Abstract:
A system for facilitating patient ownership of his or her medical data through the use of third-party health repositories that preserves the maximum information content of the medical records by displaying information relevant to the authority of the medical data as reflected by its source and types of modification as it has moved between institutions, as well as the data itself. In this way, improved use of this data is made possible.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application is a continuation of U.S. application Ser. No. 12/391,120, filed Feb. 23, 2009, which in turn claims the benefit of U.S. provisional application 61/030,734 filed Feb. 22, 2008 both of which are hereby incorporated by reference. 
     
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     BACKGROUND OF THE INVENTION 
       [0002]    The present invention relates to electronic medical records and, in particular, to an electronic medical record system providing improved integration of portable medical records. 
         [0003]    Electronic medical records offer a number of advantages over conventional paper-based recordkeeping. First, the cost of generating, storing, and accessing electronic medical records is potentially much lower than for comparable paper- or document-based record systems. Electronic medical records are more resistant to loss or damage and, with the increased availability of computer devices with display and networking capability, the speed and convenience of accessing electronic medical records is far superior to their paper counterparts. Electronic medical records facilitate the collection of all relevant information for a particular patient in a single system, giving healthcare providers a more complete view of the patient&#39;s health. Because electronic medical records are machine-readable, they may be analyzed with programs to assess the efficacy of particular courses of treatment, to provide automatic notices or devise theories, and to otherwise automate the process of delivering high-quality health care services. 
         [0004]    Electronic medical records also promise to improve the patient&#39;s access to his or her own records and thus beneficially increase patient involvement in the healthcare process. Healthcare providers having electronic medical record systems may provide Web portals to their patients allowing protected access by the patient to selected healthcare information. One such system is the MyChart™ healthcare portal commercially available from Epic Systems Corporation of Verona, Wis. Such healthcare portal systems should be distinguished from healthcare websites which allow the patient to record healthcare information but do not provide patient access to clinical medical records collected by healthcare professionals. 
         [0005]    A third benefit to electronic medical records is that they are easily transported, for example on optical or digital media or over the Internet, and in this way can provide continuity in a patient&#39;s medical history as the patient moves among institutions. Toward this end, a number of organizations both within and outside of the healthcare industry (such as Google and Microsoft) have taken steps toward creating health data repositories that might serve to hold electronic medical records in the standard formats under the control of a patient. These data repositories foresee the possibility that patients will become the custodians of their own medical records in alignment with U.S. law giving patients ownership of their medical record data. 
       SUMMARY OF THE INVENTION 
       [0006]    The present inventors have recognized that the benefits of a patient controlling his or her medical records can be at odds with the patient&#39;s desire that the physician have authoritative medical data on which the physician may rely. While a patient&#39;s characterizations of his or her medical condition is an important element in obtaining a complete picture of the patient&#39;s health, patient-edited data or data that is corrupted or materially redacted can be confusing or misleading, a fact that may lead physicians to give this data very little weight. 
         [0007]    The promise of health record portability from third-party record repositories may fall far short of expectations if patient-stored and -transported health records are ignored by physicians or treated as no better than a patient health history questionnaire currently filled out by patients when moving to a new physician or medical practice. 
         [0008]    The present invention addresses this problem by generating and preserving additional data related to the authority of transferred medical records. This authority information may be displayed to the physician concurrently with the display of the underlying medical data allowing the physician to better assess and thus more fully use data that has been transferred from other sources. In this respect, the present invention may distinguish among physician-generated data having the highest authority, patient-collected data (entrusted to the patient by another institution) having various levels of authority depending on the degree of editing and redaction of the data and patient-generated data having lesser authority for some types of data. In different embodiments, the value of the data is further enhanced by displaying the source of the data (e.g. a particular hospital or institution collecting the data) and the extent to which the data may omit important elements. 
         [0009]    In this context, “physician-generated” data will mean clinical medical data generated by the physician or other health care professional working with the physician, “patient-collected” data will mean clinical medical data entrusted to the patient and being transferred under the authority or control of the patient, while “patient-generated” data will mean medical information developed by the patient using the patient&#39;s own observations or memory. “Patient-generated” and “patient-collected” data will sometimes be referred to collectively as “patient-controlled” medical data. 
         [0010]    Specifically then, the present invention provides a health record system integrating a first and second clinical record system associated with different medical institutions and the medical record repository. The first clinical record system, associated with the first medical institution, provides at least one computer communicating with a set of data terminals and a first database executing a first stored program to collect, organize, and display physician-generated medical data for given patients. The first clinical record system includes an authentication protocol limiting access by non-healthcare professionals. The medical record repository likewise provides at least one computer communicating with a set of data terminals and a repository database and executing a repository stored program to collect, organize, and display medical data controlled by given patients. The medical record repository includes an authentication protocol limiting access by others than the given patients. 
