Patent Publication Number: US-2023138188-A1

Title: Secure computer-based pre-operative assessment

Description:
CROSS-REFERENCE TO RELATED APPLICATION 
     This application claims the benefit of and priority to U.S. Provisional Patent Application No. 63/275,275, filed Nov. 3, 2021, the content of which application is hereby incorporated by reference herein in its entirety. 
    
    
     BACKGROUND 
     The pre-operative assessment is a process that can identify comorbidities that may lead to patient complications during the anesthetic, surgical, and/or post-operative period. Patients scheduled for elective procedures can attend a pre-operative assessment before the date of their surgery. It is time consuming for patient&#39;s clinical staff and requires an additional visit to the hospital. 
     Although it is advisable for some patients to meet with an anesthesiologist pre-operative, it is not a necessary step for a significant portion of patients undergoing procedures. Screening patients that may require more hands-on approach can enhance delivery of quality and timely care. 
     SUMMARY 
     It is to be understood that both the following general description and the following detailed description are illustrative and explanatory only and are not restrictive. 
     Embodiments of this disclosure include computing system, computing devices, computer-implemented methods, and computer-program products that, individually or in combination, provide a secure computer-based pre-operative assessment. More specifically, yet not exclusively, embodiments of this disclosure include a secure software application that can allow authentication of a patient using an authentication service. After being authenticated the patient can be presented with a pre-operative survey that can include YES/NO questions and/or other queries. The assessment data can be retained in a secure storage and can be managed by a server device (such as a web server) in compliance with Health Insurance Portability and Accountability Act (HIPAA). Components of the secure software application can supply visual and/or aural representations of assessment data to client devices used by clinical staff. 
     Although embodiments of this disclosure are described in connection with pre-operative phase of surgical procedures, the disclosure is not limited in that respects. Indeed, the principles and practical applications of this disclosure can be directed to any preliminary phases of an event that can benefit from screening of participants. That event can be a sports event, an academic event (such as application of a standardized test), a chartered travel event, or similar. 
     Additional elements or advantages of this disclosure will be set forth in part in the description which follows, and in part will be apparent from the description, or may be learned by practice of the subject disclosure. The advantages of the subject disclosure can be attained by means of the elements and combinations particularly pointed out in the appended claims. 
     This summary is not intended to identify critical or essential features of the disclosure, but merely to summarize certain features and variations thereof. Other details and features will be described in the sections that follow. Further, both the foregoing general description and the following detailed description are illustrative and explanatory only and are not restrictive of the embodiments of this disclosure. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The annexed drawings are an integral part of the disclosure and are incorporated into the subject specification. The drawings illustrate example embodiments of the disclosure and, in conjunction with the description and claims, serve to explain at least in part various principles, elements, or aspects of the disclosure. Embodiments of the disclosure are described more fully below with reference to the annexed drawings. However, various elements of the disclosure can be implemented in many different forms and should not be construed as limited to the implementations set forth herein. Like numbers refer to like elements throughout. 
         FIG.  1 A  illustrates a non-limiting example of a computing system for a secure computer-based pre-operative assessment, in accordance with one or more embodiments of the disclosure. 
         FIG.  1 B  illustrates a non-limiting example of data flow for secure computer-based pre-operative assessment, in accordance with one or more embodiments of the disclosure. 
         FIG.  1 C  illustrates another non-limiting example of a computing system for a secure computer-based pre-operative assessment, in accordance with one or more embodiments of the disclosure. 
         FIG.  2 A  illustrates a non-limiting example of a user interface, in accordance with one or more embodiments of the disclosure. 
         FIG.  2 B  illustrates a non-limiting example of another user interface, in accordance with one or more embodiments of the disclosure. 
         FIG.  2 C  illustrates a non-limiting example of yet another user interface, in accordance with one or more embodiments of the disclosure. 
         FIG.  3 A  illustrates a non-limiting example of graphical user interface (GUI), in accordance with one or more embodiments of the disclosure. 
         FIG.  3 B  illustrates a non-limiting example of a sequence of user interface having textual elements, in accordance with one or more embodiments of the disclosure. 
         FIG.  4    illustrates a non-limiting example of a graphical representation of responses pertaining to a secure computer-based pre-operative assessment, in accordance with one or more embodiments of the disclosure. 
         FIG.  5    illustrates a non-limiting example of another graphical representation of responses pertaining to a secure computer-based pre-operative assessment, in accordance with one or more embodiments of the disclosure. 
         FIG.  6    illustrates a non-limiting example of a computing system for a secure computer-based pre-operative assessment in accordance with one or more embodiments of the disclosure. 
         FIG.  7    illustrates a non-limiting example of a method for a secure computer-based pre-operative assessment, in accordance with one or more embodiments of the disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     The disclosure recognizes and addresses the issue of evaluation of a subject scheduled for a surgical procedure or another type of event. As mentioned, embodiments of this disclosure include computing devices, computer-implemented methods, and computer-program products that, individually or in combination, can provide a secure computer-based pre-operative assessment. The embodiments of this disclosure are not limited to pre-operative assessments, and can be applied to other types of assessments, such as neuropsychological assessments. 
     Embodiments of this disclosure provide several advantages over existing technologies and protocols for pre-operative assessment. In a non-limiting example, embodiments of the disclosure can save time for patients and clinical staff alike, while allowing to flag issues with patients in a timely fashion. The time saving is several fold: (1) Obviates the need for a face-to-face appointment, freeing clinical staff to do other tasks; and (2) allows for increased operating room efficiency by reducing the risk for same day case cancellation. 
     With reference to the drawings,  FIG.  1 A  illustrates a non-limiting example of an computing system  100  for a secure computer-based pre-operative assessment, in accordance with one or more embodiments of the disclosure. The computing system  100  includes a client device  110  that can be operated by a subject  104 . The subject  104  can be a Veteran or another individual scheduled to undergo surgery at a future time, for example. The client device  110  can be embodied in, for example, a personal computer, a laptop computer, an electronic-reader (e-reader) device, a tablet computer, a smartphone, a smartwatch or similar device. Accordingly, the client device  110  can include computing resources (not shown) comprising, for example, central processing units (CPUs), graphics processing units (GPUs), tensor processing units (TPUs), memory, disk space, incoming bandwidth, and/or outgoing bandwidth, interface(s) (such as I/O interfaces or APIs, or both); controller devices(s); power supplies; a combination of the foregoing; and/or similar resources. The client device  110  can include, or can be functionally coupled to, a display device (not depicted in  FIG.  1 A ). 
