Clinical decision support systems, apparatus, and methods

Abstract

A system includes a centralized repository for tracking rule content and managing subscriptions to rule content by organizations and providers utilizing the system; a rule-evaluation server for receiving requests for rule-evaluations for specific patients, wherein the server determines content needing to be evaluated and retrieves the content to be used; a rule engine for performing the evaluations, wherein content, patient data, and rule evaluation parameters are provided to the engine, and the engine returns recommendations triggered by the evaluation, if any; an aggregator for aggregating recommendations from multiple sources, detecting and coordinating related recommendations, and applying configuration settings based on the patient and/or provider in context; and a client component for coordinating communication between an electronic health records system, the server, and the aggregator.

1 . A method for facilitating the real-time provision of recommendations to a health care provider, comprising the steps of:
 (a) receiving, from an electronic health records application, a user's identity;   (b) automatically determining a list of rules subscribed to by a healthcare provider;   (c) automatically determining specific information necessary to evaluate the rules from the list of rules, all of the determined specific information being necessary to evaluate one or more of the rules such that the determined specific information is the minimum possible set of information necessary to evaluate the subscribed rules;   (d) constructing a message containing only the minimum required information in a request for rule evaluation; and   (e) communicating the constructed message for rule evaluation.   
     
     
         2 . The method of  claim 1 , wherein the step of automatically determining a list of rules subscribed to by a healthcare provider comprises automatically determining, using one or more processors, a list of rules subscribed to by a healthcare provider. 
     
     
         3 . The method of  claim 1 , wherein the step of communicating the constructed message for rule evaluation comprises communicating the constructed message to a rule evaluation engine for rule evaluation. 
     
     
         4 . A method for facilitating the real-time provision of recommendations to a health care provider, comprising the steps of:
 (a) electronically receiving, from an electronic health records application, a call to evaluate rules associated with healthcare provision;   (b) determining, using one or more computer processors, a list of rules subscribed to by a healthcare provider;   (c) electronically communicating rules from the list of rules to a rule agent loaded on one or more computing devices;   (d) automatically determining specific healthcare information necessary to evaluate the rules from the list of rules, all of the determined specific healthcare information being necessary to evaluate one or more of the rules such that the determined specific healthcare information is the minimum possible set of specific healthcare information necessary to evaluate the rules;   (e) electronically communicating the specific healthcare information to the rule agent;   (f) evaluating, at the rule agent, the electronically communicated rules from the list of rules utilizing the communicated specific healthcare information;   (g) communicating, by the rule agent, one or more results based on the evaluation of the rules, the one or more results comprising one or more recommendations; and   (h) receiving, at the electronic health records application, the one or more recommendations and displaying, to a user at an electronic display via the electronic health records application, text corresponding to at least one of the one or more recommendations.   
     
     
         5 . The method of  claim 4 , wherein said step of determining, using one or more computer processors, a list of rules subscribed to by a healthcare provider is performed at a manager component configured to obviate the need to access health records. 
     
     
         6 . The method of  claim 4 , wherein the method further includes a step of receiving, via the electronic health records application, a disposition to apply to a displayed recommendation. 
     
     
         7 . The method of  claim 4 , wherein the method further includes a step of modifying, by a healthcare provider, one or more subscriptions to one or more rules via an interface of a console. 
     
     
         8 . The method of  claim 7 , wherein said step of modifying one or more subscriptions comprises subscribing to a rule. 
     
     
         9 . The method of  claim 7 , wherein said step of modifying one or more subscriptions comprises unsubscribing to a rule. 
     
     
         10 . The method of  claim 7 , wherein said step of modifying one or more subscriptions comprises subscribing to a particular version of a rule. 
     
     
         11 . The method of  claim 7 , wherein said step of modifying one or more subscriptions comprises indicating a desire for a subscription to automatically be updated to the most current version of a rule. 
     
     
         12 . The method of  claim 4 , wherein the one or more results include one or more suggestions. 
     
     
         13 . The method of  claim 12 , wherein each of the one or more suggestions is associated with a recommendation. 
     
     
         14 . The method of  claim 12 , wherein the one or more suggestions include a missing data suggestion. 
     
     
         15 . The method of  claim 12 , wherein the one or more suggestions include an out-of-range suggestion. 
     
     
         16 . The method of  claim 4 , wherein said step of determining, using one or more computer processors, a list of rules subscribed to by a healthcare provider comprises accessing a cached list of rules subscribed to by a healthcare provider. 
     
     
         17 . The method of  claim 14 , wherein the method further includes a step of receiving update information regarding a list of rules subscribed to by a healthcare provider, and updating the cached list of rules. 
     
     
         18 . A method for facilitating the real-time provision of recommendations to a health care provider, comprising the steps of:
 (a) electronically receiving, at a server component loaded on one or more electronic devices from an electronic health records application, a call to evaluate rules associated with healthcare provision;   (b) determining, at a manager component loaded on one or more electronic devices, a list of rules subscribed to by a healthcare provider;   (c) electronically communicating, by the manager component, the list of rules to the server component;   (d) grouping, by the server component, rules of the list of rules into one or more groups based on a respective rule agent necessary to evaluate the rules;   (e) communicating, by the server component, a first group of rules to be evaluated to a first rule agent;   (f) receiving, at the first rule agent, the first group of rules;   (g) automatically determining a first set of specific healthcare information necessary to evaluate the rules in the first group, all of the determined specific healthcare information being necessary to evaluate one or more of the rules in the first group such that the determined specific healthcare information is the minimum possible set of specific healthcare information necessary to evaluate the rules in the first group;   (h) receiving, at the first rule agent, the first set of specific healthcare information necessary to evaluate the rules in the first group;   (i) evaluating, at the first rule agent, the rules in the first group of rules utilizing the received first set of specific healthcare information;   (j) communicating, by the first rule agent to the server component, one or more results based on the evaluation of the rules in the first group, the one or more results comprising one or more recommendations;   (k) receiving, at the electronic health records application, the one or more recommendations and displaying, to a user at an electronic display via the electronic health records application, text corresponding to one of the one or more recommendations.   
     
     
         19 . The method of  claim 18 , wherein the method further comprises the step of communicating, by the server component, a second group of rules to a second rule agent. 
     
     
         20 . The method of  claim 19 , wherein the method further comprises the steps of:
 (a) receiving, at the second rule agent, the second group of rules;   (b) automatically determining a second set of specific healthcare information necessary to evaluate the rules in the second group, all of the determined specific healthcare information being necessary to evaluate one or more of the rules in the second group such that the determined specific healthcare information is the minimum possible set of specific healthcare information necessary to evaluate the rules in the second group;   (c) receiving, at the second rule agent, the second set of specific healthcare information necessary to evaluate the rules in the second group;   (d) evaluating, at the second rule agent, the rules in the second group of rules utilizing the received second set of specific healthcare information; and   (e) communicating, by the second rule agent to the server component, one or more results based on the evaluation of the rules in the second group, the one or more results comprising one or more recommendations.   
     
     
         21 - 60 . (canceled)