Abstract:
The present invention is directed to a system and methods for creating and maintaining electronic medical records in an environment where the records are frequently used and modified. The system is envisioned for use with medical records that particularly, but not necessarily wholly, pertain to physical therapy, occupational therapy, and speech and language pathology patients. The system includes software for facilitating entry of both patient and treatment data. Such data can be entered into the system in a myriad of ways, including by voice, keyboard, mouse, and touch screen. The system also includes software for creating dynamic, updateable templates that can be used to automatically populate screens and electronic forms to help in the treatment of patients.

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
       [0001]    This application claims priority to provisional application No. 60/1985,742, filed Nov. 6, 2007, entitled Voice-Activated Medical System and Associated Methods. 
     
    
     COPYRIGHT NOTICE 
       [0002]    A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to facsimile reproductions by anyone of the patent document or patent disclosure as it appears in the Patent and Trademark Office patent files and records, but otherwise reserves all copyright rights whatsoever. 
       BACKGROUND OF THE INVENTION 
       [0003]    1. Field of the Invention 
         [0004]    The present invention relates to an electronic system and related methods for managing medical records, and more particularly to such systems and methods that require frequent use and modification. 
         [0005]    2. Description of Related Art 
         [0006]    The maintenance of medical records in many cases is still an area of difficulty and confusion. Cumbersome file folders make it difficult to coordinate scheduling and billing operations and inhibit medical treatment personnel from retrieving data quickly and consistently. Efforts to enter data into electronic records in a consistent way has also presented difficulties. This can be particularly a problem in the fields of physical therapy, occupational therapy, and speech and language pathology treatment. 
         [0007]    The fields of physical therapy, occupational therapy, and speech and language pathology treatment usually require multiple treatment sessions with a patient over a short period of time relative to treatment sessions in other medical fields. For example, in these three fields it is possible that a clinician will need to treat a patient multiple times over a six to eight week period, with three or more treatment sessions being performed in a given week. As the patient progresses through the treatment plan, the plan needs to be modified to take into account the patient&#39;s changing medical condition. In addition, new diagnoses may be required, as well as adjustments to the stated goals for recovery. Each of these modifications can require an associated change to the patient&#39;s medical records. 
         [0008]    It would be desirable, therefore, to provide a system and method that facilitates the easy creation and frequent maintenance of electronic medical records. 
       SUMMARY OF THE INVENTION 
       [0009]    The present invention is directed to a system and methods for creating and maintaining electronic medical records in an environment where the records are frequently used and modified. The system is envisioned for use with medical records that particularly, but not necessarily wholly, pertain to physical therapy, occupational therapy, and speech and language pathology patients. The system includes software for facilitating the convenient and rapid entry and modification of patient and treatment data. This can be accomplished by a number of means, including by voice command, by keyboard, and by pointing device, as well as by other input means. 
         [0010]    Users of the system are divided into categories. The category to which a user belongs dictates the access that user has to the various screens, forms, and functions of the system. Since screens, forms, and functions required by one discipline might not necessarily be useful to one belonging to a different discipline, the system&#39;s categorization of users would seem to argue for a more orderly access to the system and an increased productivity among system users. Despite this categorization strategy, however, the system still offers flexibility. For example, in some instances the system provides a user of one discipline the ability to access areas and capabilities defined to another discipline. 
         [0011]    In keeping with this theme of flexibility, the system also provides facilities, such as software modules and updateable templates, that can be used to automatically populate screens and electronic forms. Some of these facilities are directed to administrative tasks like salaries and billing, while others are directed to the treatment of patients. The system provides updateable templates, for example, to help a clinician perform such tasks as diagnosing a patient&#39;s ailment, preparing a treatment plan, and outlining a set of clearly defined short-term and long-term goals for recovery. 
         [0012]    Using such updateable templates decreases data entry time, which increases clinician productivity. And since updateable templates can be shared among therapists and other users, the opportunity for finding better and faster ways of doing common tasks is consistently present. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS  
         [0013]    The novel features which are believed to be characteristic of this invention are set forth with particularity in the appended claims. The invention itself, however, both as to its organization and method of operation, together with further objects and advantages thereof, may best be understood by reference to the following description taken in connection with the accompanying drawings. It is to be expressly understood, however, that the drawings are for the purpose of illustration and description and not intended as a definition of the limits of the invention. 
           [0014]      FIG. 1  is a schematic diagram for a medical records system, in accordance with the present invention. 
           [0015]      FIG. 2  is a flowchart showing a method of use for the system of  FIG. 1 . 
           [0016]      FIG. 3  is an exemplary screen for logging onto the system of  FIG. 1 . 
           [0017]      FIG. 4  is a portion of an exemplary screen for accessing the screen shown in  FIG. 3  by way of a shortcut icon. 
           [0018]      FIG. 5  is an exemplary screen for gaining access to major functions of the system of  FIG. 1 . 
           [0019]      FIG. 6  is an exemplary screen for adding a user, such as a therapist, to the system of  FIG. 1 . 
           [0020]      FIG. 7  is an exemplary screen for gaining access to time-and-wage related information for a user of the system of  FIG. 1 , such as a therapist. 
           [0021]      FIG. 8  is an exemplary screen for displaying time utilization goals for a list of therapists. 
           [0022]      FIG. 9  is an exemplary screen for gaining access to major functions largely related to patient care information. 
