U.S. patent application number 13/475777 was filed with the patent office on 2012-11-15 for method and apparatus for operative event documentation and related data management.
This patent application is currently assigned to BoundaryMedical Inc.. Invention is credited to Matt D. Putnam, Mark G. Smith.
Application Number | 20120290314 13/475777 |
Document ID | / |
Family ID | 26832206 |
Filed Date | 2012-11-15 |
United States Patent
Application |
20120290314 |
Kind Code |
A1 |
Putnam; Matt D. ; et
al. |
November 15, 2012 |
METHOD AND APPARATUS FOR OPERATIVE EVENT DOCUMENTATION AND RELATED
DATA MANAGEMENT
Abstract
In one embodiment, method and apparatus are disclosed which
provide that a plurality of physicians each enter operative event
data into an operative event database, wherein the operative event
data documents planned or completed operative events and the
physicians enter the operative event data use a wide area network
through a user interface assisting the physicians in coding
operative events in a consistent manner. The physicians access the
operative event database to obtain information concerning upcoming
or previously performed operative events, with a service provider
maintaining an on-line system including one or more servers to
support the entering of operative event data into the database
through the Internet and the user interface. Further, the
physicians subscribe to the on-line system wherein the physicians
are allowed access and use the on-line system, and wherein the
physicians retain control over the use and disposition of the
operative event data entered by the physician.
Inventors: |
Putnam; Matt D.;
(Minneapolis, MN) ; Smith; Mark G.; (Edina,
MN) |
Assignee: |
BoundaryMedical Inc.
Brentwood
TN
|
Family ID: |
26832206 |
Appl. No.: |
13/475777 |
Filed: |
May 18, 2012 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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12022719 |
Jan 30, 2008 |
8185409 |
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13475777 |
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10134319 |
Apr 29, 2002 |
7409354 |
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12022719 |
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60334194 |
Nov 29, 2001 |
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Current U.S.
Class: |
705/2 |
Current CPC
Class: |
G16H 10/60 20180101;
G06Q 10/10 20130101; G06Q 40/08 20130101; G16H 30/20 20180101 |
Class at
Publication: |
705/2 |
International
Class: |
G06Q 50/22 20120101
G06Q050/22 |
Claims
1. A method, comprising: a plurality of physicians each entering
operative event data into an operative event database system,
wherein the operative event data documents planned or completed
operative events; the physicians entering the operative event data
using a wide area network through a user interface assisting the
physicians in coding operative events in a consistent manner; the
operative event database system including a library of CPT codes
cross-referenced to a region of an anatomy; a physician using the
user interface to select a region of the anatomy from an image of
the anatomy displayed to the physician; displaying to the physician
a list of CPT codes that is substantially comprised of CPT codes
cross-referenced to the selected region; and a physician picking at
least one of the CPT codes from the list for the purpose of
documenting an operative event.
2. A method according to claim 1 wherein the CPT code is selected
for the physician by an assistant.
3. A method according to claim 1 further including patient
demographic data stored in the system for each patient for which a
coded operative event has been entered in the system.
4. A method according to claim 1 further including ICD9 codes
stored in the system wherein the ICD9 codes are cross-referenced to
CPT codes.
5. A method according to claim 4 further including displaying a
list of ICD9 codes to a physician wherein the list of ICD9 codes
comprises ICD9 codes cross-referenced to the CPT codes.
6. A method according to claim 5 including the physician selecting
one or more ICD9 codes so that an operative event is documented
with CPT and ICD9 codes.
7. A method according to claim 6 further including requesting
further event detail information from the physician based at least
in part on the CPT codes selected by the physician to document the
event, wherein the requested information changes at least in some
cases based on the selected CPT.
8. A method according to claim 7 further including entering
requested detail information.
9. A method according to claim 7 wherein the event detail is
selected from the group of: anesthesia and preparation information,
technique, pathology, in-patient discharge information, outpatient
discharge information, and worker's compensation/abilities
information.
10. A method according to claim 4 further including the physician
modifying the list of CPT or ICD9 codes that are displayed such
that the codes are customized to a particular physician's
practice.
11. A system, comprising: an operative event database system,
wherein the operative event data documents planned or completed
operative events for a plurality of physicians; the operative event
database system including a library of CPT codes cross-referenced
to a region of an anatomy; a user interface for the database system
adapted to permit a physician user to select a region of the
anatomy from an image of the anatomy displayed to the physician;
the user interface including a sub-module for displaying to the
physician a list of CPT codes that is substantially comprised of
CPT codes cross-referenced to the selected region; and e user
interface including a sub-module adapted to allow a physician to
pick at least one of the CPT codes from the list for the purpose of
documenting an operative event.
12. A system according to claim 11 further including a sub-module
for storing patient demographic data in the system for each patient
for which a coded operative event has been entered in the
system.
13. A system according to claim 11 further including a sub-module
for storing ICD9 codes stored in the system wherein the ICD9 codes
are cross-referenced to CPT codes.
14. A system according to claim 13 further including a sub-module
for displaying a list of ICD9 codes to a physician wherein the list
of ICD9 codes comprises ICD9 codes cross-referenced to the CPT
codes.
15. A system according to claim 14 including a sub-module allowing
the physician to select one or more ICD9 codes so that an operative
event is documented with CPT and ICD9 codes.
16. A system according to claim 15 further including a sub-module
for requesting further event detail information from the physician
based on the CPT codes selected by the physician to document the
event, wherein the requested information changes at least in some
cases based on the selected CPT codes.
17. A system according to claim 16 further including a sub-module
for entering requested detail information.
18. A system according to claim 16 wherein the event detail is
selected from the group of: anesthesia and preparation information,
technique, pathology, in-patient discharge information, outpatient
discharge information, and worker's compensation/abilities
information.
19. A system according to claim 14 further including a
customization sub-module allowing a physician to modify the list of
CPT or ICD9 codes that are displayed such that the codes are
customized to a particular physician's practice.
20. A method according to a preceding claim further including
cross-referencing surgical event information with CPT codes.
21. A method according to claim 20 further wherein the surgical
event information includes surgical technique information.
22. A method according to claim 21 wherein the surgical technique
information includes tournequet, drape methods or equipment.
23. A method according to claim 20 further wherein the surgical
event information includes pathology information.
