Abstract:
Systems and methods for coding an aspect of a patient encounter. An example method includes: receiving a medical finding identifying medical information related to a patient, the medical finding being input by a user; identifying an internal medical code of an internal medical terminology that relates to the medical finding; retrieving one or more alternative data items from an expansion table associated with the internal medical code, the alternative data items defining the medical finding input by the user with great specificity; generating a graphical user interface, the graphical user interface displaying the medical finding input by the user and the one or more alternative data items, the displayed one or more alternative data items being selectable by the user; and in response to selecting one of the one or more alternative data items, selecting a code from the standard medical terminology that identifies the medical finding in the standard medical terminology based on the categorical information.

Description:
REFERENCE TO CO-PENDING APPLICATIONS 
       [0001]    This application claims the benefit of priority of U.S. Provisional Application No. 61/601,432, filed Feb. 21, 2012, and entitled, “ELECTRONIC MEDICAL CODING SYSTEMS,” the disclosure of which is incorporated by reference herein in its entirety. 
     
    
     BACKGROUND 
       [0002]    Many different medical coding standards exist for documenting medical information. Most standards rely on their own unique medical terminologies. In addition, each standard can require collection of different information from the caregiver. There is a need for improved techniques for collecting the appropriate information from the caregiver to be able to identify the appropriate codes. 
       SUMMARY 
       [0003]    In general terms, this disclosure is directed to an electronic medical coding system. 
         [0004]    In one embodiment, a method of coding an aspect of a patient encounter performed by an electronic computing system is presented. The method includes: receiving, at a processing unit, a medical finding identifying medical information related to a patient, the medical finding being input by a user; identifying, by the processing unit, an internal medical code of an internal medical terminology that relates to the medical finding; retrieving from memory, by the processing unit, one or more alternative data items from an expansion table associated with the internal medical code, the alternative data items defining the medical finding input by the user with great specificity; generating a graphical user interface, the graphical user interface displaying the medical finding input by the user and the one or more alternative data items, the displayed one or more alternative data items being selectable by the user; and in response to selecting one of the one or more alternative data items, selecting a code from the standard medical terminology that identifies the medical finding in the standard medical terminology based on the categorical information. 
         [0005]    In another embodiment, a system is discussed. The system includes: a database encoded on a memory device, the data comprising a first terminology and a second terminology; the first terminology including a first set of terms identifying medical information, wherein each term of the first set of terms is associated with a first medical code; the second terminology including a second set of terms, wherein each term of the second set of terms is associated with a second medical code. The system further includes a computing device in data communication with the database, wherein the computing device is programmed to retrieve data from the first terminology and map the data to a second medical code. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0006]      FIG. 1  illustrates an exemplary embodiment of an electronic healthcare system. 
           [0007]      FIG. 2  illustrates an exemplary architecture of a computing device that can be used to implement aspects of the present disclosure. 
           [0008]      FIG. 3  illustrates an exemplary architecture of an application program of the computing device of  FIG. 2  and a database of the electronic healthcare system. 
           [0009]      FIG. 4  illustrates an exemplary embodiment of a mapping of internal medical terminology to an internal diagnostic relationship data. 
           [0010]      FIG. 5  illustrates an exemplary embodiment of a data structure of internal-to-external relationship data. 
           [0011]      FIG. 6  is a flowchart illustrating an exemplary embodiment of a method of mapping user inputs associated with an internal code to an external code through a medical information coding system. 
           [0012]      FIG. 7  is a diagram illustrating exemplary operations of the method of  FIG. 6 . 
           [0013]      FIG. 8  is an exemplary screen shot during use of the medical information coding system of  FIG. 1 . 
       
    
    
     DETAILED DESCRIPTION 
       [0014]    Various embodiments will be described in detail with reference to the drawings, wherein like reference numerals represent like parts and assemblies throughout the several views. Reference to various embodiments does not limit the scope of the claims attached hereto. Additionally, any examples set forth in this specification are not intended to be limiting and merely set forth some of the many possible embodiments. 
         [0015]      FIG. 1  illustrates an exemplary embodiment of an electronic healthcare system  100 . Caregivers interact with the electronic healthcare system  100  to access medical information and/or to document patient encounters. The system  100  includes a medical information coding system  102 , a network  110 , and user computing devices  112 . User computing devices  112  include stand-alone computing devices  112   1  and  112   2  as well as networked computing devices  112   3  and  112   4  that are connected to local area network  114 . 
