WO2015054794A1 - Electronic platform for optimal treatment paths - Google Patents

Electronic platform for optimal treatment paths Download PDF

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Publication number
WO2015054794A1
WO2015054794A1 PCT/CA2014/051002 CA2014051002W WO2015054794A1 WO 2015054794 A1 WO2015054794 A1 WO 2015054794A1 CA 2014051002 W CA2014051002 W CA 2014051002W WO 2015054794 A1 WO2015054794 A1 WO 2015054794A1
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WO
WIPO (PCT)
Prior art keywords
user
information
treatment
patient information
treatment paths
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Application number
PCT/CA2014/051002
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French (fr)
Inventor
Mark David Vincent
Original Assignee
Vincent Research & Consulting Inc.
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Publication of WO2015054794A1 publication Critical patent/WO2015054794A1/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
    • G16H50/00ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics
    • G16H50/20ICT specially adapted for medical diagnosis, medical simulation or medical data mining; ICT specially adapted for detecting, monitoring or modelling epidemics or pandemics for computer-aided diagnosis, e.g. based on medical expert systems
    • 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
    • G16H10/60ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
    • 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
    • G16H70/00ICT specially adapted for the handling or processing of medical references
    • G16H70/20ICT specially adapted for the handling or processing of medical references relating to practices or guidelines

Definitions

  • the present invention pertains to the field of medical diagnosis and in particular toelectronic medical treatment models.
  • Each line of treatment generally consists of different alternatives which might be mutually exclusive for concurrent use, but some or all of which might be used in some sequential plan of therapy.
  • the lines of treatment take into account a myriad of diverse information from patient specific tolerances to costs of proposed treatment. There is a need to select amongst the potentially available alternatives at each decision point,by carefully weighing these various factors. A particular choice made now, will probably have an impact on the selection in subsequent lines of treatment, which might or might not be apparent but nonetheless could be very important.
  • Patients are very heterogeneous, with respect to criteria such as age, financial resources, smoking status, co-morbidities gender, ethnicity, cognition, values and goals, any or all of which should and do influence therapy and treatment. Furthermore, if other information becomes available in real-time, the projected course of treatment becomes difficult to re-account for, and thus the analysis must be reinitiated.
  • An object of the present invention is to provide anelectronic platform for optimal treatment paths.
  • a method for providing optimal treatment paths on an electronic network having the following steps: receiving patientinformation from one or more users on the network, the patient information including one or more data entries relating to a medical condition; retrieving database information from a database, the database information corresponding to the patient information; generating one or more user treatment paths based on the correlation between patient information and database information; prioritizing the one or more user treatment paths based on the quality of correlation of the patient information and the database information; and returning the prioritized one or more user treatment paths to the one or more users.
  • a system for providing optimal treatment paths on an electronic network having: a server configured to receive patient information from one or more users on the network, the patient information including one or more data entries relating to a medical condition; a database configured to provide information corresponding to the patient information; a processing engine configured to generate and prioritize one or more user treatment paths based on the quality of correlation of the patient information and the one or more user treatment paths; an interface to one or more users, the interface configured to allow for provision of patient information to the server; and wherein the interface to a communication means is configured to allow communication between the one or more users, the server, the database, and the processing engine.
  • Figure 1 illustrates an example of patient information input based on patient and disease characteristics
  • Figure 2 illustrates an example of patient information input based on medical details
  • Figure 3 illustrates an example of patient information input based on prior therapy considerations
  • Figure 4 illustrates an example of selection of various standards and/or resources
  • Figure 5 illustrates an example of an output of the prioritized treatment paths in a matrix like format.
  • the term "user” is used to define any entity that is able to communicate with the electronic platform.
  • Types of users may include, but are not limited to, devices, applications, and persons.
  • a user may include medical practitioners, medical researchers, medical students, health care professionals, patients, families, trusted personnel of the patient, hospital personnel, clinic staff, pharmaceutical companies, drug developers, and authorized government personnel.
  • patient information is used to define any type of information associated with the status, current or historical, of a patient.
  • Patient information includes, but is not limited to, age, medical conditions, financial resources, medical insurance coverage, smoking status, co-morbidities gender, ethnicity, cognition, values and goals, medical vitals (e.g., blood-work results, heart rate, blood pressure, cholesterol, etc.), histological sub-type, molecular profile, stage, sites of involvement, tumor burden, tolerances to toxicity, adverse relations to any anesthesia, budget for treatment, bank account, financial credentials, willingness to travel for treatment, proximity limits, preference for certain treatments (input as a pre-defined quantitative score), preference for certain physicians (input as a pre-defined quantitative score), and any information utilized at the treatment path calculation stage.
  • medical vitals e.g., blood-work results, heart rate, blood pressure, cholesterol, etc.
  • histological sub-type e.g., molecular profile, stage, sites of involvement, tumor burden, tolerances to toxicity, adverse relations to any an
  • user data refers to any information in relation to the user account associated with the electronic platform.
  • User data may include the user's credentials (e.g., medical credentials), patient list, patient characteristics based on aggregate data, and all other types of meta data associated with patients and the user's activity on the electronic platform.
  • treatment is used to define any therapy or therapeutic option in relation to any illness or disease.
  • Treatment may include surveillance of patient (e.g., observation of patient), supportive care (symptom control), pharmaceutical treatment, radiation therapy, surgery, ultrasound, psychotherapy, natural therapy, specific diet regime implementations, specific exercise based implementations, physiotherapy, chiropractic services, Ayurveda medicine, homeopathic treatments, and other similar procedures used to aid illness or disease.
  • platform administrator is used to define any entity that is able to administer the services of the electronic platform.
  • the platform administrator may configure user settings, set pre-defined values for any number of services including, but not limited to, pre-defined treatment plans.
  • the term "device” may be defined as any apparatus capable of network access.
  • the device may be wired or wireless.
  • the device may include a personal computer, tablet, mobile device, mobile phone, television, music player, personal organizer, or any similar electronic network enabled device.
  • the device may be wearable technology including, but not limited to, jewelry, watches, glasses, hats, clothing, shoes, socks - essentially anything that is placed on or in a person which includes network enablement.
