Patent Application
20080059224
These and other features and advantages of the various embodiments disclosed herein will be better understood with respect to the following description and drawings, in which like numbers refer to like parts throughout, and in which:
The detailed description set forth below is intended as a description of the presently preferred embodiment of the invention, and is not intended to represent the only form in which the present invention may be constructed or utilized. The description sets forth the functions and sequences of steps for constructing and operating the invention. It is to be understood, however, that the same or equivalent functions and sequences may be accomplished by different embodiments and that they are intended to be encompassed within the scope of the invention.
Referring now to
To create a health profile, a patient population to which healthcare is provided must first be established at step 100. The patient population established at step 100 may consist of the individual covered members of a managed care organization or any subset thereof. The established patient population may also consist of any group of individuals for which a set of conditions can be identified and analyzed to further create a map of healthcare treatment as it relates to the established patient population, as described herein.
A plurality of disparate healthcare data providers is identified at step 105. This plurality of healthcare data providers comprises healthcare professionals, healthcare institutions and any other organization or group that is not a healthcare professional or healthcare institution but is capable of storing healthcare data or other data regarding treatments or interactions with an individual patient or data that may be relevant to the health of the general patient population. The group may generally include, but is not limited to physicians, specialists, emergency facilities, inpatient and outpatient facilities, medical groups, insurance companies, employers, county, state and federal level agencies or groups and veteran's care facilities. The healthcare professionals and institutions may include any professional or facility that is capable of delivering medical treatment or services to individual patients within the established patient population. The healthcare professionals and institutions are usually responsible for assessment, diagnosis and treatment of individual patients within the patient population seeking such treatment. Health care providers may further include individuals or organizations that maintain factual databases, such as a weather or demographic database, as further described herein.
The detailed data regarding each visit or interaction between a patient and any healthcare data provider in the healthcare delivery group is typically recorded in significant documentation at step 110. For example, the documentation associated with a typical visit to a healthcare professional may include physical copies of notes from the interaction that detail the patient's verbalized symptoms, as well as any other mental impressions of the healthcare professional. In addition, the documentation may contain diagnostic and laboratory test requests and results; general data submitted to the patient's health plan; evidence or other material indicating the cost or amount associated with the treatment of the patient during the interaction; and copies of any other internal documentation that may become historically relevant to the treatment of the particular individual patient. The diagnostic and laboratory test results and other data obtained during the interaction between the patient and the healthcare professional may be charted and analyzed, if necessary. Finally, the disease states, if any, of the individual patient are diagnosed based on the data obtained from the interaction and coded in an appropriate format and sequence at step 115. It can be appreciated by one skilled in the art that initially any such documentation may be either in electronic or hard copy format, but the documentation should be ultimately electronically formatted, as described herein.
Each of the healthcare care data providers must closely adhere to the strict coding procedure that standardizes medical diagnoses of disease states because the creation of an accurate healthcare profile is dependent upon proper coding of the diagnosed disease state or states of the individual patient. The International Statistical Classification of Diseases and Related Health Problems (ICD) is an example of a detailed coding system of known diseases and injuries. Diagnostic codes are used to group and identify diseases, disorders, symptoms and medical signs for the measurement of morbidity and mortality. Although several ICD diagnostic coding system variations currently exist in practice, the health profile system utilizes the ICD-9 coding system. Individual patient visits may be characterized by four separate ICD-9 codes. Accordingly, every complete diagnosis can be broken into a primary diagnosis, a secondary diagnosis, a tertiary diagnosis and a quaternary diagnosis. It should be noted that any of the other ICD diagnostic coding systems may be utilized in accordance with the features of the disclosed system and method, as described herein. Moreover, other diagnostic coding systems may be used such as the Hierarchical Condition Categories coding system (HCC). The HCC system codes individual patients according to the severity of the disease state to enable health plans to receive cost adjustments based on the degree of illness.
At step 120, the individual patient data obtained from the visit or interaction with the healthcare data provider, in addition to the coded diagnosed disease states, are converted to an electronic format. This can require entering the data into an electronic record utilizing an appropriate database software program. The electronic record may consist of multiple fields of data that are relevant to the individual patient visit and electronically searchable. Any data for an individual patient regarding any interaction with a healthcare data provider should be documented and recorded in a manner similar to the method provided at steps 110, 115 and 120 of
Referring to
The individual patient data is stored in an electronic record format by each healthcare data provider to facilitate the subsequent transfer of healthcare data and creation of the health profile. Accordingly, the network 205 of healthcare data provider preferably includes at least one network storage device 225 which acts as a repository for healthcare data. In particular, network storage device 225 stores data related to the healthcare of each individual patient interaction or visit. It should also be understood that each healthcare data provider represented in
Database server 220 is coupled to network storage device 225 and provides access upon request to the data stored in network storage device 225. Database server 220 is coupled to a managing server 215 which manages the resources of central network 205. Coupled to managing server 215 is at least one computing device 210, such as a desktop personal computer, for entering and managing the data stored in network storage device 225. It should be noted that computing device 210 may be any computing device that can access, transmit and receive data through an electronic network, including, but not limited to, a personal digital assistant.
