The present invention is generally related to computer systems for providing health measures, and more particularly, to computer systems for providing a patient health index which takes into account socio-economic determinates of health.
The delivery of healthcare is evolving rapidly driven in no small part by the high cost of health care and an aging worldwide demographic with increased healthcare needs. Without systemic changes, there will be an increased percentage of the population without meaningful access to healthcare. Historically, patient care was performed on a case-by-case basis focused on episodic interventions by a care provider often at the request of the patient in a fee-for-service relationship.
In addition, care providers may be generalists, or specialists with a particular field of expertise, and may lack expertise in every possible medical nuance of a given patient's total clinical condition. Therefore, these care providers may only take into account a subset of the issues the patient is struggling with based on their particular expertise and miss other important issues. This may result in the caregiver failing to address some critical health issues. Or even worse, in some instances, their guidance may even create, or exacerbate, the other health issues.
Further, caregivers often do not have immediate access to the patient's complete medical history. Patient records are often unavailable, incomplete, or the caregiver may simply not have sufficient time to review the records in the time allotted. Care providers often have to rely on their personal judgment to make the best care decision possible with limited information and limited time allotted during a private consultation. Such decisions could end up being biased, outdated, based on erroneous information or otherwise suboptimal.
Due to the issues noted above, this method of patient-initiated, episodic care management has been found to have several drawbacks. Patients left to manage their own care tend to postpone seeking medical counsel until late stages in their disease progression, thus increasing healthcare costs with a resulting decreased quality of life. This is in contrast with early interventions, which are known to decrease or eliminate negative health consequences at reduced cost.
In the fee-for-service system, the caregiver may have the wrong incentive. Since they are compensated based on services rendered and penalized for poor outcomes. Their financial motivation is aligned with maximizing the delivery of services, which may be at odds with the cost-effective delivery of care. And, if they happen to overlook something they could be held responsible so it is better to over prescribe diagnostics and therapy, even if the likely need is remote. And, in many instances, once the patient seeks medical counsel, they too are often unable or unmotivated to evaluate the counsel given. They are handicapped by their lack of medical expertise, and when they are covered by health insurance, they too have little motivation to control costs. So, when the care provider stands to profit and the patient has little or no ability to disagree, expensive interventions with remote therapeutic value may be pursued thus burdening the healthcare system and needlessly raising costs.
To address the inefficiency of fee-for-service healthcare, government and private payers have sought to correct this situation and provide compensation to caregivers based on their performance rewarding superior outcomes and cost-efficiency otherwise known as value based care. While theoretically desirable, it has proven difficult to develop metrics, which create the right incentives. If the focus is solely on outcomes, then any intervention even with modest therapeutic benefit should be pursued. The obvious down side to this approach is, as with episodic care, this method will result in waste and extreme cost. On the other end of the spectrum, there an incentive system could focus solely on costs. Taken to an extreme, cost savings can be realized by refusing even therapeutic service leading to poor outcomes. So, as there has been a migration from a fee-for-service model to these incentive-based systems, it has pitted patients and physicians against payers. Patients and physicians often accuse payers of putting profits ahead of delivering on their promise of providing health coverage. And, payers argue that patients seek costly interventions when the therapeutic value is suspect. Intellectually, the problem becomes one of optimization, the goal should be to optimize care to provide the highest quality at the lowest cost. However, given the issues noted above, identifying the optimized care has proven challenging especially when the goal is to develop an intervention for a particular patient with unique characteristics.
In an effort to address this problem, there has been a rise in evidence-based medicine to support the shift from the fee-for-service model to value based care. Rather than relying on the expertise of a singular caregiver, evidence-based medicine applies scientific principles to the delivery of care in order to optimize decision-making based on a review of longitudinal patient data to develop standards of care or best practices. In these models, metrics are developed to compensate the caregiver based on their performance and seeks to reward superior results relative to their peers.
