Automated System and Method for Medical Care Selection

• US 20080262869A1
• Filed: 01/18/2008
• Published: 10/23/2008
• Est. Priority Date: 01/22/2007
• Status: Abandoned Application

• Current Assignee: National Consolidated Technologies, LLC
• Original Assignee: National Consolidated Technologies, LLC
• Inventors: Bronn, Donald G.
• Application Number:
  US12/016,963
• Publication Number:
  US 20080262869A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/087 Inventory or stock management, e.g. order filling, procurement or balancing against orders
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• 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 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• 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
• CPC Class Codes: Y02A 90/10 Information and communication technologies [ICT] supporting adaptation to climate change, e.g. for weather forecasting or climate simulation

Abstract

Provided herein is a computerized method of managing medical care through communication between a Digital Board of Medical Experts (DBME), a physician, a health insurance carrier, one or more medical facilities, and a patient and providing a diagnostic and/or therapeutic recommendation, the method comprising the following steps: i) providing a DBME core comprised of modules and algorithms for processing medical data and providing diagnostic and/or therapeutic recommendations; ii) providing a Physician Action Module (PAM) whereby a physician provides a clinical index of suspicion (CIS) through a clinical index of suspicion selection algorithm (CISSA) of the PAM to the DBME—for obtaining a recommendation for hi tech diagnostic studies and/or treatment; and iii) processing through the DBME information from the CISSA and providing a diagnostic recommendation from the diagnostic recommendation algorithm (DRA) of the Diagnostic Module (DM) of the DBME for hi tech diagnostic studies and/or a therapeutic recommendation from the therapeutic recommendation algorithm (TRA) of the Therapeutic Module (TM) of the DBME for treatment.

Claims

1. A computerized method of managing medical care through communication between a Digital Board of Medical Experts (DBME), and one or more of a physician;

an insurance carrier;

one or more medical facilities; and

a patient and providing a diagnostic and/or therapeutic recommendation, the method comprising the following steps

i) providing a DBME comprising modules and algorithms for processing medical data and providing diagnostic and/or therapeutic recommendations;

ii) providing a Physician Action Module (PAM) whereby a physician provides a clinical index of suspicion (CIS) through a clinical index of suspicion selection algorithm (CISSA) to the DBME-for obtaining a recommendation for hi tech diagnostic scheduling and/or treatment; and

iii) processing through the DBME the clinical index of suspicion and providing a recommendation through a diagnostic recommendation algorithm (DRA) for hi tech diagnostic studies and/or through a therapeutic recommendation algorithm (TRA) for treatment recommendations.

2. The method of claim 1, wherein the DBME comprises one or more of a diagnostic module (DM), a therapeutic module (TM), a digital radiological reading and review module (DRRM), a patient information module (PIM), a physician action module (PAM), a health insurance authorization module (IAM), a medical facility action module (MFAM), a continuous medical education module (CMEM), a monetization module (MM), a medical malpractice risk management module (MMRMM), a privacy compliance module (PCM), and a algorithm boards sub-specialist selection module (ABSSM).

3. The method of claim 2, wherein the PAM comprises a clinical index of suspicion selection algorithm (CISSA), a deviation factors submission algorithm (DFSA), a therapeutic specialist qualification and assignment algorithm (TSQAA), and a physician targeted advertising algorithm (PTAA).

4. The method of claim 3, further comprising selection by the physician of a CIS from a CIS menu processed through the CISSA.

5. The method of claim 2, wherein the PIM comprises a layman'"'"'s terms conversion algorithm (LTCA), a targeted advertising algorithm for patients (TAA), and a patient'"'"'s credit processing and cost comparison algorithm (PCPA).

6. The method of claim 2, wherein the DM comprises one or more of a diagnostic recommendation algorithm (DRA), diagnostic consensus review algorithm (DCRA), a diagnostic consensus improvement algorithm (DCIA), and a diagnostic time sensitive response algorithm (DTSRA).

7. The method of claim 2, wherein the TM comprises one or more of a therapeutic recommendation algorithm (TRA), a therapeutic consensus review algorithm (TCRA), a therapeutic consensus improvement algorithm (TCIA), a prevention recommendation algorithm (PRA), and a therapeutic time sensitive response algorithm (TTSRA).

8. The method of claim 2, wherein the MFAM comprises one or more of a facility and personnel qualification algorithm (FPQA), a specialist qualification algorithm (SQA), a scheduling algorithm (SA), and an equipment utilization algorithm (EUA).

9. The method of claim 2, wherein the DRRM comprises one or more of a test quality assessment algorithm (TQAA), a test reading quality assessment algorithm (TRQAA), a payment proration algorithm (PPA);

a performance tracking algorithm (PTA); and

a reading specialist qualification and assignment algorithm (RSQAA).

