Enterprise management system

• US 9,269,117 B2
• Filed: 05/09/2006
• Issued: 02/23/2016
• 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: Fraser, Scott Edward, Pocklington, William Lee, Moore, Edmund B. Jr., Kuzmak, Beth Anne, Flanagan, Michael Sean
• Primary Examiner(s): Jalil, Neveen Abel
• Assistant Examiner(s): Levitian, Karina
• Application Number:
  US11/430,753
• Publication Number:
  US 20070067753A1
• Time in Patent Office: 3,577 Days
• US Class Current: 1/1
• 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 health care enterprise management system, comprising:

a routing layer having a processor and memory;

an application layer having a plurality of graphical user interfaces;

a business rules layer comprising a rules engine that provides a plurality of selectable rules wherein each of the plurality of selectable rules has rule attributes that define each of the rules, a data language normalization engine, and a plurality of health care business rules;

a core layer having a core database resident therein, the core database having health care related data resident therein for applying different applications, wherein data is associated with the data in the core layer by a link from a data entry in the core layer to an external data node of said entry point to the world-wide web or an Intranet; and

a dedicated database resident in said business rules layer, the dedicated database having stored therein said plurality of health care business rules comprising at least one rule having multiple layers and satisfaction of one of the attributes of at least one layer will trigger application of other attributes of the at least one layer, wherein a history of rules and rules changes are stored 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, wherein a history of the rules and rules changes are maintained in said database,

said routing layer provides 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

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

2. The system as in claim 1, wherein said routing layer provides connectivity between said application layer, said business rules layer, and said core database and an external application.

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

4. The system 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 system 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 system of claim 1, wherein said health care related data comprises data selected from the group consisting of health care provider information, patient information, insurer information, plan information, institution information, entity information, and transaction information.

7. The system of claim 1, wherein said health care related data comprises an attribute that varies dependent upon a record type.

8. The system of claim 7, wherein said plurality of health care business rules comprises at least one rule that varies said attribute.

9. The system of claim 8, wherein said core database does not accept said health care related data until all attributes required by said rule have been satisfied.

10. The system 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.

11. The system as in claim 1, wherein the rules engine allows for modifications to the rules from one or more applications in the application layer.

12. The system as in claim 11, wherein the modifications to the rules include rule triggers.

13. The system as in claim 1, wherein the rules engine provides a definable variety of available rules that provide scalability to the system.

14. The system as in claim 1, 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.

15. The system as in claim 14, wherein the attributes and the multiple layers are selectable from one or more of the graphical user interfaces of the application layer.

16. The system as in claim 14, wherein each of the multiple rules has a trigger and each trigger includes finite and definite processes.

17. The system as in 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.

18. The system of claim 17, wherein rules for each of the routing layer, the application layer, the business rules layer, and the core layer are added from an application in the application layer, applied by a rules engine in the business rules layer and enforced on data in the core layer.

19. The system of claim 18, wherein providers in a healthcare system are credentialed by the data in the core layer via credentialing rules, contracting rules in the core layer provide for contracting in a healthcare system, and claim rules are applied to the core layer to provide credentialing and contracting rules.

20. The system of claim 17, wherein a plurality of health care business rules are initially available with regard to healthcare patients and healthcare providers, and wherein both databases are expanded to include healthcare claims rules that operate on data and rules already present for patients and providers.

21. An enterprise management system, comprising a processor including:

a core layer having a core database resident therein, the core database layer having health care related data resident therein for applying different applications, wherein data is associated with the data in the core layer by a link from a data entry in the core layer to an external data node of said entry point to the world-wide web or an Intranet;

an application layer having a plurality of applications each providing a graphical user interface, at least one of said plurality of applications each providing a master graphical user interface;

a business rules layer having a dedicated database distinct from the core database layer and having a plurality of health care business rules stored therein and comprising at least one rule having multiple layers and satisfaction of one of the attributes of at least one layer will trigger application of other attributes of the at least one layer, said dedicated database being resident in said business rules layer, wherein a history of rules and rule changes are stored in both the core database layer and dedicated database resident in said business rules layer to allow for rule tracking and rule reporting, and

a rules engine that provides a plurality of selectable rules wherein each of the plurality of selectable rules has rule attributes that define each of the rules, a data language normalization engine and the plurality of health care business rules; and

a routing layer having a processor and memory, being configured to provide connectivity between said core database, said application layer, said business rules layer, and said master graphical user interface so that said master graphical user interface interacts with all of said graphical user interfaces to simultaneously access said health care related data and said health care business rules available through said plurality of applications,

wherein said business rules layer comprises a data language normalization engine.

22. The system of claim 21, 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.

23. The system of claim 21, wherein said health care related data comprises data selected from the group consisting of health care provider information, patient information, insurer information, plan information, institution information, entity information, and transaction information.

24. A system comprising:

a core layer having a core database resident therein, the core database having health care related data resident therein for applying different applications, wherein data is associated with the data in the core layer by a link from a data entry in the core layer to an external data node of said entry point to the world-wide web or an Intranet;

a plurality of applications selected from the group consisting of an Internet portal, a desktop, a reporter, and a remote application data collector;

a plurality of graphical user interfaces each in electrical communication with a respective one of said plurality applications;

a business rules database, distinct from the core database, with a plurality of health care business rules and a data language normalization engine stored therein, wherein a history of rules and rules changes may be kept in both the core database and the business rules database to allow for rule tracking and rule reporting, wherein

the business rules database has a rules engine that provides a plurality of selectable rules each having rule attributes that define each of the rules a data language normalization engine, and a plurality of health care business rules, and

said business rules database provides a communicative interface between each of said plurality of graphical user interfaces, said plurality of health care business rules, and said health care related data, wherein the health care business rules comprise at least one rule having multiple layers and satisfaction of one of the attributes of at least one layer will trigger application of other attributes of the at least one layer; and

a router, having a processor and memory, that provides connectivity between said core database, said plurality of applications, said business rules database, and all of said graphical user interfaces to simultaneously access said health care related data and said health care business rules available through said plurality of applications.