Healthcare administration method for complex case and disease management

• US 10,600,516 B2
• Filed: 12/12/2012
• Issued: 03/24/2020
• Est. Priority Date: 12/12/2012
• Status: Active Grant

• Current Assignee: Advanced Healthcare Systems, Inc.
• Original Assignee: Advanced Healthcare Systems, Inc.
• Inventors: Merkin, Richard
• Primary Examiner(s): Tiedeman, Jason S
• Application Number:
  US13/712,741
• Publication Number:
  US 20140164017A1
• Time in Patent Office: 2,659 Days
• Field of Search: 705 2, 705 3
• CPC Class Codes: G06F 16/21 Design, administration or maintenance of databases
• CPC Class Codes: G06F 16/22 Indexing; Data structures therefor; Storage structures
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/60 for the operation of medical equipment or devices
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: G16H 70/00 ICT specially adapted for the handling or processing of medical references
• CPC Class Codes: G16H 70/20 relating to practices or guidelines
• CPC Class Codes: H04L 63/08 for authentication of entities cryptographic mechanisms or cryptographic arrangements for entity authentication H04L9/32
• CPC Class Codes: H04L 63/10 for controlling access to devices or network resources

Abstract

The present invention discloses substantially more efficient and effective methods for delivering healthcare whereby patient care can be coordinated effectively and efficiently through changes in different physical settings and levels of care. Coordinated care helps ensure that patients seeking healthcare, and in particular chronically ill patients, with comorbidities get timely care to avoid unnecessary Emergency Room visits and admissions. Through risk and disease stratification, member profiling, inter disciplinary team follow-up and patient education, the methods of the present invention are operative to effectively allocate available resources, formulate and execute individualized care plans and successfully manage high risk members.

Claims

1. A system, comprising:

at least one mobile device operable by a healthcare professional, comprising a network connection including internet access, loaded with, and operative to run, video teleconferencing software;

a plurality of databases located on servers connected to the network, the servers located in a plurality of medical facilities comprising hospitals, skilled nursing facilities, free standing surgery centers, dialysis centers, urgent care centers, facilities for performing radiology, and laboratory facilities;

a central database, stored on at least one server, the central database in communication with the plurality of databases, wherein the central database transfers data from the plurality of databases and transforms the data from the plurality of databases into patient files corresponding to each patient of the patient population, and wherein the central database is adapted to be routinely updated, by the plurality of databases, to provide up-to-date healthcare information for each patient within the patient population;

at least one complex case management application, implemented on the at least one server, in communication with the central database, and accessible by the mobile device, the at least one complex case management application programmed to identify a sub-population of patients within a patient population, the sub-population being afflicted with a complex medical condition, and programmed to place the sub-population of patients in to a complex care management regime, said complex medical condition defined by;

three or more chronic medical conditions selected from the group consisting of asthma, congestive heart failure, chronic obstructive pulmonary disease, diabetes, obesity, AIDS/HIV, anticoagulation, hypertension, peripheral artery disease, coronary artery disease, end-stage renal disease, and chronic kidney disease, and one high risk criteria selected from the group consisting of poor social support, poor functional status, poor nutritional status, two or more hospitalizations in the preceding twelve months, and three or more emergency room visits in the preceding twelve months;

or

a predetermined range of complexity scores calculated by a scoring module of the at least one complex case management application from an assignment of points based on criteria including;

demographic information including the patient'"'"'s age, sex, and residence, the residence selected from the group consisting of home, assisted living, skilled nursing facility, and board and care facility;

total number of ER visits and hospital admissions in the last six months;

major organ system dysfunction including cardiovascular, respiratory, renal, nervous system, hematology/oncology, digestive, urinary, infectious disease, endocrine, and musculoskeletal;

total number of drug classifications;

overall functional status including functional limitations; and

support network including social support and caregiver network;