10. The method of claim 2, wherein the IAM comprises a payment approval algorithm (PAA) and/or a billing algorithm (BA).

11. The method of claim 1, wherein the CIS comprises a presenting complaint.

12. The method of claim 8, wherein the presenting complaint comprises a chief presenting complaint.

13. The method of claim 8 wherein the presenting complaint comprises a secondary presenting complaint.

14. The method of claim 8, wherein the CIS comprises a physician adjusted chief complaint.

15. The method of claim 1, wherein the CIS comprises symptomatology derived factors.

16. The method of claim 12, wherein the symptomatology derived factors are based on patient complaints.

17. The method of claim 1, wherein the CIS comprises past medical history factors.

18. The method of claim 14, wherein the past medical history comprises prior treatments.

19. The method of claim 15, wherein the prior treatment comprises one or more of non-surgical treatment and surgical treatment.

20. The method of claim 16, wherein the non-surgical treatment comprises one or more of non-invasive procedure and medications.

21. The method of claim 1, wherein the CIS comprises physical examination findings.

22. The method of claim 1, wherein the CIS comprises results of laboratory tests.

23. The method of claim 19, wherein the laboratory tests comprises testing body fluids.

24. The method of claim 20, wherein the body fluid is selected from blood, urine, spinal fluid, sputum, or other types of body fluids.

25. The method of claim 1, wherein the CIS comprises the results of imaging test.

26. The method of claim 1, wherein the CIS comprises the results of cellular or tissue pathology findings.

27. The method of claim 23, wherein the imaging tests comprise X-ray, radionuclear and ultrasound.

28. The method of claim 1, wherein the CIS comprises one or more of asymptomatic profile, a genetic profile, environmental profile, a behavioral profile, family history profile, a proposed High tech diagnostic test.

35. The method of claim 1, wherein the DRA comprises determining an overlay fidelity index (OFI) between the CIS provided by the physician and DBME defined factors.

36. The method of claim 35, wherein the overlay fidelity index required by the DRA is determined based on the type of test, the invasiveness of the test, risk to the patient associated with the test and cost of the test.

37. The method of claim 35, wherein the overlay fidelity index required by the DRA is adjusted based on one or more of cost effectiveness data and/or predetermined percentage of false positive and/or false negative outcomes.

40. The method of claim 35, wherein the DRA provides a recommendation based on a CIS having an overlay fidelity index of 50% or greater.

41. The method of claim 35, wherein the DRA comprises requests for additional CIS factors based on a threshold overlay fidelity index.

42. The method of claim 35, wherein factors in the CIS comprises weighting factors.

43. The method of claim 1, wherein the high tech diagnostic test comprises an invasive procedure.

44. The method of claim 43, wherein the invasive procedure is selected from a colonoscopy, cystoscopy, arteriography, cholecystography, endoscopy, laparoscopy, and mediastinoscopy or other methods requiring visualization of internal organs.

45. The method of claim 1, wherein the high tech diagnostic test comprises a non-invasive procedure.

46. The method of claim 45, wherein the non-invasive procedure is selected from CAT scans, radionuclear scans, PET scans, MRI, and ultrasound imaging.

63. The method of claim 1, wherein the physician accepts the diagnostic recommendation of the DBME or challenges the recommendation and provides deviations factors for further consideration by the DBME.

64. The method of claim 1, wherein the DRA comprises a detailed description of the medical and scientific basis of the recommendation.

65. The method of claim 1, further comprising:

iv) providing notification from the physician to the DBME of the physician'"'"'s acceptance of DRA recommendations.

66. The method of claim 65, further comprising processing CME credit award to the physician.

67. The method of claim 65, further comprising providing the physician with a certificate of credit for malpractice risk reduction.

68. The method of claim 65, further comprising:

v) providing notification from DBME to the physician of scheduled hi tech diagnostic study.

69. The method of claim 65, further comprising:

vi) providing notification from DBME to the Health Insurance Company of hi tech diagnostic study approval for payment.

70. The method of claim 65, further comprising:

vii) providing notification from DBME to the Medical Facility and

viii) issuing clinical information, test schedule notification, and authorization for payment.

71. The method of claim 70, further comprising:

ix) providing through a Patient Information Module (PIM) Test schedule options available at the medical facility; and

x) providing via PIM to medical facility patient appointment acceptance.

72. The method of claim 71 further comprising:

xi) providing test results from the medical facility to Digital Radiology Reading and Review Module (DRRM).

