U.S. patent application number 13/083449 was filed with the patent office on 2011-10-20 for integrated medical software system with automated prescription service.
This patent application is currently assigned to Greenway Medical Technologies, Inc.. Invention is credited to W. Thomas Green, III, James T. Ingram, Johnathan Samples, Gregory H. Schulenburg.
Application Number | 20110258002 13/083449 |
Document ID | / |
Family ID | 42139413 |
Filed Date | 2011-10-20 |
United States Patent
Application |
20110258002 |
Kind Code |
A1 |
Green, III; W. Thomas ; et
al. |
October 20, 2011 |
INTEGRATED MEDICAL SOFTWARE SYSTEM WITH AUTOMATED PRESCRIPTION
SERVICE
Abstract
An integrated medical software system with automated
prescription management is disclosed. The system comprises a
clinical module that is utilized by a user of the system to create
an electronic document and to capture clinical data in the
electronic document with a user interface during an encounter with
a patient, said clinical data including one or more prescriptions
the user generates for the patient, and said electronic document
being pre-populated with at least a portion of demographic data for
the patient; and an application that interfaces the system with at
least one of a lab, a pharmacy, and a prescription system via a
network connection and that automatically submits instructions for
filling the one or more prescriptions to the at least one of a lab,
a pharmacy, and a prescription system as the one or more
prescriptions are generated for the patient during the encounter
with the patient, wherein the user can generate the one or more
prescriptions for the patient by using the user interface to select
the one or more prescriptions from one or more previously generated
prescriptions such that the instructions for filling the one or
more prescriptions will be automatically submitted to the at least
one of a lab, a pharmacy, and a prescription system without the
user writing a new prescription.
Inventors: |
Green, III; W. Thomas;
(Carrollton, GA) ; Ingram; James T.; (Carrollton,
GA) ; Samples; Johnathan; (Woodland, AL) ;
Schulenburg; Gregory H.; (Carrollton, GA) |
Assignee: |
Greenway Medical Technologies,
Inc.
Carrollton
GA
|
Family ID: |
42139413 |
Appl. No.: |
13/083449 |
Filed: |
April 8, 2011 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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10202627 |
Jul 25, 2002 |
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13083449 |
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60373662 |
Apr 19, 2002 |
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Current U.S.
Class: |
705/3 |
Current CPC
Class: |
G16H 10/60 20180101;
G06Q 10/10 20130101; G16H 40/20 20180101; G16H 15/00 20180101 |
Class at
Publication: |
705/3 |
International
Class: |
G06Q 50/00 20060101
G06Q050/00; G06Q 10/00 20060101 G06Q010/00 |
Claims
1-62. (canceled)
63. An integrated medical software system with automated
prescription management, the system comprising: a clinical software
module executed by a processor of the system and utilized by a user
of the system to create an electronic document and to capture
clinical data in the electronic document with a user interface
during an encounter with a patient, said clinical data including
one or more prescriptions the user generates for the patient, and
said electronic document being pre-populated with at least a
portion of demographic data for the patient; and a software
application executed by the processor of the system to interface
the system with at least one of a lab, a pharmacy, and a
prescription system via a network connection and to automatically
submit instructions for filling the one or more prescriptions to
the at least one of a lab, a pharmacy, and a prescription system as
the one or more prescriptions are generated for the patient during
the encounter with the patient, wherein the user can generate the
one or more prescriptions for the patient by using the user
interface to select the one or more prescriptions from one or more
previously generated prescriptions such that the instructions for
filling the one or more prescriptions will be automatically
submitted to the at least one of a lab, a pharmacy, and a
prescription system without the user writing a new
prescription.
64. The integrated medical software system of claim 63, further
comprising a patient registration software component executed by
the processor of the system to receive financial data and the
demographic data for the patient, wherein the patient is
pre-approved for the one or more prescriptions based on at least
one of the financial data and the demographic data.
65. The integrated medical software system of claim 64, wherein the
instructions for filling the one or more prescriptions include at
least a portion of at least one of the financial data and the
demographic data.
66. The integrated medical software system of claim 63, further
comprising: a database for storing demographic data, financial
data, scheduling data, and the clinical data in a normalized data
format; an account management software module executed by the
processor of the system to capture financial data in the normalized
data format and to automatically create at least one of a bill, a
claim, and a statement for the patient using the financial data and
the clinical data as the clinical data is captured during the
encounter with the patient; a scheduling software module executed
by the processor of the system to capture scheduling data in the
normalized data format and to schedule the patient and at least one
of a clinician, a staff member, and equipment for the encounter
with the patient using the scheduling data and the demographic
data; and a framework software module that is integrated with the
clinical software module, the account management software module,
and the scheduling software module using a common architecture and
that is executed by the processor of the system to support an
exchange of the clinical data, the demographic data, the financial
data, and the scheduling data between those software modules and
with the database in the normalized data format.
67. The integrated medical software system of claim 66, wherein the
one or more prescriptions are used by the account management
software module to automatically create the at least one of a bill,
a claim, and a statement for the patient.
68. The integrated medical software system of claim 66, wherein at
least one of the demographic data, the financial data, and the
administrative data is updated based on input from at least one of
the account management software module, the scheduling software
module, and the clinical software module.
69. The integrated medical software system of claim 63, further
comprising functionality for providing the user with an alert that
the one or more prescriptions need to be re-filled at a time when
the one or more prescriptions need to be re-filled.
70. The integrated medical software system of claim 63, wherein the
user generates instructions for re-filling the one or more
prescriptions by using the user interface to select the one or more
prescriptions from one or more previously generated prescriptions
such that the instructions for re-filling the one or more
prescriptions will be automatically submitted to the at least one
of a lab, a pharmacy, and a prescription system without the user
writing a new prescription.
71. The integrated medical software system of claim 70, wherein the
re-filling of the one or more prescriptions is automatically
documented in the patient's chart.
72. The integrated medical software system of claim 63, wherein the
system displays at least one of brand name and generic pricing and
dosage, national drug codes, medication lists, allergy cross-checks
(drug-drug, drug-food, drug-disease interactions), and side affects
at the user interface as the user generates the one or more
prescriptions.
73. A method for automating prescription management in an
integrated medical software system, said method being embodied on a
processor-executable medium and said integrated medical software
system having a processor that executes the method to perform the
steps of: allowing a user of the system to create an electronic
document prior to an encounter with a patient; pre-populating the
electronic document with previously-captured demographic data for
the patient; capturing clinical data for the patient in the
electronic document in a normalized data format during the
encounter with the patient, said clinical data including one or
more prescriptions the user generates for the patient; and
automatically submitting instructions for filling the one or more
prescriptions to at least one of a lab, a pharmacy, and a
prescription system as the one or more prescriptions are generated
for the patient during the encounter with the patient, said system
being interfaced the with the at least one of a lab, a pharmacy,
and a prescription system, and said instructions being submitted
via a network connection; wherein the user generates the one or
more prescriptions for the patient by using the user interface to
select the one or more prescriptions from one or more previously
generated prescriptions such that the instructions for filling the
one or more prescriptions will be automatically submitted to the at
least one of a lab, a pharmacy, and a prescription system without
the user writing a new prescription.
74. The method of claim 73, further comprising the steps of:
receiving financial data and the demographic data for the patient;
and pre-approving the patient for the one or more prescriptions
based on at least one of the financial data and the demographic
data.
75. The method of claim 74, wherein the instructions for filling
the one or more prescriptions include at least a portion of at
least one of the financial data and the demographic data.
76. The method of claim 73, further comprising the steps of:
automatically creating at least one of a bill, a claim, and a
statement for the patient using financial data and the clinical
data as the clinical data is captured during the encounter with the
patient; capturing the financial data in the normalized data
format; scheduling the patient and at least one of a clinician, a
staff member, and equipment for the encounter with the patient
using scheduling data and the demographic data; capturing the
scheduling data in the normalized data format; and storing the
clinical data, the financial data, the demographic data, and the
scheduling data in a database in the normalized data format;
wherein the system is built on a common architecture to support an
exchange of the clinical data, the financial data, the demographic
data, and the scheduling data in the normalized data format as
required to perform each of the steps.
77. The method of claim 76, wherein the at least one of a bill, a
claim, and a statement is automatically created using the one or
more prescriptions generated for the patient during the encounter
with the patient.
78. The method of claim 76, further comprising the step of updating
at least one of the clinical data, the financial data, and the
administrative data as that data is captured during a corresponding
step of capturing.
79. The method of claim 73, further comprising a step of alerting
the user that the one or more prescriptions need to be re-filled at
a time when the one or more prescriptions need to be re-filled.
80. The method of claim 73, wherein the user generates instructions
for re-filling the one or more prescriptions by using the user
interface to select the one or more prescriptions from one or more
previously generated prescriptions such that the instructions for
re-filling the one or more prescriptions will be automatically
submitted to the at least one of a lab, a pharmacy, and a
prescription system without the user writing a new
prescription.
81. The method of claim 80, wherein the re-filling of the one or
more prescriptions is automatically documented in the patient's
chart.
82. The method of claim 73, further comprising the step of
displaying at least one of brand name and generic pricing and
dosage, national drug codes, medication lists, allergy cross-checks
(drug-drug, drug-food, drug-disease interactions), and side affects
at the user interface as the user generates the one or more
prescriptions.
Description
RELATED APPLICATIONS
[0001] The present application is a continuation of co-pending U.S.
patent application Ser. No. 10/202,627, filed Jul. 25, 2002, which
claims priority to Provisional Application Ser. No. 60/373,662,
filed Apr. 19, 2002, the entire contents of which are incorporated
herein by reference.
BACKGROUND OF THE INVENTION
[0002] Service professionals that regularly schedule patient visits
have historically relied upon manual practice management, patient
records and managed care (i.e., insurance) techniques. For
instance, scheduling patients, tracking prescription orders, and
maintaining file documentation are typically performed through
paper calendars and files. An office assistant receives and
schedules patient appointments on the paper calendar. The service
professional then checks the paper schedule for each day.
[0003] For purposes of this application, service professionals may
include, for instance, healthcare providers such as physicians (MD
or DO), dentists, chiropractors, psychologists, and counselors.
However, the terms "clinician" or "physician" as used herein are
understood to include any service professional or healthcare
provider who treats a patient, including for instance physicians,
nurses, technicians, therapists, chiropractors, physicians
assistant, midwife, psychologists, and counselors.
[0004] All information concerning the patient's medical history,
such as clinician observations, thoughts, treatments administered,
patient history, medication lists, vaccine administration lists,
laboratory reports, X-rays, charts, progress notes, consultation
reports, hospital reports, correspondence and test results, have
traditionally been kept in the paper file. Much of this information
is handwritten and signed by the clinician, or transcribed from
clinician dictation. Paper-based medical files are typically filed
alphabetically by the patient's last name, with the patient's name,
date of birth and any known allergies on the outside of the
file.
[0005] However, manual practice management, patient record and
managed care techniques are inefficient since they require a great
deal of interaction between the service professional and the office
assistant. Last minute scheduling changes often result in lost time
for the service professional. In addition, manual tracking is prone
to error and the large amounts of paper that is generated take up
valuable office space. A small office of 2-3 physicians, for
instance, can have approximately 20,000 or more active patients,
and therefore anywhere from about 25,000 to 60,000 patient files,
depending upon how long they have been in practice.
[0006] Since the medical record is paper-based and manually
produced, the information needed to bill a patient must be manually
entered into the billing application. Clinician orders that often
generate billable procedures are difficult to process because they
are written by hand and in many cases are omitted from the
patient's bill. In addition, handwritten orders for prescriptions
have been identified as the number one cause of medical errors
resulting in patient death in the United States. Add to these
issues the complexity of insurance contracts and procedure fee
schedules that govern the amount which clinicians are to be paid
for their services, and the result is a very inefficient,
labor-intensive process requiring many checks and balances to
ensure accurate processing.
[0007] In a typical office visit for a medical clinician, the
clinician will review his/her schedule for that day or week. In any
given day, the clinician may have 20-80 office visits, and up to 2
(or more) medical procedures. Prior to a scheduled examination, the
clinician will manually flip through the paper file, which has been
retrieved from the central files by the office assistant, to
determine the purpose of the office visit and review the patient's
relevant medical history.
[0008] A typical patient visit or patient encounter takes about 10
minutes, with the physical examination comprising about 2 to 5
minutes. Following the examination, or sometimes during, the
clinician will make progress notes about the patient's medical
condition, order any necessary tests, give the patient any
prescriptions, and advise if follow-up appointments are needed. A
clinician will usually spend about 2 to 5 minutes to make progress
notes and place them in the patient file.
