Patent Application
20060095429
This invention generally relates to networked systems for obtaining, evaluating, and managing medical data and more particularly relates to a system for routing medical image data over a network for remote screening and processing.
The advantages of network communication for transmission of diagnostic information about a patient from one site to the next have been acknowledged by medical practitioners. The capability for transfer of data and images from a test site to a specialist for assessment has enabled the growth of a number of new services for remote diagnosis. While network communication of such data has a number of benefits, there remain some drawbacks to wider acceptance and use of this capability. In terms of workflow, for example, conventional network communication schemes often impose restrictive procedures that are inflexible and are not well-suited to the varying needs of patients, primary care physicians (PCPs) or medical specialists. Moreover, changes in insurance coverage rules and local and federal regulations render such inflexible systems cumbersome to adapt and more vulnerable to obsolescence.
As one exemplary problem area of interest, there is considerable concern in the medical community that timely detection and treatment for diabetic retinopathy, macular degeneration, and other vision-related conditions are not being provided for a large percentage of patients who are affected by such debilitating conditions. Over time, diabetic retinopathy affects a majority of those who suffer from diabetes, often leading to severe vision impairment and blindness if not treated early. Accurate diagnosis of diabetic retinopathy requires the skills of a trained specialist, who views the retina of a patient to look for lesions and other evidence of this condition during a periodic examination. Currently, a high percentage of these examinations are made at the office of a specialist and are performed by the specialist or by trained staff members. More recently, various camera apparatus have been devised, especially designed for the type of fundus imaging needed for preliminary diagnosis, allowing a specialist to view images of the patient for diagnostic assessment. For example, U.S. Pat. No. 5,943,116 (Zeimer) discloses an optical system for obtaining the 7-image fundus series used for this type of diagnosis.
One notable problem with conventional methods for examination of patients relates to the cost and inconvenience to patients in visiting the ophthalmologist or optometrist. Statistics show, for example, that most diabetic patients visit their regular primary care physician (PCP) on at least an annual basis; but the number of these patients who also make an annual visit to an eye specialist is relatively low in comparison.
There have been a number of recent efforts to alleviate this problem and increase the compliance percentage of patients needing periodic examinations. One approach has been the development of imaging equipment that does not require specialists for operation. U.S. Pat. No. 5,943,116, for example, addresses the need for a lower cost fundus imaging system that can be operated by non-ophthalmic staff at the PCP office, and that obtains images without requiring dilation of the patient's eyes. Images obtained in this way can then be uploaded to a centralized image reading center for evaluation by trained technicians and specialists.
The use of centralized reading center 50 for collecting and evaluating patient images, as described in U.S. Pat. No. 5,943,116, has a number of advantages for cost, efficiency, and more effective delivery of diagnostic services. There have been a number of commercial ventures established using this model. For example, Inoveon Corporation, Oklahoma City, Okla., USA provides networked diagnostic reading centers 50 for ophthalmic evaluation of retinal images for diabetic retinopathy. At reading center 50, non-physician technicians perform initial screening of images, with follow-up by medical specialists where problems are identified. Similarly, EyeTel Imaging, Inc., Centreville, Va., USA operates a central reading center 50 that is network-connected to physician's offices for obtaining images that can be remotely screened for diabetic retinopathy using fundus camera apparatus 52. Likewise, U.S. Pat. No. 5,993,001 (Bursell et al.) discloses a network-distributed system that allows a variable arrangement of image data collection units connected to a variable number of examination units for medical specialists, all accessed through a central server. Other patent disclosures that describe remote diagnostic imaging facilities include U.S. Patent Application Publication 2002/0052551 (Sinclair et al.); PCT International Application Nos. WO 96/017545 (Bursell et al.); WO 02/084511 (Yogesan); WO 03/020112 (Sinclair et al.); and U.S. Pat. No. 6,470,320 (Hildebrand et al.)
While diagnostic systems using remote, centralized reading centers provide a number of advantages, there are still perceived difficulties in providing the level of service and diagnostic accuracy needed for providing this vital function. Advantages of networked image transfer, high volume storage, and centralized data access can be readily acknowledged; however, there is an understandable reluctance among medical practitioners to adopt a new workflow for diagnostic evaluation simply because it takes advantage of these technological advances. In fact, as is shown in
In order to embrace the new methodology and workflow that this technology affords, specialists, physicians, patients, and insurance providers alike must have compelling evidence that accuracy, success rates, and overall performance of the system exceeds current methods for delivery of diagnostic services. Only when true improvements are obtained will remote diagnostic imaging systems be widely accepted as equivalent to any “gold standard” currently accepted by medical practitioners and service providers.
