|United States Patent
,   et al.
March 21, 2000
Therapeutic behavior modification program, compliance monitoring and
A therapeutic behavior modification program, compliance monitoring and
feedback system includes a server-based relational database and one or
more microprocessors electronically coupled to the server. The system
enables development of a therapeutic behavior modification program having
a series of milestones for an individual to achieve lifestyle changes
necessary to maintain his or her health or recover from ailments or
medical procedures. The program may be modified by a physician or trained
case advisor prior to implementation. The system monitors the individual's
compliance with the program by prompting the individual to enter
health-related data, correlating the individual's entered data with the
milestones in the behavior modification program and generating compliance
data indicative of the individual's progress toward achievement of the
program milestones. The system also includes an integrated system of
graphical system interfaces for motivating the individual to comply with
the program. Through the interfaces, the individual can access the
database to review the compliance data and obtain health information from
a remote source such as selected sites on the Internet. The system also
provides an electronic calendar integrated with the behavior modification
program for signaling the individual to take action pursuant to the
behavior modification program in which the calendar accesses the
relational database and integrates requirements of the program with the
individual's daily schedule, and an electronic journal for enabling the
individual to enter personal health-related information into the system on
a regular basis. In addition, the system includes an electronic meeting
room for linking the individual to a plurality of other individuals having
related behavior modification programs for facilitating group peer support
sessions for compliance with the program. The system enables motivational
media presentations to be made to the individuals in the electronic
meeting room as part of the group support session to facilitate
interactive group discussion about the presentations. The entire system is
designed around a community of support motif including a graphical
electronic navigator operable by the individual to control the
microprocessor for accessing different parts of the system.
Douglas; Peter (Montecito, CA);
Dudik; Evan (Vancouver, WA);
Evans; John (Pittstown, NJ);
Kritzer; Alan (Van Nuys, CA)
Salus Media Inc. (Sherman Oaks, CA)
October 31, 1997|
|Current U.S. Class:
||600/300; 128/921; 705/1 |
||A61B 003/00; G06F 015/00|
|Field of Search:
References Cited [Referenced By]
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Primary Examiner: O'Connor; Cary E.
Assistant Examiner: Winakur; Eric F.
Attorney, Agent or Firm: Christie, Parker & Hale, LLP
Parent Case Text
CROSS REFERENCE TO RELATED APPLICATIONS
This application claims the benefit of U.S. provisional patent application
numbers 60/029,862, filed Nov. 1, 1996, and 60/052,222, filed Jul. 11,
1997, the contents of both of which are hereby incorporated by reference.
1. A method for monitoring compliance with a therapeutic behavior
modification program, the method comprising the steps of:
providing a therapeutic behavior modification program having a series of
milestones for a patient;
inputting patient data at prescribed times;
correlating the patient's data using a microprocessor with the milestones
in the therapeutic behavior modification program to determine whether the
patient is complying with the program; and
grouping particular data using the microprocessor and linking the data to a
2. The method of claim 1 further comprising the step of using the
microprocessor to provide graphical screens for encouraging the patient to
comply with the therapeutic behavior modification program.
3. A therapeutic behavior modification program, compliance monitoring and
feedback system comprising:
means, comprising a relational database and a microprocessor coupled to the
database, for developing a therapeutic behavior modification program
having a series of milestones for an individual;
means for monitoring the individual's compliance with the program
means for prompting the individual to enter health-related data;
means for correlating the individual's entered data with the milestones in
the behavior modification program and generating compliance data
indicative of the individual's progress toward achievement of the program
means, accessible to the relational database and microprocessor, for
motivating the individual to comply with the program comprising an
integrated system of graphical system interfaces, the motivating means
means for enabling the individual to review the compliance data;
means for providing health information to the individual from a remote
an electronic calendar integrated with the behavior modification program
for signaling the individual to take action pursuant to the behavior
modification program wherein the calendar accesses the relational database
and integrates requirements of the program with the individual's daily
an electronic journal for enabling the individual to enter personal
an electronic meeting room for linking the individual to a plurality of
other individuals having related behavior modification programs for
facilitating group peer support sessions for compliance with the program;
means for providing motivational media presentations to the individual for
encouraging the individual to comply with the program; and
a graphical electronic navigator operable by the individual to control the
microprocessor for accessing different parts of the system.
4. The system of claim 3 wherein the means for developing the therapeutic
behavior modification program comprises:
means for inputting preliminary health information relating to the
means for presenting a plurality of suggested behavior modification
programs containing suggested milestones generated as a function of the
preliminary health information;
means for selecting one of the suggested behavior modification programs and
altering the milestones to generate the individual's behavior modification
means for loading the behavior modification program into the relational
5. The system of claim 3 further comprising means for providing the
motivational media presentations to the individuals in the electronic
meeting room as part of the group support sessions, thereby facilitating
interactive group discussion about the presentations.
6. The system of claim 3 further comprising means for enabling the
individual to select an avatar to represent himself or herself in the
electronic meeting room.
7. A method for assisting an individual to comply with a therapeutic
behavior modification program, the method comprising the steps of:
providing the therapeutic behavior modification program having a series of
milestones for the individual;
inputting health data relating to the individual at prescribed times;
correlating the individual's health data with the milestones in the
behavior modification program using a relational database and generating
compliance data indicative of whether the individual is complying with the
grouping particular compliance data using a microprocessor and linking the
data to a remote computer; and
motivating the individual to comply with the behavior modification program
providing medical information to the individual relating to the program;
presenting the individual with the compliance data to allow the individual
to personally monitor compliance with the program;
signaling the individual to take action according to the program through an
electronic interface integrated with the individual's daily schedule;
providing remotely accessible group support sessions and motivational media
directed toward encouraging the individual to achieve the program
enabling the individual to retrieve the medical information, compliance
data, and scheduling signals, and participate in the group support
sessions and view the motivational media through a graphical electronic
8. The method of claim 7 wherein the step of providing remotely accessible
group support sessions and motivational media comprises presenting the
motivational media during the group support sessions to facilitate
interactive group discussion about the presentations.
9. The method of claim 7 further comprising the step of selecting an avatar
to represent the individual during the group support sessions.
10. A method for assisting an individual to comply with a computer
implemented behavior modification program, the method comprising the steps
providing milestones in the behavior modification program to be achieved by
monitoring the individual's compliance with the program by:
obtaining health-related data of the individual at prescribed times;
comparing the health-related data with the milestones for generating
compliance data indicative of whether the individual is complying with the
program, and encouraging the individual to comply with the program if the
compliance data indicates lack of compliance; and
comparing the health-related data against accepted medical protocols and
alerting the individual's physician or case advisor when a health-risk is
educating the individual electronically on health topics germane to the
individual's condition and behavior modification program; and
motivating the individual to comply with the behavior modification program
providing group support for the individual by electronically linking the
individual to a plurality of other individuals having related behavior
providing a reward to the individual when certain of the milestones are
presenting the individual with the compliance data for enabling the
individual to personally monitor compliance with the program;
enabling the individual to enter comments germaine to the behavior
modification program in a computer-implemented journal; and
providing motivational multi-media presentations for encouraging the
individual to comply with the program.
11. The method of claim 10 wherein the step of obtaining the health-related
data comprises the user providing the data through a computer-implemented
12. The method of claim 11 wherein portions of the data in the journal are
accessible to a physician.
13. The method of claim 10 wherein the step of obtaining the health-related
data comprises a physician obtaining the data from office visits by the
individual to the physician.
14. The method of claim 10 wherein the step of educating comprises
providing recipes, stress management strategies, and nutritional, dieting,
and exercise information to the individual.
15. The method of claim 14 wherein ingredients appearing on the recipes are
downloaded automatically to an on-line shopping list.
16. The method of claim 10 wherein the group support is provided by a
computer-implemented meeting room wherein the individual and the plurality
of other individuals participate in on-line group meetings, the meetings
a chairperson for monitoring discussions and triggering multimedia
a means of representing the individual and the plurality of other
individuals in the group meetings.
17. The method of claim 16 wherein a computer-implemented schedule book
enables the individual to:
view a list of on-line group meetings;
sign-up for a particular group meeting from the list of group meetings; and
request automated reminders for reminding the individual of group meetings
for which the individual has signed-up.
18. The method of claim 16 wherein the meetings further comprise a means
for the individual for contacting the plurality of other individuals via
telephone directly from the computer-implemented meeting room.
19. The method of claim 10 wherein the group support is provided by a
computer-implemented mentoring area for mentoring and giving support to
the individual by other more experienced individuals.
20. The method of claim 19 wherein no more than a predetermined number of
the more experienced individuals may be present in the mentoring area at a
single time with the individual.
