Patent Publication Number: US-7716070-B2

Title: Medical triage system

Description:
COPYRIGHT NOTICE 
   A portion of the disclosure of this patent document contains material which is subject to copyright protection. The copyright owner has no objection to the facsimile reproduction by anyone of the patent document or the patent disclosure, as it appears in the Patent and Trademark Office patent file or records, but otherwise reserves all copyright rights whatsoever. 
   BACKGROUND 
   Originally, medical triage was a process deployed during wartime or disasters by which a nurse or other medical professional personally performed an initial assessment of patients to group them into one of three categories: those too ill to benefit from immediate medical care, those well enough to survive without immediate care, and those who could benefit from immediate care. In situations in which immediate medical care was a scarce resource, triage methodology helped ensure that such care would be allocated rationally, for maximum aggregate benefit. 
   In a broader sense, medical triage is a process for sorting people with medical complaints into groups based on the likelihood of them benefiting from particular levels of medical treatment. For example, most hospital emergency rooms utilize some kind of triage methodology to determine the priority in which patients receive care. The methodology can also include a decision-making strategy for deciding whether a nurse is able to dispense an adequate level of care or a physician is required for a higher level of care. Much of this is done in person, using medical assessments such as blood pressure, pulse, skin color, and general observations of the patient to supplement what the patient describes about his or her condition. The staff then applies hospital triage rules based on that information to determine treatment priority and a level of care, typically aiding those with the most serious conditions first. 
   Such medical triage systems exist to ensure that an appropriate level of care is dispensed to all individuals, by evaluating the significance of their self-reported or observed symptoms and matching them with a particular level of care. Accurate triaging means that the patient&#39;s medical concerns receive a suitable level of medical attention—neither substantially more nor substantially less than what he or she needs. 
   Triage systems can also ensure that the dispensation of care is more economically efficient. In this age of ballooning medical costs, a medical triage system can mean that ultimately pays for the medical services (e.g., government, companies or individuals) does not pay for an unnecessary level of treatment. For example, if someone with a minor injury is accurately triaged, an appropriate level of care can be determined, while expensive services, such as ambulance transport and emergency department care, can be avoided, if unnecessary. 
   Some triage systems are focused on controlling and limiting utilization of medical services (i.e., gate keeping). These triage systems are operated by or paid for by insurance companies and/or third party administrators responsible for general health care costs. The system guides callers to medical generalists, rather than to more costly specialists, except when a specialist is necessary. These systems will also direct referrals to in-network (i.e., discounted) medical providers, steering callers away from out-of-network (i.e., non-discounted) providers. 
   The spread of telecommunications means that some types of medical triage can be employed by persons who are not on-site with the patient. Advances in triage methods have enabled persons without extensive medical training to conduct some types of triage, so long as they are trained in the triage methods. A common form of triage that is conducted telephonically and by non-medical professionals with specialized training is that used by 911 Emergency Medical System (EMS) dispatching services. However, these services generally operate under the assumption that some emergency medical response will be sent to all callers. The dispatcher typically determines the level of response (e.g., whether basic or advanced life support is dispatched, which ambulance or other responder is closest to the caller, and which caller  105  gets priority when there are multiple simultaneous calls). EMS dispatchers also provide pre-arrival instructions, guiding callers in simple life saving techniques to help stabilize patients until emergency personnel arrive. 
   Medical providers, including clinic and hospital departments, may also utilize a triage service for screening purposes. For example, many expectant mothers and parents call obstetricians&#39; and pediatricians&#39; offices with a variety of medical complaints, concerns and questions. A triage service can play a role in determining which patients need to see a physician and which do not. Many clinics use their own staff for this triage service, but other clinics out-source to call centers. Similarly, many doctors&#39; offices, clinics and hospital departments use call centers to answer their telephones on weekends and after business hours. In addition to handling scheduling and message services, these call centers often use a level of triage to determine which calls warrant paging an on-call doctor. 
   Most triage calls begin with a nurse recording the medical condition or injury as stated by the caller, along with the caller&#39;s demographic information. This is followed by questioning by the nurse and a short health history. The nurse will assess the symptoms, provide information on seeking care and improving symptoms, and refer the caller to a physician, if necessary. Documentation of the call can be the final part of the triage process. 
   Many of the existing services described above provide a triage service in which nurses apply a variation of the free-form triage, answering callers&#39; medical questions using the nurse&#39;s own expertise or general guidelines. While sample protocols, risk factors and other information can be provided, these systems do not establish a broadly applicable and consistent decision-making process. Nurses are left to formulate their own questions and direct their own investigations. Even with general guidelines such a system can be rife with inconsistencies and other limitations. Each nurse can have his or her own particular predilections and can steer the inquiry in a direction not warranted by a fuller understanding of a particular patient&#39;s condition or optimal practices obtained by methodical study of prior triage cases. The nurse can miss critical points as a result of sloppiness or lack of knowledge and can, as a result, direct more treatment or less treatment than is appropriate. It can be impossible to ensure consistency and quality control with this kind of system. 
   SUMMARY 
   The invention relates to a medical triage system. 
   Using the triage system, a medical triage disposition can be determined for a person. A plurality of triage categories includes questions grouped into a plurality of tiers ranked according to urgency. Each of the plurality of tiers corresponds to one of a set of triage dispositions. At least a first relevant triage category and a second relevant triage category can be selected from the plurality of triage categories based on information about a medical condition of the person and then accessed. The person can be triaged by (a) identifying from all of the selected relevant triage categories a highest urgency tier that has at least one unasked question; (b) asking the person one of the at least one unasked question of the highest urgency tier; and (c) repeating (a) and (b) for all of the selected triage categories until the triage disposition is determined. 
   Other systems, methods, features and advantages of the invention will be, or will become, apparent to one with skill in the art upon examination of the following figures and detailed description. It is intended that all such additional systems, methods, features and advantages be included within this description, be within the scope of the invention, and be protected by the following claims. 

   
     BRIEF DESCRIPTION OF THE DRAWINGS 
     The invention can be better understood with reference to the following drawings and description, with emphasis placed upon illustrating the principles of the invention. 
       FIG. 1  is a schematic depiction of a platform for implementing triage. 
       FIG. 2  is a block diagram showing the possible hardware components of a computer system for implementing triage. 
       FIG. 3  is a block diagram showing possible database components in a computer system for implementing triage. 
       FIG. 4  is a schematic depiction of a call process for the triage system. 
       FIG. 5  shows a chart depicting four exemplary disposition sets. 
       FIG. 6  is another schematic depiction of a call process for the triage system. 
       FIG. 7  is a schematic depiction of a call process for the triage system that includes detailed notification procedures. 
       FIG. 8  is a schematic depiction of a format for a triage category. 
       FIG. 9  is a schematic depiction of one set of tiered triage questions and corresponding dispositions. 
       FIG. 10A  shows an exemplary triage category for upper extremity injuries, including a set of tiered triage questions and corresponding dispositions. 
       FIG. 10B  shows exemplary self-care instructions, follow-up criteria and frequently asked questions associated with the triage category in  FIG. 10A . 
       FIG. 11A  shows a schematic depiction of a zigzag-type alternation between sets of triage questions. 
       FIG. 11B  is a schematic depiction of a step-type alternation between sets of triage questions. 
       FIG. 12  is a schematic depiction of a method of alternating between triage questions in one triage category and another set of questions in a triage category added after triage was begun in the original category. 
       FIG. 13  shows a sample quantification tool for standardizing and defining triage questions and responses. 
       FIGS. 14A-P  show various exemplary screen formats for implementing a triage system on a computer. 
   

   DETAILED DESCRIPTION 
   The Triage Platform 
   A schematic overview of a platform for implementing a triage system of the invention is shown in  FIG. 1 . Elements used in supporting and implementing the triage system can be connected through a communications network  100 , including, for example, the Internet, an intranet, a local area network and/or a wide area network. Additional elements not shown in  FIG. 1  can be included in such a platform. The triage system can also be implemented with fewer elements than shown in  FIG. 1 . 
   The triage system can address the medical inquiries of individuals in any context in which injury management and triage is desirable. Application of the triage system can help reduce utilization of expensive, and often unnecessary, appointments with physicians and emergency room visits. By eliminating unnecessary physician appointments and visits to the emergency room, the system can also reduce unnecessary recordable injuries and unnecessary claims for Workers&#39; Compensation. The triage system can also help ensure prompt, appropriate care, thereby mitigating additional injury, reducing an individual&#39;s time away from work and preventing permanent disabilities. There can be direct cost savings by directing an individual to a preferred treatment center (where permitted by law) in which care is more appropriate or better tailored to the individual&#39;s condition, and, in some cases, less expensive. The system can also encourage those who are ordinarily reluctant to seek medical care to seek such care when they might benefit from it. 
   The triage system can include one or more triage centers  108  in which one or more triage operators  110  communicate with individuals (e.g., a caller  105 ) who have contacted the triage center  108  with medical concerns or questions. The triage operator  110  can be in contact with the caller  105  through the communications network  100  (e.g., using telephones) to allow for a remote triage investigation. The triage operator  110  can work from anywhere he can connect to the communications network  100 , including from a triage unit  126 , which can be connected through the communications network  100  to the triage center  108 . The triage operator  110  can also operate independently, for example, using a non-networked PC. 
   In other cases, however, the triage can be implemented in part by a computer system  116 , using voice recognition to process the answers offered by the caller  105  and/or using voice generation to present the questions to the caller  105  over the telephone or similar device. A computer system  116  can also present the questions in written form to the caller  105 , as in an Internet Web page, for example. The triage process can be implemented automatically using some of the above-mentioned techniques. 
