Patent Application
20080235049
[Not Applicable]
[Not Applicable]
[Not Applicable]
Embodiments of the present method and system relate generally to the field of data processing to facilitate medical diagnosis and treatment. Specifically, embodiments of the present method and system relate to predicting relevant clinical information based on historical trends and interventional plans.
In the modern healthcare environment, considerable amounts of patient data are generated during the course of a given patient's interactions with healthcare providers. The data consists principally of measured variables collected during patient observations, diagnoses, and treatments. For example, patient vital signs, laboratory test values, and other relevant measurements are entered into various computer systems at various points in time. Collectively, this data presents a historical picture of patient health.
Modern healthcare facilities typically manage these considerable amounts of patient data via computer systems. These computer systems are often networked systems having data stores or databases and workstations allowing clinical users to view patient data. Historical patient data may be displayed as isolated data points. For example,
Moreover, historical patient data may also be displayed as data trends. That is, the measurements of a given variable or set of variables may be displayed as a function of time. By displaying historical patient data in this way, a clinician may gain insight into the variation in a patient's condition over time. For example,
Displaying trends in a set of historical patient data over time also provides a clinician with a view of how different measured variables may have varied in relation to each other over time. For example, a clinician may be able to observe how a patient's weight and cholesterol levels have followed a similar trend over a certain period of time. While such a combination of trends in measured variables is helpful to a clinician, what is missing is a system capable of predicting and displaying patient data based on historical patient data trends.
One element useful for predicting future patient data based on historical patient data is a clinical framework or a set of clinical guidelines for modeling such data. Through analysis of clinical experience with diagnosis and treatment of patient conditions, a framework for decision-making related to patient treatment can be established. Clinical trials of pharmaceuticals, for example, provide data regarding patient outcomes. Actual clinical use of the same pharmaceuticals provides further data regarding such outcomes. By synthesizing the accumulated data related to a certain pharmaceutical, a clinical framework for modeling the use of that pharmaceutical in patients can be developed.
Moreover, the outcomes for a given patient may depend on a range of other variables that may have their own clinical guidelines. For example, the framework or guidelines for the management of a patient's blood pressure may indicate generally a potentially negative interaction with certain pharmaceuticals. However, close study of the clinical framework for that certain pharmaceutical may indicate a therapeutic dosage window that does not create any risk for the patient's blood pressure management. This complex interaction between two clinical frameworks is compounded by the many different possible patient variables and is especially cumbersome for patients presenting multiple clinical needs. A healthcare provider with access to the individual clinical frameworks for each of a patient's clinical needs would have a difficult time appreciating all the potential interactions and predicting the outcome of changing any of the appropriate clinical variables.
In modern clinical practice, clinicians may encounter knowledge-based expert systems that contain clinical information about specific clinical tasks or about specific patient conditions. When such expert systems are supplied with basic patient data, the expert system may supply as output a suggested therapy or course of action for a clinician to follow. The expert system typically consists of a set of rules. For example, expert systems may contain a set of rules associated with the prescription of medications
What is needed is a system and method for applying guidelines for clinical decision making to historical patient data. What is also needed is a system and method for the interactive manipulation of relevant clinical variables and the display of predicted outcomes based on such interactive manipulation. Such a system and method may take advantage of the combination of existing expert systems to provide multifaceted predictive analysis of a patient's condition.
Certain embodiments of the present invention include a method for predictive modeling of patient outcomes. The predictive method includes the steps of applying an algorithm to patient data and displaying predicted patient data. The predictive method may further include the step of adjusting one or more clinical variables.
Certain embodiments of the present invention include a system for modeling patient outcomes based on historical patient data. The system includes a database of patient data, a rules engine operably connected to the database wherein the rules engine is capable of applying algorithms to the patient data to generate predicted patient data, and a user interface operably connected to the database.
