METHOD AND APPARATUS FOR ROUTING A PATIENT TO A HEALTH CARE PROVIDER AND LOCATION

• US 20120016688A1
• Filed: 07/15/2010
• Published: 01/19/2012
• Est. Priority Date: 07/15/2010
• Status: Abandoned Application

• Current Assignee: Brevium Incorporated
• Original Assignee: Brevium Incorporated
• Inventors: Perrin, Brian William, Gerlach, Brett Cornell
• Application Number:
  US12/837,426
• Publication Number:
  US 20120016688A1
• Time in Patent Office: Days
• US Class Current: 705/2
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

A method and apparatus for identifying the best provider and location to treat a patient using standard billing and other practice management system (“PMS”) data, combined with provider, location and patient type preferences, so that exactly those patients matching said preferences will be contacted and invited to make an appointment.

Claims

1. A method for routing patients within a practice of health care providers, the method comprising:

determining a set of active providers from a plurality of providers based on whether a provider has at least one active schedule in a practice management system;

determining a set of active locations from a plurality of locations based on whether a location has at least one active schedule in the practice management system;

determining one or more patient types for the patient based on data associated with patient in the practice management system, wherein no more than one of the patient types is designated in a patient reactivation system as a primary patient type of the patient;

determining a first location based on data associated with the patient in the practice management system;

determining a first provider based on data associated with the patient in the practice management system;

determining a transfer status associated with the first provider, the transfer status indicating a scheduling preference of the first provider based on the primary patient type of the patient;

in response to the transfer status indicating that the first provider does not want existing patients to be contacted, disqualifying the patient in the patient reactivation system from being contacted to schedule a future appointment;

in response to the transfer status indicating that, for patients of the primary patient type, the first provider wants existing patients of the first provider to be routed to the first provider;

determining a second location to route the patient to based on the first location and data in the patient reactivation system;

routing the patient to the first provider at the second location;

in response to the transfer status indicating that the first provider wants existing patients of the first provider routed to a second provider;

determining a second location to route the patient to based on the first location and data in the patient reactivation system;

determining a second provider to route the patient to based on the primary patient type and data in the patient reactivation system; and

routing the patient to the second provider at the second location.

2. The method of claim 1, wherein the step of determining the first location for the patient further comprises:

determining whether a preferred location is associated with the patient in the practice management system;

in response to determining that a preferred location is associated with the patient in the practice management system, selecting the preferred location as the first location;

in response to determining that a preferred location is not associated with the patient in the practice management system, determining whether a medical history associated with the patient includes any locations in the set of locations;

in response to determining that the medical history associated with the patient includes one or more locations in the set of locations, selecting a first location from the medical history based on one or more of the following preferences;

active locations are preferred for selection over inactive locations;

locations where the patient has been treated more recently are preferred for selection over locations where the patient has been treated less recently; and

locations treating the patient type of the patient having a higher predetermined priority are preferred for selection over locations treating patient types having a lower predetermined priority;

in response to determining that the medical history of the patient does not include any locations in the set of locations, setting the first location as unspecified.

3. The method of claim 1, the step of determining the first provider for the patient further comprising:

determining whether a preferred provider is associated with the patient in the practice management system;

in response to determining that a preferred provider is associated with the patient in the practice management system, selecting the preferred provider as the first provider;

in response to determining that a preferred provider is not associated with the patient in the practice management system, determining whether a medical history associated with the patient includes any providers in the set of providers;

in response to determining that the medical history associated with the patient includes one or more providers in the set of providers, selecting a first provider from the medical history based on one or more of the following preferences;

active providers are preferred for selection over inactive providers;

providers who have treated the patient more recently are preferred for selection over providers who have treated the patient less recently; and

providers treating the patient type of the patient having a higher predetermined priority are preferred for selection over providers treating patient types having a lower predetermined priority;

in response to determining that the medical history of the patient does not include any providers in the set of providers, setting the first provider as unspecified.

4. The method of claim 1, the step of determining the first provider for the patient further comprising:

determining whether a preferred provider is associated with the patient in the practice management system;

in response to determining that a preferred provider is associated with the patient in the practice management system, selecting the preferred provider as the first provider;

in response to determining that a preferred provider is not associated with the patient in the practice management system, determining whether a medical history associated with the patient includes any providers in the set of providers;

in response to determining that the medical history associated with the patient includes one or more providers in the set of providers, selecting a first provider from the medical history based on one or more of the following preferences;

active providers are preferred for selection over inactive providers;

providers who have treated the patient more frequently are preferred for selection over providers who have treated the patient less frequently; and

providers treating the patient type of the patient having a higher predetermined priority are preferred for selection over providers treating patient types having a lower predetermined priority;

in response to determining that the medical history of the patient does not include any providers in the set of providers, setting the first provider as unspecified.

