U.S. patent application number 13/358819 was filed with the patent office on 2012-06-14 for method and system for generating personal/individual health records.
Invention is credited to MALIK M. HASAN, John C. Peterson, J. Dominic Wallen.
Application Number | 20120150566 13/358819 |
Document ID | / |
Family ID | 46324842 |
Filed Date | 2012-06-14 |
United States Patent
Application |
20120150566 |
Kind Code |
A1 |
HASAN; MALIK M. ; et
al. |
June 14, 2012 |
METHOD AND SYSTEM FOR GENERATING PERSONAL/INDIVIDUAL HEALTH
RECORDS
Abstract
A system and method for generating and/or updating a
personal/individual health record. Inputs of data to the system may
come from diverse sources including, but not limited to, patient
questionnaires, insurance company (or other payor) claims data,
hospitals, clinics and other institutional providers, and
individual physicians and physicians' offices.
Inventors: |
HASAN; MALIK M.; (Las Vegas,
NV) ; Peterson; John C.; (Tucson, AZ) ;
Wallen; J. Dominic; (Tucson, AZ) |
Family ID: |
46324842 |
Appl. No.: |
13/358819 |
Filed: |
January 26, 2012 |
Related U.S. Patent Documents
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Application
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Filing Date |
Patent Number |
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12762673 |
Apr 19, 2010 |
8131563 |
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13358819 |
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11928305 |
Oct 30, 2007 |
7707047 |
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12762673 |
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11495093 |
Jul 28, 2006 |
7440904 |
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11928305 |
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11495092 |
Jul 28, 2006 |
7533030 |
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11495093 |
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11495135 |
Jul 28, 2006 |
7509264 |
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11495092 |
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11494940 |
Jul 28, 2006 |
7428494 |
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11495135 |
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11494933 |
Jul 28, 2006 |
7475020 |
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11494940 |
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10381158 |
Oct 6, 2003 |
7720691 |
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PCT/US01/42618 |
Oct 11, 2001 |
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12762673 |
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10381158 |
Oct 6, 2003 |
7720691 |
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PCT/US01/42618 |
Oct 11, 2001 |
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11928305 |
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10381158 |
Oct 6, 2003 |
7720691 |
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PCT/US01/42618 |
Oct 11, 2001 |
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11495093 |
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10381158 |
Oct 6, 2003 |
7720691 |
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PCT/US01/42618 |
Oct 11, 2001 |
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11495092 |
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10381158 |
Oct 6, 2003 |
7720691 |
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PCT/US01/42618 |
Oct 11, 2001 |
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11495135 |
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10381158 |
Oct 6, 2003 |
7720691 |
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PCT/US01/42618 |
Oct 11, 2001 |
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11494940 |
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10381158 |
Oct 6, 2003 |
7720691 |
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PCT/US01/42618 |
Oct 11, 2001 |
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11494933 |
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60239860 |
Oct 11, 2000 |
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60239860 |
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60239860 |
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60239860 |
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Current U.S.
Class: |
705/3 |
Current CPC
Class: |
G16H 10/40 20180101;
G16H 10/60 20180101; G16H 80/00 20180101; G06Q 40/08 20130101; G16H
70/60 20180101; G16H 10/20 20180101; G06Q 10/10 20130101; G16H
50/20 20180101; G06Q 10/00 20130101 |
Class at
Publication: |
705/3 |
International
Class: |
G06Q 50/24 20120101
G06Q050/24 |
Claims
1. An electronic health record system server for use with analyzing
electronic health records of a plurality of patients enrolled in a
health plan of the payor, wherein the patients undergo encounters
with a plurality of health care providers regarding a health
related issue of the patients, wherein under the health plan the
health care providers request payment for at least a portion of the
cost for the encounters from the payor, wherein the health plan
requires health care providers to submit health related information
of the patients to the payor to support the cost of encounters with
the patient, the electronic health record system server comprising:
a memory for storing instructions and data associated with
electronic health records of a plurality of patients; and a
processor configured to execute the instructions, wherein the
instructions cause the processor to perform the steps comprising:
(a) transferring payor claims data regarding the plurality of
patients to an electronic health record system server; (b)
analyzing at the electronic health record system server said payor
claims data concerning a respective patient of the plurality of
patients to determine which portion of said payor claims data is
encounter data comprising at least one of a diagnosis or a
treatment or a medication or a procedure or a history of office
visits of the respective patient with one or more of the health
care providers; (c) populating at the electronic health record
system server electronic health records concerning the plurality of
patients by storing one or more entries into the respective
patient's electronic health record based on the encounter data,
wherein population of at least a portion of the entries in the
electronic health records of the patients is based on the encounter
data extracted from the payor claims data; (d) organizing, at the
electronic health record system server, the health records by
associating together one or more entries in the respective
patient's electronic health record that are related; and (e)
analyzing the electronic health care records by measuring the
outcomes of specific treatments of diseases under investigation and
providing a direct comparison of outcomes measured of a specific
treatment with various other treatments to allow setting up or
modification of clinical protocols.
2. The system of claim 1, further comprising an instruction for
providing a messaging facility accessible by one or more health
care providers of the patients to supplement the electronic health
records of the patients.
3. An electronic health record system server for use with analyzing
electronic health records of a plurality of patients enrolled in a
health plan of the payor, wherein the patients undergo encounters
with a plurality of health care providers regarding a health
related issue of the patients, wherein under the health plan the
health care providers request payment for at least a portion of the
cost for the encounters from the payor, wherein the health plan
requires health care providers to submit health related information
of the patients to the payor to support the cost of encounters with
the patient, the electronic health record system server comprising:
a memory for storing instructions and data associated with
electronic health records of a plurality of patients; and a
processor configured to execute the instructions, wherein the
instructions cause the processor to perform the steps comprising:
(a) transferring payor claims data regarding the plurality of
patients to an electronic health record system server; (b)
analyzing at the electronic health record system server said payor
claims data concerning a respective patient of the plurality of
patients to determine which portion of said payor claims data is
encounter data comprising at least one of a diagnosis or a
treatment or a medication or a procedure, or a history of office
visits of the respective patient with one or more of the health
care providers; (c) populating at the electronic health record
system server electronic health records concerning the plurality of
patients by storing one or more entries into the respective
patient's electronic health record based on the encounter data,
wherein population of at least a portion of the entries in the
electronic health records of the patients is based on the encounter
data extracted from the payor claims data; (d) organizing, at the
electronic health record system server, the health records by
associating together one or more entries in the respective
patient's electronic health record that are related; and (e)
analyzing the electronic health care records to profile one or more
of the health care providers reflected in the electronic health
care records for quality of care based on a measurement of the
outcomes of patients under the care of respective health care
providers.
4. An electronic health record system server for use with analyzing
electronic health records of a plurality of patients enrolled in a
health plan of the payor, wherein the patients undergo encounters
with a plurality of health care providers regarding a health
related issue of the patients, wherein under the health plan the
health care providers request payment for at least a portion of the
cost for the encounters from the payor, wherein the health plan
requires health care providers to submit health related information
of the patients to the payor to support the cost of encounters with
the patient, the electronic health record system server comprising:
a memory for storing instructions and data associated with
electronic health records of a plurality of patients; and a
processor configured to execute the instructions, wherein the
instructions cause the processor to perform the steps comprising:
(a) transferring payor claims data regarding the plurality of
patients to an electronic health record system server; (b)
analyzing at the electronic health record system server said payor
claims data concerning a respective patient of the plurality of
patients to determine which portion of said payor claims data is
encounter data comprising at least one of a diagnosis or a
treatment or a medication or a procedure, or a history of office
visits of the respective patient with one or more of the health
care providers; (c) populating at the electronic health record
system server electronic health records concerning the plurality of
patients by storing one or more entries into the respective
patient's electronic health record based on the encounter data,
wherein population of at least a portion of the entries in the
electronic health records of the patients is based on the encounter
data extracted from the payor claims data; (d) organizing, at the
electronic health record system server, the health records by
associating together one or more entries in the respective
patient's electronic health record that are related; and (e)
analyzing the electronic health care records to profile one or more
of the health care providers reflected in the electronic health
care records for cost-effectiveness of care based on a measurement
of the cost of encounters with one or more patients under the care
of respective health care providers.
Description
RELATED APPLICATIONS
[0001] This application is a continuation of U.S. application Ser.
No. 12/762,673, filed on Apr. 19, 2010, which is a continuation of
U.S. application Ser. No. 11/928,305, filed Oct. 30, 2007, which
was a continuation of U.S. application Ser. Nos. 11/495,093,
11/495,092, 11/495,135, 11/494,940, and 11/494,933, all filed on
Jul. 28, 2006. Each of these applications claimed priority to U.S.
