Method, apparatus, and data structure for capturing and representing diagnostic, treatment, costs, and outcomes information in a form suitable for effective analysis and health care guidance

• US 6,381,576 B1
• Filed: 12/16/1998
• Issued: 04/30/2002
• Est. Priority Date: 12/16/1998
• Status: Expired due to Term

• Current Assignee: ESW LLC
• Original Assignee: Edward Howard Gilbert
• Inventors: Gilbert, Edward Howard
• Primary Examiner(s): Poinvil, Frantzy
• Assistant Examiner(s): WASYLCHAK, STEVEN R
• Application Number:
  US09/212,521
• Time in Patent Office: 1,231 Days
• Field of Search: 705/2, 705/3, 705/4, 600/300
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• 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: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A diagnostic and treatment information data structure encapsulates, with or without identifying a specific patient, information regarding a particular diagnosis-treatment cycle for an individual patient. The diagnostic and treatment information data structures for a number of diagnosis-treatment cycle may be combined within a database for analysis in outcomes or cost effectiveness studies. A relational database which assists the health care provider in formulating the diagnostic and treatment information data structure for a specific diagnosis-treatment cycle can, within a user interface, display information determined during the outcomes or cost effectiveness studies to influence the health care provider at the point of decision. Effective analyses of diagnostic, treatment, and outcomes information and guidance for health care professionals based on such analyses is thus facilitated. An Internet/intranet database program employing the diagnostic and treatment information data structure contains both clinical and financial information permitting effective filtering and analysis of CPT codes as to accuracy and appropriateness.

Claims

1. A data structure stored in a computer-readable medium, to be read by a microprocessor comprising:

a first code uniquely identifying a protocol grouping assigning priorities to one or more protocol choices based on a range of one or more disease variable values;

a second code identifying a protocol choice selected from the protocol grouping and a justification for selecting the protocol choice;

a third code identifying each procedure, diagnostic test, or treatment performed pursuant to the protocol choice and a justification for selecting each respective procedure, diagnostic test, or treatment; and

a fourth code defining a charge code for all procedures, diagnostic tests, and treatments performed.

2. The data structure stored in a computer-readable medium of claim 1, further comprising:

a fifth code identifying a medical provider and specialty.

3. The data structure stored in a computer-readable medium of claim 1, wherein the third code further comprises:

an outcome code for results of the procedure, diagnostic test or treatment performed.

4. The data structure stored in a computer-readable medium of claim 1, further comprising:

at least one disease variable value for a testing result, wherein a range within which the disease variable value falls is employed to select the first code.

5. The data structure stored in a computer-readable medium of claim 1, wherein the protocol grouping identified by the first code includes a plurality of protocol choices, each protocol choice assigned a priority which is unique within the protocol grouping by a medical oversight organization.

6. The data structure stored in a computer-readable medium of claim 1, wherein comparison of the third and fourth codes identifies discrepancies in treatment and billing information.

7. A method of processing medical treatment information, to be read by a microprocessor comprising:

comparing test result values to ranges defined for mapping the test results to a protocol grouping assigning priorities to one or more protocol choices within the protocol grouping;

storing a first code in a data structure which identifies a protocol grouping identified by comparing the test results to the defined ranges;

storing a second code in the data structure uniquely identifying a selected protocol choice within the identified protocol grouping and a justification for the protocol choice selection;

storing a third code in the data structure identifying each procedure, diagnostic test, or treatment performed pursuant to the selected protocol choice and a justification for selecting each respective procedure, diagnostic test, or treatment; and

storing a fourth code in the data structure identifying charges for all procedures, diagnostic tests, and treatments performed.

8. The method of claim 7, further comprising:

responsive to identifying a protocol grouping by comparing the test results to the defined ranges, displaying each protocol choice within the identified protocol grouping together with an associated priority assigned to each respective protocol choice.

9. The method of claim 8, further comprising:

for each protocol choice within the identified protocol grouping, displaying a set of defined justifications for selecting that protocol choice.

10. The method of claim 7, further comprising:

responsive to selection of a protocol choice within the identified protocol grouping, displaying all procedures, diagnostic tests, and treatments for the selected protocol choice together with associated justifications for each procedure, diagnostic test, and treatment.

11. The method of claim 10, further comprising:

selectively displaying information regarding outcomes or cost effectiveness for a procedure, diagnostic test, treatment within the selected protocol choice.

12. The method of claim 10, further comprising:

selectively displaying insurance payment information for a procedure, diagnostic test, treatment within the selected protocol choice.

13. The method of claim 7, further comprising:

appending a fifth code identifying a medical provider and specialty to the data structure.

14. The method of claim 7, further comprising:

transmitting the data structure to a medical organization data collection server.

15. The method of claim 7, further comprising:

transmitting the data structure to an insurance company billing server.

16. A system for processing medical treatment information, to be read by a microprocessor comprising:

a data processing system;

a database within the data processing system containing a plurality of protocol groupings each assigning priorities to one or more protocol choices within the protocol groupings and ranges defined for mapping the test result values to a protocol grouping within the plurality of protocol groupings; and

a data structure within the data processing system, the data structure including;

a first code specifying a protocol grouping identified by comparing measured test result values to the defined ranges;

a second code uniquely identifying a selected protocol choice within the identified protocol grouping and a justification for the protocol choice selection;

a third code identifying each procedure, diagnostic test, or treatment performed pursuant to the selected protocol choice and a justification for selecting each respective procedure, diagnostic test, or treatment; and

a fourth code identifying charges for all procedures, diagnostic tests, and treatments performed.

17. The system of claim 16, further comprising:

an application executing within the data processing system for creating the data structure, the application;

displaying each protocol choice within an identified protocol grouping together with an associated priority in response to identifying the protocol grouping by comparing the test results to the defined ranges;

displaying, for each protocol choice within the identified protocol grouping, a set of defined justifications for selecting a respective protocol choice;

displaying, in response to selection of a protocol choice within the identified protocol grouping, all procedures, diagnostic tests, and treatments for the selected protocol choice together with associated justifications for each procedure, diagnostic test, and treatment;

selectively displaying information regarding outcomes or cost effectiveness for a procedure, diagnostic test, treatment within the selected protocol choice; and

selectively displaying insurance payment information for a procedure, diagnostic test, treatment within the selected protocol choice.

18. The system of claim 16, further comprising:

a medical organization server coupled to the data processing system and serving requests from the data processing system for information regarding outcomes or cost effectiveness for a procedure, diagnostic test, treatment within the selected protocol choice.

19. The system of claim 16, further comprising:

an insurance company server coupled to the data processing system and serving requests from the data processing system for insurance payment information for a procedure, diagnostic test, treatment within the selected protocol choice.

20. The system of claim 16, further comprising:

a communications facility within the data processing system, the communications facility;

appending a fifth code identifying a medical service provider and specialty to the data structure; and

transmitting the data structure to an insurance company billing server.