Patent Publication Number: US-2023162865-A1

Title: Health management system

Description:
FIELD OF THE INVENTION 
     This invention relates to methods and apparatus to assist in managing healthcare, including interactive systems to manage patient risk and to monitor and manage the progress of conditions such as pregnancy. 
     BACKGROUND OF THE INVENTION 
     The field of medicine continues to steadily advance, with one estimate indicating that the body of medical knowledge doubles every 73 days. But despite this progress in knowledge, U.S. pregnant women are twice as likely to die than their mothers were 30 years ago. It therefore seems that there is a significant discrepancy between what is known about pregnancy and other conditions and how well this knowledge is used in managing these conditions. 
     SUMMARY OF THE INVENTION 
     Several aspects of this invention are presented in this specification and its claims. 
     Systems according to the invention can help to improve medical care, such as care during pregnancy, by providing an interactive and organized way to evaluate and manage risk factors across a number of health determinants to prevent and treat disease. This is particularly important because many risk factors including genetic and environmental factors can have significant impact on health and healthcare spending but have tended to be overlooked in clinical care. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWING 
         FIG.  1    is a block diagram of a healthcare management system according to the invention; 
         FIG.  2    is a diagram of a trends interface for the system of  FIG.  1   ; 
         FIG.  3    is a diagram of an insights overview interface for the system of  FIG.  1   ; 
         FIG.  4    is a diagram of an insights detail interface for the system of  FIG.  1   ; 
         FIG.  5    is a diagram of a timeline interface for the system of  FIG.  1   ; 
         FIG.  6    is a diagram of an actions interface for the system of  FIG.  1   ; 
         FIG.  7    is a screenshot of an ultrasound image of a developing human fetus at approximately 34 weeks for presentation using a system such as the system of  FIG.  1   ; and 
         FIG.  8    is a screenshot of a life-sized rendering of a fetus in a virtual 3-Dimensional and dynamic display. 
     
    
    
     DETAILED DESCRIPTION OF AN ILLUSTRATIVE EMBODIMENT 
     Referring to  FIG.  1   , a healthcare management system according to the invention, such as a pregnancy management system  10 , can include a patient profile module for receiving and storing information about the patient. This information can include any information that is relevant to the patient&#39;s care, such as demographic information about the patient, information about the patient&#39;s medical conditions, and information about the patient&#39;s life conditions. 
     The system  10  can also include a number of information access modules  14   a ,  14   b , . .  14   n  that are responsive to the patient profile module  12  and each allow the system to access information about the patient from one or more of a number of different data sources  16   a ,  16   b , . .  16   n . These data sources can include in-house or third-party sources of data relating to the patient&#39;s health, such as sources of clinical data (e.g., data about infections and fetal stress) and laboratory data (e.g. genetic and hormonal data). They can also include sources of data about life conditions, such as sources of socioeconomic data (e.g. data about ethnicity and crime), environmental data, (e.g. data about exposure to lead and other pollutants) and behavioral data (e.g. data about nutrition and substance use). Some illustrative data sources include the U.S. Census Bureau, Centers for Disease Control (CDC), the Federal Bureau of Investigation (FBI), and the Environmental Protection Agency (EPA). Data can also be obtained from a variety of other sources, such as from medical records and insurance claims as well as from wearable devices. 
     The system  10  can further include a number of risk translation modules  18   a ,  18   b , . .  18   n  that can each be responsive to one or more of the information access modules  14   a ,  14   b , . .  14   n  to derive individual risk scores from information retrieved by the information access modules. A risk aggregation module  20  is responsive to the risk translation modules to derive an aggregated risk score from the individual risk scores for the patient. An intervention selection module  22  is also responsive to the risk translation modules to derive suggested interventions. A display module  24  is responsive to the risk aggregation module and the intervention selection module to display results from those modules. 
     The system can be operated by a caregiver and/or patient using a standard computer platform, such as a workstation, laptop, or smart phone. Referring to  FIGS.  2 - 6   , in one embodiment a patient focused pregnancy management system uses a smart phone in communication with a server to provide a series of patient interfaces including a trends interface  30 , an insights overview interface  50 , an insights detail interface  60 , a timeline interface  70 , and an actions interface  90  that can each be selected using an interface selection control  42 . 
     Referring to  FIG.  2   , the trends interface  30  can present a risk reporting area  34  that presents individual and aggregated risks. In this embodiment, the individual scores are shown using a colored bar graph metaphor. The aggregated risk score is presented inside a compound circular device  32  that also employs a segmented, axial colored edge to show how the individual risk scores combine to produce the aggregated risk score. This presentation method is presently preferred but other interface metaphors could also be used in the risk reporting area. 
     The trends interface  30  can also include profile areas  36 ,  38 ,  40  that show profile information for the user. These areas can show patient information, such as demographic information  36 , weight and blood pressure information  38 , and glucose readings  40 . This information can be populated directly through the smart phone and/or derived from other systems. 
     Referring to  FIG.  3   , the insights overview interface  50  can include a variety of risk profile areas  52   a ,  52   b ,  52   c ,  52   d  . . . These risk profile areas each show a score for a different type of risk. They can also show concern and prevention counts. Each of these areas can correspond to one of several insights detail interfaces, which can be reached by actuating that risk profile area. 
     Referring to  FIG.  4   , each insights detail interface (e.g.,  60 ) can show more detailed information about risks, such as environmental risks, for one of the risk profile areas in the insights overview interface. In one embodiment, the insights detail interface includes a number of risk detail areas  62   a ,  62   b ,  62   c ,  62   d  that each present information about one particular environmental risk, such as lead poisoning risk, benzene air toxin risk, formaldehyde air toxin risk, and 1,3 butadiene air toxin risk. Some more illustrative examples of risk areas are presented in table 1. 
     