Network 205 is configured to electronically communicate with a remote device 200 through a global electronic network 225, such as the Internet. In addition, managing server 215 of each healthcare data provider may be in a configuration that is controlled by one or more business entities and further configured to electronically communicate with other healthcare data providers and remote device 200 through a local area network. It should be appreciated by one skilled in the art that the illustrative embodiment shown in
Referring again to
The data retrieved at step 125 should contain most of the data gathered from the particular healthcare professional/patient interaction as originally input into an electronic record at step 110. Thus, the retrieved data includes all of the case management data, laboratory and pharmacy data, authorizations and possibly other data contained within each electronic record and related to each of the individual patient's visits, interactions, claims and encounters. The retrieved data contained within each electronic record may include specific data including, but not limited to, member identification, gender, name, the ICD-9 code or codes of the rendered diagnoses, age, place of service, hospitalization dates, provider category, health plan type, prescription medications, cost of provided services, financial or other insurance adjustment codes and other similar data generally recorded in the course of a patient visit or interaction.
At step 130, the user of the health profile system may select certain data categories from the aforementioned list or any other data category in the retrieved electronic record for inclusion in the health profile. Each electronic record, as retrieved, may contain an unlimited number of data categories that may or may not be relevant to the health profile. One category of data that is relevant to the inquiry and should be included in the health profile is the ICD-9 code.
At step 140, the user derives a subset of data from the existing set of data in which certain categories of data for each visit or interaction are each unique. This derivation is necessary to obtain only one instance of diagnosis of a particular disease state for an individual patient. For example, at step 140 the user may choose to select from the set of data obtained at step 135 the electronic record for each patient visit or interaction having a unique value for each of the following: member identification, gender and primary, secondary, tertiary and quaternary ICD-9 codes.
At step 145, each of the primary, secondary, tertiary and quaternary ICD-9 diagnoses codes are truncated to a three digit code. In the ICD-9 coding system, codes with three digits are included as the heading of a category of codes that may be further subdivided by the use of fourth and/or fifth digits to provide greater detail. For example, certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. For such conditions, the ICD-9 has a coding convention that requires the underlying condition be sequenced first followed by the manifestation. Only the three digits to the left of the decimal are relevant to the data derivation process of the health profile system. Thus, although diabetes mellitus with neurologic complications corresponds to ICD-9 code 250.6, only the diagnosis of diabetes, and not the underlying etiology, is relevant to the purpose of the health profile system. It should be noted that the user may choose not to truncate the ICD-9 code, in accordance with alternate techniques and preferences for particular data, without departing from the broader aspects of the present invention.
The data obtained at step 145 contains an unlimited number of ICD-9 codes. The number of unique ICD-9 codes may only be limited by the number of ICD-9 codes contained in the data retrieved at step 125. At step 150, the user must select the ICD-9 codes that correspond to the diagnosed disease states of interest from the set of data obtained at step 145. The purpose of the health profile system is to identify certain diagnosed disease states and predict additional expected or unexpected co-morbidities based on the diagnosis. The objective is to proactively manage the individual patient's disease state by developing a comprehensive treatment plan to prevent future episodic events, which also decreases provider utilization and healthcare service costs. Accordingly, the user of the health profile system can determine and select the particular disease states that an individual patient may be likely to suffer from simultaneously and which are relevant to the inquiry.
Referring again to
The disease conditions are clustered according to the various systems of the body. Vascular diseases include congestive heart failure, coronary artery disease, peripheral artery disease, hypertension, likelihood of strokes, and diabetes. Pulmonary diseases include asthma and chronic obstructive pulmonary disease. Neurologic complications include migraines, seizure disorder and Parkinson's Disease and gastrointestinal disorders include GERD, peptic ulcer syndrome and irritable bowl syndrome. These identified disease state diagnoses are just a few of the common complications of obesity. Other conditions may include lower back pain, hepatitis and depression.
The data derived in step 150 contains an unlimited number of point of service codes. Each point of service code corresponds to the place of service where the diagnosis was made and treatment was rendered. The point of service may be a hospital, an emergency facility, the individual patient's home, an ambulatory setting, or an inpatient or outpatient facility. Another purpose of the health profile system is to reduce the cost of healthcare services by predicting the co-morbidity and structuring the individual patient's disease management program to prevent the need for additional unnecessary treatment at certain points of service. The cost of healthcare is directly dependent upon the point of service. Thus, at step 155 the user may select the data for one or more particular places of services that correspond to treatment for the diagnosed disease states of interest. The user generates a health profile at step 160.