[0009] If tests are performed onsite, the clinician, laboratory
technician or nurse, conducts the test. If the test results can be
obtained relatively quickly, the clinician might wait for the
results before releasing the patient, and review the results with
the patient. Some testing, however, may be conducted off-site, and
later reported to the clinician. The test results must then be
analyzed and reported to the patient after the initial office
visit, and follow-up appointments may be scheduled.
[0010] The amount of paperwork required has a significant impact on
the service professional, which often detracts from the amount of
time the service provider can spend with the patient. In the
medical arena, every hour of emergency department patient care
requires an hour of paperwork. For surgery and inpatient acute
care, every hour of patient care results in 36 minutes of
paperwork. In skilled nursing care, every hour of patient care
results in 30 minutes of paperwork. And, in home health care, every
hour of patient care results in 48 minutes of paperwork. A
physician can spend 22-38% of his/her time charting on paper.
[0011] In today's practice, service professionals, and physicians
in particular, have added restraints due to increased government
and insurance regulations, liability, working longer hours, less
time to spend with patients, all of which result in the practice
being less profitable and providing a lower quality of care.
Governmental and insurance rules and regulations include, for
instance, electronic payment requirements, HIPAA (Health Insurance
Portability and Accountability Act) requirements (such as
electronic health transaction standards, unique identifiers,
privacy and confidentiality standards, and security and electronic
signature standards), coding and audit requirements, restricted
formularies, clinical pathways, increased malpractice risks from
pseudo standards of care and requirements for more structured
data.
[0012] Accordingly, there is a need for a system that can reduce
the amount of time spent by a clinician on activities outside the
practice of medicine, such as paperwork, dictation, etc. There is
also a need for a system that can reduce the amount of time spent
by other workers in the clinician's practice including the
administrative or office assistants, nurses, clinician assistant,
and laboratory technicians. Those systems must also be able to
comply with government and insurance regulations and must also
provide data that can be analyzed to develop better care
protocols.
[0013] Systems have been developed which automate patient tracking,
medical documents or billing, such as described in U.S. Pat. Nos.
5,991,730, 5,991,729, 5,946,659, 5,933,809, and 5,899,998 to Lubin
et al., Barry et al., Lancelot et al., Hunt et al. and McGauley et
al., respectively. However, automated systems have not been well
received by the service professional community, with fewer than
about 5% of all physicians using some sort of electronic medical
record (EMR) system, which is broadly understood to be a medical
record system that has the capability to electronically provide all
of the functionality and features provided by the paper chart, and
data that can be analyzed to develop better care protocols.
[0014] Service professionals have resisted those systems since they
are unable to keep up with the rapid pace and movement of the
service professional during the various tasks which are performed
throughout the day. One disadvantage of those systems is that they
are technology-driven, as opposed to being user-driven, and
therefore difficult to use, especially by those service
professionals that have difficulty with computer technology.
[0015] In addition, those systems are fragmented in that they
individually implement a single activity of practice management and
managed care to manage scheduling, patient registration, insurance
information, billing and collections. In instances where physicians
are using EMR, practice management and managed care applications to
manage their practices, the applications are typically stand-alone
and run on disparate technology platforms.
[0016] The absence of a common technology platform requires
multiple custom interfaces to connect the "silos" of information to
work together in real-time. The process of developing interfaces
between disparate applications by multiple vendors can be expensive
and difficult and is usually costly and labor-intensive to
maintain. Problems are time-consuming and difficult to identify
when they arise. These usually costly and labor intensive
interfaces are typically used by larger clinician practice groups
(50 or more), integrated delivery networks, and university-based
practices.
[0017] Consequently, those prior systems do not provide a single
system that integrates the features of practice management, patient
records and managed care. Further adding to the problem, those
systems are not set up to communicate with each other, so that
practices that have more than one system need to enter redundant
information into each system. The various systems are not well
suited for interaction between each other, or to maintain
information that would be useful to the other systems.
[0018] However, even if those fragmented systems could communicate
with one another, the systems would merely be interfaced, as
opposed to being integrated. Systems that are interfaced exchange
limited data to address practice management, EMR and managed care
needs. Interfacing systems also require multi-vendor support and
the sharing of limited data across limited system components and
multiple databases. Interfacing also leads to inconsistency in
system user interfaces and system versioning is difficult to
manage.
SUMMARY OF THE INVENTION
[0019] Accordingly, it is an object of the invention to provide a
medical software system that integrates all aspects of practice
management and managed care, including schedule management, patient
registration, insurance information, and billing and collections,
with the EMR. It is another object of the invention to provide a
practice management system that is secure, has functionality and
usability, tracks work flow for service professionals, and makes
the best use of manual resources. It is yet another object of the
invention to provide a practice management system that is cost
effective to implement and maintain, even for small practice groups
(2-5 clinicians), but is configurable to meet the needs of various
specialties.
[0020] In accordance with these and other objectives, a medical
management system is provided that integrates all aspects of
healthcare provider practice management and managed care, including
schedule management, patient registration, insurance information,
and billing and collections with the EMR. The system integrates a
central framework module, a scheduling module, a registration
component, an account management module, and clinical module to
provide a seamless exchange of information.
[0021] The clinical module provides an administration builder that
allows users to define a customized template. The templates are
used by a document builder to generate documents, such as progress
notes and H&P Notes, which are retained in the patient's
electronic chart. The progress note template allows the clinician
to record a patient encounter by presenting the clinician with
predefined sections and sentences that are easily completed by the
clinician during or after the patient encounter. The templates and
documents generated are designed to closely resemble a paper chart.
Information gathered during patient scheduling, registration,
triage, and previous encounters are referenced to pre-populate the
templates to avoid having the clinician entering redundant
information. The documents are relied upon to automatically
generate charges, from which electronic requests are sent to a
claims clearinghouse.
[0022] The system results in increased revenue due to coding
accuracy, billing and fee schedule cross referencing to reduce
under-payments and over-payments, writeoffs, improved clinician
productivity, improved claims management and payment reconciliation
of under payments, patient care reminders that generate
preventive/preventative care visits, and improved receivables
collections. The system results in a reduction of cost, such as a
reduction in the cost of copying and storing documents and records,
malpractice insurance premiums, transcription costs, paper and
related supplies, rejected claims and costs associated with claims
reprocessing, labor savings due to efficiencies and resulting in
possible staff reduction or redeployment, and decreased repeated
lab tests.
[0023] The system has intangible clinical advantages, such as
improved quality of patient care through the provision of
preventive/preventative care, improved chart availability,
drug/allergy interaction alerts, outcomes analysis, improved
response time for patient information requests, improved clinician
and administrator satisfaction, reduction in paperwork and
increased available time to spend with patients. Intangible
business benefits include more efficient scheduling and appointment
notification, avoidance of misplaced or lost patient record files,
elimination of redundant data management, improved financial
accounting accuracy and reporting, and increased market share. The
system is efficient with respect to chart pulls, referral
coordination, billing documentation compliance, coding compliance
and lab report filing.
BRIEF DESCRIPTION OF THE FIGURES
[0024] FIG. 1 shows the overall network architecture in accordance
with the preferred embodiment of the invention;
[0025] FIG. 2 shows the system architecture of the main services
server 10 of FIG. 1;
[0026] FIGS. 3 and 4 show the preferred architecture of the main
services server 10 and workstation 12, as having a client tier,
business tier and data tier;
[0027] FIG. 5 is a block diagram detailing the functional makeup of
the system, with each module implementing the client, business
(middle), and data tiers;
[0028] FIG. 6 is a block diagram of the AR module 30 of FIG. 5;
[0029] FIG. 7 is a block diagram of the clinical module 40 of FIG.
5;
[0030] FIG. 8 shows the visit information check-in screen and
patient registration information screen of the registration
component of FIG. 5;
[0031] FIG. 9 shows the appointment scheduling screen of the
scheduling module of FIG. 5;
[0032] FIG. 10 shows the desktop and internal messaging supported
by the framework module 20 of FIG. 5;
[0033] FIG. 11 shows the facesheet screen of the clinical chart
module 40 of FIG. 7;
[0034] FIGS. 12, 13 and 14 show the account information, charges
and contracts/fee schedule screens of the AR module of FIG. 6;
[0035] FIG. 15 is a flow chart depicting the overall operation of
the clinical module 40;
[0036] FIG. 16 is the template administration screen of the
clinical module 30;
[0037] FIGS. 17-27 show template administration screens used to
define a template;
[0038] FIGS. 28-32 show the preview option during the template
administration;
[0039] FIGS. 33-36 show document building screens used to build a
document in accordance with a template;
[0040] FIGS. 37-38 show a Progress Note document which was
generated in accordance with a Progress Note document building
template;
[0041] FIG. 39 shows list of documents in a patient's chart;
and,
[0042] FIG. 40 shows an H&P note being completed in accordance
with an H&P Note document building template.
DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS
[0043] In describing a preferred embodiment of the invention
illustrated in the drawings, specific terminology will be resorted
to for the sake of clarity. However, the invention is not intended
to be limited to the specific terms so selected, and it is to be
understood that each specific term includes all technical
equivalents that operate in similar manner to accomplish a similar
purpose.
[0044] The present invention delivers an ambulatory software suite
that integrates practice management, electronic medical records
("EMR") (i.e., patient records) and managed care functionality. An
ambulatory suite is a group of applications that is designed to
meet all the needs of a practice. These applications are built on
the same architecture and are designed to share information
seamlessly based on integration rather than interfacing.
[0045] The system integrates, as opposed to interfacing, all
aspects of a clinician's practice, namely the clinical, financial
and administrative processes. Integration provides a single vendor
solution that addresses all practice management, EMR and managed
care needs. It also allows for single vendor support and the
sharing of all data across all system components through a single
database which avoids errors, duplication of data entry and
inconsistency of information. For instance, scheduling and
registration data flows to billing; registration data flows to the
patient's chart; coding, scheduling and prescription data flows
from the chart to billing, to the schedule and to the pharmacy,
respectively.
[0046] A single integrated system also completes patient tracking
which facilitates cost accounting analysis, provides consistency in
all system user interfaces and allows for greater security and
audit trails. In addition, system administration of all the
applications can be handled through a single system administration
feature. An integrated system also means only a single vendor,
which eliminates the need for interface management, and that the
system can be upgraded as a single entity with consideration of all
functionality that may be affected.
[0047] The EMR is characterized as having a direct data entry into
a patient's record of all information that currently can be entered
into a paper record. The EMR is a customizable and organized
storage of information, and provides a comprehensive aggregation of
content for a single provider or location for each patient. In
addition, the EMR is capable of incorporating information from
outside sources, such as through document scanning, and has
information mobility, accessibility and reviewability.
System Architecture
[0048] Turning to the drawings, FIG. 1 shows the overall system 5
in accordance with the preferred embodiment of the invention. The
system 5 has two primary elements: a main services server 10 and
customer workstations 12. Optionally, the main services server may
be hosted at a data center (server 14) as opposed to being hosted
at the practice location. The main services server 10 is at the
center of the system 5, and is located at a central location for
communication with each of the customer workstations 12.
[0049] The main services server 10 contains all of the system
applications and controls operation of the system 5. The main
services server 10 includes the overall framework module 20 (FIG.
5), the AR (accounts receivable) module 30 (FIG. 6), the clinical
module 40 (FIG. 7) and the scheduling module 23. The main services
server 10 controls the communication of the system 5, stores data,
and controls the various operations and processes.
[0050] The customer workstations 12 are located at various
locations, remote from the main services server 10, throughout the
clinician's office(s). The customer workstations 12 are part of a
Local Area Network ("LAN"). The workstations 12 form the point of
communication between the customer and the main services server 10.
When the customer workstation 12 is located at an office remote
from the main services server 10, the customer workstation 12
preferably communicates with the main services server 10 through a
customer router which is accessed via a DSL ("Digital Subscriber
Line") network or frame relay network, and a site router. The site
router is located with the customer workstation 12 and the main
services server 10 at the customer's location, and the customer
routers are located at a central location with an enhanced services
server 16.
[0051] When the main services server 10 is hosted at a designated
data center, that hosted server 14 communicates with the customer
workstation 12 through a customer router, via the frame relay
network or DSL network, and a data center core router. The enhanced
services server 16 also controls an Internet router used to provide
access from the clinician office to the Internet for email and web
surfing capabilities. The Internet router is located behind a
firewall to provide security.
