The advent of electronic health records (EHRs) has improved the exchange of health information. Where before a healthcare provider or patient needed to request, wait for, and receive a hardcopy of medical records by fax or a postal service, the healthcare provider or patient may now receive electronic copies of medical health records nearly instantly by electronic mail or by accessing them over a computer network on a server. An increase in patient and healthcare-provider access to medical information facilitates better patient care by putting it in the hands of providers when they need it most.
Various health organizations, such as the Office of the National Coordinator for Health Information Technology (ONC) operating under the United States Department of Health and Human Services (HHS), are attempting to create and influence Health Information Technology (Health IT) infrastructures that will manage and facilitate EHR access to providers and patients. One of the standards that the ONC included in the regulations for 2014 EHR Certification was the Health Level Seven (HL7) Implementation Guide for CDA Release 2: IHE Health Story Consolidation. The HL7 “consolidated” clinical-document architecture (CDA) standard contains a library of CDA-template standards and represents a single, unified implementation guide for multiple electronic clinical documents.
Most patients, however, do not have the requisite Health IT hardware and software systems or expertise necessary to access their HL7-compliant medical records from their healthcare provider's databases. Many patients may also be discouraged from accessing their medical records because the records are stored in numerous different databases, each database hosted by a different healthcare provider that requires his or her own method of access. Additionally, many patients, upon getting access to their EHRs, may be unable to get meaningful information from the EHRs because the provider prepared the EHRs in a manner such that they are understandable to the provider rather than understandable to the patient. These problems pose unique challenges to EHRs within Health IT infrastructures because EHRs are often needed in emergency-care scenarios where one does not have time to get the necessary hardware, software, and experience to access EHRs on a remote healthcare provider's database. These problems also pose unique challenges to EHRs within Health IT infrastructures because a patient may have tens or, in some cases, hundreds of different healthcare providers over the course of their lifetime, and EHRs could be generated at each of these points of service; a patient may need to spend hours or days accessing each provider's database to find the particular collection of EHRs he or she is looking for. Even if a patient did get access to the EHRs they sought, determining which sections of the EHRs pertain to the specific condition or ailment of interest to the patient may be challenging because acquiring medical knowledge and understanding medical jargon is time-consuming, expensive, and difficult. One or more embodiments of the disclosed systems provide a solution to these problems.
Because electronic health information exchange relies primarily on Internet services and communication of highly sophisticated information that is often needed urgently and collected from hundreds of locations, the challenges of providing EHR access to patients without medical knowledge quickly and easily are unique to the field of Internet-based Health IT. Likewise, the solutions that may have worked for similar, but notably distinct, problems in non-Internet-based Health IT services are not practical or effective for Internet-based Health IT services. For example, a non-Internet-based service may alleviate the lack of medical expertise most patients have by sending an explanatory note with a hardcopy of a medical record. Doing so for an Internet-based service would be unworkable because requiring someone from the provider's office to participate in the information transfer would obviate one of the primary reasons for using an Internet-based service: to have a single-user solution (i.e., a patient requesting the EHR may do so quickly without waiting for participation by the provider who previously uploaded the EHR into his or her database). Therefore, a solution to the problem for non-Internet services does not work for Internet services, and another solution is required to allow patients effective EHR access.
The present disclosure is directed to systems and methods for merging medical information for a patient.
Consistent with at least one disclosed embodiment, a system is disclosed for providing merged medical information for a patient whose medical records are stored in one or more locations. In one embodiment this may be accomplished with one or more storage media storing computer readable instructions; and one or more processors configured to execute the instructions to cause the system to: receive authorization to access at least one medical record associated with a patient; retrieve, based on the authorization, the at least one medical record from at least one database, wherein the at least one medical record comprises one or more sections; associate the one or more sections of the at least one medical record with at least one body part; associate the one or more sections of the at least one medical record with at least one patient medical condition; determine which of the one or more sections are associated with both the same body part and the same patient medical condition; generate, for each body part and patient medical condition that have two or more sections associated with both the body part and patient medical condition, one or more merged sections comprising the two or more sections associated with both the body part and patient medical condition; generate, for each body part and patient medical condition that have one or more sections associated with both the body part and patient medical condition, one or more merged medical records comprising (i) one or more merged sections comprising two or more sections associated with both the body part and patient medical condition, and (ii) one or more sections associated with both the body part and the patient medical condition if such one or more sections associated with both the body part and the patient medical condition are not part of a merged section; receive a selection of a body part of a body image; and provide, in response to receiving the selection of a body part, one or more merged medical records comprising one or more sections associated with the selected body part.
