Title:
MODERATED COMMUNICATION SYSTEM FOR INFERTILITY TREATMENT
Document Type and Number:
WIPO Patent Application WO/2024/019963
Kind Code:
A1
Abstract:
The systems and methods of the invention provide several improvements directed at fertility treatment. These improvements include an expert/AI system configured to guide a caregiver, e.g., a physician, through the process of providing fertility treatment. They also include a communication system between the caregiver and a patient, which is moderated by the expert/AI system.
Inventors:
HOLDEN JOHN PATRICK (US)
Application Number:
PCT/US2023/027883
Publication Date:
January 25, 2024
Filing Date:
July 17, 2023
Export Citation:
Assignee:
FERTILITY BASICS INC (US)
International Classes:
G16B20/00; G06T7/00; G16B40/00; G01N33/48
Domestic Patent References:
WO2006037236A1 | 2006-04-13 |
Foreign References:
US20160357917A1 | 2016-12-08 | |||
US20170196458A1 | 2017-07-13 | |||
US20220198657A1 | 2022-06-23 | |||
US20190252043A1 | 2019-08-15 |
Attorney, Agent or Firm:
COLBY, Steven et al. (US)
Download PDF:
Claims:
CLAIMS 1. A communication system for the treatment of infertility, the communication system comprising: an expert system embodied in one or more computing devices, wherein the expert system includes: rule based logic configured to provide selections for infertility treatment responsive to clinical data regarding a first patient, the rule‐based logic including a plurality of rules association the clinical data and alternative infertility treatments, wherein the rule‐based logic is configured to apply the plurality of rules to provide selections from among the alternative infertility treatments, reinforcement logic configured to associate quality scores to members of the plurality of rules, the scores being based on at least clinical success of the selections, storage configured to store a library of information regarding the alternative infertility treatments and the clinical data regarding the first patient, the storage including non‐transient digital memory, content distribution logic configured to automatically provide content from the library of information to the first patient, and a microprocessor configured to execute at least the rule‐based logic; a caregiver application embodied in a caregiver computing device, wherein the caregiver application includes: a clinical input configured to receive the clinical data, a caregiver user interface configured for a caregiver to receive the selections from among the alternative infertility treatments, and status logic configured to track treatment status of the patient, the treatment including the selections from among the alternative infertility treatments; and one or more patient applications, each embodied in a patient computing device, wherein the patient applications include: a patient user interface configured to display the content from the library to the first patient. 2. The system of claim 1, further comprising a first machine learning system configured to supplement the selections provided by the rule‐based logic, and training logic configured to train the first machine learning system based on clinical success of the selections from among the alternative infertility treatments. 3. The system of claim 1 or 2, further comprising a knowledge graph configured to be navigated based on the clinical data and including node associated with the selections. 4. The system of claim 1, 2 or 3, further comprising couple logic configured to treat a pair of patients as a reproductive unit and to coordinate the selections provided to both members of the reproductive unit. 5. The system of claim 1‐3 or 4, further comprising a clinical input configured to receive the clinical data, the clinical input being included on the caregiver computing device or the patent computing device. 6. The system of claim 1‐4 or 5, further comprising a sensor connected to the patient computing device, the sensor being configured to collect at least part of the clinical data. 7. The system of claim 1‐5 or 6, wherein members of the plurality of rules are associated with an initial score, the initial score being based on a perceived quality of data on which the respective rule is based, and the scores are based on both the initial score associated with a particular member and the clinical success of the selections. 8. The system of claim 1‐6 or 7, wherein the clinical data includes at least one of: patient age, patient race, patient weight, patient H1c, patient birth history. 9. The system of claim 1‐7 or 8, wherein the library of information includes content selected to answer patient questions, and wherein the content distribution logic is optimized to minimize a number of questions asked a caregiver. 10. The system of claim 1‐8 or 9, wherein the caregiver user interface is configured for a caregiver to approve the selections, to forward the selections to the patient, to approve the content from the library of information, to forward the content from the library of information to the patient, to answer questions received from the patient, to require that the caregiver provide the clinical data, and/or to enter the clinical data. 11. The system of claim 1‐9 or 10, wherein the patient user interface is further configured for the patient to enter the clinical data, to send questions to the caregiver, to require that the patient provide clinical data, and/or to display data generated by the sensor. 12. The system of claim 1‐10 or 11, wherein the first machine learning system is further configured to provide a preference among selections provided by the rule‐based logic. 13. The system of claim 1‐11 or 12, wherein the training logic is configured to train the first machine learning system based on clinical success provided by the caregiver and the clinical data. 14. The system of claim 1‐12 or 13, wherein the reproductive unit includes a male patient and a female patient, and the selections are based on clinical data regarding both the male patient and the female patient. 15. The system of claim 1‐13 or 14, wherein the clinical input is configured to receive the clinical data from a medical records system or a sensor. 16. The system of claim 1‐14 or 15, wherein the sensor is configured to be worn by the first patient. 17. The system of claim 1‐15 or 16, wherein the sensor is a temperature sensor, a sleep sensor, a blood glucose sensor, a motion sensor, or a hormone sensor. 18. The system of claim 1‐16 or 17, wherein the rule based logic is configured to perform any one or more (in any combination) of the steps illustrated in FIGs. 3 and 4. 19. A method of treating infertility, the method comprising: receiving clinical data regarding a patient; receiving a selection among alternative fertility treatments from an expert system; communicating the selection to the patient; communicating content associated with the selection to the patient; receiving an outcome of the fertility treatment; and reinforcing the expert system based on the outcome. |
Description:
MODERATED COMMUNICATION SYSTEM FOR INFERTILITY TREATMEN
T CROSS‐REFERENCE TO RELATED APPLICATIONS [001] This application claims priority to and benefit of U
.S. provisional patent application Ser. No. 63/389,918 filed July 27, 2022, the disclosure of wh
ich is hereby incorporated herein by reference in its entirety. BACKGROUND [002] Field of the invention [003] The invention is in the field of fertility treatment
, and in some embodiments in the field of communication management for the optimization of ferti
lity treatment. [004] Related Art [005] Fertility treatment is an area of medicine in which
expertise is concentrated in a few locations and practitioners. It is, therefore, diffi
cult for most patents to receive optimum care. [006] SUMMARY [007] The systems and methods of the invention provide sev
eral improvements directed at fertility treatment. These improvements include an expert/AI s
ystem configured to guide a caregiver, e.g., a physician, through the process of providing fertility
treatment. They also include a communication system between the caregiver and a patient, which is
moderated by the expert/AI system. [008] The expert/AI system (hereafter referred to simply as
the “expert system”) can include a traditional rules‐based expert system and/or a machi
ne learning system, the machine learning system including neural networks and/or knowledge grap
hs. [009] The communication system is configured to provide pat
ients with appropriate information customized to their particular medical circumstances.
For example, the communication system may provide documents and/or other information to patients
to preemptively answer questions that they would otherwise direct at their caregiver. The
information provided may be selected, at least in
part, by the expert system, and may be responsive t
o the medical circumstances of the patient, e.g., to lab tests or other medically relevant characterist
ics. [0010] Patients experiencing difficulties with conception and/
or carrying a fetus to delivery, otherwise known as infertility, may often have a lar
ge number of potential anatomic or hormonal anomalies that can occur in either the man or the
woman. The Fertility Basics Applications are a linked app system which facilitates a primary care p
rovider of human healthcare to work up a couple with fertility issues. At its most fundamental level,
human fertility management involve a male and female source of gametes and a medical provider mana
ging the production and utilization of these gametes. [0011] The two apps in the Fertility Basics system include
a Provider app (FB‐Pro) and a Patient app (FB‐Patient). The provider app guides a medical pro
vider through the evaluation and management of fertility issues in both males and females. The Pati
ent app is an interactive app to the Provider app
which allows for enhanced communication between provid
ers and patients. The Patient app will not work without a link to the provider app. [0012] FB‐Pro contains an algorithm that walks a medical
care provider through the workup and treatment of both male and female fertility issues.
There is a standardized medical workup of fertility problems recognized in the medical literatur
e [reference]. However, this workup is basic in nature and the success of this treatment in achievin
g a pregnancy is reportedly 28%. [0013] The FB‐Pro algorithm is an expanded workup which i
s significantly more successful in achieving and maintaining pregnancies. It is based on
more than 25 years of clinical experience and medical literature which has been overlooked or under
utilized by the healthcare industry in the United States. The steps of the protocol are all wi
thin normal medical care standards. [0014] The barriers for primary care providers (PCP) to ent
er into treatment of fertility issues are many; however, the biggest two issues are knowledge
base and time. This has created a sub‐ specialty that is focused on fertility management. Th
is sub‐specialty has focused on a procedure heavy approach to fertility management. Our system fa
vors a medical management approach. FB‐ Pro addresses the knowledge gap that is present in
the medical community on fertility management. The FB‐Patient app provides information to the indi
vidual or couple seeking care to answer the questions they may have over why steps are being ta
ken, what the steps will inform the team of, how to interpret the results and what the next step
in the evaluation will be. The Patient App reduces the burden of communication that can prevent
the normal functioning of a PCP’s office while enhancing the communication between provider and
patient of medical information that is desired by the patient or patients. [0015] The Fertility Basics system collects data while progr
essing through the algorithm and the provider/patient interactions to track incident data.
The causes for fertility problems in the US are generally known but incident data is sparse. Data co
llection allows for refining of this information. Definitions of medical terms are imprecise which impe
des machine learning. This has limited the ability of researchers and other interested parties f
rom mining the medical literature and standardizing medical care. The Fertility Basics syste
m uses standardized definitions that provide stability for research purposes and interpretation of
results. Initial statistical analysis will be descriptive and will progress to interpretive as data
accumulates. [0016] Descriptive statistics allows for a greater understand
ing of the true causes of reduced fertility in a population. Interpretive statistics all
ows for machine learning. Given the current state of
the medical literature, the collection of descriptive
statistics is a necessary precursor to useful machine learning. [0017] Infertility is an anxiety producing condition for cou
ples trying to conceive. Infertility is a disease that often can’t be treated in rural areas
. Infertility forces couples in rural areas to trave
l long distances to receive treatment from specialists.
Currently, infertility is typically managed by expensive and invasive in vitro fertilization procedur
es. Couples undergoing these procedures must be highly motivated and are often far away from sup
port networks at the time of treatment. Despite these challenges, current products on the market offe
r little assistance in helping infertile couples manage their condition, set goals, and stay motivated
. [0018] Therefore, it would be highly desirable to provide a
system and method for addressing the above‐mentioned problems associated with obtaining fe
rtility management treatment in rural areas, obtaining non‐invasive alternatives to IVF. Specifica
lly, it would be desirable to provide an integrated
system that is easy to wear; can record and learn
from data; is easy to learn and teach; and gives t
he patient a platform to view and share data, view lon
g term trends, interact with a healthcare professional, and provide other methods for remaining
motivated. [0019] In some embodiments, the fertility management system
is composed of a Patient App, a Caregiver App, and an Expert System. In some embodim
ents, the Patient App allows the patient to input data manually or automatically through a sensor
and then sends that information to the Expert System storage and processing. In some embodiments, t
he Caregiver App allows the healthcare provider to input clinical findings and laboratory re
sults which are then sent to the Expert System for
storage and processing. The Expert System receives in
formation from the respective apps, performs algorithmic computations, stores patient information, a
nd sends information and counseling to the Patient App and diagnostic and treatment information
to the Caregiver App. [0020] In some embodiments, the Patient App has a user int
erface, sensor, and stores relevant clinical information. In some embodiments, the Caregiv
er App has a user interface, stores relevant clinical data, and can perform some computational ope
rations. In some embodiments, the Expert System has memory, a processor, and can perform algo
rithmic computations and communicate with both the Patient App and Caregiver App. In some emb
odiments, the Expert System further comprises a machine learning algorithm, a patient pre
dictive model, and a monitoring algorithm. [0021] The Patient App and Caregiver App are downloaded ont
o the respective user’s smartphone. In some embodiments, the apps may be downloaded onto
the respective user’s computer or tablet. In some embodiments, the apps may be streamed over
a web browser. In some embodiments, the Patient App may be connected to a sensor that colle
cts pertinent clinical data, displays it to the patient, and sends it to the Expert System. In some
embodiments, the Expert System resides in a physical server. In some embodiments, the Expert Syst
em resides in a cloud server system. [0022] In some embodiments, the frontend apps can communicat
e with the Expert System by wireless means such as infrared technology, Wi‐Fi,
cellular telephone technology, radio frequency technology, or Bluetooth technology or by means of a
USB port. [0023] In some embodiments, the Patient App connects to a
sensor that can automatically collect patient information. In some embodiments, the sensor
collects patient information when initiated by the patient. [0024] In some embodiments, a method for managing infertilit
y proceeds as follows. A healthcare provider registers and logs onto the Caregiver App.
The provider then adds a patient and begins investigating a series of questions produced by the
app, including a partner fertility profile. The investigation proceeds until a treatment recommendation
is reached. After said treatment, the provider returns to the Caregiver App to record the
results and continue consultation, if required. [0025] In some embodiments, the Caregiver App allows the pr
ovider the ability to register and login. In some embodiments, the Caregiver App allows
the provider the ability to add a new patient, update information about that patient (clinical data
includes at least one of: patient age, patient race, patient height and weight, patient lab results
– e.g. Hb1c, patient medical and surgical history,
patient allergies, patient current medications, family
history, patient birth history., reset the patient,
or delete the patient. [0026] In some embodiments, the Caregiver App has an “Opt
ions” tab that displays buttons for a dashboard, a list of patients, some information about
the app, and a logout button. In some embodiments, the Caregiver UI has persistent buttons
for Protocol, Demographics, Weight, and History along the bottom of the UI. [0027] BRIEF DESCRIPTION OF THE DRAWINGS [0028] FIG. 1 is a block diagram of the internal elements
of the backend server and frontend user interfaces illustrating a system configured for provid
ing fertility treatment, according to various embodiments of the invention. [0029] FIG. 2 is a flow chart illustrating a method of tr
eating infertility, according to various embodiments of the invention. [0030] FIG. 3 illustrates a typical diagnostic and treatment
methodology for the male patient in a sub‐fertile couple, according to various embodiments.
FIG. 3 is shown in parts A‐E. [0031] FIG. 4 illustrates a typical diagnostic and treatment
methodology for the female patient in a sub‐fertile couple, according to various s embodimen
ts. FIG. 4 is shown in parts A‐T. [0032] DETAILED DESCRIPTION [0033] FIG. 1 illustrates System 100 configured for providin
g fertility treatment, according to various embodiments of the invention. System 100 can
include an Expert System 110, one or more Caregiver Application 120 and one or more Patient Ap
plications 130 (individually designated 130A, 130B, etc.). It is embodied in one or more computin
g devices, such as an internet‐based server, it is
configured to communicate over Network 115. The syste
ms illustrated in FIG. 1 are configured to make selections for fertility treatments and for comm
unicating between a caregiver and one or more patients. [0034] In some embodiments, a fertility management system is
provided that includes three interrelated components: Patient Apps 130, Caregiver A
pp 120, and Expert System 110. These components interact with each other through the netwo
rk 115. [0035] The fertility management system includes three interre
lated devices, i.e., a Patient app 130B, a Caregiver App 120, and Expert System 110. T
he Patient app 130B periodically or continuously takes information from the patient. The
Patient App 130B transmits the information to the Expert System 110 via the network 115. The Expe
rt System 110 receives patient information from both the Patient App 130B and the Caregiver Ap
p 120. The Expert System110 performs algorithmic calculations and transmits information and
instructions to the two apps. The Caregiver App 120 element periodically or continuously takes pa
tient information from the healthcare provider. The Caregiver App 120 transmits the informa
tion to the Expert System 110 via the Network 115. In some embodiments, the communication between t
he apps and the server occurs over a wireless link. For example, infrared, Bluetooth, Wi‐
Fi, radio frequency, or cellular telephone networks can be used to transmit information between
the Patient App 130B and Expert System 110 and Caregiver App 120 and Expert System 110. In oth
er embodiments, the information can be communicated via wires, cables, or other physical mea
ns. [0036] In some embodiments, the Caregiver App 120 contains
a number of elements. In some embodiments, the Caregiver App 120 includes: Clinical
Input 173, Caregiver UI 175, Status Logic 177. These elements are interconnected to receive informati
on from the provider, communicate instructions to the provider, and perform calculations
related to the status of the patient. [0037] In some embodiments, the Caregiver App 120 component
embodies a caregiver interface 175 element. In some embodiments, the caregiver inter
face 175 is touch sensitive to allow the provider to interact with the system by tapping, scr
olling, or sliding a finger on the display screen.