73. The method of claim 71, further comprising:

xii) providing test results and a reading of the tests results from the medical facility to the Digital Radiology Reading and Review Module (DRRM).

74. The method of claim 72, further comprising:

xiii) checking through the DRRM the quality and comprehensiveness of the reading provided by the medical facility.

75. The method of claim 74, further comprising:

ixx) assessing through the DRRM the reading of the test results based on minimal subspecialty standards and accepting the reading or

xx) forwarding through the DRRM the test results to a subspecialty expert for further reading.

76. The method of claim 75, further comprising:

xxi) authorizing through the DRRM payment to the facility of a global fee if the reading provided by the facility is acceptable or

xxii) calculating and authorizing payment of a prorated fee if the reading was not accepted.

77. The method of claim 76, further comprising:

xxiii) processing through the TM the reading of the test results and

determining whether a TRA is available for the findings, and if not forwarding the radiological readings to the physician without a therapeutic recommendation.

78. The method of claim 76, further comprising:

xxiv) processing through the TM the reading of the test results and

determining whether a TRA is available for the findings, and if not forwarding to the physician a list of additional tests and/or results required to qualify for a TRA.

79. The method of claim 78, further comprising:

xxv) identifying through the TM a therapeutic algorithm for the findings and

running the Therapeutic Recommendation Algorithm (TRA) to process the test results for determining treatment options.

80. The method of claim 79, further comprising:

xxvi) providing through the DBME treatment options to the physician based on test results.

81. The method of claim 80, wherein the physician can accept treatment options or request consensus evaluation based on submitted deviation factors.

82. The method of claim 81, further comprising upon physician acceptance of treatment option,

xxvii) recommending through the DBME to the physician a list of qualified facilities and specialists, and

xxviii) expediting billing and automatic payment.

83. The method of claim 81, further comprising:

xxix) providing through the Patient Information Module the hi tech test recommendations in layman'"'"'s terms;

xxx) providing through the Patient Information Module the hi tech test results in layman'"'"'s terms;

xxxi) providing through the Patient Information Module accepted treatment options in layman'"'"'s terms; and

/or

xxxii) providing through the Patient Information Module interactive tools to obtain informed consent from patient prior to acceptance of recommendations for diagnostic testing and or treatment.

84. The method of claim 1, further comprising:

xxxiii) providing notification from the physician to the DBME of hi tech diagnostic testing recommendations not accepted; and

xxxiv) obtaining from the physician deviation factors for consensus review as submitted through the deviation factors submission algorithm (DFSA)

85. The method of claim 84, further comprising:

xxxv) submitting deviation factors for diagnostic consensus review algorithm (DCRA) by subspecialty experts; and

xxxvi) conducting consensus evaluation by panel of sub specialty experts for diagnostic options.

86. The method of claim 85, further comprising:

xxxvii conducting consensus vote;

(a) if majority of voting sub-specialists vote in favor of deviation factors then algorithm is modified and studies and/or treatments are approved;

(b) if majority vote is against deviation factors, then algorithm is unchanged and studies and/or treatment is denied;

(c) if vote is neutral (approximately half for and half against) then algorithm is unchanged but payment is approved due to lack of sub-specialty consensus (gray area of medical thought).

87. The method of claim 84, further comprising:

xxxiii) providing through the DBME results of consensus vote;

(a) if consensus vote is against deviation factors then recommendations by DRA are confirmed;

(b) if consensus vote accepts deviation factors then DRA is modified via Diagnostic Consensus Improvement Algorithm (DCIA) to include accepted deviation factors and recommendations are altered and approved for payment.

88. The method of claim 85, further comprising:

ixl) providing through Patient Information Module results of consensus review in layman'"'"'s terms prepared through layman'"'"'s terms conversion algorithm (LTCA).

89. The method of claim 85, further comprising:

xl) providing through the Patient Information Module physician deviation factors in layman'"'"'s terms.

90. The method of claim 81, further comprising:

xli) providing notification from the physician to the DBME of non-acceptance of therapeutic recommendations and forwarding to DBME deviation factors entered by the physician; and

xlii) submitting deviation factors for therapeutic consensus review through the therapeutic consensus review algorithm (TCRA) by subspecialty experts.

91. The method of claim 90, further comprising:

xliii) conducting consensus evaluation by a panel of subspecialty experts.

92. The method of claim 91, further comprising:

xliv) providing to the physician results of consensus vote;

(a) if consensus vote is against deviation factors then recommendations by TRA are confirmed; and

(b) if consensus vote accepts deviation factors then TRA is modified to include deviation factors and recommendations are altered and approved for payment.