24. A method according to claim 20 further wherein the surgical
event information includes surgical technique information.
25. A method according to claim 20 further wherein the surgical
event information includes discharge data information.
26. A method according to claim 20 wherein the surgical event
information includes unexpected events data.
27. A method according to claim 20 further wherein the surgical
event information includes abilities data.
28. A method according to claim 20 further wherein the surgical
event information includes surgical technique information.
Description
RELATED APPLICATION
[0001] This application is a continuation of U.S. application Ser.
No. 12/022,719, filed on Jan. 30, 2008, which is a continuation of
U.S. application Ser. No. 10/134,319, filed on Apr. 29, 2002, which
claims the benefit of priority to U.S. Provisional Patent
Application Ser. No. 60/334,194, filed Nov. 29, 2001, which
applications are herein incorporated by reference in their
entirety.
TECHNICAL FIELD OF THE INVENTION
[0002] This invention pertains generally to the field of medical
documentation, and more particularly to method and apparatus for
operative event documentation, storage and access.
BACKGROUND OF THE INVENTION
[0003] As many as 72 million surgical procedures are performed in
the United States each year. For every one of these procedures,
information about the diagnoses, treatment and relevant procedure
documentation must be captured. A major problem in this information
capture is that different entities need the same data but they
capture the data in different ways and at different times due to a
disjointed health care information structure with no one
master.
[0004] Before a physician performs surgery in a hospital or
outpatient clinic, basic information about the procedure is
captured first for the hospitals (or clinics) operating room/suite
system. This is usually done in an analog manner via telephone.
This data, collected by the MD's office, is needed for the hospital
to plan the procedure, but it is not generated in a consistent,
standard, or legible fashion. Once an Operative Event has been
completed the physician or her/his assistant completes dictation
into a tape bank that will later be transcribed into an operative
note. To be maximally useful, these notes should be transcribed and
added to the patients' record immediately. However, it is common
for the "draft" note to be outstanding for five or more days. Thus,
it is uncommon for a hospitalized patient to have a real and/or
complete Operative (event) Note in their chart during the hospital
stay. Accordingly, the JCAHO (Joint Commission for Accreditation of
Healthcare Organizations) requires that some minimal information be
"Hand Written" in to the hospital chart. Once the note is
transcribed, it is added to the patients' record, but it is not
"official" until the physician who performed the operation reads
the operative note and corrects any errors. About 20-40% of these
initial operative notes need changes. Once the operative note is
corrected and signed by the physician, the "draft" note is removed
from the patients' medical record and replaced with the signed
operative note. Separately, getting the notes to and from the
physician is a significant problem for hospital medical records
departments and for the physicians/physician offices. Not
surprisingly, a percentage of operative notes go missing-in-action.
These MIA notes are a large portion of the hospital's focus when it
is required to complete an audit of its system by the JCAHO every
three years. Most importantly, the lack of timely availability of
an accurate operative note for the use of involved parties, leads
to billing delays and errors causing payment delays, denials, and
reductions to all interested parties.
[0005] It is a universal requirement that a record of surgery be
created. This record is created for three purposes:
1. To comply with facility/governmental requirements; 2. To provide
documentation of procedure completion for insurers; and 3. To
facilitate future or current disease/procedure specific
research.
[0006] Physicians using current analog/dictation methods do not
routinely consult the coding texts which their office-clinic and
the hospitals billing department use to numerically describe to the
insurers the procedures and diagnosis for a given patient.
Consequently, operative/procedure notes do not always match the
codes that should be used to describe a specific event.
Additionally, current dictation methods do not assist a single and
certainly not a group of physicians to describe a procedure(s) in a
consistent/reproducible fashion. Of additional importance, more
than one group (Hospital, Proceduralist, Anesthesiologist,
Pathologist, Radiologist) is often coding the same event
independently. This creates more than a little confusion for the
insurer looking at a bill for a particular patient who received
treatment from three or more distinct entities, for example the 1)
hospital, 2) anesthesiologist, 3) pathologist, and 4) surgeon, all
on the same day which by report is for varying diagnosis with
varying treatments. Variations in dictation combined with coding
variations can also result in wide variations in how the physician
is paid by insurance companies. Finally, because the current data
is inconsistent, not a database, and not readily available to the
physicians, it cannot be used by the physician to improve care,
facilitate marketing, or enhance re-licensing usage without
separate time consuming data entry.
[0007] There are a number of systems in the marketplace that allow
for the entry of procedure information. These systems range from
low cost Palm Pilot based systems to online billing systems. These
systems have several major flaws. The Palm based systems are
expecting the physician to significantly change their behavior in
order utilize their software. They are complex and cumbersome to
use and provide little value to the physician, other than a
portable subset of the patients' record. These systems do not
integrate into existing systems and other than early adopter "geek
doctors", have not succeeded in the market. The existing billing
systems are designed as accounting first and an easy way to input
procedure information last or not at all. Billing systems are also
different between the hospital and the doctors' offices, thus
information is consistent only by random luck.
[0008] Accordingly, there is considerable room for improvement in
the area of operative event documentation and the storage and use
of the associated data.
SUMMARY OF THE INVENTION
[0009] According to one aspect of the invention, there is provided
a method and apparatus for operative event documentation wherein
the documentation procedure is simplified and streamlined.
[0010] According to another aspect of the invention, there is
provided method and apparatus for managing operative event
documentation data, including the ownership, control and use of
that data.
BRIEF DESCRIPTION OF THE DRAWINGS
[0011] FIG. 1 illustrates a first embodiment of the method of the
invention, wherein the method provides that a plurality of
physicians enter operative event data into an operative event
database and the operative event data documents planned or
completed operative events.
[0012] FIG. 2 illustrates an embodiment of a method of the
invention that provides for a plurality of physicians each entering
operative event data into an operative event database system,
wherein the operative event data documents planned or completed
operative events.
[0013] FIG. 3 illustrates operative events that are first planned
in the system, the actual operative event.
[0014] FIG. 4 illustrates an embodiment of the invention in which
there is created and maintained a baseline database of operative
event and post operative data which can be compared to operative
and post operative data from ongoing surgical events.
[0015] FIG. 5 illustrates an embodiment of the invention wherein a
system provides connectedness of operative procedures for workers
to ultimate disability ratings.