The foregoing summary, as well as the following detailed description of certain embodiments of the present invention, will be better understood when read in conjunction with the appended drawings. For the purpose of illustrating the invention, certain embodiments are shown in the drawings. It should be understood, however, that the present invention is not limited to the arrangements and instrumentalities shown in the attached drawings.
The methods of certain embodiments of the present invention may be carried out using the types of computer systems commonly available in the modern healthcare environment. These computer systems are often networked systems having data stores or databases and workstations allowing clinical users to view and otherwise interact with patient data. The workstations may include user interface devices, such as keyboards or touchscreens.
The components and/or functionality of system may be implemented alone or in combination in hardware, firmware, and/or as a set of instructions in software, for example. Certain embodiments may be provided as a set of instructions residing on a computer-readable medium, such as a memory, CD, DVD, or hard disk, for execution on a general purpose computer or other processing device, such as, for example, a workstation.
Certain embodiments of the present system and method make use of clinical guidelines or a clinical framework. The terms clinical guidelines or clinical framework refer to clinical protocols and practices for managing patient needs. For example, clinical guidelines include the protocol for treating a patient who has presented with a certain condition, such as high blood pressure. The guidelines for treating a patient with high blood pressure may include, for example, counseling regarding nutrition and smoking cessation. The guidelines for treating a patient with high blood pressure may also include prescribing a specific dosing profile of an appropriate pharmaceutical. The clinical guidelines for such a dosing profile may, in turn, depend on other factors such as patient age, weight, or reproductive status. It should be understood that the clinical guidelines may be substantially more complex than this example; this example is simplified for clarity.
Clinical guidelines may exist for a single condition, or they may exist in complementary fashion for multiple conditions often associated with one another. The clinical guidelines or framework may also change over time, as the standard of care for a given condition changes. The clinical frameworks have as a basis the empirical data generated by clinical practice and clinical trials, and may also change over time with the introduction of new pharmaceuticals or other treatment modalities. The present system and method is not limited to the current standards of care or clinical practices.
The clinical guidelines or clinical frameworks employed in conjunction with certain embodiments may leverage existing expert systems, or may involve the development of new expert systems. Expert systems contain clinical knowledge, usually about a very specifically defined condition, diagnosis, or treatment, and are able generate reasoned conclusions concerning individual patients. For example, an expert system can help in the formulation of likely diagnoses based on existing patient data in complex cases where diagnostic assistance is needed. Such systems may be leveraged into the rules engines that apply the clinical frameworks.
According to certain embodiments of the present invention, patient data retrieval step 310 may include identifying the source of some or all of a given patient's data but not physically retrieving the data. That is, the output of patient data retrieval step 310 may simply be a list of network locations where patient data is stored and not the actual patient data. Thus, patient data retrieval step 310 provides access to relevant patient data regardless of whether the patient data is copied, moved, or otherwise transferred from one network location to another, according to certain embodiments of the present invention. Moreover, in certain embodiments of the present invention, patient data retrieval 310 may not occur as a separate step from another step in the method, or it may occur as a subset of another step in the method.
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In certain embodiments of the present invention, algorithm step 320 may include multiple substeps that apply different algorithms to the same set of patient data. For example, certain algorithms that have clinical frameworks that are specific to a certain disease state, such as Type 2 diabetes, may be applied to the patient data alone or in conjunction with other disease-specific clinical frameworks. Thus, algorithm step 320 may not simply apply a single, global algorithm to the patient data but may instead apply a series or a set of specific algorithms, and each algorithm may be of varying scope. Moreover, algorithm step 320 may apply an algorithm to the data output from another algorithm. In other words, the clinical framework for the treatment of a first disease state may dominate the clinical framework for the treatment of another disease state in such a way that the historical patient data is run through first algorithm and only the results of the first algorithm are used as the data input for the second algorithm. Further, multiple algorithms may depend on the output of other algorithms, as dictated by the clinical frameworks involved in a specific patient's data modeling.