Among the perceived drawbacks of these new schemes for networked diagnostic imaging is the need to rearrange conventional workflow. This requirement impacts each participant in the process. For example, patients would be receptive to having screening examinations performed without the need to make a separate appointment with an eye specialist; however, the screening apparatus must be accurate and comfortable for the patient. Preferably, for example, a nonmydriatic imaging system, that is, one not requiring pupil dilation, would be preferred. Primary care physicians (PCPs) 46 would be receptive to performing the steps needed for obtaining screening images, provided the apparatus is easy to operate; certainly, the more easily operable the imaging system, the more attractive the procedure for PCPs 46. Ophthalmologists or other specialists 48 would be receptive to providing higher levels of service to their patient base, allowing them to focus on more complex diagnosis and treatment, rather than on screening services; however, the medical specialist 48 may want to preserve current workflow arrangements and must have a high degree of confidence in the overall performance and accuracy of the remote diagnostic imaging system. Insurance providers, who currently exhibit some caution concerning the accuracy and suitability of these remote diagnostic tools, would be receptive to methods that improve service to their subscribers while reducing costs. In addition, there must be conformance with applicable laws regarding the use of apparatus for obtaining, transmitting, and safeguarding diagnostic data.
In light of these complex requirements, existing networked diagnostic imaging systems, while offering the promise of improved service and performance, fall somewhat short of what is needed for broad acceptance of these systems. Some of the existing systems, for example, employ expensive camera equipment and require specialized operator training, adding cost and complexity. Existing systems are typically assembled and configured at the image capture site, which may be a PCP office. These systems can be costly to install, particularly where a service call is required for their connection and initial configuration. Imaging systems requiring administration for networking, software update, and the like place demands for training and retaining skilled staff members at a PCP office or test facility. In addition, a number of systems employing network image transfer require pupil dilation of patient 12, which is less desirable.
To date, image handling and workflow schemes that have been proposed and implemented for remote assessment of medical images have focused heavily on clinical processing and disease management. Early adopters of remote diagnostic imaging directed their efforts to obtaining accurate and efficient analysis of image content and subsequent diagnosis. However, while this is a worthwhile goal, a number of practical problems remain, preventing widespread implementation of networked diagnostic imaging schemes. For example, existing systems are characterized by a relative lack of flexibility in workflow. In many cases, the centralized reading center follows a fairly rigid workflow scheme, obtaining the patient image, performing a diagnostic assessment, and reporting information back to the attending physician, who may be a PCP or ophthalmic specialist. Understandably, some physicians 46 and specialists 48 balk at adopting a workflow that can be perceived to take work out of their control, without providing the option of their own oversight for verification. For example, specialist 48 may be willing to access patient images stored remotely, but be unwilling to accept diagnostic evaluations performed by technicians at central reading center 50. Or, specialist 48 may accept a “coarse” level of screening from reading center 50, but prefer closer, personal examination of images for patients who exhibit any type of perceived problem. Existing systems, however, are not amenable to adapt to the professional preferences of specialists 48 or PCPs 46 for providing different levels of service and access. As this example illustrates, existing systems appear to impose rigid workflows that can easily hamper their widespread acceptance by the medical community.
There has also been some resistance to networked diagnostic imaging from health insurers. Administrative complexities due to different plans, variable levels of coverage, and changing federal and state regulations hamper a broader adoption of remote diagnostic imaging simply because not all tests can be reimbursed for all patients under all health insurance programs. The accuracy of some types of remote testing remains in question and is expected to improve over time. In the meantime, however, the role of the health insurer has not been sufficiently taken into account with existing networked solutions. Similarly, employer stipulations and requirements have not been taken into account.
Conventional schemes for remote diagnostic assessment are also fairly inflexible with respect to reporting details. With most systems, the diagnostic assessment for a patient is reported back to the PCP for referral. However, there may be other parties requiring access to this information. For example, there may be cases where immediate referral to a specialist is needed; delay in the PCP office would not be desirable. Or, an insurance carrier may need access to the results, requiring the carrier to request them from the PCP office, with consequent delay and overhead costs. In addition, different levels of information might be needed for different parties to the treatment or reimbursement process.
