Patent Application
20200152327
None.
Not applicable.
Not applicable.
Patient care near the end of life may be partitioned into palliative care and hospice care. Hospice care is typically involved during the last six months of life or even just the last month of life. Hospice care is not typically directed to curing or restoring the health of the care patient but rather assuring their dignity and comfort as they approach death and possibly also assisting family and friends cope with the approaching death of the care patient. Palliative care may be involved over a longer period of time and precedes hospice care. Palliative care may be involved with helping patients maintain a good quality of life while in a slow decline caused by a chronic medical condition. Curative care, by contrast with both hospice care and palliative care, is directed to curing and/or restoring the care patient to a fully-functional health.
In an embodiment, a method of invoking scripts from captured data using a three-tier architecture to enable dynamically adapting care given to a patient based on a patient assessment is disclosed. The method comprises receiving assessment input for a patient from a patient care giver tool user interface (UI) by an assessment component executing on a computer system, where the assessment input is associated with a section of a patient assessment form, reading a plurality of scripts associated with the section by the assessment component from a data store, reading a medical condition of the patient from a plan of care associated with the patient, where the plan of care is stored in the data store, and executing each of the scripts by the assessment component, where the assessment input and the medical condition of the patient are provided as an input to the scripts. The method further comprises, based on executing the script, storing an issue in the plan of care associated with the patient in the data store by the script, looking up a goal in the data store based on the issue by a plan of care component executing on the computer system, storing the goal in the plan of care associated with the patient in the data store by the plan of care component, and, based on the goal, determining an intervention by the plan of care component. The method further comprises storing the intervention in the plan of care associated with the patient in the data store by the plan of care component and presenting the plan of care of the patient on a display of a mobile communication device by the UI, where the presentation of the plan of care comprises the intervention, whereby the care given to the patient is dynamically adapted.
In another embodiment, a system for invoking scripts from captured data using a three-tier architecture to enable dynamically adapting care given to a patient is disclosed. The system comprises at least one processor, a data store, wherein the data store comprises a plan of care table and a plurality of scripts, where each script is associated with a section of a patient assessment form, a memory, and an assessment component stored in the memory. When executed by the at least one processor the assessment component receives assessment input for a patient from a patient care giver tool user interface (UI), where the assessment input is associated with a section of the patient assessment form, reads scripts associated with the section from the data store, executes each of the scripts associated with the section, where the assessment input is provided as an input to the scripts, determines by executing one of the scripts associated with the section that the input satisfies a criterion of the script, based on determining the input satisfies the criterion of the script, stores an issue in a plan of care associated with the patient in the data store, and adapts the plan of care associated with the patient based on the issue, whereby care delivered to the patient is changed.
In yet another embodiment, a method of invoking scripts from captured data using a three-tier architecture to enable dynamically adapting care given to a patient based on a patient assessment is disclosed. The method comprises receiving assessment input for a patient from a patient care giver tool user interface (UI) by an assessment component executing on a computer system, where the assessment input is associated with a section of a patient assessment form, reading a plurality of scripts associated with the section by the assessment component from a data store, and reading a medical condition of the patient from a plan of care associated with the patient, where the plan of care is stored in the data store. The method further comprises executing each of the scripts by the assessment component, where the assessment input and the medical condition of the patient is provided as an input to the scripts, and, based on executing the script, storing an issue in the plan of care associated with the patient in the data store by the script. The method further comprises reviewing the plan of care associated with the patient by an interdisciplinary group (IDG), determining an intervention based on the issue by the IDG, storing the intervention in the plan of care associated with the patient in the data store, and presenting the plan of care of the patient on a display of a mobile communication device by the UI, where the presentation of the plan of care comprises the intervention, whereby the care given to the patient is dynamically adapted.
These and other features will be more clearly understood from the following detailed description taken in conjunction with the accompanying drawings and claims.
For a more complete understanding of the present disclosure, reference is now made to the following brief description, taken in connection with the accompanying drawings and detailed description, wherein like reference numerals represent like parts.
It should be understood at the outset that although illustrative implementations of one or more embodiments are illustrated below, the disclosed systems and methods may be implemented using any number of techniques, whether currently known or not yet in existence. The disclosure should in no way be limited to the illustrative implementations, drawings, and techniques illustrated below, but may be modified within the scope of the appended claims along with their full scope of equivalents.
Typical health care is diagnostic driven and involves a kind of linear process of “solve for this” followed by “solve for that” actions. Hospice care is different and is not diagnostic driven but rather is plan of care driven. In hospice care, the patients are not expected to improve and recover, and are experiencing a distinct decline in health that ends in their death. When federally allocated funds are involved in the hospice care, evidence of patient decline is desirably identified and documented by an interdisciplinary group (IDG). The IDG is populated by persons performing different roles, for example a doctor role, a nurse role, a spiritual advisor role, a social worker role, and a bereavement counselor role. The IDG meets periodically, for example about every two weeks or every 15 days, and findings of assessments of a patient at different IDG meetings are expected to manifest a trend of declining health of the patient. If, however, a patient exhibits signs of increasing health, they may be removed from hospice care.
Most patient care software tools are designed for typical health care, and often those patient care software tools are maladapted for use with the special needs involved in providing hospice care. Additionally, often care givers may use a plurality of different patient care giver tools that do not interoperate with each other and do not automatically share data on the same patient. Because of this lack of interoperability, care givers have to spend extra time jumping from one tool to a second tool and from the second tool back to the first tool to complete their work, which is inefficient. Additionally, this lack of interoperability interferes with members of an IDG accessing up-to-date information on hospice patients and interferes with meeting government regulations pertaining to qualification of patients for hospice reimbursement by the government. The present disclosure teaches a plan of care centric patient care giver tool system that is designed for providing hospice care. The patient care giver tool system taught herein is an integrated system that provides care givers seamless access to different tool functionalities from the same tool interface, and where the different tool functionalities have access to the same pool of patient data. The plan of care for each different patient is generated and maintained independently for each patient and reflects each patient's initial condition when admitted to hospice care and the history of the subsequent evolution of the patient's health. While much of the following is directed to examples involving hospice care, it is noted that the teachings herein may advantageously be adapted for use with palliative care, which also differs in similar ways from typical health care processes.
