Systems and methods for disease management algorithm integration

• US 8,301,462 B2
• Filed: 09/19/2007
• Issued: 10/30/2012
• Est. Priority Date: 11/22/2000
• Status: Expired due to Fees

• Current Assignee: Catalis, Inc.
• Original Assignee: Catalis, Inc.
• Inventors: Lipscher, Randolph B., Wohl, Eric, Dahlin, Michael D.
• Primary Examiner(s): Cobanoglu, Dilek B
• Application Number:
  US11/857,909
• Publication Number:
  US 20080091464A1
• Time in Patent Office: 1,868 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: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 70/60 relating to pathologies

Abstract

A method of formulating a medical order for a patient includes transmitting a medical order interface to a healthcare provider interface device. The medical order interface includes a plurality of selectable medical order items. The method further includes, in response to receiving a selection of a medical order item of the plurality of selectable medical order items, transmitting an authorization request interface to the healthcare provider interface device. The authorization request interface includes a set of selectable findings controls. Each selectable findings control of the set of selectable findings controls is associated with a set of medical findings associated with the patient. The authorization request interface includes a send control. In addition, the method includes, in response to receiving a selection of a select findings control and receiving selection of the send control, sending an electronic authorization request. The electronic authorization request includes the set of medical finding associated with the select findings control and order data associated with the medical order item.

Claims

1. A method of formulating a medical order for a patient, the method comprising:

transmitting a medical order interface to a healthcare provider interface device, the medical order interface including a plurality of selectable medical order items;

in response to receiving a selection of a medical order item of the plurality of selectable medical order items, transmitting an authorization request interface to the healthcare provider interface device, the authorization request interface associated with an electronic authorization request for authorization from a third party payer, the authorization request interface including a set of selectable findings controls, each selectable findings control of the set of selectable findings controls associated with a set of medical findings associated with the patient, at least one set of medical findings associated with a selectable findings control including a subset of medical findings less than a full set of medical findings associated with the patient, the authorization request interface including a send control; and

in response to receiving a selection of a select findings control and receiving selection of the send control, sending the electronic authorization request to request authorization for a medical order associated with the selected medical order item from the third party payer, the electronic authorization request including the set of medical findings associated with the select findings control and order data associated with the medical order item.

2. The method of claim 1, further comprising:

storing a plurality of medical findings associated with the patient on electronic storage media; and

storing a set of payer authorization rules associated with a payer on the electronic storage media, the patient associated with the payer.

3. The method of claim 2, wherein transmitting the authorization request interface includes transmitting the authorization request interface based at least in part on the set of payer authorization rules associated with the payer associated with the patient.

4. The method of claim 2, wherein the authorization request interface further comprises a modify control, the method further comprising:

transmitting a further findings interface to the healthcare provider interface device in response to receiving a selection of the modify control, the further findings interface including a second set of selectable medical findings controls based at least in part on the plurality of medical findings.

5. The method of claim 3, wherein the authorization request interface includes a set of selectable indications items, the set of selectable indications items based at least in part on the set of payer authorization rules.

6. The method of claim 3, further comprising determining an authorization status associated with the selected medical order item based at least in part on the payer authorization rules.

7. The method of claim 3, further comprising determining an authorization status associated with the selected medical order item based at least in part on the stored plurality of medical findings associated with the patient.

8. The method of claim 3, further comprising, in the authorization request interface, pre-selecting a selectable findings control of the set of selectable findings controls based at least in part on the set of payer authorization rules.

9. The method of claim 5, wherein a selectable indications item is associated with an inconclusive test result.

10. The method of claim 1, further comprising receiving the order data associated with the medical order item.

11. A method of formulating a medical order for a patient, the method comprising:

storing a plurality of medical findings associated with a patient on an electronic storage media;

storing a set of payer authorization rules associated with a payer on the electronic storage media, the patient associated with the payer;

transmitting a medical order interface to a healthcare provider interface device, the medical order interface including a plurality of selectable medical order items;

in response to receiving a selection of a medical order item of the plurality of selectable medical order items, determining an authorization status;

based on the authorization status, transmitting an authorization request interface to the healthcare provider interface device based at least in part on the set of payer authorization rules associated with the payer, the authorization request interface associated with an electronic authorization request for authorization from the payer, the authorization request interface including a set of selectable indications items, the set of selectable indications items based at least in part on the set of payer authorization rules, at least one of the set of selectable indications items indicating an inconclusive result of a test, the authorization request interface including a send control; and

in response to receiving a selection of a select indications item and receiving selection of the send control, sending the electronic authorization request to request authorization for a medical order associated with the selected medical order item to a payer system associated with the payer, the electronic authorization request including order data associated with the selected medical order item and indications data associated with the select indications item.

12. The method of claim 11, further comprising receiving the order data associated with the selected medical order item.

13. The method of claim 11, wherein determining the authorization status includes determining the authorization status based at least in part on the stored set of payer authorization rules and based at least in part on the stored plurality of medical findings associated with the patient.

14. The method of claim 11, wherein the authorization request interface further comprises a modify control, the method further comprising:

transmitting a further findings interface to the healthcare provider interface device in response to receiving a selection of the modify control, the further findings interface including a set of selectable medical findings controls based at least in part on the plurality of medical findings.

15. The method of claim 11, further comprising, in the authorization request interface, pre-selecting a selectable indications item of the set of selectable indications items based at least in part on the plurality of medical findings.

16. The method of claim 11, wherein the authorization request interface includes a set of medical findings controls, the method further comprising, in the authorization request interface, pre-selecting a medical findings control of the set of medical findings controls, at least one medical findings control of the set of medical findings controls associated with a subset of medical findings less than a full set of medical findings associated with the patient.

17. A system comprising:

processor-accessible storage including a set of authorization rules associated with a payer plan, patient information associating a patient with the payer plan, and patient medical findings associated with the patient; and

computer implemented instructions operable by a processor to transmit a medical order interface to a healthcare provider interface device, the medical order interface including a plurality of selectable medical order items;

computer implemented instructions operable by a processor to transmit an authorization request interface to the healthcare provider interface device based at least in part on the set of payer authorization rules associated with the payer plan in response to receiving a selection of a medical order item of the plurality of selectable medical order items, the authorization request interface associated with an electronic authorization request for authorization from the payer, the authorization request interface including a set of selectable indications items, the set of selectable indications items based at least in part on the set of payer authorization rules, at least one of the set of selectable indications items indicating an inconclusive result of a test, the authorization request interface including a send control; and

computer implemented instructions operable by a processor to send the electronic authorization request to request authorization for a medical order associated with the selected medical order item to the payer in response to receiving a selection of a select findings control and receiving selection of the send control, the electronic authorization request including order data associated with the selected medical order item and including indications data associated with the selected indications item.

18. The system of claim 17, further comprising computer implemented instructions operable by a processor to receive order data associated with the selected medical order item.

19. The system of claim 17, further comprising computer implemented instructions operable by a processor to determine an authorization status based at least in part on the stored set of payer authorization rules and based at least in part on the stored plurality of medical findings associated with the patient.

20. The system of claim 17, wherein the authorization request interface further comprises a modify control, the system further comprising:

computer implemented instructions operable by a processor to transmit a further findings interface to the healthcare provider interface device in response to receiving a selection of the modify control, the further findings interface including a set of selectable medical findings controls based at least in part on the plurality of medical findings.