An overall drawback of conventional remote diagnostic imaging or testing systems relates to the decision-making process that may be required once the images or other test data are obtained. Even if the test data is always routed to the same remote site for diagnosis, other reporting is necessary once the test results are obtained. The multiple and complex tasks of handling requests for different types of information from different insurance carriers, routing results to any of a number of specialists for further examination and/or treatment, maintaining patient files, and coordinating the transfer of information in accordance with privacy regulations, all may fall on the staff at the PCP office. If this is the case, it should not seem surprising that remote diagnostic systems have not been more broadly embraced and endorsed.
There is a compelling need for improving the delivery of medical treatment to patients, particularly those who have diabetic retinopathy, macular degeneration, and other debilitating conditions that affect vision. This need is particularly pronounced for patients over age 65, a growing part of the population. Early treatment of such conditions can help to preserve vision for millions of those who are at risk, with considerable concomitant savings in medical expense and costs of social services. This argues for any incremental improvement that helps to provide the benefits of remote diagnostic imaging services, particularly for vision-related conditions.
Thus, what is needed is a system for obtaining diagnostic data, obtaining routing criteria from patient, medical, and reimbursement sources, and routing the data according to routing instructions based on these routing criteria.
It is an object of the present invention to provide an improved, more flexible workflow for networked diagnostic imaging systems, particularly those related to conditions of the eye. With this object in mind, the present invention provides method for dynamically routing medical data related to a patient in a communications network, comprising:
From another aspect, the present invention provides a system for providing a diagnosis for a patient comprising:
It is a feature of the present invention that it provides a rule-based workflow that takes into account different workflow arrangements for assessment of diagnostic data and images. Individualized rules can be applied to each patient account for dynamic routing of images or other diagnostic data using this scheme.
It is an advantage of the present invention that it allows a more flexible workflow for processing diagnostic data and images, taking into account the approval/reimbursement policies of health care insurers, the variable working practices of medical professionals, and patient preferences. Advantageously, the rule-based routing workflow can be changed as needed for any diagnostic data, without requiring interaction by office staff.
It is an advantage of the present invention that it provides an image capture appliance that is easily configured and easy to operate, able to accept remotely provided instructions for its operation. It is also an advantage of the present invention that it allows sending the data directly from the image capture appliance to a networked reading appliance.
It is a further advantage of the present invention that it provides a viewing appliance that allows medical images to be assessed at a remote site, without requiring extensive system administration activities for its configuration and use. It is also an advantage of the present invention that it allows reports based on diagnosis to be transmitted back to the viewing appliance site.
These and other objects, features, and advantages of the present invention will become apparent to those skilled in the art upon a reading of the following detailed description when taken in conjunction with the drawings wherein there is shown and described an illustrative embodiment of the invention.
While the specification concludes with claims particularly pointing out and distinctly claiming the subject matter of the present invention, it is believed that the invention will be better understood from the following description when taken in conjunction with the accompanying drawings, wherein:
The present description is directed in particular to elements forming part of, or cooperating more directly with, apparatus in accordance with the invention. It is to be understood that elements not specifically shown or described may take various forms well known to those skilled in the art.
The general term “profile” is used in subsequent description as it is often used to describe a structured body of information relative to a user account or to other entity in a computer or networked system. The method of the present invention takes advantage of a number of different types of profiles available at one or more sites on a networked system.
Referring to
It should be noted that the term specialist as used herein can be interpreted broadly to include a range of medical specialties. A grouping of specialists, such as a practice group, could also participate in the system and method of the present invention.
Connected along network 16 in the embodiment of
Reading appliances 20, 22 for medical image assessment may be installed at a centralized reading center or at a specialist site. Additionally, reading appliances 26 may be installed at a health insurance provider's facility. In one embodiment, the function of reading appliance 20, 22, 26 is programmable, allowing controlled access to information at any point in network 16.
A central services processor 28 acts as a control center, performing access and functional administration functions for all sites that use diagnostic imaging system 10. With this system, central services processor 28 orchestrates, to some degree, the operation of each networked component, from installation and initial configuration to its day-to-day operation. Central services processor 28 communicates with logic processors 34, 36, 38, and 40 at various sites along the network to obtain information used to condition the routing function provided for patient diagnostic data or images and test results. Logic processors 34, 36, 38, and 40 could be conventional networked computers or dedicated systems for interface with diagnostic imaging system 10.
