PRESCRIPTION MANAGEMENT SYSTEM

• US 20090164254A1
• Filed: 02/17/2009
• Published: 06/25/2009
• Est. Priority Date: 04/30/2002
• Status: Active Grant

• Current Assignee: Express Scripts Strategic Development, Inc. (The Cigna Group)
• Original Assignee: Medco Health Solutions Incorporated (The Cigna Group)
• Inventors: Rosen, Donna L., Helmus, Scott M., Bressman, Leo H.
• Granted Patent: US 8,639,554 B2
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/063 Operations research, analysis or management
• CPC Class Codes: G06Q 10/103 Workflow collaboration or project management
• CPC Class Codes: G06Q 30/0283 Price estimation or determination
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

An imaging and workflow method, system, computer readable medium and user interface for processing information efficiently for the processing of medical prescription orders. The system includes support for document scanning, automated rules-based order processing, statistical reporting, document generation and document storage and retrieval. The present invention takes advantage of imaging technology to assist the user in scanning information into the system and software modules to improve the processing of orders. The present invention also includes database tables that identify to application processing logic the types and sequences of actions to be implemented for orders.

Claims

1. A system for processing medical prescription orders comprising:

an order receiving module;

an order imaging module;

a special handling module;

an order archiving module;

an order entry module;

a fax receiving module;

an order assignment module;

a protocol resolving module; and

a data verification module.

2. The system of claim 1, further comprising:

a print prescription order label

set module;

a product dispensing module;

a product verification module;

a product packing module;

an auto manifest module; and

a

shipping module.

3. A system for processing medical prescription orders comprising:

a computer network;

a mainframe computer connected to said computer network;

at least one hub connected to said computer network, said hub comprising

an order receiving module;

an order imaging module;

a special handling module;

an order archiving module;

a fax receiving module;

a workflow module;

a protocol resolving module; and

a data verification module.

4. The system of claim 3, wherein said hub further comprises a biometric reading module.

5. A computer-readable medium having a computer executable component for the automated processing of an order for at least one medical prescription, wherein the computer executable component processing an order for at least one medical prescription comprises the steps of:

a. receiving said order, wherein said order is received through a predefined communication channel;

b. assigning said order to at least one queue, wherein said queue is selected from a plurality of queues; and

c. processing said order, wherein said step of processing said order comprises executing actions necessary to progress said order from at least one initial queue to a final queue, through at least one intermediate queue, wherein said final queue results in said order shipped to a patient.

6. The computer-readable medium of claim 5, wherein each step or combination thereof is distributed and performed in geographically separate locations.

7. The computer-readable medium of claim 5, wherein said predefined communication channel is selected from at least one of:

facsimile, phone, World Wide Web, mail, or combinations thereof.

8. The computer-readable medium of claim 5, wherein said step of processing said order comprises the steps of:

a. receiving and reviewing images associated with said order;

b. classifying each image associated with said order,

c. verifying said order details;

d. entering said order into a processing device;

e. validating said order;

f. applying at least one protocol to said order to progress said order toward said final queue; and

g. reviewing said order after the at least one protocol has been applied.

9. The computer-readable medium of claim 8, wherein said step of applying the at least one protocol to said order comprises the steps of:

a. reviewing said order to determine whether the at least one protocol is to be applied;

b. resolving the at least one protocol when applied against at least one database; and

c. repeating the steps of reviewing said order to determine whether at least one protocol applies and resolving the at least one protocol against the at least one database until resolved.

10. The computer-readable medium of claim 9, wherein said at least one database is selected from at least one of:

a clinical database, a plan database, a rules database, a contacts database, an accounts receivable database, a formulary database, a pricing database, a client profile database, a patient history database, and combinations thereof.

11. The computer-readable medium of claim 9, wherein said step of reviewing said order to determine whether the at least one protocol applies comprises the steps of:

a. determining whether a contact is necessary to resolve said order;

b. selecting a mode of contact when the contact is necessary; and

c. initiating said mode of contact.

12. The computer-readable medium of claim 11, wherein said mode of contact is selected from at least one of facsimile, phone, e-mail, World Wide Web, mail, and combinations thereof.

13. The computer-readable medium of claim 11 wherein said contact is selected from at least one of:

prescriber, patient, plan administrator, and combinations thereof.

14. The computer-readable medium of claim 11 wherein when the mode of contact is at least a facsimile, said step of initiating said mode of contact comprises the steps of:

a. generating said facsimile; and

b. transmitting said facsimile to the contact.

15. The computer-readable medium of claim 14 wherein said step of generating said facsimile comprises the steps of:

a. selecting facsimile mode;

b. selecting the at least one protocol;

c. populating available fax fields;

d. selecting the contact; and

e. selecting a wait time in which to receive a response from said contact.

16. The computer-readable medium of claim 15 wherein said response from said contact is received in the form of at least one of a facsimile or a phone call.

17. The computer-readable medium of claim 16 wherein when said received response from said contact is a phone call, the computer executable component further comprises executing the steps of:

a routing said phone call to a designated hunt group for call backs;

b. retrieving said order from the queue;

c. obtaining information from the contact;

d. updating said order.

