Patent Publication Number: US-2009240522-A1

Title: Computer aided intake and assessment system

Description:
BACKGROUND 
     Health professionals face the increasingly difficult task of providing competent medical services at reasonable cost with an appropriate level of personal attention to each patient in their care. While the amount of potential diagnoses and treatment options are ever greater, the amount of time a health professional may spend with a patient is less, often limited by the strict reimbursement structure dictated by the health insurance industry. Such pressures may result in improper diagnoses or treatment and the associated increased risk of medical malpractice. Medical fields in which a high level of patient interaction is required to effect a diagnosis and provide medical treatment, such as the mental health field, are particularly strained and subject to unsettlingly high operating risks. 
     One of the most time intensive aspects of patient interaction is client intake, in which the patient discloses symptoms, background factors and health history to permit a health professional to make a proper assessment and offer treatment options. In the case of a psychiatric intake by a trained mental health professional, a proper initial intake and assessment will in most cases require  2 - 3  hours of a health professional&#39;s time. Mental health professionals in particular will typically ask an extensive battery of queries to arrive at a proper assessment, which in most cases will include one or more of the diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and/or International Statistical Classification of Diseases and Related Health Problems (ICD) with a corresponding identification code. Patients with a diagnosed mental health condition typically undergo long term treatment and require additional time-intensive follow-up intakes to assess improvement or deterioration of diagnosed conditions, and to make changes in background and health history information. 
     There are more than fifty commonly diagnosed mental health conditions, most of which share symptoms with one or more other ones of those mental health conditions. There is significant risk that a mental health professional may fail to present every appropriate query or fail to make record of every patient response necessary to effect a proper diagnosis. Also, the queries used to arrive at a particular mental health diagnosis may often be of a sensitive or personal nature or may require a high level of understanding of ones own feelings and reactions. Accordingly, a patient may purposely or inadvertently provide inaccurate information to a mental health professional during a psychiatric intake, hampering a fast and accurate assessment. The risk of a mental health professional failing to ask relevant and appropriate questions or receiving misinformation from a patient grows considerably during long term treatment of a patient. Accordingly, tracking a patient&#39;s progress, including the patient&#39;s reaction to prescribed mediations, is often difficult, and a mental health professional is often left to subjective factors for determining the efficacy of a course of treatment. 
     A health professional that is in fact successful in tracking a patient&#39;s progress and determining the efficacy of a particular course of treatment may ultimately be successful in treating the patient. However, the information gleaned from successes, or alternatively failures, typically inures only to the benefit of the treating health professional or the treating health professional&#39;s associates. Such data would be invaluable to other health professionals treating similar conditions or to researchers trying to determine the efficacy of a particular course of treatment. 
     It would be desirable to provide a patient intake and assessment system which permits efficient retrieval of patient information and provides a health professional with a proposed assessment of a patient. Such system should allow for a patient to answer questions at a pace and in an environment which is comfortable for the patient to encourage accurate and candid query responses. The system should allow for a health professional to review, change and selectively approve assessments. The system should permit the secure logging and storage of assessments including patient query responses for tracking a particular patient&#39;s progress, determining the efficacy of a course of treatment of a particular patient, and using data obtained during treatment of a particular patient to assess other patients. 
     SUMMARY 
     The present invention provides a patient intake and assessment system for communication with end users in a computer network. The system includes a clinical algorithm database configured to store health assessment queries and health assessments. A clinician assessment report database is configured to store clinician assessment reports. A server is in communication with the clinical algorithm database and the clinician assessment report database. The server is configured to transmit instructions to a first client application to provide the health assessment queries to a first end user and to receive health assessment query responses from the first end user. The server transmits instructions to a second client application to provide the health assessment query responses to a second end user and to provide one or more of the health assessments based on the health assessment query responses to the second end user. The server receives from the second end user selectively through the second client application acceptances of the health assessments, rejections of the health assessments, and user-generated health diagnoses. The server generates a clinician assessment report including the health assessment query responses and the acceptances of the plurality of health assessments, the rejections of the health assessments, and the user-generated health diagnoses, and logs the clinician assessment report in the clinician assessment report database. 
     The present invention further provides a method for clinical patient intake and assessment. The method includes providing a server, and transmitting from the server health assessment queries to a first end user. The server receives health assessment query responses from the first end user and generates a health assessment based on the health assessment query responses from the first end user. The server transmits the health assessment to a second end user and receives selectively from the second end user an acceptance of the health assessment and a rejection of the health assessment. The server generates a clinician assessment report including the acceptance of the health assessment or the rejection of the health assessment. One or more of the health assessment queries are transmitted from the server to the first end user based on one or more of the health assessment query responses from the first end user. 
     The present invention further provides a client application program product having a computer readable medium with instructions operable to enable a client computer to perform a procedure. This procedure includes identifying a first end user and a second end user, and receiving instructions from a server to provide health assessment queries to the first end user. This procedure further includes transmitting health assessment query responses from the first end user to the server, and receiving instructions from the server to provide a health assessment to a second end user based on the health assessment query responses from the first end user. The instructions enable a client computer to transmit from the second end user to the server selectively an acceptance of the health assessment, a rejection of the health assessment, and a user-generated health diagnosis. The client computer is further enabled to receive instructions from the server to provide to the second end user a clinician assessment report including one or more of the acceptance of the health assessment, the rejection of the health assessment, and the user-generated health diagnosis. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWING(S) 
       The foregoing Summary as well as the following detailed description will be readily understood in conjunction with the appended drawings which illustrate preferred embodiments of the invention. In the drawings: 
         FIG. 1  is a schematic illustration of an exemplary operating environment including a system for patient intake and assessment according to a preferred embodiment of the present invention. 
         FIG. 2  is a flow diagram showing a logic routine for generating a preliminary health assessment report according to a preferred embodiment of the present invention. 
         FIG. 3  is a flow diagram showing a clinician diagnosis procedure according to the preferred embodiment of the present invention. 
         FIG. 4  is a diagram of a method for patient intake and assessment according to the preferred embodiment of the present invention. 
         FIGS. 5A-5F  show sample screen captures from displays of a patient user interface generated by a patient client application implementing the method for patient intake and assessment according to the preferred embodiment of the present invention. 
     
