MONITORING OF HEALTH CARE DATA

Field of the Invention

The present invention relates to methods, apparatus and systems for gathering and representing health data, particularly data relating to the health of a patient when receiving medicinal or other forms of treatment.

Background

In the last 30 years, there has been an explosion in the number of medicines available from around 650 to around 10,000 today. This growth has led to a surge in the number of drug- related problems, making it the fourth highest cause of death behind heart disease, cancer and strokes. These drug related problems may be due to, among other things, a lack of information regarding particular drugs, incorrect drug selection/dosage/administration regime caused by medical practitioners, pharmacists and also the patients themselves, and lack of sufficient information on the side effects of particular drugs.

It should be noted that 8% of the population consume 92% of pharmaceuticals. Furthermore, 50% of medication is not taken as prescribed. Medicine complications have become the second biggest cause of complications behind accidents. Further examples of potential issues include untreated medical problems, failure to take prescribed medication, adverse drug reactions, such as through interactions between multiple drugs, between conventional and alternative medicines and between drugs and certain foods, medication use with no indication, and improper medication selection.

Pharmaceutical companies are obliged to assess the risk of drugs and determine any side effects, but, following any trials, there is considerable difficulty in communicating information from patients to practitioners, health boards and the like, and ultimately to the pharmaceutical companies or some other central monitoring point. This is partly because there are so many different channels through which drugs may be prescribed, the large number of entities working within a given health system, and also because there is no standardised objective procedure for monitoring patients' health while they are receiving treatment, particularly where they are prescribed drugs.

In the past, it has ultimately been left to medical practitioners to identify any problems, either as part of a routine check-up, or where a patient's health deteriorates sufficiently that they consult a practitioner. Information from such consultations may be gleaned from patient records but requires extra effort on the part of medical practitioners in identifying and recording the issues. Some of these issues will require intervention by a practitioner, but a sizeable proportion do not and so this does not make best use of a practitioner's time.

Summary of the Invention

It is an object of the invention to provide a method and/or an apparatus and/or a system for gathering and/or representing health data.

Alternatively, it is an object of the invention to provide at least a useful choice.

According to a first aspect of the invention, there is provided an apparatus for gathering and/or representing health data, the apparatus including means for receiving data; means for processing at least a subset of the data; and means for displaying at least a subset of the data.

The means for receiving preferably includes input means for enabling entry of the data. Additionally or alternatively, data may be remotely entered, with the means for receiving configured to receive the data via wired and/or wireless communication means.

Preferably, the input means is adapted to enable a user to enter a condition of a patient, wherein the apparatus includes or is communicatively couplable to a memory, said memory having stored therein health-related questions, and wherein the apparatus is configured to selectively prompt the user to respond to at least a subset of the questions, said at least a subset being based on the entered condition of the patient.

The memory may be integral to the apparatus or in communication therewith, such as via the internet.

Preferably, the apparatus includes means for associating a portion of the information with a unique identifier such as an NHI or social security number so that the data may be associated with a particular patient.

Preferably, responses to the questions may be provided via the input means.

Preferably, the apparatus includes means for transmitting at least a subset of the data so as to enable access at locations remote from the apparatus.

Preferably, the means for transmitting is communicatively couplable to the internet, although other communication means or mediums are also within the scope of the invention.

Preferably, the means for processing is operable to analyse and/or format the data for display by the means for displaying. For example, responses for a plurality of patients to the same question may be correlated. Additionally or alternatively, multiple responses by the same patient to the same question at different times may be processed to provide for concurrent display and/or comparisons therebetween.

According to a second aspect, there is provided a system for gathering and/or representing health data, the system includes one or more apparatus according to the first aspect; a remote station; and wired and/or wireless communication means for transferring information between each apparatus and the remote station.

Preferably, the remote station includes or is configured to act as a server although the invention is not limited thereto. As would be apparent to one of skill in the art, other suitably enabled computing devices may be configured to perform the same function.

Preferably, the communication means is configured to transfer the information via the internet.

According to a third aspect, there is provided a method of gathering and/or representing health data, the method includes receiving data; processing at least a subset of the data; and displaying at least a subset of the data.

The step of receiving the data may includes entering the data via input means such as a keyboard and/or wired and/or wirelessly receiving the data from a remote source.

Preferably, the method includes displaying one or more health-related questions to a user, wherein said questions may be selected from a pool of questions at least in part based on a condition of a patient.

Preferably, the method includes associating a portion of the information with a unique identifier such as an NHI or social security number so that the data for a particular patient may be associated therewith.

Preferably, the method includes transmitting at least a subset of the data so as to enable access at remote locations.

Preferably, the step of processing includes analysing and/or formatting the data for display.