[0016] FIG. 6 illustrates an embodiment of the invention in which
surgery is planned from manufacturer-specific templates for implant
procedures.
[0017] FIG. 7 illustrates an embodiment of the invention which
includes a patient web pages area of a web site that is a tool for
patients to use.
[0018] FIG. 8 illustrates an embodiment of the invention in which
the system provides that a physician may enter operative event data
for planning execution or follow up in a database for events that
are associated with or are conducted at more than one clinic or
hospital organization.
[0019] FIG. 9 illustrates an overview of an example embodiment
according to the apparatus of the invention.
[0020] FIG. 10 illustrates an embodiment of an account management
system which is operative on the one or more servers to maintain a
list of subscribing physicians authorized to use the on-line
system.
[0021] FIG. 11 illustrates an embodiment of the apparatus of the
invention in which an operative event database system is provided,
wherein the operative event data documents planned or completed
operative events for a plurality of physicians.
[0022] FIG. 12 illustrates an embodiment of the invention in which
a sub-module for entering requested detail information is
provided.
[0023] FIG. 13 illustrates an embodiment of the invention wherein a
customization sub-module allows a physician or other user to modify
the list of CPT or ICD9 codes are displayed such that the codes are
customized to a particular physician's practice.
[0024] FIG. 14 illustrates an example embodiment of a data flow for
planning an operative event, conducting it, and post event
activities.
[0025] FIGS. 15A-J illustrate a user interface (UI) according to
one example embodiment of the invention, wherein FIGS. 15G and H
illustrate a further event documentation input screen, and wherein
FIGS. 15I-1, I-2 and J illustrate example embodiments of operative
discharge reports.
[0026] FIGS. 16A-C illustrate an example embodiment of the
invention in which a cross reference table shows the cross
referencing of CPT codes to ICD9 codes and other documentation.
DETAILED DESCRIPTION OF THE INVENTION
[0027] In the following detailed description of the embodiments,
reference is made to the accompanying drawings which form a part
hereof, and in which is shown by way of illustration specific
embodiments in which the invention may be practiced. It is to be
understood that other embodiments may be utilized and structural
changes may be made without departing from the scope of the present
invention.
METHODS OF THE INVENTION
[0028] Referring now to FIG. 1, there is illustrated a first
embodiment 10 of the method of the invention. According to this
embodiment, the method provides that a plurality of physicians 14
enter operative event data into an operative event database 12,
wherein the operative event data documents planned or completed
operative events. Physicians entering the operative event data use
a wide area network, such as the Internet, through a user
interface, for example web-enabled, assisting the physicians in
coding operative events in a consistent manner. Physicians access
the operative event database to obtain information concerning
upcoming or previously performed operative events. A service
provider 16 maintains an on-line system 11 including one or more
servers to support the entering of operative event data into the
database through the Internet and the user interface. Further,
physicians subscribe to the on-line system wherein the physicians
such that the subscribing physicians are allowed access and use the
on-line system. In addition, the physicians retain control over the
use and disposition of the operative event data entered by the
physician. According to this embodiment, the operative event data
is entered either by the physician or by an assistant for the
physician.
[0029] According to another example embodiment, the operative event
data is used to obtain payment from a payer 18 for medical services
rendered. In another embodiment, more than one physician uses the
system to enter coding for different medical services rendered in
connection with the same operative event, and the system assists in
conforming one of the codings for an operative event to another
coding for the same operative event.
[0030] According to still another example embodiment of the method
of the invention, at least some of the operative event data is made
available to third parties 13 such as hospitals or research
operations, and additionally the operative event data is made
available so that any patient identifying information is
omitted.
[0031] According to yet still another example embodiment, the
operative event data is made available in summary form, or
according to geographical areas.
[0032] In yet another embodiment, the operative event data for a
subscriber physician is made available to actual or potential
patients 15.
[0033] In yet still another embodiment of the methods of the
invention, patient outcome data is entered into the system and the
outcome data is correlated with coded operative events. Further, in
yet another embodiment, a summary of operative event data and
associated outcomes for a subscriber physician is made available to
potential patients 15. In another embodiment, coded operative
events are reported by frequency of diagnosis, procedure, age
distribution, and satisfaction index. Further, such reports are, in
one embodiment, provided to a physician office, hospital or
designated copy sites for use or distribution.
[0034] According to still another embodiment, coded operative
events for a plurality of physicians are combined to form a group
report. In one such example, an individual physician's coded
operative events are summarized and compared with a group
summary.
[0035] According to another example embodiment, similar coded
operative events for different patients and associated outcomes are
collected as part of a study and the collected data reported to
allow tracking of a study.
[0036] According to yet another example embodiment, patient
satisfaction data are input into the system wherein the patient
satisfaction data corresponds to operative events. According to
such an embodiment, patient satisfaction data is reported and the
reporting is obtained on-line by a prospective patient.
[0037] According to yet still another example embodiment, the
physician electronically signs the operative note.
[0038] In still another example embodiment or the methods of the
invention, physicians pay a fee to the service provider based on
the entry of an operative note into the system or other criteria.
In yet still another embodiment, the system downloads an operative
note to a hospital and the hospital pays a fee to the service
provider for downloading an operative note.
[0039] According to yet another example embodiment, the system
generates discharge reports from the system in response at least in
part to the operative event data entered by physicians, and such
reports are used by a hospital or clinic treating a discharged
patient paying the service provider a fee for each discharge
report. In yet another embodiment, a physician or other
non-physician entity pays the service provider an annual charge for
access to the system.
[0040] According to still another example embodiment illustrated in
FIG. 2, a method of the invention provides for a plurality of
physicians 21 each entering operative event data into an operative
event database system 20, wherein the operative event data
documents planned or completed operative events. The physicians
enter the operative event data using a wide area network through a
user interface 22 assisting the physicians in coding operative
events in a consistent manner. The operative event database system
20 includes a library of CPT codes 23 cross-referenced to a region
of an anatomy 24. A physician uses the user interface to select a
region of the anatomy from an image of the anatomy displayed to the
physician. A list 25 of CPT codes are displayed to the physician
such that is substantially comprised of CPT codes cross-referenced
to the selected region. The physician picks at least one of the CPT
codes from the list for the purpose of documenting an operative
event. Further, an assistant may select the CPT code for the
physician.