With the system arrangement of
Control of Image Capture Appliance 14
Referring to
Image capture appliance 14 could be a networked computer workstation connected to a digital camera, as in a number of conventional networked diagnostic imaging system solutions. The preferred embodiment, however, employs a true “networked appliance” approach. The networked appliance is analogous to cable TV interconnect boxes that, to the end user, are merely “plug-in” devices, but actually include internal processors, memory, and software. Networked appliances of this type are addressable and remotely configured, with control software downloaded by the network control facility. With such an arrangement, the end user need not be concerned with complexities of making connections, passing commands and security permissions, or other data transactions when using such an appliance. In diagnostic imaging system 10, network control of this type of appliance is performed by central services processor 28. Using this model, when image capture appliance 14 is unboxed at installation, it merely needs to be plugged into the network, without extensive configuration by user personnel at the site. Central services processor 28 automatically scans and detects a newly connected image capture appliance 14 and configures the device accordingly upon detection. In one embodiment, image capture appliance 14 is configured as a device capable of executing Java code, or other interpreted code, downloaded through the network, under control of central services processor 28.
As is shown in
Central services processor 28 also exercises control over image capture appliance 14 operation. When patient 12 is identified to image capture apparatus 14, instructions provided by central services processor 28 can be used to direct image capture apparatus 14 functions, including specifying the image sequence that is obtained, for example. Once images and other data are obtained, routing instructions from central services processor 28 can be used to dictate how images are processed and to specify one or more remote reading appliances 20, 22, 26 or one or more remote reading centers 50 to receive the images.
Using the networked appliance model, then, image capture appliance 14 operation can be streamlined, customized for the needs of each patient 12. This arrangement would help to assure that the proper image sequence or series of suitable tests is obtained for each patient 12, based on that patient's condition and history and based on applicable requirements or restrictions obtained from the health insurance provider. This arrangement also allows billing and other management functions to be performed automatically, minimizing confusion due to poor communication between office personnel at the PCP 46 and those at a specialist 48 or insurance provider office. This also reduces paperwork and text data entry at the PCP office or test site and can help to provide well-documented medical images and other data for further transmittal and assessment.
Control of Reading Appliance 20, 22, 26
The same type of configuration control exercised for image capture appliance 14 can also be applied to reading appliance 20, 22, 26 at a reading center, medical specialist facility, health insurance provider, or other site that is permitted to view medical images or other data obtained by diagnostic imaging system 10. Installation of reading appliance 22 at a specialist site, for example, is straightforward, using the same “plug-in” sequence that applies for image capture appliance 14 at the PCP site. Central services processor 28 detects a newly connected reading appliance 20, 22, 26 as soon as it is plugged into the network and configures the device accordingly.
In addition, central services processor 28 can perform any necessary software updates for reading appliances 20, 22, 26. This is advantageous, particularly where software is provided that assists diagnosis or performs other functions such as initial image quality assessment, for example. Reading appliances 20, 22, 26 may include diagnostic assessment utilities, enabling specialists to take advantage of image processing tools for more accurate diagnosis. Supporting software tools may be options, available to specialists or other viewers for an additional fee, for example.
In terms of ease of use, reading appliance 20, 22, 26 is necessarily more complex than image capture appliance 14 must be. Image viewing software, even with optional additional software to aid in diagnosis, requires some level of skill to operate effectively. However, the administration of these systems can be greatly streamlined using remote administration from central services processor 28.
Reading appliance 20, 22, 26 could be a conventional computer workstation, equipped with the specific software needed for image acquisition and assessment. This arrangement would allow specialist 48 to install reading software on a networked computer that is also used for other purposes. Optionally, reading appliance 20, 22, 26 could be a dedicated appliance following the networked appliance model as described above for image capture apparatus 14, not a platform intended for other functions.
Summary of Central Services Processor 28 Functions
The functions of central services processor 28, then, may include any or all of the following:
The use of routing decisions from central services processor 28 also allows flexibility in how each site uses diagnostic imaging system 10. For example, where an insurance carrier requires that a certain series of images be obtained for patients 12 having a certain medical condition, central services processor 28 can be used to make sure that routing rules provide that this series be captured. Where a participating PCP 46 has staff that is skilled to perform only basic screening image capture procedure, central services processor 28 can control image capture apparatus 14 so that only this procedure is performed.
Routing rules and instructions from central services processor 28 can be downloaded as needed, either at periodic intervals or on a patient-by-patient basis, depending on the hardware configuration, frequency of use, differences in types of images obtained, and other factors. The operating instructions from one image capture apparatus 14 to the next and routing rules applied from one patient 12 to the next may vary, depending on specialist 48 or PCP 46 preferences, skill level of available personnel, patient 12 preferences, insurance provider coverage guidelines, employer requirements, or other appropriate factors.
