System and methods for providing medication selection guidance

• US 8,019,623 B2
• Filed: 12/30/2009
• Issued: 09/13/2011
• Est. Priority Date: 12/29/2004
• Status: Active Grant

• Current Assignee: Cerner Innovation, Inc. (Oracle Corporation)
• Original Assignee: Cerner Innovation, Inc. (Oracle Corporation)
• Inventors: McCallie, David, Finn, Christopher
• Primary Examiner(s): O'Connor; Gerald J.
• Assistant Examiner(s): NGUYEN, TRANG T
• Application Number:
  US12/650,515
• Publication Number:
  US 20100106529A1
• Time in Patent Office: 622 Days
• Field of Search: 705/2, 705/3
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients

Abstract

A system and associated methods provide medication selection guidance at the time of a prescription event for a given patient, or at other times, such as when changes occur in the patient'"'"'s healthcare plan coverage. In one medication selection guidance method, information is received regarding a clinician-preferred medication prescription related to a selected patient, and based on at least one record of the selected patient, a specific information set is retrieved. For instance, the specific information set may include medications the patient is currently taken, healthcare plan coverage for the patient, or other types of information. Then, other medications that can be prescribed to the patient as alternatives to the clinician-preferred medication prescription may be determined based on the specific information set. These alternative medications may be evaluated against the patient'"'"'s healthcare plan coverage to present available medication options and associated out-of-pocket costs to the patient.

Claims

1. A method for auditing costs of a treatment, which is prescribed to a patient, in response to a change in a healthcare plan of the patient, the method comprising:

polling a database that stores the healthcare plan of the patient, wherein the polling is performed outside a context of a prescribing event in which a clinician is prescribing one or more treatments to the patient;

in response to the polling outside the context of the prescribing event, receiving by a computing device information that describes the change in the healthcare plan of the patient, wherein the information is received outside the context of the prescribing event and includes a modified medication-formulary coverage scheme included in the healthcare plan;

in response to receiving the modified medication-formulary coverage scheme outside the context of the prescribing event, identifying a currently prescribed treatment that is prescribed to the patient; and

determining by the computing device a cost of the currently prescribed treatment by referencing the modified medication-formulary coverage scheme, wherein the cost is determined outside the context of the prescribing event, thereby auditing the costs of the treatment.

2. The method of claim 1, further comprising:

determining therapeutically equivalent medications of the currently prescribed treatment.

3. The method of claim 2 further comprising,

retrieving an identification of known allergies of the patient;

and

for the therapeutically equivalent medications, performing a drug-allergy reaction analysis based on known allergies of the patient.

4. The method of claim 2, further comprising:

evaluating fulfillment options for the therapeutically equivalent medications; and

determining patient costs for the therapeutically equivalent medications utilizing the modified medication-formulary coverage scheme for each of the fulfillment options.

5. A method for reviewing costs of a treatment, which is prescribed to a patient, in response to a change in a healthcare plan of the patient, the method comprising:

polling a database that stores the healthcare plan of the patient, wherein the polling is performed outside a context of a prescribing event in which a clinician is prescribing one or more treatments to the patient;

in response to the polling outside the context of the prescribing event, receiving by a computing device information that describes the change in the healthcare plan of the patient, wherein the information is received outside the context of the prescribing event and includes a modified medication-formulary coverage scheme included in the healthcare plan;

in response to receiving the modified medication-formulary coverage scheme outside the context of the prescribing event, identifying a currently prescribed treatment that is prescribed to the patient;

retrieving from a datastore an identification of a treatment alternative that is a therapeutically equivalent treatment of the currently prescribed treatment; and

determining by the computing device that a cost of the treatment alternative is less than a cost of the currently prescribed treatment, wherein the determining is based information listed in the modified medication-formulary coverage scheme and is performed outside the context of the prescribing event; and

presenting a recommendation that the treatment alternative be prescribed to the patient, wherein the recommendation is presented outside the context of a prescribing event.

6. The method of claim 5, wherein a networked entity sends the modified medication-formulary coverage scheme to the computing device.

7. The method of claim 5, wherein presenting the recommendation includes sending an electronic communication to the clinician outside the context of the prescribing event.