U.S. patent application number 16/778038 was filed with the patent office on 2020-05-28 for electronic physician referral management system and methods.
This patent application is currently assigned to The Advisory Board Company. The applicant listed for this patent is The Advisory Board Company. Invention is credited to Colleen Cutshaw, Troy Hollar, Cynthia Jordan-Nowe, Leslie Perls, Anne Sarabia.
Application Number | 20200167880 16/778038 |
Document ID | / |
Family ID | 69230081 |
Filed Date | 2020-05-28 |
United States Patent
Application |
20200167880 |
Kind Code |
A1 |
Jordan-Nowe; Cynthia ; et
al. |
May 28, 2020 |
ELECTRONIC PHYSICIAN REFERRAL MANAGEMENT SYSTEM AND METHODS
Abstract
A physician referral management system is provided. The system
includes a physician profile database, electronically accessible
over at least one network system. The physician profile database
stores physician profiles, each of which contain information
associated with a physician. The system further includes a
physician referral application which is hosted at least partially
on a server and electronically accessible over at least one network
system to a primary care physician device and a specialist
physician device. The physician referral application is configured
to facilitate a referral of a patient between the primary care
physician device and the specialist physician device, and to allow
a user of at least one of the primary care physician device and the
specialist physician device to search for physicians based on
information contained in the physician profiles. At least a portion
of the physician profiles contains information relating to
insurance plans accepted by particular physicians.
Inventors: |
Jordan-Nowe; Cynthia;
(Tucson, AZ) ; Cutshaw; Colleen; (Tucson, AZ)
; Perls; Leslie; (Tucson, AZ) ; Hollar; Troy;
(Tucson, AZ) ; Sarabia; Anne; (Tucson,
AZ) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
The Advisory Board Company |
Washington |
DC |
US |
|
|
Assignee: |
The Advisory Board Company
|
Family ID: |
69230081 |
Appl. No.: |
16/778038 |
Filed: |
January 31, 2020 |
Related U.S. Patent Documents
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Application
Number |
Filing Date |
Patent Number |
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13646533 |
Oct 5, 2012 |
10552930 |
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16778038 |
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61543619 |
Oct 5, 2011 |
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Current U.S.
Class: |
1/1 |
Current CPC
Class: |
G16H 80/00 20180101;
G06Q 50/22 20130101; G16H 40/20 20180101; G16H 40/00 20180101 |
International
Class: |
G06Q 50/22 20060101
G06Q050/22; G16H 80/00 20060101 G16H080/00 |
Claims
1-29. (canceled)
30. An electronic records management system, comprising: at least
one data storage device storing instructions for electronic records
management; and at least one processor configured to execute the
instructions to perform operations comprising: receiving a
plurality of physician profiles at a physician profile database
electronically accessible over at least one network system;
displaying an electronic user interface of a physician referral
application; receiving, through the electronic user interface of
the physician referral application, a search request for physicians
based on information contained in the physician profiles; in
response to the search request, determining a first group of
physicians, from the plurality of physician profiles, based on a
first grouping criteria, and determining a second group of
physicians, from the plurality of physician profiles, based on a
second grouping criteria; determining a rank of the first grouping
criteria relative to the second grouping criteria; and displaying,
on the online user interface of the physician referral application,
the first group of physicians relative to the second group of
physicians based on the determined rank of the first grouping
criteria relative to the second grouping criteria, wherein the
physicians within each group of physicians are displayed in random
order relative to other members of the respective group of
physicians.
31. The electronic records management system of claim 30, wherein
the first grouping criteria corresponds to membership in a
particular healthcare organization, and the second grouping
criteria corresponding to out-of-network physicians who are not
members of the particular healthcare organization.
32. The electronic records management system of claim 30, wherein,
in response to receiving a request to perform a search for and
referral to an out-of-network physician, the online user interface
of the physician referral application displays an electronic
message indicating the request is for an out-of-network physician,
said electronic message configured to prompt the user to respond
with a reason for requesting the search for and a referral to the
out-of-network physician.
33. The electronic records management system of claim 30, the
operations further comprising: providing a referral data record,
associated with a referral to the out-of-network physician, to both
an associated primary care physician device and an associated
specialist physician device; and generating, for a specialist
physician associated with the associated specialist physician
device, analytics data comprising a number and frequency of
referrals, and/or compiled statistics on referral providers.
34. The electronic records management system of claim 30, wherein
the physician referral application is located remotely from the
physician profile database.
35. The electronic records management system of claim 30, wherein
the plurality of physician profiles comprises at least four of: the
physician's phone number, gender, age, training, ranking
information, education, medical specialty, awards received,
malpractice information, administrative referral contact
information, and place of business.
