Data processing: financial – business practice – management – or co – Automated electrical financial or business practice or... – Health care management
Reexamination Certificate
1998-09-29
2004-02-24
Meinecke-Díaz, Susanna (Department: 3623)
Data processing: financial, business practice, management, or co
Automated electrical financial or business practice or...
Health care management
Reexamination Certificate
active
06697783
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present invention generally relates to a. computer implemented and/or assisted health information system for tracking and/or ensuring appropriate patient care, whereby the system facilitates client access to health professionals for confidential health advice, personalized treatment advice, personalized pharmaceutical advice and service, and personalized health benefit and account information.
2. Background of the Related Art
Health care costs currently represent a significant portion of the United States Gross National Product, and continue to rise at an exceptional pace. A significant portion of these increased costs represents the health care providers' inability to efficiently compile and communicate health benefit and account referral information, provide guidance on prescription drug use, and administer confidential health advice relating to items such as treatment options and disease management. Accordingly, many patients are deprived of access to the most needed medical care and information, and many patients who do receive medical care and information often do not receive information tailored to patient-specific needs in an expedient and efficient manner.
We have determined that if a system were available which allowed callers to obtain patient specific medical advice, pharmaceutical instructions and guidance, referrals, and benefits information through a single point of access, callers could quickly obtain relevant information to address their questions, concerns or problems. System users/clients could also control medical costs by efficiently identifying courses of medical and pharmaceutical treatment that may benefit the patient, by providing ready access to medical and pharmaceutical guidelines, by providing efficient access to benefit and referral information, and by integrating these elements into a single administrative function so that system administration is streamlined and a single means of tracking and/or monitoring usage is available.
One prior attempt to address the health care problem is called Ask-A-Nurse, wherein trained nurses provide health care information by telephone around-the-clock. A person with a medical problem calls an 800 number and describes the problem to the nurse. The nurse uses a computer for general or diagnostic information on the ailment or complaint mentioned by the caller. The nurse may then refer the caller to a doctor from a computerized referral list for a contracting hospital or group of hospitals. A managed care option called Personal Health Advisor is similar and adds the capability for the caller to hear pre-recorded messages on health topics 24 hours a day.
Another prior health system provides a computerized service that answers health care questions and advises people in their homes. A Health Maintenance Organization (“HMO”) may provide this service to its members in a particular geographic area. To get advice at home, an HMO member connects a box device to a telephone and calls a toll-free 800 number. Using a keyboard that is part of the box, the user answers questions displayed on a screen of the box relating to the user's symptoms. Depending on the answers, the user might be told to try a home remedy, be called by a nurse or doctor, or be given an appointment to be examined.
Several problems exist with these prior medical advice systems. First, the Ask-A-Nurse and Personal Health Advisor systems have high costs associated with having a nurse answer each telephone call. Second, these systems fail to include any means of providing callers with referrals, prescription refills, or medical benefit information in conjunction with the medical advice. Third, and significantly, these systems provide no means of either providing information that is tailored to a patient's specific needs based on the patient's medical history or updating the patient's records based on the information provided.
Prior methods of administering confidential health advice include U.S. Pat. No. 5,660,176 to Iliff, incorporated herein by reference. Iliff is directed to a computerized medical diagnostic and treatment advice system. Referring to
FIG. 1
, the components of the computerized medical diagnostic and treatment advice system
100
are shown. A personal computer
102
includes a plurality of components within an enclosure
104
. A plurality of telephone lines
106
interface the public telephone network
108
to the computer
102
. One of telephone lines
106
is shown to be switched via network
108
to connect with a telephone
110
that is used by a person desiring medical advice (user)
112
.
FIG. 2
is a block diagram illustrating a conceptual view of the database files and processes of the system of FIG.
1
. If the caller is the patient, a patient registration process
252
is used to register new or first-time callers. If the caller is not the patient, an assistant registration process
274
is used to register new or first-time assistants. An assisted registration process
278
is also available. A patient login process
250
and an assistant login process
272
are used to identify a patient or assistant who has previously registered into the system. An assisted login process
276
is also available.
The master patient and assistant enrollment database
260
is created at run-time by one of the registration processes
252
,
274
, or
278
. This database
260
is read by the patient login process
250
or the assisted patient login process
276
to validate a patient's identity at login time, and by the assistant login process
272
to validate an assistant's identity at login time. The database
260
is essentially a master file of all registered patients and assistants indexed by their patient ID number or assistant ID number, respectively.
In Iliff, the medical diagnostic and treatment advice is provided to the general public over a telephone network. The system uses a new authoring language, interactive voice response and speech recognition technology, to enable expert and general practitioner knowledge to be encoded for access by the public. However, the system in Iliff is designed to respond to caller complaints with standard information, and provides no process for ensuring and/or designing patient-specific care, as it does not use patient history (such as known conditions or previous advice given) when providing medical advice. Further, it only responds to caller inquiries and provides no means of alerting the caller of important items, such as prescription drug refill reminders, which may not have been the subject of the caller's inquiry. In addition, the system provides only medical advice, and includes no means for responding to callers' pharmaceutical or health benefit inquiries.
U.S. Pat. No. 5,471,382, to Tallman et al., incorporated herein by reference, relates to a medical network management system comprising a data processing system, which includes memory that contains a patient assessment stored program and a patient database, a display, and an input means. The patient assessment stored program includes means for checking patient eligibility, means for selecting a branched chain logic algorithm for assessing a patient for an appropriate timing and type of medical care, and branched chain logic algorithms to assess the patient for an appropriate timing and level of medical care. The system in Tallman et al. includes a member assessment component wherein the patient's risk is assessed, and a provider information component wherein the system helps the patient identify an appropriate doctor, clinic, hospital, or other provider to meet their needs. Accordingly, the system in Tallman et al. assists patients in obtaining an appropriate level of care from an appropriate provider. However, the system in Tallman is not designed to provide actual health counseling or disease management services. Further, the system in Tallman et al. does not provide the patient with prerecorded messages of health information, pharmaceuti
Angaran David
Brinkman Thomas
Gattinella Wayne
Kleinfelter William
Stettin Glen
Donner Irah H.
Medco Health Solutions Inc.
Meinecke-Díaz Susanna
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