System and method of drug disease matching

• US 8,301,468 B2
• Filed: 05/15/2000
• Issued: 10/30/2012
• Est. Priority Date: 05/15/2000
• Status: Active Grant

• Current Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Original Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Inventors: Lutgen, Gerald, Van Vorst, Krista, Bock, Adam, Valdivia, Tomás
• Primary Examiner(s): O'Connor, Gerald J
• Assistant Examiner(s): PASS, NATALIE
• Application Number:
  US09/571,648
• Publication Number:
  US 20030167189A1
• Time in Patent Office: 4,551 Days
• Field of Search: 705/26, 705 2- 4, 705/35, 707/104.1, 600/300, 340/521, 706/45, 177/25.19
• US Class Current: 705/4
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 15/00 ICT specially adapted for medical reports, e.g. generation or transmission thereof
• CPC Class Codes: G16H 20/10 relating to drugs or medications, e.g. for ensuring correct administration to patients
• CPC Class Codes: G16H 70/40 relating to drugs, e.g. their side effects or intended usage
• CPC Class Codes: G16H 70/60 relating to pathologies

Abstract

A computer implemented system and method for matching drugs and diseases and generating a weighted relationship between the matched drugs and diseases. The system stores a quantity of patient medical history billing records identifiable as patient prescription claim records and medical claim records. The system also stores a grouping of drug codes and groupings of diagnosis codes. The system is configured to match drugs identified in a specific patient'"'"'s prescription claim records with diseases identified in the patient'"'"'s medical claims. The system generates a weighted relationship between the matched drugs and diseases by calculating a link weight in accordance with a preprogrammed formula for each occurrence of the diagnosis codes identified in the patient'"'"'s medical claims that is identified as associated with the disease identified and the drug upon which the query is being processed. The link weight provides a statistical match association value to each of the matched diseases.

Claims

1. A computer implemented system for establishing a relationship between drugs and diseases, the system comprising:

a first memory area for storing a quantity of patient medical history billing records identifiable as patient prescription claim records and medical claim records,

a second memory area storing a grouping of drug codes and a grouping of diagnosis codes,

a processor coupled to said first memory area and said second memory area and configured to perform the following steps;

(a) identify at least one prescription claim for a specific patient from said patient prescription claim records;

(b) identify at least one drug identification code for said at least one prescription claim;

(c) identify at least one disease associated with said at least one drug identification code;

(d) identify patient medical claims for said specific patient associated with said at least one disease, wherein each patient medical claim identified has at least one diagnosis code associated with said at least one disease;

(e) calculate a link weight value for each said at least one diagnosis code associated with said at least one disease by determining the number of days between said at least one prescription claim identified and each said patient medical claim identified as associated with said at least one disease and generating a link weight value based on said number of days in accordance with a preprogrammed formula wherein said link weight provides a statistical match association value to each said at least one diagnosis code.

2. The computer implemented system of claim 1 wherein said processor is further configured to perform the following step:

(f) generating a match strength value by adding each said link weight value calculated for each instance of said at least one diagnosis code identified in said patient medical claims for said specific patient.

3. A computer implemented system for matching drugs and diseases, the system comprising:

a receiver for receiving a quantity of patient medical history billing records identifiable as patient prescription claim records and medical claim records,

a data storage coupled to said receiver and configured to store a grouping of drug codes and a grouping of diagnosis codes,

a processor coupled to said data storage and configured to perform the following steps;

(a) selecting a prescription claim record of a specific patient from said patient prescription claim records and identifying at least one drug prescribed to said patient in accordance with said selected prescription claim record;

(b) processing said at least one drug identified to determine at least one disease associated with said drug identified; and

(c) searching said medical claim records of said specific patient and identifying medical claims associated with said at least one disease; and

(d) determining a link weight value for each specific disease identified within each of said medical claims identified as associated with said at least one disease wherein determining a link weight value is performed by;

determining the number of days between said prescription claim selected and each of said medical claims identified as associated with said at least one disease; and

generating a link weight value based on said number of days in accordance with a preprogrammed formula.

4. The computer implemented system of claim 3 wherein the step of identifying at least one drug prescribed to said patient in accordance with said selected prescription claim is implemented by identifying a national drug code in the pharmacy claim.