   The triage operator  110  can be a physician, surgeon, medical resident, physician assistant, nurse practitioner, registered nurse, paramedic, psychiatrist, dentist, pharmacist, other medical professional or other person trained to implement the triage system. In some cases, non-medically trained people can implement the triage system, if they are properly trained to implement the triage system. It can be more efficient to use registered nurses, because they are often trained in general triage practices, can have relevant and useful general medical knowledge and experience to place triage instances into context, and because their services can be less expensive than those of physicians. Someone with credentials less than those of a registered nurse can be utilized as the triage operator  110 , although adequate supervision of lesser skilled triage operators  110  may be desirable to ensure that the triage process is accurately implemented. Applicable laws and regulations in certain jurisdictions may require minimum licensure or credentials separate from what the triage system requires in order to provide medical advice or triage service in that jurisdiction. 
   The caller  105  can be anyone who makes contact with the triage operator  110  or computer system  116  for the purposes of medical triage. The caller  105  can be the injured or ailing person, or anyone with medical questions. The caller  105  can also be someone who is assisting the injured or ailing person, especially in situations where the injured person is not able to call or communicate over the telephone. For example, a supervisor can help an employee place such a call if the employee is partially incapacitated. A supervisor can also place the call on behalf of someone else when company policy so requires. For simplicity, it can be assumed herein that the caller  105  is the person with the medical issue or complaint. 
   The caller  105  can use a telephone to call the triage center  108  or triage unit  126 , such as by using a toll-free (e.g. 1-800) number. The caller  105  can also use a mobile telephone, satellite telephone, walkie-talkie, computer via the Internet or other network, email, BLACKBERRY (Waterloo, Ontario), facsimile machine, two-way pager or any other system for communicating from a remote location to the triage operator  110 . 
   In some situations, the triage system is provided to a client organization to serve its employees, customers, and/or those at its facilities  104 . A caller  106  at the organization facilities  104  can be an employee or customer the client organization, or can have no relation with the client other than being on its property. The client organization can also extend the application of its triage program to callers  105  who are employees, including those off-site and/or not on the job. Additional cost savings can result from improved productivity and morale, as a result of the prompt medical attention available to an employee. Employees can be more satisfied with the level of care and thus more likely to comply with self-care instructions, and can be less likely to initiate litigation against the client organization. Furthermore, by shifting the medical decision-making from the client organization to the triage system provider, the risks inherent in medical decision making are shifted away from the client organization. 
   A caller  128  who is mobile can contact a triage operator  110  from multiple locations. For example, a long-haul truck driver can have access to the triage system by contacting the triage center  108  or triage unit  126  though the communications network  100  using any of the devices mentioned above. The position of the mobile caller  128  can be determined with a tracking system such as the Global Positioning System (GPS)  130 . This can assist in dispatching medical services to the mobile caller  128  and/or directing the mobile caller  128  to a nearby treatment center  118 ,  120 . GPS software employed by the triage operator  110  can help interpret and present GPS-related data for the purpose of locating a mobile caller  128 . For example, the position of the mobile caller  128  could be displayed on a display device  160  so that the triage operator  110  or computer system  116  could help identify routes to a treatment center  118 , such as the nearest treatment center, or direct an appropriate medical provider to the mobile caller  128 . 
   A caller  105  may require emergency assistance, such as assistance provided by an Emergency Medical Service (“EMS”)  124 . A call to the 911 call center  122  can be made by the caller  105  at the instruction of the triage operator  110  if the triage disposition so warrants. The 911 call center  122  can in turn dispatch an ambulance by contacting the EMS  124 , which will transport the caller  105  to a treatment center  118 ,  120 . 
   Alternatively, the situation may not require emergency attention. In that case, the triage operator  110  or caller  105  can make an appointment for the caller  105  to see a medical provider (such as a physician, physician&#39;s assistant, nurse practitioner, dentist, nurse practitioner, nurse or other medical professional) at one of the treatment centers  118 ,  120 . Treatment centers  118 ,  120  include hospitals, clinics or other locations where medical care can be dispensed. One or more treatment centers  118  can be identified as a preferred treatment center, based on the client specifications, the proximity of the treatment center  118  to the caller  105  or client facility  104 , the known capabilities of the treatment center  118 , etc. However, the system can comport with any applicable laws and regulations that govern (or prohibit) the restriction to, or selection of, preferred treatment centers. The triage operator  110  or caller  105  can first attempt to use or contact a preferred treatment center  118 ; if that fails, he can then attempt to use or contact another treatment center  120 . 
   Computer System 
   As shown in  FIG. 1 , the triage operator  110  can use a computer system  116  to help implement the triage system. Alternatively, the triage system can be implemented without computers, such as with books. The computer system  116  can be a client-server system, in which one or more computer clients  112  send requests to a server  114  and a server  114  responds to requests from one or more computer clients  112 . A “computer client” can be broadly construed to mean computer hardware that requests or receives the file, and “server” can be broadly construed to be the computer hardware that provides or downloads the file. The computer system  116  can include a personal computer (PC), laptop computer, server, workstation, and the like, running any one of a variety of operating systems. 
   The computer client  112  can be any computer hardware, such as a PC, workstation, hand-held device, electronic book, personal digital assistant, peripheral, etc. The computer client  112  can also be a software program running on a computer directly or indirectly connected or connectable in any known or later-developed manner to any type of computer network, such as the Internet. For example, a representative computer client  112  is a personal computer that is PENTIUM-based (Intel, Santa Clara, Calif.) and includes an operating system such as MICROSOFT WINDOWS (Microsoft Corp., Redmond, Wash.). The computer client  112  can also include a Web browser, such as INTERNET EXPLORER (Microsoft Corp., Redmond, Wash.). A computer client  112  can also be a notebook computer, a handheld computing device (e.g., a PDA), an Internet appliance, a telephone, or any other such device connectable to the computer network or other communications network. 
   The server  114  can be any computer hardware, such as a computer platform, an adjunct to a computer or platform, or any component thereof, such as a program that can respond to requests from a computer client  112 . For example, the server can be a PENTIUM-based computer (Intel, Santa Clara, Calif.) running WINDOWS 2000 SERVER and executing MS SQL (Microsoft Corp., Redmond, Wash.) or ORACLE (Oracle Corp., Redwood Shores, Calif.). The server  114  can also include a display supporting a graphical user interface (GUI) for management and administration, and an Application Programming Interface (API) that provides extensions to enable application developers to extend and/or customize the core functionality thereof through additional software programs. 
   The triage system can be implemented using software running on the computer system  116 . In addition, the triage system can be implemented using a transmission medium, such as one or more carrier wave signals transmitted between the computer system  116  and another entity, such as another computer system, a server, a wireless network, etc. The triage system can also be implemented using an API or a user interface. 
   Computer Hardware Components 
   A block diagram of the computer system  116  is shown in  FIG. 2 , showing a number of different hardware components coupled by a data bus  150  to allow communication therebetween. The components can communicate via hardwire or wireless connections. The computer systems embodying the triage system need not include every element shown in  FIG. 2 , and equivalents to each of the elements are intended to be included within the spirit and scope of the triage system. 
   The central processor  152  shown in  FIG. 2  can run software that assists in triaging the caller  105 . The central processor  152  can, for example, be used to process information entered by a triage operator  110  into the computer system  116 . The central processor  152  can be any type of microprocessor, such as a PENTIUM processor (Intel, Santa Clara, Calif.). 
   A main memory unit  154  can also be a part of the computer system  116 . Additional storage devices, such as a fixed or hard disk drive unit  164 , a floppy disk drive unit  166 , a tape drive unit  168  and/or optical storage devices such as a CD Rom drive  170  or a DVD drive  171  can act as adjuncts and/or alternatives to the main memory unit  154 . The storage devices, such as the DVD drive  171 , in addition to the main memory unit  154 , can be used for storing and access to recordings of the conversations between the caller  105  and the triage operator  110 , medical and other data related to the caller  105 , triage-related software and data used to execute the triage-related software. 
   The network interface  158 ,  159  can be any type of a device, card, adapter, or connector that provides the computer system  116  with network access to a computer or other device, such as a printer. In the triage system, the network interface  158 ,  159  can enable the computer system  116  to connect to a computer network such as the Internet or Ethernet. Software and data can also be loaded into the computer system via the network interface  158 ,  159 . 
   A display device  160  can be used to display, to the triage operator  110  or others, any information related to the triage system, such as triage questions to ask of the caller  105 . The display device  160  can be any type of display, such as a liquid crystal display (LCD) and the like, capable of displaying, in whole or in part, the triage categories or other outputs generated by the computer system  116 . 
   One or more input devices  162  allow the triage operator  110  to enter information into the computer system  116 , such as answers to triage questions. The input device  162  can be any type of device capable of providing the inputs described herein, such as keyboards, numeric keypads, touch screens, pointing devices, switches, styluses, scanners and light pens. An input/output controller  156  can support the input and output devices. 
   Database and Software Components 
     FIG. 3  is a block diagram showing possible database components and supporting architecture in a computer system  200  for implementing the triage system. In the system of  FIG. 3 , a user  210  can interact with a back end  250  of the computer system  200  via a server  230  and a content presentation system  240 . The computer system  200  can include one or more customer databases  280 , one or more content databases  290 , one or more telephone databases  295  and one or more audio recordings databases  297  and a data warehouse  215 . The back end  250  can be located in a triage center  108  or off-site. 
   The user  210  can be a triage operator  110  capable of interacting with the computer system  200 . The user  210  can also be someone who inputs or accesses data or triage-related information, updates the software in the computer system  200 , or otherwise alters the computer system  200 . The user  210  can also be someone who mines the data in the computer system  200  to generate reports, such as call statistics, injury reports and other reports. The user  210  can include a client or representative thereof, who can generate and/or have instant and secure access to statistical reports on employee call characteristics, incident rates and other parameters via the communications network  100 . 