21. The method of claim 10 wherein the group support is provided through
electronic mail for facilitating communication with the physician, case
advisor, or the plurality of other individuals having related behavior
22. The method of claim 10 wherein the group support is provided through an
electronic bulletin board wherein the individual posts messages and read
messages posted by the other individuals having related behavior
23. The method of claim 10 wherein the reward is rewards points for being
redeemed for goods, frequent flier miles, or a symbolic reward commending
the individual for good work.
24. A therapeutic behavior modification program, compliance monitoring and
feedback system comprising:
means, comprising a relational database and a microprocessor coupled to the
database, for developing a therapeutic behavior modification program
having a series of milestones for an individual;
means for subscribing an individual to the behavior modification program;
means for monitoring the individual's compliance with the program
means for obtaining health-related data of the individual at prescribed
times for input into a relational database;
means for comparing the health-related data with the milestones in the
behavior modification program for generating compliance data indicative of
whether the individual is complying with the program, and encouraging the
individual to comply with the program if the compliance data indicates
lack of compliance; and
means for comparing the health-related data against accepted medical
protocols and alerting the individual's physician or case advisor when a
health-risk is present;
means for educating the individual electronically on health and medical
topics germane to the individual's condition and behavior modification
means, accessible to the relational database and microprocessor, for
motivating the individual to comply with the program including:
means for providing group support for the individual by electronically
linking the individual to a plurality of other individuals having related
behavior modification programs;
means for providing a reward to the individual when certain of the
milestones are reached;
means for presenting the individual with the compliance data for enabling
the individual to personally monitor compliance with the program;
means for enabling the individual to enter personal feelings and comments
germaine to the behavior modification program into a computer-implemented
means for providing motivational multi-media presentations for encouraging
the individual to comply with the program;
means for modifying the program based on the individual's progress; and
a graphical user interface for controlling the microprocessor for accessing
different parts of the system.
25. The system of claim 24 wherein the means for developing the therapeutic
behavior modification program comprises:
means for inputting preliminary health information relating to the
means for presenting a suggested behavior modification program containing
suggested milestones generated as a function of the preliminary health
information and accepted medical protocols;
means for modifying the suggested behavior modification program to generate
the individual's behavior modification program;
means for loading the behavior modification program into the relational
means for giving access to the individual to the graphical user interface
for controlling the microprocessor for accessing different parts of the
26. The system of claim 24 wherein the means for obtaining the
health-related data comprises means of prompting the individual to input
health-related information into a computer-implemented journal.
27. The system of claim 24 wherein the means of educating comprises means
for providing recipes, stress management strategies, and nutritional,
dieting, and exercise information to the individual.
28. The system of claim 27 wherein the means for providing recipes includes
means for downloading recipe ingredients to a computer-implemented
29. The system of claim 24 wherein the means for providing group support
comprises means for providing on-line group meetings comprising:
means for electronically viewing a list of group meetings available for
means for electronically registering for a particular group meeting;
means for sending automated reminders for reminding the individual about
the particular group meeting for which the individual is registered;
means for providing an electronic meeting room for the group meetings;
means for monitoring discussion during the group meetings; means for
triggering multi-media presentations during the group meetings;
means for electronically representing the individual and the plurality of
other individuals in the group meetings; and means for contacting the
plurality of other individuals via a telephone directly from the
computer-implemented meeting room.
30. The system of claim 24 wherein the means for providing group support
comprises a means for providing a computer-implemented mentoring area for
mentoring and giving support to the individual by other more experienced
31. The system of claim 24 wherein the means for providing group support
comprises electronic mail means for facilitating communication with the
plurality of other individuals.
32. The system of claim 24 wherein the means for providing group support
comprises electronic bulletin board means for posting messages and reading
messages posted by the other individuals having related behavior
33. The system of claim 24 further comprising a means for providing
security from unauthorized access to the system.
34. The system of claim 24 further comprising a means for health plan
payors for monitoring usage of the system.
FIELD OF THE INVENTION
The present invention relates generally to a computer-implemented system
for promoting wellness and improving health, and more particularly to a
therapeutic behavior modification program, compliance monitoring and
BACKGROUND OF THE INVENTION
One of the most difficult and costly areas of health care, education, and
rehabilitation involves the need for individuals to modify their behavior
to prevent or recover from medical ailments. Heart disease, stroke,
diabetes, asthma, chronic pain, depression, addiction, cancer and a wide
variety of other ailments have been clinically shown to respond well to
lifestyle modification, including changes to diet, exercise patterns, and
stress levels. Patients who are recovering from a surgical procedure such
as heart bypass surgery or are suffering from diabetes, for example, must
often make lifestyle changes in order to survive.
When individuals are successful in making and adhering to positive
lifestyle changes, they frequently require fewer physician visits, go to
the hospital less often, and have fewer surgeries. Long term medical costs
go down accordingly.
At present, many programs for helping patients make lifestyle changes
involve a doctor's visit and distribution of a brochure describing the
health benefits of behavior modification and lifestyle change. This method
is often ineffective in modifying behavior because there is little or
nothing in the way of an on-going support mechanism to assist the patient
in complying with recommendations, insufficient means for motivating the
patient to make recommended changes, and insufficient means for monitoring
compliance with such recommendations. Participation in an on-going support
program is often effective for patients who have undergone surgery and
must make subsequent lifestyle changes, but currently available in-person
programs involve costly medical staff and facilities. It can also be
inconvenient for the patient to travel to such programs on a regular
basis. Because of their cost and the potential for inconvenience, many
support programs last for only a limited time, which is often insufficient
for the patient to modify behavior thoroughly and effectively.
Another disadvantage of existing lifestyle modification programs is the
lack of information readily available to the physician regarding the
patient's compliance with the program. With the present push toward low
cost yet high quality health care, a system by which a physician could
readily access information on patient compliance has clear benefits.
The development of a therapeutic program that could effectively motivate
patients to modify their behavior and change their lifestyles to prevent
or recover from ailments, and could be delivered to them electronically at
home, work, or while traveling, would be highly desirable. It would also
be desirable for such a system to enable physicians and their staffs to
receive frequent feedback regarding patients' compliance with their
programs. It would be further desirable if such a system allowed for
aggregate reviews of such information by health plan payors, such as HMOs,
insurance companies, and large self-insured employers, for the purpose of
enhancing the efficiency of managed health care.
SUMMARY OF THE INVENTION
The present invention therefore provides for an integrated,
computer-implemented, electronically deliverable patient therapeutic
behavior modification program, compliance, monitoring, and feedback system
which supports the design of customized therapeutic behavior and lifestyle
modification programs for subscribers; accepts the input of current health
data for these patients; enables the review of these health records by a
physician; enables the performance of aggregate reviews of such records by
health plan payors, such as HMOs, insurance companies, and large
self-insured employers; and motivates the patient to comply with the
program and make the necessary lifestyle changes through an integrated
system of interactive graphical interfaces.
In an exemplary scenario, a physician prescribes parameters and goals for a
such a therapeutic behavior modification program to help a patient recover
from an ailment or surgical procedure, and these are input into the
computer-implemented system. Alternately, one of several established
behavior modification programs that have been designed for patient
recovery from particular ailments or procedures can be utilized. The
system provides a novel interface that allows immediate patient access to
the behavior modification program and helps monitor compliance with the
program by prompting the patient to input data relating to his or her
adherence to the program's parameters. These parameters may relate, for
example, to diet, exercise, and other factors pertinent to the behavior
modification program. The patient, physician, case manager or members of
the physician's staff may also input information relating to blood
pressure, medication, and the results of other medical tests on a computer
linked to the system. Using this input, the system can recommend a plan
(also referred to as a therapeutic program) and goals based on established
medical protocols. The physician can modify the program to customize it
for the patient. Once the patient has begun to follow the program, the
system recommends modifications and updates to both physician and patient
by correlating the patient's progress with previously established goals.
The system provides ongoing multimedia (audio, video, and e-mail) feedback
to the patient through a novel, user-friendly interface designed around an
interactive "village" or "community of support" motif that allows him or
her to navigate electronically through different parts of the system. The
interface provides access to pertinent medical information, an on-line
journal that enables the patient to write down his or her feelings on a
regular basis, an electronic calendar which integrates events mandated by
the program with the patient's daily schedule, on-line interactive group
support sessions with patients on similar programs, and motivational
multimedia presentations. The system can make specific diet and exercise
suggestions based on the patient's overall program. This data is monitored
by a professional case advisor--a nurse trained in the protocols of the
system's software--as well as electronically by the system's protocols
themselves. The system provides specific feedback to the physician so that
he or she can modify or update the program as the patient progresses; and
in the aggregate to the health plan payor to assess management and cost
factors. The health plan payor can also view individual records which are
obtainable after receiving the proper medical release from the patient. By
providing several channels of continuous feedback among the patient,
physician, professional case advisor, and health plan payor through custom
designed interfaces, the system helps enhance patient compliance with the
behavior modification program, and can help make the overall health care
system more efficient.