  • the present invention provides for an electronic platform to generate the optimal treatment path based on a variety of information in order to provide various personnel, primarily heath care professionals, with the most accurate and cogent information in a convenient fashion.
  • the platform is enabled electronically whereby input to the platform is performed electronically by one or more users of the network to provide the necessary information required to provide a myriad of optimal treatment. The users access the platform using any type of network enabled device.
  • the platform may be utilized as a decision aid to help health care professionals determine the optimal treatment path. Moreover, it may be used as a verification tool for a determined treatment path. Health care professionals may utilize the platform to determine if any new recommendations or literature is available for a particular treatment path.
  • the selected treatment path may be selected based on various criteria such as optimal treatment path option, optimal cost/treatment path, optimal cost/treatment path with respect to insured treatment paths, optimal treatment path with respect to specific patient characteristics, and other similar criteria including especially maximizing survival and/or symptom control, maximizing the chance to be able to receive the next line of treatment, and minimizing toxicity in general or particular toxicities.
  • the electronic platform may be implemented by means of a software application.
  • the above mentioned user devices interact with platform hardware modules and software modules to fully execute the electronic platform.
  • the electronic platform may be implemented by any means known in the art including local installation of a software application on a mobile device with minimal retrieval of extraneous data from a server.
  • the software application is a "thin client" on the user device and retrieves substantial amounts of information from server.
  • the software application is accessed through a network client (e.g., web browser, third party aggregator application).
  • the implementation of the application may include a hybrid of conventional paradigms such as those described above.
  • the electronic platform is implemented with multi-lingual support such that various users can access the electronic platform in their language of choice without affecting electronic platform functionality.
  • Electronic Platform Modules
  • a server is implemented which functions to receive input from the one or more users of the electronic platform.
  • the server may be any hardware readily understood in the art which functions to receive the input information from the one or more users of the electronic platform.
  • the input information, or "patient information" includes any type of information required for the determination of the optimal treatment path.
  • Patient information includes, but is not limited to, age, medical conditions, financial resources, medical insurance coverage, smoking status, comorbidities gender, ethnicity, cognition, values and goals, medical vitals (e.g., blood-work results, heart rate, blood pressure, cholesterol, etc.), histological sub-type, molecular profile, stage, sites of involvement, tumor burden, tolerances to toxicity, adverse relations to any anesthesia, budget for treatment, bank account, financial credentials, willingness to travel for treatment, proximity limits, preference for certain treatments (input as a pre-defined quantitative score), preference for certain physicians (input as a pre-defined quantitative score), and any information utilized at the treatment path calculation stage.
  • medical vitals e.g., blood-work results, heart rate, blood pressure, cholesterol, etc.
  • histological sub-type e.g., molecular profile, stage, sites of involvement, tumor burden, tolerances to toxicity, adverse relations to any anesthesia, budget for treatment, bank account, financial credentials, willingness to travel for treatment, proximity limits, preference for certain treatments (
  • the user authenticates with the server in order to use the provided services on the electronic platform.
  • Any authentication means known in the art may be utilized which identifies and verifies the user.
  • Authentication means include, but are not limited to, username/password and biometrics (e.g., fingerprint, retina, voice, etc.).
  • the patient information is stored with a user account such that all relevant data may be stored for future use upon future authentication.
  • the user may exercise the option to change the patient information or keep the previous patient information on record.
  • one user may have multiple patient information inputs into the electronic database. For example one user may have 2000 patient information records assigned to that user account for the electronic platform.
  • patient information may be collected from a variety of sources including, but not limited to, user provided input directly into the electronic platform.
  • Patient information may also be retrieved from any number of third party databases holding information on the patient.
  • patient information may be collected from a patient's (e.g., person's) physician's electronic files. In this way, the most recent medical information may be directly linked with the electronic platform.
  • Another example would include the data interfacing directly with the electronic platform to provide the financial credentials required to calculate eligibility for payment schemes regarding one or more treatment paths. This may be implemented by interfacing with electronic bank records and/or insurance companies.
  • a database is implemented for the electronic platform which providesrelevant information relating to the patient information and user data.
  • the database may be of any hardware known in the art which allows for the storage of the electronic platform.
  • the hardware may be local hardware or network based hardware (e.g., "cloud-based").
  • the database may be a discrete piece of hardware.
  • the database may be the same hardware as the server performing discrete operations.
  • the database provides any and all information in relation to any one of the pieces of patient information and user accounts. For example, if the user provides patient information of ethnicity in relation to cancer, the respective information (including suggested treatment schemes) in regards to this combination are retrieved by the platform.
  • the patient information is a new type of parameter not utilized by the database for determination of a treatment path.
  • This parameter may be stored on the user's account for the specific patient as additional information as future alterations to the treatment paths may include such information.
  • the user may utilize or provide further clarification to that parameter such that it may be utilized within the current database.
  • the database information is populated by the electronic platform administrator.
  • the database information is populated and updated through an electronic interface to Medical Standards Databases (e.g., World Health Organization, Mayo Clinic, American Journal of Medicine, etc.).
  • Medical Standards Databases e.g., World Health Organization, Mayo Clinic, American Journal of Medicine, etc.
  • Various aggregate standards may be overlapped such that different standards may be compared when viewing database information is populated.
  • the patient may dictate a preference for a specific third party school of medicine which may be selected through an electronic interface. An example of the selection of various standards and/or resources can be seen in Figure 4.
  • the database information corresponds to the provided patient informationfor a user and therefore may go beyond purely medical considerations. For example, information relating to proximity of medical services may be provided such that this is taken into account when provid ing an optimal treatment path given the user input for a patient. Furthermore, variables such as "wait- time” for services such as specific drug availability may come into play addressing a "time” variable. Additionally, the patient's health insurance policy will be provided to the electronic platform such that a more accurate calculation of costs may be provided. For example, a treatment scheme may suggest that a certain type of specialized treatment is desired, however this path may be ineligible given the patient's lack of health insurance coverage for the specific type of treatment given a preexisting condition.
  • a user treatment path is generated based on patient information input from the user and database information provided corresponding to this patient information.
  • a processing engine is implemented to perform the user treatment path generation.
  • the processing engine may be of any hardware known in the art which allows for the storage of the electronic platform.