36. The electronic records management system of claim 30, wherein
the physician referral application is configured to allow a user of
at least one primary care physician device to search for physicians
based on whether the physician is a member of a particular
healthcare organization.
37. The electronic records management system of claim 30, wherein
the physician profile information comprises information received
from users of at least one of a primary care physician device and a
specialist physician device.
38. The electronic records management system of claim 30, wherein
the physician referral application is further configured to access
at least a portion of patients' electronic health records, and to
provide a specialist physician device access to at least a portion
of a patient's electronic health records when the patient has been
referred to a specialist physician associated with the specialist
physician device.
39. The electronic records management system of claim 30, wherein
the physician referral application is further configured to track
patient referrals made by and received from at least one of a
primary care physician device and a specialist physician
device.
40. The electronic records management system of claim 30, wherein
the physician referral application is further configured to provide
a primary care physician device and a specialist physician device
with access to patient insurance prior authorization
information.
41. The electronic records management system of claim 30, wherein
the physician referral application is further configured to
transmit a referral communication to a specialist via fax.
42. The electronic records management system of claim 30, wherein
the physician referral application is configured to facilitate
electronic communication between a primary care physician and a
specialist physician devices.
43. A computer-implemented method for electronic records
management, comprising: receiving a plurality of physician profiles
at a physician profile database electronically accessible over at
least one network system; displaying an electronic user interface
of a physician referral application; receiving, through the
electronic user interface of the physician referral application, a
search request for physicians based on information contained in the
physician profiles; in response to the search request, determining
a first group of physicians, from the plurality of physician
profiles, based on a first grouping criteria, and determining a
second group of physicians, from the plurality of physician
profiles, based on a second grouping criteria; determining a rank
of the first grouping criteria relative to the second grouping
criteria; and displaying, on the online user interface of the
physician referral application, the first group of physicians
relative to the second group of physicians based on the determined
rank of the first grouping criteria relative to the second grouping
criteria, wherein the physicians within each group of physicians
are displayed in random order relative to other members of the
respective group of physicians.
44. The computer-implemented method of claim 43, wherein the first
grouping criteria corresponds to membership in a particular
healthcare organization, and the second grouping criteria
corresponding to out-of-network physicians who are not members of
the particular healthcare organization.
45. The computer-implemented method of claim 43, wherein, in
response to receiving a request to perform a search for and
referral to an out-of-network physician, the electronic user
interface of the physician referral application displays an
electronic message indicating the request is for an out-of-network
physician, said electronic message configured to prompt the user to
respond with a reason for requesting the search for and the
referral to the out-of-network physician.
46. The computer-implemented method of claim 43, further
comprising: providing a referral data record, associated with the
referral to the out-of-network physician, to both an associated
primary care physician device and an associated specialist
physician device; and generating, for a specialist physician
associated with the associated specialist physician device,
analytics data comprising a number and frequency of referrals,
and/or compiled statistics on referral providers.
47. The computer-implemented method of claim 43, wherein the
physician referral application is located remotely from the
physician profile database.
48. The computer-implemented method of claim 43, wherein the
plurality of physician profiles comprises at least four of: the
physician's phone number, gender, age, training, ranking
information, education, medical specialty, awards received,
malpractice information, administrative referral contact
information, and place of business.
49. A non-transitory computer readable medium comprising
instructions that, when executed by at least one processor of at
least one computerized device, performs a method of electronic
records management comprising: receiving a plurality of physician
profiles at a physician profile database electronically accessible
over at least one network system; displaying an electronic user
interface of a physician referral application; receiving, through
the electronic user interface of the physician referral
application, a search request for physicians based on information
contained in the physician profiles; in response to the search
request, determining a first group of physicians, from the
plurality of physician profiles, based on a first grouping
criteria, and determining a second group of physicians, from the
plurality of physician profiles, based on a second grouping
criteria; determining a rank of the first grouping criteria
relative to the second grouping criteria; and displaying, on the
online user interface of the physician referral application, the
first group of physicians relative to the second group of
physicians based on the determined rank of the first grouping
criteria relative to the second grouping criteria, wherein the
physicians within each group of physicians are displayed in random
order relative to other members of the respective group of
physicians.
Description
CROSS REFERENCE TO RELATED APPLICATIONS
[0001] This application claims priority from U.S. Provisional
Application Ser. No. 61/543,619, filed Oct. 5, 2011, the contents
of which are incorporated herein by reference.
