Patent Application
20230097574
The present inventive concepts relate generally to health care systems and services and, more particularly, to retrieving clinical information associated with patients.
Health care service providers record clinical information associated with patients under their care in clinical charts, which are typically stored as electronic health records. Various stakeholders may seek access to clinical information associated with patients for a variety of different reasons. These stakeholders may include, but are not limited to, payors (e.g., private and/or public health insurance entities), life insurance companies, and/or clinical research organizations. Various options may exist for a requestor to retrieve clinical information associated with one or more patients including different media types (e.g., paper or electronic), different data formats and/or protocols used for retrieving the clinical information, different network paths, including use of one or more intermediaries (e.g., use of a third party record retrieval service), different repositories for the clinical information (e.g., storage at the health care provider facility, storage at a cloud location, storage at a third-party managed facility, etc.). Typically, a requestor relies on the same method or service for retrieving patient clinical information, but this method may not always be the most cost effective and/or efficient in retrieving the clinical information the requestor desires.
According to some embodiments of the inventive concept, a method comprises: receiving a request for clinical information associated with one or more patients from a requestor, the request being associated with requested values for one or more parameters associated with a plurality of network sources for retrieving the clinical information; comparing the requested values with characteristic values for the one or more parameters of each of the plurality of network sources to generate a comparison result; selecting one of the plurality of network sources based on the comparison result; and communicating the request for clinical information to the one of the plurality of network sources that was selected.
In other embodiments, at least one of the requested values is received with the request for the clinical information.
In other embodiments, the method further comprises: determining whether a result of the request that was communicated to the one of the plurality of network sources was successful or unsuccessful; determining a financial cost associated with the request that was communicated to the one of the plurality of network sources; and updating the characteristic values of the one of the plurality of network sources based on the result of the request and the financial cost associated with the request.
In still other embodiments, the one or more parameters associated with the plurality of network sources comprise: a financial cost for request fulfillment; a success rate for request fulfillment; a media type used for request fulfillment; a media access type used for request fulfillment; a response time for request fulfillment; a document processing technique applied for request fulfillment; or purposes of use supported for request fulfillment.
In still other embodiments, the media type used for request fulfillment parameter is configured to assume a value of electronic format or paper format.
In still other embodiments, the media access type used for request fulfillment parameter is configured to assume one or more values of Fast Healthcare Interoperability Resources (FHIR) protocol, Electronic Data Interchange (EDI) format, United States Core Data for Interoperability (USCDI) Consolidated-Clinical Document Architecture (C-CDA) format, paper communication and/or electronic mail messaging.
In still other embodiments, the financial cost for request fulfillment is configured to be expressed as a financial cost for a single request for clinical information for a single patient; and/or the financial cost is configured to be expressed as a financial cost for multiple requests for clinical information of a single patient over a defined time period.
In still other embodiments, the defined time period is one year or one month.
In still other embodiments the financial cost for request fulfillment is dependent on values for the media type used for request fulfillment parameter and/or the media access type used for request fulfillment parameter.
In still other embodiments, the purposes of use supported for request fulfillment is configured to assume a value of benefits determination, life insurance eligibility determination, clinical research, or patient risk adjustment for insurance.
In still other embodiments, the method further comprises defining priority weights for the one or more parameters associated with the plurality of network sources. Selecting the one of the plurality of network sources based on the comparison result comprises selecting the one of the plurality of network sources based on the comparison result and the priority weights for the one or more parameters associated with the plurality of network sources.
In some embodiments of the inventive concept, a system comprises a processor; and a memory coupled to the processor and comprising computer readable program code embodied in the memory that is executable by the processor to perform operations comprising: receiving a request for clinical information associated with one or more patients from a requestor, the request being associated with requested values for one or more parameters associated with a plurality of network sources for retrieving the clinical information; comparing the requested values with characteristic values for the one or more parameters of each of the plurality of network sources to generate a comparison result; selecting one of the plurality of network sources based on the comparison result; and communicating the request for clinical information to the one of the plurality of network sources that was selected.
In further embodiments, the operations further comprise: determining whether a result of the request that was communicated to the one of the plurality of network sources was successful or unsuccessful; determining a financial cost associated with the request that was communicated to the one of the plurality of network sources; and updating the characteristic values of the one of the plurality of network sources based on the result of the request and the financial cost associated with the request.
