Abstract:
A health care insurance plan, healthcare professional, or other entity may recognize that a patient or member is not in compliance with a treatment protocol, best practices, or guidelines. Entities may desire to communicate this fact along with an action needed to be performed to comply with the protocol, and, thereby, facilitate completion of the action. An interactive system and method may facilitate patient compliance during a healthcare protocol by providing the patient information to make an informed decision regarding the protocol. Further, the system and method may allow a patient to directly implement a portion of the protocol to bring him or her back into compliance with the protocol. An inexpensive, personalized, multimedia interaction specifically designed to motivate a patient and facilitate an action which closes a “Gap in Care,” brings the patient into compliance, and tracks the interaction.

Description:
RELATED APPLICATIONS 
       [0001]    This application claims priority from U.S. Patent Application Ser. No. 60/863,463, which was filed on Oct. 30, 2006, entitled “Interactive Method for Facilitating Patient Compliance During a Course of Treatment” the entire contents of which are expressly incorporated by reference herein. 
     
    
     FIELD OF THE INVENTION 
       [0002]    This patent relates to the field of digital information distribution, and more particularly, to interactive methods for delivering information to a healthcare consumer which motivates the healthcare consumer to take action and facilitates such action which will improve a healthcare consumer&#39;s compliance with desired best practice health care protocol. 
       BACKGROUND 
       [0003]    Health care providers strive to provide timely and accurate information to their patients. Interactive multi-media presentations provide an effective means for presenting health care information. Further, information dissemination from the health care provider as well as patient feedback may be facilitated when coupled with computer network systems. For example, patients undergoing surgical procedures may receive information through a Web-based informed consent process. One example of an automated system for completing the informed consent process is disclosed by U.S. patent application Ser. No. 10/410,749, entitled “Enhanced System and Method for Enhancing and Supplementing the Informed Consent Process of a Patient Undergoing a Medical Procedure,” the entire contents of which is hereby expressly incorporated by reference herein. 
         [0004]    However, patients living with protracted diseases or medical devices may be restricted in their ability to receive accurate information from their health care provider. In a typical scenario, a patient receives information during a live, in-person appointment or, alternatively, a phone conversation. The doctor and patient may discuss symptoms, test results, medical device use and maintenance, or other health care subjects during a consultation. Courses of treatment for patients with protracted diseases or patients with long-term medical devices, such as pacemakers, may also require follow-up appointments to check their progress, to modify the course of treatment, or to conduct patient testing. Some patients may decide to defer implementing doctor recommendations such as making future appointments for consultation or testing, or may forget to follow their doctor&#39;s guidance. Once a patient leaves the provider&#39;s office or completes a phone call, the provider must rely on the patient&#39;s own interest in maintaining his or her health to complete instructions, schedule testing, or otherwise perform recommended actions. Further, testing that is completed to investigate the progress of a particular symptom or disease may reveal other health care concerns that were not the focus of the original consultation or test. Thus, providing fast and accurate health care information to the patient while considering multiple aspects of the patient&#39;s current diagnosis, medical device, or surgical procedure, combined with simple and encouraging measures for patient participation in the course of treatment may be desired. 
         [0005]    A health care insurance plan, healthcare professional, or other entity may recognize that a patient or member is not in compliance with a treatment protocol, best practices, or guidelines (i.e., identification of a “Gap in Care”). These entities may desire to effectively communicate this fact along with an action needed to be performed to comply with the treatment protocol, and, thereby, facilitate completion of the action. Conventional methodologies, such as telephone calls, face-to-face visits, interventions, or mail reminders are either cost prohibitive or ineffective. Therefore, an inexpensive, personalized, and short multimedia interaction specifically designed to motivate a patient, health plan member, or healthcare consumer to close the Gap in Care, facilitate the action which closes the Gap in Care, and track the interaction may be highly beneficial. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0006]      FIG. 1  is an exemplary illustration of a computer network; 
           [0007]      FIG. 2  is an illustration of a computing device; 
           [0008]      FIG. 3  is a block diagram of a method for facilitating a patient course of treatment; 
           [0009]      FIGS. 4   a  through  4   l  illustrate a patient&#39;s view of the method for facilitating a patient course of treatment. 
