U.S. patent application number 12/834376 was filed with the patent office on 2011-01-13 for health care management system.
This patent application is currently assigned to BEST DOCTORS, INC.. Invention is credited to Lawrence S. Brewster, Evan J. Falchuk, Kenneth H. Falchuk, Jose A. Halperin.
Application Number | 20110010190 12/834376 |
Document ID | / |
Family ID | 42314175 |
Filed Date | 2011-01-13 |
United States Patent
Application |
20110010190 |
Kind Code |
A1 |
Falchuk; Kenneth H. ; et
al. |
January 13, 2011 |
HEALTH CARE MANAGEMENT SYSTEM
Abstract
The present invention relates to a system and method for
facilitating and managing health care between a medical provider
and a patient. In one aspect, the system and method includes
providing a patient having a first criteria, which includes a
medical symptom. The system and method also include selecting a
subset of medical providers having expertise in treating the
medical symptom, generating a care request to obtain a treatment
proposal for the medical symptom of the patient, and updating the
care request with medical information associated with the medical
sympton. The system and method further include receiving at least
one treatment proposal of the medical symptom from the medical
providers and selecting a treatment proposal of the medical symptom
from the medical providers.
Inventors: |
Falchuk; Kenneth H.;
(Newton, MA) ; Halperin; Jose A.; (Brookline,
MA) ; Falchuk; Evan J.; (W. Newton, MA) ;
Brewster; Lawrence S.; (East Falmouth, MA) |
Correspondence
Address: |
Patent GC LLC;c/o CPA Global
P.O. Box 52050
Minneapolis
MN
55402
US
|
Assignee: |
BEST DOCTORS, INC.
Boston
MA
|
Family ID: |
42314175 |
Appl. No.: |
12/834376 |
Filed: |
July 12, 2010 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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09705198 |
Nov 2, 2000 |
7756721 |
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12834376 |
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08818155 |
Mar 14, 1997 |
6256613 |
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09705198 |
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60163520 |
Nov 4, 1999 |
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Current U.S.
Class: |
705/2 ;
705/500 |
Current CPC
Class: |
G16H 40/20 20180101;
G16H 40/67 20180101; G16H 15/00 20180101; G16H 70/20 20180101; G06Q
99/00 20130101 |
Class at
Publication: |
705/2 ;
705/500 |
International
Class: |
G06Q 50/00 20060101
G06Q050/00; G06Q 90/00 20060101 G06Q090/00 |
Claims
1. A method for managing health care requests comprising: providing
a patient having a first criteria, including a medical symptom,
from a plurality of patients; selecting a subset of medical
providers having expertise in treating the medical symptom from a
plurality of medical providers; generating a care request to obtain
a treatment proposal for the medical symptom of the patient;
updating the care request with medical information associated with
the medical symptom; receiving at least one treatment proposal of
the medical symptom from the medical providers; and selecting a
treatment proposal from at least one of the treatment
proposals.
2. The method of claim 1 further comprising: transmitting each
treatment proposal to each medical provider to enable modifications
by each medical provider; receiving a treatment proposal from each
medical provider; and transmitting each treatment proposal to the
patient.
3. The method of claim 2 further comprising having a time period at
which the treatment proposals can be accepted.
4. The method of claim 1 wherein the generating a care request
further comprises generating a care request by one of the patient,
an insurer, a physician treating the patient, a medical director of
the insurer, and a staff member.
5. The method of claim 1 further comprising providing a comparative
report of each received treatment proposal to the patient.
6. The method of claim 1 wherein the first criteria further
comprises one of insurance coverage, other means of payment, and a
specified level of complexity required to treat the medical
symptom.
7. The method of claim 1 further comprising selecting the subset of
medical providers based on at least one of cost, medical
experience, number of procedures treating the medical symptom that
have been performed, amount of expertise related to the medical
symptom, amount of education, and reputation.
8. The method of claim 1 further comprising using a large scale
communications network to communicate at least one of the care
request, the treatment proposal, and the comparative report.
9. The method of claim 8 wherein the large scale communications
network is a secure large scale communications network.
10. The method of claim 1 wherein the medical information is
analytically developed information based on the care request.
