| Healthcare management system using patient profile data -> Monitor Keywords |
|
|
  Healthcare management system using patient profile dataRelated Patent Categories: Data Processing: Financial, Business Practice, Management, Or Cost/price Determination, Automated Electrical Financial Or Business Practice Or Management Arrangement, Health Care Management (e.g., Record Management, Icda Billing), Patient Record ManagementHealthcare management system using patient profile data description/claimsThe Patent Description & Claims data below is from USPTO Patent Application 20060143050, Healthcare management system using patient profile data. Brief Patent Description - Full Patent Description - Patent Application Claims
CROSS-REFERENCE TO RELATED APPLICATIONS [0001] The present application is related to concurrently filed, co-pending, and commonly assigned U.S. patent application Ser. No. ______, [Attorney Docket No. 66729/P021US/10409827], entitled "SYSTEM AND METHOD FOR SELECTING HEALTHCARE MANAGEMENT", the disclosure of which is hereby incorporated herein by reference. TECHNICAL FIELD [0002] This invention is related to medical systems and more particularly to systems and methods for providing medical alerts based on consolidation of a patient's medical information. BACKGROUND OF THE INVENTION [0003] Healthcare providers, such as physicians, druggists, nurses, and even the patient him or her self have only a limited view of health-related information pertaining to that patient which is necessary to make properly informed decisions. One limitation is the unavailability of the full range of data needed at a given time to make a fully informed medical decision. Another limitation is the inability to track data between different providers or between different visits to the same provider. For discussion, a visit is any contact with anyone in the chain of healthcare provision, including payors, claims processors, laboratories or pharmacists. [0004] By way of example, assume a person visits a doctor with a particular problem. The doctor (assuming it's the patients regular doctor) will know about chronic illnesses, such as diabetes, etc. of that patient. But what the doctor does not know is whether the patient has filled the last Rx and if he/she has, taken the medicine regularly. The healthcare provider may or may not know what other healthcare providers may have prescribed, and may or may not have lab test results ordered by other providers. Thus, when treatment is rendered it is done so without access to a wide body of knowledge pertaining to the patient. [0005] Another problem with the scenario discussed above is that when the provider does make a decision on treatment, he/she then tells the patient to go off and do something and to call if there is a problem. Unless the patient calls with a problem, the provider does not have any insight into what is happening to the patient. This is not a prudent way to manage a person's health and is particularly troublesome when the patient has a chronic illness. BRIEF SUMMARY OF THE INVENTION [0006] The present disclosure is directed to a system and method which gathers information from all of a person's healthcare providers and abstracts from that information the data necessary for a healthcare provider to render informed medical decisions. In one embodiment, information necessary to process proper payment to a provider (re: reimbursement to the insured patent) is used to develop a holistic view of the medical condition pertaining to the patient. Since this information comes from a myriad of providers, including physicians, surgeons, nurse case managers, druggists, testing labs, mental health counselors, dentists, oral surgeons, etc., the holistic view that is developed is comprehensive. [0007] In one embodiment, the system and method could set parameters on critical data such that if that data is outside the set parameters, alerts can be sent to the appropriate caregivers and/or patients. [0008] The foregoing has outlined rather broadly the features and technical advantages of the present invention in order that the detailed description of the invention that follows may be better understood. Additional features and advantages of the invention will be described hereinafter which form the subject of the claims of the invention. It should be appreciated that the conception and specific embodiment disclosed may be readily utilized as a basis for modifying or designing other structures for carrying out the same purposes of the present invention. It should also be realized that such equivalent constructions do not depart from the invention as set forth in the appended claims. The novel features which are believed to be characteristic of the invention, both as to its organization and method of operation, together with further objects and advantages will be better understood from the following description when considered in connection with the accompanying figures. It is to be expressly understood, however, that each of the figures is provided for the purpose of illustration and description only and is not intended as a definition of the limits of the present invention. BRIEF DESCRIPTION OF THE DRAWINGS [0009] For a more complete understanding of the present invention, reference is now made to the following descriptions taken in conjunction with the accompanying drawing, in which: [0010] FIG. 1 is one embodiment of a system and method for consolidating medical information from a myriad of healthcare providers; and [0011] FIG. 2 is a flow chart of one embodiment of system operation. DETAILED DESCRIPTION OF THE INVENTION [0012] The forms which are filed (usually electronically) by healthcare providers for reimbursement from payors contain clinical data pertaining to the patient. In addition, health care plans use pharmacy benefit management companies (PBMs) to evaluate and pay pharmacy claims. This process of verification generates pharmacy data which then compliment the treatment and diagnostic data obtained from doctors. In addition, when a physician orders diagnostic tests, (laboratory, imagine, etc. tests), the test costs are billed for either by the