BRIEF DESCRIPTION OF THE DRAWINGS
These and other aspects of the present invention will become more apparent
from the following Detailed Description of a presently preferred
embodiment of the present invention read in conjunction with the
accompanying drawings and exhibits, in which:
FIG. 1 is a block diagram illustrating how feedback and monitoring is used
in the current embodiment of the therapeutic behavior modification
program's compliance monitoring and feedback system
FIG. 2 is an exemplary prescription form for inputting a patient's baseline
FIG. 3 is a graphical representation of a set of files for patients for
whom recovery programs may be designed or modified;
FIG. 4 is a graphical representation of an exemplary patient file taken
from among those represented in FIG. 3;
FIG. 5 is a graphical representation corresponding to the program Design
option of FIG. 4;
FIG. 6 is a graphical representation corresponding to the Program Detail
option of FIG. 5;
FIG. 7 is an exemplary patient progress report;
FIG. 8 is a graphical representation of various interface tools, organized
around a village motif, available to a clinical group patient;
FIG. 9 is a graphical representation of the system's Inner Core option;
FIG. 10 is a graphical representation of the system's Schedule Book option;
FIG. 11 is an expanded graphical representation of the Schedule Book;
FIG. 12 is a graphical representation of the system's Journal option;
FIG. 13 is an expanded graphical representation of the Journal;
FIG. 14 is a graphical representation of the system's Meeting Room option;
FIG. 15 is a graphical representation of the system's Coffee Shop option;
FIG. 16 is a graphical representation of the system's Post-office option;
FIG. 17 is a graphical representation of the system's Note option;
FIG. 18 is a graphical representation of the system's Postcard option;
FIG. 19 is a graphical representation of the system's Telegram option;
FIG. 20 is a graphical representation of the system's Audio E-mail option;
FIG. 21 is a graphical representation of the system's Kitchen option;
FIG. 22 is an expanded graphical representation of the Kitchen option;
FIG. 23 is a graphical representation of the system's Recipes option;
FIG. 24 is an expanded graphical representation of a Shopping List option;
FIG. 25 is an expanded graphical representation of an educational topic
available through a pull-down menu in FIG. 22;
FIG. 26 is a graphical representation of the system's Gym option;
FIG. 27 is a graphical representation of a Stretching option of FIG. 26;
FIG. 28 is a graphical representation of a Strength Training option of FIG.
FIG. 29 is a graphical representation of the system's Tranquility Park
FIG. 30 is a graphical representation of the system's Relaxation option;
FIG. 31 is a graphical representation of the system's Yoga option;
FIG. 32 is a graphical representation of the system's Library option;
FIG. 33 is a graphical representation of the system's Articles option;
FIG. 34 is a graphical representation of a World Wide Web access option;
FIG. 35 is a graphical representation of an educational topic available
through a pull down menu in FIG. 32;
FIG. 36 is a graphical representation of the system's Travel Agency option;
FIG. 37 is an alternative user interface screen provided by the system;
FIG. 38 is a graphical representation of a log-on screen for a physician or
case manager in accordance with another aspect of the present invention;
FIG. 39 is a graphical representation of a main menu available to a
physician or case manager;
FIG. 40 is a graphical representation of an exemplary patient file;
FIG. 41 is a graphical representation of a blood pressure chart for an
FIG. 42 is a graphical representation of a physical activity chart for an
FIG. 43 is a graphical representation of a weight chart for an exemplary
FIG. 44 is a graphical representation of a cholesterol chart for an
FIG. 45 is a graphical representation of the system's Behavior option;
FIG. 46 is a graphical representation of the system's Recommend option;
FIG. 47 is an expanded graphical representation of the system's Communicate
FIG. 48 is a graphical representation of the system's Video Conferencing
FIG. 49 is a graphical representation of a main menu available to a health
plan payor or employer;
FIG. 50 is a graphical representation of a View Compliance Status option;
FIG. 51 is a graphical representation of a View Comparative Costs option;
FIG. 52 is a graphical representation through which the system indicates
whether the patient has executed a limited waiver of confidentiality;
FIG. 53 is another graphical representation of an exemplary patient record;
FIG. 54 is a graphical representation of the system's Review Costs option;
FIG. 55 is a graphical representation of the system's Review Outcomes
FIG. 56 is a graphical representation of the system's Perform Utilization
FIG. 57 is a graphical representation upon selection of an exemplary
physician group of FIG. 55;
FIG. 58 is an expanded graphical representation of a Communicate option of
FIG. 59 is a block diagram of the therapeutic behavior modification
program's compliance monitoring and feedback system; and
FIG. 60 is a flow diagram illustrating certain aspects of the therapeutic
behavior modification program's compliance monitoring and feedback system.
To facilitate description of the present invention, reference is made in
numerous instances to the flow diagram of FIG. 60. For convenience, the
blocks in the flow diagram are numbered beginning at 1000.
DETAILED DESCRIPTION OF THE INVENTION
Referring to FIG. 1, in a presently preferred embodiment of the invention,
the patient 10, physician 12, case advisor 14, and health plan payor 16
(such as an HMO, insurance company or self-insured employer), all provide
input to and/or receive output from the therapeutic behavior modification
program's compliance monitoring and feedback system. The case advisor may
be a doctor, nurse, and/or other trained medical professional experienced
in case management protocols and practices. Patients electronically
interact with the system, the case advisor and their doctor through the
system interface 18. The behavior modification program is customized to
fit the health care and recovery needs of individual patients. The system
provides at least two separate benefits: it helps the patient comply with
the program through an electronically-implemented support mechanism; and
further assists in monitoring such compliance.
A wide range of individuals can benefit from the system. By way of example
only, these individuals include those with chronic ailments such as
coronary artery disease, diabetes, chronic pain, depression, addiction,
arthritis, cancer and asthma, as well as patients who are recovering from
medical procedures such as angioplasty or by-pass surgery (the "clinical
Individuals who simply want to maintain their health and prevent or reduce
the risk of such ailments (the "wellness group") can also benefit from the
program. For these individuals, the program may be focused on stress
management, diet, and exercise. The wellness group may further include
family members of the clinical group who may need group support and/or
counseling in dealing with the family member's chronic illness.
The members of the wellness group may not need all the features available
to members of the clinical group. Furthermore, access to certain areas
within the system may be limited and/or customized to meet the individual
user's needs. However, wellness group members may choose to use the case
management functions as a "virtual coach." For example, an individual may
want to have a case advisor assist them in losing weight by helping the
individual change his or her nutrition, exercise and stress management
habits. The "virtual coach" or case advisor, can provide ongoing feedback
and encouragement throughout the process. Wellness participants may also
choose to join an on-line support group to help them achieve their health
and wellness goals.
In an exemplary scenario, a physician diagnoses an individual with an
ailment. The physician may then recommend a health care maintenance or
recovery program which requires the patient to: take certain medications;
participate in a support group; and control risk factors by altering his
or her diet, following an exercise program, and managing stress levels.
The physician can then place the patient on the system to help him or her
make these desirable or necessary lifestyle and behavior modifications. In
order to subscribe the patient to the system, his or her baseline vital
factors are entered. Such factors may include blood pressure readings,
heart rate, height, weight, and cholesterol levels. Depending on whether
the doctor is on-line (block 1000, FIG. 60), The doctor may input these
vital factors into the system directly via his or her personal computer
(block 1002, FIG. 60). Alternatively, the physician may fill out a
prescription form and send the information to a case advisor, who then
sets the patient up on the system (blocks 1004, 1006 and 1008, FIG. 60).
Referring to FIG. 2, an exemplary prescription form 22 contains
identification information 23 such as the patient's name and
identification. Using the form, the physician selects a diagnostic
category 24 and prescribes a recovery program level 26. In the exemplary
embodiment, eight separate diagnostic categories exist that correspond to
the state of the patient's health. Category I, for example, includes
patients who have suffered from a heart attack within the current year,
while Category VIII includes patients who suffer from no particular
ailment but are on the plan simply to promote wellness. Other categories
may also be added as necessary.
Depending on the diagnosis, the physician may recommend that the patient
cease smoking or that he or she lose a targeted amount of weight within a
certain period by circling the appropriate response in field 30. The
physician may also enter other information, such as the patient's
medications 32. The physician then circles or fills in desired 3-month
targets 34 relating to, among other things, daily calorie intake, percent
daily intake of saturated fat, maximum heart rate, and cholesterol level.
Referring to FIG. 3, the case administrator sets up a new patient based on
information contained in the patient prescription form or accesses the
records of existing patients through patient files 40. In this example,
the patient files 40 are identified by the patient's name and social
security number. To create or modify the program for a particular patient,
the administrator creates a new folder or selects a preexisting folder 42
corresponding to the patient in question.