       
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
       [0010]    Although the following text sets forth a detailed description of numerous different embodiments, it should be understood that the legal scope of the invention is defined by the words of the claims set forth at the end of this patent. The detailed description is to be construed as exemplary only and does not describe every possible embodiment since describing every possible embodiment would be impractical, if not impossible. Numerous alternative embodiments could be implemented, using either current technology or technology developed after the filing date of this patent, which would still fall within the scope of the claims. 
         [0011]    It should also be understood that, unless a term is expressly defined in this patent using the sentence “As used herein, the term ‘______’ is hereby defined to mean . . . ” or a similar sentence, there is no intent to limit the meaning of that term, either expressly or by implication, beyond its plain or ordinary meaning, and such term should not be interpreted to be limited in scope based on any statement made in any section of this patent (other than the language of the claims). To the extent that any term recited in the claims at the end of this patent is referred to in this patent in a manner consistent with a single meaning, that is done for sake of clarity only so as to not confuse the reader, and it is not intended that such claim term be limited, by implication or otherwise, to that single meaning. Finally, unless a claim element is defined by reciting the word “means” and a function without the recital of any structure, it is not intended that the scope of any claim element be interpreted based on the application of 35 U.S.C. § 112, sixth paragraph. 
         [0012]      FIG. 1  illustrates an embodiment of a data network  100  including a first group of facilities or entities  105  operatively coupled to a network computer  110  via a network  115 . The entities  105  may be physically co-located or geographically disparate. The plurality of entities  105  may be located, by way of example rather than limitation, in separate geographic locations from each other, in different areas of the same city, or in different states. Generally, the entities  105  may represent any of the different types of entities that may be involved in a patient&#39;s health care. For example, the entities  105  may represent patients, healthcare providers or professionals (e.g., registered nurses, doctors, therapists, etc.), health insurance providers or administrators, benefits counselors, employee health benefits plans, employer on-site health clinics, and compliance managers. Any of the entities  105  may also be an intermediary between a patient and any of the other entities  105  described above. 
         [0013]    The network  115  may be provided using a wide variety of techniques that are well known to those skilled in the art for the transfer of electronic data. For example, the network  115  may comprise dedicated access lines, plain ordinary telephone lines, satellite links, combinations of these, etc. Additionally, the network  115  may include a plurality of network computers or server computers (not shown), each of which may be operatively interconnected in a known manner. Where the network  115  comprises the Internet, data communication may take place over the network  115  via an Internet communication protocol. 
         [0014]    The network computer  110  may be a personal computer or a server computer of the type commonly employed in networking solutions. The network computer  110  may be used by an entity  105  to accumulate, analyze, and download health care provider and patient data, or may be used to direct a patient to complete an action that may bring him or her into compliance with a treatment plan or other protocol. For example, the network computer  110  may periodically receive data from each of the entities  105  indicative of information pertaining to a patient health record, provider recommended course of action, treatment plan or other protocol, test results, historic test results, compliance information, etc. A patient may use the network computer  110  to access and view information served from other network computers or servers  120  at the entities  105 . For example, as a client/server model, the entities  105  may include one or more servers  120  that may be utilized to store any of the information described herein and to serve the information to a network computer  110  acting as the client. 
         [0015]    In one embodiment, the network computer  110  or any of the entities  105  includes an interface to a health records management system at a healthcare facility. For example, the network computer  110  may be connected to a MyChart® electronic health record (EHR) system produced by the Epic Systems Corporation of Verona, Wisconson, or any other type of distributed system that may be used to facilitate a patient&#39;s compliance with a healthcare protocol. From a network computer  110 , a patient may log into an EHR system that is communicatively coupled to a server  120  within an entity  105 . 
         [0016]    Although the data network  100  is shown to include one network computer  110  and three entities  105 , it should be understood that different numbers of computers and entities may be utilized. For example, the network  100  may include a plurality of network computers  110  and dozens of entities  105 , all of which may be interconnected via the network  115 . According to the disclosed example, this configuration may provide several advantages, such as, for example, enabling nearly real time uploads and downloads of information as well as periodic uploads and downloads of information. This provides for a primary backup of all the information generated in the process of updating and accumulating provider and patient data. 
