Chronic disease prevention system

Abstract

The invention provides a chronic disease prevention system, which comprises a medical end, a cloud end and a user end, and is characterized in that the medical end contains medical data of a chronic disease user and is operated by a medical worker; the cloud comprises a health file module which comprises personal health information of a chronic disease user; the chronic disease monitoring and data tracking module comprises chronic disease related data which are monitored by a chronic disease user for a long time and updated in real time; the health education module is used for generating education information about chronic diseases according to the data of the health archive module; the self-management module is used for generating a personalized management scheme; and the user side is connected with the cloud side, receives and displays information from the cloud side, and is operated by a chronic disease user or a bound family member. According to the invention, long-term health tracking and disease prevention can be carried out on the chronic disease user, the health demand of the user can be identified more accurately, a more accurate and personalized disease prevention scheme is provided, and the health management effect and life quality of the user are provided.

Description

Technical Field

[0001] The present invention relates to the field of medical health, and specifically, to a chronic disease prevention system. Background Art

[0002] With the continuous increase in the number of chronic disease users, the need for long-term health monitoring and disease prevention has become increasingly urgent. The current health management services usually lack personalization and continuity, and the traditional medical model can no longer fully meet the needs of users for long-term monitoring and management. There are many limitations in the current solutions. For example, users need to frequently inquire and communicate with health management practitioners; it is difficult for health management practitioners to grasp the user's condition in real time, etc. Therefore, there is an urgent need to develop an auxiliary service that can provide long-term health monitoring and disease prevention solutions to meet the needs of users. Summary of the Invention

[0003] Aiming at the defects in the prior art, the purpose of the present invention is to provide a chronic disease prevention system.

[0004] According to one aspect of the present invention, there is provided a chronic disease prevention system, including a medical end, a cloud end, and a user end, wherein:

[0005] The medical end stores the medical data of chronic disease users;

[0006] The cloud end is connected to the medical end; and the cloud end includes:

[0007] A health record module that establishes a personal health record for chronic disease users;

[0008] A chronic disease monitoring and data tracking module that monitors and real-time updates the health index data of chronic disease users;

[0009] A health education module that generates education information about chronic diseases according to the personal health record of the health record module;

[0010] A self-management module that generates an interactive daily personalized management plan according to the personal health record of the health record module and the health index data of the chronic disease monitoring and data tracking module;

[0011] The user end is connected to the cloud end, receives information from each module of the cloud end, and displays it.

[0012] Preferably, the health record module includes:

[0013] A basic information unit that obtains basic information at the user end, including name, ID, gender, height, weight, BMI, body fat percentage, and chronic disease type;

[0014] Medical data unit, which obtains medical data at the user side or the medical side, including home health management records, test records, examination records, and physical examination records.

[0015] Preferably, the monitoring and data tracking module monitors the health index data of chronic disease users by connecting external detection devices, inputting at the user side, or importing from the medical side in one or more ways;

[0016] A plurality of the detection devices are connected to the chronic disease monitoring and data tracking module, and the detection devices are used to detect one or more of the daily heart rate, body temperature, blood oxygen, blood sugar, pressure, sleep, and exercise data of chronic disease users.

[0017] Preferably, the self-management module includes:

[0018] Medication reminder unit, which obtains a medication prescription by inputting at the user side or connecting and importing from the medical side, and generates medication reminder items;

[0019] Follow-up visit reminder unit, which obtains the follow-up visit time by inputting at the user side or connecting and importing from the medical side, and generates follow-up visit reminder items;

[0020] Drug discontinuation reminder unit, which obtains the drug discontinuation time by inputting at the user side or connecting and importing from the medical side, and generates drug discontinuation reminder items.

[0021] 5. A chronic disease prevention system according to claim 1, wherein the user side receives the data of the cloud health record module and displays it as a health record and medical data;

[0022] The user side receives the data of the chronic disease monitoring and data tracking module and displays it as health index data;

[0023] The user side receives the data of the health education module and the self-management module and displays it as a today's task list.

[0024] Preferably, the today's list tasks include educational information from the health education module and a daily personalized management plan from the chronic disease monitoring and data tracking module; wherein, the educational information includes science popularization knowledge reading, research questionnaire section, and diet and exercise advice section; the daily personalized management plan includes medication reminder, follow-up visit reminder, or drug discontinuation reminder section.

