| 摘要 |
<p>The present invention offers a comprehensive solution to care management which aggregates, integrates and stores clinical information from disparate sources. The system finds at-risk individuals before they experience preventable, high-cost medical events and stratifies high risk populations according to clinical criteria, which can include severity of disease states and co-morbidities. The system also compares the actual care an individual is receiving to established standards of clinical excellence and, if necessary, suggests pertinent medical care considerations to improve the care of medically mismanaged individuals. Another feature of the present invention may include a secure, patient-specific Web page which is automatically populated with a patient's own clinical information and can be personalized with customized, relevant healthcare information. The system allows users to design, facilitate and monitor clinical care plans and increase communications among physicians, nurses and patients. The system also predicts and analyzes the outcome of disease or case management for populations and individual patients.</p> |
