EMR Care Estimate Workflow Using a Secure Central Intermediary
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Solution Overview
Problem
The variety of electronic medical record (EMR) and practice management systems complicates the provision of back-end functionality, particularly in communicating with insurance companies and payors, and there is a need for integrated solutions that maintain patient privacy while providing care gap evaluations and care estimate evaluations.
Innovation Solution
A central computing entity provides back-end functionality through interactive user interfaces in EMR systems, generating care gap and care estimate evaluations, and securely transmitting notifications via SMS, MMS, instant messages, email, or online portals, using modules to analyze patient data against care standards and identify gaps or estimate costs.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If a central computing entity provides back-end functionality to multiple different EMR and practice management systems, then the adaptability and versatility of the system is improved, but the device complexity increases due to the need to interface with various different systems
Solution Approach 1:
The patent implements a universal back-end computing entity that can interface with multiple different EMR and practice management systems through standardized communication protocols. This allows a single system to perform multiple functions across diverse platforms without requiring separate integration solutions for each EMR system, thereby improving adaptability while managing complexity through standardization.
2Productivity
If patient data is transmitted and accessed across multiple systems for care gap and care estimate evaluations, then the productivity and efficiency of care management is improved, but the risk of compromising patient privacy and data security increases
Solution Approach 1:
The patent introduces a central computing entity that acts as an intermediary between EMR systems and insurance companies/payors. This intermediary consolidates data access in a secure location, implementing encryption and authorized access controls, thereby enabling efficient care management operations while maintaining patient privacy through a controlled security perimeter rather than widespread data exposure.
3Ease of operation
If care gap and care estimate evaluations are integrated into the EMR system workflow, then the ease of operation for healthcare providers is improved, but the device complexity increases due to additional processing requirements
Solution Approach 1:
The patent implements automated care gap and care estimate evaluation modules that self-activate based on triggers within the EMR workflow (such as appointment scheduling, lab ordering, or prescription entry). These modules automatically retrieve necessary data, perform evaluations against care standards, and present results to providers without requiring manual initiation or complex configuration, thereby improving ease of operation while managing processing complexity through automation.
Data Source
AI summary
A care estimate module operating on a central computing entity receives a trigger indication (a) comprising patient identifying information and (b) that identifies a service; extracts the patient identifying information from the trigger indication; determines the service; identifies a potential provider that provides the service; and determines a care estimate for the potential provider to provide the service to the patient. The potential provider is identified based on eligibility information associated with the patient, a location associated with the patient, and an address associated with the potential provider. The care estimate is determined based on the eligibility information associated with the patient. The central computing entity generates a care estimate notification that identifies the potential provider and comprises the care estimate; and provides the care estimate notification such that a user computing entity receives the care estimate notification.