System and Method for a Patient-Specific and Optimization of Medical Therapy by Simultaneous Symbolic Reasoning in All Clinical Dimensions

Abstract

A particular system and methodology by which a drug or medical therapy regimen is defined for any particular patient in a manner that takes not only a drug or therapy's effectiveness into account, but also an entire spectrum of relevant clinical dimensions so as minimize the possibility of harmful interactions while simultaneously maximizing pharmacotherapy potential. Furthermore, as a consequence of its construction, no medically relevant rule can be overlooked by the reasoning system. The system and methodology utilizes a computerized dimensional indexing system implementing multiple databases and performs therapeutic determinations by symbolic structural reasoning with respect to database elemental indices.

1 . A computerized method for providing multidimensional medical decision support, the method comprising:
 defining, in a database associated with a data processing system, a set of input variables for a patient being evaluated, each input variable associated to a corresponding relevant clinical dimension for establishing a diagnosis for a patient, each clinical dimension being a chief complaint and one or more of a history of present illness, a past medical history, a past surgical history, a family history, a social history, a medication, an allergy, a review of symptoms, a vital sign, a physical exam and a diagnostic test;   defining, in a second database associated with a data processing system, interdimensional relationships between and among the relevant clinical dimensions so as to define a plurality of interaction relationships comprising at least:
 (1) drug-drug interaction relationships, 
 (2) drug-disease interaction relationships, and 
 (3) drug-allergy testing interaction relationships; 
   entering, into the data processing system, particular values for the input variables in the course of examining a patient;   topologically mapping the inter-relationships between and among the relevant clinical dimensions;   assigning a severity score to each mapped association between and among the clinical dimensions so as to define a strength of each mapped association;   defining a set of output variables for a patient being evaluated, each output variable associated to a corresponding relevant intervention action for establishing a treatment regime for a patient;   wherein the interaction relationships identified to the physician automatically inform an intervention action in accordance with the existence and strength of a mapped association between clinical dimensions; and   automatically identifying, by the data processing system, particular ones of the plurality of interaction relationships specific to the particular patient being examined, wherein the particular ones of the interaction relationships are ranked according to the identified interdimensional relationships and identified to a physician during the course of the examination.   
     
     
         2 . The method according to  claim 1 , further comprising:
 selecting at least a portion of the set of input variables from the group of relevant clinical dimensions consisting of a current complaint dimension, a medical history dimension, a surgical history dimension, a current medications dimension, a laboratory results dimension, a social history dimension, and a family history dimension.   
     
     
         3 . The method according to  claim 2 , further comprising:
 selecting at least an additional portion of the set of input variables from the group of relevant clinical dimensions consisting of a diagnostic test findings dimension, a vital signs dimension, a physical examination findings dimension, and a diagnostic possibility dimension.   
     
     
         4 .- 5 . (canceled) 
     
     
         6 . The method according to  claim 1 , wherein the relevant intervention actions are selected from the group consisting of counseling, pharmacotherapy, procedural intervention, diagnostic testing, and specialist referral. 
     
     
         7 . The method according to  claim 6 , wherein the chief complaint dimension defines a differential diagnosis selected from a recognized standardized medical reference of clinically relevant diagnoses. 
     
     
         8 . The method according to  claim 7 , wherein the recognized standardized medical reference comprises the ICD9. 
     
     
         9 . The method according to  claim 8 , wherein ICD9 or equivalent disease codes are automatically entered into an electronic patient medical record. 
     
     
         10 . A method for developing an effective medical treatment/therapy regimen for a patient, the method comprising:
 establishing a clinically relevant diagnosis for the patient, the diagnosis relevant to the patient's chief complaint;   querying a database for a preferred intervention action established on the basis of the clinically relevant diagnosis;   receiving a set of recommended intervention actions, the actions ranked in order of preference for treatment of the condition indicated by the clinically relevant diagnosis;   analyzing the number and order of recommended intervention actions in accordance with a set of clinical decision support dimensions; and   adjusting the set of recommended intervention actions, the adjusted actions numbered and ranked in order of preference for treatment of the condition indicated by the clinically relevant diagnosis, as modified by relationships between and among the clinical decision support dimensions.   
     
     
         11 . The method according to  claim 10 , wherein at least a portion of the clinical decision support dimensions are selected from the group consisting of a current complaint dimension, a medical history dimension, a surgical history dimension, a current medications dimension, a current allergies dimension, a social history dimension, a demographic/family history dimension, a diagnostic test findings dimension, a vital signs dimension, a physical examination findings dimension, and a diagnostic possibility dimension. 
     
     
         12 . The method according to  claim 11 , wherein the relationships between and among the clinical decision support dimensions include at least a drug-drug interaction relationship, a drug-disease interaction relationship, and a drug-allergy interaction relationship. 
     
     
         13 . The method according to  claim 12 , wherein the recommended intervention action comprises a pharmacotherapy regime, the method further comprising:
 developing an initial list of effective medications on the basis of the condition situs in combination with a demographic/family history dimension;   stratify the initial list of effective medications on the basis of sensitivity to causative mechanism;   evaluate each medication for contraindications on the basis of co-existing disease, co-existing medications, co-existing allergies, and co-existing diagnostic test results;   exclude any medications having said contraindications; and   automatically developing a final, optimal list of effective medications.   
     
     
         14 . The method according to  claim 13 , wherein each of the clinical decision support dimensions are specific to a particular patient and maintained in a database associated to that patient. 
     
     
         15 . The method according to  claim 14 , wherein the recommended intervention actions are selected from the group consisting of a counseling program, pharmacotherapy, surgical therapy, diagnostic testing, and specialist referral.