Virtual Pharmacy Transaction Processing with Rule-Based Adjudication
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Solution Overview
Problem
The evaluation of health-related applications by pharmacy benefit managers is challenging due to the large number of available apps, making it difficult to identify safe and effective options, and individual patients face difficulties in selecting suitable apps for their needs.
Innovation Solution
A digital health solution system featuring a virtual pharmacy with a web portal and transaction processing module that adjudicates transactions using stored adjudication rules, supports multiple data structures, and processes transactions via secure APIs, enabling efficient and secure payment processing for digital health interventions and therapeutics.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Adaptability or versatility
If multiple vendors provide digital health applications through a virtual pharmacy marketplace, then the variety and availability of health-related products and services increase, but the complexity of evaluating safety and efficacy for each application increases significantly
Solution Approach 1:
The patent introduces a centralized transaction processing module as an intermediary between vendors and users. This module automatically evaluates digital health applications against pre-established adjudication rules, eliminating the need for manual evaluation by pharmacy benefit managers or patients. The intermediary handles the complexity of safety and efficacy assessment by applying standardized criteria to all applications in the marketplace.
Solution Approach 2:
The system enables self-service through automated adjudication where the transaction processing module independently evaluates applications without requiring external expert review. The module automatically processes transactions, applies rules, and determines compliance, allowing the system to manage its own quality control and evaluation processes efficiently.
2Ease of operation
If individual patients have access to evaluate and select health applications, then patient autonomy and personalized care improve, but the time and expertise required for proper selection increases
Solution Approach 1:
The system performs preliminary evaluation of all digital health applications before they reach patients. The transaction processing module pre-adjudicates applications against safety and efficacy rules, so when patients access the virtual pharmacy marketplace, the applications have already been validated. This eliminates the need for patients to spend time evaluating safety and efficacy themselves.
Solution Approach 2:
The automated transaction processing module acts as an intermediary that shields patients from the complexity of evaluation. Instead of patients directly assessing applications, the module handles the assessment and presents only approved applications to patients, maintaining patient autonomy while removing the time and expertise burden.
3Adaptability or versatility
If the virtual pharmacy processes transactions from multiple vendors with different data structures, then the versatility of the platform increases, but the complexity of transaction processing and data standardization increases
Solution Approach 1:
The transaction processing module is designed with universal functionality to handle multiple data structures from different vendors. It can process batch transactions with one data structure format and single transactions with another format, adapting to various vendor requirements while maintaining a unified processing framework. This multi-functionality enables the system to work with diverse vendors without requiring separate processing systems for each.
Solution Approach 2:
The system dynamically adjusts its processing parameters based on the incoming data structure. When receiving transactions, the module identifies the data format and applies appropriate parsing and validation rules. This parameter adaptation allows the system to maintain versatility across different vendors while managing processing complexity through automated format detection and transformation.
4Productivity
If automated adjudication rules are implemented for transaction processing, then processing speed and efficiency improve, but the rigidity of the system increases
Solution Approach 1:
The adjudication rule system is designed to be dynamic rather than static. The transaction processing module can load, update, and modify adjudication rules without requiring system reconfiguration. Rules can be added or modified to accommodate new digital health applications, changing regulatory requirements, or emerging safety concerns, allowing the system to maintain both automated processing speed and adaptability to new scenarios.
Data Source
AI summary
A digital health solution system includes: a virtual pharmacy comprising one or more processors configured to operate a web portal for user devices via a network, the web portal serving as a marketplace for products and services available from vendors for consumption by users; a transaction processing module configured to: receive, via a network, a transaction from a vendor regarding one or more of the products and services consumed by one or more users via the virtual pharmacy for payment to the vendor; adjudicate the transaction using adjudication rules stored in memory; bill an entity for the use of the one or more of the products and services associated with the one or more users when the adjudication of the transaction passes; and transmit, via a network, a response regarding the transaction to the vendor.