Real-Time Cost Estimation Module for Healthcare Service Ordering

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Solution Overview

Problem

Patients lack necessary cost information to make informed decisions about healthcare services, as they are typically informed about their share of costs after receiving medical services, preventing them from considering alternative, less expensive treatments or managing payment schedules.

Innovation Solution

An electronic healthcare system that provides real-time cost estimation and notification to patients through a medical service ordering module, utilizing HL7 and x12-270/271 message protocols to communicate patient information and insurance benefits, enabling patients to decide on medical tests and manage payments effectively.

Engineering Contradictions & Design Principles

VSEngineering Contradiction Analysis

1Loss of information

If cost information is provided after medical services are received, then the healthcare system maintains traditional billing processes, but patients cannot make informed decisions about alternative treatments or manage payments effectively

Engineering Contradiction:

Improvecost information availabilityVSAvoidtime to receive cost information

Core Design Contradiction:

Loss of informationVSLoss of time

Solution Approach 1:

The system performs cost estimation and notification actions before the patient receives medical services. The cost estimation module calculates expected costs in real-time when services are ordered, and the notification module sends cost information to patients prior to service delivery, enabling informed decision-making about treatment alternatives and payment management.

Inventive Principle:

Principle #10Preliminary action

Solution Approach 2:

The system implements a feedback loop where cost information is continuously updated and communicated to patients during the healthcare process. The cost estimation module receives updates on service ordering and provides real-time cost feedback to both patients and providers, allowing for dynamic decision-making about treatment alternatives and cost management.

Inventive Principle:

Principle #23Feedback

2Ease of operation

If real-time cost estimation and notification systems are implemented, then patients can make informed decisions and manage payments effectively, but the healthcare system complexity increases

Engineering Contradiction:

Improvepatient decision-making capabilityVSAvoidhealthcare system complexity

Core Design Contradiction:

Ease of operationVSDevice complexity

Solution Approach 1:

The system integrates multiple functions into unified modules: the cost estimation module handles cost calculation across different service types, the notification module manages multiple communication channels (email, SMS, patient portal), and the system interfaces with various healthcare providers and payers. This multi-functionality reduces overall system complexity by consolidating operations.

Inventive Principle:

Principle #6Universality (Multi-functionality)

Solution Approach 2:

The system introduces intermediary modules that mediate between healthcare providers, patients, and payers. The cost estimation module acts as an intermediary to calculate and communicate costs, while the notification module serves as an intermediary to deliver information across different platforms. These intermediaries simplify interactions between system components and external entities.

Inventive Principle:

Principle #24Intermediary (Mediator)

3Adaptability or versatility

If cost information is provided at the time of service ordering, then patients can consider alternative treatments and stagger payments, but the system must process and communicate cost information rapidly

Engineering Contradiction:

Improvepatient treatment option flexibilityVSAvoidcost information processing speed

Core Design Contradiction:

Adaptability or versatilityVSSpeed

Solution Approach 1:

The system replaces manual cost calculation and communication processes with automated electronic systems. The cost estimation module uses algorithmic calculations based on service codes, patient insurance information, and fee schedules to rapidly determine costs. The notification module uses electronic communication channels to instantly deliver cost information, eliminating delays associated with manual processing.

Inventive Principle:

Principle #28Mechanics substitution (Replace mechanical system)

Solution Approach 2:

The system dynamically adjusts cost estimation parameters based on real-time inputs such as service type, patient insurance coverage, and selected treatment alternatives. The cost estimation module can rapidly recalculate costs when parameters change, allowing patients to explore different treatment options and understand the cost impact of each alternative before making decisions.

Inventive Principle:

Principle #35Parameter changes

Data Source

PatentUS12125568B2Systems and methods for healthcare fees transparency and collections at the time of service

Publication Date: 2024.10.22 4MEDICA

AI summary

An electronic healthcare system for delivering medical services is described. The electronic healthcare systems can includes modules for accessing patient electronic medical records and ordering medical services. In response to a medical service order, a cost estimation and notification module can receive information associated with the medical service order. The cost estimation and notification module can determine the patient cost responsibility and quickly notify the patient of the costs. The patient can use the determined cost information to decide whether to move forward with the ordered medical tests.