CN1613087A - 用于质量坚持的病人数据挖掘 - Google Patents
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Abstract
本发明提供了用于在治疗病人的过程中自动地确保对临床方针的坚持的系统和方法。数据源(202)包含病人记录,包括正被治疗的病人的记录;方针知识库(204)包含临床方针;以及质量坚持引擎(206)被配置成为正被治疗的病人监控对临床方针的坚持。至少一些病人记录可以包括通过挖掘非结构化的病人数据获得的信息。所述系统包括用于输出质量坚持信息的输出部件(208)。输出的质量坚持信息可以包括提示,包括用于依照临床方针采取临床动作的提示。输出的质量坚持信息还可以包括所述临床方针没有遵守的警告。
Description
相关申请的交叉引用
本申请要求了于2001年11月2日提交的临时申请序号为60/335,542的美国申请的优先权,将该篇申请的全部内容引用于此,以供参考。
发明领域
本发明涉及医学信息处理系统,以及更具体来讲涉及用于为卫生保健组织提供质量坚持信息的计算机化系统和方法。
发明背景
卫生保健组织正日益致力于基于证据的方法来改善保健质量。举例来说,卫生保健组织通常采用临床方针,所述临床方针基于最有用的医疗科学证据来提供建议。可以通过比较临床动作与方针建议来测量卫生保健质量。
卫生保健组织可以使用这种比较结果来确定他们组织内优秀的领域以及需要改进的那些领域。此信息为计划和做出预算决定提供了客观基础。此外,可以用于证明对公众的责任以及支持质量要求。
目前,致力于保健质量问题的解决方案通常仅仅集中在与临床方针的追溯比较。虽然追溯的比较可以提供有价值的信息,但是通常很少有适当的机制来确保在治疗病人的过程中坚持方针。这种信息往往对碰巧发生的问题进行确定十分有用,因此可以立即采取修正动作。
随着卫生保健组织向其中自动进行病人保健管理的各个方面的环境转移,现在更加易于收集和分析病人信息。然而,卫生保健组织势必要以无数的非结构化和结构化的数据源的方式来维护信息。例如,必须访问很多不同的数据库,每个数据库均具有其自身的特定格式。更糟的是,必须参考医师注释。这些注释通常无非是自由文本听写,并且可能很难筛选所述注释来收集必要的信息。因此,花费在收集信息上的精力通常是费时的、高代价的且容易产生错误。
考虑到提供保健质量信息的重要性,在治疗病人的过程中生成准确的质量坚持信息是合乎需要的并且非常有益的。
发明概要
本发明提供了一种用于在治疗病人的过程中生成准确的质量坚持信息的技术。
依照本发明的各种实施例,提供了一种系统,所述系统包括一个包含病人记录的数据源,所述数据源包括正被治疗的病人的记录;一个包含临床方针的方针知识库;以及一个质量坚持引擎,用于为正被治疗的病人监控对临床方针的坚持。至少一些病人记录可以包括通过挖掘非结构化的病人数据获得的信息。
所述系统包括用于输出质量坚持信息的输出部件。输出的质量坚持信息可以包括提示,包括用于依照临床方针采取临床动作的提示。输出的质量坚持信息还可以包括没有遵守所述临床方针的警告。
质量坚持引擎可以被配置为通过比较临床动作与临床方针来监控对临床方针的坚持。所述临床方针可以涉及推荐的临床动作。质量坚持引擎可以通过确定下一个推荐的临床动作来监控对临床方针的坚持。可以输出用于下一个推荐的临床动作的提示,以便卫生保健提供者能够更好地遵循建议。
通过以下对优选实施例的详细说明,将使本发明的这些及其他方面、特征和优点变得清楚,其中可以结合附图进行阅读。
附图简述
图1是根据本发明实施例、可以适用于本发明的计算机处理系统的框图;
图2示出了依照本发明实施例的示范性质量保证系统;
图3示出了用于挖掘结构化的临床信息的示范性数据挖掘框架;和
图4示出了描述用于在治疗病人的过程中自动确保对临床方针的坚持的示范性技术的流程图。
优选实施例的描述
为了易于清楚理解本发明,在此提供了描述本发明特定方面的说明性的例子。然而,应该理解的是,这些例证说明不意味着限制本发明的范围,而是提供于此以便举例说明与本发明相关联的特定原理。
