Pharmaceutical information tracking system

• US 20030074225A1
• Filed: 10/12/2001
• Published: 04/17/2003
• Est. Priority Date: 10/12/2001
• Status: Abandoned Application

• Current Assignee: Gerald C. Borsand, Sue Ann Syoen
• Original Assignee: Gerald C. Borsand, Sue Ann Syoen
• Inventors: Syoen, Sue Ann, Borsand, Gerald C.
• Application Number:
  US09/976,650
• Publication Number:
  US 20030074225A1
• Time in Patent Office: Days
• US Class Current: 705/3
• 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 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 40/67 for remote operation

Abstract

A system that facilitates direct, efficient, non-linear, integrated and proactive communications between a payor, a PBM, a pharmacy, and health care provider such as a physician. The system increases efficiency and reducing costs by reducing the number of processes needed to prescribe pharmaceuticals in accordance with the policies of a payor or PBM. The system can pre-certify prescriptions, check of for unfavorable pharmaceutical interactions and allergic reactions, prevent misuse of a prescription, monitor the filling and re-filling of a prescription, as well as cancel a prescription after it has been issued by a provider. Instead of merely allowing different entities to communicate with each other through interfaces and other indirect means, one embodiment of the system actually centralizes the information storage into a one or more locations that are accessible to all the appropriate entities.

Claims

1. A pharmaceutical information tracking system comprising:

a payor;

a computer system accessible by said payor including;

a pharmaceutical subsystem, comprising a pharmaceutical representation;

a prescription subsystem, comprising a prescription representation for said pharmaceutical representation; and

a reimbursement subsystem, comprising a reimbursement representation for said prescription representation.

2. A pharmaceutical information tracking system as recited in claim 1:

wherein said pharmaceutical subsystem is accessible by said prescription subsystem and said reimbursement subsystem;

wherein said prescription subsystem is accessible by said pharmaceutical subsystem and said reimbursement system; and

wherein said reimbursement subsystem is accessible by said pharmaceutical subsystem and said prescription subsystem.

3. A pharmaceutical information tracking system as recited in claim 1, said computer system further including a single database or a plurality of interconnected databases.

4. A pharmaceutical information tracking system as recited in claim 1, said reimbursement subsystem further comprising a reimbursement rule and said reimbursement representation including a monetary value, said reimbursement rule determining the monetary value of said reimbursement representation.

5. A pharmaceutical information tracking system as recited in claim 1, said computer system further including an eligibility subsystem and an eligibility criteria, said eligibility subsystem communicating said eligibility criteria to said reimbursement subsystem, said pharmaceutical subsystem, or said prescription subsystem.

6. A pharmaceutical information tracking system as recited in claim 5, said eligibility subsystem further comprising an eligibility decision, wherein said eligibility subsystem analyzes said eligibility criteria to generate said eligibility decision.

7. A pharmaceutical information tracking system as recited in claim 6, wherein said eligibility decision is sent to said prescription subsystem before said prescription subsystem generates said prescription representation.

8. A pharmaceutical information tracking system as recited in claim 6, said pharmaceutical subsystem further comprising a plurality of pharmaceutical representations and a subset of eligible pharmaceutical representations, wherein said prescription subsystem selectively identifies said subset of eligible pharmaceutical representations from said plurality of eligibility representations using said eligibility decision.

9. A pharmaceutical information tracking system as recited in claim 1, said prescription subsystem further comprising a patient attribute, wherein said prescription subsystem analyzes said patient attribute to selectively create said prescription representation.

10. A pharmaceutical information tracking system as recited in claim 9, wherein said patient attribute is a medical history.

11. A pharmaceutical information tracking system as recited in claim 10, wherein said medical history includes medication history.

12. A pharmaceutical information tracking system as recited in claim 1, said prescription subsystem further comprising a formulary, said prescription subsystem selectively identifying said pharmaceutical representation in said formulary and selectively creating said prescription representation.

13. A pharmaceutical information tracking system as recited in claim 1, said pharmaceutical subsystem further comprising a representation of an unfavorable pharmaceutical interaction in a patient caused by two or more pharmaceuticals wherein each pharmaceutical is represented by said pharmaceutical representation, and wherein said pharmaceutical subsystem detects said representation of an unfavorable pharmaceutical interaction.

14. A pharmaceutical information tracking system as recited in claim 13, said unfavorable pharmaceutical interaction including an a representation of redundant pharmaceuticals.

