Ex Parte 8458610 et al

Patent Trials and Appeals Board

Jan 28, 2019

90013776 - (D) (P.T.A.B. Jan. 28, 2019)

UNITED STATES PATENT AND TRADEMARK OFFICE
UNITED STATES DEPARTMENT OF COMMERCE
United States Patent and Trademark Office
Address: COMMISSIONER FOR PATENTS
P.O. Box 1450
Alexandria, Virginia 22313-1450
www.uspto.gov
APPLICATION NO. FILING DATE FIRST NAMED INVENTOR ATTORNEY DOCKET NO. CONFIRMATION NO.
90/013,776 07/13/2016 8458610 DI32-016 1164
21567 7590 01/29/2019
Wells St. John P.S.
601 W. Main Avenue
Suite 600
Spokane, WA 99201
EXAMINER
DESAI, RACHNA SINGH
ART UNIT PAPER NUMBER
3992
MAIL DATE DELIVERY MODE
01/29/2019 PAPER
Please find below and/or attached an Office communication concerning this application or proceeding.
The time period for reply, if any, is set in the attached communication.
PTOL-90A (Rev. 04/07)

UNITED STATES PATENT AND TRADEMARK OFFICE
____________

BEFORE THE PATENT TRIAL AND APPEAL BOARD
____________

Ex parte DISCUS ANALYTICS, LLC
Patent Owner and Appellant
____________

Appeal 2019-000721
Reexamination Control 90/013,776
United States Patent 8,458,610 B2
Technology Center 3900
____________

Before JOHN A. JEFFERY, MARC S. HOFF, and ERIC B. CHEN,
Administrative Patent Judges.

JEFFERY, Administrative Patent Judge.

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DECISION ON APPEAL
Appellant appeals under 35 U.S.C. §§ 134 and 306 the Examiner’s
decision to reject claims 1–13, 15–37, 39, and 41–64. We have jurisdiction
under 35 U.S.C. §§ 134 and 306.1 We affirm.

STATEMENT OF THE CASE
This proceeding arose from a request for ex parte reexamination filed
on June 30, 2016 of United States Patent 8,458,610 (“’610 patent”), issued
to Kenney et al. on June 4, 2013.
The ’610 patent describes recording medical information by (1)
displaying a graphical user interface (GUI), including a graphical
representation of the human anatomy; (2) accessing user inputs interacting
with representation; and (3) generating an electronic record comprising data
pertaining to a patient’s health using the user inputs. See generally Abstract.
Claim 1 is illustrative of the invention and is reproduced below:
1. A computer-implemented medical information
recording method comprising:
displaying a graphical user interface including a graphical
representation of a plurality of joints of a human anatomy;
accessing user inputs interacting with the graphical
representation of the joints of the human anatomy, the user inputs
comprising data pertaining to a health of a patient including
associations of different conditions with different ones of the joints;
[and]
generating an electronic record which includes the data
pertaining to the health of the patient including the associations of the
different conditionswith the different ones of the joints; and

1 Appellant identifies the real party in interest as Discus Analytics, LLC.
App. Br. 4.
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wherein the computer which implements the medical
information recording method is a first computer, and further
comprising generating and outputting a communication to a second
computer, the communication comprising data of the patient for a
plurality of quality measures which are indicative of the treatment
of the conditions which are associated with the joints and for
compensation for services of medical personnel treating the conditions
which are associated with the joints of the patient.

THE REJECTIONS
The Examiner rejected claims 1, 2, 13, 17, 20–22, 24–27, 30, 33–37,
39, 41,2 42, 47–49, 55, 56, and 61–64 under 35 U.S.C. § 103 as unpatentable
over Cedric Lukas et al., METEOR as an Information Technology Tool to
Assess Rheumatoid Arthritis Disease Activity in Clinical Practice and
Improve Outcome via Tailor-Made Treatment, 7 INT’L J. OF ADVANCES IN
RHEUMATOLOGY 44 (2009) (“Lukas”) and Anderson et al. (US
2010/0191071 A1; published July 29, 2010). Final Act. 4–20.3
The Examiner rejected claims 1, 2, 4, 15–17, 20–22, and 24 under 35
U.S.C. § 103 as unpatentable over Deborah S. Collier et al., A
Rheumatology-Specific Informatics-Based Application With a Disease

2 Although the Examiner includes cancelled claim 40 in this rejection, we
nonetheless omit that claim here for clarity, and treat the Examiner’s error in
this regard as harmless.
3 Throughout this opinion, we refer to (1) the Final Rejection mailed October
18, 2017 (“Final Act.”); (2) the Appeal Brief filed May 16, 2018
(supplemented July 13, 2018) (“App. Br.”); (3) the Examiner’s Answer
mailed August 24, 2018 (“Ans.”); and (3) the Reply Brief filed October 24,
2018 (“Reply Br.”).
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Activity Calculator, 61 ARTHRITIS & RHEUMATOLOGY 488 (2009) (“Collier
I”)4 and Anderson. Final Act. 20–24.
The Examiner rejected claims 4–8 and 10–12 under 35 U.S.C. § 103
as unpatentable over Lukas, Anderson, and Heywood (US 2009/0131758 Al;
published May 21, 2009). Final Act. 24–30.
The Examiner rejected claims 5–8 and 10–12 under 35 U.S.C. § 103
as unpatentable over Collier I, Anderson, and Heywood. Final Act. 30–35.
The Examiner rejected claims 3, 18, 19, 23, 31, 43, 44, 50, 57, and 58
under 35 U.S.C. § 103 as unpatentable over Lukas, Anderson, and Arnone
(US 2008/0103825 A1; May 1, 2008). Final Act. 35–45.
The Examiner rejected claims 9, 45, and 465 under 35 U.S.C. § 103
as unpatentable over Lukas, Anderson, Heywood, and Carmeli (US
2013/0035956 Al; published Feb. 7, 2013). Final Act. 45–48.
The Examiner rejected claims 28, 29, 32, 51–54, 59, and 60 under 35
U.S.C. § 103 as unpatentable over Lukas and Kouchi (US 2006/0265136
A1; Nov. 23, 2006). Final Act. 49–55.

4 Although only one Collier reference is at issue in this appeal, we
nonetheless adopt the Examiner’s and Appellant’s nomenclature for clarity
and consistency.
5 Although the Examiner’s statement of the rejection in the Final Rejection
omits claim 46, the Examiner nonetheless includes claim 46 in the
associated discussion. Compare Final Act. 45 with Final Act. 48.
Accordingly, we present the correct claim listing here consistent with the
Examiner’s corrected listing on page 4 of the Answer.
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THE OBVIOUSNESS REJECTION OVER LUKAS AND ANDERSON
Regarding independent claim 1, the Examiner finds that Lukas
discloses a computer-implemented medical information recording method
including, among other things, (1) displaying a GUI including a graphical
representation of anatomical joints, (2) accessing user inputs interacting with
the representation, (3) generating an electronic record including data
pertaining to a patient’s health including associations of different conditions
with different joints, and (4) generating and outputting a communication to a
second computer, the communication comprising data of the patient for
plural quality measures indicating condition treatment. Final Act. 4–6.
Although the Examiner acknowledges that Lukas does not disclose explicitly
that the communication is for compensation for services of medical
personnel treating the conditions, the Examiner cites Anderson for teaching
this feature in concluding that the claim would have been obvious. Final
Act. 6.
Appellant argues the prior art does not teach or suggest the recited
quality measures as the term is understood in the art, let alone generating
and outputting a communication to a second computer comprising data for
plural quality measures indicating treatment of the conditions associated
with the joint and for compensation for services of medical personnel
treating the conditions. App. Br. 13–19; Reply Br. 2–7.
Appellant adds that not only does Lukas’ system send information to
the patient’s general practitioner who is not responsible for treatment
compensation, there is no motivation to modify Lukas’ communication to
request compensation as the Examiner proposes, let alone include patient
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data for quality measures, as claimed. App. Br. 16–17; Reply Br. 7–9.
According to the Appellant, Anderson merely saves reimbursement
requirements, procedures, and indications of previous success of
reimbursement requests in a database, but does not disclose submitting
reimbursement requests nor indicate how the requests are made. App. Br.
17–19; Reply Br. 7–9. As such, Appellant contends that the Examiner’s
proposed combination lacks articulated reasoning with a rational
underpinning and is based on improper hindsight. Id. Appellant argues
other recited limitations summarized below.

