Care engine

• US 6,802,810 B2
• Filed: 09/21/2001
• Issued: 10/12/2004
• Est. Priority Date: 09/21/2001
• Status: Expired due to Term

• Current Assignee: Activehealth Management Incorporated (CVS Health Corporation)
• Original Assignee: Activehealth Management Incorporated (CVS Health Corporation)
• Inventors: Blanksteen, Charles, Ciarniello, Anthony, Reisman, Lonny
• Primary Examiner(s): Jones, Mary Beth
• Assistant Examiner(s): McCrosky, David J.
• Application Number:
  US09/957,473
• Publication Number:
  US 20030060688A1
• Time in Patent Office: 1,117 Days
• Field of Search: 600/300, 600/301, 705/2, 705/3, 128/920, 128/923, 128/924, 128/925, 706/15, 706/20, 706/45, 706/924
• US Class Current: 600/300
• CPC Class Codes: A61B 5/0002 Remote monitoring of patients using telemetry, e.g. transmission of vital signals via a communication network A61B5/07 takes precedence; transmission systems for measured values G08C; transmission H04B; transmission of digital information H04L; wireless communication networks H04W
• CPC Class Codes: G06Q 40/08 Insurance
• CPC Class Codes: G16H 10/20 for electronic clinical trials or questionnaires
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• 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
• CPC Class Codes: G16H 50/20 for computer-aided diagnosis, e.g. based on medical expert systems
• CPC Class Codes: G16H 50/30 for calculating health indices; for individual health risk assessment
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients
• CPC Class Codes: G16H 80/00 ICT specially adapted for facilitating communication between medical practitioners or patients, e.g. for collaborative diagnosis, therapy or health monitoring

Abstract

The present invention offers a comprehensive solution to care management which aggregates, integrates and stores clinical information from disparate sources. The system finds at-risk individuals before they experience preventable, high-cost medical events and stratifies high risk populations according to clinical criteria, which can include severity of disease states and co-morbidities. The system also compares the actual care an individual is receiving to established standards of clinical excellence and, if necessary, suggests pertinent medical care considerations to improve the care of medically mismanaged individuals. Another feature of the present invention may include a secure, patient-specific Web page which is automatically populated with a patient'"'"'s own clinical information and can be personalized with customized, relevant healthcare information. The system allows users to design, facilitate and monitor clinical care plans and increase communications among physicians, nurses and patients. The system also predicts and analyzes the outcome of disease or case management for populations and individual patients.

Claims

1. An early warning detection system for identifying patient health risk, comprising:

a data base for storing a plurality of medical data and a plurality of patient data, said patient data including medical treatment information for a patient from at least one healthcare provider;

an analytical care application comprising a set of matrices, wherein each of said matrices contains a plurality of defined elements, wherein said defined elements incorporate said plurality of medical data; and

a computer processing unit for processing said plurality of patient data through said analytical care application for analysis through said matrices against said plurality of medical data, wherein said computer processing unit automatically makes an alternative treatment suggestion for the patient.

2. The early warning detection system of claim 1, wherein access to said system is available through a web based system.

3. The early warning detection system of claim 1, wherein said medical data is comprised of prescription drug data, lab data, and claims data.

4. The early warning detection system of claim 1, wherein said medical data and said patient data are retrieved over an electronic communications data link.

5. The early warning detection system of claim 1, wherein said analytical care application compares said plurality of patient data for a plurality of patients and identifies patients which may have a health risk due to identified risks defined within an element definition of said defined elements contained within said matrices.

6. The system of claim 1, wherein said plurality of elements are defined based upon clinical criteria.

7. The system of claim 6, wherein said plurality of elements include data related to the severity of disease states.

8. The system of claim 6, wherein said plurality of elements include data related to co-morbidites.

9. The system of claim 1, wherein said plurality of patient data includes a plurality of care data;

wherein said plurality of medical data contains a plurality of established standards data; and

said analytical care application compares said plurality of care data with said plurality of established standards data.

10. The system of claim 9, wherein said system identifies considerations for improvement of medical care.

11. A method of determining patients with potential health risks, comprising the steps of:

retrieving a plurality of medical data and a plurality of patient data;

storing said plurality of medical data and said plurality of patient data in a database, said patient data including medical treatment information for a patient from at least one healthcare provider;

defining a plurality of elements based upon said plurality of medical data;

grouping said plurality of elements into a plurality of matrices;

creating an analytical care application which defines the interaction amongst said plurality of defined elements grouped in said matrices and the interaction of said plurality of matrices;

processing said plurality of patient data through said analytical care application to indicate instances where some of said plurality of patient data does not correspond with a definition of at least one of said plurality of said elements; and

automatically making an alternative treatment suggestion for the patient using said analytical care application.

12. The method of claim 11, wherein said medical data is comprised of a plurality of prescription drug data, a plurality of lab data, and a plurality of claims data.

13. The method of claim 11, further comprising the steps of:

defining said plurality of elements based upon clinical criteria.

14. The method of claim 13, farther comprising the steps of:

including severity of disease states within said definitions.

15. The method of claim 13, further comprising the steps of:

including co-morbidites within said definitions.

16. The method of claim 11, further comprising the steps of:

comparing patient data related to patient care to medical data related to established standards of clinical excellence; and

identifying considerations for improvement of medical care.

18. The method of claim 11, further comprising the steps of:

designing a plurality of clinical care plans based upon said plurality of medical data; and

facilitating interaction amongst a plurality of medical personnel for use of said plurality of clinical care plans.

19. The method of claim 18, further including the steps of:

monitoring new patient data for compliance with at least one of said plurality of clinical care plans.

17. The method of claim ii, further including the steps of:

providing access to said plurality of patient data, plurality of medical data, and results of said processing said plurality of patient data through said analytical care application over a secure web based system.

20. An early warning detection system for identifying patient health risk, comprising:

a data base for storing a plurality of medical data and a plurality of patient data, said patient data including medical treatment information for a patient from at least one healthcare provider;

an analytical care application comprising a set of matrices, wherein each of said matrices contains a plurality of defined elements, wherein said defined elements incorporate said plurality of medical data; and

a computer processing unit for processing said plurality of patient data through said analytical care application for analysis trough said matrices against said plurality of medical data, wherein said computer processing unit identifies patient health risk by finding potential errors in the treatment of said patient based on available medical history.

21. The system of claim 20, wherein said computer processing unit identifies potential treatment errors automatically.