System for screening of medical decision making incorporating a knowledge base

A System for screening of medical decision making is described. The system runs on a personal computer, and incorporates a knowledge base containing the data required to perform the screening, as well as the rules to be incorporated. The knowledge base is organized into criteria sets subdivided into categories, which include clinical specialties, such as surgery, and imaging, or a level of care, or a body system. The criteria sets are further subdivided into interventions, review types, and levels of care. Finally, within each subdivision, the user selects criteria points which are representations of the patient's clinical condition. Upon selection of the criteria points, the system will indicate whether or not a selected method of treatment is medically appropriate or not. The review process is recorded for subsequent examination.

BACKGROUND OF THE INVENTION 
1. Field of the Invention 
The present invention relates to the use of knowledge base systems for the 
purpose of screening and verifying the results of decision making 
processes, and more particularly to such systems for decision-making 
processes in the context of health care. 
2. Description Relative to the Prior Art 
In the field of health care, as in many other fields involving the 
accumulation and application of masses of information, the use of 
artificial intelligence has been looked to as a means of automatic 
decision making. Artificial intelligence has not yet fulfilled its promise 
in this regard, however. No such systems provide the reliability required 
to circumvent the human decision-making process. 
However, not withstanding the failures of these systems, artificial 
intelligence has been used effectively to augment the human 
decision-making process, rather than replace it. The key to effective use 
of these systems is constant checking and verification of the 
computer-generated results by human experts. 
Common implementations of such automatic systems include the use of 
Knowledge bases in computer programs known as "Expert Systems." These 
systems are known in the art to provide an interactive means of problem 
solving by accessing information in a user-friendly environment. 
In expert systems, information is organized in data trees in which then can 
be entered by the user at any level. The data is generally arranged 
hierarchically, so that more detail is derived as the user moves farther 
toward the tips of tree branches, with more generality toward the root of 
the tree. In addition to the tree-structured data organization, the 
knowledge base contains rules for dealing with the data, and for 
proceeding further down the tree based on the history of the user's 
current activity. 
Such expert systems attempt to emulate human intelligence, and the efficacy 
of the expert system is dependent on the data contained within the 
knowledge base, as well as the rules for dealing with this data, and these 
data and rules must be input prior to use of the system. 
To use the expert system, the user begins at a low level, at the "root" of 
the data tree. At each branch the user makes a decision, and, based on the 
rules of the knowledge base, the system will give the user a number of 
specific choices as to how to proceed. The information at the root of the 
tree is quite general, but as the user continues away from the root the 
information becomes more and more specific. 
Many attempts have been made to utilize such expert systems in the health 
care setting. In particular, U.S. Pat. No. 5,583,758 describes such a 
system which provides decisions based on patient data, together with a 
knowledge base. The results provided by the system are then subjected to 
review by the health care experts. 
Diagnosis systems such as the patent described above suffer from several 
problems, however. The automated system makes a decision, without 
providing a continuous rationale for how such decision was made. The 
decision tree may be thought of as a complex road system, with decisions 
appearing as branches in the road. Once a wrong branch is taken, for any 
reason, the decision will probably be wrong. 
Furthermore, such systems require frequent updating of the knowledge base. 
Such updating requires highly-trained medical personnel and computer 
programmers, and is both time consuming and expensive. 
Other approaches to automated assistance in health care decision-making use 
a statistical data approach. Such systems use statistical calculations to 
assess the probability that a particular decision will be correct. 
Examples of statistical systems include Brown et al., MEDICAL STATISTICAL 
ANALYZING METHOD; PROCESS OF MONITORING PATIENT VITAL SIGNS, U.S. Pat. No. 
5,199,439, Altschuler et al., INTERACTIVE STATISTICAL SYSTEM AND METHOD 
FOR PREDICTING EXPERT DECISIONS, U.S. Pat. No. 5,005,143, and Saito 
Katsuyoshi et al., DATA PROCESSING SYSTEM WHICH SUGGESTS A PATTERN OF 
MEDICAL TESTS TO REDUCE THE NUMBER OF TESTS NECESSARY TO CONFIRM OR DENY A 
DIAGNOSIS, U.S. Pat. No. 4,731,725. Relying on statistical data is an 
important diagnostic approach, but it is not effective in dealing with 
cases which fall at the outer ends of the statistical distribution. 
