WO2001071641A2

WO2001071641A2 - Patient medication assessment and management system

Info

Publication number: WO2001071641A2
Application number: PCT/US2001/009151
Authority: WO
Inventors: Vincent C. Ditrapano; Mark Lehman
Original assignee: Omnicare, Inc.
Priority date: 2000-03-23
Filing date: 2001-03-22
Publication date: 2001-09-27
Also published as: AU2001249341A1; WO2001071641A3

Abstract

A patient medication assessment and management system provides a variety of case management tools for a professional health care provider which are accessible over a network, preferably a secure extranet. The tools include an electronically-submitted and maintained health and wellness record for each patient, professional consulting pharmacist services, such as a drug regimen review and medication management consulting services, and a risk assessment tool for determining a frequency of medication regimen review. In a preferred embodiment, the system will also provide information services on such subjects as drugs and diseases, as well as community information pertaining to the locale of a particular patient. The health and wellness record is available over the network to wellness coordinators of managed care facilities, as well as the patients themselves and non-professional care providers, such as family members, by permission of the resident. The system also provides a scheduling function in which a patient or care provider is provided a schedule of physician appointments for a patient, and further, the health and wellness record is transmitted automatically to a physician to a consultation, and it is subsequently updated to reflect that consultation. Most importantly, the system provides for periodic review of the health and wellness record by a pharmacist to detect any potential drug related problems and to recommend an appropriate drug regimen for the patient. Such recommendations are communicated to the wellness coordinator, patient, and/or family member.

Description

PATIENT MEDICATION ASSESSMENT AND MANAGEMENT SYSTEM

BACKGROUND OF THE INVENTION

The present invention relates to methods and systems for maintaining electronic medical records, and more particularly, methods and systems for providing electronic medical records over a secure network for access by patients, care providers and wellness coordinators.

The elderly constitute a significant segment of the United States population, and moreover, that segment is increasing in time both in size and as a percentage of the total population. A significant and growing expense associated with the care of the elderly is the cost of drug therapy. Surprismgly, the highest costs associated with drug therapy for the elderly do not result from the acquisition costs of the drugs themselves, but rather result from the incorrect use of such drugs. Treatment for drug-related problems — which can range from the taking of the wrong drug to not taking a prescribed drug in the proper doses, or at all — costs the health care system of the United States an estimated $100 billion per year. That figure exceeds the yearly cost of all prescribed medications.

A factor in drug related problems of the elderly is that an increasing portion of the elderly under medication regimens either are living at home and are under the care of a relative, or are living in a managed care facility, such as a long term care facility, and are under the care of a moderately-trained wellness coordinator. An elderly patient in such a situation may be under the care of several different care providers, each of whom is diagnosing and treating a particular aliment or condition. Such care providers often are physically distant from each other, and therefore the sharing of information pertaining to the diagnoses, illnesses and drug therapies of a particular patient may not occur. The same fragmentation of information may occur with pharmacy records, in the event that the elderly patient visits several different pharmacies to fill prescriptions.

With the advent of the Internet, the transmission of data from an electronic storage location to display at a remote location has been commonplace. Accordingly, the Internet enabled the aggregation of medical and other data in a single location which can be accessed by anyone, anywhere and anytime. For example, U.S. Patent No. 5,924,074 discloses an electronic medical records system in which a care provider is equipped with a portable, hand-held display which receives comprehensive patient information from a patient data repository. Using a touch screen, the care provider can input diagnoses and treatment data, which are then transmitted to update the patient record in the patient data repository. That system also includes the capability to access reference databases for consultation regarding allergies, medication interactions and practice guidelines. The electronic medical record disclosed in that patent may be linked to an enterprise-wide clinical database.

