Patent Publication Number: US-2016224754-A1

Title: Systems and methods for an interactive assessment and display of drug toxicity risks

Description:
CROSS REFERENCE TO RELATED DOCUMENTS 
     The present invention claims priority to U.S. Provisional Patent Application Ser. No. 62/109,929 of Hann, entitled “SYSTEMS AND METHODS FOR AN INTERACTIVE ASSESSMENT AND DISPLAY OF DRUG TOXICITY RISKS,” filed on Jan. 30, 2015, the entire disclosure of which is hereby incorporated by reference herein. 
    
    
     FIELD OF THE INVENTION 
     The present invention relates to systems and methods for an interactive assessment and display of a risk level of a patient for drug toxicity, and more particularly to methods and systems for identifying knowledge-based risk scores for a plurality of objective patient data and evaluating the risk scores to determine an overall risk level for developing drug toxicity, including displaying such risks as a quick clinical reference tool for a clinician at bedside as well as an interactive teaching tool for clinicians, and the like. 
     BACKGROUND OF THE INVENTION 
     Drug toxicity in medical and recreational use is a major public safety problem. Frail patients may die when they suffer from drug toxicity, such as opioid toxicity. It also contributes to increased acute care hospital length of stay and escalates healthcare cost. Fortunately, most of it is preventable by educating the public and healthcare personnel. 
     When the patient receives co-prescription drugs or the body&#39;s function deteriorates, normal metabolic and excretion pathways are impaired. Drugs can accumulate in major organs and cause subclinical or full blown physical and psychiatric toxicities. There is a need for interactively assessing drug toxicity risks and visually displaying the results at patient&#39;s bedside even in absence of detailed laboratory tests. 
     Nurses and physicians need a tool that helps them choose the safest drugs for an individual patient. Approaches to prevention of drug toxicity are primitive, because a physician often relies on prior experiences with a particular drug or class of drugs, or consulting with two or three different databases may be necessary. Most physicians lack knowledge and experience in drug management. For example, a physician may overlook a patient&#39;s changing condition and fail to anticipate potential toxicity. Polypharmacy may bewilder even an experienced physician or a specialty nurse practitioner. 
     A prior art (U.S. Patent WO2012122347A1 by Shiloh September, 2012) addresses an alert system for multi-drug interactions and potential adverse reactions based on data captured in the electronic medical record (EMR). Another prior art (U.S. Patent WO2008045389A2 by Chiu April 2008) addresses using a bioinformatics software to choose appropriate chemotherapy agents. A prior art (U.S. Patent 20100235378A1 Armstrong September 2010) addresses searching patient database for adverse drug reactions. For visually-oriented adult learners, however, there is an absence of visually distinctive display of drug toxicity risks for an individual patient, nor is there an interactive tool for assessing drug toxicity risks that also functions as a teaching tool of complex and changing drug research data. 
     In view of the foregoing, there is a need for systems and methods to interactively assess the risks of drug toxicity at point of care and display the results in a visually distinctive and memorable way appropriate for an adult learner. 
     SUMMARY OF THE INVENTION 
     Embodiments described herein are directed to systems and methods for interactively assessing a risk level for drug toxicity. The risk level is determined using individual risk scores provided for a plurality of objective patient data categories based on correlations in risks of toxicity development in those categories. A user provides input patient data on a plurality of patient health factors, either from an electronic medical record or at bedside, after which pre-determined risk scores for the inputted patient data are identified. The risk scores are then used to determine an overall risk assessment level of the patient for developing drug toxicity. The system and method can be applicable regardless of patient care setting, such as home care, nursing home, acute care hospital, etc. The system and method can receive patient data from an input device and calculate a risk level for the patient based on the patient data and assigned risk scores, and then outputs the risk level to a user on a display. The system and method can further function as an interactive teaching tool when parameters of input values change, the result of which determine a different assessed risk level, which is accompanied by a display of different risk level and a different set of explanations for the risk level. The system ad method can present groups of patients according to risk levels on an electronic screen to be viewed by multiple users, improving user&#39;s workflow and continuity of care. The system and method can export drug toxicity risk level data to a patient outcomes reports form. The system and method can visually display on a user&#39;s preferred device or send voice alerts of risk levels of drug toxicity. 