93. The method of claim 92, further comprising:

xlv) providing through Patient Information Module results of consensus review in layman'"'"'s terms.

94. The method of claim 92, further comprising:

xlvi) implementing modification of TRA via TCIA based on consensus vote.

95. The method of claim 94, further comprising:

xlvii) presenting to the patient information on relevant products and services relating to the patient'"'"'s specific clinical situation selected through TAA including information compiled through DBME/search engine and advertisers (pharmaceutical companies, equipment manufacturers, service providers).

96. The method of claim 94, further comprising:

xlviii) providing to the physician continuous medical educational (CME) credit through CMEM and/or medical facilities and/or sponsoring advertisers and/or health insurance company to encourage physician participation.

97. The method of claim 94, further comprising:

il) providing to the physician reduced cost Malpractice coverage through the MMRMM for following recommendations of the DBME.

98. The method of claim 1, further comprising:

l) processing payment to sub-specialty members of specific clinical algorithm board identified through the MM.

99. The method of claim 98, further comprising:

li) charging health insurance carrier for processing payment authorization for approval/denial of hi tech Diagnostic test through the MM.

100. The method of claim 1, further comprising:

lii) crediting through PCPA patient'"'"'s account for

reduced deductible and/or co-pay based on patient acceptance of DBME diagnostic and/or therapeutic recommendations and also providing through the PCPA cost comparison information enabling patient to choose among qualified healthcare providers the lowest cost options.

101. The method of claim 1, further comprising:

liii) crediting through the MM the physician'"'"'s account for submission of accepted deviation factors that resulted in modification of the specific diagnostic recommendation algorithm (DRA).

102. The method of claim 1, further comprising:

liv) processing through the MM payment to Sub-specialists participating in diagnostic consensus vote.

103. The method of claim 1, further comprising:

lv) crediting through the MM the physician'"'"'s account for submission of accepted deviation factors that resulted in modification of the specific therapeutic recommendation algorithm (TRA).

104. The method of claim 1, further comprising:

lvi) processing through the MM payment to Sub-specialists participating in the diagnostic and therapeutic consensus review votes (DCRA, TCRA).

105. The method of claim 100, further comprising:

lvii) charging through the MM advertisers for ads placed on the Patient Information Module (PIM).

106. The method of claim 105, wherein the ads comprise information on relevant products

and services as relating to patient'"'"'s specific clinical situation

107. The method of claim 100, further comprising:

lviii) charging through the MM advertisers for receiving relevant information from advertisers (pharmaceutical companies, equipment manufacturers, service providers) and loading the information on the patient information module.

108. The method of claim 107, wherein the DBME charges through the MM advertisers based on

information accessed by the patient through the PIM.

109. The method of claim 100, further comprising:

lix) charging through the MM advertisers for ads selected through PTAA and placed on Physician Action Module (PAM).

110. The method of claim 109, wherein the ads comprise information on relevant products and services relating to the physician'"'"'s specific clinical case.

111. The method of claim 100, further comprising:

lx) charging through the MM advertisers for receiving relevant information from advertisers (pharmaceutical companies, equipment manufacturers, service providers) and loading the information on the Physician Action Module (PAM).

112. The method of claim 111, wherein the DBME charges through the MM advertisers based on

information accessed by the physician through the PAM.

113. The method of claim 100, further comprising:

lxi) charging through the MM the malpractice insurance carrier for processing medical malpractice risk management credits for the physician.

114. The method of claim 100, further comprising:

lxii) charging through the MM the physician for billing the health insurance carrier for services rendered by physician in connection with ordering High Tech Diagnostic tests and/or providing treatment.

115. The method of claim 113, wherein the services rendered by the physician comprise one or more of patient examination, CIS preparation and submission, ordering and evaluating test results and/or providing treatment.

116. The method of claim 100, further comprising:

lxiii) charging through the MM the medical facility for billing health insurance carrier for services rendered by the facility in connection with performing hi tech diagnostic tests and/or providing treatments

117. The method of claim 100, further comprising:

charging through the MM the reading radiologist for billing Health Insurance Carrier for services rendered by the reading radiologist in connection with reading the results of the Hi-Tech Diagnostic test.

118. The method of claim 100, further comprising:

lxiv) charging through the MM the health insurance carrier for primary or overview radiological readings by qualified sub-specialists.

119. The method of claim 1, further comprising:

lxv) processing through the MM payment to sub-specialty members of specific clinical algorithm boards identified through TM.

120. The method of claim 100, further comprising:

lxvi) charging through the MM the health insurance carrier for processing payment authorization for approval/denial of treatment recommendation through TRA.

