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WO2015055598A1 - System and method for adaptation of telehealth content using unstructured patient input - Google Patents

System and method for adaptation of telehealth content using unstructured patient input Download PDF

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Publication number
WO2015055598A1
WO2015055598A1 PCT/EP2014/071930 EP2014071930W WO2015055598A1 WO 2015055598 A1 WO2015055598 A1 WO 2015055598A1 EP 2014071930 W EP2014071930 W EP 2014071930W WO 2015055598 A1 WO2015055598 A1 WO 2015055598A1
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WO
WIPO (PCT)
Prior art keywords
telehealth
patient
response
service
pressure
Prior art date
Application number
PCT/EP2014/071930
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French (fr)
Inventor
Caio Soares
Original Assignee
Robert Bosch Gmbh
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Publication date
Application filed by Robert Bosch Gmbh filed Critical Robert Bosch Gmbh
Publication of WO2015055598A1 publication Critical patent/WO2015055598A1/en

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    • GPHYSICS
    • G16INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
    • G16HHEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
    • G16H10/00ICT specially adapted for the handling or processing of patient-related medical or healthcare data
    • G16H10/20ICT specially adapted for the handling or processing of patient-related medical or healthcare data for electronic clinical trials or questionnaires

Definitions

  • This patent relates generally to the fields of medical information and patient management, and, more particularly, to methods and systems for adapting survey questions that are presented to patients in a telehealth system.
  • telehealth and home healthcare have experienced strong growth in recent years.
  • a patient is geographically removed from the presence of a doctor or other healthcare provider.
  • the patient could be at home instead of on site at a healthcare facility.
  • Telehealth devices enable the healthcare provider to monitor the health status of a patient and potentially diagnose and treat some medical problems without the need for the patient to travel to the healthcare facility.
  • the use of telehealth systems has the potential to reduce the cost of healthcare, and to improve the quality of healthcare through increased patient monitoring.
  • Various known telehealth systems provide a device to a patient that enables the patient to transmit medical data to a doctor or healthcare provider. Some devices are configured to record biosignals, such as heart rate, blood pressure, and respiration rates, and transmit data of the recorded biosignals to a database for later review. Other telehealth systems enable remote visits between a patient and a healthcare provider and also provide real time medical data to the provider during the visits. Many systems provide a combination of these and other telehealth technologies. [0004] Some telehealth systems also present a series of survey questions to a patient on a regular basis to obtain additional medical information from the patient. The questions are typically tailored to previously diagnosed medical conditions for the patient.
  • a telehealth device presents a series of multiple choice questions to a diabetic patient that focus on the treatment and symptoms that are associated with diabetes.
  • the telehealth system presents a series of yes or no questions to the patient.
  • the questions are relevant to known diabetic symptoms (e.g. "Do you feel tingling or numbness in your fingers or toes?").
  • the patient enters a response to each survey question using an input device that is associated with the telehealth system, and the telehealth device transmits the survey responses, in addition to other biomedical data pertaining to the patient, to a telehealth analysis system that performs automated analysis of the telehealth information and presents the information to doctors or other healthcare professionals.
  • the telehealth device presents survey questions to the patient in either a non-adaptive or pseudo-adaptive manner.
  • Non-adaptive questions refer to a series of predetermined survey questions that do not change in an automated manner.
  • a doctor may select different sets of survey questions if the patient is diagnosed with a different medical condition, but the telehealth system does not otherwise alter the survey questions.
  • the telehealth system stores a set of predetermined questions in a decision- tree or other suitable hierarchical format.
  • the patient enters responses to yes/no and other multiple choice survey questions.
  • the telehealth device selects additional predetermined survey questions to present to the patient based on the responses to earlier questions in the survey.
  • a telehealth device For example, a telehealth device generates a first survey question that asks if the patient is experiencing numbness or tingling in the extremities. If the patient answers in the affirmative, then the telehealth device selects another predetermined question that asks if the patient is having difficulty walking. If, however, the patient answers in the negative, then the telehealth device presents a different set of survey questions to the patient.
  • a method of adapting telehealth treatment using survey responses from a patient includes generating with an output device in a telehealth device a free-response question for a patient, receiving with the telehealth device a response text from the patient corresponding to the free -response question, transmitting the response text from the telehealth device to a telehealth service, identifying with the telehealth service at least one medically relevant term in the response text, identifying a survey question stored in a memory associated with the telehealth service that corresponds to the identified medically relevant term, transmitting the identified survey question from the telehealth service to the telehealth device, and generating the identified survey question for the patient with the output device in the telehealth device.
  • a method for identifying a condition of a patient with a telehealth system includes generating with an output device in a telehealth device a free-response question for a patient, receiving with the telehealth device a portion of a response text from the patient corresponding to the free-response question, transmitting with the telehealth device the portion of the response text from the patient to a telehealth service in response to the telehealth device not receiving a remaining portion of the response text from the patient within a predetermined time period, identifying with the telehealth service at least one medically relevant term in the portion of the response text received from the telehealth device, and transmitting with the telehealth service a message to a terminal associated with a healthcare provider in response to the at least one medically relevant term indicating a symptom for the patient.
  • a method for identifying a condition of a patient with a telehealth system includes generating with an output device in a telehealth device a plurality of questions for a patient, generating with a pressure sensitive input device associated with the telehealth device a plurality of signals in response to a plurality of input gestures from the patient to generate a plurality of responses to the plurality of questions, identifying with the telehealth device a plurality of pressure levels corresponding to the plurality of input gestures with reference to the plurality of signals generated by the pressure sensitive input device, transmitting with the telehealth device data corresponding to the plurality of pressure levels to a telehealth service, and transmitting with the telehealth service a message to a terminal associated with a healthcare professional in response to the plurality of pressure levels being different from a predetermined input pressure profile associated with the patient by more than a predetermined threshold.
  • a method for identifying a condition of a patient with a telehealth system includes generating with an output device in a telehealth device a plurality of questions for a patient, generating with an acoustic pressure sensitive input device associated with the telehealth device a plurality of signals from the patient to generate a plurality of acoustic responses to the plurality of questions, identifying with the telehealth device a plurality of pressure levels corresponding to the plurality of acoustic responses with reference to the plurality of signals generated by the acoustic pressure sensitive input device, transmitting with the telehealth device data corresponding to the plurality of pressure levels to a telehealth service, and transmitting with the telehealth service a message to a terminal associated with a healthcare professional in response to the plurality of pressure levels being different from a predetermined input pressure profile associated with the patient by more than a predetermined threshold.
  • FIG. 1 is a schematic diagram of a telehealth system.
  • FIG. 2 is a block diagram of a process for free-response input and survey question adaptation in the telehealth system of FIG. 1.
  • FIG. 3 is a block diagram of a process for free-response input and identification of patient condition from partially entered input in the telehealth system of FIG. 1.
  • FIG. 4 is a block diagram of a process for gesture input and analysis of input gesture pressure in the telehealth system of FIG. 1.
  • telehealth refers to a form of medicine in which a patient and healthcare provider electronically communicate with one other to enable the patient, who is not located in the healthcare provider's facility, to receive medical treatment from the healthcare provider.
  • telehealth device or “telehealth device” are used interchangeably herein and refer to any device that is configured to electronically transmit and/or receive data pertaining to a telehealth treatment received by a patient from a healthcare provider practicing telehealth on the patient.
  • a telehealth device is one example of a more general category of medical devices, which include any device having diagnostic and/or therapeutic uses, such as respirators, pace makers, blood sugar testing devices, inhalators, heart monitors, and the like.
  • the telehealth device can be a non-medical device, such as electronic wearable mountable device (eye- wear, contact lens, watches, wrist band, neck- wear, necklace, head- wear, foot-wear, gloves, socks, biomaterial thin film attachments/pads, and garments), game console, mobile device, and the like, which include functions having diagnostic and/or therapeutic uses. While the specific embodiments described herein are directed to telehealth devices, the systems and methods described herein are also suitable for use with a wide variety of medical devices. [0017] FIG. 1 depicts a telehealth system 100 that includes a telehealth device 104, a remote telehealth service 108, and a healthcare provider terminal 160.
  • a patient 116 uses the telehealth device 104 to input answers to telehealth survey questions.
  • the telehealth device 104 forwards the answers to the telehealth survey questions for the patient 116, along with optional medical monitoring data from one or more medical monitoring device, to the telehealth service 108.
  • the telehealth device 104 transfers the answers to survey questions to the telehealth service 108 using, for example, a wired or wireless Internet connection or other suitable data network connection.
  • the telehealth service 108 also sends messages regarding the medical condition of the patient 116 to the healthcare provider terminal 160 for review by a healthcare professional 124.
  • the healthcare provider terminal 160 is a personal computer (PC), mobile electronic device, or any other suitable electronic communication device that enables the healthcare professional 124 to receive messages from the telehealth service 108 and optionally access medical record data for the patient 116 that are stored in the telehealth service memory 146. While FIG. 1 depicts a single telehealth device 104 and patient 116 for illustrative purposes, the telehealth service 108 typically provides service to multiple patients who are each provided with a telehealth device.
