Clinical database of classified out-patients for tracking primary care outcome

Abstract

A computerized medical database system for the standardized recording and tracking of out-patient care by the simulation through existing software of multiple facets of a typical primary care clinical environment. Central to the system's data processing are office visit records as the primary vehicle for encoded data input and a chronic diagnosis classification table for ranking out-patients into separate, prioritized diagnostic categories. Integrated with both in a relational database are other files storing distinct but related clinical attributes of both the transactional and inventory type. The former, as event-based, include emergency room, medicine activity, specialist, lab tests and an office visit-derived or intermediary file while the latter type, as a fixed pool of clinically descriptive data elements, include long and short-term diagnosis, physical signs and symptoms and a generic medication list. The data processing is of three kinds; data entry of office visit, one master medical for each out-patient and lab test result records, data query for obtaining summary-type, narrowly focused information for a single or group of related out-patients and, thirdly, the compilation of data from office visits for reporting various clinical results. Some of the latter type processing, using sets of clinical criteria including diagnostic category for specific record selection, include detecting and justifying excessive office visits, determining lab test overusage, monitoring physician activity during episodes of protracted illnesses of differing severity and the printing of physical, medication and lab test results from the same office visit.

Claims

I claim:

1. A computerized out-patient primary care medical system for the entry of clinical data stored into a database, said medical system includes;

means for documenting up to three chronic, long term diagnosis in an out-patient office visit record, said record created during said entry of data and said diagnosis represented on a source document by a partial code that consists of the last 4 digits of a full six digit chronic diagnosis code,

means for determining the primary reason for an office visit through the use of either of two single letter codes obtained from said source document, said codes representing either a chronic, long term diagnosis or an acute short term diagnosis,

means for documenting the primary reason for an office visit, said primary reason represented on a source document as a partial code that consists of the last 4 digits of a full six digit chronic or acute diagnosis code,

means for documenting any physical data noted during an office visit, said physical data consisting of signs and symptoms and represented on a source document as partial codes that consist of the last 3 digits of a full 5 digit physical data code,

means for documenting office visit type, said type being either scheduled or unscheduled and represented by either of two single letter codes present on a source document,

means for documenting the clinical status of an out-patient during said office visit, said status being represented by one of five possible single digits that include a 1 indicating normality or baseline, 2 indicating mild instability, 3 indicating serious instability, 4 indicating improvement from the out-patient's most recent office visit, and 5 indicating that hospitalization was ordered during that office visit,

means for checking entry of said clinical status according to a set of requirements listed on a screen during entry, said requirements consisting of entering a clinical status of 4 for any improvement in said clinical status of an out-patient in comparison to that out-patient's most recent visit and the mandatory entering of at least one physical data item for any clinical status other than 1,

means for updating a related out-patient record during creation and said entry of office visit record, said updating reflecting any changes in any of an out-patient's chronic diagnosis and said related record is an out-patient master medical record,

means for identification of an out-patient master medical record, said identification being by entry of an out-patient last name and full first name present on a master medical record source document,

means for dating the creation of a master medical record,

means for documenting up to three chronic diagnosis of an out-patient in said master medical record, alternate data sets used by said documenting means consisting of either a partial code that consists of the last 4 digits of a full six digit chronic diagnosis code as a direct entry means or a clinical group indicator and a full diagnostic text of said chronic diagnosis with or without a diagnostic category indicator as an indirect entry means of said documenting,

means for identifying an out-patient laboratory test record that will store test results, said identification being a nine digit number,

means for documenting the date when laboratory tests were taken, said tests numbering up to fourteen for each out-patient lab test record,

means for assigning a special number to said lab test record, said special number being an invoice and the most unique aspect of identification of said lab test record,

means for linking said lab test record to either of two related out-patient records, said records being either an office visit record or an emergency room record of said out-patient depending upon the location from which the lab tests were ordered,

means for entering parameter or historical data with each current lab test result, said parameter or historical data is in encoded form and represents a compilation of past results of any single lab test including chronicity of abnormality and a most recent result of that test whether normal or abnormal,

means for recalling prior test results from different aspects for each current lab test result, said prior aspects include date and value of first abnormality, date and value of last abnormality, consistency of prior results, and the most recent result for a particular test normal or abnormal.

2. The computerized out-patient primary care medical system of claim 1 wherein said entry of clinical data into a database office visit record further includes;

means for entering an out-patient identification number from an office visit source document, said number entered consisting of 9 digits,

means for obtaining a special six digit number for said office visit record being created, said number is referred to as an invoice and is said record's most unique aspect of identification, and said means for obtaining includes,

means for adding one to a number being stored in a data field of the most recent office visit record created, said most recent record is usually that of another out-patient on the database,

means for accessing a full six digit chronic diagnosis code from a chronic long-term diagnosis table, and said means for accessing further includes,

means for first entering a 4 digit partial code from said office visit source document, said partial code consisting of the last 4 digits of a full six digit chronic diagnosis code, and further includes

means for searching by said 4 digit partial code entered upon said chronic, long-term diagnosis table,

means for accessing up to two full 5 digit physical data code from a physical signs table, and said means for accessing includes,

means for first entering a 3 digit partial code from said office visit source document, said partial code is the last 3 digits of a full 5 digit physical signs code, and further includes,

means for searching by said 3 digit code entered upon a said physical signs table,

means for accessing up to two full 5 digit physical symptoms codes from a physical symptoms table, and said means for accessing includes,

means for first entering a 3 digit partial code from said office visit source document, and further includes

means for searching by said 3 digit number entered upon a said physical symptom table, and

means for writing the full 5 digit physical signs and symptoms codes accessed to their appropriate data fields in said office visit record being created,

means for writing a full 6 digit chronic diagnosis codes to one of three chronic diagnosis data fields, said field written to depends upon the clinical urgency or prognosis of that chronic diagnosis in relation to any of the other two possible chronic diagnosis of that out-patient that may also be entered,

means for accessing the primary reason for an office visit, said accessing means further includes,

means for entering a single letter code from said office visit source document, and further includes

means for then entering a 4 digit partial code from said source document, said 4 digit partial code present in a data field of said source document that is designated as said office visit primary reason,

means for obtaining, if said single letter code entered indicates a chronic diagnosis as said primary reason for said office visit, a full six digit code from a chronic, long-term diagnosis table and

means for obtaining, if said single letter code entered indicates a short-term acute diagnosis as the primary reason for said office visit, a full six digit code from an acute diagnosis table,

and said means for checking the entry of said office visit clinical status according to a set of requirements listed on a computer screen during said entry of clinical data further includes,

means for preventing the entry of a status 2 immediately following a status 3 office visit record of that out-patient or a status 1 immediately following a status 2, said prevention is for ensuring that a status 4 indicating clinical improvement intervenes first in both circumstances and further includes,

means for preventing the entry of clinical status other than 1 if there are no physical data partial codes on said office visit source document, and

means for preventing the creation of said office visit record if any of the prior said clinical status conditions on said source document exists,

means for checking that all of an out-patient's current chronic diagnosis are present on said source document for entry, and said means for checking further includes,

means for first testing if any chronic diagnosis data field on said source document is blank by absence of any data entered from said field and the corresponding field of that out-patient's master medical record is also blank, and said checking further includes,

means for writing from said master medical record any chronic diagnosis of that out-patient that is present but absent from the corresponsign data field on said source document to the corresponding data field of the new office visit record being created, said writing rectifys any ommission of an out-patient's chronic diagnosis that should be entered but is absent from said source document, and further

means for testing if any changes in any of an out-patient's chronic diagnosis are to be made during an office visit record data entry, and prior said testing includes

means for comparing a said 6 digit code of a chronic diagnosis accessed for writing to a newly created office visit record to that already present in the corresponding field of that out-patient's master medical record, and further

means for writing any differences found between the two said corresponding data fields from the field position of said newly created office visit record to the field position of that out-patient's master medical record, said writing is for updating any changes in an out-patient's chronic diagnosis to that out-patient's master medical record.

3. The computerized out-patient primary care medical system of claim 1 wherein said entry of clinical data into a database master medical record further includes;

means for entering the first and last name of an out-patient from a master medical record source document,

means for determining which of two methods, direct or indirect, are to be used for entering up to three chronic diagnosis into said master medical record, said method used depending upon which of two alternate sets of data fields have been filled out on said master medical record source document, and

means for direct entry, if above said determining means finds just a 4 digit partial chronic diagnostic code present on said source document, and said means for direct entry further includes,

means for accessing by said 4 digit partial code entered a full 6 digit code and its corresponding diagnostic text from a chronic diagnosis table,

means for indirect entry, if above said determining means finds a clinical group indicator and a text of the diagnosis to be entered with or without a diagnostic category indicator present instead on said source document, and said means for indirect entry further includes,

means for displaying on a computer screen the contents of a group of chronic diagnosis records from said chronic diagnosis table that are restricted according to said clinical group indicator entered from said source document and further restricted by diagnostic category if that single letter indicator is also entered from said source document, said display of record contents consist of both the full six digit code and the text of each chronic diagnosis displayed and

means responsive to the restricted display means for selecting from said computer screen only the last 4 digits of the full 6 digit chronic diagnosis code that corresponds to and is associated with the diagnostic text also displayed that matches the one present on said master medical record source document, and

means responsive to the selecting means for then entering the said 4 digit partial diagnostic code corresponding to said text of chronic diagnosis code displayed that was found to be identical to that existing on said source document, and

means responsive to entering means for accessing both the full 6 digit diagnostic code and its corresponding text from said chronic diagnosis table by the said 4 digit partial code entered, and further

means for writing to an appropriate data field of said out-patient master medical record both the said full 6 digit code and the diagnostic text accessed from said chronic diagnosis table by said 4 digit partial code entered, and said writing completes the said indirect method of chronic diagnosis entry,

means for determining if a previous master medical record is on file for an out-patient before said record is created and said data entered,

means for informing a data entry operator of the current total after each of up to three chronic diagnosis for each out-patient is entered,

means for checking the proper ordering by clinical urgency or prognosis the relative data field positions occupied by each of up to three chronic diagnosis entered, and said checking means includes,

means for comparing the relative numeric values between the last 4 digits of the full six digits of each chronic diagnosis entered, said value of the last 4 digits of the primary field diagnosis should be less than the last 4 digits of any secondary field diagnosis which in turn should be less than the last 4 digits of any tertiary field diagnosis and,

means for re-writing any chronic diagnosis that is out of order in relation to any other chronic diagnosis for that out-patient into its correct relative field position in said master medical record.

