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System for monitoring information related to encounter with healthfully nursed patient

A related information and health care technology, applied in health insurance management, informatics, medical informatics, etc., can solve problems such as inability to provide fraud detection and monitoring, inability to initiate immediate preventive intervention, damage, etc.

Inactive Publication Date: 2004-05-12
SIEMENS MED SOLUTIONS HEALTH
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  • Summary
  • Abstract
  • Description
  • Claims
  • Application Information

AI Technical Summary

Problems solved by technology

Relying on the analysis of non-real-time historical data, such a system can neither initiate immediate preventive intervention nor be damaged by human error, nor can it provide continuous 24-hour monitoring of fraud detection

Method used

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  • System for monitoring information related to encounter with healthfully nursed patient
  • System for monitoring information related to encounter with healthfully nursed patient
  • System for monitoring information related to encounter with healthfully nursed patient

Examples

Experimental program
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Effect test

Embodiment Construction

[0016] The present inventors have advantageously recognized that it would be desirable to provide a system for real-time monitoring of information obtained from multiple organizations regarding a patient's healthcare financial and clinical encounters. figure 1 A surveillance system is shown for encounter related information being generated, transmitted and stored in figure 1 The aggregated health care encounter service, billing, and claims database 68 of ® automatically recognizes and evaluates complex data patterns in encounter-related information. As used herein, encounters include patient-health care business encounters that involve patient and health care business interactions that have financial or transactional consequences and can include, for example, patient visits, phone calls, treatments, inpatient stays, or outpatients Treatments, interviews, examinations, procedures, occurrences of treatment-related events (including imaging, radiology, electrocardiogram (ECG), et...

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Abstract

This system monitors client related financial and clinical information of a plurality of organizations in real time by automatically recognizing and evaluating complex data patterns to identify statistically significant patterns and clusters by using user created data pattern templates to detect fraud, disease outbreaks and cost reduction opportunities. The system includes an interface processor for receiving client related information comprising clinical and financial information from a plurality of different sources for storage in a database. A search processor searches the database to identify a predetermined data pattern and determines whether an identified data pattern meets predetermined criteria. A data processor processes the identified client related information to be suitable for output communication.

Description

[0001] This is a non-provisional application of Provisional Application Serial No. 60 / 371,027 filed April 9, 2002 by D. Fitzgerald et al. and Provisional Application Serial No. 60 / 384,674 filed March 31, 2002 by D. Fitzgerald et al. field of invention [0002] The present invention relates to a system and user interface for use in the process of accumulating and monitoring information about patient health care encounters to identify meaningful data patterns. Background of the invention [0003] Healthcare providers (such as hospitals, clinics, or physicians) and other entities generate records of patient encounters involving patient and healthcare business interactions that have financial or transactional consequences (such as patient visits, phone calls, treatments, inpatient stays or outpatient procedures, claim creation, etc.). This record contains valuable information and can be used for a variety of purposes, including detection of medical claim fraud or abuse, detectio...

Claims

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Application Information

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Patent Type & Authority Applications(China)
IPC IPC(8): G16H50/70
CPCG06F19/322G06F19/3443G06F19/324G06F19/327G06F19/3406G06Q50/22G06F19/328G16H40/63G16H10/60G16H40/20G16H50/70G06Q10/10
Inventor D·费茨格拉尔德D·H·老克拉森B·卢卡斯
Owner SIEMENS MED SOLUTIONS HEALTH
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