     Accordingly, in an exemplary aspect, there is provided a system, circuit, method and/or computer program product for interactively assessing a risk of developing drug toxicity, including a user input unit configured to receive objective and subjective information of a patient for a plurality of categories of patient data; a correlation unit configured to determine a corresponding risk value of developing drug toxicity for each category of patient data, based on the patient data received in each category; and a risk determination unit configured to determine a level of risk of a patient developing drug toxicity based on the correlated risk values. 
     The system, circuit, method and/or computer program product can include a user interface configured to display different components of risk assessment including a metabolic pathway of a drug, an excretion pathway of a drug, potential drug sensitivity of a patient from prior experience, drug-to-drug and drug-to-food interaction, and Cytochrome P450 genotype. 
     The system, circuit, method and/or computer program product can include a remote connection mechanism including a telemedicine connection, and a web server connecting to an appropriate application, for a user to virtually assess a patient, input patient data, and calculate a risk level of drug toxicity for the patient in real time. 
     The system, circuit, method and/or computer program product can include a user interface configured to display risk levels corresponding to correlated risk values; a multi-user platform configured to allow viewing of risk levels for allocation of clinician coverage in real time; and a trend system configured to allow tracking of progress of an individual patient and accessible from a remote location. 
     The system, circuit, method and/or computer program product can include a user interface configured to display different toxicity result levels accompanied by corresponding explanations for each of drug toxicity risk accompanied by suggestions of safer drug choices to mitigate drug toxicity, wherein each explanation is referenced for further reading. 
     The system, circuit, method and/or computer program product can include a sorting system configured for sorting of patients with similar risk levels; a display unit configured for representing by color indicators of similar risk levels; a display screen or printable sheet for at-risk patients to improve clinician workflow; an assessment tool configured for allowing for appropriate follow up for at-risk patients, including a visual screen configured for displaying at-risk patients simultaneously; a visual system configured for improving continuity of care during shift changes; a display device for submitting drug toxicity risks to patient outcomes reports, including a user interface configured to display when a risk level of a patient is at a predetermined level, and an inputted check list for drug toxicity prevention; an automated documentation tool for clinicians configured to verify that drug toxicity prevention tasks are completed, including an automated process between drug toxicity assessment with data input completion of patient outcomes reports; a user interface for real-time measurement of patient outcomes quality indicators, and a quality measurement linked to an individual user for an archived period; a user interface for continuously transmitting drug toxicity risk levels; an electronic message sharing system configured to send a message to a user group regarding drug toxicity risk levels; a user interface for automated, updated assessment of risk level when a clinical condition of a patient changes, including automated reporting of urine output; a documentation system configured for documenting when a clinician chooses a safer drug; a user interface configured for interactive assessment for drug toxicity risk, wherein the user can change a variable input to view a changed display of toxicity level, accompanying explanations, and suggestions for alternate drugs; and a user interface including a teaching tool that demonstrates various toxicity risk levels according to changing clinical parameters. 
