System for monitoring regulation of pharmaceuticals from data structure of medical and labortory records

• US 7,124,031 B1
• Filed: 05/11/2000
• Issued: 10/17/2006
• Est. Priority Date: 05/11/2000
• Status: Expired due to Term

• Current Assignee: Provantage Corporation, Express Scripts Strategic Development, Inc. (The Cigna Group)
• Original Assignee: Medco Health Solutions Incorporated (The Cigna Group)
• Inventors: Leroy, Aida A., Hoffman, Peter F., Parr, Monique
• Primary Examiner(s): Vo, Tim
• Assistant Examiner(s): Ly, Cheyne D.
• Application Number:
  US09/569,213
• Time in Patent Office: 2,350 Days
• Field of Search: 705/3, 814/3, 702/19, 702/22, 701/1
• US Class Current: 702/19
• CPC Class Codes: G06F 16/00 Information retrieval; Database structures therefor; File system structures therefor
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G16H 10/40 for data related to laboratory analysis, e.g. patient specimen analysis
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 70/60 relating to pathologies
• CPC Class Codes: Y10S 707/99931 Database or file accessing

Abstract

A system is provided that integrates of records of clinical laboratory services into the assessment and optimization of patient health care and, in particular, regulation of the use of pharmaceuticals. Laboratory test result records are used in conjunction with other health care benefits records to monitor regulation of use of pharmaceuticals by patients. The incorporation of laboratory tests and results into such a utilization system allows improvement in the management of a patient'"'"'s therapy based on a more precise picture of the patient'"'"'s level of illness as revealed by the laboratory test results. The system of the present invention also allows optimization of the selection of laboratory tests to be performed, and also provides an outcome assessment of the risk of hospitalization due to pharmaceutical treatments resulting in physician intervention, leading to a change in physician prescribing behavior and, accordingly, a decrease in drug induced hospitalizations and improved quality of patient care and savings of health care costs.

Claims

1. A system useful for reducing the risk of a drug therapy related illness in a patient, the system comprising:

at least one medical records database comprising;

i) drug therapy records, said drug therapy records including an indication of patient identification and an indication of prescribed drug therapy associated with said patient identification, and ii) laboratory test result records, said laboratory test result records including an indication of patient identification and an indication of laboratory test results associated with said patient identification;

a medical information database, said medical information database including criteria pertaining to;

i) interactions between a first drug and a second drag;

ii) a relationship between the first drug and a first disease; and

iii) administration of a laboratory test in connection with the administration of the first drug; and

a search and determination engine for reviewing said laboratory test result records, said drug therapy records and said medical information database criteria, and for determining an output for reducing the risk of the drug therapy related illness in the patient using said laboratory test result records, said drug therapy records and the medical information database criteria by determining a drug interaction indicating initiation of the first drug in a patient with current usage of the second drug, including;

(i) detecting the usage of the second drug concurrently with the first drug, (ii) monitoring for a laboratory report, (iii) generating an alert to the user of the system if such a report is not found, (iv) generating an alert to warn the user of the system about possible interaction effects between the first drug and the second drug;

or (v) generating an alert to warn the user of the system of the need for particular tests from the laboratory to monitor the levels of the first and/or second drugs,

wherein said system provides an output for the patient, to at least one of;

(1) a treatment provider of the patient;

or (2) a user of the system, wherein the output indicates the need for a laboratory test to be performed in connection with the care of said patient, and provides an alert to said treatment provider to prescribe said laboratory test, wherein said prescribing results in reducing the risk of a drug therapy related illness in said patient.

2. The system of claim 1 wherein said drug therapy records are physically remote from said laboratory test results.

3. The system of claim 1 wherein said medical records database comprises an integrated database.

4. The system of claim 1 wherein said medical records database further comprises patient health records, said patient health records including an indication of a disease diagnosis associated with said patient identification.

5. The system of claim 4 wherein said search engine reviews said patient health records and said medical information database criteria, and provides an output indicating the potential for a false positive or false negative laboratory result, thereby indicating the need for a reevaluation of a diagnosis of disease.

6. The system of claim 5 wherein the alert comprises a recommendation to perform a laboratory test, wherein the results of said laboratory test are useful in reducing the likelihood of a false positive output or a false negative output.

7. The system of claim 4 wherein said patient health records include inpatient and outpatient health benefit claims.

8. The system of claim 4 wherein said patient health records include records of physician claims made on behalf of patients.