5. The method of claim 1, the step of determining the second location in response to the transfer status indicating that the first provider wants appointments for existing patients of the first provider to be scheduled with the first provider further comprising:

determining a second set of active locations comprising each active location that is currently scheduling for the first location;

determining a subset of the set of active locations, each active location corresponding to the first provider;

determining a set of active locations comprising the intersection of the subset of active locations corresponding to the first location and the subset of active locations corresponding to the first provider; and

selecting the second location from the set of active locations comprising the intersection of the subset of active locations corresponding to the first location and the subset of active locations corresponding to the first provider, wherein the selection of the second location is based on a predetermined priority of locations in the set active locations, and wherein the predetermined priority of the first location is the highest priority.

6. The method of claim 1, the step of determining the second provider and the second location in response to the transfer status indicating that the first provider wants appointments for existing patients of the first provider to be scheduled with a second provider further comprising:

determining a second set of active locations comprising each active location that is currently scheduling for the first location;

determining a second set of active providers comprising each active provider that has a transfer status indicating that the provider will schedule appointments for patients of the primary patient type associated with another provider; and

selecting as the second location a location from the second set of active locations at which at least one of the second set of active providers is actively scheduling patients, giving preference to the locations having the highest priority;

selecting as the second provider a provider from the second set of active providers that is currently scheduling appointments at the second location.

7. The method of claim 1, wherein the determination of the first location and/or the determination of the second location is based on at least a portion of an address associated with the patient being mapped to a provider location.

8. The method of claim 1, further comprising, prior to determining the set of active providers:

resolving any duplicate providers from the set of health care providers;

resolving any duplicate locations from the set of locations that provide health care services; and

/or

resolving any duplicate patient codes from data of the practice management system.

9. The method of claim 1, wherein the step of determining a first provider further comprises:

determining whether an event in a medical history of the practice management system associated with the patient includes a provider code;

in response to determining that the event does not include a provider code, determining provider information from any notes in the medical history that correspond to the event; and

in response to determining that the event notes include provider information, associating the corresponding provider with the event.

10. The method of claim 1, wherein the step of determining a first location further comprises:

determining whether an event in a medical history of the practice management system associated with the patient includes a location code;

in response to determining that the event does not include a location code, determining location information from any notes in the medical history that correspond to the event; and

in response to determining that the event notes include location information, associating the corresponding location with the event.

11. The method of claim 1, wherein the patient is disqualified in the patient reactivation system from being contacted for scheduling a future appointment in response to an indication that the provider and location to which the patient is routed does not represent a schedule which should be filled by the patient reactivation system.

12. The method of claim 1, further comprising, prior to routing the patient to a provider and/or location:

determining whether a remote location indication is associated with the first location, wherein the remote location indication indicates that treating the patient at the first location has priority over the first provider treating the patient;

in response to determining that the remote location indication is associated with the first location and the first provider is not presently scheduling appointments at the first location for the primary patient type, routing the patient to the first location and a second provider who is presently scheduling appointments at the first location for the primary patient type.

13. A computer-readable medium encoded with computer-executable instructions for routing patients within a practice of health care providers, the computer-executable instructions, when executed by a processor of a computer, operable to cause the computer to perform the steps of:

determining a set of active providers from the plurality of providers based on whether a provider has at least one active schedule in a practice management system;

determining a set of active locations from the plurality of locations based on whether a location has at least one active schedule in the practice management system;

determining one or more patient types for the patient based on the data associated with patient in the practice management system, wherein no more than one of the patient types is designated in a patient reactivation system as a primary patient type of the patient;

determining a first location based on data associated with the patient in the practice management system;

determining a first provider based on data associated with the patient in the practice management system;

determining a transfer status associated with the first provider, the transfer status indicating a scheduling preference of the first provider based on the primary patient type of the patient;

in response to the transfer status indicating that the first provider does not want existing patients to be contacted, disqualifying the patient in the patient reactivation system from being contacted to schedule a future appointment;

in response to the transfer status indicating that the first provider wants existing patients of the first provider to be routed to the first provider;

determining a second location to route the patient to based on the first location and data in the patient reactivation system;

routing the patient to the first provider at the second location;

in response to the transfer status indicating that the first provider wants existing patients of the first provider routed to a second provider;

determining a second location to route the patient to based on the first location and data in the patient reactivation system;

determining a second provider to route the patient to based on the primary patient type and data in the patient reactivation system; and

routing the patient to the second provider at the second location.

