System and Method for Optimizing Nuclear Imaging Appropriateness Decisions

Abstract

Methods and systems of accelerating the adoption of a medical treatment by healthcare providers are disclosed. The methods include providing to a healthcare provider a set of selectable criteria for determining whether a specific medical treatment is indicated for a particular patient, analyzing the criteria selected, and indicating to the healthcare provider whether the medical treatment is indicated. A system and methods are provided which are suitable for optimizing the use of nuclear imaging for assessing risks of cardiovascular disorders and, when appropriate, for implementing intervention strategies to reduce such risks.

We claim the following inventions: 
     
         1 . A healthcare management system for providing patient care, the healthcare management system providing improvements that result in improved operating efficiency for a healthcare facility, the healthcare management system comprising:
 a) a healthcare facility network having an electronic medical records (EMR) data management system that is configured to store electronic medical records of patients;   b) one or more secure terminals each having a display, the one or more secure terminals being in network communication with the EMR data management system;   c) identifiable memory locations configured to store discrete data elements;   d) data processors associated with the one or more secure terminals;   e) a middleware system integrated with the EMR data management system;   f) the middleware system configured to securely access EMR data stored by the EMR data management system, wherein the middleware system is further configured to extract the EMR data relating to a particular patient;   g) the middleware system configured to operate through a graphic user interface configured to allow an authorized user of the middleware system to interact with the EMR data management system of the healthcare facility network;   h) the middleware system configured to identify the particular patient by an identification process performed at the one or more secure terminals;   i) the middleware system configured to electronically access a data file in the EMR data management system, the data file corresponding to electronic medical records of the particular patient identified by the middleware system;   j) the middleware system being configured to automatically format discrete data elements corresponding to data electronically accessed from the data file, the discrete data elements comprising EMR data extracted from the EMR data management system;   k) the discrete data elements comprising a plurality of date data entries, the plurality of date data entries including entries that correspond to the respective most recent dates of one or more first medical procedures performed in relation to the particular patient;   l) the middleware system being configured to apply rules for determining whether a second medical procedure, different from the first medical procedure is appropriate for the particular patient; wherein the rules relate to one or more of the following:
 1) comparisons of the plurality of date data entries corresponding to the most recent dates of the one or more first procedure; and 
 2) comparisons of a value of one or more types of risk scores corresponding to a disease related to the first medical procedure; 
   m) when application of the rules results in a determination that the second medical procedure is not appropriate for the particular patient, the middleware system is configured to indicate that a new order for the second medical procedure; and   n) when application of the rules results in a determination that the second medical procedure is appropriate for the particular patient, the middleware system is configured to cause the at least one secure terminal to present a screen bearing an option for initiating an order for the second medical procedure for the particular patient.   
     
     
         2 . The healthcare management system of  claim 1 , wherein the forms of data extracted from the EMR data management system comprise structured data, free-text data, and/or image data. 
     
     
         3 . The healthcare management system of  claim 1 , wherein the middleware system is further configured to:
 a) cause the one or more secure terminals to display the new order for the second medical procedure to a caregiver, the displayed order including particulars corresponding to a medical order template;   b) cause the data processors associated with the one or more secure terminals to populate the particulars of the medical order template with patient data corresponding to the particular patient identified and with variable data corresponding to the formatted extracted EMR data; and   c) input information on the medical order template, the information corresponding to details regarding the new order for the second medical procedure.   
     
     
         4 . The healthcare management system of  claim 1 , wherein interaction with the middleware system occurs within a user interface of the EMR data management system. 
     
     
         5 . The healthcare management system of  claim 1 , wherein the automatically formatting discrete data elements includes normalizing the extracted EMR data into a format that is usable by the middleware system. 
     
     
         6 . The healthcare management system of  claim 1 , wherein the one or more secure terminals are configured to present a plurality of order options to the caregiver, the plurality of order options including a second medical procedure ordering option. 
     