  • PC personal computer
  • mobile electronic device or any other suitable electronic communication device that enables the healthcare professional 124 to receive messages from the telehealth service 108 and optionally access medical record data for the patient 116 that are stored in the telehealth service memory 146. While FIG. 1 depicts a single telehealth device 104 and patient 116 for illustrative purposes, the telehealth service 108 typically provides service to multiple patients who are each provided with a telehealth device.
  • the telehealth service 108 is implemented using one or more server computing devices that perform content and decision support services in the system 100.
  • the telehealth service 108 includes one or more telehealth service processors 150, a memory 146, and a network device 142.
  • the telehealth service processor 150 is typically a microprocessor that includes one or more computing cores, and in some embodiments the telehealth service 108 employs a cluster of multiple computing devices with multiple processors 150 to handle communication with a large number of the telehealth devices 104.
  • the memory 146 includes both random access memory (RAM) and non-volatile data storage devices such as solid-state memory and magnetic storage devices.
  • the memory 146 stores databases that contain the medical records and telehealth data for one or more patients, such as the patient 116, a database telehealth survey questions, a database of medically relevant terms that are included in some responses to telehealth survey questions, and other relevant information to the operation of the telehealth system 100 including an association between a patient and the terminals 160 for one or more healthcare providers 124 who review medical data for the patient 116.
  • the network device 142 implements a network transmission scheme such as Ethernet that enables bidirectional communication between the telehealth service 108 and either or both of the telehealth device 104 and healthcare provider terminal 160 through a data network 106.
  • the term "content” refers to the telehealth survey questions or other health advice information that is presented to the patient 116 through the telehealth device 104.
  • the telehealth service 108 stores content in the memory 146 and transmits different sets of telehealth survey questions and other telehealth content to the telehealth device 104.
  • the term “decision support” refers to the information that the telehealth service 108 presents to doctors or other healthcare professionals based on the telehealth data that the patient 116 sends to the telehealth service 108 using the telehealth device 104 and other medical records stored in the patient medical records database.
  • “decision support” refers to any decision made with regards to what content is presented to the patient 116, when it is presented, and in what form.
  • the telehealth service 108 includes a database of health survey questions, and a database of patient information that includes medical records, patient symptom history, and a history of previous survey responses for the patient 116.
  • the telehealth device 104 typically only receives a subset of the survey questions from the telehealth service 108.
  • the telehealth device 104 receives survey questions that focus on the diagnosed medical conditions for the patient 116, and optionally receives general health-related questions that are generic to a large group of patients.
  • the telehealth service 108 identifies additional survey questions for the patient 116 from the text of the free-response input from the patient 116 to adapt the survey questions to the changing health conditions and symptoms of the patient 116.
  • the telehealth device 104 is a computing device or wearable device that includes an output device, such as a graphical monitor, graphical screen, graphical lens, or an audio output device, which provides telehealth information and presents telehealth survey questions to the patient 116.
  • the telehealth device 104 receives the telehealth information, including survey questions, from the telehealth service 108 and optionally stores the information in memory.
  • the telehealth device 104 also includes one or more input devices that enable the patient 116 to enter answers to telehealth survey questions.
  • the input devices include, for example, physical or touch-screen keyboards, digital pen-input devices for handwritten text, and microphones that record speech from the patient 116 for later conversion to text data. Other input devices such as eye-trackers that record movement or reflex of the patient's eye are incorporated into other embodiments of the telehealth device 104.
  • the telehealth device 104 includes a telehealth device processor 128, network device 132, memory 136, and one or more input/output (I/O) devices 140.
  • the telehealth device processor 128 is a microprocessor, microcontroller, or any other suitable digital processing device that executes stored program instructions to carry out the functions of the telehealth device 104.
  • the network device 132 is any network device that enables bidirectional communication between the telehealth device 104 and the telehealth service 108 through a communication network 106.
  • the communication network 106 is, for example, a local area network (LAN), wide area network (WAN), a public switched telephone network (PSTN), or a wireless cellular network.
  • Examples of network devices include wired network devices such as Ethernet adapters and analog modems or wireless networking devices including IEEE 802.11 wireless LAN transceivers, Bluetooth transceivers, 3G and 4G wireless WAN transceivers, LTE transceivers, XLTE transceivers, and the like.
  • the memory 136 includes both volatile random access memory (RAM) and non-volatile data storage devices such as solid-state memory devices, or magnetic and optical data storage devices.
  • the memory 136 stores programmed instructions for the telehealth device processor 128 and stores the contents of telehealth survey questions, stores input data from the patient 116, and optionally stores other medical data and treatment data for the patient 116.
  • the I/O devices 140 include a pressure sensitive input device, such as a capacitive touchpad or touchscreen interface, that receives tactile input gestures from the patient 116 in response to telehealth survey questions.
  • Input gestures include any tactile input that the user 116 applies to the pressure sensitive input device 140 to enter a response to telehealth survey question
  • the patient 116 presses icons or alphanumeric virtual keys on a touchscreen to provide gesture inputs.
  • the patient 116 moves two or more fingers across the surface of the pressure sensitive input device 140 to produce an input gesture, such as a drag-and-drop, swipe, zoom, un-zoom, or handwriting gesture.
  • the patient 116 uses a stylus or other implement to provide the input instead of using a finger or other appendage directly.
  • the input device 140 During operation, the input device 140 generates signals that correspond to gestures received from the patient 116.
  • the telehealth device processor 128 identifies survey response inputs based on the signals from the input device 140. As described in more detail in FIG. 4, the telehealth processor 128 is further configured to identify the pressure levels that the patient 116 applies to the pressure sensitive input device 140 based on the pressure signals that the input device 140 produces during operation. For example, in some capacitive touch sensor embodiments, the relative capacitance levels of different regions of the capacitive touch sensor change based on a level of pressure that the patient 116 applies to the touch sensor device with one or more fingers or a stylus.
  • the capacitive touch sensor measures the changes in capacitance levels either directly or indirectly and generates an output signal that corresponds to both the location of the contact for the input gesture and the pressure levels that are applied during the gesture.
  • Telehealth device processor 128 receives the pressure level signals from the pressure sensitive I/O device 140 and identifies the level of pressure from the patient 116. The telehealth device processor 128 also identifies the location of the input gestures in association with particular icons or virtual keys that the patient 116 selects to provide responses to telehealth survey questions.
  • FIG. 2 depicts a process 200 for operation of a telehealth system to identify medically relevant information about a patient in the responses to free-response questions and to modify telehealth survey questions for the patient based on the contents of the answers to free-response questions.
  • a reference to the process 200 performing an action or function refers to the execution of stored program instructions by one or more processors in a telehealth system to perform the function or action.
  • the process 200 is described in conjunction with the telehealth system 100 of FIG. 1 for illustrative purposes.
  • the telehealth device 104 presents predetermined survey questions to the patient 116, and the patient 116 enters responses to the predetermined questions in a similar manner to existing telehealth systems.
  • the telehealth device 104 generates one or more free -response questions and presents the free -response questions to the patient 116 (block 204).
  • the telehealth device 104 first presents a series of multiple choice or yes/no questions to the patient 116.
  • the predetermined questions in the survey focus on specific symptoms or activities that are associated with the diagnosed medical conditions for the patient 116.
  • the telehealth device 104 presents broader free-response questions about the overall state of health for the patient.
  • the free-response questions elicit a broader range of unstructured inputs from the patient 116 that are not easily captured in survey questions that are presented in a multiple choice answer format.
  • the telehealth device 104 receives responses to the free-response question from the patient 116 (block 208).
  • the telehealth device includes a physical keyboard or touch-screen virtual keyboard, and the patient 116 types in responses to the free -response questions.
  • the patient 116 provides a verbal response to the question and a microphone in the telehealth device 104 records audio data of the response.
  • the telehealth device 104 or the telehealth service 108 convert the audio of the response to text using speech-to-text processes that are known to the art.
  • the patient 116 provides visual response to the question and the eye-tracker in the telehealth device 104 records visual data of the response.
  • the telehealth device 104 or the telehealth service 108 convert the visual signal of the response to text using visual-to-text processes.
  • the telehealth device 104 transmits the responses to the survey questions, including the free -response questions, to the telehealth service 108 for storage with the medical records associated with the patient 116 (block 212).
  • the telehealth device 104 transmits the responses using the network device 132 through the network 106, and the telehealth service 108 receives the responses with the network device 142.
  • the telehealth service 108 receives the survey response data from the telehealth device 104 and stores the responses in the patient database in the memory 146 in association with the patient 116.
  • the telehealth service 108 receives the free-response data from the telehealth device 104 and performs additional processing of the free -response text to identify potential symptoms or questions that can be addressed with a different set of survey questions in a subsequent survey.
  • the telehealth service 108 parses the free-response text to identify medically relevant terms in the response (block 216).
  • the telehealth service 108 stores a database of medically relevant terms in the memory 146 and identifies terms in the free -response text that are also in the medical term database.