    
    
     DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT(S) 
     Certain terminology is used in the following description for convenience only and is not limiting. The words “right,” “left,” “top,” and “bottom” designate directions in the drawings to which reference is made. The words “a” and “one” are defined as including one or more of the referenced item unless specifically stated otherwise. This terminology includes the words above specifically mentioned, derivatives thereof, and words of similar import. The phrase “at least one” followed by a list of two or more items, such as A, B, or C, means any individual one of A, B or C as well as any combination thereof. 
     The preferred embodiments of the present invention are described below with reference to the drawing figures where like numerals represent like elements throughout. 
     Referring to  FIG. 1 , a schematic illustration is shown of an exemplary operating environment  10  in which a patient intake and assessment system  12  according to a preferred embodiment of the present invention may be implemented for communication with end users in a computer network. The system  12  includes a clinical algorithm database  14  configured to store health assessment queries and health assessments corresponding to the health assessment queries. A client query response database  16  is configured for storing patient health assessment query responses. A clinician assessment report database  18  is configured to store clinician assessment reports. An assessment server  20  is provided in communication with the clinical algorithm database  14 , client query response database  16 , and the clinician assessment report database  18  for communication with end users through a network. The network may include the Internet  50  as shown, or alternatively, any suitable WAN or LAN. The assessment server  20  may be provided as a single server, or alternatively, as a plurality of cooperating connected servers. Further, the clinical algorithm database  14 , client query response database  16 , and the clinician assessment report database  18  may be provided as a single integrated database or any suitable number of separate databases. 
     The patient intake and assessment system  12  is preferably a mental health assessment system, and the clinical algorithm database  14  preferably stores mental health assessment queries and corresponding mental health assessments in the form of rules based algorithms. The mental health assessment queries include symptom queries which preferably implement criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) to form the rules based algorithms, and more preferably implement a recent professionally accepted version thereof, for example the DSM-IV-TR or later revision. The mental health assessment queries may also implement other criteria not present in any version of the DSM in forming the rules based algorithms. The corresponding mental health assessments preferably include conditions set forth in the DSM and/or conditions set forth in a recent professionally accepted version of the International Statistical Classification of Diseases and Related Health Problems (ICD), for example the ICD- 9 -CM or later revision. DSM or ICD identification codes are preferably provided in the clinical algorithm database  14  corresponding with the respective conditions. Table 1 below sets forth a list of DSM conditions with corresponding DSM-IV-TR codes for which assessments may be provided by the system  12 . Alternatively, the system  12  may provide health assessments for other conditions not listed below. 
     
       
         
           
               
               
               
             
               
                 TABLE 1 
               
               
                   
               
               
                 No. 
                 Code 
                 Condition 
               
               
                   
               
             
            
               
                   
               
            
           
           
               
               
               
            
               
                 1. 
                 308.30 
                 Acute Stress Disorder 
               
               
                 2. 
                 307.10 
                 Anorexia Nervosa 
               
               
                 3. 
                 300.00 
                 Anxiety Disorder NOS 
               
               
                 4. 
                 299.80 
                 Asperger&#39;s Disorder 
               
               
                 5. 
                 314.01 
                 Attention-Deficit Hyperactivity Disorder, Combined 
               
               
                   
                   
                 Type 
               
               
                 6. 
                 314.01 
                 Attention-Deficit Hyperactivity Disorder, 
               
               
                   
                   
                 Predominantly Hyperactive- 
               
               
                   
                   
                 Impulsive Type 
               
               
                 7. 
                 314.00 
                 Attention-Deficit Hyperactivity Disorder, 
               
               
                   
                   
                 Predominantly Inattentive Type 
               
               
                 8. 
                 314.90 
                 Attention-Deficit Hyperactivity Disorder NOS 
               