While providing clear advantages, one challenge with evidence-based medicine has been the collection, storage, and analysis of large volumes of patient data in an effort to provide a customized care plan for patients or populations. To mitigate this issue, electronic medical records systems (EMRs) have been developed to assist with data management. These systems typically include the same information that would have been retained by individual caregivers across the healthcare network. Advantageously, EMRs provide a centralized repository for patient records including patient history, demographics, past visits, imaging, and the like. Collecting these records in a central repository facilitates caregiver collaboration and the longitudinal data can be used for better evidence-based care analytics thus providing a fuller picture of the patient's clinical picture.
While the shift to evidence-based medicine and analysis of EMR data has been an improvement, additional advances are desired. Disappointingly, it has been found that demographic and healthcare factors typically captured in EMRs are not as predicative of the patient's healthcare outcomes as one would expect and are, in fact, somewhat poor at predicting a patient's health status and likely outcome, thereby undermining the promise of evidence-based care as a means to achieve optimized healthcare. It has been found that equally, if not more predicative of a patient's health status and outcomes, are socio-economic factors such as economic, environmental, educational, social, and behavior factors. The data contained in current EMRs provides an imperfect picture of the patient and lacks any insight into these important socio-economic determinates of health. Moreover, as payers have shifted to a payment system that rewards efficiency, there is understandable focus regarding how efficiency is calculated. It is not uncommon for caregivers identified as low performers to argue that their low score isn't attributable to their inefficiency, but instead is due to the fact that the population they serve is more complicated than the average thus leading to worse outcomes or need more costly interventions. While there is some acceptance that no caregiver has a representative patient cross-section, it is hard to validate these assertions since the current tools available do a poor job at capturing these socio-economic determinates of health or evaluate how they impact outcomes or cost. The present invention seeks to overcome one or more of the deficiencies noted above.
One object of the present invention is to provide a flexible socio-economic model system. The system includes a computing device to performing computing functions. The system also includes at least one database including socio-economic data. A user device is provided, which has a graphical interface presented on a display. The graphical user interface displays socio-economic categories. The user may select which socio-economic categories should be used in the calculation. Next, the computing device then trains a model using machine learning and provides on the graphical user interface the calculated model that correlates one or more socio-economic categories with a socio-economic score as well as at least one predictiveness metric indicating the predictive quality of the model. The socio-economic model includes socio-economic factors selected from the selected socio-economic categories which are related by weighting factors. The predictiveness metrics indicate the quality of the socio-economic model to correlate the selected socio-economic categories with the socio-economic score.
In another embodiment, the present invention provides a computer-implemented socio-economic indexing system. The system includes receiving individual data, electronic medical records data, and socio-economic data about individuals. The system further allows a user to select socio-economic categories to be used by the computer to calculate a socio-economic score. Once the selections have been made the system performs an analysis on the received data and creates a model which includes socio-economic factors and weighting factors. The weighting factors and socio-economic factors are correlated to the socio-economic score. The model calculated by the system is then displayed on the graphical user interface of the user device as well as at least one predictiveness metrics. The predictiveness metric allows the user to evaluate the quality of the model generated by the computer-implemented socio-economic modeling system.
In another embodiment, the present invention provides a non-transitory computer readable medium with executable instruction that when executed by one or more processors causes the processors to receive individual data, electronic medical records data, and socio-economic data about individuals. The processers are programmed to cause the graphical user interface of a user device to display socio-economic categories. The display permits the user to select the socio-economic categories for use in calculating the socio-economic model. Once the socio-economic categories are selected various factors are subsequently selected. The processors then train a socio-economic model, which correlates the factors with the socio-economic score. This correlation occurs via a plurality of weighting factors. Together the socio-economic factors and their associated weighting factors define the socio-economic score. The processors then render the socio-economic model and one or more predictiveness metrics on the graphical user interface of the user device.
These and other aspects of the invention will be apparent from and elucidated with reference to the embodiment(s) described hereinafter.