The present invention is significantly different from the previous systems 
in several ways. First, the current system does not attempt to make any 
diagnosis, but rather acts as a screen or "gate keeper" to alert the 
decision makers that a proposed intervention or level of care does not 
meet the pre-determined criteria. 
Secondly, the current system is designed so that the user inputting the 
data to the system need not be the ultimate decision maker. Typically, the 
original user is a nurse reviewer. Users may include any of the following, 
however: 
a) nurse reviewer; 
b) physician assistant; 
c) physician; 
d) medical director; 
e) chief medical officer; and 
f) other health care workers who have been trained in the use of the 
system. 
Thirdly, the current system provides constant feedback to show the user how 
the system makes its decisions, displaying the rules used, and displaying 
when the criteria are met and when they are not met. 
Fourthly, the present system provides additional information in the form of 
notes and information and appropriate points in the decision process, and 
further categorizing this information into mandatory notes, which are 
automatically presented to the user, and informational notes, which may or 
may not be read at the user's discretion, as well as other categories of 
notes. 
Finally, the present system provides comprehensive user level and 
management level reports which may be reviewed by the decision maker, 
typically the doctor in charge of the case, or, alternatively, a group or 
panel of reviewers or their managers. The reviewer may then re-enact the 
steps of the decision process, reviewing the exact nature of the decisions 
made by the system at each point in the decision process. 
SUMMARY OF THE INVENTION 
A general object of the current invention is to provide a screening system 
to verify medical decisions. A specific object is to implement this system 
by means of a knowledge base computer program. A further specific object 
is to implement this system in such a way as to make the decision-making 
process transparent to the user. 
According to one aspect of the invention, a computer-based medical 
screening system verifies an intended course of action regarding a patient 
having a clinical situation. The system includes a knowledge base of 
medical information organized into criteria sets. Each such criteria set 
contains data and rules for determining when treatment is medically 
appropriate. The system includes means for inputting patient information 
and means for selecting a clinical specialty or body system. It also 
includes means for selecting a procedure within the selected clinical 
specialty or body system, means for selecting an indication within the 
selected procedure, means for selecting criteria points within the 
selected indication based on the patient's clinical situation and computer 
processing means for determining whether or not the intended course of 
action is medically appropriate. 
According to another aspect of the invention, the criteria sets further 
include Intensity of Service, Severity of Illness, and Discharge screens 
for adults, and Intensity of Service, Severity of Illness, and Discharge 
screens for pediatric patients. The criteria sets also include indications 
for imaging studies and X-rays, indications for surgery and procedures, 
indications for primary and specialty care management, and surgical 
indications monitoring. 
According to still another aspect of the invention, the system further 
includes means for including mandatory review notes in the criteria sets. 
It also includes means for associating the mandatory review notes with 
procedures and indications. And it further includes means for outputting 
the mandatory review notes upon selection of an associated procedure or 
indication. 
According to still another aspect of the invention, the system further 
includes means for including discretionary review notes in the criteria 
sets and means for associating the discretionary review notes with 
procedures and indications. It also includes means for indicating the 
presence of said discretionary review notes in association with a selected 
procedure or indication, and means for requesting the display of the 
discretionary review notes. 
According to yet another aspect of the invention, the system further 
includes means for displaying the rules for meeting the criteria for an 
intended course of action in conjunction with the procedures and 
indications selected. 
According to a final aspect of the invention, the system further includes 
means for recording the steps of the review process, means for playback of 
the steps of the review process, and means for editing the inputs to the 
review process.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS 
Definitions 
In the following description, certain terms of art will be used which are 
described as follows: 
I. Categories: Each criteria set is divided into categories. A category may 
be a clinical specialty, such as surgery, imaging, etc., a level of care, 
or a body system. 