Provisional Application Ser. No. 60/704,309 filed Aug. 1, 2005, and
are continuation-in-part applications of U.S. application Ser. No.
10/381,158, filed on Mar. 21, 2003, which was the National Stage of
International Application No. PCT/US01/42618, filed Oct. 11, 2001,
which claimed the benefit of Provisional Application No. 60/239,860
filed on Oct. 11, 2000. These applications are hereby incorporated
by reference in their entireties.
FIELD OF THE INVENTION
[0002] This invention relates generally to computer methods and
systems and, more particularly, to computer methods and systems for
generating personal/individual health records for individuals by
accessing and compiling data from diverse sources. In one
embodiment, a system/method extracts and compiles data from, among
other sources, payor claims data to generate a personal/individual
health record for an individual.
BACKGROUND AND SUMMARY OF THE INVENTION
[0003] There is a substantial distinction between an electronic
medical record ("EMR") and a personal health record ("PHR"), which
is also commonly called an individual health record ("IHR"). The
terms "PHR" and "IHR" are interchangeably used herein.
[0004] An EMR is provider-centric while a PHR is patient-centric.
An EMR is not a complete health record of a patient, but is limited
in scope to a specific health care provider. Notably, the
electronic medical record does not contain any information from any
other health care provider who does not have access or share the
same specific EMR.
[0005] Electronic medical records are known. Typically, the EMR is
established by hospitals or a group of physicians or less commonly
by a physician. The EMR details each encounter between the patient
and the provider for each episode of illness treated by the
specific provider (hospital, physicians, or other care givers).
Although the EMR is the commonly looked to as the medico legal
record of that particular episode of illness and its management, it
does not contain any information from any other provider who does
not have access or share the same specific EMR.
[0006] A patient has no control over his/her EMR. For example,
patients have no direct online access to their EMR and cannot make
any entries in the record. Patients have no control over the access
to their EMR and anyone who has access to the EMR of the specific
hospital or physician group could access their health records.
There is no complete global unified record of a patient in an EMR
unless and until the entire healthcare is being delivered by the
one provider group who is using the specific EMR for all patient
encounters. The EMR system usually is used by a limited number of
users (providers).
[0007] U.S. patents and published patent applications which relate
to the topic of electronic medical records include: U.S. Pat. No.
5,867,821; U.S. Pat. No. 6,684,276; U.S. Pat. No. 6,775,670;
2004/0078227; and 2004/0172307. This listing of U.S. patent
publications is not offered or intended to be taken as exhaustive,
but rather as illustrative of patent filings on this topic. To the
extent necessary for a complete understanding of the background
relating to known electronic medical records and related systems,
the disclosures of these publications are hereby expressly
incorporated into this application by this reference thereto.
[0008] The present invention is not merely a system for
electronically storing and accessing medical records, but relates
to computerized systems and methods, including software attendant
thereto, for generating a personal health record ("PHR"), also
described as an Individual Health Record or Electronic Health
Record (hereafter "IHR" or "EHR"). In contrast to an EMR, the PHR
contemplated herein is intended to include all relevant
health-related information for a patient, regardless of the
specific health care provider. The clinical information regarding
the individual patient may be collected from diverse sources
including, but not limited to information from claims through the
health plans, multiple EMR's being used from different providers
providing care to that patient, medication records from the
pharmacy benefit managers ("PBMs"), information from labs and
imaging centers, and direct input by the patient to provide a
unified personal/individual health record. The PHR may contain
health records of millions of patients with online access to those
millions of patients.
[0009] In one embodiment, the invention provides a system and
method for generating a personal/individual health record that is
compiled from diverse sources, such as patient questionnaires or
direct input, health plans, pharmacy benefits managers ("PBMs"),
labs, imaging centers, freestanding outpatient facilities,
hospitals and physicians. The data collected from the diverse
sources is organized into an individual health record for a
patient. The individual health record may be integrated with SNOMED
codes to allow that data to be encoded under specific medical
diagnostic concepts. SNOMED is a division of the College of
American Pathologists ("CAP"). SNOMED Clinical Terms ("SNOMED CT")
is a scientifically-validated, clinical health care terminology and
infrastructure. Health data can be captured, shared and aggregated
in a consistent manner by the SNOMED CT terminology. The
terminology currently contains over 350,000 hierarchically
specified health care concepts, each with unique meanings and
logic-based definitions. Additionally, these health care concepts
have distinct relationships that support reliability and
consistency for data retrieval. As used herein, the term "universal
health care concept codes" means a common language that enables a
consistent way of indexing, storing, retrieving, and aggregating
clinical data across specialties and sites of medical care. Each
"universal health care concept code" is a unique identifier
indicative of a node in a hierarchy of health care concepts to
which other types of medical data can be mapped. The term
"universal health care concept code" is intended to be synonymous
with the term "SNOMED code."
[0010] In some embodiments, security and medical privacy could be
provided such that a patient could have the ability to permit the
entire individual health record to be viewed by designated persons
or only permit selected parts of the record to be viewed by the
authorized persons. This authorization is based on the ability of a
patient to block any information relating to a protected class
(e.g., mental health, reproductive system conditions in a female or
STD, etc.) and/or functional area (e.g., illness/condition list,
procedure list, medication profile, etc.). Any part of the record
relating to that protected class and/or functional-area could be
blocked and continued to be automatically blocked until a change is
made by the patient.
[0011] According to another aspect, the invention provides a method
for generating a personal/individual health record. The method may
include the act of receiving a data element indicative of a health
related parameter for a patient. The act of determining a SNOMED
code corresponding to the data element may be included in the
method. An entry may be inserted into a personal/individual health
record associated with the patient based on the determined SNOMED
code.
[0012] In some illustrative embodiments, the data element may
include payor claims data. For example, the data element may be a
health insurance claim code. Depending on the exigencies of a
particular application, the data element may include patient
questionnaires or direct input, health plans, pharmacy benefits
managers ("PBMs"), labs, imaging centers, freestanding outpatient
facilities, hospitals and physicians. Embodiments are also
contemplated in which the data element may include an ICD code, a
CPT code, a NDC code, LOINC code, or a code from a proprietary
coding system, such as Lapcorps' lab and order codes.
[0013] The method may include the act of transmitting a description
of the entry to a client system in some embodiments. In some cases,
a first description and a second description may be associated with
the entry. In such embodiments, the first description could be
synonymous with the second description. For example, the first
description may use medical terminology whereas the second
description could use layman's terms. Preferably, the first
description is transmitted if the client system is associated with
a healthcare provider whereas the second description is transmitted
if the client system is not associated with a health care
provider.
[0014] In some illustrative embodiments, the method may include the
act of determining whether the individual health record includes
any entries related to the new entry. Preferably, any entries in
the individual health record that are related to the entry are
associated based on the determined SNOMED code.
[0015] According to another aspect, the invention provides a data
processing system with a messaging facility configured to receive a
data element indicative of a health related parameter for a
patient. The system may include a correlation module configured to
determine a SNOMED code corresponding to the data element. A PHR
population engine may be operably associated with the correlation
module, such that the PHR population engine is configured to insert
health related data associated with the SNOMED code into a
personal/individual health record associated with the patient.
[0016] In some embodiments, the system may include an access
management module configured to communicate with a client system.
In some cases, the access management module could be configured to
transmit a description of the health related data to the client
system. For example, the PHR population engine may associate more
than one synonymous description with the health related data.
Embodiments are contemplated in which some of the descriptions use
medical terminology and others use layman's terms.
[0017] The system may include a filtering module in some
embodiments. Typically, the filtering module may be configured to
determine whether the client system is associated with a healthcare
provider. The description transmitted to the client system may
differ depending on whether the client system is associated with a
healthcare provider. In some embodiments, the filtering module may
be configured to change the description of the health related data
based on a description of a SNOMED code up a SNOMED hierarchy to
adjust the resolution of data.
[0018] In some embodiments, the system may include a PHR database
configured to store a plurality of individual health records. The
system may also include a data analysis module configured to
identify patterns or relationships among the plurality of
individual health records in the PHR database based on related
SNOMED codes. For example, the data analysis module may be
configured to measure effectiveness of healthcare treatment based
on outcomes associated with the plurality of individual health
records having related SNOMED codes. In some cases, the data
analysis module may be configured to perform population studies
based on SNOMED codes in the plurality of individual health
records.