5. The computer implemented system of claim 3 wherein the step of searching said medical claim records of said specific patient and identifying medical claims associated with said diseases is implemented by performing the following steps:

(a) identifying at least one national drug code in the pharmacy claim;

(b) reading at least one predefined relationship between said at least one national drug code and at last one diagnosis code; and

(c) reading said medical claim records of said specific patient and selecting medical claim records having said at least one diagnosis code.

6. The computer implemented system of claim 3 wherein said preprogrammed formula is a look-up table.

7. The computer implemented system of claim 3 wherein the step of determining a link weight value is further performed by the following steps:

(a) determining whether a physician identified as prescribing drugs in said selected prescription claim is the same physician providing medical services associated with said medical claims records identified; and

(b) generating a link weight value in accordance with a preprogrammed formula when said prescribing physician is the same as said physician providing the service.

8. The computer implemented system of claim 3 wherein the said step of determining a link weight value is further performed by the following steps:

(a) determining whether a diagnosis code within each of said medical claims identified as associated with said at least one disease is a primary diagnosis or secondary diagnosis on said each of said medical claims identified; and

(b) generating a link weight value in accordance with a preprogrammed formula when said diagnosis code within said each of said medical claims identified as associated with said at least one disease is a primary diagnosis.

9. The computer implemented system of claim 3 wherein the step of determining a link weight is further performed by the following steps:

(a) determining whether a diagnosis code for at least one disease and diagnosis codes within said medical claims identified as associated with said at least one disease are in an original disease indications table; and

(b) generating a link weight value in accordance with a preprogrammed formula when said diagnosis code for said at least one disease and diagnosis codes within said medical claims identified as associated with said at least one disease are in an original disease identifications table.

10. The computer implemented system of claim 3 wherein the steps of determining a link weight value is further performed by the following steps:

(a) determining whether a physician identified as prescribing drugs in said selected prescription claim has the same specialty as the physician providing medical service associated with said medical claims records identified; and

(b) generating a link weight value in accordance with a preprogrammed formula when said physician identified as prescribing drugs has the same specialty as said physician providing the medical service.

11. A computer-implemented method of establishing a relationship between drugs and diseases comprising one or more computers performing the following steps:

(a) storing a quantity of patient medical history billing records identifiable as patient prescription claim records and medical claim records in memory;

(b) storing a grouping of drug codes and a grouping of diagnosis codes;

(c) identifying at least one prescription claim for a specific patient from said patient prescription claim records;

(d) identifying at least one drug identification code for said at least one prescription claim;

(f) identifying at least one disease associated with said at least one drug identification code;

(g) identifying patient medical claims for said specific patient associated with said at least one disease identified, wherein each patient medical claim identified has at least one diagnosis code associated with said at least one disease identified; and

(h) calculating a link weight for each said at least one diagnosis code associated with said at least one disease in accordance with a preprogrammed formula, wherein said link weight provides a statistical match association value relationship between said at least one disease identified and each said at least one diagnosis code within each said patent medical claim identified as associated with said at least one disease identified wherein calculating a link weight includes;

determining the number of days between said at least one prescription claim identified and each said patient medical claim identified as associated with said at least on disease; and

generating a link weight value based on said number of days in accordance with a preprogrammed formula.

12. A computer storage medium readable by a computing system and encoding a computer program of instructions for executing a computer process for establishing a relationship between drugs and diseases, said computer process comprising the steps of:

(a) storing in system data storage a quantity of patient medical history billing records identifiable as patient prescription claim records and medical claim records in memory;

(b) storing in system data storage a grouping of drug codes and a grouping of diagnosis codes;

(c) identifying at least one prescription claim for a specific patient from said patient prescription claim records;

(d) identifying at least one drug identification code for said at least one prescription claim;

(e) identifying at least one disease associated with said at least one drug identification code;

(f) identifying patient medical claims for said specific patient associated with said at least one disease identified, wherein each patient medical claim identified has at least one diagnosis code associated with said at least one disease identified; and

(h) calculating a link weight for each said at least one diagnosis code associated with said at least one disease in accordance with a preprogrammed formula, wherein said link weight provides a statistical match association value relationship between said at least one disease identified and each said at least one diagnosis code within each said patient medical claim identified as associated with said at least one disease identified wherein calculating a link weight includes;

determining the number of days between said at least one prescription claim identified and each said patient medical claim identified as associated with said at least one disease; and

generating a link weight value based on said number of days in accordance with a preprogrammed formula.