Computerized medical advice system and method including meta function

What is claimed is:

1. A method of evaluating a problem of a patient over time and providing advice in an automated medical advice system, comprising the steps of:

receiving, through an input device, data indicative of symptoms of a patient;

creating a consultation history database, the database comprising a sequence of records based on the received patient data, each record including the following fields: a date, a medical problem, an anatomical system, and a cause of the problem;

storing the consultation history database in a computer;

analyzing the consultation history database using a match pattern, wherein the step of analyzing comprises:

accessing a set of records within the consultation history database by use of a time window, the time window comprising a range of preselected dates;

comparing the match pattern to each of the accessed records; and

calculating a consultation frequency value from matched records identified by the comparing step; generating a recommendation if the frequency value satisfies a match threshold; and

communicating the recommendation through an output device.

2. The method defined in claim 1, additionally comprising the step of identifying at least one of a plurality of database fields of interest by use of the match pattern.

3. The method defined in claim 1, wherein the frequency value comprises a count of matched records.

4. The method defined in claim 1, wherein the match pattern includes at least a problem field.

5. The method defined in claim 1, wherein the match pattern includes at least an anatomic system field.

6. The method defined in claim 1, wherein the match threshold is predetermined so as to suggest a deteriorating medical condition when the match threshold is reached.

7. The method defined in claim 1, wherein the step of analyzing identifies a most recent record, a next most recent record, and a second most recent record, and wherein the frequency value comprises a time density ratio specified by dividing a time difference of the second most recent record and the next most recent record by the time difference of the next most recent record and the most recent record.

8. A method of evaluating a problem of a patient over time and providing advice in an automated medical advice system, comprising the steps of:

receiving, through an input device, data indicative of symptoms of a patient over a period of time;

creating a consultation history database, the database comprising a sequence of records based on the received data;

storing the consultation history in a computer;

applying a match pattern to the consultation history database;

generating a recommendation if a consultation frequency value of matched records located by applying the match pattern satisfies a match threshold; and

communicating the recommendation through an output device.

9. The method defined in claim 8, wherein each record comprises a plurality of fields which include: a date, a medical problem, an anatomical system, and a cause of the problem.

10. The method defined in claim 8, wherein the step of applying comprises:

accessing a set of records within the consultation history database by use of a time window, the time window comprising a range of preselected dates;

comparing the match pattern to each of the accessed records; and

calculating the consultation frequency value from the matched records identified by the comparing step.

11. The method defined in claim 10, wherein the match threshold is representative of a preselected minimum number of records particular to the match pattern.

12. An automated medical advice system, comprising:

a computer;

an input device connected to the computer for receiving information from a user over a period of time;

a consultation history database stored by the computer, the database comprising a sequence of records based on the received information;

a search process that searches the consultation history database using a match pattern to identify records having the match pattern;

an analysis process that analyzes the frequency of the user's diagnostic consultations, wherein the records identified by the search process permit assessment of an improvement or a deterioration of a patient's medical condition; and

an output device connected to the computer for transmitting advice to the user based on the frequency analysis.

13. The automated medical advice system defined in claim 12, wherein each record is indicative of a user's diagnostic consultation.

14. The automated medical advice system defined in claim 12, wherein each record comprises a plurality of fields which include: a date, a medical problem, an anatomical system, and a cause of the problem.

15. The automated medical advice system defined in claim 14, wherein the match pattern includes at least a problem field.

16. The automated medical advice system defined in claim 14, wherein the match pattern includes at least an anatomic system field.

17. The automated medical advice system defined in claim 14, wherein the match pattern includes at least a cause field.

18. The automated medical advice system defined in claim 14, wherein in each of the records of the consultation history database, a cause of the problem field comprises one of the following: allergy, environment, infection, mental, poison, trauma, vascular, genetic, nutritional, metabolic, endocrine, or tumor.

19. The automated medical advice system defined in claim 14, wherein in each of the records of the consultation history database, the anatomical system field is selected from the group consisting of skeletal (orthopedic), cardiovascular, gastro-intestinal, gynecologic, hematologic, larynx, nervous, ophthalmologic, respiratory, skin, urological, and endocrine.

20. The automated medical advice system defined in claim 12, wherein the match pattern comprises a character string.

21. The automated medical advice system defined in claim 20, wherein the analysis process includes a match threshold representative of a preselected minimum number of records particular to the match pattern.

22. The automated medical advice system defined in claim 21, wherein the analysis process includes a time window used to access the records identified by the search process, the time window comprising a selected period of time.

23. The automated medical advice system defined in claim 22, wherein the system provides advice to the user if the analysis process determines that the match threshold is achieved within the time window.