[0019] Embodiments are also contemplated in which the data analysis
module may be configured to analyze a health care provider's
quality of care and cost. For example, the data analysis module may
profile health care providers based on patient outcomes associated
with the health care providers. Likewise, the health care providers
could be profiled in terms of costs, such as the cost charged by
health care providers for various procedures. Health care providers
could thus be ranked based on quality of care and cost. This
information could allow various payors, such as insurance companies
or governmental entities, to establish a list of preferred health
care providers based on a formula that includes objective measures
for quality of care and cost, as well as possibly other
factors.
[0020] According to a further aspect, the invention provides a
method of generating a personal/individual health record. The
method may include the act of receiving a claims data element
indicative of a health insurance claim associated with a patient.
The SNOMED code corresponding to the claims data element may be
determined. The method may also include inserting the SNOMED code
into a personal/individual health record associated with the
patient.
[0021] In some embodiments, the method may include the act of
receiving a questionnaire data element indicative of an answer to a
questionnaire by the patient. A SNOMED code corresponding to the
questionnaire data element may be determined and inserted into the
individual health record associated with the patient. Embodiments
are also contemplated in which the method includes the act of
receiving a clinical data element indicative of clinical data
associated with the patient. In such embodiments, a SNOMED code
corresponding to the clinical data element may be determined and
inserted into the individual health record associated with the
patient.
[0022] According to another aspect, the invention provides a method
for generating a personal/individual health record. The method may
include the act of receiving a data element indicative of a health
related parameter for a patient. A health related concept that
corresponds to the data element may be identified, such that the
health related concept is selected from a hierarchical arrangement
of health related concepts. A new entry may be inserting into the
individual health care record that is representative of the
identified health related concept. Also, the new entry may be
associated with entries in the individual health record that have a
hierarchical relationship to the new entry.
[0023] In some embodiments, the hierarchical arrangement includes
nodes representative of medical diagnoses or medical procedures.
For example, the hierarchical arrangement may include at least
300,000 nodes, such as a plurality of SNOMED Clinical Terms.
[0024] According to a further aspect, the invention provides a
computer-readable medium having a data structure stored thereon.
The data structure may include a diagnosis data field for storing a
plurality of diagnosis data elements representative of medical
diagnoses associated with a patient. For example, at least one
diagnosis data element may be derived from a payor diagnosis code
based on a SNOMED code. A procedure data field for storing a
plurality of procedure data elements representative of medical
procedures associated with the patient may also be included in the
data structure. Preferably, at least one procedure data element is
derived from a payor procedure code based on a SNOMED code. In some
cases, the data element may be manually entered.
[0025] In some embodiments, a diagnosis data element may be derived
from an ICD code. Embodiments are also contemplated in which a
procedure data element may be derived from a CPT code. Other
embodiments are contemplated in which other health-related
information could be derived from other types of codes, such as
LOINC codes or proprietary codes, such as Lapcorbs' lab and order
codes.
[0026] Depending on the particular application, the data structure
may include a medication data field for storing a plurality of
medication data elements representative of medications associated
with the patient. For example, a medication data element may be
derived from a health insurance medication code based on a SNOMED
code. In some cases, a medication data element may be derived from
a NDC code. In some embodiments, the procedure data element may be
derived from a questionnaire answered by the patient based on a
SNOMED code associated with an answer to the questionnaire.
[0027] A still further aspect of the invention is achieved by a
computer-usable medium having computer readable instructions stored
thereon for execution by a processor to perform a method. In some
cases, the method includes the act of receiving a claims data
element indicative of a health insurance claim associated with a
patient. A SNOMED code corresponding to the claims data element may
be determined and inserted into a personal/individual health record
associated with the patient. The method may include the act of
receiving a questionnaire data element indicative of an answer to a
questionnaire by the patient. The SNOMED code corresponding to the
questionnaire data element may be determined and inserted into the
individual health record associated with the patient. The method
may include the act of receiving a clinical data element indicative
of clinical data associated with the patient. The SNOMED code
corresponding to the clinical data element may be determined and
inserted into the individual health record associated with the
patient.
[0028] According to another aspect, the invention provides a method
for selectively restricting access to a personal/individual health
record. The method may include associating an access list for each
user capable of accessing a personal/individual health record
associated with a patient, such that the access list categorizes
the individual health record into a restricted set of data elements
and an accessible set of data elements. A request may be received
from a user for a data element in the individual health record. The
method may include the act of determining whether the data element
is in the restricted set of data elements by reviewing an access
list associated with the user. If the data element is in the
restricted set of data elements, access to the data element will be
denied. However, if the data element is in the accessible set of
data elements, the user will be allowed to access to the data
element. In some embodiments, a predetermined list of possible
restricted areas may be presented to a patient. The access list may
be created responsive to selections by the patient.
[0029] According to a further aspect, the invention provides a
method for generating a individual health record, in which the
desired information from each source is pre-selected so as to
collect information which is important and necessary for the
continuing care of a patient and thus avoid massive accumulation of
data in the patient's individual health record, which has none or
little relevance to continuing care. This allows the user not to
spend excessive amounts of time scrolling through lots of data to
find actionable information. For example, a massive amount of
information is typically collected in an EMR following an inpatient
admission, such as extensive nursing reports, voluminous lab
results, information regarding the scheduling of tests and
procedures during the hospitalization. In some cases, the
information which is imported in the PHR may be less than ten
percent of the EMR and include only pre-selected types of data,
such as the admission history and physical exam, discharge summary
and discharge plans, and surgical report and pre-selected test
results such as MRI, CT-Scans, and angiography results.
[0030] A further aspect of the invention is achieved by a method
for generating a personal/individual health record. The method may
include the act of receiving payor claims data associated with a
patient. Encounter data indicative of an encounter between the
patient and a health care provider may be derived from the payor
claims data. A new entry may be inserted into a personal/individual
health record associated with the patient based on the encounter
data. In some embodiments, the deriving step may include deriving a
primary care physician encounter history, an outpatient encounter
history and a hospital admissions history from the payor claims
data.
[0031] According to another aspect, the invention provides a method
of filtering data in a personal/individual health record. The
method may include receiving a request from a health care provider
for a personal/individual health record associated with a patient.
A specialty associated with the health care provider may be
identified. The data elements in the individual health record that
relate to the specialty of the health care provider may be
determined. In response to the request, the health care provider
may be presented with any data elements in the individual health
record that were determined to relate to the specialty.
[0032] Additional features and advantages of this invention will
become apparent to those skilled in the art upon consideration of
the following detailed description of the illustrated embodiment
exemplifying the best mode of carrying out the invention as
presently perceived.
BRIEF DESCRIPTION OF THE DRAWINGS
[0033] FIG. 1 shows a diagrammatic representation of a health care
data system according to an embodiment of the present
invention;
[0034] FIG. 2 shows a block diagram of an example PHR system
according to an embodiment of the present invention;
[0035] FIG. 3 shows an example table using a MPI identifier
according to an embodiment of the present invention;
[0036] FIGS. 4A-4D show a database diagram illustrative of a
portion of one embodiment of a system and method according to the
present invention;
[0037] FIG. 5 shows a block diagram of a portion of an embodiment
of the present invention;
[0038] FIG. 6 shows an example window in which access control for
the individual health record may be established;
[0039] FIG. 7 shows an example window denying permission to access
a portion of the individual health record;
[0040] FIG. 8 shows an example window in which a user may override
a restriction to a personal/individual health record;
[0041] FIG. 9 shows an example audit report that may be generated
by the system according to an embodiment of the present invention;
and
[0042] FIG. 10 shows a flow chart which illustrates an embodiment
of a system and method for populating a personal/individual health
record with data.
DETAILED DESCRIPTION OF THE DRAWINGS
[0043] While the concepts of the present disclosure are susceptible
to various modifications and alternative forms, specific exemplary
embodiments thereof have been shown by way of example in the
drawings and will herein be described in detail. It should be
understood, however, that there is no intent to limit the concepts
of the present disclosure to the particular forms disclosed, but on
the contrary, the intention is to cover all modifications,
equivalents, and alternatives falling within the spirit and scope
of the disclosure.
[0044] As should be appreciated by one of skill in the art, the
present invention may be embodied in many different forms, such as
one or more devices, methods, data processing systems or program
products. Accordingly, embodiments of the invention may take the
form of an entirely software embodiment or an embodiment combining
hardware and software aspects. Furthermore, embodiments of the
invention may take the form of a computer program product on a
computer-readable storage medium having computer-readable program
code embodied in the storage medium. Any suitable storage medium
may be utilized including read-only memory ("ROM"), RAM, DRAM,
SDRAM, hard disks, CD-ROMs, DVD-ROMs, any optical storage device,
and any magnetic storage device.