II. Titles: Categories consist of titles, or clinical topics. Titles may be 
either a test, a procedure, or a clinical problem warranting referral. It 
may be a clinical activity proposed to a patient, or one already provided 
to a patient. Titles display when a category is selected in AUTOBOOK 2. 
General or mandatory notes are available at many titles. 
III. Criteria: Criteria are objective, patient-specific clinical 
information used to conduct reviews. Criteria display on AUTOBOOK 2 
screens when a title is selected. Criteria involve four main elements: 
1. Indications--reasons for performing a procedure, test, or referral. 
Indications are numbered on the AUTOBOOK 2 screens. 
2. Criteria points--representations of the patient's clinical condition. 
3. Rules--the logic decisions which determine what criteria points are 
needed to meet criteria. 
4. Notes--a display of pertinent review instructions and clinical 
information. 
The current invention operates in its preferred embodiments, by means of a 
software system that operates on a general purpose computer commonly known 
as a PC, or IBM clone system, as shown in FIG. 1. The computer system 
includes a computer cabinet, 1, which contains the central processing 
unit, RAM memory, graphics adapter, printer controller, hard disk and 
controller, and mouse controller, none of which are shown. The central 
processor must be, at a minimum, an Intel.RTM. 80486 or equivalent. At 
least 8 MB of RAM are required for proper operation, while at least 16 MB 
are recommended. 
Also included in the computer hardware are the monitor 2, keyboard 3, mouse 
4, and printer 5. 
The software of the preferred embodiments requires either a WINDOWS 
3.1.RTM. or higher operating system, WINDOWS95.RTM. or higher, or WINDOWS 
NT.RTM. operating systems. 
The preferred embodiments require a minimum of 12 MB space on the hard disk 
to operated properly. 
FIG. 2 depicts a block diagram showing the major components of the 
invention. The system, known as AUTOBOOK 2.RTM., is based on a set of 
knowledge bases called criteria sets 16, 18, and 20. These represent an 
indefinite number of criteria sets, since the system is not limited to the 
use of a particular set of these. 
Each criteria set represents a particular domain within the health care 
context. For instance, the criteria set known as ISP is the knowledge base 
used in conjunction with the surgery domain. Similarly, ISX is used within 
the imaging domain, including technologies such as X-Rays, Magnetic 
Resonance Imaging, ultrasound, etc. 
Still referring to FIG. 2, the AUTOBOOK 2 (12) process executes using the 
data within a selected criteria set in conjunction with a set of either 
manual data input 10, or linked data input 13 from a linked process In the 
case of linked data input, only the patient information and some of the 
procedure selection is automatically input. However the final selection of 
the procedure or body system data, as well as the criteria point 
selection, must always be manually input. The execution of the AUTOBOOK 2 
process on such a criteria set produces a Review, which may be recorded in 
the form of an AUTOBOOK 2 Report 14, or may be exported in the form of a 
linked data output 15. The reviews are stored in the aggregation data base 
11. 
FIG. 3 shows how this system operates in real time. The user starts, by 
assessing the patient 22. This assessment is typically done by a 
physician. The physician determines a course of action 24 based upon the 
assessment. A nurse or physician's assistant next makes a phone call 26 to 
the payor (typically an insurance company or managed care organization) 
for authorization to proceed. 
The next step is data entry 28, after which AUTOBOOK 2 will indicate either 
that the criteria have been met, or that they have not been met 30. If the 
criteria have been met, then the treatment may proceed as planned 32. But 
if not, the planned action must be reviewed 34, prior to the making of a 
final decision regarding the planned action. 
Even when the criteria have been met, there are circumstances when a second 
level review is required. For instance, certain mandatory notes 
encountered during the review may call for a second level review. 
Furthermore, a reviewer or requester may, at his or her own discretion, 
request a second level review. 