In addition, efforts have been made to review drug regimens for certain high-risk patients. For example, U.S. Patent No. 6,014,631 discloses a method for reviewing and analyzing an electronic patient record to determine whether drug therapy and/or medication issues are present, and if so, communicating to a physician certain recommendations for modifying the drug therapy. The electronic record is created by interviewing a pre-selected patient over the telephone, and the patient's physician is contacted by telephone, computer, e-mail or the like to verify medications, discuss potential interventions, establish therapeutic goals, verify adverse drug reactions, and discuss any compliance issues.

Furthermore, public-accessible websites are available which provide geriatric medication assessment. One example can be found at www.agenet.com. At that site, an individual can electronically fill out a medical form, listing such factors as diagnoses, conditions being treated, complaints, medication information, perceived side effects and other pertinent information. That information is, for a fee, submitted by the individual to a pharmacist who reviews the information and makes recommendations on appropriate drug therapy changes. However, such information and recommendations are not integrated into a electronic medical record which is made available to care providers and wellness coordinators over a network. In addition, there is no mechanism in any of the aforementioned systems for periodically reviewing an at-risk patient's medical record to evaluate his or her drug regimen.

Consequently, there is a need for a system in which an electronic medical record of a patient's drug regimen is reviewed periodically by a pharmacist to determine whether that drug regimen is appropriate. Further, there is a need to assess the electronic medical records in a database to determine the level of drug-related risk of the subject patients and adjust a frequency of review of the medical record accordingly. SUMMARY OF THE INVENTION The present invention is a system and method for patient medication assessment and management in which electronic records of the drug regimens of patients, who may be spread over a large geographic area, are maintained in a database accessible over a network, and the medical records are periodically reviewed by a pharmacist to determine whether the drug regimen set forth in the record for each patient in the database is appropriate. In the preferred embodiment of the invention, the review procedure includes the additional step of assigning a level of risk to a particular patient based upon data contained in the medical record, and consequently determining a frequency of medication review of that record, so that high-risk patients will have medication reviews performed more frequently then those patients who are less at-risk.

The system of the present invention is made available over a network, preferably a secure extranet. Consequently, the patient, typically an elderly individual residing in a managed care facility, can be spaced geographically from the medical record, and both can be distantly spaced from the pharmacist who conducts the review. Furthermore, any number of managed and long-term care facilities can be linked to a central database, thereby providing a medication assessment and management system which literally has no physical boundaries.

Also, in the preferred embodiment, the patient, or a care giver for a patient, enters relevant data at a terminal or personal computer linked to a database over a network to create a health and wellness record for that patient. The health and wellness record includes not only basic information about the patient, such as his/her gender, birth date and geographical location, but includes detailed information regarding allergies, diagnoses, medications, immunizations, and a complete list of treating physicians. Once the record has been created, it can be made available to any authorized person throughout the network. For example, such a health and wellness record may be transmitted over the network to a care provider in advance of a scheduled office visit by the patient to that care provider, so that the care provider can receive an up-to-date record. After treatment by that care provider, the wellness coordinator can input information pertaining to the details of the office visit, such as diagnoses and prescribed medications, to augment and update the health and wellness record for that patient. In addition, details of the health and wellness record can be viewed by the patient himself or herself, as well as a relative, or a wellness coordinator, any of whom with proper authorization can access the record from a personal computer connected to the network. Again, authorized personnel having access to the medical record can update the record with additional information, such as changes in the health or weight of the patient, or provide annotations concerning adverse drug reactions or drug side effects or symptoms.

With respect to the patient himself or herself, the health and wellness record can be accessed by a personal computer, in a preferred embodiment, by a personal computer incorporated into a kiosk located at the facility where the patient resides, to obtain information regarding medication and future scheduled physician appointments. Also in the preferred embodiment, the system can provide additional information such as access to articles pertaining to health and medical conditions, and other information such as community news and events pertaining to the locale or managed care facility of the patient.