Further aspects of the invention, which should be considered in all its novel aspects, will become apparent to those skilled in the art upon reading the following description which provides at least one example of a practical application of the invention.

Brief Description of the Drawings

One or more embodiments of the invention will be described below by way of example only and without intending to be limiting with reference to the following drawing, in which:

Figure 1 is a schematic diagram of a system according to an embodiment of the invention.

Figure 2 is a diagrammatic representation of a system according to an embodiment of the invention

Detailed Description of Preferred Embodiments

The inventor has recognised the problem that medicine management processes are unable to work without input from all sectors involved in the provision of health services and that information obtained from a large number of patients is required to improve the health outcome for any one particular patient, through improved health status and/or quality of life, and to contain healthcare costs.

In broad terms, the present invention provides health care providers with an interactive and collaborative environment that empowers the patient to improve their quality of life and lifestyle. Preferred embodiments of the invention involve participation by pharmacists but the

invention is not limited thereto. Pharmacists have considerable knowledge of drugs which has not hitherto been exploited to anywhere near its potential.

More particularly, the invention provides a collaborative network amongst general practitioners (GP's) and other primary health care providers, patients and pharmacists, preferably through use of a web-based tool. According to preferred embodiments, at least a subset of patients which may be receiving medical care (namely through prescription of drugs) make use of a formalised procedure to report on the treatment that they are receiving. In general terms, this involves responding to a number of questions which may be targeted depending on the treatment being received. A patient may directly provide the information. However, preferably, a pharmacist acts as an intermediary so as to provide clarification to the patient and also to ensure that information is entered in a more objective and standardised manner. Thus, embodiments of the invention are preferably implemented in pharmacies making use of suitably enabled computing devices which guide a user through a questionnaire.

Thus the invention provides for the recordal and communication of a patient's perception of their health as opposed to just the clinical data available to a GP. By combining these sources of information, patient care can be improved by providing GP's with additional information on their patients and enabling pharmacists to identify where medication may need modifying. With continued monitoring of patients over time, the invention provides an invaluable tool in identifying any trends related to particular medicaments or combinations of medicaments. This is facilitated by a user interface which may be configured so as to chart particular types of data as will become more apparent herein below. This effectively empowers patients and ushers them to take greater responsibility for their own health.

The invention includes a number of discrete modules which are referred to herein as Questionnaires Management, Graphing/Graph Access, Registration and Hierarchies, Appointment Diary and Administration Area.

The Questionnaires Management module of the invention allows administrating personnel, preferably via a web or internet portal, to administer existing questions, add new questions within a questionnaire, define scores against a question within a questionnaire, and add/update/delete questionnaires.

The Graphing/Graph Access module facilitates the generation of graphs from all or a subset of the completed questionnaires. The graphs may be made available to all users involved in the system (including patients through to health boards and pharmaceutical companies) but preferably, access rights are defined to limit the information which may be viewed by each entity or category of user within the system. For example, a patient may only be permitted to view their own data, a GP may only be permitted to view information for their own patients or a pharmaceutical company may only be permitted to view information relating to their own drugs. Furthermore, the types of information to be displayed to different users may also be set according to access rights. For example, only the patient, the pharmacist, and the GP to which the patient is registered may be able to view that patient's personal details. According to preferred embodiments, the graphs outline the scores from multiple questionnaires, both for an individual as multiple questionnaires are completed over time and for a collective group of patients.

The Registration and Hierarchies module enables an administrator of the system to add new entities to the system and to set their access rights. Any entity within a health system may be provided with access, however, in view of the sensitive nature of the information, strict controls must be in place to control who has access and what each entity may be allowed to access. Example entities include DHB's (District Health Boards), PHO's (Primary Health Organisations), Pharmacies, GP's and the patients themselves.

Preferably, DHB's are permitted to view the statistics, graphs and figures gathered from both single and collective PHO's, with the possibility of statically viewing figures/graphs based on information gathered from GP's. Information may be provided to GP's via email, in which case they may be alerted to check their email once they are logged on to the system if a message has been sent. GP's are also preferably able to statically view figures/graphs, based on information gathered from pharmacies.

The pharmacies are preferably responsible for gathering at least a sizeable proportion of the data by prompting patients to participate in undertaking the questionnaires. To this end, pharmacists preferably handle registration of patients, including associating a patient with an identifier (e.g. an NHI number or social security number) and defining their particular medical condition. Provision may be made to enable a patient to add their own notes. Patients are then assigned to registered GP's in the system and information gathered through completion of the questionnaires. Results for an individual patient or a group/collective may be viewed, preferably limited to those responding to the same questionnaire (and hence with a similar

condition) so that like data may be compared. Patients may be scheduled for their next questionnaire participation and referral notes sent to GP's. If a particular GP was unknown to the system, the information generated may be printed and delivered according to more conventional means.