4. The computerized out-patient primary care medical system of claim 1 wherein said entry of clinical data into a database lab test result record futher includes;

means for entering an out-patient identification number consisting of 9 digits

means for entering the date of when said tests were taken, said date may be as much as two or three days after they were ordered,

means for determining the origin of said lab tests, said origin being either an out-patient office visit or an emergency room visit, and said means for determining includes,

means for indicating by a single letter code entered whether or not said tests were ordered during an office visit,

means for accessing, if said determining means indicates an office visit origin of said lab tests, a 6 digit code that most uniquely identifies that office visit record of said origin, and said origin, and said means for accessing includes

means for finding the most recent office visit record for that out-patient,

means for accessing, if said determining means indicates an emergency room origin of said lab tests, a 6 digit code that most uniquely identifies that emergency room record of said origin, and said means for accessing includes,

means for finding the most recent emergency room record for that out-patient,

means for preventing entry of emergency room ordered lab test data in cases of poor patient compliance, and said means for preventing entry includes

means for determining if period of time between the emergency room visit and when test were actually taken is more than a specified amount of days following said emergency room visit,

means for entering first time lab tests for an out-patient of said database,

means for recalling prior lab test results for an out-patient who has current test results present for entry, and said means for recalling includes,

means for generating a list of selections on a computer screen, each said selection enables obtaining any prior test result already on file from different, separate aspects that include date and value of last abnormality, date and value of first abnormality, most recent result for that lab test and the pattern or consistency of a lab test's prior results, and said means for recalling further includes,

means for displaying on a computer screen the prior result of a lab test according to any of the prior said aspects selected from said list of prior aspects generated,

means for compiling said prior aspects of results for any lab test into an encoded form for accompanying the current quantitative abnormal result or a normal result into storage in said lab test result record, said compiled data constitute the parameter or historical data for indicating a combination of past results of any lab test to complement the current result stored to said lab test result record,

means for activating a customized data entry screen for each of up to 14 lab tests, said customized screen is for assigning each lab test result to a designated position for entry,

means for creating a lab test result record for the entry and storage of up to 14 different lab test results,

means for linking said lab test record with either the source office visit record or the source emergency room record, said linkage based upon the dual invoice nature of each lab test result record wherein said lab test record contains both a special 6 digit number unique and inherent to it and the special 6 digit number unique to the source or parent record, whether office visit or emergency room, representing from which said lab tests were ordered,

means for assisting a data entry operator in the said compiling of said parameter or historical data into encoded form to accompanying said current results into storage, and said means for assisting further includes,

means for instructing a data entry operator on how to select from a number of possibilities 3 single letter codes for indicating, in the case of an abnormal result, the three encoded elements of said parameter data that consist, in the case of an abnormal result, chronicity of that abnormality, intensity of that abnormality and the most recent result for that test while in the case of a normal result just one encoded letter for indicating whether or not the most recent result for that test, if present, is normal, and said means for instructing further includes,

means for displaying said instructions including sample selections on a computer screen for data entry operator review during said entry of clinical data.

5. A computerized out-patient primary care medical database system for the processing and reporting of clinical data includes;

means for creating by a set of intermediary routines new, office visit-derived intermediary records for the storage of office based clinical data in compiled form; and said creating means includes,

means for detecting by out-patient diagnostic category early and possibly unnecessary scheduled office visits, said diagnostic category established and defined by either an individual chronic diagnosis or the combined value of up to three chronic diagnosis of an out-patient present in a said office visit-derived record in reference to a table of chronic diagnosis sorted in descending order by clinical urgency or prognosis,

means for detecting by diagnostic category consecutive unscheduled out-patient office visits,

means for determining whether or not said early scheduled office visits were clinically justifiable, said justification being either absolute or tentative,

means for detecting by diagnostic category 3 types of protracted illnesses, said illnesses represented by a continuous string of office visit-derived records of an out-patient that all contain a clinical status indicator other than 1 and each of said three types of protracted illnesses differing by initial level of severity,

means for determining if any, and type of, physician intervention or action occured during each office visit included in any of 3 said types of protracted illness processing for an out-patient, said types of actions include new medication, medication changes, specialty referrals, lab tests ordered and office injections of medication including by what route, intramuscular or intravenous,

and said reporting of clinical data includes,

means for printing by said diagnostic category from said office visit-derived records the physical, medication change and laboratory test results separately but from the same office visit,

means for printing of clinical data that may reveal the overusage of office visit based lab tests ordering, said overusage because of the absence of any documented problems during those office visits when said tests were ordered,

and said reporting of clinical data further includes; means for querying of said out-patient database summary-type and narrowly formulated out-come based clinical data for computer screen display.

6. The computerized medical database system of claim 5 wherein said means for the querying of out-patient clinical data in a narrowly formulated and summary form includes;

means for accessing from several related and linked files different types of clinical data for each out-patient, said data combined to define and focus upon distinct aspects of ambulatory, primary care medicine and includes,

means for determining by database doctor if a disproportionate number of database out-patients with a particular chronic diagnosis are assigned to and under the care of particular primary care doctor in relation to other primary care doctors on that database, and said means for determining includes,

means for entering a doctor name and the full text of a particular chronic diagnosis, and

means for responsive to the entering means for accessing, by said doctor name and diagnosis entered, out-patients on the database who are both under the care of that doctor and who have that particular chronic diagnosis, and said accessing means further includes,

means for counting amongst a database file both the number of said patients with that diagnosis, and if any, the number of those patients who are under the care of that doctor whose name was entered, said database file that said count is made on is the master medical record file, and further

means for computing the percentage of all database out-patients with that chronic diagnosis, and

means for computing what percent of that percentage consists of those out-patients who are also under the care of that doctor whose name was entered, and further

means for displaying said computed data on a computer screen, said display consisting of both integers and fractions,

and said means for querying out-patient database data further includes,

means for reviewing both the medication change activity and the physical data observed amongst out-patients with a chronic cardiac diagnosis during office visits in which they were observed to be very symptomatic, said very symptomatic being indicated by a clinical status of 3 being found in that data field of office visit records, and further includes

means for entering just the name of a database doctor, and further

means responsive to the entering means for selecting a set of office visit records by both a clinical status of 3 and the presence of a chronic cardiac diagnosis and further

means for accessing the literal text corresponding to the encoded physical data stored in said set of office visit records selected,

said literal text accessed from a physical signs and symptoms table and said means for accessing includes,

means for searching said physical signs and symptoms tables by codes present in physical data fields of an office visit record selected, and

means for accessing medication activity from medication activity records linked to said office visit records selected, said linkage is by a special six digit number unique to each office visit record and also present in each said medication activity record linked, and

means for combining said physical and medication activity from each said office visit record selected with other salient office visit data, said salient data includes out-patient I.D. number and data of office visit and medication activity reported can include an addition, change, deletion or an injection of medication during said office visit, and

means for displaying on a computer screen said clinical data combined from each said office visit record selected first by doctor name entered and then by a clinical status of 3 and the presence of at least one diagnosis that is a chronic cardiac one and,

said means for querying out-patient clinical database data further includes,

means for obtaining prior lab test results for a database out-patient, said said results can be presented by either individual lab test results from any of several prior aspects or a group of tests ordered during the same office visit, and

means for entering an indicator for choosing which of the two above types of presentation of data the user desires and,

means for determining which said choice was entered and

means for entering, if said group of lab tests from an office visit was selected for viewing, an approximate date for that office visit and further

means for re-entering another date if said approximate date previously entered is incorrect until a correct date for the desired office visit is entered and,

means for accessing the related lab record linked to the office visit of the correct date entered, and said accessing means includes

means for searching an out-patient lab test result file that contains a lab record storing a special six digit number that most uniquely identifies that office visit record it is linked to and also found in said lab record, and

means for combining all the lab test results from said office visit along with each's parameter or historical data with other salient data from each office visit, said salient data includes patient name, date of visit and the chronic diagnosis of said out-patient, six digit number identifying that office visit, date lab tests drawn and the six digit number identifying that lab record and further

means for selecting one at a time from amongst 14 lab tests if prior said choosing means indicates a desire to view individual test results instead of a group of test results from the same office visit, and further includes

means for generating a menu listing several prior aspects from which to view previous results of a particular lab test of an out-patient currently on file, said prior aspects include the date and value of both the first and last abnormal result for that test if present, result of most recent test, consistency of results for that test and both the highest and lowest abnormal value of that particular lab test, and further includes

means for obtaining from that out-patient's lab test records any of said 14 lab test results depending upon what selection from said menu listing of prior aspects of results was made, and said means for obtaining include

means for searching back on said out-patients lab records arranged in chronological order to access a said record or records according to which said prior aspect of results was said selected from said menu listing, and

means for combining said individual test results from any of said prior aspect from said menu listing with other salient data, said salient data includes patient identification, date of test in question, first abnormal result and date as a reference, and further

means for displaying said combined data for computer screen review, and said means for querying clinical data from a database further includes,

means for documenting if there is any impending or actual medication induced toxicity of any databaseout-patient who is currently on medications, said said toxicity indicated by an abnormal result of a lab test that is known to be an especially sensitive marker for the toxic effects of a particular medicine and the degree of abnormality related to the level of toxicity, and said means for documenting further includes,

means for entering both a database doctor name and a medication name, and

means for accessing by doctor name and medication name entered those database out-patients who are taking that medication and are under the care of that doctor whose name was entered, and said accessing means includes

means for searching on a database file by said doctor name entered, said file is the master medical file that stores both the doctor name and the current medications each out-patient is on along with the dosages, and

means for listing by both patient I.D. number and name those out-patients taking that medications, the amounts, who are under the care of that doctor whose name was entered,

means for informing an operator if said doctor whose name was entered does not have any patients currently taking that medication entered,

means for selecting from alist of 14 lab tests, said lab test selected is one presumed by user to be specific for indicating any existing toxic effects from said medication whose name was entered, and further

means for selecting from any of said out-patients listed by name and I.D. no. said selection is by entering the I.D. no. listed alongside any patient name also listed on a computer screen,

means for combining all data accessed for that out-patient selected, said data includes all the results of that lab test currently on file for that out-patient selected in chronological order alongside the medication in question and the amount of that medication that out-patient is currently taking, and

means for displaying that data on a computer screen for user review, said review for the purpose of monitoring for any medication induced toxicity.