In the first example at 455, a patient has been hospitalized twice in a time period of one year and nine months for the diagnosed condition of Parkinson's Disease, which is a manageable disease if a patient's primary healthcare provider has the proper oversight of the patient. Although the nature of Parkinson's Disease provides for unexpected health events, such events have only occurred twice in a time period of one year and nine months. The individual patient in the first example at 455 is likely being properly managed. In the second example at 460, the individual patient has been hospitalized four times in less than a one year time period for a variety of conditions that may or may not be related. The frequency of hospitalization for the diagnosed disease states indicates that the patient is not being properly managed. The patient and the primary care provider may not be effectively communicating with respect to behavior modifications or other proper self-care techniques. The primary care provider may not even be aware of the additional provider utilization for the suffered health events. Accordingly, some form of intervention in the patient's health care is necessary. However, the primary health care provider can only intervene if he is aware of the individual patient's health status.
A healthcare provider having access to a health profile may anticipate unexpected co-morbidities with regard to an individual patient through further analysis of the occurrences of co-morbidities in other individual patients. For example,
The health profile system calculates the probabilities based on actual individual patient data so the healthcare provider can treat accordingly with a level of certainty. Preventative healthcare strategies and behavior modifications may be implemented before the individual patient develops the co-morbidities. Additionally, the health profile may provide support for other diagnostic procedures that may indicate the initial development of a co-morbidity before the condition is actually diagnosed. Therefore, it can be expected that the usual additional costs incurred may be lower or nonexistent with respect to the added complications and co-morbidities associated with a diagnosed disease state. It should be further noted that the health profile provided to an individual patient's healthcare team does not require the data of the individual patient to be included. For example, any provider or other group within the healthcare delivery system may recognize from the data contained within the health profile of a group of individual patients that one disease state appears to have a likelihood of occurring in association with another disease state and the treatment of a similarly diagnosed individual patient should be managed accordingly.
The health profile may also be analyzed to determine the likelihood of co-morbidities associated with genetic disease states to identify family members that may be at risk for developing any identified disease state. By determining the current health status of the at-risk family members and providing preventative care strategies and behavioral modification programs, the healthcare needs of these family members can be anticipated to reduce the future associated cost of treatment.
A healthcare provider having access to an individual patient's health profile may develop a holistic treatment approach to address each aspect of the patient's general health status because the healthcare provider has a map of the patient's healthcare history. The health profile can be provided to the individual patient's primary physician, in addition to any other healthcare provider that has a role in the healthcare provided to the individual patient. Each provider has a map of the general health state of the individual patient without having to search through volumes of medical data. Moreover, each provider does not have to rely on the often incomplete information provided by the patient with regard to treatment sought from other providers. The health profile may provide a global snapshot of an individual patient's relevant healthcare data, including, but not limited to, past and current diagnosed disease states, hospitalizations, prescription medications, and laboratory tests. The health profile may contain all or any combination of the data contained within the data retrieved at step 125 in
An individual patient's health profile may be coded on an integrated circuit chip, and implanted or ingested into the patient's body. In the case of implantation, the chip may be implanted anywhere on the body that does not interfere with the operation of the chip. Further, the chip should be able to establish a communication with a device outside the body, such as through wireless or radio transmission, so the data contained on the device may be easily retrieved or updated. This particular application may be implemented for soldiers engaged in military operations or, similarly, other individuals having a medical history that may not be easily accessible. An individual patient's health profile may also be coded on a wearable accessory, including but not limited to, a bracelet, belt, arm band, leg band or necklace.
The individual patient's health profile may also be encoded on a plastic card having a magnetic strip. The card may be provided to a healthcare provider that is providing services to an individual patient. The healthcare provider can swipe the plastic card in a machine adapted to read data encoded in such a manner for further review. The healthcare provider can use the data read from the encoded health profile to manage the general health state of the individual patient, as described herein. The health profile for a group of individual patients may be similarly encoded and provided to any organization or individual that may have an interest in the management of the healthcare treatment and/or associated cost, such as an employer, an insurance company or a healthcare professional. For example, an employer may choose to offer or implement educational or other awareness programs directed to the employees' wellness state. These programs can be directed to an individual or to any group of individuals that share the same or similar health concerns.
The health profile can also be utilized to create a registry of any healthcare data that may be based on two or more disparate databases. For example, the health profile system may be used to create a registry of other types of data including, but not limited to, such data associated with pathology, transplants, end state renal disease, orphan diseases, or hospice care.
To that end, it should be recognized that additional modifications and improvements of the present invention may also be apparent to those of ordinary skill in the art. Thus, the particular combination of parts and steps described and illustrated herein is intended to represent only certain embodiments of the present invention, and is not intended to serve as limitations of alternative devices and methods within the spirit and scope of the invention.
Through the mechanisms disclosed herein, the systems and methods of the present invention will be operative to identify associations of diagnosed disease states and predict future occurrences of the associated diagnosed disease states. It is contemplated that the systems and methods, although ideally suited for the use within managed care organizations, the same may find widespread applicability in virtually every type of organization responsible for the administration of healthcare, whether public or private in nature, and especially where it is considered desirable to predict future disease states and allocate resources commensurate with such forecasts. Accordingly, all far reaching applications should be considered to fall within the scope of the present invention.