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The condition component may include several factors and/or variables to be evaluated with various dependencies between them. Dependencies may include, for example, Boolean operators such as “AND,” “OR,” and “NEITHER.” The condition component may include a variety of conditions specified by an expression or operator such as “equal to,” “less than,” “greater than,” “drop by %,” and “increased by.” In addition, an expression or operator included in the condition component may include a temporal characteristic. For example, the expression might be “within the past hour” or “over one day ago.”
A rule may be implemented as a table, interpreted code, database query, or other data structure, for example. A rule may be represented in a variety of ways known to one having ordinary skill in the art. A rule may be implemented as content in a database, for example. The database may store, for example, a rule type, criteria, operator, and value. The database may contain a rule identifier with one to many criteria pairs such as “criteria=glucose level, operator=rises, value=2%,” for example.
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Moreover, the rules engine applying the clinical framework may determine that altering certain clinical variables will have minimal or no effect on patient outcomes for a particular patient condition. In that case, key variable identifying step 440 may identify variables that will have minimal or no effect on patient outcomes and flag them as variables that should not be manipulated during the interactive process.
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Multiple items, factors, and/or variables may be added to the variables being evaluated using the variable configuration panel. For example, the predictive model may include several factors and/or variables to be evaluated with various dependencies between them. Dependencies may include, for example, Boolean operators such as “AND” and “OR.” Another operator may be the “EXISTS” operator, for example. The “EXISTS” operator may be used to determine if, for example, an order exists or if a patient has a particular allergy.
Thus, various embodiments of the present system and method provide for the application of guidelines for clinical decision making to historical patient data. Certain embodiments of the present system and method provide for the interactive manipulation of relevant clinical variables and the display of predicted outcomes based on such interactive manipulation. Various embodiments of the present system and method provide the ability for a clinician to interactively visualize the impact of a specific intervention/treatment plan over time. Various embodiments of the present system and method allow healthcare professionals the ability to adjust variables such as dosage, interval and duration of a specific drug or interventional procedure over time and view the computer derived projections. Various embodiments of the present system and method provide the healthcare professional the ability to plan an intervention specific to a particular patient as opposed to leveraging the “cookie-cutter” templates provided in clinical reference manuals.
Certain embodiments of the present system and method employ a predictive modeling engine that is able to leverage existing, historical patient data with healthcare interventional plans consisting of current best-in-breed clinical guidelines. For example, based on a particular patient's trends for a particular lab value, measurement, or vital sign, an algorithm that leverages the current intervention plan is able to derive or predict what the value will be based on specific dosage, durations, and other variables. The resulting predictive information can be displayed in the context of a line chart that highlights the historical, actual data with predictive data that differentiates from the historical data. Such differentiation can occur by means of color, line weight, line symbol, or other graphical means. Certain embodiments of the present system and method provide healthcare professionals with the ability to interactively increase or decrease clinical variables such as dose, duration, or interval with the various intervention plans to visualize the potential impact of this specific intervention plan.
In one example of an embodiment of the present invention, Lipitor dosage has been increased 50% over a two month period. Based on this patient's past medical history with this drug, other drug interactions and current best-in-class clinical guidelines, a computer algorithm is able to predict an LDL cholesterol level for this patient. It should be understood that this example is simplified for clarity.
In another example of an embodiment of the present invention, a patient's mortality risk is projected as it relates to a surgical procedure. Based on how a physician is able to manage the patient's Diabetes A1C levels and Asthmatic encounters, the mortality risk can be interactively set to display what the patient's mortality risk would be for a given procedure. It should be understood that this example is simplified for clarity.
While the invention has been described with reference to certain embodiments, it will be understood by those skilled in the art that various changes may be made and equivalents may be substituted without departing from the scope of the invention. In addition, many modifications may be made to adapt a particular situation or material to the teachings of the invention without departing from its scope. Therefore, it is intended that the invention not be limited to the particular embodiment disclosed, but that the invention will include all embodiments falling within the scope of the appended claims.