However, the most important aspect of the system is that the health and wellness record in the database is reviewed by a pharmacist, who pulls the record and reviews it on a personal computer which is part of the network. The pharmacist is able to review the entire record, including diagnoses and drug regimens, and from that determine whether potential drug-related problems exist. Such drug-related problems may comprise too much or too little of a drug being prescribed, a disease or condition which is not being treated with a drug, an incorrect drug prescription, a drug not being taken, a drug interaction, an adverse drug interaction (i.e. drug side affects), a drug prescribed but not needed, and/or therapy duplication (two drugs of the same class being prescribed). In order to assist the pharmacist in making his or her evaluation of the drug regimen embodied in the health and wellness record, the pharmacist may access various background databases which would include a drug formulary, and a proprietary database of clinical algorithms. As a result of the review, and with the assistance of the background databases, the pharmacist will make appropriate recommendations, in the form of annotations and notes added to the health and wellness record, regarding changes, if any, in the drug regimen.

Also in the preferred embodiment of the invention, the pharmacist conducts a medication risk assessment at the time of the initial review of the health and wellness record. This medication risk assessment reviews factors in addition to current medications, diagnoses and conditions, such as significant health changes in the last several months, and assigns a risk classification to the patient, such as high, medium or low risk. As a result of such a risk classification of a patient, a frequency of review of the health and wellness record is determined. For example, a patient assessed as high risk would be assigned a review of his or her health and wellness record on a monthly basis; a patient assigned a medium risk would have his or her record reviewed on a calendar quarterly basis, and a patient assessed as low risk would be scheduled for a medication risk review on a semiannual basis. Consequently, the time and effort of the reviewing pharmacist is optimized since, as a result of the medication risk assessment, a greater proportion of the pharmacist's time spent reviewing health and wellness records will be directed to those of the high risk patients in the database.

Accordingly, it is an object of the present invention to provide a patient medication assessment and management system in which electronic medical records of patients distributed over a wide geographic area can be maintained and kept current; a system in which patient medical records are made available to wellness coordinators, care providers, and the patients themselves electronically at virtually any location which can access a network; a system in which patient medical records are reviewed by a pharmacist to determine from the totality of the patient's medical treatment and drug regimen data whether the drug regimen is appropriate for the patient's present condition; a system in which a pharmacist assigns a level of risk to each patient record, and that risk level determines the frequency of review of the record by a pharmacist, thereby optimizing the time utilization of that pharmacist; and a system which is sufficiently robust and flexible to provide a variety of services in addition to medical recordkeeping and review.

Other objects and advantages of the present invention will be apparent from the following description, the accompanying drawings and the appended claims.

BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1 is schematic representation of a website architecture of a preferred embodiment of the system of the present invention;

Fig. 2 is a schematic of a detail of the website shown in Fig. 1;

Fig. 3 is a schematic showing the procedure by which a pharmacist conducts a medication risk assessment; Fig. 4 is a schematic showing the procedure for creating, maintaining and utilizing a health and wellness record; and

Fig. 5 is a schematic showing a network embodying the system of the present invention.

DETAILED DESCRIPTION OF THE PRESENTLY PREFERRED EMBODIMENT As shown in Fig. 1, the patient medication assessment and management system of the present invention is made available to patients, wellness coordinators and care providers by means of an Internet website, generally designated 10. As shown in Fig. 5, the website 10 resides within a server 12 that is connected to a network 14, such as the Internet or a secure extranet, which can be accessed by a patient's personal computer 16, a personal computer 18 operated by a care giver such as a physician or wellness coordinator, or a kiosk 20 located in a managed care facility.

Referring to Fig. 1, the website 10 includes a main screen or home page 22 which provides the viewer with options to view medical records, community information, reference materials, and other products and services of interest to the elderly. Preferably, the choices are presented in tabbed format, so that the viewer can elect a particular area of interest. If the viewer selects the medical record tab, he or she is directed to a medical records screen 24. If the viewer is a wellness director or wellness coordinator, the screen will display a list of all of the patients under that director's or coordinator's care, and a list of all proximate pharmacies. As shown in screen 26, the wellness director or wellness coordinator has the option of editing the records displayed on screen 24 to add or delete a patient or pharmacy.