11. A method for managing health care requests comprising:
receiving care requests from a plurality of patients; selecting one
of the plurality of patients having a first criteria, the first
criteria including a medical symptom; selecting a subset of medical
providers having expertise in treating the medical symptom;
generating a care request by the patient to obtain a treatment
proposal for the medical symptom; updating, by a medically trained
individual, the care request with medical information associated
with the medical issue of the patient; providing the care request
to the subset of medical providers; receiving a treatment proposal
of the medical symptom from at least one of the medical providers;
providing a comparative report of the treatment proposals;
transmitting each treatment proposal to each medical provider to
enable each medical provider to modify their treatment proposal;
receiving a final treatment proposal from each medical provider;
transmitting each final treatment proposal to the patient; and
receiving a selection of one of the final treatment proposals
associated with at least one of the medical providers from the
patient.
12. The method of claim 11 further comprising informing one of the
medical providers of the selection of the treatment proposal.
13. A health care management system comprising: a patient-client
interface for providing a patient having a medical symptom; a
provider-client interface for providing a medical provider having
expertise in treating the medical symptom; and a server in
communication with the provider-client interface for receiving a
treatment proposal of the medical symptom and in communication with
the patient-client interface for receiving a care request
corresponding to the medical symptom, the server communicating the
treatment proposal to the patient-client interface, and receiving a
selection of a treatment proposal from the patient-client
interface.
14. The health care management system of claim 13 further
comprising a secure large scale communication network between the
patient-client interface and the server.
15. The health care management system of claim 13 further
comprising a secure large scale communication network between the
server and the provider-client interface.
16. The health care management system of claim 13 further
comprising a database to provide information on one of the medical
providers to the server.
17. A method of consulting a medical specialist, the method
comprising the steps of: receiving a consultation request
requesting that a specialist be consulted from a treating physician
via a telecommunications system; retrieving medical information
relevant to but independent from the consultation request from an
information data base accessible by a computer, the relevant
medical information being retrieved by a medical information
expert; providing the relevant medical information and the
consultation request to the medical specialist via the
telecommunications system, the medical information expert being
neither the treating physician nor the medical specialist;
receiving a comment made by the specialist in response to the
consultation request and the relevant medical information;
providing at least the comment to the treating physician; and
providing continuing medical education credit for the treating
physician based at least on the consultation request and the
comment.
18. The method of consulting a medical specialist set forth in
claim 17 wherein the step of providing continuing medical education
credit further comprises the steps of: retrieving instructional
material relevant to the comment and the consultation request from
the information data base and providing the instructional material
to the treating physician, the step of retrieving instructional
material being performed by the medical information expert.
19. The method of consulting a medical specialist set forth in
claim 18 wherein the step of providing continuing medical education
credit further comprises the steps of: providing an examination
based on at least the instructional material; receiving answers for
the examination from the treating physician; grading the received
answers; and if the treating physician passes the examination,
providing the continuing medical education credit.
20. The method of consulting a medical specialist set forth in
claim 17 wherein the step of providing continuing medical education
credit further comprises the steps of: providing an examination
based on at least the comment to the treating physician; receiving
answers for the examination from the treating physician; grading
the received answers; and if the treating physician passes the
examination, providing the continuing medical education credit.
Description
RELATED APPLICATIONS
[0001] This application claims priority to U.S. Provisional
Application Ser. No. 60/163,520, filed on Nov. 4, 1999 and a
continuation-in-part application of U.S. patent application Ser.
No. 08/818,155, filed on Mar. 14, 1997.
FIELD OF THE INVENTION
[0002] The invention relates generally to a health care management
system and more particularly to a system for facilitating and
managing health care between a medical provider and a patient.
BACKGROUND OF THE INVENTION
[0003] In the United States alone, approximately 4.5 million
complex surgeries are performed annually. This estimate is expected
to increase over time. Patients having a medical symptom that
necessitates a complex treatment (i.e., surgery) are typically
limited by the medical providers (e.g., hospitals and medical
specialists) included in the payer's (e.g., insurance company) plan
or network. Furthermore, medical providers included in the payer's
plan or network may not be specialized in complex treatments.
Payers also often attempt to offer "out-of-network" coverage, but
are frequently unable to manage the resulting monetary
expenditures. Due to the frequent improper management of the
resulting monetary expenditures, payers can deny the patient access
to the "out-of-network" medical provider or place a significant
supplemental cost burden on the patient.