     
         7 . The healthcare management system of  claim 6 , wherein:
 a) the rules are applied by the middleware system,   b) the middleware system is configured to determine from the discrete data elements a date data entry that corresponds to a date of one or more most recent first medical procedures performed in relation to the particular patient;   c) the middleware system is configured in such a way that, in response to the date of a most recent first medical procedure of any corresponding date data entry determined by the middleware system is within a first predetermined span preceding a current date, the middleware system is further configured to prompt the caregiver that a new order for the second medical procedure is inappropriate;   d) the middleware system being configured in such a way that, in response to the date of the most recent first medical procedure of any corresponding date data entry determined by the middleware system is not within the first predetermined span preceding the current date, the middleware system is further configured to:
 1) determine from the discrete data elements a date data entry, if any, that corresponds to a most recent third medical procedure performed in relation to the particular patient; and 
 2) when the date of the most recent third medical procedure of any corresponding date data entry determined by the middleware system is within a second predetermined span preceding the current date, the middleware system is further configured to:
 (i) determine whether the date of the most recent first medical procedure of any corresponding date data entry of the most recent first medical procedure is more recent than the date of the most recent third medical procedure of any corresponding date data entry determined by the middleware system; and 
 (ii) in response to determining that the date of the most recent first medical procedure is more recent than the date of the most recent third medical procedure, determine that a new order for the second medical procedure is not required; and 
 
   e) the middleware system being further configured in such a way that, when all requisite determinations are completed, such that the date of the most recent first medical procedure of any corresponding date data entry determined by the middleware system is not within the first predetermined span preceding the current date, and such that one of the following determinations is made by the middleware system: (1) the date of the most recent third medical procedure of any corresponding date data entry determined by the middleware system is not within the second predetermined span preceding the current date, or (2) wherein the date of the most recent third medical procedure of any corresponding date data entry determined by the middleware system is within the second predetermined span preceding the current date but the date of the most recent first medical procedure is not more recent than the date of the most recent third medical procedure, then the middleware system is further configured to cause the one or more secure terminals to present a screen bearing an option for sending a new order for the second medical procedure for the particular patient.   
     
     
         8 . The healthcare management system of  claim 7 , wherein the one or more first medical procedures include any Percutaneous Coronary Intervention (PCI), Myocardial Perfusion Imaging (MPI), and/or Cardiac Catheterization (CATH) performed in relation to the particular patient. 
     
     
         9 . The healthcare management system of  claim 8 , wherein the order for the second medical procedure includes an order for a PCI procedure for the particular patient identified by the middleware system. 
     
     
         10 . The healthcare management system of  claim 8 , wherein the middleware system is further configured to:
 a) mine the EMR data management system to compile data files corresponding to patients enrolled for care through the healthcare facility network, the compiled data files including the data file accessed by the middleware system for the particular patient; and   b) store the compiled files from mining the EMR data management system in a database separate from the EMR data management system.   
     
     
         11 . A method for operating a healthcare management system for providing patient care, where the method provides for improvements that result in improved operating efficiency for a healthcare facility, the method comprising:
 a) providing a healthcare facility network having an electronic medical records (EMR) data management system that is configured to store electronic medical records of patients;   b) providing one or more secure terminals each having a display, the one or more secure terminals being in network communication with the EMR data management system;   c) providing identifiable memory locations configured to storing discrete data elements;   d) providing data processors associated with the one or more secure terminals;   e) providing a middleware system integrated with the EMR data management system, wherein the middleware system is configured to:
 1) securely access EMR data stored by the EMR data management system, wherein the middleware system is further configured to extract the EMR data relating to a particular patient; 
   2) operate through a graphic user interface configured to allow an authorized user of the middleware system to interact with the EMR data management system of the healthcare facility network;   f) identifying, using the middleware system, the particular patient by an identification process performed at the one or more secure terminals;   g) electronically accessing, using the middleware system, a data file in the EMR data management system, the data file corresponding to electronic medical records of the particular patient identified by the middleware system;   h) formatting, using the middleware system, discrete data elements corresponding to data electronically accessed from the data file, the discrete data elements comprising EMR data extracted from the EMR data management system, where the discrete data elements comprise a plurality of date data entries, the plurality of date data entries including entries that correspond to the respective most recent dates of one or more first medical procedures performed in relation to the particular patient;   i) applying rules, using the middleware system, for determining whether a second medical procedure, different from the first medical procedure, is appropriate for the particular patient, wherein the rules relate to one or more of the following:
 1) comparisons of the plurality of date data entries corresponding to the most recent dates of the one or more first procedure, and 
 2) comparisons of a value of one or more types of risk scores corresponding to a disease related to the first medical procedure 
   j) determining, by the middleware system applying the rules, whether the second medical procedure is appropriate for a particular patient;   k) in response to determining that the second medical procedure is not appropriate for the particular patient, indicating, by the middleware system, that a new order for the second medical procedure is not required; and   l) in response to determine that the second medical procedure is appropriate for the particular patient, causing, by the middleware system, the at least one secure terminal to present a screen bearing an option for initiating an order for the second medical procedure for the particular patient.   
     
