Patent ID: 8380542

Claim:
A method carried out by a server, the server comprising a communication interface, a processor, and a data storage comprising instructions that, if executed by the processor, cause the server to carry out the steps comprising: receiving from a communication device (i) an identifier of a patient and (ii) a login credential associated with an individual from a care team comprising a plurality of individuals authorized to access a patient record of the patient, wherein the plurality of individuals comprises a physician, a nurse, and a family member of the patient, wherein the physician, the nurse, and the family member of the patient are individuals other than the patient; making a determination based on the login credential that the individual is authorized to access the patient record, wherein the patient record is stored in a database and is associated with the patient identifier; subsequent to making the determination, preparing an assessment based on the patient record, and providing the assessment to the communication device, wherein the assessment comprises a measurement; receiving a measurement result from the communication device, and updating the patient record based on the measurement result, wherein the measurement result is associated with the measurement; preparing a care plan based on the updated patient record, a patient specific need, and a patient demographic, and providing the care plan to the communication device, wherein the care plan comprises a task; receiving a task status from the communication device, and updating the updated patient record based on the task status, wherein the task status is associated with the task; determining an outcome of the care plan based on the updated patient record, wherein the outcome is a positive outcome or a negative outcome; identifying a correlation between the outcome, the care plan, and the patient demographic; preparing a subsequent care plan based on the identified correlation, the updated patient record, the task status, the patient specific need, and a physician assessment, and providing the subsequent care plan to the communication device, wherein the subsequent care plan comprises a subsequent task; receiving a subsequent task status from the communication device, and adjusting the updated patient record based on the subsequent task status, wherein the subsequent task status is associated with the subsequent task; and preparing a discharge assessment based on the adjusted patient record, and providing the discharge assessment to the communication device.