Abstract:
A system for data integration and collation of medical data is described. The system includes a plurality of data sources and a plurality of connectors, wherein the data sources include data from a physiological sensor and a caregiver data store, a connector and source are paired, and each paired connector converts source data between a first format and a second format different from the first format. The system further includes a rules engine and a medical rule associated with a medical protocol and a core transaction processing system configured to apply the medical rule to the data in the second format to implement a compliance rules check of the medical protocol. Also described is a system for monitoring post-procedure complications using a plurality of physiological sensors for collecting medical data; an on-site gateway communicating with the sensors; a server for receiving physiological data recorded by the sensors from the gateway; a database comprising a patient medical record, a prescribed protocol, and a rule set describing the prescribed protocol; and a medical rule evaluator for accessing the rule set and applying the rule set to the physiological data to determine compliance with the prescribed protocol.

Description:
TECHNICAL FIELD 
       [0001]    The present teachings are directed toward the improved collection of medical/physiometric instrumentation data. In particular, the disclosure relates to collection of analysis and utilization of medical/physiometric instrumentation data to enhance clinical workflows like monitoring post-procedure complications and preventing fraud. 
       BACKGROUND 
       [0002]    Medical instrumentation has always produced physiological data. This prior art data collection activity is instrument and processor specific. Moreover, different vendors of the same or similar medical instrumentation use different and varying protocols to collect, store and transmit data. As such, data acquisition, data storage, data retrieval, and data interpretation require custom programming and purchase of vendor specific analysis. Therefore, there is a need to provide a robust across the board analysis tool that works in a heterogeneous environment to collect and collate the data. The collated data can be provided by sensors and other healthcare domain data stores like an Electronic Medical Record (EMR). The collated data can be used to implement clinical workflow enhancements. There is also a need to standardize the heterogeneous data and use of varying analysis. 
       SUMMARY 
       [0003]    According to various embodiments, a system for monitoring post-procedure complications is described. The system comprises a plurality of physiological sensors for collecting medical data; an on-site gateway communicating with the sensors; a server for receiving physiological data recorded by the sensors from the gateway; a database comprising a patient medical record, a prescribed protocol, and a rule set describing the prescribed protocol; and a medical rule evaluator for accessing the rule set and applying the rule set to the physiological data to determine compliance with the prescribed protocol. In the system, the medical rule evaluator generates an alert if physiological data does not comply with the rule set. The alert can comprise warnings and errors. 
         [0004]    In some embodiments, the system can further comprise transmitting the physiological data to a healthcare provider for display. The gateway can comprise a connector to standardize sensor data. The plurality of sensors can be provided by different providers. The sensors can communicate with the on-site gateway using wireless technology. The gateway can communicate with the server using one or more of a leased line, telephone, cellular service, fiber optics, or Internet. The gateway can be disposed remotely from the healthcare provider. 
         [0005]    In some embodiments, a payment authorization subsystem can be activated when the medical rule evaluator verifies delivery of medical procedure per the prescribed protocol. The gateway can tag the data with a patient ID and a patient location. The prescribed protocol can comprise a post-procedure complication monitoring protocol. 
         [0006]    According to various embodiments, a system for fraud prevention in delivery of home healthcare services is described. The system comprises: a medical data entry device adapted to receive a service provider ID and a service provided ID; a plurality of physiological sensors for monitoring a patient; and a gateway to determine a patient ID, a patient&#39;s location, and provide the sensed medical data to the medical data entry device. 