Basic Operation of AUTOBOOK 2 
This process is described in greater detail by means of FIG. 4. Referring 
now to this figure, after the patient data is entered 40, the AUTOBOOK 2 
user selects a criteria set 42. Available criteria sets include the 
following: 
a) ISDa Intensity of Service, Severity of Illness, and Discharge Screens, 
adult 
b) ISDp Intensity of Service, Severity of Illness, and Discharge Screens, 
pediatric 
c) ISP Surgery and Procedures 
d) ISX Indications for Imaging Studies and X-rays 
e) IWC Indications for Workers' Compensation 
f) IRM Injury Recovery Management 
g) IPS Indications for Primary & Specialty Care Management 
h) SIMplus Surgical Indications Monitoring 
Next, the user selects a clinical specialty or body system 44. These 
categories includes Cardiology, Neurosurgery, Opthalmology, and Urology. 
This clinical specialty is thus applied to the criteria set to further 
narrow the selection. 
The user next selects a procedure 46 to further limit the selection. 
Examples of procedures are iridotomy, removal of cataracts, enucleation, 
blepharoplasty, etc. Following the procedure selection, the user selects 
an indication of the condition for which the intervention is proposed 48. 
Examples of conditions selected include: 
a) cataract with reduced visual function; 
b) cataract interferes with posterior pole procedure; and 
c) cataract interferes with posterior pole observation. 
Having input all the preceding information, the user then begins selecting 
criteria points based on the patient's clinical situation 50. Selection of 
these criteria points is done by the user via the various screens used for 
the data input, and which are described subsequently. 
After the criteria points are thus selected, the system will make a 
determination 52 either that the criteria have been met 58 or that they 
have not been met. The reviewer will always choose a review outcome and 
may write appropriate case notes 56. If criteria have not been met, the 
user marks referral codes 54, and the case is referred for medical review. 
Finally, a report is created by the system, and it may be printed out 58, 
faxed, or e-mailed 
This process may be understood in more detail by referring now to the 
following figures. FIG. 5 shows the first substantive screen which appears 
on the computer monitor. This screen is used to input patient information, 
and is organized into several areas. These include the data input area, 
which contains data input boxes for the input of data such as Review ID 
60, Patient ID 62, Patient Name 64, etc. To the right of the data input 
boxes is the Stored Reviews area 66, which contains a listing of previous 
reviews. The Review Selection area 68 is used as a filter to limit the 
reviews listed in the Stored Reviews area, and to change the order in 
which these reviews are presented within the Stored Review area. A number 
of buttons is provided, including the Recall 70, New 72, View 74, and Edit 
76 buttons, with which the user may begin a new review, recall an existing 
review, view an existing review, or edit an existing review. The Update 
Record button 78 is used to update an existing data record contained 
within the data input area. 
In using this screen, the user may begin a new review by first clicking 
with the mouse on the New button, and then inputting the data into the 
data input area. When the data input is complete, the user clicks on the 
Category ISP tab 80, and the screen of FIG. 6 next appears. By use of this 
screen the user selects the criteria set 42, as seen in FIG. 4, using the 
buttons which appear at the top left of the screen. In this case, the user 
has clicked on the ISP button 82, indicating the Indications for Surgery 
and Procedures criteria set. The user may then make a selection from the 
Clinical specialty/Body System window 84 by double-clicking with the mouse 
on the selection. In the present example the user selects Cardiology, the 
first selection, and the next screen appears. The user may also find a 
selection not listed by using the Search button 86, which allows the user 
to enter the name of a procedure or body system. 
FIG. 7 shows the next screen, which displays the selected Clinical 
specialty/Body System within the Clinical specialty/Body System window 84. 
The selection in this example is Cardiology, and the corresponding folder 
icon is now displayed as an "open" folder, with the contents of the 
selected folder appearing as indented headings. Each of these headings 
represents a particular procedure 46, as shown in FIG. 4, and for this 
example the user will select the first entry, "Angiogram, Coronary". 
It should first be noted that this entry has a "+" symbol, as well as a "*" 
to the left of the words "Angiogram, Coronary". The "+" indicates there is 
a mandatory Medical Review Note associated with this entry. When the user 
selects this entry, by double clicking with the mouse, the note is 
displayed, as shown in FIG. 8. The note appears in a Medical Review Note 
window 88, which is displayed in the foreground on top of the preceding 
screen. The user may, in addition to other choices, click on the "Set Med. 