   The user  210  can access the computer system  200  through the Internet, a remote server, or a networked device through, for example, a server  230 . Users  210  may also access the computer system  200  users using a wide area protocol (WAP), digitized voice signals, interactive television signals, electronic mail systems, voice mail, direct mail, and various messaging systems, including short message service (SMS) systems. The user  210  may also interact directly with the back end  250 . Access to the back end  250  can also be provided via one or more carrier wave signals that are accessible to the user  210  without requiring a server  230 . 
   The back end  250  can consist of various elements connected by a LAN. The elements of the back end  250  can include a file server running WINDOWS 2000 SERVER; a database server running MS SQL (Microsoft Corp., Redmond, Wash.) or ORACLE (Oracle Corp., Redwood Shores, Calif.); phone servers running a WINDOWS 2000 platform; fax servers running a WINDOWS 2000 platform (Microsoft Corp., Redmond, Wash.); an e-mail server running MICROSOFT EXCHANGE; and UNIX-based e-mail server running SENDMAIL (Sendmail, Inc., Emeryville, Calif.) for back-up; a web server running IIS (Microsoft Corp., Redmond, Wash.); a reporting engine running CRYSTAL ENTERPRISE (BusinessObjects, San Jose, Calif.); and a NETSCREEN fire wall device (Juniper Networks, Sunnyvale, Calif.). The system can run 128-bit encryption such as VERISIGN (Verisign, Inc., Mountain View, Calif.) to ensure system security. Other elements and software can be added to this back end  250 . The back end  250  can also be implemented with ACCESS (Microsoft Corp., Redmond, Wash.), DEVELOPER 2000 (Oracle Corp., Redwood Shores, Calif.), or other reporting tools, including the replacements or successors to these applications. 
   The architecture of the back end  250  can be a flexible design that includes real-time, database-resident support, permitting reporting capabilities that can take advantage of E-mail/WAP/Voice-based communication. As content is added to the back end  250  (e.g., in content databases  290 ), the attributes of the content can be delivered to the user  210  in near real time, using, for example a report generated in the data warehouse  215  and presented to the user  210  via the content presentation system  240 . The back end  250  can create queries to be provided to a user  210  and can receive responses to the queries. The back end  250  can also perform processing based at least in part on the queries and the responses, along with information stored in its databases and lookup tables, and helps determine the triage disposition. 
   The computer system  200  can also include a business logic processing system (not shown) connected to the server, to form a three-tier computer system. The business logic processing system can receive queries or responses from the user  210 . That information can be used to update the customer databases  280 , as well as retrieve data and information from both the customer databases  280  and content databases  290 . The business logic processing system can also provide inputs to and receive outputs from the data warehouse  215  and communicate with any rules systems to apply one or more predetermined rules to the user queries. These functions can be accomplished in the absence of a discreet business logic processing system. 
   The data warehouse  215  communicates with the customer databases  280  and the content databases  290  and other databases during the preparation of reports or triage-related queries which can be provided to the user  210 , such as with an on-screen display. The data warehouse  215  can also organize and store data generated using the server  230  and/or a rules system. The databases  280 ,  290  can be, for example, SQL relational databases and/or relational online analytical processing databases (ROLAP). 
   The customer databases  280  can include one or more databases for storing data provided by users  210  and/or derived from inputs by users  210 , including demographic information, answers to triage-related questions, dispositions, follow-up data, plans, or other inputs from the users  210 . The customer databases  280  can have real-time capabilities for support of the data warehouse  215 . The MedfilesMOL™ database and the telephone system database described below can be components of the customer database  280 . 
   The content databases  290  can include one or more databases storing content that can be provided to a user  210  during operation of the system. The content databases  290  can include all of the information of the triage categories, including the tiered triage questions and related information, discussed below. The triage database described below may be a part of the content databases  290 . 
   The content databases  290  can include the tiered questions, in addition to data that is “scored” in advance for one or more predetermined characteristics. This is also referred to as “derived” data. The scored data can, for example, be maintained as a set of one or more tables of scores. Certain quantitative or qualitative details about a medical condition can be assigned one or more scores based on severity. Derived data can be used in conjunction with look-up tables to accept queries from the server  230  and provide appropriate responses. For example, a given amount of pain, shortness of breath or extent of burns can be matched with a disposition through the lookup tables. Information in lookup tables can be more quickly and conveniently accessed in certain circumstances. 
   The telephone databases  295  store and provide access to telephone numbers, associated names and other telephone-related data. The audio databases  297  store digitized recordings of the calls. 
   The computer system  116  can execute dynamic updates to the screen controls to change one or more properties, without having to make coding changes and/or redeploy the triage-related software. Those properties can include position, size, backcolor, forecolor, border style, field input length and tool tip text. The computer system can also execute dynamic updates regarding whether a field receives focus when a Tab key is pressed and/or the order in which fields receive focus when the Tab key is pressed. These changes can be useful for refining the software to improve work flow and ease of use without having to reprogram the computer system  116 . 
   In the above description of  FIG. 3 , it should be understood that any portion of the functionality provided by the computer system  200  could be provided by independent systems and/or different groupings of systems than illustrated in  FIG. 3 . 
   Triage Process 
   As shown schematically in  FIGS. 4A-B , users of the triage system (e.g., callers  105 ) can contact a triage operator  110  from a remote location. The caller  105  can, depending on the traffic to the triage center  108 , be placed in a telephone system queue (step  304 ) until a triage operator  110  is available. The phone system can require the caller  105  to indicate whether the call is for a new injury; those calls are moved ahead of others in the queue who indicate that they are reporting old injuries. The triage center  108  can be located anywhere a triage operator  110  or computer  116  employs the triage system. 
   The computer system  116  and software can work together to present the triage operator  110  with information relevant to a caller&#39;s medical complaints, prompt for specific questions related to the caller&#39;s symptoms, and record the corresponding answers. The triage operator  110  can employ the information and questions within those categories to determine which disposition (i.e., timing and level of medical care) best suits the caller  105 , as described in further detail below. The triage system does not necessarily diagnose the caller&#39;s medical condition, although the triage system can be used in conjunction with a diagnosis system. 
   When the caller&#39;s turn has arrived, a triage operator  110  can answer the telephone and implement the triage system. All telephone conversations can be digitized and stored digitally on a hard drive and then transferred to DVD; a call can also be stored on analog tape. The call recording and the triage operator&#39;s computer inputs can both have a running time-stamp so that they can be linked and/or synchronized to better enable one to understand the basis for the triage operator&#39;s decisions or the effectiveness of the triage questions, when analyzed at a later date. 
   Upon receiving a call, the triage operator  110  can begin by finding and confirming the caller&#39;s location (step  308 ), so that the triage operator  110  can dispatch medical services to the caller&#39;s location if necessary. The triage operator  110  can also use the location information to determine if the caller  105  is eligible for services (step  310 ), e.g. a pre-existing client, employed by a pre-existing client, a customer of a pre-existing client, or otherwise entitled to services. An exemplary computer screen layout shown in  FIG. 14A  can be suitable for recording such information. 
   Services can be denied to a caller  105  who is not eligible. If the caller  105  is not eligible for services, he will be notified (step  312 ). However, if it is apparent that the caller  105  is in need of emergency medical attention, the triage operator  110  can instruct the caller  105  to contact the EMS and provide interim self-care instructions. If the triage operator  110  wishes to contact the EMS on the caller&#39;s behalf, it can be important to get an accurate description of the exact location of the caller  105  and information on the appropriate EMS, which the triage operator  110  may not have in the database. Other demographic information such as the caller&#39;s social security number or name can be used to determine if the caller  105  is eligible for triage services or has called before, so that his medical records can be accessed, if they exist. 
   The triage operator  110  can establish whether or not the caller  105  already exists in the triage system database (step  316 ) using personal data. If the caller  105  does not exist in the database, basic caller data are solicited by the triage operator  110  and entered (step  322 ) via any appropriate devices, such as a keypad, mouse, light pen, touch screen, scanner, etc. The information can enable the system to follow-up with the caller  105  or allow triage reports to be generated, as described below. 
   The caller  105  may already be listed in the database. If so, the caller&#39;s information is accessed. The exemplary computer screen layout shown in  FIG. 14A  can be suitable for accessing such information. Once the caller data are entered (step  322 ) or accessed, the triage operator  110  determines if the call is a report call only (step  324 ). A report call is a call in which no medical treatment is desired by the caller  105 , but merely establishes the caller&#39;s data for future contact and for more complete data records of injuries and reporting statistics for triage client organizations. For a report call, intervening triage-related steps are skipped (step  342 ) and the data collection process is initiated, as described below. The call type can be selected using radio buttons, as described in reference to  FIG. 14C , below. 
   If the call is not a report only call, then the process is continued (step  340 ), as shown in  FIG. 4B , by determining if the call is a follow-up call (step  344 ). A follow-up call is a call based on a medical condition that was previously addressed by the triage system. If it is a follow-up call, the system is set up as a follow-up call (step  350 ) by accessing the data related to the original incident, which can be associated with the caller&#39;s personal data. This can enable the follow-up call data and the original incident data to be linked within the database, and can help the triage operator  110  understand the earlier incident or condition. A follow-up caller  396  can also contact the triage operator  110  and directly commence follow-up (step  350 ). 
   If it is not a follow-up call, the call is set up as an original call (step  352 ), enabling an initial inquiry into the caller&#39;s condition and personal data. The caller&#39;s age can be collected in order to determine a suitable level of care for the caller  105 . For example, chest pains in a 65-year-old can suggest a heart attack, while they might not for an 18-year-old. If a caller  105  is identified as a minor, a “Pre-Triage for Minors” frame can become enabled, as further described in reference to  FIG. 14C , which can give the option of selecting a type of legal consent. Legal consent criteria can be required before the call can progress, in order to prevent the unauthorized triage of minors. A parental consent form on file with the triage center, over-the-phone consent from a parent, or an agreement on file with the client organization can generally allow minors to make full use of the triage system. The triage system can, however, allow for Emergent-911 and Emergent triage of minors under the legal principle of implied consent. Triaging can be discontinued following the Emergent-911 or Emergent questions for minors, as it can become harder to claim that implied consent applies to a less urgent situation. For particular clients, the “Pre-Triage for Minors” frame can be disabled. 