Once the physician or case administrator enters the patient into the
system, either the system or case advisor recommends a default set of
goals based on the patient's needs and existing medical protocols that may
be modified by the physician (blocks 1010 and 1012, FIG. 60). FIG. 4
illustrates an exemplary patient record after selection of the desired
patient file 42 in FIG. 3. The record includes, among other things, the
patient's current status and program goals. The first column 44 of the
record sets forth fields for pertinent patient information including the
patient's vital signs (e.g., weight, cholesterol level, blood pressure),
other baseline characteristics (e.g., patient's smoking habit, physical
activity, alcohol and eating habits, depression and stress levels, seat
belt use), and information relating to any medications used by the
patient. The second column 46 of the record sets forth the baseline values
corresponding to the vital signs and patient characteristics at the
beginning of his or her participation in the program. As shown in the
third column 48, the record may be updated on an ongoing basis by taking
data from the patient on-line and from subsequent office visits. Based on
the patient's initial evaluation and/or short-term progress, the physician
or case advisor can design a new program or modify an existing program for
the patient by selecting the system's Design option 50.
Referring to FIG. 5, upon selection of the Design option 50 in FIG. 4, the
system prompts the physician or case advisor to assign intensity levels 51
corresponding to the patient's diet, exercise, stress management, need for
group support, anticipated compliance, and pharmaceutical requirements.
The intensity levels in this example range from a lowest level of 1 to a
highest level of 5. Other measures of program intensity may also be
Based on the input information, the system, case advisor or physician
generates a set of goals 52 or milestones for the patient. This is done by
correlating patient information such as age, sex, weight and information
relating to the health, life situation and diagnostic category of the
patient to established medical protocols for that type of patient. Other
pertinent information that may be taken into account includes the
patient's medication and other health conditions. Based on the
correlation, the system suggests a therapeutic program including goals
relating to intake of calories from fat, exercise level, stress management
counseling, and group support and compliance management frequency. The
physician or case advisor may view details as to how the suggested goals
may be implemented by selecting the system's Program Detail option 54.
Referring to FIG. 6, upon selection of the Program Detail option 54, the
patient record 60 is presented along with the recommended one month goals
61 and final goals 62. The physician or case advisor may confirm 63 or
edit 64 the suggested program to modify the goals by making appropriate
selections (block 1012, FIG. 60).
The content of the patient records and the generated goals vary depending
on the patient's diagnostic category. For example, some of the information
shown on the patient record may not be necessary for an individual
belonging to the wellness group. Information regarding calories,
cholesterol level, blood pressure, and seat belt use, for instance, may
not pertain to a person who is on the system to get support to help deal
with a family member who suffers from a chronic ailment.
Referring to FIG. 7, the system also sends an exemplary patient status
report 70 to physicians who do not have direct access to the system. The
status report may include information regarding a patient's current status
66, suggested next steps 67, and target goals 68. Other information may
also be included in the status report as desired by the physician. The
physician has the option to agree with the suggested next steps 69 or
indicate changes to the program. The physician then sends the report 70
back to the case advisor for modification of the program as necessary.
Communication may take place via e-mail, facsimile, or any other method of
Once the patient is set up on the system, it assists him or her in
complying with his or her behavior modification program (block 1020, FIG.
60). To use the program, the patient logs into the system network via
telephone line, cable modem, cellular connection, satellite link or other
communication method that allows for a connection into a network server.
Referring to FIG. 8, in a presently preferred embodiment of the invention,
the user interface for patients in the clinical and wellness groups is
organized around a village motif. The user progresses through the system
by following paths through a graphically represented town square to
destinations including the village gymnasium 71, tranquility park 72, post
office 74, coffee shop 76, store 78, library 80, travel agency 82, as well
as the user's own "home" 84. The village motif presents the patient with
an image of a community of support. The entire on-line community revolves
around his or her recovery and well-being, and this helps bolster the
patient's confidence and motivation. Furthermore, the village motif
provides an easy-to-understand representation of the system's structure.
The patient learns to navigate the system more quickly and easily because
of the intuitive town layout.
Another benefit of the village motif is its familiarity. A patient afraid
of technology will be reassured through the symbolic images of home and
neighbor, street and store. Finally, the patient may find navigating an
electronic "neighborhood" more enjoyable than a traditional
text-menu-driven system. Other user interfaces, such as the one described
in conjunction with FIG. 37, are available.
Referring to FIG. 9, the inner core 86 of the village provides the user
with a schedule book icon 90, a journal icon 94, a meeting room icon 96, a
mail icon 98, and a rewards icon 92. These give the user access to
additional tools that assist with complying with his or her health
program, and further help the physician or case advisor monitor such
Referring to FIG. 10, upon selection the schedule book icon 90 from the
interface of FIG. 9, the system displays a graphical representation of a
schedule book 90A. As shown in FIG. 11, the schedule book presents the
user with a list of meetings that the user can participate in via his or
her computer. The list of meetings varies for each user depending on his
or her specific health recovery program. The schedule book also presents
general information on the meetings, including time 100, date (not shown),
and meeting profile 104, with a notation of how may people have signed up
for the meeting 106. The system also sets a limit on the maximum number of
individuals that may sign up for a meeting.
Based on this information, a user may then sign up for the meeting that
best fits his or her schedule. Other factors, such as the city in which
the other members are located 108 may also influence the user's choice. A
user may decide to join a group whose members are located in his or her
home city if he or she wants to meet these people face-to-face someday.
The system integrates the user's schedule book 90A with the user's personal
electronic daily calendar. For example, after a patient signs up for a
meeting, the system downloads the day and time of the meeting to the
user's calendar. The calendar may be any suitable commercial calendar or
organizer program, such as Organizer.TM. available from Lotus Development
In an alternate embodiment, the user may make a further request via the
schedule book for automated reminders to sent to him or her by e-mail.
Referring again to FIG. 9, the system also enables the user to access an
integrated patient journal 94 from the village's inner core and
self-report their progress and describe their feelings. Selection of a
journal icon leads the user to a journal 94A like one shown in FIG. 12.
Upon entering the journal 94A, the user has the option to view the
personal goals that have been set for him or her by the physician or case
administrator. The journal also provides a diary used to make a daily
record of information pertinent to accomplishing the user's goals. The
journal 94A provides an important tool that lets the patient express his
or her feelings and fears in a context other than that of a support group.
By journaling, the patient can identify fears concretely, and thus begin
to address them. Goal setting is also often more meaningful when it is
written down. Instead of merely thinking about ambiguous hopes, patients
can define in written form the concrete milestones they plan to attain.
These notes can also help remind the patient of matters he or she might
wish to discuss in support group meetings. The system also uses certain
notations in the journal to assist in generating reports to the physician
or case advisor regarding the patient's progress. As part of its overall
security measures, the system separates those journal entries which the
patient wishes to keep private from those which are to be used in
FIG. 13 exemplifies the type of information which may be contained in the
journal. For instance, a heart patient belonging to a clinical group may
need to monitor his or her emotions 100 as well as the exercises he or she
has been doing 104 by means of the journal. Depending on the patient's
program, the system might also prompt the patient to input his or her
vital signs 102, such as blood pressure and heart rate, in the journal.
This can be done manually or automatically. For example, devices can be
hooked into the computer's serial port for automatic input of blood
pressure and heart rate into the system. Depending on the particular
program, patients might be required to weigh themselves on a weekly basis
and/or measure their cholesterol level with a home cholesterol kit on a
relatively less frequent basis. This information is stored in the system's
database and is accessible to the physician and case advisor.
The kind of information required of a person in the wellness group may
differ from this. For example, if a user is in the wellness group because
a family member is suffering from a chronic illness, it will not be
necessary for him or her to input vital signs into the journal. Rather,
information as to how he or she is doing emotionally, as well as
information as to how much group support he or she is getting, may be
The user may also record his or her personal comments in the journal. This
information may only be viewed by the individual user, and is not
available to the case advisor or physician.
The journal is also integrated with the user's daily calendar. The user
may, for example, input information as to his or her exercise schedule
(such as 30 minutes walking on Tuesdays, Thursdays, and Saturdays) or
meditation schedule into the journal. The system then downloads this
information into the user's daily calendar. Previous journal entries may
also be viewed.
In addition to allowing the patient to electronically enter his or her
updated health information, the journal also provides the physician or
case advisor with a means of getting feedback on the patient's progress.
The information recorded in the journal is electronically forwarded to the
case advisor. Alternatively, the case advisor has direct access to
portions of the journal stored in the system's database. The physician or
case advisor can use the information provided in the journal to update the
program on an on-going basis.