The present disclosure teaches a patient care giver tool system crafted for use in a hospice environment that dynamically constructs a patient assessment user interface for a patient care giver tool using a three-tiered architecture. As sections of the patient assessment are completed (e.g., as patient assessment data is captured), scripts associated with the completed assessment section execute, update the plan of care, and potentially cause the care given to the patient who is being assessed to be changed at that point of time (e.g., after the assessment is completed and before the care giver leaves the patient). The system is designed to efficiently and flexibly support hospice care activities. Hospice care may be funded by government funds and may be subject to tight government cost controls. Historically, the hospice care environment has been underserved by software tools specifically designed for the hospice care environment, possibly because it has been difficult to make a paying business out of hospice care, and without profits, hospice care organizations cannot fund development of the desired software tools. The patient care giver tool system taught herein proposes to solve this computing problem and this economic problem concurrently, through its efficiency and flexibility as described hereinafter.
To perform efficiently, the system is designed to support a plurality of independent hospice care organizations from a single multi-tenant execution platform; for example, from a cloud computing environment. Additionally, the integrated nature of the system promotes efficiency of hospice care giver operations. The hospice care givers, using this system, need not move from a first tool to a second tool and back to the first tool to complete their work. They can complete their tasks using a single tool interface extended to their portable devices (e.g., a tablet computer) and work with an integrated data store containing all relevant data pertaining to their patients, and where the data is continuously up-to-date. For example, care giver inputs into an assessment of a hospice patient can immediately affect the plan of care of the hospice patient, and the same care giver may immediately see a new order or intervention in the patient's plan of care resulting from their input. This can make hospice care more efficient because a second visit to the patient may be obviated, and the changed plan of care can lead to adapting the care given to the patient dynamically, on the fly, while the care giver is still with the patient. In a different system that is not integrated, it is unlikely that an assessment input provided in an assessment tool would immediately percolate into a separate plan of care tool for example. Likewise, the assessment inputs can be accessed through the same system immediately by the members of the IDG in evaluating a patient's current status and to validate the patient's hospice care eligibility according to federal guidelines, because the system assessment microservice operates on the same data store as the IDG microservice operates on.
Flexibility is desirable, because different independent hospice care organizations are expected to demand different functionality in the patient care giver tool. Additionally, the needs of a hospice care organization are expected to change and drive differences in the functionality of the patient care giver tool as their processes evolve and government regulations change over time. The scripts that execute when an assessment section are completed are stored in the data store as text and are not compiled programs. Adding new scripts or changing scripts is simpler and cheaper. Additionally, different scripts can be associated to the same assessment sections for different hospice organizations (e.g., different tenant identities). Thus, using scripts in this way promotes the goal of flexibility. The patient care giver tool system supports a circulation process from assessments of patients to updates to a plan of care for each patient to the IDG meetings by providing shared access by each process step to the same body of patient data. In addition to promoting efficiency, this circulation process supports accuracy and prompt adaptation of the patient care plan.
The system provides different patient care functionalities from different microservices or modules that execute in a middle tier of the system architecture. For example, an assessment microservice is engaged for performing, recording, and reporting patient assessments. Other microservices may comprise one or more of a plan of care microservice, an interdisciplinary group (IDG) microservice, a scheduling microservice, an alerts and notifications microservice, a data analytics microservice, a history and event records microservice, a patient referral microservice, and a billing microservice. In an embodiment, at least some of the microservices extend a representational state transfer (REST) application programming interface (API) to a user interface (UI) application that executes in a front-end tier of the system architecture. In some contexts, the REST APIs may be referred to as RESTful APIs. A RESTful API uses hypertext transport protocol (HTTP) requests to GET, PUT, POST, and DELETE data. RESTful API technology provides some advantages such as relying on less bandwidth than a more robust communication technology such as simple object access protocol (SOAP).
In an embodiment, the UI application requests an assessment user interface format from the assessment microservice, processes the assessment user interface format to generate an assessment user interface document suitable to a specific user equipment (UE), and sends the assessment user interface document to the UE. The UE renders the assessment user interface document on a display of the UE and receives user inputs to controls presented in the display. The UE returns the user inputs to the UI application, and the UI application returns the user inputs to the assessment microservice via the RESTful API. The assessment microservice then acts upon the received user inputs, for example storing assessment data and assessment template data in a data store tier of the system architecture. In an embodiment, user interfaces of other microservices may likewise be automatically generated and sent to the UE in a manner similar to that described above for the assessment user interface. An assessment user interface format comprises one or more section formats, each section format comprises one or more card formats, and each card format comprises one or more field formats.
When a care giver completes a section of an assessment of a hospice patient and moves on to a different section, the completed section is stored or captured by the assessment microservice in the data store in the data store tier. The assessment input data is stored and the format of the section template and field template likewise is stored in the data store in the data store tier. When the section data and format are stored, the assessment microservice accesses one or more scripts stored in the data store associated to the assessment section just stored. Said in other words, capturing the assessment data causes invocation of the one or more scripts (e.g., invoking scripts as a result of capturing assessment data or invoking scripts triggered from the event of capturing assessment data). The assessment microservice executes each of the scripts, providing data from the assessment section to the script as input. In some cases, additional input may be provided to the script, for example assessment input from a different section of the assessment, a medical condition of the patient, a level of care of the patient, or other input. If the script determines that the various inputs satisfy a criterion defined by the script (e.g., the script evaluates “true”), the script creates an issue and stores the issue in the plan of care associated with the patient undergoing assessment.