ordering physician or by the providing physician, such as by a radiologist. The claim for payment also goes to the payor. In most situations the actual test results are available in electronic format and will also go the payor. [0013] The system and method described herein takes advantage of the fact that all of this data funnels through a common point and can be used to provide a comprehensive holographic view of a patient's health. Thus, in the disclosed system and method, the health plan acts as the aggregator of information pertaining to its members and that aggregated information is used to create a meaningful representation of the medical profile of the member. [0014] Turning now to FIG. 1, system 10 shows one embodiment of a system and method for consolidating medical information from diverse sources, such as Service Provider 11, to give a consolidated profile of a patient. Service provider 11 represents service providers which could encompass test lab 101, pharmacies 102, hospitals 103, and physicians 104. Claims from any provider are submitted to a patient's insurer 12. Others, such as the user, user's family, or even unrelated systems such as, for example, a credit card profile system, shown as 121. At least a portion of the information coming from these various diverse sources is stored in database 13. While it is contemplated that the raw data be stored in database 13 it could be that only abstracted data (such as above or below limit data) is so stored. Also note that database. 13 could accept data from other insurers 19 which could occur, for example, if a patient were to have multiple insurers (husband and wife; private and government, etc). [0015] Assuming patient 16 used provider 15 as a primary provider but also used other providers 17 (cardiologist, diabetic specialist, obstetrician/gynecologist), it could be appropriate for any one or more of these providers to set "rules" for the patient. These rules could pertain to filling and refilling a prescription, taking and sending certain monitored readings (sugar levels, air flow, etc.), limits on certain readings, etc. These rules are stored in rules engine 18 on a patient-by-patient basis and when a rule has been attained (i.e., a certain monitored fact is outside a limit), then monitor application 14 sends a message, (e-mails, telephone, fax, etc) to provider 15 (and possibly also to one or more other parties, including the patient). [0016] Claims are submitted from various service providers, as well as the patient, and these claims may be formatted differently based on the reason for the data exchange. To handle such a situation, proper interfacing between systems is required and this is handled by adaptors, such as adapters 120. [0017] One example of how the system and method could work is where physician A has prescribed a particular medication for a patient and physician B, possibly because that patient failed to inform physician B of the medication he/she is taking, prescribed another medication that might be dangerous when mixed with the first medication or possibly negates the effects of the first medication. In such a situation, the system would generate an alert to the patient and, if desired, to both physicians A and B. The reason the alert can be delivered is because of the composite view of a patient's medical history as obtained from payment records. Since the system is based upon data coming to a payor for reimbursement, over-the-counter medicines or medicines that are not paid for by the provider will only get into the system if the patient (or someone acting for the patient) sends in the data. [0018] Another example would be if a patient has asthma and is asked to measure his/her peak air flow daily and to call the physician if the readings go below a certain level. Frequently patients don't follow through with the instructions or are worried about calling ("bothering") the physician. Using this system a member could go online to record his/her peak flow every day. This on-line data is then sent to the system. A rule is set up in the system that says: if air flow falls below a certain level, or if there is a significant downward trend, issue an Alert Thus, even if the patient is not at the critical stage, alerts are sent and trouble can be averted. The physician cannot take phone calls from patients every day and calculate changes to air flow, but the provider could set the system to accept a patient's input and to call (alerts) when certain limits are met. In addition, patients can input symptoms, such as coughing, vomiting, chest pain, headaches, temperature, blood pressure, etc., and this data can be used to trigger an alert based either on a general group rule, or on parameters set individually for that patient. Continue reading about Healthcare management system using patient profile data... Full patent description for Healthcare management system using patient profile data Brief Patent Description - Full Patent Description - Patent Application Claims Click on the above for other options relating to this Healthcare management system using patient profile data patent application. ###  How KEYWORD MONITOR works... a FREE service from FreshPatents1. Sign up (takes 30 seconds). 2. Fill in the keywords to be monitored. 3. Each week you receive an email with patent applications related to your keywords. Start now! - Receive info on patent apps like Healthcare management system using patient profile data or other areas of interest. ### Previous Patent Application: System and method for orchestrating clinical collaboration sessions Next Patent Application: Method, system and article of manufacture, such as a card, to provide user selectable medical information and information to obtain elegibility of healthcare payments Industry Class: Data processing: financial, business practice, management, or cost/price determination ### FreshPatents.com Support Thank you for viewing the Healthcare management system using patient profile data patent info. IP-related news and info Results in 2.02915 seconds Other interesting Feshpatents.com categories: Novartis , Pfizer , Philips , Polaroid , Procter & Gamble , |
||
