Prescription management system

• US 7,493,263 B2
• Filed: 04/30/2002
• Issued: 02/17/2009
• Est. Priority Date: 04/30/2002
• Status: Active Grant

• Current Assignee: Express Scripts Strategic Development, Inc. (The Cigna Group)
• Original Assignee: Medco Health Solutions Incorporated (The Cigna Group)
• Inventors: Rosen, Donna L., Helmus, Scott M., Bressman, Leo H.
• Primary Examiner(s): Gilligan; C Luke
• Assistant Examiner(s): RINES, ROBERT D
• Application Number:
  US10/134,638
• Publication Number:
  US 20030225595A1
• Time in Patent Office: 2,485 Days
• Field of Search: 705/2, 705/3, 700/237, 700/232, 700/241, 700/231, 700/244, 221/2
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/063 Operations research, analysis or management
• CPC Class Codes: G06Q 10/103 Workflow collaboration or project management
• CPC Class Codes: G06Q 30/0283 Price estimation or determination
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G06Q 30/06 Buying, selling or leasing transactions
• CPC Class Codes: G06Q 40/00 Finance; Insurance; Tax strategies; Processing of corporate or income taxes
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

An imaging and workflow method, system, computer readable medium and user interface for processing information efficiently for the processing of medical prescription orders. The system includes support for document scanning, automated rules-based order processing, statistical reporting, document generation and document storage and retrieval. The present invention takes advantage of imaging technology to assist the user in scanning information into the system and software modules to improve the processing of orders. The present invention also includes database tables that identify to application processing logic the types and sequences of actions to be implemented for orders.

Claims

1. A method for the automated processing of an order for at least one medical prescription, the method comprising the steps of:

a. receiving said order, wherein said order is received through a predefined communication channel comprising paper document channels and electronic channels and identifying any previously information associated with said order;

b. determining whether said order requires conversion to an image;

c. converting said order, which requires imaging, into an image;

d. associating said image with said order;

e. assigning said order to at least one queue, wherein said queue is selected from a plurality of queues;

f. processing said order, wherein said step of processing said order comprises executing actions necessary to progress said order from at least one initial queue to a final queue, through at least one intermediate queue, wherein said final queue results in said order shipped to a patient;

g. tracking the order through said plurality of queues and a length of time the order spends within any one queue;

h. determining whether the length of time said order spends in any one queue exceeds a predefined value, and whether the predetermined value is exceeded, transmitting an alert a user; and

i. providing a predetermined level of access to at least one of the plurality of queues by a user responsive to a profile assigned to the user.

2. The method of claim 1, wherein each step or combination thereof is distributed and performed in geographically separate locations.

3. The method of claim 1, wherein said predefined communication channel is selected from at least one of:

facsimile, phone, World Wide Web, mail, or combinations thereof.

4. The method of claim 3, wherein said predefined communication channel includes the mail, the method further comprising the step of prepossessing said order after said step of receiving said order, wherein the step of prepossessing said order comprises the steps of:

a. opening the mail;

b. preparing the opened mail for scanning;

c. scanning the opened mail;

d. reviewing the scanned images of the opened mail;

e. storing the scanned images of the opened mail; and

f. queuing the scanned images of the opened mail for processing.

5. The method of claim 4, wherein said step of scanning the opened mail is done using a high resolution color scanner, wherein said scanned images are in color.

6. The method of claim 4, wherein said step of preparing the opened mail for the scanning comprises the steps of:

a. stamping the opened envelop with a date the mail is opened;

b. aggregating the opened mail into paper batches; and

c. ordering the paper batches.

7. The method of claim 6, wherein said step of ordering the paper batches comprises the steps of:

a. placing barcodes on the contents of said opened mail;

b. removing exception items, wherein exception items are content from said opened mail that does not meet predefined criteria;

c. inserting order separators; and

d. inserting batch header.

8. The method of claim 7, wherein said exception items include fraudulent prescriptions, orders with cash payments and three-dimensional objects.

9. The method of claim 7, wherein said exception items or representations of said exception items are scanned using a flatbed scanner.

10. The method of claim 6, wherein said step of scanning the opened mail includes the step of assigning an identification number to each paper batch and an identification number to each document that is part of the paper batch.

11. The method of claim 4, wherein said step of reviewing the scanned images of the opened mail comprises the step of electing to accept or reject the images of the scanned opened mail, wherein rejecting scanned images of the opened mail results in repeating steps (c) and (d) until additional scanned images are accepted.

12. The method of claim 4, wherein said step of storing the scanned images comprises storing the scanned images to a computer readable medium.