         [0007]    In some embodiments, the physiological data comprises one or more of a patient&#39;s weight, oxygen level, blood pressure, glucose level, heart rate or a combination thereof. The system can further comprise a server to receive the service provider ID, the service provided ID, the patient ID, the patient location, and the sensed medical data. The server can evaluate the service provided ID to locate an associated rule set and verifies delivery of the service by applying the associated rule set to the physiological medical data. In some embodiments, the server authorizes payment to the service provider ID after verifying delivery. Sometimes, the server can verify that the patient&#39;s location is associated with a set of locations where service to the patient can be provided. The gateway can include a patient ID scanner. The gateway can include a GPS sensor. The gateway can be disposed in the medical data entry device. 
         [0008]    According to various embodiments, a system for data integration and collation is described. The system comprises a data collection system comprising a plurality of data sources and a plurality of connectors, wherein the data sources include data from a physiological sensor and a caregiver data store, a connector and source are paired, and each paired connector converts source data between a first format and a second format different from the first format. The system further comprises a rules engine and a medical rule associated with a medical protocol; and a core transaction processing system configured to apply the medical rule to the data in the second format to implement a compliance rules check of the medical protocol. 
         [0009]    In some embodiments, the application of the medical rule confirms patient compliance with the medical protocol. In some embodiments, the application of the medical rule confirms caregiver compliance with the medical protocol. In other embodiments, the application of the medical rule generates health status data. 
         [0010]    According to various embodiments, the health status data is used for real-time monitoring of the patient. The application of the medical rule can generate a mental health profile of the patient. The data sources can comprise one or more of a body area network sensor, an Electronic Health Record (EHR), an EMR, an Hospital Information Services (HIS) record, a public personal profile, a restricted personal profile, geo-location data, or route data. 
         [0011]    The connector converts data from the second format to the first format and the system generates an external actionable event. The system can further comprise a data integrator to collate data from at least two data sources. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0012]    The same reference number represents the same element on all drawings. It should be noted that the drawings are not necessarily to scale. The foregoing and other objects, aspects, and advantages are better understood from the following detailed description of a preferred embodiment of the invention with reference to the drawings, in which: 
           [0013]      FIG. 1  is an embodiment of a system  100  used by medical facilities; 
           [0014]      FIG. 2  is an embodiment of how software can be logically connected to provide the systems and methods of the present teachings; 
           [0015]      FIG. 3  is a logical diagram of providing business services according to one embodiment; 
           [0016]      FIG. 4  is an embodiment of a data integrator according to one embodiment; 
           [0017]      FIG. 5  is an embodiment of a data flow diagram for a use case or workflow usable with diabetic patients; 
           [0018]      FIG. 6  is an embodiment of a data flow diagram for a use case or workflow usable for fraud detection; 
           [0019]      FIG. 7  is an embodiment of a data flow diagram for a use case or workflow usable for monitoring post-procedure monitoring of patients who have suffered from congestive heart failure; 
           [0020]      FIG. 8  is an embodiment of a data flow diagram for a use case or workflow usable for mental health profile creating and scoring; and 
           [0021]      FIG. 9  is an embodiment of a data flow diagram for a use case or workflow usable for care protocol compliance monitoring. 
       
