Aggregator Server for Real-Time Healthcare Encounter Data Access
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Solution Overview
Problem
Current healthcare systems face delays and lack transparency in claim processing, making it difficult for patients to access accurate encounter data before receiving an Explanation of Benefits (EOB, and obscuring the link between office encounters and claims due to proprietary software workflows and medical code translations.
Innovation Solution
A system and method that enables online access to encounter data from multiple disparate sources by using a synchronizer application to retrieve and decode encounter data in real-time, cutting out intermediary systems and processes, and providing an interactive user interface for patients to review and dispute the data.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Loss of information
If traditional claims processing systems are used with proprietary software workflows and medical code translations, then claim processing can be performed, but patient access to encounter data is delayed and lacks transparency
Solution Approach 1:
The patent extracts encounter data directly from the practice management system before it undergoes proprietary workflow processing and medical code translation. By pulling data early in the process and making it available through a patient portal, the system bypasses the traditional sequential processing that causes delays and information loss.
Solution Approach 2:
The patent introduces an intermediary patient portal system that sits between the practice management system and the patient. This intermediary provides real-time access to encounter data without requiring patients to wait for the complete claims processing cycle, thus reducing information loss and access time.
2Reliability
If intermediary systems and protocols are used for claims processing, then data can be transmitted between systems, but the link between office encounters and claims is obscured
Solution Approach 1:
The patent extracts the essential encounter data elements directly from the source system and presents them in a simplified, patient-friendly format through the portal. This extraction approach maintains data accuracy by pulling from the original source while reducing the complexity of intermediary translation processes.
3Productivity
If traditional offline processes are used for claims processing, then billing data can be processed, but patients must wait weeks or months for EOB receipt
Solution Approach 1:
The patent performs preliminary actions by making encounter data available to patients through the portal before the complete claims processing and EOB generation is finished. This allows patients to review and potentially correct their data early in the process, rather than waiting weeks or months for the final EOB.
Solution Approach 2:
The patent implements continuous data access through the patient portal, allowing patients to view and interact with their encounter data at any time during the claims processing cycle. This continuous access eliminates the traditional waiting periods and keeps the information flow active throughout the entire process.
4Ease of operation
If centralized access systems are implemented for real-time encounter data, then patient access is improved, but system integration complexity increases
Solution Approach 1:
The patent uses the patient portal as an intermediary layer that simplifies access to encounter data. Rather than requiring direct integration with multiple complex proprietary systems, the portal serves as a centralized interface that manages data retrieval and presentation, improving ease of operation while managing integration complexity.
Data Source
AI summary
Disclosed are systems, methods, and non-transitory computer-readable enabling online access to encounter data across multiple disparate sources. The method includes providing a synchronizer application configured to access data of a practice group server, receiving, by an aggregator server, a start time and a duration of a healthcare appointment, and determining a completion time of the healthcare appointment. Based on the completion time, the aggregator server transmits a request for encounter data for the healthcare appointment to the synchronizer application and then receives and stores the encounter data in an aggregator database. The aggregator server generates an electronic alert addressed to a computing device accessible by the patient and transmits the alert to the computing device. The aggregator server receives an electronic response to the alert and provides an interactive user interface to the computing device configured to display the encounter data on the computing device.