Thus, embodiments of the invention preferably rely on a hierarchy through which information is passed, with different layers within the hierarchy preferably serving different functions and provided with different access rights to the generation or recordal and viewing of information.

The Appointment Diary module ensures that patients are appropriately scheduled for their next review. Reminders may be generated, such as automatically generated email reminders, with default prior warning times able to be set at the pharmacies, or wherever else the questionnaires may be completed. Note that since the invention is preferably enabled using a web-based interface, there is no limitation on where it may be implemented. Hence the participation of pharmacists within the system is not essential. For example, patients may complete questionnaires at their homes. Also, patients may be flagged for attention if they miss an appointment. More particularly, the appointment diary may be used as an audit tool to keep a record of which users/patients have been providing information.

Preferably, means are provided for recording the time taken for a patient to respond to a questionnaire. This may be performed for information purposes to ascertain whether the time taken is too long and that perhaps the process needs simplifying. Additionally or alternatively, particularly where a third party such as a pharmacist is involved in aiding a patient through a questionnaire, the time may be recorded to serve as a basis of payment thereto by parties receiving the information.

The Administration Area module preferably serves to generate statistical reports, preferably through grouping together patients that belong to a particular demographic, chronic disease, age group, sex, health status, etc. Graphs may be generated at different user levels. Additional registration functionality may also be performed by this module such as allowing registration of members on to the portal (e.g. DHB's, PHO's, Pharmacies, GP's, etc) and/or setup and maintenance of questionnaires.

According to one particular aspect of the invention, means are preferably provided to enable the analysis and/or viewing of results for a selected subset of questions for a single patient.

Where a patient completes has completed the same questions on more than one occasion,

data from each occasion may be collated and viewed at the same time, such as to show how a patient's condition has changed over time. The alternative to this is relying on a patient's recollection, which, once some time has passed, may not accurately reflect the historical situation. This feature is preferably made available to all users of the invention, such as through the web-based portal of the invention, although the amount or type of information provided may be restricted for particular users as set by access rights.

To implement this aspect of the invention, entities such as DHB's are provided with means for displaying a list of at least a subset of currently registered patients falling within that DHB. To fulfil privacy requirements, preferably, patient identification details are not accessible. However, preferably, basic demographic information (e.g. age within a range, area in which they live, etc) may be accessible together with the unique patient identifier such as their NHI number. Thus, the DHB can select a particular NHI number (patient), such as through use of a web-based interface, and then view that patient's responses to a questionnaire, allowing the DHB to populate, data match and compare health risks and needs by individual NHI.

Alternatively, some other unique identifier may be used to avoid use or dissemination of an identifier directly associated with a patient. For example, a generator may generate an identifier for each new user that is stored in a secure database, with each identifier linked to a patient such as via their NHI number. This provides another layer of security.

Similarly, PHO's may be provided, preferably through a web-based interface, with an option to view data for individual patients under the care of that PHO. Other members of a health system may also be able to view such information, although the extent of access may be more or less restricted. For example, an individual's access may be limited in that they are only permitted to view their own results, but at the same time, their access rights may be broader than some other members of the system in that they are able to access all of their own personal details.

Preferably, while data for a particular patient is being viewed, such as in the form of a graph, additional data, such as the mean results for all patients having responded to the same questionnaire, may be selectively concurrently viewed, such as by display of an additional graph or the display of an additional line on the same graph.

According to preferred embodiments, the overall results for a particular questionnaire may be displayed, with the user interface operable to enable a user to select and limit display to a

subset of questions, including a single question. Where results of multiple questionnaires are to be viewed, they may be displayed as an individual chart for each question, with the response score for the question versus time.

According to another particular aspect of the invention, means are preferably provided for assimilating existing DHB forms into embodiments of the invention. More particularly, means are preferably provided for digitising current medicine review forms and integrating these into the system. Thus, when a patient registers with the system of the invention at a pharmacy, information for that patient may be passed to a particular selected DHB.

Such forms may include MUR (Medicine Use Review) Care Plan, MTA (Medicines Therapy Assessment) or CMM (Comprehensive Medicines Management) Care Plan Quarterly Report (PDF), or Pharmacist Health Education Services - Quarterly Monitoring Report.

The digitisation process may be divided into two phases. The first phase involves digitizing of the forms and electronically storing them, such as at a server. The current basic information gathered from the patient is preferably accessible in its original form allowing patients, and others, to view the information at any time. Preferably, while registering as a patient under the system, a user may view the forms together with an indication as to whether the forms have been completed. The details can then be edited such as through use of a suitably enabled computing device.