    
    
     DETAILED DESCRIPTION 
       [0022]    The teachings herein are directed to a system that accepts sensory input from non-homogenous sensors and/or non-homogenous healthcare domain data stores. The system presents the data in a homogenous user interface as needed by a healthcare provider. In some embodiments, the healthcare domain data stores can include such exemplary systems as an EMR system holding patient data, an ERP system or other data store systems located at point of care. The collected data can be converted and formatted, in order to obtain homogenized data. The homogenized data from the various sources can be collated. As such, the collated data can be provided by sensors and healthcare domain data stores. In some embodiments, the collated data can be used implement clinical workflow enhancements. 
         [0023]    The system provides a user interface that can be used by a healthcare provider. In some embodiments, the user interface can be used to make determinations about protocol compliance by the medical professional. In some embodiments, the system can access a patient&#39;s medical record from a healthcare domain data store and determine if the sensed data comports with the protocol prescribed to a patient. Warnings and errors for failure to comply with the protocol can be generated. The data can be collected at a patient&#39;s home, at a medical facility or both. The sensors can communicate with an on-site gateway, e.g., over Bluetooth, and the data recorded by the sensors can be forwarded to a central server, e.g., over the Internet. In some embodiments, a system operates with non-homogenous sensors (sensors made by different manufacturers). 
         [0024]    The present teachings save costs in custom programming because ‘connectors’ for instrument/protocol specific data acquisition are provided. The connectors can be built into the system. In some embodiments, the connectors can be provided to a user on Software as a Service (SaaS) basis. So for example, a newly supported device/instrument can be available for all users without significant re-engineering costs to the connector provider. In some embodiments, the connectors can be borrowed or purchased from industry approved solutions in market. In some embodiments, the connectors can be indigenous. 
         [0025]    In a preferred embodiment, a data gateway capable of using configured connectors to accept data from various sources is described. The gateway can be connected to data producers or sources, which can be humans or physiometric instruments. Connectors can be used to connect to data sources. 
         [0026]    The gateway can be connected to data sinks or consumers, which can be humans or physiometric instruments. Data consumers generally interpret the data. Connectors can be used to connect to data consumers. 
         [0027]    The correlation of the acquired data is enhanced after it has been homogenized/standardized within a core system. In some embodiments, the interpretation of data, either by humans or processors is targeted to specific use cases. In specific use cases, meaningful correlation of such homogenized data greatly enhances the value of the data. The correlation can be enhanced by the following exemplary means:
       Increase the scope of relations from targeted use case or workflow to hospital/enterprise wide scope   Expose homogenized data for writing enterprise level business rules while keeping device dependencies transparent to end user   Make correlated data available for real-time as well as analyzed decisions (this is not the case with currently available data interpreters)   Allow access to singular (i.e., current heart rate) as well as historical (average sugar level in last 3 months) data parameters while creating business rules.   Provide out of the box business rules (i.e., never events) which can be readily adapted by enterprises using our system.       
 
         [0033]    The standardized data can be plugged into a medical protocol. In some embodiments, the standardized data can be integrated and/or associated with a Patient&#39;s Medical Record (PMR). In some embodiments, the standardized data can be relayed back to any EMR system connected to the system. The integration can be used to provide significant benefits to a user. For example, the integration can post alarms if recommended protocols are not followed by a patient or a service provider. In some embodiments, payments to a service provider can be authorized post acquisition and integration of data related to the service provided. In some embodiments, the integration can be used for findings of fact or for other data mining activities. 
         [0034]    The present teachings use business rules at enterprise level rather the traditional use of triggers at a workflow level. For example, the system can be used to enhance quality of care and minimize human errors. A business rule that ensures that a specific drug must be dispatched by inventory for given treatment, or it can ensure that the correct patient is being given the treatment or surgery \at the enterprise level can be modeled as: 
         [0035]    When:
       (Any patient with SW financial rating &lt;X) AND (scheduled for a surgery costing &gt;Y) AND with past non-pay cases==TRUE)       
 
         [0037]    Then:
       The patient should be alarmed for.
 
Another example assuring quality of care is:
       
 
         [0039]    When:
       (A patient scheduled for surgery X has arrived into operation room Y)       
 
         [0041]    Then:
       (There should have a recent entry in inventory system for dispatch of drug Z, which is required for surgery X).       
 