wherein the mobile device is operable to display a plurality of screens of a user interface operable in the at least one complex case management application and implemented using Hyper Text Markup Language and/or JavaScript, the plurality of screens including selected data from the patient files, the plurality of screens including;

a summary page including demographic information, a clinical profile, and support network information;

a complex case management complexity profile linked to the summary page, the complex case management complexity profile including residence information, the number of ER visits and hospital admissions in the last six months, a major organ failure section, the total number of drug classifications currently prescribed for the patient, a listing of the drug classifications, a functional status summary, a listing of limitations regarding functional status;

a summary of the patient'"'"'s support network, and a complexity score;

a chronic conditions list;

a disease management member summary including actions taken, follow-up plans, and open items; and

a complexity profile report and trend including patient name and complexity scores over time;

at least one remote computer terminal linked to the at least one mobile device, the at least one remote computer terminal loaded with, and operable to run, the video teleconferencing software, and the at least one remote computer terminal accessible to patients in the complex care management regime and operative to provide direct, real time communication between a patient in the complex care management regime operating the at least one remote computer terminal and a healthcare professional operating the mobile device, the direct, real time communication concerning an acute condition being experienced by the patient of the sub-population of patients, and for the patient in the complex care management regime to initiate a request for care; and

a cloud-hosted main login table of an access management application, the access management application implemented on the at least one server, the main login table separately hosted from the access management application, the main login table limiting healthcare provider access in the disease management member summary screen of the user interface to open items that the healthcare provider has rights to close out;

wherein the at least one mobile device is configured to display the video teleconference and display the user interface regarding the patient, and wherein the patient files contain a medical history of each patient of the identified sub-population, the mobile device being operable to perform a remote screening process related to said request for care initiated by the patient in the complex care management regime, said remote screening process being performed by evaluating said patient'"'"'s up-to-date medical information stored in the central database and by assessing said patient'"'"'s medical case complexities taking into account said complex case management complexity profile accessed on the mobile device via the user interface, determining whether medical treatment for the complex medical condition being experienced by the patient is warranted, pursuant to a determination that medical treatment is warranted, determining whether the complex medical condition being experienced by the patient can be managed in a residential environment, pursuant to a determination that the complex medical condition can be managed in said residential environment, coordinating an appropriate home-based medical treatment in response to the patient'"'"'s request for care, and, pursuant to a determination that medical treatment is warranted, then, to the extent that a home-based medical treatment is not available, issuing an authorization request for medical treatment of the patient in a medical facility.

2. The system of claim 1, wherein the user interface is platform independent.

3. The system of claim 1, wherein the user interface is usable on mobile, cloud, and web-based platforms.

4. The system of claim 1, wherein the medical history of each patient of the identified sub-population that is accessed by the at least one mobile device via the user interface is updated at regular intervals.

5. The system of claim 1, wherein the plurality of screens includes an enrollment roster, wherein the enrollment roster identifies a list of patients to be enrolled into one or more chronic disease management programs.

6. The system of claim 5, wherein the at least one complex case management application is at least partially based on one or more chronic disease registries.

7. The system of claim 6, wherein the one or more disease registries are selected from the group consisting of:

anticoagulation;

asthma;

coronary artery disease (CAD);

congestive heart failure (CHF);

chronic obstructive pulmonary disease (COPD);

depression;

diabetes;

hypertension; and

obstructive sleep apnea (OSA).

8. The system of claim 1, wherein the medical history of each patient of the identified sub-population that is accessed by the at least one mobile device via the user interface is provided for assessment and implementation of patient-specific goals.

9. The system of claim 1, wherein the plurality of databases store information selected from the group consisting of each patient'"'"'s electronic medical records (EMR), each patient'"'"'s prior insurance claims and encounters information, membership enrollment data of each patient, pharmacy data associated with each patient, laboratory findings for each patient, hospital admissions information for each patient, primary care medical records, data from centers providing Medicare services, specialist and hospital reports associated with each patient, prior authorizations for medical treatment for each patient, and combinations thereof.