FIELD OF THE DISCLOSURE
[0002] The present disclosure is generally related to physician
referrals of patients to other physicians or specialists, and more
particularly is related to an electronic physician referral
management system.
BACKGROUND OF THE DISCLOSURE
[0003] Primary care physicians have traditionally made patient
referrals based on personal knowledge and individual preference.
Typically, a primary care physician will rely on his or her own
personal knowledge, however limited and/or inaccurate, of
specialists when deciding to whom to refer a particular patient.
Referrals are an important source of patients, and thus revenues,
for many medical practices. Thus, for many health care
organizations, such as Health (Hospital) Systems or Accountable
Care Organizations, there is a financial interest in preventing
patient referrals to providers outside of the organization, and to
increasing referrals coming into the organization. Out-migration of
patients from hospital systems and other healthcare networks, i.e.
away from their employed and/or contracted physicians, can result
in millions of dollars in lost revenue every year.
[0004] Changes in the primary care landscape, including growing
patient volume and the increasing primacy of insurance coverage,
may cause complications to the traditional methods of making
patient referrals. Moreover, recent changes in the economics of
providing healthcare (i.e., decreased revenues generated on a per
patient basis) may require that primary care practices and
specialists increase productivity in order to prevent lost
revenues.
[0005] Currently, some limited electronic referral systems exist.
However, such systems often require the owner of the record to
populate the information of their referring partners (name, phone,
fax, etc.), are specific to a particular electronic medical record
or technology platform and are geographically limited. Moreover,
the data included in such systems is often limited to publicly or
commercially available data.
[0006] The currently available referral systems and techniques are
inefficient, as the referring practices' staff often must contend
with multiple, complex and cumbersome processes for finding the
right specialists and making referrals. Such referral processes
take a significant amount of time and limit the focus on patient
care quality. Furthermore, such systems make referrals without
knowledge of insurance data.
[0007] Thus, a heretofore unaddressed need exists in the industry
to address the aforementioned deficiencies and inadequacies.
SUMMARY OF THE DISCLOSURE
[0008] Embodiments of the present disclosure provide a system for
coordinating physician referrals. Briefly described, in
architecture, one embodiment of the system, among others, can be
implemented as follows. A physician referral management system
includes a physician profile database, which is electronically
accessible over at least one network system. The physician profile
database stores a plurality of physician profiles, each of the
plurality of physician profiles containing information associated
with a physician. A physician referral application is hosted at
least partially on a server and is electronically accessible over
at least one network system to a primary care physician device and
a specialist physician device. The physician referral application
is configured to facilitate a referral of a patient between the
primary care physician device and the specialist physician device,
and the physician referral application is further configured to
allow a user of at least one of the primary care physician device
and the specialist physician device to search for physicians based
on information contained in the physician profiles. At least a
portion of the plurality of physician profiles contains information
relating to insurance plans accepted by particular physicians.
[0009] In another embodiment, a physician referral management
process is provided that includes the steps of: providing a
physician profile database, electronically accessible over at least
one network system, the database storing a plurality of physician
profiles, each of the plurality of physician profiles containing
information associated with a physician; providing a physician
referral application, hosted at least partially on a server and
electronically accessible over at least one network system to a
primary care physician device and a specialist physician device;
allowing a user of the primary care physician device to initiate a
search for physicians based on information contained in the
physician profiles; and facilitating a referral of a patient
initiated by the primary care physician device to the specialist
physician device. At least a portion of the plurality of physician
profiles contains information relating to insurance plans accepted
by particular physicians.
[0010] In yet another embodiment, a non-transitory computer
readable medium is provided that contains instructions for
providing a physician referral management process enabled at least
in part on a processor of a computerized device, wherein a
physician profile database is electronically accessible by the
processor, the database storing a plurality of physician profiles,
each of the plurality of physician profiles containing information
associated with a physician, and a physician referral application
is hosted at least partially on a server and electronically
accessible over at least one network system to a primary care
physician device and a specialist physician device, the
instructions, which when executed by the processor, performing the
steps of: allowing a user of the primary care physician device to
initiate a search for physicians based on information contained in
the physician profiles; and facilitating a referral of a patient
initiated by the primary care physician device to the specialist
physician device, wherein at least a portion of the plurality of
physician profiles contains information relating to insurance plans
accepted by particular physicians.
[0011] In another embodiment, a physician referral management
process is provided that includes the steps of: providing an
electronic message to a user of a physician referral application,
in response to the user attempting at least one of a search for,
and a referral to, an out-of-network physician, the electronic
message requiring the user to respond with a reason for attempting
the at least one of a search for, and a referral to, an
out-of-network physician; receiving, by the physician referral
application, the user's response; and facilitating, by the
physician referral application, the at least one of a search for,
and a referral to, an out-of-network physician.