[0041] In still another example embodiment further including
patient demographic data stored in the system for each patient for
which a coded operative event has been entered in the system. ICD9
codes 26 are stored in the system wherein the ICD9 codes are
cross-referenced to CPT codes. A list 27 of ICD9 codes are
disclosed to a physician wherein the list of ICD9 codes comprises
ICD9 codes cross-referenced to the CPT codes.
[0042] In yet still another embodiment, a physician first selects a
CPT code, which in turn is cross-referenced to one or more ICD9
codes that are displayed to the user for selection, so that an
operative event is documented with CPT and ICD9 codes. The system
requests further event detail information from the physician based
on the CPT and ICD9 codes selected by the physician to document the
event, wherein the requested information changes at least in some
cases based on the selected CPT and ICD9 codes.
[0043] According to yet another example embodiment, detail
information is entered, wherein the event detail is selected from
the group of: anesthesia and preparation information, technique,
pathology, in-patient discharge information, outpatient discharge
information, and worker's compensation/abilities information.
[0044] In yet another exemplary embodiment, a physician can modify
the list of CPT or ICD9 codes to create a set of modification data
28 that are displayed such that the codes are customized to a
particular physician's practice.
[0045] In yet another example embodiment, printed reports,
electronic reports or electronic downloads of operative event data
from the system are reported. According to this example embodiment,
the code entering physician views and accesses his or her data
only.
[0046] In yet still another example embodiment of the invention,
users search for CPT or ICD9 codes using a few front end letters
and see choices appear in a menu.
[0047] According to still another example embodiment 30 shown in
FIG. 3, operative events are first planned 31 in the system,
information is then supplied to participants 32, and then the plan
is used at least in part to create the documentation 33 of the
actual operative event. Thus, in one example embodiment, when the
surgery is planned, equipment lists, diagnosis, and baseline data
are chosen and the information is supplied to the participants in
actual surgical event. Accordingly, the planned operative event
information is accessed from the on-line system by personnel such
as the planning physician and the planning information is used to
prepare the operating facility for the operation and carry out the
invention. Further, the operative event documentation from the
event itself are used by further personnel for example to reimburse
the medical personnel or facility, or to follow the outcome of a
patient for study purposes or for worker's compensation purposes or
others.
[0048] According to still another embodiment 40 of the invention
illustrated in FIG. 4, there is created and maintained a baseline
database 41 of operative event and post operative data which can be
compared to operative and post operative data from ongoing surgical
events 42. The data can be compared against issues such as worker's
compensation.
[0049] According to still another embodiment 50 of the method of
the invention illustrated in FIG. 5, the system provides
connectedness of operative procedures for workers to ultimate
disability ratings. Using the online operative data 51, this
disabilities tracker allows physicians to achieve timely closure of
work cases and easy tracking of workers abilities and final
outcomes 52 (these are two different things as a worker can have
lost function and received a settlement yet returned to original
work duty without restriction).
[0050] According to another embodiment of the method of the
invention, there is provided a record of relatedness of procedure
to operative consent, surgical planning per hospital, discharge
planning per hospital, and patient's language. To the degree
possible, the patient is presented materials in their first
language using language specific templates.
[0051] According to yet another example embodiment 60 illustrated
in FIG. 6, surgery is planned from manufacturer-specific templates
for implant procedures. For example, each manufacturer of an
implant device may have associated with it one or more predefined
templates 61 stored in the system database that a health care
professional can use to create a surgical plan. Thus, implant
specific plans can be readily prepared 62 using the templates. In
one embodiment, "sized" x-rays are imported into system pre
planning modules, and compared to a selected template and then sent
to the and/or manufacturer/operating room equipment storage
location.
[0052] According to yet another example embodiment, alert functions
track pending pathology for specimen cases and "tack" result to
operative results for "final" approval or action.
[0053] According to still another embodiment, alert functions for a
physician or other health care provider let a radiologist know if
the operative findings did not correlate with a radiological
diagnosis.
[0054] According to still another example embodiment of the
invention, the documenting physician enters a "grade" for a
resident's technical skill or the skills of any other assisting
personnel. Such grades or rankings are preferably kept in the
operative event database such that the grades or rankings are
viewable only selectively by the entering physician and any one
else he or she authorizes to see the grades or rankings, and are
otherwise not available to other parties accessing the system.
[0055] Thus, as described above, the embodiments of the present
invention provide for: [0056] 1) A CPT code "shopping cart"; [0057]
2) An operative summary method; [0058] 3) An ability to link CPT's
and ICD's; [0059] 4) An ability to "learn" the physicians method;
[0060] 5) An ability for individual user personnel to locally
modify parts of event/operative technique; [0061] 6) An ability to
generate summary reports easily; [0062] 7) An ability to add
therapy and discharge prescription orders to the discharge summary;
and [0063] 8) An ability to import data to billing and EMR software
packages.
[0064] According to still another embodiment 70 illustrated in FIG.
7, the system of the present invention includes a patient web pages
area 72 of a web site that is a tool for patients 71 to use to
understanding the frequency of diagnosis and any proposed
procedure. In this embodiment some background information is
available regards possible procedures. Specific emphasis is placed
on procedural indications, contra-indications, goals, and common
outcomes. One feature of this portion of the site is the physician
finder. According to one example embodiment, participation in the
physician finder is voluntary. Physicians who choose to participate
must agree with the system provider to display their satisfaction
data in one of two forms (as part of the regional aggregate or as
part of the aggregate and individually). The site allows physicians
who choose to participate in the satisfaction data, to promote
themselves with "real" data (case summaries, National Library of
Medicine summaries, Board certification, State Licensure).
Satisfaction/outcome data from patients may be obtained by
telephone, mail or e-mail survey instruments. The system provider
can assemble this data and maintain its integrity.
[0065] According to one example embodiment, using the subscription
portion of the patient access web site, a patient could query the
database regards who has done at least 100.times.-procedures/year
with a 85% satisfaction rate and practices within 150 miles. The
answer to this question is currently unavailable. But the answer is
desired by ALL PATIENTS and by the physicians capable of achieving
the desired result.