ISSUES
I. Under § 103, has the Examiner erred by finding that Lukas and
Anderson collectively would have taught or suggested:
(1) generating and outputting a communication to a second computer,
where the communication comprises data of a patient for plural quality
measures indicative of treatment of conditions associated with joints and for
compensation for services of medical personnel treating the conditions as
recited in claim 1?
(2) generating a report comprising the data pertaining to the health of
the patient for submission to a medical agency with respect to compensation
for services of medical personnel treating the patient as recited in claim 13?
(3) accessing another user input selecting one of the different
conditions, and controlling the GUI to only indicate the joints having the
selected one of different conditions, and to not indicate the joints having the
non-selected ones of the different conditions as recited in claim 30?
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(4) a second GUI configured to assist a user with generating the report
to include information regarding a medication used to treat the patient for
submission to the medical agency as recited in claim 25?
II. Is the Examiner’s combining the teachings of these references
supported by articulated reasoning with some rational underpinning to
justify the Examiner’s obviousness conclusion?

ANALYSIS
Claims 1, 2, 41, and 42
We begin by construing the key disputed limitation of claim 1 that
recites, in pertinent part, generating and outputting a communication
comprising data of the patient for (1) plural quality measures indicating
treatment of conditions associated with the joints, and (2) compensation for
services of medical personnel treating the conditions. Our emphasis
underscores that the recited quality measures are but one functional aspect of
the patient data that is communicated to a second computer, the other for
compensation. The Examiner, however, construes the recited “quality
measures” as data that is both (1) indicative of treatment of conditions
associated with the joints, and (2) for compensation for services of medical
personnel treating those conditions. See Ans. 5.
Turning to the Specification, the ’610 patent does not define the term
“quality measures,” but does describe the term in connection with providing
incentives for complying with these measures via reports submitted to a
medical agency. See ’610 patent, col. 9, ll. 22–29. To this end, GUI 30 in
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Figure 3 includes a “PQRI-RA”6 link 70 that, when selected, directs medical
personnel to the window shown in Figures 6A and 6B.7 ’610 patent, col. 9,
ll. 20–25; col. 10, ll. 43–64. This window assists medical personnel with
generating reports submitted to a medical agency, such as Medicare, for
incentives for complying with quality measures of treatment and/or payment
of the services for treatment. ’610 patent, col. 9, ll. 25–29.
Apart from this reference to “quality measures” in terms of providing
incentives to comply with those measures, the ’610 patent does not further
explain what is meant by these “quality measures,” let alone define the term
to so limit its interpretation. Nevertheless, Appellant contends that the term
“quality measures” is understood in the medical profession as consisting of a
numerator and denominator that permit calculating the percentage of a
defined patient population that receive a particular process of care or achieve
a particular outcome as evidenced by the 2008 Physician Quality Reporting
Initiative Specifications Document (“PQRI Specifications”), made of record
in this appeal. App. Br. 13; Reply Br. 3.
The first page8 of the PQRI Specifications document indicates that the
document contains complete specifications for the 119 measures that make
up the 2008 PQRI, and that each measure is assigned a unique number. The
document’s first page adds that “[i]n general, the quality measures consist of

6 “PQRI-RA” stands for “Physician Quality Reporting Initiative –
Rheumatoid Arthritis.” ’610 patent, col. 10, ll. 29–30.
7 Figure 6 shows the arrangement of Figures 6A and 6B, the latter of which
is a continuation of Figure 6A. See ’610 patent, col. 1, ll. 46–49.
8 The first page of the PQRI Specifications document is not paginated,
unlike other pages that follow the document’s table of contents (including
page 1). For clarity, we refer to the unpaginated first page here.
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a numerator and denominator that permit calculating the percentage of a
defined patient population that receive a particular process of care or achieve
a particular outcome.”
To be sure, the PQRI Specifications document’s first page explains
what is meant by quality measures in the context of those particular
specifications—at least in general. Nevertheless, the claim is not limited to
these particular quality measures, despite the fact that the link 70 and
associated window in Figures 6A and 6B of the ’610 patent pertain to
complying with quality measures associated with PQRI. See ’610 patent,
col. 9, ll. 22–29.
Although the PQRI Specifications document informs our construction
of the term “quality measures,” at least with respect to that particular
reporting protocol, we decline to import that description into the claim. See
Phillips v. AWH Corp., 415 F.3d 1303, 1323 (Fed. Cir. 2005) (en banc).
(“[A]lthough the specification often describes very specific embodiments of
the invention, we have repeatedly warned against confining the claims to
those embodiments. . . . [C]laims may embrace different subject matter than
is illustrated in the specific embodiments in the specification.”) (citations
and internal quotation marks omitted). Therefore, we see no error in the
Examiner’s construction of the term “quality measures” under its broadest
reasonable interpretation as data that is (1) indicative of treatment of
conditions associated with joints, and (2) for compensation for services of
medical personnel treating those conditions. See Ans. 5.
Turning to the rejection, the Examiner finds that Lukas discloses,
among other things, generating and outputting a communication to a second
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computer, the communication comprising data of the patient for plural
quality measures indicating condition treatment. Final Act. 4–6. In Lukas, a
custom-made software tool, known as “METEOR,”9 allows rheumatologists
to easily collect critical information to improve patient care by capturing
patient data and recording outcomes over time, thus helping rheumatologists
set goals and share treatment progress with patients. Lukas 44–45. The
METEOR application, among other things, captures information on drug
treatment for RA in a dedicated module. Lukas 46. To this end, METEOR
enables users to enter treatment modalities and, after a drug is selected,
administration modalities are presented and can be modified. Id. All
entered data assists the physician in tailoring treatment by visualizing and
comparing interventions (e.g., drug prescriptions and injections) with the
trends of disease activity and functional status over time. Id. 46–47. This
information, along with graphical representations, can be printed or stored in
the patient dossier or sent to the general practitioner. Id. 47.
Based on this functionality, we see no error in the Examiner’s finding
at least to the extent that Lukas at least suggests generating and outputting a
communication to a second computer, where the communication comprises
data of the patient for plural quality measures as claimed. Despite
Appellant’s arguments to the contrary (App. Br. 4–5), nothing in the claim
precludes the information that is sent to the general practitioner on pages 46
and 47 of Lukas for at least being for such quality measures even if such
quality measures were limited to those in the PQRI Specifications

9 “METEOR” stands for “Measurement of Efficacy of Treatment in the ‘Era
of Outcome’ in Rheumatology.” Lukas 44.
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document—which they are not. Therefore, Appellant’s arguments regarding
Lukas’ lacking the recited quality measures are unavailing and not
commensurate with the scope of the claim. That Lukas on page 47 notes
that certain information is entered and recorded in accordance with
International Classification of Diseases (ICD-10) codes—the very codes
used in the PQRI Specifications document10—only bolsters the notion that
the information in METEOR, including that sent to the general practitioner,
would be at least capable of being used for the recited quality measures.
To be sure, Lukas teaches sending this information to a general
practitioner, and not an insurance company for compensation. But leaving
aside the fact that information regarding a particular medical treatment, such
as treating RA, that is sent to a general practitioner would be at least capable
of being used for compensation for associated treatment services, the
Examiner nonetheless relies on Anderson—not Lukas—for at least
suggesting that feature. As the Examiner explains, sending medical
treatment information to an insurance company for compensation for
associated services is known in the art as evidenced by Anderson, and that
such a transmission for RA-based treatment, such as that reflected in the
transmitted information in Lukas, would have been obvious. Final Act. 6;
Ans. 7–8.
The Examiner’s position has merit, for although Anderson’s system
stores information regarding reimbursement procedures and their
requirements in a database, the database also keeps track of the success of