[0052] The system 5 has features addressing each of the HIPAA
Security Regulation's requirements, including biometric login,
restricted access based on login authorization (i.e., individual
charts or chart sections), audit of who looked at what section of a
chart and when, and the restricted ability to copy, print, fax,
email and export information based on login authority. The system
also has functionality to assist in compliance with the HIPAA
Privacy Regulations, such as consent tracking and disclosure
logging functionalities. The system also supports EDI standards,
including transactions, code sets, and identifiers.
[0053] With respect to communications capabilities, HL7 (Health
Level 7) compliant messages are fully supported and allow for
inbound and outbound data communications with most healthcare
information systems. Thus, the system interfaces with other related
systems, such as hospital information systems, such as HBOC,
Meditech, and Cerner. These hospital information systems manage
electronic data for hospitals and the system exchanges information
such as patient demographics, processing pre-certifications,
orders, results. The system also interfaces with diagnostic
equipment lab systems to exchange information. Transactional
information and data associated with ADT (Admissions, Discharge,
and Transfer), orders, results, labs, prescriptions and other data
types can be efficiently shared.
[0054] The system also handles non-HL7 messages for data exchange
between claims processors, diagnostic equipment and other medical
information systems. All messages are designed with current
industry standards and the proposed/final HIPAA regulations in
mind. Messaging requiring more programmatic integration, as opposed
to data exchange interfacing, can be pursued through XML-based
programming.
[0055] The system 5 preferably uses Microsoft's Digital Dashboard
web-browser interface, Microsoft Windows 2000, Microsoft SQL Server
2000 database and the Windows Distributed interNet Applications
(DNA) technologies. The system's support for the HL7 data exchange
standards and the X12N (Insurance Subcommittee of Accredited
Standards Committee X12) EDI (Electronic Data Interchange)
standards facilitate both systematic and data-level integration,
with X12 particularly supporting claims processing and electronic
remittance advice. Additionally, use of XML (Extensible Markup
Language) provides for enhanced functionality within a browser
environment and facilitates extensive interface configuration, such
as with pharmacy or prescription systems, healthcare research
information, handheld devices and medical supplies ordering.
[0056] The system integrates the Unicor Alpha II coding database,
the First DataBank drug interaction database and the SNOMED
controlled medical vocabulary database. These databases provide
unique functionality and are provided as a "back-end" content
repository which is maintained as part of the overall system 5. The
SNOMED medical vocabulary database is optional, and need not be
provided.
[0057] The customer workstation 12 is implemented in single
technology platform--a browser, making use of a web-based, as
opposed to web-enabled, development approach. The browser
facilitates remote access to all practice and patient information
within a highly secured environment, and enables communication
between clinicians and their patients. The browser also enables a
single source of support, to thereby minimize the cost of ongoing
system maintenance. The browser also enables a scalable solution
that can be expanded from smaller clinician practices to larger
healthcare communities, and can be delivered to a targeted group of
clinician specialties. The system also includes a website that can
be hosted as a service from an application service provider, or
deployed onsite at the clinician's office.
[0058] The system 5 employs a central service, which is a utility
that runs in the background and automates tasks. It uses an event
driven design to perform tasks, wherein an event can be a file that
is empty, have a single line or a data file. The service monitors a
set of directories on the server and looks for the presence of an
event or flag file to initiate a script or application. The flag
files indicate what action to perform. The central processor of
main services server 10 manages the launching of script files to
control operation. Multiple scripts and flags can be used together
to complete tasks, and each task may consist of multiple scripts
and/or third party programs. The central service uses two types of
utilities, one that runs on the base and one that runs on the main
services server 10.
[0059] The clinician preferably uses a highly graphical and
configurable interface which is implemented with a stylus and
lightweight, mobile pentop input device. The office administrator
also interfaces with a browser interface which enables rapid data
entry and retrieval. All the user interfaces communicate with the
customer workstation 12.
[0060] The main services server 10 includes a data repository. The
repository uses relational database technology to manage all
discrete data centrally, which facilitates the sharing of
information across all areas of the system. This functionality
reduces the potential for redundant data entry and data
storage.
[0061] The system network 5 allows clinicians to collect patient
outcome results and correlate those results with treatment plans to
measure effectiveness. That information can be exchanged with data
from other clinicians, research institutes, universities and
pharmaceutical companies for broad-based ongoing research. Data is
aggregated from each participating clinician's clinical module into
a centralized repository that is maintained by the enhanced
services server 16, with appropriate de-identification performed to
protect patient privacy. A controlled medical vocabulary is
enforced to normalize the collected data. Access to the repository
is controlled to certain biomedical informatics researchers, who
can use query tools to mine the data.
[0062] The network 5 allows the clinician to submit claims directly
through the network to payors, eliminating clearinghouse costs and
delays, or through a clearinghouse, taking advantage of
clearinghouse edits and support. The network 5 can further be used
to aggregate the purchasing of supplies, goods and services by
clinicians and patients.
[0063] FIG. 2 shows the system architecture from an applications
standpoint. FIG. 2 represents the internal workings of the main
services server 10 of FIG. 1. The services represent a series of
Windows 2000 Service programs that support and enhance the
functionality of the MTS COM+ middle-tier and to provide operating
system capabilities to the product as a whole. SP (Stored
Procedures) and Functions are two different ways of storing source
code in the database. Processes can be supported at either the IIS
server or the COM+ server.
[0064] FIG. 3 shows the preferred architecture of the main services
server 10 and workstation 12, as having a client tier, business
tier and data tier. Both the data tier and the business tier are
located on the main services server 10 and the client tier is
located on the customer workstation 12. The architecture is based
on Microsoft Distributed Internet Applications ("DNA") architecture
using COM+ middle-tier objects for business rules and Microsoft
Transaction Server ("MTS") transactions for resilient database
storage and retrieval. A standard n-tier design model provides
separation of the detailed practice management business rules from
the data storage and client presentation.
[0065] The client tier targets Microsoft's Internet Explorer 6 as
the client platform. The business tier is implemented on Microsoft
Windows 2000 server using the Microsoft Internet Information Server
("IIS"), Microsoft Active Server Page ("ASP") technology, Microsoft
Transaction Server ("MTS"), and COM+ middle-tier objects. The data
tier makes use of Microsoft SQL*Server 2000. The IIS tier provides
for handling the robust, interactive client needs of the product.
The MTS COM+ middle-tier provides for a centralization of business
logic and routines. The SQL*Server Database tier focuses on data
storage and aggregation. The ITS, COM+ and SQL*Server are also
shown in FIG. 2.
[0066] FIG. 4 shows another preferred architecture of the main
services server 10 and workstation 12, as having a client tier,
business tier and data tier. FIG. 4 makes use of all the benefits
of FIG. 3, but extends the model to make use of current Microsoft
XML-based Internet architecture designs to provide an interactive
client experience. A standard web Internet design model provides
for tighter integration of the customization of business logic and
the web browser presentation, which is extended with Microsoft
Internet technologies XML and VB scripting classes.
[0067] The client tier uses Microsoft Internet Explorer 6 as the
client platform. The business tier is implemented on Microsoft's
Windows 2000 Server using IIS, ASP and native XML communication and
handling capabilities. The data tier primarily stores data in XML
files so that data, content and context can be stored together in a
meaningful way. It also makes use of Microsoft SQL*Server 2000 to
provide for fast, easy system access to list-driven data storage,
using XML-SQL functionality and enhanced functions
capabilities.
[0068] The data tier in this model also makes use of the File
System for storage of clinical documents and user customizations.
Using the File System to store clinical documents improves the
speed of the system because once a clinical document is signed, it
is always referenced as a view-only document. The web architecture
lends itself well to the transfer of documents.
Main Services Server
[0069] An overview of the main services server 10 structure is
shown in FIG. 5. The main services server 10 has a framework module
20 with various components 22, reference databases 26, scheduling
module 23, AR module 30 and clinical module 40. The clinical
documentation of the EMR is handled by the clinical module 40. FIG.
5 shows the functional makeup of the system. Each module has pieces
of code implementing the client, business (middle), and data tiers.
A majority of the EMR interaction is done through robust
client-side interaction with the customer workstation 12, but is
centrally processed, stored, and managed by the main server 10. The
main services server 10 is also capable of receiving patient
demographic and financial information from legacy systems 24 by way
of migration utilities that import that information into the main
services server 10 database.
[0070] The main services server 10 communicates with a claims
clearinghouse 28 for processing insurance claims. The AR module 30
is shown in further detail in FIG. 6 and the clinical module 40 is
shown in further detail in FIG. 7. The main services server 10 has
a centralized framework module 20 that supports communication
between the various components 22, the scheduling module 23, the AR
module 30, the clinical module 40 and the legacy system and
reference databases 24, 26.
[0071] A central database 25 is provided that is used to store data
for each of the framework module 20, the various components 22, the
scheduling module 23, AR module 30 and clinical module 40. As used
herein, patient data generally refers to demographic, financial and
clinical information. Clinical information includes symptom,
observation, treatment, assessment, diagnostic and therapeutic
information. The central database 25 ensures that all information
used by the system is retrieved and stored at the same location, to
avoid users having to enter redundant information and ensure that
all areas have access to the most current information.
[0072] The scheduling module 23, the AR module 30 and the clinical
module 40 are separate and distinct modules, but are fully
integrated through the use of shared functionality in the framework
module 20, such as the desktop, registration, reports, audit
logging, security, system setup, user preferences, alerts and
reminders, and messaging. The main services server 10 provides
seamless integration between the framework module 20, the
scheduling module 23, the AR module 30 and the clinical module 40,
as well as other ancillary components, including the central
website portal, centralized messaging, email, and protected
Internet access. The framework module 20 preferably has components
22 which include registration, reports, system administration,
communication, help, messaging and desktop.
[0073] FIG. 5 represents integration of each stage of a clinician's
practice, including scheduling, registration, charting, AR
management and reporting. The system automates each of the
processes associated with a clinician's practice, from patient
scheduling, to the clinical encounter, though the process of filing
claims and receiving payments. Information collected within one
area of the system flows together to facilitate a workflow process
at another area of the system.
[0074] For instance, information is collected throughout the
patient registration, and is used by billing to initiate the coding
and billing processes. The integrated system reduces the
administrative burden, allowing more time to spend with patients,
streamlining the claims process and improving coding and the
financial accuracy associated with the billing process and
ultimately maximizing the practice profitability.
[0075] On the financial end, the system integrates coding and
billing, fee schedule management, patient statements, AR
management, collections electronic remittance advice and reporting.
AR management includes, for instance, electronic charge tickets,
balance tracking, charges, payments and adjustments, claims
processing, claims maintenance, electronic remittance, contracts
and fee schedules, insurance plans, and statements. Coding and
billing includes, for instance, automation to facilitate coding and
documentation compliance, as well as fee contract analysis. This
assists managers in their effort to eliminate the occurrence of
undercoding, reduce the risk associated with potential overcoding
and identify instances of under-payment to maximize profits and
reduce coding liability.
[0076] Thus, the system handles point-of-care charting, such as
document management, point and click document generation,
evaluation and management ("E&M") coding assistance, summary
lists, prescription management, orders and results and flowsheets.
On the clinical side, the system integrates point of care charting,
discrete data storage, clinical reminders, laboratories and
prescriptions, documentation compliance, coding assistance, order
management and reporting.
[0077] On the administrative side, the system integrates patient
scheduling, patient reminders and alerts, desktop, registration,
insurance eligibility, visit check-in and check-out, reporting,
audit logging, security, system setup, user preferences, and
messaging.
Registration
[0078] The framework module 20 of the main services server 10 has a
registration component 22 which includes visit check-in 33 to
capture demographic, insurance coverage and administrative
information for each patient. The information in the registration
component 22 can be entered by the practice staff. However, the
information can also be entered by the patient through a secure
Internet link or at a waiting room kiosk through an interface with
the customer workstation 12. Required fields, patient flags and
checklist procedures ensure thorough information collection for new
patients and prompt the user to ensure that the existing patient
information is kept current.
[0079] The registration component 22 supports patient registration,
including new patient information and access to patient demographic
information from any prior management system which has been
imported from a legacy system 24. The registration component 22
stores any information obtained for new patients and information
modified for existing patients, including both demographic and
insurance coverage information. Registration usually takes place
after the patient has scheduled an appointment, but the system will
allow registration without a scheduled appointment, which is useful
for physician practices that accept walk-in patients.