[0025] Preferably, on the user side, the science popularization knowledge reading section is equipped with a "Go to read" button. Clicking the "Go to read" button, the science popularization content appears; the "Go to read" button turns gray and shows "Already read";

[0026] The research questionnaire section is equipped with a "Go to fill" button. Clicking the "Go to fill" button will display the questionnaire content. After filling in the content, the "Go to fill" button will turn gray and show "Already filled".

[0027] The diet and exercise advice is equipped with a "Go to learn" button. Clicking the "Go to learn" button will display recommended recipes and recommended exercises.

[0028] The medication reminder section is equipped with a "Go to take medicine" button. After clicking the "Go to take medicine" button, medication reminder items will appear, including: drug name, frequency of medication, dosage, as well as "Not taken yet" and "I have taken the medicine" buttons. If the user has completed taking the medicine, click "I have taken the medicine"; if not, SMS and IVR phone reminders will be sent.

[0029] The follow-up visit reminder section is equipped with a "Go to follow up" button. After clicking the "Go to follow up" button, follow-up visit reminder items will appear, including: categories of chronic diseases to be followed up, as well as "Not followed up yet" and "I have followed up" buttons. If the user has completed the follow-up visit, click "I have followed up" or import the completed information from the medical end; if not, SMS and IVR phone reminders will be sent.

[0030] The drug withdrawal reminder section is equipped with a "Go to withdraw medicine" button. After clicking the "Go to withdraw medicine" button, the name of the medicine to be withdrawn, the time, and the "I have withdrawn the medicine" button will appear. If the user has withdrawn the medicine, click the "I have withdrawn the medicine" button; otherwise, SMS and IVR phone reminders will be sent.

[0031] Preferably, the user terminal is connected to a smart wearable device, which is used to synchronize the cloud data received by the user terminal for easy viewing and completion of the daily task list; the wearable smart device is also used to collect the user's health index data.

[0032] Preferably, the cloud also includes a data analysis and decision support module, which includes:

[0033] An analysis unit that analyzes and integrates based on the personal health record in the health record module and the health index data in the chronic disease monitoring and data tracking module to form a health daily report, statistical report, and trend analysis.

[0034] A push unit that pushes the health daily report and the trend analysis to the user terminal; and pushes the statistical report and the trend analysis to the medical terminal.

[0035] Preferably, the cloud also includes a follow-up and remote monitoring module, which includes:

[0036] A follow-up unit where the robot generates answers based on the consultations and questions from the user terminal and feeds them back to the user terminal.

[0037] The remote monitoring unit determines whether the health index data of the chronic disease monitoring and data tracking module is within the normal range. If it is abnormal, it issues a warning to the user terminal.

[0038] Compared with the prior art, the embodiments of the present invention have at least one of the following beneficial effects:

[0039] The chronic disease prevention system according to the embodiments of the present invention can conduct long-term health tracking and disease prevention for chronic disease users, can more accurately identify the health needs of users, provide more precise and personalized disease prevention plans, and improve the health management effect and quality of life of users.

[0040] The chronic disease prevention system according to the embodiments of the present invention can directly connect to the inspection and examination reports of medical institutions and directly collect data from intelligent devices, ensuring the accuracy, timeliness, and effectiveness of the data.

[0041] The chronic disease prevention system according to the embodiments of the present invention dynamically adjusts the health management plan according to user feedback and changes in health data, improving the adaptability and effectiveness of the management plan.

[0042] The chronic disease prevention system according to the embodiments of the present invention can effectively monitor the health status of users in real time by integrating interactive functions and connecting to intelligent wearable devices, and provide reminder services such as medication, follow-up visits, and discontinuation of medication. Compared with the previous method of only reminding during consultations with health management practitioners, this system significantly improves the interaction frequency with users, thereby enhancing the compliance of users with chronic disease treatment. BRIEF DESCRIPTION OF THE DRAWINGS

[0043] By reading the detailed description of the non-limiting embodiments with reference to the following drawings, other features, objectives, and advantages of the present invention will become more apparent:

[0044] Figure 1 It is a schematic structural diagram of the chronic disease prevention system in an embodiment of the present invention;

[0045] Figure 2 It is a schematic diagram of the cloud platform server in an embodiment of the present invention;

[0046] Figure 3 It is a logical diagram of system data communication and transmission in an embodiment of the present invention;

[0047] Figure 4 It is a diagram of the association between multiple devices in an embodiment of the present invention. DETAILED DESCRIPTION OF THE EMBODIMENTS

[0048] The present invention will be described in detail below in conjunction with specific embodiments. The following embodiments will help those skilled in the art to further understand the present invention, but do not limit the present invention in any form. It should be noted that for those of ordinary skill in the art, without departing from the concept of the present invention, several modifications and improvements can still be made. These all belong to the protection scope of the present invention.