         [0011]    In the invention, the repository program of the medical record repository operates to: 
         [0012]    (a) accept into the repository database patient-generated medical data from a given patient; 
         [0013]    (b) accept into the repository database patient-collected medical data from a second clinical record system of a second medical institution in a manner to be separately identified from the patient-generated data; and 
         [0014]    (c) respond to authorization by the given patient to transmit at least some of the patient-generated data and patient-collected data to the first clinical record system. 
         [0015]    Using information from the medical record repository, the first stored program of the first clinical record system further operates to provide a display output providing medical data for the given patient visually linked to an indication of an authority of the data based on its identification as physician-generated, patient-generated, or patient-collected. 
         [0016]    It is thus a feature of at least one embodiment of the invention to provide not only medical data but also to indicate the authority of the data improving the ability of the physician to use data from other sources. 
         [0017]    The repository program further stores an identification of the second medical institution which may be displayed by the first program. 
         [0018]    It is thus a feature of at least one embodiment of the invention to provide the physician with the ability to both judge medical data based on its specific source and to permit rehabilitation of data that may have lost its authority, the rehabilitation being done by the physician contacting the original source. 
         [0019]    The medical data may have a data type related to a medical character of the data and independent of a source of the data and the first stored program may further operate to display physician-generated, patient-generated and patient-collected data sorted according to data types, so that similar data types are proximate to each other in the display. 
         [0020]    It is thus a feature of at least one embodiment of the invention to allow visual integration of data from multiple sources in the display by data type, making the data more accessible to a physician, without obscuring the underlying authority of the data. 
         [0021]    The repository program may accept health record documents from the second health institution comprised of multiple elements of medical data and may allow the given patient to selectively authorize a subset of the medical data of the document for transmission to the first clinical record system. The repository program may separately identify medical data associated with a document in which some medical data was not authorized for transmission to the first clinical record system from medical data associated with a document in which all medical data was authorized for transmission to the first clinical record system. 
         [0022]    It is thus a feature of at least one embodiment of the invention to provide an indication to the physician that there may have been material omissions in a transferred medical record, lowering its authority, even though the included portions of the medical record are of high authority. 
         [0023]    The repository program may allow editing of the patient-collected medical data by the given patient and the repository program may identify such edited medical data in a manner to be separately identified from medical data unedited by the given patient. 
         [0024]    It is thus a feature of at least one embodiment of the invention to indicate that clinical medical data may have been edited or changed by the patient, thus implicitly lowering its authority. 
         [0025]    Patient-collected data edited by the given patient may be identified as patient-generated data by the repository program. 
         [0026]    It is thus a feature of at least one embodiment of the invention to provide a simple method of categorizing the authority of edited clinical data. 
         [0027]    The repository program may accept health record documents of medical data from the second health institution and evaluate a digital signature or watermark in the documents, or the quality of a secure channel used to transfer the document, or other technological authentication system to ensure the documents have not been edited after release by the second health institution before identifying them as patient-collected data. As used herein, document shall refer to a collection of medical data received from a clinical institution presenting a cohesive view of the patient&#39;s health information and subject to a common authentication mechanism. 
         [0028]    It is thus a feature of at least one embodiment of the invention to permit the use of clinical data transferred under the custody of the patient without necessarily degrading its authority. The watermarking process allows control of the files to be transferred while ensuring their integrity. 
         [0029]    Alternatively, the repository program may communicate electronically directly with the second health institution to obtain patient-collected data. 
         [0030]    It is thus an object of the invention to provide a system of transfer of clinical data without loss of authority using a trusted third-party intermediary. 
         [0031]    The repository program may further communicate with the first program to provide a display output of the physician-generated data for the given patient to the patient using the repository program. 
         [0032]    It is thus a feature of at least one embodiment of the invention to provide a mechanism allowing the patients to view their clinical records in combination with the management of clinical records from multiple sources. 
         [0033]    The second program may further operate to: 
         [0034]    accept into the repository database patient-collected medical data from the first clinical record system in a manner to be separately identified from the patient-generated data; and 
         [0035]    respond to authorization by the given patient to transmit at least some of the patient-generated data and patient-collected data to the second clinical record system. 
         [0036]    It is thus a feature of at least one embodiment of the invention to provide a conduit for medical data between multiple institutions currently providing patient care. 
         [0037]    The repository program may further operate to respond to authorization by the given patient to transmit at least some of the patient-generated data to the second clinical record system. 
         [0038]    It is thus an object of the invention to provide a simple mechanism for a patient to update records at multiple institutions 
         [0039]    These particular features and advantages may apply to only some embodiments falling within the claims and thus do not define the scope of the invention. 
     