[0080] The information retained by the registration component 22
can be used by any other component 22, as well as the scheduling
module 23, the AR module 30 and the clinical module 40. Likewise,
the other components 22, the scheduling module 23, the AR module 30
and the clinical module 40 sometimes receive new or updated
information that is then stored by the registration component 22.
In this manner, the main services server 10 has a single source of
registration information that is used systemwide, so that users
need not enter information that has been previously stored at one
module when working in another module. In addition, the
registration information is always kept current for all
modules.
[0081] The registration component 22 can also receive patient data
from a prior management system, e.g., a legacy system database 24.
The information in the legacy system database 24 is imported from a
prior management system, either through manual entry or by
conversion of electronic information. The registration information
imported from the legacy system database 24 may include demographic
information about the patient, such as name, address, date of
birth, social security number, insurance coverage, and sex. The
legacy system database 24 may also include financial data, such as
outstanding balance, account information, and insurance claims
being processed. The system 5 also allows for the import of
financial information into the AR module via a financial migration
utility.
[0082] Visit-specific information, such as financial responsibility
and third party insurance coverage is also captured. The
information is made available to other components of the system,
such as for charts and billing to eliminate redundant data entry
and management. The system includes patient identification and
record retrieval by digital photo, which allows personal treatment
of the patient as well as positive identification to prevent
insurance fraud.
[0083] The desktop 22 displays the check-in and check-out status of
patients and supports unscheduled patients and can launch a
patient's chart. The system displays the present day schedule, as
well as open visits from prior days. If the user selects another
date, the visits and scheduled appointments for that selected date
are displayed.
[0084] The system registration allows users to associate one or
more insurance plans with an employer. Users may set up information
about local employers for association with patients and persons.
This functionality greatly speeds up the process of entering
insurance information for a specific patient. Instead of entering
detailed insurance information for every patient, using this
functionality, a user can quickly capture a patient's insurance
information by associating a patient with a specific employer
insurance plan that has already been entered into the system. Thus,
insurance plan maintenance or the addition of new plans can be
performed for a patient's record while accessing the patient's
registration information.
[0085] In the example shown in FIG. 8, the user has entered all of
a patient's demographic and insurance coverage information into the
system, including all of the CMS (Centers for Medicare &
Medicaid Services--formerly HCFA, the Health Care Financing
Administration) required data, as well as other useful information
such as e-mail address and the patient's digital photo. Once the
patient information is entered, the user is ready to check the
patient in. Additionally, from the visit check-in screen, the user
can easily see important information about the patient, such as
referral management information, payment collections notices and
co-pay arrangements. The system automates the prior approval for
referrals, admissions, orders, procedures, special medications, and
other items requiring prior approval.
[0086] The visit information component 33 is primarily used to
track a patient's office visit. In preparation for the visit, the
visit information sub-section 34 obtains information from the
scheduling module 23, namely Date of Service, Time of Service,
providers, and location. That information is used to pre-populate
the user's check-in screen and the user can fill in any missing
information.
[0087] The user may also input pre-certification information from
the insurance company or from the patient at check-in, if that
information has not been previously obtained and entered into the
scheduling module 23 or if that information has changed since the
patient made the appointment. The user also obtains information
from the patient regarding the purpose for the visit, if that
information has not been previously obtained and entered into the
scheduling module 23. The visit information, however, is not used
to update the scheduling module 23, but rather any changes to the
appointment information is retained for historical/tracking
purposes.
Scheduling
[0088] The scheduling module 23 supports scheduling for patients,
clinicians, staff members, office equipment, or any resource the
user chooses to define. Scheduling is a rules-based, flexible
module that supports many different levels of scheduling
complexity. Appointment scheduling is administered using automated
scheduling rules that ensure proper resource and time allocation,
and further facilitates a smooth flow of patient appointments.
Appointment scheduling is configurable to the practice and to the
user. The user can review schedules at any time from any point in
the office, providing the office assistant with real-time
appointment availability information, and providing the clinician
with real-time scheduling information.
[0089] Users can schedule patient visits using simple "drag and
drop" techniques in accordance with personnel, resource and
equipment availability. It provides appointment reminders and
alerts to minimize errors, allows for more efficient processing of
appointments and ensures that patients are properly prepared for
their visits. Patient flags, such as In Collections, Disabled
Patient, and History of Missed Appointments, can be associated with
a patient to serve as reminders to make special arrangements for a
specific patient when scheduling an appointment.
[0090] As an appointment is scheduled, all resources, such as
facilities, equipment, personnel and medical procedures, are taken
into consideration to ensure that conflicts do not occur between
resources. Rules templates can be defined to control the available
appointment times for resources. Templates may be defined and
applied across many resources and dates to minimize schedule
maintenance. The resources are presented to the user with several
viewing options, such as viewing multiple providers' schedules on
the same day or multiple days for one provider.
[0091] The user can perform advanced searches for multiple
resources and various time and date ranges. Once search parameters
have been defined and saved, the user may access the saved search
template for future use. The next available appointments are
quickly accessible and displayed to facilitate an efficient
scheduling process. The appointment scheduling reduces patient
scheduling conflicts.
[0092] In the example shown in FIG. 9, the user has scheduled an
appointment, and the system automatically alerts the user to remind
the patient of specific instructions to follow prior to the
appointment. The instructions are based upon the type of
appointment that has been scheduled for the patient. Additionally,
as the user attempted to schedule the appointment, the system
indicated that a rule existed for that type of appointment, which
the user then chose to view the rules.
Reports
[0093] The reports component 22 supports all reports. The system
has a standard set of reports to meet user needs which users can
display, filter and sort. Multiple filter and sort options can be
saved as configured reports for future reference. This standard
report set with its customizing options allows users to report on
almost any combination of data within the system database, which
manages administrative, clinical and financial patient data. The
user selects the report criteria, such as insurance company,
insurance plan, billable provider, and the report is generated.
[0094] In addition to the standard reports, a report writer allows
the user to modify and save existing standard reports. A
user-defined reporting tool is provided which provides a number of
pre-defined datasets which the user can choose any fields from to
create a customized report. Reports can be run immediately, or in
the background, sending a notice to the user via the messaging
system when the report is ready to view.
[0095] Reports can be generated as needed, as well as daily,
weekly, monthly, or annually. Reports can be for any date or date
range and can be sorted by many different parameters, such as
provider, practice, insurance plan, and patient. Once the report is
generated, it can be printed, and exported to a variety of other
file formats, such as Microsoft Word and Excel, for incorporation
in office documents.
[0096] Examples of the standard reports include: Patient Financial,
such as Account Information Report; Demographic Information, such
as Patient Information Sheet; Provider Productivity Analysis, such
as Summary By Provider, Procedure Code Analysis Report, and
Adjustment Analysis Report; Practice Statistics, such as Procedure
Code Analysis Report; Referral Information, such as Referring
Provider Analysis Report; Scheduling Status, such as Appointment
History Report, and Daily Scheduling Report; Delinquent Accounts,
such as Collection Balance Report, and Aging Account Summary
Report; Insurance Claims Reporting, such as Claims Analysis Report;
Audit Report, such as Audit Log Report (HIPAA Security
Requirement), and Disclosure Log Report (HIPAA Privacy
Requirement); Managed Care Reporting; Contract Analysis; Delinquent
Accounts; Insurance Claims Reporting; and Accounting Reports, such
as Account Information Report, A/R Balancing Log Balance Tracking
Report, and Transaction Detail Report.
Administration/Communication/Help/Reference Databases
[0097] The system administration component 22 supports all
administrative functions, such as setting user passwords,
system/user settings, and controlling access. Administration is
implemented, for instance, at the AR administration component 31 of
the AR module 30 (see FIG. 6).
[0098] The communication component 22 supports all the external
communication for the system 5, including communication with the
claims clearinghouses 28. The help component 22 provides user
support information for all the modules. The messaging component 22
controls internal messaging.
[0099] The reference databases 26 maintain all reference
information that is needed for the main services server 10. As
shown in FIG. 5, the reference databases 26 include, for instance,
postal information, insurance codes, drug information and a medical
vocabulary such as SNOMED (Systematized Nomenclature of Medicine).
The postal information includes information on zip code, city,
state, county and country. The insurance codes stored in the
reference database 26 include insurance rules and regulations, such
as ICD (International Code of Diseases), CPT (Current Procedural
Terminology), HCPCS (HCFA Common Procedure Coding System) codes,
and CCI (Correct Coding Initiative) edits. The CCI edits dictate
which CPT code combinations and which ICD-9 codes are valid to
support certain CPT codes in order to be valid for payment of a
Medicare claim.
Desktop
[0100] Turning to FIG. 10, the desktop is shown, which is supported
by the desktop component 22 of the framework module 20. The desktop
is the main user interface which allows centralized access to each
component within the application. The desktop is presented to the
user at a user input device, which can be a wireless pentop or
personal computer that is in communication with the user's
workstation 12. The desktop is configurable to the individual
user's needs and preferences, to help users organize daily workflow
and tasks. Users can view and filter scheduled patients and walk-in
patients, and have access to internal messaging and external
applications such as stock quotes, web access and educational
resources.
[0101] A menu bar is located at the top of the desktop, with the
options of AR management, chart, registration, schedule and system.
The menu bar has a pull-down menu that allows the user to select
the type of operations to be performed. AR management is supported
by the AR module 30 (FIG. 6). The user can check a patient's
account information, charges, or e-charge ticket; or check payments
and adjustments such as patient transactions and insurance
transactions; or check claims, such as claim maintenance, claim
processing and claim status; or check system setup such as AR
configuration, lookup tables, contracts/fee schedules, e-charge
ticket configuration, insurance plans, procedures and
statements.
[0102] If the user selects the chart option on the menu bar, the
pull-down menu offers the user the option of accessing patient
charts, build templates, or administration of HPI, diagnosis plan,
family medical history, genetic screening, past medical history,
past surgical history, physical examination, ROS, social history
and general template administration. The chart option is supported
by the clinical module 40 (FIG. 7).
[0103] The registration menu bar option allows the user to access
patient information, visit information and delivery information,
and is supported by the registration component 22 of the services
server framework 20. The schedule menu bar option allows the user
to access appointment scheduling and schedule information, and is
supported by the scheduling module 23 of the framework 20. The
system menu bar option allows the user to access report selection,
security information such as group and user administration, and
group rights, and system setup information such as care providers,
communications, employers, locations, system configuration, system
defaults and visit types. The system option is supported by the
report, communication and system administration components 22 of
the framework 20.
[0104] The envelope icon at the top right of the desktop gives the
user access to the messaging center. If the icon shows a piece of
mail (as in the embodiment of FIG. 10), the user has a new message.
Clicking on the icon brings the user to the message center. A key
icon is located next to the messaging icon, and allows the user to
change the user password. The name of the user that is logged in is
displayed to the right of the key icon, which is Kathy in the
present example. Clicking on the user's name allows the user to log
out.
[0105] A title bar is displayed beneath the menu bar. The title bar
includes a flag icon, an information function and a search
function. The present day and date are displayed on the right-hand
side of the title bar. If the user clicks on the information
button, a screen is displayed with information about the patient,
including demographics, administrative and financial data which is
retrieved from the registration and administration components 22 of
the framework module 20. If the user updates any of the patient
information, the updated information is updated at the registration
component 22. The search button allows the user to search for a
patient, by name, ID number, or other patient information.
[0106] If the user has selected a patient, so that the patient is
in the buffer, the flag icon is activated in the title bar. The
flag icon is an indicator of whether the currently selected patient
has any flags checked in the patient flags modal. If the flag is
clicked, the patient flags modal is displayed, which indicates
whether the patient has been flagged for special attention.
[0107] Fields listed in the patient flags modal include: In
Collections, No Insurance, Wheelchair, Violent, Excess Balance,
Expired Insurance, Canceled Appointments, Missed Appointments,
Collection 1, Collection 2, Collection 3, Sensitive Chart, Do Not
Call Home, Do Not Release Name, Do Not Mail to Home, Medicare
Waiver Signature, Restricted Chart, See Notes. The user can select
to add or remove flags for a patient, and the system can
automatically create a flag, such as when the patient has an
outstanding balance on their account.
