r
`
`United States Patent [19]
`Talbnan et at.
`
`[54} MEDICAL NETWORK MANAGEMENT
`SYSTEM AND PROCESS
`
`[75]
`
`Inventors: Joseph P. TallllUln; EliZllbeth M.
`Snowden, both of Boulder, Colo.;
`Barry W. Wolcott, Derwood, Md.
`
`[73) Assignee: Informed Access Systems, Inc.,
`Boulder. Colo.
`
`[21] App1. No.: 180,090
`
`. [22] Filed:
`
`Jan. 10, 1994
`
`Int. Cl.6
`................................................... G061~ 159/00
`[51]
`[52J U.S. Cl ............................................................... 3641406
`[58J Field of SClirch ......................... 364/413.0), 413.02,
`364/413.03,406
`
`[56]
`
`References Cited
`
`U.S. PATENT DOCUMENTS
`
`4,130,BSt
`4,489,387
`4,839,822
`4,858,121
`4,945,476
`5,065,315
`5,072,383
`5,253,164
`5,255,187
`
`Ilt974 Hnesslcr ct nl .................... 36111'11:>.02
`12ft984 Lamb ct a!. ............................ ~64/514
`6/1989 D()rIDond et al ....................... 364/513
`811989 Barber ct a1. ........................... 364/406
`7/l990 Hodick c! al. ..................... 364/413.02
`1111991 Garcia ................................ 364/413.01
`1211991 Brimm c! al.
`..................... 3!Y1/4D.02
`JOft993 Holloway ct al ....................... 364/406
`1011993 Sorensen ............................ 364/413.02
`
`OTHER PUBLICATIONS
`
`Broome, M. E., "1clephone Protocols for Pediatric Assess(cid:173)
`ment and Advice", Journal uf Einergellcy Nursillg, voL 12,
`No. 13, May/Jun. J986, pp. 142-146.
`Curry et a!., "Telephone Assessment of lllnClss: What Is
`Being Taught amI Learned?", Pediatrics, vol. 62, No.4, OCl.
`1978, pp. 603-605.
`Kravitz et aI., "Telephone in Diagnosis of Respiratory
`Diseases", American Journal of Dise.ases of Childrtm, pp.
`471-472.
`Obcrklaid, et ai., "Paediatric Telephone Consultation-A
`Ncglected Area of Healtb Service Delivery", Aust. Peadi·
`alTics, vol. 20, 1984, pp. 113-114.
`Fosarelli, P. D., wI'he Telephone in Pediatric Medicine",
`Clinicall'edialrics, vol. 22, No.4, Apr., 1983, pp. 293-296.
`
`111111111111111111111111111111111111111111111111111111111111111111111111111
`US005471382A
`[I1J Patent Number:
`[45J Date of Patent:
`
`5,471,382
`Nov. 28, 1995
`
`Mapes et aI .• "Feasibility Study of a Pediatric lclephonc
`Consultation Service", Pedialrics, vo!. 50, No.2, Aug. J 972,
`pp. 307-3 J I.
`Nickerson et aI., "How Dependable is Diagnosis and Man(cid:173)
`agement of Earache by Telephone?", Clinical l'ediarrics,
`vol. 14, No. JO, Oct. 1975, pp. 920-923.
`Wood, P. R., "Pediatric Resident Training in Telephone
`Management: A Survey of Tnrining Programs in the United
`States", Pediatrics, vol. 77, No.6, Jun. 1986, pp. 822-825.
`Katz, H. P., "A Schema for Improving Efficiency in an
`Ambulatory Care Setting", Clinical Pediatrics, vol. 14, No.
`7, luI. J 975, pp. 658-661.
`Knowles et aI., "ED Medical Advice Telephune Calls: Who
`Calls and Why?", Juumal of Emergency Nursing, vol. 10,
`No.6, Nov.lDec. 1984, pp. 283-286.
`Smith et aI., "Patient Management by Telephone: A Training
`Exercise for Medical Students", JOllrnal of Family Prac/icc,
`vol. 10, No.3, 1980, pp. 463-466.
`
`(List continued un next page.)
`
`Primary Examincr·- Dunald E. McElheny, Jr.
`AI/orner, Agent, or Fiml-Cooley Godward Castro Huddle(cid:173)
`son & Tatum
`
`[57]
`
`ABSTRACT
`
`In a medical network management system (NMS) (2Q),
`health plan beneficiaries access a team of health care pro·
`fessiotla1s over the telephone to help them assess their health
`needs and select appropriate care. 111e NMS (20) has a
`patien~ assessment component (22). The patient assessment
`component consists of a sct of information tools which arc
`used by health eare professionals to assess patient conditions
`and assist in the selection of health care services and to help
`patients find appropriate care at the appropriate time. The
`tOols include a comprehensive. automated set of proprietary
`assessment algorithms (26) which are based Oil branched
`chain algorithms utilizing Baye~ theorem. These unique,
`clinical tools enable a trained nurse or other health care
`professional to sort pntiellts into diJTcrcnl risk categories,
`safely and ell'ectivcly without requiring a medical diagnosis.
`Palients can then be guided to an appropriate level and type
`of care for their problem(s) based on their level of risk and
`set of potential needs.
`
`57 Claims, 60 Drawing Sheets
`
`I-----=~L-__ -...,·--_·~~==~-(-"':;:.....,
`
`I
`PAnENT
`ASSESSMENT:
`PROGRAM
`r
`NURSErOOL
`: ,
`
`PAnEt-rr
`DATABASE
`
`20
`MEMORY
`- . " .-----.~-.-.
`15
`
`Cardiocorn Ex. 1003
`
`CARDlOCOM EXH J 039
`CARDIOCOM v. BOSCH IPR2013-00468
`
`1
`
`

`
`r
`
`5,471,382
`Page 2
`
`._-----_._-
`
`OTHER PUBLICATIONS
`
`Levy Cl aI., "Development and Field Testing of Protocols for
`the Management of Pediatric Telcphone Calls: Protocols for
`Pediatric Telephone Calls", Pediatrics, vol. 64, No.5, Nov.