The system also accepts additional patient data obtained during office
visits or directly from the patient via e-mail or other means of
communication. The physician may also input additional data, such as that
derived from laboratory tests, into the system. Accordingly, the system
accepts updated patient data directly from the patient and through data
entered by the physician during office visits (blocks 1030, 1032 and 1034,
The system automatically correlates the patient's input with the
physician's to check for accuracy. In addition, the system automatically
provides the physician with reports of patient progress. Depending on the
patient's plan requirements, the case advisor periodically reviews the
patient-reported and physician-reported input to monitor whether the
patient is complying with program parameters and meeting goals (block
1036, FIG. 60).
As part of the feedback process, the system provides an "alarm" option
(block 1040, FIG. 60). The system compares actual data about the patient
with the goals and parameters residing in the system's database and
automatically notifies the physician or case advisor via e-mail or
facsimile (or pager depending upon the severity of the problem), if a
health risk is present (block 1042, FIG. 60). For instance, if a patient's
current blood pressure is potentially dangerous, the system will
automatically send an alarm to the physician or case advisor and require
his or her immediate action.
If the difference between current data and goals does not present a
threatening situation, the system will simply notify the physician or case
advisor that these goals are not being met. For example, if the current
data states that the patient has lost 5 pounds instead of 10, the system
will notify the physician or case advisor of this fact. This information,
although not life-threatening, must nonetheless be addressed by the
physician or case advisor. He or she may then contact the patient in order
to support and to further motivate him or her to meet the desired goals
(block 1044, FIG. 60). In addition, the physician or case advisor may
recommend that the program be modified to suit the patient's condition
(block 1046, FIG. 60).
Regardless of whether an alarm condition exists, the system periodically
correlates the updated patient health information with the program goals
to determine the patient's progress and compliance with the program (block
1050). If the patient is progressing in accordance with his or her
program, the system informs the physician and/or case advisor (block 1052,
FIG. 60). The physician or case advisor may then provide positive
reinforcement to the patient. Depending on the patient's progress, the
case advisor or physician can also determine whether to modify the program
by altering the goals or moving the patient into a different diagnostic
category. The patient may even be removed from the system if he or she has
met program end goals (blocks 1054, 1056, FIG. 60).
The system also notifies the physician or case advisor if the patient is
not progressing toward program goals or is not using the system (block
1060, FIG. 60). The case advisor along with the physician then determines
whether to modify the patient's therapeutic program, provide the patient
with additional support, or remove the patient from the system (blocks
1064, 1066 and 1068, FIG. 60).
The system also enables direct feedback to the individual user. As one of
the features of the journal, users may view their levels of compliance and
achievement of goals. Patients may not recognize they are making progress
until presented with reminders of how much they have improved. System
generated charts and summaries, discussed below with respect to FIGS. 41
to 44, provide patients with an overview of how far they have come.
Referring again to FIG. 9, as another tool to assist patients to comply
with their programs, the system offers an electronic meeting room and
group support room interfaces via meeting room icon 96 through which a
patient receives on-going, on-line group support. Putting a patient in
contact with people with the same or similar problems through group
counseling has clinically-proven therapeutic benefits. The system
facilitates this process through the use of electronic and on-line
technologies. On-line group counseling solves many of the logistical
difficulties encountered in bringing together, on a regular basis, a large
group of people with different schedules who live in different places.
Instead of requiring patients to travel physically to a single location,
the system enables them to attend group meetings by simply logging on to
their computers. As the burden on the individual patient decreases, group
attendance increases, and this enhances the overall practical, therapeutic
value of group counseling and support.
On-line counseling also brings a patient into contact with a wider pool of
people with similar problems than traditional counseling can. When
desirable or necessary, group membership can be drawn from people in a
wide variety of regions, instead of being limited to a single vicinity.
Furthermore, the relative anonymity of electronic communication benefits
patients who are reserved or possibly embarrassed by their situations.
These patients may be more willing to share their feelings in an on-line
environment than they would be face-to-face.
Patients have access to the meeting room interface via a meeting room icon
96. Upon selection of the meeting room icon 96, patients are presented
with meeting rules and regulations. They may then proceed to a
pre-scheduled meeting. Only those scheduled for a meeting will be
permitted to attend. The scheduling of meetings is part of the schedule
book interface explained above in conjunction with FIGS. 10 and 11.
Referring to FIG. 14, each participant 112 may chose to represent him or
herself in one of two different ways in the meeting room. The participant
112 may have his or her photo scanned to represent him or her in the
system. Alternatively, if anonymity is desired, the patient may choose to
be represented by a non-photographic icon, or "avatar," accompanied by
either his or her own name or a pseudonymous screen name. The patient will
then be represented by that avatar in group meetings and private mentoring
sessions. In some cases, patients may choose to design and construct their
A trained, experienced leader or chairperson 114 is an important part of
these group counseling sessions. It is the chairperson's responsibility to
guide the discussion and encourage participation from all members. To
enhance the beneficial aspects of group counseling, the system allows the
chairperson 114 to access selectively certain parts of the patient's
on-line journals and electronically display the selected portion in an
anonymous manner to the on-line group. The chairperson can also cut
somebody off electronically if he or she is saying things that are
In the preferred embodiment, a participant 112 "speaks" during the meeting
by entering text at 122. Upon hitting the enter key, this text appears as
"bubble-talk" 116 above the representation of the participant 112 who
entered the corresponding text. In an alternate embodiment, instead of
using a "bubble-talk" format, each participant 112 may participate at the
meetings by talking into a microphone connected to his or her PC, and
listening to other participants via speakers also connected to the PC.
A log window 110 keeps a running or scrolling record of the conversations
during the meeting. Thus, if a participant 112 loses track of the
conversation, or wants to comment on something said earlier, he or she has
access to the entire conversation as reference.
During group counseling meetings, a chairperson 114 may play on-line
multimedia presentations featuring other patients or well-known figures
who have made positive lifestyle changes. In the presently preferred
embodiment, each participant has access to the multimedia presentation,
such as a video clip, via CD-ROM or DVD received by mail on a regularly
updated basis. Alternatively, if the user has access to the appropriate
software and hardware, and has a connection of sufficient bandwidth to the
server, the multimedia presentation may be streamed to him or her over the
network. In addition to CD-ROM, the system can also use DVD disk,
downloads to the user's computer hard drive, or any other method or medium
capable of storing or transmitting audio and video data.
When it is time to view the multimedia presentation, the chairperson
selects, for instance, a particular video clip from a menu of video clips
available on his or her CD-ROM or DVD. This sends a signal via the network
to each participant's PC. The signal received matches a code on each
participant's CD-ROM or DVD, which triggers the playing of the selected
video by the PC. If the video is stored on DVD disk or on the user's
computer hard drive, or some other storage medium, the video could be
triggered to play from that medium as well.
The participants may not play the video prior to the meeting because only
the chairperson has access to the code which releases the video. Thus,
prior to a meeting, users may view a list of videos in his or her CD-ROM,
DVD disk, hard drive, or other storage medium, but videos which have not
been shown already at meetings will be inaccessible for viewing. Once a
video is released by a chairperson and played for the first time at a
meeting, the participants may access it any time thereafter.
The case administrator or advisor knows in advance who the chairperson for
a meeting will be and will give him or her access to the video clip to be
shown at that meeting.
The multimedia presentations shown at the meetings may feature well-known
or public figures and other patients who may have dealt with the same
issues that the participants are facing. For example, in a meeting for
patients who have suffered heart attacks, a video clip of a celebrity who
recovered from a similar problem may be shown. In the clip, the celebrity
would talk about his or her own heart attack, the bypass surgery that he
or she underwent, and the depression that followed. The celebrity would
also describe other struggles that he or she faced, and how these
struggles were overcome during the recovery process. Likewise, video clips
of program participants may also be used to provide motivational examples
of success stories, or to express deep-felt emotions (e.g., anger,
depression, etc.) that must be dealt with by that individual and other
members of the group in order to be successful in his or her recovery.
Such presentations may act as a source of motivation to the participants,
giving them a sense of hope. If someone else was able to overcome the same
obstacles, they can too.
The presentations may stimulate further discussion during the meeting, and
allow participants to open up about the issues and struggles that they are
facing during their recovery process.
Another function provided by the meeting room 96A interface is electronic
telephone dialing. Each participant has a phone icon 118 in front of his
or her avatar. If a participant wants to talk to any other person in the
meeting, he or she may click on the phone icon and the telephone number to
that person is dialed automatically. This allows the members to contact
each other after meetings to talk further via regular phone lines if
The conference room participants also have direct access to a more private
mentoring area by clicking on a coffee shop icon 76B. Users of the system
may also gain access to this private mentoring area by selecting the
coffee shop 76 from the village as shown in FIG. 8.