  • the medical terms database also includes predetermined associations between medically relevant terms and symptoms or medical conditions to identify if the medically relevant terms correspond to unreported symptoms or a change in the severity of previously observed symptoms for the patient 116.
  • the medically relevant terms can also include terms that are also used in some survey questions that the patient 116 has not received during previous medical surveys. Since the patient 116 is often not trained in medical terminology, the telehealth service 108 optionally performs spell checking and synonymizes the free -response text with medically relevant terms using a thesaurus or other linguistic analysis techniques.
  • the telehealth service 108 identifies survey questions with a high degree of relevance to the medically relevant terms in the free-response data from the telehealth device 104. In one embodiment, the telehealth service 108 identifies the frequency of the medically relevant terms in the free -response text and identifies survey questions that include the medically relevant terms. In this embodiment, the telehealth service 108 assigns a greater relevance to survey questions that corresponding to two or more medically relevant terms from the free-response text. The telehealth service 108 selects one or more of the medical survey questions with the greatest relevance to the medically relevant terms in the free -response text and transmits the survey questions to the telehealth device 104 for use in subsequent surveys (block 220).
  • the patient 116 answers the follow-up survey questions, which focus on the symptoms or other information that the patient 116 identified in the previous free -response questions.
  • the new survey questions are included with the existing predetermined survey questions and continuing free -response questions during subsequent surveys.
  • the telehealth system 100 generates adapted content and sends the adapted content to the telehealth device 104 for the patient 116 using the free-response question responses from the patient 116 as the basis to identify new survey questions.
  • the telehealth service 108 optionally identifies stored medical advice or other health information that corresponds to the medically relevant terms in the free-response text.
  • the telehealth service 108 identifies that the free-response input from the patient 116 describes a previously unreported symptom for the patient 116 (block 224).
  • the telehealth service 108 optionally transmits a message to the terminal 160 to alert a doctor or other healthcare professional to a potential change in the condition of the patient 116 if the free- response text indicates that the patient 116 has experienced previously unreported symptoms.
  • the telehealth service 108 identifies a previously unreported symptom in response to identifying a symptom with reference to the medically relevant terms in the free -response text and identifying that the symptom is not present in the medical records of the patient 116 stored in the medical record database 146.
  • the message includes the text of the free -response input from the patient 116 and a description of the previously unreported symptom that the processor 150 in the telehealth service 108 identifies with reference to the medically relevant terms in the free-response input.
  • the message also includes the medical records for the patient 116 from the medical records database 146 to the terminal 160, while in other embodiments the healthcare professional 124 uses the terminal 160 to request the patient medical records from the telehealth service 108 after receiving the message.
  • FIG. 3 depicts another process 300 for operating a telehealth system to identify if a patient is experiencing symptoms based on partial answers to free -response questions.
  • a reference to the process 300 performing an action or function refers to the execution of stored program instructions by one or more processors in a telehealth system to perform the function or action.
  • the process 300 is described in conjunction with the telehealth system 100 of FIG. 1 for illustrative purposes.
  • Process 300 begins as the telehealth device 104 generates at least one free-response question for the patient 116 (block 304).
  • the telehealth device 104 generates the free -response question for the patient 116 in a similar manner as described above in the processing of block 204 in FIG. 2.
  • the processor 128 in the telehealth device 104 starts a timer when the telehealth device 104 presents the free-response question to the patient 116 and begins to receive input for a response to the question (block 308).
  • the processor 128 resets the timer whenever the patient 116 enters another portion of the response, such as a word or individual letter.
  • the processor 128 operates countdown timer that provides a limited time for the patient 116 to enter a response to the free-response question.
  • the telehealth device 104 transmits the complete response to the telehealth service 108 (block 316).
  • the telehealth device 104 generates a graphical display with the I/O device 140 that presents the free-response question and provides a text-input field for the patient 116 to type in a text response using a virtual keyboard on a touchscreen or physical keyboard device.
  • the patient 116 presses a control element such as a "ENTER”, “SEND”, or “SUBMIT”, button to indicate that the telehealth device 104 has received the complete response.
  • the telehealth device 104 transmits the completed response to the telehealth service 108, and the telehealth service processor 150 stores the response in association with the medical record data for the patient 116 in the memory 146.
  • the patient 116 does not enter the complete response to the free- response question within the predetermined timeout period (block 312). For example, in some situations the patient 116 is distracted after entering a portion of a response and fails to complete the full response. In other situations, the patient 116 may experience symptoms of a medical condition and only enters a partial response before the timer in the telehealth device 104 expires.
  • the telehealth terminal 104 transmits the portion of the response text that is received from the patient 116 to the telehealth service 108 (block 320).
  • the telehealth system 108 receives the portion of the response text from the telehealth device 104 and identifies if the portion of the response has any medically relevant terms that indicate the patient 116 is experiencing symptoms of a medical condition (block 324).
  • a portion of a response text includes the terms "KNEE HURTS”.
  • the telehealth service processor 150 identifies the medically relevant terms in the portion of the response that is received from the telehealth device 104, and identifies that the terms refer to a symptom.
  • KNEE is an anatomical term
  • HURTS is one way of expressing a pain symptom in the partial response from the patient 116.
  • partial responses do not include medically relevant terms or include medically relevant terms but do not indicate that the patient 116 is experiencing symptoms.
  • a partial response of "OK” includes no medically relevant terms
  • another partial response of "TOOK MEDICINE” includes a medically relevant term (“MEDICINE”) but does not describe a symptom.
  • the telehealth service 108 processes the partial response text to identify medically relevant terms and symptoms in a similar manner to the processing that is performed in block 216 of the process 200.
  • the telehealth service 108 transmits a message to the healthcare provider terminal 160 corresponding to the partial message from the patient 116 (block 332).
  • the telehealth service 108 transmits the portion of the response text that is received from the telehealth device 104 and a description of the identified symptom to the telehealth terminal 160.
  • the healthcare professional 124 reviews the message and optionally operates the terminal 160 to retrieve additional medical records for the patient 116 from the memory 146 in the telehealth service 108.
  • the healthcare professional 124 can contact the patient 116 or update the course of telehealth treatment to focus on the symptoms in the partial response.
  • the telehealth service 108 identifies that the portion of the response text does not include a medically relevant term or does not indicate that the patient 116 is experiencing a symptom (block 328)
  • the telehealth service 108 discards the portion of the response text received in the partial response and the telehealth device 104 presents the free- response question to the patient 116 again at a later time after the expiration of the predetermined timeout period (block 336).
  • the telehealth service 108 discards partial responses that do not include medically relevant terms or that do not identify symptoms since these partial responses are often provided when the patient 116 is otherwise occupied and does not complete the response.
  • the telehealth system 100 discards the partial responses that do not include medically relevant terms that identify symptoms to improve the accuracy of recorded responses that the telehealth service 108 stores with the medical records for the patient 116.
  • FIG. 4 depicts another process 400 for operating a telehealth system to identify if a patient is experiencing symptoms based on pressure levels for touch input gestures that the patient 116 uses to respond to telehealth survey questions.
  • a reference to the process 400 performing an action or function refers to the execution of stored program instructions by one or more processors in a telehealth system to perform the function or action.
  • the process 400 is described in conjunction with the telehealth system 100 of FIG. 1 with embodiments of the telehealth device 104 that include a pressure sensitive input device 140 for illustrative purposes.
  • Process 400 begins during a training process as the telehealth device 104 generates touch input prompts for the patient 116 (block 404).
  • the telehealth device 104 generates both structured questions for the patient 116 that have a predetermined set of possible responses (e.g. multiple choice and true or false questions) as well as free-response questions. More generally, the telehealth device receives touch input gestures for the patient 116 in response to any request for patient input including telehealth questions or requests for general patient information.
  • the patient 116 uses the pressure sensitive touch input device 140 to provide responses to the questions and the telehealth device processor 128 identifies pressure levels for the input gestures (block 408).
  • the processor 128 receives a voltage signal or other suitable signal from the pressure sensitive touch input device 140 that corresponds to the level of pressure applied during the input gestures from the patient 116.
  • the pressure sensitive input device is a capacitive touch sensor that is embodied at a touchpad or as a touchscreen interface.
  • the processor 128 receives signals from the capacitive touch sensor corresponding to changes in capacitance that correspond to the level of pressure that the patient 116 applies when entering input gestures.
  • the telehealth service processor 150 updates an input pressure profile that is associated with the patient 116 based on the identified pressure levels (block 412).
  • the telehealth terminal 104 transmits either identified pressure levels that are received from the pressure sensitive I/O device 140 to the telehealth service 108 or the telehealth terminal 104 generates statistical information about a series of input gestures and transmits only the statistical information to the telehealth service 108.
  • the term "input pressure profile" refers to one or more data records corresponding to observed pressure levels that the pressure sensitive I/O device 140 receives from the patient 116 during operation of the telehealth device 104.
