INTEGRATED HEALTH MANAGEMENT SYSTEM

• US 20140316810A1
• Filed: 03/29/2014
• Published: 10/23/2014
• Est. Priority Date: 03/30/2013
• Status: Abandoned Application

• Current Assignee: Advantage Health Solutions, Inc.
• Original Assignee: Advantage Health Solutions, Inc.
• Inventors: Oliver, David L., Akosa, Anthony
• Application Number:
  US14/229,867
• Publication Number:
  US 20140316810A1
• Time in Patent Office: Days
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16Z 99/00 Subject matter not provided for in other main groups of this subclass

Abstract

A computer implemented method of integrating and managing electronic healthcare related records includes providing a digital computer having processing, data storage and data communications capabilities. A healthcare provider set of records is provided that is generated from a first population of persons, and a plurality of healthcare providers. The healthcare providers set of records is forwarded to the digital computer. A third party payor set of healthcare related records is provided that is generated from a population of persons and a plurality of third party payors. The third party payor set of health records are forwarded to the digital computer. A pre-adjudicated healthcare claims set of record is provided from a population of persons including a plurality of third party payors. The pre-adjudicated healthcare claims are forwarded to the digital computer. The healthcare provider set of records, third party payor set of records and pre-adjudicated healthcare claims set of records are processed to provide a report on a patient'"'"'s health condition and treatment history that includes information from each of the healthcare provider, third party payor and pre-adjudicated claims set of records.

Claims

1. A computer implemented method of integrating managing electronic healthcare related records comprising

providing a digital computer having processors, data storage devices and data communication capabilities,

providing a healthcare provider set of records generated from a first population of persons and a plurality of healthcare providers, and forwarding the healthcare provider set of records to the digital computer,

providing a third party payor set of healthcare related records generated from a population of persons including persons in the first population of persons and a plurality of third party payors, and forwarding the third party payor set of health records to the digital computer,

providing a pre-adjudicated healthcare claims set of records from a population of persons including persons in the first population of persons and a plurality of third party payors, and forwarding the pre-adjudicated healthcare claims to the digital computer,

processing the healthcare provider set of records, third party payor set of records and pre-adjudicated healthcare claims set of records to provide a report on a patient'"'"'s health condition and treatment history that includes information from each of the healthcare provider set of records, third party payor set of records, and pre-adjudicated claims healthcare set of records.

2. The computer implemented method of claim 1 wherein the step of providing a healthcare provider set of records comprises

providing healthcare provider records from a plurality of healthcare practitioners and healthcare institutions

3. The computer implemented method of claim 1 wherein the step of providing a healthcare provider set of records comprises

providing healthcare provider records from at least two of orders records, health information exchange records, EMR quality records, EMR clinical records and E-telehealth records.

4. The computer implemented method of claim 3 wherein the step of providing a third party payor set of healthcare related records comprises

providing third party payor healthcare related records from at least two of lab result records, benefit records, provider records, member records, financial records, post-adjudicated medical claims records and pharmacy claims records.

5. The computer implemented method of claim 1 wherein the step of providing a healthcare provider set of records comprises

providing healthcare provider records from each of orders records, health information exchange records, EMR/quality records, EMR clinical records and E-telehealth records.

6. The computer implemented method of claim 5 wherein the step of providing a third party payor set of healthcare related records comprises

providing third party payor records comprising each of lab result records, benefit records, provider records, member records, financial records, post-adjudicated medical claims records and pharmacy claims records.

7. The computer implemented method of claim 1 wherein the step of providing a third party payor set of records comprises

providing third party payor healthcare related records comprising at least two of lab result records, benefit records, provider records, member records, financial records, post-adjudicated medical claims records and pharmacy claims records.

8. The computer implemented method of claim 1 wherein the step of providing a third party payor set of records comprises

providing third party payor records comprising each of lab result records, provider records, member records, financial records, post-adjudicated medical claims records and pharmacy claim records.

9. The computer implemented method of claim 1 wherein the step of providing pre-adjudicated claims healthcare set of records comprises

forwarding pre-adjudicated healthcare claims records to the computing device generally concurrently with the pre-adjudicated healthcare claims records being transferred from a healthcare provider to a third party payor.

10. The computer implemented method of claim 1 wherein the steps of processing the healthcare provider set of records, third party payor set of records and pre-adjudicated healthcare claims set of records comprises

processing sets of records having incompatible file formats, mining information from the incompatible file formats, and placing the information in a format where the information can be mined and correlated into the reports on a patient'"'"'s health condition and treatment history.

