Electronic adaptation of a paper "dynamic" medical record encounter form developed in late 1970's to optimize both ease of use and the precision with which chronic disease activity can be documented and tracked over time.

What it does

As an add-on that can be adapted to almost any EHR (though with major economic benefits for the primary licensee) it offers universal, complete medical record interoperability, with complete display of records entered in any of the eleven 1997 CPT standard data field sets in either the same or any of the other standard data field sets.

Speech recognition error reduction technologies allow free text dictation of rich descriptive detail without need to repeatedly stop to correct.

Optional interface with automated alerting for deviations from statistical process control (SPC) for measurements uploaded from any personal health monitoring device. Data measured under different circumstances, as HR or BP at rest or after exercise, blood glucose fasting or after a meal, airway impedance on arising or before supper and with or without the presence of specified symptoms, must be grouped by both circumstance and (when clinically relevant) combination of circumstances for appropriate SPC analysis. Alerting for deviation from SPC gives the best receiver operating characteristic of which an individual motoring device is capable. Automating the processes of grouping by circumstance(s) of measurement and alerting both patient and designated recipient physicians gives the best possible early warning of disease exacerbations while freeing the physician from the need to personally review reams of mostly unremarkable monitoring data and the potential liability of being accused of failing to recognize early warning signs if a patient's disease takes an unfavorable course.

Performing SPC analysis and alerting on a central server ("e-SPC") instead of on the individual monitoring device reduces the risk of piracy of the SPC alerting technology and allows the technology to be marketed as a subscription service. Insurers should be happy to pay for disease state + device combinations for which e-SPC alerting keeps patients out of hospitals and emergency rooms. The proliferation of personal monitoring devices for numerous parameters of health and disease creates a market in which the first efficient operator to license and deploy this technology can make his portal the primary global repository for data from personal medical & health monitoring devices. Once operational he can exploit economy of scale to simultaneously profit from the service while offering it at low enough cost that no potential competitor can afford to compete.

Central collection of personal monitoring data for most devices used to track various disease states offers tremendous potential for data mining. This potential is further increased if the e-SPC operator also owns an EHR and offers waiver of e-SPC subscription co-pays or other incentives to patients in its EHR who consent to anonymous use of their health data for this purpose. Similar incentives can be offered in return for the same consent from patients whose records are kept in other EHR's that use the Add-on of the present proposal, and to other patients in return for sharing various items of personal health data.

How I built it

As an engineer who got into medicine in response to his mother's subliminal message that she wanted her son to be a doctor I've always looked at recurring health problems from the engineering perspective of how can you do it better, cheaper or both. This proposal is a compendium of solutions to four related problems:

1) Reduce computer speech recognition error sufficiently to enable free text dictation of the rich descriptive detail needed to define and measure changes in the activity and status of chronic diseases for which the usual EHR check-box lists of abnormal findings are useless because they're always abnormal: Accomplished by matching incoming speech not with what that user has ever dictated into the system but by matching what that and similar users have dictated into the same and related fields of the database for that and similar patients under the same and similar circumstances.

2) Provide an efficient method of data display and entry for the tracking of chronic disease status and activity over time. Accomplished with a computer adaptation of a spreadsheet / flowsheet "dynamic" paper medical record encounter form proven effective for this purpose in a paper medical record.

3) Provide this display with universal interoperability across different medical specialties and different EHR's. Accomplished across specialties by including all data fields of all 11 CPT 1997 standard data field sets in a Master Database and setting rules to map data from any populated fields not present in the data field set into which a stored record is called into virtual fields to be displayed in lieu of appropriately selected actual fields of that record in that data field set. Accomplished across different EHR's by standardizing the content of each data field of the Add-on so that the complete content of records in the Add-on can be easily and accurately shared between authorized users.

4) Automate the process of SPC analysis and alerting: Accomplished with IP-protected automated grouping of measurements taken under different circumstances or combinations of circumstances for SPC analysis and alerting.

Challenges I ran into

My major challenge was getting past AthenaHealth's new technology evaluation gatekeepers, who professed unwillingness to consider ANY new technology without seeing a complete working demo. For an EHR add-on that's putting the cart before the horse as the only entity capable of setting up a working demo of an EHR add-on is an EHR company interested in seeing how it works. Hopefully this More Disruption Please challenge will let the present proposal be evaluated on its merits.

Accomplishments that I'm proud of

Putting all the pieces together.

What I learned

The business of health care is so heavily top-down driven that it's very difficult for incremental improvements to gain traction if they come from the interface where physicians actually listen to and examine patients. I have yet to meet a physician who like me earns the major share of his livelihood providing ongoing care to patients whose major health issues are chronic disease states, who is not frustrated by the poor support presently available health information technology provides for the tasks of giving disease management advice and making disease management decisions.

What's next for Open platform interop, other benefits in EHR add-on:

Implementation options include a non-invasive advertiser-sponsored free-to-prescriber-users business model for users in open formulary practice settings. A competing free-to-prescriber users EHR with none of the features of the present proposal and advertiser sponsorship that's both more intrusive to physicians and less valuable to advertisers claims more than 112,000 physician users. We believe that if offered as an add-on to a strong and well-supported EHR like AthenaHealth with this free-to-prescriber-users business model, the resulting product should be able to capture a full majority of all ambulatory care prescriber-patient encounters in the U. S. within a few years of launch. (This sponsored business model part of the present proposal will probably not apply to use in hospitals as almost all hospitals have closed formularies. The rest of the proposal is fully applicable to inpatient care and particularly to the transition in both directions between hospital and outpatient settings.)

The information proposed for sale to sponsors, including name and location of physicians performing specified procedure codes or entering specified diagnosis codes with numbers of each per interval of time (while specifically NOT providing direct OR indirect information about individual physicians' prescribing patterns) should be of sufficient value to sponsors that a switch by present paid users in open formulary setting to advertiser-sponsored free-to-prescriber use should yield a net increase in revenue for the primary licensee. The market share that will come with this use will enable the primary licensee to make the add-on of the present proposal the universal national standard for the documentation of physician or allied health provider evaluation & management encounters, conferring the further economic advantages described in the accompanying PDF document.

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