  • the pressure profile is a record of pressure levels that are observed during some or all of the input gestures that the telehealth device 104 receives during operation. Since a single gesture often includes a range of measured pressure levels, the telehealth terminal 104 identifies the maximum pressure level during the gesture in one configuration or an average pressure level that is observed during the gesture in another configuration. In another embodiment, the pressure profile includes statistical data including, but not limited to, the maximum pressure level, minimum pressure level, average pressure level, standard deviation of pressure levels, and variance of pressure levels, that the patient 116 applies during multiple input gestures. The telehealth service 108 updates the input pressure profile that is stored in the memory 146 in association with medical record and other data associated with the patient 116.
  • the process 400 continues in an iterative manner with the processing of blocks 404 - 412 in a training process until the telehealth service 108 has received sufficient input pressure data to generate the input pressure profile (block 416).
  • the telehealth terminal 104 generates specific requests for input from the patient 116 to generate the input pressure data for the input pressure profile while in other embodiments the telehealth terminal 104 and the telehealth service 108 perform the training process when the patient 116 performs touch input gestures in response to telehealth survey questions.
  • the telehealth system 100 generates the input pressure profile as a predetermined profile of the range of input pressures that are expected from the patient 116. As described in more detail below, the telehealth system 100 identifies if the input pressure levels from the patient 116 differ from the predetermined input pressure profile and generates a message to alert a healthcare professional to changes in input pressure.
  • Process 400 continues after the telehealth system 100 has generated the input pressure profile for the patient 116 as the telehealth device 104 generates telehealth survey questions for the patient 116 (block 420).
  • the patient 116 provides input gestures to response to the questions using the pressure sensitive I/O device 140 and the telehealth device processor 128 identifies the pressure levels associated with the input gestures (block 424).
  • the telehealth terminal 104 uses the network device 132 to transmit data corresponding to the identified input pressure levels and the responses to the telehealth survey questions to the telehealth service 108 through the network 106 (block 428).
  • the telehealth device 104 transmits a data record for each input pressure level that is observed during each gesture as the patient 116 responds to a series of telehealth survey questions while in another configuration the telehealth device 104 generates statistical information (e.g. maximum, minimum, average, standard deviation, variance) about the identified input pressure levels and transmits the statistical information to the telehealth service 108.
  • the telehealth service processor 150 generates the statistical input pressure information with reference to the input pressure level data that are received from the telehealth terminal 104.
  • the telehealth terminal 104 performs a filtering process to remove unusually high or low input pressure levels prior to transmission of the input pressure data to the telehealth service 108.
  • the telehealth device 104 removes the maximum pressure identified pressure and the minimum identified pressure level prior to transmission of the pressure level data or generation of statistical data for the identified pressure levels.
  • the filtering process removes outlier pressure level samples to enable the telehealth system 100 to
  • the telehealth service 108 identifies if the input pressure data that are received from the telehealth terminal 104 differ from the predetermined input pressure profile for the patient 116 by more than a predetermined threshold (block 432). In one embodiment, the telehealth service 104 identifies a difference between a first average pressure level in the predetermined pressure profile that is stored in the memory 146 and a second average pressure level in the input pressure data that are received from the telehealth device 104. In another embodiment, the telehealth service 108 identifies a difference between a first standard deviation or variance in pressure levels that are received from the telehealth device 104 and the
  • the telehealth service 108 transmits a message to the healthcare provider terminal 160 to inform the healthcare provider 124 of the abnormal input pressure levels (block 436).
  • a large difference between the most recently observed input pressure levels and the predetermined input pressure levels in the input pressure level profile can be indicative of a medical symptom.
  • the telehealth service 108 transmits a message to the healthcare provider terminal 160 that indicates the unusual input pressure levels, such as if the input pressure levels are unusually high or low, and optionally transmits the survey response data to the healthcare provider terminal 160.
  • the healthcare provider 124 reviews the message with the telehealth survey information and optionally retrieves additional medical record data for the patient 116 from the telehealth service 108 to determine if the patient 116 is experiencing symptoms that cause the unusual input pressure levels during operation of the telehealth terminal 104.
  • the telehealth service 108 optionally updates the predetermined input pressure profile for the patient 116 with reference to the data corresponding to the identified input pressure levels from the telehealth device 104 (block 440).
  • the telehealth service 108 updates the input pressure profile for the patient 116 to account for gradual changes in the input pressure level that the patient 116 applies to the pressure sensitive I/O device 140 over time. For example, as a patient recovers from a surgery, the average input pressure level may increase over time as the patient regains strength.
  • the telehealth service 108 adapts to gradual changes in input pressure and generates the messages for the healthcare providers in response to large and sudden changes in input pressure.
  • the patient 116 provides a verbal response to the question and a microphone in the telehealth device 104 records audio data of the response as described earlier in FIG. 2, the acoustic signal impinge on the microphone, e.g. on the movable diaphragm (not shown) within the microphone thereby causes the diaphragm to vibrate.
  • the magnitude of the output varies depending on the acoustic pressure impinged on the diaphragm.
  • the telehealth system 100 receives electrical signals from the microphone that correspond to the pressure levels produced in the microphone in response to the plurality of acoustic responses from the patient, and the telehealth system 100 identifies if the pressure levels are unusually high or low to determine if the patient 116 is experiencing symptoms. For example, if the pressure levels that are produced from the acoustic responses from the patient either differ from or below a predetermined pressure profile, the system generates a message to alert a healthcare professional the status of the patient. The status includes abnormal pressure level, health issues. Other information may be included in the message such as help-assistance.

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Abstract

A method for adapting telehealth information for a patient includes presenting a free-response question to a patient and receiving a response text with a telehealth device, transmitting the response text to a telehealth service, identifying at least one medically relevant term in the response text corresponding to a survey question stored in a memory associated with the telehealth service, and transmitting the identified survey question back to the telehealth device for presentation to the patient.

Description

SYSTEM AND METHOD FOR ADAPTATION OF TELEHEALTH CONTENT USING
UNSTRUCTURED PATIENT INPUT
TECHNICAL FIELD
[0001 ] This patent relates generally to the fields of medical information and patient management, and, more particularly, to methods and systems for adapting survey questions that are presented to patients in a telehealth system.
BACKGROUND
[0002] The fields of telehealth and home healthcare have experienced strong growth in recent years. In a telehealth system, a patient is geographically removed from the presence of a doctor or other healthcare provider. For example, the patient could be at home instead of on site at a healthcare facility. Telehealth devices enable the healthcare provider to monitor the health status of a patient and potentially diagnose and treat some medical problems without the need for the patient to travel to the healthcare facility. The use of telehealth systems has the potential to reduce the cost of healthcare, and to improve the quality of healthcare through increased patient monitoring.
[0003] Various known telehealth systems provide a device to a patient that enables the patient to transmit medical data to a doctor or healthcare provider. Some devices are configured to record biosignals, such as heart rate, blood pressure, and respiration rates, and transmit data of the recorded biosignals to a database for later review. Other telehealth systems enable remote visits between a patient and a healthcare provider and also provide real time medical data to the provider during the visits. Many systems provide a combination of these and other telehealth technologies. [0004] Some telehealth systems also present a series of survey questions to a patient on a regular basis to obtain additional medical information from the patient. The questions are typically tailored to previously diagnosed medical conditions for the patient. For example, a telehealth device presents a series of multiple choice questions to a diabetic patient that focus on the treatment and symptoms that are associated with diabetes. In one embodiment, the telehealth system presents a series of yes or no questions to the patient. The questions are relevant to known diabetic symptoms (e.g. "Do you feel tingling or numbness in your fingers or toes?"). The patient enters a response to each survey question using an input device that is associated with the telehealth system, and the telehealth device transmits the survey responses, in addition to other biomedical data pertaining to the patient, to a telehealth analysis system that performs automated analysis of the telehealth information and presents the information to doctors or other healthcare professionals.
[0005] In existing telehealth systems, the telehealth device presents survey questions to the patient in either a non-adaptive or pseudo-adaptive manner. Non-adaptive questions refer to a series of predetermined survey questions that do not change in an automated manner. A doctor may select different sets of survey questions if the patient is diagnosed with a different medical condition, but the telehealth system does not otherwise alter the survey questions. In a pseudo- adaptive embodiment, the telehealth system stores a set of predetermined questions in a decision- tree or other suitable hierarchical format. In the decision-tree embodiment, the patient enters responses to yes/no and other multiple choice survey questions. The telehealth device then selects additional predetermined survey questions to present to the patient based on the responses to earlier questions in the survey. For example, a telehealth device generates a first survey question that asks if the patient is experiencing numbness or tingling in the extremities. If the patient answers in the affirmative, then the telehealth device selects another predetermined question that asks if the patient is having difficulty walking. If, however, the patient answers in the negative, then the telehealth device presents a different set of survey questions to the patient.
[0006] While the survey questions that existing telehealth systems present to patients provide useful information about previously diagnosed medical conditions, the patient may experience new symptoms during the course of medical treatment that are not easily captured by the existing survey questions. For example, if a patient experiences a new symptom that is not covered in the predetermined survey questions, then the telehealth system cannot identify the presence of the new symptom and update the survey questions accordingly. Consequently, improvements to telehealth systems that enable adaptation of survey questions to improve the accuracy of patient health monitoring would be beneficial.