7. The computerized medical database system of claim 5 wherein said means for the data processing of a said intermediary routine for the detection of of an early and possibley unnecessary scheduled office visit by diagnostic category further includes;

means for identifying two consecutive minimal-clinical-activity or uneventful types of office visit records for a same out-patient and whose difference in days or length of time between said consecutive office visits is less than that set for that out-patient's diagnostic category for any two uneventful visits occuring consecutively for an out-patient belonging to said category, and said uneventful or minimal-clinical-activity type, either unscheduled or scheduled, is defined as having a clinical status of 1 indicating a normal or absence of change in baseline clincal condition, a chronic diagnosis as the primary reason for said office visits and total absence of any physician action or intervention during either of said two consecutive office visits, and another said intermediary routine that includes,

means for identifying an unscheduled office visit of the minimal-clinical-activity type that is followed by a scheduled office visit by the same out-patient that is also of the minimal-clinical-activity type that occurs within the time interval for minimal-clinical-activity types by that diagnostic category, said scheduled type therefore being early and possibley unnecessary and

means for determining if said early and possibley unnecessary scheduled type of uneventful office visit is clinically justifiable, said justification may be absolute or tentative and further includes,

means for accessing a set of other related out-patient records in separate files whose data represent distinct but related aspects of out-patient primary care, said other records includes emergency room, lab tests, out-patient treatment hospital and surgery files and further

means for identifying in any of other related records of that out-patient with an early scheduled office visit of the minimal-clinical-activity type an indication of activity occuring between the two said consecutive office visits of the minimal-clinical-activity type, said activity or event may serve to justify the second early consecutive office visit of the minimal-clinical-activity type if said actvity or event met certain clinical criteria and further

means for determining if any said justification can be found in any of said other related out-patient records and includes,

means for finding an interim emergency room record of that out-patient dated within the interval of time between both said consecutive office visit records of the minimal-clinical-activity type and further

means responsive to the finding means for obtaining the six digit number identifying said interim emergency room record, said six digit number identifying the source of the potential justification for said early, second office visit of the minimal-clinical-activity and scheduled type, and

means responsive to the obtaining means for setting an indicator if there is an indication within said interim emergency room record that either an immediate office visit or a hospitalization was advised at the time of said emergency room visit for that out-patient, said indicator set will establish absolite justification for that out-patient's early, consecutive office visit of the minimal-clinical-activity or uneventful type, and said means for determining actual or tentative, potential justification for an early, consecutive office visit of the uneventful type further includes,

means for finding an interim hospitalization record of said out-patient that indicates a stay between said two consecutive office visits of the uneventful type, and further

means responsive to the finding means for obtaining a six digit number from said hospital record that at least identifys the source of a potential or tentative clinical justification for said early, second office visit and

means responsive to the obtaining means for setting an indicator if the discharge diagnosis of said hospital record is the same as the primary reason for the early, consecutive office visit of the uneventful type for that out-patient, said indicator setting establishing absolute justification for that out-patient's early, scheduled visit of the uneventful type, and said means for determining clinical justification further includes,

means for finding an interim lab test record of said out-patient that was dated between the two consecutive visits of the minimal-clinical-activity type and

means responsive to the finding means for obtaining a six digit number identifying said interim lab test record, said six digit number representing a potential or tentative source of clinical justification for the said early consecutive office visit of the uneventful or minimal-clinical-activity type and additional

means responsive to the obtaining means for setting an indicator if the parameter or historical data that is encoded and accompanies the actual result of that lab test indicates any change from the previous result for that test, said indicator setting establishing absolute justification for an early, second scheduled office visit of the minimal-clinical-activity or uneventful type and said means for determing any clinical justification amongst that out-patient's other related clinical database files further includes,

means for finding an interim out-patient treatment record dated between the two said office visit records of the uneventful type and means responsive to the finding means for obtaining the six digit number of that said treatment record, said six digit number identifying that record as at least a potential or tentative source for clinical justification for the early, second office visit of the uneventful type and further

means responsive to the obtaining means for setting an indicator if the said treatment record contains an indication by the therapist that the out-patient's condition for said therapy is getting worse, said setting of the indicator establishes absolute justification for said early, second uneventful scheduled office visit, and said means for determining any clinical justification further includes,

means for finding a most recent surgery record of that out-patient and

means responsive to said finding means for determining the date, category and type of surgery performed on said out-patient, and additional

means for obtaining a six digit number uniqely identifying said surgery record if said surgery type is from a major surgical catergory, said six digit number serves as at least potential or tentative justification for the early, second scheduled visit of the minimal-clinical-activity or uneventful type, and further

means for setting an indicator if said surgery was dated within a particular time interval from the said second, early uneventful visit of the scheduled type said indicator setting establishing absolute justification and

means responsive to said determining means for obtaining a six digit number if said surgery is from the moderate surgical category type, said six digit number establishing a potential or tentative source for clinical justification and additional

means responsive to said obtaining means for setting an indicator if said moderate surgery type occured within a time interval from the second, early visit of the uneventful type that is lesser in amount that the time interval for the said major surgical category type, said indicator setting establishing absolute clinical justification, and additional

means responsive to said determining means for obtaining a six digit number of said surgery record if said surgery is of a minor category and the date of said minor surgery is within a lesser time interval from the second, early uneventful scheduled office visit than that of the major surgical category type,

and means responsive to the obtaining means for setting an indicator if the clinical group indicator of the said minor surgery type is the same as that of the primary reason for the early, second scheduled office visit of the uneventful type for that out-patient, said indicator setting establishing absolute justification on the basis of said past minor surgery because the clinical group or organ system involved in said minor surgery is the same as the primary reason for the said second, early office visit of the scheduled and uneventful type, and additional

means for creating a new office visit-derived record in an intermediary file for each early consecutive scheduled office visit that followed either an unscheduled or scheduled uneventful type for the same out-patient, and

means responsive to said creating means for writing to said newly created office visit-derived record a variety of pertinent clinical data in coded form,

means responsive to said creating means for transferring data from said second, early scheduled uneventful office visit to said newly created office visit-derived intermediary record, said written and transferred data includes I.D. number of out-patient, date of second visit, special six digit number identifying said visit, data indicating a potential or actual clinical justification of said visit, the diagnostic category of the out-patient and an indicator for encoding the name of the intermediary routine that processed said out-patient records, and

means for identifying every successive unscheduled office visit by an out-patient that follows a first one identified,

means responsive to prior said identifying means for creating a new office visit-derived intermediary record for each successive unscheduled office visit record of an out-patient that is found beyond that out-patient's first one, and

means for writing to said newly created office visit-derived intermediary record a variety of pertinent data in coded form, and

means for transferring data from each of said successive, unscheduled office visit record to the said newly created office visit-derived record, said written and transferred data includes what number in succession each unscheduled visit represents, out-patient I.D. no., date of visit, special six digit number most uniquely identifying that office visit, encoded name of intermediary routine that processed said record and diagnostic category of that out-patient.

8. The computerized medical database system of claim 5 wherein said means for the detection, by diagnostic category, of three types of protracted out-patient illnesses that differ by initial level of severity further includes,

means for detecting a minimum number of consecutive office visit records of an out-patient that represent only a mild, fluctuating illness in which the clinical condition of said out-patient has not returned to normal or baseline but hasn't yet become serious, said clinical condition reflected by a clinical status of 2 with any one of the contiguous office visit records of that out-patient within said minimum number being possibley a 4 indicating an improvement from the previous visit and said minimum number of records being 3, and

means responsive to the detecting means for further detecting all additional subsequent office visit records for that out-patient that are also either a 2 or 4 clinical status,

means for detecting a first office visit record whose clinical condition indicates a serious, prehospital stage, said condition represented by a clinical status of 3, and further

means responsive to prior detecting means for the further detection of all antecedent and subsequent contiguous office visit records of that out-patient in which anything other than a baseline or normal clinical status of 1 is found,

means for detecting the first office visit record of any out-patient in which the clinical status is anything other than a 1, and further

means responsive to the prior detecting means for determining if a most recent office visit record of that out-patient is present, said most recent record would have a clinical status of 1 and serve as a reference for comparing data with that out-patient's subsequent non-1 clinical status records, and

means responsive to prior said determining means for the further detection of all subsequent, contiguous office visit records for that out-patient after said first office visit record of a non-1 clinical status that is also anything other than a 1 clinical status, and

means responsive to any of 3 prior said detecting means for the accessing of all said office visit records detected as part of a said protracted, continuous out-patient illness and

means responsive to any of 3 said prior detecting means for determining what, if any, physician intervention or action occured during each office visit whose record has been said detected as part of any of 3 said protracted out-patient illness, said types of physician intervention may include new medication, medication change, lab test ordering, specialty referrals and office injections of medications, and

means responsive to determining means for computing a decimal number based on which, if any, of 4 fields in said office visit records are set to true, said fields correspond to each of said physician actions except that of medication injection and any said number computed out of 16 possible ones correspond to a particular action or combination of said physician actions including zero which indicates no physician action or intervention at all, and

means responsive to the computing means for translating said number computed into one of sixteen possible single letter codes, said single letter is for indicating which, if any, type or combination of types of said physician actions occured during any of said office visits whose records were part of any of 3 said protracted out-patient illnesses, and

means for determining if an injection occured during any said office visits,

means for creating a new, office visit-derived record in an intermediary file, said new record corresponding to each office visit record detected as part of any of said 3 types of protracted out-patient illnesses, and additional

means responsive to the creating means for writing to each new record created a compilation of data derived from an office visit record detected as said part of any of 3 types of protracted out-patient illnesses, said data includes out-patient identification, date of visit, office visit identification, a single letter for indicating which of 3 said types of protracted illnesses that office visit record was detected as part of, a single letter for indicating what, if any, type or types of physician actions occured during said visit, and any medication injection that may have occured and by what route during that visit.

9. The computerized medical database system of claim 5 wherein said means for the separate printing of physical, medication and laboratory test data from the same office visit further includes,

means for selecting an intermediary file of office visit-derived records by out-patient diagnostic category, primary reason for an office visit and a cut-off date, said records derived from office visit records detected as part of any of 3 said types of protracted out-patient illnesses and said primary reason being either an acute, short-term or a chronic, long-term diagnosis, and said means for the printing of office visit based physical data includes,

means for accessing from said selected office visit derived records up to physical data codes reflecting up to 2 signs and two symptoms, said codes consisting of 5 digits with the first indicating the clinico-pathological group or organ system of those signs and symptoms with the last three digits being its most unique aspect of identification, and further

means for accessing from physical signs and symptoms tables the literal text corresponding to said codes by the last three digits of said 5 digit codes present in said office visit-derived records, and

means for accessing a master medical record belonging to that out-patient of said office visit-derived records said selected, said master medical record is linked to any of said office visit-derived records by out-patient I.D. no.