Consistent with at least one disclosed embodiment, providing merged medical information for a patient whose medical records are stored in one or more locations may also be accomplished with a display displaying a body image; at least one input device; one or more storage media storing computer readable instructions; and one or more processors configured to execute the instructions to cause the system to: provide authorization to access at least one patient medical record associated with a patient; provide an indication, via the at least one input device, of a user selection of a body part of the body image; and receive, in response to the indication, one or more merged medical records comprising (i) if such sections exist, one or more merged medical-record sections comprising two or more sections associated with both the selected body part and a common patient medical condition, and (ii) one or more sections associated with both the body part and the patient medical condition if such one or more sections associated with both the selected body part and the patient medical condition are not part of a merged section.
The accompanying drawings, which are incorporated in and constitute part of this specification, and together with the description, illustrate and serve to explain various embodiments.
It is to be understood that both the foregoing general descriptions and the following detailed descriptions are exemplary and explanatory only and are not restrictive of the claims.
The following detailed description refers to the accompanying drawings. Wherever possible, the same reference numbers are used in the drawings and the following description to refer to the same or similar parts. While several illustrative embodiments are described herein, modifications, adaptations and other implementations are possible. For example, substitutions, additions or modifications may be made to the components illustrated in the drawings, and the illustrative methods described herein may be modified by substituting, reordering, removing, or adding steps to the disclosed methods. Accordingly, the following detailed description is not limited to the disclosed embodiments and examples. Instead, the proper scope is defined by the appended claims.
An electronic health record (EHR) is a digital collection of patient health information compiled at one or more meetings in any care delivery setting. A patient's record typically includes various pieces of information, such as patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The advantage of using electronic health records over paper-based records is that it facilitates health information exchange. In order to provide better care, right information needs to be available to right people at right time. A fully interoperable infrastructure of coordinated care and communication across health care providers, patients, and public health entities would improve health care quality, lower health care costs, and improve population health. An interoperable health IT ecosystem would support critical public health functions such as real-time disease surveillance and disaster response, and data aggregation for research and value-based payment that rewards higher quality care, not necessarily a higher quantity of care. Such a system may be used by, for example, a medical patient, a healthcare provider, a caregiver, a member of a family, or a government health official.
The present disclosure describes systems for merging medical information for a patient whose medical records are stored in one or more locations. Such a system may present users with medical information as a single entity by gathering all their medical information from various sources, such as databases and electronic health portals, allowing them to also access specific portions of their medical history. Such a system may comprise, for example, an internet-based application or service. The system for providing merged medical information for a patient may operate in an environment such as exemplary system environment 100, illustrated in
Such a system 210, illustrated in
The system 210 of
The various components of the system 210, illustrated in
As described above, the system 110 of
System 110 of
(1) Application Layer 710: This layer serves as the point of entry for users to interact with the system. The Application Layer provides a login mechanism to allow authorized users to enter the system with their unique username and password. After a user has logged in, the system retrieves the user's medical information, which may be spread across various databases. The system allows the user to query and/or merge different pieces of information from the aggregated medical records. Some sample technologies that can be used to implement this layer include MeteorJS and AngularJS.
(2) Services Layer 720: This layer serves as a facilitator for passing user-initiated instructions, such as queries or merge instructions, to the underlying Semantic Layer 730, and for relaying back query results to the Application Layer for consumption by the user. Some sample technologies that can be used to implement this layer include JAX-RS and Akka.
(3) Semantic Layer 560: This layer stores a user's aggregated data using the RDF data model in a Semantic Web framework such as Jena or Stardog. At a high-level, these frameworks comprise the following components: (a) the Resource Description Framework (RDF) API 740 allows an application to create RDF graphs, store RDF triples in them and find RDF triples that match a given pattern using a high-level, user-friendly programming interface. The SPARQL API 750 allows an application to query/update RDF graphs using the SPARQL query language. The Ontology API 770 provides functions that operate over the richer semantic constructs provided by the RDF Schema and the W3C Web Ontology (OWL) languages. The Inference API 780 provides a means to compute and store inferences in an RDF triple store. The Store API 760 converts user operations defined in the RDF API into low-level, implementation-specific operations on RDF graphs. A Semantic Web framework usually supports several ways to store RDF graphs including, in-memory, SQL databases, custom disk-based tuple indexes, etc. These frameworks also provide a point for users to plug in their own custom storage solutions. The Resource Description Framework (RDF) is a component of the Semantic Web stack. RDF is a graph data model which was primarily designed to facilitate data integration and data distribution on Semantic Web. The fundamental data structure used by RDF is a Triple or a Statement. A triple comprises three parts, namely a subject, predicate and an object. A triple essentially states that the subject resource is related to the object resource via the predicate (aka property or relationship). A set of such triples comprises an RDF graph. The flexibility of RDF is mainly due to the triple data structure. An RDF graph is a graph comprising a set of resources in the form of nodes and relationships/edges/links between the nodes. A resource is represented using a URI that uniquely identifies the resource. While merging RDF graphs from two or more sources, two resources may be treated as being the same if they have the same URI's.