SUMMARY
[0007] In one embodiment, a method of adapting telehealth treatment using survey responses from a patient has been developed. The method includes generating with an output device in a telehealth device a free-response question for a patient, receiving with the telehealth device a response text from the patient corresponding to the free -response question, transmitting the response text from the telehealth device to a telehealth service, identifying with the telehealth service at least one medically relevant term in the response text, identifying a survey question stored in a memory associated with the telehealth service that corresponds to the identified medically relevant term, transmitting the identified survey question from the telehealth service to the telehealth device, and generating the identified survey question for the patient with the output device in the telehealth device. [0008] In another embodiment, a method for identifying a condition of a patient with a telehealth system has been developed. The method includes generating with an output device in a telehealth device a free-response question for a patient, receiving with the telehealth device a portion of a response text from the patient corresponding to the free-response question, transmitting with the telehealth device the portion of the response text from the patient to a telehealth service in response to the telehealth device not receiving a remaining portion of the response text from the patient within a predetermined time period, identifying with the telehealth service at least one medically relevant term in the portion of the response text received from the telehealth device, and transmitting with the telehealth service a message to a terminal associated with a healthcare provider in response to the at least one medically relevant term indicating a symptom for the patient.
[0009] In another embodiment, a method for identifying a condition of a patient with a telehealth system has been developed. The method includes generating with an output device in a telehealth device a plurality of questions for a patient, generating with a pressure sensitive input device associated with the telehealth device a plurality of signals in response to a plurality of input gestures from the patient to generate a plurality of responses to the plurality of questions, identifying with the telehealth device a plurality of pressure levels corresponding to the plurality of input gestures with reference to the plurality of signals generated by the pressure sensitive input device, transmitting with the telehealth device data corresponding to the plurality of pressure levels to a telehealth service, and transmitting with the telehealth service a message to a terminal associated with a healthcare professional in response to the plurality of pressure levels being different from a predetermined input pressure profile associated with the patient by more than a predetermined threshold. [0010] In another embodiment, a method for identifying a condition of a patient with a telehealth system has been developed. The method includes generating with an output device in a telehealth device a plurality of questions for a patient, generating with an acoustic pressure sensitive input device associated with the telehealth device a plurality of signals from the patient to generate a plurality of acoustic responses to the plurality of questions, identifying with the telehealth device a plurality of pressure levels corresponding to the plurality of acoustic responses with reference to the plurality of signals generated by the acoustic pressure sensitive input device, transmitting with the telehealth device data corresponding to the plurality of pressure levels to a telehealth service, and transmitting with the telehealth service a message to a terminal associated with a healthcare professional in response to the plurality of pressure levels being different from a predetermined input pressure profile associated with the patient by more than a predetermined threshold.
BRIEF DESCRIPTION OF THE DRAWINGS
[0011 ] FIG. 1 is a schematic diagram of a telehealth system.
[0012] FIG. 2 is a block diagram of a process for free-response input and survey question adaptation in the telehealth system of FIG. 1.
[0013] FIG. 3 is a block diagram of a process for free-response input and identification of patient condition from partially entered input in the telehealth system of FIG. 1.
[0014] FIG. 4 is a block diagram of a process for gesture input and analysis of input gesture pressure in the telehealth system of FIG. 1. DETAILED DESCRIPTION
[0015] For the purposes of promoting an understanding of the principles of the embodiments described herein, reference is now be made to the drawings and descriptions in the following written specification. No limitation to the scope of the subject matter is intended by the references. This patent also includes any alterations and modifications to the illustrated embodiments and includes further applications of the principles of the described embodiments as would normally occur to one skilled in the art to which this document pertains.
[0016] The term "telehealth" as used herein refers to a form of medicine in which a patient and healthcare provider electronically communicate with one other to enable the patient, who is not located in the healthcare provider's facility, to receive medical treatment from the healthcare provider. The terms "telehealth device" or "telehealth device" are used interchangeably herein and refer to any device that is configured to electronically transmit and/or receive data pertaining to a telehealth treatment received by a patient from a healthcare provider practicing telehealth on the patient. A telehealth device is one example of a more general category of medical devices, which include any device having diagnostic and/or therapeutic uses, such as respirators, pace makers, blood sugar testing devices, inhalators, heart monitors, and the like. The telehealth device can be a non-medical device, such as electronic wearable mountable device (eye- wear, contact lens, watches, wrist band, neck- wear, necklace, head- wear, foot-wear, gloves, socks, biomaterial thin film attachments/pads, and garments), game console, mobile device, and the like, which include functions having diagnostic and/or therapeutic uses. While the specific embodiments described herein are directed to telehealth devices, the systems and methods described herein are also suitable for use with a wide variety of medical devices. [0017] FIG. 1 depicts a telehealth system 100 that includes a telehealth device 104, a remote telehealth service 108, and a healthcare provider terminal 160. In the system 100, a patient 116 uses the telehealth device 104 to input answers to telehealth survey questions. The telehealth device 104 forwards the answers to the telehealth survey questions for the patient 116, along with optional medical monitoring data from one or more medical monitoring device, to the telehealth service 108. The telehealth device 104 transfers the answers to survey questions to the telehealth service 108 using, for example, a wired or wireless Internet connection or other suitable data network connection. The telehealth service 108 also sends messages regarding the medical condition of the patient 116 to the healthcare provider terminal 160 for review by a healthcare professional 124. The healthcare provider terminal 160 is a personal computer (PC), mobile electronic device, or any other suitable electronic communication device that enables the healthcare professional 124 to receive messages from the telehealth service 108 and optionally access medical record data for the patient 116 that are stored in the telehealth service memory 146. While FIG. 1 depicts a single telehealth device 104 and patient 116 for illustrative purposes, the telehealth service 108 typically provides service to multiple patients who are each provided with a telehealth device.
[0018] In the system 100, the telehealth service 108 is implemented using one or more server computing devices that perform content and decision support services in the system 100. In the illustrative embodiment of FIG. 1, the telehealth service 108 includes one or more telehealth service processors 150, a memory 146, and a network device 142. The telehealth service processor 150 is typically a microprocessor that includes one or more computing cores, and in some embodiments the telehealth service 108 employs a cluster of multiple computing devices with multiple processors 150 to handle communication with a large number of the telehealth devices 104. The memory 146 includes both random access memory (RAM) and non-volatile data storage devices such as solid-state memory and magnetic storage devices. The memory 146 stores databases that contain the medical records and telehealth data for one or more patients, such as the patient 116, a database telehealth survey questions, a database of medically relevant terms that are included in some responses to telehealth survey questions, and other relevant information to the operation of the telehealth system 100 including an association between a patient and the terminals 160 for one or more healthcare providers 124 who review medical data for the patient 116. The network device 142 implements a network transmission scheme such as Ethernet that enables bidirectional communication between the telehealth service 108 and either or both of the telehealth device 104 and healthcare provider terminal 160 through a data network 106.
[0019] The term "content" refers to the telehealth survey questions or other health advice information that is presented to the patient 116 through the telehealth device 104. The telehealth service 108 stores content in the memory 146 and transmits different sets of telehealth survey questions and other telehealth content to the telehealth device 104. The term "decision support" refers to the information that the telehealth service 108 presents to doctors or other healthcare professionals based on the telehealth data that the patient 116 sends to the telehealth service 108 using the telehealth device 104 and other medical records stored in the patient medical records database. In addition, "decision support" refers to any decision made with regards to what content is presented to the patient 116, when it is presented, and in what form. The telehealth service 108 includes a database of health survey questions, and a database of patient information that includes medical records, patient symptom history, and a history of previous survey responses for the patient 116. The telehealth device 104 typically only receives a subset of the survey questions from the telehealth service 108. The telehealth device 104 receives survey questions that focus on the diagnosed medical conditions for the patient 116, and optionally receives general health-related questions that are generic to a large group of patients. As described below, the telehealth service 108 identifies additional survey questions for the patient 116 from the text of the free-response input from the patient 116 to adapt the survey questions to the changing health conditions and symptoms of the patient 116.
[0020] In the system 100, the telehealth device 104 is a computing device or wearable device that includes an output device, such as a graphical monitor, graphical screen, graphical lens, or an audio output device, which provides telehealth information and presents telehealth survey questions to the patient 116. The telehealth device 104 receives the telehealth information, including survey questions, from the telehealth service 108 and optionally stores the information in memory. The telehealth device 104 also includes one or more input devices that enable the patient 116 to enter answers to telehealth survey questions. The input devices include, for example, physical or touch-screen keyboards, digital pen-input devices for handwritten text, and microphones that record speech from the patient 116 for later conversion to text data. Other input devices such as eye-trackers that record movement or reflex of the patient's eye are incorporated into other embodiments of the telehealth device 104.