[0004] Additionally, due to the complexity and variety of medical
symptoms that compel a complex treatment, each medical case
involving a patient having such a medical symptom is somewhat
unique. Therefore, although a medical provider in the payer's
network can be specialized in performing a certain complex
treatment, the patient having the medical symptom may require a
different medical provider that is focused on a subset of a
specialty of medicine. In general, the patient does not know of the
medical providers that specifically specialize in the patient's
medical symptom. Even if known, the patient typically cannot learn
about the quality of care that these specialized medical providers
have supplied to patients in similar situations. The patient does
not frequently have information to enable a comparison between two
or more medical providers. Moreover, besides a primary care
physician's referral, when patients need a complex treatment,
patients often seek alternative sources of reliable information to
help them identify the most qualified medical provider and best
course of action. The patient does not generally have broad access
to expert medical providers and information on these expert medical
providers located in various parts of the country or in other
countries.
[0005] Thus, there exists a need to enable patients to attain
information about and to have access to a broad range of medical
providers.
SUMMARY OF THE INVENTION
[0006] The present invention relates to a method for facilitating
and managing health care between a medical provider and a patient.
The present invention facilitates communications between a patient
having a medical symptom and medical providers having expertise in
treating the medical symptom of the patient. Further, the patient
communicates with the medical providers and obtains a treatment
proposal for the medical symptom in a reduced period of time. The
present invention facilitates the patient receiving medical
information on the medical providers that supply a treatment
proposal for the medical symptom. Moreover, the patient receives a
comparative report enabling the comparison of information, such as
cost and quality of service, about medical providers.
[0007] In one aspect, the invention includes a method for managing
health care. The method includes providing a patient having a first
criteria, which includes a medical symptom. The method also
includes selecting a subset of medical providers having expertise
in treating the medical symptom, generating a care request to
obtain a treatment proposal for the medical symptom of the patient,
and updating the care request with medical information associated
with the medical symptom. The method further includes receiving at
least one treatment proposal of the medical symptom from the
medical providers and selecting a treatment proposal of the medical
symptom from the medical providers. In one embodiment. the method
additionally includes transmitting each treatment proposal to each
medical provider, receiving a treatment proposal from each medical
provider, and transmitting each treatment proposal to the patient.
In one embodiment, the method includes receiving a treatment
proposal that is modified after transmitting each treatment
proposal to each medical provider.
[0008] In another aspect, the invention includes a patient-client
interface for providing a patient having a medical symptom, a
provider-client interface for providing a medical provider having
expertise in treating the medical symptom, and a server in
communication with the provider-client interface for receiving
treatment proposal of the medical symptom. The server is also in
communication with the patient-client interface for receiving a
care request corresponding to the medical symptom. The server
communicates the treatment proposal to the patient-client interface
and receives a selection of a treatment proposal from the
patient-client interface.
[0009] In yet another aspect, the invention includes a method of
consulting a medical specialist. The method includes receiving a
consultation request from a treating physician via a
telecommunications system. The consultation request requests a
specialist to be consulted. Additionally, the method includes
retrieving medical information relevant to but independent from the
consultation request from an information database accessible by a
computer. The relevant medical information is retrieved by a
medical information expert. The method also includes the steps of
providing the relevant medical information and the consultation
request to the medical specialist via the telecommunications system
and receiving a comment made by a medical specialist in response to
the consultation request and the relevant medical information.
Additionally, one or more comments are provided to the treating
physician. Further, a continuing medical education credit for the
treating physician is provided.
BRIEF DESCRIPTION OF THE DRAWINGS
[0010] The above and further advantages of this invention may be
better understood by referring to the following description in
conjunction with the accompanying drawings, in which like numerals
indicate like structural elements and features in various figures.
The drawings are not necessarily to scale, emphasis instead being
placed upon illustrating the principles of the invention.
[0011] FIG. 1 illustrates a block diagram of an embodiment of a
health care management system according to the present
invention.
[0012] FIG. 2 illustrates a flow diagram of an embodiment of the
steps performed by the health care management system according to
the present invention.
[0013] FIG. 3 illustrates an exemplary embodiment of the present
invention.
[0014] FIGS. 4A, 4B, 4C, and 4D illustrate an exemplary embodiment
of a care request according to the present invention.