An issue identifies something about a patient (e.g., weight above a threshold, weight below a threshold) that is deemed noteworthy. An issue, for example, may be considered to be a red flag related to the well-being of a patient, something that calls for additional attention from a care giver in some way. An issue is initially created in a suggested state. If the issue is reviewed and deemed valid, it may be moved to an accepted state. From an accepted state, the issue may be moved to a resolved state (e.g., after an associated goal and an associated intervention are defined for the issue). If the issue is reviewed and deemed invalid or irrelevant, it may be moved to a declined state. The issue may be transitioned from one state to other states by a care giver having a qualified role. The care giver may enter explanatory text associated with the issue as he or she changes the state of the issue; for example, entering a text explanation as to why he transitioned the issue to a declined state.
An issue on the plan of care of a patient can lead to a change in care provided to that patient in a variety of ways. The plan of care may be reviewed by the IDG, the IDG may define a goal based on the issue to be attached to the plan of care, and the IDG may further define an intervention based on the goal to be attached to the plan of care. The goal can identify a desired state of the assessment value that is associated with the issue; for example, a patient weight within normal thresholds. The goal may be O2 saturation level above a minimum threshold, blood pressure within normal limits, pulse rate within normal limits, temperature within normal limits.
The intervention may identify specific care actions to be performed for the patient in expectation of improving the patient's assessment value to achieve the associated goal; for example, a dosage of pain medication be increased, or oxygen be provided to the patient to increase his or her O2 saturation level, or a menu of higher fat content food be fed to the patient. Alternatively, in an embodiment, the plan of care microservice may automatically map an issue attached to the plan of care by a script to a goal and attach the goal to the plan of care. The plan of care microservice may further automatically map the goal to an intervention and automatically attach the intervention to the plan of care of the patient. When a care giver who is with the patient pulls up the plan of care display on his or her tablet and sees the intervention, the care giver may carry out the intervention, thereby adapting the care given to the patient. In an example, the scripts are Groovy scripts.
The patient care giver tool system taught herein is a three-tier architecture comprising a user interface tier, a middle tier (also referred to as a microservices tier herein, but optionally comprising functionality that is not considered to be delivered as a microservice), and a data store tier. This three-tier architectural structure provides advantages of efficiency and flexibility in meeting the goals of supporting hospice care and/or palliative care operations. The patient care giver tool system embodies a method of invoking scripts from (e.g., in response to, based on, triggered by) the event of capturing patient assessment data, using the three-tier architecture, that supports dynamically adapting care given to patients.
Turning now to
The UEs 102 may be tablet computers, notebook computers, laptop computers, mobile communication devices, or wearable computers. The network 106 comprises one or more public communication networks, one or more private communication networks, or a combination thereof. The wireless AP 104 may be a WiFi access point. The wireless AP 104 may be a cell site, such as a cell tower. In an embodiment, each of the microservices 112 may be provided by modules or applications that execute on server computers. In an embodiment, two or more of the microservices 112 may be hosted by the same server computer. In an embodiment, the user interface server application 110 may execute on the same server that hosts one or more of the microservices 112. In an embodiment, the data stores 114 may be provided by database management systems (DBMSs) executing on computer systems and providing mediated access to data storage. In an embodiment, the user interface server application 110, the microservices 112, and the data stores 114 may be provided by a cloud computing environment. In a cloud computing environment, the microservices 112 may execute in a multi-tenant mode of operation (e.g., serving a plurality of hospice care organizations at the same time).
The care giver UE 102 may present a user interface to the patient care giver tool system 100 that comprises a plurality of different views into the system 100. For example, the user interface on the care giver UE 102 may present an assessment section in a right hand side of the display, a plurality of assessment icons in a left hand side of the display, where the assessment icons promote selection of an assessment section, and a plan of care in a middle of the display. The plan of care may identify a patient name, a date of birth, an age, a primary diagnosis, and a secondary diagnosis. The plan of care may identify a general medical condition of the patient, for example identifying that the patient is a diabetic, that the patient is an amputee, that the patient suffers from heart arrhythmia, that the patient suffers from cardiovascular disease. The plan of care may further provide a residential address of the patient, a level of care of the patient, a list of known allergies of the patient, a list of current medications of the patient, a case manager, an attending physician, and various care instructions. If the UE 102 selects to access the plan of care, a plan of care microservice may present additional details of the plan of care, for example in a right hand side of the display. The plan of care may indicate issues, goals, and/or interventions associated with or attached to the plan of care. A care giver may act upon interventions, for example adapting or changing care given to a patient based on the intervention.
As the care giver completes sections of an assessment, he or she may save the assessment section. On selection of the save, the user interface server application 110 sends the data from the section to the assessment microservice 112, and the assessment microservice 112 stores both the input data and date defining the format of the section to a data store 114, for example in a JSON format in a JSON-B column of an entry in a Postgres database. In embodiment, assessment sections may comprise one or more of a vitals section, a neurological section, a pain section, a respiratory section, a cardiovascular section, a gastrointestinal section, a genitourinary section, a nutrition/metabolic section, a skin section, a musculoskeletal section, an ADLS/functional needs section, a precautions and safety section, a summary section, a face-to-face section, a supervisory visit section, and a hospice aide section.
Turning now to
In an embodiment, the data stores 114 may be provided by a single database management system (DBMS) and the data stores 114a, 114b, and 114c may be independent sets of tables, where each independent set of tables is governed by its own database schema. In an embodiment, the data stores 114 are provided as a PostgreSQL DBMS. PostgreSQL is often referred to alternatively as Postgres. In an embodiment, the user interface server application 110 is developed as or based on an Angular application and an Ionic application. Angular is a TypeScript-based front-end development platform. Ionic is an HTML5 mobile application interface framework. Ionic is used to provide user interface look-and-feel presentation associated to the specific operating system of the UEs 102 (e.g., an Android look-and-feel for an Android UE operating system and an iOS look-and-feel for an Apple UE operating system).