[0049] In one embodiment of the present invention, a chronic disease prevention system is provided, as Figure 1 shown, including a medical end, a cloud end, and a user end.

[0050] The medical end stores the medical data of chronic disease users;

[0051] The cloud end is connected to the medical end. The cloud end includes: a health record module, a chronic disease monitoring and data tracking module, a health education module, and a self-management module. Among them, the health record module establishes the personal health records of chronic disease users; the chronic disease monitoring and data tracking module monitors and real-time updates the health index data of chronic disease users; the health education module generates education information about chronic diseases according to the personal health records of the health record module; the self-management module generates an interactive daily personalized management plan according to the personal health records of the health record module and the health index data of the chronic disease monitoring and data tracking module.

[0052] The user end is connected to the cloud end, receives information from each module of the cloud end, and displays it.

[0053] The chronic disease prevention system in the above embodiment can achieve long-term health tracking and disease prevention for chronic disease users, improve the efficiency and convenience of chronic disease management; reduce the frequency of face-to-face contact between users and health management practitioners, reduce the difficulty of seeing a doctor and medical expenses; through personalized health management plans, improve the treatment effect and quality of life of chronic disease users.

[0054] In a preferred embodiment, the main function of the health record module is to jointly establish and maintain the user's health records by the user and medical professionals. These records include the user's personal information, medical history, diagnosis results, medication records, inspection reports, etc. The user himself and the bound relatives can access these records at any time to understand the user's condition and treatment history. Specifically, the user's health records can be established on the user end by manual input, or by connecting to the medical end to import medical data to establish, supplement, and improve the user's health records.

[0055] In a preferred embodiment, the chronic disease monitoring and data tracking module mainly records and tracks key data related to chronic diseases of users, such as blood glucose, blood pressure, weight, respiratory function, etc. These key data can be obtained in various ways. For example, an external intelligent detection device can be used. The intelligent detection device can be wirelessly connected to the chronic disease monitoring and data tracking module, and the collected detection data directly reaches the chronic disease monitoring and data tracking module and then is transmitted to the user terminal; the intelligent detection device can also be wired or wirelessly connected to the user terminal, and after the collected detection data reaches the user terminal, it is shared with the chronic disease monitoring and data tracking module. Another example is to use a more traditional detection device, and the user manually enters the detection data at the user terminal and then shares it with the chronic disease monitoring and data tracking module. Additionally, it can be connected to the medical terminal to update the detection data of the follow-up visit to the chronic disease monitoring and data tracking module and the user terminal in a timely manner. Of course, in other embodiments, there can also be other data acquisition methods, not limited to the examples here.

[0056] In the current market, a very comprehensive range of intelligent detection devices can be adopted. For example: infrared forehead thermometers to detect whether the body temperature is within the normal range; intelligent handheld pulmonary function meters to detect the vital capacity index of the respiratory system; intelligent blood glucose, uric acid, and cholesterol analyzers to detect blood glucose, uric acid, and cholesterol data; arm-type blood pressure monitors to detect blood pressure; intelligent grip trainers to relieve stress and strengthen hand strength; intelligent skipping ropes to obtain exercise data and calorie consumption; rapid electrocardiogram detectors to detect electrocardiogram waveforms and monitor heart diseases; intelligent bracelets to monitor exercise, sleep, and heart rate data; pulse oximeters to detect blood oxygen saturation and perfusion index; intelligent body fat scales to detect data such as weight, BMI, and body fat percentage. Several of them can be selected and connected to the cloud or the user terminal to monitor the health index data of users in real time.

[0057] More preferably, in some preferred embodiments, the system can analyze and visualize the data so that users and health management practitioners can monitor the changes in the condition and take corresponding measures in a timely manner.