[0015] FIGS. 5A, 5B, 5C, and 5D illustrate an exemplary embodiment
of a treatment proposal according to the present invention.
[0016] FIGS. 6A, 6B, 6C, and 6D illustrate an exemplary embodiment
of a comparative report according to the present invention.
[0017] FIG. 7 illustrates a data flow diagram depicting the
principle functions performed by a server during processing and
management of a consultation session between a primary care
physician and a selected medical provider.
DETAILED DESCRIPTION
[0018] FIG. 1 illustrates a block diagram of an embodiment of a
health care management system 2 that includes a patient-client
computer 10, or patient-client, a server 14, and a medical
provider-client computer 18, or provider-client. The patient-client
10 is in communication with the server 14 over a patient
communication path 22 and passes through a patient-server network
26. The server 14 is also in communication with the provider-client
18 over a provider communication path 30 and passes through a
provider-server network 34. It should be noted that FIG. 1 is an
exemplary embodiment intended only to illustrate, and not limit,
the invention.
[0019] The patient-server network 26 and the provider-server
network 34 are large scale communication networks and can be a
local-area network (LAN), a medium-area network (MAN), or a wide
area network (WAN) such as the Internet or the World Wide Web
(i.e., web). In one embodiment, the patient-server network 26
(e.g., the patient communication path 22) supports secure
communications. In a further embodiment, communications occur after
the user's password is verified by the server 14. In one
embodiment, the provider-server network 34 (e.g., the provider
communication path 30) is a protected network that is physically
secure from public access. In another embodiment, because the
provider-server network 34 is not a publicly available network, the
provider-server network 34 is a non-secure network (i.e., the
provider communication path 30 is a non-secure communication path).
Example embodiments of the communication paths 22, 30 include
standard telephone lines, LAN or WAN links (e.g., T1, T3, 56 kb,
X.25), broadband connections (ISDN, Frame Relay, ATM), and wireless
connections. The connections over the communication paths 22, 30
can be established using a variety of communication protocols
(e.g., TCP/IP, IPX, SPX, NetBIOS, Ethernet, RS232, and direct
asynchronous connections).
[0020] The patient-client 10 and the provider-client 18 can be any
personal computer (e.g., 286, 386, 486, Pentium, Pentium II,
Macintosh computer), Windows-based terminal, Network Computer,
wireless device, information appliance, RISC Power PC, X-device,
workstation, mini computer, main frame computer, personal digital
assistant, or other computing device that has a windows-based
desktop and sufficient persistent storage for executing a small,
display presentation program. Windows-oriented platforms supported
by the patient-client 10 and the provider-client 18 can include,
without limitation, WINDOWS 3.x, WINDOWS 95, WINDOWS 98, WINDOWS NT
3.51, WINDOWS NT 4.0, WINDOWS 2000, WINDOWS CE, MAC/OS, Java, and
UNIX. The client 10 can include a visual display device (e.g., a
computer monitor), a data entry device (e.g., a keyboard),
persistent or volatile storage (e.g., computer memory) for storing
downloaded application programs, a processor, and a mouse.
[0021] The patient-client 10 includes a patient-client interface 36
and the provider-client 18 includes a medical provider-client
interface 40. The interfaces 36, 40 can be text driven (e.g., DOS)
or graphically driven (e.g., Windows). In one embodiment, the
patient-client interface 36 is a web browser, such as Internet
Explorer.TM. developed by Microsoft Corporation in Redmond, Wash.,
to connect to the patient-server network 26. In a further
embodiment, the web browser uses the existing Secure Socket Layer
(SSL) support, developed by Netscape in Mountain View, Calif., to
establish the patient-server network 26 as a secure network.
[0022] As described more fully below, a patient having a first
criteria, including a medical symptom, employs the patient-client
interface 36 on the patient-client 10 to obtain treatment for the
medical symptom. In another embodiment, an employer group uses the
patient-client interface 36 to communicate with the server 14 to
enable treatment for the patient's medical symptom. Alternatively,
a payer organization uses the patient-client interface 36 to
communicate with the server 14. Example embodiments of a payer
organization include, but are not limited to, insurance companies
and HMO's.