               
                 9. 
                 299.00 
                 Autistic Disorder 
               
               
                 10. 
                 296.60 
                 Bipolar I Disorder 
               
               
                 11. 
                 296.60 
                 Bipolar I Disorder, Mixed 
               
               
                 12. 
                 296.89 
                 Bipolar II Disorder 
               
               
                 13. 
                 298.80 
                 Brief Psychotic Disorder 
               
               
                 14. 
                 307.51 
                 Bulimia Nervosa 
               
               
                 15. 
                 307.90 
                 Communication Disorder 
               
               
                 16. 
                 301.14 
                 Cyclothymic Disorder 
               
               
                 17. 
                 294.80 
                 Dementia NOS 
               
               
                 18. 
                 311.00 
                 Depressive Disorder NOS 
               
               
                 19. 
                 312.09 
                 Disruptive Behavior Disorder NOS 
               
               
                 20. 
                 300.15 
                 Dissociative Disorder NOS 
               
               
                 21. 
                 300.40 
                 Dysthymic Disorder 
               
               
                 22. 
                 307.70 
                 Encopresis 
               
               
                 23. 
                 307.60 
                 Enuresis 
               
               
                 24. 
                 300.20 
                 Generalized Anxiety Disorder 
               
               
                 25. 
                 312.30 
                 Impulse Control Disorder 
               
               
                 26. 
                 315.90 
                 Learning Disorder NOS 
               
               
                 27. 
                 296.00 
                 Major Depressive Disorder 
               
               
                 28. 
                 296.00 
                 Manic Episode 
               
               
                 29. 
                 296.60 
                 Mixed Episode 
               
               
                 30. 
                 296.90 
                 Mood Disorder NOS 
               
               
                 31. 
                 300.30 
                 Obsessive Compulsive Disorder 
               
               
                 32. 
                 313.81 
                 Oppositional Defiant Disorder 
               
               
                 33. 
                 300.20 
                 Overanxious Disorder 
               
               
                 34. 
                 300.01 
                 Panic Disorder 
               
               
                 35. 
                 299.80 
                 Pervasive Developmental Disorder NOS 
               
               
                 36. 
                 307.52 
                 Pica 
               
               
                 37. 
                 309.81 
                 Posttraumatic Stress Disorder 
               
               
                 38. 
                 298.90 
                 Psychotic Disorder NOS 
               
               
                 39. 
                 313.89 
                 Reactive Attachment Disorder 
               
               
                 40. 
                 295.70 
                 Schizoaffective Disorder 
               
               
                 41. 
                 295.20 
                 Schizophrenia, Catatonic Type 
               
               
                 42. 
                 295.10 
                 Schizophrenia, Disorganized Type 
               
               
                 43. 
                 295.30 
                 Schizophrenia, Paranoid Type 
               
               
                 44. 
                 295.60 
                 Schizophrenia, Undifferentiated Type 
               
               
                 45. 
                 295.40 
                 Schizophreniform Disorder 
               
               
                 46. 
                 313.23 
                 Selective Mutism 
               
               
                 47. 
                 309.21 
                 Separation Anxiety Disorder 
               
               
                 48. 
                 307.40 
                 Sleep Disorders 
               
               
                 49. 
                 300.23 
                 Social Phobia 
               
               
                 50. 
                 300.29 
                 Specific Phobia 
               
               
                 51. 
                 307.00 
                 Stuttering 
               
               
                 52. 
                 305.90 
                 Substance Abuse 
               
               
                 53. 
                 304.90 
                 Substance Dependence 
               
               
                 54. 
                 307.22 
                 Tic Disorder, Chronic Motor or Vocal 
               
               
                 55. 
                 307.23 
                 Tourette&#39;s Disorder 
               
               
                   
               
            
           
         
       
     
     The assessment server  20  is configured to interact with a clinician client application  32  on a clinician client system  30  and a patient client application  42  on patient client system  40 . The patient client application  42  is preferably accessible by a patient, and the clinician client application  32  is preferably accessible by a clinician who is a health services professional. The clinician client application  32  and the patient client application  42 , may alternatively reside on a single system, and further, the clinician client application  32  and the patient client application  42  may be provided as a single application capable of providing alternate access to the assessment server  12  by a patient and a client. Both the clinician client application  32  and the patient client application  42  are preferably web browsers. Alternatively, the clinician client application  32  and the patient client application  42  may include any application or applications suitable for interaction with the assessment server  20  through a network such as the Internet  50  or other suitable WAN or LAN. Alternatively, the server  20  may be provided integrally with the clinician client system  30  and/or the patient client system  40 , for example as a single standalone client intake and assessment system. 
     The clinician client application  32  and the patient client application  42  respectively interact with a clinician user interface  34  and a patient user interface  44 , which include suitable video and/or audio devices and input devices to permit end user interaction. The systems  30 ,  40  each preferably comprise personal computers, and the interfaces  34 , 44  each preferably include a monitor and/or audio speakers, and a keyboard device and/or a microphone input to permit an end user to communicate with the respective systems  30 ,  40  in a manner suitable and convenient for the end user. Any type of personal computers can be provided including desktop computers, laptop computers, and tablet PCs. Even PDAs and other handheld devices may function effectively as clinician or patient client systems. Accordingly, the intake and assessment system  12  may potentially be accessed by end users through the Internet  50  or other suitable network from anywhere on earth, providing a high level of convenience for clinicians, patients, and others responsible for the care of patients such as parents and guardians. While only one clinician client application  32  and one patient client application  42  with respective systems are shown, one skilled in the art will recognize that any suitable number of client and patient applications with respective systems may be provided. 
     The assessment server  20  is configured to transmit instructions to the patient client application  42  to provide the health assessment queries to a patient end user using the patient client system  40 . The queries may be provided in any manner understandable manner and may implement sound, video and voice. Preferably, a plurality of languages are available for selection by the user, and the assessment server  20  preferably includes Unicode support enabling multilingual use. An avatar in the form of an on-screen human or human-like character may be used to ask questions and respond to patient end user input to provide the patient end user with an increased level of comfort during an intake procedure. 
     The patient end user is preferably a patient with particular mental health needs and interacts with the patient client application  42  while under supervision of a health services professional. Alternatively, the patient end user may include one or more of a parent, guardian, teacher, care giver, social worker or other party responsible for the patient and legally authorized to access patient data. The patient client system  40  is preferably positioned at a location where health services are provided, such as a hospital, clinic or health service professional office location. Alternatively, the patient end user may interact with the patient client application  42  in any suitable environment where secure access is possible, including for example the patient&#39;s home or the home or office of a person responsible for the patient, in which case the personal computer of the patient or one responsible for the patient preferably functions as the patient client system  40 , and a web browser on the system may function as the patient client application  42 . 
     As indicated above, the health assessment queries preferably relate to mental health assessment and include symptom queries implementing DSM criteria. The mental health assessment queries preferably also include environmental stressor queries and risk factor queries as a well as health history queries. Where applicable, the symptom queries provide a scaled response selection so a patient end user may offer an indication of to what degree or intensity a symptom is present. Preferably the scaled response selection includes a numeric scale from 0 to 10, wherein 0 corresponds to an indication that no symptoms are present and 10 corresponds to an indication that severe symptoms are present. Where applicable, the symptom queries also provide a symptom duration selection so a patient end user may offer an indication of the duration of time a symptom has been present. Where applicable, the environmental stressor queries and the risk factor queries may also provide a scaled response selection and duration selection. The mental health assessment queries may further provide multiple choice, true-false-unknown, yes-no-unknown, free form text entry type queries or any suitable type queries. One skilled in the mental health profession would recognize that symptom queries relate to a patient&#39;s physical condition or mental outlook, while environmental stressor and risk factor queries relate to external factors not directly controlled by a patient. 
     The assessment server  20  is configured to receive health assessment query responses to the health assessment queries from a patient end user using the patient client system  40 . As indicated above, the patient end user may include one or more other parties responsible for a patient. In such manner, the intake and assessment system  12  provides for the receiving of query responses from more than one party regarding the condition of a single patient, which assists in the verification and corroboration of the query responses. In view of the query types indicated above, the query responses may be in any suitable form including but not limed to a scaled type, duration type, multiple choice, true-false-unknown, yes-no-unknown, or free form text entry response. The client query response database  16  is configured for logging the health assessment query responses from the patient end user. The assessment server  20  is configured to transmit instructions to the patient client application  42  to provide following health assessment queries based on preceding health assessment query responses from the patient end user. In this manner the patient end user is offered health assessment queries most relevant to the patient end user&#39;s potential condition or the potential condition of the patient under the responsibility of the patient end user. Preferably, during initial stages of interface with the assessment server  20 , the patient end user is provided a chief complaint query asking the client to choose from a plurality of chief complaints. Upon selection of one or more of the chief complaints, the assessment server  20  provides further health assessment queries directly corresponding to the selected chief complaint or chief complaints. Table 2 below provides a preferred list of mental health chief complaints for eliciting queries useful for assessing the mental health conditions in Table 1. The mental health assessment queries corresponding to each of the chief complaints in Table 2 preferably implement DSM criteria, for example the criteria of DSM-IV-TR or later revision. 
     
