AUTOMATED CLINICAL GUIDELINES, LLC

DOUG DEW, CEO

 

APPLICATION FOR THE THEORY OF GAMES TO HEALTHCARE

 

In recent years there has been hyperbole about the role of healthcare digitization as well as artificial intelligence in medicine. The real world applications for the benefit of patients would be considered mediocre at best. It is safe to say that IBM's cognitive business (Watson) has been a huge disappointment relative to previously high expectations - which has, correctly, been waning over time. Electronic Medical Records are now facing a similar fate where digitization of the records was a success but implementation, usability, and real world interoperatabilty and analytics for the benefit of the patient has also been a major disappointment. The wildly unpopular insurance industry is still based on a 50 year-old Medicare model with many of its transactions taking weeks and multiple FTEs to complete on both the payor and the provider levels - No transparency, no expert systems, minimal automated tracking analytics, 20th century technology, large bureaucracies, no automated payment system for services at the point of care, and definitely no artificial intelligence. So why, at the start of the 21st century, is medicine stuck in 20th century technology and what type of technology breakthrough could remove this log jam?

 

There are a number of problems that need to be solved to introduce artificial intelligence and automation at a practical level in healthcare. To solve this, one needs to look at the theory of games developed in the 1950s by John Nash, John von Neumann, and others . The decisive step in the mathematical treatment of games is the normalization achieved by the introduction of pure strategy. As first described by von Neumann, “A pure strategy is a plan formulated by a player prior to a play, which will cover all of the possible decisions which may confront them during any play permitted by the rules of the game. Since the pure strategy will provide each choice as a function of the information available to the player at the time of that choice, no freedom of action is lost by the caregiver.” In essence, what was being described is a rules engine that contains all of normalized information known at the time of the decision – the current provider-payor system lacks this.

 

The problem at hand was how to organize and make useful all of the world’s medical information and be able to write, organize, and update complex algorithms that could make up a finite game based on disease, medical necessity, coding, disease tracking, and automated payment for services. Automated Clinical Guidelines, LLC (ACG) developed a patented and proprietary logic technology that does just that - HOLMES. The system is a series of computer generated clinical decision trees as first outlined by Ramon Llull in the 13th century used to organize and classify knowledge. As a pioneer of computation theory, Lull’s system of logic was the beginning of information science. With ACG’s newly developed knowledge automation platform, what used to take a team of programmers and clinicians, 6 months to a year, to write, and test just one complex medical algorithm or clinical decision tree, can now be done in minutes with 100 percent of the code being written by machine. Through a proprietary process of directed machine learning, ACG teaches a machine how to become an expert system for medical care covering all possible decisions that may confront the caregiver. HOLMES presents a question-answer rules engine that functions as an educational system for medicine in 100 different languages with analytics built into every transaction. The machine was designed to think like a doctor by navigating a series of treatment strategies that confront the caregiver and provides clinical documentation at the point of care for each of those decisions to win the game for the patient and for those that pay for that care.

 

That brings us today, where ACG has organized a much of the world’s medical knowledge, tested disease tracking analytics in most countries, developed an open source financial transaction system for healthcare, and has beat the current prior authorization system at its own game. With the completed platform as well as an open source payor system tested over a four-year time period, ACG is on the verge of becoming the rules engine of medicine to introduce an efficiency, transparency, and intelligence to medicine and payor models that previously could not even by thought of, while becoming a true AI learning system of medicine. ACG will revolutionize health plan functions as well as clinical point of care decision making and diagnosis as a software as a service subscription model. 500,000+ files and 2,000+ web pages later, we have created an intelligent store front for all of medicine via gamification.

 

• U.S. Patent 7,962,348

• WO2016073479: Australia, Canada, Europe, India, Israel, New Zealand, Singapore, U.S.

Self-management tools and trackers

   • Personal Health Record in 80 Languages (iMHR)

 

Benefit search and selection

   • Structured Data Analytics & Benefits Platform (CNA)

 

Financial management

   • Interoperable ICD-10 Data Model

      (“The Healthcare SIM Card”)—Coming Soon!

 

   • Revenue Cycle Management

 

Administrative tools

   • ICD-10 CM Computer Assisted Coding

 

   • Interoperable ICD-10 Data Model

      (“The Healthcare SIM Card”)Coming Soon!

 

   • ICD-10 PCS Computer Assisted Coding

 

   • Medical Necessity Toolset

 

   • Medical Risk Assessment

 

   • Medicare Compliance & Audit Toolset

 

Telehealth

   • Automated Clinical Guidelines

 

   • Ambulatory Care Toolset

 

   • Clinical Decision SupportComing Soon!

 

   • Clinical Documentation Improvement

 

   • Clinical Outcome Registry

 

   • Computer Assisted Diagnosis and Error Checking

 

   • Computer Assisted Treatment PathwaysComing Soon!

 

   • Home Health Care Toolset

 

   • Hospice Care Toolset

 

   • Hospital Medicine ToolsetComing Soon!

 

   • Imaging Documentation Automation

 

   • Interoperable ICD-10 Data Model (“The Healthcare SIM Card”)Coming Soon!