[0045] FIG. 1 shows a health care data system 100 in accordance
with one illustrative embodiment that may be used to build, access,
analyze, and/or update a Personal Health Record, also described as
an Electronic Health Record or Individual Health Record (hereafter
the terms "PHR" and "EHR" and "IHR" are intended to convey the same
meaning). As shown, the health care data system 100 includes a
personal health record system 102 ("PHR System") that is configured
to provide access to individual health records via a network 104 to
one or more client systems or users 106. The PHR system 102 may
take the form of hardware, software, or may combine aspects of
hardware and software. Although the PHR system 102 is represented
by a single computing device in FIG. 1 for purposes of example, the
operation of the PHR system 102 may be distributed among a
plurality of computing devices. For example, it should be
appreciated that various subsystems (or portions of subsystems) of
the PHR system 102 may operate on different computing devices. In
some such embodiments, the various subsystems of the PHR system 102
may communicate over the network 104.
[0046] The network 104 may be any type of communication scheme that
allows computing devices to share and/or transfer data. For
example, the network 104 may include fiber optic, wired, and/or
wireless communication capability in any of a plurality of
protocols, such as TCP/IP, Ethernet, WAP, IEEE 802.11, or any other
protocol. Embodiments are contemplated in which the PHR system 102
may be accessible through a shared public infrastructure, such as
the Internet. In such embodiments, any data transmitted over the
shared public infrastructure is preferably encrypted, such as by
using a public key infrastructure ("PKI") certificate and/or secure
sockets layer ("SSL"). In some exemplary embodiments, a virtual
private network ("VPN") may be used. Those skilled in the art
should appreciate that various other security measures could be
employed in relation to transmitting data over the network 104.
[0047] The client systems (or users) 106 may be any form of
computing devices that can receive and send digital signals. By way
of example, the client systems 106 may include personal computers
("PCs"), tablet computers, notebook computers, servers, personal
digital assistants ("PDAs"), or cellular phones. The client system
106 shown in FIG. 1 includes labels indicative of typical users of
the PHR system 102. For example, embodiments are contemplated in
which patients, hospitals, employers, physicians, billing offices,
healthcare providers and/or healthcare practices may access the PHR
system 102. However, the client system's labels shown in FIG. 1 are
provided solely for purposes of example, but are not intended to
limit the type of users or require particular users to connect to
the PHR system 10.
[0048] FIG. 2 shows an example embodiment of the PHR system 102. In
the embodiment shown, the PHR system 102 includes a PHR database
200, a PHR population engine 202, a security module 204, a security
database 206, a correlation module 208, a correlation table 210, a
data analysis module 212, messaging facility 214, an access
management module 216, and a filtering module 218. Embodiments are
also contemplated in which one or more of these subsystems of the
PHR system 102 are optional, but may merely be "nice to have"
depending upon the exigencies of a particular situation. For
example, the data analysis module 212 may be optional in some
embodiments. By way of another example, the filtering module 218
may be optional in some embodiments. As shown, the PHR system 102
has access to payor claims data 220 and health related data 222. In
some embodiments, the payor claims data 220 and the health related
data 222 may be accessible to the PHR system 102 via the network
104 from the client systems 106.
[0049] The PHR database 200 may be structured to store various data
relating to the health care of patients, including individual
health records. Preferably, the PHR database 200 includes a
plurality of PHRs for a plurality of patients. Typically, the PHR
database 200 may include ten thousand to sixty million or more
PHRs. Embodiments are contemplated in which the PHR database 200
may be a single database or a plurality of databases, each of which
may be of any variety of database formats or languages. It should
be appreciated that the PHR database 200 may be a logical dataset
that may physically reside on a single storage medium or multiple
storage media. In some cases, for example, the PHR database 200 may
be a logical dataset that physically resides in multiple geographic
locations.
[0050] In some embodiments, the PHR database 200 may include a
master patient index ("MPI") field. The MPI field allows for the
assignment of a unique identifier that defines an entity, such as a
patient. Due to the massive amount of PHRs contemplated in the PHR
database 200, many of the patients may have the same name.
Consider, for example, a PHR database 200 that includes twenty
million PHRs. In this example, there may be thousands of patients
with the last name of "Smith" and numerous persons with the name
"John Smith." Although the use of the MPI will differentiate the
persons, the assignment of an MPI to a patient may include other
criteria that may be unique to a patient. In some embodiments, for
example, various other criteria, other than name, may be used to
determine whether an entity has already been assigned an MPI,
before an MPI is assigned. For example, the PHR system 102 may
determine whether various data elements already exist in the PHR
database 200 before assigning an MPI, including but not limited to
tax IDs, birthdates, gender, address, etc. If the entity is
determined to already exist, the information is applied to an
existing PHR. Otherwise, a new PHR is created and a new MPI is
assigned.
[0051] The MPI could be used to secure data, store patient specific
settings, and/or act as a key when requesting health record data,
for example. The MPI could also create a cross reference to
identifiers already being used across different information systems
of various health organizations. For example, hospitals, lab
systems, provider offices, pharmacy benefits managers, health plans
and/or other systems may be cross-referenced to the MPI, thereby
tying all relevant data to an appropriate patient. By way of
another example, the MPI allows a central patient search that would
allow users to find patients across multiple, massive and discrete
health related organizations without requiring a national ID
number. In some organizations, for example, there may be data on
fifteen million to twenty million patients. The use of the MPI also
allows data collected from various sources to be aggregated into a
single record {i.e., a single PHR with data collected from a
plurality of sources}.
[0052] FIG. 3 is an example use of the MPI with respect to a
patient identified as "Ann Smith." In this example, Ms. Smith has
been treated by or visited the six listed healthcare organizations.
Each of these organizations has assigned their own identifier for
Ms. Smith shown by the system identifier column, while the MPI
identifier remains a single unique tracking mechanism. In some
embodiments, the MPI could not only generate a unique identifier
for Ms. Smith, but could also cross reference information to the
system identifier used by each of the organizations. In this
manner, Ms. Smith's identification could be picked up when another
message from the same system is received. This allows the matching
of information originating from a wide range of medical sources and
from multiple payors to a single comprehensive display about a
patient. In some embodiments, the MPI could also be used to tie
health information related to a patient and their family members.
For example, the presentation of information regarding the patient
and their family could be available in formats that assist both the
health care provider and the patient in improving their health
care.
[0053] FIGS. 4A-4D shows a diagram of an example relational
database which could be used as the PHR database 200 in some
illustrative embodiments. It should be appreciated that the
database structure shown in FIG. 4 is for purposes of example only,
but that a multiplicity of database structures could be used for
the PHR database 200.
[0054] The PHR system 102 may include a PHR population engine 202
to populate and/or update the PHRs in the PHR database 200. The PHR
population engine 202 may collect data from a wide variety of
sources, such as medical claims, pharmacy claims, orders and
results from laboratory systems, admission summaries, op report and
discharge summaries from custom and standard hospital interfaces,
and manually entered information from surveys, health risk
assessments and direct entry. In some cases, manually entered data
may be inputted by the patients themselves or representative from
health plans, provider offices, hospitals, etc. By populating the
PHRs from a variety of sources, the PHRs would not be limited to
the data available from individual practices and hospitals. The
table below shows a variety of sources from which the PHR may be
populated, according to one embodiment, along with example
information that may be gleaned from each source:
[0055] Source Method of Collection [0056] 1. Patients Answers to
questionnaires and surveys. Regular entries pertaining to
management of their conditions, such as home blood glucose levels,
airway test results, etc., to track the progress of the disease
condition. Patients may also directly enter information, such as
over the counter drugs, immunizations and allergies, into their PHR
directly by connecting to the PHR system. [0057] 2. Health Plans
Directly collecting the claims data from the claim processing
systems on a periodic (e.g., daily basis) or real time basis.
Deriving the data to obtain clinical information. This information
may also be entered directly into PHRs by persons associated with
the health plans, such as case and disease managers. [0058] 3.
Pharmacy Benefits Manager Electronic tape or direct access to
obtain ("PBM") data relating to prescriptions. [0059] 4. Labs From
the lab systems using Universal interfaces (e.g. HL7) or customized
interfaces. [0060] 5. Imaging Centers From the Imaging Center
Systems using Universal (HL7) or customized interfaces. [0061] 6.
Freestanding Outpatient Facilities From the EMR of the facility
using Universal or customized interfaces. [0062] 7. Hospitals
Information imported from the respective EMR's of the hospital
using Universal Interfaces (such as HL7) or customized interfaces.
