Monday, April 07, 2008

Personal Health Profiler™: Part 1

In these next series of posts, I’m going to delve into the details of a truly next-generation personal health record (PHR); well, it's actually, more like a personal health knowledge system. As I discussed in my last post, one key component of a better healthcare system is a very cost-efficient and easy-to-use way to gain and use valid knowledge to improve outcomes and control costs. This is where I've been focusing much of my professional life for almost three decades. I'm now going to write about a paradigm-busting software technology I've been developing over this period. Some may see this as self-serving, but my deepest hope is to develop good collaborative relationships and help bring social good. First, some background.

Twenty-seven years ago, I began a career as a licensed clinical psychologist. That same year, 1981, was also the time that the personal computer (PC) became available and I was intrigued. As I began learning about computers, the power of spreadsheet software caught my attention. I wondered if there was a way to use spreadsheet technology to manage patient information in a way that would:

  • Help clinicians/practitioners of any type develop better treatment plans, deliver better care, and develop professionally through ongoing feedback about the progress and results (outcomes) of the care rendered.
  • Help consumers (i.e., patients, clients and others utilizing well-care and sick-care services) to make better decisions and take more responsible actions--when dealing with health problems and other difficult life situations--through increased their self-understanding, knowledge of options, and structured guidance.
  • Help researchers and policy-makers develop, validate, and disseminate best-practice guidelines.

A key question that came to my mind was this: How can a computer help an individual and his/her healthcare professionals understand how the person’s health, wellbeing and quality of life are affected by his/her:

  • Thinking processes (one’s beliefs, attitudes, perceptions, etc.);

  • Emotional processes (how one feels in different situations and why);

  • Behavioral tendencies (including how and a person act in self-defeating ways);

  • Coping strategies (how one tends to deal with life problems and the benefits one receives) ; and

  • Mind-body interactions?

My quest to find an answer resulted in a two and a half decade journey of creative discovery.

Before I present and discuss the details of my radical innovation, I’d like to reiterate my full-disclosure: The software to which I’m referring is the Personal Health Profiler™ (PHPro™) application, which is owned by my company (National Health Data Systems, Inc.) and incorporates processes I patented in 1998. My intention here is to gain exposure for my invention with the goal of stimulating dialogue about new directions for personal health records, as well as sparking creative collaboration projects aimed at transforming our current healthcare system.

Now that the brief background and disclosure are out of the way, this post will focus on one of the many unique abilities of the PHPro: Its comprehensiveness and personalized navigation. In other words, the PHPro software handles a much greater depth and breadth of health data than any other PHPro. It presents this useful information--via web-based or desktop (stand-alone) applications--in interactive reports for consumers and health professionals. A simple mouse-click process enables an individual to “drill-down” from high level views (showing only the data category headings) to increasingly detailed views and self-help modules that are tailored to a person’s particular needs.

The image below (which can be expanded by clicking it) shows the least detailed ("highest" level) view of the PHPro’s Whole-Person Health & Wellness Profile (note that clinical profiles for healthcare and wellness professionals are also available). Included in a personal health profile is information derived from:

  • Data entered manually by an individual via an intelligent "branching logic" process that I will demonstrate in a future post. Depending on the situation and type of profile being generated, the data may be entered the consumer/patient, a caregiver, and/or an authorized health professional.
  • Data obtained from external databases, such as healthcare provider's electronic medical records (EMRs).
  • Documents and other sources, including sick-care (treatment) and well-care (preventive & self-maintenance) guidelines, links to pertinent web sites, etc.

As you can see by the data category headings, the PHPro data are divided into five major (“first-level”) categories of data (in red). Within these main categories are 29 "second-level" categories (in yellow). Also notice that there are grey buttons in the right column with a down-pointing arrow.
click to enlarge image

Although the PHPro application does not look like it's a spreadsheet grid (see below), it is one, and it takes advantage of a spreadsheet's powerful, flexible computational and automation (macro) capabilities. In the screenshot above, for example, each data category heading "resides" on its own row of spreadsheet cells.
click to enlarge image


What you don't yet see (but will shortly) are the many additional rows beneath each heading row, which contain the person's actual health data. In the following image, I enabled the spreadsheet's column letters (top) and row numbers (left) to be visible temporarily, so you can see how many of the rows are hidden from view. For example, 77 rows of data related to possible symptoms are hidden between rows 139 and 216. This report, in fact, has about 1,400 rows of headings and data, of which only 34 rows are currently visible.