For example, in some embodiments, permanent buttons a
ppear on the user interface allowing the user to view “Protocol,” “Demographics,” “Wei
ght,” and “History”. In some embodiments, there
are also dynamic buttons on the user interface allowing
the user to “Reset Protocol,” and “Add Feedback/Comment”. All the information produced and
collected is stored in the Status Storage 165 element of the Expert System 110. [0038] In some embodiments, the Caregiver App 120 contains
a Clinical Input 173 element. Clinical Input 173 contains information that can be uploaded
to the Expert System 110 via Network 115. In some embodiments, the Clinical Input 173 element can
be updated by information from the Expert System 110 through Network 115. In some embodiments,
the back‐and‐forth communication can be done by wireless means such as infrared technology,
Wi‐Fi, cellular telephone technology, radio frequency technology, or Bluetooth technology or by m
eans of a USB port. [0039] In some embodiments, the Caregiver App 120 contains
a Status Logic 177 element. In some embodiments, Status Logic 177 performs diagnostic calc
ulations based on information inputted by the provider through Caregiver UI 175 and sends the
results to the Clinical Input 173 element. In some embodiments, Status Logic 177 performs diagnostic
calculations and sends the results back to the Caregiver UI 175 element to be displayed to the
provider. [0040] In some embodiments, the Caregiver App 120 contains
a Caregiver UI 175 element. In some embodiments, Caregiver UI 175 receives information fro
m the provider and sends said information to the Status Logic 177 element for calculation. In
some embodiments, the Caregiver UI 175 sends said information to the Clinical Input 173 input for
transmission to the Expert System 110 for processing and storage. In some embodiments, the Care
giver UI 175 provides instructions to the provider from the Expert System 110 or from the Sta
tus Logic 177. In some embodiments, a Caregiver User Interface is configured for a caregive
r to receive the selections from among the alternative infertility treatments in Rules‐Based Log
ic 135; in some embodiments the Caregiver UI is configured for a caregiver to receive selections deri
ved from the Machine Learning System 140 according to a ranking and scoring assignment. In so
me embodiments, the Caregiver User Interface is configured for a caregiver to approve the selecti
ons, to forward the selections to the patient, to approve the content from the library of information,
to forward the content from the library of information to the patient, to answer questions recei
ved from the patient, to require that the caregiver provide the clinical data, and/or to enter
the clinical data. [0041] In some embodiments, Status Logic 117 is configured
to track the treatment including the selections from among the alternative infertility trea
tments along with tracking the treatment status of the patient. This includes treatments received and
recorded in the treatment history. [0042] In some embodiments, the fertility management system
in FIG.1 the Patient Apps 130 (i.e., Patient Apps 130A, 130B, 130C, etc.) component contai
ns a number of elements. The patient applications are embodied in a patient computing devi
ce, wherein the patient applications include: a smartphone, a tablet, or personal computer. [0043] In some embodiments, it includes a Patient App 130A
which acts as a conduit to educate and inform the patient as to what the next step in the
protocol will be and why it is necessarily the ne
xt step. It also informs the patient as to what their
lab test results, and procedural findings are and what they mean. [0044] In some embodiments, the Patient app 130B includes:
the Clinical Input 180, Patient UI 183, and/or Sensor 185. These elements are interconnected
to receive information from the patient, communicate counseling to the patient, and receive in
formation from a sensor. In some embodiments, the Patient UI is configured to display
the content from the library to the patient. In some embodiments, the Patient UI is further configure
d for the patient to enter the clinical data, to send questions to the caregiver, to require that the
patient provide clinical data, and/or to display data generated by the sensor. [0045] In some embodiments, the Patient App 130B includes a
Clinical Input 180 element. In some embodiments, Clinical Input 180 receives information f
rom the Expert System 110 over the Network 115 and sends it to the Patient UI 183 for display
to the patient. In some embodiments, the Clinical
Input 180 element receives patient information from t
he Patient UI 183 element and sends it to the Expert System 110 for processing and storage. [0046] In some embodiments, the Patient App 130B component
contains a Patient UI 183 element. In some embodiments, Patient UI 183 receives informat
ion manually imputed by the patient to be sent to the Expert System 110 over Network 115. In
some embodiments, the Patient UI 183 receives information automatically imputed by the Sensor 185 e
lement to display to the patient and send to the Expert System 110. In some embodiments, the Pati
ent UI 183 element can also receive counseling and other information from the Expert Syst
em 110 and display said information to the patient. [0047] In some embodiments, the Patient App 130B component
contains a Sensor 185 element. Sensor 185 receives information from a medical monito
ring device and transmits said information either manually or automatically over Network 115 to
the Expert System 110 for processing. In some embodiments, Sensor 185 receives information from a m
edical monitoring device and displays that information on Patient UI 183. In some embodiments,
the sensor is a wearable medical device including but not limited to biosensors and implants.
In some embodiments, the sensor is a medical monitor that is not wearable. Garnished data may inc
lude, but is not limited to vital signs, motion detection, sleep monitoring, anatomic findings and mea
surements via ultrasound, hormone levels, metabolic and biochemical markers, and various antibod
ies. [0048] In some embodiments, the Patient App 130B may be do
wnloaded onto the patient’s smartphone. In some embodiments, the Patient App 130B
may be downloaded onto the patient’s computer or tablet. In some embodiments, the Patient
App 130B may be streamed over a web browser. Similarly in some embodiments, the Caregiver
App 120 may be downloaded onto the healthcare provider’s smartphone. In other embodiment
s, the Caregiver App 120 may be downloaded onto the provider’s computer or tablet.
In other embodiments, the Caregiver App 120 may be streamed over the provider’s web browser. I
n some embodiments, the Expert System 110 resides in a physical server. In other embodiments,
the Expert System 110 resides in a cloud server.
[0049] In some embodiments, the Expert System 110 contains
a number of elements. In some embodiments, the Expert System 110 contains one or m
ore of the following: Rule‐Based Logic 135, Machine Learning System 140, Knowledge Graph 150, Rei
nforcement Logic 145, Content Distribution Logic 163, Memory Storage System 155, Training Logic
143, Couple Logic 170, Microprocessor 190. [0050] In some embodiments, the Rule‐Based Logic 135 opera
tes on premises and parameters currently proposed by experts in the field of infert
ility and/or their overseeing governing body. From this, a list of rules has been created and an infe
rence engine performs a match‐resolve‐act cycle which measures information that it takes in against
these rules. [0051] In some embodiments, the Machine learning system 140
is configured to supplement the selections provided by the rule‐based logic, and tr
aining logic configured to train the first machine learning system based on clinical success of the sel
ections from among the alternative infertility treatments. Wherein the first machine learning system
is further configured to provide a preference among selections provided by the rule‐based logic,
Machine Learning System 140 operates on an algorithm created by selecting an appropriate AI mode
l and presenting it with a very large dataset. The algorithm then analyzes the dataset and determine
s relationships within that data; logic is then embedded in the algorithm, not encoded by a human.
This model trains itself and learns from the data, creating a cohesive relationship between data i
nferences and future data outputs. [0052] In some embodiments, the Knowledge Graph 150 can be
the patient’s accrued data entered into standardized graphs or graphs generated de novo
using machine learning. [0053] In some embodiments, the Reinforcement Logic 145 appl
ies to when the software agent receives data as its sensory inputs and then acts o
n the environment by displaying on a screen, writing files, and sending network packets. It is co
nfigured to associate quality scores to members of the plurality of rules, the scores being based on a
t least clinical success of the selections. This embraces the three basic elements of Reinforcement Le
arning: Policy, which defines the way the agent behaves at a given time; Reward, which defines
the goal of a learning problem as the maximizing of good (versus bad) results of that beha
vior; and, Value, the aggregated number of rewards expected by adherence to a refined policy. A
fourth element germane to our system is the Model of the Environment, which implies that the beh
avior of an individual’s reproductive environment (or milieu) will react in a manor favora
ble to a pregnancy. Feedback loops are at times quantitative and at times qualitative communicated fro
m the Patient App 130B and/or the Caregiver App 120 to reinforce (raise score of) rules that se
em to work while lowering rules that don’t seem a
s good. These data are requisite in concurrence with
their given step in the process or else progress halts [0054] In some embodiments, the Content Distribution Logic 1
63 refers to how data is managed and is configured to automatically provide content fr
om the library of information to the first patient; optionally after approval by caregiver. The
patient is informed of his/her data and what they mean in relation to their infertility as communicated
through Patient UI 183 and is optimized to minimize questions to care giver. The caregiver recei
ves feedback from Expert System 110 on Caregiver App 120 either through Caregiver UI 175 or
Status Logic 177. In some embodiments the content distribution logic is configured to automatica
lly provide content from the library of information to the first patient; optionally after ap
proval by caregiver. In this manner the content distributed is optimized to minimize questions to car
e giver. A second machine learning system is trained on this goal. The Expert System 110 receiv
es confirmation from both Caregiver UI 175 and ,
that content has been read by patient.In some embodi
ments, data is distributed elsewhere within each element of System 100. [0055] In some embodiments, Storage 155 is configured to st
ore a library of information regarding the alternative infertility treatments and the clinica
l data regarding the first patient, the storage including non‐transient digital memory, and a patien
t Status Storage 165 containing pertinent positive and negative clinical data regarding the ind
ividual patient including non‐transient digital memory. Storage 155 could store any of the logic di
scussed herein. [0056] In some embodiments, there is an Information Library
160 regarding the alternative infertility treatments and information including conten
t selected to answer patient questions. Herein the content distribution logic is optimized to minimi
ze the number of questions asked of a caregiver. Storage could store any of the logic discussed herei
n. The Information Library of information also includes content selected to answer patient questions,
and wherein the content distribution logic is optimized to minimize the number of questions asked
a caregiver. [0057] In some embodiments, Training Logic 143 is configured
to train the first machine learning system based on clinical success provided by the car
egiver and the clinical data. [0058] In some embodiments, Couple Logic 170 is configured
to treat a pair of patients as a reproductive unit and to coordinate the selections pr
ovided to both members of the reproductive unit based on clinical data regarding both the male
patient and the female patient. When a Male Factor is a predominant cause for a couple’s inabi
lity to conceive, priority is given to determining t
he cause for this problem and possibly providing a reme
dy. When the Male has a significant, but not absolute, problem the couple is steered towards intra
uterine insemination or In vitro fertilization. If the Male problem is absolute and incorrigible, a rec
ommendation that the couple considers using donor sperm is made. By the same token, when a Fem
ale Factor is the predominant cause of a couple’s infertility considerable time, effort, and
focus is invested in identifying and, when possible,
correcting any obstacles. When both partners have iss
ues contributing to the couple’s infertility equal time, attention, and effort must begiven on be
half of the Male and the Female. An example of where a man’s clinical data being used to suggest
treatment of woman is when a Male is found to have an uncorrectable low sperm count and this is o
ffset by ovarian hyperstimulation of the Female, or simply proceeding to In vitro Fertilization.
[0059] In some embodiments, Microprocessor 190 is configured
to execute at least the rule‐based logic; or any other logic discussed herein. [0060] A Caregiver App 120 is embodied in a caregiver comp
uting device, wherein the caregiver application includes: an ability of the Caregiver t
o insert new information into Clinical Input 173, receive feedback via the Caregiver UI 175, and affec
t change in the Status Logic 177. A clinical input
configured to receive the clinical data could be a
UI or a digital input such as a network connection
to a medical record system, or a sensor. [0061] In some embodiments, the Caregiver User Interface 175
is configured for a caregiver to receive the selections from among the alternative inf
ertility treatments through the Microprocessor 190 as they are ranked according to their associated
scores. [0062] In some embodiments, the Caregiver UI 175 is configu
red for a caregiver to approve the selections, to forward the selections to the patient,
to approve the content from the library of information, to forward the content from the library
of information to the patient, to answer questions received from the patient, to require that
the caregiver provide the clinical data, and/or to
enter the clinical data. [0063] In some embodiments, Status Logic 177 is configured
to track treatment status of the patient, the treatment including the selections from
among the alternative infertility treatments. Feedback will include treatments received, their resul
ting response, and the treatment history. [0064] FIG. 2 illustrates the method of treating infertility
, according to various embodiments of the invention. [0065] In a Receive Clinical Data Step 210, clinical data
is received from various sensors 185, from the patient interface 183, and/or from a medical rec
ords system 180 via the Patient App 130A or 130B. As an example, the patient imports her sleep
patterns, menstrual cycle characteristics, failed attempts at getting pregnant, and/or quantifiable data
. [0066] In Receive Selection Step 220 the data is delivered
to the Expert System 110 to be processed through the Rule‐Based Logic 135, the Machine Learn
ing System 140, and/or the Knowledge Graph to select an appropriate course of action. [0067] In a Communicate Selection Step 230 the action respo
nse is passed through the Reinforcement Logic 145, archived in Storage 155, run
through the Training Logic 143 and Couple Logic 170, before passing through the Microprocessor
190 on its way to being made available to be acted upon. [0068] In a Communicate Content Step 240 the action which
has been decided upon is passed on via the Network 115 to the Caregiver App 120 and t
o the Patient App 130A or 130B. This is step is reinforced both through verbal communication between c
aregiver and patient, and via the apps. A confirmation that the correct information was received
, read, and understood is made through Patient UI 183. [0069] In a Receive Outcome Step 250 further assurance that
the appropriate message and action plan was communicated is by the patient’s complianc
e to tests ordered and/or medications prescribed. [0070] In the Reinforce Step 260 a feedback loop to either
the rule‐based system and/or a machine learning system is completed. [0071] FIG.3 schematically illustrates a typical diagnostic a
nd treatment methodology for the male patient in a sub‐fertile couple. The diagnostic met
hod proceeds as follows: The healthcare provider clicks the “Register for Fertility Pathways” butto
n on the Patient UI 183 start screen. The click is
transmitted to the Expert System 110 which adds de
identified demographic data for a patient of interest using a numbering system known only to the
provider’s office. [0072] The Expert System 110 receives the addition of a ne
w male patient from Patient UI 183 and stores the information in Storage 155. Rules‐Based
Logic 135 then sends the first diagnostic question to Caregiver UI 175 at 300, “Does the patient hav
e a female partner?” The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic question to the Careg
iver UI 175, depending on the previous answer. [0073] If the answer at 300 is no, then the information w
ill be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send a recommendatio
n to Caregiver UI 175 for an oocyte donor and gestational carrier at 303 and recommend an IVF cons
ultation at 307. This information is communicated to Patient UI 183 through Network 115.
Those steps being done, the diagnostic review can continue onto 301. [0074] If the answer at 300 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagn
ostic question to Caregiver UI 175 at 301, “Is th
e patient currently being prescribed calcium‐channel bl
ockers and/or androgen supplements?” The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155 and shares this information with Patient UI 183 through
Network 115. Rules‐Based Logic 135 then sends the next diagnostic question to the Caregiver UI 175
, depending on the previous answer. [0075] If the answer at 301 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send instructions to
Caregiver UI 175 at 302, which counsels to discontinue calcium‐channel blockers and androgen sup
plements and prescribe suitable alternative hypertensive control management. This information is s
hared with Patient UI 183 through Network 115. Those steps being done, the diagnostic review c
an continue to 304. [0076] If the answer at 301 is no, then the information w
ill be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagn
ostic question to Caregiver UI 175 at 304, “Does
the patient have a vasectomy?” The provider inputs
the answer to Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic question to Caregiver UI 175, depending on the previous answer.
[0077] If the answer at 304 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagn
ostic step to Caregiver UI 175 at 308, “Has the
patient failed or is unwilling to get a reversal?”
The provider inputs the answer into Caregiver UI 1
75 which sends the information to Storage 155. Rules‐B
ased Logic then sends the next diagnostic question to Caregiver UI 175 depending on the previo
us answer. [0078] If the answer at 304 is no, then the information w
ill be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagn
ostic question to Caregiver UI 175 at 353, “Does
the patient have congenital absence of the vas defer
ens?” The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic then sends the next diagnostic question depending on the previous answer.
[0079] If the answer at 308 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagn
ostic step to Caregiver UI 175 at 317, “Is the Patient Willing to Undergo TESA?” The provider inpu
ts the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic t
hen sends the next diagnostic question to Caregiver UI 175 depending on the previous answer.
[0080] If the answer at 308 is no, then the information w
ill be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagn
ostic step to Caregiver UI 175 at 309, “A vasectomy reversal is recommended for the patient.”
The provider communicates this recommendation to the patient and schedules a follow
up. [0081] If the answer at 353 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagn
ostic step to Caregiver UI 175 at 317, “Is the patient willing to undergo TESA?” The provider inpu
ts the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic t
hen sends the next diagnostic question to Caregiver UI 175 depending on the previous answer.
[0082] If the answer at 353 is no, then the provider will
input the information into Caregiver UI 175 which sends the information to Storage 155 for recor
ding. Rules‐Based Logic 135 then processes said information and sends the next diagnostic question to
Caregiver UI 175 at 305, “Has the patient been involved in a recent pregnancy within the last
year?” The provider then inputs the response into Caregiver UI 175 which sends the information to
Storage 155 for recording. Rules‐Based Logic 135 then sends the next diagnostic question to Careg
iver UI 175 depending on the previous answer. [0083] If the patient agrees to and undergoes the vasectomy
reversal recommended at 309, then on follow up after the procedure the diagnostic proc
ess will continue. After inputting the information into Caregiver UI 175, said information w
ill be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagnostic
step to Caregiver UI 175 at 310, “Obtain a seme
n analysis within at least 2 days, but no more than
5 days of abstinence from ejaculation.” The provider communicates this recommendation to the patie
nt and schedules a follow up at 318. [0084] If the answer at 317 is yes, the provider will inp
ut the information into Caregiver UI 175 which sends the information to Storage 155 for recor
ding. Rules‐Based Logic 135 then processes said information and sends the next diagnostic question to
Caregiver UI 175 at 322, “TESA is recommended for the patient.” The provider communica
tes this recommendation to the patient and Rules‐Based Logic 135 processes the next step. [0085] If the answer at 317 is no, the provider will inpu
t the information into Caregiver UI 175 which sends the information to Storage 155 for recor
ding. Rules‐Based Logic 135 then processes said information and sends the next diagnostic step to Ca
regiver UI 175 at 316, “Donor sperm is recommended for the patient.” The provider communica
tes this recommendation to the patient and the diagnostic protocol is complete for the male par
tner. [0086] If the answer at 305 is yes, then the provider wil
l input the information into Caregiver UI 175 which sends the information to Storage 155 for recor
ding. Rules‐Based Logic 135 then processes said information and sends the next diagnostic question to
Caregiver UI 175 at 306, “The patient’s semen
can be used for impregnation. There’s no need to
check him further at this time.” At this point, t
he provider can return to the female diagnostic protocol
. [0087] If the answer at 305 is no, then the provider will
input the information into Caregiver UI 175 which sends the information to Storage 155 for recor
ding. Rules‐Based Logic 135 then processes said information and sends the next diagnostic step to Ca
regiver UI 175 at 310, “Obtain a semen analysis within at least two days, but no more than 5 days
of abstinence from ejaculation.” The provider then
orders the lab to be taken. When the lab results a
re obtained, the provider will input them into Caregiver UI 175 which sends the information to Stor
age 155 for recording. Rules‐Based Logic 135 then sends the next diagnostic question to Caregiver
UI 175 depending on the lab results. [0088] If the patient agrees to and undergoes the semen an
alysis recommended at 310, then on follow up after the procedure the diagnostic process
will continue with inputting the results at 318, “Is the semen volume greater or equal to 1.0 mL?