  • the hardware may be local hardware or network based hardware (e.g., "cloud-based").
  • the processing engine may be a discrete piece of hardware.
  • the database may be the same hardware as the server and/or database, but performing discrete operations.
  • the function of the generation of the user treatment path is to analyze the database information received from the database corresponding to the patient information and apply a logic-set in order to generate legitimate user treatment paths given the patient information and preferences.
  • This logic-set may be implemented in a variety of fashions.
  • the logic-set includes applying a numerical score to each relation and comparing it to a predetermined threshold score. If the calculated score of the user treatment path is equal or greater than the pre-determined threshold score, the user treatment path would be considered as a legitimate option.
  • the user may be able to bias a pre-defined treatment path during the generation stage.
  • the pre-defined treatment is given an artificially higher score than conventional calculation such that the output may be adjusted to prefer a specific type of treatment at the behest of the user.
  • similar actions may be conducted by the platform administrator.
  • the electronic platform is dynamic in that it has the functionality to strategize the user treatment plan based on the currency of information provided.
  • the processing engine is implemented to perform the prioritization calculations.
  • the prioritization is calculated based on the quality of the correlation. This quality calculation may be done in a variety of fashions.
  • the correlation between the input patient information and the user treatment paths to a pre-defined threshold may be implemented by applying a numerical score to each relation and comparing it to a pre-determined threshold score.
  • the pre-defined threshold may be implemented in a variety of ways.
  • the pre-defined threshold may be a percentage calculation match defined by the platform administrator.
  • the pre-defined threshold may be provided by a third party medical standards database which interfaces with the electronic platform.
  • the processing engine has calculated the pre-defined threshold calculation for each user treatment path, the output of the prioritization scheme based on how closely the user treatment path matched the pre-defined threshold is returned.
  • a communications means is implemented which allows for communication between all system modules.
  • Communication means would be understood by a worker skilled in the art to include any necessary elements of hardware, including but not limited to communications ports, wireless transmitter/receivers, wires or fibre optics; and software, including but not limited to telephony, e-mail, facsimile, Bluetooth ® , TCP/IP, FTP, XML, and IRC, that allow for the modules to exchange data packets with other modules.
  • the output of the prioritized user treatment paths may be conducted in a variety of fashions.
  • the output of the prioritized user treatment paths is returned to the one or more users electronically on the user device.
  • the prioritized user treatment paths will be displayed on the tablet in a variety of formats. These formats may include a matrix of paths, proximity, cost, availability, wait time, testimonials from similar patients, etc.
  • An example of a matrix type output may be seen in Figure 5.
  • further information may be sought based on this treatment path including, but not limited to, approved indication, funding/access alternatives, supporting data in the form of actual applications, toxicity issues in general, general strategies to deal with toxicity, and guidelines.
  • This information may stem from a prescribed medication and/or treatment plan.
  • the full cycle of the treatment path may be analyzed by the user to consider instant requirements and downstream requirements.
  • the user treatment plan is sent directly to the patient on the patient's device.
  • the fields and style of the output may be specified by the platform administrator.
  • the output may also be in the form of various standard formats including, but not limited to, standardized medical report formats, standardized laboratory research formats, standardized university medical school formats, and other similar standard formats.
  • This type of output may be useful for a variety of purposes including, but not limited to, comparison selection of treatments. For example, this may include comparison of the same treatment in different jurisdictions with the variables of time and cost as the determining factors.
  • the user may be able to access survival graphs or toxicities tables between a selection of treatments (e.g., suggested treatment and alternative treatments).
  • the retrieved metrics may be derived from a number of sources (e.g., various discrete medical publications) with or without a common comparison parameter.
  • the retrieved information is produced on the user's device such that the presentation is synthetically superimposed or presented side-by-side comparison on the same window. Information may include both the presentation of alternate treatments and the display of associated information to the treatment including trials and publications.
  • the user may appreciate a certain variable during the output process and desire a re-calculation of the prioritized treatment paths which would require a change of patient information, or a change of the pre-defined threshold for the prioritization stage.
  • a re-calculation may be done in real-time at the user's request.
  • the output which is returned is calculated rapidly such that it appears as an "automatic alteration" to the prioritized treatment paths.
  • the prioritized treatment paths may be printed and used as a hard copy for records, distribution to patients, and distribution to medical students.
  • the output of prioritized treatment paths may have "flags" on specific treatment paths based on current medical literature regarding toxicity, sideeffects, or other area of interest. These flags alert the user (e.g., medical practitioner) that there may be additional elements of risk given current updated studies which should be taken into account. Once again, the data carrying these new studies would be provided through an interface from third party information sources to the electronic platform.
  • an aggregation of user data and patient information is utilized for data collection and mining.
  • the data may be anonymized and sorted based on any particular parameter of interest. For example, if one were inclined to see the highest prioritized treatment path for Hispanic males in age 35-45 bracket with respect to lung cancer, the platform administrator could configure the platform to provide this information to an interested party. This information may be useful for discovering trends, projecting trends, and utilized for preventative care.
  • the information may be useful for government bodies to analyze funding for various treatment schemes.
  • the information may be used by companies (e.g., pharmaceutical firms) to determine product positioning, financial consequences, general marketing strategy, general R&D strategy, and competitive landscape.
  • companies e.g., pharmaceutical firms
  • the electronic platform would allow users to insert proprietary products (pharmaceutical/regimen) to determine treatment plans. This analysis may also be completed relative to other industry competitors to determine positioning within landscape.
  • side effects felt by patients with similar characteristics are analyzed via a correlation algorithm known in the art. This information is then kept within the electronic platform such that future users of the electronic platform can elect to view treatment paths with similar patient characteristic side effects data in order to have correlation data at their disposal.
  • the electronic platform may analyze and correlate data with respect to patients based on classification characteristics to derive correlation.
  • classification characteristics include, but are not limited to, age, medical conditions, financial resources, smoking status, co-morbidities gender, ethnicity, cognition, values and goals, medical vitals (e.g., blood-work results, heart rate, blood pressure, cholesterol, etc.), histological sub-type, molecular profile, stage, sites of involvement, tumor burden, tolerances to toxicity, and adverse relations to any anesthesia.
