WO2001027852A1

WO2001027852A1 - Method and apparatus for pre-consultation interview

Info

Publication number: WO2001027852A1
Application number: PCT/US2000/028766
Authority: WO
Inventors: Ascher Shmulewitz
Original assignee: Ecliniq Corporation
Priority date: 1999-10-13
Filing date: 2000-10-13
Publication date: 2001-04-19
Also published as: AU1211601A

Abstract

A pre-consultation tool (20) is provided for scheduling a consultation and for conducting a pre-consultation interview. The tool includes an expert system (23) to automate the collection of information (21) from the client concerning the subject of the consultation. A summary (28) of the collected information and a course of action recommended by the expert system are forwarded (32) to the consultant for review and possible approval. The consultant may also confirm a scheduled appointment and may set a duration of the appointment.

Description

METHOD AND APPARATUS FOR PRE-CONSULTATION INTERVIEW

Field of the Invention

This invention relates to methods and apparatus for assisting a professional, such as a doctor, attorney, or accountant, provide services to their clientele. Specifically, the present invention relates to methods and apparatus for conducting an interactive pre-consultation interview.

Background of the Invention

Sometimes it is desirable to be able to discuss a matter or situation of concern with an expert or authority on the subject. For example, a person may wish to consult an accountant about taxes or a dentist about a toothache. In some cases, such consultations may be conducted by telephone; however, for more complicated matters a face-to-face consultation is required. To provide effective assistance a consultant needs basic information about the client and the matter of the consultation. This basic information is often obtained by way of questions, which may be asked verbally or in the form of a written questionnaire. For example, upon arriving at a doctor's office, a patient is often given a clipboard with an extensive medical history form to be filled out prior to seeing the doctor.

Once the basic information has been obtained, follow-up questions focus on the subject of the consultation. These questions are exemplified by the types of questions a doctor asks a patient about their symptoms. Responses to these questions suggest further questions to the consultant based on their experience. This process enables the consultant to accurately assess the client's situation and suggest possible courses of action. Alternatively, the consultant may conclude that additional information, research, or testing is needed before effective advice may be given. For example, a doctor may require a blood test before making a diagnosis. In such cases additional consultations may be required.

Delaying advice while more information, e.g., a blood test, is collected leads to frustration on the part of both consultant and client. This is especially true when the information could have easily been provided or obtained with a little foresight. For example, a patient complaining about a sore neck following a car accident might see a doctor for only a few minutes before being told to schedule another appointment after getting a x-ray taken. In such a scenario, the need for an x-ray could have been foreseen based on a few questions and an x-ray obtained prior to the scheduled appointment .

Furthermore, the need for additional consultations following some test or data collection effort may be viewed with some degree of distrust and skepticism by the client. This is because the client may not understand the relevance of a particular test or piece of information. Indeed, some clients may view the request for additional tests or information as an unnecessary waste of time and money.

The uncertainty about a client's needs also causes difficulties in scheduling consultations. For example, too much time may be allotted for a simple consultation leaving slack time between appointments. Conversely, scheduling too little time for a more complex consultation causes subsequent appointments to be delayed.

Thus, there is a need to ensure that at a consultation a consultant has all the information needed to accurately schedule the consultation and effectively counsel the client. At the same time, there is a need to educate the client about the relevancy of the information requested by the consultant .

In light of the foregoing it would therefore be desirable to provide methods and apparatus for assisting an expert and client prepare for a consultation .

It would also be desirable to provide methods and apparatus for educating and informing the client about the relevance of information being gathered.

Summary of the Invention

It is therefore an object of the present invention to provide methods and apparatus for assisting an expert and client prepare for a consultation . It also an object of the present invention to provide methods and apparatus for educating and informing the client about the relevance of information being gathered.

In accordance with these and other objects of the present invention, methods and apparatus are disclosed for a pre-consultation tool for assisting a consultant gather information from a client in preparation for an in-person consultation. The tool includes a suitably programmed computer that controls and coordinates an interview with the client. An expert system generates queries designed to gather information about the client and about the client's situation. The expert system also analyzes the client's responses to guide the selection of further questions. The responses may also be stored in a database for long term analysis of historical trends and conditions.

When the expert system has collected sufficient information about the client's situation, the expert system generates a summary of the client information and a recommended course of action. The summary and recommendation are forwarded to a consultant for review and approval.

A client interface is provided so that the queries may be presented to the client, and responses returned to the expert system. The user interface also provides a means whereby a tentative appointment may be scheduled by the client

A consultant interface is provided whereby the consultant may interact with the expert system, data base, and client to review the client information in more detail or to examine the reasoning behind the suggested course of action. The consultant may approve the recommended course of action, or modify it if necessary. The consultant may also confirm and set the type and duration of the appointment.

