Abstract:
In one embodiment, a method of operating a clinical content management system includes providing a master server with a master content database including master content, providing at least one first derivative content database operably connected to the master content database, each of the at least one first derivative content databases including derived content derived from the master content, including new content in the master content database, identifying with the master server each of the at least one first derivative content databases including derived content related to the new content, issuing a notice of the new content based upon the identified at least one first derivative content database including derived content related to the new content, and tracking at the master server whether the new content is incorporated into the identified at least one first derivative content database including derived content related to the new content.

Description:
[0001]    This application claims the benefit of U.S. Provisional Application No. 61/671,221 filed Jul. 13, 2012, the entire contents of which is herein incorporated by reference. 
     
    
     FIELD OF THE INVENTION 
       [0002]    This disclosure relates to a content updating system and, more specifically to a system used for revising and updating clinical content. 
       BACKGROUND 
       [0003]    Content revision management systems are well known. Some well-known internet sites, for example, allow collaborative editing of documents which are published by the site with a form of editing control maintained by the site. Other systems are designed to allow for open source collaborative editing of software code. 
         [0004]    The above described systems enable a process wherein a content master is continuously updated through contributions from a large number of people in disparate locations. In some instances, a new version of a program can be created by branching the content master into a separate independent program that is then managed independently. 
         [0005]    While the known systems are highly effective for their purpose, they are not well suited for use in a health-related content management system. In a health-related management system, a number of different entities may be pursuing independent protocols. Customers would typically defer from participation in a program where the ability to act independently is stifled. Moreover, rigid adhesion to a single protocol stifles ingenuity and therefor progress. 
         [0006]    Of course, when each customer is pursuing their own protocol, the ability of other customers to rapidly learn from the advances of one customer is affected by the ability to rapidly alert the other customers using related protocols to the advances discovered by the one customer. 
         [0007]    What is needed in health content management wherein content can be continuously updated, while at the same time allowing a large number of customer-specific variations of that content master. It would be further advantageous if the system could alert customers to the opportunity to review and approve/modify changes in any derivative programs that might depend on the updated master content. It would be further advantageous if customer modifications could be reviewed and used to modify the master content. Yet another benefit would be realized if modification of the master content was not limited to customer input, while maintaining the quality of any such non-customer modification. 
       SUMMARY 
       [0008]    In accordance with one embodiment, a method of operating a clinical content management system includes providing a master server with a master content database including master content, providing at least one first derivative content database operably connected to the master content database, each of the at least one first derivative content databases including derived content derived from the master content, including new content in the master content database, identifying with the master server each of the at least one first derivative content databases including derived content related to the new content, issuing a notice of the new content based upon the identified at least one first derivative content database including derived content related to the new content, and tracking at the master server whether the new content is incorporated into the identified at least one first derivative content database including derived content related to the new content. 
         [0009]    Other features of the embodiments herein will be apparent from the drawings, and detailed description that follows below 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0010]      FIG. 1  depicts a diagram of a distributed clinical content management system which allows for a variety of different content to be used by various customers while maintaining a master content database, and which can notify the customers when content in the master content database has been added which is related to content in a customer content database; 
           [0011]      FIG. 2  depicts the master server of  FIG. 1  showing modification routes which are used to update the master content database; 
           [0012]      FIG. 3  depicts a process which is used in verifying the content which is added to the master content database; 
           [0013]      FIG. 4  depicts a diagram of a partially distributed clinical content management system which allows for a variety of different content to be used by various customers while maintaining a master content database, and which can notify the customers when content in the master content database has been added which is related to content in a customer content database; 
           [0014]      FIG. 5  depicts the master server of  FIG. 2  showing modification routes which are used to update the master content database, along with a master session server which uses the master content in accordance with general or customized rules to generate dialogue and sessions; 
           [0015]      FIG. 6  depicts the dialogue library database of  FIG. 5  with general/best practices dialogues and custom dialogues using content from the master content database; 
           [0016]      FIG. 7  depicts the program sessions database of  FIG. 5  populated with dialogues from the dialogue library database of  FIG. 5 ; and 
           [0017]      FIG. 8  depicts a block diagram of a patient device which is used to display sessions to a patient and to gather patient data. 
