Diagnostic Effectiveness Tool for Probabilistic Test Selection
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Solution Overview
Problem
The diagnostic and treatment decision-making process in healthcare is inefficient and not cost-effective due to the difficulty in searching through extensive medical records, interpreting relevant findings, and making evidence-based decisions, particularly in complex cases, leading to an adversarial relationship between providers and payers due to lack of information on costs and resource availability.
Innovation Solution
A system and method that uses a validated probabilistic model informed by aggregated electronic medical records and medical knowledge to assist healthcare providers in evaluating the effectiveness of diagnostic tests and interventions, suggesting additional tests, and generating indicia for decision-making, while also supporting reimbursement decisions by payers.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If physicians manually search through extensive medical records to find relevant findings, then diagnostic accuracy can be maintained, but time consumption and workflow efficiency deteriorate
Solution Approach 1:
The patent introduces an intermediary system (automated information retrieval system) that acts as a mediator between the physician and the extensive medical records. The system automatically retrieves relevant findings, test results, and clinical data from electronic health records, imaging systems, and laboratory information systems, presenting them to the physician in an organized manner. This intermediary handles the time-consuming search process while maintaining diagnostic accuracy by ensuring all relevant information is presented.
Solution Approach 2:
The patent replaces the mechanical process of manual searching and reviewing medical records with an automated computer-based system. The system uses algorithms to automatically search, retrieve, and present relevant clinical information from multiple sources including electronic health records, imaging systems, and laboratory systems. This substitution eliminates the time-consuming manual effort while maintaining comprehensive review of relevant findings.
2Reliability
If physicians order multiple diagnostic tests to differentiate between top-ranked diagnoses, then diagnostic effectiveness improves, but cost and resource utilization worsen
Solution Approach 1:
The patent applies partial action by selectively ordering only the necessary diagnostic tests rather than all possible tests. The system evaluates the differential diagnosis and identifies which tests will provide the most valuable information for differentiating between the top-ranked diagnoses. By ordering only the essential tests (partial action) rather than all potential tests (excessive action), the system maintains diagnostic effectiveness while reducing cost and resource utilization.
Solution Approach 2:
The patent changes the parameter of test selection from a static, guideline-based approach to a dynamic, probability-based approach. The system continuously updates the differential diagnosis probabilities based on newly acquired findings and uses these updated probabilities to determine which tests will provide the maximum diagnostic value. This parameter change allows for adaptive test ordering that optimizes the balance between diagnostic effectiveness and cost.
3Reliability
If physicians document detailed diagnostic processes to ensure quality care, then care quality improves, but time consumption and productivity worsen
Solution Approach 1:
The patent implements self-service by enabling the system to automatically generate documentation of the diagnostic process. The system tracks the diagnostic reasoning, findings evaluation, and test ordering decisions, and automatically documents this information in the patient record. This self-documentation capability maintains care quality by capturing the diagnostic process details while eliminating the time-consuming manual documentation burden from physicians.
Solution Approach 2:
The patent incorporates feedback mechanisms where the system automatically captures and documents diagnostic process information as it occurs during patient care. The system provides real-time feedback to physicians about the diagnostic reasoning process and automatically records this information, ensuring quality documentation without requiring separate documentation time. The feedback loop ensures that all diagnostic decisions are properly documented while maintaining workflow efficiency.
4Reliability
If physicians make independent diagnostic decisions without cost information, then clinical judgment quality improves, but cost-effectiveness and resource utilization worsen
Solution Approach 1:
The patent applies universality by creating a decision support system that serves multiple functions simultaneously. The system provides both clinical guidance (maintaining clinical judgment quality) and cost-effectiveness analysis (optimizing resource utilization). The integrated system presents physicians with diagnostic options that consider both clinical appropriateness and cost implications, enabling single-action decisions that satisfy both clinical and economic requirements rather than requiring separate evaluation processes.
Solution Approach 2:
The patent introduces an intermediary decision support system that mediates between clinical judgment and cost considerations. The system automatically retrieves cost information for diagnostic tests and presents this information alongside clinical recommendations. This intermediary enables physicians to make informed decisions that balance clinical quality with resource utilization without requiring separate cost-analysis processes.
Data Source
AI summary
A system is disclosed for evaluating diagnostic effectiveness of one or more diagnostic tests or additional findings from a set of known findings as to a patient. The system includes a computing device containing a software application which is used by a healthcare provider to review the patient's medical history and enter findings as to the patient's condition or symptoms, a system storing a validated probabilistic health model including a database of medical knowledge informed from aggregated electronic medical records or other sources of medical knowledge; and a medical knowledge-based inference engine operating on the patient's medical history and findings and the validated probabilistic health model. The engine determines a set of the most probable diseases of the patient, suggests a set of one or more tests or additional findings that differentiate the set of most probable diseases, and generates indicia indicating diagnostic effectiveness or relevancy of the one or more tests or additional findings.