The wellness director can elect to view a medical record of a particular patient, shown as screen 28. That screen displays options to view a general profile of the patient, an allergy profile, a diagnoses and medication profile, a listing of treating physicians and scheduled appointments, and an option to view a list of individuals who have been granted access to the medical records screen. As shown in screen 30, the general profile includes such basic information of the patient's name, address, telephone number, gender, birth date, community of residence, and any other notes of facts pertinent to the patient. The allergy profile, shown at screen 32, displays the various allergies of the patient, and the date on which such allergies were first diagnosed. That screen 32 includes a tab or button which, when activated, directs the viewer to a screen 34 which provides the details of the allergy.

The screen 28 can direct the viewer to screen 36, which contains a detailed listing of the various diagnoses and medication of the patient. With respect to the diagnoses, the screen 36 lists the description of the diagnoses, the onset date of the condition diagnosed, the consulting physician, details of the consultation, and a search option. The search option enables the viewer to consult a senior health reference, shown in screen 38, such as an on-line drug formulary. The screen 36 also lists the medications taken by the patient, and includes such information as the name of the medication the frequency of dosage, the route upon which the medication is administered, and other details of the medication.

The screen 36 also lists the immunizations given to the patient. That segment of screen 36 includes such data as the type of immunization, the date the immunization was given, and the individual who administered the immunization.

As shown in Fig. 2, the medical records screen 28 also enables the viewer to review the details of the physicians or care providers treating the patient, and a scheduler of appointments with such care providers. As shown in screen 40, the physicians and appointments information includes the names of the care providers treating the patient, the location of the care providers, telephone numbers and specialization of the care providers. With respect to appointments, each appointment is listed on the screen 40, and includes the date of the appointment, the time of the appointment, the physician or care provider to be consulted, the details of the appointment, and the appointment history.

There is also a sharing option, shown at screen 42, in which the users having access to the medical record, also known as the health and wellness record, can be adjusted to add or delete users. In each case, the name, relationship, user name and password of a user is stored and made available.

The home page 22 (see Fig. 1) also provides access to community information, shown at screen 44 in Fig. 2. The community information can include current health news, a community calendar of events, a resident wellness calendar, which may present pertinent activities and information for the residence of a particular managed care facility, policy and procedures of the facility, a customer or patient care center, where questions can be asked and answered, and the screen 44 can provide medical assistance and training.

The information screen enables a wellness coordinator to download and print out current forms, shown at screen 46. Such forms can include an activities of daily living tracking form, and a state inspection check sheet.

As shown in Fig. 3, the website 10 (shown in Figs. 1 and 2) enables a consulting pharmacist to review the health and wellness record to determine whether, for a particular patient, there exist any drug related problems, and further, and to provide an optimal drag therapy regimen. From the medical records screen 22 (see Fig. 1) a wellness coordinator, or the patient or a family member is directed to screen 48 which leads that person through a multi-step medication risk assessment procedure. Step 1 of the procedure, displayed on screen 50, provides general information about the patient, gleaned from the health and wellness record. Such information includes the name, address, birth date, gender, community of residence of the patient, and the information source.

The second step of the assessment, displayed in screen 52, requests a listing of the current medications, diagnoses and current conditions of the patient. The next screen 54 of the procedure requests information of any significant health changes in the patient occurring in the last three months. Screen 54 also requests information pertaining to the geographic background of the patient. Any such information contained in the health and wellness record automatically populates the similar data fields of the medication risk assessment tool.

