Enterprise management system

• US 9,779,210 B2
• Filed: 01/13/2016
• Issued: 10/03/2017
• Est. Priority Date: 05/10/2005
• Status: Active Grant

• Current Assignee: Change Healthcare Holdings, LLC (UnitedHealth Group Incorporated)
• Original Assignee: Mckesson Technologies Incorporated (UnitedHealth Group Incorporated)
• Inventors: Pocklington, William Lee, Moore, Jr., Edmund B., Fraser, Scott Edward, Kuzmak, Beth Anne, Flanagan, Michael Sean
• Primary Examiner(s): Khong, Alexander
• Application Number:
  US14/994,823
• Publication Number:
  US 20160125148A1
• Time in Patent Office: 629 Days
• CPC Class Codes: G06Q 10/10 Office automation; Time management
• 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 40/67 for remote operation

Abstract

A health care enterprise management system and method of management are disclosed. The system and method include a routing layer, a plurality of applications in an application layer, wherein the application layer communicates external to the enterprise manager via communicative contact through the routing layer, a business rules layer of a plurality of health care provision business rules, and a core layer.

Claims

1. A method for providing a health care enterprise management system comprising a routing layer, an application layer, a business rules layer, a data language normalization engine, and a core database layer, the method comprising:

maintaining a rules engine in the business rules layer, the rules engine comprising a plurality of selectable rules, wherein each of the plurality of selectable rules has rule attributes that define each of the selectable rules;

maintaining health care related data in a core database of the core database layer, for applying to different applications;

associating data with the health care related data in the core database by a link from a data entry point in the core layer to an external data node of said entry point to the world-wide web or an Intranet;

maintaining a dedicated database resident in the business rules layer, the dedicated database having stored therein a plurality of health care business rules comprising at least one rule having multiple layers such that satisfaction of one of the rule attributes of at least one layer will trigger application of other attributes of the at least one layer;

maintaining a history of rules and rules changes in both said core database resident in the core layer and said dedicated database resident in said business rules layer, the dedicated database having rule tracking and rule reporting;

providing, with the routing layer, connectivity between said application layer, said business rules layer, and said core database so that said health care related data is simultaneously accessible by said application layer, said business rules layer, and said core database; and

providing, by the business rules layer, a communicative interface between each of a plurality of graphical user interfaces of the application layer, a plurality of health care business rules, and said health care related data.

2. The method of claim 1, wherein providing connectivity comprises providing connectivity with the routing layer between said application layer, said business rules layer, said core database and an external application.

3. The method of claim 1, wherein said plurality of health care business rules comprise at least one subset of rules that is correspondent to each of said plurality of graphical user interfaces.

4. The method of claim 1, wherein said plurality of health care business rules include a defined set of allowable interactions between each of said plurality of graphical user interfaces and said core database.

5. The method of claim 1, wherein said plurality of health care business rules comprise credentialing rules that allow for credentialing of health care providers that have information within said health care related data.

6. The method of claim 1, wherein said health care related data comprises any of health care provider information, patient information, insurer information, plan information, institution information, entity information, or transaction information.

7. The method of claim 1, wherein said plurality of applications comprises a queue that causes, responsively to one or more user instructions, one or more rules in said business rules layer to be applied to force the performance of tasks in a predetermined order.

8. The method of claim 1, further comprising allowing for modifications by the rules engine to the rules from one or more applications in the application layer.

9. The method of claim 1, wherein said at least one rule having multiple layers includes successive layers wherein a subsequent layer is applied as each successive layer of the multiple layers of the at least one rule is satisfied, wherein each layer of the multiple layers has a series of attributes, and satisfaction of all attributes of the at least one layer will trigger application of the subsequent layer.

10. The method of claim 1, wherein the plurality of health care business rules are subject to change and the changes to the rules are enforced on all data in both databases upon execution of a new rule.

11. A computer program product for controlling a health care enterprise management system comprising a routing layer, an application layer, a business rules layer, a data language normalization engine, and a core database layer, the computer program product comprising at least one non-transitory computer-readable medium having computer-readable program instructions stored therein, the computer-readable program instructions comprising instructions, which when performed by an apparatus, are configured to cause the apparatus to at least:

maintain a rules engine in the business rules layer, the rules engine comprising a plurality of selectable rules, wherein each of the plurality of selectable rules has rule attributes that define each of the selectable rules;

maintain health care related data in a core database of the core database layer, for applying to different applications;

associate data with the health care related data in the core database by a link from a data entry point in the core layer to an external data node of said entry point to the world-wide web or an Intranet;

maintain a dedicated database resident in the business rules layer, the dedicated database having stored therein a plurality of health care business rules comprising at least one rule having multiple layers such that satisfaction of one of the rule attributes of at least one layer will trigger application of other attributes of the at least one layer;

maintain a history of rules and rules changes in both said core database resident in the core layer and said dedicated database resident in said business rules layer, the dedicated database having rule tracking and rule reporting;

provide, with the routing layer, connectivity between said application layer, said business rules layer, and said core database so that said health care related data is simultaneously accessible by said application layer, said business rules layer, and said core database; and

provide, by the business rules layer, a communicative interface between each of a plurality of graphical user interfaces of the application layer, a plurality of health care business rules, and said health care related data.

12. The computer program product of claim 11, wherein providing connectivity comprises providing connectivity with the routing layer between said application layer, said business rules layer, said core database and an external application.

13. The computer program product of claim 11, wherein said plurality of health care business rules comprise at least one subset of rules that is correspondent to each of said plurality of graphical user interfaces.

14. The computer program product of claim 11, wherein said plurality of health care business rules include a defined set of allowable interactions between each of said plurality of graphical user interfaces and said core database.

15. The computer program product of claim 11, wherein said plurality of health care business rules comprise credentialing rules that allow for credentialing of health care providers that have information within said health care related data.

16. The computer program product of claim 11, wherein said health care related data comprises any of health care provider information, patient information, insurer information, plan information, institution information, entity information, or transaction information.

17. The computer program product of claim 11, wherein said plurality of applications comprises a queue that causes, responsively to one or more user instructions, one or more rules in said business rules layer to be applied to force the performance of tasks in a predetermined order.

18. The computer program product of claim 11, wherein the computer-readable program instructions further comprise instructions, which when performed by an apparatus, are configured to cause the apparatus to at least allow for modifications by the rules engine to the rules from one or more applications in the application layer.

19. The computer program product of claim 11, wherein said at least one rule having multiple layers includes successive layers wherein a subsequent layer is applied as each successive layer of the multiple layers of the at least one rule is satisfied, wherein each layer of the multiple layers has a series of attributes, and satisfaction of all attributes of the at least one layer will trigger application of the subsequent layer.

20. The computer program product of claim 11, wherein the plurality of health care business rules are subject to change and the changes to the rules are enforced on all data in both databases upon execution of a new rule.