For constructing routing rules, patient account information is made accessible to central services processor 28 from some source. The source of this information may be accessed through an insurance provider, for example. Server 18 may store patient account information; however, since this information often requires update, and because diagnostic imaging system 10 must interface with other medical data information systems, it is unlikely that storing this duplicated information in database 24, for example, would be prudent. Instead, some source feed (not shown in
Routing of Patient Images
As the above description indicates, using diagnostic imaging apparatus 10, patient image and related diagnostic data, although typically stored at server 18 and provided from that facility, can be routed to various reading appliances 18 or to logic processors 34, 36, 40 in any number of ways. To determine the routing instructions for data from each patient 12, control logic from central services processor 28 applies requirements specific to that patient 12. This rule-based image transmittal, processing, and access control is a key to the overall flexibility of diagnostic imaging apparatus 10. Referring to
The first step in processing the patient medical image or other data is an identification step 100 for identifying the specific patient 12 to diagnostic imaging apparatus 10. For example, prior to obtaining the patient images at the office of PCP 46, a keypad could be used for operator entry, or patient self-entry, of a social security number or other individualized identifier. Or, a scanning device associated with image capture appliance 14 could be used to identify a patient. Retinal scanning itself, since it has the capability for positive identification of a subject, could even be employed for identifying a continuing patient 12. Alternately, other identification methods using biometrics, such as scanning fingerprints or DNA analysis could be used. Next, in a patient profiling step 102 a patient profile is obtained. This patient profile gives general information about patient 12 that is needed to obtain additional information and may be obtained from a logic processor (not shown in
In diagnostic imaging system 10 of the present invention, the patient profile is a collection of patient metadata, that is, data about the patient, that includes data fields that may influence the routing of patient medical images. For example, various factual or preferential data may be weighted as factors in generating routing instructions. Referring to
It must be emphasized that the fields shown in
Again referring to the process flow diagram of
It must be emphasized that the examples of
After the workflow profile is formed, it can be processed in a receiving site selection step 118 to obtain a listing of suitable alternative receiving sites for the medical image obtained in image capture step 108 or other data obtained in an equivalent medical test. Then, based on data in the workflow profile, a suitable receiving site can be selected. The patient data can be transmitted to the appropriate receiving site in a transmittal step 130. In addition, the patient data can also be stored at one or more additional networked sites.
As was described above with reference to
During the next sequence of steps, various rules and requirements are obtained from key participants in the diagnostic and authorization and reimbursement process. In an obtain PCP rules step 160, specific requirements laid down by PCP 46 are obtained. These requirements may specify, for example, preferred specialists or business arrangements, such as agreements with third-party services or with specific reading centers 50. In an obtain various rules step 162, central services processor 28, based in part on PCP rules obtained in obtain PCP rules step 160 and on the patient profile obtained in patient profiling step 154, gathers rules and requirements for transmittal of the diagnostic or other test data from patient 12 from various other sites on the network. For example, obtain various rules step 162 may obtain rules or preferences for routing image data from the following:
Based on the patient profile, as was described above, and on rules and preferences obtained in obtain, typically as profiles, in PCP rules step 160 and obtain various rules step 162, central services processor 28 may perform an optional identify specialist step 164. In this step, a suitable specialist is identified, either for referral following diagnostic results obtained at reading center 50 or for receiving the images and other data directly. Following this, an obtain specialist rules step 168 may then be executed, to download rules information from logic processor 36 at specialist 48 site (
After gathering all of the needed information from various sites along network 16, typically stored as profiles that can be maintained and independently updated by separate systems at each site, central services processor 28 is able to process and generate a routing instruction. Acting as an inference engine, central services processor 28, working with a workflow profile, carries out a make routing decision step 174. In this step, central services processor 28 evaluates the various rules and preferences from PCP 46, patient 12, specialist 48, insurance carrier(s), employer(s), including business arrangements, local and federal government guidelines and other criteria, obtained from the various profiles described. Central services processor 28 then provides a routing instruction, typically as a workflow profile, to image capture appliance 14 for sending the image and/or related diagnostic data from the PCP office or other test site at which the data were obtained.