[0012] Other systems, methods, features, and advantages of the
present disclosure will be or become apparent to one with skill in
the art upon examination of the following drawings and detailed
description. It is intended that all such additional systems,
methods, features, and advantages be included within this
description, be within the scope of the present disclosure, and be
protected by the accompanying claims.
BRIEF DESCRIPTION OF THE DRAWINGS
[0013] Many aspects of the disclosure can be better understood with
reference to the following drawings. The components in the drawings
are not necessarily to scale, emphasis instead being placed upon
clearly illustrating the principles of the present disclosure.
Moreover, in the drawings, like reference numerals designate
corresponding parts throughout the several views.
[0014] FIG. 1 is a schematic illustration of a physician referral
management system, in accordance with a first exemplary embodiment
of the present disclosure.
[0015] FIG. 2 is an illustration of a webpage which may be utilized
by the system of FIG. 1, in accordance with the first exemplary
embodiment of the present disclosure.
[0016] FIG. 3 is an illustration of a webpage which may be utilized
by the system of FIG. 1, in accordance with the first exemplary
embodiment of the present disclosure.
[0017] FIG. 4 is a flowchart illustrating a physician referral
management process, in accordance with the first exemplary
embodiment of the disclosure.
[0018] FIG. 5 is a flowchart illustrating a physician referral
management process in accordance with an exemplary embodiment of
the disclosure.
DETAILED DESCRIPTION
[0019] Many embodiments of the disclosure may take the form of
computer-executable instructions, including algorithms executed by
a programmable computer. However, the disclosure can be practiced
with other computer system configurations as well. Certain aspects
of the disclosure can be embodied in a special-purpose computer or
data processor that is specifically programmed, configured or
constructed to perform one or more of the computer-executable
algorithms described below. Accordingly, the term "computer" as
generally used herein refers to any data processor and includes
Internet appliances, hand-held devices (including palm-top
computers, wearable computers, cellular or mobile phones,
multi-processor systems, processor-based or programmable consumer
electronics, network computers, minicomputers) and the like.
[0020] The disclosure also can be practiced in distributed
computing environments, where tasks or modules are performed by
remote processing devices that are linked through a communications
network. Moreover, the disclosure can be practiced in
Internet-based or cloud computing environments, where shared
resources, software and information may be provided to computers
and other devices on demand. In a distributed computing
environment, program modules or subroutines may be located in both
local and remote memory storage devices. Aspects of the disclosure
described below may be stored or distributed on computer-readable
media, including magnetic and optically readable and removable
computer disks, fixed magnetic disks, floppy disk drive, optical
disk drive, magneto-optical disk drive, magnetic tape, hard-disk
drive (HDD), solid state drive (SSD), compact flash or non-volatile
memory, as well as distributed electronically over networks
including the cloud. Data structures and transmissions of data
particular to aspects of the disclosure are also encompassed within
the scope of the disclosure.
[0021] FIG. 1 is a schematic illustration of a physician referral
management system 10, in accordance with a first exemplary
embodiment of the present disclosure. The physician referral
management system 10, which may also be referred to as `system 10`,
includes a physician referral application 25, electronically
accessible over at least one network system 12 and hosted at least
partially on a server 20. At least one primary care physician
device 30 is positioned to access the physician referral
application 25 and at least one specialist physician device 40 is
positioned to access the application 25.
[0022] The server 20 may be or include any database capable of
storing and/or providing access to information, such as an
electronic database, a computer and/or computerized server,
database server or generally any network host capable of storing
data and connected to any type of data network. Further, the server
20 may include or be a part of a distributed network or cloud
computing environment. Any type of electronic and/or computerized
device that is capable of storing information may be included as
the server 20, and is considered within the scope of this
disclosure. The server 20 may include computer-a readable storage
media, and a processor for processing data and executing
algorithms, including any of the processes and algorithms set forth
in this disclosure. The physician referral application 25 is
electronically accessible over at least one network system 12. The
network system 12 may include any type of network infrastructure,
such as the Internet, or any other wired, wireless and/or partially
wired network. The server 20, application 25 and network system 12
may include a variety of hardware and software components to
provide successful functioning of the server 20 and the application
25, as is well-known within the art. Further, any features,
characteristics, designs and/or functions that are known within the
art may be included with the system 10 to further enhance its
efficiency.
