Patent Application
20090150329
In general, exemplary embodiments of the present invention relate to systems and methods for enhancing efficiency and communication among service providers and customers.
In the healthcare industry, systems that connect providers, patients, insurers, payors, and pharmacies are being developed at increasing rates. As the development of such systems continues, the functionality available to the users will be enhanced. The enhancements will alleviate many of the burdens of performing manual tasks that can be performed more effectively and efficiently with the aid of technology.
For instance, to communicate laboratory results to patients or others, providers typically mail letters with interpreted laboratory results, mail the laboratory results without interpreting them, or place telephone calls to report the laboratory results. Mailing the interpreted laboratory results or calling the parties can be both time consuming and prone to errors. And although mailing the actual laboratory results to patients may be quicker, it often creates patient confusion resulting in additional work for the provider.
In the same way, providers, such as pharmacists, often have workflows that health care plan providers, hospitals, and others request that the pharmacists perform. For instance, pharmacists often must check for the availability of generic prescriptions for each prescribed medication in accordance with a health care plan provider's request. Pharmacists also check for potential drug-to-drug interactions and allergic reactions that could be harmful to the patient. When potential issues like these arise, pharmacists and other providers typically place phone calls and wait in call queues to speak with the prescribing doctor to change the medication. Too often, the pharmacists wait on hold only to learn that they will receive a return phone call or must call back themselves. In addition to frustrating the pharmacist, this method of dealing with potential patient issues is inefficient and does not provide for adequate follow up for the pharmacists and providers.
Similarly, processing common tasks in high-volume can require significant provider resources if performed manually. For example, providers typically process a high number of prescription renewals for their patients. Currently, providers call or send faxes to the pharmacies to confirm prescription changes or renewals. This may result in waiting in a telephone queue to speak with a pharmacist or require typing, printing, and faxing instructions. The manual methods of performing these tasks are time consuming and error-prone ways for providers to perform common, high-volume tasks.
Thus, a need exists to provide for a more efficient way to transmit messages to and from providers reporting results, guide providers through workflows, communicate tasks that require action by third-parties, and manage and perform tasks in high-volume.
In general, exemplary embodiments of the present invention provide methods and systems for transmitting messages to and from providers reporting results, guiding providers through workflows, communicating tasks that require action to third-parties, and managing and performing tasks in high-volume.
In accordance with one embodiment, a method is provided for receiving results data, wherein the results data may include a procedure code and procedure results information. The results data containing the procedure code can then be mapped to one or more result templates. In this embodiment, one or more result templates can be displayed to a user to select one or more the result templates for use. After the appropriate result templates are selected, the method can include mapping the procedure results information to statement parts in the result template. This can then be used to generate a message reporting the results data.
In another embodiment, a system is provided in which the processor is configured to receive results data that may include a procedure code and procedure results information. The processor can be further configured to map the procedure code from the results data to at least one result template and cause the result templates to be displayed. The processor can also receive a selection selecting at least one of the result templates for use and map the procedure results information to statement parts of the result template. This can then be used to generate a message reporting the results data.
In another aspect of the invention, a method is provided for receiving customer information from a requesting party. The received customer information is used to determine if an intervention should be executed. In this embodiment, the intervention can be identified by an intervention ID. If an intervention should be executed the method provides for execution. After executing the intervention, the method provides for receiving a notification from the requesting party that at least one task needs to be performed by a third party. The method also includes notifying the third party of the task that needs to be completed.
In yet another embodiment, a system is provided in which the processor is configured to receive customer information from a requesting party and determine if the received information indicates that an intervention should be executed. If an intervention should be executed, the processor executes the intervention. The processor is also configured to receive a notification from the requesting party that at least one task needs to be performed by a third party. In response, the processor can be configured to transmit the task to be performed to the third party.
Having thus described the invention in general terms, reference will now be made to the accompanying drawings, which are not necessarily drawn to scale, and wherein:
The present invention now will be described more fully hereinafter with reference to the accompanying drawings, in which some, but not all embodiments of the inventions are shown. Indeed, these inventions may be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. Like numbers refer to like elements throughout.
As should be appreciated, the exemplary embodiments may be implemented as methods, apparatus, network entities, systems, or computer program products. Accordingly, the exemplary embodiments may take the form of an entirely hardware embodiment, an entirely software embodiment, or an embodiment combining software and hardware aspects. Furthermore, the various implementations may take the form of a computer program product on a computer-readable storage medium having computer-readable program instructions (e.g., computer software) embodied in the storage medium. More particularly, implementations of the exemplary embodiments may take the form of web-implemented computer software. Any suitable computer-readable storage medium may be utilized including hard disks, CD-ROMs, optical storage devices, or magnetic storage devices.