    
     
       BRIEF DESCRIPTION OF THE FIGURES 
         [0040]      FIG. 1  is a graphical representation of the transfer of clinical medical data between a first and second clinical institution via a health data repository serving to link the two; 
           [0041]      FIG. 2  is a logical representation of a database of the health data repository in collecting healthcare information for a given patient, the database preserving data source, organization, sharing, and editing information; 
           [0042]      FIG. 3  is a flow chart of a program executed by a clinical record system at the first clinical institution for displaying medical data, including medical data from the health data repository and providing authority indicia for that data; and 
           [0043]      FIG. 4  is a simplified representation of a display of the data as presented to a physician marked by authority levels and using an authority threshold. 
       
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT 
       [0044]    Referring now to  FIG. 1 , first and second clinical institutions  10  and  12 , such as hospitals or clinics or the like, may provide for electronic medical records systems  14  and  16  respectively. As is generally understood in the art, medical record systems  14  and  16  may store, organize, and display clinical medical data for patients. As used herein, clinical medical data refers to medical information based on direct observation of patients by healthcare professionals. 
         [0045]    The electronic medical record systems  14  and  16  may employ one or more electronic computers  18  executing stored programs  20  to implement a database  22  holding the clinical medical records as well as the other features are of the electronic medical record system. Multiple terminals  26  may communicate with the computer  18  through a local area network or via the Internet to allow access to the medical records by healthcare professionals of the institutions  10  and  12 . This access is controlled by an authorization protocol implemented by the programs  20  to limit access by non-healthcare professionals, for example, through the use of a password/username combination or other well-known authentication techniques. This limitation of access may admit to multiple permission levels allowing some access, for example, selective read access by the patients for their own records. Generally, the records within the databases  22  are subject to the recordkeeping requirements and regulations of the Health Insurance Portability and Accountability Act (HIPAA). These clinical records will be termed physician-generated, recognizing that they may be developed by a broad class of healthcare professionals including but not limited to physicians. 
         [0046]    Electronic medical record systems  14  and  16  suitable for this purpose are commercially available from Epic Systems Corporation and are described by multiple published U.S. pending applications assigned to Epic Systems Corporation including: 2008/0033761 “System and method for a seamless user interface for an integrated electronic health care information system”; 2007/0143149 “Data tagging and report customization method and apparatus”; 2006/0080620 “Electronic system for collecting and automatically populating clinical order information in an acute care setting”; 2003/0220815 “System and method of automatically determining and displaying tasks to healthcare providers in a care-giving setting”; 2003/0216945 “Method for analyzing orders and automatically reacting to them with appropriate responses”; 2003/0208391 “Rules based ticketing for self-scheduling of appointments”; 2003/0208381 “Patient health record access system”; 2003/0139943 “Healthcare information system with clinical information exchange”; 2003/0130872 “Methods and apparatus for managing and using inpatient healthcare information”; 2003/0061073 “Method and system for displaying patient information”; 2002/0120472 “System and method for integration of health care records”; 2002/0083075 “System and method for a seamless user interface for an integrated electronic health care information system”; and 2002/0080189 “Electronic system for collecting and communicating clinical order information in an acute care setting” all hereby incorporated by reference. 
         [0047]    Referring still to  FIG. 1 , a given patient may record and access patient-generated medical information by means of a health data repository  30 , for example, accessible over the Internet by the patient using a home data terminal  32 . 
         [0048]    In this regard, the health data repository  30  may use one or more computers  35  executing a stored program  33  to implement a database  34  used to hold the patient-generated medical records as well as implement other features of the health data repository  30  to be described. The home data terminal  32  may, for example, use a browser program to connect with a Web server implemented by the stored program  33  of the health data repository  30 . Typically, the patient may use the home data terminal  32  to enter patient-generated medical information including easily measured health data (height, weight etc.), allergies, medications, and information that may be duplicated by the records of the databases  22  as recalled by the patient. 