[0063] 8. Physicians a. From the claims submitted to the payers
[0064] b. direct online notes or input to the PHR
[0065] Embodiments are contemplated in which the PHR population
engine 202 may "pull" data from various sources. In some
embodiments, for example, a "flag" or other notification could be
sent to the PHR population engine 202 that health related data is
ready to be updated. It should also be appreciated that various
health related organizations could "push" data to the PHR
population engine 202. For example, the client systems 106 may
access the PHR system 102 to update the PHR of a patient in the PHR
database 200. In other embodiments, the PHR population engine 202
may periodically receive data from various sources. For example,
the PHR population engine 202 may download payor claims data (or
other health related information) from an insurance company (or
other payor or health provider) on a daily, weekly or other
periodic basis. Embodiments are contemplated in which the PHR
population engine 202 may download payor claims data or other
health related data on a "real time" basis. The term "real time"
does not necessarily mean instantaneous, but merely means that the
PHR population engine 202 would update the PHR database 200 with
new information before the information would be needed by a health
care provider. For example, consider a patient that is referred to
a specialist based on a visit with his/her primary care physician.
In this example, the PHR population engine 202 would be considered
to update the patient's PHR on a "real time" basis if the PHR is
updated with information from the visit with the primary care
physician prior to the visit with the specialist, whether the
appointment with the specialist is scheduled the same day as the
visit to the primary care physician, the next day, a week later,
etc.
[0066] In some embodiments, the PHR system 102 may include a
messaging facility 214 to interact with the PHR population engine
202 in handling messages that are received from various sources,
such as client systems 106. In some cases, the messaging facility
214 may also generate response messages for client systems 106 that
can programmically request an electronic copy of the PHR.
Embodiments are contemplated in which programmical requests for
portions of the PHR may be denied based on permissions associated
with the PHR, as described below with respect to the security
module 204.
[0067] Preferably, the messaging facility 214 is configured to
handle messages 20 in a variety of different formats, both
standardized formats, and custom formats. The message formats
described herein are provided merely for purposes of example;
however, it should be appreciated that the messaging facility 214
is not limited to the formats specifically described herein. By way
of example, the messaging facility 214 may be capable of handling
messages in HL7v2.4 and HL7v2.5 formats. These message formats
include support for various health related information, such as
hospital admission and discharge summaries, lab orders, radiology
orders, radiology results and lab results. By way of another
example, the messaging facility 214 may include support for HL7v3
format.
[0068] Embodiments are contemplated in which the messaging facility
214 includes support for ANSI-X12 837. This message format is
defined by the American National Standards committee and imposed by
the Health Insurance Portability and Accountability Act ("HIPAA")
as the currently required standard for passing health care claims
data between organizations. This message format includes a wealth
of clinical information, including diagnosis and procedure codes,
provider specialty data, treatment dates and many others.
[0069] The messaging facility 214 may also include support for
NCPDP 5.1 format. This standard for passing prescription and
medication information between entities was defined by the National
Council for Prescription Drug Programs organization, and has been
adopted by HIPAA as a pharmacy batch standard. While this message
could be sourced from many locations, it would most likely be
delivered from a Pharmacy Benefits Manager ("PBM"). The PBM may be
within a health insurance plan, or operate as an individual entity,
for example.
[0070] In some embodiments, the messaging facility 214 may receive
messages over a secure connection to a web service. In some
embodiments, the messaging facility 214 may include a certification
mechanism to ensure that the organization is eligible to submit and
request information from the PHR system 102. For example, each
participating entity may be issued a Public Key Infrastructure
("PKI") certificate that will allow verification that only
authentic messages are passed to the PHR system 102. The messages
may be sent on a real-time basis from some organizations, typically
hospitals and laboratories, but may be sent on a periodic basis
from other organizations, such as health insurance plans and
PBMs.
[0071] In some embodiments, the PHR population engine 202 may have
access to payor claims data 220. The term "payor claims data" is
intended to be broadly interpreted to include any patient related
data associated with the payment of health related services.
Typically, payor claims data 220 may be available from (or sent to)
payors(s). As used herein, the terms "payor" and "payors" means
health insurance plans and/or governmental bodies that pay for
health related services, and/or pharmacy benefit managers. For
example, the payor claims data 220 may include, but are not limited
to International Classification of Diseases ("ICD") codes, Current
Procedural Terminology ("CPT") codes, National Drug Code ("NDC")
codes, treating physicians, treatment dates, manually entered data,
or other data formats. A wide variety of information may be
obtained through the payor claims data 220. An illustrative example
of information that could be collected for a PHR from the payor
claims data 220 is provided below:
[0072] General Information [0073] Age. [0074] Sex.
[0075] Outpatient Encounter History [0076] Vaccination history.
[0077] Mammography in women; retinal examinations for diabetics;
colonoscopy for adults; PSA tests for males; etc. [0078] Visits to
primary care doctor. Dates, duration, frequency, main diagnosis at
each visit, medication prescribed following each visit, tests
ordered with each visit, changes of medication as a result of each
visit, changes in the frequency of visits to the PCP, changing
diagnoses following visits. [0079] Referrals or orders for lab
tests and imaging tests with the diagnosis justifying the tests.
Subsequent visit history to specialists, further tests and
admissions to hospitals. [0080] Referrals and visits to
specialists. Diagnoses by specialists, lab tests and imaging tests
ordered by specialists and diagnoses justifying tests. [0081]
Medications prescribed by specialists, with diagnoses. Duration of
medication. [0082] Multiple same-condition specialists, or
physicians for the same diagnoses. [0083] Medication to medication
alerts generated. Medication-clinical condition adverse reaction
alerts generated. [0084] Psychotherapy/Psychiatric Therapy--dates,
name of caregiver, diagnoses, medication.
[0085] Hospital Outpatient Encounter History [0086] Tests done at
the out patient facility--dates, tests and diagnoses. Any repeats?
[0087] Out-patient surgery--date of surgery, type of surgery,
diagnoses for surgery, name of surgeon, name of anesthesiologist,
complications. [0088] Hospitalizations following out-patient
surgeries. [0089] Physical therapy--dates, duration referring
physician and diagnosis. [0090] Out-patient or in-patient drug
rehabilitation treatment--dates, treating physicians, diagnoses and
follow up visits. Medication associated or linked with these
therapies. [0091] Urgent Care/ER Visits--dates, duration, names of
physicians, names of facilities, tests run, and diagnoses. [0092]
Admissions to hospitals or physician referrals resulting from
urgent care/ER visits. Medications prescribed and procedures
performed. [0093] Ambulances/medical transportation--dates, number
of times called in a span of time, diagnoses, treatment rendered by
EMT.
[0094] Hospital Admissions [0095] Name of hospital. Date of
admission. Date of discharge. Admitting diagnosis and discharge
diagnosis. List of complications. L.O.S. [0096] Problems list. The
names/times seen by specialists, their specialists and diagnoses by
them. Time spent by each physician on every visit. The diagnoses or
conditions for which they were seeing the patient. [0097]
Tests--lab tests, biopsies, surgical specimen exam, imaging tests
and other tests with the dates and diagnoses and names of referring
physicians and reporting physicians. [0098] Treatment days in
regular units. Treatment days in intensive care. [0099] Post
Hospitalization Management: ECF, NH, physical therapy, at home
nurse visits, and infusion therapy. [0100] Medication following
discharge. [0101] Ongoing complications, if any. [0102] Readmission
and readmission diagnoses and dates, dates of admission and
discharge, treating physicians and their specialists and the time
they spent with the patients in the hospital. It should be
appreciated that the above list is provided for purposes of example
only, but that additional information may be obtained from the
payor claims data 220.
[0103] It might at first appear implausible that transactional
information, such as payor claims data 220, would provide
meaningful medical or clinical information for inclusion in a PHR.
However, payor claims data 220 creates a type of virtual medical
record. Every claim which is processed typically includes, in
addition to various demographic information, procedural or visit
codes and diagnostic codes. Payor claims data 220 is generally more
comprehensive relating to the encounters between the patients and
different as well as diverse providers than the electronic medical
records kept by individual providers since a health plan (or other
payor) will generally receive claims from all or most of the
significant care providers for an individual. Using the electronic
medical records of the individual providers to assemble a PHR
would, at best, be much more difficult, and would likely result in
a record that is lacking in a full list of encounters, especially
providers whose access was not provided for whatever reason.
Another advantage to using the payor claims data 220 is that this
data is relatively precise and orderly when compared to other data
sources in the health care industry. The payor claims data 220 also
provides a structure which is useful in methodically organizing and
populating the data, and prioritizing the manner in which extracted
data is displayed. In addition, the payor claims data 220 would not
need coordination from the creators/keepers of the data. For
example, the use of payor claims data 220 to add information about
the hospital admission of a patient would not need the coordination
of the hospital.
