System and method for capture of qualified compliance data at point of clinical care

• US 8,751,249 B2
• Filed: 01/03/2005
• Issued: 06/10/2014
• Est. Priority Date: 01/03/2005
• Status: Active Grant

• Current Assignee: Cerner Innovation, Inc. (Oracle Corporation)
• Original Assignee: Cerner Innovation, Inc. (Oracle Corporation)
• Inventors: Palmer, Patricia A., Berg, Karen S.
• Primary Examiner(s): Chng, Joy
• Application Number:
  US11/025,998
• Publication Number:
  US 20060149590A1
• Time in Patent Office: 3,445 Days
• Field of Search: 705 2- 3, 600/300
• US Class Current: 705/2
• CPC Class Codes: G06Q 10/02 Reservations, e.g. for tickets, services or events
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• 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 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 system and related techniques generate and maintain a set of compliance-qualified data schemas or templates for deployment in a hospital or other clinical setting. According to conventional implementations, the clinical data required by regulatory reporting bodies such as CMS (Centers for Medicare and Medicaid Services), JCAHO (Joint Commission on Accreditation of Healthcare Organizations) or other government or private bodies may not be systematically captured or track, so that compliance officers and other managers are left to reconstruct compliance data after the face, for instance from patient accounting systems or other platforms not designed to filter or store regulatory data. Platforms and methods according to the invention, in contrast, may access regulatory or compliance criteria and generate a data capture or documented care template, according to which various clinical measures and other information which are required by compliance bodies are automatically captured, at the point of care. Thus patient labs, tests, outcomes and other clinically related data may be conditioned to include that information demanded by regulatory standards, including lab ratios and others, and that data may be automatically recorded, stored, and in embodiments, transmitted to regulatory bodies or agencies, electronically. The regulatory data store that results may likewise in embodiments be accessed by analytic tools to model various compliance and clinical scenarios.

Claims

1. One or more computer readable storage media having computer executable instructions embodied thereon that, when executed by a computing device, perform a method for capturing compliance-qualified data, the method comprising:

receiving a set of identifying information associated with a patient at a point of care;

accessing patient information indicating membership of the patient in a group chosen from the set consisting of;

an insurer, private payor, public payor, federal payor, Medicaid payor, and Medicare payor; and

determining whether the patient lies within a population for which capture of compliance data is mandated by the patient'"'"'s group, wherein;

upon determining that the patient lies within a population for which capture of compliance data is not mandated by the patient'"'"'s group;

ending compliance processing automatically, thereby preventing creation of a list of one or more items that require attention to meet compliance reporting requirements;

preventing the generation of an alert of the one or more items that require attention; and

preventing a quality analysis of the alert of the one or more items that require attention; and

wherein;

upon determining that the patient lies within a population for which capture of compliance data is mandated by the patient'"'"'s group;

accessing a set of group-indicated compliance requirements relevant to the patient based on the indicated patient group and the required compliance data;

generating a documented care template based on the set of group-indicated compliance requirements;

capturing a set of compliance-qualified data based on the set of group-indicated compliance requirements included in the documented care template at the point of care;

creating from a set of group-indicated compliance requirements a list of one or more items that require attention to meet compliance reporting requirements; and

generating an alert of the one or more items that require attention consisting of one or more of;

an indicator, a user-interface element, a flag, a dialog box, and a problem description, from said list.

2. The one or more computer readable storage media according to claim 1, further comprising a step of storing the set of compliance-qualified data to a clinical data store.

3. The one or more computer readable storage media according to claim 1, wherein receiving the set of identifying information associated with the patient or encounter at the point of care comprises receiving the set of identifying information associated with the patient or encounter at one or more of a hospital site, an urgent care site, a research site, a mobile care delivery vehicle and a pharmaceutical dispensing site.

4. The one or more computer readable storage media according to claim 1, further comprising a step of transmitting the set of compliance-qualified data to a compliance body.

5. The one or more computer readable storage media according to claim 4, wherein transmitting the set of compliance-qualified data to the compliance body comprises transmitting the set of compliance-qualified data to at least one of a government body and an industry body.