     The client device  110  can be functionally coupled to a pre-operative assessment subsystem  130  by means of one or several networks  120  (wireline network(s), wireless network(s), or a combination thereof). The pre-operative assessment subsystem  130  can include a server application  124  that is retained in one or more memory devices  132 . The pre-operative assessment subsystem  130  can be embodied in, or can include, one or multiple server devices. The server application  134  can include software components that can be executed by one or more processors (not depicted in  FIG.  1 A ) integrated into the server device(s). In response to execution, the server application  134  can provide the various functionalities described herein. 
     The client device  110  can include a web browser or another type of client application (not depicted in  FIG.  1 A ) that permits accessing a uniform resource located (URL) corresponding to a webpage hosted by the server application  134 . Some of functionality provided by the server application  134  can be accessed via the webpage. Specifically, accessing that URL can cause the pre-operative assessment subsystem  130  to prompt the subject  104  to self-authenticate using an authentication service. The pre-operative assessment subsystem  130  can be subscribed to the authentication service. In some embodiments, such a service can be an enterprise-grade authentication service. The authentication service can be embodied in an Identity as a Service (IaaS) platform. Multiple authentication service devices  140  constitute, and provide, the authentication service. 
     To prompt the subject  104  to self-authenticate, the server application  134  can cause the client device  110  to present a sequence of user interfaces  114 . To that, the client device  110  can direct a display device integrated therein to present such a sequence. Some user interfaces in the sequence of user interfaces  114  can be presented in response to defined user-interaction with those user interfaces. More specifically, by navigating to the URL corresponding to the webpage hosted by the server application  134 , the client device  110  can direct the display device to present a first user interface of the sequence of user interfaces  114 . A non-limiting example of the first user interface is illustrated in the  FIG.  2 A . 
     That first user interface can include a selectable visual element (e.g., UI element  220  ( FIG.  2 A )) that, in response to being selected, causes the server application  134  to direct the client device  110  to the authentication service or a device of the authentication service devices  140 . That device can be an authentication server  144 , for example. As a result, that device can cause the client device  110  to present a second user interface in the sequence of user interfaces  114 . The second user interface can permit the client device  110  to receive input data defining a user identifier (ID). The user ID can correspond to the subject  104  and can be one or a combination of a username, a password, a generated data structure, or an access token. The client device  110  can send, via one or more of the networks  120 , the user ID to the device of the authentication service devices  140 . In response, in some embodiments, the authentication server  144  can cause the client device  110  to present a third user interface in the sequence of user interfaces  114 . That third user interface can permit accessing two-factor authentication functionality. A non-limiting example of the third user interface is illustrated in  FIG.  2 B . 
     At least one first device of the authentication service devices  140 , such as the authentication server  144 , can determine if the user ID satisfies one or multiple access rules. In cases where the two-factor authentication is enabled, the at least one first device or at least one second device of the authentication service devices  140  can validate two-factor data received from the client device  110 . In situations where the user ID fails to satisfy an access rule, the at least one first device of the authentication service devices  140 , such as the authentication server  144 , can cause the pre-operative assessment subsystem  130  to implement an exception process. It is noted that in some cases, the authentication server  144  can implement the exception process. 
     In the alternative, in situations where the user ID satisfies the access rule(s), the server application  134  can establish a communication session with the client device  110 . The authentication service can secure the communication session. The server application  134  also can cause the pre-operative assessment subsystem  130  to present a fourth user interface in the sequence of user interfaces  114 . The fourth user interface can prompt configuration of access to a suite of applications (not depicted in  FIG.  1 A ) that can be used via the client device  110 . A non-limiting example of the fourth user interface is illustrated in  FIG.  2 C . 
     In addition, or in other embodiments, when the user ID satisfies the access rule(s), the authentication server  144  and/or another device of the authentication service devices  140  can authenticate a user account of the subject  104  and can redirect the client device  110  to the pre-operative assessment subsystem  130 . 
       FIG.  1 B  schematically summarizes an example of data flow involved in authentication and access to a secure computer-based pre-operative assessment, as is described herein, in accordance with one or more embodiments of the disclosure. As is illustrated in  FIG.  1 B , as part of the data flow, the client device  110  can send a request for access to the server application  134 . In response to receiving the request, the server application  134  can redirect the client device  110  to the authentication server  144 , for example. The authentication server  144  can, in turn, redirect the client device  110  to a login page. The client device  110  can then provide credentials (e.g., username and password) to the authentication server  144 . In some cases, based on the credentials, the authentication server  144  can authenticate a user account pertaining to the subject  104 . The authentication server  144  can then redirect the client device  110  to the server application  134  after such an authentication. 
     As a result authenticating that user account, the pre-operative assessment subsystem  130  can cause the client device  110  to output of a graphical user interface (GUI)  118  configured to elicit one or multiple responses. For example, the GUI  118  can include one or multiple prompts (such as questions) represented by textual elements or visual elements, or a combination of both. Causing output of the GUI  118  can include causing presentation of the GUI  118  at the client device  110 . To cause presentation of the GUI  118  at the client device  110 , the pre-operative assessment subsystem  130  can cause the client device  110  to direct a display device to present the GUI  118 . The display device can be integrated into the client device  110  or functionally coupled thereto. At least one of the response(s) can be associated with a user condition. In some cases, the user condition can be one or a combination of a pre-operative condition, a post-operative condition, a mental health condition, a wellness state, or a disease state. 
     Accordingly, as part of a pre-operative protocol, the GUI  118  can be configured to elicit the one or multiples responses by presenting one or more questions (or, in some configurations, queries, or other types of prompts) associated with the user condition. Thus, the GUI  118  can include several UI elements (selectable and non-selectable, for example) and/or other digital content that conveys the question(s). Embodiments of this disclosure can be applied to many surgical procedures, so the content of the GUI  118  can be specific to a surgical procedure. In some embodiments, the GUI  118  can convey a questionnaire or another type of assessment associated with a forthcoming surgery, such as cataract surgery. The GUI  300  illustrated in  FIG.  3 A  is a non-limiting example of the GUI  118 . The client device  110  can receive input data from the subject  104  corresponding to the user ID that has been authenticated, the input data define the one or multiple responses elicited by the GUI  118 . 