10 See, e.g., PQRI Specifications Front Page, 2 (listing ICD codes in
connection with denominator coding).
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previous reimbursement requests based on associated patient data.
Anderson ¶ 89. Our emphasis underscores the fact that to maintain a record
of previously-successful reimbursement requests made to insurance
companies for particular medical treatments, those requests would have to
have been made in the first instance. Otherwise, there would be no way to
confirm the success of those requests, let alone record them in a database.
The Examiner’s point in this regard (Ans. 7) is well taken, for it is not
improperly based on unsupported Official Notice as Appellant contends
(App. Br. 18; Reply Br. 5), but rather based on inferences ordinarily skilled
artisans would reasonably draw from Anderson.
To be sure, Anderson does not specify how these reimbursement
requests were made nor detail their particulars as Appellant indicates. App.
Br. 16; Reply Br. 6. Nevertheless, the Examiner does not rely solely on
Anderson for teaching outputting this data for compensation to a second
computer, but also Lukas, who teaches an online, internet-based RA
information tool. See Lukas 45–47, 50. Given this internet-based capability,
we see no reason why the Lukas system could not also send patient data for
compensation for treating RA conditions to a second computer, such as that
of an insurance company, in light of Anderson as the Examiner proposes for
reimbursement purposes or otherwise. See Final Act. 5; Ans. 7–8.
The Examiner’s proposed combination is not based on impermissible
hindsight as Appellant contends (App. Br. 19; Reply Br. 8), but rather uses
prior art elements predictably according to their established functions—an
obvious improvement. See KSR Int’l Co. v. Teleflex, Inc., 550 U.S. 398, 417
(2007). Appellant’s arguments regarding Lukas’ and Anderson’s individual
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shortcomings in this regard (see App. Br. 15–19; Reply Br. 4–6) do not
show nonobviousness where, as here, the rejection is based on the cited
references’ collective teachings. See In re Merck & Co., 800 F.2d 1091,
1097 (Fed. Cir. 1986). To the extent that Appellant contends that the
Examiner’s proposed enhancement would have been uniquely challenging or
otherwise beyond the level of ordinarily skilled artisans, there is no
persuasive evidence on this record to prove such a contention. Cf. In re
Salwan, 681 F. App’x 938, 938–40 (Fed. Cir. 2017) (non-precedential)
(discussing a system that transfers patient health information via a network
to, among other things, submit insurance claims and transfer patient health
records). The Examiner’s combining the teachings of Lukas and Anderson
is, therefore, supported by articulated reasoning with some rational
underpinning to justify the Examiner’s obviousness conclusion.
Accordingly, we are not persuaded that the Examiner erred in
rejecting claim 1, and claims 2, 41, and 42 not argued separately with
particularity.

Claims 13, 26, 27, 47, and 48
We also sustain the Examiner’s rejection of independent claim 13
reciting, in pertinent part, generating a report comprising the data pertaining
to the health of the patient for submission to a medical agency with respect
to compensation for services of medical personnel treating the patient. See
Final Act. 9–11; Ans. 12–14. Our emphasis on the word “for” underscores
that claim 13 does not recite submitting the report to a medical agency, but
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rather generating a report for submission to that agency—an intended use of
the report that may or may not occur.
Nevertheless, despite Appellant’s arguments to the contrary (App. Br.
25–28; Reply Br. 16–19), we see no error in the Examiner’s reliance on
Anderson and Lukas for collectively at least suggesting the recited report
generation limitation. Although Lukas’ system electronically transfers data
pertaining to a patient’s health for submission to a general practitioner,
Anderson nevertheless at least suggests generating a report that would be at
least capable of submission to an insurance company for reimbursement of
associated treatment, including RA for the reasons noted previously and
those indicated by the Examiner. See Ans. 12–14 (citing Lukas 47;
Anderson ¶ 89). Leaving aside the fact that there is no evidence on this
record that the patient health information transferred to a general practitioner
in Lukas would somehow be incapable of submission to a medical agency
with respect to compensation for associated services, we nonetheless see no
error in the Examiner’s finding that Anderson at least suggests generating a
report comprising data pertaining to a patient’s health for submission to a
medical agency for compensation of associated services, particularly given
the reference to previously-successful reimbursement requests made to
insurance companies for particular medical treatments in paragraph 89 as
noted previously.
To the extent that Appellant contends that these requests cannot at
least include a report, we disagree. The term “report” is not defined in the
Specification, so we interpret the term with its plain meaning, namely “a
usu[ally] detailed account or statement.” See MERRIAM WEBSTER’S
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COLLEGIATE DICTIONARY 992 (10th ed. 1993). Leaving aside the fact that a
report is usually—not always—a detailed account or statement under this
definition, generating such a statement pertaining to a patient’s health in
connection with Anderson’s reimbursement requests would have
nevertheless been at least an obvious variation to at least inform the
insurance company of the patient’s health status necessitating the associated
treatment. Indeed, it is difficult to envision how the requests in Anderson’s
paragraph 89 would have been successful without some sort of associated
report with respect to the patient’s health to justify the reimbursement for
associated treatment. That Anderson’s system actually generates reports
from a database in paragraph 113 only further bolsters the notion that
generating the recited reports for submission to medical agency as claimed
would have been at least an obvious variation. Accord Ans. 14 (noting that
given Lukas’ and Anderson’s collective teachings, skilled artisans would
understand that a communication can be sent to any interested or involved
party with respect to a patient’s health, including another doctor or insurance
company).
Lastly, despite Appellant’s arguments to the contrary (App. Br. 26–
27; Reply Br. 17–19), we find the Examiner’s combining the teachings of
Lukas and Anderson is supported by articulated reasoning with some
rational underpinning to justify the Examiner’s obviousness conclusion for
the reasons noted previously and those indicated by the Examiner.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 13, and claims 26, 27, 47, and 48 not argued separately with
particularity.
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Claims 17 and 20
We also sustain the Examiner’s rejection of claim 17 reciting, in
pertinent part, a computer comprising (1) processing circuitry configured to
generate an electronic communication regarding treatment of the conditions
which are associated with the joints, and (2) a communications interface
configured to output the electronic communication regarding the treatment
of those conditions to an insurer of the patient. See Final Act. 7; Ans. 14–
16. Because Appellant’s arguments regarding the alleged shortcomings of
Lukas and Anderson and their combinability are similar to those made
previously (see App. Br. 28–30; Reply Br. 19–21), we are unpersuaded by
those arguments for the reasons noted previously and those indicated by the
Examiner.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 17, and claim 20 not argued separately with particularity.

Claims 21, 22, 24, and 49
We also sustain the Examiner’s rejection of claim 21 reciting, in
pertinent part, generating and outputting a communication with respect to
compensation for services of medical personnel treating the conditions
which are associated with the joints of the patient. Final Act. 7; Ans. 19.
Because Appellant’s arguments regarding the alleged shortcomings of Lukas
and Anderson and their combinability are similar to those made previously
(see App. Br. 31–33; Reply Br. 22–23), we are unpersuaded by those
arguments for the reasons noted previously and those indicated by the
Examiner.
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Therefore, we are not persuaded that the Examiner erred in rejecting
claim 21, and claims 22, 24, and 49 not argued separately with particularity.