     From this description, in conjunction with other items, the advantages of the said invention will become clear and apparent more so based upon the hereinafter descriptions and claims, which are supported by drawings with numbers relating to parts, wherein are described in the following sections containing the relating numbers. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are incorporated in and constitute a part of the specification, illustrate embodiments of the invention and, together with the description, serve to explain the objects, advantages, and principles of the invention. In the drawings: 
         FIG. 1  is a flow diagram illustrating a user login, entering patient assessment either manually or electronically from a telemedicine portal or an electronic medical record, selecting a drug from a drug category, and inputting the patient data, according to one embodiment of the invention; 
         FIG. 2A  is a drawing illustrating a set of patient health factors which comprise patient data, according to one embodiment of the invention; 
         FIG. 2B  is a flow diagram illustrating a set of patient health factors with associated response, according to one embodiment of the invention; 
         FIG. 2C  is a flow diagram illustrating an interactive function which demonstrates the relationship between a drug toxicity level from one set of patient health care parameters as opposed to a different drug toxicity result when healthcare parameters change, according to one embodiment of the invention; 
         FIG. 3  is a flow diagram illustrating the method of assessing drug toxicity result and its display, according to one embodiment of the invention; 
         FIG. 4  is an illustration of a set of four possible results displayed to the user, according to one embodiment of the invention; 
         FIG. 5  is drawing illustration of a set of four possible toxicity risk results representing four different levels of risks, which are accompanied by a set of different explanations, according to one embodiment of the invention; 
         FIG. 6  is a table illustrating a list of an individual patient&#39;s drugs and display of multiple drug toxicity risk levels, according to one embodiment of the invention; 
         FIG. 7  is a flow diagram illustrating how drug toxicity risk results can shared with other team members by various communication modalities, send alerts, and export to quality measures outcomes report, according to one embodiment of the invention; 
         FIG. 8  is a sorting table illustrating patient sorting by plurality of patients&#39; drug toxicity risk levels, according to one embodiment of the invention; 
         FIG. 9  is a table illustrating the drug toxicity risk assessment as a quality outcomes tool, a performance and improvement tool, according to one embodiment of the invention; 
         FIG. 10  is a flow diagram illustrating an automated reminder of check list that contribute to drug toxicity risks for a given drug-host interaction, according to one embodiment of the invention; 
         FIG. 11  is a block diagram illustrating a computer/server system upon which an embodiment of the invention methodology can be implemented; 
         FIG. 12A  is a graph and a flow diagram illustrating a relationship between input variables and an interactive output display; 
         FIG. 12B  is a more detailed graph and a flow diagram illustrating a relationship between input variables an interactive output display; 
         FIG. 12C  is a flow diagram illustrating a hover feature of designated toxicity risk dots; 
         FIG. 13  is a graph illustrating multiple drug toxicity risk results shown simultaneously; and 
         FIG. 14  is a graph illustrating various functions to promote knowledge sharing. 
     
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
     After reading this description it will become apparent that one skilled in the art can implement the invention in various alternative embodiments and alternate applications. However, all the various embodiments of the present invention will not be described herein. It is understood that the embodiments presented here are presented by way of an example only, and not limitation. As such, this detailed description of various alternative embodiments should not be construed to limit the scope or breadth of the present invention as set forth below. 
     The present invention recognizes that drug toxicity can develop in any patient regardless of their clinical condition, however morbidity and mortality rates of frail patients exposed to drug toxicity are considerably higher. Drug toxicity may cause hastened death in hospice patients or precipitate in an unwanted hospital emergency room visit. 
     The extent or cost of drug toxicity in the United States are not accurately known due to lack of reporting or awareness, although prescription opioid overdose, for example, has surpassed automobile accidents as the leading cause of accidental deaths in certain age groups. 
     Approaches to prevention of drug toxicity lack a cohesive linking of a drug, its broad metabolic pathways, elimination pathways, and genotype or idiosyncratic drug sensitivities of an individualized patient. Invariably, understanding genomics and pharmacology is necessary for clinicians whose expertise may lie outside these disciplines. 
     Generally, methods and systems described herein allow a user to input patient data and receive an output risk level for that patient which assesses the patient&#39;s risk of developing drug toxicity against a particular drug. The patient data is a combination of objective and subjective input and allows for inputting information on multiple different categories, or patient health care input variables, related to a drug list from the drug database and the patient&#39;s health. Input variables can also include use of a plurality of sensors, such as flow sensors of a urinary catheter, for instance. Each of the categories includes a risk score for that category, which assesses a risk of the patient developing drug toxicity based upon the information input for that particular category. Once the user has input all of the requested patient data, the system evaluates the risk scores for each of the categories of patient data and outputs an overall risk level result of the patient&#39;s risk of developing drug toxicity. Patient&#39;s assessed risk level may change based on inputting a different patient health care variable. 
     The systems and methods allow a user, such as a nurse, healthcare professional, caretaker or even the patient to enter patient data and automatically view one of the four states of risk level indicated by a color-coded risk level indicator. The systems and methods avoid the requirement for manually having to look up each category of risk and increase the accuracy of drug toxicity risk level assessment. Input values can be uploaded from an existing electronic medical record system. Sharing the risk assessment result can improve the workflow and interdisciplinary group&#39;s coordination of care. 
