System for providing consumer access to healthcare related information

• US 20030191669A1
• Filed: 01/06/2003
• Published: 10/09/2003
• Est. Priority Date: 04/09/2002
• Status: Abandoned Application

• Current Assignee: Siemens Medical Solutions Health Services Corporation (Siemens AG)
• Original Assignee: Siemens Medical Solutions Health Services Corporation (Siemens AG)
• Inventors: Lucas, Brian, Klassen, David Hiebert Sr., Fitzgerald, David
• Application Number:
  US10/336,990
• Publication Number:
  US 20030191669A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• 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 70/20 relating to practices or guidelines

Abstract

A system uses aggregated healthcare encounter service, billing, and claim data to enable an authorized patient to access healthcare encounter related information. A system supports patient access to healthcare encounter related information including information concerning an event involving interaction of a patient with a healthcare enterprise. The system includes an interface processor for receiving patient identification information and a request for encounter related information. The system also includes a database linking a patient identifier with, a record identifying at least one patient encounter and data identifying at least one healthcare provider organization associated with the at least one patient encounter and a record containing encounter information related to the at least one patient encounter. A data processor accesses the database to provide encounter related information for a patient and processes the encounter related information to be suitable for output communication for presentation to the patient in response to the patient identification information and the request.

Claims

1. A system supporting patient access to healthcare encounter related information including information concerning an event involving interaction of a patient with a healthcare enterprise, comprising:

an interface processor for receiving patient identification information and a request for encounter related information;

a database linking a patient identifier with,

a record identifying at least one patient encounter and

data identifying at least one healthcare provider organization associated with said at least one patient encounter and

a record containing encounter information related to said at least one patient encounter; and

a data processor for accessing said database to provide encounter related information for a patient and processing said encounter related information to be suitable for output communication for presentation to said patient in response to said patient identification information and said request.

2. A system according to claim 1, wherein

said interface processor receives a patient command to schedule a visit to a healthcare provider organization, and

in response to said command, said data processor automatically initiates at least one of, (a) medical necessity verification to determine said scheduled visit is covered by a patient healthcare insurance plan, (b) a request for referral by a patient physician to support said scheduled visit and (c) healthcare insurance plan eligibility verification to verify said scheduled visit is covered by said patient healthcare insurance plan.

3. A system according to claim 2, wherein

said data processor updates said database to record the scheduling of said scheduled visit.

4. A system according to claim 1, wherein

said system includes a communication processor for communicating with a remote database for acquiring requested encounter related information for said patient in response to said patient identification information and said request.

5. A system according to claim 4, wherein

said system includes a map of available remote databases and associated communication data enabling said communication processor to establish bi-directional communication with an available remote database(s).

6. A system according to claim 1, wherein

said encounter comprises an event involving interaction of a patient with a healthcare enterprise and includes at least one of, (a) a visit, (b) a phone call, (c) an interview, (d) an examination, (e) a procedure, (f) a treatment related occurrence, (g) an admission to a healthcare enterprise, (h) a test and (i) an order for medication.

7. A system according to claim 1, wherein

said system includes a communication processor for automatically communicating encounter related information to said patient in response to identification of an update to said encounter related information.

8. A system according to claim 1, wherein

said encounter related information comprises at least one of, (a) claim related data, (b) transaction related data, (c) patient hospital admission identification data, (d) payment related data, (e) data representing a request for information, (f) data identifying a medical procedure authorization, (g) clinical data associated with the encounter and (h) data associated with reimbursement denial or acceptance.

9. A system according to claim 1, wherein

said system supports guarantor access to healthcare encounter related information and

said data processor accesses said database to provide encounter related information for a patient and processing said encounter related information to be suitable for output communication for presentation to said guarantor in response to guarantor identification information and a request for encounter related information from said guarantor.

10. A system according to claim 9, wherein

said guarantor comprises a payer organization responsible for reimbursing a healthcare provider for at least a portion of medical costs for a patient visit.

11. A system according to claim 1, wherein

said data processor encrypts said encounter related information for secure output communication for presentation to said patient.

12. A system supporting patient access to healthcare encounter related information including information concerning an event involving interaction of a patient with a healthcare enterprise, comprising:

an interface processor for receiving patient identification information and a patient command to schedule a visit to a healthcare provider organization;

a database including a medical record for said patient; and

a data processor for,

automatically initiating at least one of, (a) medical necessity verification to determine said scheduled visit is covered by a patient healthcare insurance plan, (b) a request for referral by a patient physician to support said scheduled visit and (c) healthcare insurance plan eligibility verification to verify said scheduled visit is covered by said patient healthcare insurance plan, and for

updating said medical record in said database to indicate scheduling of said visit.