           [0023]      FIG. 10  is an exemplary screen for maintaining information pertaining to a Therapist&#39;s pay schedule. 
           [0024]      FIG. 11  is an exemplary screen for assigning a therapist to a facility and a team. 
           [0025]      FIG. 12  is an exemplary screen for defining worksheets for system-wide use. 
           [0026]      FIG. 13  is an exemplary screen for creating a treatment plan table. 
           [0027]      FIG. 14  is an exemplary screen for creating a goals table. 
           [0028]      FIG. 15  is an exemplary screen for creating a comorbidity table. 
           [0029]      FIG. 16  is an exemplary screen for creating a customized billing charge ticket. 
           [0030]      FIG. 17  is an exemplary screen for adding a patient to the system of  FIG. 1 . 
           [0031]      FIG. 18  is an exemplary screen for manually adding a patient to the system of  FIG. 1 . 
           [0032]      FIG. 19  is an exemplary screen for saving a patients biographical information to the system of  FIG. 1 . 
           [0033]      FIG. 20  is an exemplary screen for selecting a patient for whom a file folder is to be created. 
           [0034]      FIG. 21  is an exemplary screen for creating a file folder for a patient. 
           [0035]      FIG. 22  is an exemplary screen for displaying a worksheet menu. 
           [0036]      FIG. 23  is an exemplary screen for displaying a worksheet form prior to printing. 
           [0037]      FIG. 24  is an exemplary screen for displaying a selection of physical therapy bodily regions. 
           [0038]      FIG. 25  is an exemplary screen for displaying a therapy diagnosis list for a musculoskeletal aspect of the lumbar region. 
           [0039]      FIG. 26  is an exemplary screen displaying notes entered into a patient evaluation. 
           [0040]      FIG. 27  is an exemplary screen displaying a portion of the patient evaluation where a treatment plan can be entered. 
           [0041]      FIG. 28  is an exemplary screen for displaying treatment plan progression and justification elements. 
           [0042]      FIG. 29  is an exemplary screen for displaying short-term and long-term goals of a treatment plan. 
           [0043]      FIG. 30  is an exemplary screen for selecting comorbidities. 
           [0044]      FIG. 31  is an exemplary screen for displaying billing information. 
           [0045]      FIG. 32  is an exemplary screen for displaying the entry of billing information into the patient evaluation. 
           [0046]      FIG. 33  is an exemplary screen for displaying the creation of a new template. 
           [0047]      FIG. 34  is an exemplary screen for displaying the selection of a template format. 
           [0048]      FIG. 35  is an exemplary screen for displaying templates. 
           [0049]      FIG. 36  is an exemplary screen for creating a customizable evaluation. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0050]    It should be noted that herein the term “comorbidity” is defined as the presence of a coexisting or additional disease that can impact a primary disease. 
         [0051]    A description of the preferred embodiments of the present invention will now be presented with reference to  FIGS. 1-36 . Note that exemplary screen images that are presented herein are not intended to be limiting on the scope of the invention. As one skilled in the art will recognize, such images can be constructed differently without departing from the spirit of the invention. 
         [0052]    Embodying the principles of the present invention is an optionally voice-activated system  10  (see  FIG. 1 ) and method  100  (see  FIG. 2 ) for establishing, using, and maintaining a medical records database  11  (see  FIG. 1 ). In a particular embodiment, not intended to be limiting, the system  10  is used for establishing, using, and maintaining a database of patient information and for initiating billing operations, among other purposes. The patients are intended to be, but are not limited to, physical therapy, occupational therapy, and speech and language pathology patients. 
         [0053]    Referring now to  FIG. 1 , the system  10  in a particular embodiment comprises a processor  12  in signal communication with the medical records database  11 . A software package  13  is resident on the processor  12  for implementing the method for establishing, using, and maintaining  100  (see  FIG. 2 ) the database  11 . The software package  13  comprises a plurality of code segments and modules adapted for carrying out the method  100 . A user  14  interfaces with the processor  12  by any number of means. Such interfacing means include those means known in the art for signal connection with a processor  12 , such as, but not limited to, speaking into a microphone  15 , keying a keyboard  16 , manipulating a mouse  17 , manipulating a touch screen  18 , offering a signature for capture  83 , consenting to scanning by a biometric device  84 , and operating a scanning device  85 . Output can be provided by, but is not limited to, a display screen  19 , a data port  20 , a printer  21 , and other output means known in the art for signal communication with a processor  12 . Note that the display screen  19  may or may not comprise a touch screen  18 . 
         [0054]    Referring now to  FIG. 3 , a user  14  (see  FIG. 1 ) gains access to the system  10  (see  FIG. 1 ) through a logon screen. The user  14  can access the screen directly, or the user  14  can use a shortcut icon  188  (see  FIG. 4 ) to access the logon screen. Using the screen to logon to the system  10  is accomplished by means known in the art, preferably by entering a user ID and a password (step  101 ; see  FIG. 2A ). 
         [0055]    Continuing with  FIG. 3 , the software package  13  (see  FIG. 1 ) permits a user  14  (see  FIG. 1 ) of the system  10  (see  FIG. 1 ) to access various categories of data and system functionality based upon certain system-defined credentials previously assigned to the user  14 , as is known in the art. One category of user  14  with broad access credentials is a system administrator  14 . The system administrator  14  uses the logon screen depicted in  FIG. 3  to access the system  10 , while other categories of users  14 , such as therapists, use a logon screen similar to the screen depicted in  FIG. 3 . 