13. The method of claim 12, further comprising the step of storing said opened mail in a predetermined manner such that said opened mail is indexed to its corresponding scanned image stored to said computer readable medium.

14. The method of claim 4, wherein said step of scanning the opened mail comprises separating payment documents from order documents.

15. The method of claim 1, wherein said step of processing said order comprises the steps of:

a. receiving and reviewing images associated with said order;

b. classifying each image associated with said order;

c. verifying said order details;

d. entering said order into a processing device;

e. validating said order;

f. applying at least one protocol to said order to progress said order toward said final queue; and

g. reviewing said order after the at least one protocol has been applied.

16. The method of claim 15, wherein said step of applying the at least one protocol to said order comprises the steps of:

a. reviewing said order to determine whether the at least one protocol is to be applied;

b. resolving the at least one protocol when applied against at least one database; and

c. repeating said steps of reviewing said order to determine whether the at least one protocol applies and resolving the at least one protocol against the at least one database until resolved.

17. The method of claim 16, wherein said at least one database is selected from at least one of:

a clinical database, a plan database, a rules database, a contacts database, an accounts receivable database, a formulary database, a pricing database, a client profile database, a patient history database, and combinations thereof.

18. The method of claim 16, wherein said step of applying the at least one protocol further comprises:

a. Reviewing said order to determine whether there is any information missing or unclear associated with said order; and

b. Resolving said missing or unclear information by steps comprising at least one of suspending said order;

cancelling said prescription;

cancelling said order;

alerting said order with generic brand drug availability;

associating said order with a new invoice; and

review of said order.

19. The method of claim 16, wherein said step of reviewing said order to determine whether the at least one protocol applies comprises the steps of:

a. determining whether a contact is necessary to resolve said order;

b. selecting a mode of contact when the contact is necessary; and

c. initiating said mode of contact.

20. The method of claim 19, wherein said mode of contact is selected from at least one of:

facsimile, phone, e-mail, World Wide Web, mail, and combinations thereof.

21. The method of claim 19, wherein said contact is selected from at least one of:

prescriber, patient, plan administrator, and combinations thereof.

22. The method of claim 19, wherein when the mode of contact is at least a facsimile, said step of initiating said mode of contact comprises the steps of:

a. generating said facsimile; and

b. transmitting said facsimile to the contact.

23. The method of claim 22, wherein said step of generating the facsimile comprises the steps of:

a. selecting facsimile mode;

b. selecting the at least one protocol;

c. populating available fax fields;

d. selecting the contact;

e. selecting a wait time in which to receive a response from said contact.

24. The method of claim 23, wherein said response from said contact is at least one of a facsimile or a phone call.

25. The method of claim 24, wherein when said response from said contact is a phone call, the method further comprises the steps of:

a. routing said phone call to a designated hunt group for call backs;

b. retrieving said order from the queue;

c. obtaining information from the contact; and

d. updating said order.

26. The method of claim 24, wherein when said response from said contact is at least a facsimile, the method further comprises the steps of:

a. matching said facsimile to said order through an automatic match process;

b. updating said order with information on said facsimile; and

c. attaching said facsimile to said order.

27. The method of claim 23, wherein when said wait time exceeds a predefined value, said method further comprises the steps of

a. routing the order to an outbound call queue;

b. scheduling a call;

c. calling the contact;

d. retrieving the order from the outbound call queue;

e. reviewing the order with the contact;

f. resolving the order; and

g. updating the order responsive to said resolving.

28. The method of claim 27, wherein when said step of calling the contact fails to reach contact, said step of calling the contact further comprises the steps of:

a. completing a call back form;

b. updating the outbound call queue; and

c. repeating the steps of scheduling a call and calling the contact until the contact is reached.

29. The method of claim 24, wherein said response from said contact is at least a facsimile, the method further comprises the steps of:

a. receiving said facsimile through a predefined communication channel comprising manual paper facsimiles and electronic facsimile;

b. imaging said received manual paper facsimile;

c. associating said imaged document with said order;

d. associating said imaged document with said paper batch;

e. updating said order with information contained in said electronic facsimile; and

f. associating said electronic fax with said order.

30. The method of claim 19, wherein when the mode of contact is a phone call, said method further comprises the steps of:

a. routing said order to the outbound call queue;

b. scheduling a call;

c. calling the contact;

d. retrieving said order from the outbound call queue;

e. reviewing said order with the contact;

f. resolving said order; and

g. updating said order.

31. The method of claim 30, wherein said step of calling the contact person comprises the steps of:

a. introducing the issue capable of resolution by a non-pharmacist;

b. transferring the call to a pharmacist; and

c. routing said order to a pharmacist accessible location.

