Automated processing of electronic medical data for insurance and disability determinations

• US 7,853,459 B2
• Filed: 08/14/2008
• Issued: 12/14/2010
• Est. Priority Date: 08/14/2008
• Status: Active Grant

• Current Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Original Assignee: QTC Management, Inc. (Leidos Holdings, Inc.)
• Inventors: Kay, Lay K.
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): NGUYEN, TRANG T
• Application Number:
  US12/192,043
• Publication Number:
  US 20100042435A1
• Time in Patent Office: 852 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/3
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records

Abstract

A machine-implemented method of assisting medical evidence collection for adjudication of a medical disability request is described. In some embodiments, the method includes providing an electronic medical record of a patient, the electronic medical record includes evidence of at least one claimable medical disability condition and locating in the electronic medical record at least one keyword associated with the at least one claimable medical disability condition. In some embodiments, the method further includes processing an inference rule associated with the at least one claimable medical disability condition, such that the evidence of the at least one claimable medical disability condition is identified in the electronic medical record and outputting, to a computer-readable medium, information indicative of (1) the evidence of the at least one claimable medical disability condition, and (2) a location of the evidence in the electronic medical record.

Claims

1. A machine-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:

providing an electronic medical record of a patient, the electronic medical record comprising evidence confirming or disconfirming at least one claimable medical disability condition;

locating in the electronic medical record at least one keyword associated with the at least one claimable medical disability condition;

processing, by a computer, an inference rule associated with the at least one claimable medical disability condition, such that the evidence confirming or disconfirming the at least one claimable medical disability condition is identified in the electronic medical record; and

outputting, to a display, (1) information indicative of the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and (2) a location reference of the identified evidence in the electronic medical record;

wherein the processing an inference rule comprises locating an indicator of a value in the electronic medical record that tends to confirm an existence of the claimable medical disability condition in the patient; and

wherein the outputting results in the display providing a visible association between the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and the location reference of the identified evidence in the electronic medical record.

2. The method of claim 1, wherein the inference rule is processed if the at least one keyword is present in the electronic medical record.

3. The method of claim 1, further comprising indexing the electronic medical record prior to the locating in the electronic medical record the at least one keyword.

4. The method of claim 1, wherein the at least one keyword is selected from a plurality of keywords associated with the at least one claimable medical disability condition.

5. The method of claim 4, further comprising determining, for each of the plurality of keywords, whether that keyword is included in the electronic medical record.

6. The method of claim 1, wherein the inference rule comprises searching, in the electronic medical record, for information associated with the at least one keyword.

7. The method of claim 1, wherein the inference rule utilizes at least one of information on a category associated with the at least one keyword, a rating code, and a search query.

8. The method of claim 1, wherein the information indicative of the identified evidence confirming or disconfirming the at least one claimable medical disability condition includes at least one of a secondary condition associated with the at least one claimable medical disability condition, a category associated with the at least one claimable medical disability condition, and a rating code associated with the at least one claimable medical disability condition.

9. The method of claim 1, wherein the visible association comprises a proximate position, of the identified evidence confirming or disconfirming the at least one claimable medical disability condition and the location reference of the identified evidence in the electronic medical record, within a visible table.

10. The method of claim 9, wherein the visible table displays the identified evidence confirming or disconfirming the at least one claimable medical disability condition and the location reference of the identified evidence in the electronic medical record within a single row.

11. The method of claim 1, wherein the evidence confirming or disconfirming the at least one claimable medical disability condition comprises at least one keyword associated with the at least one claimable medical disability condition.

12. A machine-implemented method of assisting medical evidence collection for adjudication of a medical disability request, the method comprising:

providing an electronic medical record of a patient, the electronic medical record comprising evidence confirming or disconfirming at least one claimable medical disability condition;

processing, by a computer, an inference rule associated with the at least one claimable medical disability condition, such that the evidence confirming or disconfirming the at least one claimable medical disability condition is identified in the electronic medical record; and

outputting, to a display, (1) information indicative of the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and (2) a location reference of the identified evidence in the electronic medical record;

wherein the processing an inference rule comprises locating an indicator of a value in the electronic medical record that tends to confirm an existence of the claimable medical disability condition in the patient; and

wherein the outputting results in the display providing a visible association between the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and the location reference of the identified evidence in the electronic medical record.

13. The machine-implemented method of claim 12, wherein the inference rule is processed if the indicator is present in the electronic medical record.