Review" button 90, which automatically flags this session for further 
review. The user may continue on to the next screen by clicking the 
"Continue" button 92, or may click the "Escape" button 94 and return to 
the previous screen. 
The "*" indicates there is a discretionary note associated with this entry. 
Because it is discretionary, the user will not see this note unless he/she 
clicks on the "Gen Note" button 96, as seen in FIG. 9. 
Referring now to FIG. 9, the next screen displayed allows the user to 
select an indication 48, as shown in FIG. 4, by means of the Indication 
window 98. Note that, in this window, symbols which appear to the left of 
the individual indication selections include a "*", an up arrow, a down 
arrow, and the bracket pair "[ ]". 
In the example of FIG. 9, the top line appearing in the Indication window 
is labeled "100 Severe cardiac ischemia by stress test." The up arrow to 
the left of this line indicates that the line has been expanded, and the 
subsequent lines labeled 110 to 160 are the expanded sub-indications 
following. Each of these sub-indications in turn contain down arrows, 
showing that they, too, may be expanded. 
By continuing to expand these indications as required, the criteria points 
are eventually reached. In FIG. 9 the line numbered 700 is a criteria 
point, as indicated by the bracket pair to its left. The bracket pair is 
selected by clicking with the mouse, which causes a check mark to be 
displayed within the bracket pair, as shown in FIG. 10. 
In FIG. 10 the screen shows the indication lines expanded within the 
Indication window 98, and several indications checked. The indications are 
ranked by level, which are numbered: level 1, level 2, etc. Each 
succeeding level is indicated by a succeeding indentation on the 
Indication screen. Thus, within screen 98", the line labeled 100 is at 
level 1, the line labeled 110 is at level 2, and indented relative to 
level 1, the line labeled 111 is at level 3, and indented from level 2, 
and so forth. 
Between the lines labeled 100 and 110 is the Rule, in this case labeled 
"ONE", indicating that one of the following lines on this level 
(sub-indications) must be selected to meet the criteria. Other Rules 
include TWO, THREE, ALL, etc., indicating which of the following 
indications must be selected to satisfy the criteria. 
At this point the user selects a review outcome using the Case Notes tab 
184, as seen in FIG. 22. The user in this figure has selected "Approved" 
from pull-down list 188. 
Finally, the user may click the Report button 100 to request a report be 
generated summarizing the findings of the screening system. FIGS. 11 and 
12 show the two pages of this report generated by the example herein. This 
report can also be printed on the computer printer 5 by clicking on the 
Print icon 110 of FIG. 11; it can be exported to a file by clicking on the 
Export icon 112; or it can be e-mailed by clicking on the E-mail icon 114. 
The user then terminates and saves the review for later examination by 
clicking on the Review Complete button 116 of FIG. 10. 
ISD Criteria Set Embodiments 
Among the criteria sets are those known as ISD. The ISD criteria sets are 
used to assist in assessing the appropriateness of a level of care based 
upon the patients clinical needs. The evaluations of ISD depend upon 
objective clinical information rather than upon a diagnosis. They are 
based upon the patient's episode of illness, current medication and 
treatment, and discharge readiness. 
ISD includes the following components 
a) Intensity of Service--the care being provided the patient; 
b) Severity of Illness--the symptoms and clinical findings indicating how 
sick the patient is; and 
c) Discharge Screening--the stability of the patient, the necessity of 
continuing care, the appropriateness of the patient leaving his/her 
present care level. 
d) Prerequisites--the non-patient specific factors, such as availability of 
physicians, alternate power sources, etc., for treatment at this level of 
care. 
There are presently different ISD criteria sets for adults and pediatric 
patients. 
FIG. 13 shows the steps used in performing an ISD review using AUTOBOOK 2. 
The first step is the entering of the Patient and Case Information 120. 
Next the user opens the category folder 122, and selects a Review Type 
124. Review types include: 
a) PRE--preadmission; 
b) ADM--admission; 
c) SUB--subsequent; and 
d) DIS--discharge. 