 

   • Medical Clinical Knowledge BasesComing Soon!

 

   • Medical Risk Assessment

 

   • Medicare Compliance & Audit Toolset

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Surgical Clinical Knowledge Bases

 

Gaming

   • Medical Necessity Toolset

 

   • Personal Health Record in 80 Languages (iMHR)

 

Decision support

   • Ambulatory Care Toolset

 

   • Automated Clinical Guidelines

 

   • Clinical Decision SupportComing Soon!

 

   • Computer Assisted Diagnosis and Error Checking

 

   • Computer Assisted Treatment PathwaysComing Soon!

 

   • Discharge and Care Coordination ToolsetComing Soon!

 

   • DME Medical Necessity Toolset

 

   • Home Health Care Toolset

 

   • Hospice Care Toolset

 

   • Hospital Medicine ToolsetComing Soon!

 

   • Imaging Documentation Automation

 

   • Medical Clinical Knowledge BasesComing Soon!

 

   • Medical Risk Assessment

 

   • Medicare Compliance & Audit Toolset

 

   • Surgical Clinical Knowledge BasesComing Soon!

 

Clinician workflow

   • Ambulatory Care Toolset

 

   • Automated Clinical Guidelines

 

   • Clinical Decision SupportComing Soon!

 

   • Clinical Documentation Improvement

 

   • Computer Assisted Diagnosis and Error Checking

 

   • Computer Assisted Treatment PathwaysComing Soon!

 

   • Discharge and Care Coordination ToolsetComing Soon!

 

   • Home Health Care Toolset

 

   • Hospital Medicine Toolset—Coming Soon!

 

   • Hospice Care Toolset

 

   • Imaging Documentation Automation

 

   • Medical Clinical Knowledge BasesComing Soon!

 

   • Medical Risk Assessment

 

   • Medicare Compliance & Audit Toolset

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Surgical Clinical Knowledge Bases—Coming Soon!

 

Analytics

   • Ambulatory Care Toolset

 

   • Clinical Outcome Registry

 

   • Data Normalization Platform (MAP)

 

   • Hospital Medicine ToolsetComing Soon!

 

   • Imaging Documentation Automation

 

   • Interoperable ICD-10 Data Model (“The Healthcare SIM Card”)Coming Soon!

 

   • Medical Clinical Knowledge BasesComing Soon!

 

   • Medical Risk Assessment

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Radiographic Outcome Registry

 

   • Surgical Clinical Knowledge BasesComing Soon!

 

The Cloud in the Hospital

   • Automated Clinical Guidelines

 

   • Clinical Decision SupportComing Soon!

 

   • Clinical Documentation Improvement

 

   • Computer Assisted Diagnosis and Error Checking

 

   • Computer Assisted Treatment PathwaysComing Soon!

 

   • Discharge and Care Coordination ToolsetComing Soon!

 

   • DME Medical Necessity Toolset

 

   • Hospital Medicine ToolsetComing Soon!

 

   • Hospice Care Toolset

 

   • ICD-10 CM Computer Assisted Coding

 

   • ICD-10 PCS Computer Assisted Coding

 

   • Imaging Documentation Automation

 

   • Interoperable ICD-10 Data Model (“The Healthcare SIM Card”)—Coming Soon!

 

   • Medical Clinical Knowledge BasesComing Soon!

 

   • Medical Risk Assessment

 

   • Medicare Compliance & Audit Toolset

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Surgical Clinical Knowledge BasesComing Soon!

 

Imaging and viewing tools

   • Automated Clinical Guidelines

 

   • Clinical Decision SupportComing Soon!

 

   • Clinical Documentation Improvement

 

   • Clinical Outcome Registry

 

   • ICD-10 PCS Computer Assisted Coding

 

   • Imaging Documentation Automation

 

   • Medicare Compliance & Audit Toolset

 

   • Radiographic Outcome Registry

 

Solutions for the underserved

   • Ambulatory Care Toolset

 

   • Clinical Outcome Registry

 

   • Computer Assisted Treatment PathwaysComing Soon!

 

   • Discharge and Care Coordination ToolsetComing Soon!

 

   • Hospice Care Toolset

 

   • Medical Risk Assessment

 

   • Personal Health Record in 80 Languages (iMHR)

 

Urgent care

   • Ambulatory Care Toolset

 

   • Automated Clinical Guidelines

 

   • Clinical Decision SupportComing Soon!

 

   • Clinical Documentation Improvement

 

   • Computer Assisted Diagnosis and Error Checking

 

   • Computer Assisted Treatment PathwaysComing Soon!

 

   • Discharge and Care Coordination Toolset—Coming Soon!

 

   • DME Medical Necessity Toolset

 

   • Home Health Care Toolset

 

   • Hospice Care Toolset

 

   • ICD-10 CM Computer Assisted Coding

 

   • Imaging Documentation Automation

 

   • Medical Clinical Knowledge BasesComing Soon!

 

   • Medical Risk Assessment

 

   • Medicare Compliance & Audit Toolset

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Surgical Clinical Knowledge BasesComing Soon!

 

Pharma

   • Automated Clinical Guidelines

 

   • Clinical Decision SupportComing Soon!