[0021 ] In the illustrative embodiment of FIG. 1, the telehealth device 104 includes a telehealth device processor 128, network device 132, memory 136, and one or more input/output (I/O) devices 140. The telehealth device processor 128 is a microprocessor, microcontroller, or any other suitable digital processing device that executes stored program instructions to carry out the functions of the telehealth device 104. The network device 132 is any network device that enables bidirectional communication between the telehealth device 104 and the telehealth service 108 through a communication network 106. The communication network 106 is, for example, a local area network (LAN), wide area network (WAN), a public switched telephone network (PSTN), or a wireless cellular network. Examples of network devices include wired network devices such as Ethernet adapters and analog modems or wireless networking devices including IEEE 802.11 wireless LAN transceivers, Bluetooth transceivers, 3G and 4G wireless WAN transceivers, LTE transceivers, XLTE transceivers, and the like. The memory 136 includes both volatile random access memory (RAM) and non-volatile data storage devices such as solid-state memory devices, or magnetic and optical data storage devices. In the embodiment of the system 100, the memory 136 stores programmed instructions for the telehealth device processor 128 and stores the contents of telehealth survey questions, stores input data from the patient 116, and optionally stores other medical data and treatment data for the patient 116.
[0022] The I/O devices 140 include a pressure sensitive input device, such as a capacitive touchpad or touchscreen interface, that receives tactile input gestures from the patient 116 in response to telehealth survey questions. Input gestures include any tactile input that the user 116 applies to the pressure sensitive input device 140 to enter a response to telehealth survey question For example, in one configuration the patient 116 presses icons or alphanumeric virtual keys on a touchscreen to provide gesture inputs. In other configurations, the patient 116 moves two or more fingers across the surface of the pressure sensitive input device 140 to produce an input gesture, such as a drag-and-drop, swipe, zoom, un-zoom, or handwriting gesture. In some embodiments, the patient 116 uses a stylus or other implement to provide the input instead of using a finger or other appendage directly.
[0023] During operation, the input device 140 generates signals that correspond to gestures received from the patient 116. The telehealth device processor 128 identifies survey response inputs based on the signals from the input device 140. As described in more detail in FIG. 4, the telehealth processor 128 is further configured to identify the pressure levels that the patient 116 applies to the pressure sensitive input device 140 based on the pressure signals that the input device 140 produces during operation. For example, in some capacitive touch sensor embodiments, the relative capacitance levels of different regions of the capacitive touch sensor change based on a level of pressure that the patient 116 applies to the touch sensor device with one or more fingers or a stylus. The capacitive touch sensor measures the changes in capacitance levels either directly or indirectly and generates an output signal that corresponds to both the location of the contact for the input gesture and the pressure levels that are applied during the gesture. Telehealth device processor 128 receives the pressure level signals from the pressure sensitive I/O device 140 and identifies the level of pressure from the patient 116. The telehealth device processor 128 also identifies the location of the input gestures in association with particular icons or virtual keys that the patient 116 selects to provide responses to telehealth survey questions.
[0024] FIG. 2 depicts a process 200 for operation of a telehealth system to identify medically relevant information about a patient in the responses to free-response questions and to modify telehealth survey questions for the patient based on the contents of the answers to free-response questions. In the discussion below, a reference to the process 200 performing an action or function refers to the execution of stored program instructions by one or more processors in a telehealth system to perform the function or action. The process 200 is described in conjunction with the telehealth system 100 of FIG. 1 for illustrative purposes.
[0025] During process 200, the telehealth device 104 presents predetermined survey questions to the patient 116, and the patient 116 enters responses to the predetermined questions in a similar manner to existing telehealth systems. The telehealth device 104 generates one or more free -response questions and presents the free -response questions to the patient 116 (block 204). In one embodiment, the telehealth device 104 first presents a series of multiple choice or yes/no questions to the patient 116. The predetermined questions in the survey focus on specific symptoms or activities that are associated with the diagnosed medical conditions for the patient 116. At the end of the survey, the telehealth device 104 presents broader free-response questions about the overall state of health for the patient. The following are examples of free-response questions: "Please describe any pain you have felt recently;" or "Please describe any unusual symptoms you have felt recently." The free-response questions elicit a broader range of unstructured inputs from the patient 116 that are not easily captured in survey questions that are presented in a multiple choice answer format.
[0026] During process 200, the telehealth device 104 receives responses to the free-response question from the patient 116 (block 208). In one configuration, the telehealth device includes a physical keyboard or touch-screen virtual keyboard, and the patient 116 types in responses to the free -response questions. In another embodiment, the patient 116 provides a verbal response to the question and a microphone in the telehealth device 104 records audio data of the response. The telehealth device 104 or the telehealth service 108 convert the audio of the response to text using speech-to-text processes that are known to the art. In yet another embodiment, the patient 116 provides visual response to the question and the eye-tracker in the telehealth device 104 records visual data of the response. The telehealth device 104 or the telehealth service 108 convert the visual signal of the response to text using visual-to-text processes.
[0027] The telehealth device 104 transmits the responses to the survey questions, including the free -response questions, to the telehealth service 108 for storage with the medical records associated with the patient 116 (block 212). In the system 100, the telehealth device 104 transmits the responses using the network device 132 through the network 106, and the telehealth service 108 receives the responses with the network device 142. The telehealth service 108 receives the survey response data from the telehealth device 104 and stores the responses in the patient database in the memory 146 in association with the patient 116.
[0028] During the process 200, the telehealth service 108 receives the free-response data from the telehealth device 104 and performs additional processing of the free -response text to identify potential symptoms or questions that can be addressed with a different set of survey questions in a subsequent survey. The telehealth service 108 parses the free-response text to identify medically relevant terms in the response (block 216). In one configuration, the telehealth service 108 stores a database of medically relevant terms in the memory 146 and identifies terms in the free -response text that are also in the medical term database. In some embodiments the medical terms database also includes predetermined associations between medically relevant terms and symptoms or medical conditions to identify if the medically relevant terms correspond to unreported symptoms or a change in the severity of previously observed symptoms for the patient 116. The medically relevant terms can also include terms that are also used in some survey questions that the patient 116 has not received during previous medical surveys. Since the patient 116 is often not trained in medical terminology, the telehealth service 108 optionally performs spell checking and synonymizes the free -response text with medically relevant terms using a thesaurus or other linguistic analysis techniques.
[0029] The telehealth service 108 identifies survey questions with a high degree of relevance to the medically relevant terms in the free-response data from the telehealth device 104. In one embodiment, the telehealth service 108 identifies the frequency of the medically relevant terms in the free -response text and identifies survey questions that include the medically relevant terms. In this embodiment, the telehealth service 108 assigns a greater relevance to survey questions that corresponding to two or more medically relevant terms from the free-response text. The telehealth service 108 selects one or more of the medical survey questions with the greatest relevance to the medically relevant terms in the free -response text and transmits the survey questions to the telehealth device 104 for use in subsequent surveys (block 220).
[0030] During subsequent surveys, the patient 116 answers the follow-up survey questions, which focus on the symptoms or other information that the patient 116 identified in the previous free -response questions. The new survey questions are included with the existing predetermined survey questions and continuing free -response questions during subsequent surveys. Thus, the telehealth system 100 generates adapted content and sends the adapted content to the telehealth device 104 for the patient 116 using the free-response question responses from the patient 116 as the basis to identify new survey questions. In addition to survey questions, the telehealth service 108 optionally identifies stored medical advice or other health information that corresponds to the medically relevant terms in the free-response text.
[0031 ] In some instances, the telehealth service 108 identifies that the free-response input from the patient 116 describes a previously unreported symptom for the patient 116 (block 224). The telehealth service 108 optionally transmits a message to the terminal 160 to alert a doctor or other healthcare professional to a potential change in the condition of the patient 116 if the free- response text indicates that the patient 116 has experienced previously unreported symptoms. The telehealth service 108 identifies a previously unreported symptom in response to identifying a symptom with reference to the medically relevant terms in the free -response text and identifying that the symptom is not present in the medical records of the patient 116 stored in the medical record database 146. In the embodiment of FIG. 1, the message includes the text of the free -response input from the patient 116 and a description of the previously unreported symptom that the processor 150 in the telehealth service 108 identifies with reference to the medically relevant terms in the free-response input. In some embodiments, the message also includes the medical records for the patient 116 from the medical records database 146 to the terminal 160, while in other embodiments the healthcare professional 124 uses the terminal 160 to request the patient medical records from the telehealth service 108 after receiving the message.
[0032] FIG. 3 depicts another process 300 for operating a telehealth system to identify if a patient is experiencing symptoms based on partial answers to free -response questions. In the discussion below, a reference to the process 300 performing an action or function refers to the execution of stored program instructions by one or more processors in a telehealth system to perform the function or action. The process 300 is described in conjunction with the telehealth system 100 of FIG. 1 for illustrative purposes.
