Systems and methods for healthcare risk solutions

• US 20040064341A1
• Filed: 09/27/2002
• Published: 04/01/2004
• Est. Priority Date: 09/27/2002
• Status: Abandoned Application

• Current Assignee: Employers Reinsurance Corp. (Swiss Re AG)
• Original Assignee: Employers Reinsurance Corp. (Swiss Re AG)
• Inventors: Langan, Pete F., Ritz, Jeffery S.
• Application Number:
  US10/259,086
• Publication Number:
  US 20040064341A1
• Time in Patent Office: Days
• US Class Current: 705/2
• 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 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 70/00 ICT specially adapted for the handling or processing of medical references

Abstract

Processes and systems collate hospital data and generate healthcare risk solutions. Hospitals electronically couple to one or more databases, through a firewall, to download hospital data. The hospital data may be processed to de-identify particular patient data. An application processes the hospital data to publish healthcare risk solutions reports to users over a network, e.g., the Internet. The healthcare risk solutions reports may include consultative solutions and one of the following: incidents, event tracking and trending; medical malpractice claim tracking and trending; cost impacts of adverse events and claims; analysis of incidents by type, dept, physician, specialty and/or shift; impact on hospital operations; and benchmarking to peer hospitals.

Claims

1. A process for healthcare risk solutions, comprising the steps of:

electronically collating hospital data within a database from two or more hospitals;

automatically de-identifying the hospital data to protect patient privacy; and

generating healthcare risk solutions in response to user requests to the database.

2. A process of claim 1, the step of electronically collating comprising networking with the hospitals and downloading the hospital data selected from the group of:

patient electronic medical record number, information concerning hospital incidents and adverse events, patient level billing data, medical malpractice claims information, and standard medical codes.

3. A process of claim 2, the standard medical codes comprising one or more of EMR#, DRG, CPT, ICD-9 and HCPCS.

4. A process of claim 1, the step of generating healthcare risk solutions comprising the further step of generating consultative solutions.

5. A process of claim 4, the consultative solutions comprising one or more of process consulting information and risk consulting information.

6. A process of claim 1, the step of generating healthcare risk solutions comprising the further step of generating implementation and control data.

7. A process of claim 1, further comprising the step of generating the user requests from one or more management entities networked with the database.

8. A process of claim 1, the step of generating healthcare risk solutions comprising utilizing an application service provider coupled with the database over a network.

9. A process of claim 1, the step of generating healthcare risk solutions comprising utilizing an analysis engine networked with the database.

10. A process of claim 1, the step of generating healthcare risk solutions comprising utilizing a software application with the database.

11. A process of claim 1, further comprising the step of downloading the hospital data from the hospitals through a firewall.

12. A process of claim 1, further comprising the steps of transmitting the healthcare risk solutions to a terminal of a user submitting the user requests and through a firewall.

13. A process of claim 12, further comprising the step of interfacing with the user through the Internet.

14. A process of claim 1, the step of generating healthcare risk solutions comprising generating data elements selected from the group of:

incidents;

event tracking and trending;

medical malpractice claim tracking and trending;

cost impacts of adverse events and claims;

analysis of incidents by type, dept, physician, specialty and/or shift;

impact on hospital operations; and

benchmarking to peer hospitals.

15. A process of claim 14, the step of generating healthcare risk solutions comprising electronically publishing the healthcare risk solutions as electronic graphical reports at one or more user terminals.

16. A process of claim 1, further comprising downloading the hospital data through a UB-92 data transfer to the database.

17. A system for healthcare risk solutions, comprising:

a first database for storing hospital data from one or more hospitals;

a network interface for connecting the first database to one or more users over a network; and

a risk solutions application for processing the hospital data in response to requests of the users to generate healthcare risk solutions.

18. A system of claim 17, further comprising one or more firewalls for protecting the hospital data and the healthcare risk solutions from the users.

19. A system of claim 17, the users comprising one or more management entities.

20. A system of claim 17, further comprising at least one administrative access terminal for managing one or both of the first database and the healthcare risk solutions.

21. A system of claim 17, the first database comprising a relational database.

22. A system of claim 17, further comprising one or more hospital databases networked with the first database, the hospital databases and the first database collectively storing the hospital data.

23. A system of claim 22, the hospital databases comprising one or more of (1) an incident tracking database, (2) a clinical, billing and cost information database, and (3) a medical malpractice insurance claims database.

24. A system for processing hospital data into healthcare risk solutions, comprising:

one or more databases for storing the hospital data;

means for processing the hospital data into healthcare risk solutions; and

means for protecting data transfers of the hospital data and the healthcare risk solutions to terminals networked with the databases.

25. A system of claim 24, the one or more databases comprising one or more of a relational database, an incident tracking database, a clinical, billing and cost information database, and a medical malpractice insurance claims database.

26. A system of claim 24, the means for processing comprising one or more of a risk solutions application, an analysis engine, and an application service provider.

27. A system of claim 24, the means for protecting the data comprising one or more of a firewall and network password protocol.

28. A system of claim 24, the means for processing comprising means for generating consultative solutions based on the hospital data.

29. A system of claim 24, further comprising means for de-identifying the hospital data.

30. A system of claim 24, the means for processing comprising means for producing a data collation comprising a synthesis of one or more of:

the hospital data, analysis data, healthcare risk solutions reports, consultative solutions, and implementation and control information.