The next step in the procedure is displayed in screen 56 and requests the details of the treating physicians that the patient has seen. The final information input is provided in screen 58, which lists high risk therapeutic classes of drugs which may be currently prescribed to the patient. Examples of such classes include whether the patient is taking any medications that effect his or her mood, such as medication for depression or anxiety, whether the patient is taking any medications to help them sleep, whether the patient is taking any seizure medication, and/or whether the patient is receiving insulin for diabetes.

In the preferred embodiment, the computer having the database also includes a program which assigns a score to the risk assessment document. The document is reviewed by a consulting pharmacist and a final level of risk is assigned, either high, medium or low risk categories, shown in operation block 66. The risk category is used to determine a frequency of future review of the health and wellness record for drug related problems. For example, a patient determined to be high risk will be assigned a health and wellness review on a monthly or bi-monthly basis, whereas a patient designated medium risk will be scheduled for quarterly reviews of his or her health and wellness record, while a low risk patient will be scheduled for semi-annual reviews of his or her health and wellness record. Of course, at any review, a patient can be reassigned by a pharmacist to a higher or lower category, depending upon the physical condition of the patient, the types and numbers of medications prescribed, and other factors.

The method of the patient medication assessment and management system is shown schematically in Fig. 4. The method begins with the inputting of patient information to form a health and wellness record, shown at block 70. This information may be inputted by the patient himself or herself through computer 16 (see Fig. 5), but more likely is provided by a wellness coordinator at a managed care facility via computer 18. This information is used to create a health and wellness record 72 which is resident in a database 74 (see Fig. 5). The patient information preferably is transmitted over the network 14 to the database 74 through the website server 12.

The health and wellness record data is transferred into background database 71, accessible via a personal computer or a common server which runs automated drug regimen review programs which create specific drug therapy recommendations. The pharmacist then reviews all of the data and the recommendations, indicated at block 86 (which is not a screen provided by the website). The pharmacist is able to consult various pertinent background databases 62, which may be available on the pharmacist's computer or available online, which assist the pharmacist in determining whether there exist potential drug related problems. Drug related problems may include too much or too little of a prescribed drug, not treating a disease or condition which has been diagnosed, use of the wrong drug for a disease or condition, not taking a drug which has been prescribed a physician for a diagnosed disease or condition, an adverse drag interaction, such as a drug side effect, a drug interaction, or a drug which has been prescribed but is not or is no longer needed. In addition, the evaluation can detect therapy duplication, a condition in which two drags of the same class are prescribed to the patient. At this time, any suggested changes to the drug regimen are determined and communicated electronically to the wellness coordinator, patient, and/or family member and prescriber indicated at activity block 68. That data will also be stored in the database. The health and wellness record will thereafter automatically be reviewed by the pharmacist at the frequency dictated by the medication risk assessment .

Once the health and wellness record 72 has been created, it can be transmitted over the network 14 to a care provider in advance of an office visit, shown at block 76 in Fig. 4. After treatment or consultation, the wellness coordinator can update the record, shown at block 78 after the consultation, so that the record shown at block 72, residing in database 74, is at all times current. In addition, the health and wellness record 72 can be displayed, shown at block 80 in Fig. 4, for secure access by the patient himself or herself, a relative in charge with care of that patient, wellness coordinator and/or selected care providers. An additional feature of the system of the present invention is that the health and wellness record includes a schedule of upcoming appointments for a patient, which can be displayed, shown at block 82, to aid the patient in meeting appointments.

The health and wellness record is capable of being updated and amended, shown at block 84, by authorized care providers and other personnel. In addition, the health and wellness record is periodically reviewed by a pharmacist in the manner previously described, shown at block 86, who after reviewing the information as set forth in detail in Fig. 3 and accompanying text, makes a recommendation either to change the drag therapy, indicated at block 88, or not to change drug therapy, indicated at block 90, both of which may be noted on the block 72.