[0104] Preferably, the payor claims data 220 is "normalized" or
placed into a standard format by a separate process. One such
process is the Connect.TM. process available from the assignee of
the present application. This process is described in U.S. patent
application Ser. No. 10/381,158 entitled "System for Communication
of Health Care Data" filed on Mar. 21, 2003 and claiming the
benefit of PCT International Application No. PCT/US01/42618 filed
on Oct. 11, 2001. Both U.S. and PCT applications are hereby
expressly incorporated into this application by this reference
thereto. Although specific to the payor from whom the payor claims
data is obtained, the payor claims data 220 may be more readily
utilized by the remainder of the PHR system 102 than "raw" data
available from various health related organizations.
[0105] In the embodiment shown, the PHR population engine 202 has
access to other health related data 222, which could be used to
supplement and/or enhance the payor claims data 220. For example,
the health related data 222 may be collected from patients using
questionnaires. By way of another example, the health related data
222 may include clinical data obtained from various entities, such
as hospitals, labs, imaging centers, or outpatient surgery centers.
In addition, the health related information 40 could be obtained
from physicians and/or physician offices.
[0106] In some embodiments, for example, individuals may be asked
to complete questionnaires at the time of enrollment into a health
plan, or at some later time when a PHR is being developed. The
following is an illustrative example of information collected for a
PHR using questionnaires:
[0107] General Information [0108] Race. [0109] Weight. [0110]
Change in Weight. [0111] Height. [0112] Blood Pressure. [0113]
History of diabetes, asthma, stroke, heart attack and other
conditions. [0114] History of Accident: automobile, motorcycle,
bicycle and work-related. [0115] History of potentially dangerous
hobbies. [0116] Family history of overweight, high blood pressure,
diabetes, heart disease, cancer. [0117] Lifestyle factors: smoking,
alcohol, drugs, exercise and sports. [0118] Visits to various
countries where a disease could be contracted. [0119] Any other
history information that can be obtained by changing the questions
and adding further questions.
[0120] Outpatient History [0121] Vaccination history. [0122]
Mammography in women; retinal examinations for diabetics
colonoscopy for adults; PSA tests for males; etc. [0123]
Medications prescribed by specialists, with diagnoses. Duration of
medication. It should be appreciated that the above list is
provided for purposes of example only, but that additional
information may be obtained from patient questionnaires.
[0124] In some embodiments, the health related data 222 may include
clinical data from hospitals, labs, imaging centers, outpatient
surgery centers, and/or similar entities. In some cases, the
clinical data may be extracted using a standard format. For
example, this information is generally available in electronic form
in Health Level Seven ("HL7") format and can be efficiently
extracted through the use of interfaces designed for compatibility
with this format. HL7 is a non-profit volunteer organization
headquartered in Ann Arbor, Mich. that is an American National
Standards Institute ("ANSI")-accredited Standards Developing
Organization ("SDO") operating in the field of healthcare. This
organization develops specifications that enable disparate
healthcare applications to exchange key sets of clinical and
administrative data. It should be appreciated that an interface may
be provided to extract data from some other form or format. The
following is an example list of clinical information that may be
collected from the health related data 222: [0125] Inpatient
admission history and physical examination. [0126] Inpatient
discharge summary. [0127] Selected lab results done during the
hospital stay (some of the test results may be irrelevant for
continuing care and may just add to the clutter). [0128] Imaging
test results. [0129] Pathology reports, including reports of
biopsies. [0130] Medications administered to the patient. [0131]
Any other information which is considered relevant for continuing
care. It should be appreciated that the above list is provided for
purposes of example only, but that additional clinical information
may be obtained from various entities.
[0132] The manner in which such clinical information may be
accessed will depend on the state of record keeping in each
individual entity. In hospitals having relatively modern electronic
medical record systems that use the HL7 format, for example, it
should be relatively easy to gather the desired clinical
information from the electronic medical record ("EMR") of each
patient for each encounter. In hospitals without comprehensive EMR
systems, or in those using different data formats, the information
gathering may still take place, albeit through individually crafted
interfaces or other means specific to the particular entities or
data types. For example, lab, pathology reports and imaging tests
results could be accessed by building interfaces specific to the
systems used to maintain this data. The fact that many hospitals
use outside vendors for such services, and an individual vendor may
serve many hospitals, will allow an interface to be used across a
number of providers. Similar solutions could be adopted with other
types of clinical information. Relevant information may also be
accessed through pharmacy systems, such as those maintained by
hospitals or third parties. Admission history and physical
examination and discharge summaries may also be accessed through
transcription centers. This approach may be used with labs, imaging
centers, outpatient surgery centers, and other entities. Many, if
not most, of these entities have modern electronic systems, which
are HL7 compatible, facilitating the gathering of relevant
information. As discussed above, however, other techniques could be
used to gather the information if not in HL7 format.
[0133] The health related data 222 may include information gathered
from physicians and/or physician offices. There are thousands of
physician-run clinical software systems in existence, with more
variety and less standardization in record keeping than is the case
with the other sources discussed above. One approach to obtaining
information from physicians is to recognize what information is not
available from payor claims data, questionnaire data and clinical
data, and then focusing on obtaining that information. Typically,
the information which this includes is relatively limited and
consists mainly of results of some tests done in physician offices.
Examples of such tests include EKG's, cardiac stress tests,
echocardiogram tests, EEG's, EMG's, nerve conduction studies, and
ultrasound tests done in physician offices. One possible approach
to facilitate and incentivize physicians to provide this
information to assist in building a patient's PHR is to ask or
require providers to supply the information to a PHR portal. In
some cases, for example, the supply of such information could be a
condition for payment in connection with the subject tests.
[0134] In some embodiments, the PHR population engine 202 may
interact with the correlation module 208 to correlate health
related data 222 and/or payor claims data 220 with a health care
concept in an arrangement of health care concepts. Preferably, the
correlation module 208 encodes the health related data 222 and/or
payor claims data 220 into SNOMED ("Systematic Nomenclature of
Medicine") codes. The SNOMED codes or health related data based on
the SNOMED codes may be inserted into the patient's PHR. In some
embodiments, other health entries in the PHR relating to the SNOMED
code could be associated in the PHR, regardless of the format or
mechanism from which the information is derived. By using SNOMED
codes in the PHR, differing types of entries, such as
illness/conditions, procedures, care plans, biometric trackers,
medication profile and lab results, could be tied together for
better decision making, data analysis, application of permissions
and enhanced health tracking.
[0135] SNOMED is a division of the College of American Pathologists
("CAP"). SNOMED Clinical Terms ("SNOMED CT") is a
scientifically-validated, clinical health care terminology and
infrastructure. Health data can be captured, shared and aggregated
in a consistent manner by the SNOMED CT terminology. The
terminology currently contains over 350,000 hierarchically
specified health care concepts, each with unique meanings and
logic-based definitions. Additionally, these health care concepts
have distinct relationships that support reliability and
consistency for data retrieval. In some embodiments, the
correlation module 208 may be associated with a correlation table
210, which may map health related data 222 and/or payor claims data
220 into a health care concept, such as a SNOMED code.
[0136] FIG. 5 provides an example with a PHR for a patient
identified as "Ann Smith." In this example, the PHR includes a MPI
field, which contains the MPI associated with Ann Smith, as
discussed above. The example PHR includes diagnosis, procedure, and
medication fields in which the SNOMED codes derived from ICD codes,
CPT codes and NDC codes, respectively, may be stored. In the
example shown, the payor claims data 220 is the ICD9 code of
250.00. The correlation module 208 could correlate this ICD9 code
into the diabetes concept. The PHR population engine 202 may
include the SNOMED code associated with the diabetes concept into
the diagnosis field of the PHR for Ann Smith. Other health entries
in the PHR relating to diabetes could be associated with this entry
in the PHR, regardless of the format or mechanism from which the
information is derived, whether from an ICD code, a CPT code, a NDC
number or manually entered data. Physicians, patients and others
could then categorize information related to specific health
concepts using the SNOMED codes, including visits,
illness/conditions, procedures, immunizations, medications, health
action plans, lab results or other related data. The use of the MPI
field could further enhance the PHR system 102. Since the MPI
identifies the patient and the SNOMED code designates the health
concept, the PHR system 102 may collect and present diverse data in
a PHR that can be organized, stored, viewed, and managed by all
interested parties in health care transactions.
[0137] The PHR system 102 may include an access management module
216. The access management module may provide an interface to the
PHR system 102 for client systems 106, to enhance and/or supplement
the access provided by the messaging facility 214. In some
embodiments, for example, the access management module 216 may
provide a web-based portal to access PHRs in the PHR database
200.
