Patent Issued for Systems and methods for determination of patient true state for personalized medicine (USPTO 11475996): Apixio Inc.

2022 NOV 07 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- According to news reporting originating from Alexandria, Virginia, by NewsRx journalists, a patent by the inventors Rogers, Robert Derward (Oakland, CA, US), Schneider, John O. (Los Gatos, CA, US), Schulte, Darren Matthew (San Francisco, CA, US), Sethumadhavan, Vishnuvyas (Mountain View, CA, US), filed on February 7, 2020, was published online on October 18, 2022.

The assignee for this patent, patent number 11475996, is Apixio Inc. (San Mateo, California, United States).

Reporters obtained the following quote from the background information supplied by the inventors: “The present invention relates generally to systems and methods for determination of patient true state using automated first pass review of patient medical records. Knowledge of the true state of a patient (determination of patient condition) enables management of coding risks, as well as enhanced patient management and record retention abilities. Some embodiments of the present systems and methods enable more accurate and rapid capture of MediCare eligible conditions, thereby ensuring providers are more fairly compensated, and ensure that medical records more accurately reflect a patient’s condition.

“Despite rapid growth of innovation in other fields in recent decades, the world of medical information, including patient medical records, billing, referrals, and a host of other information, has enjoyed little to no useful consolidation, reliability, or ease-of-access, leaving medical professionals, hospitals, clinics, and even insurance companies with many issues, such as unreliability of medical information, uncertainty of diagnosis, lack of standard, and a slew of other related problems.

“One common problem with the analysis of medical records is that identification of clinically pertinent conditions is often not properly identified, and further, even when identified, the evidence in the patient records to support such a finding is not always properly referenced. Moreover, the process for verifying a condition is often time consuming and labor intensive. This results in a few issues, including: MediCare compensation difficulties, missing of important health conditions and/or misdiagnosis, and lastly the clouding of medical analytics with incomplete or incorrect data.

“The first issue, compensation by MediCare, results in providers being underpaid for work performed. This may cause many providers to shy away from MediCare patients, increases cost on other patients, and generally leads to inefficiencies in the administration of government backed medical coverage. Additionally, miss-coding of MediCare claim opens providers to potential audit risk.

“The second issue, improper or incomplete diagnosis, can be extremely detrimental to the patient. Often early treatment of a condition results in a far better prognosis for the patient. In the extreme, delays of treatment may reduce the patient’s life expectancy. As such, there is a very compelling reason to ensure the medical information of a patient is properly documented, with a high degree of accuracy.

“In addition to these direct health impacts to the patient, improper or incomplete diagnosis of the patient can lead to unnecessary tests or follow-ups, which can be financially taxing as well as a drain on the resources of the medical community. Thus there are also tangible financial implications to proper diagnosis with supporting evidence.

“Lastly, incorrect or missing data may result in the skewing of analytics performed using the medical records. The medical community is entering into an age of big data analysis. These analyses of large data sets of aggregated medical records generated best practices and means for refining a medical practice. It also enables early detection of health trends and patient behavior. Using these results, medical professionals have the opportunity to greatly increase the efficiency of the administration of medical services. This translates directly into improved patient care at reduced costs. However, such analysis relies upon datasets that are accurate. When the input data is flawed, or incomplete, the analysis suffers.

“It is therefore apparent that an urgent need exists for improved means for recordation and analysis of medical records. In particular, the clinical state of patients may be determined using a computerized system, which then enables a host of subsequent activities, including: 1) enhanced personalized medicine, 2) coding audit risk management, 3) more complete and accurate record keeping for providers, and 4) MediCare reimbursement optimization via the identification of coding opportunities.”

In addition to obtaining background information on this patent, NewsRx editors also obtained the inventors’ summary information for this patent: “To achieve the foregoing and in accordance with the present invention, systems and methods for personalizing medical care are provided. In some embodiments, the true state of the patient is utilized in order to tailor the personalized care to a given patient.

“Initially a number of medical records for a patient are received. These records are subjected to predictive modeling for various conditions (known as patient ‘true state’). The true state is utilized to identify medical resources that may be useful for the patient. Additionally, a confidence interval may be determined for the true state finding.

“In some embodiments, the patient personal information, previous care, and true state may be provided into a state machine in order to determine the resources needed for the patient. The medical resources may be any of laboratory services, diagnostics, therapies and medications.