[0058] In the above-mentioned embodiment, the chronic disease monitoring and data tracking module directly collects data from intelligent devices, ensuring the timeliness and accuracy of the data. Through these real-time updated and accurate data, long-term health tracking and disease prevention of chronic disease users can be carried out, the health needs of users can be more accurately identified, more precise and personalized disease prevention plans can be provided, and the health management effect and quality of life of users can be improved.

[0059] In a preferred embodiment, the health education module mainly provides educational information and resources to users. Based on the information data from the health record module, chronic disease monitoring, and data tracking module, this module generates content related to disease prevention, treatment plans, medication use, diet, and exercise recommendations, etc. It transmits this content to the user terminal and presents it to users in the form of popular science knowledge reading and questionnaires, enabling users to better understand their diseases, learn how to manage and relieve symptoms, and adopt a positive lifestyle.

[0060] In a preferred embodiment, the self-management module, based on the information data from the health record module, chronic disease monitoring, and data tracking module, combines with the medical knowledge base to formulate a daily personalized management plan for users, including personalized medication reminders, follow-up reminders, and discontinuation reminders, etc. This personalized management plan is tailored to individuals and has an interactive nature on the user terminal. Specifically, it performs intelligent medication reminder, discontinuation, and follow-up reminder tasks according to the user's prescription, and through information interaction with the user, it confirms whether the medication, discontinuation, and follow-up have been completed. Of course, when not completed in a timely manner, it sends SMS and IVR phone reminders to remind users to take medicine on time and in the right amount, discontinue medication according to the doctor's advice, and accurately remind users to conduct home health management at the designated follow-up time. Among them, both the medication reminder and the discontinuation reminder can be set in two ways, namely, inputting on the user terminal and importing the medication frequency, drug name, and dosage from the medical end into the user's medication prescription.

[0061] In some preferred embodiments, the user's health is managed in the form of a "daily task list" on the user terminal. Specifically, the daily task list includes the information sent by the health education module and the self-management module, so that the daily tasks contain content in multiple sections, specifically: popular science knowledge reading, questionnaires, diet and exercise recommendations, medication reminders, follow-up reminders, and discontinuation reminders.

[0062] Among them, the popular science knowledge reading section is equipped with a "go to read" button. Clicking the "go to read" button will display the popular science content; the "go to read" button will turn gray and show "already read".

[0063] The questionnaire section is equipped with a "go to fill" button. Clicking the "go to fill" button will display the questionnaire content; after filling in the content, the "go to fill" button will turn gray and show "already filled".

[0064] The diet and exercise recommendations are equipped with a "go to learn" button. Clicking the "go to learn" button will display the recommended recipes and recommended exercises.

[0065] The medication reminder section is equipped with a "Go to take medicine" button; after clicking the "Go to take medicine" button, medication reminder items will appear, including: drug name, frequency of taking medicine, dosage, and buttons for "Not taken yet" and "I have taken the medicine". If the user has completed taking the medicine, click "I have taken the medicine"; if not, SMS and IVR phone reminders will be sent.

[0066] The follow-up visit reminder section is equipped with a "Go to follow-up visit" button; after clicking the "Go to follow-up visit" button, follow-up visit reminder items will appear, including: categories of chronic diseases to be followed up, and buttons for "Not followed up yet" and "I have completed the follow-up visit". If the user has completed the follow-up visit, click "I have completed the follow-up visit" or import the completed information from the medical side; if not, SMS and IVR phone reminders will be sent.

[0067] It should be noted that the "Daily Tasks" are updated daily based on the information data in the health record module, chronic disease monitoring, and data tracking module. Thus, the management of users is dynamic and most in line with the users' physical conditions. The medication reminder further improves the medication compliance of users. In addition, by designing interactive buttons on the user side (such as buttons for going to fill in, going to understand, going to take medicine, going to follow-up visit, etc., and buttons for I have taken the medicine, I have completed the follow-up visit, etc.), as well as SMS and phone reminders, users are urged to follow medical advice, improving the compliance of chronic disease treatment and being more conducive to the users' own recovery of health.