[0023] The at least one primary care physician device 30 may be any
device that is capable of communicating with the application 25,
for example via a network system 12, and may be operated by any
primary care physician, medical doctor, nurse, medical staff or
other medical professional, or any representative thereof. The at
least one specialist physician device 40 may be any device that is
capable of communicating with the application 25, for example via a
network system 12, and may be operated by any specialist physician,
medical doctor, nurse, medical staff or other medical professional,
or any representative thereof. Any number of primary care physician
devices 30 and specialist physician devices 40 may use the system
10 at any given time. The primary care physician device 30 and
specialist physician device 40 may access the application 25
through a variety of ways, including through a computerized device
in communication with the system 10 over a network system. For
example, the primary care physician device 30 and/or specialist
physician device 40 may be any computer, including any personal
computer, Internet appliance, hand-held device (including palm-top
computers, wearable computers, cellular or mobile phones,
multi-processor systems, processor-based or programmable consumer
electronics, network computers, minicomputers) and the like. Other
ways of accessing the application 25 may include using a telephone.
One or more input devices, such as a keyboard or mouse, may be used
to transmit information to and/or request information from the
application 25 by either of the primary care physician device 30
and/or the specialist physician device 40.
[0024] The physician referral application 25 may be fully or
partially hosted on the server 20. The physician referral
application 25 may include any tool, device, system, process or
combination thereof, which assists or makes possible a physician
referral of a patient to another physician. For example, the
physician referral application 25 may facilitate a patient referral
from a primary care physician using device 30 to a specialist
physician using device 40. The application 25 may include any
computer-readable memory or databases, which may be stored in any
computer-readable medium, and may be accessible by a computer
processor. The application 25 may further include or access
computer program instructions which may cause a processor to
perform any algorithms and/or functions which may be described in
this disclosure.
[0025] The system 10 further includes a physician profile database
24. The application 25 has access to the physician profile database
24, which may be fully or partially hosted on the server 20, or may
be hosted elsewhere and otherwise accessible to the application 25.
The physician profile database 24 stores profiles of physicians
(primary care and/or specialists) and/or medical practices that may
refer or receive patient referrals through the system 10. Each
physician and/or medical practice within the system has a unique
profile.
[0026] The profiles contain contact information (e.g., name,
address, phone number, etc.) for the physician and/or medical
practice, as well as information relating to insurance plans that
are accepted by the physician and/or medical practice. The profile
information may further include information relating to whether the
physician is "in-network" or "out-of-network," i.e., whether the
physician is associated with any particular healthcare
organization, such as any Accountable Care Organization or other
health care provider organizations. Additionally or alternatively,
the physician profile database 24 may be partitioned or otherwise
include two separate sets of profile data: in-network physician
profiles and out-of-network physician profiles.
[0027] The profile information may further include, for example,
information such as: the physician's name, address, gender, age,
training, ranking information, education, medical specialty,
awards, malpractice information, administrative referral contact
information, place of business, and/or any other information
associated with the physician and/or medical practice and any other
information which may be relevant to referring physicians and/or
physicians receiving patient referrals through the system 10.
[0028] The profile information may be composed from publicly
available information, as well as from privately developed and
gathered information. Further, the profile information may be input
by a physician utilizing a primary care physician device 30 or a
specialist physician device 40, for example by inputting requested
information to the system 10 upon registering as a physician in the
system 10. A physician utilizing a primary care physician device 30
or specialist device 40 may be able to add, delete or modify
profile information for that physician in the physician profile
database 24.
[0029] The application 25 may include or provide access to a web or
network-based software platform, including a graphical user
interface or webpage which provides interactive access to the
system 10 to a user of a primary care physician device 30 and/or a
specialist physician device 40. Alternatively or additionally, a
primary care physician device 30 and/or specialist physician device
40 may include software providing access to the system 10.
[0030] In practice, physicians (whether primary care or
specialists) often need to refer a patient to another physician,
e.g., to a specialist for specialized care. Using the system 10,
the referring primary care physician, a medical referral clerk or
the like uses a primary care physician device 30 to access the
physician referral application 25. The physician referral
application 25 may be a web-based application and may require
authorization information, such as username and password, before
allowing the user to access the application 25.
[0031] FIG. 2 illustrates a portion of a webpage 200 which may be
utilized by the system 10. The webpage 200, for example, may be
included in and/or provided by the physician referral application
25. The webpage 200 may be accessible by the at least one primary
care physician device 30 and/or the at least one specialist
physician device 40. For example, the webpage 200 may be the
"dashboard" or the interface provided by the application 25 to a
user after successfully logging into the application 25. The
webpage 200 may display information related to the status of
referrals, including for example, the number of referrals ordered,
the number of referrals received and/or the number of pending
follow-up referrals, through the system 10.