“Using the true state information, and number of activities may be performed for the patient based upon the patient’s needs. These activities include scheduling lab or diagnostic procedures in advance of an appointment, filling in documentation gaps, identifying items that require additional documentation using the true state, and tracking follow-up.

“In some embodiments it may also be beneficial to validate the true state. The validation process updates the predictive model and updates the confidence level for the inferred true state. Optimized routing on the evidence used for validation may be employed. This routing ensures that evidence that has the greatest impact on the true state inference is presented first.”

The claims supplied by the inventors are:

“1. A computer-implemented method for personalizing medical care in a health information management system, the computer-implemented method comprising: determining and extracting terms in a plurality of medical records associated with a patient by parsing and analyzing the plurality of medical records; transforming the terms extracted from the plurality of medical records into a standardized and structured data set, wherein the data set includes hyperlinks to the plurality of medical records to facilitate real-time reference from the structured data set back to the plurality of medical records; clustering the terms into medical concept data based at least in part upon machine learned rules; inferring a true state for the patient based upon the medical concept data, wherein the true state is inferred using a processor implementing at least one probabilistic model, and wherein the true state comprises at least one condition of the patient; validating the true state including optimizing routing of evidence for validation based upon greatest impact the evidence has on the true state inference; and determining at least one medical resource for the patient based upon the true state.

“2. The computer-implemented method of claim 1 further comprising generating a confidence level for the inferred true state.

“3. The computer-implemented method of claim 1 wherein the medical resources include any of laboratory services, diagnostics, therapies and medications.

“4. The computer-implemented method of claim 1 further comprising scheduling lab or diagnostic procedures in advance of an appointment based upon the true state.

“5. The computer-implemented method of claim 1 further comprising filling documentation gaps using the true state.

“6. The computer-implemented method of claim 1 wherein the validation updates a predictive model and updates a confidence level for the inferred true state.

“7. A health information management system for personalizing medical care comprising: a network interface in communication with a first pass analyzer, the network interface configured to receive a plurality of medical records for a patient; and the first pass analyzer including a processor and configured to: determine and extract terms in a plurality of medical records associated with a patient by parsing and analyzing the plurality of medical records; transform the terms extracted from the plurality of medical records into a standardized and structured data set, wherein the data set includes hyperlinks to the plurality of medical records to facilitate real-time reference from the structured data set back to the plurality of medical records; cluster the terms into medical concept data based at least in part upon machine learned rules; infer a true state for the patient based upon the medical concept data, wherein the true state is inferred based upon at least one probabilistic model, and wherein the true state comprises at least one condition of the patient; validate the true state including optimizing routing of evidence for validation based upon greatest impact the evidence has on the true state inference; and determine at least one medical resource for the patient based upon the true state.

“8. The system of claim 7 wherein the first pass analyzer is further configured to generate a confidence level for the inferred true state.

“9. The system of claim 7 wherein the medical resources include any of laboratory services, diagnostics, therapies and medications.

“10. The system of claim 7 wherein the first pass analyzer is further configured to schedule lab or diagnostic procedures in advance of an appointment based upon the true state.

“11. The system of claim 7 wherein the first pass analyzer is further configured to fill documentation gaps using the true state.

“12. The system of claim 7 wherein the first pass analyzer is further configured to identify items that require additional documentation using the true state.

“13. The system of claim 7 wherein the first pass analyzer is further configured to track follow-up.

“14. The system of claim 7 wherein validating the true state includes updating a predictive model and updating a confidence level for the inferred true state.

“15. The computer-implemented method of claim 1, further comprising automatically scheduling the medical resources for the patient.

“16. The computer-implemented method of claim 1, further comprising storing the true state for the patient with a plurality of true states for a plurality of patients, wherein the true states for the plurality of patients are analyzed for profiling.”

For more information, see this patent: Rogers, Robert Derward. Systems and methods for determination of patient true state for personalized medicine. U.S. Patent Number 11475996, filed February 7, 2020, and published online on October 18, 2022. Patent URL: http://patft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PALL&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.htm&r=1&f=G&l=50&s1=11475996.PN.&OS=PN/11475996RS=PN/11475996

(Our reports deliver fact-based news of research and discoveries from around the world.)