[0068] Preferably, the chronic disease prevention system in the above embodiments is applied to smartphones, tablets, and some smart wearable devices. On the one hand, smart wearable devices can monitor health indicator data, and on the other hand, synchronize the data on the user side, facilitating viewing and completion of daily tasks, thereby being more conducive to improving the compliance of chronic disease treatment.

[0069] Continuing with the above embodiment, in another embodiment of the present invention, the cloud also has a follow-up visit and remote monitoring module: the chronic disease management assistant can support users to conduct follow-up visits and remote monitoring with medical professionals. Specifically, this module is divided into a follow-up visit unit and a remote monitoring unit. The follow-up visit unit sets up a robot, which generates answers based on the consultations and questions from the user side and feeds them back to the user side; the remote monitoring unit judges whether the health indicator data in the chronic disease monitoring and data tracking module is within the normal range. If it is abnormal, it will issue a warning to the user side.

[0070] In other embodiments, the cloud also includes a data analysis and decision support module. Specifically, this module is divided into an analysis unit and a push unit. The analysis unit analyzes and integrates the personal health record in the health record module and the health indicator data in the chronic disease monitoring and data tracking module to form a health daily report, statistical report, and trend analysis.

[0071] The push unit pushes the health daily report and the trend analysis to the user terminal to provide a more comprehensive perspective and decision-making support. Pushing the statistical report and the trend analysis to the medical terminal can help health management practitioners evaluate the user's condition, treatment effect and risk, and formulate more effective treatment plans and intervention measures.

[0072] To understand the chronic disease prevention system in the above embodiments more deeply, in some specific embodiments, a schematic structural diagram of a cloud platform server (cloud) is provided, as Figure 2 shown, which includes a health record module 10, a communication unit 11, a storage unit 12, and a processing unit 13.

[0073] In the health record module, there are four sub-modules, namely an information collection sub-module 101, a data table creation sub-module 102, a data storage sub-module 103, and an access request sub-module 104. The information collection sub-module 101 collects data imported from the medical terminal and input by the user terminal. The data table creation sub-module 102 constructs an identity profile form about an individual and matches it with the ID information of the medical terminal; the data storage sub-module 103 stores the data collected by the information collection sub-module 101. The access request module 104 determines whether it is the user himself or a bound family member according to the request information of the user terminal. If so, it allows access to the entire health record module 10.

[0074] The communication unit 11 realizes data transmission between each module, such as transmitting cloud data to the user terminal for display.

[0075] The storage unit 12 is the chronic disease monitoring and data tracking module in the above embodiments, which is used to externally connect detection devices and interface with medical institution data to realize long-term monitoring and real-time update of the user's health index data.

[0076] The processing unit 13 is the health education module and self-management module in the above embodiments. According to the data of the data storage sub-module 103 and the storage unit 12, data processing is performed to generate educational information about chronic diseases and an interactive daily personalized management plan. In some more optimal embodiments, this data processing unit can also analyze and statistically process the user's health data and feedback it to the user terminal and the medical terminal.

[0077] Such as Figure 3 shown, a schematic structural diagram of each personalized management plan in an embodiment. By inputting health information through the data communication module, importing health information through the third-party platform data interface, and inputting the monitored health index data according to the detection device, a database is obtained. This database performs data processing, which can complete data analysis and statistics, and can also generate medication reminders, follow-up visit reminders, drug withdrawal reminders, etc.

[0078] Such asFigure 4 As shown in the figure, it is a schematic diagram of the background operation structure of the client in an embodiment. Based on the detection device and the wearable device, data in the cloud is obtained through the cloud management platform, and then through the analysis terminal, and finally displayed at the front end of the client.

[0079] The chronic disease prevention system in the above embodiment includes a medical end, a cloud end and a client end, which can realize seamless connection of data and information sharing. By connecting external detection devices or user input, basic information and medical data are collected, and a personal health record of chronic disease users is established. The system monitors and updates the health index data of chronic disease users in real time. According to the user's personalization, education information and personalized management plans for chronic diseases are generated to improve the user's self-management ability. The system also supports the client end to access intelligent wearable devices, synchronize data and collect health index data to improve the interaction frequency and treatment compliance. The cloud end includes a data analysis and decision support module, which forms a health daily report, a statistical report, a trend analysis, and pushes them to the client end and the medical end.