means for printing out background data for each out-patient whose office visit-derived records were said selected, said data is heading data that appears once for each out-patient whose physical data is for printing and includes up to three chronic diagnosis for that out-patient, date of birth, date of last hospitalization and full name, and

means for printing the literal text of up to four physical data elements, said elements consist of said literal text of signs and symptoms from each said office visit-derived record selected, and

means for printing a message if any said office visit-derived record that was selected did not contain any physical signs, symptoms or both, and

means for printing other clinical data from each office visit-derived record to accompany the literal text of said physical signs and symptoms, said other data includes date of visit, six digit number most uniquely identifying said visit, and the text of the primary reason for said visit, and

means for printing, in the case of a chronic diagnosis as the primary reason for said visit, the blood pressure reading from said visit in addition to the physical data, said blood pressure printing is restricted to those out-patients who have either a cardiac, neurological or a vascular basis for that chronic diagnosis that served as the primary reason for said visit, and

means for printing, in the case of a chronic diagnosis as the primary reason for an office visit, additional data with each out-patient's last office visit derived record that has been selected for said printing, said additional data is for indicating whether or not that particular protracted illness has been terminated and that out-patient has returned to a normal or baseline clinical status of 1 and whether or not a hospitalization has occured by the time of said cut-off date,

and said means for the reporting of office based laboratory data includes,

means for determining if laboratory tests were ordered during an office visit whose record was detected as part of any of 3 said types of protracted out-patient illnesses, and said means for determining further includes,

means for testing in an office visit-derived record for the presence of one several possible single letter codes, said codes for indicating if lab tests, alone or in combination with other types of physician actions, were ordered during that visit, and

means responsive to said testing means, if said means indicates the ordering of lab tests, for accessing a six digit number from that office visit-derived record, said six digit number most uniquely identifies that office visit and is also found in a lab record linked to that office visit-derived record, and

means for accessing from said linked lab record all test results present along with each lab result's encoded parameter, said encoded parameter data reflects and is derived from that lab test's track record of past results for that out-patient and includes duration of an abnormality, intensity of the current abnormality and most recent result if present, and

means for accessing a master medical record for each out-patient included in said office visit-derived record selection, and

means for printing background data once for each out-patient whose office visit-derived records were said selected for said lab test result reporting,

means for printing the results of said lab tests along with the literal text of each of the three encoded elements of the parameter data that accompanies each test result,

means for printing the normal results of any lab test along with a remark about the most recent result, if present, for that test,

means for printing other clinical data from that office visit to accompany the lab test data from that visit, said data includes date of visit, six digit number most uniquely identifying that visit, date lab tests done and the primary reason for that visit, acute or chronic diagnosis, in text form,

and said means for the reporting of office based medication data includes,

means for determining if an oral medication dosage change occured during an office visit whose record was detected as part of any of 3 prior said protracted out-patient illnesses, and said means for determining includes,

means for testing in an office visit-derived record for the pressure of one of several possible single letter codes, said codes are for indicating if medication dosage changes, alone or in combination with other said types of physician actions, were done during said office visit, and further

means for accessing, if prior determining means indicates a medication dosage change, that out-patient's first medicine activity record on file, and

means responsive to prior said accessing means for locating that out-patient's most recent medicine activity record on file, and said records may store up to three medications which may all have undergone a dosage change during said office visit, and

means for testing each of three data fields in said most recent medicine activity record for an indication that a dosage change had been made for any of three medicines that may be stored, and

means for finding for each medicine that was found to have undergone a said dosage change in said most recent medicine activity record the most recent prior amount of that medicine that out-patient was on whether or not it was also an amount changed to or a first amount as a new medication, said prior amounts for any of up to three medicines that underwent said change may be found in up to three different prior medicine activity records for that out-patient, and

means responsive to the previously said prior amount finding means for accessing both current amount or amount changed to and the most previous amount or the amount changed from for each of up to three medications that may have been found to have undergone said dosage change during said office visit and are now present in said latest medicine activity record, and further

means for accessing from said latest medicine activity record a 5 digit code, said code associated with each medication that underwent said dosage change, and further includes,

means for searching a medicine inventory table by said 5 digit code to obtain the generic name text of each medication found to have undergone said change in said latest medicine activity record,

means for accessing a master medical record for each out-patient whose office visit-derived records were said selected, and

means for printing background data once for each out-patient as heading for said medication data reporting, and

means for printing up to three medication dosage changes, both amounts changed to amounts changed from and expressed in either grams or tablets per day, and further,

means for printing other data from each office visit with said medication change data, said other data includes six digit number identifying said office visit, date of office visit and primary reason for that office visit, and

means for determining if any data errors are present, said error might be in the absence of a medicine activity record associated with that office visit even though a said single letter code is present for indicating medication activity during that office visit, and

means for printing a message indicating said error is present, and

means for printing if no medication activity occured during any office visit.

10. The computerized medical database system of claim 5 wherein said means for the printing of clinical data that may show the overusage of office visit based lab tests further includes,

means for selecting a set of out-patient office visit records according to four clinical criterion, said criterion consists of a normal or baseline clinical status of 1 indicating an absence of any disease activity or change in an out-patient's usual condition, a chronic diagnosis as the primary reason for that office visit, the office visit is of the scheduled type and yet, despite these 3 mentioned criteria that indicate an otherwise unremarkable clinical situation, the ordering of lab tests was still done as the fourth criteria, and

means for accessing from an office visit record selected by prior said criterion data that links that record to a laboratory record storing the results of said lab tests ordered, said linking data is a six digit number that most uniquely identifies that office visit record selected and is also found in that lab record linked, and

means responsive to said accessing means for obtaining all of said test results ordered during those office visits whose records were said selected, said lab tests ordered from said selected office visit records are herein referred to as a first set of lab tests, and further

means for determining if there are any prior results on file for that out-patient for each of the first set of lab test results, said prior test results that correspond to each of the said first set of test results may each be found in different prior lab records for that out-patient and said prior test results for each of said first set of test results are herein referred to as the second set of lab test results, and

means responsive to prior said determining means for searching back on that out-patient's previous lab records until any most recent prior result of that test for that out-patient is found for each of said first set of lab test results from each of said office visit records selected, and further

means for obtaining, if present, a most prior test result for each of said first set of test results ordered during said visit whose records were said selected, and said prior lab test results for each of said first set of results ordered from an office visit whose record was said selected are herein referred to as second set of lab test results but each of which may have been obtained from a different prior lab record since any of said prior or second set of lab test results may have been ordered during a different prior office visit for any out-patient, and

means for preventing said accessing of any of the said second set of test results if any of those prior test results were ordered during an emergency room visit by that out-patient, said emergency room visit is, by its very nature and unlike an office visit of the said selected type, is automatically considered significant enough to obviate the need to justify any lab test ordered during even an office visit of said selected type as long as that prior test was ordered during an emergency room visit, and said means for preventing access further includes,

means for testing if the first character in a field of a lab test record that is storing any of said most prior or second set of lab test results begins with an E instead of an O, said character E indicating that said tests were ordered during an emergency room visit and not an office one,

means for accessing a master medical record for each out-patient whose office visit records were selected by said criterion, and

means responsive to said accessing means for printing once for each out-patient whose office visit records were selected salient data as heading, said salient data includes last name of the out-patient doctor, a code indicating the name of the processing routine, last name and I.D. no. of the out-patient date of birth of out-patient, the primary chronic diagnosis of that out-patient and date of last hospitalization, and

means for printing with each office visit record selected for an out-patient some identifying data, said data includes the six digit office visit I.D. no, primary reason for that office visit, date of office visit and date lab tests drawn that were ordered from said office visit, and

means for accessing for each of said second set of prior lab tests that prior office visit during which each of said second set of tests were ordered, said prior tests may be from different prior office visits of that out-patient

means for printing together in coupled form both the first set of lab tests from selected set of office visit records and the second set of the same lab test results for an out-patient, and further

means for printing other data from each prior office visit during which each of the second set of prior lab tests for that out-patient were ordered, said data includes primary reason during each office visit and the clinical status of the out-patient during that office visit in order to enable determining the clinical need for ordering said tests from said selected office visit records by comparing the data printed together in coupled form.

11. For use in a computerized out-patient primary care medical database system

means for the automatic classification of out-patients into one of three chronic diagnosis-based clinical diagnosis categories through the use of a predefined consensus-based reference table of chronic diagnosis arranged according to the relative prognosis or clinical urgency of each, said reference table divided into three diagnostic categories with each ranked hierarchically in relation to the other two and for classifying said out-patients depending upon the diagnostic category location of up to three chronic diagnosis any out-patient may have in relation to said reference table, and said means for the automatic classification further includes,

means for creating an out-patient master medical or first office visit record, said record creation occuring during a data entry routine for either of said record type which then immediately confers upon an out-patient of that record the attribute of classification into one of said diagnostic categories, and

means for recognizing said classification of each out-patient by said database system during the execution of data processing instructions, said instructions identify each out-patient record, master medical or office visit, as belonging to one of three said diagnostic categories depending upon the combined value of up to three chronic diagnosis found in said record types determined by thier relative position in said reference table of chronic diagnosis, and said recognizing means includes,

means for checking by said data processing instructions an encoded letter present in each chronic diagnosis that is present in any out-patient record of prior said types, said encoded letter present in a fixed position in each chronic diagnosis and for indicating to which of three said diagnostic categorys of said chronic diagnosis reference table that chronic diagnosis belongs to.

Description

BACKGROUND TO THE INVENTION

American medical care has been placing this country under a tremendous financial strain and will continue to absorb an increasingly higher share of its resources into the indefinite future. Over the past 20 years its average cost increases, primarily of the institutional kind (hospitals, lab tests etc.), has risen annually at over twice the rate of inflation compared to the rest of the economy and will remain for the forseeable future as the most expensive sector of our consumer-driven society.

The reasons are chronic and multiple and in most cases simply reflect and stem from cultural features unique to 20th century American society. For example, an increasingly ageing population that will continue to consume a disproportionate share of our clinical resources, increased leisure time by all age groups that allows for such discretionary indulgences as more `health care` consumption that only creates more demand on a medical care system that is already oversubscribed to, the virtual doubling of american medical school graduates since the early 70's along with almost no effort to limit the entry of foreign medical graduates which in itself greatly expands the size of an already very elastic medical marketplace (i.e. the number of cars or refrigerators we buy is pretty fixed but not the number of times we might see a doctor). There is also the ever-present fear by doctors and hospitals of costly malpractice litigation that increases both front-end costs by higher insurance premiums and higher day-to-day costs by the defensive use of expensive tests and high-tech procedures done simply to lessen the risk of and protect against any future lawsuits.

In the wake of this dilemma in an open and free society several measures have been initiated separately and independently over time to curb costs and even improve quality of care. Unfortunately none have succeeded and the costs continue to skyrocket. That's primarily because none have addressed how we actually examine in a precise and large scale way how the daily practice of medicine is delivered and what the results actually are, especially on a comparative basis.

Up until now the `solutions` have only been regulatory and administrative in nature that in fact only interfere in the natural practice of every day medicine without a mechanism for actually assessing what has happened on a large-scale and precise analytical basis. And in many cases has only led to divisiveness and polarization amongst health care providers.

For example, the corporatization of American medicine by HMO's that use high-powered ad techniques and the `magic` of fixed pre-payments for subscribers as a way to control costs while never publicly acknowledging how their member doctors are gently co-erced to hold the line in the trenches by rationing through the limiting of tests and even office visits. But several HMO's, in Massachusetts for example, have already begun to experience financial problems and have been forced to merge due to an oversubcription by the elderly and the resultant encounter of greater than projected costs through vast and unanticipated increases in the use of resources. Also, despite the promise of cost reduction through so-called health care competition, the appearance of `alternate health care providers` like nurse practitioners and physicians assistants has been a failure in controlling costs primarily because it too only increases the size of the medical marketplace while also causing confusion over who does what, turf battles and duplication of effort. It has also caused a massive over-concentration of health care providers since these paraprofessionals always seem to locate in areas that are already heavily populated by doctors. As another example of the failure to control the cost of something as unpredictable and complicated as medicine, and therefore its consumption, is the lack of measurable success with DRG's or Diagnostic Related Groups. Basically, they are a method for assigning costs and fees to certain disease categories that's used by hospitals and insurance companies for pre-determining how much they should spend during a hospitalization. As such, they only address one aspect of medical care; hospitalization, are unable to examine on a large and precise basis the individual practices of doctors on a comparative basis and they create artificial boundaries that are overly and too neatly drawn between medical conditions that are often related and overlap clinically, and are naturally unable to take into account the many hidden uncertainties that frequently appear in clinical medicine and as such deal poorly if at all with unforseen complications. They have been operative for some time but they have failed to control costs while adding nothing to the quality of medical care.