   Next, the triage operator  110  can select the relevant triage categories (step  354 ). The categories can correspond to body parts and/or injury types that can be the focus of the triage inquiry. The categories can be generally symptom-based. Each category contains both tiered triage questions and related information. The tiered triage questions, described below, are related questions that can lead to one of a set of possible dispositions, depending on the answers provided. An exemplary computer screen layout that allows selection of relevant categories is shown in  FIG. 14C . 
   The categories that relate to particular body parts can include “abdominal injury,” “abdominal pain without injury,” “chest pain without injury,” “chest injury,” “dental injury,” “upper extremity pain without injury,” “upper extremity injury,” “lower extremity pain without injury,” “lower extremity injury,” “eye injury,” “eye chemical exposure,” “red eye,” “groin strain,” “headache, typical,” “headache, new onset/atypical,” “head injury,” “low back injury with direct trauma,” “low back injury without direct trauma,” “low back pain without injury,” “neck injury,” “pregnancy,” “shortness of breath,” etc. 
   The triage categories that are not necessarily related to a particular body part can include “bites,” “blood-borne pathogen exposure,” “burns,” “electric shock,” “frostbite,” “general complaint,” “heat illness,” “insect bite or sting,” “insecticide exposure,” “open wounds/laceration,” “psychiatric conditions/stress,” “rash,” etc. 
   As shown in  FIG. 4B , the triage operator  110  can ask the caller  105  one or more questions about his complaints to ascertain the origin or cause of the caller&#39;s inquiry and allow the triage operator  110  to select the relevant categories (step  354 ). For example, if the caller  105  states that he fell off a ladder, thereby bumping his head and cutting his arm, the triage operator  110  can select the “head injury” and “laceration” categories. Both the supporting information and tiered triage questions in those two categories—laceration and head injury—can be applied by the triage operator  110  as further described below. If more than one relevant triage category is selected, the categories can be prioritized (step  355 ). They can be prioritized based on the description the caller  105  provides or rules implemented by the triage operator  110 . Such a rule can provide, for example, that the “chest pain” category always has a higher priority than the “groin strain” category. 
   Both the category selection and the body part selection can be accomplished in the exemplary screen layout displayed in  FIG. 14C , where the body part (e.g., foot, neck, hand, torso), body part location  1  and  2  (e.g., left/right/lateral/dorsal) are selected using combo-box fields  672 - 676 , and the category  678  is selected from a list. When the “Add” button  680  is selected, the combination of category and body part are recorded and displayed in a window  682 . The same category can be applied multiple times to different areas of the body by selecting the same category a second time while selecting different body parts. For example, the laceration category can be applied to both the hand and the elbow, as primary and secondary body parts. Likewise, different categories can be applied to the same body part, if, for example, there is both a burn and an open wound at the same place. When all or some of the categories and body parts are selected, the triage operator  110  can use the arrow buttons  684  to prioritize the selections, as shown in  FIG. 14C . 
   As shown in  FIG. 4B , the information and questions within each of the relevant triage categories are applied to triage the caller&#39;s complaints (step  356 ), i.e., to determine a suitable triage disposition for the caller  105 . The possible gradations of disposition can correspond to urgency, as described below, especially with respect to  FIG. 5 .  FIG. 4B  shows that the triage operator  110  determines either that a referral is required (step  358 ) as a result of the triage process (step  356 ) or not. Thus, there are two basic dispositions shown in FIG.  4 B—“requiring a referral” and “not requiring a referral.” 
   If the triage inquiry results in a referral, the triage operator  110  can search for and refer the caller  105  to a preferred medical provider (step  366 ), including any preferred treatment centers. If there is no preferred medical provider designated by the client, or if the preferred medical provider cannot adequately address the caller&#39;s medical condition, the caller  105  can be referred to any other suitable medical provider. Alternatively, the caller  105  can be presented with a list of treatment centers to choose from for referral, or can be allowed to select his own referral clinic, depending on the client policy and applicable laws and regulations. If the triage process does not result in a referral, self-care instructions (step  364 ) can be given to the caller. An exemplary screen format for displaying triage questions and enabling access to supporting information, including self-care instructions, is shown in  FIGS. 14D-E . 
   If the caller&#39;s condition allows, the triage operator  110  can collect more information (step  368 ) about the caller  105 , beyond that requested at the beginning of the call. This information can include demographic data, incident criteria, and other information. An exemplary computer screen format for entering this information is shown in  FIG. 14J . 
   The triage operator  110  can also inquire into other data that is of special interest to the client organization, i.e. the special client requirements (step  370 ). For example, the client can require that every caller  105  with a back injury be asked if he or she was wearing a company-supplied back-belt at the time of injury. Other clients can require that every caller  105  with a laceration be asked whether he or she was wearing safety gloves. An exemplary computer screen format for entering this information is shown in  FIGS. 14M-N . 
   If there are no such client requirements, or once special client requirements are collected (step  376 ), the data acquired during the triage process can be saved to a database (step  377 ). The data can include the identification of the caller  105  and triage operator  110 , cause of injury, symptoms, answers to questions, triage disposition, instructions given by the triage operator  110  and the results from caller  105  follow-up, in addition to other information discussed elsewhere. 
   The databases for saving the post-triage data and the other acquired data include the MedfilesMOL™ database  389 , the triage database  390  and the telephone system database  391 . The triage database  390  is used for storage and organization of the information obtained during a triage call, and is implemented using an application interface which allows real-time updating and modification of the database. The MedfilesMOL™ database  389  is implemented using a post-call processing software interface that allows the development and editing of the triage software, as well as the investigation of particular call histories. The data in the three databases can be saved for long-term storage in the data warehouse repository  392  (i.e., a data warehouse). Data warehouse users  393  can access the data to prepare reports, study aggregate caller data and study the long-term efficacy of the triage system or elements thereof. The databases  389 ,  390 ,  391  and the warehouse  392  can have security features to prevent the unauthorized access to the confidential medical records or proprietary client information contained therein. 
   Once all of the selected information is saved to one or more of the databases (step  377 ), a report is generated and sent (step  378 ) to predetermined recipients. The recipients can include particular contact persons at the client or others, as detailed below. 
   The system can present an opportunity to maintain the call record (step  379 ). The client can have instructions not to save such information; if so, the call can be terminated at this point, because the call can be considered complete. If there are instructions to maintain the call record, then the records are saved (step  384 ) using the MedfilesMOL™ application  382 . The MedfilesMOL™ application  382  can be used to maintain demographic information, details about the call and any incident, or other information. 
   Application of the triage system can result in the selection of a particular disposition from a set of dispositions. A disposition is, generally, the action or actions to be taken by the triage operator  110  or caller  105  to resolve the caller&#39;s condition. A particular disposition within a disposition set can be identified by generalized indicia such as numbers or letters to express the selected level of care. For example, a “#1” disposition can indicate the most urgent level of care, indicating to the triage operator  110  that whatever actions are associated with the “#1” level (e.g., calling 911) should be executed. In the same disposition set, a “#5” disposition can indicate the least urgent level of care, indicating to the triage operator  110  that self-care instructions, for example, should be communicated to the caller  105 . When general indicia are employed, the specific set of instructions associated with each of the indicia can be modified. Dispositions can also be expressed as the disposition instructions themselves (e.g., “call 911,” “see doctor within 24 hours,” etc).  FIG. 5  shows that the triage system can use a number of triage exemplary disposition sets  396 ,  397 ,  398 ,  399 , with varying stratification and level of specificity. These disposition sets  398  can account for differing levels of urgency, from someone who needs immediate medical attention to someone who can treat himself. 
     FIG. 6  is a schematic depiction of the triage system, and offers a more detailed description of the dispositions that can be assigned to a caller  105  based on the answers given to the triage questions. As shown in  FIG. 6 , an injured employee (step  400 ) is directed to notify the supervisor (step  402 ) so they can call the triage center together (step  404 ); this step reflects a common corporate policy requiring supervisor involvement following an injury. Otherwise, the employee (step  400 ) can call the triage center directly (step  404 ). Once the triage center is contacted, a triage operator  110  can begin to inquire into the details of the injury. This allows the triage operator  110  to select and apply the triage categories (step  406 ) to assign a disposition. 
     FIG. 6  shows six possible dispositions, but more or fewer could be used. The first four dispositions (steps  408 ,  410 ,  412 ,  414 ) are variations on self-care; self-care instructions can be given over the telephone or sent by e-mail or faxed to the caller  105  and his supervisor. For example, one possible disposition is that the employee would require assurance that his condition is not serious and/or information, but would return to work (step  408 ), after which the triage operator  110  would follow up (step  416 ) using the particular follow-up information associated with the relevant categories of the previous call. Alternatively, the employee is sent home with self-care instructions and can return to work for the next shift (step  414 ). If a follow-up is indicated, the system can schedule the follow-up automatically and the caller  105  can be informed to expect a follow-up at a certain date and time. The triage system can be integrated with the calendar function MICROSOFT OUTLOOK (Microsoft Corp., Redmond, Wash.) to automatically schedule and/or document follow-up calls. 
   If the medical condition of the caller  105  is sufficiently serious, one of the more urgent dispositions (steps  418 ,  420 ) is assigned. The caller  105  can be directed to a designated medical facility for further evaluation and/or care (step  418 ). Also, a caller  105  can be directed to an alternative medical provider if that designated or preferred medical provider is unavailable or cannot effectively address the caller&#39;s condition (step  420 ). The client can specify reasons for which a medical provider is preferred and conditions suitable for overriding that preference, consistent with applicable rules and regulations. For the six dispositions detailed in  FIG. 6 , the client&#39;s claim manager can be contacted about the inquiry (step  424 ) and updated (step  426 ), as needed. The software can generate reports that are suited to updating the claim manager and others. The employee will ideally return to work (step  428 ). 