         [0043]    Presently, there is a push in the medical care industry to switch from pay per procedure to pay per bundle by an insurance carrier. The care giver is paid a fixed price for services to be rendered as a bundle rather than individually, i.e., the care giver is paid once. Examples of such treatment include treating for Congestive Heart Failure (CHF) (heart attack) including in hospital and home care post procedure. In the pay per bundle, a care provider can increase profit and reduce risk by (1) avoiding duplication of procedures by various specialists needed for treatment and (2) by verifying that post-procedure protocols that reduce complications are followed in the hospital and at home. 
         [0044]    For example, for a CHF patient weight change within 60 days of a heart attack can indicate problems. In another example, when a bulimic or anorexic patient induces vomiting, his heart stops—this can be seen by a blood pressure sensor. In another example, a patient&#39;s insulin levels retrieved from the glucose monitor can indicate when an insulin shot was received by a diabetic patient. 
         [0045]      FIG. 1  is an embodiment of a system  100  used by medical facilities. At the technical core, system  100  integrates healthcare related heterogeneous data from various sources. Data is collected from monitoring equipment  102  including on-body or off-body physiological sensors. Monitoring equipment  102  can transmit physiological data to a gateway  104 , for example, when the patient is at home or a medical facility. In some embodiments, monitoring equipment  102  can transmit physiological data via a cellular phone  106 . Data from monitoring equipment  102  or from cellular phone  104  can be transmitted over a network  112  such as the Internet to a server  114 . In some embodiments, an integrator  108  can interface with EMR systems  110 . Data from integrator  108  can be transmitted over network  112  to server  114 . Integrator  108  can connect to multiple EMR systems. Server  114  can provide data acquisition and analysis. Server  114  can also comprise a rule database. System  100  can be used for specific workflows or use cases of the same to generate actionable events for several applications including medical compliance check, patient monitoring, caregiver/patient alerts and service validation. System  100  can provide alerts using a notification system  116 . System  100  can present the collected and analyzed data using a presentation system  118 . Presentation system  118  can comprise, for example, a web-server. 
         [0046]      FIG. 2  is an embodiment of how software can be logically connected to provide the systems and methods of the present teachings. A technology stack  200  can be used to implement the software. In a preferred embodiment, data collection  202  can be provided using a combination of various data connectors. In some embodiments data connector  204  can be provided by Mirth connect software described at http://www.mirthcorp.com/products/mirth-connect. In some embodiments, a data connector  206  for connecting a data flow to and from U.S. Veterans Association (VA) EMR system can be provided. Other connectors  208  can be provided as needed. The data collected via data connectors  202  is then homogenized and processed through a core transaction processing engine  210 . Transaction processing engine  210  can use active and passive alerts. In some embodiments, the alerts can be via Rule engine  212  implemented using DROOLS (a Java based business logic processor). In some embodiments Rule engine  212  can be used in used in conjunction or replaced with a propriety rules engine  214 . Propriety rules engine  214  can be written in Microsoft VC++ and .Net. Data from data connectors  202  can be processed real-time for customer defined business rules resulting into actionable events. 
         [0047]    Processed data is then stored using an archival and analytics system  220 . In some embodiments, archival system  220  can include a database  222 , for example, a MySQL database. Archival and analytics system  220  can be exposed to customers for reporting. Archival and analytics system  220  can comprise an analytics engine  224  that uses, for example, an open source Mondrian ROLAP interface. Archival and analytics system  220  can comprise an analytics engine  226  that uses, for example, Microsoft SSAS (SQL Server Analytical Services)  224 . 
       Application of Technology 
       [0048]      FIG. 3  is a logical diagram of how the teachings herein can be utilized to provide business services. The core/gateway  302  technology stack described above is further utilized for various business and domain specific applications. Applications  310  use the core/gateway  302  and are viewed as ‘use cases’. The applications  304  can utilize integration technologies  320  to provide desired business solutions. The proposed architecture of core/gateway technology  302  includes one or more of:
       ESB (Enterprise Service Bus), e.g., Microsoft BizTalk server   DSS (Decision Support Systems) and Clinical DSS   Business Rules Management Systems (BRMS) e.g., IBM Websphere ILOG BRMS   Core: ‘pre-programmed’ business rules to be made available to customer in SAAS (Software as a Service) model. Logical groups of these pre-programmed business rules form a ‘use case’ supported. The pre-programmed rules can also be viewed as standard business practices by smaller customers.   A Business Rules Processing layer for Healthcare to alter performance of the software according to use case or workflow in either real-time, offline, or batch mode.       
 