When a hospice organization (or, alternatively, a palliative care organization) desires to configure an assessment section, card, or field, they may modify a template defining the format of the assessment in the data store 114 associated with the assessment microservice 112. This may entail editing a JSON document and storing it in a table of the data store 114, for example, in a JSON-B column of a Postgres database. Likewise, if the hospice organization desires to change the role based association of assessment sections, this can be accomplished by editing a JSON document and storing it in a table of the data store 114.
When the assessment template or the role based associations of the assessment template has been modified, the next time an assessment user interface is requested by the UE 102 from the user interface server application 110, the changed assessment format is used, without recoding, without recompiling, and without generating a new schema. Each time a UE 102 selects a different assessment section for display on the UE 102, the subject assessment section is requested from the user interface server application 110. The user interface server application 110 requests the subject assessment section via the RESTful API extended by the assessment microservice 112. The assessment microservice 112 requests the appropriate assessment section template from the data store 114 associated with the assessment microservice 112.
The assessment microservice 112 parses the JSON document containing the desired template information and constructs an assessment section document based on the JSON document and based on the role associated with the UE 102. The template information retrieved from the data store 114 contains the changed assessment format and/or the changed role based associations of the assessment template, the assessment section document that the assessment microservice 112 constructs reflects the modification of the assessment template. As an example of role based access control, a nurse may be able to see a vitals assessment section, a neurological assessment section, a pain assessment section, and other assessment sections on his UE 102; but a hospice aid may be able to see a vitals assessment section but not be able to see a neurological assessment section or a pain assessment section on his UE 102. Note that the template does define these assessment sections, but the care giver role associated to the care giver (via the UE 102 request to the user interface server application 110 that contains the identity of the user which is itself mapped to a care giver role) is used to restrict what assessment sections may be seen on the UEs 102.
The assessment microservice 112 returns the constructed assessment section document via the RESTful API to the user interface server application 110. The user interface server application 110 adapts the constructed assessment section document for presentation on the UE 102 and sends the adapted assessment section document to the UE 102. The UE 102 then presents the subject assessment section in its display.
When the user inputs data into an assessment section and saves the section on the UE 102, the input data is returned to the user interface server application 110. The user interface server application 110 sends the input data via the RESTful API to the assessment microservice 112. The assessment microservice 112 saves the assessment section input data as well as the template format data associated with the assessment section in a new row in an assessment table, for example as JSON human readable attribute-value pairs in a JSON-B column of the assessment table. The assessment table may comprise other columns that are statically defined in a database schema, for example a patient identity column, a hospice organization identity column, a date and time column. The assessment microservice 112 populates appropriate values into these statically configured columns in the new entry in the assessment table.
When a section entry has been stored in the assessment table, in an embodiment the assessment microservice 112 launches a thread that requests the data for the assessment section just stored in the data store 114 and launches a separate thread that requests all scripts defined in the data store 114 for the subject assessment section. The assessment microservice 112 executes each script in turn. The scripts each evaluates one of the items of data stored in the assessment section against a criterion. If the value of the data item satisfies the criterion, the script creates an issue that it attaches to the plan of care associated with the patient. For example, a script may define a criterion that if the patient weight is 250 LBS or more, an issue should be attached to the patient plan of care. In an embodiment, the script may evaluate the assessment input value associated with the subject assessment section based in part on values associated with other assessment sections (e.g., input values associated with previously completed assessment sections of the current assessment of the patient) and/or based in part on a medical condition of the patient. Said in other words, the criterion may be conditioned by input values associated with other assessment sections and/or by a patient medical condition. The scripts may evaluate an O2 saturation level of the patient, a blood pressure of the patient, a pulse rate of the patient, the temperature of the patient, the level of pain experienced by the patient, and other assessment input values.
Additionally, different scripts may be defined for the same assessment sections for different tenant identities (e.g., for different hospice care organizations and/or for different palliative care organizations). When the assessment microservice 112 requests scripts from the data store 114 it requests the scripts associated for the subject assessment section for the appropriate tenant identity. Different hospice care organizations or different palliative care organizations may define different thresholds for assessment input values. For example, a first organization may define a script criterion as weight above 250 LBS, a second organization may define the script criterion as weight above 240 LBS; the first organization may define a script criterion as O2 saturation level above 90%, the second organization may define the script criterion as O2 saturation level above 92%.
In an embodiment, the scripts are programmed using the Groovy scripting language. Some of the microservices 112 are at least partially developed in the Java programming language, and Groovy is a scripting language that integrates smoothly with Java programs. In another embodiment however, a different scripting language may be used to program the scripts, for example Perl or Ruby. The assessment microservice may be developed within a Spring Boot programming framework which automatically builds the RESTful API code extended for use by the assessment microservice 112 to the user interface server application 110. The Spring Boot programming framework simplifies developing a new application, relieving developers of creating repetitive structures, for example RESTful API code support.
When the user of the UE 102 completes an assessment and saves, the assessment microservice 112 accesses all the entries in the assessment table associated with that assessment (e.g., a row entry for each section of the assessment), creates a new JSON document containing input data and section template format data, and stores the new JSON document in a JSON-B column of a completed assessment table. In an embodiment, a report generation tool processes the new JSON document to create a report representing the completed assessment, for example a PDF file capturing the results of the completed assessment. In an embodiment, Jaspersoft is used to generate the report based on the JSON document.
Turning now to
Example assessment types comprise an initial comprehensive assessment type, a comprehensive assessment type, a routine visit assessment type, an emergent assessment type, an in-patient assessment type, a continuous care assessment type, a watch assessment type, an even more care assessment type, a face-to-face assessment type, a phone call assessment type, and a supervisory visit assessment type. In different embodiments, the system 100 may support fewer assessment types or more assessment types. In some circumstances the assessment types table 120 may comprise a plurality of rows associated with the same assessment type; for example, a plurality of rows defining different formats of initial assessment types. The different rows associated with the same assessment type 124 are distinguished by having different tenant IDs 122. A default definition of a format of an assessment type 124 may be created as a row in the assessment types table 120; for example, a row having a tenant ID of a null value, a zero value, or some other distinctive value that distinguishes it from a specific hospice organization. If a hospice organization wishes to define a custom assessment format for an assessment type 124 that deviates from the default format for the assessment type 124, a row may be added to the assessment types table 120 that identifies the assessment type 124, the tenant ID 122 (e.g., a unique identifier associated to the hospice organization), and defines the custom assessment format in the assessment format JSON B column 126. The assessment format JSON B column 126 may define the format of the assessment type 124 as a plurality of sections that compose the assessment form.