As shown in the image below, a person simply double-clicks an arrow next to any data category heading to reveal its details by displaying the rows beneath them. In this example, the button next to the Distressing Life Events heading is being clicked ...
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The PHPro then displays the pertinent information as shown below. In this example, the person has reported some degree of distress concerning eight life events (out of a possible 19 in the current assessment), with health problems being the most upsetting and stressful.

Note that the other 11 life events, which are not problematic for the person, remain hidden since they are not distressing. Also note that there are buttons in the left column on every data row showing an open lock symbol. If the person wants to share his/her information with certain healthcare professionals, clicking those buttons enables him/her to authorize access to certain individuals, while preventing access from others. This gives the person complete control over the privacy of his/her personal health information. click to enlarge

As per the image below, let's say the person double-clicks the down arrow next to “Having serious medical problems."
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This next image shows some of the details about the way the person thinks and feels about his/her medical problems. It also has an orange button labeled: “Manage this Problem.”
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Clicking that button launches the Coping & Problem Solving module, which starts with a brief interpretation of the person’s thoughts and feelings about the medical problem, as shown in the screen shot below. [Note that the screen shots below, unlike the ones above, are built with spreadsheet program's "user forms" instead of spreadsheet grids.]

No matter which distressing life event is selected, the person can then click the green “Solve It” button to be guided through a comprehensive “transactional problem solving” process that helps him/her deal with the problem.
click to enlarge

After clicking the Solve It button, the Introduction window appears, as shown below.
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Clicking “Next” brings up the first Coping & Problems Solving screen, as shown below. Note that this window has a yellow “See More” button.
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Clicking the “See More” button displays an analysis and interpretation of the person’s coping strategies.
click to enlarge

I’m going to stop here, but the Coping & Problems Solving process continues through a series of instructional and action steps that guides the person in:

  • Changing maladaptive thinking and reducing self-defeating emotions (from a Cognitive-Behavioral and Rational-Emotive therapeutic framework),

  • Building and evaluating possible plans of action to solve (or at least control) the problem,

  • Implementing the best plans,

  • Assessing the results, and

  • Trying to solve it again, if it is wise to do so, or learning to tolerate it better if it cannot be solved.

Note that a person can discuss his/her problem-solving plans with others and even share the details of his/her Coping & Problems Solving steps with a wellness coach, counselor, or therapist.

I’ve barely scratched the surface. In subsequent posts, I will:

  • Show the details of other categories of data
  • Discuss how the information supplied by the PHPro can be used by coaches/counselors/therapists to help break through consumer's inertia and promote positive lifestyle change for better overall health & wellbeing and self-maintenance of chronic conditions
  • Discuss the Coping & Problem-Solving process in more detail, focusing on how it can help consumers help themselves, as well as assisting their coaches/counselors/therapists Demonstrate how a person can authorize different people to view particular pieces of information and prevent other data from being accessed
  • Describe the processes for:
    • Manually inputting data using sophisticated branching logic
    • Modifying, updating, and tracking changes over time
    • Obtaining data automatically from external databases
    • Storing the Profile data in "individual record files"
    • Using computational algorithms (rules) to analyze the data
    • Developing, updating, and modifying reports
    • Sharing a data file securely
    • Accommodating any current and future data standards
    • Expanding, modifying, and validating data sets
    • Working in conjunction with other software technologies
    • Building research knowledge bases
    • Incorporating "information therapy" materials
    • Supporting centralized, decentralized (peer-to-peer), web-enabled, and asynchronous desktop architectures/platforms
  • Explain many of the unique yet simple technical methods that make all this possible.

I plan to have a fully functional version of the PHPro application available sometime this month, so collaborators can obtain their own profile and offer feedback.

I welcome your questions and comments.

My next post focuses on the need for much greater knowledge and the role PHPro can play.

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