24. The automated medical advice system defined in claim 22, wherein the system sets a meta re-enter indicator and requests the user to consult with the system upon reoccurrence of a medical condition if the analysis process determines that the match threshold is not achieved within the time window.

25. The automated medical advice system defined in claim 12, wherein the search process identifies a most recent record, a next most recent record, and a second most recent record, and wherein the analysis process includes a calculation of a time density ratio specified by dividing a time difference of the second most recent record and the next most recent record by the time difference of the next most recent record and the most recent record.

26. The automated medical advice system defined in claim 12, additionally including a plurality of medical algorithms selectively executed by the computer, the medical algorithms including commands written in an authoring language program, said commands including at least one match pattern.

27. The automated medical advice system defined in claim 26, wherein each consultation history database record is written in response to a write command in a selected one of the medical algorithms.

28. The automated medical advice system defined in claim 12, wherein the input device includes a dual tone multiple frequency (DTMF) signal processing subsystem.

29. The automated medical advice system defined in claim 12, wherein the input device includes an automatic speech recognition subsystem.

30. The automated medical advice system defined in claim 12, wherein the output means includes a speech playback system.

31. The automated medical advice system defined in claim 12, wherein the user and the patient are the same person.

Description Submit all comments and votes

MICROFICHE APPENDIX

A Microfiche Appendix containing computer source code is attached. Microfiche Appendix comprises 9 sheets of microfiche having 457 frames, including one title frame.

The Microfiche Appendix contains material which is subject to copyright protection. The copyright owner has no objection to the reproduction of such material, as it appears in the files of the Patent and Trademark Office, but otherwise reserves all copyright rights whatsoever.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to medical knowledge systems and, more particularly, to systems for giving medical advice to the general public over a telephone network.

2. Description of the Related Technology

Health care costs currently represent 14% of the United States Gross National Product and are rising faster than any other component of the Consumer Price Index. Moreover, usually because of an inability to pay for medical services, many people are deprived of access to even the most basic medical care and information.

Many people delay in obtaining, or are prevented from seeking, medical attention because of cost, time constraints, or inconvenience. If the public had universal, unrestricted and easy access to medical information, many diseases could be prevented. Likewise, the early detection and treatment of numerous diseases could keep many patients from reaching the advanced stages of illness, the treatment of which is a significant part of the financial burden attributed to our nation's health care system. It is obvious that the United States is facing health-related issues of enormous proportions and that present solutions are not robust.

One prior attempt at a solution to the health care problem is called Ask-A-Nurse, wherein a group of nurses provide health information by telephone around-the-clock. A person with a medical problem calls an 800 number and describes the problem to the nurse. The nurse uses a computer for general or diagnostic information on the ailment or complaint mentioned by the caller. The nurse may then refer the caller to a doctor from a computerized referral list for a contracting hospital or group of hospitals. Client hospitals contract with Ask-A-Nurse to provide patient referrals. A managed care option called Personal Health Advisor is similar and adds the capability for the caller to hear prerecorded messages on health topics 24 hours a day. Several problems exist with these prior medical advice systems. First, these systems have high costs associated with having a nurse answer each telephone call. Second, the caller may have to belong to a participating health plan to utilize the service. Third, if for some reason all nurses on a particular shift happen to be busy and the caller has an emergency condition (that is not known by the caller to be an emergency), precious time in getting emergency services may be lost during the delay.

Another prior health system was developed by InterPractice Systems which provides a computerized service that answers health care questions and advises people in their homes. A health maintenance organization (HMO) may provide this service to its members in a particular geographic area. To get advice at home, an HMO member connects a toaster-sized box to a telephone and calls a toll-free 800 number. Using a keyboard that is part of the box, the user answers questions displayed on a screen of the box relating to the user's symptoms. Depending on the answers, the user might be told to try a home remedy, be called by a nurse or doctor, or be given an appointment to be examined. A limitation of this system is the additional expense of the electronics box, which could either be purchased by the user for approximately $300 or purchased by the health organization with the expense to be passed on to the users. Another limitation is that this service is directed to members of a particular contracting health organization, such as an HMO. What is desired is a system that does not require additional hardware for the basic service, but that utilizes the existing communication network. The desired system should be available for use by any person, not just members of a certain organization.

A prior attempt at a health care solution for a limited set of conditions is described in U.S. Pat. No. 4,712,562. A patient's blood pressure and heart rate are measured and the measurements are sent via telephone to a remote central computer for storage and analysis. Reports are generated for submission to a physician or the patient. U.S. Pat. No. 4,531,527 describes a similar system, wherein the receiving office unit automatically communicates with the physician under predetermined emergency circumstances.