[0138] In some embodiments, for example, a patient may access
his/her PHR via the web-based portal (or through another connection
to the PHR system 102). This would allow the patient to supplement
his/her PHR with additional information, such as over the counter
medications, allergies, immunizations, etc. The patient could also
view his/her PHR using the access management module 216. For
example, the patient could view a diagnosis, laboratory results and
other information in his/her PHR via the web-based portion (or
other connection). In some circumstances, the timing of patient
access to certain records in the PHR may be controlled. For
example, a physician may not want a patient to view the lab results
until the physician has reviewed the lab results. Accordingly, in
some embodiments, the access management module 216 may be
configured to determine whether records in the PHR have been
"released" for patient access. If not, the access management module
216 would not allow the patient to view any "unreleased" entries,
but only allow access to "released" records.
[0139] In some embodiments, the access management module 216 may
interact with a security module 204 that restricts access to PHRs
in the PHR database 200. For example, some providers may not be
granted access to portions of the patient's PHR that may be
considered sensitive. Whenever a user accesses a patient's PHR, the
security module 204 may evaluate whether permission has been
granted to that user so that only the information contained in the
PHR to which that user has been granted permission will be
displayed. The use of the security module 204 in this manner allows
a patient to completely control access to his/her PHR. For example,
the patient may specify the default permissions for various types
of entities, including his/her spouse, family members, primary care
physicians, and other health care providers. The term "health care
provider" is intended to be broadly construed to include any
persons who provide health care as part of their job
responsibilities. In some embodiments, the patient may specify the
particular individuals to whom permissions may be granted. The use
of permissions addresses privacy concerns of patients, which may
allow a higher level of usage, as well as better care resulting
from more patients sharing data electronically with their
healthcare providers via the PHR.
[0140] In some embodiments, portions of the PHRs may be protected
by the security module 204 based on the types of health information
that a patient may consider sensitive. For example, a patient may
elect to allow the designed physician to have full access to their
various illness/condition list, while restricting access to
selected diseases, such as sexually transmitted diseases or
psychological disorders. If a portion of the PHR relates to an area
that may be considered sensitive, the security module 204 may
consider that area of the PHR to be a protected data class. For
example, information in a PHR related to reproductive health,
mental health, HIV, genetic testing, abortion, sexually transmitted
diseases, alcohol abuse, drug abuse, AIDS, contraceptive issues,
abuse or neglect, sexual assault and/or other sensitive health
issues may be considered protected data classes. Embodiments are
contemplated in which a predefined list of sensitive health issues
could be considered protected data classes. Of course, it should be
appreciated that additional data classes could be added and/or
deleted from the list of protected data classes. In some
embodiments, the correlation of payor claims data and/or health
related data into SNOMED codes, as described herein, may be used to
categorize the PHR into protected classes for restricting access to
the PHR. For example, each SNOMED code related to HIV could be
associated with the HIV protected class.
[0141] Embodiments are also contemplated in which the security
module 204 may restrict access based on functional areas of a PHR.
By way of example, function areas of a PHR may include summary,
health risk assessment, health calendar, medical history,
medication profile, visit summary, health event record, illness and
conditions, my plan for health, account summary, benefits and
eligibility, change PCP, claims, member information, referrals and
authorizations, permissions.
[0142] The security module 204 may allow a patient to select
entities that may access protected data classes and/or functional
areas of his/her PHR. Embodiments are contemplated in which a
patient may revoke consent, which would prevent electronic
retrieval of his/her PHR. In some embodiments, a patient may
restrict access to certain protected data classes and/or functional
areas. It should be appreciated that there could be a variety of
reasons for a patient to restrict access to protected data classes
and/or functional areas. For example, a patient may not want
clinician specialists to see information not related to their
specialty, or may not want a spouse (or other family member) to
view medication information. In some embodiments, the security
module 204 may provide an error message if access to a restricted
area is attempted. In some cases, the protected data classes and/or
functional areas that have been restricted may not be displayed,
which would prevent an entity being restricted from realizing that
a restriction is in place. If a spouse of a patient reviewed
his/her PHR, for example, the protected data classes from which the
spouse was restricted may not be visible to the spouse;
accordingly, the spouse would not know that a restriction to
accessing the PHR was in place.
[0143] FIG. 6 shows an example interface that allows a patient to
restrict access to portions of his/her PHR. In this example, the
patient has selected the access rights for a healthcare provider
called "Doctor Allbetter." As shown, the patient has revoked Doctor
Allbetter's access to all protected data classes, except
information related to mental health. In addition, the patient has
revoked Dr. Allbetter's access to all functional areas,
[0144] In some embodiments, default access rights to a PHR may be
established. For example, a payor may define default access rights
for each of its members. Embodiments are contemplated in which the
default access rights could be based on various factors, such as
relationship, gender, age and location of the patient. In this
manner, a reasonable level of access rights based on the patient
could be established, even before the patient customizes the access
rights as discussed above.
[0145] Embodiments are contemplated in which the security module
204 may include role-based security. In such embodiments, the users
may be assigned a role to define the portions of the PHRs to which
the user has access. This eliminates the need to establish security
access levels separately for each user. For example, each role may
include a security profile defined by the organization that the
data that would be accessed. By way of another example, heath plan
data may be protected by the role that the health plan defines for
the user, while the hospital data may be protected by a role that
the hospital has defined.
[0146] In some embodiments, the security module 204 may permit a
restriction to be overridden in certain circumstances. For example,
this may allow a physician to view a restricted portion of a PHR
for emergency care. By allowing some restrictions to be overridden
in certain circumstances, this balances privacy concerns with the
possible need for emergency care where PHR data is required due to
the state of the patient.
[0147] As shown in FIG. 7, for example, a user may be presented
with a window showing that permission has not been granted to the
portion of the PHR for which access is sought, but that the
restriction may be overridden. In this example, the word "here" in
the window is a hyperlink that allows the user to override the
restriction. It should be appreciated that FIG. 7 is provided for
purposes of example, but that numerous different types of user
interfaces could be used to allow a restriction to be
overridden.
[0148] In some embodiments, the user may be required to provide a
reason for overriding a restriction. For example, as shown in the
illustrative embodiment in FIG. 8, the user may be allowed to
select from a list of possible reasons for overriding the
restriction and/or manually enter a reason. This reason, along with
other information regarding the override, may be stored by the
security module 204, as described herein with respect to auditing
of the PHR.
[0149] The security module 204 may create an audit trail regarding
access to a patient's PHR. For example, the audit may include when
permission was granted, who was granted permission, who recorded
the granting of the permission and what permissions were granted.
In some embodiments, the security module 204 may audit whenever a
user accesses a patient's PHR. For example, the audit may include
when a patient's PHR is accessed, who accessed a patient's PHR and
what portions of the PHR were accessed. In some embodiments, the
audit and permission data may be stored in the security database
206 and/or in the PHR database and/or other storage location.
[0150] FIG. 9 shows an example audit report based on information
gathered by the security module 204. In this example report, the
user "Doctor Allbetter" has accessed the PHR of a patient called
"Ann Smith" on four occasions. Each time that Doctor Allbetter
accessed Ann Smith's PHR, the audit report notes the date and time
that the PHR was accessed. For information in the PHR to which
Doctor Allbetter had access, the example report includes a
"permission type" column and a column with the reason for accessing
the PHR. In this example, the first time Doctor Allbetter accessed
the PHR, he/she had consent to access that portion of the PHR. In
each of the other three occasions, Doctor Allbetter overrode the
permissions to access a functional area (shown as "FA") and a
protected data class (shown as "PDC") as part of emergency
care.
[0151] In some embodiments, the PHR system 102 may include a data
analysis module 212. The data analysis module 212 could be
configured to identify patterns or relationships in data contained
in the PHR database 200 for a single patient or across multiple
patients. For example, the data analysis module 212 could perform
population studies across many healthcare events, such as
condition, progress of condition, impact of co-morbidities on the
underlying condition, procedures and medications. Due to the
plurality of PHRs in the PHR database 200, the data analysis module
could analyze data relating to a large number of patients. The data
analysis module 212 could provide an outcomes measurement. For
example, the data analysis module 212 could identify the
medications that were the most successful in controlling diabetes.
By way of another example, the data analysis module 212 could
compare the results of surgery versus medical treatment. By way of
another example, the data analysis module 212 could analyze surveys
in the PHR database 200 regarding the effectiveness of treatments,
drugs, etc.
