Medical decision auditing method and system

• US 8,260,633 B2
• Filed: 10/30/2007
• Issued: 09/04/2012
• Est. Priority Date: 07/28/2005
• Status: Expired due to Fees

• Current Assignee: Beraja IP LLC
• Original Assignee: IBEZA, LLC
• Inventors: Beraja, Roberto, Beraja, Victor, Beraja, Esther
• Primary Examiner(s): Lubin, Valerie
• Application Number:
  US11/928,690
• Publication Number:
  US 20080052117A1
• Time in Patent Office: 1,771 Days
• Field of Search: None
• US Class Current: 705/2
• 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 70/20 relating to practices or guidelines

Abstract

A method for monitoring a medical related decision made by a medical professional includes providing access to a plurality of databases. Each of the plurality of databases contains medical related information and rules governing medical care. The method also includes receiving medical analysis information from the medical professional. The medical analysis information may be used by the medical professional to make the medical related decision. The method may further include applying at least one of the rules to the medical analysis information received from the medical professional, and auditing the medical related decision made by the medical professional for compliance with the rules. The method may further include providing an indication to the medical professional of compliance or non-compliance of the medical related decision with the rules.

Claims

1. A method for assessing compliance of a medical related decision made by a medical professional, the method comprising:

providing access to a plurality of databases, each of the plurality of databases containing medical related information and rules governing medical care, the plurality of databases being stored on a memory of a computer and accessible using a user interface;

receiving medical analysis information from the medical professional, the medical analysis information being used by the medical professional to make the medical related decision;

applying at least one of the rules governing medical care to the medical analysis information;

auditing the medical related decision made by the medical professional for compliance with the rules by comparing the medical related information associated with the medical related decision with the rules governing medical care to determine if the medical related decision is in compliance with the rules governing medical care;

providing an indication from the computer to the medical professional of compliance or non-compliance of the medical related decision with the rules prior to the medical related decision being finalized;

wherein the steps of providing access to the plurality of databases, receiving medical analysis information, applying at least one of the rules, auditing the medical related decision and providing the indication are carried out using a computer;

wherein an indication of non-compliance of the medical related decision with the rules governing medical care results in an error message being presented to the medical professional using the computer;

wherein an indication of compliance of the medical related decision with the rules governing medical care allows the medical professional to finalize the medical related decision without receiving any further error messages; and

preventing the medical professional from finalizing the medical related decision upon receipt of the error message.

2. A method according to claim 1 wherein the received medical analysis information used to make the medical related decision includes at least one selected from a group consisting of a prescribed medication, a medical test, a medical procedure recommendation, and a treatment recommendation.

3. A method according to claim 1 wherein the medical related information used to make the medical related decision includes at least one selected from the group consisting of medication information, insurance information, affordability information, and medication alternative information.

4. A method according to claim 1 wherein the plurality of databases comprises a patient information database, a diagnosis database, a medical treatment database, and a standards database.

5. A method according to claim 1 wherein the medical analysis information includes at least one selected from a group consisting of a medical image and an image of a patient chart.

6. A method according to claim 1 wherein the medical related decision is based on a comparison of the rules contained in the plurality of databases with the medical analysis information received form the medical professional.

7. A method according to claim 1 wherein the medical related decision includes at least one of selected from the group consisting of prescribing a medication, performing a medical test, performing a medical procedure, and determining applicability of insurance coverage.

8. A method according to claim 1 wherein auditing the medical related decision made by the medical professional for compliance with the rules is automated so that a processor on the computer provides the results of the audit automatically.

9. A method according to claim 1 further comprising notifying an insurance company of patient treatment;

and automatically auditing the selected medical treatment so that an insurance standard is verifiable and so that payment from the insurance company is automatically made upon verification.