Claims 30, 55, and 56
We also sustain the Examiner’s rejection of claim 30 reciting, in
pertinent part, (1) accessing another user input selecting one of the different
conditions, and (2) controlling the GUI to only indicate the joints having the
selected one of different conditions, and to not indicate the joints having the
non-selected ones of the different conditions. See Final Act. 13–15; Ans.
21–22 (citing Anderson, Figs. 4, 7–9).
Despite Appellant’s arguments to the contrary (App. Br. 37–39; Reply
Br. 27–29), we see no error in the Examiner’s reliance on Anderson’s
treatment identification and modeling functionality for at least suggesting
the recited GUI control function. Anderson’s Figure 2 outlines a method for
diagnosing, treating, and monitoring a patient where, among other things,
specific treatment options are (1) identified in step 28, and then (2) modeled
in step 30. Anderson ¶¶ 60, 74–77. To this end, the treatment options are
identified and selected using a software interface, such as that shown in
Figure 8 reproduced below. Anderson ¶¶ 75–76.

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Interface for identifying treatment options in Anderson’s Figure 8

After selecting the treatment options, they are then are modeled by
retrieving and representing an associated model of the patient’s anatomy in a
GUI as shown in Anderson’s Figure 10 reproduced below. Anderson ¶ 77;
Figs. 9–10.

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Interface with modeling representation in Anderson’s Figure 10

Notably, the model displayed in Figure 10 showing a portion of the
patient’s spinal cord pertains to the selected treatment options which, in that
example, are for treating a particular spinal condition. The clear import of
this functionality, then, is that the GUI is effectively controlled to only
indicate that part of patient’s anatomy relevant to the conditions to be treated
in connection with the selected treatment options, and not indicate other
portions of the patient’s anatomy that do not pertain to those selected
options.
Given this functionality, we see no reason why this fundamental
concept could not be applied to joint-based conditions and associated
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treatments in the Lukas/Anderson system to indicate only selected joints
(e.g., those associated with a particular condition and associated treatment
option), and not display other joints associated with other conditions and
treatment options as the Examiner proposes. Such an enhancement uses
prior art elements predictably according to their established functions—an
obvious improvement. See KSR, 550 U.S. at 417. Appellant’s arguments
regarding Anderson’s individual shortcomings in this regard (App. Br. 37–
39; Reply Br. 27–29) do not show nonobviousness where, as here, the
rejection is based on the cited references’ collective teachings. See Merck,
800 F.2d at 1097.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 30, and claims 55 and 56 not argued separately with particularity.

Claims 33, 61, and 62
We also sustain the Examiner’s rejection of claim 33 reciting, in
pertinent part, outputting a communication to a second computer with
respect to compensation for services of medical personnel treating the
conditions which are associated with the joints of a patient. See Final Act.
15–17; Ans. 25. Because Appellant’s arguments regarding the alleged
shortcomings of Lukas and Anderson and their combinability are similar to
those made previously (see App. Br. 42–43; Reply Br. 32), we are
unpersuaded by those arguments for the reasons noted previously and those
indicated by the Examiner.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 33, and claims 61 and 62 not argued separately with particularity.
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Claims 36, 63, and 64
We also sustain the Examiner’s rejection of claim 36 reciting, in
pertinent part, generating and outputting an electronic communication
regarding treatment of the conditions which are associated with the joints to
an insurer of the patient. See Final Act. 18–20; Ans. 25–26. Because
Appellant’s arguments regarding the alleged shortcomings of Lukas and
Anderson and their combinability are similar to those made previously (see
App. Br. 42–43; Reply Br. 32), we are unpersuaded by those arguments for
the reasons noted previously and those indicated by the Examiner.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 36, and claims 63 and 64 not argued separately with particularity.

Claim 25
We also sustain the Examiner’s rejection of claim 25 reciting, in
pertinent part, a second GUI configured to assist a user with generating the
report to include information regarding a medication used to treat the patient
for submission to the medical agency. See Final Act. 11–12; Ans. 26–27.
Despite Appellant’s arguments to the contrary (App. Br. 45–46; Reply Br.
34–36), we see no error in the Examiner’s reliance on Anderson’s teaching
in paragraph 89 that the software interface includes a field that allows
treating physicians or medical personnel to describe the particular use of a
medical product, and that the database can include whether the treatment
was on-label or off-label use of that product. See Final Act. 11.
Not only does this teaching at least suggest that the medical product
can be a medication given its on- or off-label use, but the fact that the GUI
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in Anderson’s Figure 4 that allows entry of field-based information may be
multiple pages including, among other things, additional menus and other
inputs in paragraph 62 at least suggests that providing a second GUI in
connection with entering and retrieving data for a medical product
associated with a particular treatment would have been at least an obvious
variation. Accord Ans. 26–27 (noting this point).
Therefore, in addition to the reasons previously discussed regarding
the Examiner’s reliance on Lukas and Anderson in connection with
independent claim 13 from which claim 25 depends, we are also
unpersuaded of error in the Examiner’s rejection of claim 25 for these
additional reasons.

Claim 34
We also sustain the Examiner’s rejection of claim 34 reciting, in
pertinent part, the communication comprises information regarding the
treatment of the conditions which are associated with the patient’s joints.
See Final Act. 17–18; Ans. 27. Because Appellant’s arguments regarding
the alleged shortcomings of Lukas and Anderson and their combinability are
similar to those made previously (see App. Br. 46–47; Reply Br. 37–38), we
are unpersuaded by those arguments for the reasons noted previously and
those indicated by the Examiner.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 34.

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Claim 35
We also sustain the Examiner’s rejection of claim 35 reciting that the
communication comprises information regarding a medication prescribed to
treat the conditions associated with the patient’s joints. See Final Act. 8;
Ans. 27. Despite Appellant’s arguments to the contrary (App. Br. 47–49;
Reply Br. 38), we see no error in the Examiner’s reliance on Lukas’ pages
46 and 47 that at least suggests sending drug-based treatment information to
a general practitioner, and that providing such information to a medical
agency for reimbursement would have been obvious in light of Anderson’s
paragraph 89. See Final Act. 8; Ans. 27. Therefore, are unpersuaded of
error in the Examiner’s rejection of claim 35 for the reasons noted
previously and those indicated by the Examiner.

Claim 37
We also sustain the Examiner’s rejection of claim 37 reciting
displaying a GUI configured to assist a user with inputting the data of the
patient for the quality measures. See Final Act. 6; Ans. 27–28. Despite
Appellant’s arguments to the contrary (App. Br. 49–50; Reply Br. 38–39),
we see no error in the Examiner’s reliance on Lukas’ data entry functionality
on pages 46 and 47 for at least suggesting a GUI that can assist the user with
inputting the patient data for the quality measures. See Final Act. 6.
Leaving aside this functional recitation, we nonetheless find that the cited
prior art at least suggests the recited quality measures for the reasons noted
previously.
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Therefore, we are not persuaded that the Examiner erred in rejecting
claim 37.

Claim 39
We also sustain the Examiner’s rejection of claim 39 reciting that the
communication comprises the associations of the conditions with the
patient’s joints. See Final Act. 8–9; Ans. 28. Despite Appellant’s arguments
to the contrary (App. Br. 50–51; Reply Br. 39), we see no error in the
Examiner’s reliance on Lukas’ functionality on pages 46 and 47 for at least
suggesting communicating the recited associations, particularly when
considered in light of Anderson, for the reasons noted previously and those
indicated by the Examiner.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 39.