     The disclosure is not limited to presenting questions (or, in some configurations, queries) in a GUI, such as the GUI  118 . In some embodiments, the pre-operative assessment subsystem  130  can implement a text bot, or another type of software module, that permit the exchange of information with the client device  110  by exchanging electronic messages. The electronic messages can be exchanged in response to executing program code that permits receiving and sending electronic messages. The program code can embody a component of the operating system (O/S) of the client device. Examples of electronic messages include short message service (SMS) messages, multimedia message service (MMS) messages, or iMessages. Implementation of the text bot, or that other software module, can cause a display device of the client device  110  to present a sequence of electronic messages that prompt respective responses. The sequence of electronic messages can embody the assessment associated with a foregoing surgery. The respective responses prompted by that sequence can be individually received at the client device  110 . In response, the client device  110  can convey to the pre-operative assessment subsystem  130  as response electronic messages. 
     Simply for purposes of illustration,  FIG.  3 B  presents examples of UIs including textual elements that embody a sequence of prompt electronic messages and another sequence of response electronic messages. Each one of those sequences can be presented in a display device  350  integrated into the client device  110 , for example. Prompt electronic messages and response electronic messages are presented alternatingly. Specifically, a UI  354 ( 1 ) can include a prompt electronic message  360  that presents a description of the purpose of the exchange of electronic messages and prompt for continuing the sequence of prompt electronic messages. The UI  354 ( 1 ) also includes a response electronic message  370  that can cause the sequence of prompt electronic messages to proceed. 
     The client device  110  can present, via the display device  350 , a UI  354 ( 2 ) in response to the response electronic message  370 . The UI  354 ( 2 ) includes a prompt electronic message  380 ( 1 ) conveying a question pertaining to a pre-operative assessment associated with a foregoing surgery. The client device  110  can receive input information defining a response electronic message  390 ( 1 ) conveying an answer to that question. The UI  354 ( 2 ) also includes the response electronic message  390 ( 1 ). The client device  110  can send data identifying the answer to the pre-operative assessment subsystem  130  ( FIG.  1 A ). 
     The sequence of prompt electronic messages can continue. To that end, the client device  110  can present, via the display device  350 , a UI  354 ( 3 ) in response to the response electronic message  390 ( 1 ). The UI  354 ( 3 ) can include a prompt electronic message  380 ( 2 ) conveying another question pertaining to the pre-operative assessment. The client device  110  can receive input information defining a response electronic message  390 ( 2 ) conveying an answer to that question. The UI  354 ( 2 ) also includes the response electronic message  390 ( 2 ). The client device  110  can send data identifying the answer to the pre-operative assessment subsystem  130  ( FIG.  1 A ). 
     Sequences of alternating prompt electronic messages and response electronic messages can continue. A terminal portion of those sequences is depicted as electronic messages  394 . The sequences can be presented until the display device presents a UI  354 (N) that includes a prompt electronic message  380 (N) conveying a terminal question pertaining to the pre-operative assessment. That is the pre-operative assessment can have N questions. The client device  110  can receive input information defining a response electronic message  390 (N) conveying a terminal answer to the terminal question. The UI  354 (N) also includes the response electronic message  390 (N). The client device  110  can send data identifying the answer to the pre-operative assessment subsystem  130  ( FIG.  1 A ). The client device  110 , via the display device  350 , can present a closing message  398  within the UI  354 (N). 
     Regardless of the manner of collecting the one or multiple responses, the server application  134  can receive, via at least one of the network(s)  120 , input data defining the one or multiple responses. The input data can be received in separate transmissions or in a single transmission. In response, the server application  134  can retain the received input data in a secure HIPAA compliant database  136  (referred to as assessment data  136 ) managed by a secure server device (not depicted) included in the pre-operative assessment subsystem  130 . The server application  134  can supply the input data to one or multiple other applications in several formats, including, for example, industry standards for clinical data transfer. Such standards can include, for example, Fast Health Interoperability Resource (FHIR) and JavaScript Object Notation (JSON). The subject  104  also can be logged out and the session information can be eliminated. In further response, the server application  134  can cause the pre-operative assessment subsystem  130  to associate the one or multiple responses with the user ID. The pre-operative assessment subsystem  130  can associate the one or multiple responses with the user ID by at least generating a data structure including a representation (e.g., a data record or metadata) of each response of the one or multiple responses and a key value corresponding to the user ID. The representation of each response of the one or multiple responses can be embodied in, or can include, an encoded value. The key value can be a numerical value or an alphanumerical code. 
     The server application  134  also can cause the pre-operative assessment subsystem  130  to generate, using the one or multiple responses, a visual representation, an aural representation, and/or a somatosensory representation. Those representations, individually or in combination, can be indicative of the user condition. A non-limiting example of the somatosensory representation is a haptic representation that can cause a device (a user device or a client device, for example) to convey the user condition by means of motion or the application of pressure. The visual representation can include graphical elements (a still image or an animation, for example) or textual elements, or a combination of graphical elements and textual elements. In some embodiments, the pre-operative assessment subsystem  130  can generate the visual representation by at least determining a graphical layout of the graphical and/or textual elements based on the number of the one or multiple responses and also based on the respective representations of each response of the one or multiple responses. That graphical layout can include one or more of (i) a UI object associated with each representation of each response of the one or multiple responses; (ii) a position of the UI object within a viewport encompassing the visual representation; (iii) time of the UI object, or (iv) a color of the object. 