Once routing instructions for patient 12 data are obtained in this way, transmit routing instructions step 180 is executed by central services processor 28, sending the routing instructions to image capture appliance 14 at the PCP site. Image capture appliance 14 then transmits the obtained images to one or more other systems on network 16 accordingly. Typically, patient images will be transmitted to server 18, even where image data was also sent to some other party on network 16. Images are transmitted to server 18 for storage and for making images accessible as needed by various reading appliances 20, 22, 26 on network 16. In addition to routing the image data, transmit routing instructions step 180-may also execute the supporting step of providing other sites with additional background information or medical history for the patient.
Role of the Specialist
One important aspect of diagnostic imaging system 10 of the present invention relates to interaction with specialists 48. Considerable flexibility is provided to adapt to specialist preferences and requirements in image acquisition, routing, and assessment, encouraging specialist participation in the workflow scheme of the present invention. As noted earlier, some specialists 48 have expressed reluctance, at least initially, in accepting the diagnosis of reading center 50 personnel. Or, specialist 48 may want only a specific level of assessment from remote reading center 50. This may vary with patients 12 and their conditions and can change over time. By developing a unique routing instruction for each set of patient images, the system and method of the present invention allow specialist 48 the flexibility to interact with reading centers 50 and PCP sites in a preferred way.
In the conventional model employed in the commercial systems currently in use, the centralized reading center automatically obtains all images from PCP or other testing sites. The reading center than performs initial screening and provides test results back to the PCP for referral. The specialist has little or no involvement in this initial screening process. In contrast, diagnostic imaging system 10 of the present invention allows a number of different schemes for medical image routing and initial assessment. A particular specialist 48 may be satisfied with the assessment of reading center 50, particularly for non-critical cases, and may not choose to view images for patients 12 unless conditions of a certain threshold level are detected. Alternately, specialist 48 may want the capability to access to any and all patient images, regardless of reading center 50 determinations. Specialist 48 preferences as to image viewing would be applied to routing instructions for patients 12 whose cases are referred to that practitioner.
Image Quality Feedback
Diagnostic imaging system 10 provides an image quality feedback mechanism that enables images of suitable image quality to be obtained from image capture appliance 14. Each image obtained for patient 12 can be immediately transmitted to reading center 50, where some combination of assessment by trained personnel as well as automated image assessment tools can help determine whether or not image quality is acceptable for screening purposes. This helps to prevent the need for recalling patient 12 in the event of operator error or incorrect adjustment of imaging components in image capture appliance 14. Feedback can be provided immediately upon receipt of the patient image or other data. This feedback could relate to the quality of the data or could related to diagnostic assessment of the data itself. For example, a technician at a reading appliance 22 could be assigned the function of reporting back on the overall image quality of a retinal scan. Or, a certified specialist may be assigned to provide a diagnostic assessment and report this information back immediately. This real-time, on-line reporting of diagnostic results is advantaged over conventional systems, that may provide image quality assessment such as using diagnostic software to report back to the PCP site.
How Rules for Participant Interaction Determined
As shown in the flow diagram of
In obtain various rules step 162, central services processor 28 queries insurance carrier(s), employer(s) and other relevant parties for routing preferences information. For example, an employer may specify that certain types of tests are or are not covered for a level of reimbursement under an employer plan, such as for a certain classification of salaried employees. This may override, supercede, or supplement restrictions or guidelines posited by the insurance carrier. It can be seen that preliminary to obtain various rules step 162, a number of software utilities must be employed at sites of these various participants in diagnostic imaging system 10. In one embodiment, a software utility is provided to employers to determine special coverage conditions and to maintain a file profiling these conditions, where this file can be accessed and interpreted by central services processor 28.
For interaction with insurance carriers, central services processor 28 may maintain a feed directly from the insurance carrier database. This interface uses database access techniques well known to those skilled in the database software arts. This enables central services processor 28 to have up-to-the-moment coverage information on each patient 12, so that medical images and test data can be suitably routed based on coverage at the time the data are obtained. In one embodiment, a health plan profile is provided and constantly updated, as was shown in the example of
It must be noted that, while central services processor 28 provides the data gathering and inference engine logic for obtaining rules and preferences from numerous sites around network 16 in the embodiment described with reference to
One key consideration for providing routing instructions is to maintain updated information. Outdated information about any of the participating partners to diagnostic imaging system 10 could cause the generation of routing instructions that are not correct. For example, a particular specialist 48 may go on extended vacation, visiting professorship, maternity leave, sabbatical, or move to another practice. Similarly, continuing changes in insurance provider provisions, in local and federal governmental requirements, and in employment status could easily render stored information obsolete unless a continuing update effort is maintained. Thus, regardless of where the routing instruction is generated, each participant in diagnostic imaging system 10 must regularly update information provided for preferences and rules.