Each row in the sections table 130 comprises a section identity 134 and defines a format of a section, for example in a section format JSON B column 136. The section format JSON B column 136 may define the format of the section as a plurality of cards that compose the section. In some circumstances, the sections table 130 may comprise a plurality of rows associated with the same section identity 134. The different rows in the sections table 130 associated with the same section identity are distinguished by having different tenant IDs 132. A default definition of a format for a section identity 134 may be created as a row in the sections table 130 having a tenant ID 132 that is distinctive value such as a null value or a zero value. If a hospice organization wishes to define a custom section format for a section identity 134 that deviates from the default format for the section identity 134, a row may be added to the sections table 130 that identifies the section identity 134, the tenant ID 132, and defining the custom section format in the section format JSON B column 136.
Each row in the cards table 140 defines a card identity 144 and defines a format of a card, for example in a card format JSON B column 146. The card format JSON B column 146 may define the format of the card as a plurality of fields that compose the card and further defines the layout of the fields. In some circumstances, the cards table 140 may comprise a plurality of rows associated with the same card identity 144. The different rows associated with the same card identity 144 are distinguished by having different tenant IDs 142. A default definition of a format for a card identity 144 may be created as a row in the cards table 140 having a tenant ID having a null value, a zero value, or another distinctive value. If a hospice organization wishes to define a custom card format that deviates from the default card format defined for the card identity 144, a row may be added to the cards table 140 that identifies the card identity 144, the tenant ID 142, and defining the custom card format in the card format JSON B column 146.
The assessment type format JSON B column 126, the section format JSON B column 136, and card format JSON B column 146 associated with a given hospice organization may be viewed as an assessment format template 150 associated to that given hospice organization. It is understood that the assessment template 150 may comprise some default format template components as well as some custom format template components. In some contexts, the section format JSON B 136 associated with a specific section ID 134 and a specific tenant ID 132 may be viewed as an assessment section format template or a section template. In some contexts, the card format JSON B 146 associated with a specific card ID 144 and a specific tenant ID 142 may be viewed as an assessment card format template or a card template. In another embodiment, the assessment format template 150 may be stored in a different way. In an embodiment, the assessments data store 114a comprises additional tables and data that are not illustrated in
Turning now to
At block 202, the method 200 comprises storing an assessment template in a relational database, wherein the assessment template is stored in a format comprising a plurality of human readable attribute-value pairs in a column of the relational database and identifies the format of an assessment for each of a plurality of different assessment roles and assessment types and wherein the assessment template comprises a plurality of sections. In an embodiment, the format comprising a plurality of human readable attribute-value pairs is a JSON format. In an embodiment, the relational database is the data store 114 in the data store tier 115. In an embodiment, the relational database is a PostgreSQL database (in some contexts PostgreSQL is referred to as a Postgres database). The assessment template stored during block 202 may be an initial assessment template established on first deploying the patient care giver tool 101. Alternatively, the assessment template stored during block 202 may be a revised assessment template, created by text editing the human readable attribute-value pairs, adding one or more human readable attribute-value pairs, and/or deleting one or more human readable attribute-value pairs.
The human readable attribute-value pairs may define sections, cards, and/or fields of the assessment form, for example defining section layouts in terms of cards, card layouts in terms of fields, field layout in terms of data types and data size or length. The human readable attribute-value pairs may define text to be displayed in sections, cards, and/or fields, for example names of sections, cards, and/or fields.
At block 204, the method 200 comprises receiving a request for an assessment form by an assessment component executing on a computer system from a patient care giver tool user interface (UI). In an embodiment, the patient care giver tool UI is the user interface server application 110. The assessment component may receive the request for the assessment form via a REST application programming interface (API) that it extends to the patient care giver tool UI. The request may identify a patient care giver role of the user of the UE 102 initiating an assessment. The request may identify an assessment type. The patient care giver role of the user of the UE 102 may be determined based on a login of the user. For example, every user granted a login to the patient care giver tool 101 may be predefined to be associated to a specific patient care giver role, e.g., one of a nurse role, a doctor role, a spiritual advisor role, or a social worker role.
At block 206, the method 200 comprises creating an assessment form by the assessment component based on an assessment type, based on a patient care giver role, and based on the assessment template. The assessment component may execute role based access control rules to select sections from a generic assessment template for creating the assessment form. Likewise, the assessment component may select some but not all of the sections from the generic assessment template based on the assessment type. In an embodiment, the processing of block 206 may further be based on an identity of a hospice organization and/or on a tenant ID. In an embodiment, the processing of block 206 may further be based on a level of care associated with the patient. In an embodiment, levels of care comprise routine home care, continuous care, respite care, and general in-patient care. In another embodiment, either fewer or more levels of care may apply.
At block 208, the method 200 comprises transmitting the assessment form by the assessment component to the patient care giver tool UI. In an embodiment, the assessment component transmits the assessment form via the REST API to the patient care giver UI. At block 210, the method 200 comprises receiving assessment input associated with a completed section of the assessment by the assessment component from the patient care giver tool UI. In an embodiment, the patient care giver tool UI sends the assessment input via the REST API. The assessment input may have been input by a user of the UE 102 and a save button in an assessment section screen may have been selected or the user may have navigated from a first assessment section display to a second assessment display on the UE 102.