14. The computer-readable medium of claim 13, wherein the instructions for determining the first location for the patient further comprise instructions for:

determining whether a preferred location is associated with the patient in the practice management system;

in response to determining that a preferred location is associated with the patient in the practice management system, selecting the preferred location as the first location;

in response to determining that a preferred location is not associated with the patient in the practice management system, determining whether a medical history associated with the patient includes any locations in the set of locations;

in response to determining that the medical history associated with the patient includes one or more locations in the set of locations, selecting a first location from the medical history based on one or more of the following preferences;

active locations are preferred for selection over inactive locations;

locations where the patient has been treated more recently are preferred for selection over locations where the patient has been treated less recently; and

locations treating the patient type of the patient having a higher predetermined priority are preferred for selection over locations treating patient types having a lower predetermined priority;

in response to determining that the medical history of the patient does not include any locations in the set of locations, setting the first location as unspecified.

15. The computer-readable medium of claim 13, the instructions for determining the first provider for the patient further comprising instructions for:

determining whether a preferred provider is associated with the patient in the practice management system;

in response to determining that a preferred provider is associated with the patient in the practice management system, selecting the preferred provider as the first provider;

in response to determining that a preferred provider is not associated with the patient in the practice management system, determining whether a medical history associated with the patient includes any providers in the set of providers;

in response to determining that the medical history associated with the patient includes one or more providers in the set of providers, selecting a first provider from the medical history based on one or more of the following preferences;

active providers are preferred for selection over inactive providers;

providers who have treated the patient more recently are preferred for selection over providers who have treated the patient less recently; and

providers treating the patient type of the patient having a higher predetermined priority are preferred for selection over providers treating patient types having a lower predetermined priority;

in response to determining that the medical history of the patient does not include any providers in the set of providers, setting the first provider as unspecified.

16. The computer-readable medium of claim 13, the instructions for determining the first provider for the patient further comprising instructions for:

determining whether a preferred provider is associated with the patient in the practice management system;

in response to determining that a preferred provider is associated with the patient in the practice management system, selecting the preferred provider as the first provider;

in response to determining that a preferred provider is not associated with the patient in the practice management system, determining whether a medical history associated with the patient includes any providers in the set of providers;

in response to determining that the medical history associated with the patient includes one or more providers in the set of providers, selecting a first provider from the medical history based on one or more of the following preferences;

active providers are preferred for selection over inactive providers;

providers who have treated the patient more frequently are preferred for selection over providers who have treated the patient less frequently; and

providers treating the patient type of the patient having a higher predetermined priority are preferred for selection over providers treating patient types having a lower predetermined priority;

in response to determining that the medical history of the patient does not include any providers in the set of providers, setting the first provider as unspecified.

17. The computer-readable medium of claim 13, the instructions for determining the second location in response to the transfer status indicating that the first provider wants appointments for existing patients of the first provider to be scheduled with the first provider further comprising instructions for:

determining a second set of active locations comprising each active location that is currently scheduling for the first location;

determining a subset of the set of active locations, each active location corresponding to the first provider;

determining a set of active locations comprising the intersection of the subset of active locations corresponding to the first location and the subset of active locations corresponding to the first provider; and

selecting the second location from the set of active locations comprising the intersection of the subset of active locations corresponding to the first location and the subset of active locations corresponding to the first provider, wherein the selection of the second location is based on a predetermined priority of locations in the set active locations, and wherein the predetermined priority of the first location is the highest priority.

18. The computer-readable medium of claim 13, the instructions for determining the second provider and the second location in response to the transfer status indicating that the first provider wants appointments for existing patients of the first provider to be scheduled with a second provider further comprising instructions for:

determining a second set of active locations comprising each active location that is currently scheduling for the first location;

determining a second set of active providers comprising each active provider that has a transfer status indicating that the provider will schedule appointments for patients of the primary patient type associated with another provider; and

selecting as the second location a location from the second set of active locations at which at least one of the second set of active providers is actively scheduling patients, giving preference to the locations having the highest priority;

selecting as the second provider a provider from the second set of active providers that is currently scheduling appointments at the second location.

19. The computer-readable medium of claim 13, wherein the determination of the first location and/or the determination of the second location is based on at least a portion of an address associated with the patient being mapped to a provider location.