         [0054]    Core/gateway  302  can begin by standardizing data from non-homogenous physiological sensors and perform heterogeneous data integration  304 . Data from heterogeneous data integration can be used by various use case or workflow applications  310  such as mental health use case  312 , a CHF Post-procedure Monitoring use case  314 , a Care protocol Compliance Monitoring use case  316 , a diabetes use case  318 , and a fraud detection through validation of services use case  330 . 
         [0055]      FIG. 4  is an embodiment of a data integrator  400  that accepts data from various heterogeneous health, medical and bio data sources, stores the data in a homogenous format, collates the data and makes the data available for other applications for applying business rules. A user/actor layer  490  of data integrator  400  can obtain personal data  402 , caregiver data  404 , profile data  406 , and/or geo-location data  408 . The data can be divided into one or more of these categories. Data integrator  400  can retrieve a Personal Health Record (PHR)  412 , physiological data collected from a body area network (BAN)  414 , an EHR  416 , an EMR  418 , data from a HIS  420 , or a combination thereof. In some embodiments, profile data  406  like a public personal profile  422  or a restricted personal profile  424 . In some embodiments, geo-location data  408  can comprise a location  426  or a route  428 . In some embodiments, data integrator  400  can include outbound connectors  410  for actionable events  430  or for EHR updates  432 . User/actor layer  490  can interface with an integration and interface layer  492  which can include connectors to the various categories of data available to user/actor layer  490 . In some embodiments, one or more of a BAN/device connector, an offline data capture  436 , or an on-demand data-pull  438  can be provided. Integration and interface layer  492  can also provide an application protocol interface (API)  440 . API  440  can provide web-services. In some embodiments, API  440  can provide lower level API services. In other embodiments, integration and interface layer can include a portal  442 . Portal  442  can provide functions to access, manage and define use cases. In some embodiments, portal  442  can provide an interface for social networking integration. In other embodiments, portal  442  can provide an interface for reporting and analytics. In a preferred embodiment, portal  442  can include a business tool configuration and definition interface. 
         [0056]    Integration and interface layer  492  can interface with an application layer  494 . Application layer  494  can include one or more of a data collection  444 , data formatting  446 , data indexing  448 , analytics  450 , and generating dynamic data  452  module. Application layer  494  can interface with a pluggable business rules layer  496 . Pluggable business rules layer  496  can include one or more of a patient rules check  454 , a compliance rules check  456 , a validation of services  458 , a health status monitoring  460 , a mental health profiling  462  module. Pluggable business rules layer  496  can interface with a data services and store layer  498 . Data services and store layer  498  can be capable of storing dynamic data  464 , real-time data  466 , archiving  468 , media  468 , analysis services  470 , or any other data  472  needed by the data integrator  400 . Archiving  468  can store exceptions, audit events, events, vital signs etc. Other data  472  can include, for example, user accounts, billing, security logs, or audit logs. In some embodiments, application layer  494  can collate the data received at user/actor layer  490 . According to various embodiments, pluggable business rules layer  496  can collate the data received at user/actor layer  490 . 
         [0057]    The following examples illustrate how the present teachings can be used. 
       Diabetes 
       [0058]      FIG. 5  illustrates a data flow diagram for a use case or workflow  500  usable with diabetic patients. Using data  502  obtained from multiple healthcare related systems like EMR  504 , EHR  506  or PHR  508  a system can generate actionable events  520  for diabetic patients with or without co-morbidities. By applying business rules  510 , data from EMR  504 , EHR  506  or PHR  508  can be collated. When a patient has a higher than usual glucose level norm per rules  512 ,  514 , the two levels can be compared per rule  516 . As such, when a patient gets admitted in a hospital, the patient&#39;s medical history can be provided to use case  500 . If business rules  510  generate an event to notify a caregiver  524  about the expected higher glucose level and a suggestion to take care of the glucose level before the step of getting the glucose level down is suggested. Additionally, business rules  510  can update EHR  526 . 
         [0059]    When—
       Patient.EMR.standardGlucodeLevel&gt;Standards.glucoseLevel OR   Patient.EHR.standardGlucodeLevel&gt;Standards.glucoseLevel OR   Patient.PHR.standardGlucodeLevel&gt;Standards.glucoseLevel       
 
         [0063]    Then—
       Patient.Notifications.Alert (“Watch for abnormal glucose level”, Priority.high).       
 