         [0049]    A health data repository  30  differs from a personal health record (PHR) to the extent that it also allows importing of clinical medical data from the databases  22 . For this purpose, the health data repository  30  may provide for a direct network connection  38  via the internet or other means with the computers  18  of the institutions  10  and  12  which may transfer medical records from the databases  22  using, for example, a common document format such as the Continuity of Care Document (CCD) described by ANSI standard ANSI/HL7 R1-2000, R2-2005 hereby incorporated by reference or the Continuity of Care Record (CCR) described by ASTM CCR standard E2369-05 hereby incorporated by reference. 
         [0050]    The goal of the health data repository  30  is to provide for control by a patient of the patient&#39;s health record and thereby to assist in preservation of medical records as a patient moves between institutions  10  and  12  through his or her life providing continuity in these records. 
         [0051]    Prototype health data repositories  30  of this type are currently being offered by Epic Systems Corporation under the Lucy trademark, by Microsoft Corporation under the HealthVault tradename and by Google Corp. under the tradename Google Health. 
         [0052]    The present invention contemplates that the program  33  of the health data repository  30  will give the patients considerable latitude in organizing their medical information in the health data repository  30 , both patient-generated and physician-generated. In such systems, the patient-generated and physician-generated data will be collectively referred to as patient-controlled data. 
         [0053]    Specifically, such health data repositories  30  may provide one or more of the following features: selective sharing or redaction of portions of physician-generated medical data documents, elimination of the duplicate patient-controlled medical data, selection among conflicting patient-controlled medical data, and editing (including creation) of patient-controlled medical data. The selective sharing feature allows a patient to provide an indication associated with elements of medical data indicating whether the patient wishes to have the elements shared with the institutions  10  and  12 . Using this sharing feature, medical data control by the patient may be automatically forwarded to each of the institutions (or automatically transferred by institution request) providing a simple method of updating the multiple institutions  10  and  12  both with patient-generated data and with physician-generated data from the other institution. Documents uploaded by the patient from an institution  10  or  12  may have all or portions of the documents shared so that some portions of the documents are not shared. A functionally similar approach allows redaction of elements of the documents by the patient in the database of the repository so that these records are also removed from access by the patient as well as anyone else accessing the records from the repository. 
         [0054]    As data is imported from different institutions or provided by the patient to the health data repository  30 , duplications in the data may occur. If the duplicate data is the same, the program  33  of the health data repository  30  may allow the patient to delete redundant data with respect to its display to the patient and/or sharing. Alternatively, if the duplicate data is different, the patient may reconcile the data selecting one data element in favor of the others and deleting or redacting the others. In addition, the health data repository  30  through program  33  may permit the patient to edit the data, changing its value. 
         [0055]    Referring to  FIG. 2 , a database  34  of the health data repository  30  may be logically represented tabularly as a set of records  40  each represented by one row of a database  34  with each of the records  40  divided into fields represented by columns of the table. It will be understood that this logical representation embraces a variety of different database organizational structures of types well known in the art, and further that it is a simplification and that an actual database will include different fields and organization. 
         [0056]    As shown in  FIG. 2 , the first field  42  may provide a unique number for each record  40  and a second field  44  may provide for a patient identification, being a unique number or the like identifying a patient from others. The patient identification may provide a link to other information about the patient including name, address, and the like. In this case, the records  40  of the single patient are shown which represents a minimum health data repository  30 . Typically, the health data repository  30  will serve multiple patients, and so the patient identification may also link to a username/password for implementing a secure logon to health data repository  30  limiting access to the patient&#39;s records  40  by persons other than the patient. 
         [0057]    A next field  46  may provide a machine-readable data-type indicating the type of medical data represented by the record  40 . The data type of field  46  may be followed by the particular medical data of field  48 . For example, the data type of field  46  may be allergy information and the medical data of field  48  may be the allergen. 
