button602, which can time-stamp the phone call and enable the triage system to be implemented. Amenu bar605 allows for selection of various actions and parameters, including exiting the program and changing program options.
• As described above, the triage system can be implemented for a corporate client. Thus, thecaller105, if he is an employee, can be asked to identify the company for which he works, including the particular site, or where he is located. The company can be selected using a combo-box field606, and the site can be selected using another combo-box field610. As an alternative, search fields can be filled out, such ascompany608,zip code602,state609,city614,address616 andphone number618. Once selected fields are entered, the “Search”button611 can be selected to generate a list of matchingcompanies622 in thecompany field620. If one of the matchingcompanies622 is the correct one, it can be selected by double-clicking or other selection method.
• Thecaller105 can be asked if he is already in the database; if he is, the “Existing Person Call”button604 is selected and the information about thecaller105 is accessed. Any number of search fields can be filled out to search for the relevant demographic data, includinglast name624,first name626,social security number630, type ofemployee632,gender634,birth date636, andjob status638. The entire database can be searched by checking theappropriate box627, or the search can be restricted to a particular company by checking adifferent box625. Once one or more fields are entered, thetriage operator110 can select the “Search”button639, which brings the various matching identities into theperson field640, where the corresponding identity can be selected.
• As shown inFIG. 14B, if thecaller105 is not in the system, the “New Person Call”button644 is selected, and, as a result, the “Create Person” dialog box appears, havingtext fields652 and combo-box fields653, for entering demographic information such as birth date, social security number, gender, etc. Once all of the information is entered, the information can be saved by selecting the “Save”button654, at which point the “Create Person”dialog box651 disappears.
• By selecting the “Close”button645, thenext screen650 appears, in which the relevant triage categories can be selected, as shown inFIG. 14C. While thetext box662 can be used for any relevant information, it can also be used to enter the answers that thecaller105 provides for the introductory questions regarding the context or mechanism of injury, which can be a first step in the selection of the relevant triage category. The initial questioning can also help determine if the call is an injury, follow-up or report-only call, which can be selected using theradio buttons663. Toward the beginning of the call, thetriage operator110 can request the age of thecaller105. If a birthday entered in theage box664 indicates that thecaller105 is a minor, then thetriage operator110 can select one of thelegal consent categories668 described above in order to proceed. The system can prevent thetriage operator110 from proceeding if there is no indication of consent, although this feature can be disabled. Aninformation bar661 is visible throughout the call, indicating the name of thecaller105, as well as the name and location of the company for which thecaller105 works, the reference number for the call and the call type.
• The triage categories can be selected incategory selection box670 ofFIG. 14C from the list ofcategories678. To apply the chosen category, the applicable information is selected using combo-boxes corresponding tobody parts672, body part location1 (674) and body part location2 (676). The body part location combo-boxes include such descriptors as dorsal, lateral, anterior, posterior, left, right, etc. Once these have been selected, the “Add”button680 is selected, which saves the selected combination in the relevanttriage category list682. This process can be repeated using different categories and/or different body parts until there are no more relevant categories for the caller's particular condition. Using thearrows684, a plurality of categories can be ordered in terms of importance or other criteria. Selected categories can also be removed using the “Remove”button686. Also, the “911-Override”button690 and the “Triage Operator Override”button692 can be selected throughout the triage process. Once the selection process is finished, thetriage operator110 can select the “Continue”button688 to move to the screen ofFIG. 14D.
• Thescreen700 ofFIG. 14D starts the triage questioning based on the categories selected in theprevious screen650. The triage questioning starts with the questions in the highest urgency tier of the highest priority category, which are identified by thequestion identification712 bar. TheTriage Navigator714 shows which tier of questions is currently being asked716 and which tier of questions is next718, based on thetier list715. When asking the triage questions, thetriage operator110 can access thequantification tool708 which displays a methodology for quantifying certain symptoms. Thetriage operator110 can also select thebutton710 to open a text box that allows the entry of additional information acquired from thecaller105 in the course of answering a particular question.
• As stated above, the Critical Considerations section can be accessed throughout the triage process. In the screen shown inFIG. 14E, this section can be selected using the “Critical Considerations”button722, which opens a window containing the relevant information. Some additional features that can be available through the triage process are the “Change Call Type” button730 (for alternating between a follow-up call, new call and report-only call), the “DIC” button726 (for accessing self-care instructions and FAQs), the “Triage Navigator”button724, the “General Information”button729 and the “Flag Review”button728, which are all discussed above. Furthermore, there are buttons for accessing aprior call menu731, accessing a list of outgoing follow-up calls to be made733, printing thescreen735, closing allscreens737 and exiting theprogram739. The “Protocol Management” (i.e., Category Selection)button741 allows thetriage operator110 to return to thescreen650 shown inFIG. 14C to select additional categories or to change categories.