In still further embodiments, the one or more parameters associated with the plurality of network sources comprise: a financial cost for request fulfillment; a success rate for request fulfillment; a media type used for request fulfillment; a media access type used for request fulfillment; a response time for request fulfillment; a document processing technique applied for request fulfillment; or purposes of use supported for request fulfillment; wherein the media type used for request fulfillment parameter is configured to assume a value of electronic format or paper format; wherein the media access type used for request fulfillment parameter is configured to assume one or more values of Fast Healthcare Interoperability Resources (FHIR) protocol, Electronic Data Interchange (EDI) format, United States Core Data for Interoperability (USCDI) Consolidated-Clinical Document Architecture (C-CDA) format, paper communication and/or electronic mail messaging; wherein the financial cost for request fulfillment is configured to be expressed as a financial cost for a single request for clinical information for a single patient, and/or wherein the financial cost is configured to be expressed as a financial cost for multiple requests for clinical information of a single patient over a defined time period; wherein the financial cost for request fulfillment is dependent on values for the media type used for request fulfillment parameter and/or the media access type used for request fulfillment parameter; and wherein the purposes of use supported for request fulfillment is configured to assume a value of benefits determination, life insurance eligibility determination, clinical research, or patient risk adjustment for insurance.
In still further embodiments, the defined time period is one year or one month.
In still further embodiments, the operations further comprise: defining priority weights for the one or more parameters associated with the plurality of network sources. Selecting the one of the plurality of network sources based on the comparison result comprises selecting the one of the plurality of network sources based on the comparison result and the priority weights for the one or more parameters associated with the plurality of network sources.
In some embodiments, a computer program product comprises a non-transitory computer readable storage medium comprising computer readable program code embodied in the medium that is executable by a processor to perform operations comprising: receiving a request for clinical information associated with one or more patients from a requestor, the request being associated with requested values for one or more parameters associated with a plurality of network sources for retrieving the clinical information; comparing the requested values with characteristic values for the one or more parameters of each of the plurality of network sources to generate a comparison result; selecting one of the plurality of network sources based on the comparison result; and communicating the request for clinical information to the one of the plurality of network sources that was selected.
In other embodiments, the operations further comprise: determining whether a result of the request that was communicated to the one of the plurality of network sources was successful or unsuccessful; determining a financial cost associated with the request that was communicated to the one of the plurality of network sources; and updating the characteristic values of the one of the plurality of network sources based on the result of the request and the financial cost associated with the request.
In still other embodiments, the one or more parameters associated with the plurality of network sources comprise: a financial cost for request fulfillment; a success rate for request fulfillment; a media type used for request fulfillment; a media access type used for request fulfillment; a response time for request fulfillment; a document processing technique applied for request fulfillment; or purposes of use supported for request fulfillment; wherein the media type used for request fulfillment parameter is configured to assume a value of electronic format or paper format; wherein the media access type used for request fulfillment parameter is configured to assume one or more values of Fast Healthcare Interoperability Resources (FHIR) protocol, Electronic Data Interchange (EDI) format, United States Core Data for Interoperability (USCDI) Consolidated-Clinical Document Architecture (C-CDA) format, paper communication and/or electronic mail messaging; wherein the financial cost for request fulfillment is configured to be expressed as a financial cost for a single request for clinical information for a single patient, and/or wherein the financial cost is configured to be expressed as a financial cost for multiple requests for clinical information of a single patient over a defined time period; wherein the financial cost for request fulfillment is dependent on values for the media type used for request fulfillment parameter and/or the media access type used for request fulfillment parameter; and wherein the purposes of use supported for request fulfillment is configured to assume a value of benefits determination, life insurance eligibility determination, clinical research or patient risk adjustment for insurance.
In still other embodiments, the defined time period is one year or one month.
In still other embodiments, the operations further comprise: defining priority weights for the one or more parameters associated with the plurality of network sources. Selecting the one of the plurality of network sources based on the comparison result comprises selecting the one of the plurality of network sources based on the comparison result and the priority weights for the one or more parameters associated with the plurality of network sources.
Other methods, systems, articles of manufacture, and/or computer program products according to embodiments of the inventive concept will be or become apparent to one with skill in the art upon review of the following drawings and detailed description. It is intended that all such additional systems, methods, articles of manufacture, and/or computer program products be included within this description, be within the scope of the present inventive subject matter and be protected by the accompanying claims.
Other features of embodiments will be more readily understood from the following detailed description of specific embodiments thereof when read in conjunction with the accompanying drawings, in which:
In the following detailed description, numerous specific details are set forth to provide a thorough understanding of embodiments of the inventive concept. However, it will be understood by those skilled in the art that embodiments of the inventive concept may be practiced without these specific details. In some instances, well-known methods, procedures, components, and circuits have not been described in detail so as not to obscure the inventive concept. It is intended that all embodiments disclosed herein can be implemented separately or combined in any way and/or combination. Aspects described with respect to one embodiment may be incorporated in different embodiments although not specifically described relative thereto. That is, all embodiments and/or features of any embodiments can be combined in any way and/or combination.
As used herein, the term “provider” may mean any person or entity involved in providing health care products and/or services to a patient.
