System and method for the rationalization of physician data

• US 5,784,635 A
• Filed: 12/31/1996
• Issued: 07/21/1998
• Est. Priority Date: 12/31/1996
• Status: Expired due to Term

• Current Assignee: Empyrean Benefit Solutions, Inc.
• Original Assignee: Integration Concepts, Inc.
• Inventors: McCallum, William J.
• Primary Examiner(s): Shah, Alpesh M.
• Assistant Examiner(s): Nguyen, Dzung C.
• Application Number:
  US08/777,796
• Time in Patent Office: 567 Days
• Field of Search: 395/800.32, 395/800.36, 395/883, 395/885, 707/522, 707/523, 707/524, 707/908
• US Class Current: 712/32
• CPC Class Codes: G06F 40/151 Transformation
• CPC Class Codes: G06F 40/205 Parsing

Abstract

A system and method for rationalizing physician data in which source data is collected from source computers located at, for example, physicians'"'"' offices, hospitals, testing laboratories and pharmacies. Source data is expected to be in diverse formats and syntax, according to the particular hardware/software/operating system configuration of the source computer. Source data is converted to a common format, advantageously ASCII text, and is parsed and binned into a standard data element "layout." Source data is then cross-referenced and cleaned against standard data resources such as Medicare UPIN tables and AMA ICD9 tables. In this way, analogous data elements acquire a common alphanumeric syntax. Keying errors may also be corrected and missing information may be supplied. Source data is then ready to be accumulated into a standard database of universal format. The database may be processed in various ways to provide reports to physician groups and Independent Practice Associations ("IPAs") to support critical information systems.

Claims

1. A system for rationalizing data extracted from a plurality of source systems, said data characterized by a plurality of combinations of data format, data syntax and data element structure, said source systems characterized by a plurality of combinations of hardware, software and operating systems, said system comprising:

means for transferring said data from each of said source systems to a host processor;

means for standardizing said data, said means for standardizing further comprising;

means for converting said data to a uniform format;

means for parsing said data to identify first selected data elements; and

means for binning said first selected data elements into a uniform data element structure;

means for cleaning said standardized data, said means for cleaning further comprising;

means for linking data having second selected data elements with recognized equivalent values;

means for comparing said linked data against standard resources, each of said standard resources characterized by a known data structure including a predefined association of a plurality of resource elements having reliably accurate alphanumeric values;

means for matching, by recognized equivalence of value thereof, ones of said second selected data elements with ones of said resource elements, so as to identify matched data elements corresponding with matched resource elements; and

means for updating data having said matched data elements, said means for updating data operable by substituting values in third selected data elements therein with values copied from selected resource elements associated with said matched resource elements;

means for adding said cleaned data to a single-format database of uniform data structure; and

means for processing data within said database to create output, said output including data combined from a plurality of said source systems, said output further including data specific to individual ones of said source systems.

2. The system of claim 1, in which said standard resources include at least one standard resource selected from the group consisting of:

(a) American Medical Association (AMA) DRG tables;

(b) AMA ICD9 tables;

(c) AMA CPT tables;

(d) U.S. postal service zip code/geographic location tables;

(e) State medical examiners'"'"' databases;

(f) AMA relative value scales;

(g) AHA databases;

(h) Medicare UPIN tables; and

(i) Standard fee schedules.

3. The system of claim 1, in which said means for processing data, in creating output including data combined from a plurality of said source systems, suppresses values contained in fourth selected data elements.

4. The system of claim 3, in which said fourth selected data elements contain values representing personal details of individual people.

5. The system of claim 1, in which said source systems include at least two computerized information systems selected from the group consisting of:

(a) a physicians'"'"' office information system;

(b) a hospital information system;

(c) a clinical testing facility information system; and

(d) a pharmacists'"'"' dispensary information system.