FIG. 15 is an exemplary illustration of the inside of the coffee shop 76B.
Conversation here occurs much like in the meeting room 96A, except for the
fact that the conversation is not monitored and structured by a
chairperson. Text is inputted at 132 and appears as bubble talk at 134. A
record of the conversation is also kept at the log window 130.
In the preferred embodiment, the system allows a maximum of four people
into a single coffee shop at a time. Such a restriction is desirable given
that the purpose of the coffee shop is for one-on-one mentoring. In the
private setting of a coffee shop, more experienced individuals can pass on
their experiences to less experienced ones as well as advice as to how to
overcome the obstacles that they may be facing.
The group support room 96A and coffee shop 76B applications are implemented
by means of third-party chat room applications such as Palace,
commercially available from The Palace, Inc., Beaverton, Oreg. The chat
room applications may be integrated into the system and modified to
provide additional functionality. Triggering of multimedia presentations
during group meetings and the monitoring of attendance are separately
programmed into the system.
Through on-line group meetings and private mentoring rooms, the system
allows patients to maintain contact with other people who have the same or
similar problems, all in entertaining ways that encourage and assist the
patient to adhere to program parameters and achieve program goals.
The communications feature of the system further allows users to keep in
constant contact with their physician, case advisor, or other users of the
system. Although in the presently preferred embodiment of the invention
communication is done via e-mail, other methods of communication may also
be used. For instance, it is envisioned that the system will allow instant
messaging, conference calls, and/or video conferencing as alternate means
Referring again to FIG. 9, the mail icon 98 gives a user access to the
e-mail feature. A user may also access his or her e-mail by selecting the
village post office 74 shown in FIG. 8.
Referring to FIG. 16, the system includes four different types of e-mail
options: letters 140, postcards 142, telegrams 144, and audio e-mail 146.
FIG. 17 is an example of a letter 140A, which functions as standard e-mail.
FIG. 18 is an example of a postcard 142B, which may be used to send short
notes. For instance, postcards may be sent to users to survey the level of
satisfaction with the service provided by the system. The postcard would
contain questions on this issue, and users would be asked to send the
postcard back after having answered the questions.
FIG. 19 is an example of a telegram 144A, which has the highest priority
among the types of e-mail provided by the system. The telegram may be
used, for instance, to alert a user that he or she has missed a meeting,
or just as a short note of encouragement by the case advisor or group
leader to an individual user.
FIG. 20 is an example of an audio e-mail 146A notification. Upon clicking
this icon, users can hear a recording of the message sent to them via
speakers attached to their PCs.
The communications functionality may be implemented by integrating any one
of a number of conventional e-mail programs with the system.
As will become more apparent from a detailed description of the system's
other interfaces, the system takes a two-pronged approach to behavior
modification: education and motivation. Entertainment is used as a means
of both educating and motivating a user to make the sometimes difficult
changes required for recovery or even for maintaining a healthy lifestyle.
Motivation is one approach to behavior modification. It is the path from
education to compliance, which is a goal of the system as a whole. The
support group and case advisor described above add a human element to this
motivational component. Patients are more likely to respond positively to
the encouraging words of others than they would be to a program which must
be followed in isolation.
The system's multimedia capabilities allow it to use graphics, videos, and
music to communicate and educate. These features provide a refreshing
boost to the patient's endeavor to modify his or her behavior, replacing
the drudgery typically associated with clinical medical rehabilitation
programs. Segments featuring celebrities, medical experts, motivational
speakers and successful program participants delivering motivational
speeches and personal testimonials further inspire the user. Humor is
integrated throughout the system, for example in the whimsical artwork.
The entertainment derived from these features of the system is used to
spark and maintain the patient's interest in the unfolding drama of his or
her recovery and lifestyle change.
The rewards feature is yet another motivational tool provided by the
system. Referring again to FIG. 9, the reward "apples" icon 92 allows a
user to view information on the rewards point system and how it works, as
well as the user's own personal rewards account. Users may earn points by
good participation in the program and by reaching certain milestones. For
instance, points may be earned for good attendance at meetings, good
participation during the meetings, chairing a meeting, or losing a certain
amount of weight, if this was a goal to be accomplished.
Rewards range from the symbolic kind, such as getting "gold stars" that
commend a user for his or her progress, to reward points and frequent
flier miles which may be exchanged for goods in the village store 78 or
plane tickets in the village travel agency 82, respectively.
Education is a complementary behavior modification approach offered by the
system. Education is provided through informative on-line multimedia
presentations and the interactive areas of the village devoted to diet,
exercise, and stress management. For example, the recipes provided in the
village kitchen, discussed below in conjunction with FIGS. 21-24, are
designed to improve patients' diets without forcing them to take on
impossible austerities or give up their love for food.
Exercise and stress management programs, discussed below in conjunction
with FIGS. 26-31, are designed both to allow for variety and to lie within
the individual patient's ability range. By making exercise and a healthy
diet both feasible and interesting, the system enables patients to stick
with their new lifestyles.
The system also provides relevant articles and includes hyperlinks to
other, reputable Internet sites devoted to providing medical and
health-related information, as discussed below in conjunction with FIGS.
Referring again to FIG. 8, the system encompasses a "home" 84 interface as
part of the village motif. Upon its selection, a screen showing the inside
of the user's "home" 84 follows, as depicted in FIG. 21. Once inside his
"home" 84, the user may access the kitchen by selecting the kitchen icon
FIG. 22 illustrates the interior of the user's kitchen 155. Once in the
kitchen 150A, users have the option to get nutritional and dieting
information from low-fat cookbooks 153, or view and print recipes from a
recipe book 154. FIG. 23 gives an example of a recipe which may be
contained in the recipe book 154.
Referring again to FIG. 22, users also have the option to prepare and print
a shopping list 156. A user may chose several recipes from the recipe book
154, and the system can automatically enter the ingredients into the
user's shopping list 156. The user can also manually enter items into the
shopping list 156 via his or her PC keyboard. FIG. 24 gives an example of
a user's shopping list.
The system can also indicate which recipes are allowable under the
particular patient's program. For example, the system might recommend
certain low-fat items that meet the criteria of a patient's program as
well as suitable foods he or she might consider when eating out. The
system is also capable of generating weekly shopping lists based on
program parameters. According to personal preference, users may choose to
substitute certain allowable foods for other.
Moreover, users have access to a pull-down computer menu by selecting the
computer menu icon 152. From this computer menu, users can access various
educational topics related to food, nutrition, and diet. One such topic
may, for instance, relate to the basic food groups and may provide
information as to the suggested amount of servings for each category of
food, as shown in FIG. 25.
The guest chef 158 option shown in FIG. 21 further allows users to view
audio or video clips of a chef showing how to prepare a certain recipe. In
the presently preferred embodiment, these clips are contained in the
user's CD-ROM or DVD, but with proper technology could be sent via
streaming audio or video.
From the kitchen, a user may substitute foods (e.g., asparagus for
broccoli); access and print food related articles; view new recipes or
articles by selecting the "what's new" button (not shown); or join a
discussion group via a bulletin board (not shown).
Referring again to FIG. 8, another part of the village motif is the village
gymnasium 71, which is used by the system to make recommendations or
supply information regarding suitable exercise routines. Each exercise
program is generated according to individualized parameters and needs,
with progress being regularly charted by user input via the journal 94A
Upon entering the gymnasium 71, a user may view featured video clips or
listen to audio clips; do key-word searches to access and print exercise
related articles; read and print exercise manuals; or join a discussion
group via a bulletin board.
FIG. 26 illustrates the inside of a gymnasium 71 shown in FIG. 9. Shown
here are various exercise topics 160 that a user may access. For instance,
selecting the stretching topic 162 gives the user information on
recommended exercises for stretching different muscle groups. FIG. 27
illustrates one such stretching exercise.
Similarly, selecting the strength training topic 164 gives the user
information on recommended exercises to help strengthen various muscle
groups. FIG. 28 illustrates one such strength training exercise.
Referring again to FIG. 9, the village tranquility park 72 focuses on
stress management strategies, including relaxation techniques,
biofeedback, yoga, and meditation. Upon entering the park 72, a user may
access and print articles on stress management subjects; view video clips
or listen to audio clips on these subjects; and join discussion groups via
a bulletin board.
An expanded illustration of the tranquility park 72 is shown in FIG. 29.
Upon selection of the relaxation option 170, an instructional article on
the subject is invoked, as shown in FIG. 30. Similarly, upon selection of
the yoga option 172, an instructional article about yoga is invoked, as
shown in FIG. 31.
Referring back to FIG. 8, the system also gives access to a village library
80 which allows users to do research germane topics. Thus, patients
interested in learning more about their medial condition may access the
library 80 in order to educate themselves on the topic.