       
         
           
               
               
             
               
                 TABLE 2 
               
               
                   
               
               
                 Chief Complaint 
                 Abbreviation 
               
               
                   
               
             
            
               
                 Behavior Problems 
                 BP 
               
               
                 Difficulty paying attention 
                 DPA 
               
               
                 Hyperactivity 
                 HYPER 
               
               
                 Irritability, anger, rages 
                 ANG 
               
               
                 Violent behavior 
                 VIOL 
               
               
                 Mood instability, “moody”, or crying spells, or “giggly” 
                 MOOD 
               
               
                 Anxiety or excessive worries 
                 ANX 
               
               
                 Sleep difficulties 
                 SLEEP 
               
               
                 Academic/School-related problems 
                 SCHO 
               
               
                 Depression or being withdrawn 
                 DEP 
               
               
                 Suicide thoughts or behavior 
                 SUI 
               
               
                 Eating difficulties 
                 EAT 
               
               
                 Obsessed, stubborn, rigid, “set in their ways”, “picky”, 
                 STUBB 
               
               
                 doing things “over and over” 
               
               
                 Hearing voices that others cannot hear 
                 VOICE 
               
               
                 Experienced traumatic event or victim of abuse 
                 TRAU 
               
               
                 Odd, strange or unusual behavior 
                 ODD 
               
               
                 Not talking or not communicating as expected for 
                 TALK 
               
               
                 his/her age 
               
               
                 Failed to develop age appropriate relationships 
                 RELAT 
               
               
                 Abuses nicotine, and/or alcohol, and/or drugs and/or 
                 DRUG 
               
               
                 pills, and/or inhalants 
               
               
                   
               
            
           
         
       
     