         [0017]    The computer  110  may be connected to a network, including local area networks (LANs), wide area networks (WANs), portions of the Internet such as a private Internet, a secure Internet, a value-added network, or a virtual private network. Suitable network computer  110  may also include personal computers, laptops, workstations, disconnectable mobile computers, mainframes, information appliances, personal digital assistants, and other handheld and/or embedded processing systems. The signal lines that support communications links to a computer  110  may include twisted pair, coaxial, or optical fiber cables, telephone lines, satellites, microwave relays, modulated AC power lines, and other data transmission “wires” known to those of skill in the art. Further, signals may be transferred wirelessly through a wireless network or wireless LAN (WLAN) using any suitable wireless transmission protocol, such as the IEEE series of 802.x standards. Although particular individual and network computer systems and components are shown, those of skill in the art will appreciate that the present invention also works with a variety of other networks and computers. 
         [0018]      FIG. 2  is a schematic diagram of one possible embodiment of the network computer  110  shown in  FIG. 1 . The network computer  110  may have a controller  200  that is operatively connected to a database  205  via a link  210 . It should be noted that, while not shown, additional databases may be linked to the controller  200  in a known manner. The controller  200  may include a program memory  215 , a processor  220  (may be called a microcontroller or a microprocessor) for executing computer executable instructions, a random-access memory (RAM)  225  for temporarily storing data related to the computer executable instructions, and an input/output (I/O) circuit  230  for accepting and communicating the computer executable instructions, data for producing results with the computer executable instructions that are executed on the processor  220 , and the results of any executed computer executable instructions. In one embodiment, the program memory  215  includes a compliance module  232  to implement a method for directing a patient to complete an action to bring the patient into compliance with an assigned healthcare protocol, as described below in relation to  FIG. 3 . In another embodiment (not shown) the compliance module  231  may be a separately-implemented IC. Of course, many other implementations of the compliance module  231  are possible. The compliance module may also include a plurality of modules to implement the method, for example, a detection module  232 , a communication module  233 , and an implementation module  234 . The compliance module  231 , and the plurality of modules  232 ,  233 ,  234  are discussed below in relation to  FIG. 3 . 
         [0019]    The program memory  215 , processor  220 , and RAM may be interconnected via an address/data bus  235 . It should be appreciated that although only one processor  220  is shown, the controller  200  may include multiple processors  220 . Similarly, the memory of the controller  200  may include multiple RAMs  225  and multiple program memories  215 . Although the I/O circuit  230  is shown as a single block, the I/O circuit  230  may include a number of different types of I/O circuits. The RAM(s)  225  and program memories  215  may be implemented as semiconductor memories, magnetically readable memories, and/or optically readable memories, for example. The controller  200  may also be operatively connected to the network  115  ( FIG. 1 ) via a link  235 . 
         [0020]    The methods illustrated in the figures and described below may be implemented as computer-executable instructions on a variety network computers  110 , servers  120 , other network devices using a variety of wired and wireless networks and connections, or within a compliance module  231 . Further, any action associated with the blocks described below and illustrated in  FIG. 3  may be performed in any order, or at any time during the method  300  execution. With reference to  FIGS. 1 ,  3 , and  4 , an interactive method  300  for facilitating patient compliance during a course of treatment, treatment plan, or other protocol by allowing the patient to directly implement an action to bring him or her into compliance is discussed and described. 
         [0021]    At block  302 , a patient may be notified of his or her non-compliance with a treatment plan or medical protocol and gain access to a compliance interface  400 . As used herein, a treatment plan or protocol may be a course of treatment, a pharmaceutical regimen, a physical therapy regimen, or any other set of rules, procedures, or steps to which the patient is expected or required to comply that may be assigned or prescribed by a healthcare professional or voluntarily assumed by a patient. In one embodiment, a patient receives an email message from an entity  105  that includes a hyperlink or other predefined linkage from the email message to a compliance interface  400 . The email message may be created manually or automatically upon satisfaction of rules, conditions, or other logic within the compliance module  231 . For example, a detection module  232  within the compliance module  231  may determine when a patient is not complying with a protocol or may detect an out-of-compliance event associated with a patient participating in a protocol. For example, a healthcare professional or an EHR system at an entity  105  may receive and evaluate test results, prescription medication information, or other data and determine that the patient is not complying with a protocol. The healthcare professional or EHR system may then send the email including the hyperlink to the patient though a communication module  233  of the compliance module  231 . Also, the professional or EHR system may notify a compliance manager or other third party entity  105  of the non-compliance. Upon receiving the notification, the compliance manager or other third party entity  105  may compose and send the email to the patient. Of course, many other methods may notify a patient of his or her non-compliance to a medical protocol and allow the patient to gain access to the compliance interface  400 . 