[0023] Similar to the clients 10, 18, the server 14 can be any
personal computer described above. In one embodiment, the server 14
hosts one or more software modules 44 that the patient-client 10
and/or the provider-client 18 can access. In another embodiment,
the server 14 is a member of a server farm, which is a logical
group of one or more servers that are administered as a single
entity. In the embodiment shown, the server farm includes the
server 14, a second server 48, and a third server 52.
[0024] As described more fully below, a medical provider having
expertise in treating the medical symptom of the patient employs
the provider-client interface 40 to propose a treatment for the
symptom of the patient. Examples of the medical provider include,
but are not limited to, medical physicians, medically trained
individuals, hospitals, medical specialists, medical experts, other
facilities providing medical treatment, and the like.
[0025] In one embodiment, the server 14 is also in communication
with a database 56. The database 56 is a server that stores and
manages data. The server 14 accesses the information stored on the
database 56 by interfacing with a database module 60. In one
embodiment, the database module 60 maintains the server 14 data in
a Lightweight Directory Access Protocol (LDAP) data model. In other
embodiments, the database module 60 stores data in an
ODBC-compliant database. For example. the database module 60 can be
provided as an ORACLE database, manufactured by Oracle Corporation
of Redwood Shores, Calif. In other embodiments, the database module
60 can be a Microsoft ACCESS database or a Microsoft SQL server
database. The database 56 retrieves data from local memory and
transmits the data to the server 14 over a data communications
network 64. In another embodiment, a database 56' is located on the
server 14.
[0026] In a further embodiment, a second medical provider-client
computer 18' having a second medical provider-client interface 40'
communicates with the server 14 through the provider-server network
34. A second medical provider, such as a second hospital, can
propose a second treatment for the medical symptom of the
patient.
[0027] FIG. 2 illustrates a flow diagram of an embodiment of the
steps performed by the health care management system 2 according to
the present invention. Patients use the patient-client interface 36
to submit (step 202) a care request (i.e., a request for treatment)
to the server 14 over the patient communication path 22. The
software module 44 executing on the server 14 then selects (step
204) one of the patients having a first criteria. The first
criteria includes a medical symptom of the patient. Additional
examples of the first criteria include, without limitation,
insurance coverage of the patient, other means of payment, and a
certain level of complexity required to treat the medical
symptom.
[0028] The software module 44 selects (step 206) a subset of
medical providers that have expertise in treating the medical
symptom. For example, the software module 44 selects the subset of
medical providers based on, but not limited to, the previous cost
of treating an identical or similar medical symptom, the medical
experience in the area related to the medical symptom (e.g., time
working in the area related to the medical symptom), the number of
procedures treating the medical symptom that have been performed by
the medical provider, the amount of education received, the
reputation of the medical provider, and the like. In one
embodiment, the server 14 retrieves from the database 56 (using the
database module 60) medical information associated with a group of
medical providers to assist in the determination of the subset of
medical providers that have expertise in treating the medical
symptom. In another embodiment, a staff physician, or medically
trained individual, that is independent from the medical providers
selects the subset of medical providers that have expertise in
treating the medical symptom.
[0029] Although described above with multiple patients submitting
care requests. one patient can submit a care request to the server
14. In this embodiment, the software module 44 continues to
determine if the patient is accepted based on the determination of
the patient having the first criteria (e.g., insurance
coverage).
[0030] In one embodiment, staff physicians use the server 14 to
update (step 208) the care request with medical information
associated with the medical symptom of the patient. The staff
physician uses the server 14 to research the medical symptom before
updating the care request. The database 56 provides the server 14
with relevant articles and other information on the medical symptom
that the staff physician uses to update the care request. Once the
care request is complete, the server 14 provides the care request
to the provider-clients 18, 18' over the provider-server network
34. Although described below with two provider-clients 18, 18', the
invention functions properly when the server 14 provides the care
request to the single provider-client 18.
[0031] Each medical provider reviews the care request and
determines a treatment proposal, as described further below, to
treat the medical symptom of the patient. For example, each medical
provider determines its treatment proposal by examining the
difficulty associated with treating the medical symptom, the
familiarity with treating the medical symptom. and the availability
of the correct medical specialists. The medical providers then
transmit (step 212) their treatment proposals to the server 14 over
the provider-server network 34.