[0080] In a specific embodiment of the present invention, taking the client end as a smart phone as an example, the display of the chronic disease prevention system at the client end will be described in detail:

[0081] First, the user registers the chronic disease prevention system on the smart phone through a small program and inputs personal health information, including identity information, chronic disease type, treatment history, etc. The system also supports direct connection to the hospital interface. When the identity information matches the medical port, the user's case information, user information, home health management summary and drug information of the home health management prescription can be directly obtained, and at the same time, inspection reports and test reports can be obtained. It also supports the user to independently fill in the inspection and test reports of medical institutions. Specifically: click on "Inspection / Test Report", and the imported or entered inspection / test reports can be seen. Click on "Add Inspection / Test Report", select the report type, inspection date, test data, and upload picture attachments to complete the manual input of the inspection / test report.

[0082] Next, the smart phone authorizes access to intelligent devices (such as smart bracelets), and automatically collects the user's physiological data, such as blood sugar, blood pressure, etc. In some specific embodiments, when collecting blood pressure data, blood pressure calibration can be performed. In addition, the collection of blood pressure data is divided into two modes of whether taking antihypertensive drugs, making blood pressure monitoring more accurate.

[0083] Then, based on the collected personal health records and the health indicator data monitored by smart devices, the cloud generates a daily plan list and displays it on the smartphone. This daily plan list formulates personalized health management plans for users, such as diet, exercise, medication reminder, follow-up visit reminder, and discontinuation reminder, etc. It performs intelligent medication reminder and discontinuation reminder tasks according to the medication frequency prescribed by the user, and at the same time sends SMS and IVR phone reminders when they are not completed in time, and accurately reminds users to conduct home health management at the designated follow-up visit time. In some specific embodiments, the daily plan list on the smartphone includes popular science knowledge reading, research questionnaire, medication reminder, report upload, and follow-up visit reminder listed in sequence from top to bottom.

[0084] There is a "Go to Read" button on one side of the popular science knowledge reading, which displays educational popular science information related to the disease.

[0085] There is a "Go to Check" button on one side of the research questionnaire, such as to investigate the user's symptoms and other conditions.

[0086] There is a "Go to Take Medicine" button on one side of the medication reminder, which displays detailed medication reminders, including: drug name,

[0087] number of doses, and dosage. If the medicine has been taken, click "I have taken the medicine", if not, click "Not taken yet" or provide feedback on whether the medicine has been taken, and the system will send SMS and IVR phone reminders.

[0088] Similarly, there is a "Go to Follow-up Visit" button on one side of the follow-up visit reminder, which displays the content of today's follow-up visit. If the follow-up visit has been completed, click "I have completed the follow-up visit" or import the follow-up visit information from the medical side; if not, click "Not completed yet" or there is no feedback on whether the follow-up visit has been completed, and the system will send SMS and IVR phone reminders.

[0089] The system will generate a health report and trend analysis based on daily monitoring and long-term data summary statistics, and push it to the smartphone. Users can view today's heart rate, blood pressure, blood oxygen, body temperature, stress trend, and night sleep analysis.

[0090] The specific embodiments of the present invention have been described above. It should be understood that the present invention is not limited to the above specific embodiments, and those skilled in the art can make various deformations or modifications within the scope of the claims, which do not affect the essence of the present invention. The above preferred features can be used in any combination without conflict.

Claims

1. A chronic disease prevention system, characterized in that, It includes a medical end, a cloud end, and a user end, where: the medical end stores the medical data of chronic disease users; the cloud end is connected to the medical end; The cloud end includes: A health record module that establishes personal health records for chronic disease users; A chronic disease monitoring and data tracking module that monitors and real-time updates the health index data of chronic disease users; A health education module that generates education information about chronic diseases based on the personal health records of the health record module; A self-management module that generates an interactive daily personalized management plan based on the personal health records of the health record module and the health index data of the chronic disease monitoring and data tracking module; The user end is connected to the cloud end, receives information from each module of the cloud end, and displays it.

2. The chronic disease prevention system according to claim 1, characterized in that, The health record module includes: A basic information unit that obtains basic information at the user end, including name, ID, gender, height, weight, BMI, body fat percentage, and chronic disease type; A medical data unit that obtains medical data at the user end or the medical end, including home health management records, test records, examination records, and physical examination records.