         [0022]    In one embodiment, the hyperlink within the email message includes a Universal Resource Locator (URL) that, when selected by the patient at a network computer  110 , communicates GETs and POSTs (or any other message, such as an FTP command or an SNMP message that may request and/or communicate parameters to the method  300 ) from or to an entity  105 . A launching URL may include a plurality of parameters to pass information about the patient to an entity  105  or to the method  300 . For example, the launching URL may include a partner ID, a plan ID, and employer ID, a patient ID, a compliance message ID, or a message occurrence. 
         [0023]    The launching URL may also accommodate parameters specific to the compliance message ID (e.g., test results that are displayed within the compliance interface  400 ), a modification of the method  300 , or a parameter to ignore the parameters. The parameters may be used by an entity  105  to instantiate an application, routine, or other computer-executable instructions represented by the method  300 . For example, selecting a hyperlink from an email message may pass parameters that identify a patient ID and a compliance message ID for the compliance interface  400  (e.g., Member #1704, Compliance Message #17) to the method  300 . The passed parameters may also include test results or other data that may be used by the method  300  and may be presented to the patient in the compliance interface  400 , as explained below. The parameters may also be encoded so that any patient information is not visible or accessible by any entity  105  that has not been approved by the patient. Further, any communication or transferal of medical or personal information may be compliant with the Health Insurance Portability and Accountability Act (HIPAA), or other legal standards. 
         [0024]    Also, the method  300  may terminate and generate an error message if one of the parameters is missing or malformed or, alternatively, may allow the method  300  to continue. In one embodiment, receipt of missing or malformed parameters at a network computer  110  may initiate a number of operations to resolve any of the damaged parameters or to provide any missing parameters. For example, the method  300  may initiate a login screen for a patient to enter membership or other information in order to supply or correct missing parameters. Alternatively, the message or other command may initially direct a patient to a login screen to enter security or other information to confirm the patient&#39;s identity before the method  300  presents any medical or other personal information. In a further embodiment, the URL identifies a patient and a compliance message, but does not contain any parameters. Of course, many other sources of email messages, combinations of parameters, and delivery methods are available to direct or re-direct a patient to the compliance interface  400 . 
         [0025]    A patient may also be notified of his or her non-compliance and gain access to the compliance interface  400  by logging into a network-implemented, healthcare portal or interface either voluntarily, at the request of an entity  105 , or through an email message sent by an entity. The healthcare interface may include access to an EHR, as previously described, from an entity  105  such as a hospital, insurance provider, compliance manager, or other third party entity  105 . In one embodiment, a hospital or other entity notifies the patient (via mail, email, telephone, or other form of communication) that a compliance message has been sent to the patient&#39;s EHR. The EHR may include an indication that the patient is not in compliance with a protocol. The indication may be selectable by the patient and, upon selection, the method  300  routes the patient to the compliance interface  400 . 
         [0026]    Upon routing the patient to the compliance interface  400 , the method  300  may observe and/or record any number of events related to the patient&#39;s interaction with the method  300 . For example, each block of the method  300  may include a plurality of events that may be observed or recorded to a database  205 . The recorded events may be associated with each instance or “session” of the method  300 . The events may include a start time of the method  300 , a time the patient entered a block of the method  300 , a time the patient exited a block of the method  300 , when or if the patient asked a question or performed the action, text of a question, if asked, and an entity  105  to which the question was asked, and selected or entered reasons, if any, for quitting the method  300 . Each of these events is described in further detail below. Further, the method  300  may record the events to a database  205 . The database  205  may store data related to the method  300  each time the method  300  is executed. Further, the database  205  may associate collected data with a discrete method  300  session, wherein the data may be keyed on a particular iteration or instantiation of the method  300 . The data stored in the database  205  may include the parameters, as previously discussed. 