9. The system of claim 1 wherein said drug therapy records include pharmaceutical benefit claims.

10. The system of claim 1 wherein said criteria in said medical information database comprises data pertaining to at least one of:

(1) drug treatment guidelines, (2) textbooks, (3) journals, (4) pharmaceutical manufacturer guidelines and (5) FDA requirements.

11. The system of claim 1 wherein said medical information database is in the form of a look-up table.

12. The system of claim 1 wherein said absence of the laboratory test pertains to a need for a laboratory test pursuant to a change in a prescribed dosage level of the prescribed drug.

13. The system of claim 1 wherein said alert pertains to a diagnosis of a first disease type and monitoring laboratory test result records for a predetermined time.

14. The system of claim 1 wherein when the second drug comprises insulin, the first drug is in the sulfonylurea class, and the laboratory test referred to in the output pertains to the patient'"'"'s blood glucose level.

15. The system of claim 1 wherein said alert indicates a need to increase or decrease the dosage level of a prescribed drug which has been prescribed for the patient.

16. The system of claim 1 wherein said search engine review further includes:

detection of abnormal laboratory test results indicating the need for an additional laboratory test.

17. The system of claim 1 wherein said search engine review identifies conflicts between said prescribed drug therapy and said criteria for drug usage regulation, said conflicts being quantified by risk factors relating to risk of drug induced hospitalization.

18. The system of claim 17 wherein said risk factors include an assessment of factors relating to one or more of the group of:

(1) patient age, (2) patient sex, (3) number of drugs prescribed to a patient, (4) number of physicians treating a patient, (5) number of pharmacies prescribing drugs to a patient, (6) number of laboratory tests, and (7) number of laboratory test triggering conflicts.

19. The system of claim 17 wherein said patients having said identified conflicts are prioritized based on risk of drug-induced hospitalization.

20. The system of claim 19 wherein said prioritized patients are further segregated by clinically significant risks of drug-induced hospitalization.

21. The system of claim 20 wherein at least one alert pertaining to clinically significant risks is sent to a treating physician as a result of said segregation by a clinical pharmacist.

22. The system of claim 21 wherein said at least one alert causes modification of at least one action of said treating physician.

23. A system for detecting a subtherapeutic drug dosage or a toxic drug dosages in a patient receiving drug therapy, said system comprising:

at least one medical records database comprising;

i) drug therapy records, said drug therapy records including an indication of patient identification and an indication of prescribed drug therapy associated with said patient identification, and ii) laboratory test result records, said laboratory test result records including an indication of patient identification and an indication of laboratory test results associated with said patient identification;

a medical information database, said medical information database including criteria for drug usage regulation; and

a search and determination engine receiving a user query and reviewing at least a portion of said laboratory test result records and at least a portion of at least one of said drug therapy records and said criteria for drug usage regulation, and determining an output for detecting a subtherapeutic drug dosage or a toxic drug dosages in a patient receiving drug therapy, wherein said laboratory test result records, said drug therapy records and said medical information database criteria are used for the determining of the output,

wherein said system provides an output for the patient, wherein the output indicates at least one of;

i) an alert suggesting that a laboratory tests be performed to detect a toxic dosage of a drug that is being administered to the patient; and

ii) an alert suggesting that a laboratory tests be performed to detect a subtherapeutic dosage of a drug that is being administered to the patient.

24. A method for detecting a subtherapeutic drug dosage or a toxic drug dosages in a patient receiving drug therapy, said method comprising:

providing at least one medical records database comprising;

i) drug therapy records, said drug therapy records including an indication of patient identification and an indication of prescribed drug therapy associated with said patient identification, and ii) laboratory test result records, said laboratory test result records including an indication of patient identification and an indication of laboratory test results associated with said patient identification;

providing a medical information database, said medical information database including data pertaining to interaction of a first prescribed drug and a second prescribed drug; and

utilizing a search and determination engine to receive a user query and review at least a portion of said laboratory test result records, said drug therapy records and the data pertaining to interaction of a first prescribed drug and a second prescribed drug, and to determine an output for detecting a subtherapeutic drug dosage or a toxic drug dosage in a patient receiving drug therapy, wherein the laboratory test result records, the drug therapy records and the medical information database criteria are used for the determining of the output,

wherein said method provides an output for the patient, to at least one of;

(1) a treatment provider of the patient;

or (2) a user of the system, said output indicating at least one of;

i) an alert suggesting that a laboratory test be performed to detect a toxic dosage of a drug that is being administered to the patient; and

ii) an alert suggesting that a laboratory test be performed to detect a subtherapeutic dosage of a drug that is being administered to the patient.