         [0058]    The present invention contemplates one or more additional fields  50 - 58  which increase the usability of the data as it is transferred. The first field  50  indicates whether the data was patient-generated (P) or patient-collected (C). As noted above, “patient-collected” data will mean clinical medical data entrusted to the patient and being transferred under the authority or control of the patient, while “patient-generated” data will mean medical information developed by the patient using the patient&#39;s own observations or memory. “Patient-collected” data can include data collected from automatic monitoring equipment. 
         [0059]    The next field  52  provides an attribution or source for patient-collected data (for example, an identification of a particular hospital or clinic). These two fields can be conflated into one, with a blank entry in field  52 , indicating patient-collected data, and all other data being considered patient-generated. 
         [0060]    The present invention contemplates that this field can hold not only the name of the institution, but potentially, also the name of the health care professional responsible for the collection of the data either directly or under his or her supervision (“the sourcing physician”). In either case, a field  51  is provided allowing the health care professional responsible for the data to highlight or flag certain records  40  with respect to their importance. This highlighting (shown as an * in  FIG. 2 ) does not change the medical data but like the other information in fields  50 - 58  serves to characterize the significance or authority of the data. A numeric ranking scale of importance may also be employed. 
         [0061]    The next fields  53  and  54  apply to patient-collected data and provide the document structure of the data, field  53  providing a unique document number that will be shared by all data (records) associated with a single document (e.g. CCD, CCR). Field  54  provides unique numbers of each record  40  of that document. The numbers of these fields may be chosen arbitrarily so long as they are unique for each document and for each record  40  within a document. 
         [0062]    Field  56  provides a set of sharing codes indicating the patient&#39;s preference for sharing of the particular record  40 . A given record  40  or data element may be shared (Y) or not shared (N) on a record  40  or element-by-element basis. These sharing codes may be expanded to permit sharing to particular institutions  10  or  12  and not to others. 
         [0063]    The field  58  provides an edit code allowing the program  33  to distinguish among a variety of types of modifications of the records  40  or their environment. The edit codes may include, for example: not edited (N), duplicate (D), redacted (RD), reconciled (R), and edited (F). No editing is self-evident and indicates that the medical data of the record  40  controlled by the patient has not been edited by the patient, his may be established, for example, by watermarking techniques for example using public-key encryption) associated with the record  40  or through a direct downloading of the record  40  to the health data repository  30  under the control of the health data repository  30 . Patient-generated data can never be classified as not edited (N) but is always automatically classified as edited (E). Patient-generated data, however, may be attributed to a clinic or the like by the patient using field  54  (such attribution is not shown in  FIG. 2 ). 
         [0064]    The edit code of duplicate (D) is used when a record  40  received from an institution  10  or  12  provides duplicate information (identical data type of field  46  and data value of field  48 ) that is already in the database  34  from another institution  10  or  12  or from the patient. The existence of duplicate records  40  may be noted to the patient during a merging process when that document is received and need not alter or erase data of the record  40  but only indicates that the record  40  is a duplicate and ideally provides pointers to the other records  40  with which duplication exists. This edit code may be used, for example, by the health data repository  30  to prevent the display of redundant data. 
         [0065]    In the example of  FIG. 2 , records  2  and  7  both indicate a penicillin allergy recorded by different institutions  10  and  12  and each may be marked as a duplicate. 
         [0066]    The edit code of redacted (RD) may be used to indicate that a portion of a document is missing (deleted or not shared) per records  3  and  4 . Note that the edit code of (RD) is attached to non-redacted data, and indicates that other data of the document was redacted. In an alternative embodiment of the invention, multiple edit codes are possible for each record  40 , so, for example, records  5  may have the (RD) edit code and the (R) edit code. Or the edit codes may conflate to one edit code as shown. 
         [0067]    The edit code of reconciled (R), unlike duplicate, indicates that the patient made a selection among inconsistent records  40  for duplicate data types. For example, record  5  and record  8  may indicate different clinical data values for medical data related to a medical type, for example weight, and the patient may select between these. Again, each reconciled record  40  may preserve a link to the other records  40  with which it was reconciled so that the complete data set can be reconstructed. 