• Thetriage screen700 ofFIG. 14F shows multiple triage categories being applied. In particular,FIG. 14F showsOpen Wounds740 andFrostbite742, as indicated in theTriage Navigator744. The Triage Navigator can be used to view any of the completed or active tiers in any of the selected categories. Because one of the questions has been given a “yes”answer734, theDisposition box738 shows the selected disposition and theTriage Navigator744 shows that thecaller105 has been referred748. Because the disposition is Emergent, thetriage status box736 shows that the triage process has been completed; if, however, the selected disposition was of a less urgent nature, theprotocol status box736 may not show that the triage process has been completed until all of the triage questions in all tiers have been asked, as described above. The “Continue”button749 can be selected to move to the next screen.
• Thescreen800, shown inFIG. 14G, allows thetriage operator110 to find an appropriate medical provider, and offers a number of different search modes. For example, the search can be restricted to designated medical facilities, client specifications, or can be expanded to all providers using a number ofradio buttons804. Alternatively, any number offields802 can be filled to search the provider database. The results of the search show up in alist806. Details about the medical provider can be obtained by selecting the “Open Prov”button814 which opens a text window. The “Referrals List”button816 can be selected to obtain the referrals for a particular medical provider. Directions to a provider can be obtained by selecting the “Get Directions”button812, which can access a map or directions from any appropriate service or software, such as MAPQUEST.COM. If a medical provider is not in the database, the medical provider can be entered by selecting the “New Provider”button808 and entering the new provider fields810.
• Once a medical provider has been selected, the “Refer”button830 is selected, which opens thecaller referral window832, shown inFIG. 14H. Thecaller referral window832 summarizes the referral by providing the date ofreferral836 and other information. Abutton840 can also allow a map to the medical provider to be generated. A number of details about the nature of the referral can be selected; these are indicated asExceptions834 to an ordinary call, and include such details as whether there was a self-referral by thecaller105, whether thecaller105 requested an appointment, refused a recommendation, etc. TheExceptions834 also allows the referral information to be printed on the medical report.
• Once the “Save”button838 is selected, the information is saved in arecord842, and thetriage operator110 can select the “Continue”button844 to move to thenext screen850, shown inFIG. 145. Further demographic information can be acquired, such aspersonal information852,home address854 andemployment data856. The “Continue”button858 can be selected to move to thenext screen900, shown inFIG. 14K.
• When a particular call is selected from thecall list901, a summary of that call is displayed in the various fields of ascreen900 shown inFIG. 14K. When the “Open”button903 is selected, anarrative description902 of the call is generated and displayed, as shown inFIG. 14L. The narrative description can be closed using the “Close”button904, and thenext screen950 can be accessed using the “Continue”button906.
• Thescreen950 shown inFIG. 14M allows additional demographic information to be entered, including a Workers'Compensation Claim Number952,family information954,employment information956, and contextual information relating to the incident itself, including the task performed at the time ofincident958, the objects or substances involved960, the details about the occurrence of theinjury962, and the supervisor'sname964. After this information is input, thenext screen970, shown inFIG. 14N, permits the recording of information specific to the employer of thecaller105, such as compliance withparticular safety procedures972. Some of these special requirements can be printed, and if printed, will show up in atext box974.Additional text976 can alert thetriage operator110 to any other details particular to the caller's employer. When this information is entered, the “Continue”button978 is selected to access thenext screen990.
• Thenext screen990, shown inFIG. 140, displays the details of theautomated communications991 that will be sent on command, including the destination, the report name, the recipient, and the output format. The list of communications can be selected or deselected using check-boxes992. Themethod993 of the communication can include e-mail and fax, but all other communication methods described above can be employed. Once the selections are made, the “Send”button994 is selected. InFIG. 14P, thefinal screen995 is shown. TheCall Complete996 orCall Pending Information997 boxes can be checked, after which the “Finish”button998 is selected to complete the call.
• While various embodiments of the triage system have been described, it will be apparent to those of ordinary skill in the art that many more embodiments and implementations are possible within the scope of the triage system. Accordingly, the triage system is not to be restricted except in light of the attached claims and their equivalents.