       
    
    
       [0018]    Although specific features of the embodiments are shown in some drawings and not in others, this is done for convenience only as each feature may be combined with any or all of the other features in accordance with the embodiments. 
       DESCRIPTION 
       [0019]    For the purposes of promoting an understanding of the principles of the disclosure, reference will now be made to the embodiments illustrated in the drawings and described in the following written specification. Descriptions of well-known components and processing techniques are omitted so as to not unnecessarily obscure the embodiments herein. It is understood that no limitation to the scope of the disclosure is thereby intended. It is further understood that the present disclosure includes any alterations and modifications to the illustrated embodiments and includes further applications of the principles of the disclosure as would normally occur to one skilled in the art to which this disclosure pertains. 
         [0020]    With initial reference to  FIG. 1 , a clinical content management system  100  is depicted. The clinical content management system  100  includes a master server  102  which includes a master content database  104 . Content within the master content database  104  can be modified, as described more fully below, based upon input proposed by content editors  106 ,  108 , and  110 . 
         [0021]    The content within the master content database  104  can also be modified based upon content modifications received from derivative content servers  112 ,  114 , and  116 . Each of the derivative content servers  112 ,  114 , and  116  includes a respective derivative content database  118 ,  120 , and  122 . As will be discussed more fully below, the content within each of the derivative content databases  118 ,  120 , and  122  is modified by associated content editors, and such modifications are added to the master content in the master content database  104 . Specifically, content editors  124 ,  126  and  128  provide proposed modification to the derivative content database  118 , content editors  130  and  132  provide proposed modification to the derivative content database  120 , and content editors  134 ,  136  and  138  provide proposed modification to the derivative content database  122 . 
         [0022]    While the clinical content management system  100  includes only a single layer of derivative content servers (i.e., derivative content servers  112 ,  114 , and  116  are in direct communication with the master server  102 ), in some embodiments one or more of the derivative content servers  112 ,  114 , and  116  include one or more layers of further derivative content servers which hare thus only indirectly linked to the master server  102 . Of course, direct connection to the master server  102  by the further derivative servers is also possible. 
         [0023]    The “content” within the master content database  104  in one embodiment is in the form of questions to be posed to patients along with their related answers. Such questions may be for example “how are you feeling today?” or “do you have discoloration in your fingers?”. The content thus reflects current knowledge as to both indications of medical issues as well as the form of questions which are used in order to understand the medical condition of a patient. Because understanding of both medical symptoms and how individuals react to the manner in which questions are posed varies, the content in the master content database  104  is allowed to change. 
         [0024]      FIG. 2  depicts the master content database  104  within the master server  102 . Also depicted are modification routes  150  and  152 . New content from content editor proposals/credentials database  154  is incorporated into the master database  104  by the modification route  150  while new content from new derivative content database  156  is incorporated into the master database  104  by the modification route  152 . While either modification route  150  or  152  can be used to modify the content within the master content database  104 , the manner in which proposed new content is incorporated varies based upon the source of the new content. 
         [0025]    Specifically, when new content is submitted by one of the content editors  106 ,  108 , or  110 , the proposed new content from the content editors  106 ,  108 , or  110  enters the master server  102  at the content editor proposals/credentials database  154 . The new content is accompanied by the credentials of the particular content editor and the basis for the change. For example, the credentials may include the laboratory or school/research team which is submitting the new content and the credentials may include a study or research project which supports the new content. The credentials may further be the name of the author generating the new content, the name of an expert panel that reviewed the new content, or the citation of an article related to the new content. 
         [0026]    The modification route  150  entails a review of the proposed new content along with the associated credentials of the content editor  106 ,  108 , or  110 . The review is conducted by an expert panel. The expert panel may accept the new content for addition to the master content database, reject the new content, or determine that a modified version of the new content is to be added to the master content database. 