`1979, Pl'. 558-563.
`Tripp, S., "Telephone Techniques in Pediatric Practice",
`American journal aJNursing, vol. 71, No.9, Scpo 1971, pp.
`1722-1724.
`Geller et al., "American Poison Control Centers: Still Not
`All the Same?". annals oJEmergency Medicine, vol. 17, No.
`6, Jun. 1988, pp. 599-603.
`Trautlcin ct aI., "Malpractice in the Emergency Depart(cid:173)
`ment-Review of 200 Cases", Annals oj Emergenc'Y Medi(cid:173)
`cine, vol. 13, No.9, Sep. 1987, pp. 709-710.
`Thompson et al., "Evaluation of Regional and Nonregional
`Poison Centers", The New England Journal of Medicine,
`vol. 306, No.4, Jan. 27, 1981, pp. [91-194.
`Dunn, J. M., "Warning: Giving Thlcphone Advice is Haz(cid:173)
`ardous to Your Professional Health", Nursing85, Aug., pp.
`40-4l.
`Dunn ct at, "Using Simulated Patients to Teach Family
`Practice Residenls to Manage Patients by Telephone", Jour(cid:173)
`nal of Medical Education, vol. 62, Jun. 1987. pp. 524-526.
`Dickinson ct a!., "Pediatric HOllse Slaff Communication
`Skills: Assessment and Intervention", JOllmal of Medical
`Education, vol. 58, Aug. 1983, pp. 659-662.
`Evens el al.. "using Patient-Simulators to Teach Telephone
`Communication Skills to Health Professionals". JOI/mal oj
`Medical Education, vol. 58. Nov. 1983, pp. 894-898.
`Pope ot aI., "Dotcnllillants of Medical Care Utilization: The
`Use of Telephone for Reporting Symptons", fOllmai oj
`Health and Social BeJzavior, vol. 12, No.2. Jun. 1971, pp.
`155-162.
`Strain ct aI., w[,he Preparation, Utilization, and Evaluation of
`a Rcgistered Nurse Tntined to Give Telephone Advice in a
`Private Pediarric Office", Pedialrics, vol. 47, No.6. Jun.
`1971, pp. 1051-1055.
`Komarolf et al., "ProtocolS/Clinical Algorithms in Amlmla(cid:173)
`tory Medienl Care", paper presented in Boston, Mass.,
`approximately 1977n8.
`Hcagarty et ai., "Use of the Telcphom: by Low-income
`Families", Joumal oj Pediatrics, vol. 73, No.5, pp.
`74(}'-744.
`Wang et al., "usc of the Thlephone in a Health Maintenance
`Service for the Chronically Ill: A Preliminary Report", J
`Cllron Dis, vol. 24, 1971, pp. 489-494.
`Grecnlick et al., "Comparing the Use of Medical Care
`Services by a Medically Jndigent and a General Membership
`Population in a C()mprchcn~ive Prepaid Group Prac~ice
`Program", Medical Care, vol. X, No.3, May-Jun. 1972, pp.
`187-·200.
`Shah et a\., "An Expanded Emergency Service: Role of
`Telephone Services in the Emergency Department", An/l
`J:"merg Med, vol. 9, No. 12, Dec. 1980, pp. 617-623.
`Grcenliek ct a1., "Determinants of Medical Care Utilization:
`The Role of the Telephone in Tutal Medical Care", Medical
`Care, vol. XI, No.2, Mar.-Apr. 1973, pp. 121-134.
`Oll ct aI., "Patient Management oy Telephone by Child
`Health Associates and Pediatric [louse Ollicers", JOllrnal of
`Mp.dical EdUC(llio!!. vul. 49, Jun. 1974, pp. 596-600.
`Fosarelli, P. D., "The Emphasis of Telephone Medicine in
`Pediatric Training Program5", IUDC. vol. 139, Jun. 1985,
`pp.555-557.
`Wood el al.. ''Telephone Management Curriculum for Pedi·.
`
`ulric Interns: A Controlled Trial", Pediatrics, vol. 83, No.6,
`Jun. 1989, pp. 925-930.
`ESJ, Eligibility Services, Inc. brochure.
`Wilson et nI., "Pediatric Algorithm-Directed Triage: A Pro·
`speetive Study".
`Poole ct aI., "After-Hours Telephone Coverage: The Appli(cid:173)
`cation of an Area-Wide Telephone Triage and Advice Sys(cid:173)
`(em for Pediatric Practices", Oregon Health Forum, vol. 6,
`Aug. 1992.
`Wilson et a1., "Pediatrie Physician Extenders in a Walk-in
`Clinic: Algorithm-Directed Triage-The Beginning".
`Pl!rrin ct aI., wlblcphone Management of Acule Pedialric
`Illness", 71,,: New England foumal oj Medici,w, vol. 298,
`No.3, Jan. 19. 1978, pp. 130-135.
`Verdile et aI., "Emergency Department Telephone Advice",
`Annals oj Emergency Medicine, vol. 18, No.3, Mar. 1989,
`pp. 278--282.
`Greitzer ct nI., ''Telephone Assessment of lIlness by Prac(cid:173)
`ticing Pediatricians", Journal of Pediatrics, vul. 88, No.5,
`May 1976, pp. 880-882.
`Isaacman et aI., "pediatric Telephune Advice in the Emer(cid:173)
`gency Department: Results of a Mock Scenario", Pedialrics,
`vol. 89, No.1, Jan. 1992. pp. 35··39.
`Strllsser cr aI., "controlled Clinical Trial of Pediatric Tele(cid:173)
`phone Protocols", Pediatrics, vol. 64, No.5, Nov. 1979, pp.
`553···557.
`Kat? er aI., "Quality Assessment of a Telephone Care System
`Utilizing Nun-Physician Personnel", AJPH, vol. 68, No.1,
`Jan. 1978. pp. 31-38.
`Sclbst ct nI., "The Telephone in Pediatric Emergency Medi(cid:173)
`cine", Pediatric Emergency Care, vol. 1, No.2, Jun. 1985,
`pp. 108-110.