32. The method of claim 30, wherein when said step of calling the contact fails to reach the contact, said step of calling the contact further comprises the steps of:

a. completing a call back form;

b. updating the outbound call queue; and

c. repeating the steps of scheduling the call and calling said contact until said contact is reached.

33. The method of claim 1 wherein said step of processing said order comprises the steps of:

a. classifying each document in said order;

b. verifying each document in said order;

c. verifying the total number of prescriptions in said order;

d. at least one of verifying and entering a prescription classification for said order;

e. at least one of verifying and entering at least one of a member number, a group number, and a subgroup number;

f. at least one of verifying and entering an amount and type of payment;

g. at least one of verifying and entering patient provided correspondence;

h. at least one of verifying and entering renewal or refill numbers if present;

i. at least one of verifying and entering prescriber name;

j. at least one of verifying and entering patient name;

k. at least one of verifying and entering prescription issue date;

l. at least one of verifying and updating patient information;

m. at least one of verifying and updating-drug information;

n. at least one of verifying and updating drug strength;

o. at least one of verifying and updating drug directions; and

p. verifying each element of said order is correct.

34. The method of claim 33, wherein when said step of verifying each element of said order is correct, further comprising the steps of repeating steps (l.) through (o.) when an element of said order is not correct.

35. The method of claim 33, further comprising the step of:

repeating steps (l) through (o) if said order is a multi-prescription order.

36. The method of claim 35, further comprising the step of dispensing a portion of said order before all prescriptions in said multi-prescription order are complete.

37. The method of claim 33, wherein steps (m.) through (o.) includes an order annotation builder, wherein annotations made to said order are created from at least one pull down menu, wherein said at least one pull down menu comprises annotation choices.

38. The method of claim 33, wherein a user'"'"'s ability to perform a step or combination thereof is determined by the user'"'"'s profile.

39. The method of claim 1, wherein said plurality of queues communicate with each other through a positive control mechanism, and wherein said positive control mechanism allows said order to be tracked through said automated processing.

40. The method of claim 39, wherein said positive control mechanism sending an acknowledgement upon receipt of said order to a preceding queue from which said order was received.

41. The method of claim 39, wherein said positive control mechanism tracks the length of time said order spends in any one queue.

42. The method of claim 41, wherein when the length of time said order spends in any one queue exceeds a predefined value an alert is sent to a user.

43. The method of claim 1, further comprising an algorithm for calculating when an order needs to be dispensed, wherein the calculation comprises weighting the channel by which the order was received and the patient'"'"'s identity to determine when an order needs to be dispensed.

44. The method of claim 1, wherein if the order fails to meet a predetermined criterion the order is sent to an optional exception handling area.

45. The optional exception handling area of claim 44, wherein the optional exception handling area determines whether the order comprises at least one of a fraudulent order, a cash payment, a nonscannable order, and an otherwise unreadable order.

46. The method of claim 1, wherein after imaging the order is compared to the image.

47. The method of claim 1, wherein after said order is converted to the image said order is entered.

48. The method of claim 47, wherein said entered order is verified against said imaged order and locked.

49. The method of claim 1, wherein after said order is converted to the image said image is reviewed and classified.

50. The method of claim 1, wherein all orders received have a barcode placed on them.

51. The method of claim 1, wherein said order received further comprises at least one of cash, check, and money order.

52. The method of claim 51, wherein if said order comprise cash a receipt is completed in duplicate.

53. The method of claim 1, wherein said step of determining if imaging is required further comprises the steps of:

a. receiving said order;

b. identifying any previously imaged document or information, which can be associated with said order, wherein said relevant information comprises number of prescriptions in an order, prescription classification, member number associated with a benefit plan, group number associated with the benefit plan, and sub-group number s associated with the benefit plan, amount and type of payment, patient/client correspondence, prescriber name, patient/client name, prescription issue date, drug information, drug strength, drug usage directions, number of allowed refills, quantity of medication to dispense, and dosage per day; and

c. bypassing said imaging step if said information or said previously imaged document is identified to process said order without performing said imaging step.