FIG. 32 illustrates the interior of the library 80. From here, a user may
select an Articles option 180 to gain access to an available list of
articles 186 via his or her CD-ROM, as shown in FIG. 33. The kind of
articles 186 available to a user will vary depending on the type of user.
For instance, if the user suffers from a chronic cardiac condition, the
articles 186 will all relate to such topic. The list of articles 186 is
updated on an ongoing basis to reflect new developments and research on
Users are also provided with hypertext links 188 to other reputable
Internet sites devoted to providing medical and health-related
information. These Internet sites may also be accessed by selecting the
world wide web option 182 as shown in FIG. 32.
Once linked to an Internet article, a user is taken to a separate web
browser from which he or she may navigate the web. FIG. 34 is an example
of an Internet site to which a user might get connected upon selection of
the world wide web option 182 of FIG. 32.
Furthermore, users have access to a pull-down menu by clicking the menu
icon 184. From this menu, users can select various educational topics
germane to the user's condition. For instance, an article available
through the pull-down menu may teach a user suffering from a chronic
cardiac condition how to determine his or her target heart rate zone, as
shown in FIG. 35.
Users may also do key word searches to access and print articles of
interest, to view featured video clips, or listen to audio clips.
Referring again to FIG. 8, the village store 78 and travel agency 82 are
two additional interfaces accessible to users. Upon entering the store 78,
users are taken to an in-house or third-party web site through which they
may order relevant items, either on-line or by telephone.
Users may also search the store database and view product information,
including pictures, descriptions, and prices of products. Moreover, users
may view the status of their orders and contact customer service via
e-mail or telephone.
Similarly, when a user enters the travel agency 82, he or she is linked to
a third-party co-branded reservation system. FIG. 36 illustrates the
inside of travel agency 82. From here, a user may make on-line travel
reservations by selecting a Reservations option 202.
A user may also view the frequent flier miles he or she has accrued so far
by selecting a Check Reward Points option 200. As discussed above, a user
may gain frequent flier miles by good participation in the program and
reaching certain milestones.
Although the user-interface for clinical and wellness group members has
been described in terms of a village motif, an alternative user-interface
could incorporate another alternate embodiment of the system interface
shown in FIG. 37. A multi-frame screen is shown which includes: a main
navigation area 210; content area 212; message or video screen area 214;
and an instructions area 216. The message or video screen area 214 may be
used to show advertisements. The instructions area 216 may be used as a
"What's New" area or for the bulletin board functionality discussed above
for the kitchen 150A (FIG. 22), gymnasium 71 (FIG. 26), and tranquility
park 72 (FIG. 29) interfaces.
FIGS. 38-47 and 49-58 illustrate user interfaces for the case advisor and
HMO, some of which are also accessible by the patient. Unlike the user
interface for patients, the navigation for the physician/case advisor is
generally less graphical and more chart oriented.
Referring now to FIG. 38, a log-on screen 220 for the user interface for a
physician/case advisor is shown. The screen 220 requires the physician or
case advisor to input their name 222 and corresponding password 224.
Screen 220 thus acts as a security measure by ensuring that only
legitimate users are able to gain access to the system.
Referring to FIG. 39, an initial screen containing a main menu 230 of the
options available to the physician/case advisor follows the log-on screen
220. A Design Program For Patient option 232 allows a physician/case
advisor to create a new program or modify an existing program for a
patient, as described above in conjunction with FIGS. 3-6.
A second option within the main menu 230 is a Review Patient Record option
234 which allows a physician/case advisor to review the health record of a
A list of current patients (not shown), substantially similar to the list
shown in FIG. 4 follows upon selection of a Review Patient Record option
Referring now to FIG. 40, a health record of an exemplary patient is shown.
The record may provide identifying information, including the patient's
name 240, subscription ID 242, and social security number 244.
Furthermore, information as to the total amount of time that the patient
has been participating in the program may be given as shown at 246.
Column 258 shows the patient's vital signs and other health-related
factors, such as blood pressure 250, number of cigarettes smoked per day
252, amount of physical activity 254, weight 256, and cholesterol level
258. Some of these factors may be monitored and reported on a weekly
basis, as shown in columns 260-268. Other factors, such as the patient's
cholesterol level 258, may be monitored and reported on a bi-weekly basis,
as shown in columns 260, 264, and 268. The ultimate goal to be achieved in
each of the specified areas is given in column 272.
A list of the risk factors which may affect the patient's recovery may
further be pin-pointed as shown at 270.
Vital signs may be represented graphically for the patient, physician and
case advisor. These may include charts or graphs of the patient's blood
pressure 250A (FIG. 41), physical activity 254A (FIG. 42), weight 256A
(FIG. 43), and cholesterol level 258A (FIG. 44). These graphs allow the
physician/case advisor to review and grasp the patient's progress visually
over a period of time, and help him or her determine how the patient is
doing in relation to the ultimate goals that are to be achieved in the
Referring again to FIG. 40, a physician/case advisor is also given an
option 274 to assess the patient's behavior. Upon selection of this
option, the system provides a behavioral change assessment form 305 like
the one shown in FIG. 45. This form 305 is used to determine how inclined
the selected patient is toward complying with the recommended program. In
the preferred embodiment, on-line questionnaires are submitted to the
patients, asking them to rate their behavioral intention 300,
self-efficacy 302, and social support 304. Alternate forms of evaluation
may also be used to assess the likelihood of a patient's compliance with
The system periodically assesses and reports the patient's behavioral
change as shown in columns 306 and 308. The desired goals 310 are also
listed to monitor whether the patient is making progress towards them. If
a patient continues to score low on the behavioral change assessment form
305, this may indicate that he or she is unable to change his or her
lifestyle, and lead to the conclusion that the patient should be taken off
The system generates reports on patient progress based on the data shown in
FIGS. 40-45, as frequently as the physician desires. These reports can be
received via either e-mail or facsimile. The frequency of reports will
depend on the needs of the particular patient, and may be triggered by the
achievement of goals or the setting off of alarm signals as described
The system can also generate regularly scheduled reports for a physician's
review on a default basis, depending on a patient's needs. For example,
patients who are relatively ill can be reviewed twice a week or more, even
if no warning signals occur.
Upon receiving feedback from the system regarding changes to a patient's
behavior modification program, a physician or case adviser may want to
make recommendations about the program. FIG. 46 shows an exemplary
recommendation screen which follows the selection of a Recommend 276
option of FIG. 40. If, for example, a patient initially placed on a
program of walking 15 minutes three times a week loses 5 pounds and lowers
his or her blood pressure, the system might generate a report to the
physician recommending an increase in the patient's walking time to 45
minutes per session as shown at 322. The system may further make
recommendations as to the frequency and duration of stress reduction
exercises 328 as well as on other areas of the program as shown at 326.
The physician reading the report can accept 330 or modify 332 the
The system's reporting features enable a physician to handle more patients
in the same amount of time without decreasing the quality of care. The
system also allows for a patient feedback loop independent of this
self-monitoring capability. If the patient has a difficult night, for
example, he or she can send an e-mail through the system directly to the
case advisor or the physician via the mail 98 (FIGS. 9, 16-20) or post
office 74 (FIG. 8) interfaces.
Once the physician/case advisor is satisfied with the recommendations, he
or she may electronically communicate 334 program changes to the
FIG. 46 also shows an example of a patient who has earned reward points 324
for not having smoked for 60 days. The reward points shown here are to be
cashed in at the village store 78 shown in FIG. 8.
Referring to FIG. 47, the system presents a message screen upon the
selection of a communications 334 option of FIG. 46. The case advisor may
send the recommendation 346 made by the system and reviewed and/or
modified by the physician, to the subscriber 340 with an attached audio
e-mail message 344, or alternately via text e-mail or facsimile. A copy of
the recommendation 346 and message 344 may also be stored in the system's
Physicians/case advisors may further communicate with patients by video
conferencing. An existing third-party video conferencing package may be
integrated to the system to allow the video conferencing feature. The
minimal requirements for a PC to support the video conferencing capability
is a clock cycle of 90 megahertz, 24 megabytes of random access memory, a
color camera, a video capture board, an audio board, a video input capture
board, and an ISDN line. The technical specification may change as
technology affecting bandwidth and/or data compression changes.
As shown in FIG. 47, the video conferencing feature may be accessed upon
selection of a video conferencing option 347. A video conferencing
manager, like one illustrated in FIG. 48 may then be used to conduct the
A health plan payor, such as an HMO, insurance company, or self-insured
employer, may also access the system. Information that is released by a
patient may also be sent electronically to the health plan payor. The
information can then be combined with the provider's information to
analyze individual patients or aggregate results of all people on the
program. The analysis may include, for example, cost per patient, cost for
patients in each category or group, and physician utilization. The
system's relational database that allows for the custom gathering of data,
depending upon the requirements of the health plan. The system may also
provide aggregate reports to the health plan payor for management review
and cost control purposes. A health plan payor may be less interested in
looking at individual patient files and more interested in looking at
information as to the number of subscribers on the system, the cost of
keeping the subscribers on the system, and how this cost compares to that
incurred by patients who are not on the system. At the same time, several
layers of electronic security measures insure the individual patient's
privacy by strictly segregating the type of information available to the
various parties who have access to the system.