`Vaughn CL al., "Ellcetive Algorithm·-I3a.~cd Triage and
`Self-Cure Pwtoeols; Quality Medicine at Lower Costs",
`Annals oj Emergency Medicine, vol. 9, No.1, Jan. 1980, pp.
`32-36.
`Wood ct aI., "An Efficient Strategy for Managing Acute
`Respiratory Illness in Adults", Almals of Internal Mr.dicine,
`vol. 93, 1980, pp. 757·-763.
`Wolcott, B. W., "Basic Decisions in Emergency Depanment
`Cases: A Logical Approach", lACE?, vol. 7, No.4, Apr.
`1978, pp. 149-151.
`Wolcott, B. W., "Editorials-For Whom the (Phone) Bell
`Tolls", Mar. 1989.
`Wolcott, B. W., "Refining Criteria for X-Ray Utilization as
`a Result of a Patient Care Evalualion Study", Quality Re.view
`Blllletin, Jul. 19RO.
`Wolcott ct aI., "The Usc of In-Barracks Scrccners 10
`Improve Military Sick Call", Military Medicine, Fcb. 1979,
`pp. 99-102.
`Wolcott. B. w., "WI1::1I is an Emergency? Depends on Whom
`You Ask", JACH', JUII. 1979 (Reprint).
`Deriet ct aI., "Keeping Non·urgent Patients Out \If Ihe
`Emergency Department: Would it Make a DifTcrcnec?",
`Academic F"omm.
`Albin et aI., "Evaluation of Emergency Room Triage Per(cid:173)
`Conned by Nurses", AJPll, vol. 65, No. \0, Oct. 1975. pp.
`1063-lOGS.
`Levy et aI., "Development and field Testing o[Protocois for
`the Management of Pediatric Telephone. Cnlls: Protocols for
`Pediatric Telephone Calls", Pediatrics, vol. 64., No.5, Nov.
`1979, pp. 558-563.
`Rivara cl aI., "Pediatric Nurse Triage", AJDC, vol. 140. Mar.
`1986, pp. 205-210.
`Berman, D. A., "Camputcrizcd Algorithm ·Directed Triage
`
`2
`
`

`
`5,471,382
`Page 3
`
`in the Em(;rgcm.:y Department", Annals of Hmergency Medi(cid:173)
`cine, vol. 18, No.2, Feb. 1989, pp. 141-144.
`George ct aI., "Differences in Priorities Assigned to Patients
`by Triage Nurses and hy Consultant Physicians in Accident
`and Emergency Departments", Journal of Epidemiology and
`
`Communilylleallh, vol. 47,1993, pp. 312-315.
`
`Wilson ot a!., "Computerized Triage of Pediatric Patients:
`Automated Triage Algorithms", Annals of Emergency Medi(cid:173)
`cine, vol. 10, No. 12, Dec. 1981, pp. 636-640.
`
`3
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 1 of 60
`
`5,471,382
`
`17 (
`
`19
`~
`-r
`
`PATIENT
`ASSESSMENT I PATIENT
`DATABASE
`PROGRAM
`NURSETOOL
`
`T
`I
`
`I
`I
`!
`
`MEMORY
`
`20)
`
`15)
`
`!
`DISPLAY
`
`COMPUTER
`\
`13
`
`r----23
`
`I
`INPUT
`
`~1
`1
`r---.21
`
`FIG. I
`
`4
`
`

`
`20
`NElWORK MANAGEMENT SYSTEM (COMPONENTS)
`~
`+
`~------ "NURSErOOL"(CALL PROCESSING/HANDLING MECHANISM) - - - - - - ,
`
`PATIENT ASSESSMENT
`COMPONENT
`
`- PATIENT DATABASE
`- ELEGIBILITY CHECKING
`MODULE
`- ALGORITHM SELECTION
`MODULE
`26
`- ALGORITHMS
`- SELF-CARE PROTOCOLS
`- CALL-BACK SCHEDULING
`MODULE
`- PROVIDER CODES
`
`PROVIDER INFORMATION
`COMPONENT
`-PROVIDER DATABASE
`- PROVIDER INFO FORMS
`-PROVIDER RELATION
`MODULE
`-PROVIDER DESCRIPTION
`SCREENS
`- APPOINTMENT/REFERRAL
`MODULE
`
`~4
`
`PROVIDER CODES
`PATIENT INFO(SEX,AGE.Z1P CODE,HEALTH PLAN ETC.)
`
`CHANGES/UPDATES
`
`REPORTS
`
`FIG. IA
`
`~ ALGORITHM EDITOR
`VI
`(PROPRIETARY COMPUTER PROGRAM. ~
`100
`t
`TO ALLOW DEVELOPMENT
`-
`+ MODIFICATION OF ALGOS)
`
`OQ
`t-.i
`
`5
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 3 of 60
`
`5,471,382
`
`40
`------
`
`PATIENT
`CALLS/SEES
`NURSE
`
`42 D
`
`44
`
`ACCESS DATA
`FROM "PATIENT
`CHART'
`
`GATHER PATIENT
`INFO; ELIGIBILITY
`CONFIRMED
`
`46
`.. ~
`
`DOES PATIENT REQUIRE
`MEDICAL INTERVENTION?
`
`~<{EsJ
`
`54
`
`WHAT LEVEL/TYPE OF
`CARE
`fS NEEDED?
`
`56
`
`48
`
`50
`
`SCHEDULE FOLLOW-UP
`CALL AS NECESSARY
`
`IS THE MOST
`WHAT
`APPROPRIATE SOURCE
`AND TIMING OF CARE?
`
`60
`
`P~M
`
`52
`
`IF NOT RESOLVED ...-" '--___ ----' ~ PROBLEM
`--.. ---
`j5AFELY
`RESOLVED
`SAFELY \0
`t58
`
`D
`
`FIG. 2
`
`6
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 4 of 60
`
`5,471,382
`
`92
`
`94
`
`96
`
`98
`
`FIG. 3
`
`7
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 5 of 60
`
`5,471,382
`
`1:
`ADULT_BACK_PAIN_1
`
`4:TRANSF[R TO
`. PEDIATRIC BACK PAIN
`ALGORITHM
`
`8:TRANSFER TO ADULT
`CHEST PAIN
`ALGORITHM
`
`YES
`
`YES
`
`2: IS THE PATIENT
`PRE-PUBERTAl?