     The assessment server  20  is alternatively configured to transmit instructions to the clinician client application  32  to provide the health assessment queries to a clinician end user, who may personally interview the patient or use other accepted methods for obtaining information for responding to the health assessment queries related to the patient. In such case, the health assessment queries are preferably provided to the clinician end user in the form of a mental status exam (MSE), permitting information to be obtained in a standard format accepted universally by most physicians, and as such a patient would not be required to interact with the patient client system  40  or other computing system. The clinician end user may query a patient in a conventional manner, for example during a live office visit, and input patient responses using the clinician client application  32  simultaneously with the patient response during an interview, or alternatively, at some period of time thereafter. The assessment server  20  is configured to receive health assessment query responses to the patient-related health assessment queries from the clinician end user using the clinician client system  30  in the manner indicated above with reference to the patient client system  40 . 
     Based on the health assessment query responses elicited by the patient end user or clinician end user, the assessment server  20  transmits instructions to the clinician client application  32  to provide one or more of the health assessments along with the health assessment query responses to a clinician end user using the clinician client system  30 . The clinician end user is preferably a health services professional such as a doctor responsible for care of the patient end user. As indicated above, the health assessments are preferably mental health assessments including condition assessments set forth in the DSM or ICD with their corresponding DSM or ICD codes, as set forth in Table 1. Moreover, condition assessments are provided with a corresponding Clinical Global Impression (CGI) score delivered on a scale from 1 to 7 where 1 is “not ill”, 2 is “very mildly ill”, 3 is ”mildly ill”, 4 is moderately ill”, 5 is “markedly ill”, 6 “is seriously ill” and 7 is “extremely ill”. Preferably, an affirmative condition assessment, defined as a condition assessment corresponding to a CGI of 2 or greater, is provided to the clinician client application  32  in response to receipt of affirmative responses from the patient end user to two or more of the symptom queries, indicating presence of those two or more symptoms. In the case where a symptom query provides a scaled selection having a severity range from 0-10, an affirmative response is preferably one in which the selected severity is 4 or greater. A non-affirmative condition assessment, defined as a condition assessment corresponding to a CGI of 1, is provided to the clinician client application  32  in response to receipt of affirmative responses of less than two of the symptom queries associated with the particular condition assessment, and may be provided with or without a CGI, or alternatively, may not be provided to the clinician end user. 
     Each relevant condition assessment and its associated DSM or ICD identification code transmitted to the clinician client system  30  is displayed through the clinician client application  32 , with the health assessment query responses corresponding to the particular condition assessment displayed in proximity thereto. In such manner, the clinician end user may see how the health assessment query responses relate to a particular condition. Preferably, affirmative condition assessments are provided with a CGI. 
     In addition to generating a condition assessment, a traumatic brain injury assessment with a corresponding CGI is preferably also generated by the assessment server  20 . An affirmative traumatic brain injury assessment indicating the presence of traumatic brain injury is generated by the assessment server  20  in response to receiving from the patient end user affirmative responses to one or more relevant symptom queries and one or more relevant risk factor queries. A suicide risk assessment is preferably also generated by the assessment server  20 . An affirmative suicide risk assessment, indicating presence of a suicide risk, is generated with a corresponding CGI in response to receiving from the first end user affirmative responses to one or more relevant symptom queries, one or more relevant stressor queries, and one or more relevant risk factor queries. In another embodiment of the present invention, a homicide risk assessment may also be provided. Preferably, the condition assessment, the traumatic brain injury assessment, and the suicide risk assessment are provided in the form of a preliminary health assessment report for delivery by the assessment server  20  to the clinician end user through the clinician client application  32 . 
       FIG. 2  sets forth a logic routine  100  according to a preferred embodiment of the present invention for generating a preliminary health assessment report  120  using the patient end user responses to queries generated by the assessment server  20 . Preferably, the assessment server  20  follows the logic routine  100  through implementation of clinical algorithms, for example those clinical algorithms derived from the DSM and stored in the clinical algorithm database  14 . Chief complaint selections  102  are used in the determination of appropriate symptom queries. User symptom responses  104  to the symptom queries are used to generate condition assessment data  106  with corresponding CGI or CGIs. As indicated above, symptom responses  104  to the symptom queries and risk factor responses  112  to risk factor queries are used in generating traumatic brain injury assessment data  114 . Further, symptom responses  104  to symptom queries, risk factor responses  112  to risk factor queries, and stressor responses  110  to environmental stressor queries are used along with the condition assessment data  106  in generating suicide risk assessment data  116 . The condition assessment data  106 , traumatic brain injury assessment data  114  and suicide risk assessment data  116  are provided by the assessment server  20  through the clinician client application  32  to the clinician end user in the form of the preliminary health assessment report  120 , which is logged in the clinician assessment report database  18 . 
     Referring to  FIG. 3 , a clinician diagnosis procedure  200  is set forth according to the preferred embodiment of the present invention. The clinician diagnosis procedure  200  is preferably implemented by a clinician end user in response to receipt of a health assessment or plurality of health assessments from the assessment server  20  through the clinician client application  32 . The assessment server  20  is configured to receive from the clinician end user through the clinician client application  42  one of an acceptance (step  202 ), a rejection (step  204 ), and a ruling out (step  206 ) of each health assessment provided to the clinician end user. Preferably an acceptance, rejection or ruling out is received by the assessment server  20  from the clinician client application  32  in response to each affirmative condition assessment, affirmative traumatic brain injury assessment, and affirmative suicide risk assessment provided by the assessment server  20 . This provides a way for the clinician end user to prepare a diagnosis by first considering the health assessment query responses and the health assessment or health assessments provided by the assessment server  20 , as well as additional information received as a result of an in person client interview or physical test results. An acceptance of a particular health assessment may be considered to be a diagnosis if rendered by a health services professional authorized to make such a diagnosis. The assessment server  20  is further configured to receive from the clinician end user through the clinician client application  32  an adjusted CGI (step  208 ) for a particular accepted affirmative condition assessment, whereby the clinician end user may, pursuant to personal observations or other information, change the CGI indicated in the health assessment provided by the assessment server  20 . 