     The systems and methods can be implemented as software running on a computer or on any mobile device or hosted by a server on a network, so that a plurality of users can access the methodology to continually input new data and provide updated risk level assessments for patients. 
     In one embodiment, the system stores the overall risk level for each patient over a period of time during several separate risk assessments, such that an overall pattern of risk level can be analyzed to determine if the patient is becoming more or less at risk for developing drug toxicity. The risk levels can be stored for auditing purposes as well. The system can also store the patient data input by the user for the plurality of patient categories, as this data can be used for future analytic applications and for audit purposes as well. In one embodiment, if a particular category of patient data is not input by the user, the system can trigger an audit to determine why the category was not entered or determined. 
     One embodiment of the system and method is illustrated in  FIG. 1A , whereby the user inputs user data  102  which identifies relevant information about the user. The user completes Patient Assessment  104 , which can be completed face-to-face  106 , virtually through a telemedicine portal  108 , or by accessing patient&#39;s electronic medical record (EMR) data. Patient identification data can be input from Patient Assessment  104 . Remote monitoring sensors  118 , such as urine output monitoring device, can input data directly to Patient Data  116 . The user chooses one or more drugs  114  from a drug category  112  to assess its drug toxicity risk. Patient Data  116  is composed of plurality of subjective and objective categories. 
       FIG. 2A  is a user interface displaying set  116  of plurality of subjective and objective inputted patient data, organized in such a manner that reflects the natural order of drug behavior in a living patient. Once a drug enters the body, it must first be broken down or metabolized, as represented by the first category  202  within the set  116  of Patient Data. After metabolism, a drug must be eliminated, whereby second category  204  within the set  116  is presented. Further modification of a drug behavior by the patient&#39;s unique characteristics is represented in the third  206  and fourth category  208  within the set  116 . 
     Responses to each Patient Data category illustrated in  FIG. 2B  represents a patient&#39;s capacity for metabolizing the drug  202 , capacity for excreting the drug  204 , and presence or absence of potential idiosyncratic drug behavior  206 ,  208  for the individual patient. 
     Each drug within a drug category database has a corresponding stored risk value associated with a response in  208 ,  210 ,  212  in  FIG. 2B . This association determines a specific level of toxicity risk, thereby rendering the present embodiment an interactive drug toxicity software. The risk values can be determined based on any suitable methodology which evaluates drug&#39;s toxicity risks for each possible data entry in each drug category. If applicable, input from  208  weighs in as an additional determinant to the risk level assessment. The risk values can be determined from clinical data, generally accepted medical literature and research, and other medical knowledge from literature or a user, and the like. Additionally, the risk values can be updated regularly to reflect changes in patient condition through a patient monitoring sensor, such as urine output sensor, laboratory tests, genotype testing, and the like, in medical knowledge or analysis of past data, all of which can input Patient Data. 
       FIG. 2C  is a flow diagram illustrating different drug toxicity risks when any of the responses  208 ,  210 ,  212  are changed. Scenario number one  212  exemplifies drug toxicity risk number one  208 , accompanied by the display for the toxicity  210  and the explanation, suggestion, alternate drugs  212  for scenario number one. Whereas scenario number two  223  exemplifies a different drug toxicity risk number two  218 , accompanied by the display for the toxicity  220  and the explanation, suggestion, alternate drugs  222  for scenario number two. When the user can see in real-time different risk levels as patient data variable input change, an opportunity for better understanding drug toxicity is presented. 
     In  FIG. 3 , when Drug Selection  114  and Patient Data  116  are entered  302 , the system and method assesses a risk level for the patient  304  based on the risk values corresponding to each of the patient data categories. In one embodiment, the determination of the risk level can be made by looking for the highest risk score associated with the input data of the patient data categories  306 . The risk level can be determined by evaluating more than one risk score to provide some type of weight or other valuation factor to one risk score depending upon its significance (i.e. or its insignificance). The risk level defaults to the highest risk to reflect an overall warning to a particular drug use regardless of the risk score of each category. For example, if a patient who has “Decreasing urine output or impaired kidney function” for an entered drug  114 , then a risk level of High can be output to the user if impaired kidney function contributes to a High risk level. However, the same patient data entered into the “Jaundiced or impaired liver function” category may indicate a level of Low or Moderate and an overall risk level of High is assessed. 