None of the above measures have succeeded because they are superficial, politically expedient and often costly in themselves due to their promotion of additional regulations and new agencies that increase the administrative and bureacratic cost of medical care. Unfortunately none of them are designed to look directly at and examine what actually happens on a day-to-day basis at the level of the patient-physician encounter at that point in the medical care system that has traditionally been the most responsible for eventually determining how much we will spend; the primary care, general practice, out-patient setting. Until now, no one has bothered to look at what happens and why at the level of the primary care out-patient physician practice where all the medical-consumer habits, trends and diseases originate.

Primary care, out-patient medicine is the most frequent point of contact in the medical care system and until a method for its precise and large-scale analysis is found, a rational basis for cost control in medicine will never be obtained.

What is therefore needed is an automated method for looking at what doctors do, their observations, tests, treatments, and diagnoses, etc., on a daily basis to a large, organized and well defined population of out-patients in a primary care setting under clearly spelled out and uniform conditions and circumstances. A kind of primary care `audit trail system` that uses the power and flexibility of the computer to collect, store and process data under pre-defined conditions that enable applying uniform standards of analyzing care by doctors to patients in regard to both outcome and resource utilization.

My computer-based system, with its database and programs, is a model for demonstrating the feasibility of doing just that. It is an information-management-system for the analysis of clinical data processed by the computer in such a way as to reflect what has happened during the natural and traditional way out-patient medicine is conducted. It records the identical set of data under an identical method for all patients and then processes that data for specific groups of out-patients according to uniform criteria that create specific aspects of primary care medicine through the `customized` design of computer-program software.

Both out-patients and their doctors are members of the database. Each out-patient is placed into one of three diagnostic categories for the purpose of selective data processing that depends upon the single or combined value of up to three chronic diagnosis any one patient may have. Other elements of the system are a family of related files that store separate, related aspects and items of clinical medicine, many of which are linked to each out-patient as individual clinical attributes that contribute to the total medical profile of each out-patient. And as with other types of more common database systems, this one has two general types of files; transactional and inventory. The former are event-based, its records accumulating over time through data entry programs and how many of them any one patient has depends upon the condition or disease activity of that out-patient. On the other hand the inventory type files contain a fixed number of records and consist of data items that are used to affix those clinical attributes appropriate to any out-patient, i.e. symptoms, diagnosis, medicines, etc. that can clinically define them at any point in time.

Such a database, with its integrated set of related files of both types, then serves as the informational base for the processing operations conducted by a separate set of computer programs (other than the data entry ones) that are designed to simulate or mimic aspects or conditions of out-patient medicine. With such distinct and `logical views` that create special facets of out-patient clinical medicine drawn by such programs that now process that centralized pool of integrated clinical data stored in separate files, it becomes possible to apply precise and large-scale analysis uniformly from an outcome based perspective while also being able to look at what doctor did what and for what reason. Under uniform and standardized conditions you can now analyze clinical results about any number of out-patients from both the same diagnostic group or make comparative results between different diagnostic groups. And you can establish a level of priority in the analysis of results and resource usage that includes a measure of expectation by the selective processing of different diagnostic groups or out-patients within any group that differ by chronic diagnosis.

In short, my model database system collects and loads the same set of clinical data in the same way for out-patients classified according to diagnostic groupings. The data reflects the natural activity that normally occurs every day in a primary care setting. The data is then processed by an associated set of programs that select for certain clinical conditions and criteria that by design create special aspects of out-patient medicine. For example, viewing lab test results ordered during a special type of office visit in conjunction with other salient clinical data observed during that same visit that then enable determining if said lab tests ordered were justified in view of what that doctor observed about that out-patient. As another example, a computer program in this model system enables one to look at both symptoms and medications ordered during a special type of office visit for a group of patients with the same chronic diagnosis who are being cared for by the same doctor. In this way analysis is possible under conditions uniformly applied to groups of patients and doctors from highly focused aspects of out-patient, primary care medicine that make such analysis easy because it creates identical reference points for comparisons.

Such a model system, as outlined in this specification, can at least be used for one important purpose; to supplement the traditional `non-system` of medical record keeping. It can remedy the current system which, as everyone knows, is non-integrated and non-standardized, which is manually based and highly individualized from physician to physician depending upon that physician's personal bias or style. And as such is totally incapable of being viewed from specially created clinical circumstances through program design for special emphasis or on a large scale basis that can offer comparative analysis.

My model, computer-based system doesn't have to replace anything and it doesn't have to interfere with the way things have been done. But it offers, by way of proven technology, a new, different way of looking and analyzing the outcome and resource usage at the most frequent and critical point of our health care system from the long-term point of view: the primary care, out-patient setting.

SUMMARY OF THE INVENTION

A computerized clinically oriented out-patient medical database for the retrospective and outcome-based tracking and monitoring of both quality of care and the proper utilization of clinical resources from a variety of medical aspects and conditions that characterize a primary care setting.

This model `audit trail` system, its data pool, file relationships and programs that process the data to load, manipulate, print and query the clinical data along with its method of triaged data processing by out-patient diagnostic categories, now enables the unlimited versatility of storing, accessing and reporting computer-based clinical data for classified out-patients, both individually and by groups, and from a variety of medical aspects or clinical perspectives that allow for special emphasis or particular focus. For example, detecting the overuse of office visits by out-patients pre-selected by diagnostic category, monitoring the actions by physicians during protracted episodes of out-patient illnesses, and the separate reporting of physical, medication and lab test results from the same office visits selected by the primary reason, acute or chronic diagnosis, for the office visit.

Such a system can readily supplement the only other current, highly individualized and vagaried record-keeping `non-system` doctors have traditionally used. An anachronism in today's computer age since the way in which patient data is viewed and expressed often reflects personal physician biases. For instance it is always looked at on a patient by patient basis, isolated and in a non-comparative way, manually and without the capacity for special or particular clinical emphasis and in the absence of fixed and uniform standards that enable legitimate comparisons amongst and between the same and differently classified patient groups.

The out-patients of this database would ideally be fixed adult subscribers to a Managed Health Care Plan such as an HMO with each patient assigned to one of several database doctors. Upon a first record creation a new patient automatically classified into one of three diagnostic categories depending upon the nature and the amount of up the three chronic, long-term diagnosis any out-patient may have. The classification is based upon the relative positions of that patient's diagnosis in reference to the other chronic diagnoses' present in a table of chronic diagnosis that contain the entire pool of diagnosis that any database patient may have and which is arranged according to a sorting of the chronic diagnosis by prognosis or clinical urgency. If an out-patient is placed into the uppermost diagnostic category of the chronic diagnosis table, it is because that patient has at least one diagnosis from that highest table category and is then ranked for the purpose of selective data processing within the highest priority group. Since the classification enables the ranking and therefore the selection of out-patients by diagnostic categorys into priority groups, the classification itself serves as an initial clinical focus for many programs in this system's data processing because it enables anyone to view the resultant data from the kind of clear reference point that clinical urgency or prognosis is. And therefore enabling users of the system to be alerted sooner and easier to the need for more immediate attention to such priority based clinical data.

After the initial out-patient record selection, each program then contains deeper level code for specifying further criteria and conditions that further limit the data generated to a particular and narrow aspect of out-patient medicine. For example, a program might first select only office visit records of those out-patients from the highest ranked diagnostic category and then further limit the clinical aspect to only cardiac patients within that highest priority group, excluding for instance patients with fulminant lupus or bad liver disease, etc.. Then through additional program code it may further limit the clinical aspect or condition to only those office visit (records) in which those cardiac patients were documented to be very symptomatic (ill). And then, as a final criteria or facet, to complete the particular clinical `configuration`, the program may only select the physical data (signs and symptoms) observed and any medication changes enacted by the physician during those office visits, and excluding other data from being processed in this program that is also present in each office visit record. And it is then possible to limit the information generated to only a few database doctors or even just one in particular.

This kind of `configurating` in which narrow and specific aspects of out-patient primary care medicine can be drawn by individual facts being combined together through sequential program criteria is, thanks to database software, a process that is potentially unlimited in its versatility.

It should also be noted that this computerized medical database system, with its adaptation of business database software, is analogous to a standard and more familiar computerized accounts receivable section of a mail ordering business, a traditional application for database software. In the first place, the office visit record parallels the pivotal nature of the orders/invoice record since they both represent each system's most frequent, initial contact point as principal data entry processes and the primary source from which other related data records are generated. Secondly, and as a derivative of the first example, both the medicine-activity and lab test records are similar to a payments/financial record since they reflect actions subsequent to the initial, respectively, office visit and the orders/incoice encounters.

Thirdly, the system medication and physical data files are both analogous in in purpose and function to an inventory or parts file. They both contain a fixed number of `stock` or attributes that reflect the distinct nature of the two systems; clinical features of patients in the former and the consumer choice of customers in the latter. Lastly, the analogy between the master medical record and the customer record since they contain both current and biographical data for use as reference information with other data for each individual patient or customer.

A full elaboration of the features and functions of this invention are found in the description section of the specification. There is a complete narration of the preferred embodiments as represented by the program flow diagrams of FIGS. 17-55 and another set of descriptions that refer to the drawings of FIGS. 1-16 and 56-150 which include both the system's data files and sample input/output data used with and generated by the system's computer programs illustrated by FIGS. 1 and 2.

BRIEF DESCRIPTION OF THE DRAWINGS (BDD)

Referring to FIG. 1, a complete list of the system's computer programs (data processing routines) grouped into three categories. The main calling programs are on the left with each of it's subroutines to the right. One subroutine may be associated with more than one main calling program and any one main calling program may have more than one subroutine. The top group are intermediary routines that compile data into new, intermediary records, the middle group are data entry routines and the bottom group are pre-written queries. The numbers indicate the main files, illustrated in FIG. 2, that are used in each of the programs listed.

Referring to FIG. 2, an overview of the system's database files and their general inter-relationships during data processing. Files numbered 2,7,8,9,10 and 15 are inventory in type from which a variety of out-patient clinical attributes are obtained and used to profile each patient. The rest are transactional in nature and reflect the extent and nature of out-patient clinical activity over time.

Referring to FIG. 3, the classification table of chronic long-term diagnosis, chrmedli.dbf, arranged by increasing clinical urgency or worsening prognosis in ascending order. Each out-patient is classified into one of three diagnostic categories depending upon the relative positions in the table of up to three chronic diagnosis any out-patient may have. The first character designates to which of three diagnostic categories that table entry belongs while the second indicates its clinico-pathological group. The assignment of an A category diagnosis to any patient automatically places that patient in the A diagnostic category while the presence of three chronic diagnosis assigned to any patient that are all from either B or C category automatically places that patient into the next higher (A or B) category.