The provider inputs this information into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next diagnostic question to Caregiver UI 175 dependin
g on the previous answer. [0089] If the answer at 318 is yes, then the provider wil
l input the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
question to Caregiver UI 175 at 324, “Is the Morphology >14%?” The provider inputs the answe
r into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic question to Caregiver UI 175, depending on the previous answer.
[0090] If the answer at 318 is no, the provider will in
put the information into Caregiver UI 175 which will send said information to be recorded in
Storage 155. Rules‐Based Logic 135 will then process said information and send the next diagnostic
question to Caregiver UI 175 at 319, “Is the Morphology greater than or equal to 14.0%?” The pr
ovider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next diagnostic question to Caregiver UI 175, depending on the previ
ous answer. [0091] If the patient agrees to TESA at 322, then the pro
vider communicates the next step provided by Rules‐Based Logic 175 to the patient at 332,
IVF is recommended for the patient.” At this poi
nt the diagnostic protocol is complete. [0092] At 316, a recommendation is made to use donor sperm
at both Caregiver UI 174 and Patient UI 183 with content disseminated throughout System 11
0 via Content Distribution Logic 163. Diagnosis is complete. [0093] At 306, a recommendation is made at both Caregiver
UI 174 and Patient UI 183 to return to the female partner’s focus of care as the seminal
parameters have been found to be satisfactory. This conclusion is disseminated throughout System 110
via Content Distribution Logic 163. Diagnosis is complete. [0094] If the answer at 324 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
question to Caregiver UI 175 at 324, “Is the Motility greater than or equal to 50%?” The provid
er inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐Based
Logic 135 then sends the next diagnostic question to Caregiver UI 175, depending on the previ
ous answer. [0095] If the answer at 324 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
question to Caregiver UI 175 at 323, “Is the Motility Grade greater than 30% (+3/+4)?” The provi
der inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐
Based Logic 135 then sends the next diagnostic question to Caregiver UI 175, depending on the previ
ous answer. [0096] If the answer at 319 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 336, “Is the sperm
count greater than or equal to 20 million/mL?” The
provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐
Based Logic 135 then sends the next diagnostic question to Caregiver UI 175, depending on the previ
ous answer. [0097] If the answer at 319 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 325, “Is greater than 30% Grade Motility (+3/+4)?” The provider inpu
ts the lab result into Caregiver UI 175 which sends said information to Storage 155. Rules‐Based
Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on the previous answer.
[0098] At 332 a recommendation is made to proceed with IVF
and diagnosis is complete. [0099] If the answer at 334 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 347, “Is the sperm
count greater than or equal to 20 million/mL?” The
provider inputs the lab result into Caregiver UI 175 which sends said information to Storage 155. Rul
es‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on th
e previous answer. [00100] If the answer at 334 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 333, “Is the sperm
count greater than or equal to 20 million/mL?” The
provider inputs the lab result into Caregiver UI 175 which sends said information to Storage 155. Rul
es‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on th
e previous answer. [00101] If the answer at 323 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 335, “Is the Motility greater than or equal to 50%?” The provid
er inputs the lab result into Caregiver UI 175 which sends said information to Storage 155. Rules‐
Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on the previous
answer. [00102] If the answer at 323 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
question to Caregiver UI 175 at 331, “Does the
patient have a previous history of vasectomy?” The
provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐
Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on the previous
answer. [00103] If the answer at 336 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 348, “Is sperm count greater than or equal to 20 million/mL?” The
provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐
Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on the previous
answer. [00104] If the answer at 336 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
question to Caregiver UI 175 at 345, “Does the
patient have a varicocele?” The provider inputs the
answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175, depending on the previous answer. [00105] If the answer at 325 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 335, “Is the Motility greater than or equal to 50%?” The provid
er inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐Based
Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on the previous lab resu
lt. [00106] If the answer at 325 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
question to Caregiver UI 175 at 331, “Does the
patient have a previous history of varicocelectomy?”
The provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155.
Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on th
e previous answer. [00107] If the answer at 347 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 350, “Is greater than 30% Grade Motility (+3/+4)?” The provider inpu
ts the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐Based Logic
135 then sends the next diagnostic step to Caregiver UI 175, depending on the previous lab resu
lt. [00108] If the answer at is no, the provider will input th
e information into Caregiver UI 175 which will then send said information to be recorded in Storage
155. Rules‐Based Logic 135 will then process said information and send the next diagnostic step t
o Caregiver UI 175 at 346, “Is total sperm count
greater than 40 million?” The provider inputs the
answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175, depending on the previous lab result. [00109] If the answer at 333 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 352, “Intrauterine Insemination (up to 6x).” The provider communicates
this recommendation to the patient and the Rules‐Based Logic 135 processes the next step. [00110] If the answer at 333 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
question to Caregiver UI 175 at 345, “Does the
patient have a varicocele?” The provider inputs the
answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175, depending on the previous answer. [00111] If the answer at 335 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 348, “Is the sperm
count greater than or equal to 20 million/mL?” The
provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐
Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on the previous
lab result. [00112] If the answer at 335 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 336, “Is the sperm
count greater than or equal to 20 million/mL?” The
provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐
Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on the previous
lab result. [00113] If the answer at 331 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 330, “Is the patien
t taking Tamoxifen, Clomid, or Aromatase Inhibitors?”
The provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155.
Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on th
e previous answer. [00114] If the answer at 331 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
question to Caregiver UI 175 at 345, “Does the
patient have a varicocele?” The provider inputs the
answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175, depending on the previous answer. [00115] If the answer at 348 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 352, “Intrauterine insemination (up to 6x).” The provider communicates
the recommendation to the patient and Rules‐ Based Logic 135 processes the next diagnostic step.
[00116] If the answer at 348 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
question to Caregiver UI 175 at 331, “Does the
patient have a previous history of varicocelectomy?”
The provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155.
Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on th
e previous answer. [00117] If the answer at 345 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 349, “Ligation, recheck semen analysis in 3 months.” The provider
communicates the recommendation to the patient. Rules‐Based Logic 135 then processes the n
ext diagnostic step at 310 following the recommended procedure and sends it to Caregiver UI 1
75. [00118] If the answer at 345 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 330, “Is the patien
t taking Tamoxifen, Clomid, or Aromatase Inhibitors?”
The provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155.
Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on th
e previous answer. [00119] If the answer at 350 is yes, the provider will inp
ut the information into Caregiver UI 175 which will send said information to be recorded in
Storage 155. Rules‐Based Logic 135 will then process said information and send the next diagnostic
step to Caregiver UI 175 at 351, “Male patient
appears to be suitable for pregnancy. Check female p
artner.” At this point the diagnostic protocol for the male patient is completed. [00120] If the answer at 350 is no, the provider will inpu
t the information into Caregiver UI 175 which will send said information to be recorded in
Storage 155. Rules‐Based Logic 135 will then process said information and send the next diagnostic
step to Caregiver UI 175 at 352, “Intrauterine insemination (up to 6x).” The provider will communi
cate this recommendation to the patient. Rules‐ Based Logic 135 will process the next step at 306
to be sent to the Caregiver UI 175. [00121] If the answer at 346 is yes, the provider will inp
ut the information into Caregiver UI 175 which will send said information to be recorded in
Storage 155. Rules‐Based Logic 135 will then process said information and send the next diagnostic
step to Caregiver UI at 352, “Intrauterine insemination (up to 6x).” The provider will communi
cate this recommendation to the patient. Rules‐ Based Logic 135 will process the next step at 306
to be sent to the Caregiver UI 175. [00122] If the answer at 346 is no, the provider will inpu
t the information into Caregiver UI 175 which will send said information to be recorded in
Storage 155. Rules‐Based Logic 135 will then process said information and send the next diagnostic
question to Caregiver UI at 345, “Does the patient have a varicocele?” The provider will input
the answer into Caregiver UI 175 which will send
said information to Storage 155. Rules‐Based Logic
135 processes said information and sends the next diagnostic step to Caregiver UI 175, depending
on the previous answer. [00123] Transmit recommendation at 352 to Patient UI 183, Ca
regiver UI 175, and Content Distribution Logic 163. Then proceed to 306. [00124] If the answer at 330 is yes, the provider will inp
ut the information into Caregiver UI 175 which will send said information to be recorded in
Storage 155. Rules‐Based Logic 135 will then process said information and send the next diagnostic
step to Caregiver UI 175 at 332, “IVF is recommended for the patient.” The provider will com
municate this recommendation to the patient and the protocol is completed. [00125] If the answer at 330 is no, the provider will inpu
t the information into Caregiver UI 175 which will send said information to be recorded in
Storage 155. Rules‐Based Logic 135 will then process said information and send the next diagnostic
step to Caregiver UI 175 at 329, “Obtain FSH and Testosterone Levels.” The provider will order t
he labs for the patient. Rules‐Based Logic 135 wil
l process the next step at 315 to be sent to the Ca
regiver UI 175. [00126] After the recommended procedure at 349, the Rules‐B
ased Logic 135 will process the next diagnostic step and send it to Caregiver UI 175 at
310, “Obtain a semen analysis within at least 2
days, but no more than 5 days, of abstinence from
ejaculation.” The provider will communicate this to the patient and order the follow up lab work. T
he Rules‐Based Logic 135 will then process the next diagnostic step at 318. [00127] If the answer at 315 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 316, “Donor sperm is recommended for the patient.” The provider will
communicate this recommendation to the patient and the male diagnostic protocol is complete.
[00128] If the answer at 315 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 314, “Is the Testosterone less than or equal to 350 ng/dL?” The
provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rules‐
Based Logic 135 then processes and sends the next diagnostic step to Caregiver UI 175, depending
on the lab results. [00129] If the answer at 314 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 313, “Is FSH greater than or equal to 10 IU/L?” The provider i
nputs the answer into Caregiver UI 175 which sends
said information to Storage 155. Rules‐Based Logic
135 then sends the next diagnostic step to Caregiver UI 175, depending on the previous answer.
[00130] If the answer at 314 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 321, “Is Testosterone greater than or equal to 850 ng/dL?”
The provider inputs the answer into Caregiver UI 175 which sends said information to Storage 155. Rul
es‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depending on th
e previous answer. [00131] If the answer at 313 is yes, the provider will inp
ut the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 311, “Has the patient already had a trial with Tamoxifen + Depo‐
Testosterone?” The provider inputs the answer into Caregiver UI 175 which sends said information t
o Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175, depend
ing on the previous answer. [00132] If the answer at 313 is no, the provider will inpu
t the information into Caregiver UI 175 which will then send said information to be recorded
in Storage 155. Rules‐Based Logic 135 will then
process said information and send the next diagnostic
step to Caregiver UI 175 at 320, “Prescribe Tamoxifen 20 mg/day x 6 months but recheck FSH and
testosterone in one month.” The provider communicates this recommendation to the patient and s
chedules a follow up in one month. Rules‐ Based Logic 135 processes and sends the next diagnos
tic step at 337 to Caregiver UI 175. [00133] FIG.4 schematically illustrates a typical diagnostic a
nd treatment methodology for the female patient in a sub‐fertile couple. The diagnos
tic method proceeds as follows: The healthcare provider clicks the “Register for Fertility Pathways
” button on the Patient UI 183 start screen. The
click is transmitted to the Expert System 110 which
adds deidentified demographic data for a patient of interest using a numbering system known only to
the provider’s office. [00134] The Expert System 110 receives the addition of the
new female patient from Patient UI 183 and stores the information in Storage 155. Rules‐Ba
sed Logic 135 then sends the first diagnostic step
to Caregiver UI 175 at 4000, “Is the patient over
43 years of age?” The provider inputs the answer
into Caregiver UI 175 which sends the information to
Storage 155. Rules‐Based Logic 135 then sends the next step in the sequence, depending upon the p
revious response. [00135] If the answer at 4000 is yes, the information will
be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send a notification to
Caregiver UI 175 and Patient UI 183 at 4001, “Our
maximum age for a female patient is 42”. The enco
unter is concluded, thus ending the patient’s access to the algorithm. [00136] If the answer at 4000 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 sends the second diagnost
ic step to Caregiver UI 175 at 4002, “Is the patient over 38 years of age?” The provider inputs
the answer into Caregiver UI 175 which sends the
information to Storage 155. Rules‐Based Logic 135 t
hen sends information and explanations to Patient UI 183 and the next directive or diagnostic
step to Caregiver UI 175, depending upon the previous response. [00137] If the answer at 4002 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation and explanations to Patient IU 183 and the next step to Caregiver UI 175 at 4003, “The patie
nt is over 38. There is an increased risk for feta
l chromosomal abnormalities.” The provider will instruc
t the patient as to the directive and enter a confirmation in Caregiver UI 175 which sends the inf
ormation to Storage 155. Rules‐Based Logic 135 sends the diagnostic step to Caregiver UI 175 at 40
04, “Was the patient’s weight entered within the
last 7 days?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends infor
mation and explanations to Patient UI 183 and the next directive or diagnostic step to Caregiver U
I 175, depending upon the previous response. [00138] If the answer at 4002 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation and explanations to Patient UI 183 and the next diagnostic step to Caregiver UI 175 at 4004,
Was the patient’s weight entered within the last
seven days?” The provider inputs the answer into C
aregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends infor
mation and explanations to Patient UI 183 and the next directive or diagnostic step to Caregiver U
I 175, depending upon the previous response. [00139] If the answer at 4004 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send a directive to
Caregiver UI 175 at 4005, “Update patient weight.” The provider will instruct the patient as
to the directive, enter the requisite data, and ent
er a confirmation to Caregiver UI 175 which sends the
information to Storage 155. Rules‐Based Logic 135 will send relevant information and explanations t
o Patient UI 183 and the next diagnostic step to Caregiver UI 175 at 4006, “Is BMI ≥17 and ≤37
?” The provider inputs the answer into Caregiver 1
75 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00140] If the answer at 4004 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagn
ostic step to Caregiver UI 175 at 4006, “Is BMI
≥17 and ≤37?” The provider inputs the answer into Ca
regiver 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00141] If the answer at 4006 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send the next diagn
ostic question to Caregiver UI 175 at 4008, “Has
the patient had a previous pregnancy?” The provider
inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00142] If the answer at 4006 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation and explanations to Patient UI 183 and the next directive to Caregiver UI 175 at 4007 stating,
“Patient’s BMI must be between 17 and 37 before
proceeding.” The provider will instruct the patient
as to the directive and enter a confirmation to Caregiver UI 175 which sends the information to Stor
age 155. The algorithm comes to a hard stop until BMI re‐entry complies with requirement of bei
ng between 17 and 37. This gets passed through the Expert System 110 in all 5 stages (135, 140, 1
50, 145, and 163). Resumption of protocol will again
begin at 4000. [00143] If the answer at 4008 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4009, “Is the patient currently breastfeeding?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
or diagnostic step to Caregiver UI 175 depending on the previous answer. [00144] If the answer at 4008 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation and explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4016, “Does the patient have a male partner?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
or diagnostic step to Caregiver UI 175 depending on the previous answer. [00145] If the answer at 4009 is yes, the information will
be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant information
and explanations to Patient UI 183 and the directive to Caregiver UI 175 and Patient UI 183 at
4010, “The patient must stop breastfeeding and return in 3 months.” The provider will instruct th
e patient as to the directive and enter a confirmation to Caregiver UI 175. The algorithm comes
to a hard stop until breastfeeding has stopped for 3 months. This gets passed through the
Expert System 110 in all 5 stages (135, 140, 150,
145, and 163). Resumption of protocol will re‐enter
at 4011. [00146] If the answer at 4009 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4011 stating, “Was the end of the last pregnanc
y less than one year ago?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00147] If the answer at 4011 is yes, then information will
be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4012, “Was the pregnancy carried to viability?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00148] If the answer at 4011 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation and explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4016, “Does the patient have a male partner?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00149] If the answer at 4012 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4013, “Is the patient’s age ≥35?” The prov
ider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver
UI 175 depending on the previous answer. [00150] If the answer at 4012 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4098, “Has the patient been tested for the presence of anticardiolipin antibodies, lupus anticoagu
lant, anti‐beta2‐glycoprotein 1 antibodies, and Factor V Leiden mutation?” The provider inputs
the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 1
35 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the previous
answer. [00151] If the answer at 4013 is yes, the information will
be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant information
and explanations to Patient UI 183 along with the hard‐stop directive to Caregiver UI 175 at 401
4, “The algorithm should be restarted 6 months postpartum.” The provider will instruct the patient
as to the directive and enter a confirmation to Caregiver UI 175. Re‐entry will be at 4000. [00152] If the answer at 4013 is no, the information will
be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant information
and explanations to Patient UI 183 along with the hard‐stop directive to Caregiver UI 175 at 401
5, “The algorithm should be restarted 12 months postpartum.” The provider will instruct the patient
as to the directive and enter a confirmation to Caregiver UI 175. Re‐entry will be at 4000. [00153] If the answer at 4016 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4018, “Is the couple using a lubricant during intercourse that could be spermicidal?” The provider
inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00154] If the answer at 4016 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation and explanations to Patient UI 183 along the directive to Caregiver UI 175 at 4017, “Donor
sperm will be used for this pregnancy.” The provider will instruct the patient as to the directi
ve and enter a confirmation to Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 will send relevant information with explanations to Patient UI 183 along with the
next diagnostic step to Caregiver UI 175 at 4022, “Does the patient have spontaneous monthly cycles?
The provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155.
Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 dep
ending on the previous answer. [00155] If the answer at 4018 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the instruction to Caregiver UI 175 and Patient
UI 183 at 4019, “Discontinue use of spermicidal
lubricants.” The provider will instruct the patient
as to the directive and enter a confirmation to Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 will send relevant information with explanations to Patient UI
183 along with the next diagnostic step to Caregiver UI 175 at 4020, “Has the male protocol
been executed on the male partner?” The provider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Ca
regiver UI 175 depending on the previous answer. [00156] If the answer at 4018 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4020, “Has the male protocol been executed on the male partner?” The provider inputs the answer
into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00157] If the answer at 4020 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4022, “Does the patient have spontaneous monthly cycles?” The provider inputs the answer int
o Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends t
he next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00158] If the answer at 4020 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 and Pat
ient UI 183 at 4021, “Execute the male protocol before proceeding.” This is a soft stop/pause which
will allow the Couple Logic 170 to proceed to the
diagnostic step at 4022, “Does the patient have sp
ontaneous monthly cycles?” as the male protocol is also underway. The provider inputs the answer int
o Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends t
he next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00159] If the answer at 4022 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4023, “Is the patient taking Provera?” The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive to Ca
regiver UI 175 depending on the previous answer. [00160] If the answer at 4022 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the directive to Caregiver UI 175 and Patient
UI 183 at 4025, “Prescribe Provera 10mg/day x12 days.” The provider will instruct the patient as t
o the directive, prescribe the medication, and enter
confirmation in Caregiver UI 175 which sends the inf
ormation to Storage 155. Rules‐Based Logic 135 will process the next diagnostic step at 4026, “Do
es the patient experience withdrawal bleed within three days of stopping Provera?” The provider input
s the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 1
35 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00161] If the answer at 4023 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along the directive to Caregiver UI 175 and Patient UI 18
3 at 4024, “The patient should stop taking Provera.” The provider will instruct the patient as
to the directive and enter a confirmation to Caregiver UI 175. Rules‐Based Logic will send the
next directive to Caregiver UI 175 and Patient UI 183 at 4027, “Blood tests required on Day 2 (or
3) of cycle: estradiol and FSH” The provider will
instruct the patient as to the directive, order the
blood tests, and enter the results in Caregiver UI
175 which sends the information to Storage 155. Rule
s‐Based Logic 135 will send relevant information with explanation to Patient UI 183 along
with the next diagnostic step to Caregiver UI 175 at 4030, “Is FSH <4 mIU/mL?” The provider
inputs the answer into Caregiver UI 175 which send
s the information to Storage 155. Rules‐Based Logic 1
35 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the previous
answer. [00162] If the answer at 4023 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the directive to Caregiver UI 175 and Patient
UI 183 at 4027, “Blood tests required on Day2 (or
3) of cycle: estradiol and FSH.” The provider will
instruct the patient as to the directive, order th
e blood tests, and enter the results in Caregiver UI
175 which sends the information to Storage 155. Rules‐Based Logic 135 will send relevant information
with explanation to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 step a
t 4030, “Is FSH <4 mIU/mL?” The provider inpu
ts the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00163] If the answer at 4026 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the directive to Caregiver UI 175 and Patient
UI 183 at 4027, “Blood tests required on Day 2 (
or 3) of cycle: estradiol and FSH.” The provider will
instruct the patient as to the directive, order th
e blood tests, and enter the results in Caregiver UI
175 which sends the information to Storage 155. Rules‐Based Logic 135 will send relevant information
with explanation to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 at 403
0, “Is hCG ≥ 5 mIU/mL?” The provider inputs t
he answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00164] If the answer at 4026 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the instruction to Caregiver UI 175 and Patient
UI 183 at 4028, “Labs needed: Estradiol, FSH, hCG (or uCG)” The provider will instruct the patie
nt as to the directive, order the blood tests, and
enter the results in Caregiver UI 175 which sends t
he information to Storage 155. Rules‐Based Logic 135 will send relevant information with explanation t
o Patient UI 183 along with the next diagnostic step to Caregiver UI 175 at 4029, “Is hCG ≥ 5
mIU/mL or urine pregnancy test positive?” The prov
ider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00165] If the answer at 4029 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the directive to Caregiver UI 175 and Patient
UI 183 at 4039, “Draw estradiol and progesterone.” The provider will instruct the patien
t as to the directive, order the blood tests, and
enter the results in Caregiver UI 175 which sends t
he information to Storage 155. Rules‐Based Logic 135 will send relevant information with explanation t
o Patient UI 183 along with the next diagnostic step to Caregiver UI 175 at 4040, “Is progesterone
≤ 25 ng/mL?” The provider inputs the answer in
to Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending o
n the previous answer. [00166] If the answer at 4029 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4030, “Is FSH < 4 mlU/mL?” The provider in
puts the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00167] If the answer at 4030 is yes, the information will
be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant information
with explanations to Patient UI 183 along with the next hard stop directive to Caregiver UI 175 an
d Patient UI 183 at 4038, “The patient needs injectable gonadotropins prescribed by a fertility cli
nic.” The provider will instruct the patient as to
the directive and provide counselling about adoption
or a referral to a specialty center. [00168] If the answer at 4030 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4031, “Is FSH > 25 mlU/mL?” The provider i
nputs the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00169] If the answer at 4031 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4032, “Is estradiol <200 pg/mL?” The provide
r inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Ca
regiver UI 175 depending on the previous answer. [00170] If the answer at 4031 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4035, “FSH mlU/mL > 20?” The provider input
s the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00171] If the answer at 4032 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the directive to Caregiver UI 175 at 4033, “
No ovarian reserve; patient will need donor eggs and
IVF”. The provider will instruct the patient as to
the directive and enter a confirmation. The algorithm comes to a hard stop and the patient rece
ives counselling about adoption or a referral to a
specialty center. [00172] If the answer at 4032 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the directive to Caregiver UI 175 and Patient
UI 183 at 4034, “Patient appears to be currently
ovulating.” The provider will instruct the patient
as to the directive and enters a confirmation into
Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 will send relevant information with explanation to Patient UI 1
83 along with the next diagnostic step to Caregiver UI 175 at 4097, “Does the patient have
a personal history of miscarriage or a family histor
y of deep vein thrombosis?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00173] If the answer at 4035 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations Patient UI 183 along with the directive to Caregiver UI 175 and Patient
UI 183 at 4036, “Is estradiol ≥150 pg/mL?” The
provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive to Ca
regiver UI 175 depending on the previous answer. [00174] If the answer at 4035 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4097, “Does the patient have a personal history
of miscarriage or a family history of deep vein thr
ombosis?” The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending o
n the previous answer. [00175] If the answer at 4036 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the directive to Caregiver UI 175 and Patient
UI 183 at 4034, “Patient appears to be currently
ovulating.” The provider will instruct the patient
as to the directive and enters a confirmation in Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 will send relevant information with explanations Patient UI 183
along with the directive to Caregiver UI 175 at 4097, “Does the patient have a personal history of
miscarriage or a family history of deep vein thrombosis?” The provider inputs the answer into Ca
regiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00176] If the answer at 4036 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations Patient UI 183 along with the hard stop directive to Caregiver UI 175 an
d Patient UI 183 at 4037, “Ovarian reserve is extremely limited, an IVF consult is recommended for
patient.” The provider will instruct the patient as to the directive and provide counselling about ad
option or a referral to a specialty center. [00177] If the answer at 4040 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4041, “Is the patient currently taking P4 supplements?” The provider inputs the answer into C
aregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00178] If the answer at 4040 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4052, “Is estradiol ≥150 pg/mL?” The provider
inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00179] If the answer at 4041 is yes, the information will
be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant information
with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 at 404
2, “Is the patient currently taking progesterone in
oil (50mg/mL) 100mg IM dose daily?” The provider i
nputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00180] If the answer at 4041 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the directive to Caregiver UI 175 at 4043, “
Prescribe oral micronized progesterone 200 mg AM and PM. Then recheck progesterone in two days.” Th
e provider will instruct the patient as to the directive, prescribe the medication, order the lab te
sts, and enter the results in Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 will send relevant information with explanations to Patient UI 183 along with the
next diagnostic step to Caregiver UI 175 at 4040 “Is progesterone ≤ 25 ng/mL?” The provider inpu
ts the answer into Caregiver UI 175 which sends the
information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00181] If the answer at 4042 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4052, “Is estradiol ≥150 ng/mL?” The provider
inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00182] If the answer at 4042 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4046, “Is the patient currently taking oral micronized progesterone 200 mg TID?” The provider i
nputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00183] If the answer at 4044 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the directive to Caregiver UI 175 at 4043, “
Prescribe oral micronized progesterone 200 mg BID. Then recheck progesterone in two days.” The provide
r will instruct the patient as to the directive, prescribe the medication, order the lab tests, and e
nter the results which sends the information to Storage 155. Rules‐Based Logic 135 will send releva
nt information with explanations to Patient UI 183 along with the next diagnostic step to Caregiver
UI 175 at 4040 “Is progesterone ≤ 25 ng/mL?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00184] If the answer at 4044 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4047, “Is progesterone ≥ 18 & < 22 ng/
mL?” The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive to Ca
regiver UI 175 depending on the previous answer. [00185] If the answer at 4045 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4048, “Is progesterone ≥ 22 & ≤ 25 ng/m
L?” The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive to Ca
regiver UI 175 depending on the previous answer. [00186] If the answer at 4045 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4044, “Is P4 ≥ 22 & ≤25 ng/mL?” The
provider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Ca
regiver UI 175 depending on the previous answer. [00187] If the answer at 4046 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4049
, “Prescribe progesterone in oil (50 mg/mL) 100 mg IM dose daily.” The provider will instruct the
patient as to the directive, prescribe the medication, and enter a confirmation in Caregiver UI
175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next dia
gnostic step to Caregiver UI 175 at 4052, “Is estradiol > 150 pg/mL?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00188] If the answer at 4046 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4045, “Is the patient currently taking oral micronized progesterone 200 mg BID?” The provider i
nputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00189] If the answer at 4047 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4051
, “Prescribe oral micronized progesterone 200mg TID.” The provider will instruct the patient as to
the directive, prescribe the medication, and enter
this compliance into Caregiver UI 175 which sends th
e information to Storage 155. Rules‐Based Logic then sends the next diagnostic step to Caregiver UI
175 at 4052, “Is estradiol > 150 pg/mL?” The
provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive or di
agnostic step to Caregiver UI 175 depending on the previous answer. [00190] If the answer at 4047 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4050
, “Prescribe progesterone in oil (50 mg/mL) 100 mg IM dose daily.” The provider will instruct the
patient as to the directive, prescribe the medication, and enter this compliance into Caregiver
UI 175 which sends the information to Storage 155. Rules‐Based Logic then sends the next diagnost
ic step to Caregiver UI 175 at 4052, “Is estradio
l > 150 pg/mL?” The provider inputs the answer in
to Caregiver UI 175 which sends the information to
Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00191] If the answer at 4048 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4051
, “Prescribe oral micronized progesterone 200mg TID.” The provider will instruct the patient as to
the directive, prescribe the medication, and enter
this compliance into Caregiver UI 175 which sends th
e information to Storage 155. Rules‐Based Logic then sends the next diagnostic step to Caregiver UI
175 at 4052, “Is estradiol > 150 pg/mL?” The
provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive or di
agnostic step to Caregiver UI 175 depending on the previous answer. [00192] If the answer at 4048 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4050
, “Prescribe progesterone in oil (50 mg/mL) 100 mg IM dose daily.” The provider will instruct the
patient as to the directive, prescribe the medication, and enter this compliance into Caregiver
UI 175 which sends the information to Storage 155. Rules‐Based Logic then sends the next diagnost
ic step to Caregiver UI 175 at 4052, “Is estradio
l > 150 pg/mL?” The provider inputs the answer in
to Caregiver UI 175 which sends the information to
Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00193] If the answer at 4052 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4055
, “Repeat hCG, estradiol, and progesterone levels 48 hours after most recent positive pregnancy test.
The provider will instruct the patient as to the
directive, order the lab tests, enter the results, a
nd register this compliance into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic will process the next diagnostic step to Caregiver UI 175 at 4057, “Was the increase in
hCG < 65%?” The provider inputs the answer in
to Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 17
5 depending on the previous answer. [00194] If the answer at 4052 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4053, “Is patient taking micronized estradiol?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00195] If the answer at 4053 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4056
, “Increase supplemental dose of micronized estradiol by 2 mg PO per day.” The provider will
instruct the patient as to the directive, prescribe
the medication, and enter this compliance into Caregiver
UI 175 which sends the information to Storage 155. Rules‐Based Logic then sends the next directiv
e to Caregiver UI 175 at 4055, “Repeat hCG, estradiol, and progesterone levels 48 hours after mos
t recent positive pregnancy test.” The provider will instruct the patient as to the directive, order
the lab tests, enter the results, and register thi
s compliance into Caregiver UI 175 which sends the inf
ormation to Storage 155. Rules‐Based Logic 135 will process the next diagnostic step at 4057, “Wa
s the increase in hCG < 65%?” The provider inp
uts the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00196] If the answer at 4053 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4054
, “Prescribe micronized estradiol 2mg PO BID.” Th
e provider will instruct the patient as to the directi
ve, prescribe the medication, and enter this compliance into Caregiver UI 175 which sends the inf
ormation to Storage 155. Rules‐Based Logic then sends the next directive to Caregiver UI 175 a
t 4055, “Repeat hCG, estradiol, and progesterone levels 48 hours after most recent positive pregnancy
test.” The provider will instruct the patient as
to the directive, order the lab tests, enter the re
sults, and register this compliance into Caregiver UI
175 which sends the information to Storage 155. Rule
s‐Based Logic 135 will process the next diagnostic step at 4057, “Was the increase in hCG
< 65%?” The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 17
5 depending on the previous answer. [00197] If the answer at 4057 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4058
, “Stop estradiol and progesterone supplements.” The provider will instruct the patient as to the di
rective and enter this compliance into Caregiver UI
175 which sends the information to Storage 155. Rule
s‐Based Logic 135 will send relevant information with explanations to Patient UI 183 along
with the next directive 4059, “Recheck hCG in one week.” The provider will instruct the patient
as to the directive, order the lab test, enter the
result, and register this compliance into Caregiver U
I 175 which sends the information to Storage 155. Rules‐Based Logic 135 will process the data f
rom 4059 in the next diagnostic step at 4060, “Is
this hCG value less than the previous one?” Rules
Based Logic will access Storage 155 and Information Library 160. Rules‐Based Logic shares re
levant information and explanations to Patient UI 183 along with the next diagnostic step to Careg
iver UI 175 depending on the previous answer. [00198] If the answer at 4057 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4065, “Is progesterone < 25 ng/mL?” The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next diagnostic step
to Caregiver UI 175 depending on the previous answer. [00199] If the answer at 4060 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4061, “Is hCG ≥ 5 mIU/mL?” The provider inp
uts the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00200] If the answer at 4060 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4062, “Is Urine hCG Positive?” The provider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Ca
regiver UI 175 depending on the previous answer. [00201] If the answer at 4061 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4059
, “Recheck hCG in one week.” The provider will
instruct the patient as to the directive, order the
lab tests, enter the results, and register this compliance into Caregiver UI 175 which sends the inf
ormation to Storage 155. Rules‐Based Logic 135 will process the next diagnostic step at 4060, “Is
the hCG value less than the previous one?” Comparison of results are made at the Information Li
brary 160 and conclusions sent to the Caregiver UI 175 and recorded in Storage 155. The provider in
puts the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00202] If the answer at 4061 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4098, “Has the patient been tested for the presence of anticardiolipin antibodies, lupus anticoagu
lant, anti‐beta2‐glycoprotein 1 antibodies, and Factor V Leiden mutation?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00203] If the answer at 4062 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4063
, “Prescribe methotrexate 1mg/kg IM and avoid folic acid.” The provider prescribes and administers
the medication, then enters compliance information into Caregiver UI 175 which is then sent
to Storage 155. Rules‐Based Logic then sends the next directive to Caregiver UI 175 at 4059, “
Recheck hCG in one week.” The provider will instru
ct the patient as to the directive, order the blood te
st, and enter the result in Caregiver UI 175 and Storage 155. The data will be assessed via Knowledge
Graph 150 and addressed in the Information Library 160. Rules‐Based Logic 135 will send releva
nt information with explanations to Patient UI 183 along with the next step to Caregiver UI 175 at 40
60, “Is this hCG value less than the previous one
?” Comparison of results are made at the Information Li
brary 160, recorded at Status Storage 165, and conclusions sent to the Caregiver UI 175. The provid
er confirms the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous
answer. [00204] If the answer at 4062 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next step to Caregiver UI 175 at 4098,
Has the patient been tested for the presence of anticardiolipin antibodies, lupus anticoagulant, anti‐
beta2‐glycoprotein 1 antibodies, and Factor V Leiden mutation?” The provider inputs the answer in
to Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00205] If the answer at 4065 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4041, “Is the patient currently taking progesterone supplements?” The provider inputs the a
nswer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00206] If the answer at 4065 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4066, “Does the patient have a history of tubal
disease (ectopic pregnancy, tubal occlusion, tubal rec
analization)?” The provider inputs the answer into Caregiver UI 175 which sends the information to
Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver UI 175 depending on
the previous answer. [00207] If the answer at 4066 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4068
, “Ultrasound at 3 weeks post conception.” The provider will instruct the patient as to the directi
ve, order the study for the patient, and enter the
results in Caregiver UI 175 and Storage 155. Rules
Based Logic 135 and Knowledge Graph 150 will assess the next diagnostic step at 4069, “Is a ge
stational sac seen within the uterus?” The provider
inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver
UI 175 depending on the previous answer. [00208] If the answer at 4066 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4067
, “Ultrasound for fetal viability at 5 weeks post
conception.” The provider will instruct the patient
as to the directive, order the study for the patie
nt, and enter the results in Caregiver UI 175 and Stora
ge 155. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the information. Rules‐Based
Logic will then send the next diagnostic step at 4075, “Are fetal pole and yolk sac present?” The
provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00209] If the answer at 4069 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4067
, “Ultrasound for fetal viability at 5 weeks post
conception.” The provider will instruct the patient
as to this directive, order the study for the pati
ent and enter the results in Caregiver UI 175 and Stora
ge 155. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the information. Rules‐Based
Logic will then send the next diagnostic step at 4075, “Are fetal pole and yolk sac present?” The
provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00210] If the answer at 4069 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4070
, “Recheck hCG level.” The provider will instruct
the patient as to the directive, order the blood te
st for the patient, and enter the result in Caregiv
er UI 175 and Storage 155. Rules‐Based Logic 135 and
Knowledge Graph 150 will assess the information and send the next diagnostic step at 4071, “Is hC
G > 1000 mIU/mL?” The provider inputs the answe
r into Caregiver UI 175 which sends the information to
Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver UI 175 depending on
the previous answer. [00211] If the answer at 4071 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4072
, “Repeat ultrasound at 4 weeks post conception.”
