Researchers Submit Patent Application, “Identification, Stratification, And Prioritization Of Patients Who Qualify For Care Management Services”, for Approval (USPTO 20210043287)

2021 MAR 02 (NewsRx) -- By a News Reporter-Staff News Editor at Hospital & Nursing Home Daily -- From Washington, D.C., NewsRx journalists report that a patent application by the inventors Stadler, Phillip M. (Olathe, Ks); Harrington, Andrea K. (Lee’s Summit, Mo); Quick, Megan K. (Kansas City, Mo); Sutariya, Bharat B. (Parkville, Mo), filed on October 28, 2020, was made available online on February 11, 2021.

The patent’s assignee is Cerner Innovation Inc. (Kansas City, Kansas, United States).

News editors obtained the following quote from the background information supplied by the inventors: “Care management refers to activities that are intended to improve a patient’s health status, coordinate the patient’s care across different care venues, reduce the patient’s need for medical services, and ultimately decrease the amount of money spent on healthcare services for the patient. Effective care management relies on care managers to engage with patients and affect the care management goals. Care managers are generally licensed personnel (R.N., L.P.N., and/or licensed social workers) who may be affiliated with a provider or a provider’s office, an insurance company, or a hospital.

“Care managers face a number of challenges when attempting to implement effective care management practices. One of these challenges is the fragmentation of patient care over multiple clinical care venues. For instance, a patient may utilize an ambulatory care clinic, an emergency department, a post-acute care facility, and home health services in the course of the patient’s care over, for example, a period of one year. These disparate facilities often do not share the patient’s clinical information with each other, and so a care manager affiliated with, for example, the ambulatory care clinic may only have access to the patient’s health data from that particular clinic. The care manager’s ability to provide effective care management is limited by being able to access only a limited portion of the patient’s health profile.

“Another problem faced by care managers is the inability to view the patient’s health history over the span of the patient’s life. This type of health record, known as a longitudinal patient record often does not exist due to the difficulties in compiling the data needed to generate the record. Although it may be possible to cobble together a semblance of a longitudinal medical record by interviewing the patient, this approach generally leaves major gaps and/or inaccuracies in the record. Instead of being able to access the patient’s longitudinal medical record, care managers often only have access to a patient’s health data compiled at a particular care venue. This health data is limited to the time period in which the patient has utilized the particular venue, and in today’s mobile world, this time period may only account for a small fraction of the patient’s total medical history. The care manager’s efforts to provide effective care management are further stymied by being provided with only a small glimpse of a patient’s total health profile.

“Although traditional enterprise care management solutions have tried to address some of the shortcomings noted above, they have generally fallen short as they rely almost exclusively on insurance claims data when determining if the patient is eligible for care management services. Utilizing only insurance claims data has several shortcomings. For example, insurance claims data is often compiled weeks to months after a patient event has occurred such as a visit to an emergency department, a readmission to a hospital, and the like. Because claims data is retroactive in nature, care managers are unable to timely identify patients who may need care management services. As an example, a patient may have died or the patient’s insurance eligibility for care management services may have expired in the lag period between when a patient event occurred and when information from the insurance claim is available to a care manager. Moreover, insurance claims data provides only a limited profile of the patient--a profile that fails to take into account such things as the patient’s longitudinal medical record, the patient’s socioeconomic status, the patient’s support system, the patient’s preferences regarding his/her care, and the like. These factors may make or break the difference between effective care management and ineffective care management.”

As a supplement to the background information on this patent application, NewsRx correspondents also obtained the inventors’ summary information for this patent application: “This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter. The present invention is defined by the claims.

“In brief and at a high level, this disclosure describes, among other things, an enterprise care management solution for identifying, stratifying, and prioritizing patients who are eligible for care management services. The enterprise care management solution may be implemented as a system, a computerized method, and as computer-readable media. Health data for a population of patients is compiled and processed at a central location. The health data includes patient electronic medical record data received from a plurality of disparate care venues as well as insurance claims data. For each patient in the population, the health data is processed to determine a disease burden associated with the patient, an amount of health system utilization by the patient, and/or the amount of money spent on healthcare services for the patient. Each of these criteria may be associated with a threshold parameter, and it is further determined which patients in the population exceed a threshold parameter for a respective criteria. For those patients who exceed one or more of the threshold parameters, the patients are then stratified or categorized into one of four groups: 1) high-risk senior; 2) high-risk adult, 3) high-risk pediatrics, or 4) high-risk maternity. After stratification, the patients may further be prioritized based on, for instance, a determined risk level associated with each patient. Once identified, stratified, and prioritized, patients who qualify for care management services may then be notified.