         [0027]    At block  305 , a welcome message  405  ( FIG. 4   a ) may be communicated from an entity  105  to a patient at a network computer  110 . In one embodiment, the patient receives the welcome message at the patient&#39;s personal computer as a response from a server. The welcome message  405  may include a dynamic element  406  that indicates if the patient has previously reviewed this compliance message, has recently completed an action that brings the patient into compliance with a protocol, or any other information related to the patient or an action taken by the patient. For example, the dynamic element  406  may communicate “Great job on completing your last three blood tests!” or “Thank you for recently seeing your cardiologist for your follow-up appointment. You are on your way to a complete recovery!” or other information that is related to a patient&#39;s recent actions. The method  300  may also determine whether or not the patient has previously accessed or viewed information at the website and change the welcome message accordingly. In one embodiment, the method  300  accesses a number of previously recorded events, as described above, that are associated with the patient. For example, the method  300  may access the recorded events associated with the patient. If the method  300  determines that there are previously recorded events associated with the patient, the method  300  may change the dynamic element  406  of the welcome message to include a fact about the previous events. However, if the method  300  detects no previous events, the method  300  may determine that the patient has not previously viewed messages from the provider, and the dynamic element  406  of the welcome message may indicate that this is the patient&#39;s first visit, or may be absent from the interface  400 . Further, a patient may have previously viewed information through the website and accomplished a task assigned during the previous visit as described below in relation to block  335 . Upon logging in after completing the task, the welcome message may indicate that the patient completed the previous task or provide a similar greeting that may be specific to the previous visit. In a further embodiment, the method  300  may provide a unique welcome message based on the prior visit alone, provide the patient with a simple, unrelated greeting (e.g., “Hello!”), or communicate a welcome message that is specific to the entity  105  (e.g., “Thank you for accessing XYZ Health Services”). 
         [0028]    The content presented to the patient within the compliance interface  400  may be modular and adaptable to a variety of interactive presentations. The content may be shared between a plurality of presentations, such as between a compliance message regarding diabetes and a compliance message regarding a patient&#39;s post-surgical protocol. Also, the content may include standard classes of information that correspond to specific message  410  and action  415  types ( FIG. 4   c ), or the patient&#39;s health record information. For example, a standard class of information may be “test results.” A message  410  within the “test results” class may be modified to accommodate a patient&#39;s specific test results by instantiating the method  300  with patient data and patient test results. In response to abnormal test results, the detail message  425  may include a template of information that compares the patient&#39;s results with normal test results. The message  410  and action  415  may be tailored to a variety of other protocols. For example, if the patient has completed one of a plurality of sequential actions related to a medical device, a template may present information tailored to medical devices. Also, if the patient has completed or will complete a surgical procedure, a template may present information customized for surgical procedures. 
         [0029]    Further, the method  300  may present the information within the compliance interface  400  in a standardized way. For example, information may be presented in a fixed arrangement of text, audio, or video for the test results, medical devices, or surgical procedure scenarios described above. Audio, video, and text content may also be accessed from disparate sources to be presented to the patient. The location of the information may be explicit, or from a common directory to be shared among many instantiations of the method  300  that are associated with related subjects. 
         [0030]    At block  310 , a compliance message  407  ( FIG. 4   b ) may be communicated to the patient. The compliance message may include both a message  410  ( FIG. 4   c ) and a selectable action  415 . In one embodiment, either or both of the message  410  and the selectable action  415  may be retrieved directly from the patient&#39;s EHR at an entity  105 . In another embodiment, the message  410  is sent by the entity  105  to a third party to be distributed to the patient via email or other method, for example, through the communication module  233 . Upon communication of the compliance message  407 , the patient may be able to take the action as described below in relation to block  335 . The message  410  may present a variety of information to the patient regarding his or her health. For example, the message  410  may present parameters that are passed to the method  300  (as described above in relation to block  302 ), test results, a diagnosis based on the test results, a recommendation from the patient&#39;s health care provider (e.g., the patient should schedule a follow-up appointment, the patient should schedule a repeat of a previous test, the patient should be screened for another disease, etc.), advice or actions related to a medical device, messages generated to coincide with the progression of a disease, or any other message related to the patient&#39;s health care that may require further action. 
         [0031]    The selectable action  415  may allow a patient to directly implement an act to influence his or her healthcare or may provide a patient with the resources to implement a healthcare act (e.g., schedule an appointment, schedule a test, obtain more information, submit a prescription, contact an entity  105 , etc.). In one embodiment, an implementation module  234  of the compliance module  231  directly implements one or more steps of a healthcare protocol to bring the patient into compliance. The action  415  may further include any act that is related to the message  410  that may resolve a complication indicated by the message  410 , may bring a patient into compliance with a course of treatment or other protocol, or may improve a patient&#39;s adherence to the protocol. For example, if the message  410  indicates a diagnosis or other conclusion based on test results that may require further attention, the action  415  may allow the patient to schedule an appointment with his or her health care provider. In one embodiment, the method  300  may be interfaced with an appointment scheduling system of an entity  105  to facilitate the action  415 . 
