System for monitoring regulation of pharmaceuticals from data structure of medical and laboratory records

• US 8,489,417 B2
• Filed: 12/13/2010
• Issued: 07/16/2013
• Est. Priority Date: 05/11/2000
• Status: Expired due to Fees

• Current Assignee: Provantage Corporation, Express Scripts Strategic Development, Inc. (The Cigna Group)
• Original Assignee: Medco Health Solutions Incorporated (The Cigna Group)
• Inventors: Hoffman, Peter F., Parr, Monique
• Primary Examiner(s): Morgan, Robert
• Assistant Examiner(s): Fuelling, Michael
• Application Number:
  US12/966,206
• Publication Number:
  US 20110137682A1
• Time in Patent Office: 946 Days
• Field of Search: 705/3
• US Class Current: 705/2
• CPC Class Codes: G06F 16/00 Information retrieval; Database structures therefor; File system structures therefor
• CPC Class Codes: G06Q 10/00 Administration; Management
• CPC Class Codes: G06Q 30/02 Marketing; Price estimation or determination; Fundraising
• CPC Class Codes: G16H 10/40 for data related to laboratory analysis, e.g. patient specimen analysis
• 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 20/30 relating to physical therapies or activities, e.g. physiotherapy, acupressure or exercising
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 70/60 relating to pathologies
• CPC Class Codes: Y10S 707/99931 Database or file accessing

Abstract

A system is provided that integrates of records of clinical laboratory services into the assessment and optimization of patient health care and, in particular, regulation of the use of pharmaceuticals. Laboratory test result records are used in conjunction with other health care benefits records to monitor regulation of use of pharmaceuticals by patients. The incorporation of laboratory tests and results into such a utilization system allows improvement in the management of a patient'"'"'s therapy based on a more precise picture of the patient'"'"'s level of illness as revealed by the laboratory test results. The system of the present invention also allows optimization of the selection of laboratory tests to be performed, and also provides an outcome assessment of the risk of hospitalization due to pharmaceutical treatments resulting in physician intervention, leading to a change in physician prescribing behavior and, accordingly, a decrease in drag induced hospitalizations and improved quality of patient care and savings of health care costs.

Claims

1. A computer system for reducing the risk of a drug therapy related illness in a patient, the system comprising:

a computer processor;

a medical records database including a plurality of drug therapy records and a plurality of laboratory test results records, a drug therapy record of the plurality of drug therapy records including an indication of prescribed drug therapy associated with a patient and a laboratory test result record of the plurality of laboratory test result records including an indication of a laboratory test result associated with the patient;

a medical information database including medical information criteria pertaining to an interaction between a first drug and a second drug and a relationship between the first drug and a first disease; and

a search and determination engine, performed on the computer processor,

to review the plurality of laboratory test result records, the plurality of drug therapy records, and the medical information database criteria, and

to identify a potential health risk related event by performing one or more of the following functions;

a monitor drug initiation function determining that the patient has been prescribed the first drug, detecting of initiation of the first drug, monitoring for a first laboratory report within a first predetermined number of days (X days) after initiation of the first drug for a duration period of a second predetermined number of days (Z days), and generating an alert if the first laboratory report indicates that no test has been run during the current period after the initiation, and wherein monitoring of lab testing after the initiation provides information regarding a level of the first drug in the patient and effectiveness of the first drug as a treatment;

a monitor drug frequency function determining that the patient has been provided two treatment phases of the first drug including detecting of start of second treatment phase of the first drug, monitoring for report from the first laboratory report every X days for duration period of Z days, and generating an alert if the first laboratory report indicates that it has not run at least one test during each period of X days for duration period of Z days, or generating an alert about the effectiveness of the first drug for a second treatment phase for the first disease indicated in the laboratory test result record, and wherein monitoring of lab information regarding further treatment phases provides information about effectiveness of the first drug as a treatment;

a monitor drug dosage changes function determining that the patient has been provided with a change in dosage level of greater than 50% of the previous dose of the first drug including detecting of change in dosage level of the first drug, monitoring for report from first laboratory report every X days for duration period of Z days, and generating an alert if first laboratory report indicates that it has not run at least one test during the period of X days for duration period of Z days, or generating an alert about the level of dosage of the first drug in the patient and the effectiveness of particular dosage levels of the first drug for the treatment of the first disease;

a monitoring of disease function determining that the patient has the first disease including detecting of presence of the first disease, monitoring for report from the first laboratory report within X days after first indication of the first disease for duration period of Z days, and generating an alert if such a report is not found or generating an alert about the effectiveness of particular drugs or the need for particular tests from a laboratory;

a drug discontinuation function determining discontinuation of the second drug in the patient who is currently using the first drug including detecting of discontinuation of the second drug of the first drug, monitoring for a report from the first laboratory report within X+30 days after the last use of the second drug, and generating an alert if the report is not found or generating an alert about possible effects from the discontinuation of the second drug;