Many aspects of the invention can be better understood with reference to the following drawings, which are diagrammatic. The components in the drawings are not necessarily to scale, emphasis instead being placed upon clearly illustrating the principles of the present invention. Moreover, in the drawings, like reference numerals designate corresponding parts throughout the several views.
Disclosed herein are certain embodiments of a socio-economic score and indexing system 10 that visually presents a user an adjustable socio-economic algorithm for generating socio-economic models. These models can be subsequently used for indexing patients or patient populations as outlined in detail below.
The socio-economic system 10 provides a measure of a variety of socio-economic factors, which have been found to be equally, if not more important, to predicting clinical outcomes than clinical factors. With reference to
Similarly, a user 24 may be physician, nurse, administrator, or other caregiver. The user 24 may access the system 10 via a user device 26. As with the patient device 14, user device 26 also includes a display 28, input 30, processor 32, a communications device 34, and a memory 35. As is well-known in the art, the display 28 may present a graphical user interface with menus, tables, icons, and the like to permit interaction with the system. The input 30 may be any of a variety of input devices such as a keyboard, touchscreen, computer mouse, trackball, voice recognition, and the like capable of allowing the user to interact with the graphical user interface presented on the display 28. The communications device 34 may be any communication device capable of connecting the user device 26 to the system 10 such as Ethernet, Wi-Fi, Bluetooth, GSM, CDMA, or the like.
The system also includes a computing device, or computer, 40 that also includes a display 42, input 44, processor 46, a communications device 48, and memory 50. As is well-known in the art, the display 42 may present a graphical user interface with menus, tables, icons, and the like to permit interaction with the system 10. The input 44 may be any of a variety of input devices such as a keyboard, touchscreen, computer mouse, trackball, voice recognition, and the like capable of allowing the user to interact with the graphical user interface presented on the display 42. The communication device 48 may be any communication device capable of connecting the computer 40 to the system 10 such as Ethernet, WiFi Bluetooth, GSM, CDMA, or the like.
The system 10 also includes access to third party database resources 52 which may be located on-site or accessed remotely from third party providers. For instance, clinical information regarding the individuals 12 may be retrieved from an electronic medical records (EMR) database from providers such as Epic, Inc. or Cerner, Inc. In addition, socio-economic information may be retrieved from a socio-economic information databases from providers such as CentraForce, Inc. The system may also include electronic storage 54 which may include private information regarding individuals collected by a healthcare provider. The database resource 52 and electronic storage 54 may be co-located within the first user device 14, the second user device 26, the computer or remote (as depicted). Ideally, given the size of the databases contained in either the database resources or electronic storage, these databases 52, 54 are preferably contained in cloud-based data storage such as that provided by SalesForce.com, Inc, Amazon Web Services, Inc. or other similar providers.
The processor 46 of computing device 40 includes an individual component 56, a model component 58, a prediction component 60, and a presentation component 62. The individual component 56 is configured to process information about individuals 12 such as claims data, clinical data or socio economic data received from the databases 52, 54. The model component 58 is configured to define and train a socio-economic model, which correlates various socio-economic factors as explanatory variables with clinical outcomes, costs or self-reported patient health status as response variables via weighting factors associated with each factor. Lastly, the presentation component 62 displays the output of the model to the user 24 on display 16 and inquires whether the user 24 wishes to accept the model or make adjustments and retrain the model. The user provides these responses via the input 18.
While the network environment of the system depicted in
As seen in
While having access to all of the information depicted on
As seen in
The individual information component 56 also receives data from claims or EMR databases 108. Again, these databases may come from external providers stored on 3rd party database resources 52. Or, this data may be private in nature stored on electronic storage 54. In a preferred embodiment, the inventors contemplate that information regarding the patient's 12 age, ethnicity, marital status, and zip code or address can be extracted from the database 52, 54. This data can be used as inputs to extract the appropriate data from the socio-economic database contained on a third party database resource 52, or electronic storage 54.