Next, a level of care is selected 126. Level of care includes: Critical, 
Acute, Rehabilitation, Subacute, and Home Care. Then a body system is 
selected. Body systems available include the blood/lymph/immune system, 
the cardiovascular system, the eye, ear, nose, and throat, etc. Then the 
user proceeds to the first Component 130. Components include 
Prerequisites, Severity of Illness, Intensity of Service, or Discharge. 
There may be an additional component following, depending upon the review 
type. If a second component is called for, the user will select this 
second component. 
The criteria points are then input 132, at which point the system indicates 
either a Criteria Met or Criteria Not Met condition. If the Criteria Met 
condition appears, then the level of care planned and described is 
medically appropriate, and vice versa. 
Next, the Case Notes Folder is opened 134, and a Review Outcome is chosen 
136. Review Outcomes include Approved, Referred for Medical Review, 
Awaiting More Information, etc. Then Referral Codes, Target Review Date, 
and Case Notes are entered 138. Alternate level of Care 140, and Variance 
Days, Ref LOS, and Case Notes are also entered 142. 
Finally, a report is created and printed 144. The review is then saved for 
possible future referral 146. 
This process may be understood in more detail by referring now to the 
following figures. FIG. 14 shows the Category-ISD screen which appears on 
the computer monitor after the entry of the Patient Information. The four 
Review Type buttons appear as PRE 150 (preadmission), ADM 152 (admission), 
SUB 154 (subsequent), and DIS 156 (discharge). ADM has been selected in 
the example, as reflected by the depressed appearance of the ADM button. 
Still referring to FIG. 14, the Acute level of care 158 has been selected, 
and the Peripheral Vascular 160 body system has been selected by double 
clicking with the mouse. 
Upon selecting the body system, the Admission Review folder is opened, and 
the Admission Review Screen appears, as seen in FIG. 15. The component 
buttons PR (prerequisites) 162, SI (Severity of Illness) 164, IS 
(Intensity of Service) 166, and DS (Discharge Screening) 168 appear, and 
SI is selected, as seen by the depressed appearance of the SI button. 
Next, the criteria which are true for the patient are selected. The Rule is 
displayed 170, and the Clinical Topic "Imaging Findings" is selected by 
means of a mouse click. As a result, the "Imaging Findings" clinical topic 
is expanded, as shown in FIG. 16, allowing the user to input Criteria 
Points 170 and 172. 
The user next clicks the IS button, and the screen of FIG. 17 appears, 
showing the Rule that either one of the two conditions 174, 176 must be 
TRUE. By double clicking on the down arrow 174, the line is expanded to 
display the various Criteria Points available, as seen in FIG. 18. 
By clicking on the DVT protocol &lt;=3d line 176, the user sets this criteria 
point to TRUE, and the CRITERIA MET display 178 appears, indicating that 
admission to the proposed level of care in this case is medically 
appropriate. 
FIG. 18 demonstrates the use of "star IS criteria points". Referring to 
FIG. 18, the entry 177 is entitled "o&gt;=Three *IS. The *IS represents 
services which may be safely administered at lower levels of care but 
which, in aggregate, three or more, will warrant the additional monitoring 
associated with the proposed level. 
A report may be generated by clicking on the Report button 180, although 
this step is discretionary. The review is saved by clicking on the Review 
Complete button 182. The review will then be available for subsequent 
examination when desired. 
IWC--Worker's Compensation Criteria Sets 
An additional category provided is identified by the acronym IWC, or 
"Indications for Workers' Compensation". IWC is actually a collection of 
criteria sets, the collection including IRM (injury recovery management), 
and subsets of the ISD, ISP, and ISX criteria sets. These subsets function 
identically to the fully-functional versions of these criteria sets, as 
previously described. 
IWC is entered by clicking on the Category tab 80 which appears in FIG. 5. 
The result is the screen shown in FIG. 20. Referring now to FIG. 20, the 
category buttons 194 include the IWC button 196, which is shown depressed 
to indicate that it has been previously selected. Directly below the IWC 
button is a row 198 of four buttons labeled IRM, ISD, ISP, and ISX, which 
are used to select the corresponding criteria sets. In FIG. 20 IRM has 
been selected, as seen by the depressed appearance of the IRM button 200. 