         [0056]    Referring now to  FIG. 5 , among tasks the system administrator  14  (see  FIG. 1 ) can perform are the tasks of adding therapists  14  to the system  10  (see  FIG. 1 ), defining access credentials assigned to the therapists  14 , and defining various system-specific characteristics of the therapists  14 . After the system administrator  14  has successfully logged onto the system  10 , the system administrator  14  is taken to a System Administration screen. Using this screen, the system administrator  14  is able to gain access to a screen that will allow the system administrator  14  to add a therapist  14  to the system  10  (see  FIG. 1 ) and to configure the credentials of the therapist  14 . To do so, the system administrator  14  first selects a Users tab  151  on the System Administration screen. This takes the system administrator  14  to a User Administration screen (see  FIG. 6 ). 
         [0057]    Referring now to  FIG. 6 , the system administrator  14  (see  FIG. 1 ) uses the User Administration screen to add such information as the name  154  of the therapist  14  and a therapist ID  155 . The system administrator  14  also uses the User Administration screen, along with other related screens, to define the access credentials of the therapist  14 , hourly salary rate, salaried status, team assignment, and data pertaining to the therapist&#39;s  14  access to the system, such as whether by voice commands or by other means such as a keyboard. 
         [0058]    Referring now to  FIGS. 7 and 8 , the system administrator  14  (see  FIG. 1 ) reenters the System Administration screen (see  FIG. 7 ) to enter more information for the therapist  14 . Here, the system administrator  14  selects a Goals option  157  (see  FIG. 7 ) under a TUI tab  152  (see  FIG. 7 ). This takes the system administrator  14  to a TUI Goals Administration screen (see  FIG. 8 ). On the TUI Goals Administration screen, the new therapist  14  is further assigned a Facility ID  158  (see  FIG. 8 ) and a time utilization Index (“TUI”)  72  (see  FIG. 8 ). The TUI  72  is a productivity tool that takes the hourly salary of a therapist  14  and multiplies it by the hours worked in a day, then divides that amount by the total revenue generated by the therapist  14 . 
         [0059]    Regarding  FIGS. 7 and 8 , multiple categories of users  14  can be defined to the system  10  (see  FIG. 1 ), and each category can have different access credentials. Note that sensitive data, such as salary information, might be hidden from some categories of users  14  who have access to the TUI Goals Administration screen but are without proper system credentials. 
         [0060]    Referring now to  FIG. 9 , selecting a Misc Tables tab  153  on the System Administration screen displays a list of options  169  that are accessible to the system administrator  14  (see  FIG. 1 ) and are used for maintaining various aspects of the system  10  (see  FIG. 1 ). Some of the listed options  169  can be used when adding or updating information pertaining to a therapist  14 . 
         [0061]    Referring now to  FIG. 10 , selecting a Start Dates option  167  (see  FIG. 9 ) from the list of options  169  (see  FIG. 9 ) on the System Administration screen (see  FIG. 9 ) transfers the system administrator  14  (see  FIG. 1 ) to a screen where a Start Dates Table is maintained. The Start Dates Table works with a Time Sheet module to show how a therapist&#39;s  14  time sheet will appear based upon a given pay period, such as weekly, biweekly, monthly, or bimonthly. 
         [0062]    Referring now to  FIG. 11 , selecting a Facility ID and Team ID option  168  (see  FIG. 9 ) from the list of options  169  (see  FIG. 9 ) on the System Administration screen (see  FIG. 9 ) transfers the system administrator  14  (see  FIG. 1 ) to a screen where a Facility ID Table and a Team ID Table can be maintained. The Facility ID Table assigns a therapist  14  to a facility. The Team ID Table assigns a therapist  14  to a team. Note that the system administrator  14  can also use the Facility ID Table to define overtime multipliers for non-salaried therapists  14 . 
         [0063]    Referring now to  FIG. 12 , selecting a Worksheets option  166  (see  FIG. 9 ) from the list of options  169  (see  FIG. 9 ) on the System Administration screen (see  FIG. 9 ) transfers the system administrator  14  (see  FIG. 1 ) to a screen where worksheets can be defined. This screen gives the system administrator  14  the ability to create custom worksheets, which are then made available to therapists  14  across the system  10  (see  FIG. 1 ). 
         [0064]    Referring now to  FIG. 13 , selecting a Treatment Plan Quick Picks option  164  (see  FIG. 9 ) from the list of options  169  (see  FIG. 9 ) on the System Administration screen (see  FIG. 9 ) transfers the system administrator  14  (see  FIG. 1 ) to a Treatment Plan Administration screen. This screen is used to maintain a Treatment Plan Quick Picks Table  78 . The Treatment Plan Quick Picks Table  78  displays body parts  79  and phrases  80  that can be customized by therapists  14  and that is made available to therapists  14  across the system  10  (see  FIG. 1 ). 
         [0065]    Referring now to  FIG. 14 , selecting a Goals Quick Picks option  163  (see  FIG. 9 ) from the list of options  169  (see  FIG. 9 ) on the System Administration screen (see  FIG. 9 ) transfers the system administrator  14  (see  FIG. 1 ) to a Goals Administration screen. This screen is used to maintain a Goals Quick Picks Table  75 . The Goals Quick Picks Table  75  displays body parts  76  and phrases  77  that can be customized by therapists  14  and that is made available to therapists  14  across the system  10  (see  FIG. 1 ). 