  • medical vitals e.g., blood-work results, heart rate, blood pressure, cholesterol, etc.
  • histological sub-type e.g., molecular profile, stage, sites of involvement, tumor burden, tolerances to toxicity, and adverse relations to any anesthesia.
  • the patient information input is not for an actual patient but rather a fictitious or virtual patient used for simulation and/or educational purposes.
  • the electronic platform performs the same way based on the patient information input.
  • the user may be an individual or team of health care professionals determine a treatment path using the electronic platform.
  • the health care professionals one or more users have configured their account with the electronic platform to select "expert review function". This selection provides for a secondary expert review team to view the selected treatment path through the platform and provide guidance as to whether the selected treatment path is the optimal path.
  • the electronic platform may be utilized to determine the viability of choosing a specific type of treatment plan without implementing the treatment plan to verify whether further lines of treatment within a selected treatment plan are operable given the manipulation of a specific parameter (e.g., insurance coverage in a province/state).
  • a specific parameter e.g., insurance coverage in a province/state.
  • the determination of the eligibility of different lines is calculated by the processing engine based on an elimination logic type algorithm or any other known algorithm known in the art.
  • a particular first line of treatment may exclude a number of potential second lines of treatment given a controlled parameter (toxicity thresholds specified initially). This may be applied prior to the insertion of specific patient information to gain a general state of medicine without specific patient specific particularities. In this way, the parameters may be toggled by the user to determine various outcomes based on the various permutations and combinations with the tweaking of various control parameters (e.g., toxicity threshold).
  • various control parameters e.g., toxicity threshold
  • other lines of treatment which were previously unavailable may become available. The determination of availability of treatments is conducted by the processing engine. The lines of treatment within a treatment plan operate as a sequential plan of therapy.
  • the user provides feedback testimonials to the prescribed and selected user treatment path for a patient. This may be used purely for the patient in the future or potentially anonymized for all future uses regarding this specific user treatment path.
  • the electronic platform integrates with third party tools to more effectively provide correct analysis. For example, in calculation of a user's toxicity prediction, one may integrate using an interface with a third party toxicity prediction service. Likewise, for calculation risk of particular event for preemptive intervention.
  • the patent application CA 2,650,562 Dranitsaris et al. discloses a system which provides for facilitating the development of an individualized treatment regimen for a patient based on an evaluation of the risk(s) associated with a disease and/or associated with known treatment options.
  • the data would be reinserted in the electronic platform to more accurately model toxicity based on patient information and third party tools.
  • the electronic platform provides for the integration of "off-label use” of medical materials in relation to one or more user treatment paths.
  • This notification of "off-label use” may be sent through the electronic platform to the user and/or patient.
  • the electronic platform provides for notification alerts for previously selected and generated user treatment paths for specific users (and patients). For example, if the platform is integrated with various medical standard organizations which provide for new guidance with respect to certain treatment, the platform will automatically generate an alert for the user (e.g., oncologist) stating that the user has four patients under this selected generated treatment path and new literature suggests this is detrimental. A new generation of treatment paths is conducted providing the user with optimal selection going forward. In this way, there is no positive obligation on the part of the user to be updated with all new medical literature, rather the platform provides the notification when the literature affects previously selected treatment paths for patients.
  • an alert for the user e.g., oncologist
  • the notification is sent to the user's device in real time such that the user can keep updated with the latest information in real time.
  • the user may customize the level of priority of various treatment paths currently implemented to create a notification hierarchy to configure which notifications are high priority and which are lower priority. The higher priority notifications may be sent in real time to the device, while low priority designated notifications may be accessed via a dashboard on the electronic platform.

Abstract

The present invention provides an electronic platform for optimal treatment paths. In accordance with an aspect of the present invention, there is provided a method for providing optimal treatment paths on an electronic network having the following steps: receiving patient information from one or more users on the network, the patient information including one or more data entries relating to a medical condition; retrieving database information from a database, the database information corresponding to the patient information; generating one or more user treatment paths based on the correlation between patient information and database information; prioritizing the one or more user treatment paths based on the quality of correlation of the patient information and the database information; and returning the prioritized one or more user treatment paths to the one or more users.

Description

ELECTRONIC PLATFORM FOR OPTIMAL TREATMENT PATHS
FIELD OF THE INVENTION
[0001] The present invention pertains to the field of medical diagnosis and in particular toelectronic medical treatment models.
BACKGROUND
[0002] Practitioners within the medical field routinely provide the essential service of recommending lines of treatment corresponding to the patient's diagnosis and general condition. Each line of treatment generally consists of different alternatives which might be mutually exclusive for concurrent use, but some or all of which might be used in some sequential plan of therapy. The lines of treatment take into account a myriad of diverse information from patient specific tolerances to costs of proposed treatment. There is a need to select amongst the potentially available alternatives at each decision point,by carefully weighing these various factors. A particular choice made now, will probably have an impact on the selection in subsequent lines of treatment, which might or might not be apparent but nonetheless could be very important.
[0003] Patients are very heterogeneous, with respect to criteria such as age, financial resources, smoking status, co-morbidities gender, ethnicity, cognition, values and goals, any or all of which should and do influence therapy and treatment. Furthermore, if other information becomes available in real-time, the projected course of treatment becomes difficult to re-account for, and thus the analysis must be reinitiated.
[0004] Therefore there is a need for a comprehensive singular approach to accessing and providing all relevant information in a delivery system which allows for manipulation while still retaining the initial input information in a convenient fashion.
[0005] This background information is provided to reveal information believed by the applicant to be of possible relevance to the present invention. No admission is necessarily intended, nor should be construed, that any of the preceding information constitutes prior art against the present invention. SUMMARY OF THE INVENTION
[0006] An object of the present invention is to provide anelectronic platform for optimal treatment paths. In accordance with an aspect of the present invention, there is provideda method for providing optimal treatment paths on an electronic network having the following steps: receiving patientinformation from one or more users on the network, the patient information including one or more data entries relating to a medical condition; retrieving database information from a database, the database information corresponding to the patient information; generating one or more user treatment paths based on the correlation between patient information and database information; prioritizing the one or more user treatment paths based on the quality of correlation of the patient information and the database information; and returning the prioritized one or more user treatment paths to the one or more users.