         [0032]    The action  415  may also permit the patient to obtain further information about the message  410  including allowing the patient to research information related to the message  410  from an external source such as the Internet, or from an internal source such as an on-line library stored on a network computer  110 . The action  415  may also direct the patient to other sources of information, may allow the patient to submit further information, or may permit the patient to repeat an action that precipitated the initial compliance message  407 . For example, the patient may have personal information that, if known, would explain the information contained in the compliance message  407 . One situation may be that the patient consumed a type of food or a medication that he or she knew would likely result in inaccurate test results. In this situation, the action  415  may permit the patient to submit the personal information to a healthcare professional or an administrator that may evaluate the information to determine if another test is necessary. The administrator may then modify the method  300  to permit the patient to re-schedule the test or may provide additional information to the patient to avoid making the same mistake. 
         [0033]    In one embodiment, the patient may select the action  415  as soon as it is displayed. In a further embodiment, the patient may only complete the action after viewing messages  410  or other information related to the patient&#39;s health. Further, the patient may be presented with a plurality of actions  415  to take based on the presentation of messages  410 . In a still further embodiment, the action  415  sends the patient to another web-based presentation to complete an informed consent presentation related to a surgical procedure or a consent to release medical data. For example, the method  300  may interface with other interactive healthcare applications, programs, or libraries such as Emmi® Success™, Emmi® Prep™ Emmi® Health™, or Emmi® Kids™ produced by Emmi Solutions, LLC of Chicago, Ill. 
         [0034]    The message  410  and action  415  may be presented in a variety of media formats. For example, the message  410  and action  415  may be presented to the patient in any combination of text, audio, or video that is delivered in any format. In one embodiment, the message  410  remains visible to the patient throughout the method  300 . Further, the action  415  may include any object or web-based structure that is recognizable to the patient as being selectable. For example, the action  415  may take the form of a button, an input field, or a slide bar. In one embodiment, a button may consist of a standard button and a graphic overlay specific to the method  300 . 
         [0035]    The patient may also be presented with a selectable quitting option  420  ( FIG. 4   d ). The quitting option  420  may allow the patient to stop the message and close the application or otherwise end the method  300 . The quitting option  420  may be visible to the patient for all or substantially all of the method  300 . Selecting the quitting option  420  may also present a number of alternatives to the action  415  that may be more desirable to the patient. The alternatives may be linked to data in the patient&#39;s health record that may indicate acceptable, though less-desirable alternatives to the presented action  415 . Further, upon selection of the quitting option  420 , the patient may, at block  312 , be asked to choose a reason  422  ( FIG. 4   e ) that the message  410  is not appropriate for them. In one embodiment, where the compliance message is related to diabetes protocol, upon selecting the quitting option  420 , the method  300  displays reasons  422  for quitting including “I don&#39;t have diabetes,” “Test results are wrong,” “I have already made an appointment with my doctor,” “I have seen my doctor in the past month,” “I don&#39;t want to do anything about this now,” and “Other.” The reasons  422  may be accessed from a variety of sources. In one embodiment, the reasons  422  are pulled from a script associated with the method  300 . Additionally, the reasons  422  may be pulled from a server  120  or a database  205 . 