20. The computer-readable medium of claim 13, further comprising instructions for, prior to determining the set of active providers:

resolving any duplicate providers from the set of health care providers;

resolving any duplicate locations from the set of locations that provide health care services; and

/or

resolving any duplicate patient codes from data of the practice management system.

21. The computer-readable medium of claim 13, wherein the instructions for determining a first provider further comprise instructions for:

determining whether an event in a medical history of the practice management system associated with the patient includes a provider code;

in response to determining that the event does not include a provider code, determining provider information from any notes in the medical history that correspond to the event; and

in response to determining that the event notes include provider information, associating the corresponding provider with the event.

22. The computer-readable medium of claim 13, wherein the instructions for determining a first location further comprise instructions for:

determining whether an event in a medical history of the practice management system associated with the patient includes a location code;

in response to determining that the event does not include a location code, determining location information from any notes in the medical history that correspond to the event; and

in response to determining that the event notes include location information, associating the corresponding location with the event.

23. The computer-readable medium of claim 13, wherein the patient is disqualified in the patient reactivation system from being contacted for scheduling a future appointment in response to an indication that the provider and location to which the patient is routed does not represent a schedule which should be filled by the patient activation system.

24. The computer-readable medium of claim 13, further comprising instructions for, prior to routing the patient to a provider and/or location:

determining whether a remote location indication is associated with the first location, wherein the remote location indication indicates that treating the patient at the first location has priority over the first provider treating the patient;

in response to determining that the remote location indication is associated with the patient and the first provider is not presently scheduling appointments at the first location for the primary patient type, routing the patient to the first location and a second provider who is presently scheduling appointments at the first location for the primary patient type.

25. A patient reactivation system for routing patients within a practice of health care providers, the practice comprising a plurality of health care providers and a plurality of locations for providing health care services, the system comprising:

a processor;

a memory coupled to the processor, the memory comprising a computer-readable medium encoded with computer-executable instructions that, when executed by a processor of a computer, are operable to cause the computer to perform the steps of;

determining a set of active providers from the plurality of providers based on whether a provider has at least one active schedule in a practice management system;

determining a set of active locations from the plurality of locations based on whether a location has at least one active schedule in the practice management system;

determining one or more patient types for the patient based on the data associated with patient in the practice management system, wherein no more than one of the patient types is designated in a patient reactivation system as a primary patient type of the patient;

determining a first location based on data associated with the patient in the practice management system;

determining a first provider based on data associated with the patient in the practice management system;

determining a transfer status associated with the first provider, the transfer status indicating a scheduling preference of the first provider based on the primary patient type of the patient;

in response to the transfer status indicating that the first provider does not want existing patients to be contacted, disqualifying the patient in the patient reactivation system from being contacted to schedule a future appointment;

in response to the transfer status indicating that the first provider wants existing patients of the first provider to be routed to the first provider;

determining a second location to route the patient to based on the first location and data in the patient reactivation system;

routing the patient to the first provider at the second location;

in response to the transfer status indicating that the first provider wants existing patients of the first provider routed to a second provider;

determining a second location to route the patient to based on the first location and data in the patient reactivation system;

determining a second provider to route the patient to based on the primary patient type and data in the patient reactivation system; and

routing the patient to the second provider at the second location.

26. The system of claim 25, wherein the instructions for determining the first location for the patient further comprise instructions for:

determining whether a preferred location is associated with the patient in the practice management system;

in response to determining that a preferred location is associated with the patient in the practice management system, selecting the preferred location as the first location;

in response to determining that a preferred location is not associated with the patient in the practice management system, determining whether a medical history associated with the patient includes any locations in the set of locations;

in response to determining that the medical history associated with the patient includes one or more locations in the set of locations, selecting a first location from the medical history based on one or more of the following preferences;

active locations are preferred for selection over inactive locations;

locations where the patient has been treated more recently are preferred for selection over locations where the patient has been treated less recently; and

locations treating the patient type of the patient having a higher predetermined priority are preferred for selection over locations treating patient types having a lower predetermined priority;

in response to determining that the medical history of the patient does not include any locations in the set of locations, setting the first location as unspecified.