The provider will instruct the patient as to the di
rective, order the study for the patient, and enter
the results in Caregiver UI 175 and Storage 155. Ru
les‐Based Logic 135 and Knowledge Graph 150 will assess the information and send the next diagno
stic step at 4073, “Is a gestational sac within t
he uterus?” The provider inputs the answer into Caregi
ver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive to Caregiver UI 175 depending on the previous answer. [00212] If the answer at 4071 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4058
, “Stop estradiol and progesterone supplements.” The provider will instruct the patient as to this d
irective, order the blood test, enter the result in
Caregiver UI 175 and Storage 155. Rules‐Based Logic
135 will send relevant information with explanations to Patient UI 183 along with the next
directive to Caregiver UI 175 at 4059, “Recheck hCG in one week.” The provider will instruct the
patient as to the directive, order the blood test f
or the patient, and enter the result in Caregiver UI 1
75 and Storage 155. Rules‐Based Logic 135 and Knowledge Graph 150 will compare results in the Info
rmation Library 160 and present the next diagnostic step at 4060, “Is this hCG value less
than the previous one?” The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver UI 175 d
epending on the previous answer. [00213] If the answer at 4073 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4074
, “Repeat ultrasound at 5 weeks post conception.”
The provider will instruct the patient as to the di
rective, order the study for the patient, and enter
the results in Caregiver UI 175 and Storage 155. Ru
les‐Based Logic 135 and Knowledge Graph 150 will assess the information and send the next diagno
stic step at 4075, “Are fetal pole and yolk sac
present?” The provider inputs the answer into Careg
iver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00214] If the answer at 4073 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4064
, “Stop estradiol and progesterone supplements.” The provider will instruct the patient as to this d
irective, confirm the communication, and proceed to the next directive at 4063, “Prescribe methotrexate
1mg/kg IM and avoid folic acid.” The provider will instruct the patient as to this directive, pres
cribe and administer the medication, then confirm compliance in Caregiver UI 175 and Storage 155. Rule
s‐Based Logic 135 will send relevant information with explanations to Patient UI 183 along
with the next directive to Caregiver UI 175 at 4059, “Recheck hCG in one week.” The provider wi
ll instruct the patient as to this directive, order
the blood test, enter the result in Caregiver UI 17
5 and Storage 155. Rules‐Based Logic 135 and Knowledge Graph 150 will compare results in the Info
rmation Library 160 and present the next diagnostic step at 4060, “Is this hCG value less
than the previous one?” Results are shared in Caregiver UI 175 and Patient UI 183. The provider i
nputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00215] If the answer at 4075 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4077, “Is fetal cardiac activity seen?” The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive to Ca
regiver UI 175 depending on the previous answer. [00216] If the answer at 4075 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4076
, “Stop estradiol and progesterone supplements and allow miscarriage or perform suction D&C.”
The provider will instruct the patient as to this directive and proceed according to patient preference
and confirm compliance in Caregiver UI 175 and Storage 155. Rules‐Based Logic 135 will send r
elevant information with explanations to Patient UI 183 along with the next directive to Caregiver U
I 175 at 4059, “Recheck hCG in one week.” The
provider will instruct the patient as to this direct
ive, order the blood test, enter the result in Caregiver UI 175 and Storage 155. Rules‐Based Logic
135 and Information Library 160 will assess the next diagnostic step at 4060, “Is this hCG value
less than the previous one?” The information is shared in Caregiver UI 175 and Patient UI 183. The
provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00217] If the answer at 4077 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4080
, “Recheck estradiol and progesterone at 10 weeks post conception and begin Standardized Obstetric
Care.” The provider will instruct the patient as to this directive, order the blood tests, enter
the results in Caregiver UI 175 and Storage 155. Rules‐Based Logic 135 and Information Library 160 w
ill assess the next diagnostic step at 4081, ‘’I
s progesterone level < 40 ng/mL?’’ The provider
inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 1
35 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00218] If the answer at 4077 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4078
, “Recheck ultrasound for cardiac activity at 6 weeks post conception.” The provider will instruct
the patient as to this directive, order the study,
and enter the results in Caregiver UI 175 and Stora
ge 155. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the next diagnostic step at 4
079, “Is fetal cardiac activity present?” The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive or di
agnostic step to Caregiver UI 175 depending on the previous answer. [00219] If the answer at 4079 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4080
, “Recheck estradiol and progesterone at 10 weeks post conception and begin Standardized Obstetric
Care.” The provider will instruct the patient as to this directive, order the blood tests, enter
the results in Caregiver UI 175 and Storage 155. Rules‐Based Logic 135 and Knowledge Graph 150 will
assess the next diagnostic step at 4081, ‘’Is progesterone level < 40 ng/mL?’’ The results a
re shared in Caregiver UI 175 and Patient UI 183.
The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive to Ca
regiver UI 175 depending on the previous answer. [00220] If the answer at 4079 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4076
, “Stop estradiol and progesterone supplements and allow miscarriage or perform suction D&C.”
The provider will instruct the patient as to this directive and proceed according to patient preference
and confirm compliance in Caregiver UI 175 and Storage 155. Rules‐Based Logic 135 will send r
elevant information with explanations to Patient UI 183 along with the next directive to Caregiver U
I 175 at 4059, “Recheck hCG in one week.” The
provider will instruct the patient as to this direct
ive, order the blood tests, enter the results in Caregiver UI 175 and Storage 155. Rules‐Based Logic
135 and Knowledge Graph 150 will assess the next diagnostic step at 4060, “Is this hCG value
less than the previous one?” The information is shared in Caregiver UI 175 and Patient UI 183. The
provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00221] If the answer at 4081 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4089
, “Ultrasound for viability.” The provider will instruct the patient as to this directive, order the
study for the patient and enter the results in Caregiver UI 175 and Storage 155. Rules‐Based Logic
135 and Knowledge Graph 150 will assess the next diagnostic step at 4095, “Is fetal cardiac ac
tivity seen?” The results are shared in Caregiver
UI 175 and Patient UI 183. The provider inputs the ans
wer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive to Caregiver UI 175 depending on the previous answer. [00222] If the answer at 4081 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4082
, “Discontinue progesterone supplements.” The provider will instruct the patient as to this direct
ive and enter confirmation in Caregiver UI 175 and
Storage 155. Rules‐Based Logic 135 will send releva
nt information with explanations to Patient UI 183 along with the next diagnostic step to Caregiver
UI 175 at 4083, “Is estradiol ≥ 400 pg/mL?”
The information is shared in Caregiver UI 175 and Patien
t UI 183. The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next directive to Caregiver UI 175 depending on the
previous answer. [00223] If the answer at 4083 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4086
, “Stop estradiol supplementation. Recheck estradiol and progesterone in 2 days.” The provider
will instruct the patient as to this directive, or
der the blood tests, enter the results, and register con
firmation in Caregiver UI 175 and Storage155. Rules‐Based Logic 135 will send relevant information
with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 at 408
7, “Is progesterone ≥ 25 ng/mL?” The informatio
n is shared in Caregiver UI 175 and Patient UI 183.
The provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer
. [00224] If the answer at 4083 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4084, “Is patient taking estradiol supplements?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
or diagnostic step to Caregiver UI 175 depending on the previous answer. [00225] If the answer at 4084 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4085
, “Continue estradiol supplements for another 2 weeks, then recheck level.” The provider will instr
uct the patient as to this directive, order the blo
od test, enter the result, and register confirmation in
Caregiver UI 175 and Storage155. Rules‐Based Logic 135 will send relevant information with explana
tions to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 at 4083, “Is
estradiol ≥ 400 pg/mL?” The information is shared
in Caregiver UI 175 and Patient UI 183. The provider i
nputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00226] If the answer at 4084 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4087, “Is progesterone ≥ 25 ng/mL?” The information is shared in Caregiver UI 175 and Patien
t UI 183. The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 17
5 depending on the previous answer. [00227] If the answer at 4087 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next hard stop directive to Caregiver UI 1
75 at 4088, “Recheck ultrasound and continue obstetrical care without estradiol or progesterone sup
plementation.” The provider will instruct the patient as to this directive, order the study for t
he patient and enter the results in Caregiver UI 17
5 and Storage 155. The algorithm will close. [00228] If the answer at 4087 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4094
, “Prescribe micronized progesterone 200 mg PO BID and Ultrasound for viability.” The provider wil
l instruct the patient as to this directive, order
the medication and the study, and enter the results in
Caregiver UI 175 and Storage 155. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the n
ext diagnostic step at 4095, “Is fetal cardiac activity seen?” The results are shared in Caregiver
UI 175 and Patient UI 183. The provider inputs th
e answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver UI 175 d
epending on the previous answer. [00229] If the answer at 4090 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4091, “Is progesterone ≥ 25 ng/mL?” The resu
lts are shared in Caregiver UI 175 and Patient UI 183.
The provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer
. [00230] If the answer at 4090 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4076
, “Stop estradiol and progesterone supplements and allow miscarriage or perform suction D&C.”
The provider will instruct the patient as to this directive and proceed according to patient preference
and confirm compliance in Caregiver UI 175 and Storage 155. Rules‐Based Logic 135 will send r
elevant information with explanations to Patient UI 183 along with the next directive to Caregiver U
I 175 at 4059, “Recheck hCG in one week.” The
provider will instruct the patient as to this direct
ive, order the blood tests, enter the results in Caregiver UI 175 and Storage 155. Rules‐Based Logic
135 and Knowledge Graph 150 will assess the next diagnostic step at 4060, “Is this hCG value
less than the previous one?” The information is shared in Caregiver UI 175 and Patient UI 183. The
provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00231] If the answer at 4091 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4093
, “Continue supplements and recheck estradiol and progesterone in 2 weeks.” The provider will in
struct the patient as to this directive, order the
blood tests, and enter the results in Caregiver UI
175 and Storage 155. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the next diagnostic
step at 4081, ‘’Is progesterone level < 40 ng/mL?’’ The results are shared in Caregiver UI
175 and Patient UI 183. The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00232] If the answer at 4091 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4092
, “Progesterone supplementation should be 200 mg 3 times daily.” The provider will instruct the
patient as to this directive, make needed changes t
o the progesterone dosing, record it in Storage 155, a
nd then communicate this directive through Patient UI 183. Rules‐Based Logic 135 and Knowledge
Graph 150 will then proceed to the next directive at 4093, “Continue supplements and recheck
estradiol and progesterone in 2 weeks.” The provider will order the study for the patient and e
nter the results in Caregiver UI 175 and Storage 155. Rules‐Based Logic 135 and Knowledge Graph 150
will assess the next diagnostic step at 4081, ‘’Is progesterone level < 40 ng/mL?’’ The
results are shared in Caregiver UI 175 and Patient
UI 183. The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00233] If the answer at 4095 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4096
, “Check estradiol and progesterone levels in 2 days.” The provider will instruct the patient as t
o this directive, order the blood tests, and enter
the results in Caregiver UI 175 and Storage 155. Rules
Based Logic 135 and Knowledge Graph 150 will assess the next diagnostic step at 4081, ‘’Is pr
ogesterone level < 40 ng/mL?’’ The results are
shared in Caregiver UI 175 and Patient UI 183 The provider
inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00234] If the answer at 4095 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4076
, “Stop estradiol and progesterone supplements and allow miscarriage or perform suction D&C.”
The provider will instruct the patient as to this directive and then proceed according to patient prefe
rence. Results will be entered into Caregiver UI 175 and Storage 155. Rules‐Based Logic 135 and Kno
wledge Graph 150 will assess the information at 4059, “Recheck hCG in one week.” The provider wi
ll instruct the patient as to this directive, order
the blood tests, and enter the results in Caregiver
UI 175 and Storage 155. Rules‐Based Logic 135 and Information Library 160 will assess the next dia
gnostic step at 4060, “Is this hCG value less tha
n the previous one?” The information is shared in Ca
regiver UI 175 and Patient UI 183. The provider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver
UI 175 depending on the previous answer. [00235] If the answer at 4097 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4098, “Has the patient been tested for the presence of anticardiolipin antibodies, lupus anticoagu
lant, anti‐beta2‐glycoprotein 1 antibodies, and Factor V Leiden mutation?” The information is
shared in Caregiver UI 175 and Patient UI 183. The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
or diagnostic step to Caregiver UI 175 depending on the previous answer. [00236] If the answer at 4097 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4102
, “Baseline blood tests are to be drawn in the morning and before eating breakfast: TSH, prolactin,
DHEA‐S, 17‐OH progesterone, CBC, CMP, and insulin. Also add this cycle's Day 2 (or 3) estradi
ol and FSH. (Bring on a withdrawal bleed using Provera 10mg for 10 days, if necessary.)” The prov
ider will instruct the patient as to this directive,
order the blood tests, and enter the results in Car
egiver UI 175 and Storage 155. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the next di
agnostic step at 4103, “Is TSH < 0.6 mlU/mL?”
The results are shared in Caregiver UI 175 and Pati
ent UI 183. The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending o
n the previous answer. [00237] If the answer at 4098 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4100, “Were any of these positive?” The result
s are shared in Caregiver UI 175 and Patient UI 183.
The provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 then sends the next directive step to Caregiver UI 175 depending on the previous
answer. [00238] If the answer at 4098 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4099
, “Test for the presence of anticardiolipin antibodies, lupus anticoagulant, anti‐beta2‐glycoprot
ein 1 antibodies, and Factor V Leiden mutation now.” The provider will instruct the patient as to
this directive, order the blood tests, and enter t
he results in Caregiver UI 175 and Storage 155. Rules
Based Logic 135 and Knowledge Graph 150 will assess the next diagnostic step at 4100, “Were any
of these positive?” The results are shared in Caregiver UI 175 and Patient UI 183. The provider i
nputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00239] If the answer at 4100 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 and Pat
ient UI 183 at 4101, “Prescribe enoxaparin 40mg injection and aspirin 81mg orally, daily during next
pregnancy.” The provider will instruct the patient
as to this directive, order the medications, and ent
er confirmation in Caregiver UI 175 and Storage 155. Rules‐Based Logic 135 and Knowledge Graph 150
will proceed to the next directive to Caregiver UI 175 and Patient UI 183 at 4102, “Baseline bloo
d tests are to be drawn in the morning and before
eating breakfast: TSH, prolactin, DHEA‐S, 17‐OH pr
ogesterone, CBC, CMP, and insulin. Also add this cycle's Day 2 (or 3) estradiol and FSH. (Bring on
a withdrawal bleed using Provera 10mg for 10 days,
if necessary.)” The provider will instruct the pati
ent as to this directive, order the blood tests, an
d enter the results in Caregiver UI 175 and Storage 1
55. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the next diagnostic step at 4103,
Is TSH < 0.6 mlU/mL?” The results are shared
in Caregiver UI 175 and Patient UI 183. The provider i
nputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00240] If the answer at 4100 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 and Pat
ient UI 183 at 4102, “Baseline blood tests are to
be drawn in the morning and before eating breakfast:
TSH, prolactin, DHEA‐S, 17‐OH progesterone, CBC, CMP, and insulin. Also add this cycle's Day 2
(or 3) estradiol and FSH. (Bring on a withdrawal bleed using Provera 10mg for 10 days, if necessary.)