         [0027]    Upon addition to the master content database, the new content is provided with a metatag. The metatag is used, among other purposes, to track the relationship of the new content to other content in the master content database. For example, if an original master content was a question in the form of “do you have any discoloration in your extremities?” and the new content was a question in the form of “do you have any discoloration in your fingers?”, the new content would be designated as a derivative of the original content. Significantly, the new content does not replace the original content. Thus, even if the new content is not as effective as the old content in obtaining the desired information, the new content is still added. The more effective question (old content or new content), however, would be identified as the “best practices” form of the question. 
         [0028]    Because the new content does not replace the old content, duplication of efforts is avoided. For example, a customer attempting to improve the phrasing of a question would be able to access the master content database  104  and ascertain that a particular phrasing has already been attempted. Additionally, when the new content is accepted or modified, the reasons for the change, the citations, references and the supporting materials are stored along with the accepted or modified content in the master content database. Thus, the credentials/basis of the entity which submitted the content would also be available for review so that the customer could determine for themselves the credibility of the conclusions drawn. 
         [0029]    New content is submitted to the new derivative content database  156  whenever one of the derivative content databases  118 ,  120 , or  122  is modified. The new content is accompanied by the credentials of the particular content editor and the basis for the change which is similar to the process described above for the content editor proposals/credentials database  154 . The modification route  152  also entails a review of the new content along with the associated credentials. Because the new content is already in one of the derivative content databases  118 ,  120 , or  122 , however, the new content will always be added to the master content database  104 . The derivative content databases  118 ,  120 , or  122  thus function as content editors of the master content database  104 . In instances where the new content is not designated as source confidential (i.e., allowed to be shared with other customers), the expert panel assesses the new content to determine if the new content is to be designated as a best practice. The new content is otherwise handled in the same manner as the new content arriving from the modification route  150 . 
         [0030]    Returning to  FIG. 1 , the derivative content servers  112 ,  114 , and  116  are each associated with the various content editors  124 - 138 . The derivative content databases  118 ,  120  and  122  may be updated in a manner similar to the manner in which the master content database  104  was updated. In some embodiments, a sole content editor will be the owner of the derivative content server (the customer). Accordingly, the customer may modify the derivative content database based upon their own research efforts or using a customized review process. 
         [0031]    Once new content is added to the master content database  104 , regardless of the pathway, the clinical content management system  100  makes the new content available to each of the derivative content servers  112 ,  114 , and  116 . The manner and form in which the content is made available can vary between the derivative content servers  112 ,  114 , and  116 . For example, derivative content server  116  may be configured to only maintain the best practices of a particular set of master content in the master content database  104 . Accordingly, if the new content in the master content database is designated as a best practice in the selected set of master content, the derivative content database  122  is automatically updated. Typically, the customer will also be notified of the automatic update. 
         [0032]    In instances wherein a customer does not simply maintain the best practices version of content on a derivative content server, an alert is issued from the master server when new content is added which is related to content maintained on the derivative content server. The alert or notification may be sent by email or by system messages that appear to the customer upon logging into the derivative content servers or through both processes. 
         [0033]    Continuing with the example above, if the derivative content on the derivative content database  118  includes the question “do you have any discoloration in your extremities?” and the new content was a question in the form of “do you have any discoloration in your fingers?”, the customer operating the derivative content server  112  would be alerted to the new content. The customer could then accept the new content, typically by replacing the content in the derivative content database  118  with the new content, reject the new content, or modify the new content thereby creating another derivative new content. 
         [0034]    Regardless of the customer&#39;s particular decision, the decision is transmitted back to the master server  102 . Accordingly, the master server  104  tracks the version of content in each of the derivative content databases  118 ,  120 , and  122 . This allows the master server  102  to properly identify customers who should receive alerts/updates as new content is added to the master content database  104 . 
         [0035]    The general process of updating the master content and informing the customers of the master server  102  is summarized in process  170  of  FIG. 3 . At block  172 , new content is received at the master server  102  in either the content editor proposals/credentials database  154  or the new derivative content database  156 . The new content is then verified (block  174 ) using either the modification route  150  or  152 . Upon verification, the new content is added to the master content database  104  (block  176 ) and the customers are notified of the availability of new content at block  178 . 
         [0036]    In addition to being a repository of content used to obtain patient data, the clinical content management system  100  further functions as a repository of patient data collected as indicated by patient data database  180  of  FIG. 2 . This allows for customers to compare results of the various customer endeavors, enabling additional insight into the effectiveness of the content in the master content database  104 . 