The cascading menu text screen 210 of FIG. 20 corresponds to the IRM 
function selected. The entries on this menu screen are organized into body 
systems, which, in turn are organized into classes of procedures. Upon 
selecting the "Back" entry (line 1 of screen 210), and further selecting 
the "Cauda Equina Syndrome" (line 2 of this screen), a new screen appears 
as shown in FIG. 21. 
Pended Reviews 
AUTOBOOK 2 has the ability to suspend reviews pending more information. 
Although under normal circumstances the user will want to complete a 
review at a single sitting, there are circumstances which require 
information not currently available to complete a review. Reviews may be 
pended (suspended) by using the Case Notes or Med. Review Notes screens. 
Referring to FIG. 18, the Case Notes tab 184 is clicked, resulting in the 
display of the Case Notes screen, FIG. 19. In FIG. 19 the Review Outcome 
pulldown menu 188 has been expanded, and the "Awaiting More Information" 
entry shown 192. The user has also checked the "Diagnostic service delay" 
Referral Code 190, indicating the reason for the delay. 
The Med. Review Notes screen has similar capabilities, and is accessed by 
clicking the Med. Review Notes tab 186, as shown in FIG. 18. 
Pended reviews may be selected for review by means of the Patient 
Information screen, as shown in FIG. 5. The Review Selection area 68 
contains a radio button entitled "Pended Reviews" 69. When this button is 
checked, the only reviews listed in the "Stored Reviews" area 66 are those 
reviews which are pended by the first reviewer. 
Reviews which have been either pended by the medical reviewer, or referred 
by the first level reviewer and not processed by the second level 
reviewer, are filtered by the "Referred" radio button. 
Report Generation 
The reports generated by AUTOBOOK 2 are a key element in the review 
process. These reports not only allow the monitoring of the progress of a 
medical treatment. They also provide a means for creating a repository of 
knowledge. 
For instance, the performance of different doctors within the same 
environment can be compared. As an example, if a particular doctor is 
ordering 300% more x-rays than the average, this result can be detected by 
amassing the reports and subjecting them to analysis. Similarly, the 
system can generate utilization reviews to assess and monitor 
under-utilization and over-utilization. 
AUTOBOOK 2 allows the data which constitute the individual reports to be 
output in two different ways. First of all, the data can be exported to a 
disk file, by clicking on the Export icon 112, as shown in FIG. 11. The 
user may choose any one of a number of different formats for the export, 
including ASCII, tab-separated ASCII, and WORK FOR WINDOWS.RTM. formats. 
The data making up a report can also be E-mailed by clicking on the e-mail 
icon 114 as shown in FIG. 11. Data exported by e-mail may be formatted in 
any of the same formats available when exporting to a disk file. 
The ability of AUTOBOOK 2 to export data allows the utilization of 
third-party report writers. 
Linkages to Other Systems 
AUTOBOOK 2 is written in Visual Basic.RTM.. As a result, the program has 
the ability, through Microsoft's OLE2.RTM. facility, to link its input and 
output to other programs. This facility makes it possible, for instance, 
to automatically enter data from an external process, and to automatically 
feed back the results into the same external process. As a result, 
AUTOBOOK 2 may be easily embedded in other HIS systems. 
WINDOWS, WINDOWS 95, WINDOWS 98, WINDOWS 3.1, and WORD FOR WINDOWS are 
registered trademarks of Microsoft Corporation. 
Import of Data 
AUTOBOOK 2 has the facility to import standard LOS (length of stay) codes 
corresponding to user-entered ICD9 diagnosis or procedure codes. These 
parameters are displayed in the Patient Information screen shown in FIG. 5 
as data input boxes 63 and 65. 
The ICD9 Code may be entered by clicking on the ICD9 Code button 87 shown 
in FIG. 7. 
While the invention has been described with reference to specific 
embodiments, it will be apparent that improvements and modifications may 
be made within the purview of the invention without departing from the 
scope of the invention defined in the appended claims.