” The provider will instruct the patient as to th
is directive, order the blood tests, and enter the resu
lts in Caregiver UI 175 and Storage 155. Rules‐ Based Logic 135 and Knowledge Graph 150 will assess
the next diagnostic step at 4103, “Is TSH < 0
.6 mlU/mL?” The results are shared in Caregiver UI 17
5 and Patient UI 183. The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00241] If the answer at 4103 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4104, “Is the patient taking Propylthiouracil or
Methimazole?” The provider inputs the answer into C
aregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00242] If the answer at 4103 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4110, “Is TSH >2 and <5 mIU/mL?” The pr
ovider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Ca
regiver UI 175 depending on the previous answer. [00243] If the answer at 4104 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive and hard stop to Caregiver
UI 175 at 4122, “Refer to an endocrinologist.” T
he provider will instruct the patient as to this direct
ive and input the confirmation in Caregiver UI 175
which sends the information to Storage 155. Upon com
pliance to this directive, the patient will resume at the beginning of the algorithm. [00244] If the answer at 4104 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4105, “Does the patient have a palpable thyroid
nodule?” The provider will instruct the patient as
to this directive, carefully palpate the patient’s
thyroid gland, and input the answer into Caregiver U
I 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next dir
ective or diagnostic step to Caregiver UI 175 depending on the previous answer. [00245] If the answer at 4105 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive and hard stop to Caregiver
UI 175 at 4122, “Refer to an endocrinologist.” T
he provider will instruct the patient as to this direct
ive, make the referral, and input confirmation in Caregiver UI 175 which sends the information to Stor
age 155. Upon compliance to this directive, the patient will resume at the beginning of the algorith
m. [00246] If the answer at 4105 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4106, “Is the Hepatic Function Panel normal?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
to Caregiver UI 175 depending on the previous answer. [00247] If the answer at 4106 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4107
, “Check patient's Free T3 and Free T4.” The provider will instruct the patient as to this direct
ive, order the blood tests, and enter the results i
nto Caregiver UI 175 and Storage 155. The Expert System1
10 will process these data and Rules Based Logic 135 will send relevant information with explana
tions to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 at 4108, “Is
Free T3 ≥ 4.1 pg/mL or T4 > 12 µg/dL?” Res
ults will be entered in Caregiver UI 175 and Storage 155. The
provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the
previous answer. [00248] If the answer at 4106 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive and hard stop to Caregiver
UI 175 at 4122, “Refer to an endocrinologist.” T
he provider will instruct the patient as to this direct
ive, make the referral, and input confirmation in Caregiver UI 175 which sends the information to Stor
age 155. Upon compliance to this directive, the patient will resume at the beginning of the algorith
m. [00249] If the answer at 4108 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4109
, “Prescribe propylthiouracil 50 mg BID x 7 days.
Then, 50 mg TID thereafter and recheck TSH in 1 mo
nth.” The provider will instruct the patient as to
this directive, prescribe the medication, order the b
lood test, and enter the result into Caregiver UI 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 and Knowledge Graph 150 will assess the information. Rules‐Based Logic 135
then sends the next diagnostic step to Caregiver UI 175 at 4103, “Is TSH < 0.6 mIU/mL?” The
provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00250] If the answer at 4108 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4117, “Is prolactin ≥ 20?” The results are
shared in Caregiver UI 175 and Patient UI 183. The provide
r inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00251] If the answer at 4110 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4111
, “Add levothyroxine 25 µg daily.” The provider
will instruct the patient as to this directive, pres
cribe the medication, and enter confirmation into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4116, “Reche
ck TSH in one week.” The provider will instruct t
he patient as to this directive, order the blood test,
enter the result in Caregiver UI 175 which sends t
he information to Storage 155. The Expert System 110 wi
ll process these data and Rules Based Logic 135 will send relevant information with explanations
to Patient UI 183 and Storage 165. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the n
ext diagnostic step at 4103, “Is TSH < 0.6 mIU/mL?” The results are shared in Caregiver UI 17
5 and Patient UI 183. The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00252] If the answer at 4110 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4112, “Is TSH > 5 and ≤ 10 mIU/mL?” The
provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive or di
agnostic step to Caregiver UI 175 depending on the previous answer. [00253] If the answer at 4112 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4113
, “Add levothyroxine 50 µg daily.” The provider
will instruct the patient as to this directive, pres
cribe the medication, and enter confirmation into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4116, “Reche
ck TSH in one week.” The provider will instruct t
he patient as to this directive, order the blood test,
enter the result in Caregiver UI 175 which sends t
he information to Storage 155. The Expert System 110 wi
ll process these data and Rules Based Logic 135 will send relevant information with explanations
to Patient UI 183 and Storage 165. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the n
ext diagnostic step at 4103, “Is TSH < 0.6 mIU/mL?” The results are shared in Caregiver UI 17
5 and Patient UI 183. The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00254] If the answer at 4112 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4114, “Is TSH > 10 mIU/mL?” The provider i
nputs the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00255] If the answer at 4114 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4115
, “Add levothyroxine 100 µg daily.” The provider
will instruct the patient as to this directive, pres
cribe the medication, and enter confirmation into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4116, “Reche
ck TSH in one week.” The provider will instruct t
he patient as to this directive, order the blood test,
enter the result in Caregiver UI 175 which sends t
he information to Storage 155. The Expert System 110 wi
ll process these data and Rules Based Logic 135 will send relevant information with explanations
to Patient UI 183 and Storage 165. Rules‐Based Logic 135 and Knowledge Graph 150 will assess the n
ext diagnostic step at 4103, “Is TSH < 0.6 mIU/mL?” The results are shared in Caregiver UI 17
5 and Patient UI 183. The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00256] If the answer at 4114 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4117, “Is prolactin ≥ 20 ng/mL?” The results
are shared in Caregiver UI 175 and Patient UI 183. The
provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous
answer. [00257] If the answer at 4117 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4118, “Is the patient currently on cabergoline?
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00258] If the answer at 4117 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4124, “Does the patient have galactorrhea?” The
provider examines the patient and inputs the answer
into Caregiver UI 175 which then sends the information to Storage 155. Rules‐Based Logic 135 s
ends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00259] If the answer at 4118 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4119
, “Increase cabergoline by 0.25mg per dose and recheck prolactin each week until prolactin <20 ng
/mL or to maximum of cabergoline 2mg per week.” The provider will instruct the patient as t
o this directive, prescribe the medication, and order
the test in one week, inputs the test results int
o Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 at 4120, “Is current cabergoline dose ≥2mg weekly but prol
actin still >20ng/mL?” The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00260] If the answer at 4118 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4125, “Is prolactin ≥ 30mg/L?” The provider
inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00261] If the answer at 4120 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4121, “Is a prolactinoma seen on CT or MRI?”
The provider will instruct the patient as to this d
irective, order the imaging study, and inputs the te
st results into Caregiver UI 175 which sends the inform
ation to Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver UI 175 d
epending on the previous answer. [00262] If the answer at 4120 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4133, “Is 17‐OH Progesterone ≥200ng/mL?” The
results are shared in Caregiver UI 175 and Patient
UI 183. The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending o
n the previous answer. [00263] If the answer at 4121 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive and hard stop to Caregiver
UI 175 at 4123, “Refer to neurosurgery.” The provider will instruct the patient as to this direct
ive, makes the referral, and inputs confirmation of
compliance to this directive in Caregiver UI 175 and
Storage 155. Re‐entry after treatment back onto
the protocol will be at the beginning. [00264] If the answer at 4121 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive and hard stop to Caregiver
UI 175 at 4122, “Refer to endocrinologist.” The
provider will instruct the patient as to this direct
ive, makes the referral, and inputs confirmation of
compliance to this directive in Caregiver UI 175 and
Storage 155. Re‐entry after treatment back onto the protocol will be at the beginning. [00265] If the answer at 4124 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4118, “Is the patient currently on cabergoline?
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00266] If the answer at 4124 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4133, “Is 17‐OH Progesterone ≥200 ng/mL?” T
he results are shared in Caregiver UI 175 and Patient
UI 183. The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending o
n the previous answer. [00267] If the answer at 4125 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4128
, “Prescribe cabergoline 0.25 mg PO every Sunday and Wednesday.” [00268] The provider will instruct the patient as to this d
irective, prescribe the medication, and enter a confirmation in Caregiver UI 175. Rules‐Based Log
ic 135 will send the next directive to Caregiver UI
175 at 4132, “Prolactin should be rechecked in 1
week.” The provider will instruct the patient as t
o this directive, order the blood test, and enter the
result in Caregiver UI 175. The Expert System 110
will process these data and Rules Based Logic 135 w
ill send relevant information with explanations to Patient 183 along with the next diagnostic step
to Caregiver UI 175 at 4117, “Is prolactin ≥ 20
ng/mL?” The provider inputs the answer into Caregiv
er UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00269] If the answer at 4125 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4126, “Is patient currently on bromocriptine 1.25mg PO qHS?” [00270] The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00271] If the answer at 4126 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4129
, “Prescribe bromocriptine 2.5mg PO qHS.” The provider will prescribe the medication and instruct t
he patient as to this directive and then enter confirmation into Caregiver UI 175. Rules‐Based Logi
c 135 will send the next directive to Caregiver UI
175 at 4132, “Prolactin should be rechecked in 1
week.” The provider will instruct the patient as t
o this directive, order the blood test, and enter the
result in Caregiver UI 175. The Expert System 110
will process these data and Rules Based Logic 135 w
ill send relevant information with explanations to Patient UI 183 along with the next diagnostic st
ep to Caregiver UI 175 at 4117, “Is prolactin ≥
20 ng/mL?” The provider inputs the answer into Caregiv
er UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00272] If the answer at 4126 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4127, “Is patient currently on bromocriptine 2.5mg PO qHS?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends t
he next directive to Caregiver UI 175 depending on the previous answer. [00273] If the answer at 4127 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4130
, “Stop bromocriptine.” The provider will instruct
the patient as to this directive and enter a confir
mation in Caregiver UI 175. Rules‐Based Logic 135
will send the next directive to Caregiver UI 175 at
4128, “Prescribe cabergoline 0.25 mg PO every Sunday and Wednesday.” The provider will instruct t
he patient as to this directive, prescribe the medication, and enter a confirmation in Caregiver UI
175. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4132, “Prolactin
should be rechecked in 1 week.” The provider will
instruct the patient as to this directive, order the
blood test, and enter the result in Caregiver UI
175. The Expert System 110 will process these data and R
ules Based Logic 135 will send relevant information with explanations to Patient UI 183 along
with the next diagnostic step to Caregiver UI 175 at 4117, “Is prolactin ≥ 20 ng/mL?” The p
rovider inputs the answer into Caregiver UI 175 whic
h sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00274] If the answer at 4127 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4131
, “Prescribe bromocriptine 1.25mg PO qHS.” The provider will instruct the patient as to this direct
ive, prescribe the medication, and enter a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next directive to Caregiver UI 175 at 4132, “Prolactin should be rechecked in 1
week.” The provider will instruct the patient as t
o this directive, order the blood test, and enter the
result in Caregiver UI 175. The Expert System 110
will process these data and Rules Based Logic 135 w
ill send relevant information with explanations to Patient 183 along with the diagnostic step to Ca
regiver UI 175 at 4117, “Is prolactin ≥ 20 ng/m
L?” The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
to Caregiver UI 175 depending on the previous answer. [00275] If the answer at 4133 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4134, “Is DHEA‐S >200 ng/ml?” The provider
inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Ca
regiver UI 175 depending on the previous answer. [00276] If the answer at 4133 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4137, “Is DHEA‐S >200 ng/ml?” The provider
inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Ca
regiver UI 175 depending on the previous answer. [00277] If the answer at 4134 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4135, “Is the patient currently taking dexamethasone?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends t
he next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00278] If the answer at 4134 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4138, “Is the patient currently taking dexamethasone?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends t
he next directive or directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00279] If the answer at 4135 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4138, “Is the patient currently taking dexamethasone?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends t
he next diagnostic step to Caregiver UI 175 depending on the previous answer. [00280] If the answer at 4135 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4136
, “Rx dexamethasone 0.25mg PO qHS.” The provider will instruct the patient as to this direct
ive, prescribe the medication, and then enter a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next directive to Caregiver UI 175 at 4140, “Recheck 17‐OH Progesterone and DHEA
‐S in 7 days.” The provider will instruct the patient as to this directive, order the blood test,
and enter the result in Caregiver UI 175. The Expe
rt System 110 will process these data and Rules Based
Logic 135 will send relevant information with explanations to Patient UI 183 along with the next
diagnostic step to Caregiver UI 175 at 4133, “Is
17‐OH Progesterone ≥200 ng/mL?” The provider inp
uts the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00281] If the answer at 4137 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4138, “Is the patient currently taking dexamethasone?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends t
he next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00282] If the answer at 4137 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4142, “Is Hgb < 8 gm/dL?” The provider inp
uts the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00283] If the answer at 4138 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4139, “Current dose of dexamethasone 0.25mg PO qHS?” The provider inputs the answer into Careg
iver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00284] If the answer at 4138 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4136
, “Rx dexamethasone 0.25mg PO qHS.” The provider will instruct the patient as to this direct
ive, prescribe the medication, and enter a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next directive to Caregiver UI 175 at 4140, “Recheck 17‐OH Progesterone and DHEA
‐S in 7 days.” The provider will instruct the patient as to this directive, order the blood test,
and enter the result in Caregiver UI 175. The Expe
rt System 110 will process these data and Rules Based
Logic 135 will send relevant information with explanations to Patient UI 183 along with the next
diagnostic step to Caregiver UI 175 at 4133, “Is
17‐OH Progesterone ≥200 ng/mL?” The provider inp
uts the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00285] If the answer at 4139 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4141
, “Increase dose of dexamethasone to 0.5mg PO qHS.” The provider will instruct the patient as to
this directive, prescribe the medication, and enter
a confirmation into Caregiver UI 175. Rules‐Based Logi
c 135 will send the next diagnosis step to Caregiver UI 175 at 4142, “Is Hgb < 8 gm/dL?
The provider inputs the answer into Caregiver UI
175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous
answer. [00286] If the answer at 4139 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4142, “Is Hgb < 8 gm/dL?” The provider inp
uts the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00287] If the answer at 4143 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive and hard stop to Caregiver
UI 175 at 4148, “Consult hematology.” The provider informs the patient, makes the referral, and
inputs confirmation of compliance to this directive in Caregiver UI 175 and Storage 155. Re‐
entry after treatment back onto the protocol will be at the beginning. [00288] If the answer at 4143 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4144
, “Prescribe prenatal vitamins and iron.” The provider will instruct the patient as to this direct
ive, prescribe the medication, and enter a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next directive to Caregiver UI 175 at 4145, “Check CBC in 1 month.” The provid
er will order the test and results will be entered
into Caregiver UI 175. The Expert System 110 will p
rocess these data and Rules Based Logic 135 will send relevant information with explanations to Patient
183 along with the next diagnostic step to Caregiver UI 175 at 4142, “Is Hgb < 8 gm/dL?
The provider inputs the answer into Caregiver UI
175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous
answer. [00289] If the answer at 4146 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive and hard stop to Caregiver
UI 175 at 4148, “Consult hematology.” The provider informs the patient, makes the referral, and
inputs confirmation of compliance to this directive in Caregiver UI 175 and Storage 155. Re‐
entry after treatment back onto the protocol will be at the beginning. [00290] If the answer at 4146 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4147, “Are platelets < 150k or > 450k?”
The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive or di
agnostic step to Caregiver UI 175 depending on the previous answer. [00291] If the answer at 4147 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive and hard stop to Caregiver
UI 175 at 4148, “Consult hematology.” The provider informs the patient, makes the referral, and
inputs confirmation of compliance to this directive in Caregiver UI 175 and Storage 155. Re‐
entry after treatment back onto the protocol will be at 4150. [00292] If the answer at 4147 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4149, “Is WBC <4 or >11?” The provider
inputs the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00293] If the answer at 4149 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive and hard stop to Caregiver
UI 175 at 4148, “Consult hematology.” The provider informs the patient, makes the referral, and
inputs confirmation of compliance to this directive in Caregiver UI 175 and Storage 155. Re‐
entry after treatment back onto the protocol will be at 4150. [00294] If the answer at 4149 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4150, “Are the electrolytes within normal limits?” The provider inputs the answer into Caregi
ver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00295] If the answer at 4150 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4153, “Is fasting glucose > 126 mg/dL?” The
provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next diagnostic step
to Caregiver UI 175 depending on the previous answer. [00296] If the answer at 4150 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4151
, “Correct electrolyte abnormalities.” The provider
will instruct the patient as to this directive, reme
dy the situation, and then enter a confirmation into
Caregiver UI 175. Rules‐Based Logic 135 will send
the next directive to Caregiver UI 175 at 4152, “Recheck electrolytes in one week.” The provider
will instruct the patient as to this directive, orde
r the blood test, and enter the results in Caregiver
UI 175. The Expert System 110 will process these data and Rules Based Logic 135 will send relevant i
nformation with explanations to Patient UI 183 along with the diagnostic step to Caregiver UI 175
at 4150, “Are the electrolytes within normal limits?” The provider inputs the answer into Caregi
ver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00297] If the answer at 4153 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4154, “Is patient currently taking metformin 1,000 mg BID?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive to Caregiver UI 175 depending on the previous answer. [00298] If the answer at 4153 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4156, “Is fasting glucose ≥ 99 mg/dL &
126 mg/dL?” The provider inputs the answer into Caregiv
er UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00299] If the answer at 4154 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4155
, “Prescribe insulin to control blood glucose until
hemoglobin A1c is less than 6.” The provider will
instruct the patient as to this directive, remedy t
he situation, then input a confirmation in Caregiver UI
175. Rules‐Based Logic 135 will send the next diagnostic step to Caregiver UI 175 at 4162, “Are
CO2, BUN, creatinine, albumin, calcium, bilirubin, AST, ALT, alkaline phosphatase within normal limits?
The provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155.
Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 dep
ending on the previous answer. [00300] If the answer at 4154 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4160
, “Prescribe metformin 500mg PO BID for 2 weeks,
then 500mg TID for 3 weeks, followed by 1000 mg BI
D thereafter.” The provider will instruct the patient as to this directive, order the medication,
and enter a confirmation into Caregiver UI 175. Rules‐Based Logic 135 will send the next directive
to Caregiver UI 175 at 4161, “Repeat fasting glucose and insulin 8 weeks after initiation of metf
ormin.” The provider will instruct the patient as
to this directive, order the blood test, and enter the
results in Caregiver UI 175. The Expert System 110
will process these data and Rules Based Logic 135 w
ill send relevant information with explanations to Patient UI 183 along with the next diagnostic st
ep to Caregiver UI 175 at 4153, “Is fasting gluco
se >126 mg/dL?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00301] If the answer at 4156 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4157
, “Prediabetic: Diet and Exercise.” The provider
will instruct the patient as to this directive and
then inputs the confirmation into Caregiver UI 175.
Rules‐Based Logic 135 will send the next diagnostic
step to Caregiver UI 175 at 4158, “Is fasting insulin ≥ 10?” The provider inputs the answer in
to Caregiver UI 175 which sends the information to
Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00302] If the answer at 4156 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4158, “Is fasting insulin ≥ 10?” The provide
r inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Ca
regiver UI 175 depending on the previous answer. [00303] If the answer at 4158 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4159, “Is patient currently taking metformin 1000 mg BID?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00304] If the answer at 4158 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4162, “Are CO2, BUN, creatinine, albumin, calcium, bilirubin, AST, ALT, alkaline phosphatase wit
hin normal limits?” The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00305] If the answer at 4159 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4162, “Are CO2, BUN, creatinine, albumin, calcium, bilirubin, AST, ALT, alkaline phosphatase wit
hin normal limits?” The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00306] If the answer at 4159 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4160
, “Prescribe metformin 500mg PO BID for 2 weeks,
then 500mg TID for 3 weeks, followed by 1000 mg BI
D thereafter.” The provider will instruct the patient as to this directive, order the medication a
nd enter a confirmation in Caregiver UI 175. Rules
Based Logic 135 will send the next directive to Car
egiver UI 175 at 4161, “Repeat fasting glucose and
insulin 8 weeks after initiation of metformin.” The
provider will instruct the patient as to this directive, order the blood tests, and enter the resu
lts in Caregiver UI 175. The Expert System 110 will
process these data and Rules Based Logic 135 will s
end relevant information with explanations to Patient UI 183 along with the diagnostic step to Ca
regiver UI 175 at 4153, “Is fasting glucose >12
6 mg/dL?” The provider inputs the answer into Caregiv
er UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00307] If the answer at 4162 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4164, “Is FSH ≥ 25 IU/L?” The provider inpu
ts the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00308] If the answer at 4162 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4163
, “Pause to resolve any abnormalities. Re‐enter a
t 4164.” [00309] The provider will instruct the patient as to this d
irective, repeat the blood test, enter the results, and register a confirmation into Caregiver U
I 175. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4164, “Is FSH
25 IU/L?” The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 17
5 depending on the previous answer. [00310] If the answer at 4164 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4172
, “No ovarian reserve; patient will need donor eggs and IVF. Refer to a specialist.” The provid
er will instruct the patient as to this directive,
enter confirmation into Caregiver UI 175. Rules‐Based Logi
c 135 will come to a hard stop. [00311] If the answer at 4164 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4165, “Is FSH ≥12 & ≤25 mIU/mL?” The
provider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Ca
regiver UI 175 depending on the previous answer. [00312] If the answer at 4165 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4171, “Is this the third time in a row that F
SH is ≥12 mIU/mL?” The provider inputs the answer into
Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive to Caregiver UI 175 depending on the previous answer. [00313] If the answer at 4165 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4166, “Is patient’s age >35 & estradiol
>85 pg/mL?” The provider inputs the answer into Caregiv
er UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00314] If the answer at 4166 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4173
, “Recheck Day 2 (or 3) FSH and estradiol.” The
provider will instruct the patient as to this direct
ive, order the blood test, and enter a confirmation
in Caregiver UI 175. Rules‐Based Logic 135 will se
nd the next directive to Caregiver UI 175 at 4164,
“Is FSH ≥ 25 IU/L?” The provider inputs the a
nswer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00315] If the answer at 4166 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4167, “Is patient age < 30?” The provider
inputs the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00316] If the answer at 4167 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4168, “Has the patient had a hysterosalpingogram within the last year?” The provi
der inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous
answer. [00317] If the answer at 4167 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4174, “Is estradiol ≥20 & ≤85 ng/mL?”
The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive or di
agnostic step to Caregiver UI 175 depending on the previous answer. [00318] If the answer at 4168 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4169, “Is there bilateral tubal patency?” The
provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next diagnostic step
to Caregiver UI 175 depending on the previous answer. [00319] If the answer at 4168 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4175, “Does the patient have a history of bilateral tubal ligation?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00320] If the answer at 4169 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4183, “Was a uterine cavity abnormality seen on
HSG?” The provider inputs the answer into Caregiver
UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next dia
gnostic step to Caregiver UI 175 depending on the previous answer. [00321] If the answer at 4169 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4170, “Are there bilateral proximal tubal occlusions?” The provider inputs the answer into Ca
regiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00322] If the answer at 4170 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4180,” Was a tubal re‐canalization or re‐ anastomosis recently performed?” The provider inputs
the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 1
35 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the previous
answer. [00323] If the answer at 4170 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4183, “Was a uterine cavity abnormality seen on
HSG?” The provider inputs the answer into Caregiver
UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next dia
gnostic step to Caregiver UI 175 depending on the previous answer. [00324] If the answer at 4171 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4172
, “No ovarian reserve; patient will need donor eggs and IVF. Refer to a specialist.” The provid
er will instruct the patient as to this directive,
enter confirmation into Caregiver UI 175. Rules‐Based Logi
c 135 will come to a hard stop. [00325] If the answer at 4171 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4173
, “Recheck Day 2 (or 3) FSH and estradiol.” The
provider will instruct the patient as to this direct
ive, orders the blood test, enters the result, and
registers a confirmation in Caregiver UI 175. Rules
Based Logic 135 will send the next diagnostic step
to Caregiver UI 175 at 4164, “Is FSH ≥ 25 IU/L
?” The provider inputs the answer into Caregiver U
I 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00326] If the answer at 4174 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4168, “Has the patient had a hysterosalpingogram within the last year?” The provi
der inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous
answer. [00327] If the answer at 4174 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4179
, “Refer to a specialty clinic for complicated car
e.” The provider will instruct the patient as to this d
irective, make the referral, and enter a confirmation
into Caregiver UI 175. Rules‐Based Logic 135 will
come to a hard stop. [00328] If the answer at 4175 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4177, “Is it possible for the patient to have
a tubal re‐anastomosis?” The provider inputs the ans
wer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00329] If the answer at 4175 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4176
, “Perform a hysterosalpingogram on 2nd, 3rd, or 4th day after end of menses.” The provider will i
nstruct the patient as to this directive, schedules
the procedure, records the results, and then inputs a co
nfirmation into Caregiver UI 175. Rules‐Based Logic 135 will send the next diagnostic step to Car
egiver UI 175 at 4169, “Is there bilateral tubal
patency?” The provider inputs the answer into Careg
iver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00330] If the answer at 4177 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4178
, “Perform a Tubal re‐anastomosis. Permit 6 weeks of healing before performing an HSG.” The pr
ovider will instruct the patient as to this directive, schedule and perform the procedure, then e
nter a confirmation into Caregiver UI 175. Rules‐Based Logic 135 will send the next directive
to Caregiver UI 175 at 4176, “Perform a hysterosalpingogram on 2nd, 3rd, or 4th day after en
d of menses.” The provider will schedule the procedure and results will be entered into Caregiver
UI 175. The Expert System 110 will process these data and Rules Based Logic 135 will send rele
vant information with explanations to Patient UI 183 along with the diagnostic step to Caregiver UI
175 at 4169, “Is there bilateral tubal patency The
provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next diagnostic step
to Caregiver UI 175 depending on the previous answer. [00331] If the answer at 4177 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4179
, “Refer to a specialty clinic for complicated car
e.” The provider will instruct the patient as to this d
irective, make a referral, and enter a confirmation
into Caregiver UI 175. Rules‐Based Logic 135 will
come to a hard stop. [00332] If the answer at 4180 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4182, “Was the tubal re‐canalization successful?” The provider inputs the answer into Ca
regiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00333] If the answer at 4180 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4181
, “Perform a tubal re‐canalization.” The provide
r will instruct the patient as to this directive, sche
dules the procedure, records the results, and registers a confirmation in Caregiver UI 175. Rules
Based Logic 135 will send the next diagnostic step
to Caregiver UI 175 at 4182, “Was the establishmen
t of patency to at least one tube successful?” Th
e provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next directive or di
agnostic step to Caregiver UI 175 depending on the previous answer. [00334] If the answer at 4182 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4183, “Was a uterine cavity abnormality seen on
HSG?” The provider inputs the answer into Caregiver
UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next dia
gnostic step to Caregiver UI 175 depending on the previous answer. [00335] If the answer at 4182 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4179
, “Refer to a specialty clinic for complicated car
e.” The provider will instruct the patient as to this d
irective, make a referral, and enter s confirmation
in Caregiver UI 175. Rules‐Based Logic 135 will come
to a hard stop. [00336] If the answer at 4183 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4190, “Has the patient undergone surgery to correct the uterine cavity abnormality in the last y
ear?” The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 17
5 depending on the previous answer. [00337] If the answer at 4183 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4184, “Does the patient experience pelvic pain?
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00338] If the answer at 4184 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4185, “Has the patient undergone laparoscopy in
the last year?” The provider inputs the answer int
o Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00339] If the answer at 4184 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4189
, “Perform an operative hysteroscopy” The provider will instruct the patient as to this direct
ive, schedule the surgery, and then enter confirmation into Caregiver UI 175. Rules‐Based Logi
c 135 will send the next directive to Caregiver UI
175 at 4186, “Appropriate surgery (fulguration of e
ndometriosis, neo salpingostomy, myomectomy, lysis of adhesions, polypectomy, and/or resection of
septum) including an intraoperative chromotubation.” The provider will perform the proce
dure and enter the resulting data into Caregiver UI 175. The Expert System 110 will process
these data and Rules Based Logic 135 will send relevant information with explanations to Patient 183
along with the diagnostic step to Caregiver UI 175 at 4187, “Has the patient had baseline blood
tests drawn within the last year?” The provider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver
UI 175 depending on the previous answer. [00340] If the answer at 4185 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4187, “Has the patient had baseline blood tests
drawn within the last year?” The provider inputs t
he answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00341] If the answer at 4185 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4186
, “Appropriate surgery (fulguration of endometriosis, neo salpingostomy, myomectomy, lysis of
adhesions, polypectomy, and/or resection of septum) including an intraoperative chromotubation.
The provider will instruct the patient as to this directive, schedule the procedure, and then regi
sters a confirmation in Caregiver UI 175. Rules‐ Based Logic 135 will send the next diagnostic step
to Caregiver UI 175 at 4187, “Has the patient had
baseline blood tests drawn within the last year?”
The provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on
the previous answer. [00342] If the answer at 4187 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4188
, “Resume diagnosis and treatment pathway 8 weeks post‐operatively.” The provider will instruct
the patient as to this directive and input a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next diagnostic step to Caregiver UI 175 at 4103, “Is TSH < 0.6 mlU/mL
?” The provider inputs the answer into Caregiver U
I 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on
the previous answer. [00343] If the answer at 4187 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4102
, “Baseline blood tests are to be drawn in the morning and before eating breakfast: TSH, prolactin,
DHEA‐S, 17‐OH progesterone, CBC, CMP, and insulin. Also add this cycle's Day 2 (or 3) estradi
ol and FSH. (Bring on a withdrawal bleed using Provera 10mg for 10 days, if necessary.)” The prov
ider will instruct the patient as to this directive,
order the blood tests, enter the results, and then
register a confirmation in Caregiver UI 175. Rules‐
Based Logic 135 will send the next diagnostic step
to Caregiver UI 175 at 4192, “Are menstrual cycles
between 21 and 38 days apart (start of one heavy f
low to start of next heavy flow) but consistently same number of days +/‐ 1 day?” The provider in
puts the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 1
35 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the previous
answer. [00344] If the answer at 4190 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4191
, “Refer to specialist for IVF using a Gestational
Carrier” The provider will instruct the patient as
to this directive, make a referral, enter a confirmation into Caregiver UI 175. Rules‐Based Logi
c 135 will come to a hard stop. [00345] If the answer at 4190 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4184, “Does the patient experience pelvic pain?
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
or diagnostic step to Caregiver UI 175 depending on the previous answer. [00346] If the answer at 4192 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4193
, “Use ovulation prediction kit, check for 6 days
starting [average cycle length minus 16 days].” The
provider will instruct the patient as to this directive, and then input a confirmation into Caregiv
er UI 175. Rules‐Based Logic 135 will send the next diagnostic step to Caregiver UI 175 at 4194,
Was there a robust LH surge?” The provider input
s the answer into Caregiver UI 175 which sends the in
formation to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00347] If the answer at 4192 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4236, “Is BMI < 20?” The provider inputs
the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next directive to Caregiver UI 175 d
epending on the previous answer. [00348] If the answer at 4194 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4195, “Does the male have more than 4 million
motile normal morphology sperm?” The provider inputs
the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00349] If the answer at 4194 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4218
, “Draw estradiol and progesterone” The provider
will instruct the patient as to this directive, orde
r the blood tests, enter the results, and register
a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next diagnostic step to Caregiver UI 175 at 4219, “Is progesterone > 2
ng/mL?” The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 17
5 depending on the previous answer. [00350] If the answer at 4195 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4196
, “Timed intercourse day of positive surge and following day.” The provider will instruct the pati
ent as to this directive, and then enter a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next directive to Caregiver UI 175 at 4197, “Check estradiol and progesterone leve
ls one week later.” The provider will instruct the
patient as to this directive, order the blood tests,
and enter the results in Caregiver UI 175. The Expert System 110 will process these data and Rules
Based Logic 135 will send relevant information with explanations to Patient UI 183 along with the
diagnostic step to Caregiver UI 175 at 4198, “Is
progesterone > 15 ng/mL?” The provider inputs th
e answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00351] If the answer at 4195 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4225
, “Intra Uterine Insemination the day after positive surge (or hCG trigger injection)” The prov
ider will instruct the patient as to this directive,
perform the procedure, and then enter a confirmation
in Caregiver UI 175. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at
4197, “Check estradiol and progesterone levels one week later.” The provider will instruct the pa
tient as to the directive, order the blood tests, a
nd enter the results in Caregiver UI 175. The Expert S
ystem 110 will process these data and Rules Based Logic 135 will send relevant information with explana
tions to Patient UI 183 along with the diagnostic step to Caregiver UI 175 at 4198, “Is
progesterone > 15 ng/mL?” The provider inputs th
e answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00352] If the answer at 4198 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4199, “Patient currently prescribed estradiol 2 mg BID?” The provider inputs the answer into Careg
iver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next diagnostic step to Caregiver UI 175 depending on the previous answer. [00353] If the answer at 4198 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4207, “Is the patient currently taking progesterone supplements?” The provider inputs the a
nswer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next diagnostic step to Caregiver UI 175 depending on the previous answer. [00354] If the answer at 4199 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4202, “Onset of menses less than 14 days following LH surge or hCG injection?” The provider
inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00355] If the answer at 4199 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4200, “Is estradiol > 150 pg/mL? The provider
inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnosti
c step to Caregiver UI 175 depending on the previous [00356] If the answer at 4200 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4202, “Onset of menses less than 14 days following LH surge or hCG injection?” The provider
inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00357] If the answer at 4200 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4201
“Prescribe oral micronized estradiol 2mg PO BID now (and in future cycles beginning 2nd day after t
he LH surge or hCG trigger injection).” The provider will instruct the patient as to this direct
ive, prescribe the medication, and input a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next diagnostic step to Caregiver UI 175 at 4202, “Onset of menses less t
han 14 days following LH surge or hCG injection?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
or diagnostic step to Caregiver UI 175 depending on the previous answer. [00358] If the answer at 4202 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4203, “Patient previously prescribed oral micronized progesterone 200mg PO TID?” The provider
inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer. [00359] If the answer at 4202 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4204
, “Check hCG level 2 weeks post LH surge.” The
provider will instruct the patient as to this direct
ive, order the blood test, enter the result, and register a confirmation into Caregiver UI 175. Rules
Based Logic 135 will send the next diagnostic step to Caregiver UI 175 at 4205, “Is hCG > 5
.0 IU/L?” The provider inputs the answer into Care
giver UI 175 which sends the information to Storage 155.