[0108] In the embodiment of FIG. 10, the user has configured the
desktop to include a message from the messaging center, a listing
of scheduled patients appointments and checked-in patients. The
user is creating a message regarding medication refills. Once the
user selects the patient name, the message is automatically
pre-populated with information about the patient which is retrieved
from the registration component 22 of the framework module 20. The
message can also be pre-populated with the patient's chief
complaint, and current medication information.
[0109] The listing of scheduled patients appointments can be
configured by the user, but generally includes the time of the
appointment, the patient name, any scheduled resources, the type of
appointment, and the chief complaint. If the user wants to access
patient information, the user selects a patient, which results in
the patient name being displayed at the top right-hand side of the
title bar, which is Laura Barrows in our example. The check mark to
the right of the selected patient is a pull-down menu that displays
a list of recently-selected patients. If the user selects a patient
from that list, that newly selected patient will be the current
patient in the buffer. The user can also select patients by
selecting the search function from the title bar to search for the
patient's name.
[0110] The system defines different types of users, such as
clinical, research and administrative, each having different user
rights. The desktop only displays those functions and information
that are available for that particular user. For instance, the
desktop would guide a clinical user into the EMR portion of the
system, and the administrative user into the AR practice management
portion of the system.
AR Module 30
[0111] Returning to FIG. 6, the AR module 30 is shown in further
detail, and is implemented in accordance with the architecture
shown in FIG. 3. The AR module 30 supports AR administration for a
practice office. The AR module 30 summarizes patients' financial,
medical and insurance information to produce a financial record of
the patient's visit used in collecting payment for the services
rendered.
[0112] The AR module 30 includes AR administration 31,
procedure/financial mapping 34, service detail entry 35, insurance
claims 36, claim detail/service detail history 37 and service
details 38. The AR administration component 31 supports
administration of the office practice, and communicates with the
registration component 22, namely the patient information 32 and
visit information 33. For instance, the AR administration component
31 includes look-up tables and configuration information, fee
schedules, contracts and insurance companies and plans. The
information in the AR administration component 31 is preferably set
up by the practice office administration to be specific to the
practice.
[0113] The patient information sub-section 32 supports patient
information, including access, retrieval and storing. If a user
wishes to access patient information, the patient information
component 32 communicates with the registration component 22 of the
framework module 20, which either stores the information or
retrieves the information from a database. The patient information
component 32 also retrieves insurance information from the AR
administration component 31.
[0114] The information retrieved from the registration component 22
and the AR administration component 31 is presented to the user for
display and manipulation. For instance, the patient information
component 32 may pre-populate a form being viewed by the user, such
as an insurance form or progress note, with the patient
demographics and/or insurance information. Information that is new
or updated from the patient is added to the customer workstation 12
and sent to the registration component 22 and the scheduling module
23.
[0115] The procedure/financial mapping component 34 supports
billing codes from the reference database 26, such as Unicor/Alpha
II and CodeCorrect, as well as charges, cost and time which are
obtained from the AR administration component 31. The mapping
component 34 relates procedures to the reason they were performed
(diagnosis) and the charges, cost and time for those
procedures.
[0116] The service detail entry component 35 retrieves information
from the visit information component 33. That information is then
used to pre-populate the associated date of service, providers,
locations, and insurance plans for the service detail being
entered. Information for the service detail component 35 is entered
either manually from an electronic charge ticket or from a paper
superbill, or can be entered electronically, such as by being
electronically imported from the clinical module 40. The paper
superbill is essentially a charge ticket that is used during
checkout and/or billing and is created in response to the
clinician's diagnosis and orders. The electronic charge ticket is
an electronic representation of the paper superbill which may be
used during checkout and/or billing either manually or through an
automatic import.
[0117] The service detail entry component 35 sends information to
the Unicor/Alpha II reference database 26 for validation prior to
claim creation. Information from the service detail entry component
35 is used to generate an insurance claim. The information is
sorted and stored in a database according to insurance claims 36,
the claim detail/service detail history 37 and/or the service
details 38. The service detail entry component 35 communicates with
the clearinghouse 28 to process insurance claims, which responds to
insurance claim requests with a pass, fail or error.
[0118] FIG. 12 shows account information for a patient. As the
documentation for a patient visit is completed and authorized, all
of the appropriate billing codes may be automatically posted to the
charge entry portion of the system. Coding assistance is available
for ICD, CPT, and HCPCS codes, and warnings and alerts are based on
the Medicare reimbursement guidelines to facilitate coding and
billing compliance.
[0119] The system then references the respective insurance plans,
contracts and/or fee schedules to locate and enter the appropriate
charges into the bill. Upon entry of the appropriate charges, a
claim is generated and available for automatic electronic
transmission. As payments are received, the system allows users to
post payments and immediately reconcile the payments to ensure that
all accounts balance properly.
[0120] A sample of the charge posting is shown in FIG. 13. Charge
posting consolidates and prepares the coding data as it comes over
from the visit documentation captured within the system. Integrated
coding edits enable the system to assist users in compliance with
CMS and the National Correct Coding Initiative. Warnings and alerts
based on the CMS reimbursement guidelines are displayed prior to
saving the information, and available for reference purposes.
[0121] Additionally, users can search for all applicable diagnosis
and procedure codes and arrange the format of a customized
electronic superbill specific to the needs of the practice. When
necessary, assignment of insurance coverage at the individual
charge level is supported for tracking of charges within a single
visit that are attached to different insurance coverage. Support
for tracking multiple pre-certification numbers by insurance plan
is included, and all patient demographic and insurance information
is accessible for real-time edits during charge entry.
[0122] AR administration 31 also includes system parameters that
allow accounting and claims information to be processed in
"real-time" for automatic account posting and accurate reporting,
or in "batch mode" for review and editing purposes. Users can also
set up the administrative portion of the system to properly manage
billing for multiple locations using a single Tax I.D.
[0123] Attachment of non-billable care providers to billable care
providers allows more accurate revenue tracking. Users may
establish multiple charges and descriptions for single CPT or HCPCS
codes with defaults to streamline charge posting. Plan specific
edits may be established to automate conversions of data for
specific claim generation requirements, such as type of service or
modifiers.
[0124] Claims and statements may consist of single or multiple
pages and are automatically generated and available for electronic
processing. Each claim that is created contains data for only one
patient and for only one visit. After charges are grouped together
by patient and by visit, they are then evaluated for multi-claim or
multi-page separation. Once the claims have been created, they can
be selected and edited prior to electronic submission. The system
supports multiple claim formats including HCFA 1500, UB92 and ANSI
X12N 837 and NSF. Claim payments are automatically posted and
underpayment situations identified.
[0125] Claims management provides detailed filtering and sorting
options that allow users to work with claims by insurance plan,
date created, date submitted, claim priority, claim payment status,
etc. This functionality provides quick access to claims
information, notes and actions, as well as allowing users to view a
claim in HCFA 1500 format.
[0126] Payment and adjustment posting retrieves the allowed amounts
and contractual adjustments from the appropriate fee schedule and
posts them simultaneously during payment entry. Additionally,
applicable contractual adjustments may be posted at the time of
charge posting, or during payment entry according to the respective
insurance plan setup. Should insurance coverage change, the
respective allowed amounts are automatically recalculated. Credit
management allows users to select a credit category for designation
of payment overages or credits. The utilization of these "credit
buckets" reduces the efforts required for refund processing and
balance transfers by reducing the research needed for processing
credit balances.
[0127] Account information is quickly accessible for viewing,
processing and editing purposes in summary and expanded line item
displays. From the account line item view, all related transactions
and notes can be displayed. Account information can be viewed in
chronological order by date of service, posting date or visit
order. Additionally, robust filtering and sorting options are
available and can be saved for repeated usage based on job function
needs.
[0128] The system also generates collections letters, and performs
tracking of aged delinquent accounts and call tracking. Criteria
can be defined so that accounts and claims qualify for concentrated
collection and follow up activity by the office staff. Monitoring
tools enable management to track and evaluate collection
efforts.
[0129] In addition, contracts and fee schedules can be set up and
maintained with minimal effort, as shown in FIG. 14. Medicare part
B fee schedules come pre-loaded with the system and are annually
updated, enabling users to simply select the geographic region for
their practice. The claim amounts are matched to the allowable
amount of the contract to automatically establish the correct
allowed amounts for procedures. A/R management gives users several
methods to establish a variety of fee schedules: percentage of
charge, allowed amount, percentage of another fee schedule
(including Medicare), etc., and to indicate which of these fee
schedules should be rounded and/or capitated. Contract fee
schedules are integrated into the system's charge posting and
payment entry functions.
Clinical Module 40
[0130] FIG. 7 shows the details of the clinical module 40, which
has a template administration builder 41, templates 42, 43,
document builder 44 and virtual file folders 45, 46, 47. The
clinical module 40 supports the clinician's routines, from when the
patient arrives at the practice office, until the patient leaves.
The clinical module 40 is implemented in accordance with the
architecture shown in FIG. 4.
[0131] The general operation of the clinical module 40 is shown in
FIG. 15. The template administration builder 41 is used to create
templates 42, 43 which are subsequently used to generate a
document. Accordingly, at step 52, the user defines a template
using one of the available template administrations, such as HPI
administration, ROS administration or PE administration are first,
then templates. Once the template 42, 43 is defined at step 52, it
can be used to create documents by the document builder 44, step
54.
[0132] At step 54, the template builder 48 gathers information
which, together with prescription and medication lists and any
imported documents, is used to build a document, step 56. The
template builder can gather information from the registration
component 22, such as CC and/or demographics, or information about
history and habits that may have been entered during triage or
documentation of prior visits. The template structure ensures that
a document can convert between XML and HTML formats. The document
is sorted and stored in a file system 45, 46, 47, in accordance
with its document type.
[0133] The clinical module 40 supports the use of a triage note
that prompts the clinician to enter in detailed triage data for a
patient. It is designed to be the initial documentation point in a
patient's visit and will usually be completed by a nurse before the
patient starts the encounter with the clinician. All information
entered in the triage note will be used in other sections of the
patient's visit as well as his or her patient record. The
information available for entry includes Reason for Visit,
Presenting Symptoms, Additional Notes, Vital Signs (Blood Pressure,
Heart Rate, Respiratory Rate, Temperature, etc.), Review of Systems
and Orthostatic Vital Signs. The Reason for Visit is updated in the
visit check-in information of the registration component 22 of the
framework module 20, for use by other areas of the system.
[0134] The clinical module 40 supports the patient charts, or EMR.
If the user selects Patient Charts from the Chart option of the
Desktop menu bar (FIG. 10), the facesheet is displayed, as shown in
FIG. 11. The facesheet of the currently selected patient chart is
displayed when a user opens a patient chart. It contains critical
but brief patient information most frequently used by the physician
and nurse. It serves as a "homebase" allowing quick and easy access
to more detailed parts of the chart. It allows the user to view and
add vital clinical information (Vital Signs, problems, medications,
Allergies etc.) at a glance without having to navigate further into
a patient's chart.
[0135] As shown, the facesheet preferably includes the patient's
reason for visit, vital signs, problem list, past medical history,
medication list, and other pertinent information regarding the
patient's medical history, which may have been entered during
registration, scheduling or triage of the patient, or from a prior
patient visit. The information displayed within the facesheet can
be customized to show different information lists. In FIG. 11, the
clinician has chosen to add a new medication to the patient's
medical record. Also, the clinician has multiple patient records
open, as shown by the multiple tab options listed across the bottom
of the screen. The clinician can simultaneously see and rotate
amongst multiple patients while also having immediate access to
each patient's specific information.
[0136] The patient chart also allows the user to view summary
information (a summary report), which includes, for instance, a
listing of allergies, medications, family history, genetic
screening, past medical history, past surgical history and any
other user-defined information. The Documentation selection of the
patient chart presents the user with a listing of all of the
patient documents, such as Progress Notes, H&P Notes, Triage
Notes and scanned documents. The documents can be amended, printed
and cosigned.
[0137] The user can also move to any other area of the system from
the patient charts section, and can create a document, such as an
H&P Note, Miscellaneous Note or Progress Note or Nursing Notes
such as a Triage Note or Miscellaneous Note.
[0138] The clinical module 40 and the Desktop 22 support the
following operations: indicating to the clinician that the patient
encounter has begun by indicating that the patient has arrived and
to retrieve the patient from the waiting room; entering the
patient's height, weight and vital signs; review and update or
record the chief complaint, allergies, current medications, past
medical, family and/or social history, present illness, review of
symptoms, miscellaneous notes; allows the clinician to review
previously entered information, including demographics and progress
notes; update any patient information in the system; record the
results of a physical examination, the clinician's assessment;
automatically code the diagnosis (based on selections that were
made during system setup and template building); record the
clinician's plan; generate and document prescriptions and orders;
record treatment; select evaluation and management codes; generate
a superbill for checkout processing; and close the patient
encounter.