       
         
           
               
             
               
                 TABLE 1 
               
             
            
               
                   
               
               
                 Illustrative risk factors 
               
            
           
           
               
               
               
               
               
            
               
                 Behavioral 
                 Environmental 
                 Clinical 
                 Laboratory 
                 Socioeconomic 
               
               
                   
               
               
                 Smoking 
                 Lead exposure 
                 Intrauterine 
                 Genetic 
                 Ethnicity 
               
               
                 Alcohol 
                 Tobacco smoke 
                 infections 
                 Inflammation 
                 Maternal stress 
               
               
                 Recreational 
                 Sulfur dioxide 
                 Uteroplacental 
                 (interleukins) 
                 (life events- 
               
               
                 drugs (cocaine) 
                 and other  
                 thrombosis 
                 Hormonal 
                 divorce, job 
               
               
                 poor nutrition 
                 pollutants 
                 Fetal stress 
                 (GGH) 
                 loss) 
               
               
                 (poor iron, long 
                   
                   
                 Stress (cortisol) 
                 Domestic  
               
               
                 chain fats, folate) 
                   
                   
                 Vaginal (lactic, 
                 violence 
               
               
                   
                   
                   
                 TIMP)  
                 Neighborhood 
               
               
                   
                   
                   
                 Placental (PIGF, 
                 crime 
               
               
                   
                   
                   
                 fibronectin) 
               
               
                   
               
            
           
         
       
     