6. The one or more computer readable storage media according to claim 5, wherein transmitting the set of compliance-qualified data to the at least one of the government body and the industry body comprises transmitting the set of compliance-qualified data to a government body that determines at least clinical cost payment or reimbursement based on the set of compliance-qualified data.

7. The one or more computer readable storage media according to claim 5, wherein transmitting the set of compliance-qualified data to the at least one of the government body and the industry body comprises transmitting the set of compliance-qualified data to an industry body that determines at least an accreditation status based on the set of compliance-qualified data.

8. The one or more computer readable storage media according to claim 1, wherein generating a documented care template based on the set of compliance requirements comprises generating the documented care template based on a set of clinical measures.

9. The one or more computer readable storage media according to claim 8, wherein generating the documented care template based on the set of clinical measures comprises generating the documented care template based on at least one of blood-derived test ratios, patient population ratios and clinical outcome ratios.

10. The one or more computer readable storage media according to claim 1, wherein generating a documented care template based on the set of compliance requirements comprises generating an extensible documented care template.

11. The one or more computer readable storage media according to claim 1, further comprising a step of analyzing analytic scenarios based on the set of compliance-qualified data.

12. One or more computer readable storage media having computer executable instructions embodied thereon that, when executed by a computing device, perform a method for capturing a set of compliance-qualified data, the method comprising:

receiving patient information indicating group membership of the patient in a group chosen from the set consisting of;

an insurer, private payor, public payor, federal payor, Medicaid payor, and Medicare payor; and

determining whether the patient lies within a population for which capture of compliance data is mandated by the patient'"'"'s group, wherein;

upon determining that the patient lies within a population for which capture of compliance data is not mandated by the patient'"'"'s group;

ending compliance processing automatically, thereby preventing creation of a list of one or more items that require attention to meet compliance reporting requirements;

preventing the generation of an alert of the one or more items that require attention; and

preventing a quality analysis of the alert of the one or more items that require attention; and

wherein;

upon determining that the patient lies within a population for which capture of compliance data is mandated by the patient'"'"'s group;

determining what compliance data is required for the patient at a point of care based on the information indicating group membership;

generating a documented care template based on a set of group-indicated compliance requirements for the patient based on the information indicating group membership;

conditioning the capture of a set of compliance-qualified data on the set of group-indicated compliance requirements included in the documented care template at the point of care;

creating from a set of group-indicated compliance requirements a list of one or more items that require attention to meet compliance reporting requirements; and

generating an alert of the one or more items that require attention consisting of one or more of;

an indicator, a user-interface element, a flag, a dialog box, and a problem description, from said list.

13. The one or more computer readable storage media according to claim 12, wherein the method further comprises a step of storing the set of compliance-qualified data to a clinical data store.

14. The one or more computer readable storage media according to claim 12, wherein determining that compliance data is required for the patient or encounter at the point of care comprises determining that compliance data is required for the patient or encounter at least one or more of a hospital site, an urgent care site, a research site, a mobile care delivery vehicle and a pharmaceutical dispensing site.

15. The one or more computer readable storage media according to claim 12, wherein the method further comprises a step of transmitting the set of compliance-qualified data to a compliance body.

16. The one or more computer readable storage media according to claim 15, wherein transmitting the set of compliance-qualified data to the compliance body comprises transmitting the set of compliance-qualified data to at least one of a government body and an industry body.

17. The one or more computer readable storage media according to claim 16, wherein transmitting the set of compliance-qualified data to the at least one of a government body and an industry body comprises transmitting the set of compliance-qualified data to a government body that determines at least clinical cost payment or reimbursement based on the set of compliance-qualified data.

18. The one or more computer readable storage media according to claim 16, wherein transmitting the set of compliance-qualified data to the at least one of a government body and an industry body comprises transmitting the set of compliance-qualified data to an industry body that determines at least an accreditation status based on the set of compliance-qualified data.