     Because a visual representation indicates the user condition in connection with a surgical procedure, for example, the pre-operative assessment subsystem  130 , via the server application  134 , can generate one or more elements (graphical or textual) of the visual representation to reveal relative importance of two or more responses that characterize the user condition. As a non-limiting example, a first response to a survey (such as a pre-operative assessment or questionnaire) can be represented visually by a rectangle having a cool color (e.g., blue or green) or a non-conspicuous type of markings (e.g., sparse stippling), representing that the first response does not create an issue related to the surgical procedure. In turn, a second response to the survey can be represented visually by another rectangle having a hot color (e.g., red or yellow) or a conspicuous type of markings (e.g., dense stippling or dense cross-hatching), representing that the second response potentially creates an issue related to the surgical procedure. Accordingly, such a visual representation can convey actionable information at a glance. Thus, an end-user (e.g., a healthcare provider) that reviews the responses to a survey can determine, based on the type of visual representation of a response, if a response may require further inquiry or is in agreement with moving forward with an operative procedure without further inquiry. The visual representation  400  shown in  FIG.  4    and the visual representation  500  shown in  FIG.  5    are non-limiting examples of visual representations of multiple responses to a survey or assessment in accordance with this disclosure. Each one of the visual representation  400  and the visual representation  500  convey actionable information at a glance. Specifically, in the visual representation  400 , respective responses to questions Q 0 , Q 2 , continuing up to question Q 17  are represented visually in a manner indicative of agreement with moving forward with an operative procedure without further review. In turn, the response to question Q 18  is represented visually in a manner indicative of potential need for further review. In the visual representation  500 , respective responses to questions Q 0  to Q 17  and questions Q 19  to Q 29  are represented visually in a manner indicative of agreement with moving forward with an operative procedure without further review. In turn, the response to question Q 18  is represented visually in a manner indicative of potential need for further review. In some cases, visual elements corresponding to respective questions within a visual representation can be selectable or otherwise interactive. As such, in response to a click, tap, swipe or another gesture (such as hovering over a selectable visual element), or yet another type of interaction, the client device  150  can redraw the visual representation  500  to present a question or prompt corresponding to the visual element being selected. Simply as an illustration, in the visual representation  500 , the question Q 20  is shown as an overlay in response to the visual element corresponding to Q 20  being selected. In some cases, questions Q 10  to Q 29  represented in  FIG.  5    can be part of the same survey that includes questions Q 1  to Q 18  represented in  FIG.  4   . 
     Thus, visual representations and aural representations of this disclosure can provide an intuitive and easy to understand characterization of a user condition related to a forthcoming procedure. As a result, the visual representations can simplify decision-making processes for a practicing clinician involved in that procedure. 
     In some embodiments, the server application  134  can include one or more components that provide functionality accessible to clinical staff. At least one of those component(s) can access assessment data for a subject and a visual representation of that assessment data, and can cause the pre-operative assessment subsystem  130  to supply the visual representation to a client device  150 . That assessment data can be contained in assessment data  136 . Those component(s) also can cause the pre-operative assessment subsystem  130  to supply an aural representation corresponding to the assessment data to the client device  150 . The client device  110  can be embodied in, for example, a personal computer, a laptop computer, an electronic-reader (e-reader) device, a tablet computer, a smartphone, a smartwatch or similar device. Accordingly, the client device  150  can include computing resources (not shown) comprising, for example, central processing units (CPUs), graphics processing units (GPUs), tensor processing units (TPUs), memory, disk space, incoming bandwidth, and/or outgoing bandwidth, interface(s) (such as I/O interfaces or APIs, or both); controller devices(s); power supplies; a combination of the foregoing; and/or similar resources. The client device  150  can include, or can be functionally coupled to, a display device (not depicted in  FIG.  1 A ). 
     In some embodiments, supplying the visual representation includes causing the client device  150  to output the visual representation. For instance, the pre-operative assessment subsystem  130  can cause the client device  150  to direct a display device to present a user interface  154  according to the visual representation. The display device can be integrated into the client device  150  or functionally coupled thereto. In addition, or in other embodiments, supplying an aural representation includes causing output of the aural representation at the client device  150 . For instance, the pre-operative assessment subsystem  130  can cause the client device  150  to direct an audio output unit (a speaker or a haptic device, for example) to present the aural representation. Further, or in yet other embodiments, rather than causing the client device  150  to present a visual representation or aural representation, the pre-operative subsystem  130  can cause the client device  150  can present a somatosensory representation of (i) one or more responses and/or (ii) a condition of the subject  104 . 
     The server application  134  can cause the pre-operative assessment subsystem  130 , or a component thereof, to supply a visual representation and/or an aural representation in response to receiving a query message that includes a request to access the one or multiple responses associated with an assessment of a user condition of a subject (e.g., subject  104 ). 
     In some embodiments, data indicative of responses to a pre-operative survey or other types of questionnaires (such as an electronic clinical outcome assessment (eCOA) or a neuropsychological assessment) can be obtained in other ways. In some cases, with reference to  FIG.  1 C , the client device  110  can present, after a survey or questionnaire has been completed, a selectable visual element indicative of a prompt to receive a token. In one example, the token is a QR code or a barcode. In another example, the toke is a non-fungible token (NFT). In response to receiving input data indicative of the token being desired, the client device  110  can present a second prompt to select the manner of receiving the token. For example, the second prompt can request the subject  104  to select one of several forms of electronic communication to receive the token. For example, the token can be received via email or electronic messaging (e.g., SMS, MIMS, iMessage). As such, the second prompt can permit entering an email address or a mobile telephone number. In further response, the client device can send a request message for the token to the pre-operative assessment subsystem  130 , where the request message can include payload data indicative of the electronic address (e.g., email address or mobile telephone number) desired for communication of the token. One or more components present in the pre-operative assessment subsystem  130  can generate the token and can send the token to the client device  110 . Generating the token can include creating an address (e.g., a uniform resource locator (URL)) where the data indicative of the responses is retained within a network of computing devices. In one example, the address can be indicative of the data storage  132  where the responses are retained as part of assessment data  136 . Sending the token includes sending data defining the token to the electronic address indicated in the request message. The data defining the token include first data indicative of the address where the data indicative of the responses is stored. In some cases, such data can include formatting information that can permit the client device  110  to draw a visual representation of the token in a UI. The client device  110  can draw that visual representation via a UI library (e.g., a UI toolkit) therein and a messaging application (note depicted in  FIG.  1 C ) included in the client device, for example. 
     The client device  110  can then move to a location proximate to the client device  150 . Such movement represent by an dash-line arrow in  FIG.  1 C . The client device  110  can then be caused to present a visual representation of the token, or the toke itself in cases the token is a QR code. For example, causing presentation of the visual representation of the token can include executing a messaging application (e.g., an email application) within the client device  110  and presenting a UI containing email content including the token or the visual representation thereof. 