15. A pharmaceutical information tracking system as recited in claim 13, wherein said prescription subsystem is prevented from generating said prescription representation for said pharmaceutical representations that would result in said representation of unfavorable pharmaceutical interaction.

16. A pharmaceutical information tracking system as recited in claim 1, further comprising a representation of an allergy and a representation of an unfavorable allergy interaction in a patient between said allergy and a pharmaceutical represented by said pharmaceutical representation, wherein said pharmaceutical subsystem detects said representation of an unfavorable allergy interaction in a patient.

17. A pharmaceutical information tracking system as recited in claim 16, wherein said prescription subsystem is prevented from generating said prescription representation for said pharmaceutical representation that would result in said representation of an unfavorable allergy interaction in a patient.

18. A pharmaceutical information tracking system as recited in claim 1, including a superseding criteria, wherein said prescription subsystem alters said prescription representation after said prescription subsystem creates said prescription representation.

19. A pharmaceutical information tracking system as recited in claim 18, wherein said altering includes a canceling of said prescription representation.

20. A pharmaceutical information tracking system as recited in claim 1, wherein said prescription subsystem includes a representation of filling a prescription, wherein said prescription subsystem monitors said representation of filling a prescription.

21. A pharmaceutical information tracking system as recited in claim 20, wherein said representation of filling a prescription includes a representation of re-filling a prescription.

22. A pharmaceutical information tracking system as recited in claim 1, said reimbursement subsystem further comprising a pre-certified status, wherein said reimbursement of said pre-certified status is attributed to said prescription representation by said prescription subsystem at the time said prescription subsystem selectively creates said prescription representation.

23. A pharmaceutical information tracking system as recited in claim 22:

said computer system further including an eligibility subsystem, said eligibility subsystem further comprising an eligibility criteria and an eligibility decision;

wherein said eligibility subsystem analyzes said eligibility criteria to create said eligibility decision;

wherein said prescription subsystem analyzes said eligibility decision to determine if said pre-certified status is attributed to said prescription representation.

24. A pharmaceutical information tracking system as recited in claim 1, said reimbursement subsystem further comprising a reimbursement rule and a change in said reimbursement rule, wherein said change in said reimbursement rule is made by said reimbursement subsystem, and said change in said reimbursement rule is accessible by said prescription subsystem or said pharmaceutical subsystem in a substantially simultaneous manner.

25. A pharmaceutical information tracking system as recited in claim 1, said reimbursement subsystem further comprising a cost analysis and a cost criteria, wherein said reimbursement subsystem generates said cost analysis using said cost criteria.

26. A pharmaceutical information tracking system as recited in claim 1, said reimbursement subsystem further comprises a treatment protocol, wherein said reimbursement subsystem communicates said treatment protocol to said prescription subsystem.

27. A pharmaceutical information tracking system as recited in claim 1, said prescription subsystem further comprising a diagnosis, wherein said prescription subsystem stores said diagnosis with said prescription.

28. A pharmaceutical information tracking system comprising:

a payor;

a computer system accessible by said payor including;

a pharmaceutical subsystem comprising a plurality of pharmaceutical representations, a representation of an unfavorable pharmaceutical interaction, a representation of an unfavorable allergy interaction, and a subset of eligible pharmaceutical representations;

a prescription subsystem comprising a plurality of prescription representations, a patient attribute representation, and a representation of filling a prescription;

a reimbursement subsystem comprising a reimbursement representation, a reimbursement rule, a pre-certified status, a cost analysis, a cost criteria, and a treatment protocol; and

an eligibility subsystem comprising an eligibility criteria and an eligibility decision; and

wherein said pharmaceutical subsystem, said prescription subsystem, said reimbursement subsystem, and said eligibility subsystem share information in a substantially simultaneous manner.

29. A method of tracking pharmaceutical information comprising the steps of:

using a single computer system to track pharmaceutical, prescription, eligibility and reimbursement information; and

pre-certifying a prescription before generating an electronic representation of the prescription.

30. A method of tracking pharmaceutical information as recited in claim 29, further comprising detecting a representation of an unfavorable pharmaceutical interaction.

31. A method of tracking pharmaceutical information as recited in claim 29, further comprising identifying a representation of an unfavorable allergy interaction.

32. A method of tracking pharmaceutical information as recited in claim 29, further comprising altering a prescription representation after generating a representation of a filled prescription.

33. A method of tracking pharmaceutical information as recited in claim 29, further comprising monitoring a representation of patient usage after generating a representation of a filled prescription.

34. A method of tracking pharmaceutical information as recited in claim 29, further comprising consulting an electronic formulary before generating a prescription representation.