         [0016]    Some embodiments of medical information coding system  102  include a server  104  and a database  108  that communicate across local area network  106 . The database  108  includes various external and internal medical terminologies, and operates to store medical information relating to medical conditions and to send selected portions of the medical information across network  110  when requested by a computing device  112 . The medical information coding system  102  can be located at the same location (such as in the same room, building, or facility) as one or more of the computing devices  112 . Alternatively, the medical information coding system  102  is located remotely from the computing devices  112 , such as in a different building, city, state, country, or continent. 
         [0017]    The server  104  controls access to information stored in the medical information coding system  102 , in some embodiments. In one example embodiment, the server  104  is a computing device that includes a database software application, such as the SQL SERVER® database software distributed by MICROSOFT® Corporation. In other possible embodiments, the server  104  is a Web server or a file server. When a request for medical information is received by the server  104 , the server retrieves the medical information from the database  108  and sends it across the network  110  to the computing device  112  that requested it. 
         [0018]    The database  108  is a data storage device configured to store a variety of medical information. Examples of a possible database  108  include a hard disk drive, a collection of hard disk drives, digital memory (such as random access memory), a redundant array of independent disks (RAID), or other data storage devices. In some embodiments, medical information is distributed across multiple local or remote data storage devices. The database  108  stores data or data items in an organized manner, such as in a hierarchical or relational database structure, or in lists and other data structures such as tables. Although the database  108  is illustrated as being separated from the computing devices  112  by the network  110 , the database  108  is alternatively a local data storage device of a computing device  112  or is connected to the same local area network  114  as the computing device  112 . 
         [0019]    The network  110  communicates digital data between one or more computing devices, such as between the medical information coding system  102  and the computing devices  112 . Examples of the network  110  include a local area network and a wide area network, such as the Internet. 
         [0020]    In some embodiments, the network  110  includes a wireless communication system, a wired communication system, or a combination of wireless and wired communication systems. A wired communication system can transmit data using electrical or optical signals in various possible embodiments. Wireless communication systems typically transmit signals via electromagnetic waves, such as in the form of radio frequency (RF) signals. A wireless communication system typically includes a RF transmitter for transmitting radio frequency signals, and an RF receiver for receiving radio frequency signals. Examples of wireless communication systems include Wi-Fi communication devices (such as utilizing wireless routers or wireless access points), cellular communication devices (such as utilizing one or more cellular base stations), and other wireless communication devices. 
         [0021]    In some example embodiments, computing devices  112  are computing devices used by a caregiver that display a caregiver interface  118 . Caregivers include physicians, psychiatrists, counselors, therapists, medical assistants, secretaries, receptionists, or other people that are involved in providing care to a patient and/or documenting clinical visits with a patient. In some embodiments, a computing device  112  is located at a point of care, such as within a room where a caregiver and a patient interact. In other embodiments, a computing device  112  is located near the point of care, such as in a hallway or nearby room. However, in other possible embodiments the computing device  112  is not located near the point of care. 
         [0022]    In some embodiments, computing devices are mobile computing devices, such as a tablet computer (such as the iPad® device available from Apple, Inc.), a smartphone, or other mobile computing devices. In some embodiments, computing devices  112  include a touch sensitive display for receiving input from a user. 
         [0023]    In one example embodiment, the electronic healthcare system  100  includes stand-alone computing devices  112   1  and  112   2 , as well as networked computing devices  112   3  and  112   4 . Stand-alone computing devices  112   1  and  112   2  connect directly to network  110  and are not part of an additional local area network. In some embodiments, the stand-alone computing devices connect through a wireless network, such as a cellular telephone network. Networked computing devices  112   3  and  112   4  are connected to a local area network  114  which may be within a facility  116 , such as a hospital, clinic, office, or other building. In some embodiments, a connection to the local area network is made wirelessly through a wireless access point connected to the local area network. More or fewer computing devices  112  are included in other possible embodiments and can be located in one or more facilities or locations. 
         [0024]      FIG. 2  illustrates an exemplary architecture of a computing device that can be used to implement aspects of the present disclosure, including the server  104  or the computing device  112 . One or more computing devices, such as the type illustrated in  FIG. 2 , are used to execute the operating system, application programs, and software modules (including the software engines) described herein. 