As used herein, the term “network source” may mean a combination of network path and information repository. Thus, one network source may differ from another network source if they have different network paths, different information repositories, and/or different network paths and different information repositories.
Some embodiments of the inventive concept stem from a realization that stakeholders, such as payors (e.g., private and/or public health insurance entities), life insurance companies, clinical research organizations, and the like may seek access to patient clinical information stored, for example, as patient health records or charts. Oftentimes, the clinical information requested may be obtained from more than one information repository and/or using more than one network path. These clinical information repositories and/or network paths may have advantages and disadvantages relative to each other with respect to financial cost, convenience, reliability, speed, or other performance metrics. Embodiments of the inventive concept may provide a network source selection system that may receive a request for clinical information along with one or more values for parameters associated with the different network sources that may be used to retrieve the requested clinical information. These parameters may include, but are not limited to, a financial cost for fulfilling the request, a success rate in fulfilling requests, a media type used in fulfilling requests (e.g., electronic format or paper format), a media access type used in fulfilling requests (e.g., use of the Fast Healthcare Interoperability Resources (FHIR) protocol, use of the Electronic Data Interchange (EDI) format, use of the United States Core Data for Interoperability (USCDI) Consolidated-Clinical Document Architecture (C-CDA) format, use of paper communication and/or electronic mail messaging), a response time for request fulfillment (e.g., is the document requested in real time, near real time, over a 24-hour period, or some other requested response time), a document processing technique applied for request fulfillment (e.g., is the document pre-processed for duplication, standardization, and/or normalization), and the purposes of use supported in fulfilling requests.
The financial cost may be expressed in different ways. For example, the financial cost for request fulfillment may be expressed as a financial cost for a single request as some network sources charge a particular amount for each record pull corresponding to a single patient. The financial cost for request fulfillment may also be expressed as a financial cost for multiple requests for clinical information for a single patient over a defined time period, such as a single year or single month. In this regard, a network source may charge a requestor, such as a payor, a set amount based on a per member (e.g., patient) per year or month basis.
The purposes of use parameter may assume a value of benefits determination, life insurance eligibility determination, patient risk adjustment for insurance, and/or clinical research. Certain network sources may restrict the release of clinical information to requestors based on the manner in which the information will be used.
A requestor may define priority weights for the one or more parameters associated with the network sources. The network source selection system may use these weights in selecting one of the network sources to fulfill a request. For example, while one network source may provide the lowest financial cost, the network source may have a relatively low success rate for request fulfillment. A requestor may place greater priority on reliability as manifest by successful request fulfillments relative to financial cost. A network source may also provide a low financial cost, but is capable of fulfilling requests only in paper format resulting in a relatively slow response time and a more difficult format in which to review the retrieved clinical information. Accordingly, a requestor may place greater priority on media type relative to financial cost.
Once a network source is selected and the clinical information request is communicated to the network source, the network source selection system may determine whether the request was fulfilled successfully and may also determine the financial cost associated with fulfilling the request to update characteristic values of the parameters corresponding to the selected network source. The characteristic values may be a typical value or a range of values for one or more of the parameters corresponding to a particular network source.
The network source selection system may, therefore, identify a network source for fulfilling a request for clinical information that aligns with the requestor's preferences in terms of financial cost, convenience, format, and reliability.
Referring to
According to embodiments of the inventive concept, a network source selection system may be configured to retrieve clinical information by way of patient charts or records for one or more requestors, such as, but not limited to, a payor 160a, a life insurance provider 160b, and a clinical researcher 160c. The network source selection system includes a network source selection server 130, which may include a network source selection module 135 that may be configured to receive a request for clinical information along with one or more values for parameters associated with the different network sources that may be used to retrieve the requested clinical information. The clinical information that is requested may be obtained from more than one information repository and/or using more than one network path. For example, as shown in
A network 150 couples the patient intake/accounting system servers 105a, 105b to the network source selection server 130 and couples requestors, such as the payor 160a, life insurance provider and 160b, and clinical researcher 160c to the network source selection server 130 and the various network sources for retrieving clinical information. The network 150 may be a global network, such as the Internet or other publicly accessible network. Various elements of the network 150 may be interconnected by a wide area network, a local area network, an Intranet, and/or other private network, which may not be accessible by the general public. Thus, the communication network 150 may represent a combination of public and private networks or a virtual private network (VPN). The network 150 may be a wireless network, a wireline network, or may be a combination of both wireless and wireline networks.
The network source selection service for retrieving clinical information provided through the network source selection server 130 and the network source selection module 135 may, in some embodiments, be embodied as a cloud service. For example, clinical information requestor may access the network source selection system as a Web service. In some embodiments, the network source selection system service may be implemented as a Representational State Transfer Web Service (RESTful Web service).