[0032] The physician referral application 25 may be integrated into
the primary care physician's and/or the specialist physician's
electronic health record system, such that when a physician orders
a referral (e.g., a primary care physician refers a patient to a
specialist physician through the system 10), healthcare information
from the referred patient's electronic health record may be
transmitted or otherwise made available through the application 25
to the specialist physician receiving the referred patient. As
shown in FIG. 2, a referred patient's electronic health record
information 210 may be displayed on the webpage 200. The webpage
200 provides links to other subpages or features of application 25,
such as: "My Referrals" 202, "Favorites" 202, "Search" 206, and
"Reports & Tracking" 208.
[0033] Using the "My Referrals" 202 feature, a user such as staff
in primary care physician offices may use the physician referral
application 25 to make and track patient referrals into, or coming
from, specialists or other healthcare providers' offices. The
listing of "My Referrals" can be sorted by date and/or time and may
include information regarding the as patient, the status of the
referral and so on.
[0034] The "Favorites" 204 feature allows the staff in the primary
care physician's office to identify providers they frequently refer
patients to and allows them to make referrals to them without going
through the formal search process.
[0035] The dashboard webpage 200 may further include a "Prior
Authorization" feature which assists the staff or other user of the
system 10 in obtaining prior authorizations from insurance carriers
when needed. For example, the prior authorization feature may
include links which take the user to the prior authorization
website of the insurance carrier for a particular patient.
Information relating to all insurance plans in a given market,
including prior authorization websites for each, may be loaded into
or otherwise accessible by the application 25. Thus, before
referring a patient to a particular specialist physician, the
referring primary care physician or her referral clerk may use the
application to first determine whether the specialist accepts the
type of insurance carried by the patient, and may further perform a
prior authorization to ensure, for example, that the patient is
insured for the care provided by the specialist.
[0036] The "Search" 206 feature allows a user of the at least one
primary care physician device 30 and/or the at least one specialist
physician device 40 to search and find listings of specialists
based on many search criteria. The search criteria may be pulled
from profile information for physicians stored in the physician
profile database 24. For example, the user may search for
physicians based on accepted insurance plans, whether the physician
is in-network or out-of-network, location of the physician, gender,
age, training, ranking information, education, medical specialty,
awards, and/or any other information associated with the physician
and/or medical practice and any other information which may be
relevant to referring physicians and/or physicians receiving
patient referrals. The search results may be displayed as a list of
physicians, and may further include information for each physician
as may be included in the physician profiles. The search results
may be displayed in a randomized order, so that all physicians
matching the search criteria are given equal opportunity, or as may
be required by relevant statutes, laws or policies.
[0037] The application 25 may be configured to only provide access
to, or to preferentially provide access to, "in-network"
physicians, i.e., those who are associated with a particular
healthcare organization, such as a particular Accountable Care
Organization or a particular hospital system. For example, the
application 25 may be configured to display search results for only
those physicians that are associated with the particular healthcare
organization, or to rank or otherwise display higher in the search
result order those physicians that are associated with the
particular healthcare organization. Additionally or alternatively,
the application 25 may provide search results separately within two
or more predefined groups of physicians. For example, the search
results may be provided as two separate groups of physicians: those
who are "in-network" physicians, and those who are "out-of-network"
physicians. In such a case, the physicians within each group of
search results may be displayed in a random order. The predefined
groups of physicians may be ranked or displayed based on preference
such that, for example, the group of "in-network" physicians is
displayed with a higher rank or more prominently provided to the
user, while the group of "out-of-network" physicians is given a
lower rank.
[0038] Once a specialist physician is found to whom the user wishes
to refer the patient, the user may utilize the application 25 to
send an online referral or a fax referral to the specialist
provider. When the user makes an online referral, the application
25 will transmit a message to the referred specialist's dashboard
webpage. That is, when the referred specialist (or her staff, etc.)
logs into the application 25 using a specialist physician device
40, the specialist will see a new referral, which may include
information about the referred patient such as name, referring
physician, insurance information, condition for which the patient
was referred, date of referral, and the like. Referrals received by
a specialty physician office, for example as displayed to a
specialist physician device 40 when accessing the webpage 200, may
be searched to find patient referrals by name, status, referred
from, referred by, referral date and so on.
[0039] A fax referral may be made through the application 25, in
which case the application 25 may utilize a fax number for the
referred specialist physician, which may be included in the
specialist's physician profile, to transmit a fax to the specialist
indicating that the patient has been referred. The fax may
similarly include information about the referred patient such as
name, referring physician, insurance information, condition for
which the patient was referred, date of referral, and the like.