Claims (22)

1. A method for directing an employee to a treatment center, the method executable by a computer having a processor and memory, the method comprising:

receiving an electronic communication from an employee of a client while the employee is traveling away from a normal location of work, the employee initiating the electronic communication with a GPS-enabled mobile device;

determining the location of the employee based on a GPS location of the mobile device with a GPS-tracking system coupled with the computer;

performing triage on the employee by a triage operator to determine a level of urgency of a medical condition of the employee, to thereby determine an appropriate disposition for the employee, wherein a plurality of triage questions are provided to the triage operator by the computer based on a category related to the medical condition; and

automatically determining, with the computer, a nearest treatment center to the location of the employee based on the GPS location of the mobile device, the nearest treatment center being adequate to address the level of urgency required by the determined disposition and a designated preferred provider of the client.

2. The method ofclaim 1, further comprising:

referring the employee to any treatment center of a client-preferred provider in a network of providers when the computer determines that the nearest treatment center designated as preferred by the client is not adequate to address the level urgency of the medical condition.

3. The method ofclaim 1, further comprising:

referring the employee to any treatment center of a client-preferred provider in a network of providers when the computer determines that there are no nearest treatment centers in a proximity of the location that are designated as preferred by the client.

4. The method ofclaim 3, further comprising:

referring the employee to a treatment center of any suitable medical provider when no client-preferred provider in the network of providers is within the proximity of the location of the employee.

5. The method ofclaim 1, further comprising:

dispatching emergency personnel from the treatment center to the location of the employee.

6. The method ofclaim 1, further comprising:

integrating within the triage as provided by the computer an alternate one or more additional treatment centers that are not designated as preferred to which to refer the employee where required by applicable laws or regulations that govern the restriction to, or selection of, preferred treatment centers.

7. The method ofclaim 1, further comprising:

referring the employee to any treatment center of a client-preferred provider in a network of providers when the computer determines that the nearest treatment center designated as preferred by the client that is adequate to address the level urgency of the medical condition is not currently open.

8. The method ofclaim 1, further comprising:

obtaining directions to the nearest treatment center by selecting an indicia for obtaining directions on a screen of the computer displaying the nearest treatment center; and

providing the directions to the employee.

9. A system for directing an employee in a remote location to a treatment center, comprising:

a computer having a processor and memory and coupled with a GPS-tracking system, wherein the processor is configured to receive an electronic communication from an employee of a client while the employee is traveling away from a normal location of work, the employee initiating the electronic communication with a GPS-enabled mobile device, the processor further configured to determine the location of the employee with the GPS-tracking system based on a GPS location of the mobile device;

wherein a triage operator performs triage on the employee with the computer to determine a level of urgency of a medical condition of the employee, to thereby determine an appropriate disposition for the employee, wherein a plurality of triage questions are provided to the triage operator by the computer based on a category related to the medical condition; and

wherein the processor automatically determines a nearest treatment center to the location of the employee based on the GPS location of the mobile device, the nearest treatment center being adequate to address the level of urgency required by the determined disposition and a designated preferred provider of the client.