Referring to FIG. 4, the system's primary care office visit record, encounte.dbf, and the principal unit of information for most of the system's data processing. The TYPE field is either `S` for scheduled or `U` for unscheduled and the STATUS field will contain 1 of 5 possibilities numbered 1-5; 1 for normal or base-line, 2 for mild severity of symptoms, 3 for serious, severe symptoms, 4 for clinical improvement from most previous visit and 5 for hospitalization ordered from that visit. Each record may have up to three chronic diagnosis and in cases were an out-patient has only one, that chronic diagnosis alone, by virtue of its relative position in the table, determines which diagnostic category that patient is to be placed in. Otherwise it is usually the diagnosis from the highest category in reference to the table that determines the diagnostic category of that patient.

The CONDITION field of the office visit record will contain either a chronic long term diagnosis or an acute short-term diagnosis as the main or primary reason for that office visit. If it is a chronic one then it will be any of up to three chronic diagnosis that patient already has while a short-term diagnosis indicates either a new as yet uncharacterized problem or possibley a complication or `flare up` of an existing chronic diagnosis. Note the presence of four physical data fields, each as 5 digit codes for indicating up to 2 signs (findings) and 2 symptoms (complaints) with both types of physical data items derived from their respective signs and symptoms tables. Each office visit record is most uniquely identified by it's six digit INVOICE field since it is entirely possible that any out-patient may be seen for an office visit twice in the same day.

Referring to FIG. 5, the system's intermediary file, notify.dbf. As a derivative file each record is created during program execution, and the data compiled from and representing one office visit record. The records are then used as basic unit of information for other system programs. Which fields contain data and the nature of that data depends upon which program type was responsible for creating the notify.dbf records. The type of data the notify.dbf records contain consist of data compiled and written from the original office visit records of the encounte.dbf file and `conditional` data depending upon the nature of the program's input data. Note the CATEGORY and the CODE fields. The category field generally identifies the name of the program responsible for creating that notify.dbf record, the diagnostic category of the out-patient whose office visit record was being processed and that notify.dbf record represents, clinical status of that out-patient at the time of the office visit, whether the visit was scheduled or not, a single letter code for indicating the nature of what the physician did during that visit, whether there was any injection during the visit and by what route. If the program responsible for the creation of notify.dbf records is intended to find unscheduled office visits that occur consecutively by any out-patient then the above field will contain, alternatively, an integer for indicating the consecutive number for that unscheduled visit. If the programs that identify protracted out patient illnesses are being run then a problem resolution indicator will be encoded in that field during processing. The data in the CODE field also depends upon what program type is being run and therefore responsible for creating the office visit derived records of notify.dbf It can be used to indicate that absolute justification for an early scheduled office visit has been found or the occurrence of one or more consecutive unscheduled office visits for any out-patient.

Referring to FIG. 6, the system's master medical record file, medical.dbf.. There is one for each out-patient in the database and it stores both current diagnostic and medication data and background, biographical information. The data field named DIAGNOSIS1 store that patient's highest category diagnosis, if there are two or more diagnosis from the same category then the one from the highest position in the chronic diagnosis reference table occupies that field position. Similarly, any chronic diagnosis present in the DIAGNOSIS2 field will be from a higher position in the chronic diagnosis reference table than any one in the DIAGNOSIS3 field. The MEDFLAGN and MEDINV(N) fields are used to indicate the last time that chronic diagnosis was assigned to that patient. It is a tracking device since it `points` to that office visit (record) during which that diagnostic change, addition, etc. occurred and therefore when that patient's master medical record was updated t reflect that activity. Note the full documentation of all 3 possible current medications. The last 3 fields are for both the first recorded office visit blood pressure (top) and bottom readings) and the date of that master medical record creation.

Referring to FIG. 7, the system's laboratory test file, abn.sub.-- lab.dbf. The date field refers to when the tests were done since the date ordered is the same date as the office visit or emergency room visit from which the tests were ordered. Each lab record has two invoices, one denoting it as a lab test invoice and the other for representing either the office visit or emergency room visit parent (or source) record that serves as a cross-link. There are 14 fields for storing the results of 14 possible types of lab tests. Each field is divided into two segments, one for storing the numeric amount with abnormal results and the other for the historical or parameter data for profiling the track record of that lab test's results over time. The parameter data consists of 3 letters that encode a compilation of prior results for any abnormal test result and is determined by obtaining such aspects of prior results as date and value of first abnormality, date and value of last abnormality, consistency of the results and the most recent result of that test for comparison. The three single letters that constitute the parameter data that accompanys the abnormal result data in each lab test field are, from left to right, duration of the abnormality (chronic, acute, intermediate), intensity of abnormality and comparison to most recent result (improved, worsened, etc.). Normal results contain only a single letter in the first position of the parameter field and another in the first position of the numeric field for comparison with any most recent result for that test.

Referring to FIG. 8, the system's short-term, acute or new problem diagnosis table, er.sub.-- list.dbf. It is identical in basic structure to the 6 digit chronic diagnosis code except that the clinico-pathological group indicator is in the first position instead of the second. These entries are for alternate use in the CONDITION CODE field of the office visit record in instances of a new clinical problem or an as yet uncharacterized complication of an established, chronic diagnosis, and under those conditions replaces a chronic diagnosis as the primary reason for that office visit. As in traditional record-keeping, it is meant to serve as a temporary clinical device for describing in a non-etiological manner the nature of the new problem before and while its exact nature and basis for it is being determined. At which point another or an existent chronic diagnosis for that out-patient will assigned. The entries from the short-term, acute diagnosis table, er.sub.-- list.dbf, may also be used for the only diagnosis field of the emergency room record in a similar instance when the exact and causitive nature of the clinical problem is not as yet fully understood or it appears to be a complication of an established chronic diagnosis of that out-patient.

Referring to FIG. 9, the medicine-activity record file named medicine.dbf. It is for storing up to three medications acted upon during an office visit. The med(n) fields store the generic name of the medication and are derived from the medication inventory table, med.sub.-- list.dbf. The ACTION(n) field is to record the nature of the activity; a change, addition, deletion, etc. of a medication. The amount(n) fields can accomodate total dosage per day, tablets per day or amount and route of any parental (injection) dosage.

Referring to FIG. 10, the system's physical findings (or signs) file of records, findings.dbf. It is the data from both the CODETYPE and CODE fields of any record from findings.dbf file that is loaded onto an office visit record in cases where that particular physical data item was documented during an office visit. The first character of the codetype field is the same indicator used with both chronic and acute diagnosis for indicating what clinico-pathological group that particular clinical attribute belongs. Also, but not used, in the same manner as both acute and chronic diagnosis, the second character can place the physical data item into one of three categorys depending upon its relative clinical urgency or priority.

Referring to FIG. 11, the system's physical symptom's (complaints) file,cc.sub.-- list.dbf. Except for it storing the other type of physical data, it is identical in structure and purpose as the physical signs table previously described with its data elements being handled and accessed in the same way.

Referring to FIG. 12, the system's medication inventory table, med.sub.-- list.dbf. It stores the complete list of medications available to the system in the form of their generic names.

Referring to FIG. 13 a table containing a list of surgical procedures involving various clinico-pathological groups as indicated by the coded letters of the second position. It is another type of inventory table that provides the appropriate clinical attribute for a patient with a surgical history.

Referring to FIG. 14, two transactional type system files, surglink.dbf and treatmen.dbf. The former stores each surgical procedure any database patient has had with the date the surgery was done. The SURGCODE field will contain any of the entries from the surgfind.dbf table. The latter file stores records of various out-patient treatments for common ailments performed by physical therapists. The REASON field of a treatmen.dbf record will contain the chronic diagnosis of that out-patient for which that treatment is being performed while the RX field is a literal definition or text of the treatment being performed, i.e. `inhalation therapy`. The STATUS field is for indicating the therapist's assessment of that patient's condition at the end of each therapy session. It will be either one of four possibilities, improved, same as before, worse or hospitalization recommended.

Referring to FIG. 15, the system's out-patient emergency room record, ER.sub.-- ROOM.dbf. It is similar in general structure and kind of data stored as the office visit record (see encounte.dbf, FIG. 4) but much abbreviated in comparison and with a few important exceptions. There is only one diagnosis field which is for storing the primary reason for the patient coming to the emergency room. It may be from either the acute, short-term or the chronic long-term diagnosis table depending upon the evaluation of the emergency room physician. The status field is for encoding one of three types of dispositions the e.r. physician will make; follow-up office visit necessary or not and if hospitalization was advised. The condition field is for indicating the presence of and degree of clinical instability of the patient at the time of the e.r. visit. As another type of transaction file, the 6 digit INVOICE field is the emergency room record's most unique data item of identification. Referring to FIG. 16, the system's in-hospital record for any hospitalized out-patient, pt.sub.-- hosp.dbf. Like the surgical history file (see surglink.dbf, FIG. 14), it serves mainly to document its occurrence and stores only that data that can be o use in out-patient management. There are two diagnosis fields, one upon admission and the other at the time of discharge. They may be the same and both may be from either the short-term, acute or the chronic, long-term diagnosis field. The narrative field allows for a brief synopsis of hospital course that is optional.

Referring to FIG. 17, a main computer program entitled schedul1.prg that detects actual or possible overuse of office visit resources by identifying two successive office visits of any out-patient that were both scheduled, completely unremarkable and uneventful, and which occured within a time interval as prescribed by that patient's diagnostic category. Upon identification, a sub-routine is called that searches through a set of clinical `transaction` files on that patient in order to find any data that indicate activity of some type occuring between those two visits that could justify that early, second scheduled visit.

Referring to FIG. 18, a continuation of FIG. 17 that illustrates the process whereby a search is also conducted on the system's surgical history file in order to find any data, based upon certain criteria, of a past surgical event for that patient that could justify, in itself, that early, second visit.

Referring to FIG. 19, a subroutine entitled Searchv.prg called by Schedul1.prg that will search on 4 clinical file types (emergency room, treatment, hospitalization, lab test results) in order to find, by a set of criteria dependent upon the type of file, clinical activity occuring between the two office visits in question that are of such a nature as to justify the early, second visit. If and when that occurs the data is then passed back to the main program and written to a newly created, intermediary record.

Referring to FIG. 20, a continuation of the processing of FIG. 19 showing the criteria used and the decision making involved in establishing whether or not any data found in, this case, the lab test file indicating activity from between those two types of office visits that could justify the early, second scheduled visit.

Referring to FIG. 21, a main computer program entitled unschedu1.prg that is similar in part to schedul1.prg since it also looks for office visit overuse but with a primary emphasis upon unscheduled visits. Therefore, it identifies two types of problems; unscheduled visits occuring in succession for any out-patient and a scheduled one of a completely unremarkable nature that has occured right after an unscheduled one for that out-patient that is also completely unremarkable and within a time interval (i.e., too early) as prescribed for that patient's diagnostic category. Upon identifying the latter, the subroutine searchv.prg is also called from this main program.