     
         12 . The method of  claim 11 , wherein the forms of data extracted from the EMR data management system comprise structured data, free-text data, and/or image data. 
     
     
         13 . The method of  claim 11 , wherein the middleware system is further configured to:
 a) causing, by the middleware system, the one or more secure terminals to display the new order for the second medical procedure to a caregiver, the displayed order including particulars corresponding to a medical order template;   b) causing, by the middleware system, the data processors associated with the one or more secure terminals to populate the particulars of the medical order template with patient data corresponding to the particular patient identified and with variable data corresponding to the formatted extracted EMR data; and   c) inputting, by the middleware system, information on the medical order template, the information corresponding to details regarding the new order for the second medical procedure.   
     
     
         14 . The method of  claim 11 , wherein interaction with the middleware system occurs within a user interface of the EMR data management system. 
     
     
         15 . The method of  claim 11 , wherein the formatting of discrete data elements includes normalizing the extracted EMR data into a format that is usable by the middleware system. 
     
     
         16 . The method of  claim 11 , further comprising presenting, using the one or more secure terminals a plurality of order options to the caregiver, the plurality of order options including a second medical procedure ordering option. 
     
     
         17 . The method of  claim 16 , further comprising:
 a) determining from the discrete data elements, using the middleware system, a date data entry that corresponds to a date of one or more most recent first medical procedures performed in relation to the particular patient;   b) in response to the date of a most recent first medical procedure of any corresponding date data entry determined by the middleware system being within a first predetermined span preceding a current date, prompting, using the middleware system, the caregiver that a new order for the second medical procedure is inappropriate;   c) in response to the date of the most recent first medical procedure of any corresponding date data entry determined by the middleware system not being within the first predetermined span preceding the current date:
 1) determining, by the middleware system, from the discrete data elements a date data entry, if any, that corresponds to a most recent third medical procedure performed in relation to the particular patient; and 
 2) in response to determining that the date of the most recent third medical procedure of any corresponding date data entry determined by the middleware system is within a second predetermined span preceding the current date, the middleware system is further configured to:
 (i) determining, by the middleware system, whether the date of the most recent first medical procedure of any corresponding date data entry of the most recent first medical procedure is more recent than the date of the most recent third medical procedure of any corresponding date data entry determined by the middleware system; and 
 (ii) in response to determining that the date of the most recent first medical procedure is more recent than the date of the most recent third medical procedure, determining that a new order for the second medical procedure is not required; and 
 
   d) the middleware system being further configured in such a way that, when all requisite determinations are completed, such that the date of the most recent first medical procedure of any corresponding date data entry determined by the middleware system is not within the first predetermined span preceding the current date, and such that one of the following determinations is made by the middleware system: (1) the date of the most recent third medical procedure of any corresponding date data entry determined by the middleware system is not within the second predetermined span preceding the current date, or (2) wherein the date of the most recent third medical procedure of any corresponding date data entry determined by the middleware system is within the second predetermined span preceding the current date but the date of the most recent first medical procedure is not more recent than the date of the most recent third medical procedure, then the middleware system is further configured to cause the one or more secure terminals to present a screen bearing an option for sending a new order for the second medical procedure for the particular patient.   
     
     
         18 . The method of  claim 17 , wherein the one or more first medical procedures include any Percutaneous Coronary Intervention (PCI), Myocardial Perfusion Imaging (MPI), and/or Cardiac Catheterization (CATH) performed in relation to the particular patient. 
     
     
         19 . The method of  claim 18 , wherein the order for the second medical procedure includes an order for a PCI procedure for the particular patient identified by the middleware system. 
     
     
         20 . The method of  claim 18 , further comprising:
 a) mining, using the middleware system, the EMR data management system to compile data files corresponding to patients enrolled for care through the healthcare facility network, the compiled data files including the data file accessed by the middleware system for the particular patient; and   b) storing, using the middleware system, the compiled files from mining the EMR data management system in a database separate from the EMR data management system.