THE REJECTION OVER LUKAS, ANDERSON, AND ARNONE
Claims 3, 18, 19, 43, and 44
We also sustain the Examiner’s rejection of independent claim 3
reciting, in pertinent part, generating the electronic record includes a table
having plural entries corresponding to the joints and including the
associations of the different conditions with different ones of the joints. See
Final Act. 35–37; Ans. 11–12. Despite Appellant’s arguments to the
contrary (App. Br. 22–24; Reply Br. 14–16), we see no error in the
Examiner’s reliance on Arnone for at least suggesting the recited table,
particularly when considered in light of Lukas. As the Examiner explains
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and as noted previously, Lukas teaches generating an electronic record
pertaining to a patient’s health that includes associations of different
conditions with different joints. Final Act. 36 (citing Lukas 47). Although
the Examiner acknowledges that Lukas does not state explicitly that this
record of joint/condition associations is a table, we nonetheless see no
reason why these associations could not be so presented, particularly in view
of tabular presentation of anatomical information—including associated
conditions—in Arnone’s Figures 2 and 15 as the Examiner indicates. See
Final Act. 36–37; Ans. 11–12. Certainly, summarizing the joint/condition
associations in a table would assist in visualizing the information associated
with various conditions and their respective joints as the Examiner indicates
by organizing the information in rows and columns—a predictable result.
Accord Lukas 47 (noting that the number of tender and swollen joints is
counted and used to calculate the value of the disease activity score for the
patient on graphs and tables).
Even assuming, without deciding, that the tables in Arnone’s Figures
2 and 15 refer to only one part of the anatomy as Appellant contends (App.
Br. 23–24; Reply Br. 14–15), the Examiner does not rely solely on Arnone
in connection with the recited table-based electronic record, but rather the
collective teachings of the cited prior art, including Lukas. See Final Act.
35–37; Ans. 11–12. That is, the Examiner cites Arnone merely to show that
it is known to present anatomical information, including associated
conditions, in a table, and that, in light of this known technique, presenting
Lukas’ joint/condition associations in a table would assist in visualizing the
information—a predictable result. See id. Appellant’s contention, then, that
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modifying Arnone’s table to include plural entries for different parts of the
human anatomy would somehow frustrate Arnone’s tabular arrangement and
render it unsatisfactory for its intended purpose (Reply Br. 14–15) is not
only unsubstantiated on this record, this argument is not germane to the
Examiner’s rejection that proposes to modify Lukas to present Lukas’
joint/condition associations in a table, such as that shown in Arnone, to
assist in visualizing the information by organizing the information in rows
and columns. See Final Act. 35–37; Ans. 11–12. Such an enhancement uses
prior art elements predictably according to their established functions—an
obvious improvement. See KSR, 550 U.S. at 417. On this record, then, the
Examiner’s combining the teachings of the cited references is supported by
articulated reasoning with some rational underpinning to justify the
Examiner’s obviousness conclusion.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 3, and claims 18, 19, 43, and 44 not argued separately with
particularity.

Claims 31, 57, and 58
We also sustain the Examiner’s rejection of claim 31 reciting, in
pertinent part, displaying a table having the joints listed in a first column, the
conditions of the joints listed in plural additional columns, and plural visual
indications which indicate the associations of the different conditions with
the different ones of the joints. See Final Act. 42–44; Ans. 22–23. Despite
Appellant’s arguments to the contrary (App. Br. 39–40; Reply Br. 29–31),
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we see no error in the Examiner’s reliance on Arnone for at least suggesting
the recited table, particularly when considered in light of Lukas.
As we noted previously in connection with claim 3, summarizing
Lukas’ joint/condition associations in a table in view of Arnone would assist
in visualizing the information associated with various conditions and their
respective joints as the Examiner indicates by organizing the information in
rows and columns—a predictable use of prior art elements according to their
established functions to achieve a predictable result. See KSR, 550 U.S. at
417. Accord Lukas 47 (noting that the number of tender and swollen joints
is counted and used to calculate the value of the disease activity score for the
patient on graphs and tables). Therefore, Appellant’s arguments regarding
Arnone’s alleged shortcomings in this regard by referring to only one part of
the anatomy (App. Br. 39; Reply Br. 29–30) are unavailing for the reasons
noted previously.
To be sure, the cited references under the Examiner’s proposed
combination do not state explicitly that (1) the joints are listed in a first
column of the table; (2) the conditions are listed in additional columns; and
(3) visual indications indicate the respective associations of joints and
conditions. But this particular tabular arrangement would have been at least
an obvious variation within the level of ordinarily skilled artisans to
visualize the data consistent with that arrangement. Given a certain number
of joints and associated conditions in Lukas, there are only so many ways to
represent those associations in a table, namely by designating information to
be represented by the table’s columns and rows, such that the intersection of
a particular column and row identifies a corresponding cell with information
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pertaining to both the associated column and row, as in a spreadsheet. See,
e.g., Enfish LLC v. Microsoft Corp., 822 F.3d 1327, 1340 (Fed. Cir. 2016)
(discussing data representing rows and columns in a table in Microsoft Excel
5.0—a version of a well-known spreadsheet program that was in public use
by early 1994).
Therefore, given a data set with a certain number of joints and their
associated conditions as in Lukas, presenting this data in a table such that (1)
the joints are listed in a first column; (2) the conditions are listed in
additional columns; and (3) visual indications indicate the respective
associations of joints and conditions would have been a creative step within
the level of ordinarily skilled artisans to, among other things, visualize the
data consistent with that arrangement—an obvious variation. See KSR, 550
U.S.at 421 (“A person of ordinary skill is also a person of ordinary
creativity, not an automaton.”). To the extent that Appellant contends that
designating the joints and associated conditions of Lukas’ in columns of a
table would have been uniquely challenging or otherwise beyond the level of
ordinarily skilled artisans, there is no persuasive evidence on this record to
substantiate such a contention. Cf. Leapfrog Enters., Inc. v. Fisher-Price,
Inc., 485 F.3d 1157, 1162 (Fed. Cir. 2007). And where, as here, there are a
finite number of known identified, predictable solutions (e.g., representing
the joint and condition data in columns or rows of a table), ordinarily skilled
artisans would have had a good reason to pursue the known options within
their grasp, including listing the joints in a first column, and the conditions
in additional columns as claimed. See KSR, 550 U.S. at 421.
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Lastly, nothing in the claim precludes the “visual indications”
resulting from this tabular arrangement, including the intersection of a
particular column and row. Not only can this intersection itself be a “visual
indication” of an association, but nothing in the claim precludes other forms
of visual indications—including text—associated with the displayed table
that at least indicate the recited joint/condition associations.
On this record, then, we find that the cited references at least suggest
the recited limitations, and the Examiner’s combining the teachings of these
references is supported by articulated reasoning with some rational
underpinning to justify the Examiner’s obviousness conclusion.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 31, and claims 57 and 58 not argued separately with particularity.

Claims 23 and 50
We also sustain the Examiner’s rejection of claim 23 reciting, in
pertinent part, displaying a table having plural entries corresponding to the
joints of the human anatomy and the different conditions associated with the
different ones of the joints. See Final Act. 40–42; Ans. 26–27. Despite
Appellant’s arguments to the contrary (App. Br. 51–53; Reply Br. 40), we
see no error in the Examiner’s reliance on Arnone for at least suggesting the
recited table, particularly when considered in light of Lukas, for the reasons
noted previously and those indicated by the Examiner.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 23, and claim 50 not argued separately with particularity.