         [0036]    Several events may occur upon selecting one or more of the reasons  422 . In one embodiment, the selected reason  422  and any data entered by the patient is passed to an entity  105 , such as a health care plan administrator. In a further embodiment, upon selecting any of the reasons  422 , more compliance information or another action  415  may be displayed to the patient. For example, upon selecting an “I don&#39;t have (condition)” reason, the method  300  may present an action  415  that allows the patient to explore possible reasons for the test results leading to the condition, to submit an error message to an administrator, to call an administrator, or to review the patient&#39;s EHR to resolve the mistake. Selecting the “Test results are wrong” reason  422  may allow the patient to re-schedule a test, submit correct test data, or present reasons that the current test data may be incorrect. Selecting the “I have already made an appointment with my doctor” or the “I have seen my doctor in the past month” reason  422  may allow the patient to enter a date of the appointment, a confirmation code to update the system, or call or write an administrator. Selecting the “I don&#39;t want to do anything about this now” may cause the method  300  to terminate or may present additional reasons that the patient should complete the suggested action. For example, the method  300  may present information to encourage the patient to comply with the protocol, such as a worst-case scenario, or an escalating reason that the patient should comply. Selecting the “Other” reason  422  may present the patient with an editable text field in which to type a reason for quitting. In a still further embodiment, a patient&#39;s responses to the reasons  422  may be accumulated and passed to an entity  105  for further analysis. For example, statistical analysis of patients&#39; reasons for non-compliance may allow an entity  105  to modify its practices to increase compliance. Also, the window displaying the message  410  and action  415  may close and the patient may be directed to another web page or, at block  313 , directed to the provider, or the method  300  may terminate. The patient may also have the option of canceling out of the reasons  422 . If the patient cancels the reasons  422  after selecting the selectable quitting option  420 , the presentation may resume at the point at which the patient originally selected the option. 
         [0037]    At block  315 , the method  300  may present the patient with detail  425  ( FIG. 4   d ) regarding the message  410  and the action  415 . The detail  425  may include a reasoning for the message  410  and resulting action  415 . The detail  425  may also be conditioned by other information, such as the patient&#39;s health record information or other parameters that may have been passed to the entity  105 , as previously discussed. For example, the detail  425  may be presented to the patient by comparing information from the patient&#39;s health record to other information such as test data or statistical information to allow the patient to fully comprehend the justification for the action  415 . Also, the detail  425  may include information related to the patient&#39;s condition, disease, device, or surgical procedure. For example, in  FIGS. 4   f  and  4   g , the detail  425  information includes information that is specific to the patient&#39;s current diagnosis (e.g., information to help the patient reduce his or her blood sugar level) and information to keep the patient in compliance with the protocol. 
         [0038]    At block  320 , the patient may be presented with a motivational message  430  ( FIG. 4   h ) that links the detail  425  with a subsequent message. The motivational message  430  may be derived from the patient&#39;s current condition, the message  410 , or the action  415  as it relates to historic treatment data. In one embodiment, the patient may be presented with a “teaser” message that personalizes the relationship between the condition or diagnosis that prompted the compliance message  407  and the detail  425 . For example, the message  425  may include typical reasons patients have historically not performed the action  415  in response to the message  410 . 
         [0039]    At block  325 , the patient may receive additional information as one or more reasons to take action  435  ( FIG. 4   i ). A reason to take action  435  may include more detailed information about the patient&#39;s message  410  and action  415 . Also, the reason to take action may explain a specific risk or benefit associated with the patient&#39;s diagnosis, disease, or device. In one embodiment, the patient may receive information explaining a consequence of not taking action. 
         [0040]    At block  330 , the patient may receive a conclusion message. In one embodiment, the conclusion message may allow the patient to view the previously-presented information In a further embodiment, the conclusion may allow the patient to view additional information regarding the message  410  or action  415 . The conclusion may also redirect a patient to another website containing related health information that may be related to data contained within the patient&#39;s health record. The redirect website may also contain health information that is unrelated to the message  410  or the patient&#39;s record. Additionally, the conclusion message may allow the patient to review the message  410  and detail  425  as described in relation to blocks  310 - 325  and to, optionally, select the action  415 . 
         [0041]    In connection with any of the previously-described blocks, and at block  335 , the patient may select the action  415 . Upon selection, the patient may complete or schedule an event related to the message  410  that brings the patient into compliance with a protocol, as previously described. The redirection may be partner, plan, employer, and message  410  specific. In one embodiment, the event corresponding to the action  415  is dependent on one or more factors associated with the patient who is viewing the message  410 . For example, the action may be dependent on the patient type and the healthcare plan in which the patient is enrolled. If the patient is a member of a healthcare benefits plan that permits scheduling appointments, then, at block  313 , selecting the action  415  may re-direct the patient to a website associated with the healthcare benefits plan to schedule an appointment. If the patient receives his benefits through an employer that also maintains work site healthcare facilities for the primary policy holder, then selecting the action  415  may direct the primary policy holder to a website to schedule an appointment at the work site facilities. If the same policy provides insurance coverage for spouses, but not for the work site facilities, then selecting the action  415  by a spouse my re-route the spouse to a different scheduling website to complete the action  415 . Of course, many factors other than patient type and healthcare plan may determine the result of selecting the action  415 . The patient may also be presented with an acknowledgement message  440  ( FIG. 4   j ) that informs the patient of the next steps involved in performing or completing the action  415 . The patient may also be presented with an option to ask a question  445  and an option to view the information again  455 . 
