System for communication of health care data

• US 20040064343A1
• Filed: 10/06/2003
• Published: 04/01/2004
• Est. Priority Date: 10/11/2000
• Status: Active Grant

• Current Assignee: Healthtrio LLC (Spok Holdings, Inc.)
• Original Assignee: Healthtrio LLC (Spok Holdings, Inc.)
• Inventors: Korpman, Ralph A, Wallen, J. Dominic, Post, Cindy A., Peterson, John C.
• Granted Patent: US 7,720,691 B2
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• 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 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 80/00 ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring

Abstract

An apparatus for communicating health care data from a sender to a receiver is provided. The apparatus has a first computer system (10), a second computer system, and a rules engine. The first, computer system (10) has health care data stored therein. The second computer system is in operable communication with, and is configured to extract the health care data from the first computer system (10). The rules engine normalizes the extracted health care data to a predefined format. The rules engine defines a plurality of health care data fields in the predefined format, as well as a plurality of relationships between fields of normalized data.

Claims

1. Apparatus for communicating health care data from a sender to a receiver comprising:

a first computer system having health care data stored therein;

a second computer system in operable communication with, and configured to extract the health care data from the first computer system; and

a rules engine to normalize the extracted health care data to a predefined format, said rules engine defining a plurality of health care data fields in the predefined format and a plurality of relationships between fields of normalized data.

2. Apparatus of claim 1, further comprising a third computer system, in operable communication with, and configured to receive the normalized data from, the second computer system.

3. The system of claim 1, wherein the first computer is a plurality of computers each having portions of the health care data stored thereon.

4. The system of claim 2, wherein the rules engine determines whether the third computer is authorized to receive the health care data.

5. The system of claim 1, wherein the normalized data exchanged between the sender and receiver is chosen from a group comprising eligibility/benefit display, member roster, claim submission, provider lookup, formulary lookup, diagnosis code lookup, procedure code lookup, access health plan information online, communicate with a health plan on-line, communicate with patients on-line, patient-centric view of data across several health plans, order generation and tracking, results review and release, result printing, prescription writing, medication profile for each patient, access to patient'"'"'s personal health record based on patient approval, personalized medical and health care content integration, both context-specific and on demand, e-commerce integration:

office, medical and health-related product awareness and buying capabilities, email, practice management system subscription, support disease management, and physician credentialing subscription, wherein the receiver is a health care provider.

6. The system of claim 1, wherein the normalized data exchanged between the sender and receiver is chosen from a group comprising group eligibility, group enrollment, enrollment changes, formulary lookup, e-commerce integration, access from health plan web site or direct access via URL, personalized content integration, both context-specific and on demand, e-commerce integration and health care-related product awareness and buying capabilities, wherein the receiver is an employer.

7. The system of claim 1, wherein the normalized data exchanged between the sender and receiver is chosen from a group comprising identification card requests, address changes, provider directory inquiries, personalized health information based on an interest profile, diagnosis information, relevant articles and patient education materials, communications from health care providers and health care plans, lab and radiology results, scheduled appointments with a health care provider, prescription refills, personal health records, eligibility/benefit information, claim information, referral and authorization information and status, provider lookup, family history, medication profile and formulary lookup, wherein the receiver is a patient.

8. A method for communicating health care data from one computer system to another, comprising the steps of:

storing health care data in a first computer system;

extracting health care data from the first computer system and communicating the extracted data to a second computer system;

normalizing the extracted data to a predefined format in accordance with a rules engine that defines a plurality of health care data fields in the predefined format and a plurality of relationships between fields of normalized data; and

communicating the normalized data to a third computer system.

9. The method of claim 8, wherein said first computer system comprises a plurality of computers, and wherein said storing step includes storing health care data in more than one of said computers.

10. A method of claim 8, wherein said third computer system comprises a plurality of computers.

11. The method of claim 8, wherein the health care data exists across a plurality of databases, each of the plurality of databases being in operable communication with the second computer system.

12. A system of exchanging health care data between a sender and a receiver, the system comprising:

a sender computer upon which health care data is stored;

an

intermediary computer in operable communication with the sender computer;

wherein the intermediary computer is configured to extract the health care data;

a rules engine configured to receive the extracted data and normalize same to a predefined format, said rules engine defines each field of the extracted data and converts each field to a corresponding field in the predefined format, creating normalized data, said rules engine also defines how the normalized data should relate to each other pursuant to predetermined instructions; and

a receiver computer in operable communication with the intermediary computer and configured to receive the normalized data.

