Perioperative education and engagement of surgical patients

An apparatus, comprising:

• one or more computers, each having a processor and a memory, the memory having stored therein instructions programmed to cause the one or more computers to maintain an electronic medical record (EMR) system that stores patient encounters as separate fee-for-service billable patient encounter records in which no patient encounter record is linked with any other patient encounter record and to, in response to receiving a referral of a patient for a multi-encounter medical procedure:
• store a library of electronic pathways for treatment of patients, each pathway being a standardized sets of tasks, medications, and/or interventions for an identified population of patients and including orders, each pathway and its orders being neutral as to patient and schedule;
• automatically, as part of pre-surgical evaluation by a hospital, in response to receiving a referral of a patient to a physician for a multi-encounter medical procedure, retrieve EMR information about a patient from the patient's EMR stored in the EMR system;
• assemble a database record reflecting patient encounters of the patient and assembling the patient encounters into a plurality of medical episode records for the patient, the medical episode records relating to corresponding medical conditions of the patient, each medical episode record storing information relating to patient encounters relating to treatment of the corresponding medical condition;
• store the database record in a database of medical episode records, designed to permit longitudinal retrieval of patient encounters of a medical episode record;
• in response to the EMR evaluation determining that the patient is possibly at risk, pose a questionnaire to all patients for specified classes of procedures, the patients meeting specified criteria for possible risk, the questionnaire being specifically diagnostic for the at risk condition and/or appropriateness of care preferences of the patient, and obtaining answers from the patient to questions of the questionnaire;
• evaluate the information from the patient's EMR and the answers from the patient to the questions of the questionnaire together to evaluate risk characteristics of the patient and/or appropriateness of care preferences of the patient:
• if the evaluating of the information from the patient's EMR and the answers from the patient to the questions of the questionnaire together indicates the at risk condition for the patient, recommend to medical staff a pathway chosen from among the library:
• determine, based on the evaluating of the information from the patient's EMR and the answers from the patient to the questions of the questionnaire together, whether the patient is eligible for a telephone preoperative evaluation;
• based on the evaluation of the EMR information and the patient's answers together, recommend to medical staff a pathway template to be implemented by the medical staff to perform the multi-encounter medical procedure on the patient, from among a library of pathway templates, the pathway templates being standardized sets of tasks, medications, and/or interventions for an identified population of patients, each pathway template being neutral as to patient and schedule,
• instantiate the recommended pathway template to create an instantiated pathway to be implemented for the patient based on the evaluation of the EMR information and the patient's answers together, the instantiated pathway to be implemented including a determination, based on the evaluation of the EMR information and the patient's answers together, of whether the patient is eligible for a telephone preoperative evaluation or an in-person preoperative evaluation;
• and
• link patient encounter records of the multi-encounter medical procedure generated by implementation of the instantiated pathway and stored in the patient's EMR into a longitudinally-linked episode, and store the longitudinally-linked episode in the patient's EMR as a connective record that links to the patient encounter records of the multi-encounter medical procedure.

A method, comprising:

• storing a library of electronic pathways for treatment of patients, each pathway being a standardized sets of tasks, medications, and/or interventions for an identified population of patients and including orders, each pathway and its orders being neutral as to patient and schedule;
• automatically, as part of pre-surgical evaluation by a hospital, in response to receiving a referral of a patient to a physician for a multi-encounter medical procedure, retrieving information from a patient's electronic medical record (EMR) of the patient stored in an electronic medical record system, the patient's EMR storing patient encounters as separate patient encounter records in which no patient encounter record is linked with any other patient encounter record;
• evaluating the information retrieved from the patient's EMR for conditions suggesting the possibility of an at risk condition for the patient, at least one at risk condition under evaluation being frailty;
• assembling a database record reflecting patient encounters of the patient and assembling the patient encounters into a plurality of medical episode records for the patient, the medical episode records relating to corresponding medical conditions of the patient, each medical episode record storing information relating to patient encounters relating to treatment of the corresponding medical condition;
• storing the database record in a database of medical episode records, designed to permit longitudinal retrieval of patient encounters of a medical episode record;
• in response to the EMR evaluation determining that the patient is possibly at risk, posing a questionnaire to all patients for specified classes of procedures, the patients meeting specified criteria for possible risk, the questionnaire being specifically diagnostic for the at risk condition and/or appropriateness of care preferences of the patient, and obtaining answers from the patient to questions of the questionnaire, the questionnaire including at least a question of whether the patient is able to lie flat comfortably;
• evaluating the information from the patient's EMR and the answers from the patient to the questions of the questionnaire together to evaluate risk characteristics of the patient and/or appropriateness of care preferences of the patient;
• if the evaluating of the information from the patient's EMR and the answers from the patient to the questions of the questionnaire together indicates the at risk condition for the patient, recommending to medical staff a pathway chosen from among the library;
• determining, based on the evaluating of the information from the patient's EMR and the answers from the patient to the questions of the questionnaire together, whether the patient is eligible for a telephone preoperative evaluation;
• based on the evaluating of the information from the patient's EMR and the answers from the patient to the questions of the questionnaire together, recommending to the medical staff, at least one pathway from the library relating to the at risk condition to be implemented by the medical staff in the patient's care, the at least one pathway to be implemented including whether the patient is eligible for a telephone preoperative evaluation or an in-person preoperative evaluation;
• instantiating the selected pathway and its orders as orders for the identified patient in a database of orders, and populating the instantiated orders with data to particularize the instantiated orders to the patient and the patient's medical condition, the data obtained by a query to the patient's EMR;
• performing a medical procedure on the patient utilizing the selected pathway;
• linking patient encounter records of the multi-encounter medical procedure stored in the patient's EMR into a longitudinally-linked episode;
• and
• storing the longitudinally-linked episode in the patient's EMR as a connective record that links to the patient encounter records of the multi-encounter medical procedure.