     FIG. 7  shows another schematic depiction of the triage system. The triage process can be initiated with a telephone call to the triage center when an employee has an injury or medical concern (step  430 ). In this scheme, the supervisor can be notified (step  432 ) before a toll-free telephone call is placed (step  434 ). The triage operator  110  triages the caller (step  436 ). The triage process can result in an on-site resolution (step  438 ), wherein the caller  105  is given on-site treatment or instructions for self-care without visit to an off-site provider. There may be no Workers&#39; Compensation claims (step  438 ) when the employee returns to work (“RTW”) after being given medical information (step  442 ), when on-site self-care is provided (step  444 ), or when an alternative duty is assigned to the employee (step  446 ). With these dispositions (steps  442 ,  444 ,  446 ), the triage operator  110  follows up with the caller, as indicated by the relevant triage categories (step  448 ). 
   Alternatively, the caller  105  will be referred to a medical provider (step  440 ). This can happen for any of the following dispositions: Emergent-911 disposition (step  458 ), Emergent disposition (step  456 ), Urgent disposition (step  454 ), or Non-Urgent disposition (step  452 ), as determined by the instructions associated with each of these dispositions. Care is then transferred to the off-site provider (step  460 ) per the selected disposition. 
   The triage center can update the data warehouse and then notify the client organization of the particular injury and resolution (steps  450 ,  452 ). Work sites, regional offices, franchise offices, division offices, etc. can be the recipients of such a report, or receive other communications regarding the injury or issue. Each of those levels can have a particular interest in safety, human resources issues, Workers&#39; Compensation issues, or other relevant issues. Likewise, a third-party administrator, insurance carrier, insurance broker, or other entity can be contacted when the client so requests (step  452 ). Ultimately, it is hoped that the employee returns to work (step  454 ). 
   Triage Categories 
   Within the triage system, different triage categories are applied based on the caller&#39;s complaints. The triage categories aggregate different types of supporting information and germane inquiries that apply to the particular conditions targeted by the categories.  FIG. 8  shows schematic representation of the various sections of an exemplary triage category  480 : Critical Considerations  482 , Clinical Frame  484 , Tiered Triage Questions  486 , Question Rationale  488 , Self-Care  490  (including an overview, self-care instructions, prevention advice and follow-up questions), Frequently Asked Questions (“FAQ”)  492  and General Information  494 . An exemplary screen format for accessing these sections is described with regard to  FIGS. 14E-F . 
   Any of these sections can be accessed at any time by opening up frames, or can be automatically presented to the triage operator  110  when a certain category  480  is called up. For example, one or more of the sections  482 - 494  could open as a frame automatically as soon as a particular category  480  is accessed, while others are available at the option of the triage operator, by selecting a button, drop-down menu or other selection modality. The categories do not necessarily have all of these sections, and can have additional sections not listed here. 
   The Critical Considerations  482  section generally guides the triage operator&#39;s questioning of the caller  105 . The Critical Considerations  482  section can be used to flag important information or safety concerns for consideration during application of the tiered triage questions  486  and alert the triage operator  110  to other important information related to the tiered triage questions  486 . For example, when the triage operator  110  decides to apply the abdominal injury triage category, the Critical Considerations  482  window appears on-screen before any questions are asked. The Critical Considerations  482  can alert the triage operator  110  to the fact that an abdominal injury can result in potentially life-threatening conditions, including the rupture of solid or hollow viscera and that an abdominal injury in a pregnant woman can result in uterine abruption or rupture. If this were not known by a triage operator  110 , he or she might incorrectly discount the level of danger that the caller  105  faces. The software can automatically present the relevant Critical Consideration  482  on screen when the category  480  is selected, or it can be presented upon selection of an icon on the computer screen. 
   A Clinical Frame section  484  in a triage category  480  can be accessed by the triage operator. Unlike the Critical Considerations section  482 , this section can be structured as a text box in which the triage operator  110  can type a short description of the mechanism, location and time of injury and any treatment attempted and corresponding results. A text box  662  for entering the clinical frame is shown in  FIG. 14C . Alternatively, this section can actively request information, and such requests can be tailored to each triage category. 
   The Clinical Frame  484  can be important in determining the severity of the complaint. Answers to the questions provided in this section can help define the context for the injury or condition and alert the triage operator  110  to important issues, as well as any other categories that ought to be applied in a given inquiry. For example, symptoms resulting from a fall can be treated differently depending on whether the fall was from a 10-foot ladder or on level ground. A fall from a 10-foot ladder can alert the triage operator  110  to an increased potential severity of the condition and add to the list of, or cause the software to automatically access, applicable triage categories and/or dispositions. 
   One of the basic features of the triage category  480  is the tiered triage questions  486 , which, when applied, can determine the disposition of the caller. The tiered triage questions  486  are discussed below, in reference to  FIG. 9 . 
   For each prompted question in the triage questions  486 , the triage operator  110  can access the Question Rationale  488  section. The Question Rationale  488  section can help triage operators  110  understand the process and provide guidance for real world situations that do not fit neatly into tiered triage questions  486 . This section can also be helpful for triage operators  110  who are in training or who are using a new triage category or a triage category with which they are not familiar. 
   The Self-Care section  490  provides category-specific self-care instructions to the caller  105  and a brief explanation of the condition, including measures the caller  105  might take to prevent a similar medical condition in the future. For example, the self-care instructions for the upper extremity injury category shown in  FIG. 10  include: the administration of acetaminophen, aspirin, or ibuprofen; that the affected area be elevated; that ice and/or heat be applied to the affected area; and that work is modified to restrict lifting or forced grasp. This section  490  can include a list of symptoms that can develop and for which follow-up and reevaluation is necessary (i.e., “red flags”). For example, in the “bite wounds” triage category, any sign of infection or loss of sensation can suggest that the caller  105  should contact a medical provider immediately. The Self-Care section  490  can include general information about the category, discharge instruction, and a definition of all possible dispositions. This section can include both self-care as the ultimate treatment and interim self-care instructions which are applied in the time before a medical facility can be reached or other medical help arrives. 
   If the caller  105  asks questions about his condition, the triage operator  110  can choose to answer the questions using his or her own knowledge. In some cases, the triage operator  110  can find it helpful to refer to a Frequently Asked Questions section  492  of the triage category for a brief explanation of the medical condition and answers to common concerns. For example, those being triaged for animal bite wounds often ask if HIV can be transmitted to them as a result; the answer provided in the Frequently Asked Questions section  492  is that animals do not transmit HIV. 
   The General Information section  494  can contain additional information about the condition or information not suited for the other sections. For example, hyperlinks to Internet sites, Local Area Network, or other data sources containing more detailed medical information can be put in this section. 
   Tiered Triage Questions 
   As stated before, the triage questions can be tiered. That is, there are groups of questions in each tier and the tiers are ranked by urgency level. For each tier there is a corresponding disposition that is appropriate for the urgency level of the tier. An exemplary format of the tiered triage questions is shown in  FIG. 9 . Tiers  500 ,  508 ,  514 ,  522  are shown in  FIG. 9 . In this example, the highest urgency tier is the Emergent-911 tier  500 . Each of the tiers can have a corresponding disposition  506 ,  514 ,  518 ,  526 , as shown in  FIG. 9 . An exemplary screen format for displaying the tiered triage questions and accepting answer inputs from the triage operator  110  is shown in  FIGS. 14D-F . 
   In the Emergent-911 tier  500 , for example, there can be at least one yes/no question. If any of the questions are answered “yes,” then the corresponding disposition for that caller  105  is the Emergent-911 disposition  506 . The Emergent-911 disposition  506  can include instructions for immediate referral to an ER by the local EMS, and, like some of the other dispositions, can include condition-specific interim care instructions. The Emergent-911 disposition  506  can be modified to include other instructions. The Emergent-911 tier  500  can be designed so that it can select those callers  105  who need quick transport, severe pain relief and/or special emergency medical services, such as cardiac monitoring and defibrillation capability. Emergent-911 is typically the highest urgency disposition. Interim care instructions can be provided for all categories when triaging results in an Emergent-911 disposition  506 , Emergent disposition  514 , Urgent disposition  518  or Non-Urgent disposition  526 . 
   If all of the questions of the Emergent-911 tier are answered “no,” then the triage operator  110  moves to the Emergent tier  508 . In the Emergent tier  508 , there can also be a number of questions, for which any “yes” answer results in the corresponding Emergent disposition  514 . An Emergent disposition  514  can indicate that there should be an immediate referral to a medical provider, but not by an EMS. However, if all of the questions in the Emergent tier are answered “no,” then the triage operator  110  can move down to the Urgent tier  514 . 
   If any of the Urgent tier  514  questions are answered “yes,” then the Urgent disposition  518  is warranted. An Urgent disposition  518  can require a referral to a medical provider on the day of the complaint or within 24 hours. If all of the answers to the Urgent tier questions are “no,” then the triage operator  110  should move to the Non-Urgent tier  522 . Any “yes” answers to any of the Non-Urgent tier  522  questions should result in the selection of the Non-Urgent disposition  526 , which can require a referral to a medical provider within three days of the complaint. 
   In the example shown in  FIG. 9 , if there is a “yes” answer for an Urgent tier question, all remaining questions can still be asked of the caller  105 , including those in the Non-Urgent  522  or Self-Care tiers. This can be in contrast to a “yes” answer for an Emergent tier  508  or Emergent-911 tier  500  question, for which the entire triage process can be halted, and the disposition immediately implemented. The cut-off point in the triage process in which a disposition is selected but questions of a lesser urgency are still asked can be set at any particular tier. 