The consultant interface also enables the input of post-consultation information such as the actual course of action taken or the actual duration of the consultation. This information may be used to update the expert system so that the preferences and idiosyncracies of the consultant may be taken into account when making future recommendations .

Brief Description of the Drawings

The above and other objects and advantages of the present invention will be apparent upon consideration of the following detailed description taken in conjunction with the accompanying drawings, in which like characters refer to like parts throughout, and in which:

FIG. 1 is a conceptual block diagram of a pre-consultation tool in accordance with the principles of the present invention; FIG. 2 is a exemplary flow chart showing the patient side of an illustrative pre-consultation interview;

FIGS. 3A-C show illustrative examples of a patient interface; FIG. 4 is an illustrative example of a query and an explanation of why the query is relevant to making a diagnosis;

FIG. 5 is an illustrative flow chart showing the physician side of a pre-consultation interview in accordance with the principles of the present invention; FIG. 6 shows an illustrative example of a consultant interface; and

FIG. 7 is a schematic representation of an illustrative system for implementing an embodiment of the present invention.

Detailed Description of the Invention

The present invention is disclosed hereinbelow in terms of a patient seeking medical diagnosis and treatment. However, it is to be understood that the present invention is applicable to other fields of endeavor. For example, an attorney may find the present invention useful in preparing for a consultation with a new client, or a mortgage broker may find it useful in tailoring a real estate loan to a client's financial situation.

In a doctor's office scheduling of appointments is often performed by staff employees with little or no medical training. This makes it difficult for the staff employee to ascertain when and for how long an appointment should be scheduled. For example, should an appointment be scheduled as soon as possible or postponed until after some diagnostic tests. In some instances an appointment may not even be needed. Indeed, it has been estimated that a majority of patient complaints may be diagnosed on the basis of a thorough medical history and description of current medical symptoms. This information is easily obtained over a communication medium such as the telephone or Internet without the need for an face-to- face consultation.

Because of their extensive medical training a doctor would best be able to determine whether an appointment is necessary, how long an appointment should take, and whether diagnostic tests should be done before the appointment. However, having a doctor schedule appointments is clearly an inefficient use of their skills, talents, and time; all of which are better used treating patients. This is especially true when much of the information to be gathered is routine in nature, and only a few specific questions and a final diagnosis require a physician' s specialized knowledge. The alternative, using highly trained office staff for scheduling appointments, would result m higher costs.

In accordance with the principles of the present invention a pre-consultation tool is used to schedule appointments and to ensure that sufficient information is gathered from a patient so that a physician may make a diagnosis and begin treatment during a first office visit. A pre-consultation tool, or system, is described by reference to FIG. 1, wherein pre-consultation tool 10 includes patient interface 12, expert system 13, physician interface 15, data base 16, and control process 17.

Patient interface 12 is used by control process 17 to present questions to a patient and collect responses to the questions. Patient interface 12 may be a web browser, such as Netscape^® Navigator, used to access pages on the world wide web, or may be custom software running on a patient's computer. Alternatively, a DTMF/voice response system may be used to provide access using nothing but a touch tone telephone. Patient interface 12 also provides a mechanism for a patient to schedule an appointment with the doctor. Expert system 13 includes one or more computer programs designed to apply knowledge in a particular medical field to help diagnose a patient's illness or disease and recommend a treatment plan. An exemplary expert system is described in patent No.

5,711,297 to Iliff which discloses an expert system for diagnosing medical complaints and suggesting appropriate treatment .

Physician interface 15 enables a doctor to view information about the patient and the treatment plan recommended by expert system 13. If desired, the doctor may interact with expert system 13 to examine the rationale for the recommendation before approving, modifying, or rejecting the recommended treatment plan. In one embodiment of the present invention a doctor or an assistant may use physician interface 13 to monitor the interaction between a patient and the pre-consultation tool, as a form of process and quality control . This enables the doctor to assess on a statistical basis how patients are treated, average time for patients to use the tool, patient satisfaction, and the like. Such information may be used to improve patient care.

Physician interface 13 also enables a doctor to provide information about the results of any in- person consultations or about post-consultation changes in the patient's situation. Such information may be incorporated into expert system 13 and database 16 so that it will be taken into account for subsequent recommendations.

Data base 16 provides storage for information about the patient and about previous consultations with the patient. For example, data base 16 may contain a patient's address, telephone number, and insurance information so that this information does not have to be collected each time the patient uses pre- consultation tool 10. Data base 16 may also contain doctor preferences as to specific questions to ask the patient and the treatments and pharmaceuticals the doctor prefers .