27. The system of claim 25, the instructions for determining the first provider for the patient further comprising instructions for:

determining whether a preferred provider is associated with the patient in the practice management system;

in response to determining that a preferred provider is associated with the patient in the practice management system, selecting the preferred provider as the first provider;

in response to determining that a preferred provider is not associated with the patient in the practice management system, determining whether a medical history associated with the patient includes any providers in the set of providers;

in response to determining that the medical history associated with the patient includes one or more providers in the set of providers, selecting a first provider from the medical history based on one or more of the following preferences;

active providers are preferred for selection over inactive providers;

providers who have treated the patient more recently are preferred for selection over providers who have treated the patient less recently; and

providers treating the patient type of the patient having a higher predetermined priority are preferred for selection over providers treating patient types having a lower predetermined priority;

in response to determining that the medical history of the patient does not include any providers in the set of providers, setting the first provider as unspecified.

28. The system of claim 25, the instructions for determining the first provider for the patient further comprising instructions for:

determining whether a preferred provider is associated with the patient in the practice management system;

in response to determining that a preferred provider is associated with the patient in the practice management system, selecting the preferred provider as the first provider;

in response to determining that a preferred provider is not associated with the patient in the practice management system, determining whether a medical history associated with the patient includes any providers in the set of providers;

in response to determining that the medical history associated with the patient includes one or more providers in the set of providers, selecting a first provider from the medical history based on one or more of the following preferences;

active providers are preferred for selection over inactive providers;

providers who have treated the patient more frequently are preferred for selection over providers who have treated the patient less frequently; and

providers treating the patient type of the patient having a higher predetermined priority are preferred for selection over providers treating patient types having a lower predetermined priority;

in response to determining that the medical history of the patient does not include any providers in the set of providers, setting the first provider as unspecified.

29. The system of claim 25, the instructions for determining the second location in response to the transfer status indicating that the first provider wants appointments for existing patients of the first provider to be scheduled with the first provider further comprising instructions for:

determining a second set of active locations comprising each active location that is currently scheduling for the first location;

determining a subset of the set of active locations, each active location corresponding to the first provider;

determining a set of active locations comprising the intersection of the subset of active locations corresponding to the first location and the subset of active locations corresponding to the first provider; and

selecting the second location from the set of active locations comprising the intersection of the subset of active locations corresponding to the first location and the subset of active locations corresponding to the first provider, wherein the selection of the second location is based on a predetermined priority of locations in the set active locations, and wherein the predetermined priority of the first location is the highest priority.

30. The system of claim 25, the instructions for determining the second provider and the second location in response to the transfer status indicating that the first provider wants appointments for existing patients of the first provider to be scheduled with a second provider further comprising instructions for:

determining a second set of active locations comprising each active location that is currently scheduling for the first location;

determining a second set of active providers comprising each active provider that has a transfer status indicating that the provider will schedule appointments for patients of the primary patient type associated with another provider; and

selecting as the second location a location from the second set of active locations at which at least one of the second set of active providers is actively scheduling patients, giving preference to the locations having the highest priority;

selecting as the second provider a location from the second set of active providers that is currently scheduling appointments at the second location for the primary patient type.

31. The system of claim 25, wherein the determination of the first location and/or the determination of the second location is based on at least a portion of an address associated with the patient being mapped to a provider location.

32. The system of claim 25, further comprising instructions for, prior to determining the set of active providers:

resolving any duplicate providers from the set of health care providers;

resolving any duplicate locations from the set of locations that provide health care services; and

/or

resolving any duplicate patient codes from data of the practice management system.

33. The system of claim 25, wherein the instructions for determining a first provider further comprise instructions for:

determining whether an event in a medical history of the practice management system associated with the patient includes a provider code;

in response to determining that the event does not include a provider code, determining provider information from any notes in the medical history that correspond to the event; and

in response to determining that the event notes include provider information, associating the corresponding provider with the event.

34. The system of claim 25, wherein the instructions for determining a first location further comprise instructions for:

determining whether an event in a medical history of the practice management system associated with the patient includes a location code;

in response to determining that the event does not include a location code, determining location information from any notes in the medical history that correspond to the event; and

in response to determining that the event notes include location information, associating the corresponding location with the event.

35. The system of claim 25, wherein the patient is disqualified in the patient reactivation system from being contacted for scheduling a future appointment in response to an indication that the provider and location to which the patient is routed does not represent a schedule which should be filled by the patient activation system.

36. The system of claim 25, further comprising instructions for, prior to routing the patient to a provider and/or location:

determining whether a remote location indication is associated with the first location, wherein the remote location indication indicates that treating the patient at the first location has priority over the first provider treating the patient;

in response to determining that the remote location indication is associated with the first location and the first provider is not presently scheduling appointments at the first location for the primary patient type, routing the patient to the first location and a second provider who is presently scheduling appointments at the first location for the primary patient type.