     Preferably, the assessment server  20  is also configured to receive through the clinician client application  32  from an authorized health services professional an additional, user-generated health diagnosis (step  210 ) including a affirmative condition assessment, affirmative traumatic brain injury assessment, or affirmative suicide risk assessment with a corresponding CGI, such not having not been transmitted from the assessment server  20  to the clinician client application  32  in the form of an affirmative assessment. The user-generated health diagnosis is preferably selectable through the clinician client application  32  from the health assessments stored in the clinical algorithm database  14 . Alternatively, the authorized health services professional may manually enter a new diagnosis not provided in the form of a health assessment in the clinical algorithm database  14 . The clinician preferably provides the user-generated health diagnosis and the acceptance, rejection, or ruling out of each health assessment after personally interviewing the patient end user. Clinician comments are also preferably transmittable (step  212 ) through the clinician client application  32  to the assessment server  20 . 
     The assessment server  20  generates a clinician assessment report preferably including the health assessment query responses and, for each health assessment transmitted, the acceptance, the rejection, or the ruling out of the health assessment, along with any user-generated health diagnosis and comments provided by the clinician end user. As such, the clinician assessment report includes both the proposed assessments set forth in the preliminary assessment report  120  discussed above along with input provided by the clinician end user. Preferably, the clinician assessment report includes applicable affirmative condition assessments, affirmative traumatic brain injury assessment, and/or affirmative suicide risk assessment with corresponding CGI and an indication of whether the assessment or assessments were accepted, rejected or ruled out by the clinician end user. The assessment server  20  logs the clinician assessment report in the clinician assessment report database  18 . The clinician end user is preferably provided access to the report through the clinician client application  32 . The assessment server  20  as well as the client query response database  16  and the clinician assessment report database  18  are preferably secure and Health Insurance Portability and Accountability Act (HIPAA) compliant. If desired, the patient end user may also be provided secure access to the patient&#39;s clinician assessment report through the patient client application  42 . 
     The assessment server  20  is configured to transmit instructions to the patient client application  42  to provide the health assessment queries to the patient end user using the patient client system  40  during multiple intakes. During an initial patient end user intake, the patient preferably registers with the assessment server  20  and may be provided with or select a pass code to permit the assessment server  20  to identify the patient end user during a later intake. During follow-up intakes, the assessment server  20  may identify the patient end user and present follow-up health assessment queries relevant to that patient end user, preferably including health assessment queries corresponding to conditions assessed during a prior intake. The preliminary assessment report  120  preferably shows the patient end user&#39;s progress, including improvement or deterioration of conditions, by providing the clinician end user a comparison of current health query responses with prior health query responses entered during a prior intake. 
     As indicated above, the clinical algorithm database  14  preferably stores mental health assessment queries and corresponding mental health assessments in the form of rules based algorithms preferably governed at least in part by DSM criteria. In this manner, the assessment server  20  utilizes data in the clinical algorithm database  14  to generate health assessments, preferably in the form of the preliminary assessment report  120 , based on health assessment query responses from a patient end user. Alternatively, the clinical algorithm database  14  may be updated, or another database provided, to permit use of data from the patient end users and clinician end users to implement case based algorithms for generating mental health assessments. In this manner, the assessment server  20  may generate mental health assessments for a given patient end user based on health assessment query responses given by one or more preceding patient end users in preceding intakes, or based on responses from one or more clinician end users, in the form of acceptances, rejections, ruling outs, added diagnoses, and modified CGIs transmitted in response to preceding intakes. 
     A preferred manner of implementing case based algorithms is one in which the assessment server  20  uses data regarding the plurality of patient end users stored in either or both of the client query response database  16  and the clinician assessment report database  18  to generate the case based algorithms for storage in the clinical algorithm database  14 . As a first example, a plurality of patient end users may, as evidenced by two or more separate intakes, show improvement, deterioration or no change in severity of symptoms of a particular diagnosed condition as a result of a particular treatment. Case based algorithms may be generated by the assessment server  20  and stored in the clinical algorithm database, for generating health assessments for later patient end users based on the improvement, deterioration or no change in the severity of symptoms of previous patient end users. The case based algorithms are preferably in the form of modified rules based algorithms. These case based algorithms may alternatively be implemented for providing the clinician end user with proposed treatments for a diagnosed condition. As a second example of generating and implementing case based algorithms, one or more clinician end users may provide an acceptance, a rejection, a ruling out, added diagnoses, or a modified CGI in response to a particular health assessment generated by the assessment server  20  in response to health assessment query responses received by patient end users. Case based algorithms may be generated by the assessment server  20  for generating health assessments for later patient end users who provide similar health assessment query responses to the query responses provided by prior patient end users based on the acceptance, rejection, ruling out, added diagnoses, or modified CGI by the one or more clinician end users. The first and second examples show that the patient intake and assessment system  12  may function as an artificial intelligence system capable of learning from data stored in the client query response database  16  and the clinician assessment report database  18 . Preferably, the assessment server  20  may pursuant to the desire of the clinician end user selectively implement either or both of rules based algorithms or case based algorithms in generating the health assessments. 