Moreover, the application 25 may allow a referring user to fax
other information or documents accessible to the application 25
(such as, for example, clinical information or electronic health
record information available to the application 25) to the referred
specialist, along with the faxed referral.
[0040] The physician referral application 25 may further include a
communication tool which enables online communication between users
of primary care physician devices 30 and/or specialist physician
devices 40. For example, using the communication tool of
application 25, a referral clerk using a primary care physician
device 30 can send a message directly to the specialist's office
indicating that a referral has been made, details of the referred
patient, an inquiry as to whether the specialist has available
appointments, or any other message. The communication tool may
facilitate online communication between users of the application
25, and may allow, for example, one physician to contact other
physician offices regarding patient referrals. The communications
made through the communication tool may include chat, email, SMS or
text messages, video, voice or any other type of electronic
communication, and further may be encrypted and securely stored in
the application 25.
[0041] The application 25 may further allow a physician profile to
be printed, for example by any printer connected to a primary care
physician device 30 and/or a specialist device 40. Thus, a
referring physician or her staff can print the profile of the
referred specialist physician for the patient to view. The profile
may include special instructions for the practice.
[0042] The application 25 may further allow a user to make a
referral to providers who are not yet registered in the system 10,
i.e. who do not have a physician profile or other information in
the physician profile database 24. In such a case, the referring
user may enter information for the physician to whom the user
wishes to refer a patient, which may include, for example, name,
address, email address, phone number, fax number, specialty, and
the like. By entering such information for the referred physician,
the referred physician now has a physician profile which may be
stored in the physician profile database 24 and may thus become
available to accept referrals from other users of the system
10.
[0043] The application 25 may further allow a referring user to
indicate an electronic signature is attached to the referral
(thereby making it an "order" for care). The "Reports &
Tracking" 208 feature of the application 25 allows specialists who
receive referrals through the application 25 to create reports and
track referral trends for their practice. The reports may include
information such as who their referrals come from, from what
geographical area or healthcare organizations, what types of
patients and/or conditions are they being referred for, number and
frequency of referrals and/or any other referral information which
may be available through the system 10.
[0044] As discussed above, the physician referral application 25
may be configured to restrict searches of physicians to only
include, or to preferentially display, in-network physicians. This
may be preferable to some users, including healthcare organizations
such as Accountable Care Organizations which may prefer to refer
patients to physicians within their own organization. Additionally,
the application 25 may be configured to display to a user any
physician, whether in-network or out-of-network, and to allow the
user to select and refer a patient to any physician within the
system 10.
[0045] FIG. 3 illustrates a portion of a webpage 300 which may be
utilized by the system 10 and may be, for example, a subpage or
webpage which is accessible to a user through the dashboard webpage
200 and may be included in and/or provided by the physician
referral application 25. As shown in FIG. 3 one or more
out-of-network physicians 310 may be displayed on the webpage 300,
whether as the result of a search, by utilizing the "Favorites" 204
feature, or through any other means for displaying one or more
physicians through the system 10. When a user of a primary care
physician device 30 or a specialist physician device 40 attempts to
make a patient referral to the out-of-network physician 310, the
application 25 may cause the webpage 300 to provide a message 320
requiring the user to provide a reason as to why the user is
attempting to refer the patient to an out-of-network physician.
After providing a reason for making the out-of-network referral,
the referral may be facilitated to the out-of-network physician 310
by the application 25. The reason may be provided, for example, by
selecting one of a number of reasons that loaded into the
application 25, or by typing or otherwise inputting textual
information explaining the reason.
[0046] Further, the physician referral application 25 may be
configured to provide a message 320 when the user attempts to
search for out-of-network physicians. That is, upon attempting a
search of out-of-network physicians, the webpage 300 may provide a
message 320 which requires the user to provide a reason as to why
the user is attempting to search for an out-of-network physician.
After providing a reason for the out-of-network search, the
application 25 may display search results for the out-of-network
physicians.
[0047] Information provided by a user as the reason for referring
to, or searching for, out-of-network physicians may be provided to
healthcare organizations or medical practices in order to allow
such organizations or practices to better understand and/or track
the sources and impacts of referrals to out-of-network
physicians.
[0048] The system 10 may further provide advertising opportunities,
which may allow, for example, users such as physicians and/or
medical practices to increase their exposure and referral sources.
For example, the application 25 may cause the webpage 200 and/or
any subpages to display electronic advertisements for users wishing
to receive referrals. Further, the application 25 may allow third
parties, such as insurance companies, to advertise over the system
10. Insurance companies may, for example, pay an advertising fee
and the application 25 may cause the webpage 200 to display
advertisements of the insurance company to users of the system
10.
