Clinical care utilization management system

• US 7,734,480 B2
• Filed: 01/30/2001
• Issued: 06/08/2010
• Est. Priority Date: 11/13/2000
• Status: Active Grant

• Current Assignee: Peter Stangel
• Original Assignee: Peter Stangel
• Inventors: Stangel, Peter
• Primary Examiner(s): Gilligan; Luke
• Assistant Examiner(s): Cobanoglu; Dilek B
• Application Number:
  US09/772,394
• Publication Number:
  US 20020165735A1
• Time in Patent Office: 3,416 Days
• Field of Search: 705/2, 705/3, 705/4, 705/67, 715/506, 715/741, 715/516, 600/300, 713/600, 706/45, 434/262, 707/104.1, 707/3, 700/83, 348/207.1, 422/68.1
• US Class Current: 705/3
• CPC Class Codes: G06Q 20/3674 involving authentication
• 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 40/20 for the management or administration of healthcare resources or facilities, e.g. managing hospital staff or surgery rooms
• CPC Class Codes: G16H 40/63 for local operation
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems

Abstract

A computer implemented system facilities the submission of clinical events data to a reviewing agency by prompting for data needed to authorize the appropriateness of the event. The system directs an appropriate submission to authorize the event. The system further stores the patient clinical event data and presents the data for review. The system confirms that the clinical event is appropriate by referring to the input data and predetermined validation rules.

Claims

1. A method for collecting patient clinical encounter information comprising the steps of:

storing, on a computer-readable medium operatively connected to a server, computer-executable instructions comprising;

a) a navigation module;

b) a verification module; and

,

c) a user interface comprising a plurality of fields, at least one of the fields comprising a pop-up list, the arrangement of the plurality of fields being fixed and arranged as on a clinical chart;

transmitting, via a network, the navigation module, the verification module and the user interface from the server to a client device;

causing the client device to display the user interface, including the plurality of fields, within a single screen to a user, the user interface facilitating the entry of patient clinical encounter information into the plurality of fields by not requiring the user to scroll the user interface within the single screen;

receiving, via the user interface displayed on the client device, patient clinical encounter information from the user;

causing the navigation module on the client device to modify the contents of at least one of the plurality of fields in response to the received patient clinical encounter information;

receiving, via the user interface displayed on the client device, at least one diagnosis selected by the user via the user interface;

causing the verification module on the client device, to determine an authorization level for the at least one diagnosis by referring to the contents of at least a subset of the plurality of fields; and

,

receiving on the server, via the network, the patient clinical encounter information and the at least one diagnosis from the client device after the determination of the authorization level for the at least one diagnosis by the verification module.

2. The method of claim 1, the computer-executable instructions stored on the computer-readable medium and transmitted to the client device further comprising instructions for one or more criteria corresponding to a diagnosis, the criteria being displayed to the user in at least one of the plurality of fields.

3. The method of claim 2, the computer-executable instructions stored on the computer-readable medium and transmitted to the client device further comprising instructions for determining of an authorization level by referring to the criteria.

4. The method of claim 1, the computer-executable instructions stored on the computer-readable medium and transmitted to the client device further comprising instructions for a rule database, the rule database being employed by the verification module when determining the authorization level on the client device.

5. The method of claim 4, the rule database storing at least two levels of rules, the levels comprising:

a criteria level, the criteria level rules determining a criteria status by referring to data from at least one of the plurality of fields; and

,

a diagnosis level, the diagnosis level rules determining a diagnosis authorization level by referring to the criteria status of at least one criteria level rule.

6. The method of claim 1, at least a subset of the plurality of fields being related in a hierarchical manner, the navigation module changing the content of at least one of the plurality of fields based on selections made therein by the user.

7. The method of claim 6, the verification module further comprising a plurality of criteria rules, the verification module evaluating the criteria rules to determine whether the patient clinical encounter information meets one or more criteria for determining an authorization level.

8. The method of claim 1, the instructions being transmitted via the Internet.

9. Computer readable media having instructions for determining the appropriateness of patient clinical encounter information tangibly stored thereon, the instructions, when executed by a computer, comprising instructions for:

causing a client device to display a criteria selection interface to a user, the criteria selection interface allowing the user to select a diagnosis-based criteria, the criteria selection interface being presented in a clinical format that is familiar to clinicians and healthcare reviewers, the criteria selection interface being presented to the user within a single screen such that the user does not have to scroll within the single screen while selecting criteria, the client device retrieving the criteria selection interface from a server via the Internet;

receiving diagnosis related data from the user;

causing the client device to apply a verification rule to the received diagnosis related data, the verification rule providing a verification result, the verification result providing an authorization level for each selected criterion in the criteria selection interface.