Rules‐Based Logic 135 then sends the next directive to Caregiver UI 175 depending on the previ
ous answer. [00360] If the answer at 4203 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4204
, “Check hCG level 2 weeks post LH surge.” The
provider will instruct the patient as to this direct
ive, order the blood test, enter the result, and register a confirmation in Caregiver UI 175. Rules‐
Based Logic 135 will send the next diagnostic step
to Caregiver UI 175 at 4205, “Is hCG > 5.0 IU
/L?” The provider inputs the answer into Caregiver
UI 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 then sends the next directive to Caregiver UI 175 depending on the previous answer
[00361] If the answer at 4203 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4206
, “Prescribe oral micronized progesterone 200mg PO TID, beginning 2 days after LH surge or hCG tri
gger injection” The provider will instruct the patient as to this directive, prescribe the medicatio
n, and then enter a confirmation in Caregiver UI 175. Rules‐Based Logic 135 will send the next dire
ctive to Caregiver UI 175 at 4226, “If currently
taken, stop estradiol and/or progesterone supplements
The provider will instruct the patient as to the directive, and enter the confirmation into Caregi
ver UI 175. Rules Based Logic 135 will send relevant information with explanations to Patient UI
183 along with the diagnostic step to Caregiver UI 175 at 4227, “Has the patient already taken le
trozole?” The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 17
5 depending on the previous answer. [00362] If the answer at 4205 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4055
, “Repeat hCG, estradiol, and progesterone levels 48 hours after most recent positive pregnancy test.
The provider will instruct the patient as to this
directive, order the blood tests, enter the results,
and register a confirmation in Caregiver UI 175. Rules‐Based Logic 135 will send the next diagnostic
step to Caregiver UI 175 at 4057, “Was the increase in hCG <65%?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00363] If the answer at 4205 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4226
“If currently taken, stop estradiol and/or progesterone supplements.” The provider will instruct
the patient as to this directive and input a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next diagnostic step to Caregiver UI 175 at 4227, “Has the patient previou
sly taken letrozole?” The provider inputs the answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00364] If the answer at 4207 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4208, “Patient currently prescribed progesterone‐in‐oil (50mg/mL) 100mg IM daily?” Th
e provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on
the previous answer. [00365] If the answer at 4207 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4213, “Is progesterone ≥ 12 and ≤ 15ng/mL?
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00366] If the answer at 4208 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4210
, “Prescribe progesterone in oil (50mg/mL) 100mg IM dose daily, starting now and in future cycles be
ginning 2nd day after the LH surge or hCG trigger
injection.” The provider will instruct the patient
as to this directive, prescribe the medication, and
input a confirmation in Caregiver UI 175. Rules‐Bas
ed Logic 135 will send the next diagnostic step to
Caregiver UI 175 at 4199, “Patient currently prescr
ibed estradiol 2 mg BID?” The provider inputs the
answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00367] If the answer at 4208 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4209, “Patient currently prescribed oral micronized progesterone 200mg PO TID?” The provider
inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00368] If the answer at 4209 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4210
, “Prescribe progesterone in oil (50mg/mL) 100mg IM dose daily, starting now and in future cycles be
ginning 2nd day after the LH surge or hCG trigger
injection.” The provider will instruct the patient
as to this directive, prescribe the medication, and
input a confirmation in Caregiver UI 175. Rules‐Bas
ed Logic 135 will send the next diagnostic step to
Caregiver UI 175 at 4199, “Patient currently prescr
ibed estradiol 2 mg BID?” The provider inputs the
answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00369] If the answer at 4209 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4211, “Was the patient currently prescribed oral
micronized progesterone 200mg PO BID?” The provider
inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐B
ased Logic 135 then sends the next diagnostic step to Caregiver UI 175 depending on the previous
answer. [00370] If the answer at 4211 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4206
, “Prescribe oral micronized progesterone 200mg PO TID, beginning 2 days after LH surge or hCG tri
gger injection” The provider will instruct the patient as to this directive, prescribe the medicatio
n, and then enter confirmation into Caregiver UI 175. Rules‐Based Logic 135 will send the next dire
ctive to Caregiver UI 175 at 4226, “If currently
taken, stop estradiol and/or progesterone supplements
The provider will instruct the patient as to the directive, and enter the confirmation into Caregi
ver UI 175. Rules Based Logic 135 will send relevant information with explanations to Patient UI
183 along with the diagnostic step to Caregiver UI 175 at 4227, “Has the patient already taken le
trozole?” The provider inputs the answer into Caregiver UI 175 which sends the information to Stor
age 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 17
5 depending on the previous answer. [00371] If the answer at 4211 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4212
, “Prescribe oral micronized progesterone 200mg PO BID starting today and in future cycles beginning
2nd day after the LH surge or hCG trigger injection” The provider will instruct the patient a
s to this directive, prescribes the medication, and
then inputs the confirmation into Caregiver UI 175.
Rules‐Based Logic 135 will send the next diagnostic step to Caregiver UI 175 at 4199, “Pati
ent currently prescribed estradiol 2 mg BID?” The
provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next diagnostic step
to Caregiver UI 175 depending on the previous answer. [00372] If the answer at 4213 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4214
, “Prescribe oral micronized progesterone 200mg PO qHS, starting today and in future cycles beginnin
g 2nd day after the LH surge or hCG trigger injection” The provider will instruct the patient a
s to this directive, prescribe the medication, and input a confirmation in Caregiver UI 175. Rules‐Bas
ed Logic 135 will send the next diagnostic step to
Caregiver UI 175 at 4199, “Patient currently prescr
ibed estradiol 2 mg BID?” The provider inputs the
answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00373] If the answer at 4213 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4215, “Is progesterone ≥ 8 and ≤ 11 ng/mL?
The provider inputs the answer into Caregiver UI 175 whi
ch sends the information to Storage 155. Rules‐ Based Logic 135 then sends the next diagnostic step
to Caregiver UI 175 depending on the previous answer. [00374] If the answer at 4215 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4216
, “Prescribe oral micronized progesterone 200mg PO BID starting today and in future cycles beginning
2nd day after the LH surge or hCG trigger injection” The provider will instruct the patient a
s to this directive, prescribe the medication, and input a confirmation in Caregiver UI 175. Rules‐Bas
ed Logic 135 will send the next diagnostic step to
Caregiver UI 175 at 4199, “Patient currently prescr
ibed estradiol 2 mg BID?” The provider inputs the
answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00375] If the answer at 4215 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4217
, “Prescribe oral micronized progesterone 200mg TID starting now and in future cycles beginning 2nd
day after the LH surge or hCG trigger injection”
The provider will instruct the patient as to this d
irective, prescribe the medication, and input a confirmation in Caregiver UI 175. Rules‐Based Logic
135 will send the next diagnostic step to Caregiver UI 175 at 4199, “Patient currently prescr
ibed estradiol 2 mg BID?” The provider inputs the
answer into Caregiver UI 175 which sends the informa
tion to Storage 155. Rules‐Based Logic 135 then sends the next diagnostic step to Caregiver UI
175 depending on the previous answer. [00376] If the answer at 4219 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4220
, “Educate patient as to proper use of the ovulation kit.” The provider will instruct the pati
ent as to this directive, and then enter confirmatio
n into Caregiver UI 175. Rules‐Based Logic 135 will
send the next diagnostic step to Caregiver UI 175 a
t 4227, “Has the patient already taken letrozole?”
The provider inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rule
s‐Based Logic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on
the previous answer. [00377] If the answer at 4219 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4221, “Is estradiol > 150 pg/mL?” The provi
der inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00378] If the answer at 4221 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4222
, “Pelvic ultrasound to measure the dominant ovarian follicle.” The provider will instruct the p
atient as to this directive, order the image study,
input findings, and register a confirmation in Caregi
ver UI 175. Rules‐Based Logic 135 will send the next diagnostic step to Caregiver UI 175 at 4223,
Is the dominant follicle ≥ 17mm?” The provider
inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00379] If the answer at 4221 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4227, “Has the patient already taken letrozole?
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
or diagnostic step to Caregiver UI 175 depending on the previous answer. [00380] If the answer at 4223 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4224
, “Prescribe hCG 10,000 IU IM to trigger ovulation” The provider will instruct the patient a
s to this directive, prescribe and administer the medication, and then enter a confirmation in Caregive
r UI 175. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4225, “Intra
Uterine Insemination the day after positive surge (or hCG trigger injection)” The provider will instr
uct the patient as to the directive, perform the procedure and enter a confirmation in Caregiver UI 1
75. Rules Based Logic 135 will send relevant information with explanations to Patient UI 183 along
with the next directive to Caregiver UI 175 at 4197, “Check estradiol and progesterone levels one
week later.” The provider will instruct the patient as to this directive, order the blood tests,
enter the results, and input a confirmation in Caregiver UI 175. Rules‐Based Logic 135 will send
the next diagnostic step to Caregiver UI 175 at 4198, “Is progesterone > 15 ng/mL?” The provid
er inputs the answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based L
ogic 135 then sends the next directive or diagnostic step to Caregiver UI 175 depending on the
previous answer. [00381] If the answer at 4223 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4227, “Has the patient already taken letrozole?
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
or diagnostic step to Caregiver UI 175 depending on the previous answer. [00382] If the answer at 4227 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4229, “Was the last dosing of letrozole 2.5mg TID x 5 days?” The provider inputs the answer int
o Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00383] If the answer at 4227 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4228
, “Await next cycle and prescribe letrozole 2.5mg
daily x 5 days, starting Day 3 of cycle.” The pr
ovider will instruct the patient as to this directiv
e, order the medication and then enter a confirmation into Ca
regiver UI 175. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4234, “
Ovulatory prediction kit for 12 days, beginning 3 da
ys after last dose of letrozole.” The provider will i
nstruct the patient as to the directive and enter a
confirmation in Caregiver UI 175. Rules Based Logic
135 will send relevant information with explanations to Patient UI 183 along with the diagno
stic step to Caregiver UI 175 at 4194, “Was there a robust LH surge?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00384] If the answer at 4229 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4230, “Has the patient had 3 cycles on letrozol
e 2.5mg TID?” The provider inputs the answer into Ca
regiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 then sends the
next directive or diagnostic step to Caregiver UI 175 depending on the previous answer. [00385] If the answer at 4229 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4232
, “Increase letrozole by 2.5mg daily x 5 days, starting Day 3 of cycle.” The provider will instru
ct the patient as to this directive, order the medication and then enter a confirmation in Caregiver
UI 175. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4234, “Ovula
tory prediction kit for 12 days, beginning 3 days after last dose of letrozole.” The provider will i
nstruct the patient as to the directive and enter a
confirmation in Caregiver UI 175. Rules Based Logic
135 will send relevant information with explanations to Patient UI 183 along with the diagno
stic step to Caregiver UI 175 at 4194, “Was there a robust LH surge?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00386] If the answer at 4230 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4231
, “Refer to specialist for injectable consultation
or IVF.” [00387] The provider will instruct the patient as to the di
rective, make a referral, and enter a confirmation in Caregiver UI 175. Rules‐Based Logic
135 then meets a hard stop. [00388] If the answer at 4230 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next diagnostic step to Caregiver UI 175 a
t 4233, “Should the couple be more aggressive?”
The provider inputs the answer into Caregiver UI 175
which sends the information to Storage 155. Rules‐Based Logic 135 then sends the next directive
to Caregiver UI 175 depending on the previous answer. [00389] If the answer at 4233 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4231
, “Refer to specialist for injectable consultation
or IVF.” The provider will instruct the patient as to
the directive, make a referral, and enter a confirmation in Caregiver UI 175. Rules‐Based Logic
135 then meets a hard stop [00390] If the answer at 4233 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4235
, “Prescribe letrozole 2.5mg PO TID x 5 days, starting Day 3 of cycle.” The provider will instru
ct the patient as to this directive, order the medication and then enter confirmation into Caregiver
UI 175. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4234, “Ovula
tory prediction kit for 12 days, beginning 3 days after last dose of letrozole.” The provider will i
nstruct the patient as to the directive and enter confirmation into Caregiver UI 175. Rules Based Logic
135 will send relevant information with explanations to Patient UI 183 along with the diagno
stic step to Caregiver UI 175 at 4194, “Was there a robust LH surge?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00391] If the answer at 4236 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4237
, “Increase caloric intake and decrease exercise regimen if excessive. Resume protocol once BMI ≥ 2
0.” The provider will instruct the patient as to
this directive and then inputs the confirmation into
Caregiver UI 175. Rules‐Based Logic 135 will encounter a hard stop until BMI is >17. Resumptio
n of protocol will be at 4006. [00392] If the answer at 4236 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4238
, “Prescribe Provera 10mg/day x12 days.” The provider will instruct the patient as to this direct
ive, prescribe the medication and then inputs the confirmation into Caregiver UI 175. Rules‐Based Logi
c 135 will send the next diagnostic step to Caregiver UI 175 at 4239, “Withdrawal bleed within
3 days of stopping Provera?” The provider inputs
the answer into Caregiver 175 which sends the inform
ation to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00393] If the answer at 4239 is yes, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4235
, “Prescribe letrozole 2.5mg PO TID x 5 days, starting Day 3 of cycle” The provider will instruc
t the patient as to this directive, order the medication and then enter confirmation into Caregiver
UI 175. Rules‐Based Logic 135 will send the next directive to Caregiver UI 175 at 4234, “Ovula
tory prediction kit for 12 days, beginning 3 days after last dose of letrozole.” The provider will i
nstruct the patient as to the directive and enter confirmation into Caregiver UI 175. Rules Based Logic
135 will send relevant information with explanations to Patient UI 183 along with the diagno
stic step to Caregiver UI 175 at 4194, “Was there a robust LH surge?” The provider inputs the
answer into Caregiver UI 175 which sends the information to Storage 155. Rules‐Based Logic 135 t
hen sends the next directive or diagnostic step to
Caregiver UI 175 depending on the previous answer. [00394] If the answer at 4239 is no, then the information
will be sent to and recorded in Storage 155 and Rules‐Based Logic 135 will send relevant inform
ation with explanations to Patient UI 183 along with the next directive to Caregiver UI 175 at 4028
, “Order blood tests: estradiol, progesterone, and
hCG (or uCG)” The provider will instruct the patie
nt as to this directive, order the blood tests, ent
er the results, and register a confirmation in Caregiver
UI 175. Rules‐Based Logic 135 will send the next
diagnostic step to Caregiver UI 175 at 4029, “Is
hCG ≥5 mIU/mL or uCG positive?” The provider inputs the answer into Caregiver UI 175 which sends
the information to Storage 155. Rules‐Based Logic 135 then sends the next directive or diagnosti
c step to Caregiver UI 175 depending on the previous answer. [00395] Several embodiments are specifically illustrated and/or
described herein. However, it will be appreciated that modifications and variations are cove
red by the above teachings and within the scope of the appended claims without departing from
the spirit and intended scope thereof. For example, the systems and methods discussed herein may
be applied to other medical treatments and/or conditions. [00396] The embodiments discussed herein are illustrative of
the present invention. As these embodiments of the present invention are described wi
th reference to illustrations, various modifications or adaptations of the methods and or s
pecific structures described may become apparent to those skilled in the art. All such mo
difications, adaptations, or variations that rely upon
the teachings of the present invention, and through
which these teachings have advanced the art, are considered to be within the spirit and scope of
the present invention. Hence, these descriptions and drawings should not be considered in a limiting
sense, as it is understood that the present invention is in no way limited to only the embodime
nts illustrated. [00397] Computing systems and/or logic referred to herein can
comprise an integrated circuit, a microprocessor, a personal computer, a server, a dist
ributed computing system, a communication device, a network device, or the like, and various
combinations of the same. A computing system or logic may also comprise volatile and/or non‐volatile
memory such as random access memory (RAM), dynamic random access memory (DRAM), static random ac
cess memory (SRAM), magnetic media, optical media, nano‐media, a hard drive, a compact
disk, a digital versatile disc (DVD), optical circui
ts, and/or other devices configured for storing analog or
digital information, such as in a database. A computer‐readable medium, as used herein, expressly
excludes paper. Computer‐implemented steps of the methods noted herein can comprise a set of
instructions stored on a computer‐readable medium that when executed cause the computing system
to perform the steps. A computing system programmed to perform particular functions pursuant to
instructions from program software is a special purpose computing system for performing those
particular functions. Data that is manipulated by a special purpose computing system whi
le performing those particular functions is at least electronically saved in buffers of the computin
g system, physically changing the special purpose computing system from one state to the next with ea
ch change to the stored data. [00398] The “logic” discussed herein is explicitly defined
to include hardware, firmware or software stored on a non‐transient computer readable medium,
or any combinations thereof. This logic may be implemented in an electronic and/or digital device
(e.g., a circuit) to produce a special purpose computing system. Any of the systems discussed here
in optionally include a microprocessor, including electronic and/or optical circuits, configure
d to execute any combination of the logic discussed herein. The methods discussed herein optio
nally include execution of the logic by said microprocessor.