         [0025]    The computing device  112  includes, in some embodiments, at least one processing device  120 , such as a central processing unit (CPU). A variety of processing devices are available from a variety of manufacturers, for example, Intel or Advanced Micro Devices. In this example, the computing device  112  also includes a system memory  122 , and a system bus  124  that couples various system components including the system memory  122  to the processing device  120 . The system bus  124  is one of any number of types of bus structures including a memory bus, or memory controller; a peripheral bus; and a local bus using any of a variety of bus architectures. 
         [0026]    Examples of computing devices suitable for the computing device  112  include a desktop computer, a laptop computer, a tablet computer, a mobile phone device such as a smart phone, or other devices configured to process digital instructions. 
         [0027]    The system memory  122  includes read only memory  126  and random access memory  128 . A basic input/output system  130  containing the basic routines that act to transfer information within computing device  112 , such as during start up, is typically stored in the read only memory  126 . 
         [0028]    The computing device  112  also includes a secondary storage device  132  in some embodiments, such as a hard disk drive, for storing digital data. The secondary storage device  132  is connected to the system bus  124  by a secondary storage interface  134 . The secondary storage devices and their associated computer readable media provide nonvolatile storage of computer readable instructions (including application programs and program modules), data structures, and other data for the computing device  112 . 
         [0029]    Although the exemplary environment described herein employs a hard disk drive as a secondary storage device, other types of computer readable storage media are used in other embodiments. Examples of these other types of computer readable storage media include magnetic cassettes, flash memory cards, digital video disks, Bernoulli cartridges, compact disc read only memories, digital versatile disk read only memories, random access memories, or read only memories. Some embodiments include non-transitory media. 
         [0030]    A number of program modules can be stored in secondary storage device  132  or memory  122 , including an operating system  136 , one or more application programs  138 , other program modules  140 , and program data  142 . The database  108  may be stored at any location in the memory  122 , such as the program data  142 , or at the secondary storage device  132 . 
         [0031]    In some embodiments, computing device  112  includes input devices to enable the caregiver to provide inputs to the computing device  112 . Examples of input devices  144  include a keyboard  146 , pointer input device  148 , microphone  150 , and touch sensitive display  152 . Other embodiments include other input devices  144 . The input devices are often connected to the processing device  120  through an input/output interface  154  that is coupled to the system bus  124 . These input devices  144  can be connected by any number of input/output interfaces, such as a parallel port, serial port, game port, or a universal serial bus. Wireless communication between input devices and interface  154  is possible as well, and includes infrared, BLUETOOTH® wireless technology, 802.11a/b/g/n, cellular, or other radio frequency communication systems in some possible embodiments. 
         [0032]    In this example embodiment, a touch sensitive display device  156  is also connected to the system bus  124  via an interface, such as a video adapter  158 . The touch sensitive display device  156  includes touch sensors for receiving input from a user when the user touches the display. Such sensors can be capacitive sensors, pressure sensors, or other touch sensors. The sensors not only detect contact with the display, but also the location of the contact and movement of the contact over time. For example, a user can move a finger or stylus across the screen to provide written inputs. The written inputs are evaluated and, in some embodiments, converted into text inputs. 
         [0033]    In addition to the display device  156 , the computing device  112  can include various other peripheral devices (not shown), such as speakers or a printer. 
         [0034]    When used in a local area networking environment or a wide area networking environment (such as the Internet), the computing device  112  is typically connected to the network through a network interface, such as a wireless network interface  160 . Other possible embodiments use other communication devices. For example, some embodiments of the computing device  112  include an Ethernet network interface, or a modem for communicating across the network. 
         [0035]    The computing device  112  typically includes at least some form of computer-readable media. Computer readable media includes any available media that can be accessed by the computing device  112 . By way of example, computer-readable media include computer readable storage media and computer readable communication media. 
         [0036]    Computer readable storage media includes volatile and nonvolatile, removable and non-removable media implemented in any device configured to store information such as computer readable instructions, data structures, program modules or other data. Computer readable storage media includes, but is not limited to, random access memory, read only memory, electrically erasable programmable read only memory, flash memory or other memory technology, compact disc read only memory, digital versatile disks or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium that can be used to store the desired information and that can be accessed by the computing device  112 . 