Because doctors may already have patient information in computer databases, it is an important feature of the present invention to provide compatibility with such legacy systems. In its simplest form this feature is provided by a utility program that converts legacy data bases into a format suitable for use with pre-consultation tool 10. However, in a preferred embodiment, routines are provided for expert system 13 to access the legacy data bases directly and ask the patient to verify the data. For example, if the legacy data base shows a patient is taking a prescription medication, expert system 13 may ask the patient whether they are still taking the medication and on what schedule. Verified, up-to-date information is then stored into data base 16.

Control program 17 orchestrates communication between patient interface 12, expert system 13, physician interface 15, and data base 16. In general, these components have different interfaces, data formats, and control languages. For example, world wide web based patient and physician interfaces may use HTML or XML for the transmission of content and Java or JavaScript for control. Conversely, database 16 may use SQL to retrieve and store data. Control program 17 provides translations services between the components of pre-consultation tool 10. Turning now to FIG. 2, an exemplary process for obtaining information from the patient is now described. Flow chart 20 begins at steps 18 and 19 with a patient logging into the system. For a previous patient the login may be simplified to simply having the patient enter a name or identification number along with a personal identification number (PIN) or password. However, the login for a new patient will likely be more detailed and may include registering for the service and providing identifying information such as name, insurance coverage, telephone number, and the like. Exemplary input screen 35 for gathering identifying information from a patient is shown in FIG. 3A. Clearly, world wide web based systems must employ suitable encryption technology to keep patient information confidential.

At step 21, the patient is able to schedule a tentative appointment with the doctor and at step 22, basic information about the patient is collected. For new patients this entails collecting some background information including the patient's medical history and current symptoms or complains. Input screens 36 and 37 of FIGS. 3B and 3C, respectively, are portion of an exemplary on-line medical history questionnaire. This information is stored in database 16 for future reference. Medical histories of previously seen patients may simply be retrieved from data base 16 and updated as necessary.

In one embodiment of the present invention, a patient's medical history is stored on a computer accessible by the doctor. This provides the doctor with ready access to the information for the purposes of making a diagnosis or m looking for trends over many consultations. It also enables the doctor to send the information to another physician or to a specialist to confirm a diagnosis.

However, some patients may be fearful that this highly confidential information could be accessible to or compromised by unauthorized persons. Thus, in a second embodiment of the present invention, a patient's medical history is stored on the patient's computer for long term retention. In this embodiment, the medical history is only uploaded to pre- consultation tool 10 when needed by expert system 13 or by the physician. Then when the information is no longer needed, it may be removed from any temporary storage in pre-consultation tool 10. Alternatively, a patient's medical history may be retained by pre-consultation tool 10 in an encrypted form, with the decryption key held by the patient or trusted third party. This reduces the likelihood of a patient's medical history being lost as a result of failure of the patient's computer.

After basic patient information has been collected, either directly from the patient or from data base 16, expert system 13 is consulted at step 23. Some information needed to make a diagnosis may have been obtained in the basic information collected at step 22 or retrieved from data base 16. At step 24, expert system 13 determines whether there is sufficient information upon which to make a recommendation. Initially, there will be insufficient information for a diagnosis and additional information must be collected. Based on the information sought, one or more diagnostic queries are formulated at step 25 and presented to the patient at step 26. In a web based system multiple queries may be grouped and displayed on a single web page to minimize communication overhead. In contrast, a voice or DTMF based system must present the queries one at a time to minimize confusion on the part of the patient.

The diagnostic queries are designed to gather information necessary for a proper diagnosis of the patient's condition. The questions are selected by expert system 13 based on knowledge represented in the expert system as well as on patient responses to previous questions. Expert system 13 may also make use of knowledge gleaned from previous consultations that have been recorded in database 16.

Many expert systems are limited in scope to a narrow field of knowledge. For example, one medical expert system may be limited to diseases of the intestinal tract, while another is limited to skin conditions. Expert system 13 may, therefore, include a more general expert system that is able to select appropriate ones of the more narrowly focused expert systems .

Expert system 13 may also be programmed to provide a triage-like service for grading the severity of an illness or injury. When warranted, expert system 13 may recommend that the patient call 911 for emergency medical treatment, or that the patient seek immediate medical attention at an emergency room. Alternatively, if the patient interview indicates a potential crisis situation pre-consultation tool 10 may notify the doctor or assistant immediately enabling them to become involved more quickly.