At step 310 of process 300 in
At step 320, the instructions 240 executed by the one or more processors 230 cause the system to retrieve medical records from one or more of databases 160 and 170. The medical records may comply with a particular or group of architectures, such as a consolidated clinical document architecture (C-CDA) template standardized by Health Level Seven International (HL7). Examples of such templates may include, but are not limited to, Continuity of Care Document, Consultation Note, Diagnostic Imaging Report, Discharge Summary, History and Physical, Operative Note, Procedure Note, Progress Note, and Unstructured Document. C-CDA is an XML-based markup standard for specifying encoding, structure, and semantics of clinical documents.
Databases 160 and 170, from which the medical records may be retrieved, may be associated with healthcare institutions. For example, second user 140 may be a healthcare provider (Provider A) operating on a second user device 140A, such as a computer managed by a healthcare institution. The medical records retrieved at step 320 may be created or edited by Provider A 140, and may be stored locally on Provider A's device—second user device 140A—or may be stored in one or more databases 160 and 170. Alternatively or in addition, a third user 150 may be another healthcare provider (Provider B) operating on a third user device 150A, such as a computer managed by another healthcare institution. System 100 may be set up so that database 160 is used exclusively by second user 140 and database 170 is used exclusively by third user 150. The medical records retrieved at step 320 may come from any combination of the databases 160 and 170 and may have originated at any combination of healthcare providers, such as second user 140 and third user 150.
At step 330, the instructions 240 executed by the one or more processors 230 cause the system to associate sections of medical records with body parts and conditions. This process may include data-extraction techniques such as screen scraping the C-CDA compliant medical records and storing the extracted data in a markup language such as Hypertext Markup Language (HTML) or XML. The information may then be organized in a manner that complies with a particular data model, such as Resource Description Framework (RDF) triples, specified by the World Wide Web Consortium. Organization may occur according to a semantic ontology, such as the C-CDA Ontology, though other ontologies may be used instead or in addition to C-CDA. Specifically, each individual medical record may have its information transformed from markup-language form into a named graph of RDF triples using the C-CDA Ontology. Such ontology may contain schema information, such as RDF Schema or OWL constructs, that may be used to convert information from the particular type of C-CDA template implemented by the document to RDF triples. Alternatively, or in addition, the same can be accomplished manually by using a MongoDB schema which captures the semantic relations expressed in the ontology in an offline manner. The schema information may comprise an ontology or a combination of ontologies reflecting a mapping between body parts and medical conditions. In certain embodiments, this schema information may be constructed to reflect a mapping without reliance on a semantic ontology.
At step 340, the instructions 240 executed by the one or more processors 230 cause the system to associate sections of medical records pertaining to medical conditions with a body part. The sections of the medical records may comport to certain templates, such as those specified in the C-CDA standard. An association may be created if, for example, a section within a medical record has information pertaining to a certain body part or a medical condition that may affect the particular body part. This association may be done by assigning a digital tag or other metadata structure to the sections. Multiple tags may be assigned to the section. Alternatively or in addition, the entire medical record may be associated with a body part if the medical record has sections with information pertaining to a medical condition. Alternatively or in addition, the entire medical record may be associated with a body part regardless of whether the medical record has information pertaining to a medical condition. Alternatively or in addition, the entire medical record may be associated with a medical condition regardless of whether the medical record has information pertaining to a body part. In certain embodiments, the entire medical record may be associated with a medical condition and/or by parsing the information within the medical record without regard to what sections are and are not contained within the medical record.
In certain embodiments, the system may determine whether the medical record has information pertaining to a medical condition and then determine itself whether the medical condition is inherently associated with a body part. This may be done, for example, by relying on a mapping between diseases and conditions and other ontologies (such as a mapping between the International Classifications of Diseases, version 10 and the Systemized Nomenclature of Medicine). The mapping may be between medical conditions and body parts. It will be appreciated by one of skill in the art that the structures representing the medical conditions and body parts may be concepts within a semantic ontology that may internally comprise or link to other associated medical conditions and/or body parts. In the case of body parts, for example, the body image may comprise an interconnection of body parts which themselves comprise other body parts and may be navigated at the user 130's request to reach a particular level of specificity or detail within the body image. The medical record's sections may be analyzed for content using a markup language parser, such as an HTML parser or an XML parser.
At step 350, the instructions 240 executed by the one or more processors 230 cause the system to receive a request for medical records or sections therein that are associated with a selected body part. Such request may be received from first user 130. The user may select a body part by selecting a body part on a displayed body image. The selection may comprise clicking on a body part on the body image or hovering a cursor over a body part on the body image. The selection may create a SPARQL query.
