Cloud Radiology Image Repository Fraud Prevention
Find Innovative SolutionsGenerate Solutions
Solution Overview
Problem
Current medical data information systems face issues such as duplication and inappropriate utilization of diagnostic imaging services, claim fraud and abuse, lack of quality assurance in imaging, difficulty in identifying diagnostic modalities, inappropriate application of imaging to preventable conditions, and inability to generate comprehensive data and analytics for imaging and radiology services, leading to significant costs and inefficiencies in healthcare and insurance industries.
Innovation Solution
A cloud-based system and method for obtaining, transferring, and managing diagnostic images through a secure repository, enabling authorized users to access and review images, cross-referencing them with medical claims, validating image quality, identifying appropriate diagnostic modalities, and generating comprehensive data and analytics, while routing imaging studies to contracted teleradiology groups and maintaining contract rates, thereby reducing duplication, fraud, and improving quality and cost management.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Speed
If diagnostic images are stored in distributed local systems, then accessibility and retrieval speed are improved, but data security and fraud prevention are worsened
Solution Approach 1:
The patent consolidates distributed diagnostic image storage into a single centralized secure repository, merging multiple storage locations into one unified system. This eliminates the security vulnerabilities of distributed systems while maintaining fast retrieval through dedicated access protocols and infrastructure.
Solution Approach 2:
The patent introduces a centralized repository as an intermediary between diagnostic providers and insurance companies, mediating all image access and verification. This intermediary layer ensures security and fraud prevention while enabling controlled access for all stakeholders.
2Reliability
If comprehensive image storage and verification systems are implemented, then fraud detection and quality assurance are improved, but system complexity and implementation cost are worsened
Solution Approach 1:
The centralized repository serves multiple functions simultaneously: secure storage, fraud detection through claim cross-referencing, quality assurance via image verification, and analytics generation. This multi-functionality reduces the need for separate systems while achieving comprehensive reliability.
Solution Approach 2:
The system automatically cross-references diagnostic images with insurance claims and performs verification processes without manual intervention. This self-service capability handles fraud detection and quality assurance automatically, reducing the perceived complexity for users while maintaining high reliability.
3Manufacturing precision
If manual verification of diagnostic images is performed, then image quality and appropriateness are improved, but processing time and operational cost are worsened
Solution Approach 1:
The system implements automated feedback loops where diagnostic images are immediately cross-referenced with claims data and verified against established criteria. This continuous feedback process maintains high image quality standards while eliminating manual verification delays.
Solution Approach 2:
The system performs preliminary verification of diagnostic images automatically upon receipt, checking quality and appropriateness before further processing. This preliminary action ensures high standards are met upfront, eliminating the need for time-consuming manual verification later in the workflow.
Data Source
AI summary
A cloud-based system, method and computer program product for obtaining and transferring diagnostic images to a secure data repository for archiving, accessing and future retrieval by patients, medical care providers and medical insurance providers. A variety of subsystems are provided for providing the aforementioned cloud-based radiology DICOM receipt, storage and management system wherein a web-based portal is communicatively coupled to a centralized repository thereby enabling a user to archive, retrieve and transfer diagnostic images between insurance companies and the medical community.