PRESCRIPTION MANAGEMENT SYSTEM

• US 20090222289A1
• Filed: 05/13/2009
• Published: 09/03/2009
• 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: HELMUS, Scott M., BRESSMAN, Leo H., ROSEN, Donna L.
• Granted Patent: US 8,032,395 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 computer implemented method for the automated processing of an order for at least one medical prescription, the method comprising:

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

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

tracking by the computer system the order through said plurality of queues and a length of time the order spends within any one queue;

determining by the computer system whether the length of time said order spends in any one queue exceeds a predefined value, and whether the predetermined value is exceeded, transmitting an alert a user; and

processing by the computer system said order comprising executing actions by the computer to process 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 recipient of said order.

2. The method of claim 1, wherein the method is performed responsive to a user'"'"'s. profile.

3. The method of claim 1, further comprising communicating through a positive control mechanism by said plurality of queues with each other, and wherein said positive control mechanism allows said order to be tracked through said automated processing.

4. The method of claim 3, further comprising sending by the positive control mechanism an acknowledgement upon receipt of said order to a preceding queue from which said order was received.

5. The method of claim 3, further comprising tracking by the positive control mechanism the length of time said order spends in any one queue.

6. The method of claim 3, further comprising tracking by the positive control mechanism the length of time said order spends in any one queue, and wherein when the length of time said order spends in any one queue exceeds a predefined value an alert is sent to a user.

7. The method of claim 1, further comprising:

receiving said order, wherein said order is received through a predefined communication channel comprising paper document channels and electronic channels and identifying any previously information associated with said order;

determining whether said order requires conversion to an image;

converting said order, which requires imaging, into an image; and

associating said image with said order.

8. The method of claim 7, wherein said step of determining if imaging is required further comprises the steps of:

receiving said order;

identifying any previously imaged document or information, which can be associated with said order, wherein said relevant information comprises number of prescriptions in an order, prescription classification, member number associated with a benefit plan, group number associated with the benefit plan, and sub-group number s associated with the benefit plan, amount and type of payment, patient/client correspondence, prescriber name, patient/client name, prescription issue date, drug information, drug strength, drug usage directions, number of allowed refills, quantity of medication to dispense, and dosage per day; and

bypassing said imaging step if said information or said previously imaged document is identified to process said order without performing said imaging step.

9. The method of claim 1, further comprising:

analyzing said order to determine whether there is any information missing or unclear associated with said order; and

resolving said missing or unclear information by steps comprising at least one of suspending said order;

cancelling said prescription;

cancelling said order;

alerting said order with generic brand drug availability;

associating said order with a new invoice; and

review of said order.

10. The method of claim 1, further comprising:

providing a predetermined level of access to at least one of the plurality of queues by a user responsive to a profile assigned to the user.

11. The method of claim 1, further comprising:

scanning the order and assigning an identification number to each order.

12. The method of claim 1, further comprising:

receiving and analyzing images associated with said order;

classifying each image associated with said order;

verifying said order details;

entering said order into a processing device;

validating said order;

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

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

13. The method of claim 12, further comprising:

analyzing said order to determine whether the at least one protocol is to be applied;

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

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

14. The method of claim 13, wherein said at least one database is selected from at least one of:

a clinical database, a plan database, a sales 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.

15. The method of claim 1, further comprising:

classifying each document in said order;

verifying each document in said order;

verifying the total number of prescriptions in said order;

verifying and entering a prescription classification for said order;

at least one of verifying and entering at least one of a member number, a group number, and a subgroup number for said order.

16. The method of claim 1, further comprising dispensing a portion of said order before all prescriptions in said multi-prescription order are complete.

17. The method of claim 1, further comprising restricting user access to available queues.

18. A computer implemented method for the automated processing of an order for at least one medical prescription, the method comprising:

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

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

tracking by the computer system the order through said plurality of queues and a length of time the order spends within any one queue;

providing a predetermined level of access to at least one of the plurality of queues by a user responsive to a profile assigned to the user;

determining by the computer system whether the length of time said order spends in any one queue exceeds a predefined value, and whether the predetermined value is exceeded, transmitting an alert a user; and

processing by the computer system said order comprising executing actions by the computer to process 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 recipient of said order.

19. The method of claim 18, wherein the method is performed responsive to a user'"'"'s. profile.

20. The method of claim 18, further comprising communicating through a positive control mechanism by said plurality of queues with each other, and wherein said positive control mechanism allows said order to be tracked through said automated processing.

21. The method of claim 20, further comprising sending by the positive control mechanism an acknowledgement upon receipt of said order to a preceding queue from which said order was received.

22. The method of claim 20, further comprising tracking by the positive control mechanism the length of time said order spends in any one queue.

23. The method of claim 20, further comprising tracking by the positive control mechanism the length of time said order spends in any one queue, and wherein when the length of time said order spends in any one queue exceeds a predefined value an alert is sent to a user.

24. The method of claim 18, further comprising:

receiving said order, wherein said order is received through a predefined communication channel comprising paper document channels and electronic channels and identifying any previously information associated with said order;

determining whether said order requires conversion to an image;

converting said order, which requires imaging, into an image; and

associating said image with said order.

25. The method of claim 24, wherein said step of determining if imaging is required further comprises the steps of:

receiving said order;

identifying any previously imaged document or information, which can be associated with said order, wherein said relevant information comprises number of prescriptions in an order, prescription classification, member number associated with a benefit plan, group number associated with the benefit plan, and sub-group number s associated with the benefit plan, amount and type of payment, patient/client correspondence, prescriber name, patient/client name, prescription issue date, drug information, drug strength, drug usage directions, number of allowed refills, quantity of medication to dispense, and dosage per day; and

bypassing said imaging step if said information or said previously imaged document is identified to process said order without performing said imaging step.

26. The method of claim 18, further comprising:

analyzing said order to determine whether there is any information missing or unclear associated with said order; and

resolving said missing or unclear information by steps comprising at least one of suspending said order;

cancelling said prescription;

cancelling said order;

alerting said order with generic brand drug availability;

associating said order with a new invoice; and

review of said order.

27. The method of claim 18, further comprising:

receiving and analyzing images associated with said order;

classifying each image associated with said order;

verifying said order details;

entering said order into a processing device;

validating said order;

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

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

28. The method of claim 27, further comprising:

analyzing said order to determine whether the at least one protocol is to be applied;

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

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

29. The method of claim 28, wherein said at least one database is selected from at least one of:

a clinical database, a plan database, a sales 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.

30. The method of claim 18, further comprising:

classifying each document in said order;

verifying each document in said order;

verifying the total number of prescriptions in said order;

verifying and entering a prescription classification for said order;

at least one of verifying and entering at least one of a member number, a group number, and a subgroup number for said order.

31. The method of claim 18, further comprising dispensing a portion of said order before all prescriptions in said multi-prescription order are complete.

32. A computer implemented method for the automated processing of an order for at least one medical prescription, the method comprising:

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

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

applying at least one protocol to said order to progress said order toward a final queue;

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

analyzing said order to determine whether the at least one protocol is to be applied;

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

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

tracking by the computer system the order through said plurality of queues and a length of time the order spends within any one queue;

providing a predetermined level of access to at least one of the plurality of queues by a user responsive to a profile assigned to the user;

determining by the computer system whether the length of time said order spends in any one queue exceeds a predefined value, and whether the predetermined value is exceeded, transmitting an alert a user; and

processing by the computer system said order comprising executing actions by the computer to process said order from at least one initial queue to the final queue, through at least one intermediate queue, wherein said final queue results in said order shipped to a recipient of said order.