As shown in Fig. 5, the network 14 which comprises the system for providing the medication assessment, interconnects the computer 92 which is used by the pharmacist in reviewing the health and wellness record 72 (see Fig. 4) which resides in the database 74. The computer 86 of the pharmacist is also connected to a network 94, which can be the same as network 14, to various background databases, shown at 96, which include databases of drugs, drug interactions, disease diagnoses, formulary data and clinical algorithms. It is understood that the databases may be physically discrete from each other and therefore physically present at different locations along the network 94. However, for the convenience of the drawing figure, they are shown in a single location 96. The database server, which is incorporated into the database 74, includes a fax capability 98, which enables faxes of medical records to be transmitted to medical personnel in advance of office visits, in the event that the treating physician or care provider is not part of the network 14. In such a situation, it will be necessary for the care provider to input details of the treatment and diagnoses from computer 18 through the website server 12 to update the patient record 74.

An optional feature of the system 10 of the present invention, is the kiosk 20, which, utilizing current technology, can accept a "smart card" which includes media, such as a magnetic stripe, containing identification and other information of a patient. With a "swipe" of the smart card, patient can access on a kiosk screen information pertaining to prescriptions, upcoming caregiver appointments, and information pertaining to medications. Such a kiosk 20 preferably is located in a managed care facility.

Also in the preferred embodiment, the health and wellness record comprises an electronic medical record which uses national drag code (NDC) numbers and international classifications of diseases (ICD) ICD-9 codes to provide a readily identifiable display of information.

It is within the scope of the invention to provide additional services over the invention 10 to provide additional services over the network 14. Such services would include the ordering and sale of prescriptions, the retail sale of private label and over the counter medications and drags, and the retail sale of vitamins.

In conclusion, the method and system outlined above provide a flexible medication management system, an especially adapted to serve as a medication management tool for the elderly in managed care facilities. However, the system of the present invention can be adapted for use by the ambulatory elderly who do not reside in managed care facilities. All that is needed in that situation is to provide such an elderly person with access to the network, typically by a personal computer, or interactive cable television. Consequently, the pharmaceutical case management services of the present invention can be provided to a widely dispersed and desperate population of elderly individuals.

While the method and apparatus herein described constitute a preferred embodiment of the invention, it is to be understood that the invention is not limited to this precise method and apparatus, and that changes may be made therein without departing from the scope of the invention. What is claimed is:

Claims

1. A method for patient medication assessment and management comprising the steps of: creating a health record for a patient including information pertaining to care providers treating and having treated said patient, allergies of said patient, prior diagnoses of said patient, past and current medications prescribed for said patient and immunizations given to said patient; storing said record in a database accessible over a network; and providing said record to a care provider in advance of said care provider's consulting with said patient.

2. The system of claim 1 further comprising the step of, subsequent to said patient consultation, updating said health record with information pertaining to said consultation.

3. The system of claim 1 further comprising the step of providing access to said record over said network to a wellness coordinator for said patient.

4. The system of claim 3 wherein the step of providing access to said record includes the step of transmitting said record to said wellness coordinator over a network.

5. The system of claim 1 further comprising the step of providing access to said record over said network to said patient.

6. The system of claim 5 wherein said step of providing access to said record includes the step of transmitting said record to said patient over a network.

7. The system of claim 1 further comprising the steps of reviewing said record to determine whether potential drug-related problems may exist; and if said potential drag- related problems are found in said record, recommending alternate drug regimens to minimize or eliminate said drug-related problems.

8. The system of claim 7 further comprising the step of assigning one of a plurality of risk levels to a patient as a result of said reviewing step, said risk levels corresponding to different frequencies of future review of said record for drag-related problems.

9. A system for comprehensive patient health record management comprising the steps of: creating a health record for a patient including information pertaining to care providers treating and having treated said patient, allergies of said patient, prior diagnoses of said patient, past and current medications prescribed for said patient and immunizations given to said patient; storing said record in a database accessible over a network; and periodically reviewing said record to determine whether appropriate drags and dosages are prescribed, and if inappropriate drugs or drag dosages are present, recommending alternate medication regimens to reflect optimal drag usage.