At block 212, the method 200 comprises storing the assessment input of the completed section of the assessment along with an associated section portion of the assessment template in the format comprising a plurality of human readable attribute-value pairs in a column of an entry associated with the completed section of the assessment in the relational database. In an embodiment, the assessment input and the associated section portion of the assessment template are stored in JSON format in a JSON-B column of the relational database. In an embodiment, the assessment input and the associated section portion of the assessment template are stored in a new row entry in the relational database, where some information in the new row entry is formatted in statically structured columns of the new row entry and the assessment information and associated section portion of the assessment template are stored in an unstructured column of the new row entry. The statically structured columns of the new row entry may identify a patient, a hospice care organization, and a time and date.
At block 214, the method 200 comprises storing an updated version of the assessment template in the relational database, wherein the updated version of the assessment template is stored in the format comprising a plurality of human readable attribute-value pairs in a column of the relational database and identifies the format of an assessment for each of a plurality of different assessment roles and assessment types and wherein the updated version of the assessment template comprises a plurality of sections. The updated version of the assessment template stored during block 214 may be a revised assessment template, created by text editing the human readable attribute-value pairs, adding one or more human readable attribute-value pairs, and/or deleting one or more human readable attribute-value pairs. The assessment template may be updated by a hospice care organization or may be updated by a third party based on requirements defined by the hospice care organization. The assessment template may be updated to comply with additional regulatory requirements. The assessment template may be updated to improve a hospice care process of a hospice care organization.
At block 216, the method 200 comprises receiving a second request for an assessment form by the assessment component from a patient care giver tool user interface (UI). At block 218, the method 200 comprises creating a second assessment form by the assessment component based on an assessment type, based on a patient care giver role, and based on the updated version of the assessment template. In an embodiment, the processing of block 218 may further be based on an identity of a hospice organization and/or on a tenant ID. In an embodiment, the processing of block 218 may further be based on a level of care associated with the patient.
At block 220, the method 200 comprises transmitting the second assessment form by the assessment component to the patient care giver tool UI. It is understood that the second assessment form created based on the updated version of the assessment template is different in some way from the assessment form created in block 206. For example, the second assessment form may comprise one or more fields in an assessment section which were not present in the assessment form created at block 206. Thus, the second assessment form may comprise a field that has a different input length than the same field in the assessment form created at block 206.
At block 222, the method 200 comprises receiving assessment input associated with a completed section of the second assessment by the assessment component from the patient care giver tool UI. At block 224, the method 200 comprises storing the assessment input of the completed section of the second assessment along with an associated section portion of the updated version of the assessment template in the format comprising a plurality of human readable attribute-value pairs in a column of an entry associated with the completed section of the second assessment in the relational database.
Turning now to
At block 234, the method 230 comprises receiving a request for an assessment form by an assessment component executing on a computer system from a patient care giver tool user interface (UI). At block 236, the method 230 comprises creating an assessment form by the assessment component based on an assessment type, based on a patient care giver role, and based on the assessment template. In an embodiment, the processing of block 236 may further be based on an identity of a hospice organization and/or on a tenant ID. In an embodiment, the processing of block 236 is further based on a level of care associated with the patient. At block 238, the method 230 comprises transmitting the assessment form by the assessment component to the patient care giver tool UI.
At block 240, the method 230 comprises receiving assessment input by the assessment component from the patient care giver tool UI. At block 242, the method 230 comprises storing the assessment input along with associated portions of the assessment template in the format comprising a plurality of human readable attribute-value pairs in a column of a table in the data store. At block 244, the method 230 comprises updating a patient plan of care based on storing the assessment input, whereby care provided to a patient is adapted based on the received assessment input. For example, at block 244, an issue is attached to the plan of care. The plan of care is reviewed in an interdisciplinary group (IDG) and a goal is added to the plan of care based on the issue. Based on the newly added goal, an intervention is added to the plan of care. When a hospice care giver next conducts a visit and/or assessment of the subject patient, the care giver provides care based on the newly added intervention. For example, the care giver encourages the patient to listen to classical music to relieve their boredom and depression. For example, the care giver encourages the patient to drink more water. For example, the care giver boosts a pain medication dosage. For example, the care giver spends time to ask the patient to tell a story from his or her youth.
Turning now to
At block 254, the method 250 comprises reading a plurality of scripts associated with the section by the assessment component from a data store. The processing of block 254 may comprise selecting those scripts associated with a predefined tenant identity (e.g., the tenant identity associated with the organization who is caring for the patient undergoing the assessment) and excluding those scripts associated with other tenant identities. In an embodiment, if no tenant identity is identified or a null value tenant identity is identified, a one or more default scripts defined for the assessment section may be read by the assessment component from the data store. In an embodiment, the scripts comprise Groovy scripts, Ruby scripts, or Perl scripts.
At block 256, the method 250 comprises reading a medical condition of the patient from a plan of care associated with the patient, where the plan of care is stored in the data store. In an embodiment, the medical condition of the patient may be one of a diabetic condition, a heart arrhythmia condition, an amputee condition, or a cardiovascular disease condition. In an embodiment, the medical condition of the patient may be an allergy to a medication. In an embodiment, the medical condition of the patient may be a stage and a location of a cancer.
At block 258, the method 250 comprises executing each of the scripts by the assessment component, where the assessment input and the medical condition of the patient is provided as an input to the scripts. In an embodiment, the assessment component may provide additional information to the scripts as input; for example, assessment data from other sections of the assessment of the patient. At block 260, the method 250 comprises, based on executing the script, storing an issue in the plan of care associated with the patient in the data store by the script.
At block 262, the method 250 comprises looking up a goal in the data store based on the issue by a plan of care component executing on the computer system. In an embodiment, a plurality of issues are predefined in the data store. Some of the issues may be associated to predefined goals, such that when a script creates an issue, the plan of care component maps the issue to the associated goal. In an embodiment, the plan of care component is a plan of care microservice 112. At block 264, the method 250 comprises storing the goal in the plan of care associated with the patient in the data store by the plan of care component.