The queries generated by expert system 13 are generally formulated as either true/false, yes/no, or multiple choice questions. Although some queries may have a range of possible answers. For example, a first query may ask if the patient has a fever and a second query may ask for the patient's temperature. Clearly the first query would accept an yes/no type of response whereas the second query would accept any numerical value within a reasonable range, e.g., from about 90°F to about 107°F. Queries may also instruct the patient to take some action. For example, a patient may be directed to have a blood test done or an x-ray taken. In one preferred embodiment of the present invention, the queries generated by expert system 13 are accompanied by an explanation about the relevancy of the query and the diagnosis under consideration by expert system 13. For example, expert system 13 may inform the patient that a blood test is required to rule out anemia as a cause of the patient's lethargy. Providing information about the differential diagnosis helps the patient to intelligently discuss their condition and treatment with their doctor.

In one embodiment, explanations are provided as notes accompanying specific queries made by expert system 13. This type of explanation indicates why the information may be useful in making a diagnosis, and clearly shows the link between a diagnosis and the questions asked. An exemplary display of a query accompanied by its supporting rationale is shown in FIG. 4.

In an alternative embodiment of the present invention, the patient is provided with more information about the differential diagnosis and given an opportunity to investigate. For example, the patient may be provided with a list of current diagnoses with hyperlinks to descriptions of each diagnosis, including descriptions of the symptoms, tests, and links to similar diagnoses. Where appropriate, further links may provide the patient with information on treatments such as the efficacy and side effects of pharmaceuticals.

Responses to the queries are collected at step 27. Preferably, the results of any requested tests are forwarded directly to expert system 13 of pre-consultation tool 10. However, the results may also be provided by the patient. Expert system 13 is re-consulted with the new information at step 23. This process repeats until sufficient information has been collected to enable expert system 13 to recommend a course of action to be taken.

A summary of the information collected is then generated at step 28 and presented to the patient for review and approval at steps 29 and 30. If the information summary contains errors or is otherwise inaccurate, the patient is given an opportunity to edit the data at step 31. Should any of the patient information be changed, expert system 13 is re- consulted to ensure any recommendations are based on accurate information. Once the information summary has been verified by the patient the information summary, tentative appointment, and the treatment plan recommended by expert system 13 are sent to the doctor for review, at step 32.

Referring now to FIG. 5, the doctor's portion of the process is described. The information summary, recommendation, and tentative appointment, if any, are received and reviewed by the doctor at step 51, and may be approved by the doctor at step 53. If desired, the doctor may consult expert system 13 , at step 52 , to learn the rationale for the treatment plan recommended by expert system 13. FIG. 6 is an exemplary screen of the physician interface showing a patient summary and a recommended course of action.

If the doctor agrees with the recommendation, the doctor is given an opportunity, at step 54, to confirm the tentatively scheduled appointment, or to suggest an appointment if the patient has not scheduled one. At step 55 the doctor sets the expected duration of the appointment .

However, if the doctor does not approve of the recommended treatment, the doctor may conclude, at step 56, that more information is needed and send additional queries to the patient at step 57. These additional queries return the user to step 26 of FIG. 2, and the doctor returns to step 51 of FIG. 5 to await a new information summary and recommendation. If the doctor disagrees with the recommendation of expert system 13, but concludes that enough information is available to recommend a treatment, the doctor may, at step 58 override the recommendation and specify a course of action to be taken by the patient. Regardless of how it is obtained the treatment plan is sent to the patient at step 59. Although it is not shown in FIG. 5, pre- consultation tool 10 may also monitor the performance of the physician in providing patient care. This monitoring may be provided by another expert system that looks at the actions and recommendations of the physician, or statistical routines that report on information such as the number of patients seen, the number of tests ordered, or the number of times the doctor overrode the recommendation of expert system 13.

In a simplified embodiment of the present invention pre-consultation system 10 comprises a general purpose computer loaded with appropriate software. A more powerful exemplary system for implementing the pre-consultation tool of the present invention comprises multiple computers connected by a network as shown in FIG. 7. In system 70, a patient uses a web browser on computer 71 to access the pre- consultation tool on server 72 via Internet 73.

Alternatively, a walk-in patient may access the pre- consultation tool via computer 74, which may be located in the waiting room of the doctor's office.

Similarly, the physician may access the system via a web browser or custom interface software executing on computer 74. In a medical office or clinic having multiple doctors, multiple physician computers 77, may be connected to server 72 by network 75. Computer 79 used by a medical specialist, for example, a neurologist, may also be given access to the pre-consultation tool over the Internet for purposes of referral or diagnosis confirmation.