         [0066]    Referring now to  FIG. 15 , selecting a Comorbidity Quick Picks option  165  (see  FIG. 9 ) from the list of options  169  (see  FIG. 9 ) on the System Administration screen (see  FIG. 9 ) transfers the system administrator  14  (see  FIG. 1 ) to a Comorbidity Administration screen. This screen is used to maintain a Comorbidity Quick Picks Table  81 . The Comorbidity Quick Picks Table  81  displays comorbidities and conditions  82  that can be customized by therapists  14  and that is made available to therapists  14  across the system  10  (see  FIG. 1 ). 
         [0067]    Referring now to  FIG. 16 , selecting a Super Bill option  162  (see  FIG. 9 ) from the list of options  169  (see  FIG. 9 ) on the System Administration screen (see  FIG. 9 ) transfers the system administrator  14  (see  FIG. 1 ) to a Super Bill Administration screen. This screen allows for the creation of a customized billing charge-ticket known as a superbill. Ordinary charges and allowed charges  74  both may be entered into a superbill. Allowed charges  74  are charges that a third party payer is willing to pay. The system administrator  14  can define which treatment elements are classified as timed  73  elements in a superbill. The system administrator  14  can also set accessibility parameters that define which disciplines are given access to which current procedural terminologies (“CPTs”) and descriptions. The system administrator  14  also has the authority to add, edit, or delete a superbill. 
         [0068]    Referring now to  FIG. 9 , selecting a File Folders option  161  from the list of options  169  transfers the system administrator  14  (see  FIG. 1 ) to a screen where medical records can be archived and where archived medical records can be returned to active status. 
         [0069]    Continuing with  FIG. 9 , selecting a Rename Visit tab  159  on the System Administration screen transfers the system administrator  14  (see  FIG. 1 ) to a screen where the system administrator  14  can rename medical records. 
         [0070]    Still referring to  FIG. 9 , selecting a Change Date of Onset tab  160  on the System Administration screen transfers the system administrator  14  (see  FIG. 1 ) to a screen where the system administrator  14  can modify an onset date in a selected medical record. 
         [0071]    Referring now to  FIG. 5 , among the tasks that the system administrator  14  (see  FIG. 1 ) can perform is the task of adding new patients to the database  11  (see  FIG. 1 ) of the system  10  (see  FIG. 1 ). To add a patient, the system administrator  14  selects a Patients tab  150  on the System Administration screen. This takes the system administrator  14  to a Patient Administration screen (see  FIG. 17 ). 
         [0072]    Referring now to  FIG. 17 , on the Patient Administration screen the system administrator  14  (see  FIG. 1 ) selects an Add option  68  from a Patients menu  66  on a Patient Administration toolbar  67 . The Add option  68  displays two additional options, Manually  170  and Import from file  171 . The system administrator  14  selects the Manually option  170  to add the patient manually. 
         [0073]    Referring now to  FIGS. 18-20 , a New Patient window  172  (see  FIG. 18 ) is now displayed requesting a social security number  173  for the new patient. The system administrator  14  (see  FIG. 1 ) enters the social security number  173  in the window  172 . This action gives the system administrator  14  access to a biographical data entry area  174  of the screen where biographical information for the new patient can be entered. The system administrator  14  enters the biographical information and clicks the Save button  175  (see  FIG. 19 ), whereupon the new patient is added to a Patients Table  71 . A portion of the Patients Table  71  is displayed on the screen. When the new patient is added, the Patients Table  71  is refreshed on the screen to show the newly-added patient among the other patients who have been previously added to the database  11  (see  FIG. 1 ). 
         [0074]    Regarding  FIGS. 18-20 , note that it is possible for the system credentials of users  14  who are not system administrators  14  to be configured so as to allow these users  14  the ability to manually add new patients to the database  11 . 
         [0075]    Referring now to  FIG. 17 , alternatively the system administrator  14  (see  FIG. 1 ) can add a new patient to the database  11  (see  FIG. 1 ) using information from an external billing system that is associated with the system  10  (see  FIG. 1 ). The system administrator  14  accomplishes this by going to the Patients menu  66  on the Patient Administration toolbar  67  and selecting the Add option  68 . As described above, the Add option  68  displays two additional options, Manually  170  and Import from file  171 . The system administrator  14  selects the Import from file option  171 . A window (not shown) is then displayed requesting the new patient&#39;s billing ID  70 . The system administrator  14  enters the patient&#39;s billing ID  70  to add the patient. A module of the software package  13  (see  FIG. 1 ) designed to access the associated external billing system uses the billing ID  70  to locate the patient&#39;s information in the database of the external billing system. When found, the module  13  adds the patient to the Patients Table  71  in the database  11  of the system  10 . If the module  13  fails to add the patient, notice of this failure is displayed. 
         [0076]    Regarding  FIG. 17 , note that it is possible for the system credentials of users  14  who are not system administrators  14  to be configured so as to allow these users  14  the ability to add new patients to the database  11  of the system  10 . 
         [0077]    Referring now to  FIG. 20 , once a patient has been added to the database  11  (see  FIG. 1 ), a new file folder is created for the patient. A file folder is an electronic version of the patient&#39;s chart. To add a new file folder for the patient, first the patient&#39;s name is chosen from the Patients Table  71 . Next, a Create a New File Folder option  176  under a File Folders menu  69  on the Patient Administration toolbar  67  is selected. This brings up a Create a File Folder window  180  (see  FIG. 21 ). 