13. A system supporting patient access to healthcare encounter related information including information concerning an event involving interaction of a patient with a healthcare enterprise, comprising:

an interface processor for receiving patient identification information and a request for encounter related information;

a communication processor for communicating with a plurality of databases for acquiring requested encounter related information for said patient in response to said patient identification information and said request; and

a data processor for collating encounter related information for a patient acquired from said plurality of databases using said communication processor, said collated encounter related information linking a patient identifier with,

a record identifying at least one patient encounter and

data identifying at least one healthcare provider organization associated with said at least one patient encounter and

a record containing encounter information related to said at least one patient encounter.

14. A system according to claim 13, wherein

said data processor maintains an audit trail for use in identifying accesses made by a user to patient record information.

15. A system according to claim 13, wherein

said collated encounter related information links a patient identifier with at least one of, (a) at least one record identifying multiple encounters, (b) data identifying multiple healthcare provider organizations, (c) data identifying multiple healthcare provider organization associated locations involved in delivering healthcare to said patient, (d) at least one record containing encounter information related to multiple patient encounters, (e) a total cost of multiple encounters associated with treatment of a patient medical condition and (f) treatment eligibility information under a payer health plan applicable to said patient.

16. A system according to claim 13, wherein

said data processor processes said collated encounter related information to be suitable for presentation to said patient in at least one of, (a) single encompassing record, (b) a single display image, (c) a scrollable display image, (d) a printable report and (e) a composite multi-window display image.

17. A system according to claim 13, wherein

said plurality of databases comprise databases containing encounter related information for at least one of, (a) a hospital, (b) a clinic, (c) a physician, (d) a payer, (e) pharmacy, (f) Long-Term-Care facility, (g) Skilled Nursing facility, (h) Ambulance and (i) Durable Medical Equipment

18. A system according to claim 13, wherein

said plurality of databases include a payer database and

said communication processor is able to communicate with said payer database to acquire encounter related information comprising treatment eligibility information under a payer health plan applicable to said patient.

19. A system according to claim 13, including

an authorization processor for authorizing access to records of said patient by an entity in response to received authorization information from said patient authorizing said entity to access records of said patient.

20. A system according to claim 13, including

an authorization processor for authorizing access to records of an individual related to said patient in response to received healthcare insurance policy information provided by said patient.

21. A system according to claim 20, wherein

said authorization processor authorizes access to records of an individual related to said patient by an employee of a payer organization.

22. A system supporting patient access to healthcare encounter related information comprising information concerning an event involving interaction of a patient with a healthcare enterprise, comprising:

an interface processor for receiving patient identification information and a request for encounter related information;

a data processor for

acquiring requested encounter related information for said patient and for

supporting user communication with a payer organization and a healthcare provider concerning said acquired encounter related information in response to said received patient identification information and said request.

23. A system according to claim 22, wherein

said data processor acquires encounter related information to provide collated encounter related information linking a patient identifier with,

a record identifying at least one patient encounter and

data identifying at least one healthcare provider organization associated with said at least one patient encounter and

a record containing encounter information related to said at least one patient encounter.

24. A system according to claim 22, wherein

said data processor supports user communication with a payer organization and a healthcare provider for at least one of, (a) correcting said acquired encounter related information and (b) supplementing said acquired encounter related information.

25. A user interface system supporting patient access to healthcare encounter related information including information concerning an event involving interaction of a patient with a healthcare enterprise, comprising the steps of:

receiving patient identification information and a request for encounter related information;

accessing a database to provide encounter related information for a patient, said database linking a patient identifier with,

a record identifying at least one patient encounter and

data identifying at least one healthcare provider organization associated with said at least one patient encounter and

a record containing encounter information related to said at least one patient encounter; and

processing said encounter related information to be suitable for presentation to said patient in response to said patient identification information and said request.

26. A system according to claim 25, including the step of

initiating generation of a display image and a printable report including said processed encounter related information in response to said request.

27. A system according to claim 25, including the step of

collating said acquired encounter related information to provide at least one of, (a) a claim history, (b) encounter related information over a user determined time period and (c) encounter related information between user selected events.

28. A system according to claim 25, including the step of

collating said acquired encounter related information to provide supplemental healthcare information concerning at least one of, (a) a claim, (b) an encounter, (c) an insurance health plan eligibility rule and (d) a record of a payment.

29. A system according to claim 25, including the steps of

acquiring and collating encounter related information for a plurality of individuals and

processing said collated encounter related information for said plurality of individuals to be suitable for presentation to a user.

30. A method enabling patient access to healthcare encounter related information comprising information concerning an event involving interaction of a patient with a healthcare enterprise, comprising the steps of:

receiving patient identification information and a patient command to schedule a visit to a healthcare provider organization;

in response to said patient command,

automatically initiating at least one of, (a) medical necessity verification to determine said scheduled visit is covered by a patient healthcare insurance plan, (b) a request for referral by a patient physician to support said scheduled visit and (c) healthcare insurance plan eligibility verification to verify said scheduled visit is covered by said patient healthcare insurance plan; and

updating a medical record of said patient in a database to indicate scheduling of said visit.