At block 266, the method 250 comprises, based on the goal, determining an intervention by the plan of care component. In an embodiment, some of the goals may be associated to predefined interventions, such that when the plan of care component maps the issue to the goal, the plan of care component additionally maps the goal to the associated intervention. At block 268, the method 250 comprises storing the intervention in the plan of care associated with the patient in the data store by the plan of care component. At block 270, the method 250 comprises presenting the plan of care of the patient on a display of a mobile communication device by the UI, where the presentation of the plan of care comprises the intervention, whereby the care given to the patient is dynamically adapted. For example the user interface server application 110 formats a plan of care display document comprising the intervention and sends the plan of care display document to the care giver UE 102, and the care giver UE 102 presents the plan of care document and intervention to a care giver.
Turning now to
At block 282, the method 280 comprises receiving assessment input for a patient from a patient care giver tool user interface (UI) by an assessment component executing on a computer system, where the assessment input is associated with a section of a patient assessment form. In an embodiment, the assessment component is the assessment microservice 112. The assessment input may be received from the care giver UE 102 by the patient care giver tool 101, for example by the user interface server application 110. The user interface server application 110 may provide the assessment input to the assessment microservice 112.
At block 284, the method 280 comprises reading a plurality of scripts associated with the section by the assessment component from a data store. The processing of block 284 may comprise selecting those scripts associated with a predefined tenant identity (e.g., the tenant identity associated with the organization who is caring for the patient undergoing the assessment) and excluding those scripts associated with other tenant identities. In an embodiment, if no tenant identity is identified or a null value tenant identity is identified, a one or more default scripts defined for the assessment section may be read by the assessment component from the data store. In an embodiment, the scripts comprise Groovy scripts, Ruby scripts, or Perl scripts.
At block 286, the method 280 comprises reading a medical condition of the patient from a plan of care associated with the patient, where the plan of care is stored in the data store. At block 288, the method 280 comprises executing each of the scripts by the assessment component, where the assessment input and the medical condition of the patient is provided as an input to the scripts. In an embodiment, the assessment component may provide additional information to the scripts as input, for example assessment data from other sections of the assessment of the patient. At block 290, the method 280 comprises, based on executing the script, storing an issue in the plan of care associated with the patient in the data store by the script.
At block 292, the method 280 comprises reviewing the plan of care associated with the patient by an interdisciplinary group (IDG). At block 294, the method 280 comprises determining an intervention based on the issue by the IDG. At block 296, the method 280 comprises storing the intervention in the plan of care associated with the patient in the data store. At block 298, the method 280 comprises presenting the plan of care of the patient on a display of a mobile communication device by the UI, where the presentation of the plan of care comprises the intervention, whereby the care given to the patient is dynamically adapted.
It is understood that by programming and/or loading executable instructions onto the computer system 380, at least one of the CPU 382, the RAM 388, and the ROM 386 are changed, transforming the computer system 380 in part into a particular machine or apparatus having the novel functionality taught by the present disclosure. It is fundamental to the electrical engineering and software engineering arts that functionality that can be implemented by loading executable software into a computer can be converted to a hardware implementation by well-known design rules. Decisions between implementing a concept in software versus hardware typically hinge on considerations of stability of the design and numbers of units to be produced rather than any issues involved in translating from the software domain to the hardware domain. Generally, a design that is still subject to frequent change may be preferred to be implemented in software, because re-spinning a hardware implementation is more expensive than re-spinning a software design. Generally, a design that is stable that will be produced in large volume may be preferred to be implemented in hardware, for example in an application specific integrated circuit (ASIC), because for large production runs the hardware implementation may be less expensive than the software implementation. Often a design may be developed and tested in a software form and later transformed, by well-known design rules, to an equivalent hardware implementation in an application specific integrated circuit that hardwires the instructions of the software. In the same manner as a machine controlled by a new ASIC is a particular machine or apparatus, likewise a computer that has been programmed and/or loaded with executable instructions may be viewed as a particular machine or apparatus.
Additionally, after the system 380 is turned on or booted, the CPU 382 may execute a computer program or application. For example, the CPU 382 may execute software or firmware stored in the ROM 386 or stored in the RAM 388. In some cases, on boot and/or when the application is initiated, the CPU 382 may copy the application or portions of the application from the secondary storage 384 to the RAM 388 or to memory space within the CPU 382 itself, and the CPU 382 may then execute instructions that the application is comprised of. In some cases, the CPU 382 may copy the application or portions of the application from memory accessed via the network connectivity devices 392 or via the I/O devices 390 to the RAM 388 or to memory space within the CPU 382, and the CPU 382 may then execute instructions that the application is comprised of. During execution, an application may load instructions into the CPU 382, for example load some of the instructions of the application into a cache of the CPU 382. In some contexts, an application that is executed may be said to configure the CPU 382 to do something, e.g., to configure the CPU 382 to perform the function or functions promoted by the subject application. When the CPU 382 is configured in this way by the application, the CPU 382 becomes a specific purpose computer or a specific purpose machine.
The secondary storage 384 is typically comprised of one or more disk drives or tape drives and is used for non-volatile storage of data and as an over-flow data storage device if RAM 388 is not large enough to hold all working data. Secondary storage 384 may be used to store programs which are loaded into RAM 388 when such programs are selected for execution. The ROM 386 is used to store instructions and perhaps data which are read during program execution. ROM 386 is a non-volatile memory device which typically has a small memory capacity relative to the larger memory capacity of secondary storage 384. The RAM 388 is used to store volatile data and perhaps to store instructions. Access to both ROM 386 and RAM 388 is typically faster than to secondary storage 384. The secondary storage 384, the RAM 388, and/or the ROM 386 may be referred to in some contexts as computer readable storage media and/or non-transitory computer readable media.
I/O devices 390 may include printers, video monitors, liquid crystal displays (LCDs), touch screen displays, keyboards, keypads, switches, dials, mice, track balls, voice recognizers, card readers, paper tape readers, or other well-known input devices.