[0066] According to yet still another embodiment 80 illustrated in
FIG. 8, the system of the present invention provides that a
physician 81 may enter operative event data for planning execution
or follow up in a central database 82 for events that are
associated with or are conducted at more than one clinic or
hospital organization 83. Thus, the physician/physician office
documents, owns, distributes, and retrieves the critical components
of an operative event, not the clinic or hospital at which the
event is executed. The physician can later query her/his data from
any web enabled device and design personal practice summaries,
competitive practice summaries, and plan targeted practice growth.
A physicians personal practice data is only specifically available
to others to whom the physician allows access. This access can be
time, region (hospital/practice), or site (anatomic) limited. This
product contains x-links, specialized procedure picker, and
specialized procedure templates, as described above.
Apparatus of the Invention
[0067] Referring now to FIG. 9, there is illustrated an overview of
an example embodiment according to the apparatus of the invention.
An on-line system 90 includes one or more servers to support the
entering of operative event data into an operative event database
92 through a wide area network 93 and a user interface 94 presented
on a client computer. The operative event database contains
operative event data documenting planned or completed operative
events performed by a plurality of physicians. A client computer 95
is connected to the one or more servers 91 through a wide area
network. The interface is adapted to assist the physicians in
coding operative events in a consistent manner. Referring to FIG.
10, an account management system 100 is operative on the one or
more servers maintains a list of subscribing physicians authorized
to use the on-line system. An operative event data management
module 102 operative on the one or more servers allows authorized
physicians to control the use and disposition of the operative
event data entered by the physician in the on-line system.
According to one example embodiment, an assistant enters operative
event data for the physician.
[0068] According to yet another example embodiment, a system
according to the apparatus of the invention further provides that
the operative event data is used to obtain payment from a payer for
medical services rendered.
[0069] In still yet another example embodiment of the invention,
more than one physician to document different medical services
rendered in connection with the same operative event enters the
operative event data.
[0070] According to yet another example embodiment of the invention
shown in FIG. 10, module 102 includes a data processing sub-module
that assists in conforming one of the codings for an operative
event to another coding for the same operative event. According to
yet another example embodiment of the invention, a data output
module outputs 103 at least some of the operative event data to
third parties.
[0071] In yet another example embodiment of the invention, the
operative event data is output without any patient identifying
information, and the operative event data is output in summary
form.
[0072] According to yet another example embodiment of the
invention, the operative event data is output according to
geographical areas. In yet another example embodiment of the
invention, a prospective patient data output module makes operative
event data for a subscriber physician available to potential
patients.
[0073] In yet another example embodiment, there is provided an
input and storage module 104 is provided for entering patient
outcome data into the system and correlating the outcome data with
coded operative events.
[0074] According to yet another example embodiment of the
invention, a reporting module 105 makes at least a summary of
operative event data and associated outcomes for a subscriber
physician available to potential patients. Further, reporting
module 105 reports operative events by frequency of diagnosis,
procedure, age distribution, and satisfaction index. According to
yet another example embodiment of the invention, reporting module
105 includes a sub-module for outputting coded operative event
reports to a physician office, hospital or designated copy sites
for use or distribution. According to yet another example
embodiment of the invention, the reporting module 105 includes a
sub-module for combining reporting coded operative events for a
plurality of physicians to form a group report. In yet another
example embodiment of the invention, the reporting module 105
includes a sub-module for comparing an individual physician's coded
operative events summary with a group summary.
[0075] According to still yet another example embodiment of the
invention, a study module 106 is provided for collecting similar
coded operative events for different patients and associated
outcomes as part of a study and reporting the collected data to
allow tracking of a study.
[0076] In still another example embodiment of the invention, a
input module 104 includes a satisfaction data input sub-module that
receives patient satisfaction data into the system corresponding to
operative events, and a satisfaction data output module is provided
to output satisfaction data to interested parties.
[0077] According to yet another example embodiment of the
invention, a signing module 107 enables a physician to
electronically sign the operative note.
[0078] In yet still another example embodiment of the invention, a
billing module 108 is provided for charging a physician a fee to
the service provider based on the entry of an operative note into
the system. The billing module includes a sub-module for charging a
fee to a hospital for downloading an operative note.
[0079] In another example embodiment, a discharge-reporting module
109 generates discharge reports from the system in response at
least in part to the operative event data entered by
physicians.
[0080] According to yet another example embodiment of the
invention, the billing module 108 includes a sub-module for billing
a hospital or clinic treating a discharged patient a fee for each
discharge report. In another embodiment, the billing module
includes a sub-module for charging a physician or other entity an
annual charge for access to the system.
[0081] In yet still another example embodiment 110 of the apparatus
of the invention illustrated in FIG. 11, an operative event
database system is provided, wherein the operative event data
documents planned or completed operative events for a plurality of
physicians. Further, the operative event database system including
a library of CPT codes 111 cross-referenced to regions of an
anatomy 112 and ICD9 codes 116, and a user interface 113 for the
database system is adapted to permit a physician user to select a
region of the anatomy from an image 114 of the anatomy displayed to
the physician. The user interface 113 includes a sub-module for
displaying to the physician a list 115 of CPT codes that is
substantially comprised of CPT codes cross-referenced to the
selected region. The user interface includes a sub-module adapted
to allow a physician to pick at least one of the CPT codes from the
list for the purpose of documenting an operative event.
[0082] According to yet another example embodiment of the
invention, a sub-module is provided for storing patient demographic
data in the system for each patient for whom a coded operative
event has been entered in the system.
[0083] According to still yet another example embodiment of the
invention, there is provided a sub-module for storing ICD9 codes
116 stored in the system wherein the ICD9 codes are
cross-referenced to CPT codes 111. According to yet another example
embodiment of the invention, a sub-module displays a list 117 of
ICD9 codes to a physician wherein the list of ICD9 codes comprises
ICD9 codes cross-referenced to the CPT codes. A sub-module allows
the physician to select one or more ICD9 codes so that an operative
event is documented with CPT and ICD9 codes.
[0084] According to yet another example embodiment of the a
sub-module for requesting further event detail information from the
physician based on the CPT and ICD9 codes selected by the physician
to document the event, wherein the requested information changes at
least in some cases based on the selected CPT and ICD9 codes.