18. The computer-readable medium of claim 16, wherein when said received response from said contact is at least a facsimile, the computer executable component further comprising the step of processing said response, wherein the step of processing said response comprises the steps of:

a. matching said facsimile to said order through an automatic match process;

b. updating said order with information on said facsimile; and

c. attaching said facsimile to said order.

19. The computer-readable medium of claim 15, wherein when said wait time exceeds a predefined value, the computer executable component further comprising executing the steps of:

a. routing the order to an outbound call queue;

b. scheduling a call;

c. calling the contact;

d. retrieving the order from the outbound call queue;

e. reviewing the order with the contact;

f. resolving the order, and

g. updating the order responsive to said resolving.

20. The computer-readable medium of claim 19, wherein when said step of calling the contact fails to reach contact, the computer executable component further comprising executing the steps of:

a. completing a call back form;

b. updating the outbound call queue; and

c. repeating the steps of scheduling a call and calling the contact until said contact is reached.

21. The computer-readable medium of claim 11, wherein when the mode of contact is

a phone call, the computer executable component further comprising the step of processing said response, wherein the step of processing said response comprises the steps of:

a. routing said order to the outbound call queue;

b. scheduling a call;

c. calling the contact;

d. retrieving said order from the outbound call queue;

e. reviewing said order with the contact;

f. resolving said order, and

g. updating said order.

22. The computer-readable medium of claim 21, wherein said step of calling the contact person comprises the steps of:

a. introducing an issue capable of resolution by a non-pharmacist;

b. transferring the call to a pharmacist; and

c. routing said order to a pharmacist accessible location.

23. The computer-readable medium of claim 21, wherein when said step of calling the contact fails to reach the contact, the computer executable component further comprises executing the steps of:

a. completing a call back form;

b. updating the outbound call queue; and

c. repeating the steps of scheduling the call and calling said contact.

24. The computer-readable medium of claim 5, wherein said step of processing said order comprises the steps of:

a. classifying each document in said order;

b. verifying each document in said order;

c. verifying the total number of prescriptions in said order;

d. at least one of verifying and entering a prescription classification for said order;

e. at least one of verifying and entering at least one of a member number, a group number, and a subgroup number;

f. at least one of verifying and entering an amount and type of payment;

g. at least one of verifying and entering patient provided correspondence;

h. at least one of verifying and entering renewal or refill numbers if present;

i. at least one of verifying and entering prescriber name;

j. at least one of verifying and entering patient name;

k. at least one of verifying and entering prescription issue date;

l. at least one of verifying and updating patient information;

m. at least one of verifying and updating drug information;

n. at least one of verifying and updating drug strength;

o. at least one of verifying and updating drug directions; and

p. verifying each element of said order is correct.

25. The computer-readable medium of claim 24, wherein when said step of verifying each element of said order is correct, further comprising the steps of repeating steps (l.) through (o.) when an element of said order is not correct.

26. The computer-readable medium of claim 24, further comprising the step of:

repeating steps (l.) through (o.) if said order is a multi-prescription order.

27. The computer-readable medium of claim 26, further comprising the step of dispensing a portion of said order before all prescriptions in said multi-prescription order are complete.

28. The computer-readable medium of claim 24, wherein steps (m.) through (o.) includes an order annotation builder, wherein annotations are available from at least one pull down menu, wherein said at least one pull down menu comprises annotation choices.

29. The computer-readable medium of claim 24, wherein a user'"'"'s ability to perform a step or combination thereof is determined by the user'"'"'s profile.

30. The computer-readable medium of claim 5, wherein said plurality of queues include a positive control mechanism, and wherein said positive control mechanism allows said order to be tracked through the entire automated processing of said order.

31. The computer-readable medium of claim 30, wherein said positive control mechanism sending an acknowledgement upon receipt of said order to a preceding queue from which said order was received.

32. The computer-readable medium of claim 30, wherein said positive control mechanism tracks the length of time said order spends in any one queue.

33. The computer-readable medium of claim 32, wherein when the length of time said order spends in any one queue exceeds a predefined value an alert is sent to the user.

34. The computer-readable medium of claim 5, wherein access to any one queue from said plurality of queues by a user is determined by a user'"'"'s profile.

35. The computer-readable medium of claim 5, further comprising an algorithm for calculating when an order needs to be dispensed, wherein the calculation comprises weighting the channel by which the order was received and the patient'"'"'s identity to determine when an order needs to be dispensed.

36. A computer-readable memory device containing an order processing data structure for the automated processing of orders for at least one medical prescription accessed by a user interface sever program that is encoded in the computer-readable memory device and that is run by a processor in a data processing system, the data structure comprising a plurality of entries comprising:

a patient identifier;

a prescriber identifier;

at least one drug identifier;

a member identifier;

an order identifier;

wherein the user interface sever program accesses the data structure to process said order by using the patient identifier, the prescriber identifier, the at least one drug identifier, the member identifier, and the order identifier.

37. The computer-readable memory device of claim 36, further comprising:

a payment identifier;

wherein the user interface sever program accesses the data structure to process said order by using the patient identifier, the prescriber identifier, the at least one drug identifier, the member identifier, the order identifier, and the payment identifier.