       Fraud Detection 
       [0065]      FIG. 6  is an embodiment of a data flow diagram for a use case or workflow  600  usable for fraud detection. Using data  602  obtained from a sensor on a body area network  604  and a Geo-location sensor  606 , use case  600  can validate delivery of health services. When a caregiver provides a patient a pre-scheduled service which has recordable impact on body vitals, business rules  610  can collate the data from body area network  604  and Geo-location sensor  606 . The collated data can identify physiological changes in a patient&#39;s vital signs  612 . The physiological data can be related to changes with expected service events  614 . The results from the changes with expected service events  614  can generate corresponding events  620 . Events  620  can record exceptions  622 , validate service  624 , authorize payment  626  or detect fraud  628 . 
         [0066]    When—
       Organization.Caregiver.ScheduledPatientVisit.Time &lt;is in&gt; +/−2 hours AND   Organization.Caregiver.Location &lt;is NOT in proximity of&gt; Organization.Caregiver.ScheduledPatientVisit.Patient.location OR   Organization.Caregiver.ScheduledPatientVisit.Patient.VitalSigns &lt;Do not show&gt; Organization.Caregiver.ScheduledPatientVisit.Treatment.ExpectedResults       
 
         [0070]    Then—
       Organization.Notifications.Alert (“Caregiver might have missed the scheduled appointment”, Priority.high).       
 
       Congestive Heart Failure—Post Procedure Monitoring 
       [0072]      FIG. 7  is an embodiment of a data flow diagram for a use case or workflow  700  usable for monitoring post-procedure monitoring of patients who have suffered from congestive heart failure. Use case  700  can be used for remote monitoring of discharged patients. When, a patient is discharged from hospital after a congestive heart failure treatment, the patient needs to be monitored real time. Using data  702  obtained from multiple healthcare related systems like EMR  704 , EHR  706  or BAN sensors  708  and applying business rules  710 , use case  700  can generate actionable events  720  for the treatment of the patient. In some embodiments, by applying business rules  710 , data from EMR  704 , EHR  706  or BAN sensors  708  can be collated. In some embodiments, BAN sensors  708  can comprise body area networked devices. BAN sensors  708  can monitor the patient while he is stationary—for example, at home—or when the patient has restricted mobility. Business rules  710  can monitor equipment and services and can generate events  720 . Events  720  can be to alert caregiver  722 . The alert can raise alarms/notifications to the caregiver if something goes ‘wrong’, as defined by business rules  710 . Additionally, business rules  710  can update EHR  726  with the progress of the patient. For example, the rule structure can comprise: 
         [0073]    When—
       Patient.RealtimeData.HeartRate&gt;Standards.HeartRate AND   Patient.EHR.UnderCHFMonitoring==True       
 
         [0076]    Then—
       Patient.Caregiver.Notifications.Alert (“Heart rate out of bounds”, Priority.high).       
 