     The client device  150  can be functionally coupled to a reader device  160  that can optically scan (or otherwise capture) a token or a visual representation  170  of the token. In response, the client device  150  can obtain data of the address (e.g., a URL) where the data indicative of the responses to the pre-operative survey or questionnaire is stored. The client device  150 , using that address, can access such data and can present the responses in the UI  154  as is described herein. 
     By providing a token, embodiments of this disclosure can permit efficiently accessing responses to pre-operative surveys and/or other types of questionnaires. Such efficient access can mitigate or entirely avoid human intervention to access such responses. 
     Non-limiting Example Scenario—Cataract Surgery Scenario. Cataract Surgery is a common low risk procedure done on older patients in their 7th, 8th and 9th decades of life. This procedure is accomplished successfully in the majority of patients using minimal sedation and local anesthetics applied by the operating ophthalmologist. A minimal requirement is that the patient can lie still for the duration of the procedure allowing the surgeon to operate. 
     It is the standard of practice to offer pre-operative anesthetic evaluation to these patients on the account of the medical complexity they often present. By far and large while medically complex, patients successfully undergo the procedure with minimal anesthetic intervention. 
     On rare occasions, a patient cannot tolerate or cannot cooperate for the duration of surgery while presenting an anesthetic challenge to the anesthesiologist taking care of the patient. In other words, anesthesiologists are presented with two extreme scenarios: (i) the majority of cases that can safely be done with minimal sedation and (ii) the rare event where anesthetic management becomes extremely complex necessitating further evaluation and more decision making. 
     The low expectation of challenges calls into question whether a full pre-operative evaluation is indeed worthwhile the anesthesiologist&#39;s time investment. As such the majority of such consultations are phone consultations or chart reviews. However, not interviewing or examining the patient puts the anesthesiologist at a disadvantage to address pertinent questions that may or may not be available in the chart necessitating a large time investment to study the chart, in what is otherwise a process with low expectation of yielding anything meaningful. 
     In order to provide some context, the computing systems, computing devices, computer-program products, and techniques of this disclosure can be implemented on a computer  601  as illustrated in  FIG.  6    and described below. Similarly, the computing systems, computing devices, computer-program products, and techniques disclosed herein can utilize one or more computers, or computing devices, to perform one or more functions in one or more locations.  FIG.  6    is a block diagram illustrating an example computing system  600  for performing the disclosed methods. This example computing system  600  is only an example of a computing system and is not intended to suggest any limitation as to the scope of use or functionality of computing system architecture. Neither should the computing system  600  be interpreted as having any dependency or requirement relating to any one or combination of components illustrated in the example computing system. In some embodiments, the example computing system can embody, or can include, the computing system  100  ( FIG.  1 A  and  FIG.  1 C ). 
     The present methods and systems can be operational with numerous other general purpose or special purpose computing system environments or configurations. Non-limiting examples of well-known computing systems, environments, and/or configurations that can be suitable for use with the systems and methods comprise, but are not limited to, personal computers, server computers, laptop devices, and multiprocessor systems. Additional non-limiting examples comprise set-top boxes, programmable consumer electronics, network PCs, minicomputers, mainframe computers, distributed computing environments that comprise any of the above systems or devices, and the like. 
     The processing of the disclosed methods and systems can be performed by software components. The disclosed systems and methods can be described in the general context of computer-executable instructions, such as program modules, being executed by one or more computers or other devices. Generally, program modules comprise computer code, routines, programs, objects, components, data structures, etc. that perform particular tasks or implement particular abstract data types. The disclosed methods can also be practiced in grid-based and distributed computing environments where tasks are performed by remote processing devices that are linked through a communications network. In a distributed computing environment, program modules can be located in both local and remote computer storage media including memory storage devices. 
     Further, one skilled in the art will appreciate that the systems and methods disclosed herein can be implemented via a general-purpose computing device in the form of a computer  601 . The components of the computer  601  can comprise, but are not limited to, one or more processors  603 , a system memory  612 , and a system bus  613  that couples various system components including the one or more processors  603  to the system memory  612 . The system can utilize parallel computing. 
     The system bus  613  represents one or more of several possible types of bus structures, including a memory bus or memory controller, a peripheral bus, an accelerated graphics port, or local bus using any of a variety of bus architectures. The bus  613 , and all buses specified in this description can also be implemented over a wired or wireless network connection and each of the subsystems, including the one or more processors  603 , a mass storage device  604 , an operating system  605 , software  606 , data  607 , a network adapter  608 , the system memory  612 , an Input/Output Interface  610 , a display adapter  609 , a display device  611 , and a human-machine interface  602 , can be contained within one or more remote computing devices  614   a, b, c  at physically separate locations, connected through buses of this form, in effect implementing a fully distributed system. 
     The computer  601  typically comprises a variety of computer-readable media. Exemplary readable media can be any available media that is accessible by the computer  601  and comprises, for example and not meant to be limiting, both volatile and non-volatile media, removable and non-removable media. The system memory  612  comprises computer readable media in the form of volatile memory, such as random access memory (RAM), and/or non-volatile memory, such as read only memory (ROM). The system memory  612  typically contains data such as the data  607  and/or program modules such as the operating system  605  and the software  606  that are immediately accessible to and/or are presently operated on by the one or more processors  603 . 
     In another aspect, the computer  601  can also comprise other removable/non-removable, volatile/non-volatile computer storage media. By way of example and not limitation,  FIG.  6    illustrates the mass storage device  604  which can provide non-volatile storage of computer code, computer readable instructions, data structures, program modules, and other data for the computer  601 . For example and not meant to be limiting, the mass storage device  604  can be a hard disk, a removable magnetic disk, a removable optical disk, magnetic cassettes or other magnetic storage devices, flash memory cards, CD-ROM, digital versatile disks (DVD) or other optical storage, random access memories (RAM), read only memories (ROM), electrically erasable programmable read-only memory (EEPROM), and the like. 