     The patient intake and assessment system  12 , through its client query response database  16  and clinician assessment report database  18  provides an invaluable resource for tracking patient progress over multiple intakes, including the patient&#39;s reaction to a course of treatment, for example prescribed mediations. Accordingly, data mining for epidemiological research may be facilitated. Preferably, the assessment server  20  is configured to selectively de-identify patient data in compliance with HIPPA privacy policies to permit patient data to be accessed by those who wish to track the efficacy of a particular course of treatment. Moreover, permission is requested from a patient prior to using the patient&#39;s medical data for any purpose other than treating the patient. Clinician end users are preferably provided access to de-identified data of patient end users not under their care for the purpose of determining the efficacy of a particular treatment for other patient end users. For example, before prescribing a patient with a particular medication, the clinician end user is preferably provided access to the client query response database  16  and clinician assessment report database  18  to permit the clinician end user to assess the progress of other patients corresponding to one or more identical or similar health assessment query responses or health assessments as compared with the particular patient which the clinician end user is treating. 
     Aside from the direct benefits to health professionals, the patient intake and assessment system  12  provides researchers the ability to quantify vast patient and health professional clinical experience into one or more researchable databases to establish behavioral and psychiatric treatment response measures, behavioral measures, and treatment history analyses including but not limited to: treatment adverse event analyses, co-morbidity analyses, synergistic medication response analyses, genetic analyses, CGI improvement analyses, CGI severity analyses, symptom improvement analyses, psycho-social analyses, and congenital analyses. These measures, which to-date take vast amounts of human and financial capital to measure, may be extracted and analyzed with vastly less effort and financial cost from one or more of the above-indicated databases using de-identified patient data provided by the intake and assessment system  12  according to the preferred embodiment of the present invention. 
     During an initial patient end user intake, the assessment server  20  is preferably further configured to transmit instructions to the patient client application  42  to query a patient end user regarding whether the patient end user consents to be contacted regarding potential treatment options or clinical research projects. A patient end user may consent or not consent to be made aware of any new treatments or studies that may be made available for his or her condition or the condition of the person under his or her care. Preferably, an affirmative consent constitutes only a research pre-consent, such that a patient end user is not consenting to be a part of any particular clinical research study, rather the patient end user is only consenting to be made aware of any potential new studies. A patient end user is preferably informed of a potential new study via an Institutional Review Board (IRB) approved research consent form, and thereafter the patient end user may choose whether or not to participate in the study. 
     Referring to  FIG. 4 , a method  300  for patient assessment according to the preferred embodiment of the present invention is provided. The method  300  includes providing a server (step  302 ), and transmitting from the server health assessment queries to a first end user (step  304 ). The server receives health assessment query responses from the first end user (step  306 ) and generates one or more health assessments based on the health assessment query responses (step  308 ). The server transmits the one or more health assessments to a second end user (step  310 ) and receives selectively from the second end user an acceptance or rejection of each of the one or more health assessments (step  312 ). The server generates a clinician assessment report including the acceptance or rejection of each of the one or more health assessments (step  314 ). Preferably, one or more of the health assessment queries are transmitted from the server to the first end user based on one or more of the health assessment query responses from the first end user (step  306 ). 
     Referring to  FIGS. 5A-5F , shown are sample screen captures from displays of the patient user interface  44  generated by the patient client application  42  implementing the method for patient intake and assessment according to the preferred embodiment of the present invention. A first screen capture  400  and a second screen capture  410  each show a scaled response selection  402  permitting a patient end user to offer an indication of to what degree or intensity a symptom is present. The symptom query is positioned above the scaled response selection as shown. A third screen capture  420  shows a multiple choice selection field  412 , a fourth screen capture  430  shows a free form text entry response field  432 , and a fifth screen capture  440  shows a yes-no-unknown text entry response field  442 . A sixth screen capture  450  displays exit instructions indicating that the patient end user portion of the intake and assessment has been completed. Each of the screen captures show a progress meter  404  indicating how far the patient end user has progressed through the intake and assessment. An interview structure bar  406  classifies the query or particular set of queries which the patient end user is presented with. 
     Table 3 below shows an example excerpt of a preliminary health assessment report  120  for delivery to the clinician end user through the clinician client application  32 , showing patient end user symptom query responses. In the example excerpt shown, the displayed patient end user responses are provided in the form of a severity scale selection of the type indicated above on a scale from 0-10. As also indicated above, other responses from the patient end user related in the preliminary health assessment report  120  may include multiple choice, true-false-unknown, yes-no-unknown, free form text entry type queries or any suitable type query responses. Query responses are grouped with a corresponding condition, designated by a DSM code, which is assessed based on the respective group of query responses. In the example case excerpted below, shown are condition assessment descriptions for “Manic Episode” and “Overanxious/Generalized Anxiety Disorder”, with the queries used to assess these conditions conveniently positioned under the condition assessment descriptions. 
     As indicated above, a selection by a patient end user of a chief complaint in Table 2, may elicit queries pertaining to one or more of the condition assessments in Table 1. For example, a user selection of any of the chief complaints BP, ANG, VIOL, MOOD, SLEEP, DEP, SUI, LEGAL in Table 2 may elicit queries for assessing “296.00 Manic Episode”, among other conditions. Preferably, chief complaints should elicit queries corresponding to more than one of the condition assessments listed in Table 1. For example, selecting only DPA “Difficulty paying attention” from Table 2 as a chief complaint may elicit queries corresponding to the assessment of “314.00 ADHD, Inattentive type”, “315.90 Learning Disorder”, “307.40 Sleep Disorder”, and “307.90 Communication Disorder”. One skilled in the art will recognize that any suitable selection of queries may be implemented which is consistent with the criteria set forth in an accepted version of the DSM. 
     At the bottom of Table  3 , affirmative condition assessments “300.02 Generalized Anxiety Disorder” and “307.40 Sleep Disorders” as generated by the assessment server  20  are clearly listed, indicating the presence of these conditions based on the patient end user query responses. The clinician end user and may selectively accept, reject or rule out each affirmative condition assessment after which a finalized clinician assessment report may be generated. 
     