         [0042]    At block  345 , the patient may select the option to ask a question  445  and optionally ask a question  445  regarding any of the information that the method  300  has previously presented. In one embodiment, the method  300  may not present the patient with the option of asking a question until after a first presentation of a conclusion message, as described above in relation to block  330 . Upon selecting the option to view the information again  455  (described below in relation to block  350 ), the patient may be presented with the option  455  throughout the interactive presentation. In a further embodiment, the patient may be presented with a virtual form  450  ( FIG. 4   k ) on which he or she may type a question to submit to another entity. For example, the patient may be able to type a question on the form  450  and, at block  350 , submit it to his or her health care provider. Additionally, the patient may send the question to a number of different health care providers in search of a second opinion. Any or all of the patient&#39;s health record data may be sent along with the question. In a still further embodiment, only the patient&#39;s health record information pertaining to the current message  410  or action  415  may be sent. When a question is sent to a health care provider to which the patient has not previously given consent for release of personal health record data, the patient may also be asked to execute an online consent form or otherwise provide consent to the outside provider before the data may be sent. After sending the question, the patient may be presented with an acknowledgement that the message has been sent  460  ( FIG. 4   l ). In a still further embodiment, after submitting the question, the method  300  resumes the presentation at the point at which the patient began the question process. In a still further embodiment, the provider may optionally enable or disable the patient&#39;s ability to ask questions. 
         [0043]    At block  350 , the patient may select the option to view the information again  455  and optionally begin the presentation again. In one embodiment, selecting the option  455  directs the patient to the motivational message  430  as previously described in relation to block  320 . Of course, any other portion of the presentation may be presented to the patient upon selection of the option. Further, at any time after viewing the motivational message, the patient may select the quitting option  420 , as previously described in relation to block  312 . Upon one or more of the patient quitting the presentation (block  312 ) or the patient taking the action (block  335 ), the patient may receive a closing statement  465  ( FIG. 4   m ) that indicates the method  300  has terminated. In one embodiment, at termination  355 , the patient may be redirected to another website. 
         [0044]    Data may also be passed to another entity based on the patient&#39;s actions during the method  300 . For example, as previously described, the patient&#39;s reason for quitting the method  300 , as well as selecting an action  415 , or submitting a question may be transferred to the provider or any other entity. The data may be passed either synchronously as the action occurs, or asynchronously as a cumulative data dump to one or more entities. The data may be passed over secure FTP, and may be in the form of a spreadsheet, text file, proprietary data file, or other structure and may be encrypted. 
         [0045]    Much of the inventive functionality and many of the inventive principles are best implemented with or in software programs or instructions and integrated circuits (ICs) such as application specific ICs. It is expected that one of ordinary skill, notwithstanding possibly significant effort and many design choices motivated by, for example, available time, current technology, and economic considerations, when guided by the concepts and principles disclosed herein will be readily capable of generating such software instructions and programs and ICs with minimal experimentation. Therefore, in the interest of brevity and minimization of any risk of obscuring the principles and concepts in accordance to the present invention, further discussion of such software and ICs, if any, will be limited to the essentials with respect to the principles and concepts of the preferred embodiments. 
         [0046]    Although the forgoing text sets forth a detailed description of numerous different embodiments, it should be understood that the scope of the patent is defined by the words of the claims set forth at the end of this patent. The detailed description is to be construed as exemplary only and does not describe every possible embodiment because describing every possible embodiment would be impractical, if not impossible. Numerous alternative embodiments could be implemented, using either current technology or technology developed after the filing date of this patent, which would still fall within the scope of the claims. 
         [0047]    Thus, many modifications and variations may be made in the techniques and structures described and illustrated herein without departing from the spirit and scope of the present claims. Accordingly, it should be understood that the methods and apparatus described herein are illustrative only and are not limiting upon the scope of the claims.