[0007] In accordance with another aspect of the present invention, there is provided a system for providing optimal treatment paths on an electronic network having: a server configured to receive patient information from one or more users on the network, the patient information including one or more data entries relating to a medical condition; a database configured to provide information corresponding to the patient information; a processing engine configured to generate and prioritize one or more user treatment paths based on the quality of correlation of the patient information and the one or more user treatment paths; an interface to one or more users, the interface configured to allow for provision of patient information to the server; and wherein the interface to a communication means is configured to allow communication between the one or more users, the server, the database, and the processing engine.
BRIEF DESCRIPTION OF THE FIGURES
[0008] Embodiments of the present invention will be better understood in connection with the following Figures, in which:
[0009] Figure 1 illustrates an example of patient information input based on patient and disease characteristics;
[0010] Figure 2 illustrates an example of patient information input based on medical details;
[0011] Figure 3 illustrates an example of patient information input based on prior therapy considerations;
[0012] Figure 4 illustrates an example of selection of various standards and/or resources; and
[0013] Figure 5 illustrates an example of an output of the prioritized treatment paths in a matrix like format.
DETAILED DESCRIPTION OF THE INVENTION
Definitions
[0014] The term "user" is used to define any entity that is able to communicate with the electronic platform. Types of users may include, but are not limited to, devices, applications, and persons.A user may include medical practitioners, medical researchers, medical students, health care professionals, patients, families, trusted personnel of the patient, hospital personnel, clinic staff, pharmaceutical companies, drug developers, and authorized government personnel.
[0015] The term "patient information" is used to define any type of information associated with the status, current or historical, of a patient. Patient information includes, but is not limited to, age, medical conditions, financial resources, medical insurance coverage, smoking status, co-morbidities gender, ethnicity, cognition, values and goals, medical vitals (e.g., blood-work results, heart rate, blood pressure, cholesterol, etc.), histological sub-type, molecular profile, stage, sites of involvement, tumor burden, tolerances to toxicity, adverse relations to any anesthesia, budget for treatment, bank account, financial credentials, willingness to travel for treatment, proximity limits, preference for certain treatments (input as a pre-defined quantitative score), preference for certain physicians (input as a pre-defined quantitative score), and any information utilized at the treatment path calculation stage.
[0016] The term "user data" refers to any information in relation to the user account associated with the electronic platform. User data may include the user's credentials (e.g., medical credentials), patient list, patient characteristics based on aggregate data, and all other types of meta data associated with patients and the user's activity on the electronic platform.
[0017] The term "treatment" is used to define any therapy or therapeutic option in relation to any illness or disease. Treatment may include surveillance of patient (e.g., observation of patient), supportive care (symptom control), pharmaceutical treatment, radiation therapy, surgery, ultrasound, psychotherapy, natural therapy, specific diet regime implementations, specific exercise based implementations, physiotherapy, chiropractic services, Ayurveda medicine, homeopathic treatments, and other similar procedures used to aid illness or disease.
[0018] The term "platform administrator" is used to define any entity that is able to administer the services of the electronic platform. The platform administrator may configure user settings, set pre-defined values for any number of services including, but not limited to, pre-defined treatment plans.
[0019] As used herein, the term "device" may be defined as any apparatus capable of network access. The device may be wired or wireless. In some embodiments, the device may include a personal computer, tablet, mobile device, mobile phone, television, music player, personal organizer, or any similar electronic network enabled device. In some embodiments, the device may be wearable technology including, but not limited to, jewelry, watches, glasses, hats, clothing, shoes, socks - essentially anything that is placed on or in a person which includes network enablement.
[0020] Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs.
Electronic Platform Summary
[0021] The present invention provides for an electronic platform to generate the optimal treatment path based on a variety of information in order to provide various personnel, primarily heath care professionals, with the most accurate and cogent information in a convenient fashion. [0022] The platform is enabled electronically whereby input to the platform is performed electronically by one or more users of the network to provide the necessary information required to provide a myriad of optimal treatment. The users access the platform using any type of network enabled device.
[0023] The platform may be utilized as a decision aid to help health care professionals determine the optimal treatment path. Moreover, it may be used as a verification tool for a determined treatment path. Health care professionals may utilize the platform to determine if any new recommendations or literature is available for a particular treatment path.
[0024] The selected treatment path may be selected based on various criteria such as optimal treatment path option, optimal cost/treatment path, optimal cost/treatment path with respect to insured treatment paths, optimal treatment path with respect to specific patient characteristics, and other similar criteriaincluding especially maximizing survival and/or symptom control, maximizing the chance to be able to receive the next line of treatment, and minimizing toxicity in general or particular toxicities.
[0025] In at least one embodiment, the electronic platform may be implemented by means of a software application. The above mentioned user devices interact with platform hardware modules and software modules to fully execute the electronic platform.
[0026] The electronic platform may be implemented by any means known in the art including local installation of a software application on a mobile device with minimal retrieval of extraneous data from a server. In at least one embodiment, the software application is a "thin client" on the user device and retrieves substantial amounts of information from server. In at least one embodiment, the software application is accessed through a network client (e.g., web browser, third party aggregator application). In at least one embodiment, the implementation of the application may include a hybrid of conventional paradigms such as those described above.
[0027] In at least one embodiment, the electronic platform is implemented with multi-lingual support such that various users can access the electronic platform in their language of choice without affecting electronic platform functionality. Electronic Platform Modules
[0028] A server is implemented which functions to receive input from the one or more users of the electronic platform. The server may be any hardware readily understood in the art which functions to receive the input information from the one or more users of the electronic platform. The input information, or "patient information", includes any type of information required for the determination of the optimal treatment path. Patient information includes, but is not limited to, age, medical conditions, financial resources, medical insurance coverage, smoking status, comorbidities gender, ethnicity, cognition, values and goals, medical vitals (e.g., blood-work results, heart rate, blood pressure, cholesterol, etc.), histological sub-type, molecular profile, stage, sites of involvement, tumor burden, tolerances to toxicity, adverse relations to any anesthesia, budget for treatment, bank account, financial credentials, willingness to travel for treatment, proximity limits, preference for certain treatments (input as a pre-defined quantitative score), preference for certain physicians (input as a pre-defined quantitative score), and any information utilized at the treatment path calculation stage. An example of patient information input based on patient characteristics can be seen in Figure 1. An example of patient information input based on medical details can be seen in Figure 2. An example of patient information input based on prior therapy considerations can be seen in Figure 3.