14. The machine-implemented method of claim 12, further comprising indexing the electronic medical record prior to the locating in the electronic medical record the indicator.

15. The machine-implemented method of claim 12, wherein the indicator is selected from a plurality of indicators associated with the at least one claimable medical disability condition.

16. The machine-implemented method of claim 15, further comprising determining, for each of the plurality of keywords, whether that keyword is included in the electronic medical record.

17. The machine-implemented method of claim 12, wherein the inference rule comprises searching, in the electronic medical record, for information associated with the indicator.

18. The machine-implemented method of claim 12, wherein the inference rule utilizes at least one of information on a category associated with the indicator, a rating code, and a search query.

19. The machine-implemented method of claim 12, wherein the information indicative of the evidence confirming or disconfirming of the at least one claimable medical disability condition includes at least one of a secondary condition associated with the at least one claimable medical disability condition, a category associated with the at least one claimable medical disability condition, and a rating code associated with the at least one claimable medical disability condition.

20. The machine-implemented method of claim 12, wherein the visible association comprises a proximate position, of the identified evidence confirming or disconfirming the at least one claimable medical disability condition and the location reference of the identified evidence in the electronic medical record, within a visible table.

21. The machine-implemented method of claim 20, wherein the visible table displays the identified evidence confirming or disconfirming the at least one claimable medical disability condition and the location reference of the identified evidence in the electronic medical record within a single row.

22. The machine-implemented method of claim 12, wherein the evidence of the at least one claimable medical disability condition comprises at least one keyword associated with the at least one claimable medical disability condition.

23. A non-transitory machine-readable medium encoded with instructions for assisting medical evidence collection for adjudication of a medical disability request, the instructions comprising code for:

locating in an electronic medical record at least one keyword associated with at least one claimable medical disability condition;

processing an inference rule associated with the at least one claimable medical disability condition, such that the evidence confirming or disconfirming the at least one claimable medical disability condition is identified in the electronic medical record; and

outputting, to a display, (1) information indicative of the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and (2) a location reference of the identified evidence in the electronic medical record;

wherein the processing an inference rule comprises locating an indicator of a value in the electronic medical record that tends to confirm an existence of the claimable medical disability condition in the patient; and

wherein the outputting results in the display providing a visible association between the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and the location reference of the identified evidence in the electronic medical record.

24. A non-transitory machine-readable medium encoded with instructions for assisting medical evidence collection for adjudication of a medical disability request, the instructions comprising code for:

processing an inference rule associated with at least one claimable medical disability condition, such that evidence confirming or disconfirming the at least one claimable medical disability condition is identified in the electronic medical record; and

outputting, to a display, (1) information indicative of the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and (2) a location reference of the identified evidence in the electronic medical record;

wherein the processing an inference rule comprises locating an indicator of a value in the electronic medical record that tends to confirm an existence of the claimable medical disability condition in the patient; and

wherein the outputting results in the display providing a visible association between the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and the location reference of the identified evidence in the electronic medical record.

25. A system, for assisting medical evidence collection for adjudication of a medical disability request, comprising:

a searching module, stored in a computer-readable medium, configured to locate in an electronic medical record at least one keyword associated with at least one claimable medical disability condition; and

a processing module, stored in a computer-readable medium, configured to process an inference rule associated with the at least one claimable medical disability condition, such that evidence confirming or disconfirming the at least one claimable medical disability condition is identified in the electronic medical record, the processing module further configured to send an output to a display;

wherein the output comprises computer-readable (1) information indicative of the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and (2) a location reference of the identified evidence in the electronic medical record;

wherein the processing an inference rule comprises locating an indicator of a value in the electronic medical record that tends to confirm an existence of the claimable medical disability condition in the patient; and

wherein the output to the display results in the display providing a visible association between the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and the location reference of the identified evidence in the electronic medical record.

26. The system of claim 25, wherein the inference rule is processed if the at least one keyword is present in the electronic medical record.

27. The system of claim 25, wherein the processing module is further configured to index the electronic medical record prior to the locating in the electronic medical record the at least one keyword.

28. The system of claim 25, wherein the at least one keyword is selected from a plurality of keywords associated with the at least one claimable medical disability condition.

29. The system of claim 28, wherein the searching module is further configured to determine, for each of the plurality of keywords, whether that keyword is included in the electronic medical record.

30. The system of claim 25, wherein the inference rule comprises searching, in the electronic medical record, for information associated with the at least one keyword.

31. The system of claim 25, wherein the inference rule utilizes at least one of information on a category associated with the at least one keyword, a rating code, and a search query.

