Decision Support System for Laboratory Test Coordination
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Solution Overview
Problem
Healthcare providers face complexity in selecting optimal laboratory tests, managing laboratory utilization, and understanding insurance coverage, leading to inefficiencies in patient care and increased costs.
Innovation Solution
A system and method that provides healthcare providers with integrated access to patient information, laboratory information, and health plan details through a network, facilitating decision-making by presenting relevant test options and coverage information, and allowing interaction between healthcare providers, laboratories, and health plans.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If the number of laboratories, laboratory tests, health plans, and medical codes increases to provide more comprehensive services, then the quality and coverage of health care services is improved, but the complexity of managing the ordering, delivery, and fulfillment of laboratory tests increases
Solution Approach 1:
The patent introduces a decision support system that acts as an intermediary between health care providers, laboratories, and health plans. This system receives test ordering requests, automatically determines coverage eligibility by interfacing with health plan databases, and coordinates between multiple laboratories to fulfill test orders. The intermediary handles the complex coordination and information exchange, allowing the system to support comprehensive services without proportionally increasing management complexity for individual providers.
2Reliability
If health care providers manually manage laboratory test selection and coordination, then they can maintain control over patient care decisions, but the time and effort required for test ordering and coordination increases
Solution Approach 1:
The decision support system enables semi-automated self-service functionality where the system automatically performs coverage verification, laboratory selection, and order coordination based on pre-configured rules and databases. The health care provider initiates the test ordering process and receives automated recommendations, but the system handles the time-consuming manual tasks of checking health plan coverage, selecting appropriate laboratories, and coordinating test fulfillment. This maintains provider control over clinical decisions while eliminating administrative time losses.
3Loss of information
If health care providers access multiple separate systems for patient information, laboratory information, and health plan details, then they can obtain comprehensive information, but the efficiency of decision-making and patient care delivery decreases
Solution Approach 1:
The patent merges previously separate information systems into a unified decision support platform that simultaneously accesses patient information databases, laboratory capability databases, and health plan coverage databases. The system integrates these multiple data sources through a common interface, allowing health care providers to obtain comprehensive information about patient history, available laboratory tests, laboratory capabilities, and insurance coverage all in one place. This consolidation maintains complete information availability while dramatically improving decision-making efficiency by eliminating the need to switch between multiple separate systems.
Data Source
AI summary
Systems, methods, and media for laboratory benefit services are disclosed. Embodiments of the present invention provide systems, methods, and media that enhance the quality of health care related services to a patient, thereby enhancing patient care. In an embodiment, the present invention provides systems, methods and media that present a health care provider with information to support a decision, for example, a decision relating to a test, or tests, for a patient. In addition, or in additional embodiment, the present invention provides systems, methods and media that present information relating to a patient's health plan to advantageously facilitate a health care provider's knowledge and use of a patient's health plan information. Further, or in an additional, or further, embodiment, the present invention provides systems, methods and media that present information relating to a laboratory to advantageously facilitate a health care provider's knowledge and use of laboratory information, including laboratory expertise.