`• NO
`7:IS THERE Am
`ASSOCIATED
`CHEST PAIN?
`, NO
`
`9:OID THE PAIN FOLLOW A YES
`DIRECT BLOW OR AN
`ACCELERATION/
`DECELERATION
`INJURY?
`
`NO
`
`t 0:15 THERE ANY NEW YES
`DECREASE IN MOTOR
`FUNCTION?
`
`+ NO
`
`YES
`
`14:15 THERE ANY NEW
`DECREASE IN SENSORY
`FUNCTION?
`, NO
`16:IS THERE ANY NEW YES
`LOSS OF BOWEL OR
`BLADDER CONTROL?
`, NO
`18:IS THERE ANY PAIN YES
`RADIATING
`INTO THE
`BUTTOCKS, PERINEUM,
`GENITALS OR LEGS?
`.. NO
`20:00E5 THE PAIN PREVENT
`ACTIVl[S OF NORMAL
`LMNG DESPITE HOME CARE
`ANALGESIA?
`NO
`l22:!S THERE my BLOODY I YES
`OR COLA-COLORED URINE? I
`NO
`
`YES
`
`'----
`
`FIG. 4A
`
`11 :SPEAK TO
`PROVIDER
`
`lAS
`
`15:SPEAK TO
`PROVIDER
`
`lAS
`
`17:SPEAK TO
`PROVIDER
`
`lAS
`
`19:5PEAK TO
`PROVIDER
`
`lAS
`
`21 :SPEAK TO
`PROVIDE~
`
`lAS
`
`... 23:SPEAK TO
`PROVIDER
`
`lAS
`
`24-:ACCESS
`SELF·-CARE
`INSTRUCTIONS
`I
`
`8
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 6 of 60
`
`5,471,382
`
`YES
`
`.1 58:SPEAK TO lAS
`PROVIDER
`
`lAS I
`
`40:SPEAK TO
`PROVIDER
`
`42:SPEAK TO
`PROVIDER
`
`lAS
`
`44:SPEAK TO
`PROVIDER
`
`lAS
`
`46:EARLYllLNESS
`APPOINTMENT
`
`48:SPEAK TO
`PROVIDER
`
`lAS
`
`36:01D THE FIRST EPISODE YES
`r-----
`OF THIS OF BACK PAIN
`OCCUR AFTER AGE 45?
`NO
`
`37:00E5 THE PATIENT HAVE
`DIAGNOSED AORTIC
`ANEURYSM
`• NO
`59:DOE5 THE PATIENT HAVE
`A NEWLY COLD, BLUE OR
`PULSELESS FOOT?
`
`t NO
`
`41:IS THERE ASSOCIATED
`SEVERE ABDOMINAL PAIN?
`
`YES
`
`YES
`
`NO
`43:15 THE PAIN DESCIBED A YES
`"TEARING" OR "RIPPING~?
`NO
`
`r NO
`47:DOES THE PATIENT HAVE
`A DIAGNOSED AORTIC
`ANEURYSM?
`
`NO
`
`49:ARE THERE ANY
`50:IS THERE ASSOIATEO
`YES
`ASSOCIATED RIGORS !---to NEW DYSURIA, FREQUENCY OR
`OR FEVER?
`FLANK PAIN?
`
`YES
`
`51 :URGENT CARE
`
`NO
`
`NO
`
`52:15 THERE ASSOC:ATED
`NEW VOMITING AND/OR NEW
`DIARRHEA?
`NO
`.,.
`
`54:15 THERE ASSOCIATED
`URETHRAL OR VAGINAL
`DISCHARGE?
`
`YES
`
`YES
`
`NO
`
`--'"
`
`y_ ••• " •••• -
`
`FIG. 48
`
`53:SPEAK TO
`PROVIDER- -
`SORTING-LATER
`J
`
`55:URGENT CARE
`
`J
`
`56:SPEAK TO
`PROVIQER -.-
`SORTING-LATER
`I
`
`9
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 7 of 60
`
`5,471,382
`
`57:15 THERE ASSOCIATED
`NEW LOSS OF BOWEL OR
`BLADDER CONTROL?
`
`YES
`
`58:15 THIS LOSS OF
`FUNCTION LESS THAN
`72 HOURS OLD?
`
`YES
`
`S9;URGENT CARE
`
`NO
`
`NO
`
`60:EARL Y ILLNESS
`APPOINTMENT
`I
`
`65:IS THERE ASSOCIATED
`NEW LOSS OF
`MOTOR FUNCTION?
`
`YES
`
`67:IS THE lOSS OF
`FUNCTION LESS THAN
`72 HOURS OLD?
`
`YES
`
`68:URGENT CARE
`
`NO
`
`NO
`
`YES
`
`169:EARlY ILLNESS,
`APPOINTMENT
`I
`
`71:EARLY ILLNESS
`APPOINTMENT
`
`I
`
`YES
`
`73:1S THE PATIENT A YES
`SEXUAlI.Y-ACTIVE
`WOMAN?
`
`74:SPEAK TO
`PROVIDER -
`-
`SORTING-NOW
`
`f--
`
`70:IS THERE ASSOCIATED
`NEW LOSS Of SENSORY
`FUNCTION?
`NO
`•
`
`72:!S THERE ASSOCIATED
`NEW ABDOMINAL PAIN?
`
`NO
`
`NO
`
`75:TRANSFER TO
`
`ALGORITHM •
`
`FIG. 4C
`
`10
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 8 of 60
`
`5,471,382
`
`l,78:00[5 THE PATIENT HAVE I
`A KNOWN MALIGNANCY
`
`YES
`
`NO
`
`80:IS THE PATIENT TAKING
`ANY ANTI-COAGULANTS OR
`LONG-TERM STEROIDS?
`
`YES
`
`NO
`
`..