“The enterprise care management solution described above is configurable by, for example, a client or end-user using the solution. A client or end-user in this case may comprise a hospital, an insurer, a physician or physician group, an ambulatory care clinic, and the like. For instance, the client may specify which of the criteria--disease burden, health system utilization, or amount of healthcare spend--the client wishes to use when identifying patients eligible for care management services. The client may utilize one, two, or all three of the criteria when identifying patients. The client may also configure the threshold parameters associated with each of the criteria. Moreover, the client can configure the order of the identification and stratification process. For example, the client may first want to stratify its patient population into one of the four categories enumerated above and then execute the selected criteria against the patients in each of the categories. Alternatively, and as detailed above, the client may choose to run the identification criteria against its patient population and then stratify the identified patients into one of the four categories. In yet another aspect, the client may choose to run the identification and stratification processes in parallel. Any and all such aspects, and any variation thereof, are contemplated as being within the scope described herein.”

The claims supplied by the inventors are:

“1. One or more non-transitory computer-readable media having computer executable instructions embodied thereon that, when executed by a computing device, perform a method of compiling longitudinal medical records for identifying, stratifying and prioritizing a population of patients eligible for care management services, the method comprising: continuously receiving, at a cloud computing platform by the computing device communicating through a computer network with a plurality of remote computing devices of disparate data sources, data associated with the population of patients from the plurality of disparate data sources using the cloud computing platform, wherein the data includes updates to the patients’ health data from one or more end-user computing devices, wherein disparate data sources are data sources that do not share patient health data with each other, wherein the data comprises at least insurance claims data and patient electronic medical record data, wherein the data from one or more of the plurality of disparate data sources is in a non-standard format, and wherein the data is transformed from the non-standard format to a standard format and compiled by the computing device to generate a longitudinal medical record for each patient; storing, by the computing device, the longitudinal medical record in one or more data stores associated with the cloud computing platform; providing, by the computing device, remote access to the longitudinal medical record by the one or more end-user computing devices, wherein the one or more end-user computing devices include the plurality of remote computer devices of the disparate data sources; for each patient within the population of patients, using, by the computing device, the data including the longitudinal medical record for each patient to determine: (1) the disease burden associated with each patient, (2) the amount of health system utilization by each patient, and (3) the amount of money spent on healthcare services for each patient; determining in the received order, by the computing device, that a first patient within the population of patients exceeds a predetermined threshold value associated with one or more of the disease burden, the amount of health system utilization, or the amount of money spent on healthcare services; subsequent to determining that the first patient exceeds the received predetermined threshold value, categorizing, by the computing device, the first patient into one of the following categories: (1) high-risk senior, (2) high-risk adult, (3) high-risk pediatrics, or (4) high-risk maternity; generating, by the computing device, a first graphical user interface which displays via a display of the one or more end-user computing devices a notification that the first patient is eligible for care management services; communicating, by the computing device, the first graphical user interface through the computer network to the one or more end-user computing devices; identifying in the received data, by the computing device, an update in at least one of a care management status, a care management plan, and a health data that meets a criteria for one or more health intervention, by continuously monitoring the data being continuously received from the plurality of disparate data sources; responsive to identifying an update in the data continuously received from the plurality of disparate data sources, automatically and without human intervention generating, by the computing device, a second graphical user interface which displays an update notification of the identified update including patient-specific data in a customized template corresponding to the identified update; and communicating, by the computing device, the second graphical user interface through the computer network to the one or more end-user computing devices.

“2. The media of claim 1, further comprising: subsequent to categorizing the first patient, assigning a priority level to the first patient.

“3. The media of claim 2, wherein the disparate data sources comprise at least a plurality of healthcare facilities.

“4. The media of claim 3, wherein the disease burden comprises at least a number of chronic disease conditions associated with each patient, and a number of disease interactions associated with each patient.

“5. The media of claim 3, wherein the amount of health system utilization comprises at least a number of emergency department visits within a one-year period, a number of inpatient admissions during the one-year period, a number of re-admissions within the one-year period, medication utilization within the one-year period, durable medical equipment utilization within the one-year period, and a number of radiographic imaging procedures within the one-year period.

“6. The media of claim 3, wherein the amount of money spent on healthcare services is derived from the insurance claims data and information from billing systems associated with the disparate data sources.

“7. The media of claim 3, wherein the predetermined threshold value is configurable by a particular healthcare facility of the plurality of healthcare facilities.

“8. The media of claim 3, wherein the high-risk senior category comprises patients 65 and older, wherein the high-risk adult category comprises patients between 18 and 64 years of age, and wherein the high-risk pediatric category comprises patients between 0 and 17 years of age.

“9. The media of claim 3, further comprising communicating the notification to the first patient.