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THE OBVIOUSNESS REJECTION OVER LUKAS AND KOUCHI
Claims 28, 51, and 52
We also sustain the Examiner’s rejection of independent claim 28
reciting, in pertinent part, (1) determining, for each different condition, a
percentage change value which compares the number of joints having the
respective condition at different moments in time, and (2) displaying the
percentage change values for the different conditions using the GUI. See
Final Act. 49–51; Ans. 19–20. Notably, Appellant does not squarely
address—let alone persuasively rebut—the Examiner’s finding that Lukas’
system tracks trends of disease activity over time on page 49. See Final
Act. 51; Ans. 19.
Given this undisputed finding, we see no error in the Examiner’s
reliance on Kouchi for at least suggesting displaying a percentage change
value of a medical condition over a period of time given the percentage-
based metrics associated with treatment effect predictions in Figure 22, and
the fact that the treatment effect over time can be displayed after one month,
three months, six months, and a year. See Kouchi ¶¶ 145–46.
Although Kouchi’s Figure 22 displays treatment effect predictions and
probabilities of a patient achieving a blood sugar decrease given a particular
treatment as Appellant indicates (App. Br. 34–36; Reply Br. 25), we
nonetheless see no error in the Examiner’s reliance on Kouchi for the limited
purpose for which it was cited, namely merely to show that displaying
percentage change values for a certain medical condition over time is known
in the art, albeit in a predictive sense. Despite this predictive context, we
nonetheless see no reason why a percentage-based display of a medical
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condition that shows such changes over time, such as that in Kouchi, could
not be used in connection with Lukas’ system that tracks trends of disease
activity over time on page 49—disease activity that pertains to the
associations of joints and their respective conditions as noted previously.
See Lukas 47 (noting that the number of tender and swollen joints is counted
and used to calculate the value of the disease activity score for the patient on
graphs and tables). To the extent that Appellant contends that providing a
percentage-based display of a medical condition that shows such changes
over time, such as that in Kouchi, in connection with Lukas’ temporal
disease activity tracking functionality would have been uniquely challenging
or otherwise beyond the level of ordinarily skilled artisans, there is no
persuasive evidence on this record to substantiate such a contention. Cf.
Leapfrog, 485 F.3d at 1162. Moreover, it is well settled that familiar items
may have obvious uses beyond their primary purposes, and often ordinarily
skilled artisans can fit multiple references’ teachings together like puzzle
pieces. See KSR, 550 U.S. 398 at 420.
In short, the Examiner’s proposed combination uses prior art elements
predictably according to their established functions—an obvious
improvement. See id. at 417. Appellant’s arguments regarding Kouchi’s
individual shortcomings in this regard (App. Br. 34–36; Reply Br. 25) do not
show nonobviousness where, as here, the rejection is based on the cited
references’ collective teachings. See Merck, 800 F.2d at 1097.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 28, and claims 51 and 52 not argued separately with particularity.

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Claims 29, 53, and 54
We also sustain the Examiner’s rejection of claim 29 reciting, in
pertinent part, (1) using the data pertaining to the health of the patient to
determine values of an outcome measure at different moments in time for
the patient; (2) determine a percentage change value which compares the
values of the outcome measure at the different moments in time; and (3)
displaying the percentage change value using the GUI. See Final Act. 51–
53; Ans. 20–21. Despite Appellant’s arguments to the contrary (App. Br.
36–37; Reply Br. 26–27), we see no error in the Examiner’s reliance on
Kouchi for at least suggesting the recited outcome measure determination
and display, particularly when considered in light of Lukas, for the reasons
noted previously and those indicated by the Examiner.
Although the term “outcome measure” is not defined in the
Specification, the Specification nonetheless indicates that an exemplary
outcome measure is “DAS28”11 that uses data from plural parameters
including conditions of tenderness (pain) and swelling of joints, laboratory
information, and a physician’s evaluation of the patient’s general health in
term of an amount of disease activity present in the patient resulting from
examination and observation of the patient. ’610 patent, col. 6, ll. 46–59.
Notably, this passage indicates that this particular outcome measure is
exemplary, and other outcome measures may be used in other embodiments.
Id., col. 6, ll. 46–49.
Although this description informs our understanding of the recited
outcome measure, it is not so limited. To the extent that Appellant contends

11 “DAS-28” stands for “Disease Activity Score in 28 joints.” Collier I 488.
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that the recited outcome measure must be limited to this particular
description (see App. Br. 36), we decline to import that description into the
claim. See Phillips, 415 F.3d at 1323 (“[A]lthough the specification often
describes very specific embodiments of the invention, we have repeatedly
warned against confining the claims to those embodiments. . . . [C]laims
may embrace different subject matter than is illustrated in the specific
embodiments in the specification.”) (citations and internal quotation marks
omitted).
Turning to the rejection, Appellant does not squarely address—let
alone persuasively rebut—the Examiner’s finding that Lukas determines the
values of an outcome measure at different moments in time. See Final
Act. 52. Rather, Appellant’s arguments center on Kouchi’s alleged
shortcomings with respect to the recited outcome measure—not Lukas. See
App. Br. 36–37. Nor does Appellant squarely address—let alone
persuasively rebut—the Examiner’s finding that Lukas’ system tracks trends
of disease activity over time on page 49. See Final Act. 53; Ans. 21.
Given these undisputed findings, we see no error in the Examiner’s
reliance on Kouchi for at least suggesting displaying a percentage change
value of a medical condition over a period of time given the percentage-
based metrics associated with treatment effect predictions in Figure 22, and
the fact that the treatment effect over time can be displayed after one month,
three months, six months, and a year. See Kouchi ¶¶ 145–46.
Although Kouchi’s Figure 22 displays treatment effect predictions and
probabilities of a patient achieving a blood sugar decrease given a particular
treatment as Appellant indicates (App. Br. 36–37; Reply Br. 26), we
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nonetheless see no error in the Examiner’s reliance on Kouchi for the limited
purpose for which it was cited, namely merely to show that displaying
percentage change values for a certain medical condition over time is known
in the art, albeit in a predictive sense. Despite this predictive context, we
nonetheless see no reason why a percentage-based display of a medical
condition that shows such changes over time, such as that in Kouchi, could
not be used in connection with Lukas’ system that tracks trends of disease
activity over time on page 49. Notably, this disease activity not only pertains
to the associations of joints and their respective conditions as noted
previously, but also determining the values of an outcome measure at
different moments in time as the Examiner indicates. See Final Act. 52. To
the extent that Appellant contends that providing a percentage-based display
of a medical condition that shows such changes over time, such as that in
Kouchi, in connection with Lukas’ temporal disease activity tracking
functionality would have been uniquely challenging or otherwise beyond the
level of ordinarily skilled artisans, there is no persuasive evidence on this
record to substantiate such a contention. Cf. Leapfrog, 485 F.3d at 1162.
Moreover, it is well settled that familiar items may have obvious uses
beyond their primary purposes, and often ordinarily skilled artisans can fit
multiple references’ teachings together like puzzle pieces. See KSR, 550
U.S. 398 at 420.
Lastly, we note that Appellant also contends for the first time in the
Reply Brief that the Examiner failed to provide articulated reasoning with
rational underpinning for the proposed combination because Lukas already
teaches visualizing and comparing interventions with trends of disease
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activity, and therefore, there is allegedly no basis for further modification.
See Reply Br. 26–27. This argument, however, was not made in the Appeal
Brief. Compare Reply Br. 26–27 with App. Br. 36–37. These new
arguments are, therefore, waived as untimely. See 37 C.F.R. § 41.41(b)(2)
(2012). Nor has good cause been shown to raise these new combinability
arguments in the first instance in the Reply Brief, particularly given the
striking similarity between the Examiner’s response to arguments in the
Answer for claim 29 and the rejection with respect to the references’
combinability. Compare Final Act. 53 with Ans. 21. Nevertheless, even if
these arguments were timely submitted (which they were not), we still find
them unpersuasive for the reasons noted previously and those indicated by
the Examiner.
In short, the Examiner’s proposed combination uses prior art elements
predictably according to their established functions—an obvious
improvement. See KSR, 550 U.S. 398 at 417. Appellant’s arguments
regarding Kouchi’s individual shortcomings in this regard (App. Br. 36–37)
do not show nonobviousness where, as here, the rejection is based on the
cited references’ collective teachings. See Merck, 800 F.2d at 1097.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 29, and claims 53 and 54 not argued separately with particularity.