19. The one or more computer readable storage media according to claim 12, wherein generating a documented care template based on the set of compliance requirements comprises generating a documented care template based on a set of clinical measures.

20. The one or more computer readable storage media according to claim 19, wherein generating a documented care template based on the set of clinical measures comprises generating a documented care template based on at least one of blood-derived test ratios, patient population ratios and clinical outcome ratios.

21. The one or more computer readable storage media according to claim 12, wherein generating the documented care template based on the set of compliance requirements comprises generating an extensible documented care template.

22. The one or more computer readable storage media according to claim 12, wherein the method further comprises a step of modeling analytic scenarios based on the set of compliance-qualified data.

23. One or more computer readable storage media having computer executable instructions embodied thereon that, when executed by a computing device, perform a method for capturing a set of compliance-qualified data, the method comprising:

accessing patient information indicating membership of a patient in a group;

determining on the basis of said patient information whether the patient lies within a population that requires capture of compliance data;

upon determining that said patient lies within a population that does require the capture of compliance data, performing compliance processing comprising;

accessing a set of group-indicated compliance requirements relevant to the patient based on the indicated patient group and the required compliance data;

generating a documented care template based on the set of group-indicated compliance requirements;

capturing a set of compliance-qualified data based on the set of group-indicated compliance requirements included in the documented care template at a point of care;

creating from a set of compliance requirements for the patient'"'"'s group a list of one or more items that require attention to meet compliance reporting requirements,

generating an alert of the one or more items that require attention consisting of one or more of;

an indicator, a user-interface element, a flag, a dialog box, and a problem description, from said list,

providing said alert to a quality analyst, and

transmitting a compliance qualified report to a compliance agency based on the set of group-indicated compliance requirements; and

upon determining that said patient lies within a population that does not require capture of compliance data;

ending compliance processing automatically, thereby preventing the creation of a list of one or more items that require attention to meet compliance reporting requirements,

preventing the generation of an alert of the one or more items that require attention, and

preventing a quality analysis of an alert of the one or more items that require attention.

24. The one or more computer readable storage media according to claim 23, further comprising a step of storing a set of compliance-qualified data to a clinical data store.

25. The one or more computer readable storage media according to claim 23, further comprising receiving a set of identifying information associated with the patient or encounter at a point of care.

26. The one or more computer readable storage media according to claim 25, wherein receiving the set of identifying information associated with the patient or encounter at the point of care comprises receiving a set of identifying information associated with the patient or encounter at one or more of a hospital site, an urgent care site, a research site, a mobile care delivery vehicle and a pharmaceutical dispensing site.

27. The one or more computer readable storage media according to claim 23, wherein transmitting the compliance-qualified report to the compliance agency comprises transmitting the set of compliance-qualified data to at least one of a government body and an industry body.

28. The one or more computer readable storage media according to claim 27, wherein transmitting the compliance-qualified report to the at least one of the government body and the industry body comprises transmitting the set of compliance-qualified data to a government body that determines at least clinical cost payment or reimbursement based on the set of compliance-qualified data.

29. The one or more computer readable storage media according to claim 27, wherein transmitting the compliance-qualified report to the at least one of the government body and the industry body comprises transmitting the set of compliance-qualified data to an industry body that determines at least an accreditation status based on the set of compliance-qualified data.

30. The one or more computer readable storage media according to claim 23, further comprising generating a documented care template based on a set of compliance requirements.

31. The one or more computer readable storage media according to claim 30, wherein the step of generating a documented care template based on the set of compliance requirements comprises generating the documented care template based on a set of clinical measures.

32. The one or more computer readable storage media according to claim 31, wherein generating the documented care template based on the set of clinical measures comprises generating the documented care template based on at least one of blood-derived test ratios, patient population ratios and clinical outcome ratios.

33. The one or more computer readable storage media according to claim 30, wherein generating a documented care template based on the set of compliance requirements comprises generating an extensible documented care template.

34. The one or more computer readable storage media according to claim 23, further comprising a step of analyzing analytic scenarios based on the set of compliance-qualified data.