25. The method of claim 24, wherein the medical information database further includes data pertaining to drug and disease interactions.

26. The method of claim 24, wherein the output further includes an indication of a need for the patient to undergo a liver function test.

27. A computer-implemented and human-assisted method for identifying a risk of drug induced hospitalization, comprising:

providing a medical information database comprising criteria pertaining to;

i) at least one drug that is contraindicated in the presence of at least one disease;

ii) at least one interaction between a first prescribed drug and a second prescribed drug, wherein the interaction renders one or both of the first and second drugs toxic or subtherapeutic;

iii) criteria for overutilization of a prescribed drug;

iv) criteria for underutilization of a prescribed drug;

v) laboratory test result records, said laboratory test result records including an indication of patient identification and an indication of laboratory test results associated with the patient identification; and

vi) criteria for use of a prescribed drug for an excessive time period;

providing a plurality of drug therapy records comprising a patient identification and a patient prescribed drug therapy;

comparing the drug therapy records and the medical information database to identify patients having at least one criteria as specified in the medical information database;

quantifying the risk of drug induced hospitalization by utilizing;

i) the criteria identified in said comparing step and ii) at least one patient attribute;

identifying patients having a clinically significant risk, and

providing a communication to a medical provider, indicating patients having a clinically significant risk and informing the medical provider of the clinically significant risk.

28. The method of claim 27 wherein the patient attributes comprise age, sex, number of prescribed drugs, number of diseases, number of physicians, number of pharmacies, and a number of laboratory tests.

29. The method of claim 27 wherein the communication is a written communication.

30. A system for identifying a risk of drug induced hospitalization, said system comprising:

(I) a server system comprising;

(1) a medical records database, wherein said medical records database comprises;

i) a pharmaceutical claims database comprising data pertaining to drug treatment and drug dosage information for at least one patient;

ii) a patient claims database comprising data comprising records from medical claims made on behalf of the patient, and information submitted by one or more treating physicians or other medical providers in connection with the patient;

iii) a laboratory test claims results database comprising data pertaining to;

laboratory tests performed for the patient, laboratory test results for the patient, a date of a laboratory test, a laboratory test description, and an identification of a treatment provider who ordered a laboratory test; and

iv) a medical information database comprising criteria pertaining to;

at least one interaction between a first prescribed drug and a second prescribed drug which renders one or both of the first and second drugs toxic or ineffective;

an overutilization of a prescribed drug;

an underutilization of a prescribed drug;

a use of a prescribed drug for an excessive time period;

an interaction between a drug and a disease; and

a duplication of a prescribed drug, and

(2) a server engine for comparing the medical information database and at least the patient claims database to identify a patient having at least one criteria as specified in the medical information database, and for determining an output for detecting the risk of drug induced hospitalization in a patient receiving drug therapy using said laboratory test result records, said drug therapy records and said medical information database criteria;

said server system quantifying the risk of drug induced hospitalization for the patient by utilizing;

i) the criteria identified by said server search engine and ii) at least one attribute of the patient, the at least one attribute comprising an age, a sex, a number of prescribed drugs, a number of diseases, a number of physicians, a number of pharmacies, and a number of laboratory test results,

wherein the risk of drug induced hospitalization comprises;

an absolute risk of drug induced hospitalization, defined as a ratio of a number of hospitalized patients having criteria identified by said server search engine to a total number of patients having criteria identified by said server search engine; and

a relative risk of drug induced hospitalization defined as a ratio of a number of patients having a particular criteria identified by said server search engine that are hospitalized to a total number of patients having a same particular criteria identified by said server search engine that are not hospitalized;

said server system prioritizing the relative risk of drug induced hospitalization for the at least one patient by selecting a predetermined percentage of the at least one patient having the highest relative risk of drug induced hospitalization; and

(II) a medical professional for reviewing medical data of the predetermined percentage of the patient having the highest relative risk of drug induced hospitalization to determine which of the at least one patient has clinically significant criteria identified by said server search engine, wherein said server system provides the output, suitable for delivery to a physician treating the patient, indicating that the patient has a clinically significant risk of drug induced hospitalization.