Multicomputer data transferring and processing system

• US 10,606,983 B2
• Filed: 08/17/2016
• Issued: 03/31/2020
• Est. Priority Date: 12/12/2012
• Status: Active Grant

• Current Assignee: Quality Standards, LLC
• Original Assignee: Quality Standards, LLC
• Inventors: Thesman, Debra
• Primary Examiner(s): Weisenfeld, Aryan E
• Assistant Examiner(s): Blanchette, Joshua B
• Application Number:
  US15/239,454
• Publication Number:
  US 20160357920A1
• Time in Patent Office: 1,322 Days
• Field of Search: 705 2, 705 3
• CPC Class Codes: G06F 3/0482 Interaction with lists of selectable items, e.g. menus
• CPC Class Codes: G06F 3/04842 Selection of displayed objects or displayed text elements G06F3/0482 takes precedence
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/40 relating to mechanical, radiation or invasive therapies, e.g. surgery, laser therapy, dialysis or acupuncture
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms

Abstract

Healthcare is administered to members/enrollees of a healthcare plan according to objective quality standards. A patient population of eligible members/enrollees is identified and for each member/enrollee, medical information is aggregated via a web-based compilation of medical data from multiple sources that is continuously updated so as to provide an accurate, up-to-date and readily accessible compilation of a member/enrollee past diagnoses, healthcare history, medical procedures, medications and the like. Such member/enrollees are continuously tracked, on an individual basis, and monitored to ensure healthcare is delivered for a variety of specific medical conditions pursuant to objective health program quality criteria.

Claims

1. A system, comprising:

a central database having a hierarchical access control based on a category of user, the category of user being selected from the group consisting of member/enrollee, provider, management, coder, and auditor, the central database storing medical records for each of a plurality of patients in a patient population, and structured to filter out all incoming updates to the central databases except those corresponding to one of the plurality of individuals;

a computer running a plurality of applications, including a program for creating an individual profile, wherein the individual profile for each of the plurality of patients is stored in the central database; and

a server for providing a remote computer with access to the central database via a web-based application, the web-based application performing operations comprising;

generating a plurality of graphical user interfaces dynamically created by the program for viewing information from the central database and providing users with a capability to derive information at a specified level;

wherein a first graphical user interface of the plurality of graphical user interfaces displays a dashboard for displaying information on the patient population with review capabilities as to services provided to patients within the patient population, wherein the dashboard includes a navigation menu with a plurality of navigation elements, the plurality of navigation elements including Summary, Review by Plan, Review By Primary Care Physician (PCP), Review by Category, Evaluations, Prevalence, Record Upload, and Reports Library, wherein, under Review by Plan, a plurality of reports by PCP are selectable;

wherein a second graphical user interface of the plurality of graphical user interfaces displays information providing Risk Adjusted Factor (RAF) comparative analysis by plan for the Current Year (CY) active or termed members to provide users an overall RAF score for the same membership between two years;

wherein a third graphical user interface of the plurality of graphical user interfaces displays a member summary page;

wherein a fourth graphical user interface of the plurality of graphical user interfaces displays information on claims, medication refills, provider, designated specialty of said provider, and date of services rendered;

wherein a fifth graphical user interface of the plurality of graphical user interfaces displays a screen for displaying diagnostic information for a specific patient from among the plurality of patients, the diagnostic information including one or more diagnostic codes and a diagnosis description corresponding to each of the one or more diagnostic codes.

wherein the operations further comprise;

displaying, on the screen, one or more data entry fields by which an additional diagnostic code may be added to the medical records stored for the specific patient in the central database;

applying a plurality of code edits to prevent the addition of inappropriate diagnostic codes using the web-based application; and

,

for each additional diagnostic code added using the web-based application, tracking a page number of the medical records stored for the specific patient in the central database;

wherein a sixth graphical user interface of the plurality of graphical user interfaces displays information on objective quality measures as represented in a Centers for Medicare and Medicaid Services (CMS) star ratings program format;

wherein a seventh graphical user interface of the plurality of graphical user displays information of a monthly trend report tracking historical compliance scores for each objective quality measure; and

wherein an eighth graphical user interface of the plurality of graphical user interfaces displays information specific to a patient of the patient population regarding specific quality measures that have been met or not met, and providing for supplemental data or exclusions that may apply to said patient for the specific quality measure.

2. The system of claim 1, wherein the diagnostic information further includes a hierarchical condition category (HCC) corresponding to each of the one or more diagnostic codes.

3. The system of claim 1, wherein the operations further comprise displaying, on the screen, a comment input tool by which a user of the web-based application may add comments to the medical records stored for the specific patient in the central database.

4. The system of claim 3, wherein the comment input tool includes a plurality of selectable prewritten comments.

5. The system of claim 4, wherein the comment input tool further includes a text field for adding a comment other than the selectable prewritten comments.