[0139] The clinical module 40 forms the Electronic Medical Record
(EMR), which is comprised of all documents generated by the user
for a patient, including facesheets (FIG. 11), Progress Notes
(FIGS. 37-38) and H&P Notes (FIG. 40). The EMR provides an
automated encounter documentation process and electronic patient
record solution within an easy to use interface that is both mobile
and secure. Clinicians can electronically access and update all of
their patient records within the practice while seeing patients,
and have remote access to patient records to assist clinicians
while "on-call" or at the hospital.
[0140] Patient data can be entered in different formats, including
scanned documents, dictation, transcribed electronic documents and
through interface with third-party software and devices which
capture results. The data is stored in the patient's electronic
record. The EMR eliminates redundant and illegible data in patient
records, and focuses on quick, dynamic generation of accurate notes
that adheres to regulatory guidelines.
[0141] Authorized users may access the same patient record
simultaneously to review patient medical history and vital signs,
capture a patient's history of present illness, review of systems
and physical exam, document an assessment and plan and have orders
and prescriptions automatically generated for fulfillment by labs
or pharmacies. Patient information can be displayed in multiple
views and formats, such as text, form, table, flow sheet, or
graphs, to facilitate rapid chart review and determination of the
context in which a patient's symptoms occur.
[0142] As the clinician completes the encounter documentation, the
appropriate ICD, CPT and E&M codes are suggested and captured
for automated billing purposes. Thus, the EMR automates the entry
of charges into the A/R Management portion of the system for proper
billing and claims filing, thereby reducing lost charges, ensuring
that third-party reimbursement requirements are met, and increasing
revenue. The coding and billing process is initiated and any
patient documentation is electronically signed.
[0143] Thus, the system eliminates the need for separate E&M
coding for office visits through the automatic calculation and
suggestion of the E&M coding level based upon template-driven
point-of-care documentation. The system includes an integrated
coding database which facilitates proper documentation and improves
reimbursement by enabling compliance with government and insurance
coding guidelines.
[0144] The patient record is the medical record for a single
patient. Each patient's medical record contains instances of
documents. The document instance is a single entry in a patient's
record. Each document instance added to a patient's record has a
date/time stamp and may be associated with a visit. It also has a
document type associated with it, for example a Progress Note, or a
Triage Note, or a History & Physical. The document type is used
to sort and filter documents when viewing the list of documents in
a patient's record.
Template Administration
[0145] Template administration permits the user to conduct
administration tasks for various document sections, such as ROS,
PE, and HPI. The main function of template administration is to
create configured or customized templates, step 52 of FIG. 15.
Templates are configurable by the user, either by creating a
template from scratch or by editing a standard or existing
template.
[0146] An example of building a template is shown in FIGS. 16-32.
At FIG. 16, a template administration screen is shown which permits
the user to create, edit, or delete templates. The templates are
organized in folders and displayed in a table. The user may add,
rename, or remove folders and move files between folders.
[0147] The administration builder 41 is used to establish
documentation choices for the chief complaint, HPI (history of
present illness), ROS (review of symptoms), PE (physical
examination) and assessment/plan. The administration builder
component 41 is used to prepare templates 42, 43 which assist the
clinician in entering data into the system, which in turn are used
to generate progress notes that are retained in the patient's EMR.
The templates are used to guide the user in building a document, as
reflected by the uni-directional arrows from the data options of
each of the templates should into the corresponding sections of the
template document builder 48.
[0148] To build a custom template from scratch, the user selects to
create the template from the options displayed in FIG. 16, and
identifies the type of template to be built. If the user selects to
create a procedure note template, for instance, the system would
exclude data categories for ROS and PE since those categories are
not applicable to a procedure note.
[0149] Once the type of template is selected, the system guides the
user through the process for creating the template. The system
defines the appropriate sections for the template, such as Chief
Complaint, HPI, ROS, PE and AP (assessment and plan). FIG. 17 shows
the initial section to be defined by the user, Chief Complaint. The
Chief Complaint is a concise statement describing the patient's
symptom, problem condition, diagnosis, physician recommended return
or other factor that is the reason for the encounter. This field
includes the chief complaints identified by the user to include in
the template. The system allows the user to define a default chief
complaint and other possible complaints. The user can add
additional chief complaints by clicking the "Add another option"
button or tabbing out of the textbox.
[0150] Once the user completes the CC section, the navigation
button brings the user to the History of Present Illness section
template builder, as shown in FIG. 18. The History of Present
Illness is a chronological description of the development of the
patient's present illness from the first sign and/or symptoms or
from the previous encounter to the present. It includes the
following HCFA recommended elements: Location, Quality, Severity,
Duration, Timing, Context, Modifying factors, and Associated signs
and symptoms.
[0151] The History of Present Illness template section builder is
used to add topics and the related text to include within a
template. Subjective information routinely reviewed with the
patient for a particular complaint or disease process should be
included. Such topics may include one of the HCFA recommended
element names (including chronology, onset, description, intensity,
exacerbation, etc.) or one of the user's own choosing. Related text
can then be typed in the sentence as one might normally report the
finding.
[0152] Within the sentence, text may be selected, options such as
text entry fields or drop-down boxes can be specified, and
appropriate responses included. Other text options include patient
specific demographic information or gender specific pronouns to
default into the sentence. The HPI template section builder is used
to define the elements of the History of Present Illness that may
need to be addressed when a patient presents with a specific
complaint or group of complaints. The HPI selections will be unique
to the template it is created within.
[0153] As shown in FIG. 18, the template builder provides a
drop-down menu for the topic name field. The user can select from
the defined list or type a topic name that will display within the
template builder and describe the information that the related
sentence addresses. HCFA recommended elements are denoted by a
different color. Specific sentences are associated with each topic
name. As shown in FIG. 19, if the user selects the topic name
Chronology, the sentence "The patient complains of ______ for the
last ______ of ______." The suggested sentences are pulled in from
the HPI administration piece.
[0154] The user can attach control types to text within the
sentence by highlighting or selecting a phrase, as shown in FIG.
19. A list of available control types is displayed for selection by
the user. Control types include, for instance, Care Provider List,
Date Stamp, Duration, Measurement, Make Input Box, Make Multiple
Select, Make Select List, Number Selector and Demographic
Information. The Care Provider List attaches a list of care
providers; Measurement is used to select a number and unit of
measure; Make Input Box enables the user to create a point in the
sentence where data can be typed; Make Multiple Select allows the
user to identify and add a list of multiple choices that will be
available in the sentence when using the template.
[0155] The Make Select List option creates a list of options that
can be applied to a selected text within the sentence. The user can
branch the sentence to give more details about the sentence
contents. For example, if the patient responds positively to the
question "Have you ever had these symptoms before?" then the
physician may follow up with questions such as "How long ago?" and
"What treatments were used?" If the patient responds negatively to
the initial question, the physician does not need to ask the
follow-up questions. The Demographic Information control type
attaches the text "age/race/sex" control to this point in the
sentence. When the template is being used in the document builder,
the patient's age, race and sex will populate the field.
[0156] Other control types include He/She, Him/Her,
Himself/Herself, and His/Her. These control types are used to
designate a point where the correct gender specific pronouns will
default into the sentence.
[0157] The user can preview the selected choices, as they will be
viewed in the template, at any time during the building process.
All body systems and associated elements of exam may be available
to all templates. A preview of the template is shown in FIG. 20,
for both the Chief Complaint and History of Present Illness
sections.
[0158] As shown in FIG. 21, the ROS template section builder
displays a list of body systems the user can select to add to the
template. Once the systems are selected, the user will navigate to
the next page and select the items associated with the body system
that are regularly reviewed with the patient. Users will ask the
patient questions about the body systems, depending on the reason
for visit.
[0159] For each of the body systems selected from the inventory,
the examination element is displayed, as shown in FIG. 22.
Comprehensive sets of elements and modifiers have been included as
system defaults for each system to cover a general review of
systems. Each user may build the elements into his templates
according to practice needs. As each system heading is selected by
the user, multiple symptoms related to that system are displayed.
As shown in FIG. 22, the user can also define the default settings
for the symptom to appear neutral, negative or positive. This
allows the user to more quickly document the findings, eliminating
clicks of the mouse (or taps with the stylus) during the encounter.
The user can also define any modifiers that can be added to further
detail the conditions.
[0160] The ROS administration section of the chart allows the user
to specify which symptoms will display for each body system, and in
which order. It will also allow the physician to set normal default
text. The user may choose to add additional symptoms. The ROS
administration must be used to perform additional actions that are
not available from this page. Any symptoms added to the ROS
administration page will be available to all templates and not just
the current template being edited. The options selected during the
ROS building display with the associated default responses for
positives and pertinent negatives displayed.
[0161] FIG. 23 shows the PE administration of the template builder.
The setup chosen by the user is applied to all document templates
having a PE section, such as Progress Notes, H&P Notes, etc.
The PE administration can be accessed from the desktop or
facesheet. The PE administration enables the user to configure a
page that is used as a worksheet or checklist for the physician's
physical examination of a patient.
[0162] Systems is a label for the systems that are displayed on the
administration page and are also used as a guideline or checklist
for the physician during examination of the patient. The categories
are displayed in the following order by default (to correspond to
the CMS default): Constitutional, Eyes, HENT, Neck, Chest,
Cardiovascular, Breasts, Gastrointestinal, Genitourinary,
Lymphatic, Musculoskeletal, Skin, Neurologic, and Psychiatric. Each
category is a body system and is therefore a component of the
physical exam. As each category is opened, there is a level of
subcategories displayed beneath. Subcategories can be created to
greater and greater levels on the page. The system will support as
many levels as the user wishes to create.
[0163] The findings content area displays the various systems
available to the user. In the example, the user has chosen Eyes,
and that selection is displayed in the title or control bar. The
system Eyes has four macros, namely Comprehensive Exam,
Conjunctivae, Sclerae and Lids, which is also listed in tree format
in the navigation sidebar. The user can use the navigation sidebar
to move between the various systems and locations, and can expand
and collapse the systems and macros in the tree.
[0164] One or more findings are listed for each macro that is
displayed. The user can add new macros and/or findings to the
selected system by using the control buttons in the control bar.
The user is then presented with a list of the current macros or
findings, and can add, delete, reorder or edit any of the macros
and findings.
[0165] The user selects those findings that the user would like
displayed in the progress note and template builder preview page.
Unselected findings will not show up in the progress note and
template builder preview page. Once the user selects a finding, the
user is presented with a list of defined values for the specified
finding. The values are listed in the order that they will be
displayed in the template. The user can select one or more of the
displayed values to be the default value for the finding, and can
add, delete, reorder or edit any of the displayed values. The
selected values will appear on the template when the user selects
the finding during document building. The user can then select the
values that are appropriate to be added to the document being
built, or can add, delete or edit those values.
[0166] The user can also associate one or more modifiers to any of
the findings. The modifiers are listed according to categories,
such as measurements, locations, descriptions. An example of a
modifier would be "inches" for the finding "eyelid symmetry", which
would be displayed on the template and allow the user to specify a
measurement in inches to be associated with that finding. The user
can add, delete or edit the categories and modifiers.
[0167] The systems are linked to E/M coding by the system. Because
of this, the findings of the physical exam which are selected from
the default menu will all be linked to E/M coding. The
user/caregiver may add his/her own findings, which will also be
linked to the E/M coding by virtue of their being located in
subcategories (folders) that are linked. The user may also link his
added findings and subcategories to SNOMED CMV via the SNOMED
selection tool, which is available on the page to allow the user to
search the SNOMED database.
[0168] The next section in the template builder is Assessment. As
shown in FIGS. 24 and 25, the Assessment template builder section
allows the user to build a differential diagnosis list for the
present template. The user selects a diagnosis from a previously
built "favorite" diagnosis list or searches for diagnoses using the
ICD-9 search tools.
[0169] FIG. 26 shows the Plan section building administration,
which is used to create group-level and diagnosis-specific plans.
The Plan section building can be accessed from the Template
administration page, and is part of creating a Progress Note or
H&P template. The group-level plan, shown as the Common Plan,
is used to define a plan for the template, whereas the
diagnosis-specific plans can be created that are specific to a
clinician's diagnosis as selected from the differential diagnosis
list in the present template.