   The self-care disposition  534  can be automatically selected ( 530 ) if all of the answers to the preceding triage questions are “no.” Thus, no tiered triage questions are shown in this particular example, and the self-care disposition functions as a catch-all for those who do not fit in the other tiers. Alternatively, there may be triage questions in a self-care tier in order to assist in customizing the self-care instructions for the caller&#39;s condition, or if there is a lower urgency tier, among other reasons. This Self-Care disposition  534  can require self-care that is distinguishable from interim self-care, discussed above. If there is an on-site triage operator  110 , such as a nurse, this nurse can help implement the Self-Care disposition. 
   As shown in  FIG. 9 , the triage questions from higher urgency tiers can be asked before those of lower urgency. Within the “abdominal pain” category, for example, the question about shortness of breath is in the Emergent-911 tier and precedes the question about blood in the urine which is in the Emergent tier. There can be any number of questions in each tier. Whether a “yes” or “no” answer is provided, the triage operator  110  can record comments made by the caller  105  or the triage operator&#39;s observations or thoughts. In some situations, the triage questions can be answered by the triage operator  110  instead of the caller  105 . 
   For consistency, the triage system can be designed, as shown in  FIG. 9 , so that any “yes” answer to a question within a specific tier (typically indicating the presence of particular symptoms) results in the selection of the disposition that corresponds to that tier. This ensures consistency and prevents error. The software can present the triage questions as a list, grouped according to tier, and each having yes and no buttons. The selection of a “yes” answer using a button or drop-down menu could immediately bring up a frame that contains the disposition information. However, it is not necessary to require “yes” answers for selecting a disposition; “no” answers and combinations of “yes” and “no” answers can result in the selection of a particular disposition. Similarly, qualitative or quantitative information given by the caller  105  can result in one of the possible dispositions, such as with the quantification tool described below. Any question that does not lead to a disposition can be excluded from any of the triage questions. 
   The questions can be symptom-based. That is, the questions can relate to what the caller  105  can sense. This can allow a quicker and more consistent disposition of the caller  105  because it does not require an attempt at quantification or objectivity. This can also be a requirement for selection of suitable triage questions. However, quantified details of the actual incident, if there was one, can also be used to determine a suitable disposition. The questions can also be history-based, that is, addressing family history (e.g., family history of heart disease), social history (e.g., whether or not the caller  105  ever smoked) and past history (e.g., whether the caller  105  has a history of heart disease). 
   One aspect of the triage system can include its flexibility. It can be beneficial to allow the triage operator  110  to revisit any of the questions to review the answers or associated comments. The triage operator  110  also has the ability to navigate between unanswered triage question groups within the same tier. Using a “Triage Navigator” screen, the triage operator  110  can jump directly to specific categories or specific tiers within the triage questions. The Triage Navigator can take the form of a drop-down list, or a pop-up window with links to the other categories, as shown in  FIG. 14D . The system can also utilize the responses to questions in other triage categories if the same question appears again later in another triage category. The system can also determine and consider the variation in responses to the same or similar questions that are asked more than once during the triage process and, for example, alert the triage operator  110  to that fact. 
     FIG. 10  shows an exemplary triage category  480  for triaging upper extremity injuries including a set of triage questions. The elements of the category  480  can be displayed as shown, or elements or portions thereof can be presented by computer frames automatically or on command. The category  480  includes supporting information such as Critical Considerations  482  in addition to the tiered triage questions  486 . The tiered triage questions  486  are set up similarly to those in  FIG. 9 , in that any “yes” answer indicates the presence of a symptom and leads to the selection of a corresponding disposition. There are four question tiers  500 ,  508 ,  514 ,  522  shown in  FIG. 10 . No questions are associated with the Self-Care disposition  534 . 
   The triage questions  486  and categories  480  can be drafted and organized so that they satisfy a particular set of rules or so that they have a particular set of characteristics, including those rules and characteristics discussed above. Having the triage questions  486  and/or categories  480  standardized in this way throughout the triage system can help streamline the triage process and make the triage process more predictable and/or consistent for the triage operator  110  and the caller  105 , thereby helping to ensure consistent results. 
   In an example of a set of rules, reflected in the triage category  480  of  FIG. 10 , the triage questions  486  and/or categories are symptom-based. The triage questions  486  are organized according to urgency. Applying the triage questions  486  results in one of five dispositions: Emergent-911, Emergent, Urgent, Non-Urgent or Self-Care, corresponding to each of the tiers  500 ,  508 ,  514 ,  522 ,  490 . Emergent-911 referrals may be based on a caller&#39;s need for speed of transport by an EMS, pain relief and/or special emergency medical services, such as cardiac monitoring and defibrillation capability. Emergent referrals are immediate referrals to a medical provider when the user does not need the specialized services of EMS, but requires an immediate evaluation. An urgent referral is a referral to a medical provider within about two days of the disposition being selected. A Non-Urgent referral is a referral to a medical provider within several days of the disposition being selected. A Self-Care disposition includes providing self-care instructions to the caller  105  so that he can care for his illness or injury. Additional dispositions can be “interim self-care” which relates to providing information before an eventual visit to a medical provider and “report only” which can be appropriate when there is no need for any level of medical care but the call is still reported. These dispositions are discussed further with reference to  FIG. 9 . 
   Further describing an exemplary set of rules, the questions are answered “yes” or “no” and can be answered by the triage operator  110 , and are not necessarily the answers given by the caller  105 . Any questions that are not yes/no questions can be eliminated from the set of tiered triage questions. The rule set can require that “yes” answers always result in the selection of the corresponding disposition. The questions  486  are tiered such that the first group of questions leads to an Emergent-911 disposition, the second group of questions leads to an Emergent disposition, and so on. For example, the question about significant gross deformity, which, if positive, leads to an Emergent-911 disposition, precedes the question about swelling over joints, which, if positive, leads to an Emergent disposition. One of the dispositions is selected when all of the triage questions  486  are asked. Triage questions  486  that do not add to the disposition are not included in the category  480 . A clinical frame  484  can be requested via a prompt, as described above, which can include information related to the time, place and mechanism of injury. 
   Multiple Relevant Triage Categories 
   Often, for a given inquiry, more than one category can apply. When dealing with multiple categories, the software can facilitate the presentation of all relevant categories on-screen, including the tiered triage questions and supporting information. Additionally, the software can prompt for answers to the highest urgency questions from all of the relevant categories before prompting for answers to the questions that are of a lower urgency. For example, a user can call with symptoms that, following a brief consultation, are categorized as “abdominal pain without injury” and “chest pain without injury.” The software would ensure that all of the questions that result in an “Emergent-911” disposition from both the “abdominal pain without injury” and “chest pain without injury” categories are answered before moving on to the questions that result in an Emergent disposition. Although it could be possible to ask all of the abdominal pain questions before moving on to the chest pain questions, this may cause an unnecessary delay of a 911 call or other action if the subsequent triage of the chest pain resulted in a higher urgency disposition. 
   One way of applying two sets of triage questions simultaneously is presented in  FIG. 11A . This is termed a zigzag-type alternation. In the zigzag-type alternation, the questions in the Emergent-911 tier  544  from a first category  522  are asked, then the Emergent-911 questions  566  from the second category  522  are asked. Thereafter, the questioning returns to the first category  550 , and the process is repeated at the next tier, as shown in  FIG. 11A . Any “yes” answers for the Category 1 triage questions  550  can result in a selection of a corresponding disposition. Likewise, any “yes” answers, for the Category 2 triage questions  552  can result in a selection of a corresponding disposition. If “no” answers are given to all questions in the Emergent-911 and Emergent tiers, then the questions of the remaining tiers  576 ,  580 ,  588 ,  590 ,  592 ,  594  in both categories can be asked, without terminating the triage process at the first “yes” answer. 
     FIG. 11B  shows a step-type alternation for applying two sets of triage questions simultaneously. In  FIG. 11B , the Emergent-911 questions are asked from a first triage category  550 ; then the Emergent-911 questions are asked from the second category  552 . Instead of switching back to the first category  550 , the triage operator  110  then asks the Emergent question  568  from the second category  552 . Any “yes” answer for the Category 1 triage questions  550  can result in a selection of a corresponding disposition. Likewise, any “yes” answer for the Category 2 triage questions  552  can result in a selection of a corresponding disposition. If “no” answers are given to all questions in the Emergent-911 and Emergent tiers, then the questions of the remaining tiers  576 ,  580 ,  588 ,  590 ,  592 ,  594  in both categories can be asked, without terminating the triage process at the first “yes” answer. 
   The zigzag-type alternation depicted in  FIG. 11A  can be better for asking triage questions of two different categories when it is established that one of the categories is more important of the two. However, the scheme illustrated in  FIG. 11B  can be superior in some cases because there is less switching between different subject matters, thereby streamlining the flow of the conversation and minimizing the potential for either the caller  105  or triage operator  110  to become confused. However, regardless of the type of alternation scheme applied, the triage operator  110  can decide which category to apply first; this ordering can be more important in situations where there are more than two relevant categories and when the triage operator  110  suspects that a particular category or categories are more likely to yield a more urgent disposition. 
   In the course of conducting a triage, a triage operator  110  can determine that an additional triage category is warranted. It is not uncommon to discover information about the injury and its cause that leads the triage operator  110  to suspect additional, perhaps more severe, injuries. If the triage operator  110  determines that an additional category is relevant, the software allows him or her to apply the triage questions of that category at any time in the triage process. 
   For example, a triage for a “laceration” can reveal that the laceration extended into the eye. Thus, the “eye injury” category may need to be triaged along with the original laceration. Being able to immediately add the additional triage categories increases the likelihood that a more urgent disposition can be found sooner. Furthermore, the higher-priority questions of the after-added category can be posed to the caller  105  first before alternating between the two categories as shown in  FIGS. 11A and 11B . 