         [0037]    Computer readable communication media typically embodies computer readable instructions, data structures, program modules or other data in a modulated data signal such as a carrier wave or other transport mechanism and includes any information delivery media. The term “modulated data signal” refers to a signal that has one or more of its characteristics set or changed in such a manner as to encode information in the signal. By way of example, computer readable communication media includes wired media such as a wired network or direct-wired connection, and wireless media such as acoustic, radio frequency, infrared, and other wireless media. Combinations of any of the above are also included within the scope of computer readable media. 
         [0038]      FIG. 3  illustrates exemplary aspects of the electronic healthcare system  100 . As one example embodiment, an application program  138  operates on the computing device  112 . In other embodiments, however, the application program  138  operates on one or more other computing devices, such as server  104 . In this example, the medical coding system  102  includes a plurality of engines that, when executed by the processor, perform one or more operations of the application program  138 . The engines include a user interface engine  170  and an intelligent prompting engine  172 . The intelligent prompting engine  172  includes an internal terminology prompting engine  176  and an internal-to-external prompting engine  174 . In other embodiments, the plurality of engines could be stored at any other location in the memory  122 , such as the program modules  140  (shown in  FIG. 2 ). 
         [0039]    The database  108  is stored in one or more data storage devices, such as the memory  122  or the secondary storage device  132  (shown in  FIG. 2 ) of the computing device  112  or another server computing device. The database  108  can alternatively be part of the computing device  112 , or selected data or data items can be retrieved from database  108  and stored locally on the computing device  112 . The database  108  includes a knowledge base  178 , an external standard terminology  180 , and an internal-to-external relationship data  182 . The knowledge base  178  includes an internal medical terminology  184  and an internal diagnostic relationship data  186 . 
         [0040]    The user interface engine  170  receives inputs from a caregiver through the input/output interface  154 . Examples of such inputs include inputs from a keyboard  146 , a pointer input device  148 , a microphone  150 , or touch sensitive display  152 . In some embodiments, touch inputs are received from a caregiver through the touch sensitive display device  156 . Examples of inputs from a caregiver include descriptions and/or names of medical conditions and health problems, findings, symptoms, and/or answers to questions presented to the user through the input/output interface  154  by the intelligent prompting engine  172 . 
         [0041]    In general, the intelligent prompting engine  172  functions in two main ways. First, the intelligent prompting engine  172  utilizes the internal terminology prompting engine  176  to prompt the caregiver with a list of findings related to an inputted medical condition, or alternatively, prompt the caregiver with a list of medical conditions related to a list of inputted symptoms. For example, if a caregiver inputs “bacterial pneumonia” into the system  102 , the user interface engine  170  processes the input, and the internal terminology prompting engine  176  may present a listing of symptoms associated with bacterial pneumonia, including “coughing,” “wheezing,” “chest congestion,” etc. Alternatively, the caregiver may input “coughing,” “wheezing,”, and/or “chest congestion,” and the internal terminology prompting engine  176  may present a listing of medical conditions associated with the symptoms. Upon receiving the prompted list, the caregiver may select the appropriate symptoms or medical conditions that appear to be relevant for the patient. 
         [0042]    It is understood that a caregiver input may be any medical information. Medical information can be any medical item, such as, for example, a symptom, medical history, an examination finding, a diagnosis, a test, a physical characteristic, a mental characteristic, a therapy, and the like. The medical information may be information gathered during the course of a patient/caregiver interaction or general medical information not related to a particular patient. In some embodiments disclosed herein, findings are stored as data items in one or more data records. 
         [0043]    The system  102  utilizes the knowledge base  178  to present the appropriate listing of findings and/or medical conditions to the caregiver. For example, the internal medical terminology  184  may include a list of symptoms, medical conditions, and internal medical codes for each, utilized internally by the computing device  112 . Furthermore, the internal diagnostic relationship data  186  may include data structures such as tables and/or lists which internally connect the various medical conditions, associated symptoms, and associated internal medical codes. In some embodiments, for example, all of the information or a substantial part of the information stored in the internal medical terminology  184  and the internal diagnostic relationship data  186  is relevant to medical diagnoses. Examples of how the system  102  intelligently prompts the caregiver based on the knowledge base  178  are shown in the issued patent entitled, INTELLIGENT PROMPTING, U.S. Pat. No. 5,823,949, issued on Oct. 20, 1998, by Peter S. Goltra, the entire disclosure of which is incorporated by reference herein. 