         [0078]    Referring now to  FIG. 21 , the Create a File Folder window  180  requires entry of the new patients system identification number  177 , name of a referring doctor  179 , and a date of onset  178 . The system administrator  14  (see  FIG. 1 ) then enters these fields  177 ,  178 ,  179 . The software package  13  (see  FIG. 1 ) notes the combination of the three fields  177 ,  178 ,  179  and searches tables in the database  11  (see  FIG. 1 ) for an entry matching this combination of fields  177 ,  178 ,  179 , as is known in the art. The tables searched are the File Folder Table, the Admissions Table, and the Visits Table. If this combination of fields  177 ,  178 ,  179  matches an entry in any of the three tables, a flag is raised preventing the addition of the new file folder. If the combination of fields  177 ,  178 ,  179  does not match any entries in the three tables, then the software package  13  adds the new information to the database  11  as a new entry to the File Folders Table, a new entry to the Admissions Table, and a new entry to the Visits Table. A therapist  14  can now prepare an electronic evaluation  26   a  (see  FIG. 26 ) for the patient. 
         [0079]    Regarding  FIG. 21 , note that it is possible for the system credentials of users  14  who are not system administrators  14  to be configured so as to allow these users  14  the ability to add file folders for patients. Note also that a visit date is assigned at billing time. 
         [0080]    Referring now to  FIG. 1 , to create an electronic evaluation  26   a  (see  FIG. 26 ) for the patient, the therapist  14  must first logon to the system  10 . Upon logging onto the system  10  (step  101 ; see  FIG. 2A ), the software package  13  consults the database  11  to determine the therapist&#39;s  14  discipline, work location, and team assignment (step  102 ; see  FIG. 2A ). Note that the software package  13  allows a therapist  14  access to various categories of data and system functionality based upon certain system-defined credentials previously assigned to the therapist  14 , as described above with reference to  FIG. 3 . The system  10  makes screen options and forms available to the therapist  14  based on the therapist&#39;s assigned  14  discipline (step  103 ; see  FIG. 2A ). 
         [0081]    Referring now to  FIGS. 22 and 23 , optionally the therapist  14  (see  FIG. 1 ) can print a worksheet  23  (see  FIG. 23 ) (step  104 ; see  FIG. 2A ) for making manual notes prior to creating an electronic patient evaluation  26   a  (see  FIG. 26 ). The worksheet  23  to be printed is selected from a list of worksheet options displayed in a Worksheet menu  22  (see  FIG. 22 ). The worksheet  23  can also be inserted into an open document or into the patient&#39;s file folder and then printed.  FIG. 23  depicts a screen showing a printable worksheet  23 . Information in the worksheet  23  is organized in the same order that such information is generally requested from the patient. 
         [0082]    Referring now to  FIG. 2 , the therapist  14  (see  FIG. 1 ) next accesses a drop-down menu from a toolbar, such as known in the art, to request a list of file folders (step  105 ; see  FIG. 2A ). As previously mentioned, a file folder is an electronic version of a patient&#39;s chart. Note that in some instances it is possible that information in a patient&#39;s file folder will have been imported from a scheduling or billing module of the software package  13  (see  FIG. 1 ). Requesting a list of file folders (step  105 ) causes a list of electronic file folders to be displayed (step  106 ; see  FIG. 2A ). The therapist  14  then selects a patient&#39;s file folder from the list of folders (step  107 ; see  FIG. 2A ). Information from the patient&#39;s file folder is then displayed (step  108 ; see  FIG. 2A ). Note that in some instances an alert window might appear along with the display of patient information (step  108 ). The alert window is meant to bring some matter to the attention of the therapist  14 . For example, the alert window might notify the therapist  14  that the patient has made a predefined number of visits and that as a result the therapist  14  should send the physician a progress report. At this point, the therapist  14  can update any of the biographical information displayed in the patient&#39;s folder (step  109 ; see  FIG. 2A ). 
         [0083]    Referring now to  FIGS. 24 and 25 , the therapist  14  (see  FIG. 1 ) now begins composing the patient evaluation  26   a  (see  FIG. 26 ) (step  110 ; see  FIG. 2A ) by such input means as, for example, voicing or using a mouse. To compose the evaluation  26   a,  the therapist  14  selects from drop-down menus  24  (see  FIG. 24 ) an appropriate impairment diagnosis (step  111 ; see  FIG. 2A ) that corresponds to an International Statistical Classification of Diseases and Related Health Problems (“ICD9”) code. The example shown in  FIG. 24  depicts the therapist  14  selecting a Physical Therapy option and a Lumbar option. These selections initiate the loading of therapy diagnosis information (step  112 ; see  FIG. 2A ). The therapy diagnosis information shows diagnostic elements such as Musculoskeletal, Neuromuscular Patterns, Cardiovascular/Pulmonary Patterns, and Integumentary Patterns. Selecting the Lumbar option, as shown in  FIG. 24 , displays a Therapy Diagnosis list  25  (step  113 ; see  FIG. 2A ), as shown in  FIG. 25 . 