[0085] According to yet another example embodiment 120 of the
invention illustrated in FIG. 12, there is provided a sub-module
for entering requested detail information 121 and storing in
operative event database 122. According to yet another example
embodiment of the invention, the event detail is selected from the
group of: anesthesia and preparation information, technique,
pathology, in-patient discharge information, outpatient discharge
information, and worker's compensation/abilities information.
[0086] According to yet another example embodiment 130 of the
invention shown in FIG. 13, a customization sub-module allowing a
physician to modify 131 the list of CPT or ICD9 codes that are
displayed such that the codes are customized 132 to a particular
physician's practice.
[0087] In still yet another example embodiment of the invention,
module 103 provides an output sub-module for outputting printed
reports, electronic reports or electronic downloads of operative
event data from the system.
[0088] According to yet another example embodiment of the
invention, a sub-module is provided for allowing the code-entering
physician to view and access his or her data only.
[0089] In yet still another example embodiment of the invention, a
module 101 provides that users search for CPT or ICD codes using a
few front end letters and see choices appear in a menu.
[0090] According to still another example embodiment, module 101
provides that operative events are first planned in the system, and
then the plan is used at least in part to create the documentation
of the actual operative event. Thus, when the surgery is planned,
equipment lists, diagnosis, and baseline data is chosen which will
flow to the actual surgical event. Accordingly, personnel such as
the planning physician access the planned operative event
information from the on-line system and the planning information is
used to preparing the operating facility for the operation and
carry out the invention. Further, the operative event documentation
from the event itself are used by further personnel for example to
reimburse the medical personnel or facility, or to follow the
outcome of a patient for study purposes or for worker's
compensation purposes or others.
[0091] According to still another aspect of the invention, module
101 provides for creating and maintaining a baseline database of
operative event and postoperative data which can be compared to
operative and postoperative data from ongoing surgical events. The
data can be compared against issues such as worker's
compensation.
[0092] According to still another aspect of the invention, module
101 provides that the system provides connectedness of operative
procedures for workers to ultimate disability ratings. Using the
operative data online, this disabilities tracker module allows
physicians to achieve timely closure of work cases and easy
tracking of workers abilities and final outcomes (these are two
different things as a worker can have lost function and received a
settlement yet returned to original work duty without
restriction).
[0093] According to another embodiment of the apparatus of the
invention, module 101 provides a record of relatedness of procedure
to operative consent, surgical planning per hospital, discharge
planning per hospital, and patient's language. To the degree
possible, the patient is presented materials in their first
language using language specific templates.
[0094] According to yet another example embodiment of the
apparatus, module 101 provides that surgery is planned from
manufacturer-specific templates for implant procedures. For
example, each manufacturer of an implant device may have associated
with it one or more predefined templates stored in the system
database that a health care professional can use to create a
surgical plan. Thus, implant specific plans can be readily
prepared. In one embodiment, "sized" x-rays are imported into
system pre planning modules, and compared to a selected template
and then sent to the and/or manufacturer/operating room storage
location.
[0095] According to yet another example embodiment, alert functions
module is provided and tracks pending pathology for specimen cases
and "tack" result to operative results for "final" approval or
action. According to still another embodiment, alert functions for
a physician or other health care provider let a radiologist know if
the operative findings did not correlate with a radiological
diagnosis.
[0096] Thus, as described above, the various embodiments of the
invention change the document creation method so that the
creator/author retains primary control of the created data. Because
the system is accessed online, the individual physicians account is
available anywhere/anytime. Also, the present invention makes a
"signed" created report available to all authorized parties
immediately, regardless of location. Moreover, the cost to
produce/access such a report is less than that which is currently
incurred.
[0097] The long-term availability of physician data offers a value
to individual physicians that are not currently available. The
projected cost of offering this secure service makes the
creation/maintenance of a similar database untenable for the
average physician.
[0098] Additionally, the present invention can be used to
facilitate procedure planning. That is, the physician can
communicate to the operating room in advance the planned procedure
and equipment requirements.
[0099] Finally, the present invention offers the individual
physician an affordable means to collecting practice-wide
satisfaction data, which can be displayed, competitively to the
world.
[0100] According to some example embodiments, the method and
apparatus of the invention provide an interactive web site, which
is designed to take advantage of emerging technology and its
widespread distribution. It can provide benefit to an individual
practice or health system even before patients have gained routine
access to the Internet. By way of some devices, the Internet site
could interact with registered parties through wireless means even
without a direct Internet connection. But, this wireless ability is
just one method for accessing the Internet system. Using current
jargon, the present invention is desirably implemented as an ASP
(application service provider).
[0101] One advantage of the present invention is its ability to
deliver and subsequently securely restore, a language/cultural
specific visual interactive message, of a proven communications
quality, to a worldwide audience simultaneously and individually,
which saves the users money and time. This advantage over existing
media is magnified by virtue of: [0102] 1. being individually
customizable while at the same time up-dateable on a system-wide
basis instantaneously, [0103] 2. being interactive with the
patient, the caregivers, and potentially, third parties. [0104] 3.
being "intelligent". This occurs in two ways: 1) the initial
software product adapts itself to reflect the user's most common
method of care delivery and 2) the user can "teach" the original
database new data as long as it is entered following the
established framework. This new data or method is unique to the
individual who entered the new data. But because it is in specific
fields it can still be compared to the whole experience. [0105] 4.
This "intelligence" is able to instantaneously translate between a
variety of languages. According to one example embodiment, the
program may offer face-to-face language appropriate interaction.