Referring to FIG. 22, a subroutine entitled surgfind.prg called by the program unschedu1.prg to search for any prior surgical event of that out-patient that by its nature could justify that early second visit of a completely unremarkable nature. Its steps are identical to a bloc of source code present in schedul1.prg, but due to the size of unschedul.prg a separate subroutine had to be written to accomodate it.

Referring to FIG. 23, a main program entitled AstatusB.prg that is one of three in this system that identifies and processes contiguous, successive office visit records that represent a protracted out-patient illness. In this program the minimum number necessary in order to trigger processing is three since the illness, by its selection of only certain types of records, is only of a moderate degree. It calls a subroutine, binary.prg., for accessing encoded physical data present in each record involved and for determining the extent and nature of the actions taken by the physician during each visit in response to the illness.

Referring to FIG. 24, a subroutine entitled Binary.prg called by AstatusB.prg that accesses encoded physical observations during each visit of the illness and what, if any, kinds of actions were undertaken in the treatment and management of the patient during each visit. By a scheme based upon binary numbering the subroutine compiles into a single letter code any combination of several possible actions taken by the physician during each visit and it also provides for pointing to other records storing other clinical data emanating from that visit during that illness. And for the purpose of later accessing specific records created as a result of this type of processing, this subroutine also determines and encodes for the name of the particular main program that has called it, since in this system there may be three that do.

Referring to FIG. 25, a main program entitled Astatus3 that is similar to AstatusB since it also identifies and processes what might turn out to represent a protracted out-patient illness but its threshold for activation is different. It first has to identify an office visit record with a clinical status of 3 indicating severe symptomatology and possibley need for hospitalization before processing begins and then it will process all contiguous antecedent and subsequent office visit records of that out-patient that also indicate disease activity (i.e., non-1 clinical status). And, like AstatusB.prg the number of records involved depends upon the length of that out-patient's uninterrupted illness. And it to calls the subroutine binary.prg for each record involved.

Referring to FIG. 26, a continuation of FIG. 25 showing stepwise program logic and note how there is movement of the record pointer in both directions and how the program is informed each time.

Referring to FIG. 27, a main program entitled clinevol.prg that, like AstatusB.prg and Astatus3.prg, identifies and processes a string of successive office visit records that represent a protracted out-patient illness. The basic difference here is that processing is triggered whenever a non-1 clinical status record is encountered, there is no minimum number of records necessary and no particular level of disease intensity required. But it will also process, if present, the most previous office record of that out-patient (a status 1) in order to obtain the `baseline` condition of that patient just prior to the onset of that illness. The number of records involved here also depends upon the length of the continuous illness and after each record involved is detected the subroutine binary.prg is also called.

Referring to FIG. 28, a print program entitled print1a.prg that reports out physical data (signs and symptoms) in combination with other salient data of both an identifying and clinical nature from office visit-derived records created during one of the three main programs mentioned previously, in this case clinevol.prg. As such it represents continuity of data flow through program sequencing.

Referring to FIG. 29, a continuation of the print program print1a.prg. Note how additional clinical data, if indicated, is also printed from the same office visit in combination with the signs and symptoms.

Referring to FIG. 30, another print program entitled print2a.prg that complements print1a.prg by printing out medication activity data from the same office visits. In order to access the medicines involved in that visit it calls a subroutine digout1.prg.

Referring to FIG. 31, a subroutine entitled digout1.prg called by print2a.prg in order to locate the medicine activity record linked to the office visit currently being processed for the purpose of organizing the data and encoding it for printing it back in print2a.prg.

Referring to FIG. 32, a print program entitled print3.prg that complements both print1a.prg and print2a.prg by reporting out another clinical aspect of each of those office visits originally processed by clinevol.prg, this time it is lab test results. It also calls a subroutine.

Referring to FIG. 33, a subroutine entitled digout2.prg called by print3a.prg in order to access the lab test results from lab records linked to that office visit record currently being processed.

Referring to FIG. 34, an interactive query routine entitled Caseload.prg that has a monitoring function. By counting on the system's master medical file it determines if there is a proper balance or distribution of out-patients on the database with a particular diagnosis amongst the database doctors. Is there any doctor who carries an inordinate amount of patients with a particular condition, since the database consists of non-specialist, primary care doctors?

Referring to FIG. 35, a subroutine entitled print4.prg called by Caseload.prg for the purpose of computing and formatting the data into percentage terms and displaying it to the screen.

Referring to FIG. 36, another interactive query routine entitled meditoxi.prg that serves another type of monitoring function. For any given medication and database doctor, who are the patients under the care of that doctor and on that medication, if any, who are in an actual or impending situation of medication induced toxicity. As such it displays lab test results in chronological order that are known to be sensitive to the adverse effects of the medication inquired into along with the amounts that patient is taking.

Referring to FIG. 37, another interactive query routine entitled Heartmed.prg that also produces summary type and narrowly focused clinical data. It identifies office visit records of out-patients who have at least one diagnosis indicating chronic Heart disease of some nature and who have been documented at that visit of being in a clinical status of 3 (severe symptoms). Upon that, the program combines the physical data and any medication data and displays it on the screen with other identifying data. In order to access the medication data, it calls a subroutine.

Referring to FIG. 38, a subroutine entitled Medget.prg that is called by Heartmed in order to search for and test the medication activity record linked to the office visit under processing for evidence of change data. It then organizes that data for passage back to Heartmed for display to the screen along with the physical data.

Referring to FIG. 39, the top, main calling program entitled labfirst.prg in the overall process that creates and loads records with lab test results. Note it is primarily involved with the entry of initial identifying data and then determining the invoice (or most unique aspect of any record type) to be assigned to the record that will be created. It then passes control to lower level programs that perform other specific functions in the process.

Referring to FIG. 40, the main subroutine entitled labentry.prg controlling several functions including the actual creation and loading of the test results along with their parameter data. It generates a menu that enables the selection from which other lower level routines are called in order to access prior results from several different aspects for each current lab test result present for entry. From there control is returned to labfirst.prg when finished.

Referring to FIG. 41, a subroutine entitled Findout1.prg that is entered if the user had selected from a menu of options in the higher subroutine labentry.prg to obtain either the first date abnormality for any lab test and the results or the last date of abnormality for that test and the results. Control is then passed back to labentry.prg.

Referring to FIG. 42, a subroutine entitled findout2.prg that is entered if the user had selected from a menu of options in the higher subroutine labentry.prg to obtain either how consistent the results have been for that lab test or the most recent result for that test. Control is returned back to labentry.prg.

Referring to FIG. 43, the top, main calling program entitled Doctorpg.prg of another interactive query routine that generates narrowly focuse clinical data. In this case either a set of lab test results from a particular office visit or individual results of any lab test from several different, prior aspects. In this routine that choice is made and the name of the name of the patient whose data is to be looked is entered. It then calls a lower level subroutine.

Referring to FIG. 44, a main subroutine of the interactive query routine whose main program is illustrated in FIG. 43. It is this subroutine that is entered if the results of individual lab tests was selected in Doctorpg.prg, and form here the selection is made on what prior aspects of that lab test should the results be expressed. The two lower routines called by selectpg.prg are not shown since they are identical to the two lowest subroutines of the labfirst.prg that creates and loads lab records.

Referring to FIG. 45, the main, top calling program entitled addencrc.prg that controls the process that creates and loads a new office visit record. The only data entered here is the patient ID number and whether or not the main reason for that visit was a new problem. Otherwise all the other data is accessed and entered from lower subroutines under its control.

Referring to FIG. 46, the subroutine addnewrc.prg called by addencrc.prg for a first time office visit record creation and data entry. Once entered it acts like addencrc.prg in controlling the processing of the lower subroutines.

Referring to FIG. 47, the main subroutine entitled part1.prg of the office visit data entry. It is here that the record is created and the main data is written to it. It includes the multiple steps involved in accessing the full 6 digit codes of the chronic diagnoses, and the 6 digit code for the condition code field which represents the main reason for that office visit. It also controls entry into the two lower subroutines that load the physical data.

Referring to FIG. 48, a lower level subroutine entitled part2.prg called by part1 in order to load up to two physical symptoms that may be present on the data entry form to the new office visit record.

Referring to FIG. 49, a lower level subroutine entitled part3.prg called by part1 in order to load up to two physical signs that may be present on the data entry form to the new office visit record.

Referring to FIG. 50, an illustration of the model data entry source document used for loading the office visit record created in addencrc.prg. Note how it provides for two alternate methods for entering the physical data (signs and symptoms)

Referring to FIG. 51, a main program entitled Addmedrc.prg that creates and loads a master medical record once for each out-patient on the database. The program uses two alternate methods for the entry of up to three diagnosis for any out-patient. There is only one master medical record for each out-patient on the database.

Referring to 52, a subroutine entitled checkrec.prg called by addmedrc.prg that tests if the chronic diagnosis that were entered to the master medical record created is properly sequenced in relation to each other depending upon their relative positions in the chronic diagnosis table.

Referring to FIG. 53, a model source document for use in the data entry program that creates and loads one master medical record for each out-patient on the database. Note the presence of two alternate methods for entering the chronic diagnoses.

Referring to FIG. 54, a main program entitled Overdrawn.prg that monitors for the overuse of office visit based lab tests. It searches for results from lab tests drawn during office visits that were entirely unremarkable and uneventful, and then combines those results with their most recent results along with other salient data from both their respective visits in order to determine why the later tests were drawn. In order to access the lab data it calls a subroutine.

Referring to FIG. 55, a subroutine entitled digoutod.prg called by overdrawn.prg for accessing both lab results from the currently identified office visit, and for each test present it accesses it's most recent result from any of that out-patient's prior lab records.

Referring to FIG. 56, the system's office visit file, encounte.dbf, loaded with sample data for processing by schedule1.prg in order to detect and justify any early and consecutively uneventful office visit by an out-patient.

Referring to FIG. 57, the remaining office visit records of the file depicted in FIG. 56.

Referring to FIG. 58, the system intermediary file, notify.dbf, as the output from a run by schedu1l.prg while using the sample data of FIGS. 56 and 57 as the basic unit of information. Note the anomalous type of condition code in record #1 and how it has no effect on processing since only the setting in the new problem field is tested and not the actual nature of the 6 digit condition code itself.

Referring to FIG. 59, the system laboratory test file, abn.sub.-- lab.dbf, sample loaded and as one of several related out-patient files for use in schedu1l.prg in the search for data justifying the early consecutively uneventful office visit of an out-patient.

Referring to FIG. 60, the remaining four system files that contain related out-patient data for use in searching for clinical data in schedu1l.prg that can justify an early consecutively uneventful office visit by an out-patient. They are er.sub.-- room.dbf(A), surgfind.dbf(B), pt.sub.-- hosp.dbf (C) and treatmen.dbf(D). All are loaded with sample data.

Referring to FIG. 61, a version of the office visit file for serving as basic input to the program unsched1.prg.