         [0084]    Referring now to  FIG. 26 , after the therapist  14  (see  FIG. 1 ) selects an appropriate diagnosis (step  114 ; see  FIG. 2A ) from the Therapy Diagnosis list  25  (see  FIG. 25 ), the therapist  14  is offered an opportunity to insert notes into the evaluation  26   a  (step  115 ;  FIG. 2A ). Note that the software package  13  (see  FIG. 1 ) automatically inserts biographical data, such as the patient&#39;s age and gender, into the evaluation  26   a  (step  116 ; see  FIG. 2A ). Note also that the therapist  14  can navigate through the evaluation  26   a  by voice  15  (see  FIG. 1 ), by keyboard  16  (see  FIG. 1 ), or by mouse  17  (see  FIG. 1 ), or by a combination of voice  15 , keyboard  16 , and mouse  17 . 
         [0085]    Referring now to  FIG. 27 , the therapist  14  (see  FIG. 1 ) next enters a treatment plan (step  117 ; see  FIG. 2A ) into the evaluation  26   a  (see  FIG. 26 ). Such a treatment plan is entered into a Treatment Plan table  181 . To help with entering a treatment plan, a Quick Picks tab  27  is available on a toolbar  26 . The Quick Picks tab  27  displays a drop-down menu  28  presenting the therapist  14  with a list of options, one of which is an Insert Treatment Plan from Table option  184 . Note that the table referred to in the option  184  is a table of treatment plans that includes treatment plans created as described above with reference to  FIG. 13 . Selecting the Insert Treatment Plan from Table option  184  displays a table of treatment plans  185  (see  FIG. 28 ). 
         [0086]    Referring now to  FIG. 28 , the therapist  14  (see  FIG. 1 ) selects one or more treatment plans from the displayed table of treatment plans  185  (step  118 ; see  FIG. 2A ) on a Treatment Plan Quick Picks screen. Each treatment plan includes a progression element  29  and a corresponding justification  30 . The treatment plans are inserted into the Treatment Plan table  181  (see  FIG. 27 ) of the evaluation  26   a  (see  FIGS. 26 and 27 ) in the order in which they are selected. Note that the therapist  14  may optionally make selections from a Body Part list  31  as well. 
         [0087]    Continuing with  FIG. 28 , at this point the therapist  14  can optionally create a Treatment Plan macro  32  (step  119 ; see  FIG. 2A ). The Treatment Plan macro  32  can be created so as to be associated with a voice command. Simply speaking the associated voice command will then automatically open the Treatment Plan macro  32 . When opened, the Treatment Plan macro  32  selects the treatment progression elements  29  and the corresponding justifications  30  in the exact order that the therapist  14  had previously selected them and fills in the Treatment Plan table  181  of the patient evaluation  26   a.  The therapist  14  can then customize any of these treatment plans for the specific patient being treated. 
         [0088]    Still referring to  FIG. 28 , the system  10  (see  FIG. 1 ) can also provide the therapist  14  with a list of exercises that the therapist  14  might incorporate into the patient&#39;s therapy. The therapist  14  can print a paper copy of an exercise grid of selected exercises for use when working with the patient. Later, the paper copy of the exercise grid can be scanned into the patient&#39;s file folder. 
         [0089]    Referring now to  FIG. 29 , the therapist  14  (see  FIG. 1 ) next enters one or more long-term goals, short-term goals, or both long-term and short-term goals (step  120 ; see  FIG. 2B ) into the evaluation  26   a  (see  FIGS. 26 and 27 ). To help with entering a goal, a Quick Picks tab  27  (see  FIG. 27 ) is available. The Quick Picks tab  27  displays a drop-down menu  28  (see  FIG. 27 ) presenting the therapist  14  with a list of options, one of which is an Insert Goal from Table option  183  (see  FIG. 27 ). Note that the table referred to in the option  183  is a table of goals that includes goals created as described above with reference to  FIG. 14 . Selecting the Insert Goal from Table option  183  displays a table of goals  186 . 
         [0090]    Continuing with  FIG. 29 , the therapist  14  selects one or more goals from the displayed table of goals  186  on a Goals Quick Picks screen. The table of goals  186  includes both short-term goals  33  and corresponding long-term goals  34 . The goals are inserted into the evaluation  26   a  in the order in which they are selected. Note that the therapist  14  may optionally make selections from a Body Part list  35  as well. 
         [0091]    Still referring to  FIG. 29 , at this point the therapist  14  can optionally create a Goals macro  36  (step  121 ; see  FIG. 2B ). The Goals macro  36  can be created so as to be associated with a voice command. Simply speaking the associated voice command will then automatically open the Goals macro  36 . When opened, the Goals macro  36  selects the short-term goals  33  and corresponding long-term goals  34  in the exact order that the therapist  14  had previously selected them and populates the short-term goals and long-term goals section of the patient evaluation  26   a  (step  122 ; see  FIG. 2B ). The therapist  14  can customize any of these goals for the specific patient being treated. 
         [0092]    Referring now to  FIG. 30 , if the therapist  14  (see  FIG. 1 ) has identified any complicating conditions or comorbidities that might affect a patient&#39;s speed of recovery, the therapist  14  next enters those conditions or comorbidities into the evaluation  26   a  (see  FIGS. 26 and 27 ). To help with entering a comorbidity, a Quick Picks tab  27  (see  FIG. 27 ) is available. The Quick Picks tab  27  displays a drop-down menu  28  (see  FIG. 27 ) presenting the therapist  14  with a list of options, one of which is an Insert Comorbidity option  182  (see  FIG. 27 ). Note that the comorbidities referred to in the option  182  include comorbidities created as described above with reference to  FIG. 15 . Selecting the Insert Comorbidity option  182  displays a list of comorbidities  37  (step  123 ; see  FIG. 2B ). 
