“Systems and Methods for Enhancing Workflow Efficiency in a Healthcare Management System” in Patent Application Approval Process (USPTO 20160048780)

By a News Reporter-Staff News Editor at Managed Care Weekly Digest -- A patent application by the inventors Sethumadhavan, Vishnuvyas (Mountain View, CA); Schneider, John O. (Los Gatos, CA); Belcinski, Richard Joseph (San Jose, CA), filed on August 18, 2015, was made available online on February 25, 2016, according to news reporting originating from Washington, D.C., by NewsRx correspondents (see also Patents).

This patent application has not been assigned to a company or institution.

The following quote was obtained by the news editors from the background information supplied by the inventors: "The present invention relates generally to systems and methods for improvements in workflow management in a healthcare system. In particular the presently disclosed systems and methods enable contextual bundling of data into discrete work items, contextual workflow configuration, and efficient energy based routing of the work items in order to maximize a given objective. Some embodiments of the present systems and methods enable more accurate and rapid capture of MediCare eligible conditions, and more valuable and frequent reimbursements for these conditions.

"Despite rapid growth of innovation in other fields in recent decades, the world of medical information, including patient medical records, billing, MediCare reimbursements, 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, under compensation for legitimate MediCare conditions, 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 workflow management within a medical information system. In particular, the ability to contextually bundle data elements into work items, and contextually configure workflows enables users of such a system significant flexibility in their ability to identify patients with specific diagnosed ailments, enhanced coder efficiency, and larger reimbursements from MediCare or other insurer. In addition to the ability to bundle and configure workflows, the presently disclosed systems and methods enable 'energy based routing' of the work items in order to maximize a user's objective. Thus, not only are the workflows and items contextually pertinent, the actual completion of the actions is completed at maximum efficiency."

In addition to the background information obtained for this patent application, NewsRx journalists also obtained the inventors' summary information for this patent application: "To achieve the foregoing and in accordance with the present invention, systems and methods for workflow management are provided. Such systems and methods enable the configuration of workflows, bundling of work items for processing by the workflows, and energy based routing of work items through the workflows in order to improve the efficiency of healthcare management.

"In some embodiments, a set of data elements, which are extracted from medical information, are received. Medical information may include medical records, patient entered information, care team entered information, healthcare device generated information, and billing information. The elements are bundled according to one or more similar attributes to form work items. Work items are bundles of data elements for which value is to be extracted for a particular user objective

"Next the workflows are configured according to event history for the work items, current action, and user context. The work items may then be routed through the workflow based upon the work items' 'energy'. Work item energy is the probability and degree to which a next action taken in a workflow to that particular work item will further a user objective. The routing is either exploration or exploitation based upon confidence in a probabilistic model for workflow action outcomes. The exploration routing collects results from processing of work items through a given workflow action in order to tune the probabilistic model. Conversely, the exploitation routing compares an expected outcome for the processing of each work item through the workflow versus a user objective and selects work items that maximize the objective.

"Note that the various features of the present invention described above may be practiced alone or in combination. These and other features of the present invention will be described in more detail below in the detailed description of the invention and in conjunction with the following figures.

BRIEF DESCRIPTION OF THE DRAWINGS

"In order that the present invention may be more clearly ascertained, some embodiments will now be described, by way of example, with reference to the accompanying drawings, in which:

"FIG. 1 shows a medical system, in accordance with an embodiment;

"FIG. 2 shows further details of the medical system including the bundler and workflow manager, in accordance with an embodiment;

"FIG. 3 shows an example embodiment of the bundler, in accordance with an embodiment;

"FIG. 4 shows an example diagram of data clustering by the bundler, in accordance with an embodiment;

"FIG. 5A shows an example embodiment of the workflow manager which includes state machines for workflow configuration and an energy based router, in accordance with an embodiment;

"FIG. 5B shows one example of a state machine configuring a workflow, in accordance with an embodiment;

"FIG. 6 shows an example diagram of a knowledge extractor within the event stream workflows, in accordance with an embodiment;

"FIG. 7 shows an example diagram of an event stream workflow, in accordance with an embodiment;

"FIG. 8 shows an example flow chart for the process of workflow management and processing, in accordance with an embodiment;

"FIG. 9 shows an example flow chart for the process of generating a machine readable dataset, in accordance with an embodiment;

"FIG. 10 shows an example flow chart for the process of contextual bundling, in accordance with an embodiment;

"FIG. 11 shows an example flow chart for the process of contextual workflow configuration, in accordance with an embodiment;

"FIGS. 12-14 show example flow charts for the process of energy based routing, in accordance with an embodiment; and

"FIGS. 15A and 15B are example illustrations of a computer system capable of embodying the current invention."

URL and more information on this patent application, see: Sethumadhavan, Vishnuvyas; Schneider, John O.; Belcinski, Richard Joseph. Systems and Methods for Enhancing Workflow Efficiency in a Healthcare Management System. Filed August 18, 2015 and posted February 25, 2016. Patent URL: http://appft.uspto.gov/netacgi/nph-Parser?Sect1=PTO2&Sect2=HITOFF&u=%2Fnetahtml%2FPTO%2Fsearch-adv.html&r=2057&p=42&f=G&l=50&d=PG01&S1=20160218.PD.&OS=PD/20160218&RS=PD/20160218

Keywords for this news article include: Patents, Medicare, Legal Issues, Health Policy.

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