         [0037]    While the embodiment of  FIG. 1  was described as a decentralized system, where use of the master content was controlled by the derivative content servers  112 ,  114 , and  116 , the clinical content management system  100  can be augmented by or replaced with a more centrally controlled system. For example,  FIG. 4  depicts a clinical content management system  200  wherein some of the functions performed in the derivative content servers  112 ,  114 , and  116  are performed centrally for some of the customers. 
         [0038]    The clinical content management system  200  includes a master server  202  which includes a master content database  204 . Content within the master content database  204  can be modified based upon input proposed by content editors  206 ,  208 , and  210  in a manner like that described above for the clinical content management system  100 . 
         [0039]    Like the clinical content management system  100 , the content within the master content database  204  can also be modified based upon content modifications received from derivative content servers  212  and  214  which function like the derivative content servers  112  and  114  of  FIG. 1  using input from the master content database  204  and content from content editors  224 ,  226 ,  228 ,  230 , and  232  to populate derivative content databases  218  and  220 . 
         [0040]    The clinical content management system  200  also includes a customer  240 . The customer  240  does not maintain a derivative content database. Rather, the customer  240  relies upon the master server  202  and a master session server  242  for functions performed by the derivative servers  212  and  214 . The master session server  242  thus provides dialogues to, and receives patient data from, patient devices  244 ,  246 , and  248 . While only one customer  240  is shown, the clinical content management system  200  may include any number of customers like customer  200 . Moreover, while associated directly with the master server  202  and session sever  242 , other customers may be associated with the derivative content server  212  and the derivative content server  214 . 
         [0041]    Some the functions provided by the session sever  242  are further explained with initial reference to  FIG. 5 .  FIG. 5  depicts the master content database  204  within the master server  202 . Also depicted are modification routes  250  and  252 . New content from content editor proposals/credentials database  254  is incorporated into the master database  204  by the modification route  250  while new content from new derivative content database  256  is incorporated into the master database  204  by the modification route  252  in a manner similar to the processes described above with respect to modification routes  150  and  152 . The master server  202  also includes a patient data database  258 . 
         [0042]    The master server  202  is in communication with the master session server  242  which includes a dialogue library  260  and program sessions  262 . The master session server  242  further includes rules  264 , customized rules  266 , and patient variables  268 . The rules  264  and customized rules  266  are used by the master session server  242  to populate sublibraries  280 ,  282  and  284  with, e.g., dialogues  286 ,  288 ,  290 ,  292 ,  294 , and  296 . 
         [0043]    By way of example, dialogue  286  is generated by the rules  264  using the best practices master content (MC) for type (A) content while dialogue  290  is generated by the rules  264  using the best practices master content (MC) for type (B) content. Categorization and relationship of the master content, which include questions and other data, is tracked using the metatags associated with the master content. Type “A” content may be questions related to fatigue, while type “C” may be related to weight gain. In accordance with the rules  264 , master content in the master content database  204  indicates that content MC-A1, MC-A2, and MC-A3 are the best practices content. Thus, the rules generate a best practices dialogue  286  for type “A” content. Dialogue  290  is similarly generated for type “B” content, and dialogue  294  is generated for type “C” content. 
         [0044]    At least one customer, such as customer  240 , has chosen to use a customized dialogue for at least a portion of a session that is to be given to a patient. Accordingly, the master session server  242  accesses the customized rules  266  and determines that a customized dialogue  288  is required. The customized rules  266  indicate that the customized dialogue  288 , which includes type “A” content, should include both MC-A2 and MC-A3. In place of MC-A1, however, the customer  240  requires a derivative content in the form of MC-A1-1. MC-A1-1 is thus related to MC-A1, but is a variant. 
         [0045]    Similarly, the customized rules  266  indicate that the customized dialogue  296 , which includes type “C” questions, should include master content which is not the best practices content. Thus, in place of MC-C1, variant MC-C1-4 is used. Likewise, in place of MC-C2, variant MC-C2-1 is used. Moreover, a master content that is not related to the best practices content is required in the form of MC-C4. 
