Clinical care utilization management system

• US 20020165735A1
• Filed: 01/30/2001
• Published: 11/07/2002
• Est. Priority Date: 11/13/2000
• Status: Active Grant

• Current Assignee: Peter Stangel
• Original Assignee: Peter Stangel
• Inventors: Stangel, Peter
• Granted Patent: US 7,734,480 B2
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 20/3674 involving authentication
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• 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 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A computer implemented system facilities the submission of clinical events date to a reviewing agency by prompting for date needed to authorize the appropriateness of the event. The system directs an appropriate submission to authorize the event. The system further stores the patient clinical event data and presents the date for review. The system confirms that the clinical event is appropriate by referring to the input data and predetermined validation rules.

Claims

1. A computer implemented system for generating a medical diagnosis clinical record for submission to a health care organization, comprising:

a data entry interface, the data entry interface facilitating the entry of data corresponding to a medical diagnosis;

at least one selection interface, the selection interface adapted to facilitate the selection of at least a diagnosis;

a navigation module, the navigation module facilitating the identification of fields for which data should be entered, the navigation module facilitating said identification in response to the selection from said selection interface; and

a verification module, the verification module determining the authorization level for the diagnosis by referring to at least the data in the directed-to fields, the verification module determining said level prior to the submission of the record to a processing module.

2. The system of claim 1, wherein said selection interface further facilitates the selection of a criteria corresponding to a selected diagnosis.

3. The system of claim 1, wherein said diagnosis authorization level depends on a plurality of associated criteria.

4. The system of claim 1, wherein the data entry interface is a single screen interface whereby the user does not scroll the screen when entering data in at least the directed-to fields.

5. The system of claim 1, wherein said verification module is coupled to a rule database which stores rules employed by the verification module in determining said authorization level.

6. The system of claim 5, wherein the database stores at least two levels of rules, said levels comprising:

a criteria level, the criteria level rules determining a criteria status by referring to data from the directed-to fields of said clinical record; and

a diagnosis level, the diagnosis level determining a diagnosis authorization level by referring to the criteria status of associated criteria.

7. A medical data utilization system, comprising:

a user interface to facilitate the submission of data to the system, the user interface associated with a forms database that is used in generating the user screens by which data is entered;

a forms database storing forms and controls employed to facilitate the generation of user screens;

a navigation module operatively coupled to the user interface, the navigation module guiding the user interaction with the user screens, the navigation module associated with a selection database;

a selection database, the selection database providing information as to the data selections that should be available to a user;

a verification module operatively coupled to the user interface, the verification module adapted to determine a level of authorization and criteria compliance based on the entered data, the verification module is associated with a criteria database; and

a criteria database, the criteria database storing criteria rules, which are evaluated to determine an authorization level.

8. A method for facilitating the submission of a clinical record for automated processing, comprising:

providing at least one selection interface, the selection interface adapted to facilitate the user selection of one of a plurality of predetermined data values;

receiving a selection from said selection interface; and

providing at least one data field in response to said selection, the data field is a quantified data field associated with an objective criteria, whereby said quantified data field is adapted to be examined so as to facilitate the automated processing of said clinical record.

9. A method for entering medical diagnosis data, comprising:

entering a diagnosis into the system;

entering a criteria into the system, the criteria corresponding to a rule required for authorizing a diagnosis, the criteria associated with at least one finding; and

entering a finding into the system.

10. The method of claim 9, further comprising entering additional data corresponding to the entered finding.

11. The method of claim 9, further comprising entering a request for additional information by employing an additional request selection interface.

13. The interface of claim 12, wherein said display area displays said parameter and corresponding findings by displaying each parameter and associated finding on a single line.

14. The interface of claim 12, wherein the data entry area is adapted to facilitate the entry of more than one finding for a parameter.

16. The method of claim 15, wherein the first set of rules and the second set of rules are substantially the same.

17. The method of claim 15, further comprising providing an indication to the user of the internet site regarding the authorization level for the entered procedure data, the indication provided before the user submits the form to the internet site.

12. An interface for entering data for the authorization of a diagnosis, comprising:

a first portion adapted to facilitate the selection of a system group;

a second portion adapted to display data entered for said diagnosis element wherein the displayed data changes in response to a change in said element selection;

a display area within the second portion, the display area displaying parameter and corresponding findings for the selected system group from the first portion; and

a data entry area, the data entry area facilitating at least the selection of findings and parameters for said system group.

15. A method for processing medical procedure data by a health care organization, comprising:

establishing an internet site that provides forms that facilitate the entry of procedure data;

configuring the forms to apply a first set of rules for authorizing procedures;

receiving medical procedure data from medical care providers interacting with the internet site; and

processing the received data automatically in accordance with a second set of rules.

18. A method for facilitating the single screen submission of medical diagnosis data in a computer implemented utilization management system, comprising:

providing an element selection interface, the element selection interface facilitating the selection of an element associated with a diagnosis symptom;

providing a system group selection interface, the system group selection interface facilitating the selection of a system group of the selected element;

providing a parameter selection interface, the parameter selection interface facilitating the selection of a parameter of the selected system group;

providing a finding selection interface, the finding selection interface facilitating the selection of a finding of the selected parameter;

displaying parameter and corresponding findings for the selected element as a single line of a display scrollbox; and

adding selected findings to the single line display when findings are selected for a parameter already in the display scrollbox.

19. a method for providing an indication of criteria authorization level to a user of a utilization system that facilitates the submission of medical diagnosis data, comprising:

providing a selection interface to select a diagnosis criteria;

receiving diagnosis related data from the user;

applying a verification rule to the received data; and

providing an indication of verification result, the indication provided within the selection items in the criteria selection interface to indicate criteria authorization level.