U.S. Pat. No. 4,838,275 discloses a device for a patient to lay on or sit in having electronics to measure multiple parameters related to a patient's health. These parameters are electronically transmitted to a central surveillance and control office where a highly trained observer interacts with the patient. The observer conducts routine diagnostic sessions except when an emergency is noted or from a patient-initiated communication. The observer determines if a nonroutine therapeutic response is required, and if so facilitates such a response. As previously mentioned, highly trained people are needed by this system along with the special measurement apparatus (embedded in a bed or chair).

Other prior attempts at a health care solution are typified by U.S. Pat. No. 5,012,411 which describes a portable self-contained apparatus for measuring, storing and transmitting detected physiological information to a remote location over a communication system. The information is evaluated by a physician or other health professional. As before, highly trained people are necessary to utilize such an apparatus.

Several services to provide medical or pharmaceutical advice are now available via "1-900" telephone numbers, e.g., "Doctors by Phone." These services are available 24 hours a day and 7 days a week. A group of doctors, including some specialties, is available to answer questions about health care or medical conditions for people anywhere in the United States who call the "1-900" telephone of one of the services. A group of registered pharmacists answers questions about medications for the "1-900" pharmaceutical service.

SUMMARY OF THE INVENTION

The present solution to the health care problem is a computerized medical diagnostic and treatment advice (MDATA) system that is a medical knowledge-based system designed to give medical advice to the general public over the telephone network. The goal of the MDATA system is to provide everyone with equal access to high quality, 100%-consistent medical advice at a reasonable cost. The MDATA system provides callers with extremely fast and virtually unlimited access to health care information, twenty-four hours a day, from any location around the world. Health care advice is made available to an entire spectrum of users, from elderly patients confined to their homes to travelers in a foreign country with telephones in their cars.

The central ideas leading to the development of the MDATA system are based on the following assumptions:

Nearly 90% of all patient complaints are confined to approximately 100 medical problems.

Almost all primary care decisions involved in these 100 problems can be made based upon information learned solely by obtaining a detailed medical history. The results of the physical examination, laboratory, and imaging studies only tend to confirm a diagnosis.

The minimal amount of information that many doctors believe can only be obtained from the physical examination can actually be directly acquired from the patient when given appropriate instructions.

In most cases, a face-to-face interaction between the doctor and patient is not necessary. A detailed and well-constructed history, along with physical findings elicited from the patient, can be obtained over the telephone.

Medicine is basically diagnosis and treatment. Although treatment recommendations change frequently, the fundamental principles of making the diagnosis do not.

There is a significant delay between the time a new therapy is recognized as safe and effective and the time physicians are able to provide it to their patients.

These central ideas are utilized in the implementation of the MDATA system.

A goal of the MDATA system is to give better medical advice than a family practitioner who is unfamiliar with a patient, e.g., an on-call physician. A person seeking medical advice frequently will not be able to see or speak with his or her personal physician in a timely manner. The MDATA system provides medical advice whenever desired by the caller--seven days a week/24 hours a day.

All previous medical algorithms, including those used in the military, are designed for face-to-face interactions. Self-help books generally do not consider age and sex in their algorithms. Furthermore, a book cannot take into account how many times a person has consulted the same algorithm within a short period of time for the same problem. The medical algorithms used by the MDATA system are designed for use in a telecommunications setting and overcome the deficiencies of self-help books.

Previous medical advice systems do not do a time-density analysis for a number of factors with regard to the number of complaints per unit of time. The MDATA system uses "meta" functions to perform these analyses.

Previous medical advice algorithms do not have a way of detecting the consciousness level of the person seeking consultation. The MDATA system invokes a "mental status examination" whenever a complaint or problem has the possibility of an altered level of consciousness. In addition, the MDATA system uses "semantic discrepancy evaluator loops" which allow the system to invoke the mental status exam if there are differences in answers to the parallel threads of thought that are woven or embedded into the system.

Other medical advice systems do not have a "re-enter" feature to monitor a patient's progress or worsening over time. The MDATA system checks for and responds to changing conditions over time.

Prior medical advice systems suffer from the inability to be nearly instantly up-dated as new medical information is made available. The MDATA system regularly and frequently updates the treatment aspect of the system.

The computerized medical diagnostic and treatment advice (MDATA) system is a medical knowledge-based system designed to give medical advice to the general public over the telephone network. Using a new authoring language, interactive voice response and speech recognition technology, the MDATA system encodes a highly useful core of expert and general practitioner diagnostic and treatment knowledge into a computerized system for access by non-medically trained personnel.