Although
As described above, the network source selection system, according to some embodiments of the inventive concept, may be configured to monitor the result of the request to update the characteristic values for parameters corresponding to the selected network source. Referring to
Referring now to
The network source selection rules module 815 may provide the rules 345 for automatically selection a network source for retrieving clinical information as described above with respect to
Although
Computer program code for carrying out operations of data processing systems discussed above with respect to
Moreover, the functionality of the network source selection server 130 of
The data processing apparatus described herein with respect to
Some embodiments of the inventive concept may provide a network source selection system that may automate the evaluation of multiple network sources for retrieving clinical information for a requestor thereby improving the ability of a requestor to obtain clinical information a more cost effective and efficient manner. Moreover, a requestor may assign priority weights to parameters associated with the network sources to express the requestor's preferences with respect to the relative importance of one parameter to another. This may allow the network source selection system to select a network source for fulfilling a clinical information request that more closely aligns with the requestor's preferences with respect to cost, format, speed, reliability, or other factor.
In the above-description of various embodiments of the present inventive concept, it is to be understood that the terminology used herein is for the purpose of describing particular embodiments only and is not intended to be limiting of the invention. Unless otherwise defined, all terms (including technical and scientific terms) used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this inventive concept belongs. It will be further understood that terms, such as those defined in commonly used dictionaries, should be interpreted as having a meaning that is consistent with their meaning in the context of this specification and the relevant art and will not be interpreted in an idealized or overly formal sense expressly so defined herein.
The flowchart and block diagrams in the figures illustrate the architecture, functionality, and operation of possible implementations of systems, methods, and computer program products according to various aspects of the present inventive concept. In this regard, each block in the flowchart or block diagrams may represent a module, segment, or portion of code, which comprises one or more executable instructions for implementing the specified logical function(s). It should also be noted that, in some alternative implementations, the functions noted in the block may occur out of the order noted in the figures. For example, two blocks shown in succession may, in fact, be executed substantially concurrently, or the blocks may sometimes be executed in the reverse order, depending upon the functionality involved. It will also be noted that each block of the block diagrams and/or flowchart illustration, and combinations of blocks in the block diagrams and/or flowchart illustration, can be implemented by special purpose hardware-based systems that perform the specified functions or acts, or combinations of special purpose hardware and computer instructions.
The terminology used herein is for the purpose of describing particular aspects only and is not intended to be limiting of the inventive concept. As used herein, the singular forms “a”, “an” and “the” are intended to include the plural forms as well, unless the context clearly indicates otherwise. It will be further understood that the terms “comprises” and/or “comprising,” when used in this specification, specify the presence of stated features, integers, steps, operations, elements, and/or components, but do not preclude the presence or addition of one or more other features, integers, steps, operations, elements, components, and/or groups thereof. As used herein, the term “and/or” includes any and all combinations of one or more of the associated listed items. Like reference numbers signify like elements throughout the description of the figures.
In the above-description of various embodiments of the present inventive concept, aspects of the present inventive concept may be illustrated and described herein in any of a number of patentable classes or contexts including any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof. Accordingly, aspects of the present inventive concept may be implemented entirely hardware, entirely software (including firmware, resident software, micro-code, etc.) or combining software and hardware implementation that may all generally be referred to herein as a “circuit,” “module,” “component,” or “system.” Furthermore, aspects of the present inventive concept may take the form of a computer program product comprising one or more computer readable media having computer readable program code embodied thereon.
Any combination of one or more computer readable media may be used. The computer readable media may be a computer readable signal medium or a computer readable storage medium. A computer readable storage medium may be, for example, but not limited to, an electronic, magnetic, optical, electromagnetic, or semiconductor system, apparatus, or device, or any suitable combination of the foregoing. More specific examples (a non-exhaustive list) of the computer readable storage medium would include the following: a portable computer diskette, a hard disk, a random access memory (RAM), a read-only memory (ROM), an erasable programmable read-only memory (EPROM or Flash memory), an appropriate optical fiber with a repeater, a portable compact disc read-only memory (CD-ROM), an optical storage device, a magnetic storage device, or any suitable combination of the foregoing. In the context of this document, a computer readable storage medium may be any tangible medium that can contain or store a program for use by or in connection with an instruction execution system, apparatus, or device.
The description of the present inventive concept has been presented for purposes of illustration and description, but is not intended to be exhaustive or limited to the inventive concept in the form disclosed. Many modifications and variations will be apparent to those of ordinary skill in the art without departing from the scope and spirit of the inventive concept. The aspects of the inventive concept herein were chosen and described to best explain the principles of the inventive concept and the practical application, and to enable others of ordinary skill in the art to understand the inventive concept with various modifications as are suited to the particular use contemplated.
