Computing system and method for supporting selective prioritization
Inventors
Kaye, Elizabeth • Irmen, Monique • Crozier, Keith
Assignees
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Publication Number
US-12315623-B1
Publication Date
2025-05-27
Expiration Date
Abstract
A computing system, method and computer program product selectively prioritize patients for a medical procedure. In relation to a computing system, the computing system includes one or more databases configured to store a plurality of different data sets including a pharmacy and/or medical claims data set, a medication history data set and a patient data set. The computing system also includes processing circuitry configured to access the plurality of different data sets and to analyze the plurality of different data sets in accordance with one or more rule sets. The processing circuitry is further configured to identify a subset of the plurality of patients to be prioritized for the medical procedure as a result of satisfying one or more predefined requirements for the medical procedure based upon an analysis of the plurality of different data sets in accordance with the one or more rule sets.
Core Innovation
The invention provides a computing system configured to support selective prioritization of a patient for a medical procedure. The system combines one or more real-time or near real-time processes with one or more batch processes to identify, at a point of contact, a subset of patients to be prioritized for the medical procedure. This prioritization is determined as a result of satisfying predefined requirements and is delivered in real time or near real time at the point of care.
The computing system includes one or more databases storing different data sets collected over time in the batch processes from a plurality of different sources. The data sets include one or more of a pharmacy claims data set or a medical claims data set, a medication history data set, and a patient data set providing demographic information. Processing circuitry accesses the stored data sets, analyzes diagnosis codes from the claims to determine that a patient has a medical condition, and applies one or more rule sets to determine which patients satisfy the predefined requirements.
The invention further includes a communication interface configured to deliver information regarding the prioritization of a respective patient via a communication network in a manner that conserves limited communication network resources. The communication interface increases communication network use for delivery of prioritization information while reducing network consumption for information otherwise provided for patients that have not been prioritized. The communication interface causes a notification to be provided at the point of care, including the respective patient and one of a healthcare provider, a pharmacist or a payor, and causes a notification to be pushed to a pharmacy or a pharmacy chain regarding a number of patients prioritized for the medical procedure to facilitate stocking of medication.
The system also supports additional rule-set constructs and contextual factors for prioritization. A disease state confidence matrix is used to determine disease likelihood based on claims, medication history, and patient-provided healthcare information, and predefined requirements define a plurality of risk levels where each risk level is defined by a unique combination of the requirements. Patient context can include patient age, disease history, occupation, and location, including inferring patient location based on the location of a pharmacy that has most recently dispensed medication, particularly when that pharmacy location is distant relative to the patient’s home address.
Claims Coverage
The document provides three independent claims covering a computing system, a method, and a computer program product for selective patient prioritization using batch-collected multi-source datasets plus real-time or near real-time processing. Across the independent claims, the inventive approach includes rule-based analysis from stored claims/medication/demographics, real-time/near real-time identification of a prioritized patient subset based on predefined requirements, and network-conserving delivery of prioritization notifications to point of care and pharmacy stakeholders.
Real-time and batch process combination for prioritized patient subset identification
One or more predefined requirements for the medical procedure are satisfied based upon an analysis of the plurality of different data sets in accordance with one or more rule sets, and a subset of the plurality of patients to be prioritized is identified in real time or near real time with respect to an inquiry at a point of contact.
Rule-set diagnosis-code analysis using over-time batch data sets
The computing system analyzes diagnosis codes from the claims of one or more of the pharmacy claims data set or the medical claims data set to determine that a patient has a medical condition, and performs real-time or near real-time processing using the one or more rule sets to identify a prioritized subset based on the predefined requirements.
Network-conserving delivery of prioritization information at point of care
Information regarding the prioritization of the respective patient for the medical procedure is delivered via a communication network in real-time or near real-time at the point of care, in a manner that conserves limited communication network resources by increasing use for delivery of prioritization information while reducing network consumption for information otherwise provided for patients that have not been prioritized.
Point-of-care and pharmacy-chain notifications to support stocking
A notification is provided at the point of care including the respective patient and one of a healthcare provider, a pharmacist or a payor, and a notification is pushed to a pharmacy or a pharmacy chain regarding a number of patients prioritized for the medical procedure for whom medication is to be dispensed at a respective pharmacy to facilitate stocking of the medication.
Risk modeling via disease state confidence matrix and risk levels
A disease state confidence matrix is used to determine that a patient has a respective disease by determining a likelihood based on claims and medication history and healthcare information, and predefined requirements define a plurality of risk levels, where each risk level is defined by a unique combination of the requirements.
Contextual patient modeling including location from most-recent dispensing pharmacy
A location of a patient is analyzed by inferring location based on the location of a pharmacy that has most recently dispensed medication, particularly when that pharmacy location is distant relative to the patient’s home address.
Rule sets depend on age, disease history, occupation, and location
One or more rule sets are applied that depend at least in part on the patient’s age, disease history, occupation, and location.
Covered medical procedure types include vaccines, treatments, and testing
The medical procedure is one or more of a vaccine, a treatment, or a testing procedure.
Collectively, the independent claims cover selecting a prioritized subset of patients by applying rule sets to batch-collected claims/medication/demographics and diagnosis-code analysis, performing real-time or near real-time prioritization at point of contact, and delivering prioritization notifications in a network-conserving manner to point of care and pharmacy or pharmacy chains for stocking, with additional structures for disease likelihood, risk levels, and contextual modeling (including location inference).
Stated Advantages
Conserves limited communication network resources by increasing use of the communication network for delivery of the prioritization information while reducing network consumption for information otherwise provided for patients that have not been prioritized.
Facilitates stocking of medication for patients who have been prioritized for the medical procedure by providing a notification to a pharmacy or a pharmacy chain regarding a number of patients prioritized for whom medication is to be dispensed.
Documented Applications
Point-of-care prioritization notifications in response to an inquiry as to a relative prioritization of a respective patient at a point of contact, including notification to the respective patient and one of a healthcare provider, a pharmacist or a payor.
Pharmacy and pharmacy-chain notifications regarding a number of prioritized patients for whom medication is to be dispensed at a respective pharmacy to facilitate stocking.
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