Expert system 13 may be hosted on server 72 or on remote server 78. Expert system 13 may also comprise multiple expert systems hosted on multiple ones of the computers and servers shown in FIG. 7. Similarly, database 16 may be hosted on servers 72 or 78, or one or more of computers 74, 77 and 79. Control program 17 executes on server 72 to coordinate communication between patient computer 71, expert system 13, database 16, and physician computer 74.

In one embodiment of the present invention, one or more of expert system 13 and data base 16 are provided on a contractual basis by a third party. Such an arrangement amortizes the costs of developing and maintaining pre-consultation tool 10 over a larger number of doctors. In addition, hosting pre- consultation tool 10 on multiple computers and servers increases system reliability and robustness.

One skilled in the art will appreciate that the present invention may be practiced by other than the described embodiments and in fields other than the medical profession; and that the embodiments and examples described herein are presented for purposes of illustration and not of limitation; and that the present invention is limited only by the claims which follow.

Claims

What is claimed is:

1. A method for gathering information prior to a consultation between an advisee and advisor, the method comprising: programming a computer with an expert system in a field of knowledge relevant to the consultation; obtaining information from the advisee related to a problem to be solved in the field of knowledg ; submitting the information to the expert system for evaluation; generating a recommended course of action; summarizing the information; providing the summary and the recommended course of action to the advisor; and accepting from the advisor an indication that the recommended course of action is approved or rejected.

2. The method of claim 1 further comprising: enabling the advisee to schedule a tentative in-person appointment with the advisor; and enabling the advisor to confirm the tentative in-person appointment .

3. The method of claim 2 further comprising : enabling the advisor to set a duration of the tentative in-person appointment.

4. The method of claim 1 wherein the step of evaluating further comprises: determining whether sufficient information is available to generate a recommended course of action; and responsive to a determination that there is insufficient information obtaining additional information from the advisee.

5. The method of claim 1 wherein the step of obtaining information further comprises : obtaining historical information about the client; and storing the historical information in a database .

6. The method of claim 5 wherein the historical information is obtained from the advisee during a first use of the method and retrieved from the database during a subsequent use of the system.

7. The method of claim 6 wherein the historical information may be updated prior to submission to the expert system.

8. The method of claim 1 wherein the step of obtaining information further comprises: generating queries to solicit information needed by the expert system; presenting the queries to the advisee; and accepting responses from the advisee.

9. The method of claim 8 wherein the steps of presenting the queries and accepting responses comprises generating an form on a page on the world wide web and processing data entered in the form.

10. The method of claim 9 wherein the form is displayed in a web browser.

11. An information gathering system comprising: a computer system; a client communications interface coupled to the computer system for accepting a communication link from a client; and a consultant communications interface coupled to the computer system for establishing a communication link to a consultant; and a memory coupled to the computer system containing a set of programmed routines including: a client interface routine for communicating queries to the client and receiving responses to the queries from the client; a consultant interface routine for communicating to the consultant a summary of the responses and a recommended course of action, and for accepting from the consultant an indication of approval of the recommended course of action; and an expert system routine for generating the queries, summarizing the responses, analyzing the responses, and determining the recommended course of action.

12. The information gathering system of claim 11 further comprising: a database coupled to the computer system, wherein the memory further includes database routines for storing the responses in the database and for selectively retrieving responses from the database .

13. The information gathering system of claim 12 wherein the memory further includes: a control routine for coordinating interaction between the client interface routines, the consultant interface routines, the expert system, and the database.

14. The information gathering system of claim 13 wherein the control routine further includes: a translation routine for translating between data formats and communications protocols used by at least two of the client interface routine, the consultant interface routine, the expert system routine, and the database.

15. The information gathering system of claim 11 wherein the computer system comprises at least two computers connected by a network, and the memory comprises at least two memories coupled to corresponding ones of the at least two computers .

16. The information gathering system of claim 15 wherein the client communications interface comprises a connection to a network to which the client is connected.

17. The information gathering system of claim 15 wherein the client interface routine includes: a display routine for generating pages for display in a web browser; and an input routine for accepting information from the web browser.

18. The information gathering system of claim 17 wherein the display routine and input routine are routines that are downloaded to the client's computer for execution thereon.

19. The information gathering system of claim 11 wherein the computer system comprises a first and second computer, the memory comprises first and second memories coupled, respectively, to the first and second computers, and the expert system comprises first and second expert systems contained in the first and second memories, respectively.

20. The information gathering system of claim 19 wherein the expert system routine further comprises a third expert system for selecting between the first and second expert systems based on the responses .