[0170] There are preferably at least three parts to each plan,
namely Orders, Medications and Instructions. In FIG. 27, the user
has selected to configure the Orders, and a menu list is displayed
having various Plan Types and Categories. Plan Types include Labs,
Procedures, Consults, Imaging, Immunization and Injections. In the
example, the user has selected the Plan Type of Labs, and the
Categories for Labs is displayed as Panels, Chemistry, Endocrine,
Hematology, Microbiology, Urinalysis, Fetal Test, and Surgical. The
user can create new Plan Types.
[0171] Once the Plan Type is selected, the user can choose from
amongst the possible Categories, or can create a new Category. The
user has selected the Category Endocrine, and the list of Labs for
that Category are displayed for the user's selection. As shown in
FIG. 26, the user has selected two Panels and an Endocrine from the
menu list. The selections are displayed on the Plan page beneath
Orders for the Lab Plan Type.
[0172] The user can preview the entire template that he/she has
created, rather than in separate sections. In the preview mode, the
user is able to view the template sections as they will appear when
creating a document using this template. The user can see items in
each template section and may add omitted items or delete
unnecessary items.
[0173] FIGS. 28 and 29 show an example of template preview. FIG. 28
shows the various sections of the template built by the user. At
FIG. 29, the user clicks the "+" button beside the Review of
Systems label and the ROS list is displayed in the action bar. The
user may then add or delete systems in the ROS Template Section.
However, in order to edit the symptoms within each system, the user
must return to the ROS template builder section and/or the ROS
Administration page.
[0174] FIG. 30 shows the preview for the Physical Examination
section. The user can either select the option "B" to preview a
basic exam, or can select option "C" to preview a comprehensive
exam. At FIG. 31, the user is previewing the Assessment section of
the template. If the user selects a diagnosis from the Assessment
(congestive heart failure in the example), the Orders, Medications
and Instructions or Education pre-fill into template sections, as
shown in FIG. 32. The Orders, Medications, and Instructions or
Education are associated with the selected diagnosis.
Document Builder 44
[0175] The document builder 44 supports the creation and generation
of documents such as Progress Notes, which is implemented through
the use of templates. A template is a pre-defined set of data
options that is used to dynamically generate a document. Templates
do not specify how sections are presented to the user, but rather
the data that is utilized at the time of documentation. A document
may be created using no template, one template, or more than one
template. For instance, the Flu template and the Cold template can
be combined for a new visit document where the patient presents
with flu-like symptoms.
[0176] The document builder 44 includes features that assist the
user in quickly building document text for each section of a
document for the patient chart. Multiple data capture formats are
supported in this feature. Data options defined in a template may
be used to further simplify creation of that section of a document.
For example, a "normal sore throat" template may have been defined
to automatically populate the CC, HPI, ROS, PE, and A/P sections of
the document with appropriate questions and answers for a patient
presenting with a sore throat.
[0177] The system has intuitive templates 42, 43 with easy-to-use
point and click data entry and optional keyboard use. There are
multiple ways to enter information, from point-and-click using the
templates, to drawing on the input device, taking digital
photographs or video, dictation (voice recognition), audio, typing,
and hand writing (handwriting recognition). Information can be
viewed as text, in table form, as a flow sheet, or as a graph. The
user has a library of templates to choose from, with certain
templates being for general use by nearly all clinicians, and other
templates beings detailed to specialty clinicians such as
dermatologists and urologists. In addition, the user can create
templates from scratch, or by editing other templates.
[0178] The templates 42, 43 facilitate the entry of information
into the system in a manner that is easy to use, intuitive to the
user and faster than making paper entries. The templates 42, 43
help the user ensure that all necessary information is entered so
that documentation is complete and accurate. The system provides
for direct entry of documentation into the computer, eliminating
the need to dictate, review and sign transcription. The templates
42, 43 allow the user to pull forward data from prior visits, so
that the clinician can simply note changes since the last visit
without re-recording information that was previously collected and
has not changed.
[0179] The system primarily has three types of templates: history
and physical ("H&P")/progress notes, procedure notes, and
consultation notes. Summary lists (such as medication, allergy and
problem lists) are automatically updated directly from progress
note documentation. The templates automate the generation of
documents for consultation correspondence, hospital admission,
H&P (history and physical) documentation, procedure notes, work
and school excuses, and other standard communications.
[0180] In the exemplary embodiment of FIG. 7, a flu template 42 and
cold template 43 are shown. Each H&P/Progress Note template may
include the following sections: chief complaint (CC), history of
personal illness (HPI), review of systems (ROS), physical
examination (PE), Assessment and Plan. The flu template 42 includes
sections for chief complaint, HPI and ROS, and the cold template 43
has assessment, plan and ROS sections, which are defined in the
respective sections of the template builder component 41.
[0181] Each section of the templates 42, 43 permits the clinician
to select from among a list of default data options. For instance,
the ROS options available to the clinician for the flu template 42
may include runny nose, sinus drip, sneezing, and difficulty
breathing. The template building and document building are designed
to track the manner in which a clinician would typically record
events at a patient encounter process on paper, from CC to HPI to
ROS to PE to Assessment to Plan. However, the user can jump from
one section to another and need not follow any particular
order.
[0182] The templates are used to quickly generate documents. Once
the clinician has completed the template 42, 43, the document
builder 44 generates a progress note that will be retained as the
final document for that patient encounter. The document will have a
main body section that consists of the sections from the templates
42, 43, as well as a section for histories and habits to address
patient history information such as past medical history, specific
condition history (e.g., cardiac history), surgical history,
medications, allergies, family medical history, genetic screening,
social history and problems. In the example of FIG. 7, the main
body section of the document being generated for flu template 42
indicates the chief complaint, HPI, ROS and any other text entered
by the clinician.
[0183] The document builder compiles the various sections into a
document based upon the clinical document architecture (CDA), as
defined by HL-7 (Health Level 7, a standards body). The document
can be electronically signed. The document is created in XML
format, and can be converted into a modified XML format which is
compliant with the HL-7 CDA standard by XSLT processing. Once the
document is created, it is sorted according to its document type,
and stored in a respective file system 45, 46, 47, where it resides
in the patient chart. The documents may be sorted, for instance, by
document type (e.g, History & Physical, Progress Note,
Procedure Note, etc.), document status (e.g., Authenticated or In
Progress), creation date/time, or by the user who created the
document.
Document Building--Progress Notes
[0184] The Progress Note is an example of a document that is
created by the document builder 44 in accordance with a pre-defined
template. The Progress Note is the physician's primary note for a
particular patient encounter, and is amendable and printable. The
system extensively uses intuitive graphical user interface
technologies and electronic drawing tools to ensure that an entire
patient encounter can be documented by just pointing and clicking
through the patient record. However, the system also allows for
keyboard entry as an alternative method to input information. On
average, a clinician can complete a Progress Note in about 1-2
minutes or less. Once the Progress Note is completed and
electronically signed by the clinician, the note is saved and
available for printing and future access.
[0185] A sample Progress Note template used to generate a Progress
Note document is shown in FIG. 33. The user can select to complete
a progress note from the desktop, facesheet or document list. Once
the user selects to create a Progress Note, a blank progress note
is displayed. The user then determines if the visit displayed on
the action bar is appropriate. If the user chooses to create a
Progress Note without a visit link, the user can select the default
visit displayed (last visit is the default) or select a new one by
clicking a link button which allows the user to search for a visit
date.
[0186] Once the visit date is selected, the user selects a template
to use from a list of template fields that are displayed on the
action bar. Several template fields can be provided to assist the
user in finding the desired template, such as either a physician's
template field or a nurse's template field. Upon clicking on the
template field, a drop-down menu displays the user's custom
templates that were earlier created, as well as any standard
pre-defined system templates designed for that template field.
[0187] In FIG. 33, the user has selected to work with the template
"CABG Pre-Surgical Office Visit" from the list of templates in the
drop-down menu. Multiple templates may also be selected by the user
by clicking another template from the list. The user can work on
different templates for multiple patients, and a tab is shown at
the bottom of the screen for each patient that the user is working
on to enable the user to quickly switch between templates and/or
patients. In addition, the name of the selected template "CABG
Pre-Surgical Office Visit", is displayed above the template field
and the template pre-fills into the Progress Note.
[0188] The system pre-fills all of the selected items for the
Template, which were defined during the Template administration,
and displays the defined template sections. Typically, the template
has the following sections: Chief Complaint, History of Present
Illness, Review of Systems, Physical Examination, Assessment, and
Plan.
[0189] To create the completed Progress Note, the user edits the
Progress Note by clicking desired findings from the patient
encounter. The Chief Complaint document section builder of the
template builder 48 enables the user to select the chief complaint
that most closely relates to the patient's subjective description
about the problem that has brought the patient to see the
physician. A list of possible chief complaints, such as "I am
tired" or "My chest hurts", that were associated with the template
is displayed for the user to select to add to the document.
[0190] The HPI document section builder of the template builder 48
enables the user to enter information into the HPI section.
Selecting the History of Present Illness header on the document
will populate the field with the document view of selected
descriptions associated with the template. Information can be
selected in the document builder in accordance with the manner set
up when the template was constructed. Information can be entered by
the user in the form of a list, date stamp, input box, multiple
select (select multiple choices from a predefined list of multiple
choices), and demographic information. An example of a list is
shown in FIG. 33, where the user's selection of "severe" has been
entered into the document. Certain text may designate where the
correct gender specific pronouns of he/she, himself/herself,
his/her, him/her will default into the sentence.
[0191] FIG. 34 shows further editing in the ROS document section
being performed by the use of checkboxes. The ROS document section
is an inventory of body systems obtained through a series of
questions seeking to identify signs and/or symptoms which the
patient may be experiencing or has experienced. The ROS document
section is a vital part of the patient encounter. The ROS can be
accessed from the patient chart in the triage note or from the
Progress Note. When ROS is in a document, ROS will appear on the
menu bar in the Template Administration page for selection by the
user.
[0192] The user can complete the ROS document section based on
information gathered during the patient's office visit, as the user
asks the patient questions concerning particular body organs and/or
regions. The review is documented in a systematic manner and
certain sections can pre-fill from registration or triage to the
ROS document section of the physician's Progress Note. The user may
examine all systems or one or more systems, and may choose to not
include the remaining systems, depending on the patient's reason
for visit, physical appearance, etc. When some systems are not
included in the ROS document section, those systems will not be
shown in the narrative summary of the ROS. If all symptoms are
neutral, the system is not included. If the system has either a
negative or positive symptom, the system is included.
[0193] As each system heading of the ROS document section is
selected by the user, multiple symptoms related to that system are
displayed. The default settings for each symptom will be "neutral".
The user may click on the checkbox next to the symptom once to
change the status to "negative" (-); one click on the checkbox
again changes the status to "positive" (+). In FIG. 34, the user
has selected the systems, Constitutional and Cardiovascular, and
the respective symptoms are displayed, such as absence of pain,
cardiac murmur and chest pain. The user has selected the symptom
"chest pain" as a positive status (indicating that the patient is
experiencing chest pain). The negative status indicates that the
patient denies a symptom, such as chest pain.
[0194] To enter more details about the positive status of a
symptom, the user can click on the actual word (name of the
symptom). Clicking on the word will cause the radio button to
change to "positive" and a pop-up details box will appear, as shown
in FIG. 34. The details box allows the user to select more detailed
information, such as duration, severity, location, alleviating
factors, etc. The descriptive terms have been defined by the user
in the ROS administration piece. After entering a further
description of the positive symptom, the descriptor appears next to
the symptom name. Categories of body systems and the symptoms under
each body system may be edited, added or deleted in the ROS
administration piece.
[0195] As shown in FIG. 35, the Physical Exam document section
builder of the template builder 48 enables the user to complete a
physical exam of the patient. The user selects the PE document
section associated with a pre-built template or by choosing the
system and related components independent of any template and
enabling the care giver to create a document describing the
examination from the physician.
[0196] When the basic exam or "B" button is clicked, all systems
selected for the template are pre-selected for the basic exam. When
the comprehensive physical exam or "C" button is clicked, all
systems selected for the template are pre-selected for the
comprehensive exam. If nothing is selected under "Full Exam", then
the user may select B or C for each of the systems, as shown in
FIG. 35 for Cardiovascular. Only the systems selected are
displayed. With each system, the user may select basic exam,
comprehensive exam, or both. If nothing is selected, then the
default that is displayed is both exams--the list of findings
specifically included in the template being used for this document.