还应该理解的是,本发明可以依照硬件、软件、固件、专用处理器或者它们的组合的各种形式来实现。优选的是,本发明是以作为在程序存储装置上可确定实现的程序的软件来实现的。所述程序可以上载到包括任何适当的体系结构的机器中,并由该机器执行。优选的是,所述机器在具有硬件的计算机平台上实现,所述硬件诸如一个或多个中央处理单元(CPU)、随机存取存储器(RAM)以及输入/输出(I/O)接口。计算机平台还包括操作系统以及微指令代码。此处所述的各种过程与功能可以是微指令代码的一部分或者是程序的一部分(或者其组合),其经由操作系统执行。此外,可以将各种其他外围设备与计算机平台相连,诸如附加的数据存储设备以及打印设备。
应该理解的是,因为在附图中描述的构成的系统部件以及方法步骤是优选地是以软件实现的,所以系统部件(或者工序)之间的实际连接可以是不同的,取决于本发明被编程的方式。
图1是根据本发明实施例、适用于本发明的计算机处理系统100的框图。所述系统100包括至少一个处理器(以下称处理器)102,其经由系统总线104可操作地与其他部件耦合。将只读存储器(ROM)106、随机存取存储器(RAM)108、I/O接口110、网络接口112以及外部存储器114可操作地与系统总线104耦合。通过I/O接口110或者网络接口112,可以可操作地把诸如显示装置、盘存储装置(例如,磁盘或者光盘存储装置)、键盘以及鼠标之类的各种外围设备耦合到所述系统总线104。
计算机系统100可以是独立系统或者经由网络接口112与网络相链接。网络接口112可以是硬线连接的接口。然而,依照各种示范性实施例,所述网络接口112可以包括适合于向另一个装置发送并从中接收信息的任何装置,诸如通用异步接收器/发送器(UART)、并行数字接口、软件接口或者已知接口的任意组合,或者以后开发的软件以及硬件。所述网络接口可以与各种类型的网络相链接,包括局域网(LAN)、广域网(WAN)、内联网、虚拟专用网络(VPN)以及因特网。
所述外部存储器114可以利用数据库管理系统(DBMS)实现,所述数据库管理系统由处理器102管理并且驻留在诸如硬盘的存储器上。然而,应该理解的是,所述外部存储器114可以在一个或多个附加计算机系统上实现。例如,外部存储器114可以包括驻留在独立的计算机系统上的数据仓库系统。
本领域技术人员将理解的是,在不脱离本发明的精神和范围的情况下,可以使用其他可选的计算环境。
参见图2,举例说明了自动质量坚持系统200。所述自动质量坚持系统200包括一个包含病人记录的数据源202、临床方针知识库204、质量坚持引擎206以及输出部件208。所述自动质量坚持系统200被配置成为正被治疗的病人监控对临床方针的坚持。
优选的是,数据源202被组织成结构化的临床病人记录(CPR),并且使用数据挖掘技术利用病人信息来填充数据源202,所述数据挖掘技术在Rao等人一并提出的序号为10/__,__,(代理人变编号为2001P20906US01)、标题为“Patient Data Mining(病人数据挖掘)”的共同待审的美国专利申请中有所描述,将该篇申请的全部内容引用于此,以供参考。
如图3中举例说明的,用于挖掘高质量结构化的临床信息的示范性数据挖掘框架包括数据挖掘器350,该数据挖掘器使用知识库330中包含的特定领域知识、从CPR310中挖掘信息。所述数据挖掘器350包括用于从CPR中提取信息的部件352,随着时间以有原则的方式组合所有可用证据的部件354,以及根据此组合过程得出推理的部件356。可以将挖掘的信息存储在结构化的CPR380中。
所述提取部件352处理从涉及病人的每个数据源收集小块信息,将其表示为在特定时间有关病人的概率断言(probabilisticassertion)。将这些概率断言称作元素。组合部件354组合在相同时间周期中引用相同变量的所有元素,以形成一个与该变量有关的统一标准的概率断言。将这些统一的概率断言称作仿真陈述(factoid)。推理部件356在相同的和/或不同的时间点处理对这些仿真陈述的组合,以产生病人状态随时间进展的连贯且简洁的图片。病人状态的这种进展被称为状态序列。