The use of profiles, as described and shown in the examples of
In one embodiment, all of the image data obtained is available to any authorized participant who uses diagnostic imaging system 10. However, this may not be necessary or desirable with some types of data. For example, an insurance carrier may not want transmission of several megabytes of image data to logic processor 40. Instead, all the information the insurance carrier may need can be packaged in a small text file, giving patient identification, date of the test performed, image routing information, specialist recommendations or preferences, employer data, and other suitable information. This minimal amount of data may be all that is needed in order for the insurance carrier to initiate reimbursement processing.
With further reference to the sequence of steps shown in
In one embodiment, the routing instruction is an IP address; in another embodiment, a separate file is appended to the patient's data, listing suitable network addresses for transmittal of image data and for results transmittal.
As an example using the method of the present invention, during the routine visit by a patient to a first site, which may be primary care practice office, a retinal image is acquired. The system prompts for the patient's identification from the image acquisition operator, or automatically requests it from a medical practice management system. This identification is used by the system to access the patient profile. Since the patient is covered by an insurance company, the system proceeds to access the insurance company's profile to determine which health plan is applicable to the patient based on the patient's employer id and plan option. From the applicable healthcare plan the system extracts the plan's eligibility requirements for the exam. For example, an exam may be covered once a year provided the images are read by an approved ophthalmic specialist. The patient profile is checked to verify that the patient's previous exam was more than a year ago.
The system next extracts the list of eligible eye specialists from insurance company profile. The system uses the ID of the eye specialist who had written the previous report from the patient profile and extracts the profile from of this eye specialist and also extracts the list of preferred eye specialist from the PCP's profile. In this example, the system detects from the specialist's profile that the eye specialist has retired, and proceeds to compute a common list from the insurance company's eligible list and the PCP preferred list. This common list is now validated against the preferences of the patient specified in the patient profile. Assuming that the patient prefers an English-speaking specialist, the system shortens the list accordingly. Assuming that the short list has only one candidate, the system proposes this name to the operator and the patient for their final approval. Assuming for our example that the proposed specialist is acceptable the system begins the task of preparing the final workflow profile (as shown in the process of
If an electronic patient record is available, the system can access it for additional clinical information such as glucose level, weight gain etc to assemble the information that is necessary, in addition to the medical images, for the specialist/technician to perform the diagnostic screening for the diabetic retinopathy. Otherwise the system prompts for the operator to input the necessary clinical information.
The system then accesses the profile of the selected eye specialist at the second site. First, the profile is checked to assure that the specialist is available for the diagnosis. Next, the notification preferences of the eye specialist are checked to see how and when to notify the second site once the medical data is transmitted to the second site. The second site may specify, for example, that notification be initiated via pager message whenever four or more screening tests are pending, or at the end of the day. The system accesses the wait queue for the second site and, assuming that there are three tests in the queue, concludes that the new test will reach the specified threshold for notification. The system then proceeds to send medical data to the second site and sends a pager message that includes the total diagnostic screening tests in the wait queue for the specialist at the second site.
In a slightly different example, during the routine visit by a patient to a first site, which may be primary care practice office, a retinal image is acquired. The system prompts for the patient identification from the image acquisition operator or automatically requests it from the medical practice management system. Patient identification is used by the system to access patient profile. The system extracts the ID of the eye specialist who has written the previous report from the patient profile. The system uses the specialist's id to access the specialist's profile to test specialist availability. Assuming for this example that the specialist is away on vacation, the system will then extract the backup specialist's ID specified by the original specialist profile, as well as any backup reporting requirements. The system next accesses the profile of the backup specialist to extract the address of the second site and the reporting and notification specification in a similar manner described in the first example above.
The system also accesses the PCP profile, which contains preferences for how and when to notify the PCP office of the availability of the report from the specialist. For example, the PCP may specify that a plain English version of the diagnostic report be mailed to the patient that includes educational literature under the PCP's letterhead with a copy to the PCP. In addition, if the diagnostic report is not normal, the PCP may wish to be notified by pager of the abnormal exam, to be followed up by a report by fax. This information is included in the final version of the workflow profile.