3. A chronic disease prevention system according to claim 1, characterized in that, The monitoring and data tracking module monitors the health index data of chronic disease users through one or more of connecting external detection devices, inputting at the user end, or importing from the medical end; Multiple of the detection devices are connected to the chronic disease monitoring and data tracking module, and the detection devices are used to detect one or more of the daily heart rate, body temperature, blood oxygen, blood sugar, pressure, sleep, and exercise data of chronic disease users.

4. A chronic disease prevention system according to claim 1, characterized in that, The self-management module includes: A medication reminder unit that obtains a medication prescription through input at the user end or connection and import from the medical end, and generates medication reminder items; A follow-up visit reminder unit that obtains a follow-up visit time through input at the user end or connection and import from the medical end, and generates follow-up visit reminder items; A medication discontinuation reminder unit that obtains a medication discontinuation time through input at the user end or connection and import from the medical end, and generates medication discontinuation reminder items.

5. A chronic disease prevention system according to claim 1, wherein, The user end receives the data of the cloud end health record module and displays it as a health record and medical data; The user end receives the data of the chronic disease monitoring and data tracking module and displays it as health index data; The user end receives the data of the health education module and the self-management module and displays it as today's task list.

6. The chronic disease prevention system according to claim 5, wherein Today's list tasks include education information from the health education module and a daily personalized management plan from the chronic disease monitoring and data tracking module; among them, the education information includes a popular science knowledge reading section, a research questionnaire section, and a diet and exercise advice section; the daily personalized management plan includes a medication reminder, a follow-up visit reminder, or a medication discontinuation reminder section.

7. The chronic disease prevention system according to claim 6, wherein At the user end, The popular science knowledge reading section is equipped with a "Go to Read" button. Clicking the "Go to Read" button shows the popular science content; the "Go to Read" button turns gray and shows "Already Read"; The research questionnaire section is equipped with a "Go to Fill" button. Clicking the "Go to Fill" button shows the questionnaire content; After filling in the content, the "Go to Fill" button turns gray and shows "Already Filled"; The diet and exercise advice is equipped with a "Learn More" button. Clicking on the "Learn More" button will display recommended recipes and recommended exercises. The medication reminder section is equipped with a "Take Medication" button. After clicking the "Take Medication" button, medication reminder items will appear, including: drug name, frequency of administration, dosage, as well as buttons for "Not Taken Yet" and "I Have Taken It". If the user has completed taking the medication, click "I Have Taken It"; if not, SMS and IVR phone reminders will be sent. The follow-up appointment reminder section is equipped with a "Go for Follow-up" button. After clicking the "Go for Follow-up" button, follow-up appointment reminder items will appear, including: the categories of chronic diseases to be followed up, as well as buttons for "Not Followed Up Yet" and "I Have Followed Up". If the user has completed the follow-up appointment, click "I Have Followed Up" or import the completed information from the medical side; if not, SMS and IVR phone reminders will be sent. The medication discontinuation reminder section is equipped with a "Discontinue Medication" button. After clicking the "Discontinue Medication" button, the name of the drug to be discontinued, the time, and a button for "I Have Discontinued" will appear. If the user has discontinued the medication, click the "I Have Discontinued" button; otherwise, SMS and IVR phone reminders will be sent.

8. A chronic disease prevention system according to claim 5, characterized in that, The user terminal is connected to a smart wearable device, which is used to synchronize the cloud data received by the user terminal for easy viewing and completion of the daily task list. The wearable smart device is also used to collect the user's health indicator data.

9. The chronic disease prevention system according to claim 1, characterized in that The cloud also includes a data analysis and decision support module, which includes: An analysis unit that analyzes and integrates the personal health record in the health record module and the health indicator data in the chronic disease monitoring and data tracking module to form a health daily report, a statistical report, and a trend analysis. A push unit that pushes the health daily report and the trend analysis to the user terminal; and pushes the statistical report and the trend analysis to the medical terminal.

10. A chronic disease prevention system according to claim 1, characterized in that, The cloud also includes a follow-up and remote monitoring module, which includes: A follow-up unit where the robot generates answers to the consultations and questions from the user terminal and feeds them back to the user terminal. A remote monitoring unit that determines whether the health indicator data in the chronic disease monitoring and data tracking module is within the normal range. If it is abnormal, a warning will be sent to the user terminal.

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