`
`77:EARLY ILLNESS
`APPOINTMENT
`I
`
`61:SPEAK TO
`PROVIDER -
`-
`SORTING-LATER
`
`90:ARE THERE ASSOCIATED
`NEW SIGNS OF ARTHRlTIS?
`
`YES
`
`91:EARLY ILLNESS
`APPOINTMENT
`
`NO
`
`...
`
`1
`92:15 THERE ASSOCIATED
`NEW URETHRAL OR VAGINAL
`DISCHARGE?
`
`YES
`
`NO
`
`94:IS THERE ASSOCIATED
`NEW HIP PAIN ON
`LIGHT -BEARING,ABDUCTION
`ADDUCTION OR ROTATION
`
`YES
`
`NO
`
`96:1$ THIS A SELF -CARE I YES
`I
`FAILURE?
`
`NO
`
`93:EARLY ILLNESS
`APPOINTMENT
`
`95:EARLY ILLNESS
`APPOINTMENT
`
`97:SPEAK TO
`PROVIDER -
`-
`SORTING-LATER
`
`98:1$ THE PATIENT INVOLVED
`IN A RELATED WORKMAN'S
`COMPENSATION OR PERSONAL
`LIABILITY CLAIM?
`--
`NO
`
`r
`
`YES
`
`I 99:ROUTINE ILLNESS I
`I
`APPOINTMENT
`
`FIG. 40
`
`11
`
`

`
`U.s. Patent
`
`Nov. 28, 1995
`
`Sheet 9 of 60
`
`5,471,382
`
`.,
`
`100:HAS THE PATIENlY
`PASSEOMORE THAN 7 DAYS
`NORMAL ACTIVITIES IN
`OF THE LAST THREE YEARS
`
`NO
`
`!-tIoo COMPREHENSIVE EVALUATION
`FOR THIS BACK PAIN?
`NO
`
`YES 101:HAS THE PATIENT HAD H 102:ROUTINE ILLNESS I
`
`APPOINTMENT
`
`104:00ES THE PATIENT
`HAVE RADICULAR LOWERBACK
`PAIN?
`NO
`
`YES
`
`FIG~· 4E
`
`J 1O.3:ROUTINE ILLNESSI
`l
`APPOINTMENT
`
`10S:ACCESS
`SELF-CARE
`INSTRUCTIONS
`
`106:ACCESS
`.SELF-CARE
`INSTRUCTIONS
`
`12
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 10 of 60
`
`5,471,382
`
`FIG. 5
`
`Root Menu
`New Window
`Shuffle Up
`Shuffle Down
`Refresh
`1~lJrselool
`Restart-..
`Quit mwm
`
`FIG. 6
`I
`Start Coli
`(F1)
`
`FIG. 7
`
`I
`
`lAS Moin
`lAS Nurselool -
`Stop Coli
`Work list
`(F3)
`(F2)
`
`Problem
`Nolebook
`(F4)
`
`I I
`
`Medicol
`Information
`(F5)
`
`lAS Nursetool - Coller Info
`
`!
`
`Patient Problem/Nursing Assessment:
`
`Patient complaint of lower back poin -
`con't move around at all.
`
`really painful;
`
`~
`
`cc: acute lower bock poin (w/o mention of radiating
`poin) x 24hours.
`
`~--------------------------------~~
`I Doyid Johnson I
`Coller Nome:
`I self
`I [!]
`I Dovid Johnson I
`I 303-4043-4600" I
`
`Relationship:
`
`Petient Nome:
`
`Phone Now:
`
`OK
`
`13
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 11 of 60
`
`5,471,382
`
`FIG. 8
`I
`Emergency
`(F6)
`
`'--
`
`lAS Nursetool - Coli Type Selection
`
`Illness Core
`(F7)
`
`Provider
`Selections
`(F8)
`
`Information
`(F9)
`
`Other
`(F10)
`
`I I
`
`FIG. 9
`
`FIG. 10
`
`I
`
`lAS Nursetool - Emergency Handling
`
`I
`
`Coller Nome:
`
`Coller Phone:
`
`Assessment of Situation:
`
`~-----------------------------'e
`
`~------------------------------~~
`OK
`
`Concel
`
`14
`
`

`
`Nov. 28, 1995
`
`Sheet 12 of 60
`
`5,471,382
`
`u.s. Patent
`
`FIG. II
`
`I
`
`lAS Nursetool - Eligibility Verification
`
`I I
`
`Patient Lost Nome:
`
`Patient First Name:
`
`I Johnson
`I Robert..-.
`
`Health Pion:
`
`Health Pion ID:
`
`Social Security Number: 1 -1 __________ - - - - '
`
`Sponsor's Employer
`
`Patient Zip Code:
`
`Patient Phone:
`
`Results:
`
`Check Eligibility (ESC-Ft 1)
`
`~
`=~~========================~~~
`I New Patient I
`
`OK
`
`15
`
`

`
`FIG. 12
`
`I
`
`Last Nome:
`
`First Nome, MI:
`
`Street Address:
`
`Cily, Stote:
`
`Zip Cede:
`
`Phone:
`
`Date Of Birth:
`
`Gender:
`
`Ethnic Origin:
`
`Moritel Status:
`
`OK
`
`lAS Nursetool - New Patient Doto Entry
`
`I Johnson
`I Robert
`II
`! 3423 W. 44th Avenue
`I Boulder, CO
`I B0301
`! (303)-443-4600
`I 02-mov-1938
`I Mole
`I White
`I Widowed
`
`I Patient's SSN:
`1 Sponcer's Employer:
`I Client:
`I Plan Nome:
`I Pion Type:
`I Health Plan 10:
`I Primary Physician:
`I [!]
`I ~
`I [!]
`
`I 333-22-1111
`I Stote of Colorado
`I Stote of Colorado
`I Kaiser
`I Standard
`
`190611
`lOr. Hillery Krus~
`
`d •
`00 •
`~
`I , ~ =
`I
`I
`I [!]
`I [!]
`I [!1
`
`z Q
`
`~
`N
`... Q1;;
`
`~
`
`,...
