AUTOMATED PROCESSING OF ELECTRONIC MEDICAL DATA FOR INSURANCE AND DISABILITY DETERMINATIONS

• US 20110054947A1
• Filed: 11/05/2010
• Published: 03/03/2011
• Est. Priority Date: 08/14/2008
• Status: Active Grant

• Current Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Original Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Inventors: KAY, Lay K.
• Granted Patent: US 8,725,538 B2
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A machine-implemented method of assisting medical evidence collection for adjudication of a medical disability request is described. In some embodiments, the method includes providing an electronic medical record of a patient, the electronic medical record includes evidence of at least one claimable medical disability condition and locating in the electronic medical record at least one keyword associated with the at least one claimable medical disability condition. In some embodiments, the method further includes processing an inference rule associated with the at least one claimable medical disability condition, such that the evidence of the at least one claimable medical disability condition is identified in the electronic medical record and outputting, to a computer-readable medium, information indicative of (1) the evidence of the at least one claimable medical disability condition, and (2) a location of the evidence in the electronic medical record.

Claims

1. A system, for assisting medical evidence collection for adjudication of a medical disability request, comprising:

a computer-readable library storing an inference rule associated with at least one claimable medical disability condition; and

a processor configured to locate, based on the inference rule, an indicator of a value in an electronic medical record of a patient that tends to confirm an existence of the claimable medical disability condition in the patient, and to display information indicative of the indicator and a location reference of the indicator in the electronic medical record.

2. The system of claim 1, wherein the information indicative of the indicator and the location reference of the indicator in the electronic medical record are visibly associated in a table.

3. The system of claim 2, wherein the visible association comprises a proximate position, of the information indicative of the indicator and the location reference of the indicator, within the table.

4. The system of claim 2, wherein the table comprises the value in the electronic medical record that tends to confirm the at least one claimable medical disability condition.

5. The system of claim 2, wherein the visible association comprises displaying the information indicative of the indicator and the location reference of the indicator in the electronic medical record within a single row of the table.

6. The system of claim 1, wherein the processor is also configured to electronically tag a portion of the electronic medical record that includes the indicator

7. The system of claim 1, wherein the inference rule utilizes at least one of information on a category associated with the indicator, a rating code, and a search query.

8. The system of claim 1, wherein the value comprises at least one of a secondary condition associated with the at least one claimable medical disability condition, a category associated with the at least one claimable medical disability condition, and a rating code associated with the at least one claimable medical disability condition.

9. The system of claim 1, wherein the value confirming the at least one claimable medical disability condition comprises at least one keyword associated with the at least one claimable medical disability condition.

10. The system of claim 9, wherein the at least one keyword is selected from a plurality of keywords associated with the at least one claimable medical disability condition.

11. A method of assisting medical evidence collection for adjudication of a medical disability request, comprising:

providing an electronic medical record of a patient, the electronic medical record comprising evidence confirming at least one claimable medical disability condition;

identifying, using a processor, and based on an inference rule associated with the at least one claimable medical disability condition, evidence in the electronic medical record that tends to confirm an existence of the at least one claimable medical disability condition in the patient; and

outputting information indicative of the identified evidence confirming the at least one claimable medical disability condition, and a location reference of the identified evidence in the electronic medical record.

12. The method of claim 11, wherein the outputting results in displaying a visible association between the information indicative of the identified evidence and the location reference of the identified evidence in a table.

13. The method of claim 12, wherein the visible association comprises a proximate position, of the information indicative of the identified evidence and the location reference of the identified evidence, within the table.

14. The method of claim 12, wherein the visible association comprises displaying the information indicative of the indicator and the location reference of the indicator in the electronic medical record within a single row of the table.

15. The method of claim 11, further comprising indexing the electronic medical record prior to the identifying the evidence in the electronic medical record.

16. The method of claim 11, wherein the identified evidence comprises a keyword associated with the at least one claimable medical disability condition.

17. The method of claim 16, wherein the keyword is selected from a plurality of keywords associated with the at least one claimable medical disability condition.

18. The method of claim 11, wherein the inference rule utilizes at least one of information on a category associated with the indicator, a rating code, and a search query.

19. The method of claim 11, wherein the evidence confirming the at least one claimable medical disability condition comprises at least one of a secondary condition associated with the at least one claimable medical disability condition, a category associated with the at least one claimable medical disability condition, or a rating code associated with the at least one claimable medical disability condition.

20. A non-transitory machine-readable medium encoded with instructions for adjudication of a medical disability request, comprising:

providing an electronic medical record of a patient, the electronic medical record comprising evidence confirming at least one claimable medical disability condition;

identifying, using a processor, and based on an inference rule associated with the at least one claimable medical disability condition, evidence in the electronic medical record that tends to confirm an existence of the at least one claimable medical disability condition in the patient; and

outputting information indicative of the identified evidence confirming the at least one claimable medical disability condition, and a location reference of the identified evidence in the electronic medical record.