     In  FIG. 3 , The Drug Toxicity  302  assesses an overall toxicity risk level  304  based on Drug selection  114  and Patient Data  116 , whereby the highest drug toxicity level result  304  displays output  308  to the user. 
       FIG. 4  is a user interface displaying four states  402  of toxicity risks for each drug  114 , each represented by a distinctive and ubiquitous color. Bold colors serve as a warning when the user should be cautious. Toxicity risk in red color  404  is a symbol for High risk  406 , followed by yellow color  408  for Moderate risk  410 , and Low risk  412  in green color  414 . No color  416  is designated to the state of Not Determined  418 . 
     Some adult learners recall information more easily when visual information is displayed with an explanation.  FIG. 5  is a user interface displaying a set  502  of four, color-coded risk levels  404 ,  408 ,  412 ,  416  paired with four, descriptive text boxes  504 ,  512 ,  520 ,  527  that explain the reasons for the assigned toxicity risks. Each text box offers an Explanation for the risk level result  506 ,  514 ,  522 ,  528 , followed by a clinical Suggestion  508 ,  516 ,  524 ,  530  and a list of Alternate Drugs  510 ,  518 ,  526 ,  532 . For example, Morphine Sulfate in the Drug Name box  114  for this patient may show High risk  404 , which is paired with text box  504  describing an Explanation  506  of decreasing urine output or impaired kidney function, with Suggestion  508  to discontinue the drug and select Fentanyl for an Alternate Drug  510 . On the other hand, Morphine sulfate may be assessed as Moderate risk  408  for toxicity for the same patient, in which case the text box  512  describing a different Explanation  514 , Suggestion  516 , and Alternate Drugs  518  will be displayed to the user. If the patient has normal kidney function and liver function, then Morphine sulfate is Low risk  412  with an accompanying text box  520  with a different set of Explanation  522 , Suggestion  524 , and no need for Alternate Drugs  526 . A drug which cannot be assigned a risk level based on the latest evidence-based research criteria, Not Determined risk level  642  is assigned with Explanation  528 , Suggestion  530 , and Alternate Drugs  532 . Print  641 , Share  642 , Export  644 , or Voice Alerts  646  can be used for efficient team work. 
     In pain management, it&#39;s a common practice for a patient to be prescribed a long-acting scheduled opioid and a short-acting opioid for breakthrough pain.  FIG. 6  is a user interface displaying a table with multiple drug toxicity risks for an individual patient  601 . Columns are headed by Drug name  604 , Toxicity Risk  606 , Explanation  608 , Suggestion  610 , and Alternate Drugs  612 . For example, a Patient  601  who is prescribed a long-acting opioid  114  which carries a High risk level in red-colored bar  404 , and Explanation  614  for the toxicity, Suggestion  616 , Alternate Drugs  618  are displayed to the user. If the patient also takes a short-acting opioid for breakthrough pain, second drug  620  may display Moderate Risk in yellow-colored bar  622 , with Explanation  624 , Suggestion  626 , and Alternate Drugs  628  respectively. Likely, a third drug  620  may be a Low toxicity risk drug  632 , with Explanation of why  634 , Suggestion  636 , and possibly no Alternate Drugs  638 . A fourth drug may show Not Determined toxicity risk  642 , with Explanation  644 , Suggestion  646 , and Alternate Drugs  648 . Each page can be printed  641 , shared  642 , exported  644 , or receive Voice Alert  646 . Risk level column  606  can be sorted  607  for a comprehensive understanding of highest toxicity risk drug to the lowest risk. 
     The user may prefer to share the result of the drug toxicity risk or export to other quality reports or EMR. In  FIG. 7 , patient&#39;s Drug Toxicity Risk Level Result  601  can be exported  705  to Patient Quality Outcomes Report  704  or to patient&#39;s EMR database  110 . Workflow and interdisciplinary group coordination of care are important aspects of a good team work. Share  642  can send the risk result to the user&#39;s email, text message, or voice mail or trigger a Voice Alert  648 . 