     Optionally, any number of program modules can be stored on the mass storage device  604 , including by way of example and not limitation, the operating system  605  and the software  606 . Each of the operating system  605  and the software  606  (or some combination thereof) can comprise elements of the programming and the software  606 . The data  607  can also be stored on the mass storage device  604 . The data  607  can be stored in any of one or more databases known in the art. Non-limiting examples of such databases comprise, DB2®, Microsoft® Access, Microsoft® SQL Server, Oracle®, mySQL, PostgreSQL, and the like. The databases can be centralized or distributed across multiple systems. The data  607  can include, among other data, the assessment data  136 . 
     In an aspect, the software  606  can comprise various processor-executable components that provide at least some of the functionality of the computer  601 . In an aspect, the software  606  can comprise the processor-executable image of the server application  134  ( FIG.  1 A ) and/or an interface to that processor-executable image of the server application  134  ( FIG.  1 A ). 
     In another aspect, the user can enter commands and information into the computer  601  via an input device (not shown). Non-limiting examples of such input devices comprise, but are not limited to, a keyboard, pointing device (e.g., a “mouse”), a microphone, a joystick, a scanner, tactile input devices such as gloves, and other body coverings, and the like. These and other input devices can be connected to the one or more processors  603  via the human-machine interface  602  that is coupled to the system bus  613 , but can be connected by other interface and bus structures, such as a parallel port, game port, an IEEE 1394 Port (also known as a Firewire port), a serial port, or a universal serial bus (USB). 
     In yet another aspect, the display device  611  can also be connected to the system bus  613  via an interface, such as the display adapter  609 . It is contemplated that the computer  601  can have more than one display adapter  609  and the computer  601  can have more than one display device  611 . As a non-limiting example, the display device  611  can be a monitor, an LCD (Liquid Crystal Display), or a projector. In addition to the display device  611 , other output peripheral devices can comprise components such as speakers (not shown) and a printer (not shown) which can be connected to the computer  601  via the Input/Output Interface  610 . Any operation and/or result of the methods of this disclosure can be output in any form to an output device. Such output can be any form of visual representation, including, but not limited to, textual, graphical, animation, audio, tactile, and the like. The display device  611  and computer  601  can be part of one device, or separate devices. 
     The computer  601  can operate in a networked environment using logical connections to one or more remote computing devices  614   a, b, c.  By way of example and not limitation, a remote computing device can be a personal computer, portable computer, smartphone, a server, a router, a network computer, a peer device or other common network node, and so on. Logical connections between the computer  601  and a remote computing device  614   a, b, c  can be made via one or more networks  615  (generically referred to as network  615 ), such as a local area network (LAN) and/or a general wide area network (WAN). The network  615  can embody the network(s)  120 . Such network connections can be through the network adapter  608 . The network adapter  608  can be implemented in both wired and wireless environments. In an aspect, one or more of the remote computing devices  614   a, b, c  can comprise an external engine and/or an interface to the external engine. While not illustrated, at least one of the remote computing devices  614   a, b, c  can include respective display devices or can be functionally coupled to respective display devices. In some embodiments, the computer  601  can embody the pre-operative assessment subsystem  130 , a first computing device of the remote computing devices  614   a, b, c  can embody the client device  110 , and a second computing device of the remote computing devices  614   a, b, c  can embody the client device  150 . 
     For purposes of illustration, application programs and other executable program components such as the operating system  605  are illustrated herein as discrete blocks, although it is recognized that such programs and components reside at various times in different storage components of the computing device  601 , and are executed by the one or more processors  603  of the computer. An implementation of the software  606  can be stored on or transmitted across some form of computer-readable media. Any of the disclosed methods can be performed by computer readable instructions embodied on computer-readable media. Computer-readable media can be any available media that can be accessed by a computer. By way of example and not meant to be limiting, computer-readable media can comprise “computer storage media” and “communications media.” “Computer storage media” comprise volatile and non-volatile, removable and non-removable media implemented in any methods or technology for storage of information such as computer-readable instructions, data structures, program modules, or other data. Exemplary computer storage media comprises, but is not limited to, RAM, ROM, EEPROM, flash memory or other memory technology, CD-ROM, digital versatile disks (DVD) or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices, or any other medium which can be used to store the desired information and which can be accessed by a computer. 
     In view of the various aspects of the techniques disclosed herein, a non-limiting example method that can be implemented in accordance with embodiments of this disclosure can be more readily appreciated with reference to the flowchart in  FIG.  7   . For purposes of simplicity of explanation, the non-limiting example methods disclosed herein are presented and described as a series of blocks (with each block representing an action or an operation in a method, for example). However, it is to be understood and appreciated that the disclosed methods are not limited by the order of blocks and associated actions or operations, as some blocks may occur in different orders and/or concurrently with other blocks from that are shown and described herein. As a non-limiting example, the various methods or processes of the disclosure can be alternatively represented as a series of interrelated states or events, such as in a state diagram. Furthermore, not all illustrated blocks, and associated action(s), may be required to implement a method in accordance with one or more aspects of the disclosure. Further yet, two or more of the disclosed methods or processes can be implemented in combination with each other, to accomplish one or more functionalities and/or advantages described herein. 
     The methods of the disclosure can be retained on an article of manufacture, or computer-readable non-transitory storage medium, to permit or facilitate transporting and transferring such methods to a computing device for execution, and thus implementation, by a processor of the computing device or for storage in a memory thereof or functionally coupled thereto. Such a computing device can be embodied in a mobile computer, such as an electronic book reader (e-reader) or other tablet computers, or a smartphone; a mobile gaming console; or the like. In one aspect, one or more processors, such as processor(s) that implement one or more of the disclosed methods, can be employed to execute program instructions retained in a memory, or any computer- or machine-readable medium, to implement the one or more methods. The program instructions can provide a computer-executable or machine-executable framework to implement the methods described herein. 
       FIG.  7    illustrates a non-limiting example of a method  700  for a secure computer-based pre-operative assessment, in accordance with one or more embodiments of the disclosure. A computing system can implement, entirely or partially, the non-limiting example method  700 . To that end, the computing system includes computing resources that can implement at least one of the blocks included in the non-limiting example method  700 . The computing resources include, for example, central processing units (CPUs), graphics processing units (GPUs), tensor processing units (TPUs), memory, disk space, incoming bandwidth, and/or outgoing bandwidth, interface(s) (such as I/O interfaces); controller devices(s); power supplies; and the like. For instance, the memory can include programming interface(s) (such as APIs); an operating system; software for configuration and or control of a virtualized environment; firmware; and similar resources. 