         [0044]    Secondly, the intelligent prompting engine  172 , utilizes the internal-to-external prompting engine  174  to prompt the user with a variety of questions so that the system  102  can map the selected symptoms and/or medical conditions from the internal medical terminology  184  (discussed above) to the associated symptoms, medical conditions, or descriptions in the external standard terminology  180 . For example, in some embodiments, the internal-to-external prompting engine  174  utilizes the internal-to-external relationship data  182  to determine the relationships between selected symptoms and/or medical conditions in the internal medical terminology  184  to the external standard terminology  180 . In some embodiments, the external standard terminology  180  includes data that is informational, but not diagnostically relevant, for example, information relevant to billing. 
         [0045]    The external standard terminology  180  is stored in the database  108 . In some embodiments, the external standard terminology  180  includes a list of descriptions, such as, symptoms, medical conditions, and/or medical conditions in conjunction with terms that are not diagnostically relevant, with associated external medical codes for each item. The internal-to-external relationship data  182  includes various data structures, such as tables, hierarchical structures, or the like, to store information relating the internal medical terminology  184  to the external standard terminology  180 . In some embodiments, each data structure in the internal-to-external relationship data  182  indicates to the internal-to-external prompting engine  174  that more information is needed from the caregiver to accomplish the mapping. At such time, the internal-to-external prompting engine  174  prompts the caregiver with a query, such as an open-ended question, multiple choice question, or an option to select items (as shown in  FIG. 8 ). 
         [0046]    An example of the external standard terminology  180  is the International Statistical Classification of Diseases and Related Health Problems (ICD), such as the ICD-10-CM (10 th  revision), which was scheduled for use in the United States beginning on Oct. 1, 2013, although implementation has been recently put on indefinite hold. Future revisions are also examples of the external standard terminology. Other embodiments utilize other standard medical terminologies, such as one or more of the RxNORM standard, the Logical Observation Identifiers Names and Codes (LOINC) standard, and other medical terminology standards. 
         [0047]      FIG. 4  illustrates an exemplary embodiment of a mapping  188  between an internal medical terminology table  190  in the internal medical terminology  184  to a table  198  in the internal diagnostic relationship data  186 . The table  190  includes an internal medical code column  192  and an internal description column  194 . The internal medical code column  192  includes internal medical codes  192   a - f . The internal description column  194  includes internal descriptions  194   a - f . The list  190  is connected to the table  198  through a link  196 . The data structure  198  includes an internal medical code column  200 , an internal description column  202 , and an intelligent prompting score (“IPS”) column  204 . The internal medical code column  200  includes internal medical codes  200   a - d . The internal description column  202  includes internal descriptions  202   a - d . The IPS column  204  includes IPSs  204   a - d . Though the tables  190  and  198  appear as tables, it is understood that the internal medical terminology  184  and the internal diagnostic relationship data  186  may organize information in any data structure form. 
         [0048]    As illustrated in the table  190 , each internal description  194   a - f  is associated with a corresponding internal medical code  192   a - f . The internal medical codes  192   a - f  are utilized by the internal terminology prompting engine  176  to determine relationships between medical conditions and symptoms and prompt the caregiver when more information is needed by the system  102 . For example, if the caregiver inputs “Lyme disease” into the system  102 , the internal terminology prompting engine  176  may search the internal diagnostic relationship data  186  for the link  196  to locate table  198  which includes the various symptoms associated with Lyme disease. 
         [0049]    As shown, the symptoms in the table  198  also include internal medical codes  200   a - d , descriptions  202   a - d , and IPSs  204   a - d . The IPSs  204   a - d  indicate the prevalence of the associated symptom with the underlying condition, in this case, Lyme disease. In some embodiments, as  FIG. 4  shows, a lower IPS indicates a greater likelihood that the corresponding symptom will be present if the patient is in fact suffering from Lyme disease. Thus, as illustrated, fever and chills are more likely to be associated with a diagnosis of Lyme disease than headache and muscle pain. 
         [0050]    The internal medical codes  192   a - f  and  200   a - d  are also utilized by the internal-to-external prompting engine  174  to navigate through the internal-to-external relationship data  182  to determine relationships between internal medical codes and external medical codes and prompt the caregiver when more information is needed by the system  102 . Such mapping is described in greater detail below. 