       FIG. 8  is a user interface displaying drug toxicity risk level results for multiple patients  801 . Assessed risk levels for multiple patients can be sorted according to the risk levels in a color-coded state as illustrated in table  802 . In one embodiment, the user selects the type of patients presented on the display screen. Columns are headed by Patient Name  804 , Drug Name  805 , Toxicity Risk  806 , Suggestion  808 , and Alternate Drugs  810 . Toxicity Risk  806  can sort patients from the highest risk level  402  to Moderate risk  814  Low risk  822  or Not Determined  832 . Patient Name in cells  104 ,  812 ,  820 ,  828 , Drug Name cells  114 ,  813 ,  821 ,  830 , Suggestion cells  508 ,  816 ,  824 ,  834 , and Alternative Drugs cells  510 ,  818 ,  826  toggle when the Risk Level is sorted. Trending  838 , Print  641 , Share  642 , and Export  644  can help with the team workflow and the team&#39;s priority. 
       FIG. 9  is a user interface displaying a table illustrating a Multiple Patient Quality Outcomes Report focused on drug toxicity risks  902 . Table  903  is a Patient Quality Outcomes Report comprised of Number of Patients at Risk  904 , Incidence of Events  906 , Length of Hospital Stay  908 , Short-Term Outcomes  910 , and Long-term Outcomes  912 . For example, number of patients  914  may suffer from reported events of drug toxicity incidence  916 . Correlation with Length of Hospital Stay  918 , Short-Term outcomes  920 , and Long-Term Outcomes  922  may be explored for continued patient quality improvement. Trending  924  can indicate areas of improvement. 
       FIG. 10  is a flow diagram illustrating a machine learning opportunity of the software. The user logs in first time  1002  with assessed drug toxicity risk  1004 . When the user logs in again, the user is prompted to re-assess patient data variables that can increase drug toxicity risks. For example, a patient who is prescribed Morphine Sulfate may be assessed Low risk level initially. When the user logs in again, a prompt asks the user to re-assess patient&#39;s kidney function because kidney dysfunction increases the drug&#39;s toxicity risk. 
       FIG. 11  is a block diagram that illustrates an embodiment of a computer/server system upon which an embodiment of the inventive methodology can be implemented. The system  1100  includes a computer/server platform  1104  including a processor  1106  and memory  1108 , which operate to execute instructions and maintain a database. The term “computer-readable storage medium” as used herein can refer to any tangible medium, such as a disk or semiconductor memory, that participates in providing instructions to processor  1106  for execution. Additionally, the computer platform  1104  receives input  1102  from an EMR as well as a plurality of input devices, such as keyboard, mouse, touch screen device, wearable device such as glasses, sensor imbedded garment, or a Voice Input (via a microphone). The computer platform  1104  can additionally be connected to a removable storage device  1118 , such as a portable hard drive, optical media (e.g., CD or DVD), disk media or any other tangible medium from which a computer can read executable code. The computer platform can further be connected to network resources  1114 , which connect to the Internet or Intranet or other components of a local public or private network. Remote monitoring via sensors  1116  can input to an EMR or a device  1102 . The connections to the network resources  1114  can be via wireless protocols, such as the  802 . 11  standards, Bluetooth or cellular protocols, or via physical transmission media, such as cables or fiber optics, or telephone. The network resources can include storage devices for storing data, HIPAA-compliant remote server, and executable instructions at a location separate from the computer platform  1104 . The computer interacts with any suitable type of display on a mobile-device or a PC, or voice-activated audio system  1010  to output data and other information to a user on a responsive-screen, as well as to request additional instructions and input from the user. The display  1110  can therefore further act as an input device  1102  for interacting with a user. 
     The computer/server system  1100  can be implemented, for example, for an anonymous patient user, and include a standalone executable program. Any suitable user can access such program via the internet or any available mobile technology, or have another user input data remotely via telephone. The result can be displayed or verbally presented or printed for view. 