The user interface for the health plan payor is similar to the user
interface used by a physician/case advisor. When the health plan payor
signs onto the system, a main menu screen with a list of options available
is provided, as shown in FIG. 49. From here, the payor may choose to view
overall compliance status 350, perform case management review 352, perform
an utilization review 356, review outcomes 354, or communicate 358, each
of which options is described in further detail below.
Upon selection of a view compliance status 350 option, the health payor
views current compliance status based on pre-determined categories 360, as
shown in FIG. 50. For each category, information as to the total number of
eligible patients 364, number of participating patients 366, participating
patients complying with the program 368, participating patients put on
probation due to lack of compliance 372, and patients terminated 376, may
A comparative cost analysis screen is also invoked via a view comparative
costs option 362. FIG. 51 shows an example of the cost of maintaining
patients on the system. The total cost 380 may be compared against costs
incurred by a control group of patients who have not subscribed to the
system 382. Comparative savings achieved by use of the system are shown in
Referring back to FIG. 49, the main menu 348 also includes a perform a case
management review 352 option. A list of current patients (not shown),
substantially similar to the list shown in FIG. 4, follows selection of
Once a patient file has been selected, a confidentiality waiver information
390 is displayed, as shown in FIG. 52. A patient will be assured
confidentiality and privacy in the areas where waiver has not been given.
For instance, portions of the patient's journal will be kept confidential
and unavailable to the health plan payor, ensuring that patients remain
open and honest in making daily journal entries.
Upon selection of a continue option 392, a screen similar in content to the
screen shown in FIG. 40 is shown in FIG. 53. As with the user interface
for physicians/case advisors, indications of the patient's blood pressure
level 404, physical activity 406, weight 408, and cholesterol levels 410
over time, are given. These may also be represented graphically to the
health plan payor in a form substantially similar to FIGS. 41, 42, 43, and
A health plan payor, however, has a review costs option 400 which is not
available to a physician/case advisor.
FIG. 54 illustrates an exemplary screen viewable upon selection of the
review costs option 400 of FIG. 53. Shown here is information as to the
costs incurred to date in maintaining the selected patient on the system.
The system costs 410, health service costs 412, and total costs 414 are
represented in a bar graph format in this particular example. The cost
incurred by a control group patient who is not on the system is also shown
418. This cost is compared to the total costs 414 and the amount of
savings 416 thus achieved, and is also displayed in a bar graph format.
Referring back to FIG. 49, another option provided by the main menu 348 is
a review outcomes 354 option, which provides a screen like the one shown
in FIG. 55 with information as to the various patient outcomes, based on
various pre-determined categories. For instance, information as to the
percent of compliant subscribers who had an emergency room ("ER") visit
420 is shown. This information may be compared against ER visits made by
non-compliant subscribers 422 and control group patients who have not
subscribed to the system 424.
Referring back to FIG. 49, the main menu 348 also provides for a
utilization review 356 option. As shown in FIG. 56, upon making this
selection, a screen appears with information including the name of the
group or facility using the system, this group or facility's specialty
432, the number of cases to date 434, the percentage of cases referred to
the system 436, and how this percentage compares 438 to the targeted
utilization percentage 440.
Upon selection of a particular group or facility 442, the same type of
information for the doctors within the selected group or facility 442 may
be obtained, as shown in FIG. 57.
The main menu 348 in FIG. 49 further provides a communicate 358 option
leading to FIG. 58. The health plan payor may send an audio e-mail 456,
text e-mail 458, or fax 460 to the case advisor 450, responsible physician
452, or subscriber 454 as shown here.
In this way, the system provides an on-going loop of compliance monitoring
and feedback to help the patient make difficult lifestyle changes. Once
the patient has achieved the desired goals, he or she can continue to use
the system as a health maintenance or wellness program. An aim of the
system is to educate and motivate patients to take control of their lives
and improve their health by modifying their behavior and changing their
FIG. 59 is a block diagram of the present system. It will be apparent to
those skilled in the art that the invention described herein may be
implemented on various platforms. In a preferred embodiment, however,
patients, physicians, case advisors, and health plan payors have access to
a PC 500 with a Pentium microprocessor. The PC 500 contains audio and
CD-ROM 502 capabilities. However, a PC 500 may have other multimedia
capabilities including video display and capture capabilities,
microphones, etc. The PC 500 is further connected to a printer 504 for
generating hard copies of any data accessible by the computer.
In a preferred embodiment, the operating system utilized by the PC 500 is a
windows-based operating system, preferably Windows 95.
In the preferred embodiment of the invention, each PC 500 is electronically
linked to network server 508 via the Internet 518. Contained in each
server 508 is a transaction server 510, meeting server 512, "inner circle"
server 514, and "outer circle" server 516. The transaction server 510 is
utilized to handle secure purchases via the store 78 (FIG. 9) or travel
agency (FIG. 36) interfaces.
The secure meeting server 512 is dedicated to implementing the meeting room
96 and coffee shop functionalities discussed in reference to FIGS. 9, 14,
and 15. The secure "inner circle" server 514 is dedicated to handle
sensitive data, such as medical records.
Other servers may be added as needed. For instance, there may be a separate
media server to handle the audio and video functionalities of the system.
Communication via the Internet 518 is achieved in the preferred embodiment
of the invention through telephone lines by means of a high-speed modem
506 connected to the PC 500. Alternatively, satellites, television cable
systems, and ISDN lines may be utilized to access the Internet 518.
Standard TCP/IP is utilized as the protocol to communicate between the
servers 508 and a PC 500 via the Internet 518.
The network server 508 may be located at a health plan payor facility with
an independent third party that acts as an Internet Service Provider or
elsewhere. The servers 510-516 have access to one or more relational
databases 522 (such as SQL) that contain all the health plan data,
including information input to the journal and schedule book information.
For example, pertinent information from a patient's journal will be
uploaded to the server and downloaded to the physician and case advisor.
Information provided by the physician will also be uploaded to the same
server. System data will be downloaded to the case advisor on a periodic
basis for review.
All the information needed by a user of the system is located in the
databases 522 or on CD-ROM and/or DVD distributed to the users on a
periodic basis, or, as technology permits, via streaming audio and video.
For instance, in the presently preferred embodiment, the video and audio
clips available to a chairperson 114 for conducting meetings (FIG. 14), or
via the kitchen (FIGS. 21, 22), gym (FIG. 26), tranquility park (FIG. 29),
and library (FIG. 32) interfaces is located on CD-ROM or DVD. However,
with the emergence of ISDN, cable modem, XDSL, and direct satellite
delivery, it is anticipated that the system will be capable of sending
streaming video and audio over the network.
There are three levels of security implementation to help achieve secure
transmission of data to and from the servers 510-516, as well as to ensure
that only authorized users may access the databases 522. User security for
patients, physicians/case advisors, and health plan payors is assured by a
two tier (user id and password) system. An example of such log-on screen
is shown in FIG. 36.
Furthermore, a "cookie"-based code is used to monitor when users log in and
out, and to keep track of how each user uses the system. This will, for
example, allow the system to keep attendance at group meetings. If a user
has missed a group meeting, the case advisor would then be able to follow
up with him or her about the absence.
Referring back to FIG. 59, a firewall 520 is also provided at the server
level to protect confidentiality of health plan data. Furthermore,
encryption is furnished to ensure that communication between servers
510-516 and PCs 500 is secure.
A network administrator 524, who may be the case administrator or an
independent third party, is also attached to the server 508. The network
administrator subscribes all users to the system except for clinical or
wellness group participants. Physicians or case advisors are responsible
for subscribing clinical or wellness members. The network administrator is
also in charge of maintaining the system's databases 522.
In the preferred embodiment, the system is constructed using the C++
programming language in conjunction with SQL 6.5, Cold Fusion,
commercially available from Alaire Company, Visual Basic, commercially
available from Microsoft Corporation), and HTML. Active X and Java
components may also be invoked to handle the multimedia functions of the
It will be understood that the foregoing is merely illustrative of the
principles of the invention, and that various modifications can be made by
those skilled in the art without departing from the spirit and scope of
the invention as defined by the following claims. For example, the system
can be programmed in any number of programming languages besides C++ code
to achieve the underlying principles of the present invention. The screens
can be reformatted to change their appearance, and many different data
sets can be used for various patients with different chronic diseases.
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