a subtherapeutic drug dosage level function determining that a result of the first laboratory report is below a lower range indicating a subtherapeutic dosage of the first drug including detecting of usage of the first drug, monitoring for report from within 30 days of first usage of the first drug in order to monitor blood level, detecting of subtherapeutic dosage of the first drug, and generating an alert about the dosage level of the first drug;

a toxic drug dosage level function determining that the result of the first laboratory report is above the normal range indicating a toxic dosage level of the first drug including detection of usage of the first drug, monitoring for report from the first laboratory report within 30 days of first usage of the first drug in order to monitor blood level, detection of toxic dosage of the first drug, and generating an alert about the dosage level of the first drug;

a disease reevaluation function determining that the result of the first laboratory report is below the lower range or above the upper range indicating a reevaluation of the diagnosis or condition as the first disease including detection of diagnosis of the first disease, and monitoring for a report from a laboratory within 30 days of diagnosis for lab markers indicating correct diagnosis of disease;

a lab marker positives or negatives function determining that the result of the first laboratory report is positive or is negative suggesting a reevaluation of the diagnosis or condition as the first disease including detection of diagnosis of the first disease, and monitoring for report from the laboratory with lab markers indicating correct diagnosis of disease;

a false positives, false negatives or other result interference function determining that the first drug or the first disease interferes with the first laboratory report and may lead to false positive, false negative, falsely elevated, falsely decreased or other improper influences on the results, and generating an alert suggesting an alternative test or other mechanism to minimize or eliminate the influence of the first drug, the first disease, or both the first drug and the first disease on the result of the first laboratory report;

a frequency of testing function determining normal or abnormal results obtained from the first laboratory report, and generating an alert that the abnormal results indicate that the first laboratory report test should be performed again or every X days, or generating an alert that the normal results indicates that the first laboratory report test should be performed no more than every X days;

an inappropriate conditions function determining that use of the result of the first laboratory report for the patient with the first disease is not valid, and generating an alert sent to modify conditions associated with the first laboratory report or use a second laboratory test for the first disease;

an obsolete tests function determining that the first laboratory report is using obsolete tests, and generating an alert; and

a duplicative tests function determining that the first laboratory report and the second laboratory report measure the same functional area and are considered duplicative, and generating an alert,

wherein the search and determination engine at least determines an output for reducing risk of a drug therapy related illness in the patient using the plurality of laboratory test result records, the plurality of drug therapy records, and the medical information criteria by determining a drug interaction of the first drug with a second drug, including the computer processor detecting the usage of the second drug concurrently with the first drug, monitoring for a laboratory report, generating an alert to a system user if the laboratory report is not found, generating an alert to warn the system user about possible interaction effects between the first drug and the second drug, generating an alert to warn the system user of the need for a laboratory test to monitor levels of the first drug, the second drug, or the first drug and the second drug;

wherein the computer processor generates and electronically transmits the output about the patient a treatment provider of the patient, the system user, or both the treatment provider and the system user,

the output indicating a need for an additional laboratory test to be performed in connection with the care of the patient, and wherein the computer processor provides the alert to the treatment provider to prescribe the laboratory test.

2. The system of claim 1, wherein the medical records database further comprises patient health records, the patient health records including an indication of a disease diagnosis associated with identification of the patient.

3. The system of claim 2, wherein the search and determination engine reviews the patient health records and the medical information database criteria,

wherein the output indicates the potential for a false positive or false negative laboratory result, thereby indicating the need for a reevaluation of a diagnosis of disease.

4. The system of claim 1, wherein said the drug therapy record includes pharmaceutical benefit claims.

5. The system of claim 1, wherein the medical information criteria includes data pertaining to drug treatment guidelines, textbooks, journals, and pharmaceutical manufacturer guidelines, or combinations thereof.

6. The system of claim 1, wherein absence of the laboratory test pertains to a need for an additional laboratory test pursuant to a change in a prescribed dosage level of the prescribed drug.

7. The system of claim 1, wherein the second drug includes insulin, the first drug is in the sulfonylurea class, and the laboratory test referred to in the output pertains to the blood glucose level of the patient.

8. The system of claim 1, wherein the alert indicates a need to increase or decrease the dosage level of a prescribed drug which has been prescribed for the patient.

9. The system of claim 1, wherein the alert includes a recommendation to perform a laboratory test, wherein the results of the laboratory test are useful in reducing the likelihood of a false positive output or a false negative output.

10. The system of claim 1, wherein the search and determination engine detects abnormal laboratory test results indicating the need for an additional laboratory test.

11. The system of claim 1, wherein the search and determination engine identifies conflicts between the prescribed drug therapy and the medical information criteria for drug usage rules, the conflicts being quantified by risk factors relating to risk of drug induced hospitalization.

12. The system of claim 11, wherein the risk factors include an assessment of factors relating to:

patient age, patient sex, number of drugs prescribed to the patient, number of physicians treating the patient, number of pharmacies prescribing drugs to a patient, number of laboratory tests, and number of laboratory test triggering conflicts.

13. The system of claim 11, wherein the patients having the conflicts are prioritized based on risk of drug-induced hospitalization.

14. The system of claim 1, wherein the alert further includes an indication of a need for the patient to undergo a liver function test.