[0029] In at least one embodiment, the user authenticates with the server in order to use the provided services on the electronic platform. Any authentication means known in the art may be utilized which identifies and verifies the user. Authentication means include, but are not limited to, username/password and biometrics (e.g., fingerprint, retina, voice, etc.).
[0030] In at least one embodiment, the patient information is stored with a user account such that all relevant data may be stored for future use upon future authentication. The user may exercise the option to change the patient information or keep the previous patient information on record. In at least one embodiment, one user may have multiple patient information inputs into the electronic database. For example one user may have 2000 patient information records assigned to that user account for the electronic platform.
[0031] In at least one embodiment, patient information may be collected from a variety of sources including, but not limited to, user provided input directly into the electronic platform. Patient information may also be retrieved from any number of third party databases holding information on the patient. For example, patient information may be collected from a patient's (e.g., person's) physician's electronic files. In this way, the most recent medical information may be directly linked with the electronic platform. Another example would include the data interfacing directly with the electronic platform to provide the financial credentials required to calculate eligibility for payment schemes regarding one or more treatment paths. This may be implemented by interfacing with electronic bank records and/or insurance companies.
[0032] A database is implemented for the electronic platform which providesrelevant information relating to the patient information and user data. The database may be of any hardware known in the art which allows for the storage of the electronic platform. The hardware may be local hardware or network based hardware (e.g., "cloud-based"). In at least one embodiment, the database may be a discrete piece of hardware. In at least one embodiment, the database may be the same hardware as the server performing discrete operations.
[0033] The database provides any and all information in relation to any one of the pieces of patient information and user accounts. For example, if the user provides patient information of ethnicity in relation to cancer, the respective information (including suggested treatment schemes) in regards to this combination are retrieved by the platform.
[0034] In at least one embodiment, the patient information is a new type of parameter not utilized by the database for determination of a treatment path. This parameter may be stored on the user's account for the specific patient as additional information as future alterations to the treatment paths may include such information. In at least one embodiment, the user may utilize or provide further clarification to that parameter such that it may be utilized within the current database.
[0035] In at least one embodiment, the database information is populated by the electronic platform administrator. In at least one embodiment, the database information is populated and updated through an electronic interface to Medical Standards Databases (e.g., World Health Organization, Mayo Clinic, American Journal of Medicine, etc.). Various aggregate standards may be overlapped such that different standards may be compared when viewing database information is populated. In at least one embodiment, the patient may dictate a preference for a specific third party school of medicine which may be selected through an electronic interface. An example of the selection of various standards and/or resources can be seen in Figure 4.
[0036] The database information corresponds to the provided patient informationfor a user and therefore may go beyond purely medical considerations. For example, information relating to proximity of medical services may be provided such that this is taken into account when provid ing an optimal treatment path given the user input for a patient. Furthermore, variables such as "wait- time" for services such as specific drug availability may come into play addressing a "time" variable. Additionally, the patient's health insurance policy will be provided to the electronic platform such that a more accurate calculation of costs may be provided. For example, a treatment scheme may suggest that a certain type of specialized treatment is desired, however this path may be ineligible given the patient's lack of health insurance coverage for the specific type of treatment given a preexisting condition.
[0037] A user treatment pathis generated based on patient information input from the user and database information provided corresponding to this patient information. A processing engine is implemented to perform the user treatment path generation. The processing engine may be of any hardware known in the art which allows for the storage of the electronic platform. The hardware may be local hardware or network based hardware (e.g., "cloud-based"). In at least one embodiment, the processing engine may be a discrete piece of hardware. In at least one embodiment, the database may be the same hardware as the server and/or database, but performing discrete operations.
[0038] Through the generation of the user treatment paths, it is possible that some user treatment paths are ineligible given certain user input variables. For example, if the user provides that no travel is to be taken, any inter-jurisdictional options will be relegated in the priority scheme. In at least one embodiment, all ineligible user treatment paths will be eliminated without report. In at least one embodiment, all ineligible user treatment paths will be relegated in the priority scheme but will still be reported. Therefore, the function of the generation of the user treatment path is to analyze the database information received from the database corresponding to the patient information and apply a logic-set in order to generate legitimate user treatment paths given the patient information and preferences.
[0039] This logic-set may be implemented in a variety of fashions. In at least one embodiment, the logic-setincludes applying a numerical score to each relation and comparing it to a predetermined threshold score. If the calculated score of the user treatment path is equal or greater than the pre-determined threshold score, the user treatment path would be considered as a legitimate option.
[0040] In at least one embodiment, the user may be able to bias a pre-defined treatment path during the generation stage. In this manner the pre-defined treatment is given an artificially higher score than conventional calculation such that the output may be adjusted to prefer a specific type of treatment at the behest of the user. In at least one embodiment, similar actions may be conducted by the platform administrator. The electronic platform is dynamic in that it has the functionality to strategize the user treatment plan based on the currency of information provided.
[0041] Once the one or more user treatment paths are calculated, they must be prioritized in view of the input patient information provided by the one or more users. The processing engine is implemented to perform the prioritization calculations. The prioritization is calculated based on the quality of the correlation. This quality calculation may be done in a variety of fashions. In at least one embodiment, as mentioned previously, the correlation between the input patient information and the user treatment paths to a pre-defined threshold may be implemented by applying a numerical score to each relation and comparing it to a pre-determined threshold score.
[0042] The pre-defined threshold may be implemented in a variety of ways. In at least one embodiment, the pre-defined threshold may be a percentage calculation match defined by the platform administrator. In at least one embodiment, the pre-defined threshold may be provided by a third party medical standards database which interfaces with the electronic platform.
[0043] Once the processing engine has calculated the pre-defined threshold calculation for each user treatment path, the output of the prioritization scheme based on how closely the user treatment path matched the pre-defined threshold is returned.