         [0093]    Continuing with  FIG. 30 , the therapist  14  selects one or more comorbidities  38  from the displayed list of comorbidities  37  on a Comorbidity Quick Picks screen (step  124 ; see  FIG. 2B ). Note that a description  39  of a selected comorbidity  38  is displayed on the screen. The comorbidities  38  are then inserted into the evaluation  26   a  in the order in which they are selected, populating a conditions/comorbidities section of the patient evaluation  26   a  (step  125 ; see  FIG. 2B ). 
         [0094]    Still referring to  FIG. 30 , at this point if the therapist  14  has identified any conditions or comorbidities, then those will have been entered into the patient evaluation  26   a  along with their associated ICD 9  codes. After the therapist  14  has worked with the patient, the therapist  14  might determine which of the conditions and comorbidities could impact the patient&#39;s speed of recovery (step  126 ; see  FIG. 2B ). In this event, a more detailed description can be added to the evaluation  26   a  (step  127 ; see  FIG. 2B ). Note that here again the Insert Comorbidity option  182  can be selected to aid in entering comorbidity information into the patient evaluation  26   a.  The therapist  14  can then customize any of the comorbidity information for the specific patient being treated. 
         [0095]    Referring now to  FIG. 31 , following a patient&#39;s visit the therapist  14  (see  FIG. 1 ) can use a billing utility to select the appropriate CPT items for which to bill  40  (step  128 ; see  FIG. 2B ). For proper billing, the therapist  14  enters the date of the current visit  41 , the time spent with the patient  42 , and the number of units performed  43 . If the item to be billed has a timed procedure code associated with it, then the actual number of minutes of therapy delivered is entered. This procedure continues for all of the items that were performed and that are to be billed. After all entry is completed, the therapist  14  clicks a button  44  to bill the visit (step  129 ; see  FIG. 2B ), and the billing date is confirmed. 
         [0096]    Regarding  FIG. 31 , note that a module of the software package  13  (see  FIG. 1 ) is designed to prompt the therapist  14  to enter the time the therapist  14  spent treating the patient. The module  13  will then automatically calculate the correct number of units performed and notify the therapist  14  if there is an error. 
         [0097]    Referring now to  FIG. 32 , the billing information is now automatically entered into the patient evaluation  26   a  (step  130 ; see  FIG. 2B ). The billing information is also populated in the billing database and made available to the billing program (step  131 ; see  FIG. 2B ). 
         [0098]    Referring now to  FIG. 1 , another feature provided by the software package  13  of the system  10  is a template creation tool that allows the therapist  14 , and other users  14 , to create customized text that can be inserted into selected screens and forms. 
         [0099]    Referring now to  FIG. 33 , to create a template  49  (see  FIG. 34 ) the therapist  14  (see  FIG. 1 ) first selects a New Template option  45  from the Templates drop-down menu  46  on the toolbar  26 . The therapist  14  is then prompted to enter a name for the new template  49 . The name can be entered by voice, keyboard, or other like means. When creating the template  49  the therapist  14  is permitted to create blanks  47  in the template  49  that can be filled in later. The template  49  is then closed and saved. 
         [0100]    Referring now to  FIG. 34 , the template creation tool displays an option box  48  that appears over the text of the template  49  to specify whether the new template  49  will start on the top of a new page, whether the system will automatically insert the current date, and whether the therapist&#39;s  14  (see  FIG. 1 ) predefined name and credentials will be inserted at the end of the template  49 . If the therapist  14  created any blanks in the template  49 , the tool will seek out the first blank and place the insertion point in that position so that the therapist  14  can begin entering text into the template  49  there. 
         [0101]    Referring now to  FIG. 33 , the therapist  14  (see  FIG. 1 ) may insert a template  49  (see  FIG. 34 ) into a screen by using a voice command or a mouse. To insert the template  49 , an Insert Template option  50  from the Templates drop-down menu  46  is selected. A list of templates  49  will then appear from which the therapist  14  can select the desired template  49  for insertion. 
         [0102]    Referring now to  FIG. 34 , a template  49  may also be modified. To do so, a therapist  14  (see  FIG. 1 ) opens the desired template  49 , modifies the template  49 , and then closes and saves the template  49  with the modifications. As described above, the therapist  14  can choose whether the modified template  49  will start on the top of a new page, whether the system will automatically insert the current date, and whether the therapist&#39;s  14  predefined name and credentials will be inserted at the end of the template  49 . 
         [0103]    Referring now to  FIG. 33 , a template  49  (see  FIG. 34 ) may be deleted from the system by clicking a Delete Template option  51  from the Templates drop-down menu  46 . A template is then selected from a list of templates  49  and a Delete button clicked. 
         [0104]    Referring now to  FIGS. 33 and 35 , another software tool is provided that allows for the viewing of an individual therapist&#39;s  14  (see  FIG. 1 ) templates  49  (see  FIG. 34 ). The therapist&#39;s  14  templates  49  can be accessed by selecting an Insert Personal Templates for Viewing option  52  (see  FIG. 33 ) on the Templates drop-down menu  46  (see  FIG. 33 ). A User&#39;s Templates screen (see  FIG. 35 ) is then displayed with the name of the therapist&#39;s  14  templates  49  listed in alphabetical order. A portion of each template  49  is shown followed by a dotted line to separate the templates  49 . 
