U.S. CareLink LLC is medical software R&D company which develops innovative applications to assist physicians and patients. The company’s initial focus has been on a state-of-the-art technology for creating individually customized, “intelligent” interviewing questionnaires for taking patient medical histories and capturing other outcome information from patients and families.
Problems with Medical History Software
In the vast majority of ambulatory care, the patient’s past medical history and current symptoms are fundamental to making the correct diagnostic and treatment decisions. Most current electronic health record systems (EHRs) have neither:
(i) a front-end application for efficiently capturing this information in an organized and codified form, nor
(ii) appropriate fields in their data repository for storage and retrieval of this codified information.
Without codified history and symptom data, the efficacy of automated clinical decision support rules may often be crippled by their absence and, in some cases, may lead to erroneous recommendations.
EHRs that contain appropriate history/symptom data fields, which can be completed by a physician, have not in general succeeded in operational practice since physicians often do not have the time to take a full history. And even when time is made available, the process of data entry often proves too time inefficient for routine use.
To overcome this hurdle, many individuals and organizations have developed tools for gathering history and symptom data directly from patients, or from their family members or proxies. Such tools generally work well for simple, single medical problems, such as a healthy young adult with a sore throat. When the patient has multiple co-morbid medical conditions and / or a complex presenting problem as a chief complaint, the performance of most history taking tools currently on the market have proven to be less than satisfactory for the physician and the patient. Yet, it is with these more ill and complex patients where the systematic capture and use of codified data is so important for improving clinical outcomes.
ixiHistory: The U.S. CareLink Internet Expert Interviewing System for Medical Histories
Based on in-depth experience and assessment of the problems encountered with prior medical history software, U.S. CareLink has built the ixiHistory system with two main components. This history interviewing system consists of an authoring system and deployment system designed to overcome many of the identified problems associated current history taking systems.
Key features of the design of the ixiHistory deployment system component, the ixiHistory Questionnaire System, include:
- The ability to dynamically produce a questionnaire customized to each individual or class of individuals based on both prior information gathered from or about the patient. Such information can be accessed in real time by the ixiHistory from other external clinical databases in addition to an ixiHistory questionnaire database. This information can include such data as the patient’s most recently prescribed medications and test results.
- The ability to use non-sequential logic rules, not just simple branching logic rules in order to select and ask appropriate questions. Thus, for example, if at an early point in the questionnaire a patient reports a hysterectomy as part of the surgical history section, this allows the gynecologic review of system section, much later sequentially in the questionnaire, not to try and ask questions about the patient’s menstrual cycle. Most branching logic questionnaire systems would fail this challenge.
- The ability to calculate or score results from multiple separate questions and then use this output as the basis for determining the selection in real time of additional questions.
- The ability to operate as either an independent history taking system or to operate seamlessly within a clinic’s or a health system’s patient portal and EHR framework.
- The ability for questionnaires to be completed before the patient visit, or the encounter, or in follow-up or as an on-going diary.
- The ability to have available questionnaire results as reports or as discrete data, either integrated with the health care provider’s EHR and clinical software or in a stand-alone manner.
The ixiHistory authoring system component, the ixiHistory Questionnaire Editor, is a sophisticated authoring environment which facilitates re-use of question components (e.g., questions, response sets, question groups), codes, question variants, etc. and provides for the assembly of both dynamic and fixed batteries of questions (called “question groups”). These question groups can be nested and/or combined to create larger question groups or full questionnaires. The ixiHistory Questionnaire Editor provides for rapid development, modification, customization and maintenance of questionnaires.
Why You Should Use ixiHistory
U.S. CareLink’s automated patient history system has multiple benefits, among which are:
· Enhanced Productivity of Your Clinicians
By shifting the burden of the input of medical history and symptom data to patients, minutes of valuable clinician time are saved for almost every encounter. Combined across a full day of patient visits, this saved time can represent hundreds of dollars per day in additional revenue production. Even when the patient cannot complete the questionnaire his or her self, clerical personnel can assist them and save valuable time. Completion from home permits a family member to enter information if the patient cannot do so directly.
· Improved Information for Decision Support
ixiHistory can take a more complete history than most physicians can afford to take in today’s pressured environments. It can enhance patient’s willingness to answer questions about psychosexual and behavioral issues that clinicians are often reluctant to ask and patient’s are reluctant to answer truthfully in a face-to-face setting. Yet these may be extremely important data for fully understanding the causes of a patient’s symptoms and the best approach to treatment.
· Improved Information for Meeting Meaningful Use, Regulatory & Reimbursement Guidelines
U.S. CareLink’s questionnaire system can assist clinicians in medication and problem list reconciliation For example by asking the patient such questions as: “are you still taking the following medications?: … ”, based on the current know patient’s medication list, and then documenting any reported changes for the physician. ixiHistory can ask and document any required questions, for example, about smoking habits and cessation treatment offers and use, ask depression screening questions, and insure that diagnostic specific history items for other regulatory and pay-for-performance criteria are met.
· Questionnaire Results immediately available
The ixiHistory results of a patient questionnaire are saved both as discrete data in an XML format and in a text report format. These are exported to the health care provider or may be viewed within the ixiHistory System. In either case, the results of the electronically based patient questionnaire are immediately available to the clinician.
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