As described in the first example, the system assembles the medical data and sends it to the second location, and then notifies the second site. Upon receipt of the notification, the specialist accesses the pending medical data, performs the diagnosis, and inputs the report and the level of disease progress. Assume for this example that the diagnosis is not normal, but that the patient need not see an eye specialist immediately. The system detects this diagnosis and accesses the workflow profile associated with the original medical data. It extracts the reporting and notification requirements for this workflow profile. In particular, it obtains information on how to form the diagnostic report and how to send it to the PCP. In this example, the system sends a copy of the report to the PCP via fax and sends a notification to the PCP via an e-mail message as specified. In this example, the system requests a third site to convert the original report into plain English language, add specified literature and customize it under the letter head of the specified medical practice. This material is then mailed from the third site to the patient via regular mail. In addition, a report is sent to the original eye specialist on vacation in the form and factor that is specified in their profile for their records. This example assumes that the original specialist has specified that the kind report be send in the form of e-mail with a link to an secured site where the text of the report is stored.
Notification and Transmission of Diagnostic Assessment Results
Among advantages of diagnostic imaging system 10 are its flexibility in providing flexible and dynamic routing instructions that also encompass the transmission of diagnostic results. That is, the routing instructions generated by central services processor 28, or generated by some other logic control device or arrangement of devices on network 16, may also provide instructions for transmitting a diagnostic report giving results of an assessment of images or other test data. Thus, for example, following assessment by specialist 48, a diagnosis report, compiled by specialist 48 or qualified staff members, is transmitted to one or more participants according to routing instructions. Or, following assessment by reading center 50, a summary report may be generated and distributed according to routing instructions.
One aspect of results reporting relates to the types of information sent to other participants. The patient, for example, may require only a quick summary of the diagnosis in text form. An insurance carrier may need other information that is not of direct interest to patient 12 or to PCP 46, but is of interest for billing or for use in subsequent treatment considerations. An employer may not need or be permitted to have access to specific diagnostic information, but may need only to know that the test was performed and the diagnosis properly reported. In one embodiment, the initial routing instructions generated from central services processor 28 at the time the image or test data is obtained from patient 12 provide this information for obtaining feedback from diagnostic participants. In another embodiment, a separate set of routing instructions is generated by central services processor 28 following diagnostic assessment. In this embodiment, the diagnostic results themselves condition the routing instructions generated. Thus, for example, results from reading center 50 may be forwarded to specialist 48 directly where patient 12 exhibits a condition determined to require immediate attention. The format of the data can be varied, based on the intended recipient. For example, results forwarded to the patient may include a key subset of the data, with analysis expressed in layman's terms, whereas reports sent to a specialist may include the full set of data and more specialized terminology.
A notification profile can be included as part of the patient, PCP, or specialist profiles or can be generated as a separate data entity, with the overall schema arrangement shown in
Coordination with Billing and Reimbursement Systems
One aspect of the present invention that can be particularly advantageous relates to its flexibility for dealing with variable billing and reimbursement schemes. Unlike the static image transmission and reporting characteristic of existing systems, diagnostic imaging system 10 of the present invention allows billing and reimbursement information to be available at any of several points in network 16, according to permitted access. Thus, for example, patient 12 may be informed of proposed reimbursement at the PCP office, before or immediately following testing. PCPs 46 and specialists 48 can obtain information relative to reimbursement and billing for current and referred patients 12, even including a preference for obtaining reimbursement information as part of results reporting. Payment on a per-test basis can be computed. A payment profile, as shown in the example of
While the apparatus and methods described above for the present invention primarily relate to medical images, it can be appreciated that much of the same arrangement of diagnostic imaging system 10 could be applied for obtaining other types of diagnostic test data for patient 12 and for determining how to route this data to participants around network 16. Other types of test data of interest could include blood sample results or information from tests of other body fluids, data from EKG apparatus, or sleep pattern data for example.
The invention has been described in detail with particular reference to certain preferred embodiments thereof, but it will be understood that variations and modifications can be effected within the scope of the invention as described above, and as noted in the appended claims, by a person of ordinary skill in the art without departing from the scope of the invention. For example, diagnostic imaging system 10 flexibly allows connection between any number of image capture appliances 14 and reading appliances 20, 22, 26, serving patients and medical professionals over a broad geographic area. A number of different arrangements for dynamic generation of routing instructions for diagnostic imaging data are possible, depending on the needs and requirements of various participants in providing and reimbursing diagnostic imaging services. A variety of notification methods may be used, including notification from a remote site.
As noted above, there is a compelling need for improvement in the delivery of medical treatment to patients, particularly those who have diabetic retinopathy, macular degeneration, and other debilitating conditions that affect vision. The apparatus and method of the present invention provide a flexible system for more efficiently and effectively providing remote screening of ophthalmic and other medical images.
