System for communication of health care data

• US 7,693,730 B2
• Filed: 10/26/2007
• Issued: 04/06/2010
• Est. Priority Date: 10/11/2000
• Status: Expired due to Fees

• Current Assignee: Healthtrio LLC (Spok Holdings, Inc.)
• Original Assignee: Healthtrio LLC (Spok Holdings, Inc.)
• Inventors: Wallen, J. Dominic, Post, Cindy A., Korpman, Ralph A., Peterson, John C., Hasan, Malik M.
• Primary Examiner(s): Morgan; Robert W
• Application Number:
  US11/925,124
• Publication Number:
  US 20080103820A1
• Time in Patent Office: 893 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 40/67 for remote operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 80/00 ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring

Abstract

An apparatus for communicating health care data from a sender to a receiver is provided. The apparatus has a first computer system, a second computer system, and a rules engine. The first computer system has health care data stored therein. The second computer system is in operable communication with, and is configured to extract the health care data from, the first computer system. The rules engine normalizes the extracted health care data to a predefined format.

Claims

1. A computer system to process health care data from two or more health care records from two or more sources related to a patient in order to communicate that health care data to a participant, the computer system comprising:

a computer configured to communicate with one or more payor databases from two or more payors that each store one or more health care records containing a plurality of health care data related to the patient;

wherein the computer is configured to communicate with the plurality of health care data related to the patient of a type where each of the health care data is displayed in a separate field;

wherein any of the plurality of health care data related to the patient which are intended to have the same meaning, are expressed in either different formats, or have not previously been subject to a normalized format;

wherein the normalized format is of a type that displays health care data from one or more sources associated with a single patient such that any health care data associated with that patient having the same meaning is expressed in the same format despite any prior formatting;

a rules engine that establishes the normalized format for health care data associated with the patient and predetermines how each of the plurality of selected health care data is to appear in its respective field to send to the participant;

wherein the health care data for the patient not expressed as predetermined by the normalized format is remodeled to be expressed as predetermined by the normalized format becoming normalized data;

wherein the computer is configured to transfer the normalized data over a data network to a participant computer system.

2. The computer system of claim 1, further comprising a referral authorization system that applies the normalized data to refer the patient to a health care provider, wherein a referral is evaluated by the rules engine pursuant criteria and configured to transmit the referral to the participant computer system selected from a group consisting of the health care provider, the patient, employer, and the one or more payors.

3. The computer system of claim 2, wherein the referral is transmitted to an adjudication system of the one or more payors for evaluation, and the determination transmitted to the health care provider and the patient.

4. The computer system of claim 3, further comprising a provider computer system that makes a request that initiates extracting the plurality of the selected health care data from the payor computer system.

5. The computer system of claim 1, wherein the participant is a patient, employer, provider or the payor.

6. The computer system of claim 1, wherein the computer is configured to receive a request by the participant computer system that initiates extracting the health care data from the payor computer system.

7. The computer system of claim 6, wherein the normalized data is applied to respond to the request of a patient computer system.

8. The computer system of claim 6, wherein the normalized data is applied to respond to the request of a provider computer system.

9. The computer system of claim 6, wherein the normalized data is used by a payor computer system.

10. The computer system of claim 1, wherein the participant computer system is configured to transmit a request that is sent to the computer that determines which health care data is to be extracted and normalized to respond to the request.

11. The computer system of claim 1, wherein the computer is configured to transfer the normalized data of a type that is selected from a group consisting of eligibility/benefit display, member roster, claim submission, provider lookup, formulary lookup, diagnosis code lookup, procedure code lookup, access health plan information online, communicate with a health plan on-line, communicate with patients on-line, patient-centric view of data across several health plans, order generation and tracking, results review and release, result printing, prescription writing, medication profile for each patient, access to patient'"'"'s personal health record based on patient approval, personalized medical and health care content integration, both context-specific and on demand, e-commerce integration:

office, medical and health-related product awareness and buying capabilities, email, practice management system subscription, support disease management, and physician credentialing subscription.

12. The computer system of claim 1, wherein the computer is configured to transfer the normalized data of a type that is selected from a group consisting of group eligibility, group enrollment, enrollment changes, formulary lookup, e-commerce integration, access from health plan web site or direct access via URL, personalized content integration, both context-specific and on demand, e-commerce integration and health care-related product awareness and buying capabilities.

13. The computer system of claim 1, wherein the computer is configured to transfer the normalized data of a type that is selected from a group consisting of identification card requests, address changes, provider directory inquiries, personalized health information based on an interest profile, diagnosis information, relevant articles and patient education materials, communications from health care providers and health care plans, lab and radiology results, scheduled appointments with a health care provider, prescription refills, personal health records, eligibility/benefit information, claim information, referral and authorization information and status, provider lookup, family history, medication profile and formulary lookup.

14. The computer system of claim 1, further comprising a medical administration system including a process of executing a medical test referral that includes transmitting a determination of the referral to the participant computer system from a health care provider, patient, employer, or payor.

15. A computer system to generate a medical health record related to a patient, the computer system comprising:

a computer including one or more payor databases that stores one or more health care records containing a plurality of health care data related to the patient;

wherein any of the plurality of health care data related to the patient which are intended to have the same meaning, are expressed in either different formats, or have not previously been subject to a normalized format;

wherein the normalized format is of a type that displays health care data from one or more sources associated with a single patient such that any health care data associated with that patient having the same meaning is expressed in the same format despite any prior formatting;

wherein the plurality of health care data related to the patient is remodeled into the normalized format by a rules engine becoming normalized data such that any health care data for the patient not expressed as predetermined by the normalized format is expressed as predetermined by the normalized format; and

wherein the normalized data related to the patient is transferable over a data network.