In certain embodiments, the exemplary body image 400 of
At step 360, the instructions 240 executed by the one or more processors 230 cause the system to provide non-merged medical records with sections that are associated with the selected body part, or, if sections within the medical records were merged as described in preceding sections of this disclosure, provide merged medical records with merged sections associated with the selected body part. Alternatively, or in addition, the medical records provided may be non-merged regardless of whether sections within the medical records were merged.
Alternatively, or in addition, in certain embodiments the system may provide information medically pertinent to the selected body part. This medically pertinent information may include, but is not limited to, information about providers who treat conditions relating to the selected body part; prophylactic information or other preventative information that helps patients avoid problems with the selected body part; medical treatments; homeopathic treatments for selected body part ailments; nutritional information to maintain or improve functioning of the selected body parts; food-related information that describes various foods that provide the necessary nutrients related with the conditions relating to the selected body part; symptoms and supplement information for the conditions relating to the selected body part; user discussions and comments for the conditions or other topics of interest relating to the selected body part; exercise information to increase strength and/or endurance of the selected body part; or medical literature associated with the body part or conditions affecting the body part. In addition or alternatively, an Internet hyperlink to the information may be provided. The requested information may be collected from publically and/or privately available sources, such as webpages on the World Wide Web. In certain embodiments, the information provided may comprise the pricing and availability of products in various marketplaces that pertain to the selected body part. This information may comprise, for example, supplement price comparisons from different dealers, wherein the supplements are those that pertain to the body part (e.g., vitamin A supplements if the selected body part is the eyes). The information may comprise, for example, books or other literature for sale and the prices associated therewith at different online or brick-and-mortar dealers and merchants. The information provided to the first user 130 may also be merged by subject matter, such as merging sections relating to the selected body part but appearing in different medical reports into a single document. In certain embodiments, the specific information displayed or linked to may be chosen based on information contained within the medical records. For example, if a patient's medical records have sections pertaining to obesity or tags associating the medical condition of obesity with the medical records or the sections therein, selecting the abdomen on the body image may present information pertaining to nutrition and exercise, whereas if the patient's medical records have sections pertaining to pregnancy, selecting the abdomen may give information relevant to pregnant women. In an exemplary embodiment of a medical information system interface, illustrated in
At optional step 370, optionally following step 340, the instructions 240 executed by the one or more processors 230 cause the system to identify and merge sections that pertain to both a common medical condition and a common body part. This may require first determining if there is more than one medical record section that is associated with both the same body part and the same patient medical condition. If so, these sections may be merged. In addition, or alternatively, sections may be merged if they are associated with a common body part. In addition, or alternatively, sections may be merged if they are associated with a common patient medical condition. To facilitate the identification of sections for merging and performing the actual merge, a query language can be used to retrieve and manipulate the necessary metadata, such as that stored in RDF triples. For example, a SPARQL Protocol and RDF Query Language query may be used.
At optional step 380, optionally following optional step 370, the instructions 240 executed by the one or more processors 230 cause the system to generate merged medical records from merged sections and unmerged sections that pertain to both a common medical condition and a common body part. In some embodiments, these merged sections may be placed consecutively in a new document. In some embodiments, sections that were not merged may be added at the end, beginning, or another part of a newly-created document with merged sections. In addition, or alternatively, the system may generate merged medical records from merged sections and/or unmerged sections that pertain to a common medical condition. In addition or alternatively, the system may generate merged medical records from merged sections and/or unmerged sections that pertain to a common body part. In certain embodiments, information comprising a merged document's history may be created. The document's history may comprise information describing when the document was produced, what system the document was produced with, what documents the merged sections originated from, and other information describing the merged document's history, formation, and pedigree. Such document history may be embedded, associated, or both with the merged document.
The systems and methods described above may be implemented by any hardware, software, or a combination of hardware and software having the above-described functions. The software code, either in its entirety or a part thereof, may be stored in a computer readable memory.
While several implementations have been provided in the present disclosure, it should be understood that the disclosed systems and methods may be implemented in many other specific forms without departing from the 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 implementations 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 coupled or 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.
While the above detailed description has shown, described, and pointed out the fundamental novel features of the disclosure as applied to various implementations, it will be understood that various omissions and substitutions and changes in the form and details of the system illustrated may be made by those skilled in the art, without departing from the intent of the disclosure.
This application claims the benefit of U.S. Provisional Application Ser. No. 62/139,142, filed Mar. 27, 2015, which is hereby incorporated by reference in its entirety.
Number | Date | Country | |
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62139142 | Mar 2015 | US |