The individual information component 56 also receives data from socio-economic databases 110, which is extracted based on the EMR and/or claims data received from claims or EMR databases 108. The socio-economic data 110 may be located on external data resources 52 such as from a public provider like CentraForce. Alternatively, the socio-economic data 104 may be a private database stored in electronic storage 54, which may be resident with computing device 40, or remote from computing device 40.
In step 104, the computing device 40 uses the data 106, 108, and 110 to select the relevant data related to the selected factors 92-100 of the categories 90. For example, the system will use the individual's zipcode or address to extract the relevant socio-economic factors associated with the patient's zipcode or address while excluding the factors that are not as predictive based on the desired outcome model. Moreover, if the user 24 desires to build a model related to A1C levels to determine a patient's risk of getting diabetes while dietary and health club use may be highly predictive, mental health may be less predictive and thus the system could be configured to exclude less predictive features. Next, in step 112, the system trains a model 122 using the selected data to provide a socio-economic score 122. Machine learning techniques are applied to create a model 122, which fits the data and is predictive. The model includes socio-economic factors 134 and an associated weighting factor 136. For example, the computing device 40 may calculate a model 122 such as:
SES=(Af)*(Age)+(Uf)*Unemployment+(AQf)*Air quality, where
Age is the age of the patient 134;
Unemployment represents the unemployment status of the patient 134;
Air quality represents the air quality the patient is exposed to 134
Af is the Age weighting factor 136;
Uf is the unemployment factor 136; and
AQf is the Air Quality factor 136.
The inventors contemplate that in a preferred embodiment linear regression may be employed to develop the socio-economic model 122. However, a variety of other techniques can be employed as well such as Bayesian linear regression, least-angle regression, theil-sen estimator, Lasso, Ridge, or even polynomial regression techniques could be employed without deviating from the scope of the present invention.
In step 113, the prediction component 60 calculates the predictive quality of the model 122 generated by the model component 58. In a preferred embodiment this can be accomplished by performing a Root-Mean-Square Error (RMSE) and R-Square R2 values for the model 122. These values are well-known in the art and would provide the user with a ready metric indicating the quality of the model 122. Of course, a variety of other techniques could be used to assess the predictive quality of the model 122 such as average mean variance, median mean variance, and average absolute deviation.
The presentation component 62 displays the model generated by the model component 58 and the predictive quality of the model generated by the prediction component 60 for the user 24 on display 28 in step 114. In step 116, the user 24 is given the option to accept or reject the model 122. If the user 24 accepts the model, the user 24 is given the option to display and save the model 120. If the user rejects the model, the user is allowed to adjust the model in step 118 via input 30 of the user device 26.
While the preceding description is one demonstrative embodiment of the invention wherein the model is generated with each socio-economic category simultaneously to generate a singular socio-economic model, the inventors contemplate, as seen in
Another unique feature of the present invention is its customizability, which allows users to customize the model 122 as desired to fit their particular application. With reference to
Alternatively, the inventors contemplate that the socio-economic score can also be used to show the correlation of socio-economic factors to various health outcomes such as the Charleston Comorbidity Index, A1C level, Total claim cost, Medication adherence. As seen I
SHO=HO*SEI*Sf, where
SHO is the scaled health outcome;
HO is the health outcome;
SEI is the socio-economic index for a particular patient; and
Sf is a scaling factor to relate the health outcome with the Socio-economic Index.
In step 104, the display 28 provides the user 24 with the socio-economic categories 92-100 and health outcomes 126 from which the user 24 may choose. This uniquely provides the user 24 with the flexibility to determine which socio-economic categories 92-100 should be included in the model 122 and which categories 92-100 the user 24 wishes the system 10 to exclude from the analysis. Next the user selects the desired health outcome 126. The model component of the computing device will select the appropriate socio-economic factors based on the selected socio-economic categories 124 and the selected health outcomes 126. Given that the system 10 also calculates predictiveness metrics in step 113. The user 24 can generate multiple models 122 using different categories 92-100 and evaluate which ones provide the best correlation.