The user may select which one of the two types of exams he wishes
to document in the patient record.
[0197] The user can select findings for any of the terms in the
Physical Exam document section. In the example of FIG. 35, the PE
document section Cardiovascular has a subcategory to Auscultation
called "Rate", "Rhythm", and "S1", which are displayed when the
user selects Auscultation. By hovering over the text, a pop up box
is displayed with more detailed information about selected
findings. Here, the user clicks "S1" and the cascading menu for S1
displays. The user may select from this menu. In this case,
whatever finding the user selects will be added to the Auscultation
portion of the physical exam, and the finding is displayed.
[0198] Alternatively, the PE builder can be implemented in a manner
similar to that described with respect to FIG. 23, which is for
template administration. That is, a navigation sidebar can be
provided that lists all the systems, and the systems and finding
can be displayed with selection boxes. Values and modifiers can be
associated with each finding. At any time during the document
building process, the user can preview the document by selecting
Preview on the navigation bar at the top of the page. All sections
of the customized template are displayed on the preview page, and
can be edited by the user.
[0199] In FIG. 36, the Assessment and Plan document sections are
displayed and the selections are bolded. Upon the user's selection
of a diagnosis from the Assessment section, the orders,
medications, and instructions of the plan section are automatically
completed, as shown. The user may utilize any of the note options.
The Assessment document section contains diagnoses (with related
ICD-9 coding) chosen by the user in the Assessment & Plan
template section builder. The Progress Note is created and the
section of that document called "Assessment" displays the
pre-selected diagnosis options from which the user may select the
desired diagnosis or multiple diagnoses. The user selects the
diagnosis or multiple diagnoses by clicking on the checkbox of the
desired diagnosis.
[0200] Checkboxes can also be provided to allow a clinician to mark
an item as "rule out" instead of a diagnosis. That is used when
tests are ordered to rule out a certain diagnosis, so the code for
that item should not be used to bill the encounter, as it is not
really a diagnosis. The selected diagnosis and the associated ICD-9
code becomes bolded, as shown. Once the Progress Note is
documented, it is displayed to the user in completed form.
[0201] Following a patient encounter, the clinician will usually
have orders, prescriptions, and instructions for the patient. The
clinician is able to document the "plan" for the patient in a
section of a document which becomes part of the patient's chart,
such as in the Progress Note document. These plan items can be
associated with each particular diagnosis. For example, a patient
who is having chest pain will typically require at least a chest
x-ray, an EKG, a prescription for nitroglycerin, and a follow-up
visit.
[0202] In the Order section of the document, the physician lists
the orders associated with the progress note and/or office visit.
The orders are linked to CPT coding. They may be the CPT codes as
well as user-created orders that are linked to the CPT codes. The
Orders associated with the diagnoses for this particular template
are pre-filled into the Progress Note under the "Orders" section,
as shown above. A checkbox to the left of each Order is present to
enable the physician to choose the particular Orders for this
patient. The user selects the desired Order for the patient by
checking the checkbox. The selected item is bolded, and the CPT
coding is placed to the right.
[0203] At this point, the document is complete and the user's
selections are displayed as a final document, as shown in FIGS. 37
and 38. Each section is displayed, even if no entries were made to
that section. However, areas that were not examined or inquired
into by the clinician are not displayed, so that for instance
Constitutional is not displayed under the PE section. The Progress
Note, if saved or authenticated (saved & signed), is then
displayed in the document list of the patient's EMR chart, FIG. 39.
It may be closed, opened, or amended if saved or authenticated. If
not saved, it can be deleted. The Progress Note is saved and
displayed on the document list, "Chart Documentation."
[0204] Other documents can be generated by the document builder,
and other medical history information can be included in a progress
note as separate sections, including Past Medical History (PMH),
Past Surgical History, Social History, and Family Medical History.
These documents generally enable the clinician to gather
information about the medical, social and family history of a
patient. As an example for PMH, for instance, illnesses can be
organized under the categories of the body systems they affect. The
list of illnesses are pre-selected by the clinician. When specific
illnesses are selected, the user may enter dates of onset and any
notes concerning the situation. This function can be accessed from
the other areas in the system, such as the face sheet.
[0205] Another type of document that is generated from the document
builder is the H&P Note. An example of the PE section of an
H&P Note is shown, for instance, in FIG. 40. Here, the system
macros are listed along the left side of the page, such as
Constitutional, Eyes, HENT, Neck and Chest. The user selects a
system in order to display the findings and place the findings in
edit mode. The user can choose option "T" to only edit the findings
that were defined during the template administration, option "C" to
edit all findings in the location, or option "F" to edit all
findings for one or more macros. In the example, the user has
selected the system Eyes, and the options All; Cond, Sclera, Lids;
Pupils and Irises; and Funduscopic Exam are displayed in the order
of location of the systems.
[0206] The findings are displayed adjacent the location options. In
the example, the findings for the system Eyes is displayed in edit
mode. When a user selects a finding name, a list of modifiers is
presented for further selection by the user. For instance, the
modifier can indicate the severity of the finding as being
"severe", "moderate" or "mild". The user can select the appropriate
modifier, which then becomes associated with the finding in the
final H&P Note, whereas the findings for the system HENT are
displayed with their default values and modifiers which have been
selected for this system in the PE template builder upon which this
note is based.
[0207] A drawing can also be incorporated into the H&P note or
progress note. The drawing allows the user to select anatomical
images from a library, draw on them and embed them into documents
and notes to better document medical information that might be
difficult to communicate with words alone. For instance, the
physician can select an image of a patient's abdomen and draw the
location of previous surgical scars, changes in discoloration or
area of infection between visits. As the H&P or progress note
is being created, the user has the option of selecting to include a
drawing. The user then selects the desired image from the library
of images. Preferably, this is achieved by displaying an image of a
full human body, and allowing the user to focus in on a specific
area. Once the desired image is displayed, the user then draws the
desired shape and color to add to that image.
Order Management
[0208] An additional system feature includes clinical alerts,
reminders and tracking. These features allow clinicians to more
effectively serve their patients. Once a patient leaves the office,
the system tracks the status of requested consultations and tests,
and provides respective alerts and reminders to the respective
users. The alerts can be requested by the clinician or based on
standard health maintenance protocols. It automates the process of
reviewing and tracking incoming and pending order results so that
fulfillment is documented and failure to fulfill is investigated
and remedied.
[0209] Clinicians can also define alerts, reminders and
recommendations for treatment based on the user's preferred
treatment algorithms or on insurance rules for reimbursement. Users
can also define links to internal and external resources for
clinician reference and patient education.
[0210] The system also has automated prescription writing, and
interaction reference access. Electronic transmission capability to
fulfillment resource and refill management is automated, thereby
reducing prescription and refill processing. The system automates
fulfillment of orders by real-time transfer of instructions
directly from an encounter documentation template to the
fulfillment source, without the need to duplicate the instructions
in an intervening document or data entry process.
[0211] For example, prescriptions are automatically electronically
transmitted directly from the encounter documentation to the
participating pharmacy, lab orders are automatically transmitted
directly to the participating lab with supporting diagnoses and
prior approval included, diagnoses and coding are automatically
transferred from the encounter documentation to the billing module,
and follow-up appointment requests are directly transferred from
the encounter documentation to the scheduling module (i.e., part of
the practice management module).
[0212] Prescription refills are also automated, so that the
clinician need only make a single selection for refills requiring
no changes. The clinician need not write a new prescription for the
refill, the refill is automatically documented in the patient's
chart, and the instructions are electronically transmitted to the
pharmacy.
[0213] Another feature of the system is order placement which
integrates with billing processes to reduce charge entry efforts
and ensure that third-party reimbursement requirements are met.
Messaging
[0214] The system supports communication between the clinician and
other staff members from any point in the facility at any time.
Messaging is implemented by a messaging component 22 of the
framework module 20, that creates, stores and retrieves
intra-office communication. Messages can also be generated by the
system to indicate situations where action is required. Messages
are automatically added to the patient chart, when the user chooses
to "attach" a patient to the message.
[0215] The messaging module gives near real time updates that new
messages have arrived. The customer workstation 12 is in contact
with the main services server 10 every few seconds to check if new
messages have arrived. A service is used, as opposed to a web page,
to keep the constant pinging from affecting the application. The
messaging module maintains an icon to the desktop that indicates
that a new message has arrived. The system indicates to the user
that a new message has arrived, which the user can then
retrieve.
[0216] When composing a message, once a Patient is selected, the
corresponding Patient Frame overlays in the body of the Message. If
there is a photograph of the patient displayed in the Patient
Frame, the photo will also be displayed in the Message. If there is
a Patient Name in the Patient field, the Message will be associated
with that Patient. All Messages composed and sent by the user are
audit logged, indicating that the action was a sent message, the
patient ID, the sender and the recipient, and the time.
[0217] The messaging system is provided with predefined response
templates for common requests and routine calls and questions.
Responses generate a note in the patient's chart.
Patient Access
[0218] The system provides secured and structured two-way
communication between the patient and the clinician. The patient
can submit post-treatment outcome results and status to the
clinician in a predefined template. That allows the clinician to
analyze the effectiveness of the treatment provided without the
burden of reading free-text email. The increased patient
interaction strengthens the clinician-patient relationship and
increases the efficiency in scheduling appointments, registration,
the interview process and requesting prescription refills. That is
not only more convenient for the patient, but allows the clinician
practice to shift a great deal of data entry from their clerical
staff to the patient.
[0219] Patients access the system through a centralized web portal,
such as their clinician's website. The web portal allows the
patient to perform limited functions with respect to appointment
scheduling, patient interviews, prescription refill requests,
personal health record access, appointment follow-up information
and electronic consults. Patients can choose to be reminded of
appointments electronically at various intervals before visits.
Data from paper records can also be moved to the personal health
record (PHR). A PHR allows a patient to track visits to a
clinician, medications, in-home observations of blood sugar, vital
signs, etc.
Audit Logging and Security
[0220] Audit logging is performed throughout the system to assist
system administrators in enforcing practice policies and compliance
with regulations. Security options include username and password
and/or biometric identification for access control. The username
allows role-based and/or user-based control of permission to use
various system functions.
Overview of Features
[0221] The system is designed to be intuitive to the user and
provide a secure environment that can be accessed at the
clinician's office or at a remote site. The system also interfaces
to email and the clinician's website, and provides support for
phone messaging, patient education materials, website, direct
patient data entry via the web, email, and ROI studies.
[0222] The system eliminates the need for paper charts, thereby
reducing the amount of office space allocated to storing patient
records, and allowing electronic transfer of information between
practices. All incoming paper documents and existing paper patient
files, can be scanned or otherwise entered into the system and the
paper files eliminated. The patient's EMR can be accessed at any
time and from any location, thereby eliminating manual chart pulls
and misplaced paper files. The number of chart pulls is reduced by
about 50% within six months of implementing the present invention,
and about 85% at twelve months.
[0223] Once the system is fully implemented, transcription costs
could be eliminated, malpractice premiums could be reduced by about
3-5% from insurance companies that offer physicians who use an EMR
a discount due to the increased detail of documentation with an EMR
as opposed to dictation or handwriting, and staff savings of about
15%. Perhaps most importantly, clinician productivity gain
increases by about 20% after only twelve months, resulting in a
savings of about $7,000-15,000 per clinician each year.
[0224] The information provides rapid and concise malpractice proof
to help the user defend against malpractice claims and HCFA audits.
The system also offers the clinician prescription assistance with
brand name and generic pricing and dosage, national drug codes,
medication lists, allergy cross-checks (drug-drug, drug-food,
drug-disease interactions), and side affects. The entry of charges
is automated and the resulting documentation is checked for
compliance with billing and claims filings.
[0225] Although the preferred embodiment of the invention is for
use at a clinician's practice, the system can be implemented at the
office of any service professional. The system is configurable at
the user and practice levels, so that a practice can assign
specific duties and responsibilities to employees to maximize
overall office productivity without restrictions imposed by
existing practice management and EMR systems.
[0226] The foregoing description and drawings should be considered
as illustrative only of the principles of the invention. The
invention is not intended to be limited by the preferred
embodiment. Numerous applications of the invention will readily
occur to those skilled in the art. Therefore, it is not desired to
limit the invention to the specific examples disclosed or the exact
construction and operation shown and described. Rather, all
suitable modifications and equivalents may be resorted to, falling
within the scope of the invention.
* * * * *