Claims 32, 59, and 60
We also sustain the Examiner’s rejection of claim 32 reciting, in
pertinent part, displaying a graph depicting a total number of joints of the
patient having one of the conditions at different moments in time. Notably,
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Appellant does not persuasively rebut the Examiner’s finding that Lukas’
system specifies and counts tender and swollen joints to calculate and
display the patient’s disease activity score value on follow-up graphs or
tables. Ans. 24 (citing Lukas 47). Nor does Appellant persuasively rebut
the Examiner’s finding that Lukas’ system tracks trends of disease activity
over time on page 49. See Final Act. 55; Ans. 24.
Given these undisputed findings, we see no error in the Examiner’s
reliance on Kouchi for at least suggesting displaying a graph of the status of
medical condition over a period of time in light of the graphs in Figures 10
to 16, particulary when considered in light of Lukas’ disease activity
graphing and tracking functionality noted by the Examiner. Although
Kouchi’s graphs pertain to simulation results as Appellant indicates (App.
Br. 31–32), we nonetheless see no reason why the fundamental concept of
graphing the status of a certain medical condition over time as shown in
Kouchi, whether the graph represents a simulation or otherwise, could not be
applied to Lukas’ system that includes joint-based disease activity graphing
and tracking functionality to depict visually the total number of joints having
a particular condition over time via a graph.
To the extent that Appellant contends that the Examiner’s proposed
enhancement to Lukas would have been uniquely challenging or otherwise
beyond the level of ordinarily skilled artisans, there is no persuasive
evidence on this record to substantiate such a contention. Cf. Leapfrog, 485
F.3d at 1162. Moreover, it is well settled that familiar items may have
obvious uses beyond their primary purposes, and often ordinarily skilled
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artisans can fit multiple references’ teachings together like puzzle pieces.
See KSR, 550 U.S. 398 at 420.
In short, the Examiner’s proposed combination uses prior art elements
predictably according to their established functions—an obvious
improvement. See KSR, 550 U.S. 398 at 417. Appellant’s arguments
regarding Kouchi’s individual shortcomings in this regard (App. Br. 40–41;
Reply Br. 31–32) do not show nonobviousness where, as here, the rejection
is based on the cited references’ collective teachings. See Merck, 800 F.2d
at 1097.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 32, and claims 59 and 60 not argued separately with particularity.

THE OTHER OBVIOUSNESS REJECTIONS BASED ON LUKAS
We also sustain the Examiner’s obviousness rejections of claims 4–
12, 45, and 46 based on Lukas. Final Act. 24–30, 45–48. Because these
rejections are not argued separately with particularity, we are not persuaded
of error in these rejections for the reasons previously discussed.

THE OBVIOUSNESS REJECTION OVER COLLIER I AND ANDERSON
Regarding independent claim 1, the Examiner finds that Collier I
discloses a computer-implemented medical information recording method
including, among other things, (1) displaying a GUI including a graphical
representation of anatomical joints, (2) accessing user inputs interacting with
the representation, (3) generating an electronic record including data
pertaining to a patient’s health including associations of different conditions
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with different joints, and (4) generating and outputting a communication to a
second computer, the communication comprising data of the patient for
plural quality measures indicating condition treatment. Final Act. 20–22.
Although the Examiner acknowledges that Collier I does not disclose
explicitly that the communication is for compensation for services of
medical personnel treating the conditions, the Examiner cites Anderson for
teaching this feature in concluding that the claim would have been obvious.
Final Act. 22.
Appellant argues the prior art does not teach or suggest the recited
quality measures as the term is understood in the art, let alone generating
and outputting a communication to a second computer comprising data for
plural quality measures indicating treatment of the conditions associated
with the joint and for compensation for services of medical personnel
treating the conditions. App. Br. 20–22; Reply Br. 9–13.
Appellant adds that not only does Collier I’s system send email to
physicians who are not responsible for treatment compensation, Anderson
merely saves reimbursement requirements, procedures, and indications of
previous success of reimbursement requests in a database, but does not
disclose submitting reimbursement requests nor indicate how the requests
are made. App. Br. 17–19; Reply Br. 7–13. As such, Appellant contends
that the Examiner’s proposed combination lacks articulated reasoning with a
rational underpinning and is based on improper hindsight. Id.

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ISSUE
Under § 103, has the Examiner erred by finding that Collier I and
Anderson collectively would have taught or suggested generating and
outputting a communication to a second computer, where the
communication comprises data of a patient for plural quality measures
indicative of treatment of conditions associated with joints and for
compensation for services of medical personnel treating the conditions as
recited in claim 1?