121. The method of claim 100, further comprising:

lxvii) charging through the MM the physician for billing the health insurance carrier for services rendered by the physician in connection with providing treatment.

122. The method of claim 100, further comprising:

lxviii) charging through the MM the medical facility for billing the health insurance carrier for services rendered by the facility in connection with performing the recommended treatments.

123. The method of claim 1, further comprising:

lxix) removing patient personal identifying information from clinical information by a de-coupler program and encryption identity assigned within the privacy compliance module (PCM).

124. The method of claim 1, further comprising:

lxx) Removing physician personal identifying information from clinical information by a de-coupler program and encryption identity assigned within the privacy compliance module (PCM).

125. The method of claim 1, further comprising:

lxxi) Providing patient ID/PASSWORD PROTECTION so that only patients can access their own information on the Patient Information Module (PIM) via a re-coupler program provided in the Privacy Compliance Module (PCM)

126. The method of claim 1, further comprising:

lxxii) providing physician ID/PASSWORD PROTECTION so that only physicians can access their own patients information on the Physician Action Module (PAM) via a re-coupler program in the Privacy Compliance Module (PCM)

127. The method of claim 1, further comprising:

lxxiii) providing health insurance carrier ID/PASSWORD PROTECTION so that only carriers can access their own patients subscriber information on the Insurance Authorization Module (IAM) via a re-coupler program in the Privacy Compliance Module (PCM).

128. The method of claim 1, further comprising:

lxxiv) providing health insurance carrier ID/PASSWORD PROTECTION so that only carrier can access their own patients subscriber health care provider information on the Insurance Authorization Module (IAM) via a re-coupler program in the Privacy Compliance Module (PCM)

129. The method of claim 1, further comprising:

lxxv) providing medical facility ID/PASSWORD PROTECTION so that only medical facility can access their own patients information on the Medical Facility Action Module (MFAM) via a re-coupler program in the Privacy Compliance Module (PCM)

29-34. -34. (canceled)

38. (canceled)

39. (canceled)

47-62. -62. (canceled)

130. A computerized method of providing information to any one of a plurality of patients for use in a medical diagnostic or treatment advice system on a computer network, the method comprising;

accessing a portion of the patient medical history during an evaluation process, wherein each patient is associated with at least one file containing medical information unique to the medical condition of the patient, selectively executing at least one medical algorithm comprising accessing a database populated with data generated through a digital board of medical experts (DBME); and

providing the medical advice to the selected patient;

wherein the medical advice comprises an unbiased recommendation for a diagnostic test.

131. The method of claim 130, wherein a portion of the patient'"'"'s history comprising high tech diagnostics tools is accessed.

132. The method of claim 131, wherein the high tech diagnostic tools comprise one or more of CT, MRI, PET/CT and SPECT.

133. The method of claim 130, comprising digital analysis of physician provided index of suspicion.

134. The method of claim 133, wherein the clinical index of suspicion is based on an evaluation comprising symptom analysis, physical exam, lab tests and other test results.

135. The method of claim 130, comprising automatic scheduling of an optimal modality test.

136. The method of claim 135, wherein unbiased modalities are represented.

137. The method of claim 136, wherein the unbiased modalities comprise one or more of CT, MRI, PET/CT and SPECT.

138. The method of claim 137, comprising consideration of test results by Digital Board of Medical Experts.

139. The method of claim 138, further comprising insurance coverage precertification based on DBME recommendation.

140. The method of claim 137, further comprising processing deviation factors submitted by physician prior to insurance coverage precertification.

141. The method of claim 130, further comprising cost effectiveness evaluation based on clinical outcomes and costs associated with the recommendation.

142. The method of claim 130, wherein the DBME comprises members selected based on expertise in sub-specialty fields of medicine.

143. The method of claim 130, wherein the DBME comprises members who are digitally linked.

144. The method of claim 130, comprising generating a diagnosis during the selective execution of the medical algorithm.

145. The method of claim 130, comprising protecting the medical history of the patient against unauthorized access.

146. The method of claim 130, wherein the file unique to the patient stores medical information specific to the patient.

147. The method of claim 130, wherein the database is accessed through a browser.

148. The method of claim 130, wherein the computer network comprises the Internet.

149. The method of claim 130, wherein the computer network comprises an intranet.

150. The method of claim 130, comprising generating a referral to a physician.

151. The method of claim 150, wherein the medical algorithm minimizes or eliminates education and/or financial bias in generating said physician referral.

152. The method of claim 130, comprising radiological reading.

153. The method of claim 152, wherein the reading is conducted by a subspecialty radiologist who is a member of the DBME.

154. The method of claim 130, comprising an electronic notification reporting availability of the recommendation.