10. The method of claim 9 wherein said reviewing step includes the step of consulting a database of acceptable medication guidelines.

11. A patient medication assessment and management method comprising the steps of: creating a health record for a patient including information pertaining to care providers treating and having treated said patient, allergies of said patient, prior diagnoses of said patient, past and current medications prescribed for said patient and immunizations given to said patient; storing said record in a database accessible over a network; reviewing said record to determine whether risk factors are present; and determining a frequency for future reviews, said frequency being proportional to an amount of risk detected.

12. The method of claim 11 further comprising the step of creating a said record to include data reflecting said frequency of said future reviews.

13. The method of claim 11 further comprising the step of annotating said record to include recommendations of appropriate drag use.

14. The method of claim 11 further comprising the step of conducting further reviews according to said determined frequency.

15. The method of claim 13 further comprising the step of providing said annotated record to a care provider.

16. The method of claim 15 wherein said providing step includes the step of transmitting said annotated record to said care provider.

17. The method of claim 13 further comprising the step of providing said annotated record to said patient.

18. A method for patient medication assessment and management comprising the steps of: creating a health record for a patient including information pertaining to care providers treating and having treated said patient, allergies of said patient, prior diagnoses of said patient, past and current medications prescribed for said patient and immunizations given to said patient; storing said record in a database accessible over a network; and providing said record to a care provider in advance of said care provider's consulting with said patient; subsequent to said patient consultation, updating said health record with information pertaining to said consultation; transmitting said record over said network to a wellness coordinator for said patient; periodically reviewing said record to determine whether potential adverse drug interactions may exist, and if potential drag interactions are found in said record, recommending alternate drag regimens to minimize said adverse drag interactions; periodically reviewing said record to determine whether appropriate drags and dosages are prescribed, and if inappropriate drags or dosages are present, recommending alternate drag regimens to reflect optimal drag usage, said reviewing step including the step of consulting a database of acceptable medication guidelines; reviewing said record to determine whether risk factors are present; and determining a frequency for future reviews, said frequency being proportional to an amount of risk detected.

19. A method for patient medication assessment and management comprising the steps of: creating a health record for a patient including information pertaining to care providers treating and having treated said patient, allergies of said patient, prior diagnoses of said patient, past and current medications prescribed for said patient and immunizations given to said patient; storing said record in a database accessible over a network; and providing said record to a care provider in advance of said care provider's consulting with said patient, said providing step including the step of transmitting said record to said care provider by facsimile transmission.

20. A computer program memory, storing computer instructions to implement an interactive, computer-assisted method of assessing and managing a drag regimen review for a patient in which the drug regiment for a patient is reviewed by a person trained in pharmacology to determine whether drag-related problems exist, the computer instructions including: creating, by the computer, a health record for a patient including information pertaining to care providers treating and having treated said patient, allergies of said patient, prior diagnoses of said patient, past and current medications prescribed for said patient and immunizations given to said patient; storing, by said computer, in said computer memory said record in a database accessible over a network; and periodically reviewing said record, by at least one of said person and said computer, to determine whether appropriate drugs and dosages are prescribed, and if inappropriate drugs or drag dosages are present, recommending, by at least one of said person and said computer, alternate medication regimens to reflect optimal drag usage.

21. The computer program memory of claim 20 further comprising the instraction of assigning, by said person, one of a plurality of risk levels to a patient as a result of said periodical review, said risk levels corresponding to different frequencies of future review of said record for drag-related problems.

22. The computer program memory of claim 21 further comprising the instraction of consulting, by said person, a database of acceptable medication guidelines.

23. The computer program memory of claim 20 further comprising the instraction of providing access to said record over said network to a wellness coordinator.

24. The computer program memory of claim 20 wherein said creating instructions include instractions for receiving said information over said network from a care provider and a wellness coordinator.