     In some embodiments, the computing system can embody, or can constitute, the pre-operative assessment subsystem  130 . In other embodiments, the computing system can embody, or can include, the computing system  100  ( FIG.  1   ). As is described herein, in some cases, the example computing system  601  ( FIG.  6   ) can embody, or can include, the computing system that implements the example method  700 . The computing system that implements that example method  700  can include one or more computing devices that host the server application  134 , and can implement one or more of blocks of the example method  700  in response to execution of the server application  134 . At least one processor of such computing device(s) can execute the server application  134 . 
     At block  710 , the computing system can authenticate a user identifier (ID) via an authentication service. As mentioned, in some cases, the authentication service can be embodied in, or can include, an Identity as a Service (IaaS) platform. The user ID corresponds to a subject and can be one or a combination of a user name, a password, a generated data structure, or an access token. 
     At block  720 , the computing system can determine if the user ID satisfies one or multiple access rules. In response to a negative determination, the computing system can implement an exception process at block  730 . 
     In response to an affirmative determination, the flow of the non-limiting example method  700  can continue to block  740 , at which block the computing system can cause output of a graphical user interface (GUI) configured to elicit one or multiple responses. At least one of the response(s) can be associated with a user condition. In some cases, the user condition can be one or a combination of a pre-operative condition, a post-operative condition, a mental health condition, a wellness state, or a disease state. Causing output of the GUI can include causing presentation of the GUI at a client device (e.g., client device  110  ( FIG.  1   )). The client device can receive input data from the subject corresponding to the user ID that has been authenticated, the input data defining the response(s). 
     In some cases, the GUI is configured to elicit the one or multiples responses associated with the user condition by presenting one or more questions (or, in some configurations, queries) associated with the user condition. In some embodiments, the GUI can be a questionnaire or another type of assessment associated with a forthcoming surgery. See GUI  300  ( FIG.  3 A ), for example. 
     In addition, or instead of causing output of the GUI, the computing system can cause presentation of a sequence of alternating and adapting prompt electronic messages and response electronic messages, at block  740 . See  FIG.  3 B  and related description, for example. The prompt electronic messages can be adaptive based on one or multiple algorithms to generate a natural language (NL) statement that is responsive to another NL statement (e.g., a response electronic message) and is substantially logically sound. The algorithm(s) can include decision support trees, for example. 
     At block  750 , the computing system can associate the one or multiple responses with the user ID. Associating the one or multiple responses with the user ID can include generating a data structure including a representation (e.g., a data record or metadata) of each response of the one or multiple responses and a key value corresponding to the user ID. The representation of each response of the one or more responses can be embodied in, or can include, an encoded value. 
     At block  760 , the computing system can generate, using the one or multiple responses, a visual representation, an aural representation, a somatosensory representation, or a combination of the foregoing. Those representations, individually or in combination, can be indicative of the user condition. In some embodiments, generating the visual representation includes determining a graphical layout of the visual representation based on the number of the one or multiple responses and also based on the respective representations of each response of the one or multiple responses. That graphical layout can include one or more of an object associated with each representation of each response of the one or multiple responses, a position of the object, time of the object, or a color of the object. 
     At block  770 , the computing system can supply at least one of the visual representation, the aural representation, or the somatosensory representation generated at block  760 . In cases where only the visual representation has been created, the computing system can supply that visual representation. In cases where only the aural representation has been created, the computing system can supply that aural representation. In cases where both the visual representation and the aural representation have been created, the computing system can supply the visual representation and the aural representation. Supplying the visual representation or the aural representation, or both, can be responsive to receiving a query message and can include causing output of the visual representation or the aural representation, or both. The query message can include a request to access the one or multiple responses associated with the user condition. 
     As used in the specification and the appended claims, the singular forms “a,” “an,” and “the” include plural referents unless the context clearly dictates otherwise. Ranges may be expressed herein as from “about” one particular value, and/or to “about” another particular value. When such a range is expressed, another configuration includes from the one particular value and/or to the other particular value. When values are expressed as approximations, by use of the antecedent “about,” it will be understood that the particular value forms another configuration. It will be further understood that the endpoints of each of the ranges are significant both in relation to the other endpoint, and independently of the other endpoint. 
     Throughout the description and claims of this specification, the words “include” and “comprise” and variations of the word, such as “including,” “comprising,” “includes” and “comprises,” mean “including but not limited to,” and are not intended to exclude other components, integers or steps. “Such as” is not used in a restrictive sense, but for explanatory purposes. 
     It is understood that when combinations, subsets, interactions, groups, etc. of components are described that, while specific reference of each various individual and collective combinations and permutations of these may not be explicitly described, each is specifically contemplated and described herein. This applies to all parts of this application including, but not limited to, steps in described methods. Thus, if there are a variety of additional steps that may be performed it is understood that each of these additional steps may be performed with any specific configuration or combination of configurations of the described methods. 
     As will be appreciated by one skilled in the art, hardware, software, or a combination of software and hardware may be implemented. Furthermore, a computer program product on a computer-readable storage medium (e.g., non-transitory) having processor-executable instructions (e.g., computer software) embodied in the storage medium. Any suitable computer-readable storage medium may be utilized including hard disks, CD-ROMs, optical storage devices, magnetic storage devices, memristors, Non-Volatile Random Access Memory (NVRAM), flash memory, or a combination thereof. 
     Embodiments of this disclosure have been described with reference to diagrams, flowcharts, and other illustrations of computer-implemented methods, systems, apparatuses, and computer program products. Each block of the block diagrams and flowchart illustrations, and combinations of blocks in the block diagrams and flowchart illustrations, respectively, may be implemented by processor-accessible instructions. Such instructions may include, for example, computer program instructions (e.g., processor-readable and/or processor-executable instructions). The processor-accessible instructions may be built (e.g., linked and compiled) and retained in processor-executable form in one or multiple memory devices or one or many other processor-accessible non-transitory storage media. These computer program instructions (built or otherwise) may be loaded onto a general-purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine. The loaded computer program instructions may be accessed and executed by one or multiple processors or other types of processing circuitry. In response to execution, the loaded computer program instructions provide the functionality described in connection with flowchart blocks (individually or in a particular combination) or blocks in block diagrams (individually or in a particular combination). Thus, such instructions which execute on the computer or other programmable data processing apparatus create a means for implementing the functions specified in the flowchart blocks (individually or in a particular combination) or blocks in block diagrams (individually or in a particular combination). 