The network connectivity devices 392 may take the form of modems, modem banks, Ethernet cards, universal serial bus (USB) interface cards, serial interfaces, token ring cards, fiber distributed data interface (FDDI) cards, wireless local area network (WLAN) cards, radio transceiver cards that promote radio communications using protocols such as code division multiple access (CDMA), global system for mobile communications (GSM), long-term evolution (LTE), worldwide interoperability for microwave access (WiMAX), near field communications (NFC), radio frequency identity (RFID), and/or other air interface protocol radio transceiver cards, and other well-known network devices. These network connectivity devices 392 may enable the processor 382 to communicate with the Internet or one or more intranets. With such a network connection, it is contemplated that the processor 382 might receive information from the network, or might output information to the network in the course of performing the above-described method steps. Such information, which is often represented as a sequence of instructions to be executed using processor 382, may be received from and outputted to the network, for example, in the form of a computer data signal embodied in a carrier wave.
Such information, which may include data or instructions to be executed using processor 382 may be received from and outputted to the network, for example, in the form of a computer data baseband signal or signal embodied in a carrier wave. The baseband signal or signal embedded in the carrier wave, or other types of signals currently used or hereafter developed, may be generated according to several methods well-known to one skilled in the art. The baseband signal and/or signal embedded in the carrier wave may be referred to in some contexts as a transitory signal.
The processor 382 executes instructions, codes, computer programs, scripts which it accesses from hard disk, floppy disk, optical disk (these various disk based systems may all be considered secondary storage 384), flash drive, ROM 386, RAM 388, or the network connectivity devices 392. While only one processor 382 is shown, multiple processors may be present. Thus, while instructions may be discussed as executed by a processor, the instructions may be executed simultaneously, serially, or otherwise executed by one or multiple processors. Instructions, codes, computer programs, scripts, and/or data that may be accessed from the secondary storage 384, for example, hard drives, floppy disks, optical disks, and/or other device, the ROM 386, and/or the RAM 388 may be referred to in some contexts as non-transitory instructions and/or non-transitory information.
In an embodiment, the computer system 380 may comprise two or more computers in communication with each other that collaborate to perform a task. For example, but not by way of limitation, an application may be partitioned in such a way as to permit concurrent and/or parallel processing of the instructions of the application. Alternatively, the data processed by the application may be partitioned in such a way as to permit concurrent and/or parallel processing of different portions of a data set by the two or more computers. In an embodiment, virtualization software may be employed by the computer system 380 to provide the functionality of a number of servers that is not directly bound to the number of computers in the computer system 380. For example, virtualization software may provide twenty virtual servers on four physical computers. In an embodiment, the functionality disclosed above may be provided by executing the application and/or applications in a cloud computing environment. Cloud computing may comprise providing computing services via a network connection using dynamically scalable computing resources. Cloud computing may be supported, at least in part, by virtualization software. A cloud computing environment may be established by an enterprise and/or may be hired on an as-needed basis from a third party provider. Some cloud computing environments may comprise cloud computing resources owned and operated by the enterprise as well as cloud computing resources hired and/or leased from a third party provider.
In an embodiment, some or all of the functionality disclosed above may be provided as a computer program product. The computer program product may comprise one or more computer readable storage medium having computer usable program code embodied therein to implement the functionality disclosed above. The computer program product may comprise data structures, executable instructions, and other computer usable program code. The computer program product may be embodied in removable computer storage media and/or non-removable computer storage media. The removable computer readable storage medium may comprise, without limitation, a paper tape, a magnetic tape, magnetic disk, an optical disk, a solid state memory chip, for example analog magnetic tape, compact disk read only memory (CD-ROM) disks, floppy disks, jump drives, digital cards, multimedia cards, and others. The computer program product may be suitable for loading, by the computer system 380, at least portions of the contents of the computer program product to the secondary storage 384, to the ROM 386, to the RAM 388, and/or to other non-volatile memory and volatile memory of the computer system 380. The processor 382 may process the executable instructions and/or data structures in part by directly accessing the computer program product, for example by reading from a CD-ROM disk inserted into a disk drive peripheral of the computer system 380. Alternatively, the processor 382 may process the executable instructions and/or data structures by remotely accessing the computer program product, for example by downloading the executable instructions and/or data structures from a remote server through the network connectivity devices 392. The computer program product may comprise instructions that promote the loading and/or copying of data, data structures, files, and/or executable instructions to the secondary storage 384, to the ROM 386, to the RAM 388, and/or to other non-volatile memory and volatile memory of the computer system 380.
In some contexts, the secondary storage 384, the ROM 386, and the RAM 388 may be referred to as a non-transitory computer readable medium or a computer readable storage media. A dynamic RAM embodiment of the RAM 388, likewise, may be referred to as a non-transitory computer readable medium in that while the dynamic RAM receives electrical power and is operated in accordance with its design, for example during a period of time during which the computer system 380 is turned on and operational, the dynamic RAM stores information that is written to it. Similarly, the processor 382 may comprise an internal RAM, an internal ROM, a cache memory, and/or other internal non-transitory storage blocks, sections, or components that may be referred to in some contexts as non-transitory computer readable media or computer readable storage media.
While several embodiments have been provided in the present disclosure, it should be understood that the disclosed systems and methods may be embodied in many other specific forms without departing from the spirit or scope of the present disclosure. The present examples are to be considered as illustrative and not restrictive, and the intention is not to be limited to the details given herein. For example, the various elements or components may be combined or integrated in another system or certain features may be omitted or not implemented.
Also, techniques, systems, subsystems, and methods described and illustrated in the various embodiments as discrete or separate may be combined or integrated with other systems, modules, techniques, or methods without departing from the scope of the present disclosure. Other items shown or discussed as directly coupled or communicating with each other may be indirectly coupled or communicating through some interface, device, or intermediate component, whether electrically, mechanically, or otherwise. Other examples of changes, substitutions, and alterations are ascertainable by one skilled in the art and could be made without departing from the spirit and scope disclosed herein.