[0033] Process 300 begins as the telehealth device 104 generates at least one free-response question for the patient 116 (block 304). The telehealth device 104 generates the free -response question for the patient 116 in a similar manner as described above in the processing of block 204 in FIG. 2. During process 300, the processor 128 in the telehealth device 104 starts a timer when the telehealth device 104 presents the free-response question to the patient 116 and begins to receive input for a response to the question (block 308). In one configuration, the processor 128 resets the timer whenever the patient 116 enters another portion of the response, such as a word or individual letter. In other embodiments, the processor 128 operates countdown timer that provides a limited time for the patient 116 to enter a response to the free-response question. [0034] During process 300, if the patient enters a complete response within a predetermined timeout period (block 312) then the telehealth device 104 transmits the complete response to the telehealth service 108 (block 316). For example, in one embodiment the telehealth device 104 generates a graphical display with the I/O device 140 that presents the free-response question and provides a text-input field for the patient 116 to type in a text response using a virtual keyboard on a touchscreen or physical keyboard device. The patient 116 presses a control element such as a "ENTER", "SEND", or "SUBMIT", button to indicate that the telehealth device 104 has received the complete response. The telehealth device 104 transmits the completed response to the telehealth service 108, and the telehealth service processor 150 stores the response in association with the medical record data for the patient 116 in the memory 146.
[0035] Under some conditions, the patient 116 does not enter the complete response to the free- response question within the predetermined timeout period (block 312). For example, in some situations the patient 116 is distracted after entering a portion of a response and fails to complete the full response. In other situations, the patient 116 may experience symptoms of a medical condition and only enters a partial response before the timer in the telehealth device 104 expires. During process 300, the telehealth terminal 104 transmits the portion of the response text that is received from the patient 116 to the telehealth service 108 (block 320). The telehealth system 108 receives the portion of the response text from the telehealth device 104 and identifies if the portion of the response has any medically relevant terms that indicate the patient 116 is experiencing symptoms of a medical condition (block 324). For example, a portion of a response text includes the terms "KNEE HURTS". The telehealth service processor 150 identifies the medically relevant terms in the portion of the response that is received from the telehealth device 104, and identifies that the terms refer to a symptom. For example, "KNEE" is an anatomical term and "HURTS" is one way of expressing a pain symptom in the partial response from the patient 116. Some partial responses do not include medically relevant terms or include medically relevant terms but do not indicate that the patient 116 is experiencing symptoms. For example, a partial response of "OK" includes no medically relevant terms, and another partial response of "TOOK MEDICINE" includes a medically relevant term ("MEDICINE") but does not describe a symptom. The telehealth service 108 processes the partial response text to identify medically relevant terms and symptoms in a similar manner to the processing that is performed in block 216 of the process 200.
[0036] If the telehealth service identifies that the contents of the portion of the response text include both medically relevant terms and indicate that the patient 116 is experiencing a symptom (block 328) then the telehealth service 108 transmits a message to the healthcare provider terminal 160 corresponding to the partial message from the patient 116 (block 332). In the embodiment of FIG. 1, the telehealth service 108 transmits the portion of the response text that is received from the telehealth device 104 and a description of the identified symptom to the telehealth terminal 160. The healthcare professional 124 reviews the message and optionally operates the terminal 160 to retrieve additional medical records for the patient 116 from the memory 146 in the telehealth service 108. Depending upon the nature of the message and the medical history of the patient 116, the healthcare professional 124 can contact the patient 116 or update the course of telehealth treatment to focus on the symptoms in the partial response.
[0037] During process 300, if the telehealth service 108 either identifies that the portion of the response text does not include a medically relevant term or does not indicate that the patient 116 is experiencing a symptom (block 328), then the telehealth service 108 discards the portion of the response text received in the partial response and the telehealth device 104 presents the free- response question to the patient 116 again at a later time after the expiration of the predetermined timeout period (block 336). The telehealth service 108 discards partial responses that do not include medically relevant terms or that do not identify symptoms since these partial responses are often provided when the patient 116 is otherwise occupied and does not complete the response. The telehealth system 100 discards the partial responses that do not include medically relevant terms that identify symptoms to improve the accuracy of recorded responses that the telehealth service 108 stores with the medical records for the patient 116.
[0038] FIG. 4 depicts another process 400 for operating a telehealth system to identify if a patient is experiencing symptoms based on pressure levels for touch input gestures that the patient 116 uses to respond to telehealth survey questions. In the discussion below, a reference to the process 400 performing an action or function refers to the execution of stored program instructions by one or more processors in a telehealth system to perform the function or action. The process 400 is described in conjunction with the telehealth system 100 of FIG. 1 with embodiments of the telehealth device 104 that include a pressure sensitive input device 140 for illustrative purposes.
[0039] Process 400 begins during a training process as the telehealth device 104 generates touch input prompts for the patient 116 (block 404). During process 400, the telehealth device 104 generates both structured questions for the patient 116 that have a predetermined set of possible responses (e.g. multiple choice and true or false questions) as well as free-response questions. More generally, the telehealth device receives touch input gestures for the patient 116 in response to any request for patient input including telehealth questions or requests for general patient information. The patient 116 uses the pressure sensitive touch input device 140 to provide responses to the questions and the telehealth device processor 128 identifies pressure levels for the input gestures (block 408). In the telehealth device 104, the processor 128 receives a voltage signal or other suitable signal from the pressure sensitive touch input device 140 that corresponds to the level of pressure applied during the input gestures from the patient 116. As described above, in one embodiment the pressure sensitive input device is a capacitive touch sensor that is embodied at a touchpad or as a touchscreen interface. The processor 128 receives signals from the capacitive touch sensor corresponding to changes in capacitance that correspond to the level of pressure that the patient 116 applies when entering input gestures.
[0040] In the system 100, the telehealth service processor 150 updates an input pressure profile that is associated with the patient 116 based on the identified pressure levels (block 412). The telehealth terminal 104 transmits either identified pressure levels that are received from the pressure sensitive I/O device 140 to the telehealth service 108 or the telehealth terminal 104 generates statistical information about a series of input gestures and transmits only the statistical information to the telehealth service 108. As used herein, the term "input pressure profile" refers to one or more data records corresponding to observed pressure levels that the pressure sensitive I/O device 140 receives from the patient 116 during operation of the telehealth device 104. In one embodiment, the pressure profile is a record of pressure levels that are observed during some or all of the input gestures that the telehealth device 104 receives during operation. Since a single gesture often includes a range of measured pressure levels, the telehealth terminal 104 identifies the maximum pressure level during the gesture in one configuration or an average pressure level that is observed during the gesture in another configuration. In another embodiment, the pressure profile includes statistical data including, but not limited to, the maximum pressure level, minimum pressure level, average pressure level, standard deviation of pressure levels, and variance of pressure levels, that the patient 116 applies during multiple input gestures. The telehealth service 108 updates the input pressure profile that is stored in the memory 146 in association with medical record and other data associated with the patient 116.
[0041 ] The process 400 continues in an iterative manner with the processing of blocks 404 - 412 in a training process until the telehealth service 108 has received sufficient input pressure data to generate the input pressure profile (block 416). In some embodiments the telehealth terminal 104 generates specific requests for input from the patient 116 to generate the input pressure data for the input pressure profile while in other embodiments the telehealth terminal 104 and the telehealth service 108 perform the training process when the patient 116 performs touch input gestures in response to telehealth survey questions. The telehealth system 100 generates the input pressure profile as a predetermined profile of the range of input pressures that are expected from the patient 116. As described in more detail below, the telehealth system 100 identifies if the input pressure levels from the patient 116 differ from the predetermined input pressure profile and generates a message to alert a healthcare professional to changes in input pressure.
[0042] Process 400 continues after the telehealth system 100 has generated the input pressure profile for the patient 116 as the telehealth device 104 generates telehealth survey questions for the patient 116 (block 420). The patient 116 provides input gestures to response to the questions using the pressure sensitive I/O device 140 and the telehealth device processor 128 identifies the pressure levels associated with the input gestures (block 424).