[0032] In one embodiment, the software module 44 (or the staff
physician) prepares a preliminary comparative report of the
received treatment proposals. The report lists the treatment
proposals submitted in step 212 and facilitates comparisons between
the two treatment proposals. The software module 44 then transmits
the report to both provider-clients 18 and 18', thereby enabling
each medical provider to view (step 214) the other treatment
proposals submitted by the other medical providers. The medical
provider can compare its treatment proposal with the other
treatment proposals and can modify (step 216) its treatment
proposal after viewing the other proposals. For example, if the
patient requests treatment for a liver transplant, a first medical
provider can interpret the question (on the treatment proposal)
about the number of times that a liver transplant has been
performed at that medical provider to mean a transplant on a living
person and a second medical provider can interpret the question as
a number representing the total number of liver transplants
performed (i.e., cadaveric and living liver transplants). More
specifically, if the treatment proposal submitted by the first
medical provider states that the medical provider has performed
liver transplants on 10 people over the past year and a second
treatment proposal submitted by the second medical provider states
that the medical provider has performed cadaveric and living liver
transplants 150 times this year, the first medical provider reviews
the second medical provider's treatment proposal and can change
their number of liver transplants performed to accurately reflect
the total number of transplants performed in the year. The viewing
(step 214) and modifying (step 216) of treatment proposals can
occur several times. This process of multiple views and
modifications of the treatment proposal benefits both the patient
and the medical providers. More specifically, the patients benefit
because they obtain treatment proposals that accurately reflect the
services of the medical providers. Further, the medical providers
benefit because they can correct mistakes and inaccurate portrayals
of their services. In one embodiment, the software module 44 on the
server 14 provides the provider-clients 18, 18' with a date on
which no further changes to the treatment proposals can occur. Upon
this date, the medical providers submit final treatment proposals
to the server 14.
[0033] Once the final treatment proposals are submitted, the staff
physician and/or the software module 44 generates a final
comparative report that includes each treatment proposal and
provides (step 218) the final comparative report to the patient via
the patient-client interface 36. In one embodiment, the staff
physician recommends a treatment proposal submitted by one of to
the medical providers that the staff physician considers to meet
the patient's interests. Examples of factors that can affect the
staff physician's recommendation include, without limitation, the
quality of service of the medical provider, cost of the medical
provider, experience of the medical provider, and travel expenses
for the patient to arrive at the medical provider. The patient then
submits (step 220) its selection of a treatment proposal to the
server 14 over the patient-server network 26. The server 14
consequently informs the medical provider that submitted the
selected treatment proposal of the patient's acceptance through a
message to the provider-client interface 40 (or 40'). In one
embodiment, the server 14 transmits an email message to the
provider-client 18 to denote acceptance. However, any other
communication between the medical provider and the staff physician
indicating the patient's acceptance to the treatment proposal is
sufficient.
[0034] FIG. 3 is an illustrative example of the present invention.
Sam, a patient, is diagnosed (step 302) with a solitary cancer
nodule in his left lung. He also has a significant history of
coronary artery disease with angina, which is a condition in which
spasmodic attacks of suffocating pain occur. After weighing his
choices, Sam determines that he should undergo surgery with a team
of cardiac and thoracic surgeons to perform a coronary by-pass and
remove the lung. Sam's primary care physician (i.e., which is
member of his medical insurance network) referred him to a hospital
with a good local reputation. However, Sam's particular case is
complex and risky, and Sam determines (step 304) that he should
look at a range of medical providers (i.e., "out-of-network"
medical providers).
[0035] Sam uses a user interface (i.e., the patient-client
interface 36) which, in one embodiment is executing on his computer
(i.e., patient-client 10), to submit (step 306) a care request.
After Sam's submission, the server 14 and/or the independent staff
physician selects (step 308) a subset of medical providers having
expertise in treating a solitary cancer nodule in a patient's left
lung while having a history of coronary artery disease with angina
(i.e., expertise in performing a coronary by-pass and removing the
left lung). After the server 14 selects the medical providers, the
staff physician updates (step 310) the care request with additional
medical information. The staff physician then transmits (step 312)
Sam's care request to these medical providers. The selected medical
providers each review Sam's care request and submit (step 314) a
treatment proposal to perform Sam's surgeries. The server 14
prepares (step 316) a comparative report of the treatment proposals
and transmits (step 318) the report to the medical providers for
review and/or modifications of their respective treatment
proposals. Once the time period for modifications elapses, the
server 14 prepares a final comparative report of the treatment
proposals and transmits (step 320) this report to Sam. Sam reviews
the report and selects (step 322) one of the treatment proposals.