再次参见图2,自动质量坚持系统200可以被配置为用于输出诸如提示之类的质量坚持信息。可以生成这些提示以便提醒医师依照临床方针采取临床动作。输出的质量坚持信息还可以包括没有被遵守所述临床方针的警告。
数据源202中包含的病人记录可以包括涉及在治疗病人期间采取的临床动作的信息。例如,病人记录可以包含涉及各种测试以及给病人开药方的规程的信息。
质量坚持引擎206可以被配置为通过比较临床动作与临床方针来监控对临床方针的坚持。由于临床动作信息可以是推理的产物,因此它本质上可以是概率随机的。由此,如果存在这些方针没有被遵循的可能性,那么可以生成这些警告。可以向每个临床动作指派概率值,并且如果没有遵循方针的概率超过预定阈值,那么发布警告。
质量坚持引擎206还可以通过确定下一个推荐的临床动作来监控对临床方针的坚持。可以输出用于下一个推荐的临床动作的提示,以便卫生保健人员能够更好地遵循建议。
例如,由鉴定卫生保健组织联合委员会(Joint Commission onAccreditation of Healthcare Organizations,JCAHO)公布的急性心肌梗塞(AMI)治疗方针提倡确定的AMI病人没有阿斯匹林禁忌症,以便在到达医院前后24小时内服用阿斯匹林。在这种情况下,质量坚持引擎206可以从数据源202中选择AMI病人的病人记录,并且生成提示,即应该给予确定的那些病人阿斯匹林。如果24个小时周期期满而没有向AMI病人提供阿斯匹林,那么代之以输出警告。
所述输出部件208可以输出这些提示以及警告,视情况而定,以及其他质量坚持信息。所述输出部件208可以被实现成经由印刷报告、计算机显示装置等等输出此信息。然而,依照各种实施例,可以将质量坚持信息整合到医师日历/进度表中。
参见图4,举例说明了描述用于自动确保在治疗病人的过程中对临床方针的坚持的示范性技术的流程图。从步骤402开始,从数据源获得病人记录。至少一些获得的病人记录可以包含从非结构化的信息中导出的治疗信息,诸如像医师注释、医疗图像以及波形信息之类的。优选的是,此信息驻留在结构化的数据储存库中,所述结构化的数据储存库使用挖掘的非结构化的病人信息加以填充,如Rao等人一并提出的序号为10/__,__(代理人编号为2001P20906US01)、题为“Patient Data Mining(病人数据挖掘)”的共同待审的美国专利申请所描述的。
在步骤404中,从临床方针知识库中检索临床方针。例如,可以将临床方针存储在数据库中,并且这些临床方针包含针对感兴趣的各种疾病的推荐的临床动作。这些临床方针可以包括由鉴定组织(诸如JCAHO)、政府机构和消费者卫生保健组织公布的推荐。此外,可以创建临床方针以供内部使用(例如由医院使用以便测量保健质量)。总的来说,临床方针可以包括推荐的临床动作的任何列表。
接下来,在步骤406中,监控对临床方针的坚持。这可能涉及确定当前病人诊断,并且将相对于病人所采取的临床动作与相关方针进行比较。如果没有遵守推荐的临床动作,可以向医师及其他医务人员生成警告。还可以确定推荐的、用于病人的下一个临床动作,并且可以生成提示。
在步骤408中,诸如提示和警告的质量坚持信息可以经由报告、计算机显示器输出,乃至可以被整合到日历或者进度系统中。
如图1-4所示,优选的是,使用通用计算机系统来实现本发明。然而本发明的系统和方法可以使用一个或多个编程的通用计算机、编程的微处理器或者微控制器以及外围集成电路元件、ASIC或者其他的集成电路、数字信号处理器、诸如分立元件电路的硬连接的电子或逻辑电路、诸如PLD、PLA、FPGA或者PAL之类的可编程逻辑器件等等的任何组合来实现。
虽然在此已经参照附图描述了本发明的例证性实施例,但是应该理解的是,本发明不局限于那些特定的实施例,在不脱离本发明的范围或者精神的情况下,本领域技术人员可以对其做出不同的其他改变和修改。