[0043] The telehealth terminal 104 uses the network device 132 to transmit data corresponding to the identified input pressure levels and the responses to the telehealth survey questions to the telehealth service 108 through the network 106 (block 428). In one configuration, the telehealth device 104 transmits a data record for each input pressure level that is observed during each gesture as the patient 116 responds to a series of telehealth survey questions while in another configuration the telehealth device 104 generates statistical information (e.g. maximum, minimum, average, standard deviation, variance) about the identified input pressure levels and transmits the statistical information to the telehealth service 108. In another embodiment, the telehealth service processor 150 generates the statistical input pressure information with reference to the input pressure level data that are received from the telehealth terminal 104. In some embodiments, the telehealth terminal 104 performs a filtering process to remove unusually high or low input pressure levels prior to transmission of the input pressure data to the telehealth service 108. For example, in one embodiment the telehealth device 104 removes the maximum pressure identified pressure and the minimum identified pressure level prior to transmission of the pressure level data or generation of statistical data for the identified pressure levels. The filtering process removes outlier pressure level samples to enable the telehealth system 100 to
[0044] During process 400, the telehealth service 108 identifies if the input pressure data that are received from the telehealth terminal 104 differ from the predetermined input pressure profile for the patient 116 by more than a predetermined threshold (block 432). In one embodiment, the telehealth service 104 identifies a difference between a first average pressure level in the predetermined pressure profile that is stored in the memory 146 and a second average pressure level in the input pressure data that are received from the telehealth device 104. In another embodiment, the telehealth service 108 identifies a difference between a first standard deviation or variance in pressure levels that are received from the telehealth device 104 and the
corresponding second standard deviation or variance in the input pressure profile for the patient 116. [0045] If the difference between the first and second pressure levels exceeds a predetermined threshold, then the telehealth service 108 transmits a message to the healthcare provider terminal 160 to inform the healthcare provider 124 of the abnormal input pressure levels (block 436). A large difference between the most recently observed input pressure levels and the predetermined input pressure levels in the input pressure level profile can be indicative of a medical symptom. The telehealth service 108 transmits a message to the healthcare provider terminal 160 that indicates the unusual input pressure levels, such as if the input pressure levels are unusually high or low, and optionally transmits the survey response data to the healthcare provider terminal 160. The healthcare provider 124 reviews the message with the telehealth survey information and optionally retrieves additional medical record data for the patient 116 from the telehealth service 108 to determine if the patient 116 is experiencing symptoms that cause the unusual input pressure levels during operation of the telehealth terminal 104.
[0046] If the difference between the first and second pressure levels does not exceed the predetermined threshold, then the telehealth service 108 optionally updates the predetermined input pressure profile for the patient 116 with reference to the data corresponding to the identified input pressure levels from the telehealth device 104 (block 440). The telehealth service 108 updates the input pressure profile for the patient 116 to account for gradual changes in the input pressure level that the patient 116 applies to the pressure sensitive I/O device 140 over time. For example, as a patient recovers from a surgery, the average input pressure level may increase over time as the patient regains strength. The telehealth service 108 adapts to gradual changes in input pressure and generates the messages for the healthcare providers in response to large and sudden changes in input pressure. [0047] In other embodiment, the patient 116 provides a verbal response to the question and a microphone in the telehealth device 104 records audio data of the response as described earlier in FIG. 2, the acoustic signal impinge on the microphone, e.g. on the movable diaphragm (not shown) within the microphone thereby causes the diaphragm to vibrate. The magnitude of the output varies depending on the acoustic pressure impinged on the diaphragm. The telehealth system 100 receives electrical signals from the microphone that correspond to the pressure levels produced in the microphone in response to the plurality of acoustic responses from the patient, and the telehealth system 100 identifies if the pressure levels are unusually high or low to determine if the patient 116 is experiencing symptoms. For example, if the pressure levels that are produced from the acoustic responses from the patient either differ from or below a predetermined pressure profile, the system generates a message to alert a healthcare professional the status of the patient. The status includes abnormal pressure level, health issues. Other information may be included in the message such as help-assistance.
[0048] It will be appreciated that variants of the above-described and other features and functions, or alternatives thereof, may be desirably combined into many other different systems, applications or methods. Various presently unforeseen or unanticipated alternatives,
modifications, variations or improvements may be subsequently made by those skilled in the art that are also intended to be encompassed by the following embodiment.

Claims

What is claimed is:
1. A method for modifying and adapting telehealth treatment comprising: generating with an output device in a telehealth device a free-response question for a patient; receiving with the telehealth device a response text from the patient corresponding to the free -response question; transmitting the response text from the telehealth device to a telehealth service; identifying with the telehealth service at least one medically relevant term in the response text; identifying a survey question stored in a memory associated with the telehealth service that corresponds to the identified medically relevant term; transmitting the identified survey question from the telehealth service to the telehealth device; and generating the identified survey question for the patient with the output device in the telehealth device.
2. The method of claim 1 further comprising: identifying with the telehealth service a symptom for the patient with reference to the at least one medically relevant term in the response text; and transmitting with the telehealth service a message to a terminal associated with a healthcare provider in response to the symptom for the patient not being present in medical record data stored in the memory of the telehealth service.
3. The method of claim 2, the transmission of the message further comprising: transmitting with the telehealth service the response text and a description of the symptom to the terminal associated with the healthcare provider.
4. A method for identifying a condition of a patient with a telehealth system comprising: generating with an output device in a telehealth device a free-response question for a patient; receiving with the telehealth device a portion of a response text from the patient corresponding to the free-response question; transmitting with the telehealth device the portion of the response text from the patient to a telehealth service in response to the telehealth device not receiving a remaining portion of the response text from the patient within a predetermined time period; identifying with the telehealth service at least one medically relevant term in the portion of the response text received from the telehealth device; and transmitting with the telehealth service a message to a terminal associated with a healthcare provider in response to the at least one medically relevant term indicating a symptom for the patient.
5. The method of claim 4, the transmission of the message further comprising: transmitting with the telehealth service the message including the portion of the response text and a description of the symptom to the terminal.
6. The method of claim 4 further comprising: discarding the portion of the response text with the telehealth service in response to the portion of the response text including no medically relevant terms; and generating with the output device in the telehealth device the free-response question for the patient after the predetermined time period to receive another response from the patient.
7. A method for identifying a condition of a patient with a telehealth system comprising: generating with an output device in a telehealth device a plurality of questions for a patient; generating with a pressure sensitive input device associated with the telehealth device a plurality of signals in response to a plurality of input gestures from the patient to generate a plurality of responses to the plurality of questions; identifying with the telehealth device a plurality of pressure levels corresponding to the plurality of input gestures with reference to the plurality of signals generated by the pressure sensitive input device; transmitting with the telehealth device data corresponding to the plurality of pressure levels to a telehealth service; and transmitting with the telehealth service a message to a terminal associated with a healthcare professional in response to the plurality of pressure levels being different from a predetermined input pressure profile associated with the patient by more than a predetermined threshold.
8. The method of claim 7 further comprising:
transmitting with the telehealth device the plurality of responses to the telehealth service; and transmitting with the telehealth service the message to the terminal associated with the healthcare professional including the plurality of responses.
9. The method of claim 7 wherein the pressure sensitive input device is a capacitive touch sensor.
10. The method of claim 7 further comprising: identifying with the telehealth service an average pressure level of the plurality of input gestures with reference to the data corresponding to the plurality of pressure levels received from the telehealth device; and transmitting with the telehealth service the message to the terminal associated with a healthcare professional in response to the average pressure level being greater than a
predetermined average pressure level for the patient in the predetermined input pressure profile by more than the predetermined threshold.
11. The method of claim 7 further comprising: identifying with the telehealth service an average pressure level of the plurality of input gestures with reference to the data corresponding to the plurality of pressure levels received from the telehealth device; and transmitting with the telehealth service the message to the terminal associated with a healthcare professional in response to the average pressure level being less than a predetermined average pressure level for the patient in the predetermined input pressure profile by more than the predetermined threshold.
12. The method of claim 7 further comprising: identifying with the telehealth device a maximum pressure level and a minimum pressure level in the plurality of pressure levels; and transmitting with telehealth device the data corresponding to the plurality of pressure levels without the maximum pressure level and the minimum pressure level.
13. The method of claim 7 further comprising:
updating the predetermined input pressure profile associated with the patient in the telehealth service to include the data corresponding to the plurality of pressure levels received from the telehealth device in response to the plurality of pressure levels not being different from the predetermined input pressure profile associated with the patient by more than the
predetermined threshold.
14. A method for identifying a condition of a patient with a telehealth system comprising: generating with an output device in a telehealth device a plurality of questions for a patient; generating with an acoustic pressure sensitive input device associated with the telehealth device a plurality of signals from the patient to generate a plurality of acoustic responses to the plurality of questions; identifying with the telehealth device a plurality of pressure levels corresponding to the plurality of acoustic responses with reference to the plurality of signals generated by the acoustic pressure sensitive input device; transmitting with the telehealth device data corresponding to the plurality of pressure levels to a telehealth service; and transmitting with the telehealth service a message to a terminal associated with a healthcare professional in response to the plurality of pressure levels being different from a predetermined input pressure profile associated with the patient by more than a predetermined threshold.
PCT/EP2014/071930 2013-10-17 2014-10-13 System and method for adaptation of telehealth content using unstructured patient input WO2015055598A1 (en)

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Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2002009004A1 (en) * 2000-07-21 2002-01-31 Surromed, Inc. Computerized clinical questionnaire with dynamically presented questions
US20060184393A1 (en) * 2004-12-29 2006-08-17 Ewin Leon H Online medical data collection
US20120165618A1 (en) * 2010-12-22 2012-06-28 Richard Algoo Method and apparatus for health avatar

Patent Citations (3)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
WO2002009004A1 (en) * 2000-07-21 2002-01-31 Surromed, Inc. Computerized clinical questionnaire with dynamically presented questions
US20060184393A1 (en) * 2004-12-29 2006-08-17 Ewin Leon H Online medical data collection
US20120165618A1 (en) * 2010-12-22 2012-06-28 Richard Algoo Method and apparatus for health avatar

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