     The previously described illustrative embodiments of  FIGS. 1-11  provide systems and methods for assessing drug toxicity risks in individual patients, whereby a drug&#39;s effects on varying patient variables is calculated, and the like.  FIG. 12A  is a graph and a flow diagram illustrating a drug  1221 , which interacts with patient variables  1222 ,  1224 , and  1226 . In this illustrative embodiment, the system and method can be used to assess a drug&#39;s toxicity risks, and display relevant outputs, for example, in an interactive display panel  1223 , and the like, including Continuum of Use  1216  on an x-axis, and Toxicity Risk  1202  on a y-axis, as shown. 
     The assessed drug toxicity risks determine and correlate, for example, with a circle size of dots  1218 ,  1220 , and  1221  on the graph, as well as their positions  1206 ,  1210 , and  1214 , and on a Continuum of Use (e.g., color bar). For example, a drug  1204  with low toxicity risk can be positioned in a left lower corner  1218 , and gradually move to the right upper corner  1221 , as the toxicity risk increases, as does a color indicator in the Continuum of Use bar  1216  (e.g., due to patient variables shown at  1208  and  1212 ). 
     Often, initially assessed drug toxicity risks may decrease when a patient&#39;s condition improves, for example, as illustrated in  FIG. 12B . Indicated by a reverse arrow from positions  1210  to  1206 , a patient whose clinical condition improves may be able to metabolize and eliminate drugs more efficiently and become safer. Such a change is reflected in the color indicator Continuum of Use bar  1216 . The reverse arrow from Patient Variable B  1224  to Patient Variable A  1222  reflects the fact that when one organ recovers, the burden of metabolizing and eliminating the drug and its metabolites is more equally shared among patient variables. An added useful feature of the embodiment is illustrated in the Hover functionality  1226 ,  1228  in  FIG. 12C . For example, when a user hovers over each dot circle, detailed drug information and other useful learning points are displayed, all of which are designed for improved recall. 
     Drug applications may typically show one drug at the time without the aid of a visual application. However, in a further illustrative embodiment, the system and method can group and display several drugs, for example, grouped together at  1229  and  1232  by their toxicity risks, at respective positions  1230  and  1234 , and the like, as illustrated in  FIGS. 13-14 . Systematically grouping drugs together at  1229 , and  1232  by toxicity risks  1230 , and  1234  offers an added advantage for the user, who can choose a drug within their formulary list of insurer-covered drugs, and the like. For example, Groups of drugs  1229  may start at baseline of low toxicity at positions  1230  to move later to varying groups  1232  with corresponding toxicity risks at positions  1234 , and as shown at  1236 ,  1238  and  1240 . Enhanced interactive display features may include a share feature  1241 , a forward feature  1242 , a copy feature  1243 , and/or a print feature  1244 , and the like, adapted for various technology platforms, and the like. 
     Accordingly, above-described device and subsystems of the illustrative embodiments can include, for example, any suitable servers, workstations, PCs, laptop computer, PDAs, Internet appliances, handheld devices, cellular telephones, wireless devices, iPad, Android devices, and the like, capable of performing the processes of the illustrative embodiments. The devices and subsystems of the illustrative embodiments can communicate with each other using any suitable protocol and can be implemented using one or more programmed computer systems or devices. 
     One or more interface mechanisms can be used with the illustrative embodiments, including, for example, Internet access, telecommunications in any suitable form, (e.g., voice, modem, and the like), wireless communications media, and the like. For example, employed communications networks or links can include one or more wireless communications networks, cellular communications networks, G3 communications networks, G4 communications networks, Public Switched Telephone Network (NSTNs), Packet Data Networks (PDNs), the Internet, intranets, cloud computing networks, a combination thereof, and the like. 
     It is to be understood that the described devices and subsystems are for illustrative purposes, as many variations of the specific hardware used to implement the illustrative embodiments are possible, as will be appreciated by those alike in the relevant art(s). For example, the functionality of one or more of the devices and subsystems of the illustrative embodiments can be implemented via one or more programmed computer systems or devices. 
     To implement such variations as well as other variations, a single computer system can be programmed to perform the special purpose functions of one or more of the devices and subsystems of the illustrative embodiments. On the other hand, two or more programmed computer systems or devices can be substituted for any one of the devices and subsystems of the illustrative embodiments. Accordingly, principles and advantages of distributed processing, such as redundancy, replication, and the like, also can be implemented, as desired, to create the robustness and performance of the devices and subsystems of the illustrative embodiments. 
