System and method of drug disease matching

• US 8,645,171 B2
• Filed: 09/12/2012
• Issued: 02/04/2014
• Est. Priority Date: 05/15/2000
• Status: Expired due to Term

• Current Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Original Assignee: Optuminsight, Inc. (UnitedHealth Group Incorporated)
• Inventors: Lutgen, Gerald, Valdivia, Tomas, Van Vorst, Krista, Bock, Adam
• Primary Examiner(s): Najarian, Lena
• Assistant Examiner(s): Pass, Natalie A
• Application Number:
  US13/612,164
• Publication Number:
  US 20130030842A1
• Time in Patent Office: 510 Days
• Field of Search: 705 2- 4, 600300-301
• 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 involves matching drugs identified in a specific patient'"'"'s prescription claim records with diseases identified in the patient'"'"'s medical claims. A weighted relationship is generated between the matched drugs and diseases by calculating a link weight in accordance with a preprogrammed formula for each of the diagnosis codes identified in the patient'"'"'s medical claims that is identified as associated with the disease identified and the drug. The link weight provides a statistical match association value to each of the matched diseases identified by way of a diagnosis code in the patient'"'"'s medical claim and the drug identified in the prescription claim.

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; and

(e) calculate a link weight value for each said at least one diagnosis code associated with said at least one disease, wherein said link weight value represents a degree of confidence that said at least one drug identification code for said at least one prescription claim is for a drug prescribed for said at least one disease identified that provides a statistical match association value to each said at least one diagnosis code within said patient medical claims identified as associated with said at least one disease.

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 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 arrangement and configured to perform the following steps;

(a) selecting a prescription claim 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;

(b) processing said at least one drug identified to determine at least one disease associated with said drug identified in said prescription claim; 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, wherein said link weight value represents a degree of confidence that the at least one drug prescribed to said patient is for said at least one disease identified in the medical claims that provides a statistical match association value between said drug and each specific disease identified within said medical claims identified as associated with said at least one disease.

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 least one diagnosis code;

(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 the step of determining a link weight value is performed by the following steps:

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

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

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

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

(a) determining whether a prescribing physician in the prescription claim is the same as a physician providing the service in the medical claim records; 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.

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

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

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

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

(a) determining whether a 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 indications table;

(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 indications table.

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

(a) determining whether a prescribing physician in the prescription claim has the same specialty as a physician providing the service in the medical claim records; and

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

12. A computer implemented method of establishing a relationship between drugs and diseases comprising the following steps:

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

(b) storing a grouping of drug codes and a grouping of diagnosis codes in the computer memory;

(c) using a computer processor to identify at least one prescription claim for a specific patient from said patient prescription claim records;

(d) using the computer processor to identify at least one drug identification code for said at least one prescription claim;

(e) using the computer processor to identify at least one disease associated with said at least one drug identification code;

(f) using the computer processor to identify 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

(g) using the computer processor to calculate a link weight value 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 value represents a degree of confidence that said at least one drug identification code for said at least one prescription claim is for a drug prescribed for said at least one disease identified that provides a statistical match association value 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.

13. A non-transitory 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

(g) calculating a link weight value 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 value represents a degree of confidence that said at least one drug identification code for said at least one prescription claim is for a drug prescribed for said at least one disease identified that provides a statistical match association value 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.