6. The system of claim 1, in which said uniform format is ASCII text.

7. A method for rationalizing data extracted from a plurality of source systems, said data characterized by a plurality of combinations of data format, data syntax and data element structure, said source systems characterized by a plurality of combinations of hardware, software and operating systems, said method comprising the steps of:

transferring said data from each of said source systems to a host processor;

standardizing said data, said standardizing step further comprising the substeps of;

converting said data to a uniform format;

parsing said data to identify first selected data elements; and

binning said first selected data elements into a uniform data element structure;

cleaning said standardized data, said cleaning step further comprising the substeps of;

linking data having second selected data elements with recognized equivalent values;

comparing said linked data against standard resources, each of said standard resources characterized by a known data structure including a predefined association of a plurality of resource elements having reliably accurate alphanumeric values;

matching, by recognized equivalence of value thereof, ones of said second selected data elements with ones of said resource elements so as to identify matched data elements corresponding with matched resource elements; and

updating data having said matched data elements by substituting values in third selected data elements therein with values copied from selected resource elements associated with said matched resource elements;

adding said cleaned data to a single-format database of uniform data structure;

processing data within said database to create output, said output including data combined from a plurality of said source systems, said output further including data specific to individual ones of said source systems; and

in creating output including data combined from a plurality of said source systems, suppressing values contained in fourth selected data elements.

8. The method of claim 7, in which said standard resources include at least one standard resource selected from the group consisting of:

(a) American Medical Association (AMA) DRG tables;

(b) AMA ICD9 tables;

(c) AMA CPT tables;

(d) U.S. postal service zip code/geographic location tables;

(e) State medical examiners'"'"' databases;

(f) AMA relative value scales;

(g) AHA databases;

(h) Medicare UPIN tables; and

(i) Standard fee schedules.

9. The method of claim 7, in which said fourth selected data elements contain values representing personal details of individual people.

10. The method of claim 7, in which said source systems include at least two computerized information methods selected from the group consisting of:

(a) a physicians'"'"' office information system;

(b) a hospital information system;

(c) a clinical testing facility information system; and

(d) a pharmacists'"'"' dispensary information system.

11. The method of claim 7, in which said uniform format is ASCII text.

12. A general purpose computer system for rationalizing source data extracted from a plurality of source systems, said source data characterized by a plurality of combinations of data format, data syntax and data element structure, said source systems characterized by a plurality of combinations of hardware, software and operating systems, said general purpose computer system comprising:

a central processing unit including a memory;

input means disposed to receive said source data from each of said source systems;

mass data storage means accessible by the central processing unit and disposed to store data including said source data;

an application program operable to generate output, said output including anonymized data combined from a plurality of said source systems, said output further including data specific to individual ones of said source systems, said application program comprising;

means for converting said source data to a uniform format;

means for parsing said converted data to identify first selected data elements;

means for binning said first selected data elements into a database having a uniform data element structure;

means for recognizing, within said database, second selected data elements having equivalent values;

means for linking data in said database having said second selected data elements with recognized equivalent values;

means for comparing said linked data against standard resources, each of said standard resources characterized by a known data structure including a predefined association of a plurality of resource elements having reliably accurate alphanumeric values;

means for matching, by recognized equivalence of value thereof, ones of said second selected data elements with ones of said resource elements so as to identify matched data elements corresponding with matched resource elements; and

means for updating data within said database having matched data elements, said means for updating data operable by substituting values in third selected data elements therein with values copied from selected resource elements associated with said matched resource elements.

13. The general purpose computer system of claim 12, in which the input means includes communications means operable to receive selected source data by electronic data transfer.

14. The general purpose computer system of claim 12, in which said uniform format is ASCII text.

15. The general purpose computer system of claim 12, in which selected ones of said standard resources are stored on the mass data storage means.

16. The general purpose computer system of claim 12, in which said source systems include at least two computerized information systems selected from the group consisting of:

(a) a physicians'"'"' office information system;

(b) a hospital information system;

(c) a clinical testing facility information system; and

(d) a pharmacists'"'"' dispensary information system.