 

   • Computer Assisted Diagnosis and Error Checking

 

   • Discharge and Care Coordination ToolsetComing Soon!

 

   • ICD-10 CM Computer Assisted Coding

 

   • Medicare Compliance & Audit Toolset

 

Mental health

   • Automated Clinical Guidelines

 

   • Clinical Decision SupportComing Soon!

 

   • Clinical Documentation Improvement

 

   • Clinical Outcome Registry

 

   • Computer Assisted Diagnosis and Error Checking

 

   • Computer Assisted Treatment PathwaysComing Soon!

 

   • Home Health Care Toolset

 

   • Hospice Care Toolset

 

   • Interoperable ICD-10 Data Model (“The Healthcare SIM Card”)Coming Soon!

 

   • Medical Risk Assessment

 

   • Medicare Compliance & Audit Toolset

 

   • Personal Health Record in 80 Languages (iMHR)

 

Information exchange

   • Data Normalization Platform (MAP)

 

   • Healthcare SIM CardComing Soon!

 

   • Interoperable ICD-10 Data Model (“The Healthcare SIM Card”)Coming Soon!

 

   • Personal Health Record in 80 Languages (iMHR)

 

Patient-provider communication

   • Ambulatory Care Toolset

 

   • Automated Clinical Guidelines

 

   • Computer Assisted Treatment PathwaysComing Soon!

 

   • Discharge and Care Coordination ToolsetComing Soon!

 

   • Home Health Care Toolset

 

   • Hospital Medicine ToolsetComing Soon!

 

   • Medical Clinical Knowledge Bases—Coming Soon!

 

   • Medical Risk Assessment

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Surgical Clinical Knowledge Bases

 

Clinical research information systems

 

   • Ambulatory Care Toolset

 

   • Clinical Outcome Registry

 

   • Data Normalization Platform (MAP)

 

   • Hospital Medicine ToolsetComing Soon!

 

   • Interoperable ICD-10 Data Model (“The Healthcare SIM Card”)Coming Soon!

 

   • Medical Clinical Knowledge BasesComing Soon!

 

   • Medical Risk Assessment

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Radiographic Outcome Registry

 

   • Surgical Clinical Knowledge Bases—Coming Soon!

 

ESL applications and services

 

   • Ambulatory Care Toolset

 

   • Discharge and Care Coordination Toolset—Coming Soon!

 

   • Home Health Care Toolset

 

   • Hospice Care Toolset

 

   • Personal Health Record in 80 Languages (iMHR)

 

Care transitions

   • Ambulatory Care Toolset

 

   • Automated Clinical Guidelines

 

   • Clinical Decision Support—Coming Soon!

 

   • Clinical Documentation Improvement

 

   • Computer Assisted Diagnosis and Error Checking

 

   • Computer Assisted Treatment Pathways—Coming Soon!

 

   • Discharge and Care Coordination Toolset—Coming Soon!

 

   • Home Health Care Toolset

 

   • Hospital Medicine Toolset—Coming Soon!

 

   • Hospice Care Toolset

 

   • Imaging Documentation Automation

 

   • Interoperable ICD-10 Data Model (“The Healthcare SIM Card”)—Coming Soon!

 

   • Medical Clinical Knowledge Bases—Coming Soon!

 

   • Medical Risk Assessment

 

   • Medicare Compliance & Audit Toolset

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Surgical Clinical Knowledge Bases—Coming Soon!

 

Ambulatory

   • Ambulatory Care Toolset

 

   • Automated Clinical Guidelines

 

   • Clinical Decision Support—Coming Soon!

 

   • Clinical Documentation Improvement

 

   • Computer Assisted Diagnosis and Error Checking

 

   • Computer Assisted Treatment Pathways—Coming Soon!

 

   • DME Medical Necessity Toolset

 

   • Home Health Care Toolset

 

   • Hospital Medicine Toolset—Coming Soon!

 

   • Hospice Care Toolset

 

   • ICD-10 CM Computer Assisted Coding

 

   • Imaging Documentation Automation

 

   • Interoperable ICD-10 Data Model (“The Healthcare SIM Card”)—Coming Soon!

 

   • Medical Clinical Knowledge Bases—Coming Soon!

 

   • Medical Risk Assessment

 

   • Medicare Compliance & Audit Toolset

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Surgical Clinical Knowledge Bases—Coming Soon!

 

Big data

   • Ambulatory Care Toolset

 

   • Clinical Outcome Registry—Coming Soon!

 

   • Data Normalization Platform (MAP)

 

   • Hospital Medicine Toolset—Coming Soon!

 

   • Imaging Documentation Automation

 

   • Interoperable ICD-10 Data Model (“The Healthcare SIM Card”)—Coming Soon!

 

   • Medical Clinical Knowledge Bases—Coming Soon!

 

   • Medical Risk Assessment

 

   • Personal Health Record in 80 Languages (iMHR)

 

   • Radiographic Outcome Registry

 

   • Surgical Clinical Knowledge Bases—Coming Soon!

 

 

ACG's H.O.L.M.E.S. is 24 discrete modules as listed under the following industry sub-headings:

 

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