`
`\0
`\Q
`til
`
`r
`
`I
`
`rt.l
`;:r
`t't)
`.....
`t't)
`......
`(J.)
`0 ....,
`
`~
`Q
`
`Concel
`
`16
`
`

`
`u.s. Patent
`FIG. 13
`
`Nov. 28, 1995
`
`Sheet 14 of 60
`
`5,471,382
`
`lAS Nursetool - Patient Chart
`
`Nome:
`Address:
`
`Zip:
`Home Phone:
`SSN:
`Employer:
`Health Plan:
`Plan Type:
`Subscriber Number:
`
`Robert Johnson
`3423 W. 44th Avenue
`Boulder, CO
`80301
`(303)-443-4600
`333-22-1111
`Stote of Colorado
`Koiser
`Standard
`333221111
`
`L-__________________________ ~~
`
`Identifying Information
`
`Oemographic Information
`
`Health InformQtion
`
`Prior lAS Contacts
`
`FIG. 14
`
`.,
`
`lAS Nursetool - Patient Chart
`
`I
`
`No health history found tor this patient
`
`k -_______ ______ ___ ~~
`
`Identifying Information I r Demographic Information
`Health Information l I Prior lAS Contacts
`
`17
`
`

`
`U.s. Patent
`
`FIG. 15
`
`Nov. 28, 1995
`
`Sheet 15 of 60
`
`5,471,382
`
`lAS Nursetool - Patient Chart
`
`Dote Of birth:
`Gender:
`Ethnic Group:
`Family Status:
`Primary Physician:
`
`02-may-1938
`Male
`White
`Widowed
`Dr. Hillary Kruse
`
`FIG. 16
`
`~----------------------~~
`
`Identifying Informotion
`
`Demographic Information
`
`Health Information
`
`Prior lAS Contacts
`
`I
`
`I
`
`lAS Nursetool - Potient Chort
`•• * ••• ** ••••••••••••• * ••••• **................. t1i
`;;(
`CALL START:
`24-oug-1993 15:02:59
`CALL END:
`24-oug-1993 15:08:18
`Liz Snowden
`NURSE:
`1031
`CALL ID:
`STATUS:
`PATIENT PROBLEM/NURSE ASSESSMENT:
`
`i!lness Core
`
`CALL 1YPE:
`AUX!LLlARY INFO:
`Mrs. Snawden was very happy with the service.
`*-* ILLNESS CARE CONTEXT ...
`FIRST ALGORITHM:
`PEDIATRIC_ABDOMINAL PAIN
`SECOND ALGORITHM:
`;1:
`ACTION TAKEN:
`Speak to Provider - Starting Now
`~
`..............................•..•....•.•..... ~
`
`Identifying Informotion 1 I Demographic Inform~j
`Health Informolion 1 I Prior lAS Contocts
`
`18
`
`

`
`u.s. Patent
`FIG. 17
`
`Nov. 28, 1995
`
`Sheet 16 of 60
`
`5,471,382
`
`Patient 1
`
`FIG. 18
`
`I
`I Cardiorespiratory
`I Constitutional
`I
`I Eor-Nose-Throat
`I
`I Gostrointestinal
`[
`I Gynecological
`I Musculoskeletal
`
`Dermatologic
`
`Eye-Visual
`
`Genitourinary
`
`I Pediatric Abdominal Poin
`I Pediatric Abnormal Growth Developn
`I Pediatric Asthma
`I Pediatric Bock Poin
`I
`I Pediatric Bites Insect
`I Pediatric Boils
`I Pediatric Chest Poin
`I Pediatric Constipation
`
`Pediatric Acne
`
`Pediatric Athletes Foot
`
`Pediatric Bites Animal
`Pediatric Bites Human
`
`Pediatric Bites Snake
`
`Pediatric Burn
`
`Pediatric Circumcision Problems
`
`I
`
`~
`
`:.":
`"
`
`):;~
`.~;'
`
`~
`tf
`''\
`f! ,,;!
`;!i.
`lw
`flt;
`
`;{!
`
`lAS Nursetool - Alqorythm Section
`Topical Listing
`Alphabetical listing
`
`Neuropsychiatric
`
`Miscellaneous
`
`~
`
`Selected Algorithm: I
`I
`
`Keywords:
`
`Purpose of Selected Algorithm:
`
`Wi
`~
`m'G
`
`I 8
`
`I
`
`I
`
`Associated Algorithms:
`
`1.0
`
`I
`~
`
`~
`
`gjI
`
`19
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 17 of 60
`
`5,471,382
`
`.' . : lAS Nursetool
`
`AI orthm Selection:
`
`Topical Listing
`
`Cardiorespiratory
`
`Constitutional
`
`Dermatologic
`
`Ear-Nose-Throet
`
`Eye-Visual
`
`Gastrointestinal
`
`Genitourinory
`
`Gynecological
`
`Musculoskeleto!
`
`Neuropsychiatric
`
`Miscellaneous
`Selected Algorithm:
`
`Keywords:
`
`Alphabetical Listing
`Pediatric Headache Chronic
`Pediatric Headache New
`
`Ei
`=a~================~~~
`
`.!ain;headi",
`
`I I S~ect I
`r-'=============I
`FIG. 19
`
`.
`
`Selected Algorithm: I Pediatric Headache New
`L
`. ____ --11
`
`Keywords:
`
`I I Se~ct I
`
`Purpose of Selected Algorithm:
`
`designed to sort children with complaints of specific. acute
`headache
`
`FIG. 20
`
`20
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 18 of 60
`
`5,471,382
`
`..
`
`lAS Nurselool:· .
`
`....... 1::1
`
`Algorithm Summary:
`
`Algorithm Nome: PEDIATRIC NEW HEADACHE
`
`Purpose: Sorts children with new onset headache.
`
`Algorithm "Rood Mop· :
`Loops:
`
`Excluded Populations:.