The server 14 consequently informs (step 324) the medical provider
that submitted the selected treatment proposal of Sam's
acceptance.
[0036] Referring to FIGS. 4A, 4B, 4C, and 4D, an example of a care
request is shown. A payer of the treatment that the patient
requests, such as the insurance company that provides coverage to
the patient, provides general payer information elements
402(a)-402(m). In another embodiment, the patient provides the
general payer information elements 402(a)-402(m). The patient then
provides general patient information elements 404(a)-404(f) and a
description of treatment requested 406. Further, the patient (or
payer) provides Current Procedure Terminology, or CPT, codes 408.
CPT is an accepted listing of descriptive terms and identifying
codes for reporting medical services under public and private
health insurance programs. The patient can also provide a medical
summary 410, and other medical problems 412. In another embodiment,
a staff physician provides the medical summary 410 of the medical
symptom of the patient, as illustrated in FIG. 4D.
[0037] Referring to FIGS. 5A, 5B, 5C, and 5D, an example of a
treatment proposal 500 that a medical provider submits to the
server 14 is shown. Information identifying the care request (i.e.,
a case number) and the medical provider is denoted by the
identifying information elements 502(a)-502(d). General information
regarding the medical provider, such as the city of the hospital,
is denoted by provider information elements 504(a)-504(e). General
information of the principle medical expert, such as the number of
years in practice, is denoted by the medical expert information
elements 506(a)-506(h).
[0038] The treatment proposal 500 further includes a core plan 508.
An embodiment of the care plan is illustrated with care information
elements 508(a) through 508(g) and can include information such as
a detailed description 508(a) of the proposed treatment. The
treatment proposal 500 includes pre-admission information elements
510(a)-510(b) to describe additional information that is required
for pre-admission of the patient. Additionally, the treatment
proposal 500 contains further information such as, but not limited
to, in-hospital care information elements 512(a)-512(e), support
team information elements 514(a)-514(e), post-discharge information
elements 516(a)-516(c), additional considerations 518, and
financial proposal information elements 520(a)-520(e).
[0039] FIGS. 6A, 6B, 6C, and 6D illustrate an embodiment of an
example of a comparative report 600. The comparative report 600
facilitates the comparison between the information included in a
first treatment proposal 602 and a second treatment proposal 604.
The comparative report 600 includes several of the information
elements included in the treatment proposal 500 shown in FIGS. 5A,
5B, 5C, and 5D, such as the detailed description 508(a) of the
proposed treatment and the total proposed price 520(d).
[0040] FIG. 7 illustrates a data flow diagram depicting an
embodiment of functions performed by the patient-client 10 during
processing and management of a consultation session between a
primary care physician and a medical provider. In this embodiment,
a medical physician utilizes the patient-client 10 to formulate and
transmit a request for consultation to the server 14. The server 14
processes and relays the request to the provider-client 18. The
server 14 receives the request for consultation and displays
information contained in the request for initial review by the
staff physician, as indicated at 732. Programmatic tests are
performed by the patient-client 10 and/or the server 14 to test the
validity of the data entered into the formatted fields of the
consultation request. Consequently, the staff physician need only
review the request to insure that its content is adequate to enable
the selection of one or more medical providers having expertise in
the specialty in which consultation is sought. If the content is
deficient, the staff physician notes the deficiency in a rejection
message returned to the requesting physician as indicated at 736
and 737 in FIG. 7.
[0041] The staff physician then selects a medical provider to
handle the request as indicated at 738 and forwards the request to
the selected medical provider together with selected materials
which are obtained and assembled at 739 from the database 56' which
stores medical information which can be relevant to the
request.
