Data processing: financial – business practice – management – or co – Automated electrical financial or business practice or... – Health care management
Reexamination Certificate
1998-12-07
2001-05-01
Millin, Vincent (Department: 2765)
Data processing: financial, business practice, management, or co
Automated electrical financial or business practice or...
Health care management
C705S001100, C705S003000, C705S007380
Reexamination Certificate
active
06226620
ABSTRACT:
This invention relates to an iterative problem solving technique with particular application to both the medical and legal domains. Typically, this is computer assisted.
BACKGROUND TO INVENTION
Accountants started with work sheets which are ruled ledger forms, to get a picture of the financial status of a company. With computerisation, the manual work sheet has evolved into the electronic spreadsheet, a powerful tool indispensable to the accounting profession. In an electronic spreadsheet, there is a huge grid of cells in which one can enter numbers or formulae that will perform calculations based on the values of other cells. Other than the occasional spreadsheets that allow text string entries and provide basic string manipulations for use as headers, the spreadsheet is essentially a number calculation device. The spreadsheet calculates the numbers and gives the accountants quick answers to “What if?” type queries. The results of this “What if?” analysis are placed in the spreadsheet cells, this sets up the conditions for the next round of calculations with no manual transcription. The accountant's electronic spreadsheet is prodigious for tasks that require repetitive work with a hand held calculator. Hitherto, there is no such equivalent spreadsheet in the medical or legal domains with the capability of, during a client encounter, i) data entry and recording ii) performing “what if” calculations pertaining to client diagnosis and management, with results placed in cells for the next round of evaluation and iii) a spreadsheet with features such as scrollable work sheets that can be saved.
The present invention relates to an approach which allows the traditional accountant spreadsheet to be adapted to other applications, eg for use in a real or simulated patient or client encounter environment or in the legal environment. Whilst the following description is with reference to the medical and legal fields, the invention is not so limited.
Traditionally the manual/electronic medical record keeping may be divided effectively in three modes: 1) fully manual, 2) manual cum electronic, and 3) filly electronic medical record system.
Current manual medical record systems are not properly designed from the information flow viewpoint. In particular, hitherto there is difficulty in presenting encounter data and global patient data using the same medical model. The end result is poorer patient care which can be attributed to medical information being hidden or lost in the jungle of data in a patient medical record regardless of its medium. While the best of the current crop of medical record systems as epitomised by the Problem Oriented Medical Record/Subjective Objective Assessment Plan model (POMR/SOAP) by Lawrence Weed (Medical Records, Medical Education and Patient Care. Cleveland: Case Reserve Press 1969.), attempts to structure medical record in a logical manner, it still does not lend itself to smooth information flow and effective computerisation as there is a schism in the day of consultation encounter data model and the patient global health status data model.
The present day medical record systems, regardless of whether they are manual or electronic, do not promote clear thinking in the mind of the clinician, pointedly there are no formal relationships among the various sections of the medical record. Present day record systems can be described as incongruous, non-optimised, and when computerised end up as a non-optimal systems also.
Current manual medical records are not designed for quick and accurate evaluation of patient clinical health status. Patient health data is often buried in clinical notes, important and exceptional patient data are often hidden from the health workers due to poor record design. This leads to medical accidents and potential litigation. There is potential to achieve better health outcomes and better quality patient care by not doubling on medical investigations, not missing tests that ought to be done, maximising available information and reducing litigation by overcoming current weaknesses in medical recording. Such weaknesses include the lack of a section for well defined diagnoses to precede treatment and sections reserved for evidence to support such clear diagnostic entities.
There also exists the promise of improved patient care by the computerisation of patient medical record. However this is tempered by the uncertainty over the veracity and legality of computerised medical records in medical litigation. This is one argument to keep some form of written notes. Keying in notes or dictating into a microphone by the clinician during the consultation process is acceptable only to a minority of doctors who are also technologically competent. The above would suggest that an ideal health record system for some doctors would comprise both manual and electronic elements.
Current medical record design is not conducive to rapid and effective evaluation of patient clinical status in its paper format. Any hope of leveraging the power of electronic computation into the medical record domain is predicated on a congruent patient health data model that is functional in both the manual and electronic medical record situations. Hitherto the paper medical record has been hard to computerise as there does not exist a congruous data model of the patient medical record that is effective for both the manual and the electronic medical record version. The Problem Oriented Medical Record of Weed is difficult to computerise as there is a separate data model for the encounter called SOAP and a global model of the patient called the problem list.
Another barrier to medical computerisation and mentioned above, and of a greater magnitude, is that pertaining to disruption of the doctor's work flow during the consultation. The traditional approach of pen and paper works well during a consultation as there is minimal disruption to the consultation process. During this process, the doctor has to concentrate on verbal and body language cues to achieve optimal communication with the patient; while at the same time, in a discrete manner makes notes and conducts an evaluation process in his or her professional mind.
To type in notes or to dictate into a voice recognition system during a consultation are strong disincentives for the majority of doctors to computerise their medical notes. Yet the computer is a powerful tool for making quick evaluation of patient status such as calculating, tracking the date of the last pap smear and recalling the patient. For instance in the tracking of pap smears the computer can easily work out to the nearest day since the last pap smear in a mere instant. The computer is also excellent in detecting drug interactions and disease-drug interactions. Hence, the quality of medical care can be promoted in a fully computerise medical record, as long as the medical data captured is structured in a way to be evaluated by the computer program. The scanning of word processed documents and medical images such as X-ray pictures to be placed into the patient electronic folder does not make use of the computer evaluation capacity at all and hence is a second rate implementation of the electronic medical record.
An inimical influence to the proper design of the manual medical record is the traditional teaching in medical schools to countless generations of medical students of the need to separate clinical symptoms and signs when approaching a patient clinical problem. In this paradigm, the consultation process begins with history taking (the collection of symptoms), this is followed by the physical examination of the patient (the collection of signs). Hence traditional medical notes will have two separate categories, one for symptoms and the other for signs. The traditional model of medical notes go like this: symptoms→physical examination/physical signs→assessment→treatment plan
This current art of the manual medical record system is described in the POMR/SOAP model by Dr L Weed (Medical Records, Medical Education and Patient
Kanof Pedro
Leydig , Voit & Mayer, Ltd.
Millin Vincent
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