       
         
           
               
               
             
               
                   
                 TABLE 3 
               
               
                   
                   
               
               
                   
                 Severity 
               
               
                   
                   
               
             
            
               
                   
               
            
           
           
               
               
            
               
                 Symptoms - 296.00 Manic Episode 
                   
               
               
                 1. Inflated self-esteem, elation or grandiosity during manic episode 
                 3 
               
               
                 2. Severe irritability during manic episode 
                 3 
               
               
                 3. Decreased need for sleep 
                 6 
               
               
                 4. More talkative than usual 
                 0 
               
               
                 5. Flight of ideas (jumps from one topic to another) 
                 0 
               
               
                 6. Distractibility 
                 0 
               
               
                 7. Increase in goal-directed activity (several unfinished projects) 
                 0 
               
               
                 8. Excessive pleasurable activities with high risk of painful consequences 
                 0 
               
               
                 . . . 
               
               
                 Symptoms - 300.02 Overanxious/Generalized Anxiety Disorder 
               
               
                 1. Excessive worries, restlessness or feeling on edge for more than six months 
                 6 
               
               
                 2. Being easily fatigued 
                 4 
               
               
                 3. Difficulty concentrating or mind going blank 
                 4 
               
               
                 4. Irritability 
                 4 
               
               
                 5. Muscle tension 
                 4 
               
               
                 6. Sleep Disturbance 
                 4 
               
               
                 7. Difficulty controlling worries 
                 5 
               
               
                 . . . 
               
               
                 Symptoms - 307.40 Sleep Disorder 
               
               
                 1. Difficulty falling asleep 
                 5 
               
               
                 2. Difficulty maintaining sleep 
                 5 
               
               
                 3. Fatigue 
                 5 
               
               
                 4. Excessive sleep during daytime 
                 5 
               
               
                 5. Sudden urges to sleep during daytime 
                 3 
               
               
                 5. Snoring for at least one month 
                 3 
               
               
                 6. Stops breathing while asleep for at least one month 
                 0 
               
               
                 7. Sleep walking 
                 0 
               
               
                 8. Sleep talking 
                 0 
               
               
                 10. Nightmares 
                 0 
               
               
                 . . . 
               
               
                 Assessments To Be Reviewed By Clinician: 
               
               
                 . . . 
               
               
                 300.02 Generalized Anxiety Disorder 
                 CGI 5 
               
               
                 . . . 
               
               
                 307.40 Sleep Disorders 
                 CGI 5 
               
               
                 . . . 
               
               
                   
               
            
           
         
       
     
     Table 4 below shows an example excerpt from a clinician assessment report, which is the finalized version of the preliminary health assessment report  120  set forth in part in Table 3, and further including the clinician end user&#39;s acceptances, rejections, ruling-outs, comments and added diagnosis. 
     
       
         
           
               
             
               
                 TABLE 4 
               
               
                   
               
             
            
               
                 Assessments Reviewed By Clinician 
               
            
           
           
               
               
               
            
               
                 295.40 Schizophreniform Disorder 
                 Accepted by Clinician 
                 CGI 5 
               
               
                 300.02 Generalized Anxiety Disorder 
                 Rejected by Clinician 
                 CGI 5 
               
               
                 300.21 Panic Disorder with Agoraphobia 
                 Accepted by Clinician 
                 CGI 5 
               
               
                 300.4 Dysthymic Disorder 
                 Accepted by Clinician 
                 CGI 6 
               
               
                 307.40 Sleep Disorders 
                 Accepted by Clinician 
                 CGI 5 
               
               
                 309.81 Posttraumatic Stress Disorder 
                 Rejected By Clinician 
                 CGI 4 
               
               
                 Consider Traumatic Brain Injury 
                 Rule Out 
                 Need to obtain more data 
               
               
                 Suicidality 
                 Accepted By Clinician 
                 CGI 6 
               
            
           
           
               
            
               
                 Diagnoses Added By Clinician 
               
            
           
           
               
               
            
               
                 313.01 Oppositional Defiant Disorder 
                 CGI 4 
               
               
                 296.89 Bipolar II Disorder 
                 CGI 5 
               
            
           
           
               
            
               
                 Comments 
               
            
           
           
               
            
               
                 none 
               
            
           
           
               
               
            
               
                 Clinician Signature: Dr. John Doe 
                 Date: Jan. 20, 2008 
               
               
                   
               
            
           
         
       
     
     In the example excerpt shown in Table 4, the clinician end user provided five assessment acceptances, two assessment rejections, and one assessment ruling out. Further, two additional diagnoses were provided which were not initially provided as assessments by the assessment server  20  through the clinician client application  32 . Alternatively, the clinician assessment report may be exported as a narrative report in continuous paragraph form, rather than an itemized list as shown in Table 4, suitable for integration into referral letters, reports, or other documents benefiting from such continuous description. 
     Alternatively, the assessment server  20  may be configured to automatically export data from the clinician assessment report database  18 , including any data received from a clinician end user or patient end user, to populate an electronic medical record system (EMR system). Data corresponding to one or more patients may be extracted item by item from the clinician assessment report database  18  to populate corresponding fields within an EMR system. 
     The present invention further provides a client application program product having a computer readable medium with instructions operable to enable a client computer to perform a procedure. This procedure includes identifying a first end user and a second end user, and receiving instructions from a server to provide health assessment queries to the first end user. This procedure further includes transmitting health assessment query responses from the first end user to the server, and receiving instructions from the server to provide a health assessment to a second end user based on the health assessment query responses from the first end user. The instructions enable a client computer to transmit from the second end user to the server selectively an acceptance of the health assessment, a rejection of the health assessment, and a user-generated health diagnosis. The client computer is further enabled to receive instructions from the server to provide to the second end user a clinician assessment report including one or more of the acceptance of the health assessment, the rejection of the health assessment, and the user-generated health diagnosis. 
     While the preferred embodiments of the invention have been described in detail above, the invention is not limited to the specific embodiments described above, which should be considered as merely exemplary. Further modifications and extensions of the present invention may be developed, and all such modifications are deemed to be within the scope of the present invention as defined by the appended claims.