         [0051]      FIG. 5  illustrates an exemplary embodiment of a data structure  210  in the internal-to-external relationship data  182 . The data structure  210  includes an internal medical code column  212 , an internal description column  214 , a map type column  216 , an external medical code column  218 , and an external description column  220 . The internal medical code column  212  includes internal medical codes  212   a - h . The internal description column  214  includes internal descriptions  214   a - h . The map type column  216  includes map types  216   a - h . The external medical code column  218  includes external medical codes  218   a - h . The external description column  220  includes external descriptions  220   a - h.    
         [0052]    The data structure  210  illustrates one example of a mapping between internal medical terminology  184  and external standard terminology  180 . For example, as shown in the data structure  210 , various internal medical codes  212   a - h  and the associated internal descriptions  214   a - h  are mapped to corresponding external codes  218   a - h  and the associated external descriptions  220   a - h.    
         [0053]    The map type column  216  indicates the complexity of the mapping between the internal medical codes  212   a - h  and the external medical codes  218   a - h . For example, in some embodiments, the map type may indicate that the internal description is the “same as” the external description, such as the map types  216   c, f -h. In these cases, the internal-to-external prompting engine  174  determines that the mapping is one-to-one, and therefore, no further information is needed by the caregiver for the system  102  to determine the corresponding external code. 
         [0054]    However, if an internal description has a map type that indicates that the internal description is both “same as” and “broader than” the external description, such as the internal descriptions  214   a, b, d, e  indicating “Lyme disease” and “malignant neoplasm of ovary”, the internal-to-external prompting engine  174  determines that the mapping is not one-to-one, and therefore, more information is required by the caregiver so that the internal-to-external prompting engine  174  may access the relevant data from the internal-to-external relationship data  182 . This is because the map type “broader than” indicates to the system  102  that the internal description associated with the internal code does not exactly correlate with an external description associated with any external code. For example, the closest external description to the internal description may include narrowing aspects to the internal description or may include diagnostically irrelevant information which also narrows the internal description. 
         [0055]    For instance, if the caregiver selects “Lyme disease,” the internal-to-external prompting engine  174  might prompt the caregiver for information relating to whether this is a subsequent visit with the patient. In the example, “subsequent visit” is an example of narrowing diagnostically irrelevant information that is present in the external description, but not in the internal description. If the caregiver indicates that it is not a subsequent visit with the patient, the system  102  will select the external code  218   b , “A69.2.” However, if the caregiver confirms that it is a subsequent visit with the patient, the system  102  will select the external code  218   a , “A69.20.” 
         [0056]    In other embodiments, the internal-to-external prompting engine  174  may utilize the response provided by the caregiver to locate and read an expansion table, described in more detail herein, within the hierarchical structures of the internal-to-external relationship data  182  to determine whether more questions need to be prompted to the caregiver to determine the associated external code. The number of hierarchical tables in the internal-to-external relationship data  182  associated with one internal code may indicate how many questions must be prompted to the caregiver to determine the associated external code. 
         [0057]      FIG. 6  is a flowchart illustrating an exemplary method  230  of mapping user inputs associated with an internal code to an external code through the medical information coding system  102 . The method includes operations  232 ,  234 ,  236 ,  238 ,  240 ,  242 ,  244 ,  246 , and  248  As stated below, a user may be a caregiver who is examining or has examined a patient and is now using the system  102  to document the patient visit. 
         [0058]    The method begins with the operation  232 . During operation  232 , the user of the medical information coding system  102  begins the system and enters initial inputs, such as a medical condition. The user selects or enters, for example, “Lyme disease.” At this time, the system processes the user inputs at the operation  234 . In some embodiments, during operation  234 , the internal terminology prompting engine  176  accesses the knowledge base  178  to determine the associated internal medical terminology  184  that relates to the user inputs. In some embodiments the input is a data item which is a medical finding that identifies a physical or mental characteristic of a person, such as the patient or a relative of the patient. In other embodiments, the input is a medical finding, as described herein. 