   An example of a scheme for asking questions of after-added triage categories is shown in  FIG. 12 . As shown, the Emergent-911 ( 554 ) and Emergent questions  564  were asked of Category 1 ( 550 ), and “no” answers were offered to all of the yes/no questions in those two tiers. Then in the midst of the questions of the Urgent tier  576 , it was discovered that a second category applies, so the triage operator  110  can immediately skip  654  to the Emergent-911 ( 556 ) questions of that new category, Category 2 ( 552 ). If all of the questions of the Emergent-911 tier  556  are “no” then the triage operator  110  continues to the Emergent tier questions  568 . Again, if all of the answers are “no,” the Urgent tier  580  questions can then be asked. At this point, if the Urgent tier  580  questions of Category 2 are all “no”, then the triage operator  110  can continue with whatever Urgent tier  576  questions of Category 1 ( 550 ) have not been answered. If the answers to the Urgent tier  576  questions are “no,” then the triage operator  110  can alternate between the remaining triage tiers  588 ,  590 ,  592 ,  594 , as shown above. This can help ensure that any of the more urgent dispositions can be identified first before alternating between the lower-urgency tiers. 
   Record-Keeping, Reporting and Data Mining 
   The triage system can collect and store caller  105  data, including all data acquired during the triage process. The data is stored so that it can be selectively accessed for the purposes of record-keeping, reporting and data mining. Standard software reporting tools, such as BUSINESSOBJECTS 6.5 or subsequent versions (BusinessObjects, San Jose, Calif.), or the MedfilesMOL™ application described above can be used to access data that conforms to any of a variety of parameters, including dates, locations, individuals, company, corporate divisions, job type, age, etc. The record-keeping and reporting procedures can be customized to meet a client&#39;s specific needs, including by having reports tailored to particular state and/or industry requirements. 
   For example, the MedfilesMOL™ application can assist in Occupational Safety &amp; Health Administration—(“OSHA”) and state-mandated record-keeping. This can include generating First Report of Injury and OSHA log updates. The application can identify recordable incidents by comparing injury type and treatments to OSHA&#39;s recording criteria. The MedfilesMOL™ application then tracks recordable cases and automatically updates the OSHA log. The client can be given partial access to a database so that a current OSHA log can be printed or viewed at any time, and, at year end, the OSHA-A summary can be generated. 
   The triage system can also improve the client&#39;s claim process system by providing more timely, accurate, complete and consistent reporting of injury incidents. The system can also collect and manage information with which to investigate and/or challenge, defend against, or settle such a claim. 
   Details about particular calls can be kept on file at the triage center  108  or elsewhere for auditing purposes. The triage software can automatically generate short narrative reports about each call or caller  105 ; these can be based on a pre-formatted report template. Reports, including narrative reports, can be automatically faxed, emailed, or otherwise communicated to the client or any interested division or entity listed above. 
   Users  210  can analyze the data to create reports, study injury trends, identify hazards, and compare one facility or department with another or with industry benchmarks, pre-determined goals, or projected outcomes. The data gathered can also contribute to the maintenance of complete and accurate company records, accessible to authorized company personnel and/or others. Other reports can be automatically generated and sent to a company&#39;s safety officer, risk manager and/or insurance carrier to trigger accident investigation and preventive measures. The database of the system can be securely accessible to designated client managers via the Internet or other means so that the client can have access to these reports and other reporting options on demand. An exemplary computer screen format for accomplishing these reporting functions is shown in  FIG. 14O . 
   Allowing the compilation and analysis of injury statistics can be helpful in situations where it is suspected that a small percentage of employees of a client can account for a large or disproportionate percentage of injury claims and costs. Users  210  can monitor particular callers  105  who use the triage system at higher rates and/or are more accident-prone. For example, the triage system can be designed to notify a user  210  when a certain caller  105  has reached a predetermined threshold for use of the triage system or injury rate. 
   The user  210  can mine the existing injury data to discover injury patterns or safety issues, including locations, job tasks, supervisors, or other criteria that may contribute to injuries. The system also allows users  210  to set injury threshold rates or other parameters for automatic notification via the system. The parameters can include a date range, site (e.g., “Store 315”), location (e.g., the loading dock), city and state, call type, caller gender, triage category applied, triage disposition, referral and/or treatment. 
   The user  210  can analyze the data to identify preventive measures, improve work safety rules and monitor compliance with work safety rules. For example, user  210  can assess whether any required safety equipment has an overall health or cost benefit. If the data reveal that wearing back-belts has no effect on back injury rates or costs over time, then client organizations can abandon the belts in favor of other preventative measures. Similarly, a manager can measure the rate of compliance with the safety measures. Customizing and automating this process can further help loss-prevention. The client can also monitor the performance of and cost-savings of the client&#39;s injury management service and the triage system itself. 
   The triage-related data can also be routinely mined to test the effectiveness of and fine-tune the instructions or other information dispensed by the triage operator  110 . Various statistical methods can help pinpoint potential areas for improvement. This can help ensure optimal, evidence-based care. For example, if the follow-up for all callers  105  assigned to the Urgent disposition show unfavorable aggregate outcomes, the Emergent tier questions could be edited so that the Emergent tier captures a greater proportion of callers  105  or so that the questions better select those for whom that disposition is most appropriate. Triage questions and supporting information can be modified, supplemented or removed. Such undesirable outcomes can include both adverse health-related results of the applied disposition (e.g., when care is inadequate) and also when a level of care is excessive, resulting in unneeded expenditures. Alternatively, for example, the Urgent disposition could be modified, setting a smaller window of time in which to see a medical providers. 
   A threshold level of undesirable aggregate triage outcomes can be set. When the threshold level is exceeded, a user  210  can be alerted to modify the triage system to reduce the level of undesirable aggregate triage outcomes. Following any changes, the triage-related data can be again analyzed to determine the efficacy of any modification that was made to the system. 
   Additional Features of the Triage System 
   The triage system can be adapted to a client&#39;s specifications. The triage inquiry can be tailored to individual divisions, location of the incident, or job type. Likewise, the triage system can be specially configured for a particular U.S. state, call type, patient gender, category, disposition, referral, impression, and/or treatment. To accomplish this, the system can include, exclude or modify certain triage questions provided to the caller  105  or triage operator  110 . Supporting information can also be included, excluded or modified. The particular client variations are identified and accessed as the caller  105  is identified. These variations can also be keyed to the place or business from which the caller  105  is calling. The triage system can, for example, suppress any data from being collected. 
   In a triage center, there can be triage operators answering the telephones and performing triage, and, in addition, a manager who monitors the center. An additional feature of the triage system can be a “Flag Review” button, which allows the triage operator  110  to flag a call for review by a manager. The “Flag Review” button can be used to identify a problem with the caller  105  or the way the triage category functions during the call. It can be used for immediate assistance, or for identifying possible areas for long-term improvements. 
   The triage system can allow for different types of system overrides. One kind of override is the 911 Override, which allows the triage operator  110  to immediately bypass the remaining triage process and call 911 or direct the caller  105  or the caller&#39;s supervisor to call 911. If the triage operator  110  feels the caller&#39;s condition has become dangerous and requires EMS dispatch, clicking this button by-passes triage and expedites the 911 referral. The 911 Override can be employed at any time in the triage process. The 911 Override can be accessed by a single button that is always present on the computer screen. The user can see a pop-up screen requesting entry of a caller&#39;s name, and a call-back telephone number. 
   Another kind of override, Triage Operator Override (“TO Override”), allows a triage operator  110  the ability to immediately bypass the remaining triaging of a caller. This TO Override feature also allows the triage operator  110  to automatically navigate to the Provider Search (Referral) screen at any point during the call flow. This allows the triage operator  110  to use his own discretion and professional judgment to, if desired, substitute a disposition that he feels is more prudent than that provided by the triage system. While a computerized triage system provides a valuable framework for triage, it is recognized that the software cannot anticipate the infinite number of variables and situations that a triage operator  110  can face. The TO Override feature helps the triage operator  110  address a situation in which he believes there is a more logical, safe or appropriate response than what the software has indicated. TO Override can also be used when, for example, the triage disposition is Self-Care, but the caller  105  insists on a referral. Selection of the TO Override feature can prompt the display of the Provider Search (i.e., Referral) screen. 
   A system override can prompt the triage operator  110  to provide the reason for the override and flag the call for manager review. The reason for the override can be indicated in an electronic record linked to the call record, but can be excluded from reports to the client organizations or government agencies, consistent with applicable laws and agreements with clients. 
   With some conditions, it can be important to obtain from the caller  105  quantitative details about the symptoms or cause of the ailment. Quantification tools supported by the software can be used by the triage operator  110  to quantify symptoms. Quantification tools can deal with the extent of bleeding, the amount of pain, shortness of breath, extent of burns, time of a possible rabies-infecting bite, and tetanus status. A quantification tool can, for example, help the triage operator  110  decide if bleeding can be considered “severe” bleeding.  FIG. 13  shows an exemplary quantification tool  597  for determining whether a wound is deep or not. The triage operator  110  can ask some of the questions  598  within the quantification tool  597  and thereby choose the proper yes/no conclusion  598  about the wound depth. An icon can appear to the left of any triage question involving one of these symptom patterns, and can open a document with quantifying information to aid in answering the accompanying question. The information can assist in the selection of triage categories or selection of a disposition within a triage category. The quantification tools also provide standardization between the triage operators so triage results are consistent. 
   The time elapsed between an injury and the time the injured person contacts the triage operator  110  can be a factor in the triage analysis. For example, if a caller  105  is concerned about the possibility of a broken bone, a call immediately after the incident may not reveal some of the more important symptoms—whether there is swelling or bruising, for example. Therefore, the system can alert the triage operator  110  to the elapsed time and its relevance, modify questions based on the elapsed time (including eliminating questions that would not have relevance at a particular time and/or automatically adding others), have questions automatically answered in certain ways based on the time elapsed and indicate whether it is important for the caller  105  to follow-up at a later time. The elapsed time can otherwise be used to determine a disposition, such as, for example, when the incident was so long ago that nothing more than self-care is needed. The system can also make note of what time the event occurred in the caller&#39;s time zone, which will then be adjusted for a correct calculation of the elapsed time. This information can become part of the recorded triage-related data and stored in the database with the answers to the triage questions. 
