Electronic health record case management system

• US 8,126,740 B2
• Filed: 03/30/2009
• Issued: 02/28/2012
• Est. Priority Date: 03/28/2008
• Status: Active Grant

• Current Assignee: Rebecca S. Busch
• Original Assignee: Rebecca S. Busch
• Inventors: Busch, Rebecca S.
• Primary Examiner(s): O'Connor, Gerald J.
• Assistant Examiner(s): PHONGSVIRAJATI, POONSIN
• Application Number:
  US12/384,033
• Publication Number:
  US 20090259491A1
• Time in Patent Office: 1,065 Days
• Field of Search: 705 2- 4
• US Class Current: 705/3
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 20/00 ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance

Abstract

A method and system for transparent recording, storing, and accessing financial, clinical, and data/information case management services. The method includes collecting service data pertaining to a customer from a plurality of sources, storing the data, and providing multiple points of access to the data for retrieval by an individual via a user interface. A decision-support system may operate independently as an electronic health record or in conjunction with an integrated electronic health record and allows customers or their representatives to plan, facilitate, and monitor the management of financial, clinical, and data/information issues pertaining to their healthcare. In particular, the system is adapted to identify data tending to indicate an anomaly in the customer'"'"'s health record and facilitate the selection and implementation of one or more options to address and/or correct the anomaly.

Claims

1. A system for identifying and addressing anomalies in a customer'"'"'s health records comprising

a device encoded with logic;

a display;

an input device;

a data storage device; and

one or more processors adapted to execute the logic to;

collect fragmented health data pertaining to the customer from a plurality of data sources including patients, health benefit program sponsors, healthcare payers, healthcare providers, and healthcare vendors;

convert the fragmented data to a unified electronic format;

merge the converted data into a data library in the data storage device;

apply an algorithm to the unified and merged data to identify data indicating an anomaly;

route the anomalous data to an appropriate one of a plurality of decision matrices and anomaly engines stored in the system to be executed by the processor, the appropriate decision matrix or anomaly engine corresponding to a type of anomaly identified and to a list of a plurality of options for addressing the type of anomaly;

output a message to a user indicating the type of anomaly and listing the plurality of options for addressing the type of anomaly on the display;

receive a decision selected by the user operating the input device; and

store the decision selected by the user in the data library,

further comprising an alert component configured to access public health data indicating that a medication type has been stolen from a pharmaceutical inventory or counterfeited and to display an alert on the display if the customer'"'"'s health data indicates use of the medication type by the customer in the past, present or future.

2. The system of claim 1, the plurality of decision matrices and anomaly engines including a medical error anomaly engine, a financial error anomaly engine, a contractual error anomaly engine, a health decision matrix, a health financial matrix, and a fraud prevention matrix.

3. The system of claim 1, the logic including data filter logic, the one or more processors adapted to execute the data filter logic to exclude segmented, fragmented, insulated, and non-transparent service and price data from the data library.

4. A method of identifying and correcting medical anomalies in a customer'"'"'s health records comprising

providing a system including a display, an input device, a data storage device, and a device encoded with and adapted to execute

logic to collect fragmented health data pertaining to the customer from a plurality of data sources including patients, health benefit program sponsors, healthcare payers, healthcare providers, and healthcare vendors;

logic to convert the fragmented data to a unified electronic format;

logic to merge the converted data into a data library in the data storage device;

logic to apply an algorithm to the unified and merged data to identify data indicating a medical anomaly;

logic to output a message to a user on the display notifying the user of the medical anomaly and listing a plurality of options for addressing the medical anomaly;

logic to receive a decision selected by the user operating the input device;

logic to store the decision selected by the user in the data library; and

alert component logic to access public health data indicating that a medication type has been stolen from a pharmaceutical inventory or counterfeited and to display an alert on the display if the customers health data indicates use of the medication type by the customer in the past, present or future;

receiving a message from the system on the display device indicating that a medical anomaly in the customer'"'"'s health records was identified and listing options for addressing the medical anomaly;

selecting an option from the listed options and inputting the selection into the input device; and

providing treatment to the customer to correct the medical anomaly in accordance with the selected option.

5. A system for identifying and addressing anomalies in a customers health records comprising

a device encoded with logic;

a display;

an input device;

a data storage device; and

one or more processors adapted to execute the logic to;

collect fragmented health data pertaining to the customer from a plurality of data sources including patients, health benefit program sponsors, healthcare payers, healthcare providers, and healthcare vendors;

convert the fragmented data to a unified electronic format;

merge the converted data into a data library in the data storage device;

apply an algorithm to the unified and merged data to identify data indicating an anomaly;

route the anomalous data to an appropriate one of a plurality of decision matrices and anomaly engines stored in the system to be executed by the processor, the appropriate decision matrix or anomaly engine corresponding to a type of anomaly identified and to a list of a plurality of options for addressing the type of anomaly;

output a message to a user indicating the type of anomaly and listing the plurality of options for addressing the type of anomaly on the display;

receive a decision selected by the user operating the input device; and

store the decision selected by the user in the data library,

further comprising an alert component configured to access public health data indicating that a perpetrator of medical identity theft has been identified and to display an alert on the display if the medical identity theft has compromised the customer'"'"'s health data or the health data of a provider of healthcare to the customer.

6. The system of claim 5, the plurality of decision matrices and anomaly engines including a medical error anomaly engine, a financial error anomaly engine, a contractual error anomaly engine, a health decision matrix, a health financial matrix, and a fraud prevention matrix.

7. The system of claim 5, the logic including data filter logic, the one or more processors adapted to execute the data filter logic to exclude segmented, fragmented, insulated, and non-transparent service and price data from the data library.

8. A method of identifying and correcting medical anomalies in a customer'"'"'s health records comprising

providing a system including a display, an input device, a data storage device, and a device encoded with and adapted to execute

logic to collect fragmented health data pertaining to the customer from a plurality of data sources including patients, health benefit program sponsors, healthcare payers, healthcare providers, and healthcare vendors;

logic to convert the fragmented data to a unified electronic format;

logic to merge the converted data into a data library in the data storage device;

logic to apply an algorithm to the unified and merged data to identify data indicating a medical anomaly;

logic to output a message to a user on the display notifying the user of the medical anomaly and listing a plurality of options for addressing the medical anomaly;

logic to receive a decision selected by the user operating the input device;

logic to store the decision selected by the user in the data library; and

alert component logic to access public health data indicating that a perpetrator of medical identity theft has been identified and to display an alert on the display if the medical identity theft has compromised the customers health data or the health data of a provider of healthcare to the customer;

receiving a message from the system on the display device indicating that a medical anomaly in the customer'"'"'s health records was identified and listing options for addressing the medical anomaly;

selecting an option from the listed options and inputting the selection into the input device; and

providing treatment to the customer to correct the medical anomaly in accordance with the selected option.