       Mental Health 
       [0078]      FIG. 8  shows an embodiment, where a system  800  can be used to create and score individuals profile using data obtained from an individual EHR. The information can include public and restricted personal profiles. For example, data source  802  can comprise a patient intake system. When a new EHR  806 , for example, a veteran&#39;s record, is received into the EHR system, the system can invoke business rule  810 . Business rule  810  can retrieve a profile  804  and EHR  806 . In some embodiments, profile data  804  may not exist in the healthcare data domain. In such events, profile data  804  can be collected by business rule  810  from government sources (e.g., military records, NCIC database), or from private sources (e.g., credit reports, employment records), or from other public sources (e.g., facebook, linkedin) to generate one or more profiles. This data can be collated. Per the rule engine  810 , the patient&#39;s mental health is then assessed by the system or by a health care provider and a score is generated. If deemed medically necessary by the system and/or health care provider, events  820  can be generated. 
         [0079]    Events  820  can alert caregiver  822  to contact the patient. In some embodiments, alert caregiver  822  can contact the patient through the web for a mental health assessment built for suicide prevention. The resulting scores of the assessment packet from business rule  810  can then be entered into the EHR system for clinicians review. For example, the rule structure can comprise: 
         [0080]    When 
         [0081]    Patient.PerformMentalHealthCheck==true AND 
         [0082]    Patient.MentalHealthAssesmentDetails &lt;are&gt; available 
         [0083]    Then— 
         [0084]    NewScore=Patient.MentalHealthAssesmentScore+ 
         [0085]    Patient.MentalHealthAssesmentDetails+ 
         [0086]    Patient.PublicFeeds.FinancialScore+ 
         [0087]    Patient.PublicFeeds.LegalScore 
         [0088]    Patient.EMR.SubmitClinicalNote(NewScore). 
       Care Protocol Compliance Monitoring 
       [0089]      FIG. 9  an embodiment of a data flow diagram for a use case or workflow  900  to validate compliance against configurable protocols and care workflows. Using data  902  obtained from multiple healthcare related systems like HIS  903 , EHR  904 , EMR  906  or BAN sensors  908  and applying business rules  910 , use case  900  can generate actionable events  920  for the treatment of the patient. In some embodiments, by applying business rules  910 , data from HIS  903 , EHR  904 , EMR  906  or BAN sensors  908  can be collated. Business rules  910  in the target hospital can monitor activity of HIS  912  within the hospital. Business rules  910  can then compare the activity with patient data  914  and watch for exceptions  916 . In this manner, business rules can evaluate whether a protocol is being violated. For example, if a patient is undergoing certain operative procedure, business rules  910  can check if the expected set of medications is dispatched from inventory. Another example would be to monitor certain ‘never events’ and prevent them from occurring. Business rules  910  can monitor equipment and services and can generate events  920 . Events  920  can be to alert caregiver  922 . The alert can raise alarms/notifications to the caregiver if something goes ‘wrong’, as defined by business rules  910 . Additionally, business rules  910  can update EHR  924  with the progress of the patient. For example, the rule structure can comprise: 
         [0090]    When—
       Patient.RealtimeData &lt;indicates&gt; Standards.NeverEvents OR   Patient.EMR &lt;indicates&gt; Standards.NeverEvents OR   Patient.EHR &lt;indicates&gt; Standards.NeverEvents OR   Organization.HIS.Events &lt;indicates&gt; Standards.NeverEvents       
 
         [0095]    Then—
       Patient.Caregiver.Notifications.Alert (“Patient candidate for Never event &lt;event description&gt;”, Priority.high).       
 
       Integration Process an Exemplary RPC Object Model for Vista 
       [0097]    ‘Vista’ is a historical EHR/EMR system being used by certain U.S. hospitals for a long time. The system is adapted and customized by certain government agencies such as VA and Department of Defense (DoD) for storing medical records of individuals. The system is not so open for third party developers outside of VA and DoD, and currently there is a lack of publicly available tools to integrate with Vista. Current challenges can be summarized as:
       Tools available to integrate with Vista provide high level support for HL7 or RPC calls. However there is no specific support to perform certain system functions.   Vista implementations may differ across locations of VA hospitals and there is no publicly available common API to provide integration.   Vista accepts ‘CPRS’ as its client software. CPRS talks with Vista using ‘RPC calls’ these RPC calls are very specific and may differ across locations/Vista installations. There is not a publicly available authorized list of RPC calls for outside integrators.       
 
         [0101]    An integration package can be trained with an instance of Vista server and the trained system can later be utilized for performing specific integration tasks. The integration package has following parts:
       A ‘recorder’ module which listens and records RPC traffic between CPRS and Vista in a log file   A ‘player’ module which replays the traffic recorded in log file in earlier step   An object based substitution engine written in Java which substitutes key data elements of the RPC calls being replayed thus allowing external software to repetitively replay log files with different data elements to perform the job frequently without involving manual usage of CPRS.       
 