“10. A computerized method carried out by at least one server having at least one processor compiling longitudinal medical records for identifying, stratifying, and prioritizing a population of patients who are eligible for care management services, the method comprising: continuously receiving by the at least one processor in a cloud computing platform communicating through the computer network with a plurality of remote computing devices of disparate data sources, data associated with the population of patients from a plurality of disparate data sources including a patient profile for each patient within the patient population, wherein the data include updates to the patient’s health data from one or more end-user computing devices, wherein the plurality of disparate data sources are data sources that do not share patient health data with each other, wherein the data from one or more of the plurality of disparate data sources is in a non-standard format, and wherein the at least one processor transforms the data from the non-standard format to a standard format, and machine learning and generates a longitudinal medical record for each patient within the population of patients; storing, by the at least one processor, the longitudinal medical record in one or more data stores associated with the cloud computing platform; providing, by the at least one processor, remote access to the longitudinal medical record by the one or more end-user computing devices, wherein the one or more end-user computing devices include the plurality of remote computer devices of the disparate data sources; using the data including the longitudinal medical record for each patient and to stratify by the at least one processor, each patient within the population of patients into one of the following categories in the received order: (1) senior, (2) adult, (3) pediatrics, or (4) maternity; for each patient within each category, using the data to determine by the at least one processor: (1) the disease burden associated with each patient, (2) the amount of health system utilization by each patient, and (3) the amount of money spent on healthcare services for each patient; determining, by the at least one processor, that at least a first patient within a respective category exceeds a received predetermined threshold value associated with one or more of the disease burden, the amount of health system utilization, or the amount of money spent on healthcare services; generating, by the at least one processor, a first graphical user interface which displays via a display of the one or more end-user computing devices a notification that the first patient is eligible for care management services; communicating, by the at least one processor, the first graphical user interface through the computer network to the one or more end-user computing devices; identifying in the received data, by the at least one processor, an update in at least one of a care management status, a care management plan, and a health data that meets a criteria for one or more health intervention, by continuously monitoring the data being continuously received from the plurality of disparate data sources; responsive to identifying an update in the data continuously received from the plurality of disparate data sources, automatically and without human intervention generating, by the at least one processor, a second graphical user interface which displays an update notification of the identified update including patient-specific data in a customized template corresponding to the identified update; and communicating, by the at least one processor, the second graphical user interface through the computer network to the one or more end-user computing devices.

“11. The method of claim 10, further comprising: subsequent to determining that the first patient within the respective category exceeds the predetermined threshold value, assigning a priority level to the first patient.

“12. The method of claim 10, wherein the data is received at a central processing location.

“13. The method of claim 12, wherein the central processing location processes the patient electronic medical record data into a longitudinal medical record for each patient within the population of patients.

“14. The method of claim 10, further comprising communicating the notification that the first patient is eligible for care management services to a physician or a healthcare facility caring for the patient.

“15. The method of claim 14, further comprising communicating the notification to the first patient.

“16. One or more computer-readable media having computer-executable instructions embodied thereon that, when executed by a computing device, perform a method of enabling a healthcare organization to identify and stratify patients within a patient population cared for by the healthcare organization who are eligible for care management services, the method comprising: receiving from the healthcare organization a selection of one or more criteria used to identify patients who are eligible for care management services, the one or more criteria comprising: (1) a disease burden associated with each patient, (2) an amount of health system utilization by each patient, and (3) an amount of money spent on healthcare services for each patient; receiving from the healthcare organization a threshold value for each of the selected one or more criteria; receiving data associated with the patient population from a plurality of disparate data sources, wherein the data comprises at least insurance claims data and patient electronic medical record data, wherein the received data is in a non-standard format, and wherein the computing device transforms the data from the non-standard format to a standard format and generates a longitudinal medical record for each patient; storing, by the computing device, the longitudinal medical record in one or more data stores; determining from the longitudinal medical record for each patient that at least a first patient within the patient population exceeds the respective threshold value for each of the selected criteria specified by the healthcare organization; categorizing the first patient into one of the following categories: (1) high-risk senior, (2) high-risk adult, (3) high-risk pediatrics, or (4) high-risk maternity; and generating a notification that the first patient is eligible for care management services.

“17. The media of claim 16, further comprising: subsequent to categorizing the first patient into one of the categories, assigning a priority level to the first patient.

“18. The media of claim 17, wherein the priority level is based on degree of risk associated with the first patient.”

For additional information on this patent application, see: Stadler, Phillip M.; Harrington, Andrea K.; Quick, Megan K.; Sutariya, Bharat B. Identification, Stratification, And Prioritization Of Patients Who Qualify For Care Management Services. Filed October 28, 2020 and posted February 11, 2021. Patent URL: http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO1&Sect2=HITOFF&d=PG01&p=1&u=%2Fnetahtml%2FPTO%2Fsrchnum.html&r=1&f=G&l=50&s1=%2220210043287%22.PGNR.&OS=DN/20210043287&RS=DN/20210043287

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