         [0068]    Referring now to  FIG. 3 , the database  34  of  FIG. 2  allows a sophisticated integration of this data into the clinical medical records of databases  22  by a program  20 ′ being, for example, part of program  20 . Using program  20 ′, institution  12 , for example, may receive data from a health data repository  30 . This receipt of data may be incident with receiving a new patient for care (the patient having a health data repository  30 ). Alternatively, the receipt of data may occur as part of an ongoing relationship with a patient who uses multiple institutions  10  and  12 , the data being transmitted from the health data repository  30  on a regular basis or by request by the patient or the institution  10  or  12 . While the data from the health data repository  30  has great value, as noted above, not all of the data has the same authority. Accordingly upon receipt of the data, program  20 ′ undertakes an assessment of the data using all or some of the information from the editing fields  50 - 58  preserved by the health data repository  30 . 
         [0069]    This evaluation may be performed per any of the events described above as indicated by decision block  64 . For each record  40 , as indicated by process block  62 , the record  40  may be evaluated to determine whether there is an attribution (field  52 ) as indicated by decision block  64  or whether the record  40  is patient-generated as recorded by field  50 . If there is no attribution or the data is patient-generated, then the record of  40  is marked as patient-generated per process block  66 . 
         [0070]    If there is an attribution and the record  40  is part of a patient-collected document having other records  40 , then at decision block  67  it is determined whether the entire document (that is all of its records  40 ) is marked for sharing per field  56 . If any of the records  40  are not marked for sharing, then at process block  68  all of the records  40  of that document are marked as redacted, indicating that the data is accurate but some, possibly material, medical data may be omitted. 
         [0071]    In either case, at succeeding decision block  70 , the record  40  is evaluated to determine whether it has been edited. Regardless of its previous attribution, if the document was edited, then at process block  72 , the record  40  is marked as edited; however, the attribution that is the source of the document may still be retained. Generally, in the case of patient editing, any marking of the record as important by the sourcing physician is removed. 
         [0072]    If the document has not been edited, then the program  20 ′ proceeds to decision block  74  to determine if the particular record  40  has been marked duplicated by the health data repository  30 . If so, at process block  76 , the record  40  is marked a duplicate and the attribution of the duplicate record  40  is retained providing information to the physician that multiple institutions have validated this particular piece of data. Any marking of either redundant record as “important” by the sourcing physician is preserved and attached to the displayed record. 
         [0073]    If the record  40  was not marked as a duplicate, it is examined at decision Hock  78  to see if it has reconciled data and, if so, at process block  80  the data is marked as reconciled. Optionally, the attributions for the reconciled data may be saved as well as the values of that data. If one of the reconciled records has been marked as “important” by the sourcing physician, this importance may be displayed, provided the unreconciled records is also displayed as will be described below. 
         [0074]    This process is repeated per process block  82  in a loop until records  40  from the health data repository  30  are analyzed and marked. The marked data may then be integrated into the database  22  after which the program  20 ′ may proceed to process block  84  to display, the records to the physician. 
         [0075]    During the display process  84 , the marked records from the health data repository  30  may also be in conflict or duplicated with existing clinical records of database  22  at the institution  12 . The program  20 ′ may automatically delete or hide duplicate records received from the health data repository  30  in favor of the high authority records of the clinical database  22  and likewise may reconcile any conflicting data to the high authority records of the clinical database  22 , optionally with confirmation and possible override by the physician. 
         [0076]    The display process  84  may permit selecting among the types of markings that will be displayed. For example, the “redacted” marks may be suppressed if the physician is not interested in this level of detail. 
         [0077]    Referring now to  FIG. 4 , a typical display for such a system would display the patient name as deduced from the patient ID of field  44  together with selected medical data  90  culled from the records  40  of the patient, for example, selected from the database  22  through a database query executed by the physician or automatically being part of a predefined form. Different display modes  92  (for example highlighting or color) may optionally be applied to the data  90  to indicate qualitatively the authority of the data. Preferably, the highest quality medical data may be highlighted according to a threshold that may be programmed by the institution  12  separating among the various levels of authority ranked generally as follows: 
         [0000]    
       
