Method and system for generating personal/individual health records

• US 7,533,030 B2
• Filed: 07/28/2006
• Issued: 05/12/2009
• Est. Priority Date: 10/11/2000
• Status: Expired due to Term

• Current Assignee: Healthtrio LLC (Spok Holdings, Inc.)
• Original Assignee: Malik M. Hasan
• Inventors: Wallen, J. Dominic, Peterson, John C., Hasan, Malik M.
• Primary Examiner(s): Morgan; Robert W
• Assistant Examiner(s): SEREBOFF, NEAL
• Application Number:
  US11/495,092
• Publication Number:
  US 20070027721A1
• Time in Patent Office: 1,019 Days
• Field of Search: None
• US Class Current: 705/2
• CPC Class Codes: G06Q 30/04 Billing or invoicing
• CPC Class Codes: G16H 10/60 for patient-specific data, e.g. for electronic patient records
• CPC Class Codes: G16H 50/70 for mining of medical data, e.g. analysing previous cases of other patients

Abstract

A system and method for generating and/or updating a personal/individual health record. Inputs of data to the system may come from diverse sources including, but not limited to, patient questionnaires, insurance company (or other payor) claims data, hospitals, clinics and other institutional providers, and individual physicians and physicians'"'"' offices.

Claims

1. A data processing system for generating a personal/individual health record of a patient enrolled in a health plan of a payor, wherein the patient undergoes encounters with a plurality of health care providers regarding a health related issue of the patient, wherein the health care providers request payment for at least a portion of the cost for the encounters from the payor, wherein the health care providers submit health related information of the patient to the payor to support the cost of encounters with the patient, the data processing system comprising:

a personal health record (“

PHIR”

) system server comprising;

a messaging facility that receives payor claims data regarding the patient from the payor and not the health care providers and not the patient;

a personal health record (“

PHR”

) population engine operably associated with the messaging facility, wherein the PHR population engine extracts encounter data comprising at least one of a diagnosis, a treatment, a medication, and a procedure of the patient from the payor claims data received from the messaging facility, wherein the PHR population engine initially creates a personal/individual health record of the patient by storing one or more entries in the personal/individual health record based on the encounter data that was exclusively extracted from the payor claims data;

a correlation module that determines a universal health care concept code corresponding to the entries in the personal/individual health record and associates the universal health care concept code with one or more entries in the personal/individual health record; and

an access management module that communicates with at least one of the health care providers and the patient, wherein said access management module supplements existing entries in said personal/individual health record created by the PHR population engine based on input received from at least one of said patient and the health care providers of said patient via the Internet.

2. The system of claim 1, wherein said access management module is configured to transmit a description of said universal health care concept code to said client system.

3. The system of claim 2, wherein said PHR population engine is configured to associate a first description and a second description with said universal health care concept code, wherein said first description is synonymous with said second description.

4. The system of claim 2, wherein said first description uses medical terminology and wherein said second description uses layman'"'"'s terms.

5. The system of claim 4, further comprising a filtering module configured to determine whether said client system is a healthcare provider and wherein said access management module is configured to transmit said first description and not said second description if said filtering module determines said client system is a health care provider.

6. The system of claim 5, wherein said access management module is configured to transmit said second description and not said first description to said client system if said filtering module determines said client system is not a health care provider.

7. The system of claim 2, wherein said filtering module is configured to change the description of said universal health care concept code based on a description of a universal health care concept code up a universal health care concept code hierarchy to adjust the resolution of data.

8. The system of claim 6, wherein said PHR population engine is configured to determine whether said personal/individual health record includes any entries related to said universal health care concept code.

9. The system of claim 1, wherein said population engine is configured to associate entries in said personal/individual health record related to said universal health care concept code.

10. The system of claim 1, further comprising a PHR database configured to store a plurality of personal/individual health records and further comprising a data analysis module configured to identify patterns or relationships among said plurality of personal/individual health records based on related universal health care concept codes.

11. The system of claim 10, wherein said data analysis module is configured to identify patterns or relationships among over ten thousand personal/individual health records.

12. The system of claim 11, wherein said data analysis module is configured to measure effectiveness of healthcare treatment based on outcomes associated with said plurality of personal/individual health records having related universal health care concept codes.

13. The system of claim 11, wherein said data analysis module is configured to perform population studies based on universal health care concept codes in said plurality of personal/individual health records.

14. The system of claim 11, wherein said data analysis module is configured to analyze quality of care associated with health care providers based on an analysis of said plurality of personal/individual health records.

15. The system of claim 11, wherein said data analysis module is configured to analyze cost effectiveness of health care providers based on an analysis of said plurality of personal/individual health records.

16. The system of claim 1, further comprising a security module configured to associate an access list with each user capable of accessing the personal/individual health record, wherein said access list categorizes said personal/individual health record into a restricted set of entries and an accessible set of entries based on the universal health care concept code associated with each entry in the personal/individual health record, wherein the security module is configured to deny access to a user requesting an entry in the personal/individual health record if the requested entry is in the restricted set of entries, wherein the security module is configured to allow access to a user requesting an entry in the personal/individual health record if the requested entry is in the accessible set of entries.