The exemplary embodiments are described below with reference to block diagrams and flowchart illustrations of methods, apparatus, network entities, systems, and computer program products. It should be understood that each block of the block diagrams and flowchart illustrations, respectively, can be implemented by computer program instructions, e.g., as logical steps. These computer program instructions may be loaded onto a general purpose computer, special purpose computer, or other programmable data processing apparatus to produce a machine, such that the instructions which execute on the computer or other programmable data processing apparatus implement the functions specified in the flowchart block or blocks.
These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including computer-readable instructions for implementing the functionality specified in the flowchart block or blocks. The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer-implemented process such that the instructions that execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart block or blocks.
Accordingly, blocks of the block diagrams and flowchart illustrations support various combinations for performing the specified functions, combinations of steps for performing the specified functions and program instructions for performing the specified functions. It should also be understood that each block of the block diagrams and flowchart illustrations, and combinations of blocks in the block diagrams and flowchart illustrations, can be implemented by special purpose hardware-based computer systems that perform the specified functions or steps, or combinations of special purpose hardware and computer instructions.
The Distribution Service System (“DSS”) 100 is a secure online connectivity solution that connects providers, patients, insurers, payors, and pharmacies. The DSS 100 can provide secure access to information in real-time. For example, the DSS 100 can provide the functionality that allows patients to access up-to-date account information, the ability to pay their bills online, and the ability to receive lab results via email. Providers can use DSS 100 to provide results to patients via email or fax, such as the results of a cholesterol panel. It can also be used to help providers process prescription renewals with pharmacies and/or guide providers through workflows while providing messaging, follow up, and billing functionality for each party. In short, a system such as DSS 100 has virtually endless functionality. The various embodiments of the DSS 100 could be implemented on a variety of platforms.
Alternatively, in another embodiment shown in
As mentioned,
In addition, the DSS 100 may include a storage device 63, such as a hard disk drive, a floppy disk drive, a CD ROM drive, or an optical disk drive, for storing information on various computer-readable media, such as a hard disk, a removable magnetic disk, or a CD-ROM disk. As will be appreciated, each of these storage devices 63 may be connected to the system bus 61 by an appropriate interface. The storage devices 63 and their associated computer-readable media provide nonvolatile storage. The computer-readable media described above could be replaced by any other type of computer-readable media, e.g., magnetic cassettes, flash memory cards, digital video disks, and Bernoulli cartridges.
A number of program modules may be stored by the various storage devices and within RAM 67. Such program modules may include a volume processing module 50, a workflow module 60, a template module 70, and an operating system 80. The volume processing module 50, the workflow module 60, and the template module 70 control certain aspects of the operation of the DSS 100, with the assistance of the processor 60 and operating system 80.
Also located within the DSS 100 is a network interface 74 for interfacing and communicating with other elements of a computer network. It will be appreciated that one or more of the DSS 100 components may be located remotely from other DSS 100 components. Furthermore, one or more of the components may be combined, and additional components performing functions described herein may be included in the DSS 100. In this regard, although various program modules are described, the software need not be modularized. Some of the functionality of the DSS 100 is described in the following sections.
The template module 70 can be used to communicate messages to and/or from providers, patients, insurers, payors, pharmacies, and/or any party desired. The template module 70 can populate or map (the terms populate and map are used interchangeably) information to a template that can be used to generate a message. In one embodiment, the template module 70 can be used to communicate messages such as laboratory results to patients. It should be understood, though, that the template module 70 can be used to map information that can be used to generate any kind of message.
As indicated in
The final step in creating a result template, in this embodiment, is to associate the range of results relating to the procedure or code with a statement part(s) (Step 310). A statement part is typically a statement(s) related to a range of results for a specific procedure. Exemplary statement parts are shown in
As indicated in
The result templates can be displayed, such as by name or otherwise in a listing or the like, to the provider as a suggestion of which template should be used. In this step, a single result template can be suggested by the template module 70 or several templates can be suggested (as seen in
As shown in
In the following sections, exemplary embodiments are described with a pharmacist as a user performing an intervention (or workflow) that requires action by a patient's doctor (e.g., a third party). In the embodiments, the workflow module 60 is described in phases that may include one or more steps. The phases and steps do not necessarily need to be performed in a specific order, but are presented as such to aid in understanding the various embodiments of the present invention. It should also be recognized that the embodiments of the present invention are not limited to pharmacists and doctors or to the health care industry. In fact, the various embodiments can be useful in a variety of industries in which client/customer plans that require action items and/or follow up by various parties.