[0106] 5. Finally, the media can be customized to represent any
health system directly. Thus, any provider or system can use the
invention as their content provider for purposes of documenting
surgical/operative care. [0107] 6. The CPT Picker. This is
analogous to a shopping cart. When a user MD/surgeon signs on to
the on-line system, for example web site, of the invention, the
physician is recognized as an orthopaedist, cardiac surgeon, or
whatever, based on a profile for the physician maintained in the
system. The screens seen from that point are type specific. Thus,
when the web page to pick CPT's is seen it makes sense based upon
specialty and, unlike the CPT books, the spectrum of codes for a
specific region are directly visible. Moreover, the codes are
linked to correct ICD and RVU codes with care taken to cancel
overlapping codes. This combined system places the most
knowledgeable person at the front end of the description process
regards "coding" the operative event. But, unlike some other
methods, the method and apparatus of the present invention displays
the critical data in user-friendly medical language while retaining
back-office organization to assist in rapid preparation of code
correct operative notes. [0108] 7. The shopping cart can handle a
sufficient number of codes so that any patient event can be
described. [0109] 8. The operative note engine of one example
embodiment of the invention assembles the templates from data
previously entered by MD experts and retained as part of
continuously updated operative note content. These templates allow
the MD to click/key/and "speak" (assume voice recognition
available) the notes in a proscribed manner. The engine finishes by
allowing the MD to post the note, which is then electronically
signed and distributed, simultaneously to all key parties for a
fee. [0110] 9. According to still other example embodiments,
additional value items are associated with an operative note:
[0111] 1. tracking of surgical teaching; [0112] 2. abilities and
permanency track for worker's compensation; [0113] 3. discharge
summary data; [0114] 4. follow-up data for specific procedures;
[0115] 5. ability to link multiple MD's together to study specific
problems; [0116] 6. ability to prospectively complete
implant/device studies in a secure affordable manner; and [0117] 7.
Ability to collect CPT/surgeon/hospital specific case data and
display against satisfaction data gleaned directly from patients
contacted by the company acting as a neutral 3.sup.rd party.
[0118] According to still other aspects of the invention, the
methods and apparatus of the invention function simultaneously as
a: [0119] 1. ASP for individual surgeons or health systems to
accurately document surgical events. [0120] 2. Portal for learning
about surgery (Surgeon CME, patient). [0121] 3. Interactive Web
site for patients, providers, and purchasers of Operative services.
[0122] 4. Business-to-Business pathway to monitor progress in
treating a single patient, a group of patients with a single
disease, or an entire population of patients. Patient's privacy can
be built in to this system. However, particularly in work or
vehicular injury cases, monitoring of the patients progress is
common, although disorganized. This method would allow monitoring
of therapy, prediction and calculation of disability, and
comparison among groups (providers, patients, employers). [0123] 5.
Advertising Portal.
[0124] The method and apparatus of the invention can be accessed
via the Intra/Internet. As an ASP for a practice it can offer
direct access to case data at a lower cost for billing purposes
than the current methods employed. Patients with "prescribed"
access will see a postoperative care protocol designed for them by
their provider. Patients without "prescribed" access can visit the
generic portions of the site. Providers are encouraged to maintain
their contacts with patients by participating in satisfaction
surveys.
[0125] According to yet another example embodiment of the
invention, the service provider hosting the on-line system owns
"generic" case data derived from the patient data of physicians but
stripped of any data identifying a particular patient. This
ownership of the generic data is a term of the use of the system by
a medical personnel. According to another embodiment, the
individual physician can decide what parts of generic patient data,
if any, to release for viewing. In this embodiment, a variety of
users desire portions of the data owned by the service provider.
Although individual patient case data will not be made available,
data summaries are provided. In this scenario, the physician's case
numbers would fall into a generic summary of the region. In this
embodiment, the individual physician controls the individual
physician's case data, for example, physician employees are managed
as individuals with superimposed time-sensitive contracts. For
example, it is envisioned that a physician who, after residency,
joins a health maintenance organization or other group, will
release all of her/his data to the organization for the period of
her/his employment. Whatever her/his next job, the physician will
no longer release procedure information to the organization.
Questions will arise for individual physicians who work for large
groups related to the volume of information that they are allowed
to retain after leaving.
[0126] According to another example embodiment, large-scale data
displays and research studies are currently desired. However, they
are impossible to achieve because of the separate and unique nature
of billing systems and interstate regulations. The method and
apparatus of the present invention uses coding methods and
descriptive language that is increasingly universal. In one example
embodiment, codes used by the company are provided by the American
Medical Association (AMA). A license fee is be paid by the system
provider to the AMA for each registered customer. The company will
cover this cost within a yearly registration fee charged to each
physician customer. Because of it's large-scale, wide area
deployment it is likely that its data can be used to understand
medical problems and potential solutions. The present invention
envisions variable charging for searches and studies. Examples of
customers for searches are: medical insurers, Medicare, a large
company which is partially self-insured, and a medical device
manufacturer wanting to know the frequency of utilization of
specific devices for specific diagnosis/treatments. Customers that
request specific study designs could be: a group of specialists who
seek to prove their excellence, a medical study group (the
International Wrist Investigators), a medical Organization/Board
seeking to gain understanding of its own comparative skill against
a competitive discipline (for example Family Physicians delivering
babies compared to Ob/Gyn MD's).
[0127] According to still yet another example embodiment, highly
targeted advertising is offered on the system pages to individuals
about to "buy" a product. When patients access the system for
informational purposes prior to a surgery or selecting a physician,
the system reaches the patient/customer prior to use of their
product inside the customer by the physician. Also, the system
increases the efficiency of reaching targeted physicians by a
medical device or other medical product, service or drug
manufacturer. By suggesting/advertising products at the point in
time that an operative event is planned, highly relevant
information is placed in front of the physician at a highly
effective time.
[0128] Thus, as described in more detail above, the present
invention includes a number of features including: [0129] 1.
X-Links [0130] Links/medical language operative
terminology/cpt's/icd's/rvus in a manner visible to the MD [0131]
2. Geographic/Anatomic CPT Picker [0132] Presents data to MD in a
manner familiar and allows selection of multiple cpts without
constant renavigation [0133] 3. Geographic/Anatomic Results Display
[0134] Allows MD to study personal practice without displaying
results to world [0135] 4. Physician Picker [0136] Allow patients
to see pattern of procedures as well as MD's willing to display
results [0137] 5. Procedure Planning Templates [0138]
Operative/Event planning tool which starts the process in office
and alerts Or to equipment needs as well as allows MD to preplan
case even completing the note the day before and review any latest
equipment notes/care updates. This is a potential CME process.
[0139] 6. Procedure documentation [0140] This portion of the
process allows for one or many CPT codes to be combined into a
single note, which matches the Hospitals, needs and can cross
whatever EDI barrier exists. A key part of this process is its
ability to cross into billing software for the MD and the hospital
thus saving a labor step but not actually taking on the process of
claims submission. [0141] 7. Custom procedure building [0142]
Unlike some competitors, the content learns the users preferred
method and defaults to the common screens. Also, the individual MD
can modify the templates to be displayed to him/her without
altering the main database. [0143] 8. Personal Data [0144] The MD
can download and assemble data from his/her database without
special programming skills A report builder is provided. [0145] 9.