54. A method for the automated mail order pharmacy industry processing of an order for at least one medical prescription, the method comprising the steps of:

receiving said order, wherein said order is received through a predefined communication channel comprising paper document channels and electronic channels and identifying any previously information associated with said order,

determining whether said order requires imaging,

converting said order which requires imaging, to an image by a scanner and the image is compared to the order on at least one of a computer screen and graphical user interface,

processing said order by exception handling if the order can not be converted to a legible image, and associating said image with said order;

assigning said order to at least one queue, wherein said queue is selected from a plurality of queues;

processing said order, wherein processing said order comprises validating the order, resolving protocol, and reviewing the order;

tracking the order through said plurality of queues and a length of time the order spends within any one queue;

determining whether the length of time said order spends in any one queue exceeds a predefined value, and whether the predetermined value is exceeded, transmitting an alert a user;

providing a predetermined level of access to at least one of the plurality of queues by a user responsive to a profile assigned to the user;

and dispensing said order to a patient, wherein at least one of receiving said order, assigning said order, processing said order, and dispensing said order occur at different geographical locations.

55. The method of claim 54, wherein after said order is converted to the image said order is entered.

56. The method of claim 55, wherein said entered order is verified against said imaged order and locked.

57. The method of claim 54, wherein after said order is converted to the image the order is verified and locked.

58. The method of claim 54, wherein after said order is converted to said image, said image is reviewed and classified.

59. The method of claim 54, wherein all orders received have a barcode placed on them.

60. The method of claim 54, wherein said order received further comprises at least one of cash, check, and money order.

61. The method of claim 60, wherein if said order comprise cash a receipt is completed in duplicate.

62. The method of claim 54, wherein said step of determining if imaging is required further comprises the steps of:

a. receiving said order;

b. identifying any previously imaged document or relevant information, which can be associated with said order, wherein said relevant information comprises number of prescriptions in an order, prescription classification, member number associated with a benefit plan, the group number associated with the benefits plan, and the sub-group number associated with the benefits plan, amount and type of payment, patient/client correspondence, prescriber name, patient/client name, prescription issue date, drug information, drug strength, drug usage directions, number of allowed refills, quantity of medication to dispense, and dosage per day; and

c. bypassing said imaging step if said information or said previously imaged document is identified to process said order without performing said imaging step.

63. A method for the automated processing of mail order medical prescriptions, the method comprising the steps of:

receiving said order, wherein said order is received through a predefined communication channel comprising paper document channels and electronic channels, identifying any previously information associated with said order, and determining whether said order requires conversion to an image and converting said order to an image by a high resolution color scanner wherein exception items comprising at least one of fraudulent prescriptions, orders with cash payments, and three-dimensional objects are removed and wherein said exception items or representations of said exception items are converted to an image and associating said image with said order;

assigning said order to at least one queue, wherein said queue is selected from a plurality of queues;

processing said order, wherein said step of processing said order comprises validating the order, resolving protocol, reviewing the order, and shipped said order to a patient;

tracking the order through said plurality of queues and a length of time the order spends within any one queue;

determining whether the length of time said order spends in any one queue exceeds a predefined value, and whether the predetermined value is exceeded, transmitting an alert a user;

providing a predetermined level of access to at least one of the plurality of queues by a user responsive to a profile assigned to the user;

wherein resolving protocol comprises the steps of;

reviewing said order to determine whether the at least one protocol is to be applied;

resolving the at least one protocol when applied against at least one database selected from at least one of;

a clinical database, a plan database, a rules database, a contacts database, an accounts receivable database, a formulary database, a pricing database, a client profile database, a patient history database, and combinations thereof;

repeating said steps of reviewing said order to determine whether the at least one protocol applies and resolving the at least one protocol against the at least one database until resolved;

and wherein at least one step or combination thereof is distributed and performed in geographically separate locations.

64. The method of claim 63, wherein after said order is converted to the image said order is entered.

65. The method of claim 64, wherein said entered order is verified against said imaged order and locked.

66. The method of claim 63, wherein after said order is converted to the image the order is verified and locked.

67. The method of claim 63, wherein after said order is converted to the image, said image is reviewed and classified.

68. The method of claim 63, wherein all orders received have a barcode placed on them.

69. The method of claim 63, wherein said order received further comprises at least one of cash, check, and money order.

70. The method of claim 69, wherein if said order comprise cash a receipt is completed in duplicate.

71. The method of claim 63, wherein said step of determining if imaging is required further comprises the steps of:

d. receiving said order;

e. identifying any previously imaged document or relevant information, which can be associated with said order, wherein said relevant information comprises number of prescriptions in an order, prescription classification, member number associated with a benefit plan, the group number associated with the benefits plan, and the sub-group number associated with the benefits plan, amount and type of payment, patient/client correspondence, prescriber name, patient/client name, prescription issue date, drug information, drug strength, drug usage directions, number of allowed refills, quantity of medication to dispense, and dosage per day; and

f. bypassing said imaging step if said information or said previously imaged document is identified to process said order without performing said imaging step.