13. The system of claim 12, wherein sender computer is a plurality of computers each having portions of the health care data stored thereon.

14. The system of claim 12, wherein the rules engine determines whether the receiver computer is authorized to receive the health care data.

15. The system of claim 12, wherein the normalized data exchanged between the sender and receiver is chosen from a group comprising eligibility/benefit display, member roster, claim submission, provider-lookup, formulary lookup, diagnosis code lookup, procedure code lookup, access health plan information online, communicate with a health plan on-line, communicate with patients on-line, patient-centric view of data across several health plans, order generation and tracking, results review and release, result printing, prescription writing, medication profile for each patient, access to patient'"'"'s personal health record based on patient approval, personalized medical and health care content integration, both context-specific and on demand, e-commerce integration:

office, medical and health-related product awareness and buying capabilities, email, practice management system subscription, support disease management, and physician credentialing subscription, wherein the receiver is a health care provider.

16. The system of claim 12, wherein the normalized data exchanged between the sender and receiver is chosen from a group comprising group eligibility, group enrollment, enrollment changes, formulary lookup, e-commerce integration, access from health plan web site or direct access via URL, personalized content integration, both context-specific and on demand, e-commerce integration and health care-related product awareness and buying capabilities, wherein the receiver is an employer.

17. The system of claim 12, wherein the normalized data exchanged between the sender and receiver is chosen from a group comprising identification card requests, address changes, provider directory inquiries, personalized health information based on an interest profile, diagnosis information, relevant articles and patient education materials, communications from health care providers and health care plans, lab and radiology results, scheduled appointments with a health care provider, prescription refills, personal health records, eligibility benefit information, claim information, referral and authorization information and status, provider lookup, family history, medication profile and formulary lookup, wherein the receiver is a patient.

18. A system of normalizing health care data for transfer between an insurer and a participant, the system comprising:

an insurer system configured to maintain at least one database comprising the health care data;

an intermediary system operatively connected to the insurer system and to the database;

wherein the intermediary system is configured to extract the health care data from the database of the insurer system, and store the health care data in a staging database as extracted data;

a rules engine configured to receive the extracted data and normalize same to a predefined format, said rules engine defines each field of the extracted data and converts each field to a corresponding field in the predefined format, creating normalized data, said rules engine also defines how the normalized data should relate to each other pursuant to predetermined instructions; and

a participant system in operable communication with the intermediary system;

wherein the participant system is configured to receive the normalized data subject to the rules engine.

19. The system of claim 18, wherein the at least one database is a plurality of databases, wherein the intermediary system is operatively connected to the plurality of databases.

20. The system of claim 18, wherein the participant system transmits a request that is sent to the intermediary system that determines which health care data is to be extracted and normalized in order to respond to the request.

21. The system of claim 20, wherein the participant system transmits the request and the intermediary system transmits the normalized data over the internet.

22. The system of claim 18, wherein the intermediary system comprises an error data system that removes extracted data identified as invalid when the extracted data is normalized.

23. The system of claim 22, wherein the extracted data identified as invalid is corrected and reintroduced and is normalized.

24. The system of claim 18, wherein the intermediary system comprises an audit database to track activity of the intermediary system.

25. The system of claim 20, wherein the rules engine defines the relationships among the normalized data pursuant to predetermined instructions to determine a response to the request.

26. A system of health care management of medical testing administration between an insurer, a medical laboratory and at least one health care participant, the system comprising:

a participant computer at which a medical test request is made pursuant to a first predefined format;

an insurer processing system that is operatively coupled to the participant'"'"'s computer, and through which the medical request is transferred;

wherein the processing system is operatively coupled to a rules database to approve the medica test request pursuant to predetermined criteria; and

a laboratory computer operatively coupled to the processing system and receives the medical test request if approved by the rules engine;

wherein results of a medical test are transmitted from the laboratory computer to the processing system where the results are transmitted to an insurer computer operatively coupled to the laboratory computer and to participant'"'"'s computer.

27. The system of claim 26, wherein the processing system converts the results of the medical test to a second predefined format readable by a database stored on the insurer computer.

28. The system of claim 26, wherein the at least one health care participant is chosen from a group comprising from a health care provider, an employer, and a patient.

29. The system of claim 26, wherein the medical test request and the results of the medical test is transmitted through the internet.