     These computer program instructions may also be stored in a computer-readable memory that may direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including processor-accessible instruction (e.g., processor-readable instructions and/or processor-executable instructions) to implement the function specified in the flowchart blocks (individually or in a particular combination) or blocks in block diagrams (individually or in a particular combination). The computer program instructions (built or otherwise) may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operations to be performed on the computer or other programmable apparatus to produce a computer-implemented process. The series of operations may be performed in response to execution by one or more processor or other types of processing circuitry. Thus, such instructions that execute on the computer or other programmable apparatus provide operations for implementing the functions specified in the flowchart blocks (individually or in a particular combination) or blocks in block diagrams (individually or in a particular combination). 
     Accordingly, blocks of the block diagrams and flowcharts support combinations of devices for performing the specified functions, combinations of steps for performing the specified functions and program instruction means for performing the specified functions. It will also be understood that each block of the block diagrams and flowcharts, and combinations of blocks in the block diagrams and flowcharts, may be implemented by special purpose hardware-based computer systems that perform the specified functions or steps, or combinations of special purpose hardware and computer instructions. 
     As is used in this specification and annexed drawings, the terms “module,” “component,” “system,” “platform,” and the like, can refer to and/or can include a computer-related entity or an entity related to an operational machine with one or more specific functionalities. Such entities can be either hardware, a combination of hardware and software, software (program code or executable program code, for example), or software in execution. In one example, a component can be a process running on a processor, a processor, an object, an executable (e.g., binary software), a thread of execution, a computer program, and/or a computing device. Simply as an illustration, a software application running on a server device can be a component and the server device also can be a component. One or more modules can reside within a process and/or thread of execution. One or more components also can reside within a process and/or thread of execution. Each one of a module and a component can be localized on one computing device and/or distributed between two or more computing devices. In another example, respective components (or modules) can execute from various computer-readable storage media having various data structures stored thereon. The components (or modules) can communicate via local and/or remote processes such as in accordance with a signal having one or more data packets (e.g., data from one component interacting with another component in a local system, distributed system, and/or across a network such as the Internet with other systems via the signal). As another illustrations, in some cases, a component can emulate an electronic component via a virtual machine, e.g., within a cloud computing system. The terms “module” and “component” (and their plural versions) may be used interchangeably where clear from context, in some cases. 
     As is used in this specification and annexed drawings, the term “processor” can refer to substantially any computing processing unit or computing device, including single-core processors; single-processors with software multithread execution capability; multi-core processors; multi-core processors with software multithread execution capability; multi-core processors with hardware multithread technology; parallel platforms; and parallel platforms with distributed shared memory. Additionally, a processor can refer to electronic circuitry designed in assembled to execute code instructions and/or operate on data and signaling. Such electronic circuitry can be assembled in a chipset, for example. Accordingly, in some cases, a processor can be embodied, or can include, an application specific integrated circuit (ASIC), a digital signal processor (DSP), a field programmable gate array (FPGA), a complex programmable logic device (CPLD), a discrete gate or transistor logic, discrete hardware components, or any combination thereof designed and assembled to perform the functionality described herein. Further, in some cases, processors can exploit nano-scale architectures, such as molecular and quantum-dot based transistors, switches and gates, in order to optimize space usage or enhance performance of computing devices. A processor can also be implemented as a combination of computing processing units. 
     Further, in this specification and annexed drawings, terms such as “storage,” “data storage,” “repository,” and substantially any other information storage component relevant to operation and functionality of a system, subsystem, module, and component are utilized to refer to “memory components,” entities embodied in a “memory,” or components including a memory. As is described herein, memory and/or memory components of this disclosure can be either volatile memory or nonvolatile memory, or can include both volatile and nonvolatile memory. Simply as an illustration, nonvolatile memory can include read only memory (ROM), programmable ROM (PROM), electrically programmable ROM (EPROM), electrically erasable ROM (EEPROM), flash memory, or nonvolatile random access memory (RAM) (e.g., ferroelectric RAM (FeRAM). Volatile memory can include RAM, which can act as external cache memory, for example. By way of illustration and not limitation, RAM is available in many forms such as synchronous RAM (SRAM), dynamic RAM (DRAM), synchronous DRAM (SDRAM), double data rate SDRAM (DDR SDRAM), enhanced SDRAM (ESDRAM), Synchlink DRAM (SLDRAM), direct Rambus RAM (DRRAM), direct Rambus dynamic RAM (DRDRAM), and Rambus dynamic RAM (RDRAM). Embodiments of this disclosure are not limited to these types of memory, and other types of memory devices can be contemplated. 
     This detailed description may refer to a given entity performing some action. It should be understood that this language may in some cases mean that a system (e.g., a computer or multiple computers) owned and/or controlled by the given entity is actually performing the action. 
     While the computer-implemented methods, apparatuses, devices, and systems have been described in connection with preferred embodiments and specific examples, it is not intended that the scope be limited to the particular embodiments set forth, as the embodiments herein are intended in all respects to be illustrative rather than restrictive. 
     Unless otherwise expressly stated, it is in no way intended that any method set forth herein be construed as requiring that its steps be performed in a specific order. Accordingly, where a method claim does not actually recite an order to be followed by its steps or it is not otherwise specifically stated in the claims or descriptions that the steps are to be limited to a specific order, it is no way intended that an order be inferred, in any respect. This holds for any possible non-express basis for interpretation, including: matters of logic with respect to arrangement of steps or operational flow; plain meaning derived from grammatical organization or punctuation; the number or type of configurations described in the specification. 
     It will be apparent to those skilled in the art that various modifications and variations may be made without departing from the scope or spirit. Other configurations will be apparent to those skilled in the art from consideration of the specification and practice described herein. It is intended that the specification and described configurations be considered as exemplary only, with a true scope and spirit being indicated by the following claims.