`
`Totol Questions: 17
`.3
`Febrile:
`Prior treatment: 2
`Adults, Children with chronic. recurrent headaches
`
`Stem Questions: 1 1
`Visual change: 1
`
`Relevant Medicol Risk Factors:
`Relevant Life-Style Risk factors:
`
`None
`None
`
`SELF CARE: 80%
`Anticipated Coli Distribution:
`Activate Emergency Procedures:
`0%
`Urgent Core:
`OX
`Speak to lAS Provider:n < 1 %
`Speak to Provider-Sorting: 10"
`Speak to Provider-Treatment:
`0"
`Eorly Illness Appointment: 10%
`Routine Illness Appoiment:
`0%
`L -____________________________________ ~~
`
`OK
`
`FIG. 21
`
`21
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 19 of 60
`
`5,471,382
`
`. AS Nursetool - Algorithm Navigation:'
`
`.. I
`
`[ Pediatric Headoche New
`
`I
`
`Algorithm Name:
`
`Clinical Question:
`
`Has there been head trauma in the past 72 hours?
`
`loy Question:
`
`In the post three days, has the chifd had a serious
`blow to the heod ... like a car occident or a bad foil?
`
`Rationale:
`
`:7'i
`
`~
`
`i7I
`
`III
`
`Intra-cranial bleeding con be delated; especially in children, the symptons
`of the intra-cranial bleeding con e tem,p.orolly distant from the nead injury.
`The • trauma· here is more thon simply bumping the head", but need not
`hove "knocked out the child" for a long time.
`
`~
`I UNSURE I ! BACK I
`
`I I NO
`
`I
`
`YES
`
`I
`Comments:
`
`I
`
`I Insert
`I Erase
`
`I
`I
`
`FIG. 22
`
`22
`
`

`
`u.s. Patent
`
`Nov.28~ 1995
`
`Sheet 20 of 60
`
`5,471,382
`
`AS Nursetool
`
`.101
`
`Further Explanation
`
`After having the caregiver touch the child to test for fever, treat os a NO
`response.
`
`OK
`
`FIG. 23
`
`23
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 21 of 60
`
`5,471,382
`
`.
`
`I-
`
`f.S Nursetool - Nurse Action list
`
`. -
`
`- .
`
`I
`
`LPfAK TO lAS PROVIDER
`
`!S':I
`
`!
`
`Select
`
`1m
`
`151
`
`I
`
`Clinical Rationale:
`Stiff neck, fever, and headache suggest meningitis. The !AS Provider will
`determine if it will be necessary to activate Emergency Procedures.
`
`- ------.
`
`Message to Potient:
`
`If you will stay on the line, we will connect you as quickly as
`
`our physician.
`pos~ible.
`
`"'¥-~"-"-
`
`Symptom Pattern:
`
`Fever and stiff neck in a child with 0 headache>
`
`~
`Because the child appears to have 0 stiff neck, we wonl you to speak now to ~
`~
`.-~~
`I~
`I Cancel
`I
`
`Need to Consider:
`
`I Meningitis
`
`Provider Codes:
`
`I
`
`" m'~:ne
`
`I
`
`FIG. 24
`
`24
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 22 of 60
`
`5,471,382
`
`Action in Nurse Action List Window
`Acivote Emergency Procedures
`Speak To lAS Provider
`Urgent Core
`Transfer to Algorithm
`Speak To Provider-Sorting
`Speak To Provider-Treatment
`Early Illness Appointment
`Routine Illness Appointment
`Self Core
`
`Effect of Clicking the Select Button
`Opens Emergency Honding window
`Opens Speak With lAS Provider window
`Not implemented; but is logged as recommended
`Opens Algorithm Navigation window
`Open Speak With Provider window
`Open Speak With Provider window
`Not implemented, but is logged os recommended
`Not implemented, but logged os recommended
`Open Self Core Endpoint window
`
`FIG. 25
`
`25
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 23 of 60
`
`5,471,382
`
`lAS Nursetool-Self Core End Point.:
`
`.. ··1
`.. I
`
`Instructions:
`
`PEOIATRIC CONSTIPATON SELF CARE INSTRUCTIONS
`
`SELF -CARE PROTOCOL : PEDIATRIC CONSTRUCTION
`General Information to reassure:
`- we understond your concern about the constipation
`- be assured thot this is common in children and there's no indication of 0
`serious underlying problem
`- mony children routinely go three or four days between bowel movements;
`this is normal
`-0 "chonge" in bowel habits happens occasionally to olmost every child:
`routine use of laxatives or enemas in children is not necessory(ond moy
`-
`be harmful)
`- a diet with adequate fiber cnd • bulk" is recommended.
`Instruction for Sympton/Poin relief:
`- Give more fluids, i.e. juices, Kool-Aid, woter;
`- Prune juice, on old • favorite", is effective:
`- Add more "bulk" -include a level teaspoon of bran in daily food for
`child one year or older; odd up to 3 tablespoonful of bran to food for
`children 8 years or older;
`- Avoid getting too" worried" about child's bowel habits;
`- Unless specifically recommended by a medicol provider, do not use
`laxatives, rectol suppositories, or enemas; they may interfere with
`child's ability to reestablish regular bowel habits;
`- We con orronge to coli you bock in 0 few doys, if thot would help.
`I-"
`L-____ ~~~~ ____ ~ ________ ~~ ______ ~ __ ~~
`
`Does patient accept?
`
`+'T'ES
`Callback Date: L[ ______ ...J
`End Point Disposition:
`
`o NO
`
`Callback Time:
`
`OK
`
`[
`
`Concel
`
`FIG. 26
`
`26
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 24 of 60
`
`5,471,382
`
`.1 .": '.':': lAS Nursetaal - Speak With lAS Provider.'. '. '.' ,,: .,
`I ~O_r._E_m_m_et_F_re_hl ______ ~I~
`
`Provider Nome:
`
`Provider Comments:
`Asthmatic child with complaint of • unable to handle
`secretions.
`
`~
`
`Cannot rule out acute asthmatic episode.
`' - - - - - - - '
`
`Recommendation:
`
`I Emergency Handling
`
`Does patient accept?