Referring to FIG. 62, the remaining office records of the file named encountu.dbf depicted in FIG. 61 and which is identical, except for name, as the office visit file encounte.dbf. (its last letter changed to identify it as sample loaded for special use by a particular program)

Referring to FIG. 63, the system intermediary file, notify.dbf, now represented as output from an unsched1.prg run. Note the presence of the `C` indicator written to the CODE field of a notify.dbf record in instances of consecutive unscheduled office visits for the same patient that the program unschedul.prg is designed to identify while the same field is used for indicating an absolute justification in instances of early scheduled and consecutive office visits by the same outpatient, something which unschedl.prg is also capable of identifying and documenting.

Referring to FIG. 64, a version of the office visit file named encountb.dbf that serves as basic input to astatusb.prg.

Referring to FIG. 65, the remaining office visit records of the file depicted in FIG. 64.

Referring to FIG. 66, the system intermediary file now as output from the program astatusb.prg. Note the second character in the CATEGORY field that indicates the name of the program.

Referring to FIG. 66A, a translation table for illustrating how, in the binary.prg subroutine, the assignment is made of a single letter code to each of 16 possible types or combinations of physicianaction or intervention occurred during an office visit, including the code for none at all.

Referring to FIG. 67, schematic of computer program execution sequences that demonstrate continuity of data flow. Output to an intermediary file, notify.dbf, is then used as input to a print program in both the upper and lower diagram.

Referring to FIG. 68, the system medicine-activity record file, medicine.dbf, sample loaded for use with the program atatus3.prg.

Referring to FIG. 69, another sample loaded version of the office visit record file as the basic input to astatus3.prg. Note how the last letter of name has been changed in order to properly identify and access this particular version of the office visit file for use with astatus3.prg.

Referring to FIG. 70, remaining office visit records of the encount3.dbf file.

Referring to FIG. 71, the system intermediary file, notify.dbf, now as output from astatus3.prg. Note the relationship between record #1 and #5 of notify.dbf and that of #8 and #30 in medicine.dbf of FIG. 68.

Referring to FIG. 72, the system's physical signs table, findings.dbf. For use in the physical data report of print1a.prg.

Referring to FIG. 73, another sample loaded version of the office visit file, encounte.dbf for use as basic input for clinevol.prg.

Referring to FIG. 74, remaining office visit records of the encounte.dbf file.

Referring to FIG. 75, the system's physical symptoms table, cc.sub.-- list.dbf, for use in the physical data report of print1a.prg.

Referring to FIG. 76, the system's chronic diagnosis table, chrmed1i.dbf, for use in print1a.prg.

Referring to FIG. 77, another example of the system intermediary file, notify.dbf, generated as output from clinevol.prg and now serves as basic input to print1a.prg, which is based upon a chronic diagnosis as the primary reason for an office visit.

Referring to FIG. 78, an out-patient office based physical data report. Note the indication of whether or not resolution of the out-patient illness has or hasn't occured. Note that two physical data items of the same type (signs or symptoms) present in the same office visit record are separated by the "and" when both are printed out during that out-patient's processing.

Referring to FIG. 79, an out-patient office based physical data report which, like in FIG. 78, shows two visits by the same patient. Note hospitalization indicator while the clinical resolution indicator is set to positive because the next record in the office visit file is that out-patient's and its clinical status is a 1 indicating a return of the patient's clinical condition to normal or baseline and therefore termination of the out-patient illness.

Referring to FIG. 80, another out-patient physical data report.

Referring to FIG. 81, another out-patient physical data report, this time only one visit for an out-patient is involved. Note that it resulted in a hospitalization but at the next office visit, that out-patient was found to be without continuing illness due to the presence of a clinical status of 1 resulting in the `problem resolved` indicator as shown.

Referring to FIG. 82, another out-patient physical data report involving two visits by the same patient.

Referring to FIG. 83, another out-patient physical data report.

Referring to FIG. 84, another out=patient physical data report, this time involving 3 office visits.

Referring to FIG. 85, another out-patient physical data report, this time involving 5 office visits by the same patient. Note that after the second record there has a temporary termination of the illness as indicated by the `problem resolved` message but that was apparently only a brief remission followed by a re-occurrence of another period of illness.

Referring to FIG. 86, another out-patient physical data report.

Referring to FIG. 87, another sample loaded version of the system master medical record file, medical.dbf, for use in the querying of lab data by the program doctorpg.prg.

Referring to FIG. 88, continuation of the master medical file, medical.dbf. Note record #12 for use as the sample data that generates the display illustrated in a higher number figure.

Referring to FIG. 89, the continuation of medical.dbf records displayed in FIGS. 87 and 88.

Referring to FIG. 90, another sample loaded version of the system office visit file for use in the querying of out-patient lab data. Note the sample data of record #19 for use in generating the display to be found in a higher numbered figure.

Referring to FIG. 91, continuation of the office file records of FIG. 90.

Referring to FIG. 92, a sample loaded version of the system laboratory test file, abn.sub.-- lab.dbf, for use in the querying of out-patient lab data. Note records numbered 8 and 25 for use in generating the display to be found in a higher-numbered figure.

Referring to FIG. 93, continuation of the system laboratory test file of FIG. 92.

Referring to FIG. 94, alternate displays of the lab data querying routine depending upon the user's choice. Subfigure A displays all the test results ordered from the same office visit while subfigure B represents the results of an individual lab test from one of several historical perspectives.

Referring to FIG. 95, another sample loaded version of the system master medical file, medical.dbf, for use in the querying routine named meditoxi.prg.

Referring to FIG. 96, continuation of the system master medical file of FIG. 95.

Referring to FIG. 97, continuation of the system master medical file displayed in FIGS. 95 and 96.

Referring to FIG. 98, another sample loaded version of the system laboratory test file, abn.sub.-- lab.dbf, for use in the querying routine meditoxi.prg. Note records 11, 12, 13 and the `wbc` field for use in the meditoxi.prg screen display of a higher numbered figure.

Referring to FIG. 99, continuation of the system laboratory file, abn.sub.-- lab.dbf, from FIG. 98.

Referring to FIG. 100, subfigure A displays two separate sequential steps of meditoxi.prg. First is a listing of all out-patients who are currently taking the medication entered at the top of the routine and who are under the care of the doctor whose name was also entered at the top of the routine. Then after one of the names of the patients listed is entered, all the results of that test on file for that patient are listed in chronological order. Subfigures B, C and D are displays from the querying routine named Heartmed.prg. They list the physical data documented and any medication activity enacted by a database doctor for those out-patients selected on the basis of chronic cardiac disease and who were very symptomatic(ill) during an office visit.

Referring to FIG. 101, a sample loaded version of the system medicine-activity file medicine.dbf, used in the heartmed.prg query routine.

Referring to FIG. 102, a sample loaded version of the laboratory test file, abn.sub.-- lab.dbf, for use in the report program, overdraw.prg, the output of which is illustrated in a higher numbered drawing.

Referring to FIG. 103, continuation of the laboratory test file of FIG. 102.

Referring to FIG. 104, another sample loaded version of the system office visit file, encounte.dbf, for use in the overdraw.prg report program.

Referring to FIG. 105, continuation of the office visit file of FIG. 104.

Referring to FIG. 106, an out-patient report generated by the program overdraw.prg. It involves three office visits. Note how the most recent result for any two tests ordered at the same office visit (and therefore drawn at the same time) may have been ordered from different prior office visits and therefore found in different lab records of that patient.

Referring to FIG. 107, another out-patient report from the overdraw.prg program. This involves two office visits.

Referring to FIG. 108, another out-patient report from overdraw.prg. Note how the Sed Rate test result from the office visit of 01/13/87 then appears on the right hand side as a most recent result of that test ordered during the subsequent office visit of 02/17/87. Note that three visits for that patient are involved.

Referring to FIG. 109, another out-patient report from the overdraw.prg program.

Referring to FIG. 110, another out-patient report from the overdraw.prg program. Note how, for the ekg results from the third office visit, the most recent ekg results are drawn from a different prior lab record than the other results for that patient.

Referring to FIG. 111, another out-patient report from the overdraw.prg program.

Referring to FIG. 112, another sample loaded version of the system master medical file, medical.dbf, for use in the caseload.prg program.

Referring to FIG. 113, continuation of the system master medical file of FIG. 112. Note the sample use of the 6 digit chronic diagnosis code CP0026, iron deficeincy anemia, for use in the caseload program display present in a higher numbered figure(drawing).

Referring to FIG. 114, continuation of the master medical file of FIG. 112 and 113.

Referring to FIG. 115, output from the program caseload.prg. Note the out-patient breakdown into diagnostic categories for the doctor whose name was entered.

Referring to FIG. 116, diagrammatic outline of sequential computer programs and progression of data flow. Office visit records are first processed by any of 3 routines that identify office visits that represent protracted out-patient illnesses and determine what the physician observed and did. The data compiled into those records created and written to as a result of the aforementioned processing are then used for any of 3 print programs that report out clinical data from those original visits. The phrase `new clinical problems` indicates that the office visit(records) selected were on the basis of a new clinical problem(or an as yet uncharacterized complication of an established diagnosis) as the primary reason for that patient's office visit.

Referring to FIG. 117, a version of the laboratory test file loaded with sample data for use in the lab test data report program, print3.prg.

Referring to FIG. 118, a sample loaded version of the system intermediary file, notify.dbf, for use with the lab test report program print3.prg. It is identical to that present in FIG. 141 but has less total records since the print3.prg cutoff date is different from that of print1.prg and print2.prg.

Referring to FIG. 119, an out-patient lab test report by print3.prg.

Referring to FIG. 120, an out-patient lab test report by print3.prg.

Referring to FIG. 121, an out-patient lab test report by print3.prg.

Referring to FIG. 122, an out-patient lab test report by print3.prg.

Referring to FIG. 123, an out-patient lab test report by print3.prg.

Referring to FIG. 124, an out-patient lab test report by print3.prg.

Referring to FIG. 125, an out-patient lab test report by print3.prg.

Referring to FIG. 126, the system's inventory type medication table listing the generic names of the medicines available to the database patients, med.sub.-- list.dbf.

Referring to FIG. 127, a sample loaded version of the transactional type medicine-activity record file, medicine.dbf, for use in the execution of print2.prg.

Referring to FIG. 128, an out-patient medication change report by print2.prg.

Referring to FIG. 129, an out-patient medication change report by print2.prg.

Referring to FIG. 130, an out-patient medication change report by print2.prg.

Referring to FIG. 131, an out-patient medication change report by print2.prg.

Referring to FIG. 132, an out-patient medication change report by print2.prg.

Referring to FIG. 133, an out-patient medication change report by print2.prg.

Referring to FIG. 134, an out-patient medication change report by print2.prg.

Referring to FIG. 135, a sample loaded version of the system master medical file, medical.dbf.

Referring to FIG. 136, a continuation of the master medical file of FIG. 135.

Referring to FIG. 137, a continuation of the master medical file of FIG. 136 and 135

Referring to FIG. 138, the physical complaints or symptoms table, cc.sub.-- list.dbf, for use in physical data report print1.prg.