10. A method for assessing compliance of a medical related decision made by a medical professional, the method comprising:

receiving medical analysis information from the medical professional, the medical analysis information being used by the medical professional to make the medical related decision, the medical analysis information being received by a computer having a memory that is accessible using a user insurance;

applying at least one rule governing medical care to the medical analysis information;

auditing the medical related decision made by the medical professional for compliance with the at least one rule prior to the medical related decision being finalized by comparing the medical related information associated with the medical related decision with the at least one rule governing medical care to determine if the medical related decision is in compliance with the at least one rule governing medical care;

providing results of the audit to the medical professional;

providing an indication to the medical professional of compliance or non-compliance of the medical related decision with the rules;

wherein auditing the medical related decision made by the medical professional for compliance with the rules is automated so that a processor on the computer provides the results of audit automatically;

wherein the steps of receiving medical analysis information from the medical professional, applying the at least one rule governing medical care, auditing the medical related decision and providing the results of the audit are carried out using a computer;

wherein an indication of non-compliance of the medical related decision with the at least one rule governing medical care results in an error message being presented to the medical professional using the computer;

wherein an indication of compliance of the medical related decision with the at least one rule governing medical care allows the medical professional to finalize the medical related decision without receiving any further error messages; and

preventing the medical professional from finalizing the medical related decision upon receipt of the error message.

11. A method according to claim 10 wherein the received medical analysis information used to make the medical related decision includes at least one selected from a group consisting of a prescribed medication, a medical test, a medical procedure recommendation, and a treatment recommendation;

and wherein the medical related information used to make the medical related decision includes at least one selected from the group consisting of medication information, insurance information, affordability information, and medication alternative information.

12. A method according to claim 10 wherein the plurality of databases comprises a patient information database, a diagnosis database, a medical treatment database, and a standards database.

13. A method according to claim 10 wherein the medical analysis information includes at least one selected from a group consisting of a medical image and an image of a patient chart.

14. A method according to claim 10 wherein the medical related decision includes at least one selected from the group consisting of prescribing a medication, performing a medical test, performing a medical procedure, and determining applicability of insurance coverage.

15. A method according to claim 10 further comprising notifying an insurance company of patient treatment;

and automatically auditing the selected medical treatment so that an insurance standard is verifiable and so that payment from the insurance company is automatically made upon verification.

16. A medical related decision compliance assessment system comprising:

at least one user interface;

a plurality of databases stored on a memory and each accessible using said at least one user interface, each of the plurality of databases containing medical related information and rules governing medical care; and

an auditing system in communication with said plurality of databases;

wherein at least one of the rules is applied to medical analysis information used by the medical professional to make a medical decision, and wherein the auditing system audits a medical related decision made by the medical professional for compliance with the rules prior to the medical related decision being finalized by comparing the medical related information associated with the medical related decision with the rules governing medical care to determine if the medical related decision is in compliance with the at least one rule governing medical care;

wherein an indication is provided to the medical professional of compliance or non-compliance of the medical related decision with the rules;

wherein an indication of non-compliance of the medical related decision with the at least one rule governing medical care results in an error message being presented to the medical professional using the computer;

wherein receipt of the error message prevents the medical professional from finalizing the medical related decision; and

wherein an indication of compliance of the medical related decision with the at least one rule governing medical care allows the medical professional to finalize the medical related decision without receiving any further error messages.

17. A system according to claim 16 wherein the received medical analysis information used to make the medical related decision includes at least one selected from a group consisting of a prescribed medication, a medical test, a medical procedure recommendation, and a treatment recommendation.

18. A system according to claim 16 wherein the medical related information used to make the medical related decision includes at least one selected from the group consisting of medication information, insurance information, affordability information, and medication alternative information.

19. A system according to claim 16 wherein the plurality of databases comprises a patient information database, a diagnosis database, a medical treatment database, and a standards database.

20. A system according to claim 16 wherein the medical analysis information includes at least one selected from a group consisting of a medical image and an image of a patient chart.

21. A system according to claim 16 wherein the medical related decision is based on a comparison of the rules contained in the plurality of databases with the medical analysis information received form the medical professional.

22. A system according to claim 16 wherein the medical related decision includes at least one of selected from the group consisting of prescribing a medication, performing a medical test, performing a medical procedure, and determining applicability of insurance coverage.

23. A system according to claim 16 wherein said auditing system is automated.

24. A system according to claim 16 further comprising an insurance compliance auditing system that automatically audits the selected medical treatment so that an insurance standard is verifiable and so that payment from the insurance company is automatically made upon verification.