         [0059]    At operation  236 , the system prompts the user with relevant findings associated with the initial user input. For example, in some embodiments, the internal terminology prompting engine  176  may scan the internal medical terminology  184  and follow any links which exist to the internal diagnostic relationship data  186  to compile all of the associated symptoms with the user-inputted medical condition. After determining the associated symptoms, the internal terminology prompting engine  176  utilizes the user interface engine  170  to prompt the symptoms to the user. Upon prompting the findings to the user, the user is free to select any findings that appear relevant to the patient&#39;s condition. 
         [0060]    At operation  238 , the system  102  processes the findings that the user selected. For example, in some embodiments, the internal terminology prompting engine  176  may search the knowledge base  178  to determine locate the data structures in the internal medical terminology  184  and the internal diagnostic relationship data  186  which relate to the selected findings. At operation  240 , the system  102  determines the internal medical codes associated with each selected finding and underlying medical condition. To do this, in some embodiments, the internal terminology prompting engine  176  scans the related data structures gathered during operation  238  and selects the associated internal medical codes with each selected finding and underlying condition. For instance, in the example above, the system  102  would determine the internal medical codes for all of the symptoms of Lyme disease selected by the user, as well as the internal medical code for Lyme disease itself. 
         [0061]    At operation  242 , the system  102  makes a determination of whether an expansion table exists for the first internal medical code. As explained above, an expansion table indicates that more information needs to be provided by the user to determine the corresponding external code. In some embodiments, the expansion table can be any data structure which stores information linking the internal medical terminology  184  with the external standard terminology  180 . One example of the structure of an expansion table is shown in  FIG. 7 . 
         [0062]    In some embodiments, the determination of whether an expansion table exists is made by the internal-to-external prompting engine  174 . The internal-to-external prompting engine  174  uses the internal medical code determined in operation  240  to search the internal-to-external relationship data  182  for this internal medical code. At this time, if the map type associated with the internal medical code indicates that the mapping is not one-to-one (as discussed above in relation to  FIG. 5 ), the internal-to-external prompting engine  174  determines that an expansion table exists. If on the other hand, the map type associated with the internal medical code indicates that the mapping is one-to-one, the internal-to-external prompting engine  174  determines that no expansion table exists. 
         [0063]    If it is determined that no expansion table exists, the method proceeds to operation  246  where the external code is determined. In some embodiments, this is accomplished when the internal-to-external prompting engine  174  scans the data structure and retrieves the associated external code. In some embodiments, the external code is displayed to the user by way of the user interface engine  170 . In other embodiments, the external code is not displayed to the user, but simply used within the system  102 . After retrieving the external code, the method terminates at the end operation  248 . 
         [0064]    If, on the other hand, the internal-to-external prompting engine  174  determines that an expansion table exists, the user is prompted for further information at operation  244 . To determine the question, the internal-to-external prompting engine  174  follows a link in the internal-to-external relationship data  182  to the expansion table and determines the information needed to make a selection in the expansion table. This information is then presented to the user through the user interface engine  170  as either an open-ended question or multiple-choice question or selection. Upon receiving a user response, the method returns to operation  242  and determines if a further expansion table exists. This process is repeated until the internal-to-external prompting engine  174  determines that no further expansion tables exist and an external code can be determined at operation  246 . At this time, the method terminates at the end operation  248 . 
         [0065]      FIG. 7  is a diagram  260  illustrating examples of operations  240 - 246  of the method  230  (discussed in  FIG. 6 ). The diagram  260  includes operations  262 ,  270 ,  284 , and  296 . The operation  262  utilizes an exemplary internal medical terminology table  264 . The operation  270  utilizes an exemplary expansion table  272 . The operation  284  utilizes a second exemplary expansion table  286 . The operation  296  utilizes an exemplary external standard terminology table  298 . The exemplary internal medical terminology table  264  includes an internal code  266  and an internal description  268 . The exemplary expansion table  272  includes rows  274 ,  276 , and  278 . Row  276  includes an identifier  280  and an expansion table description  282 . The second exemplary expansion table  285  includes rows  288  and  290 . Row  288  includes an identifier  292  and an expansion table description  294 . The exemplary external standard terminology table  298  includes an external description  300  and an external medical code  302 . 