     Referring to  FIG.  5   , the timeline interface  70  organizes items on a timeline to allow a patient to follow the progress of a treatment plan or condition, such as pregnancy. In one embodiment, the timeline view includes a personalized caption  72 , a development column  76 , and an actions column  78 . The development column can include a succession of development milestone items  80   a ,  80   b ,  80   c  . . . that each present a milestone such as a fetal developmental milestone. The actions column can include a succession of recommended and/or optional action items  80   a ,  80   b ,  80   c  . . . for the patient to consider. Date items  82   a ,  82   b  . . . and  86   a ,  86   b ,  86   c  . . . can separate and organize the items in the two columns. 
     Referring to  FIG.  6   , the actions interface  90  can include a date control  92  to allow the patient to navigate through a series  96  of the recommended and/or optional action items. The different interfaces presented by the system are presently contemplated as well suited to the healthcare management system  10 , but other approaches to the user interface could also be employed. 
     Overall, the system can provide a trusted platform to help to inform the patient about what they can do to understand, prepare for, and/or avoid potential complications, such as preterm birth, gestational diabetes, preeclampsia, caesarean section, embolism, hemorrhage, infection, and cardiomyopathy. The system can also provide peace of mind, help to interest, engage, and empower the patient in his or her own care, and promote better patient compliance with courses of treatment. It may further help to standardize and coordinate care, as well as to reduce unnecessary procedures and expenses. 
     These objectives are aided by the calculation of the aggregated risk score, which is a multi-factorial weighted mathematical construct to assess an overall patient status that accounts for their “assets and liabilities” in health (see  FIG.  2   ). After analyzing the incoming data, the user is credited for factors working in their favor (e.g., clean air, high median home income, etc.) and charged for at-risk factors. The goal is to drive each user to 100% by giving them actions to address the difference between their score and 100%. These recommendations can take on various forms, from evidence-based clinical guidelines, to common-sense recommendations (e.g., if Radium is detected in the local water system, simply don&#39;t drink the tap water), to alerting the user of risks (as a bare minimum). If we refer to evidence that three out of five maternal deaths are attributed to errors in diagnosis, the system can potentially save countless lives, or avoid substantial pain and suffering, by simply alerting mother and clinician that there is a statistical risk of harm. 
     Risks are categorized by determinant (see  FIG.  3   ) in order to further educate the user on the concepts of precision medicine, and further listing the actual risks factors (see  FIG.  4   ) in context of authoritative sources for further reading. Once the aggregated risk score has been calculated, the system can further ‘gamify’ the experience by assigning points to every actionable intervention such that the user may engage with the system, anticipate actions and preventions via a timeline (see  FIG.  5   ), perform the relevant tasks, complete them on the phone (see  FIG.  6   ), and get credit which translates into a higher aggregated score (see  FIG.  1   ). By closing this loop the system can effectively create a virtuous gamification cycle of: Educate. . . Inform. . . Engage. . . Act. . . Credit, which repeats itself through the user&#39;s experience with the system. 
     Referring to  FIG.  7   , the system  10  can also include a development montage creation module that provides a development montage interface  100  to show the progression of a condition, such as the development of a fetus during pregnancy. This type of interface preferably presents a montage of separate images from the fetus during the course of a pregnancy. These images can be obtained from different imaging sessions, such as ultrasound imaging sessions, as the pregnancy progresses. They can be obtained directly from the ultrasound imaging instrument, or by entering them later, such as using a camera interface on the smart phone to acquire an image from a display screen on the ultrasound imaging instrument or a paper printout from the ultrasound imaging instrument. The montage is preferably updated on an ongoing basis during the pregnancy and can be formatted in any suitable way, such as using the Graphics Interchange Format (GIF). 
     The system can also receive audio information such as from a fetal Doppler ultrasound heartbeat monitor and overlay this information as a soundtrack on the montage. This audio information can be received directly from the instrument or it can be acquired indirectly, such as using the microphone of the smart phone. The system  10  can employ pattern recognition to recognize and align features of the fetus in the images and match audio features with image features. The system can also employ machine learning to stitch” or “morph” the images together such that the montage actually looks like a real-time rendering of the growing baby. It may also be possible to apply analytics to these images in order to (1) offer diagnostic support and/or (2) project what the baby may look like once born. The montage creation module can also add intermediate views, a generic heartbeat soundtrack if one is missing, or make other enhancements to the montage. The montage creation module can also be provided as a standalone application separate from the rest of the healthcare management system  10 . 
     Referring to  FIG.  8   , the system  10  can also include a life-sized rendering of the fetus in a virtual 3-Dimensional and dynamic display. This type of interface would present the user with a life-like view of their unborn fetus at the particular time of use. Average fetus measurements were obtained by week of pregnancy and converted to device-independent-pixels in order to accurately represent physical measurements (mm, cm, inches) on any digital device. Graphical renderings of fetuses at each week of pregnancy were gathered and isolated from their backgrounds so that they may be superimposed over a stationary background that is independent of the fetus image. These time-dependent fetus illustrations are presented to the user in accordance to their week of pregnancy at time of viewing. The device&#39;s gyroscope is then used to capture the device motion so that movement in the X/Y/Z coordinates translate into perceived movement by the fetus as it “floats” above a stationary background. The user is then given various options for further inspection, either manually through hand-gestures and finger movements, or with presented statistics and relevant materials and representations. 
     Referring to Appendix  1 , another version of a healthcare management system according to the invention is presented in a screenshot and description format. This version includes many of the features described above but uses a different user interface metaphors and includes some additional features. Some of the additional features include adding notes and/or changing the due date, an agenda page that categorizes events, actions and completed, kick tracking, a printout feature that allows the user to take a printout to a doctor&#39;s appointment, and a weight tracking feature. 
     The system described above has been implemented with a server running special-purpose software programs on a general-purpose computer platform, such as a Microsoft Windows or UNIX/Linux-based platform, and communicating with patient and/or caregiver smart phones, such as Android or iOS-Based smart phones. But they can also be implemented in whole or in part with other platforms or in other ways such as using dedicated hardware and/or in cloud-based or virtualized environments. And while the system can be broken into the series of modules and steps shown for illustration purposes, one of ordinary skill in the art would recognize that it is also possible to combine them and/or split them differently to achieve a different breakdown, and that the functions of such modules and steps can be arbitrarily distributed and intermingled within different entities, such as routines, files, and/or machines. Moreover, different providers can develop and operate different parts of the system. 
     The present invention has now been described in connection with a number of specific embodiments thereof. However, numerous modifications which are contemplated as falling within the scope of the present invention should now be apparent to those skilled in the art. Therefore, it is intended that the scope of the present invention be limited only by the scope of the claims appended hereto. In addition, the order of presentation of the claims should not be construed to limit the scope of any particular term in the claims.