         [0105]    The use case or workflow which needs to be automated for integration can be identified. Examples of a workflow or use case include:
       a. Add/view a patient record   b. Add/view a clinical note for a patient   c. Add clinical reminder into clinical note for given patient, such as, AUDIT-C, PHQ-9, TBI, MST, Tobacco, PC_PTSD   d. Retrieve list of registered patients to check if a patient already has a record in Vista   e. Digitally sign or not sign a newly created/existing note. Document in the clinical note a need for placing a consult to other departments.       
 
         [0111]    The system can perform the use case or workflow through CPRS and record the RPC calls into a log file. Then the ‘player’ code is changed to set values to be substituted in the RPC calls being replaced. Finally, the system replays the log files with different values to perform the same use case in a black box mode. 
         [0112]    For adding a clinical reminder into an existing patient record in Vista. The EMR records maintained within Vista are not publicly accessible. Information provided by VA on the RPC calls is described, for example, at: http://www.va.gov/vdl/documents/Infrastructure/Remote_Proc_Call_Broker_(RPC)/xwb1 — 1p47r elease_notes.doc. The following RPC commands will be updated real time using value substitution as described: 
         [0113]    XUS AV CODE 
         [0114]    ORWU DT5001 
         [0115]    TMG CONSOLE SERVER QUERY 
         [0116]    TMG CONSOLE SHUT DOWN 
         [0117]    TIU CREATE RECORD 
         [0118]    TIU LOCK RECORD 
         [0119]    ORWPCE SAVE 
         [0120]    TIU UPDATE RECORD 
         [0121]    TIU SET DOCUMENT TEXT 
         [0122]    TMG CONSOLE INITIATE 
         [0123]    ORQQVI NOTEVIT 
         [0124]    TIU UNLOCK RECORD 
         [0125]    ORWDX UNLOCK 
         [0126]    ORWOR UNSIGN 
         [0127]    TIU SIGN RECORD 
         [0128]    ORWPT LASTS 
         [0129]    Following are the assumed interpretations of the data source to be consumed by the system described. An EMR comprises medical information of a person stored at unit level caregiver, mostly about current instance of care. An EHR comprises medical and health related information of a personal stored at global level of the caregiver, mostly about historical records. A Personal Health Record (PHR) comprises health records in possession of an, individual. A Body Area Network (BAN) comprises data about vital signs collected from devices worn on or in proximity of body. A HIS can comprise software systems running in a hospital, including but not limited to, Patient Intake, Operations Room Mgmt, ERP, Inventory, Billing, etc. 
         [0130]    In some embodiments, personal profiles are publicly available and legally obtainable. In some embodiments, private profile data comprises profiles including but not limited to social network profiles, financial data, driving records, legal records. 
         [0131]    In some embodiments, dynamic dimensional data is not restricted to a business of medical function or use case. This is a homogeneous form of data obtained from heterogeneous data sources. 
         [0132]    Actionable Events comprise events, alerts and notifications generated by the system when the data qualifies configurable business rules. 
         [0133]    Business Rules comprise Business function/domain/use case specific rules which are user configured, and the system needs to apply on available data. 
         [0134]    The EHR server software used and maintained by certain U.S. government agencies including VA and DoD is named Vista. CPRS is the EHR client software used and maintained by certain U.S. government agencies including VA and DoD. RPC is the TCP/IP based non-public interface CPRS uses to talk with Vista. 
         [0135]    The various embodiments described above are provided by way of illustration only and should not be constructed to limit the invention. Those skilled in the art will readily recognize the various modifications and changes which may be made to the present invention without strictly following the exemplary embodiments illustrated and described herein, and without departing from the true spirit and scope of the present invention, which is set forth in the following claims.