Automated Vaccination Adherence Monitoring via Claims Data
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Solution Overview
Problem
Current systems for monitoring patient adherence to medications and vaccinations are inefficient, relying on manual processes that are cumbersome and unreliable, lacking direct benefits for healthcare providers and adding network traffic overhead.
Innovation Solution
An apparatus and method that utilize a processor and memory configured to generate and store vaccination adherence notification requests, monitor networks for claim submissions, and notify healthcare providers of vaccination administration status, while also determining patient eligibility for vaccinations and recommending appropriate providers or pharmacies.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If manual processes are used to monitor prescription fill status, then healthcare providers can obtain adherence information, but the process becomes cumbersome and unreliable
Solution Approach 1:
The system performs preliminary actions by automatically generating notification requests and monitoring claims processors before the healthcare provider needs adherence information. The system proactively tracks prescription fill status through automated network monitoring of claims data, eliminating the need for manual status checks and providing reliable adherence information ready when needed.
Solution Approach 2:
The system introduces an intermediary automated monitoring component that acts as a mediator between the healthcare provider and the claims processor. This intermediary automatically generates notification requests, monitors network traffic for claims data, and retrieves adherence information without requiring the healthcare provider to manually intervene, thus improving both reliability and ease of operation.
2Loss of information
If the fill status option is added to prescription request format, then adherence information can be obtained, but network traffic overhead increases
Solution Approach 1:
The system extracts adherence information monitoring from the traditional prescription request-response workflow. Instead of adding fill status options to prescription requests, the system separately generates notification requests and monitors claims processors independently, obtaining adherence information through automated claims data monitoring rather than through increased prescription request complexity.
Solution Approach 2:
The system maintains continuous monitoring of the claims processor for adherence information without interrupting or adding to the prescription request workflow. The automated notification request generation and claims monitoring operate continuously in the background, providing adherence information without requiring additional network traffic from the prescription request process.
3Adaptability or versatility
If vendor system support is required for fill status option, then adherence monitoring capability is provided, but additional overhead for the vendor is created
Solution Approach 1:
The system achieves universal adherence monitoring capability by utilizing the existing claims processor infrastructure already present in healthcare systems. The automated notification request generation and claims monitoring can operate across different vendor systems without requiring vendor-specific implementations, as the system leverages the universal claims processing function that already exists in healthcare billing systems.
Solution Approach 2:
The system enables self-service adherence monitoring by automatically generating notification requests and monitoring claims processors without requiring vendor system support or configuration. The system independently retrieves adherence information from the claims processor using standard claims data, eliminating the need for additional vendor overhead while maintaining adaptability across different healthcare systems.
Data Source
AI summary
An improved adherence monitoring and notification system notifies a healthcare provider of vaccination eligibility during a patient encounter, and improves the network of a healthcare provider and service provider by providing automated adherence monitoring. The improved adherence monitoring and notification system reduces network traffic with regards to the communication of patient adherence information. The improved adherence monitoring and notification system can increase patient adherence by notifying prescribers. The improved adherence monitoring and notification system may also increase the efficiency by which notification regarding vaccination eligibility, and patient adherence information is disbursed.