Computer implemented medical integrated decision support system

• US 20050065818A1
• Filed: 02/24/2004
• Published: 03/24/2005
• Est. Priority Date: 09/30/1997
• Status: Active Grant

• Current Assignee: Express Scripts Strategic Development, Inc. (The Cigna Group)
• Original Assignee: Medco Health Solutions Incorporated (The Cigna Group)
• Inventors: Teagarden, J. Russel, Gattinella, Wayne, Brinkman, Thomas, Angaran, David, Stettin, Glen, Kleinfelter, William
• Granted Patent: US 7,216,084 B2
• 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 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 70/40 relating to drugs, e.g. their side effects or intended usage
• CPC Class Codes: G16H 70/60 relating to pathologies

Abstract

A software-based, integrated member decision support system provides a method for corporations, insurance carriers, health maintenance organizations, physicians, physician groups, or other clients to efficiently provide medical, pharmaceutical, and health benefit advice and information for an enrolled population. The system contains one or more databases which include member profiles, clinical information and guidelines, pharmaceutical information and guidelines, health benefit information, and optional additional information. A caller establishes communication with the system, which directs the caller to an operator who provides the caller with medical, pharmaceutical, and/or health benefit advice based on an inquiry from the caller and the information stored on the system. The system may automatically alert the caller or the operator of important medical or pharmaceutical information. At the conclusion of the call, the system or the system with the operator'"'"'s input, may update the caller'"'"'s member profile, request written materials, generate referrals, order prescriptions, or generate reports.

Claims

1. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice using a computer system, a caller, and one or more operators, said method comprising of:

(a) prompting the caller to select a service by one of the computer system and the one or more operators;

(b) selecting, by the caller, a service;

(c) validating, by the computer system, that the caller is an eligible caller;

(d) accessing, by the operator via the computer system, one or more of a member information database, a clinical information database, a pharmaceutical information database, and a health benefit information database; and

(e) generating, via the computer system and the operator, one or more of clinical advice, pharmaceutical advice, and health benefit advice.

2. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 1, further comprising the steps of:

(a) updating, via the computer system, the member information database; and

(b) reporting, via the computer system, a call report.

3. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 1, wherein said operator Consists of a person selected from the group consisting of a nurse, a pharmacist, a customer service representative, a health benefit specialist, and an operator.

4. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 1, wherein said generating step (e) further comprises the step of alerting, via the computer system, the operator of one or more outbound interventions.

5. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 1, wherein said generating step (e) further comprises the step of writing, via the computer system, one or more of drug prescriptions, drug prescription refills, and drug prescription renewals.

6. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 1, wherein said generating step (e) further comprises the step of referring, via the computer, the caller to a health professional.

7. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 1, further comprising the step of updating a member record in the member information database to include the one or more of clinical advice, pharmaceutical advice, and health benefit advice.

8. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 1, further comprising the step of notifying a health care provider of the one or more of clinical advice, pharmaceutical advice, and health benefit advice.

9. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 1, wherein said one or more of clinical advice, pharmaceutical advice, and health benefit advice comprises pre-recorded messages.

10. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice using a computer system, a caller, and one or more operators, said method comprising:

(a) routing, by the computer system, the caller to a service;

(b) validating, by the computer system, that the caller is an eligible caller;

(c) accessing, by the operator via the computer system, one or more of a member information database, a clinical information database, a pharmaceutical information database, and a health benefit information database; and

(d) generating, via the computer system and the operator, one or more of clinical advice, pharmaceutical advice, and health benefit advice.

11. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 10, further comprising the steps of:

(a) updating, via the computer system, the member information database; and

(b) reporting, via the computer system, a call report.

12. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 10, wherein said operator consists of a person selected from the group consisting of a nurse, a pharmacist, a customer service representative, a health benefit specialist, and an operator.

13. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 10, wherein said generating step (e) further comprises the step of alerting, via the computer system, the operator of one or more outbound interventions.

14. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 10, wherein said generating step (e) further comprises the step of writing, via the computer system, one or more of drug prescriptions, drug prescription refills, and drug prescription renewals.

15. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 10, wherein said generating step (e) further comprises the step of referring, via the computer, the caller to a health professional.

16. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 10, further comprising the step of updating a member record in the member information database to include the one or more of clinical advice, pharmaceutical advice, and health benefit advice.

17. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 10, further comprising the step of notifying a health care provider of the one or more of clinical advice, pharmaceutical advice, and health benefit advice.

18. A computer-assisted method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 10, wherein said one or more of clinical advice, pharmaceutical advice, and health benefit advice comprises pre-recorded messages.

19. A method of providing clinical, pharmaceutical, and health benefit information and advice, comprising:

(a) a computer;

(b) a communicating means, for transferring information and advice between the computer and a caller;

(c) a member information database, stored in the computer;

(d) a medical database, stored in the computer;

(e) a pharmaceutical database, stored in the computer; and

(f) a health benefit database, stored in the computer.

20. The method of providing clinical, pharmaceutical, and health benefit information and advice according to claim 19 wherein the computer links one or more of the member information database, the medical database, the pharmaceutical database, and the health benefit database to provide advice for the caller.