32. The system of claim 25, wherein the information indicative of the evidence confirming or disconfirming the at least one claimable medical disability condition includes at least one of a secondary condition associated with the at least one claimable medical disability condition, a category associated with the at least one claimable medical disability condition, and a rating code associated with the at least one claimable medical disability condition.

33. The system of claim 25, wherein the visible association comprises a proximate position, of the identified evidence confirming or disconfirming the at least one claimable medical disability condition and the location reference of the identified evidence in the electronic medical record, within a visible table.

34. The system of claim 33, wherein the visible table displays the identified evidence confirming or disconfirming the at least one claimable medical disability condition and the location reference of the identified evidence in the electronic medical record within a single row.

35. The system of claim 25, wherein the evidence confirming or disconfirming the at least one claimable medical disability condition comprises at least one keyword associated with the at least one claimable medical disability condition.

36. A system, for assisting medical evidence collection for adjudication of a medical disability request, comprising:

a processing module, stored in a computer-readable medium, configured to process an inference rule associated with at least one claimable medical disability condition, such that the evidence confirming or disconfirming at least one claimable medical disability condition is identified in an electronic medical record, the processing module further configured to send an output to a display;

wherein the output comprises computer-readable (1) information indicative of the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and (2) a location reference of the identified evidence in the electronic medical record;

wherein the processing an inference rule comprises locating an indicator of a value in the electronic medical record that tends to confirm an existence of the claimable medical disability condition in the patient; and

wherein the output to the display results in the display providing a visible association between the identified evidence confirming or disconfirming of the at least one claimable medical disability condition, and the location reference of the identified evidence in the electronic medical record.

37. The system of claim 36, wherein the inference rule is processed if the indicator is present in the electronic medical record.

38. The system of claim 36, wherein the inference rule utilizes at least one of information on a category associated with the indicator, a rating code, and a search query.

39. The system of claim 36, wherein the information indicative of the evidence confirming or disconfirming the at least one claimable medical disability condition includes at least one of a secondary condition associated with the at least one claimable medical disability condition, a category associated with the at least one claimable medical disability condition, and a rating code associated with the at least one claimable medical disability condition.

40. The system of claim 36, wherein the visible association comprises a proximate position, of the identified evidence confirming or disconfirming the at least one claimable medical disability condition and the location reference of the identified evidence in the electronic medical record, within a visible table.

41. The system of claim 36, wherein the visible table displays the identified evidence confirming or disconfirming the at least one claimable medical disability condition and the location reference of the identified evidence in the electronic medical record within a single row.

42. The system of claim 36, wherein the evidence confirming or disconfirming the at least one claimable medical disability condition comprises at least one keyword associated with the at least one claimable medical disability condition.

43. A system, for assisting medical evidence collection for adjudication of a medical disability request, comprising:

means for providing an electronic medical record of a patient, the electronic medical record comprising evidence confirming or disconfirming at least one claimable medical disability condition;

means for locating in the electronic medical record at least one keyword associated with the at least one claimable medical disability condition;

means for processing, by a computer, an inference rule associated with the at least one claimable medical disability condition, such that the evidence confirming or disconfirming the at least one claimable medical disability condition is identified in the electronic medical record;

means for outputting, to a means for displaying, (1) information indicative of the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and (2) a location reference of the identified evidence in the electronic medical record;

wherein the processing an inference rule comprises locating an indicator of a value in the electronic medical record that tends to confirm an existence of the claimable medical disability condition in the patient; and

wherein the means for displaying provides a visible association between the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and the location reference of the identified evidence in the electronic medical record.

44. A system, for assisting medical evidence collection for adjudication of a medical disability request, comprising:

means for providing an electronic medical record of a patient, the electronic medical record comprising evidence confirming or disconfirming at least one claimable medical disability condition;

means for processing, by a computer, an inference rule associated with the at least one claimable medical disability condition, such that the evidence confirming or disconfirming the at least one claimable medical disability condition is identified in the electronic medical record;

means for outputting, to a means for displaying, (1) information indicative of the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and (2) a location reference of the identified evidence in the electronic medical record;

wherein the processing an inference rule comprises locating an indicator of a value in the electronic medical record that tends to confirm an existence of the claimable medical disability condition in the patient; and

wherein the means for displaying provides a visible association between the identified evidence confirming or disconfirming the at least one claimable medical disability condition, and the location reference of the identified evidence in the electronic medical record.