The present invention can be used for a variety of advantageous purposes. For instance, as noted above, physicians are increasingly being compensated, or incentivized, based on efficiency. However, physicians identified as low performers often complain that their patient population is sicker or more complicated than the average and rather than incentivizing efficiency such systems encourage doctors to abandon complicated, or costly patients 12 while doctors who take on complicated patients 12 are penalized. Accordingly, providing administrators, payors, or governmental organizations a reliable tool that can benchmark a provider's patient population would go far to address this problem in the art, which could lead to a fairer compensation schemes which account for socio-economic factors. This in turn might encourage physicians to desire complicated patients since they would represent the greatest opportunity for therapeutic improvement and compensation, if successful.
The present invention can also be used to enhance care if provided to a physician, nurse or other caregiver. The user 24 may be able to have a quick assessment regarding socio-economic factors that may complicate care, and as noted above, may be more important to determining patient's health outcome than clinical data. Typically, physicians had little insight into these components, but simply providing the caregiver with all the data on a patient may not solve the problem even if the patient would be willing to provide it. Most caregivers are under extreme time pressures and are not data scientists. Finding this data, analyzing it and determining the correlations with the health outcomes of interest is simply too time consuming and complicated to be performed by a caregiver in real time. The present invention could provide caregivers with a ready tool to provide quick index regarding a patient's socio-economic factors that may impact outcomes so they can focus additional services on the patients that are most likely in need of additional support and avoid providing services to patients that don't need additional support. In addition, if the socio-economic score is high to a patient due to behavioral factors. The user may, as part of their care plan, prescribe social services such as a counselling, a support group, etc. Or, if the patient is being discharged, the discharging physician may consider whether additional community support or at-home care is justified in an effort to avoid the cost associated with readmission. So, in a way, the present invention could provide socio-economic decision support mirroring clinical decision support which is ubiquitous in the industry.
As another example, administrators have extreme pressures put on them by payers to contain costs as healthcare organizations continue to consolidate, it becomes increasingly difficult for administrators to determine where they have inefficiencies in their large and growing organization. The present invention can help them analyze the actual impact their providers are having on their patients and highlight areas where improvements can have the greatest impact on patient outcomes and reduce costs.
Although the description identifies or describes specifics of one or more embodiments, such specifics are not necessarily part of every embodiment, nor are all various stated advantages associated with a single embodiment. On the contrary, the intent is to cover all alternatives, modifications and equivalents included within the scope of the socio-economic system and method as defined by the appended claims. Further, it should be appreciated in the context of the present disclosure that the claims are not necessarily limited to the particular embodiments set out in the description.
Note that reference to thresholds refers to minimum triggers for certain conditions for actions to commence. The thresholds may be based on historical or experimental data, or based on the expertise of a user and/or context. In some embodiments, a threshold may be established based on a combination of experience and context.
While the invention has been illustrated and described in detail in the drawings and foregoing description, such illustration and description are to be considered illustrative or exemplary and not restrictive; the invention is not limited to the disclosed embodiments. Other variations to the disclosed embodiments can be understood and effected by those skilled in the art in practicing the claimed invention, from a study of the drawings, the disclosure, and the appended claims. Note that various combinations of the disclosed embodiments may be used, and hence reference to an embodiment or one embodiment is not meant to exclude features from that embodiment from use with features from other embodiments. In the claims, the word “comprising” does not exclude other elements or steps, and the indefinite article “a” or “an” does not exclude a plurality. A single processor or other unit may fulfill the functions of several items recited in the claims. The mere fact that certain measures are recited in mutually different dependent claims does not indicate that a combination of these measures cannot be used to advantage. A computer program may be stored/distributed on a suitable medium, such as an optical medium or solid-state medium supplied together with or as part of other hardware, but may also be distributed in other forms. Any reference signs in the claims should be not construed as limiting the scope.
This application claims the benefit of U.S. Patent Application No. 62/587,921, filed on 17 Nov. 2017. This application is hereby incorporated by reference herein.
Number | Date | Country | |
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62587921 | Nov 2017 | US |