10. The system ofclaim 9, the processor further configured to refer the employee to any treatment center of a client-preferred provider in a network of providers when the computer determines that the nearest treatment center designated as preferred by the client is not adequate to address the level urgency of the medical condition.

11. The system ofclaim 9, the processor further configured to refer the employee to any treatment center of a client-preferred provider in a network of providers when the computer determines that there are no nearest treatment centers in a proximity of the location that are designated as preferred by the client.

12. The system ofclaim 11, the processor further configured to refer the employee to a treatment center of any suitable medical provider when no client-preferred provider in the network of providers is within the proximity of the location of the employee.

13. The system ofclaim 9, the processor further configured to dispatch emergency personnel from the treatment center to the location of the employee.

14. The system ofclaim 9, the processor further configured to integrate within the triage as provided by the computer an alternate one or more additional treatment centers that are not designated as preferred to which to refer the employee where required by applicable laws or regulations that govern the restriction to, or selection of, preferred treatment centers.

15. The system ofclaim 9, the processor further configured to refer the employee to any treatment center of a client-preferred provider in a network of providers when the computer determines that the nearest treatment center designated as preferred by the client that is adequate to address the level urgency of the medical condition is not currently open.

16. The system ofclaim 9, the processor further configured to:

obtain directions to the nearest treatment center by selecting an indicia for obtaining directions on a screen of the computer displaying the nearest treatment center; and

provide the directions to the employee.

17. A computer-readable storage medium comprising a set of instructions for directing an employee to a treatment center, the instructions executable by a computer having a processor and memory, the set of instructions to direct the processor to perform the acts of:

receiving an electronic communication from an employee of a client while the employee is traveling away from a normal location of work, the employee initiating the electronic communication with a GPS-enabled mobile device;

determining the location of the employee based on a GPS location of the mobile device with a GPS-tracking system coupled with the computer;

performing triage on the employee by a triage operator to determine a level of urgency of a medical condition of the employee, to thereby determine an appropriate disposition for the employee, wherein a plurality of triage questions are provided to the triage operator by the computer based on a category related to the medical condition; and

automatically determining, with the computer, a nearest treatment center to the location of the employee based on the GPS location of the mobile device, the nearest treatment center being adequate to address the level of urgency required by the determined disposition and a designated preferred provider by the client.

18. The computer-readable storage medium ofclaim 17, the set of instructions further to direct the processor to perform the act of referring the employee to any treatment center of a client-preferred provider in a network of providers when the computer determines that the nearest treatment center designated as preferred by the client is not adequate to address the level urgency of the medical condition.

19. The computer-readable storage medium ofclaim 17, the set of instructions further to direct the processor to perform the act of referring the employee to any treatment center of a client-preferred provider in a network of providers when the computer determines that there are no nearest treatment centers in a proximity of the location that are designated as preferred by the client.

20. The computer-readable storage medium ofclaim 19, the set of instructions further to direct the processor to perform the act of referring the employee to a treatment center of any suitable medical provider when no client-preferred provider in the network of providers is within the proximity of the location of the employee.

21. The computer-readable storage medium ofclaim 19, the set of instructions further to direct the processor to perform the act of integrating within the triage as provided by the computer an alternate one or more additional treatment centers that are not designated as preferred to which to refer the employee where required by applicable laws or regulations that govern the restriction to, or selection of, preferred treatment centers.

22. The computer-readable storage medium ofclaim 19, the set of instructions further to direct the processor to perform the act of referring the employee to any treatment center of a client-preferred provider in a network of providers when the computer determines that the nearest treatment center designated as preferred by the client that is adequate to address the level urgency of the medical condition is not currently open.

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