         [0066]    In operation  262 , the system  102  maps the internal description  268  to the internal code  266 . In some embodiments, after retrieving the internal code  266 , the internal-to-external prompting engine  174  determines whether an expansion table exists by determining whether a map type (not shown) within the internal-to-external relationship data  182  indicates whether the mapping is one-to-one or more complex. In the example embodiment, an expansion table exists for the description, “open wound of the shoulder”, and therefore, at operation  270 , the system  102  searches and retrieves the exemplary expansion table  272 . 
         [0067]    Upon retrieving the expansion table  272 , the system  102  determines whether any further information is required by the user. In some embodiments, the internal-to-external prompting engine  174  scans the expansion table and queries the user to choose within the various expansion table descriptions, such as the description  282 . In this case, the internal-to-external prompting engine  174  may ask the user to select between: right, left, and unspecified. 
         [0068]    If, in the example embodiment, the user selects “left,” the system  102  next determines in operation  284  whether a further expansion table exists for the description, “open wound of the left shoulder.” Again, the internal-to-external prompting engine  174  determines whether an expansion table exists for this description by determining whether a map type (not shown) within the internal-to-external relationship data  182  indicates whether the mapping is one-to-one or more complex. In the example embodiment, an expansion table exists for the description, “open wound of the left shoulder”, and therefore, at operation  284 , the system  102  searches and retrieves the second exemplary expansion table  286 . 
         [0069]    After retrieving the second expansion table  286 , the system  102  again determines whether any further information is required by the user to determine an external code for the description. The internal-to-external prompting engine  174  scans the expansion table and queries the user to choose within the various second expansion table descriptions. For example, the system  102  may prompt the user to select between: initial encounter and subsequent encounter. 
         [0070]    If, in the example embodiment, the user selection “initial encounter,” the system  102  again determines whether a further expansion table exists for the description. If, in the example embodiment, the system  102  determines that no further expansion table exists, the system  102  then does a one-to-one mapping of the description  300  to the external code  302 . In some embodiments, this is accomplished by the internal-to-external prompting engine  174 . Upon determining that no expansion table exists, the internal-to-external prompting engine  174  searches the external standard terminology  180  for the description, “open wound of the left shoulder initial encounter,” and retrieves the corresponding external code  302 . 
         [0071]    In some embodiments, the external code  302  may be formulated by identifiers  280  and  292 . For example, if the general external code for “open wound of the shoulder” is “R27,” then the external code  302  may be “R27.21” by utilizing the identifier  280  as the first decimal, indicating the identifier in the first expansion table  272 , and utilizing the identifier  292  as the second decimal, indicating the identifier in the second expansion table  292 . In other embodiments, however, the identifiers are not utilized in determining the external code  302 . 
         [0072]      FIG. 8  is an exemplary screen shot  310  from the computing device  112  during use of the system  102 . Specifically, the screen shot  310  is an example of an intelligent prompt presented by the intelligent prompting engine  172 . The screen shot  310  includes prompt selection rows  312 ,  314 ,  316 , and user interface buttons  318 ,  320 . 
         [0073]    As shown, the screen shot  310  includes three prompt selection rows  312 ,  314 ,  316 . The user may utilize a pointer input device, a touch sensor, such as a finger or stylus, or any other display selection/input device to select one option from each row  312 ,  314 ,  316  so that the system  102  may map the internal code to an external code. It is understood that though in the example embodiment three questions (in selection format) are presented to the caregiver at a single time, other intelligent prompts may be presented to the caregiver as single questions. In some embodiments, this is due to the fact that an answer to one question is dependent on the next question to be answered. However, in other embodiments, as the example embodiment, subsequent questions may not be dependent on the answer of a previous question. Upon selecting an item from each row  312 ,  314 ,  316 , the caregiver can either submit his responses by selecting the user interface button  318  or cancel his responses by selecting the user interface button  320 . In some embodiments, the selection rows  312 ,  314 , and  316  may be compiled into one selection row. The single selection row may include all possible combinations of selections. For example, in the example embodiment, the single selection row may include “Unspecified open wound, Right, Initial Encounter,” “Unspecified open wound, Left, Initial Encounter,” “Unspecified open wound, Unspecified, Initial Encounter,” and so on until all possible combinations of categories are listed. 
         [0074]    The various embodiments described above are provided by way of illustration only and should not be construed to limit the claims attached hereto. Those skilled in the art will readily recognize various modifications and changes that may be made without following the example embodiments and applications illustrated and described herein, and without departing from the true spirit and scope of the following claims.