`
`• YES
`
`OK
`
`o NO
`
`Cancel
`
`FIG. 27
`
`27
`
`

`
`u.s. Patent
`FIG. 28 1
`
`Nov. 28 J 1995
`
`Sheet 25 of 60
`
`5,471,382
`
`lAS Nursetool - Speak With Provider
`
`I
`
`Provider Nome:
`
`Does Potient Accept?
`
`• Yes
`
`OK
`
`ONo
`
`Concel
`
`FIG. 29
`
`lIAS Nursetool -
`
`Information Type Selection I
`
`• Medicol Information
`<> Health PIon Rules
`
`OK
`
`Cancel
`
`FIG. 30
`I
`
`lAS Nursetool - Self Core Selection
`
`I
`
`Alphabetical Listing
`~--~------~--~~
`Adult Musculoskeletal Bock Poin
`Adult Sciatica
`Adull Troumatic Back Poin
`Pediatric Abdominal Pain
`Pediatric Block Widow/Brown Recluse:
`Pediatric Asthma (Resolved)
`(fu
`Pediatric Asthma {Medicotion)'f
`Pediatric Constipation
`Pediatric Analgesic
`Pediatric Birthmarks
`Pediatric Avulsed Tooth
`Pediatric Acute Bleeding
`Pediatric Cough
`~:~;~~~;~ ~:e~ain
`
`J
`.~
`·.~,~.~,;i':,:: .•
`r,~
`""
`~~
`%
`
`Topical listing
`Cardiorespiratory
`
`Constitutional
`
`Dermatologic
`
`Eor-Nose-Throat
`
`Eye-Visual
`
`Gastrointestinal
`
`Genitourinary
`
`Gynecological
`
`Musculoskeletal
`
`Neuropsychiatric
`
`Miscellaneous
`
`Seleded:
`
`Keywords:
`
`28
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 26 of 60
`
`5,471,382
`
`. lAS Nursetool •
`
`..... ' 1::1
`. .' I
`
`Self Core Instructions:
`
`ADULT TRAUMATIC BACK PAIN
`
`SELF-CARE INSTRUCTIONS
`
`GENERAL INFORMATION TO RfASSURE:
`- Bock pain is the second most frequent medical condition experienced in
`the U.S. (Cough is first)
`
`- About 1 in every 10 persons will have 0 backache in any given year.
`Over a lifetime, 80-85~ of all people will have suffered from Ihis
`problem.
`
`- Experts say that about 90-95% of all acute bock poin episodes will
`correct themselves in 7-10 days; the sharp pain usually begins to
`improve in 2-3 doys.
`Bock pain is often very painful, but it is rarely a serious medical condition.
`L-______________________________________________ ~~
`
`OK
`
`FIG. 31
`
`.: lAS Nursetool - Health Plan Rules Selection·,
`I Stote of Colorado
`I Kaiser
`rytandard~
`
`,.' ,I
`
`I~
`II2l
`I~
`Cancel I
`
`1 .. '.
`
`Client:
`
`Plan Nome:
`
`Pion Type:
`
`OK
`
`FIG. 32
`
`29
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 27 of 60
`
`5,471,382
`
`. lAS Nursetool'
`
`. .
`
`Health Pion Rules:
`
`OK
`
`FIG. 33
`
`30
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 28 of 60
`
`5,471,382
`
`. .
`..
`
`. .
`
`lAS Nursetool - Othereall: ..... ·. : .'. :
`. .
`. .
`
`Coli Type:
`
`• Wrong Number
`
`<> Phantom Coli
`
`0 Prank Coli
`
`0
`
`Inappropriate Coli
`
`OK
`
`I
`
`I I
`
`Cancel
`
`I
`
`FIG. 34
`
`31
`
`

`
`u.s. Patent
`·t·: •.... , ..•
`
`Nov. 28, 1995
`
`Sheet 29 of 60
`
`: lAS Nursetool - Call Termination : ..
`
`5,471,382
`
`..... I
`. .'
`
`: '.'
`
`Termination:
`
`• Normal
`
`o Abnormol
`
`What would this patient have done if this service were not available?
`
`<> Soughl emergency core
`
`<> Mode appointment with physician
`
`<> Attempted self core
`
`• other:
`
`Tog for rapid retrieval?
`
`• Yes
`
`ONo
`
`Indicate Reason:
`
`o This coli involved 0 potential life-s{)ving intervention
`
`o This call involved a potential saving of medical costs
`
`o This coli was a noteworthy example of service value
`
`o This was a problematic call - may require fotlow-up
`
`Comments:
`
`Done
`
`FIG. 35
`
`32
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`Sheet 30 of 60
`
`5,471,382
`
`lAS Nursetoal - Problem Noteboak:' .. , :,' :,
`
`":,, ". I
`', .
`
`,"
`
`Select By:
`
`[ ~ u_se_' ___ ---'I ~ Select Key:
`......
`
`.... 1 _T ri....;;o9:.-e _Us_er_---JI ~
`~------------------------------------------------~~
`PN=224:23-aug-1993 - Triage User - Selected pod abdominal ptan, blew up ...
`PN=1S8:06-aug-1993 - Triage User - When I enter 0 new potient record with
`only SSN •••
`PN= 14B:06-aug-1993 - Triage User - Swoltowing spelled wrong in Algorithm
`Navigotion ...
`
`~K~I==============================================~~~
`Problem Type: I System Problem I [21
`
`Priority:
`
`When I enter a new petient with only SSN and client filled in, everything works fine, ~
`However, the next time I do eligibilty verfication, TWO records for this new patient
`appear in the eligibilty results list. NOTE: I can't get this lo repeat every time
`(intermittent) - John Brinegar
`
`Status:
`
`... 1 _Re_so_lv_8d ___ -'1 ~ Resolved By:
`
`I John Brinegar
`
`I&J
`
`This wos found a long time ogo by God. JOY - NO DEFECT FOUND - 06/31/93 A
`'--------____ U
`
`Clear
`
`OK
`
`Insert
`
`FIG. 36
`
`Update
`
`Concel
`
`33
`
`

`
`u.s. Patent
`
`Nov. 28, 1995
`
`