The MDATA system does not provide advice for every medical problem, nor does it make an exhaustive study of one vertical cross-section of medicine. Instead, the MDATA system provides up-to-date medical advice for approximately one hundred of the most commonly encountered problems in general practice and emergency medicine. It also provides valuable information to the public on any number of other medical topics.

As another embodiment of the MDATA system, a person desiring medical advice and having access to a personal computer (PC) loads a program into the PC to produce a stand-alone medical diagnostic and treatment advice (SA-MDATA) system. Rather than listening to questions and responding via touch tone keypresses or via voice, the user responds to questions and directions displayed on the computer screen via a computer input device, such as a keyboard or mouse. The diagnosis and/or treatment recommendations provided by the MDATA system are the same as that provided by the SA-MDATA system. The user of the SA-MDATA system can procure updates by contacting the MDATA system sponsor/administrator to obtain the most current treatment table information for a particular diagnosis.

One aspect of the present invention includes, in an automated medical advice system including a computer, at least one input device and at least one output device, a method of evaluating a problem of a patient over time and providing advice, comprising the steps of: receiving, through the input device, data indicative of symptoms of a patient; creating a consultation history database, the database comprising a sequence of records based on the received patient data, each record including the following fields: a date, a medical problem, an anatomical system, and a cause of the problem; storing the consultation history database in the computer; analyzing the consultation history database using a match pattern, wherein the step of analyzing comprises: accessing a set of records within the consultation history database by use of a time window, the time window comprising a range of preselected dates; comparing the match pattern to each of the accessed records; and calculating a consultation frequency value from matched records identified by the comparing step; generating a recommendation if the frequency value satisfies a match threshold; and communicating the recommendation through the output device.

Another aspect of the present invention includes, in an automated medical advice system including a computer, at least one input device and at least one output device, a method of evaluating a problem of a patient over time and providing advice, comprising the steps of: receiving, through the input device, data indicative of symptoms of a patient over a period of time; creating a consultation history database, the database comprising a sequence of records based on the received data; storing the consultation history database in the computer; applying a match pattern to the consultation history database; generating a recommendation if a consultation frequency value of matched records located by applying the match pattern satisfies a match threshold; and communicating the recommendation through the output device.

Yet another aspect of the present invention includes an automated medical advice system, comprising: a computer; an input device connected to the computer for receiving information from a user over a period of time; a consultation history database stored by the computer, the database comprising a sequence of records based on the received information; a search process that searches the consultation history database using a match pattern to identify records having the match pattern; an analysis process that analyzes the frequency of the user's diagnostic consultations, wherein the records identified by the search process permit assessment of an improvement or a deterioration of a patient's medical condition; and an output device connected to the computer for transmitting advice to the user based on the frequency analysis.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram illustrating the components of a presently preferred embodiment of the computerized medical diagnostic and treatment advice (MDATA) system of the present invention;

FIG. 2 is a diagram of the off-line process used in producing the speech files shown in FIG. 1;

FIG. 3 is a diagram of the Node Translation process used in creating files for use by the system of FIG. 1;

FIG. 4 is a diagram of some of the files and components of FIGS. 1 and 3 that are utilized at run time;

FIG. 5a is a diagram of the utilization of the files shown in FIG. 3 at run time;

FIGS. 5b-5g are an exemplary sequence of data structures of the system shown in FIG. 1 at run time;

FIG. 6 is a block diagram illustrating a conceptual view of the database files and processes of the system of FIG. 1;

FIGS. 7a, 7b, 7c and 7d are a top-level flow diagram of the MDATA system of FIG. 1;

FIGS. 8a and 8b are a flow diagram of the patient login process 250 defined in FIG. 7a;

FIGS. 9a and 9b are a flow diagram of the patient registration process 252 defined in FIG. 7a;

FIGS. 10a and 10b are a flow diagram of the evaluation process 254 defined in FIG. 7d;

FIGS. 11a and 11b are a flow diagram of the meta function 500 defined in FIG. 10b;

FIGS. 12a and 12b are a flow diagram of the assistant login process 272 defined in FIG. 7b;

FIGS. 13a and 13b are a flow diagram of the assisted patient login process 276 defined in FIG. 7b;

FIGS. 14a and 14b are a flow diagram of the assistant registration process 274 defined in FIG. 7b;

FIGS. 15a and 15b are a flow diagram of the assisted patient registration process 278 defined in FIG. 7b;

FIGS. 16a and 16b are a flow diagram of the mental status examination function 508 defined in FIG. 10b;

FIG. 17 is a flow diagram of the semantic discrepancy evaluator routine (SDER) 510 defined in FIG. 10b;

FIG. 18 is a flow diagram of the past medical history routine 512 defined in FIG. 10b;

FIG. 1