[0042] This database 56' advantageously includes a publication
database module 742 consisting of abstracts or the full text of
articles in medical journals, either stored locally in the server's
processor's mass storage facility, or in an available medical
database 60 (not shown), such as Medline/Medlars, connected to the
server 14 over the data communications network 64 (not shown). In
addition, the database 56' further advantageously contains a
tutorial database module 744 containing background lessons which
are selectively made available to the requesting physician as an
adjunct to, and in support of, the comments to be received from the
information to assembled at 739 in support of the request. The case
study database module 748 stores this information in a case history
file for this consultation, as indicated at 751. Further
information is thereafter added to this case history file as the
consultation proceeds. The server 14 advantageously stores the
request for consultation in the case history file in the form of a
summary document expressed in hypertext markup language (HTML)
which incorporates links to other HTML documents and/or supporting
materials from the information database module 740. The
consultation request can then be reviewed by the selected medical
provider using a hypertext document browser, which retrieves and
displays selected linked HTML documents and linked files as needed
directly from the information database 740.
[0043] To insure that the request for consultation is handled in a
timely fashion by the selected medical provider, the staff
physician or other supervisory personnel is notified, as indicated
at 752, in the event that an acknowledgment is not received from
the provider-client 18 within a predetermined duration. In the
absence of an indication that the request for consultation has been
received and is being handled, delay notification 752 permits the
staff physician to select a different available medical provider to
handle the request in timely fashion when necessary.
[0044] Using the facilities provided by the provider-client 18, the
selected provider enters a text comment answering the consultation
report to form information structure comment information. which can
include reference to supporting articles, lessons, protocols, or
prior case studies in the information database module 740. As
indicated at 754, the provider can make independent search requests
to the database 56' to obtain information in aid of the
consultation, so that the citations supplied by the consulting
medical provider can include not only those materials identified by
the automated searches performed by the staff physician but also
supplemental materials newly cited by the medical provider.
Moreover, the provider can append any other data which is available
to the structured comment information, including image data or
materials available to the medical provider from another database
(not shown).
[0045] The structured comment information from the consulting
medical provider is then returned to the server 14 which forwards
the comment information to the patient-client computer 10 as
indicated at 755. In addition, the server 14 also stores the
responsive comment in the case study database module 748 for
inclusion in the case history file established at 751 to hold the
original consultation request, as indicated at 756.
[0046] The requesting primary care physician is accordingly
supplied with the advisory to comments of the consulting provider
and a body of documented supporting materials, which can include
relevant published articles from publication database module 742.
documented practices and protocols from database module 744,
tutorial lessons material from the database module 746, and prior
relevant case histories from the case study database module 748.
The response to the consultation request which is supplied to the
physician also advantageously takes the form of a summary document
expressed in HTML and includes links to supporting HTML documents
and retrieval supporting documents supplied by the medical
provider. Using an HTML browser, the requesting primary care
physician can, accordingly, review the provider's comments and the
supporting documentation using the HTML browsing facilities of the
patient-client 10.
[0047] Although the initial comment and documentation supplied by
the medical provider can in many cases wholly satisfy the needs of
the requesting primary care physician, clarification can be
requested when needed. The clarification request message is
transmitted to the server 14 from the patient-client 10 and
received as indicated at 763. The incoming message is examined at
765 to determine whether a clarification is requested or, in the
alternative, that the requesting physician wishes to conclude the
consultation. If the received message is a request for
clarification, it is transmitted to the medical provider for
further comment as indicated at 766; otherwise, a continuing
education (CME) accreditation module indicated generally at 770 is
notified that the consultation has been successfully concluded. The
accreditation module 770 administers a CME database module 772
which records information concerning the consultation sessions and
produces accreditation reports 775 which can be submitted to the
responsible accreditation authority to certify that the requesting
physician is entitled to CME credits based on his or her
participation in the consultation session. When required for
credit, the requesting physician can also be requested to complete
an examination form testing the knowledge gained, in which case an
examination is made available to the requesting physician as
indicated at 777. This examination form can also be advantageously
implemented by an HTML form which is transmitted to the requesting
physician, completed, and resubmitted to the server 14 as indicated
at 779. The completed examination form is then graded and the
results posted to the CME database module 772 as indicated at 780.
The credits accumulated by individual primary care physicians who
have participated in learning sessions are then detailed in the CME
credit report 775 which is thereafter produced for submission to
the responsible accrediting body as indicated at 782.
[0048] While the invention has been particularly shown and
described with reference to specific preferred embodiments, it
should be understood by those skilled in the art that various
changes in form and detail can be made therein without departing
from the spirit and scope of the invention as defined by the
appended claims.
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