[0044] A communications means is implemented which allows for communication between all system modules. Communication means would be understood by a worker skilled in the art to include any necessary elements of hardware, including but not limited to communications ports, wireless transmitter/receivers, wires or fibre optics; and software, including but not limited to telephony, e-mail, facsimile, Bluetooth®, TCP/IP, FTP, XML, and IRC, that allow for the modules to exchange data packets with other modules.
Output of the Prioritized Treatment Paths
[0045] The output of the prioritized user treatment paths may be conducted in a variety of fashions. In at least one embodiment, the output of the prioritized user treatment paths is returned to the one or more users electronically on the user device. For example, if the user is accessing the electronic platform using a tablet computer, the prioritized user treatment paths will be displayed on the tablet in a variety of formats. These formats may include a matrix of paths, proximity, cost, availability, wait time, testimonials from similar patients, etc. An example of a matrix type output may be seen in Figure 5. In this type of example further information may be sought based on this treatment path including, but not limited to, approved indication, funding/access alternatives, supporting data in the form of actual applications, toxicity issues in general, general strategies to deal with toxicity, and guidelines. This information may stem from a prescribed medication and/or treatment plan. In this way, the full cycle of the treatment path may be analyzed by the user to consider instant requirements and downstream requirements. In at least one embodiment, the user treatment plan is sent directly to the patient on the patient's device.
[0046] The fields and style of the output may be specified by the platform administrator. The output may also be in the form of various standard formats including, but not limited to, standardized medical report formats, standardized laboratory research formats, standardized university medical school formats, and other similar standard formats.
[0047] This type of output may be useful for a variety of purposes including, but not limited to, comparison selection of treatments. For example, this may include comparison of the same treatment in different jurisdictions with the variables of time and cost as the determining factors. In another example, the user may be able to access survival graphs or toxicities tables between a selection of treatments (e.g., suggested treatment and alternative treatments). In at least one embodiment, the retrieved metrics may be derived from a number of sources (e.g., various discrete medical publications) with or without a common comparison parameter. In at least one embodiment, the retrieved information is produced on the user's device such that the presentation is synthetically superimposed or presented side-by-side comparison on the same window. Information may include both the presentation of alternate treatments and the display of associated information to the treatment including trials and publications.
[0048] In at least one embodiment, the user may appreciate a certain variable during the output process and desire a re-calculation of the prioritized treatment paths which would require a change of patient information, or a change of the pre-defined threshold for the prioritization stage. In this way, a re-calculation may be done in real-time at the user's request. In a sense, the output which is returned is calculated rapidly such that it appears as an "automatic alteration" to the prioritized treatment paths.
[0049] In at least one embodiment, the prioritized treatment paths may be printed and used as a hard copy for records, distribution to patients, and distribution to medical students. [0050] In at least one embodiment, the output of prioritized treatment paths may have "flags" on specific treatment paths based on current medical literature regarding toxicity, sideeffects, or other area of interest. These flags alert the user (e.g., medical practitioner) that there may be additional elements of risk given current updated studies which should be taken into account. Once again, the data carrying these new studies would be provided through an interface from third party information sources to the electronic platform.
Data Aggregation
[0051] In at least one embodiment, an aggregation of user data and patient information is utilized for data collection and mining. The data may be anonymized and sorted based on any particular parameter of interest. For example, if one were inclined to see the highest prioritized treatment path for Hispanic males in age 35-45 bracket with respect to lung cancer, the platform administrator could configure the platform to provide this information to an interested party. This information may be useful for discovering trends, projecting trends, and utilized for preventative care.
[0052] In another example, the information may be useful for government bodies to analyze funding for various treatment schemes.
[0053] In another example, the information may be used by companies (e.g., pharmaceutical firms) to determine product positioning, financial consequences, general marketing strategy, general R&D strategy, and competitive landscape. For example, the electronic platform would allow users to insert proprietary products (pharmaceutical/regimen) to determine treatment plans. This analysis may also be completed relative to other industry competitors to determine positioning within landscape.
[0054] In at least one embodiment, side effects felt by patients with similar characteristics are analyzed via a correlation algorithm known in the art. This information is then kept within the electronic platform such that future users of the electronic platform can elect to view treatment paths with similar patient characteristic side effects data in order to have correlation data at their disposal. In a similar fashion, the electronic platform may analyze and correlate data with respect to patients based on classification characteristics to derive correlation. Example of classification characteristics include, but are not limited to, age, medical conditions, financial resources, smoking status, co-morbidities gender, ethnicity, cognition, values and goals, medical vitals (e.g., blood-work results, heart rate, blood pressure, cholesterol, etc.), histological sub-type, molecular profile, stage, sites of involvement, tumor burden, tolerances to toxicity, and adverse relations to any anesthesia.
Simulation Embodiment
[0055] In at least one embodiment, it is contemplated that the patient information input is not for an actual patient but rather a fictitious or virtual patient used for simulation and/or educational purposes. The electronic platform performs the same way based on the patient information input.
Expert Review Embodiment
[0056] In at least one embodiment, it is contemplated that the user may be an individual or team of health care professionals determine a treatment path using the electronic platform. The health care professionals (one or more users) have configured their account with the electronic platform to select "expert review function". This selection provides for a secondary expert review team to view the selected treatment path through the platform and provide guidance as to whether the selected treatment path is the optimal path.
[0057] This may have application in jurisdictions where top caliber medical expertise is sparse and the electronic platform allows for an expert review to ensure a higher chance of quality treatment path selection facilitated through the electronic platform.
Dynamic Treatment Selection
[0058] In at least one embodiment, the electronic platform may be utilized to determine the viability of choosing a specific type of treatment plan without implementing the treatment plan to verify whether further lines of treatment within a selected treatment plan are operable given the manipulation of a specific parameter (e.g., insurance coverage in a province/state). The determination of the eligibility of different lines is calculated by the processing engine based on an elimination logic type algorithm or any other known algorithm known in the art.