Tagging of information is preferably performed using the unique patient identifier such as an NHI number. Access rights may be controlled so that only certain users may modify information while a larger sub-group may view the information.

Through use of a unique identifier it is possible for information for a particular patient, provided from multiple sources, to be associated. Furthermore, it provides a means for information regarding a particular patient to be easily transferred from one database to another where records for a patient are required, avoiding the need for multiple data entry.

The second phase involves passing or transferring the information elsewhere in the system, such as to the DHB's.

Figure 1 is a schematic diagram of a system, generally marked 10, according to an embodiment of the present invention. System 10 includes server 11 and terminals 12,

communicatively coupled via communications interface 13 (e.g. the internet). Note that the invention is not limited to the transfer of data via the internet and it is intended that all alternatives which would be apparent to one of skill in the art are also included within the scope of the invention. For example, dedicated links or virtual dedicated links may be provided between various terminals in system 10.

Terminals 12 may be placed at any point in a health care system. Preferably, terminals 12 are at least provided within pharmacies, GP and other primary healthcare practices, and DHB's. Patients themselves may also have a terminal 12 or access thereto. Preferably, all information entered into the system is stored at server 11 or at a memory associated therewith. Note that the invention does not preclude the storage of information locally. For example, a pharmacy may locally store information for all patients registered with that pharmacy.

Server 11 may be managed and in the control of a third party or alternatively may be incorporated in the computing system of one of the entities within system 10. For example, each DHB may control and manage their own server for all patients registered therewith.

Figure 2 shows a flow chart of a method according to an embodiment of the invention. The example shows a pharmacy as the user of the system but it should be noted that the invention is not limited to use by pharmacies.

An operator at the pharmacy may access the homepage of the invention through their terminal. Preferably, the user is first requested to log in and is then presented with a main menu. The pharmacy then selects MRS (Medicine Review Services) on the toolbar and is presented with DHB forms, which may be stored on the server. Only forms that are relevant to the DHB which the pharmacy is registered under are preferably presented.

The pharmacy either registers a patient or selects MRS service criteria. The pharmacy is then able to complete general health and chronic condition questionnaires and/or is able to go to MRS services to complete MUR questionnaires. Pre-populated digitised MUR care plan forms are presented and the pharmacy is prompted to complete the MUR questionnaire before completing the MUR care plan forms. The pharmacy then completes the Complete Care Plan which is submitted and archived on the server.

The patient's GP is notified manually or automatically, by means which may include email and/or fax and/or via internet or intranet interface. According to a preferred embodiment, the GP registration form is in the form of an edi (Electronic Data Interchange) file or otherwise configured such that information is structured to facilitate it being exchanged electronically between different computer systems. Thus, terminals at pharmacies may communicate with a GP's terminal via the network of the invention. Users at pharmacies engage with their patients through the MUR Care Plan process which involves various steps concluded by a report form page. Users may have the option of sending the report form to the patient's respective GP. The user may be provided with an immediate notification that the message has been sent. The report form will include a time stamp of the last time the GP was messaged through the system of the invention for the current patient undertaking the consultation. A record may be kept of sent messages and message receipt acknowledgements so as to keep track of the history of information exchange.

At this stage the GP can log in, such as via the internet, to access their patient's graphs and MUR Care Plan results. The GP is preferably only able to view the graphs and MUR Care Plan results. The patients are also able to log in via the internet to view their own results.

The DHB's can log in to the system and view patient MUR questionnaire results under NHI and/or Patient Record Number. Automated DHB quarterly reports, per pharmacy, are available and pre-populated with details which may include reporting period, Claimant

Number (pharmacy), Patient Record Number, date enrolled, date of consult, NHI, ethnicity,

Knowledge, Perception, Adherence Score (taken from MUR questionnaire results), Key

Interventions undertaken (from Care Plan) and/or consult time (minutes). Pharmacies are preferably only able to view the reports.

An additional option is for Crystal Reports or the like to be available from a web database. The reports may be for demographics per DHB, PHO, GP, and/or pharmacy. For example, ethnicity vs. drug group adherence issues, monetary value of unused medicines, specific drug group causing adherence problems vs. monetary value etc.

Where in the foregoing description reference has been made to specific components or integers of the invention having known equivalents, then such equivalents are herein incorporated as individually set forth.

It should be noted that various changes and modifications to the presently preferred embodiments described herein will be apparent to those skilled in the art. Such changes and modifications may be made without departing from the spirit and scope of the invention and without diminishing its attendant advantages. It is therefore intended that such changes and modifications be included within the present invention.