[0152] In embodiments in which SNOMED encoding is used, as
described herein, the data analysis module 212 could use SNOMED
codes as a mechanism to tie events together, to identify patterns
or relationships. For example, the use of SNOMED codes in the PHR
database 200 aids in outcomes measurements because healthcare
events, such as conditions, procedures, medications, and survey
information, could be tied to related SNOMED codes. By way of
example, survey results covering the effectiveness of chiropractic
care for back pain could be measured, as well as the effectiveness
of wellness programs. The use of an MPI could also aid in data
analysis. For example, the use of an MPI ensures that all episodes
of care, as well as each clinical event from the various data
sources, are collected and appropriately stored with the correct
patient. By collecting all relevant healthcare information for a
patient, data analysis is greatly enhanced as compared to
traditional approaches. Most pertinent is the ability to compare
data from different events that may have come from different
sources. For example, the data analysis module 212 could determine
how many patients that on taking a particular medication are
subsequently treated for a particular condition, for example. By
way of another example, the data analysis module 212 could analyze
how many patients that have had a given surgical procedure had been
given a follow-up laboratory procedure.
[0153] In some embodiments, the PHR system 102 may include a
filtering module 218. The filtering module 218 may be configured to
change modes to vary the resolution of data that is viewed by a
user. By "resolution" it is meant that the filtering module 218 may
filter the patient data to provide either a higher level view or a
lower level view of data in a PHR. For example, consider data in a
PHR related to an optic condition. If the filtering module 218 were
configured to provide a higher level view, the optic condition may
be described merely as "an optic condition." If the filtering
module 218 were configured to provide a lower level view, the optic
condition may be described as a "staphylococcal eye infection."
[0154] In some embodiments, the filtering module 218 may be
configured to traverse up and down the SNOMED hierarchy to adjust
the resolution of data that is viewed by the user. For example, if
the filtering module 218 were configured for the lowest level view,
the user may view a description associated with the SNOMED code. If
the filtering module 218 were configured for a higher level view,
the user may view a description associated with a more generalized
code related to the SNOMED code stored in the patient's PHR. For
example, if the filtering module 218 were configured for a high
level view, and the SNOMED concept related to the SNOMED code in
the PHR were "kidney disease," the user may view the more
generalized SNOMED concept described as "disorder of the urinary
system."
[0155] In some embodiments, the filtering module 218 may be
configured to filter patient data based on the type of user
accessing the information. For example, the filtering module 218
may filter patient data unrelated to the specialty of the physician
accessing the PHR database 200. In such an embodiment, physicians
may be associated with a specialty code, such as an X12 code, based
on the specialty of the physician. A cross-reference table (or
other lookup function) may be provided to determine the relevant
SNOMED codes based on the specialty code of the physician accessing
the patient data. In this manner, the physician will not be
overloaded with voluminous patient data, but will be presented with
patient data relevant to his/her specialty. Of course, the
physician may instruct the filtering module 218 to reveal
additional patient data that may not be associated with his/her
specialty.
[0156] Embodiments are contemplated in which various synonyms may
be associated with each medical concept in the PHR. For example,
each PHR in the PHR database 200 may include synonyms or synonymous
descriptions for one or more entries in the PHR that describe the
same medical concept, such as a condition, procedure, etc., using
varying terminology. The filtering module 218 may display the
synonym that is best suited to the type of user accessing the PHR.
Embodiments are contemplated in which certain descriptions may use
medical terminology while another description may use layman's
terms. For example, a patient accessing his/her PHR may view an
entry as "Heart Attack" while a healthcare provider accessing the
same entry may view "myocardial infarction." This allows patients
to view the PHR using consumer friendly terms whereas health care
providers, such as physicians and nurses, can view detailed medical
terms.
[0157] FIG. 10 is a diagram showing acts that may be performed by
the PHR System 102. In some embodiments, the PHR system 102 may
access or be provided with payor claims data 220. In some
embodiments, the payor claims data 220 could be comprehensively
coded using the SNOMED codes. Using the payor claims data 220, the
PHR system 102 may determine, for a selected individual and PHR,
the diagnosis code associated with a particular claim. For example,
the ICD 9 ("International Classification of Diseases, 91h
Revision") code may be determined. This operation is represented by
process block 1004. Following this step, the PHR system 102 may
retrieve the SNOMED code associated with the diagnosis code. This
operation is represented by process block 1006.
[0158] Next, as illustrated by process block 1008, a health issue
record associated with the SNOMED code may be retrieved. The PHR
system 102 may then determine, in decision operation 1010, whether
the subject information is already described in an existing user
record. If so, the PHR system 102 updates the data, as shown in
operation 1012. If not, the PHR system 102 adds this information to
the user's PHR, as illustrated by process block 1014. If not, the
PHR system 102 populates the user's record with the identified
health issue.
[0159] In addition to handling diagnosis codes, such as ICD 9
codes, the PHR system may also determine procedure codes, such as
CPT ("Current Procedural Terminology") codes, from each unique
claim present in the payor claims data 220. (Process Block 1016).
As illustrated by process block 1018, the PHR system 102 may
retrieve the SNOMED code associated with the subject procedure
coded (e.g., CPT code). Following this step, a health action record
associated with the subject SNOMED code may be retrieved, as
illustrated by process block 1020. The PHR system 102 may then
determine, in decision operation 1022, whether the user has this
health action as an existing entry. If so, the PHR system 102
updates the data in process block 1024. If not, the PHR system 102
adds this information to the user's PHR, as illustrated by process
block 1026.
[0160] In some embodiments, the PHR system 102 may be configured to
populate a PHR with prescription related information in the payor
claims data 220. Process block 1028 represents the operation of
determining the NDC ("National Drug Code") number and prescription
number for medications identified in the payor claims data. After
this information is identified, the PHR system 102 determines, in
decision operation 1030, whether the user has this medication or
prescription as an existing entry associated with this provider. If
yes, refill information is updated, as indicated by process block
1032, as necessary. If no, the PHR system 102 recognizes this
information as being new information and adds it to the medication
profile in the PHR of the subject user, as indicated by processor
block 1034.
[0161] In some embodiments, the PHR system 102 may be configured to
populate and/or update a PHR using health-related data 222 from an
entity (e.g., payor or laboratory organization) other than payor
claims data 220. Process block 1038 represents the operation of
determining the lab order and/or result code from the health
related data 222. As illustrated by process block 1040, the PHR
system 102 may retrieve the SNOMED code(s) associated with the
code(s). Following this step, a health action record associated
with the subject SNOMED code(s) may be retrieved, as illustrated by
process block 1042. The PHR system 102 may then determine, in
decision operation 1022, whether the user has this health action as
an existing entry. If so, the PHR system 102 updates the data in
process block 1024. If not, the PHR system 102 adds this
information to the user's PHR, as illustrated by process block
1026. In some embodiments, the data from which the SNOMED code is
derived (e.g., ICD 9 code, CPT code, NDC code, lab order and/or
result code, directly entered data) may be captured for auditing
purposes, as this would provide an explanation of the information
from which the SNOMED was derived. It should be appreciated that
information, other than a SNOMED code, could be derived from the
data received from the PHR system 102. For example, the location,
type of service, service dates, servicing provider, requesting
provided, could also be derived from the payor claims data and/or
health related data received from the PHR system 102.
[0162] Process block 1044 represents an operation whereby the user
can enter information into his or her PHR. This information is
preferably entered via an interface that guides the user through
the addition of health record entries in such a manner as to
capture and classify the appropriate SNOMED code, such as the
Connect.TM. application marketed by the assignee of the present
application. Following the entry of this information by the user,
the PHR system 102 inserts a corresponding health issue or action
into the user's PHR, as illustrated by process block 1046.
[0163] Similarly, a health care provider (or other entity) may
enter information into the PHR of a selected user, as indicated by
process block 1048. This information is also preferably entered via
an interface like the Connect.TM. software. Following entry, a
health issue or action is inserted into the provider's PHR, as
illustrated by process operation 1050.
[0164] Following entry of all health issues or actions by the PHR
system 102, as discussed above, the subject issues and actions are
stored and tracked in the PHR database 200. One such data base is
provided as part of the Connect.TM. application referenced above.
An application-specific identifier may be assigned to each member
by the Connect.TM. software.
[0165] Process block 1052 illustrates the processing of an access
request by a member or user (i.e., one of the individuals for whom
a PHR is stored and maintained by the PHR system). A properly
logged on and identified user can access the information stored in
a PHR stored in PHR database 200. As discussed herein, the PHR
system 102 may verify permission of the user as to the requested
portion of the PHR, as indicated by process block 1054 and the
security database 206. The subject information can be displayed in
a variety of formats and using a variety of display to
technologies, as illustrated by block 1056.
[0166] Although the present disclosure has been described with
reference to particular means, materials and embodiments, from the
foregoing description, one skilled in the art can easily ascertain
the essential characteristics of the invention and various changes
and modifications may be made to adapt the various uses and
characteristics without departing from the spirit and scope of the
invention.
* * * * *