11. The computer implemented method of claim 1 wherein the step of processing the healthcare provider set of records, third party payor set of records and pre-adjudicated healthcare claims set of records comprises

correlating data from a plurality of persons served by at least one common healthcare provider to prepare a report providing performance related information about the at least one common healthcare provider.

12. The computer implemented method of claim 1 wherein the step of processing the healthcare provider set of records, third payor set of records and pre-adjudicated healthcare claims set of records comprises

correlating data from a plurality of persons having a common health condition to prepare a report providing at least one of health, financial and outcome information about persons being treated for the common healthcare condition.

13. The computer implemented method of claim 1 wherein the step of processing the records includes the step of providing an analytics and decision support engine and processing the records through the analytics and decision support record to provide a plurality of different reports.

14. The computer implemented method of claim 1 wherein the step of processing the healthcare records includes comparing the processed records with best practice data for ordering the healthcare provider to determine whether deficiencies exist in a patient'"'"'s healthcare regime and to suggest healthcare strategies for the patient.

15. The computer implemented method of claim 1 wherein the step of processing healthcare records includes comparing the processed records with appropriate conditions data to determine whether any reported condition for which a patient was tested requires treatment or attention.

16. The computer implemented method of claim 1 wherein the step of providing a digital computer includes providing a digital computer having an aggregator component capable of receiving data from a plurality of different systems, processing the data to convert the data on to a format capable of providing reports that can be received and read and displayed by the plurality of different systems.

17. The computer implemented method of claim 16 wherein the step of providing a computing device that includes the step of providing a computing device capable of at least one of

(a) transferring data via an HL7 standard format,

(b) employing CDA, QRDA or HL7 interfaces,

(c) transferring data in a NCPDP format, and

(d) transferring data via A WSI EDI-837 I/P.

18. The computer implemented method of claim 1 wherein the step of processing the records to provide a report include the steps of

processing the records to provide reports having at least one of the following functionalities relating to the reports

(a) eligibility rosters;

(b) electronic messaging functionalities between stakeholders and the computing device;

(c) care plans;

(d) provider reporting

(e) a user dashboard for facilitating user navigation of the system;

(f) a care and disease management assessment functionality;

(g) a remotely based provider useable electronic medical records system;

(h) a single sign on electronic medical records access functionality;

(i) a payment reporting functionality;

(j) a population management functionality; and

(k) a utilization and quality reporting functionalities.

19. The computer implemented method of claim 1 wherein the step of processing the records to provide a report includes the step of

processing the records to provide reports having at least seven of the following functionalities relating to the report

(a) eligibility rosters;

(b) electronic messaging functionalities between stakeholders and the computing device;

(c) care plans;

(d) provider reporting;

(e) a user dashboard for facilitating user navigation of the system;

(f) a care and disease management assessment functionality

(g) a remotely based provider useable electronic medical records system;

(h) a single sign on electronic medical records access functionality;

(i) payment reporting functionality;

(j) population management functionality; and

(k) cost utilization and quality reporting functionality.

20. The computer implemented method of claim 1 wherein the step of processing records includes the step of processing the records to perform a productive modeling function.

21. The computer implemented method of claim 1 wherein the step of processing the records includes the step of processing the records to create a report relating to an assessment of at least one of the health, outcome and financial performance of at least one of the healthcare provider, third party payor and patient.

22. A computing device having one or more processors, data storage and data storage device and communication devices, for managing electronic healthcare related records and configured to execute operations comprising

obtaining a healthcare provider set of records generated from a first population of persons and a plurality of healthcare providers, and storing the healthcare provider set of records on the computing device,

obtaining a third party payor set of healthcare related records generated from a population of persons including persons in the first population of persons and a plurality of third party payors, and storing the third party payor set of health records in the computing device, obtaining a pre-adjudicated healthcare claims set of records from a population of persons including persons in the first population of persons and a plurality of third party payors, and storing the pre-adjudicated healthcare claims on the computing device.

processing the healthcare provider set of records, third party payor set of records and pre-adjudicated healthcare claims set of records to provide a report on a patient'"'"'s health condition and treatment history that includes information from each of the healthcare provider set of records, third party payor set of records, and pre-adjudicated claims healthcare set of records