         
               
               
             
           
               
                   
               
               
                 Level of 
                   
               
               
                 Authority 
                 Source Medical Data 
               
               
                   
               
             
             
               
                 1* 
                 Data with attribution, not edited or redacted, but duplicated by 
               
               
                   
                 multiple institutions, flagged by sourcing physician as 
               
               
                   
                 important 
               
               
                 1 
                 Data with attribution, not edited or redacted, but duplicated by 
               
               
                   
                 multiple institutions 
               
               
                 2 
                 Data with attribution, not edited or redacted and not 
               
               
                   
                 duplicated 
               
               
                 3 
                 Data with attribution, not edited, but reconciled 
               
               
                 4 
                 Data with attribution, not edited but some data redacted 
               
               
                 5 
                 Data with attribution, edited 
               
               
                 6 
                 Patient-generated, edited data 
               
               
                   
               
             
          
         
       
     
         [0078]    For example, data with authority values 1-3 may be highlighted as high-quality data for the physician. Alternatively, the display of records may be controlled by their authority level with a physician selecting by filter settings, a desired level of authority of all displayed records. In this case, for example, the physician may set the authority level to level 3 or below (levels 1-3) in which case data associated with levels 4-6 would not be displayed. Similarly, individual levels may be suppressed, for example, level 5, while allowing level 6. 
         [0079]    Each element of medical data derived from a record may be further labeled with a label providing additional physician guidance. For example, authority level 5 data (shown in  FIG. 4  as “medical data  1 ”) may be marked with the text “patient-generated” or a similar abbreviation or symbol. Similarly as shown with “medical data  3 ”, data with an attribution (e.g. institution  10  or  12 ) but edited will be indicated as patient-generated yet the attribution retained. This allows the physician to confirm the data with the institution if desired and preserves the attribution information even though it may not provide self-authentication. 
         [0080]    As indicated with “medical data  4 ”, un-edited data from an institution where the data is part of a document having some data removed or unshared, may be labeled “redacted” and the institution attribution provided. Data from the clinical database  22  of institution  12  itself, for example, “medical data  2 ” may be highlighted with no attribution indicating that it is internal data of the highest quality. 
         [0081]    High quality data from another institution being part of a document that has neither been edited nor redacted, as indicated by “medical data  5 ” and “medical data  7 ” and the data that has been reconciled with other high-authority data from other institutions that has neither been edited nor redacted, shown by “medical data  8 ”, may be displayed as high-value with the rejected values and their attributions displayed. As shown by “medical data  5 ” any data marked as important by a physician in the sourcing institution may be marked as such. 
         [0082]    Duplicate data may select the data of the highest authority to display. Reconciled data may further show the attributions together with the conflicting data. 
         [0083]    The present invention thus provides a method for a physician to obtain the very best data that has been collected for his or her patient while, also understanding the chain of custody of that data to the extent that it can affect the data&#39;s authority and the physician&#39;s decisions. Note that the authority provided by the present invention necessarily varies in importance depending on the type of data and the amount of reconciliation. For example, inconsistent data related to the patient&#39;s weight may be easily understood (within certain ranges) as being of relatively low significance. Further, some types of clinical information that are patient-generated or sourced from a redacted or edited document may nevertheless be perfectly acceptable because there is little likelihood of a serious mistake or missing data being materially relevant to the data provided. Other data may be more sensitive to any editing or redaction and the redaction itself may be significant to the physician in certain cases even when the data itself has not been shared. 
         [0084]    It will be understood that the term physician as used herein includes any authorized health care professional using the clinical records system. 
         [0085]    It is specifically intended that the present invention not be limited to the embodiments and illustrations contained herein and the invention should be understood to include modified forms of those embodiments including portions of the embodiments and combinations of elements of different embodiments as come within the scope of the following claims.