[0049] As specified herein, the system 10 may include a number of
other features to enhance the design, use or functionality of the
system 10 to provide better physician referrals. These additional
features may include functional or aesthetic components within the
application 25, such as website components, software based
automation or the ability to tailor the system 10 to the
preferences of a particular primary care physician or specialist
physician using the system 10.
[0050] FIG. 4 is a flowchart 400 illustrating a physician referral
management process in accordance with the first exemplary
embodiment of the disclosure. It should be noted that any process
descriptions or blocks in flow charts should be understood as
representing modules, segments, portions of code, or steps that
include one or more instructions for implementing specific logical
functions in the process, and alternate implementations are
included within the scope of the present invention in which
functions may be executed out of order from that shown or
discussed, including substantially concurrently in reverse order,
depending on the functionality involved, as would be understood by
those reasonably skilled in the art of the present invention.
[0051] As shown in block 402, a physician profile database is
provided. The database is electronically accessible over at least
one network system 12 and stores a plurality of physician profiles.
Each of the plurality of physician profiles contains information
associated with a physician. As shown in block 404, a physician
referral application 25 is provided. The physician referral
application 25 is hosted at least partially on a server 20 and is
electronically accessible over at least one network system 12 to a
primary care physician device 30 and a specialist physician device
40.
[0052] In operation, a user utilizes a primary care physician
device 30 and/or a specialist physician device 40 to access the
physician referral application 25 through a network 12. The
application 25 may, for example, display a webpage 200 which
provides access to the system 10. As shown at block 406, a user of
a primary care physician device 30 and/or specialist device 40 is
allowed to initiate a search for physicians based on information
contained in the physician profiles. At block 408, a referral of a
patient initiated by the primary care physician device to the
specialist physician device 40 is facilitated. At least a portion
of the plurality of physician profiles contains information
relating to insurance plans accepted by particular physicians.
[0053] FIG. 5 is a flowchart 500 illustrating a physician referral
management process in accordance with an exemplary embodiment of
the disclosure. As shown in block 502, an electronic message 320 is
provided to a user of a physician referral application 25, in
response to the user attempting a search for, or referral to, an
out-of-network physician. The electronic message 320 requires the
user to respond with a reason for attempting the search for, or
referral to, an out-of-network physician. At block 504, the
physician referral application 25 receives the user's response. At
block 506, the physician referral application 25 facilitates a
search for, or referral to, an out-of-network physician.
[0054] A feature and advantage of the present disclosure which
results from the adoption and integration of electronic medical
record technology is that such technology helps medical
organizations and practices manage clinical workflows. Thus, in
addition to providing provider-to-provider electronic referral
capabilities, which may result in users having more efficient and
higher revenue generating practices, the systems and methods
disclosed herein provide users the ability to better manage
clinical workflows. These two systems usually are independent of
each other.
[0055] Also, the ability to restrict searches of physicians to only
those that are in-network, or alternatively to preferentially
display physicians that are in-network, allows Accountable Care
Organizations to preferentially provide referrals to providers
within their own organization, while further providing physicians
with the ability to refer patients to out-of-network providers when
an in-network provider is not available. Moreover, by providing
physicians with the ability to create and edit their own physician
profiles, complete profiles of physicians may be generated, and may
include information such as the insurance plans accepted, accurate
UPIN and state license numbers, which is not available for sale in
the market currently.
[0056] After a referral is made via the system 10, the referral
form, containing relevant clinical and administrative data may then
be available to both the primary care and the specialty practice
via the system 10. The system 10 allows a primary care physician to
attach a portion of a medical record document to the referral form
allowing the specialist practice to view the medical record, for
example when logging into the application 25. When purchased by a
healthcare organization such as a hospital system or Accountable
Care Organization, the physician referral application 25 may be
configured to provide specific results (custom search hierarchy)
for primary care providers when searching for a specialist
provider.
[0057] It should be emphasized that the above-described embodiments
of the present disclosure, particularly, any "preferred"
embodiments, are merely possible examples of implementations,
merely set forth for a clear understanding of the principles of the
disclosure. Many variations and modifications may be made to the
above-described embodiment(s) of the disclosure without departing
substantially from the spirit and principles of the disclosure. For
example, while the disclosure primarily describes referrals as
being primary care provider to specialist referrals, referrals may
also be made between specialists (e.g., using specialist physician
devices) and/or between primary care physicians (e.g., using
primary care physician devices). All such modifications and
variations are intended to be included herein within the scope of
this disclosure and the present disclosure and protected by the
following claims.
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