   Screen Formats and Selection Modalities 
     FIGS. 14A-P  show various exemplary computer screen formats and selection modalities that can be used to help implement the triage system on a computer. 
     FIG. 14A  shows a screen  600  that enables the identification of the caller  105  so that the triage-related data, including any information related to triage outcomes, can be associated with his demographic or personal information and so that client preferences can be applied to the call. When the triage operator  110  answers the call from the caller  105 , the triage operator  110  can select the “Start Call” button  602 , which can time-stamp the phone call and enable the triage system to be implemented. A menu bar  605  allows for selection of various actions and parameters, including exiting the program and changing program options. 
   As described above, the triage system car be implemented for a corporate client. Thus, the caller  105 , if he is an employee, can be asked to identify the company for which he works, including the particular site, or where he is located. The company can be selected using a combo-box field  606 , and the site can be selected using another combo-box field  610 . As an alternative, search fields can be filled out, such as company  608 , zip code  602 , state  609 , city  614 , address  616  and phone number  618 . Once selected fields are entered, the “Search” button  611  can be selected to generate a list of matching companies  622  in the company field  620 . If one of the matching companies  622  is the correct one, it can be selected by double-clicking or other selection method. 
   The caller  105  can be asked if he is already in the database; if he is, the “Existing Person Call” button  604  is selected and the information about the caller  105  is accessed. Any number of search fields can be filled out to search for the relevant demographic data, including last name  624 , first name  626 , social security number  630 , type of employee  632 , gender  634 , birth date  636 , and job status  638 . The entire database can be searched by checking the appropriate box  627 , or the search can be restricted to a particular company by checking a different box  625 . Once one or more fields are entered, the triage operator  110  can select the “Search” button  639 , which brings the various matching identities into the person field  640 , where the corresponding identity can be selected. 
   As shown in  FIG. 14B , if the caller  105  is not in the system, the “New Person Call” button  644  is selected, and, as a result, the “Create Person” dialog box appears, having text fields  652  and combo-box fields  653 , for entering demographic information such as birth date, social security number, gender, etc. Once all of the information is entered, the information can be saved by selecting the “Save” button  654 , at which point the “Create Person” dialog box  651  disappears. 
   By selecting the “Close” button  645 , the next screen  650  appears, in which the relevant triage categories can be selected, as shown in  FIG. 14C . While the text box  662  can be used for any relevant information, it can also be used to enter the answers that the caller  105  provides for the introductory questions regarding the context or mechanism of injury, which can be a first step in the selection of the relevant triage category. The initial questioning can also help determine if the call is an injury, follow-up or report-only call, which can be selected using the radio buttons  663 . Toward the beginning of the call, the triage operator  110  can request the age of the caller  105 . If a birthday entered in the age box  664  indicates that the caller  105  is a minor, then the triage operator  110  can select one of the legal consent categories  668  described above in order to proceed. The system can prevent the triage operator  110  from proceeding if there is no indication of consent, although this feature can be disabled. An information bar  661  is visible throughout the call, indicating the name of the caller  105 , as well as the name and location of the company for which the caller  105  works, the reference number for the call and the call type. 
   The triage categories can be selected in category selection box  670  of  FIG. 14C  from the list of categories  678 . To apply the chosen category, the applicable information is selected using combo-boxes corresponding to body parts  672 , body part location  1  ( 674 ) and body part location  2  ( 676 ). The body part location combo-boxes include such descriptors as dorsal, lateral, anterior, posterior, left, right, etc. Once these have been selected, the “Add” button  680  is selected, which saves the selected combination in the relevant triage category list  682 . This process can be repeated using different categories and/or different body parts until there are no more relevant categories for the caller&#39;s particular condition. Using the arrows  684 , a plurality of categories can be ordered in terms of importance or other criteria. Selected categories can also be removed using the “Remove” button  686 . Also, the “911-Override” button  690  and the “Triage Operator Override” button  692  can be selected throughout the triage process. Once the selection process is finished, the triage operator  110  can select the “Continue” button  688  to move to the screen of  FIG. 14D . 
   The screen  700  of  FIG. 14D  starts the triage questioning based on the categories selected in the previous screen  650 . The triage questioning starts with the questions in the highest urgency tier of the highest priority category, which are identified by the question identification  712  bar. The Triage Navigator  714  shows which tier of questions is currently being asked  716  and which tier of questions is next  718 , based on the tier list  715 . When asking the triage questions, the triage operator  110  can access the quantification tool  708  which displays a methodology for quantifying certain symptoms. The triage operator  110  can also select the button  710  to open a text box that allows the entry of additional information acquired from the caller  105  in the course of answering a particular question. 
   As stated above, the Critical Considerations section can be accessed throughout the triage process. In the screen shown in  FIG. 14E , this section can be selected using the “Critical Considerations” button  722 , which opens a window containing the relevant information. Some additional features that can be available through the triage process are the “Change Call Type” button  730  (for alternating between a follow-up call, new call and report-only call), the “D/C” button  726  (for accessing self-care instructions and FAQs), the “Triage Navigator” button  724 , the “General Information” button  729  and the “Flag Review” button  728 , which are all discussed above. Furthermore, there are buttons for accessing a prior call menu  731 , accessing a list of outgoing follow-up calls to be made  733 , printing the screen  735 , closing all screens  737  and exiting the program  739 . The “Protocol Management” (i.e., Category Selection) button  741  allows the triage operator  110  to return to the screen  650  shown in  FIG. 14C  to select additional categories or to change categories. 
   The triage screen  700  of  FIG. 14F  shows multiple triage categories being applied. In particular,  FIG. 14F  shows Open Wounds  740  and Frostbite  742 , as indicated in the Triage Navigator  744 . The Triage Navigator can be used to view any of the completed or active tiers in any of the selected categories. Because one of the questions has been given a “yes” answer  734 , the Disposition box  738  shows the selected disposition and the Triage Navigator  744  shows that the caller  105  has been referred  748 . Because the disposition is Emergent, the triage status box  736  shows that the triage process has been completed; if, however, the selected disposition was of a less urgent nature, the protocol status box  736  may not show that the triage process has been completed until all of the triage questions in all tiers have been asked, as described above. The “Continue” button  749  can be selected to move to the next screen. 
   The screen  800 , shown in  FIG. 14G , allows the triage operator  110  to find an appropriate medical provider, and offers a number of different search modes. For example, the search can be restricted to designated medical facilities, client specifications, or can be expanded to all providers using a number of radio buttons  804 . Alternatively, any number of fields  802  can be filled to search the provider database. The results of the search show up in a list  806 . Details about the medical provider can be obtained by selecting the “Open Prov” button  814  which opens a text window. The “Referrals List” button  816  can be selected to obtain the referrals for a particular medical provider. Directions to a provider can be obtained by selecting the “Get Directions” button  812 , which can access a map or directions from any appropriate service or software, such as MAPQUEST.COM. If a medical provider is not in the database, the medical provider can be entered by selecting the “New Provider” button  808  and entering the new provider fields  810 . 
   Once a medical provider has been selected, the “Refer” button  830  is selected, which opens the caller referral window  832 , shown in  FIG. 14H . The caller referral window  832  summarizes the referral by providing the date of referral  836  and other information. A button  840  can also allow a map to the medical provider to be generated. A number of details about the nature of the referral can be selected; these are indicated as Exceptions  834  to an ordinary call, and include such details as whether there was a self-referral by the caller  105 , whether the caller  105  requested an appointment, refused a recommendation, etc. The Exceptions  834  also allows the referral information to be printed on the medical report. 
   Once the “Save” button  838  is selected, the information is saved in a record  842 , and the triage operator  110  can select the “Continue” button  844  to move to the next screen  850 , shown in  FIG. 14J . Further demographic information can be acquired, such as personal information  852 , home address  854  and employment data  856 . The “Continue” button  858  can be selected to move to the next screen  900 , shown in  FIG. 14K . 
   When a particular call is selected from the call list  901 , a summary of that call is displayed in the various fields of a screen  900  shown in  FIG. 14K . When the “Open” button  903  is selected, a narrative description  902  of the call is generated and displayed, as shown in  FIG. 14L . The narrative description can be closed using the “Close” button  904 , and the next screen  950  can be accessed using the “Continue” button  906 . 
   The screen  950  shown in  FIG. 14M  allows additional demographic information to be entered, including a Workers&#39; Compensation Claim Number  952 , family information  954 , employment information  956 , and contextual information relating to the incident itself, including the task performed at the time of incident  958 , the objects or substances involved  960 , the details about the occurrence of the injury  962 , and the supervisor&#39;s name  964 . After this information is input, the next screen  970 , shown in  FIG. 14N , permits the recording of information specific to the employer of the caller  105 , such as compliance with particular safety procedures  972 . Some of these special requirements can be printed, and if printed, will show up in a text box  974 . Additional text  976  can alert the triage operator  110  to any other details particular to the caller&#39;s employer. When this information is entered, the “Continue” button  978  is selected to access the next screen  990 . 
   The next screen  990 , shown in  FIG. 14O , displays the details of the automated communications  991  that will be sent on command, including the destination, the report name, the recipient, and the output format. The list of communications can be selected or deselected using check-boxes  992 . The method  993  of the communication can include e-mail and fax, but all other communication methods described above can be employed. Once the selections are made, the “Send” button  994  is selected. In  FIG. 14P , the final screen  995  is shown. The Call Complete  996  or Call Pending Information  997  boxes can be checked, after which the “Finish” button  998  is selected to complete the call. 
   While various embodiments of the triage system have been described, it will be apparent to those of ordinary skill in the art that many more embodiments and implementations are possible within the scope of the triage system. Accordingly, the triage system is not to be restricted except in light of the attached claims and their equivalents.