     The devices and subsystems of the illustrative embodiments can store information relating to various processes described herein. The information can be stored in one or more memories, such as hard disk, optical disk, magneto-optical disk, RAM, and the like, of the devices and subsystems of the illustrated embodiments. One or more databases of the devices and subsystems of the illustrative embodiments can store information used to implement illustrative embodiments of the present inventions. The database can be organized using data structures (e.g., records, tables, arrays, fields, graphs, pigeons, trees, lists, and the like) included in one or more memories or storage devices listed herein. The processes described with respect to the illustrative embodiments can include appropriate data structures for storing data collected and/or generated by the processes of the devices and subsystems of the illustrative embodiments in one or more databases thereof. 
     All or a portion of the devices and subsystems of the illustrative embodiments can be conveniently implemented using one or more general purpose computer systems, microprocessors, digital signal processors, micro-controllers, and the like, programmed according to the teachings of the illustrated embodiments of the present inventions, as well be appreciated by those skilled in the computer and software arts. Appropriate software can be readily prepared by programmers of ordinary skill based on the teachings of the illustrative embodiments, as will be appreciated by those skilled in the software art. Further, the devices and subsystems of the illustrative embodiments can be implemented on the World Wide Web. In addition, the devices and subsystems of the illustrative embodiments can be implemented by the preparation of application-specific integrated circuits or by interconnecting an appropriate network of conventional component circuits, as will be appreciated by those skilled in the electrical art(s). Thus, the illustrative embodiments are not limited to any specific combination of hardware circuitry and/or software. 
     Stored on any one or on a combination of computer readable media, the illustrative embodiments of the present inventions can include software for controlling the devices and subsystems of the illustrative embodiments, for driving the devices and subsystems of the illustrative embodiments, for enabling the devices and subsystems of the illustrative embodiments to interact with a human user, and the like. Such software can include, but is not limited to, device drivers, firmware, operating systems, development tools, applications software, and the like. Such computer readable media further can include the computer program product of an embodiment of the present inventions for performing all or a portion (if processing is distributed) of the processing performed in implementing the inventions. Computer code devices of the illustrative embodiments of the present inventions can include any suitable interpretable or executable code mechanism, including but not limited to scripts, interpretable programs, dynamic link libraries (DLLs), Java classes and applets, complete executable programs, Common Object Request Broker Architecture (CORBA) objects, and the like. Moreover, parts of the processing of the illustrative embodiments of the present inventions can be distributed for better performance, reliability, cost, and the like. 
     As stated above, the devices and subsystems of the illustrative embodiments can include computer readable medium or memories for holding instructions programmed according to the teachings of the present inventions and for holding data structures, tables, records, and/or other data described herein. Computer readable medium can include any suitable medium that participates in providing instructions to a processor for execution. Such a medium can take many forms, including but not limited to, non-volatile media, volatile media, transmission media, and the like. Non-volatile media can include, for example, optical or magnetic disks, magneto-optical disks, and the like. Volatile media can include dynamic memories, and the like. Transmission media can include coaxial cables, copper wire, fiber optics, and the like. Transmission media also can take the form of acoustic, optical, electromagnetic waves, and the like, such as those generated during radio frequency (RF) communications, infrared (IR) data communications, and the like. Common forms of computer-readable media can include, for example, a floppy disk, a flexible disk, hard disk, magnetic tape, any other suitable magnetic medium, a CD-ROM, CDRW, DVD, any other suitable optical medium, punch cards, paper tape, optical mark sheets, any other suitable physical medium with patterns of holes or other optically recognizable indicia, a RAM, a PROM, an EPROM, a FLASH-EPROM, any other suitable memory chip or cartridge, a carrier wave or any other suitable medium from which a computer can read. 
     The above description of disclosed embodiments is provided to enable any person skilled in the art to make or use the invention. Various modifications to the embodiments will be readily apparent to those skilled in the art, the generic principals defined herein can be applied to other embodiments without departing from spirit or scope of the invention. Thus, the invention is not intended to be limited to the embodiments shown herein but is to be accorded the widest scope consistent with the principals and novel features disclosed herein.