Claims (24)
1.一种用于自动地确保对临床方针的坚持的系统,包括:
一个包含病人记录的数据源,包括正被治疗的病人的记录;
一个包含临床方针的方针知识库;以及
一个质量坚持引擎,用于为正被治疗的病人监控对临床方针的坚持。
2.如权利要求1所述的系统,其中至少一些病人记录包括通过挖掘非结构化的病人数据获得的信息。
3.如权利要求1所述的系统,还包括用于输出质量坚持信息的输出部件。
4.如权利要求3所述的系统,其中输出的质量坚持信息包括提示。
5.如权利要求4所述的系统,其中所述提示包括用于依照临床方针采取临床动作的提示。
6.如权利要求3所述的系统,其中输出的质量坚持信息包括没有遵守临床方针的警告。
7.如权利要求3所述的系统,其中输出的质量坚持信息包括可能没有遵守临床方针的警告。
8.如权利要求1所述的系统,其中数据源中包含的病人记录包括涉及在治疗病人期间采取的临床动作的信息。
9.如权利要求8所述的系统,其中质量坚持引擎至少部分地通过比较临床动作与临床方针来监控对临床方针的坚持。
10.如权利要求9所述的系统,其中所述临床方针涉及推荐的临床动作。
11.如权利要求10所述的系统,其中质量坚持引擎至少部分地通过确定下一个推荐的临床动作来监控对临床方针的坚持。
12.如权利要求11所述的系统,其中质量坚持引擎至少部分地通过输出对下一个推荐的临床动作的提示来监控对临床方针的坚持。
13.一种用于在治疗病人的过程中自动地确保对临床方针的坚持的方法,包括以下步骤:
获取正被治疗的病人的病人记录,至少一些病人记录包含来自于挖掘的非结构化的数据源的信息;
从方针知识库中检索临床方针;以及
为正被治疗的病人监控对临床方针的坚持。
14.如权利要求13所述的方法,还包括输出质量坚持信息的步骤。
15.如权利要求14所述的方法,其中输出的质量坚持信息包括提示。
16.如权利要求15所述的方法,其中所述提示包括用于依照临床方针采取临床动作的提示。
17.如权利要求14所述的方法,其中输出的质量坚持信息包括没有遵守临床方针的警告。
18.如权利要求14所述的方法,其中输出的质量坚持信息包括可能没有遵守临床方针的警告。
19.如权利要求14所述的方法,其中所获取的病人记录包括在治疗病人期间采取的临床动作。
20.如权利要求19所述的方法,其中监控对临床方针的坚持包括比较临床动作与临床方针。
21.如权利要求20所述的方法,其中所述临床方针涉及推荐的临床动作。
22.如权利要求20所述的方法,其中监控对临床方针的坚持还包括确定下一个推荐的临床动作。
23.如权利要求22所述的方法,其中监控对临床方针的坚持还包括为下一个推荐的临床动作输出提示。
24.一种机器可读的程序存储设备,确实地包括一个指令程序,该指令程序可在该机器上执行以实施用于自动地确保对临床方针的坚持的方法步骤,所述方法步骤包括:
获取正被治疗的病人的病人记录,至少一些病人记录包含来自于挖掘的非结构化的数据源的信息;
从方针知识库中检索临床方针;以及
为正被治疗的病人监控对临床方针的坚持。
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Cited By (2)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
CN104205105A (zh) * | 2012-03-30 | 2014-12-10 | 皇家飞利浦有限公司 | 用于将计算机可解读指南引擎的状态与患者护理的状态同步的方法 |
CN104205105B (zh) * | 2012-03-30 | 2018-08-17 | 皇家飞利浦有限公司 | 用于将计算机可解读指南引擎的状态与患者护理的状态同步的方法 |
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