         [0105]    Referring now to  FIG. 33 , in a preferred embodiment templates  49  (see  FIG. 34 ) are stored in the database  11  (see  FIG. 1 ) but are available only to a specific user  14  (see  FIG. 1 ) when that user  14  is logged onto the system  10  (see  FIG. 1 ). If the user  14  wishes to share one or more templates  49  with other users  14  on the network  60  (see  FIG. 1 ), however, a Published Templates utility can be accessed from a Published Templates tab  53 . A published template  49  can be created, inserted, modified, renamed, saved, and closed in a fashion similar to that of unpublished templates  49 . Published templates  49 , however, can be accessed by all users  14  on the network  60 . 
         [0106]    Continuing with  FIG. 33 , there may be situations when a user  14  wishes to create personal documents that are not a part of any patient&#39;s record. For example, a chief therapist  14  might want to write a letter to colleagues concerning a continuing education class. The user  14  may create these documents using a Personal Document utility located under a Documents tab  54 . A personal document can be created, inserted, modified, renamed, saved, and closed in a fashion similar to that of templates  49  (see  FIG. 34 ). 
         [0107]    Still referring to  FIG. 33 , an insert feature  55  allows the user  14  to insert files or images into a template  49  (see  FIG. 34 ), document, or patient record. The insert feature can be accessed from an Insert tab  55  on the toolbar  26 . Another feature, called a format feature, allows the user  14  to modify text within a template  49 , document, or patient record. The format feature can be accessed from a Format tab  56  on the toolbar  26 . Yet another feature, called a tables feature, allows the user  14  to insert tables  57  into a template  49 , document, or patient record. The tables feature can be accessed from a Tables tab  57  on the toolbar  26 . 
         [0108]    Continuing with  FIG. 33 , the system  10  also comprises a plurality of utilities. When a user  14  logs onto the system  10 , forms and menu selections are presented that are discipline specific. For example, a physical therapist will see physical therapy forms and evaluations, but will not see speech therapy forms and evaluations. If the therapist  14  wishes to see forms from other disciplines, however, the therapist  14  may access a utility under the Utility tab  58  on the toolbar  26  that resets the forms menu to show PT (physical therapy), OT (occupational therapy), SLP (speech and language pathology), or ALL FORMS. Menu selections will then change to provide access to the desired content. 
         [0109]    Still referring to  FIG. 33 , another utility is used to update timesheets. This utility is also accessible via the Utility tab  58 . When using this utility, a time period is selected and the therapist  14  keys in his/her time. Note that if the therapist  14  is salaried, his/her effective time can differ from actual time expended. The timesheet can then be saved, and the timesheet utility exited. One more utility is accessible by selecting a List Voice Commands option under the Utility tab  58 . This utility provides users  14  with a quick reference to available voice commands. 
         [0110]    Referring now to  FIG. 1 , in a particular embodiment voice model files can reside on an individual computer  69  on a network  60  in signal communication with the main processor  12 . In this configuration, a user  14  can back up the voice files to the central server  12  using a utility that provides two important functions. First, the utility backs up data on the server  12 , including the user&#39;s  14  voice model, generally each night. Second, the utility allows the user  14  to download a voice model to a different computer  59  on the network  60 . 
         [0111]    Continuing with  FIG. 1 , if the user  14  wants to copy such files as voice model files, templates  49  (see  FIG. 34 ), documents, or custom voice commands to a location outside of the network  60 , a utility can back up the files to a storage medium, such as a CD or DVD, so that these files can be transported to the new location. 
         [0112]    Referring now to  FIG. 36 , another utility accessible from the Utility tab  68  (see  FIG. 33 ) of the toolbar  26  (see  FIG. 33 ) is an Eval Wizard. The Eval Wizard allows the user  14  (see  FIG. 1 ) to create customizable patient evaluations  26   a  (see  FIGS. 7 and 8 ) that permit data mining. The user  14  selects sections  61  of the evaluation  26   a,  which are then displayed with preformafted text  62  and that can be modified by the user  14 . Areas of a patient evaluation  26   a  that differ greatly based upon a body part have an exploded sub-application that allows for easy modification. These sections are completely customizable by the user  14 . Once text is modified to the user&#39;s  14  satisfaction, the user  14  can save the text, and the new section  64  is added to the evaluation  26   a.  A custom header  63  can also be added to the top of the evaluation  26   a.  Once finished, the user  14  saves the new evaluation  26   a.    
         [0113]    Referring now to  FIG. 34 , often a therapist  14  (see  FIG. 1 ) needs to insert a Patient&#39;s age into a document. This is accomplished by using a utility accessible from an Insert Age tab  65 . The utility calculates the patient&#39;s age based on the current date and inserts the result into the document. Another utility creates a user-defined letter that thanks a referring physician for a referral. This utility is accessible from the Add MD tab  187 . The text of the letter is customizable by the user  14 . 
         [0114]    In the foregoing description, certain terms have been used for brevity, clarity, and understanding, but no unnecessary limitations are to be implied therefrom beyond the requirements of the prior art, because such words are used for description purposes herein and are intended to be broadly construed. Moreover, the embodiments of the system and method illustrated and described herein are by way of example, and the scope of the invention is not limited to the exact details of construction and use.