[0059] For example, in Figure 5 if a particular first line of treatment was selected, it may exclude a number of potential second lines of treatment given a controlled parameter (toxicity thresholds specified initially). This may be applied prior to the insertion of specific patient information to gain a general state of medicine without specific patient specific particularities. In this way, the parameters may be toggled by the user to determine various outcomes based on the various permutations and combinations with the tweaking of various control parameters (e.g., toxicity threshold). In another example, depending on the line of treatment selected, other lines of treatment which were previously unavailable may become available. The determination of availability of treatments is conducted by the processing engine. The lines of treatment within a treatment plan operate as a sequential plan of therapy.
Feedback Embodiment
[0060] In at least one embodiment, it is contemplated that the user provides feedback testimonials to the prescribed and selected user treatment path for a patient. This may be used purely for the patient in the future or potentially anonymized for all future uses regarding this specific user treatment path.
Integration with Third Party Tools
[0061] In at least one embodiment, it is contemplated that the electronic platform integrates with third party tools to more effectively provide correct analysis. For example, in calculation of a user's toxicity prediction, one may integrate using an interface with a third party toxicity prediction service. Likewise, for calculation risk of particular event for preemptive intervention. For example, the patent application CA 2,650,562 Dranitsaris et al. discloses a system which provides for facilitating the development of an individualized treatment regimen for a patient based on an evaluation of the risk(s) associated with a disease and/or associated with known treatment options.
[0062] Utilizing the output from this application, the data would be reinserted in the electronic platform to more accurately model toxicity based on patient information and third party tools.
[0063] It is contemplated that any variety of diagnostic or predictive tools may be integrated with the instant electronic platform including information pertinent to tumor sensitivity to particular treatmentsin order to provide a more accurate output of prioritized user treatment paths. Off-Label Usage
[0064] In at least one embodiment, it is contemplated that the electronic platform provides for the integration of "off-label use" of medical materials in relation to one or more user treatment paths.
[0065] This notification of "off-label use" may be sent through the electronic platform to the user and/or patient.
Notification Alerts
[0066] In at least one embodiment, it is contemplated that the electronic platform provides for notification alerts for previously selected and generated user treatment paths for specific users (and patients). For example, if the platform is integrated with various medical standard organizations which provide for new guidance with respect to certain treatment, the platform will automatically generate an alert for the user (e.g., oncologist) stating that the user has four patients under this selected generated treatment path and new literature suggests this is detrimental. A new generation of treatment paths is conducted providing the user with optimal selection going forward. In this way, there is no positive obligation on the part of the user to be updated with all new medical literature, rather the platform provides the notification when the literature affects previously selected treatment paths for patients.
[0067] In at least one embodiment, the notification is sent to the user's device in real time such that the user can keep updated with the latest information in real time. In at least one embodiment, the user may customize the level of priority of various treatment paths currently implemented to create a notification hierarchy to configure which notifications are high priority and which are lower priority. The higher priority notifications may be sent in real time to the device, while low priority designated notifications may be accessed via a dashboard on the electronic platform.
[0068] It is obvious that the foregoing embodiments of the invention are examples and can be varied in many ways. Such present or future variations are not to be regarded as a departure from the spirit and scope of the invention, and all such modifications as would be obvious to one skilled in the art are intended to be included within the scope of the following claims.

Claims

THE EMBODIMENTS OF THE INVENTION FOR WHICH AN EXCLUSIVE PROPERTY OR PRIVILEDGE IS CLAIMED ARE DEFINED AS FOLLOWS:
1. Amethod for providing optimal treatment paths on an electronic network comprising the following steps:
Receiving patient information from one or more users on the network, the patient information including one or more data entries relating to a medical condition;
Retrieving database information from a database, the database information corresponding to the patient information; generating one or more user treatment paths based on the correlation between patient information and database information; prioritizing the one or more user treatment paths based on the quality of correlation of the patient informationand the database information; and returning the prioritized one or more user treatment paths to the one or more users.
2. The method of claim 1, wherein the one or more user treatment paths are returned to the one or more users if the one or more treatment paths meet a pre-determined threshold.
3. The method of claim 1, wherein one or more external databases are integrated to allow for additional patient information for the user and/or additional database information.
4. The method of claim 1, wherein the returning of prioritized one or more user treatment paths is sent to a user device based on a pre-determined output.
5. The method of claim 4, wherein the pre-determined output is provided in one of the following formats: synthetically superimposed and side-by-side.
6. The method of claim 5, wherein the information may be derived from one or more information sources.
7. The method of claim 1, wherein the prioritized one or more user treatment paths contain additional warnings based on third party information relating to the one or more user treatment paths.
8. The method of claim 1, wherein the patient information entered for the user may be input for simulation.
9. The method of claim 1, wherein the generating one or more user treatment paths modifies further lines of treatment to include compatible lines of treatment and exclude incompatible lines of treatment.
10. A system for providing optimal treatment paths on an electronic network comprising: a server configured to receive patient information from one or more users on the network, the patient information including one or more data entries relating to a medical condition; a database configured to provideinformation corresponding to the patient information; a processing engine configured to generate and prioritize one or more user treatment paths based on the quality of correlation of the patient information and the one or more user treatment paths; an interface to one or more users, the interface configured to allow for provision of patient information to the server; and wherein the interface to a communication means is configured to allow communication between the one or more users, the server, the database, and the processing engine.
11. The method of claim 10, wherein the one or more user treatment paths are returned to the one or more users if the one or more treatment paths meet a pre-determined threshold.
12. The system of claim 10, wherein one or more external databases are integrated to allow for additional patient information for the user and/or additional database information.
13. The system of claim 10, wherein the prioritized one or more user treatment paths contain additional warnings based on third party information relating to the one or more user treatment paths.
14. The system of claim 10, wherein the returning of prioritized one or more user treatment paths is sent to a user device based on a pre-determined output.
15. The system of claim 14, wherein the pre-determined outputs is provided in one of the following formats: synthetically superimposed and side-by-side.
16. The system of claim 15, wherein the information may be derived from one or more information sources.
17. The system of claim 10, wherein the patient information entered for the user may be input for simulation.
18. The system of claim 10, wherein third party tools may be integrated with the electronic platform to calculate additional patient information for the user.
19. The system of claim 10, wherein the generation of one or more user treatment paths is further configured to modify further lines of treatment to include compatible lines of treatment and exclude incompatible lines of treatment.
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