ANALYSIS
Claims 1, 2, 4, 15, and 16
We begin by noting that, as with the rejection of claim 1 based on
Lukas, the key disputed limitation recites, in pertinent part, generating and
outputting a communication comprising data of the patient for (1) plural
quality measures indicating treatment of conditions associated with the
joints, and (2) compensation for services of medical personnel treating the
conditions. As we noted in connection with the Lukas-based rejection, the
’610 patent does not define the term “quality measures,” but does describe
the term in connection with providing incentives for complying with these
measures via reports submitted to a medical agency. See ’610 patent, col. 9,
ll. 22–29. To this end, GUI 30 in Figure 3 includes a “PQRI-RA” link 70
that, when selected, directs medical personnel to the window shown in
Figures 6A and 6B. ’610 patent, col. 9, ll. 20–25; col. 10, ll. 43–64. This
window assists medical personnel with generating reports submitted to a
medical agency, such as Medicare, for incentives for complying with quality
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measures of treatment and/or payment of the services for treatment. ’610
patent, col. 9, ll. 25–29.
Apart from this reference to “quality measures” in terms of providing
incentives to comply with those measures, the ’610 patent does not further
explain what is meant by these “quality measures,” let alone define the term
to so limit its interpretation. Nevertheless, Appellant contends that the term
“quality measures” is understood in the medical profession as consisting of a
numerator and denominator that permit calculating the percentage of a
defined patient population that receive a particular process of care or achieve
a particular outcome as evidenced by the PQRI Specifications document,
made of record in this appeal. Reply Br. 9.
The first page of the PQRI Specifications document indicates that the
document contains complete specifications for the 119 measures that make
up the 2008 PQRI, and that each measure is assigned a unique number. The
document’s first page adds that “[i]n general, the quality measures consist of
a numerator and denominator that permit calculating the percentage of a
defined patient population that receive a particular process of care or achieve
a particular outcome.”
To be sure, the PQRI Specifications document’s first page explains
what is meant by quality measures in the context of those particular
specifications—at least in general. Nevertheless, the claim is not limited to
these particular quality measures, despite the fact that the link 70 and
associated window in Figures 6A and 6B of the ’610 patent pertain to
complying with quality measures associated with PQRI. See ’610 patent,
col. 9, ll. 22–29.
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Although the PQRI Specifications document informs our construction
of the term “quality measures,” at least with respect to that particular
reporting protocol, we decline to import that description into the claim. See
Phillips, 415 F.3d at 1323 (“[A]lthough the specification often describes
very specific embodiments of the invention, we have repeatedly warned
against confining the claims to those embodiments. . . . [C]laims may
embrace different subject matter than is illustrated in the specific
embodiments in the specification.”) (citations and internal quotation marks
omitted). Therefore, we see no error in the Examiner’s construction of the
term “quality measures” under its broadest reasonable interpretation as data
that is (1) indicative of treatment of conditions associated with joints, and (2)
for compensation for services of medical personnel treating those conditions.
See Ans. 8.
Turning to the rejection, the Examiner finds that Collier I discloses,
among other things, generating and outputting a communication to a second
computer, the communication comprising data of the patient for plural
quality measures indicating condition treatment. Final Act. 20–22. Collier I
discloses a rheumatology-specific application, known as “Rheumatology
OnCall” (ROC), with an integrated disease activity calculator. Collier I
Abstract. The application’s single Web page format includes a dashboard
view of, among other things, (1) clinical and laboratory data relevant to
rheumatic disease, (2) medication-related adverse effects graphed over time,
(3) a DAS28 calculator and trend reporter; (4) laboratory results; (5) a
current medication list; and (6) a medication history bar graph. Collier I
490. The application’s compact grouping of graphs allows a clinician to
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quickly assess trends and facilitate tracking disease activity and monitoring
for potential medication-related adverse effects. Id. The application also
enables the clinician to label each joint as normal, swollen, tender, etc. Id.
In one aspect, an automated email correspondence is sent weekly to
each clinician with a table of the previous week’s calculated DAS28 scores
for that clinician’s patients. Id. 491. In one 12-week study, each physician
who accessed the disease activity calculator during the previous week
received an automated email correspondence with a summary table listing
the proportion of DAS28 predictions that were in or out of range during the
previous week and throughout the study. Id.
Based on this functionality, we see no error in the Examiner’s reliance
on Collier I at least to the extent that Collier I at least suggests generating
and outputting a communication to a second computer, where the
communication comprises data of the patient for plural quality measures as
claimed. Despite Appellant’s arguments to the contrary (App. Br. 20–22),
nothing in the claim precludes the information that is sent to the clinician on
pages 491 of Collier I for at least being for such quality measures even if
such quality measures were limited to those in the PQRI Specifications
document—which they are not. In any event, we find that the information in
Collier I’s ROC application, including information sent to the clinician,
would be at least capable of being used for the recited quality measures.
In short, Appellant’s arguments regarding Collier I’s lacking the
recited quality measures are unavailing and not commensurate with the
scope of the claim. To the extent that Appellant contends that the summary
table of the calculated DAS28 scores that is sent to a clinician on Collier I’s
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page 491 is an outcome measure—not a quality measure (see App. Br. 20),
we disagree.
To be sure, the Specification indicates that an exemplary outcome
measure is “DAS28” that uses data from plural parameters including
conditions of tenderness (pain) and swelling of joints, laboratory
information, and a physician’s evaluation of the patient’s general health in
term of an amount of disease activity present in the patient resulting from
examination and observation of the patient. ’610 patent, col. 6, ll. 46–59.
But even assuming, without deciding, that DAS28 scores themselves that are
sent to clinicians on Collier I’s page 491 can be considered “outcome
measures” in light of the ’610 patent, nothing in the claim or the
Specification precludes the summary table listing the proportion of these
scores that were in or out of range during the relevant time period as being
considered “quality measures” under the term’s broadest reasonable
interpretation. Not only does this information indicate the effectiveness of
the joint-based treatment, it would be at least capable of being used for the
recited quality measures, including compensation for associated treatment
services.
To be sure, Collier I teaches sending this information to a clinician,
and not an insurance company for compensation. But leaving aside the fact
that information regarding a particular medical treatment, such as treating
RA, that is sent to a clinician would be at least capable of being used for
compensation for associated treatment services, the Examiner nonetheless
relies on Anderson—not Collier I—for at least suggesting that feature. As
the Examiner explains, sending medical treatment information to an
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insurance company for compensation for associated services is known in the
art as evidenced by Anderson, and that such a transmission for RA-based
treatment, such as that reflected in the transmitted information in Collier I,
would have been obvious. Final Act. 22; Ans. 9–11.
The Examiner’s position has merit, for although Anderson’s system
stores information regarding reimbursement procedures and their
requirements in a database, the database also keeps track of the success of
previous reimbursement requests based on associated patient data.
Anderson ¶ 89. Our emphasis underscores the fact that to maintain a record
of previously-successful reimbursement requests made to insurance
companies for particular medical treatments, those requests would have to
have been made in the first instance. Otherwise, there would be no way to
confirm the success of those requests, let alone record them in a database.
The Examiner’s point in this regard (Ans. 10) is well taken, for this finding
is based on inferences ordinarily skilled artisans would reasonably draw
from Anderson.
To be sure, Anderson does not specify how these reimbursement
requests were made nor detail their particulars as Appellant indicates. App.
Br. 21; Reply Br. 11. Nevertheless, the Examiner does not rely solely on
Anderson for teaching outputting this data for compensation to a second
computer, but also Collier I, who teaches a web-based RA information tool.
See Collier I 490–91. Given this web-based capability, we see no reason
why the Collier I system could not also send patient data for compensation
for treating RA conditions to a second computer, such as that of an insurance
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company, in light of Anderson as the Examiner proposes for reimbursement
purposes or otherwise. See Final Act. 22; Ans. 9–12.
The Examiner’s proposed combination is not based on impermissible
hindsight as Appellant contends (App. Br. 22; Reply Br. 13), but rather uses
prior art elements predictably according to their established functions—an
obvious improvement. See KSR, 550 U.S. at 417. Appellant’s arguments
regarding Collier I’s and Anderson’s individual shortcomings in this regard
(see App. Br. 10–12; Reply Br. 20–22) do not show nonobviousness where,
as here, the rejection is based on the cited references’ collective teachings.
See Merck & Co., 800 F.2d 1091, 1097 (Fed. Cir. 1986). To the extent that
Appellant contends that the Examiner’s proposed enhancement would have
been uniquely challenging or otherwise beyond the level of ordinarily skilled
artisans, there is no persuasive evidence on this record to prove such a
contention. Cf. Salwan, 681 F. App’x at 938–40 (discussing a system that
transfers patient health information via a network to, among other things,
submit insurance claims and transfer patient health records). The
Examiner’s combining the teachings of Collier I and Anderson is, therefore,
supported by articulated reasoning with some rational underpinning to
justify the Examiner’s obviousness conclusion.
Accordingly, we are not persuaded that the Examiner erred in
rejecting claim 1, and claims 2, 4, 15, and 16 not argued separately with
particularity.

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Claims 17 and 20
We also sustain the Examiner’s rejection of claim 17 reciting, in
pertinent part, a computer comprising (1) processing circuitry configured to
generate an electronic communication regarding treatment of the conditions
which are associated with the joints, and (2) a communications interface
configured to output the electronic communication regarding the treatment
of those conditions to an insurer of the patient. See Final Act. 23; Ans. 17–
18. Because Appellant’s arguments regarding the alleged shortcomings of
Collier I and Anderson and their combinability are similar to those made
previously (see App. Br. 30–31; Reply Br. 21–22), we are unpersuaded by
those arguments for the reasons noted previously and those indicated by the
Examiner.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 17, and claim 20 not argued separately with particularity.

Claims 21, 22, and 2412
We also sustain the Examiner’s rejection of claim 21 reciting, in
pertinent part, generating and outputting a communication with respect to
compensation for services of medical personnel treating the conditions
which are associated with the joints of the patient. See Final Act. 23; Ans.
19. Because Appellant’s arguments regarding the alleged shortcomings of
Collier I and Anderson and their combinability are similar to those made
previously (see App. Br. 31–33; Reply Br. 22–23), we are unpersuaded by

12 Although Appellant also includes claim 49 in this grouping (see App. Br.
33; Reply Br. 23), the claim was not so rejected. See Final Act. 20; Ans. 3.
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those arguments for the reasons noted previously and those indicated by the
Examiner.
Therefore, we are not persuaded that the Examiner erred in rejecting
claim 21, and claims 22 and 24 not argued separately with particularity.

THE OTHER OBVIOUSNESS REJECTION BASED ON COLLIER I
We also sustain the Examiner’s obviousness rejection of claims 5–8
and 10–12 over Collier I, Anderson, and Heywood. Final Act. 30–35.
Because this rejection is not argued separately with particularity, we are not
persuaded of error in this rejection for the reasons previously discussed.

CONCLUSION
The Examiner did not err in rejecting claims 1–13, 15–37, 39, and 41–
64 under § 103.

DECISION
The Examiner’s decision to reject claims 1–13, 15–37, 39, and 41–64
is affirmed.
Requests for extensions of time in this ex parte reexamination
proceeding are governed by 37 C.F.R. § 1.550(c). See 37 C.F.R. § 41.50(f).

AFFIRMED