Data is available following the principle of 5 9's. Data is
permanent and private with shared overlapping ownership (patient,
hospital, MD, insurer).
[0146] Referring now to FIG. 14, there is illustrated an example
data flow for planning an operative event, conducting it, and post
event activities. First, as illustrated in flow chart item 141, a
surgeon decides to operate, the operating room (OR) is scheduled
and the physician enters the initial planning codes and equipment
into the online database. The surgeon finishes coding in the online
database 142, and the data is then resident in the database 143.
The OR can then receive this information from the online database
and plan the surgery based upon an exact request 144. Once the
surgery is complete, the final operative event data is entered into
the database 143. The surgeon's office then receives an electronic
document with the ICD9/CPT codes that are compatible with legacy
billing systems, as shown in item 145. The medical records and
hospital receives a electronically signed record of the operative
event 146, and any third parties receive any desired information
from the database 147. The insurer can subsequently receive the
electronic records as illustrated in item 148. Due to the common
origin of the operative event documentation from database 143, the
ICD9 and CPT codes are identical and thus eliminates delays and
inconsistencies that may detrimentally effect the reimbursement
claim.
Additional Example Embodiment
[0147] According to one particular example embodiment, the wide
area network of the invention is the Internet, and the on-line
system is provided by a server on the Internet that supports client
computers executing web browsers.
[0148] Referring now to FIGS. 15A-15J, there is illustrated a user
interface (UI) according to one example embodiment of the
invention. After identifying a patient, in this example patient
Barbara B. Smith, the UI offers the physician or other health care
professional user the choice to Pick CPT or Short Form Entry. If
Pick CPT is chosen, the user is presented with the screen shown in
FIG. 15B, allowing them to either select a region of the body from
an image of the anatomy, in this case a skeletal image.
Alternatively, a user may choose the CPT code directly from a drop
down menu. If, for example, the user chooses the right forearm and
wrist region (by pointing at it with a cursor controlled by a
pointing device such as a mouse), the display of FIG. 15C is
presented, showing a list of categories including, in this example,
arthroscopy, casts, general, integrument, nerve and vascular. If
the nerve category is selected, for example, the UI of FIG. 15D is
presented, showing a list of subcategories including excision,
neuroplasty, neurostim and repair. If the user chooses neuroplasty,
the display of FIG. 15E is presented, with a list of CPT codes. If
CPT code 64721 is selected, the display of FIG. 15F is presented,
which requests the entry of event information including hospital,
event date, medical record number, incisions start and incision
close times, referring physicians, assistants, and assistants
proficiency levels. At the bottom, the ICD9 codes that are cross
referenced in the database to the chosen PCT code are displayed,
and may be chosen by the physician by entering a check in the PreOp
or PostOp boxes or both, indicating the ICD9 codes applicable
before and after the surgery.
[0149] Referring to FIGS. 15G and H, there is illustrated a further
event documentation input screen, including provision for a variety
of procedure documentation including anesthesia, anesthesia class,
unexpected events, estimated blood loss, preparations, drape,
tournequet and tournequet time, equipment, and technique
information, in this case incision type. Further, pathology can
also be documented, including findings, In op testing and nerve,
pathology comments. Discharge data, follow up timing, abilities
data and notes can also be entered. If the documentation input
meets the physician's approval, the post event data button is
selected and the information is posted in to the on-line database.
If not, the information can reset to its initial condition.
[0150] FIG. 15I illustrates a discharge report that is generated
after the documentation is posted, and includes itemization of
procedure, preoperative and postoperative information, operative
pathology and technique, as generated from the posted
documentation. By pressing the discharge summary button, a
discharge summary report is generated as shown in FIG. 15J,
including procedure, discharge data and abilities information.
[0151] According to yet still another example embodiment, FIGS. 16A
to 16C illustrate a cross reference table showing the cross
referencing of CPT codes to ICD9 codes and other documentation
entered by a physician or other input personnel, such as surgical
techniques. Such techniques or preparation include, by way of
example and not by limitation, tournequet, drape method and
equipment lists cross-referenced to CPT codes.
[0152] Thus, as described above, the method and apparatus of the
present invention solve many of the problems that the current
system has, streamline the process, lower the costs and enter the
market in a manner that yields immediate payback to the physicians.
This web based system allows the physician to enter procedure
information one time using simple, yet sophisticated screens that
should allow the input of data in the same or less time as the
physician currently takes to dictate the information. Partially,
this input process is facilitated by providing a procedure
notification screen for use by the physician's office-clinic which
facilitates procedure planning for the office and hospital while at
the same time reducing any keying requirements for the physician.
At the end of a procedure, after the operative/event data is input,
the physician can immediately review the information and send the
completed information to both the hospitals systems and his systems
at the same time. The system of the present invention also retains
the information for later usage in licensing reports, patient
satisfaction surveys and other value added solutions.
[0153] The consumer side to the system facilitates consumers
searching for expert physicians with documented experience. This
site is open to advertisers for the purpose of reaching patients
with specific needs.
[0154] Thus, as described above, the present invention provides, in
one or more of the embodiments described below, for a health care
professional to build an original operative event note or
documentation using a documentation database. In addition, at their
option, change the content of a note or documentation online.
Further, professionals may also, in some embodiments, add to the
existing content of a documentation database within defined groups
to better reflect their practice, without changing the structure to
other users. Further, the manner in which the documentation
database is presented to users can also be altered.
[0155] Thus, the approach of the various embodiments of the
invention are designed to streamline an existing cost accountable
step in the information gathering process, without trying to solve
all of the problems in the medical information world. Physicians
are already entering patient and procedure data utilizing changing,
often cumbersome, phone based systems. The system seeks to simplify
this process and increase the value of the data through effective
capture techniques. The apparatus and method of the invention can
immediately reduce physician and hospital overhead while increasing
the quality of the information at the same time. An important side
benefit is returning ownership of the operative record and lifetime
work summary to the individual physician. In this age of rapid
change, the value to the individual physician of a clear work
record is large.
* * * * *