         [0046]    Once the dialogue library  260  is populated (or modified based upon new master content), the program sessions database  262  is populated. The program sessions database  262  includes groups of dialogues from the dialogue library  260 . The ordering and content of the sessions are governed by the rules  264 , the customized rules  266  and patient variables  268 . For example, for a customer who chooses to have their patients receive only the best practices master content for a particular condition, such as diabetes, the rules  264  would determine that type “A” and type “C” content should be used to create a session  300  which includes the best practices content of dialogues  286  and  294 . 
         [0047]    The session server  242  further generates sessions  302  and  304  for different customers (not shown) who have decided to use customized content for their patients, or for different patients of the customer  240 . Accordingly, the customized rules  266  determine that session  302  should have the customized type “A” content of dialogue  288 , along with a customized type “B” content of dialogue  292 . The customized rules  266  further determine that session  304  should have the best practices type “B” content of dialogue  290 , along with a customized type “C” content of dialogue  296 . 
         [0048]    The clinical content management system  200 , like the clinical content management system  100 , thus generates an assembly of content and the master content includes the manner in which various master content is strung together and branched, the order that questions appear, and how the questions are sequenced over time. A system which produces such content is described in U.S. Pat. No. 8,353,827 which issued on Jan. 15, 2013, the entire contents of which are herein incorporated by reference. 
         [0049]    Accordingly, the clinical content management system  200  allows for each customer to use a customized protocol, while maintaining a comprehensive master content database  204 . A software tool with logic capabilities may be used with the database tagging structure and customized rules to ensure that custom content is provided to the customer rather than the standard or best practices master content content. The best practices master content will only be used as the default version in the absence of a customized rule. 
         [0050]    Once the appropriate session  300 / 302 / 304  has been generated, and in accordance with the patient variables, the master session server  242  establishes a link with the appropriate patient device  244 / 246 / 248 .  FIG. 8  illustrates a block diagram of the patient device  244  in accordance with one embodiment. The patient device  244  includes a processor  310 , a memory  312 , a display or other user interface  314 , a sensor  316 , and a communication unit  318 . The memory  312  stores the session received from the master session server  242  through the communication unit  318  for execution by the processor  310 . The content is displayed on the display  314 , and user input in response to the session is stored in the memory  312  for transmission to the patient data database  258  where it is accessed by the customer  240 . The user input is augmented with sensor data from the sensor  316  to produce the patient data. 
         [0051]    Unlike previously known systems, where the disparate users are updating the master document until they decide to branch the program, in the embodiments above, the disparate users or customers are updating their own branch of content, which triggers a notice that affords the managers of the master content to incorporate the updates and changes from the derivative content, and vice versa. 
         [0052]    In addition, in view of the fact that many different customers are running variations of the master content in systems that collect data from patients and track outcomes, each of the derivative content is in essence a separate track of a controlled experiment. If some medical groups/customers are obtaining better results from their derivative content, then that derivative content can be noted for its results and other users of the system can associate content variations with variations in results, using those results in their decision-making process for adapting their own derivative content. The disclosed system thus enables the continuous improvement of crowd-sourced or customer-sourced medical content based on results. 
         [0053]    Moreover, when master reference content is changed for any reason, all derivative works may be located immediately and the revised content may be updated automatically or manually, or presented to the customer for a decision as to whether to update derivative content. 
         [0054]    The disclosed medical content revision management system is extremely useful applications such as a remote health management program where content is automated over a network to interact with patients for the purpose of health monitoring, coaching and education. The system finds further utility in embodiments incorporating scripts used by nurses in call centers talking to patients over the phone, or in clinical guidelines and protocols for any kind of clinical practice, in the hospital, in the clinic, in home care settings, or in remote disease management. Moreover, the disclosed system can be used in any field that operates by guidelines using scripts and protocols that have a central authoritative content master with a large number of customer variations. 
         [0055]    While the invention has been illustrated and described in detail in the drawings and foregoing description, the same should be considered as illustrative and not restrictive in character. It is understood that only the preferred embodiments have been presented and that all changes, modifications and further applications that come within the spirit of the invention are desired to be protected.