Generally, the workflow module 60 enables providers, e.g., doctors and pharmacists, to view patient records, document medical information, and perform patient interventions via the DSS 100. The term “intervention” is used generically to connote a workflow that is used to generate an actionable care plan for a patient. The various interventions (or workflows) can be sponsored by different parties, such as health care plan providers, hospitals, or any other party. For example, a health care plan provider can require prescription-specific interventions such that each time a particular medication is prescribed it triggers a specific intervention. In one embodiment, the workflow module 60 can then guide the pharmacist through a series of questions, submit action items to the patient's doctor (e.g., requesting a change in medication or dosage), and receive the doctor's response once the action items have been acted upon.
Thus, as indicated, the “care plan” typically includes medical information about the patient and action that needs to be taken for or on behalf of the patient. In one embodiment, the created care plan can be sent electronically to the patient's doctor for completion of the action items. In response, the doctor can communicate the action item results via the DSS 100 to the pharmacist who created the care plan. In one embodiment, the doctor's response may indicate that the action items were completed/approved, rejected/denied, or that more follow-up is necessary. As should be recognized, the responses to the action items may vary depending on the nature of the items. Additionally, the workflow module 60 can also provide the doctor (or other third party) with ability to view and modify each care plan received or automatically generate follow-up tasks, including viewing the status of previously communicated action items and documenting notes or results related to the action items (see
As mentioned, in one embodiment, the workflow module can have several phases, some of which are indicated in
a. Identify Patients
One of the first steps that can be performed by the pharmacist is to locate a specific patient(s). As seen in
b. Document Medical Information
After retrieving the patient's record or other information, the pharmacist can document/record medical information relating to the patient (“Pamela Jones” in this example). To aid the pharmacist, the patient's record can be linked to the patient's actual medical record so that the pharmacist can retrieve any additional information that may be relevant to the intervention. As shown in
c. Execute/Run Interventions
As can be seen in
To access the various interventions, each intervention typically is associated with an intervention identification number (“intervention ID”). The intervention ID can contain a range of information including the amount billable by the providers for the intervention (the interventions may also be free) and/or the sponsoring health care plan provider. The intervention ID and the documented medical information can also be used to automatically retrieve information related to the intervention or patient. For example, in a cost effectiveness intervention, the workflow module 60 can automatically retrieve generic medications for the prescribed medication and the formulary status for the generic medication. After selecting the desired interventions (shown in
In either case, after selecting an intervention to execute and initiating the intervention (Step 1440), the pharmacist is guided through the intervention (e.g., a series of questions/steps). As shown in
d. Care Plan Creation and Follow Up
After confirming that the proposed care plan is accurate, the pharmacist can create the care plan and transmit it to the patient's physician (and Steps 1450 and 1455). The care plan can be communicated in a variety of ways, include fax, phone, or secure messaging (as shown
In addition to pending the action items for the doctor, the DSS 100 and workflow module 60 can be used to provide reminders to the doctor or pharmacist that action needs to be taken for a given intervention, care plan, and/or action item. In short, this provides the doctor with a user interface to view the pending interventions, care plans, and/or action items and to act upon them accordingly. Also, the doctor can view the completed interventions, care plans, and action items, which can then be used for billing purposes.
e. Billing and Reconciliation:
Each intervention ID can be associated with a billing code and/or a procedure code, such as an LOINC. This not only allows the providers to know how much they can bill for each intervention, care plan, or action item, it enables the workflow module 60 to automatically bill for the services once rendered (Step 1470). For example, when an action item is marked as complete, the workflow module 60 can notify the appropriate parties that the action item was completed and automatically submit the action item using the associated billing code and/or procedure code to a billing system (typically another module in the DSS 100).
Further, the DSS 100 can be used to provide the billing parties with a user interface through which they can track the status of each billed item. For example, as shown in
The volume processing module 50 also provides the user with the capability to scroll through or otherwise view the various tasks to choose one for processing. By selecting, scrolling over, or otherwise activating a task for processing, an expanded menu is provided for the task. The expanded menu can be used, for example, to resolve patient identities, create patient messages, create action items for doctors to perform, make prescription requests, and/or print and view the audit trail of the tasks. For instance, as shown in
Thus, the volume processing module 50 allows the user to process multiple tasks with efficiency. It should also be noted that the volume processing module 50 can process renewal requests and other such tasks in the same way or a similar way as the workflow module 70 processes an intervention as described above.
Many modifications and other embodiments of the inventions set forth herein will come to mind to one skilled in the art to which these inventions pertain having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is to be understood that the inventions are not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended claims. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for purposes of limitation.
