Care engine

Abstract

The present invention offers a comprehensive solution to care management which aggregates, integrates and stores clinical information from disparate sources. The system finds at-risk individuals before they experience preventable, high-cost medical events and stratifies high risk populations according to clinical criteria, which can include severity of disease states and co-morbidities. The system also compares the actual care an individual is receiving to established standards of clinical excellence and, if necessary, suggests pertinent medical care considerations to improve the care of medically mismanaged individuals. Another feature of the present invention may include a secure, patient-specific Web page which is automatically populated with a patient's own clinical information and can be personalized with customized, relevant healthcare information. The system allows users to design, facilitate and monitor clinical care plans and increase communications among physicians, nurses and patients. The system also predicts and analyzes the outcome of disease or case management for populations and individual patients.

1 . A method of providing a personal health record to an individual patient, the method comprising:
 aggregating electronic medical care information relating to the patient using an automated health care computer information system programmed to integrate a plurality of disparate medical data sources, the health care computer information system having access to at least one source of data, including claims data reflecting clinical information obtained from at least one health care provider and submitted in connection with a claim under a health plan;   organizing the aggregated medical care information into a medical data file for the patient and storing the medical data file in a computer readable medium of the health care computer information system;   providing a password-protected, personal Web page for the patient, the Web page including a display of certain elements of the patient's healthcare history automatically populated based on the contents of the medical data file, and further including a section for use by the patient to enter additional healthcare information;   receiving the additional healthcare information entered by the patient using the Web page; and   updating the medical data file with the received information.   
     
     
         2 . The method of  claim 1  wherein the section of the Web page for use by the patient comprises a healthcare diary for recording information of a type selected from the group consisting of: (a) results of self-administered tests, (b) use of over-the-counter medications, and (c) use of dietary supplements. 
     
     
         3 . The method of  claim 1  further comprising:
 electronically accessing the patient's laboratory test results;   storing the laboratory test results in the patient's medical data file; and   providing with the Web page a display automatically populated with information reflecting the laboratory test results.   
     
     
         4 . The method of  claim 1  wherein the aggregating step comprises electronically accessing medical care information from a source of data selected from the group consisting of: (a) a source of laboratory test result data, (b) a source of prescription drug data, and (c) a source of in-patient information. 
     
     
         5 . The method of  claim 1  further comprising:
 providing to the patient, via the Web page, access to an online, interactive health risk assessment questionnaire;   receiving a response to the questionnaire from the patient, wherein the response to the questionnaire supplements the information in the medical data file to enable an assessment of the patient's health status; and   providing the assessment of the patient's health status based on the received response.   
     
     
         6 . The method of  claim 1  further comprising providing to the patient, via the Web page, access to a physician view function that provides a summary of the patient's medical information in a physician-oriented format. 
     
     
         7 . The method of  claim 1  further comprising providing to the patient, via the Web page, access to information relating to the health plan selected from the group consisting of: (a) eligibility information, (b) referral information, and (c) procedure authorization information. 
     
     
         8 . The method of  claim 1  further comprising providing to the patient, via the Web page, access to disease management content. 
     
     
         9 . The method of  claim 1  further comprising providing to the patient, via the Web page, access to relevant health reference information based on the contents of the medical data file. 
     
     
         10 . The method of  claim 9  wherein:
 the medical data file includes clinical information reflecting the presence of a medical condition; and   the health reference information includes medical information relating to the condition.   
     
     
         11 . A health care computer information system for providing a personal health record to an individual patient, the system comprising:
 an aggregation module for automatically collecting electronic medical care information relating to the patient, the module having access to at least one source of data, including claims data reflecting clinical information obtained from at least one health care provider and submitted in connection with a claim under a health plan;   a medical data file stored in a computer readable medium of the health care computer information system and comprising medical care information for the patient collected by the aggregation module;   a personal, password-protected Web page for the at least one patient, the Web page comprising:   a display of certain elements of the patient's healthcare history automatically populated based on the contents of the medical data file; and   a section for entry of additional patient healthcare information; and   a system portal for presenting the personal Web page for the patient, the system portal capable of receiving the additional healthcare information entered via the Web page in order to update the medical data file for the patient.   
     
     
         12 . The system of  claim 11  wherein the section of the Web page for entry of additional patient healthcare information comprises a healthcare diary for recording information of a type selected from the group consisting of: (a) results of self-administered tests, (b) use of over-the-counter medications, and (c) use of dietary supplements. 
     
     
         13 . The system of  claim 11  wherein the medical care information collected by the aggregation module comprises the patient's laboratory test results. 
     
     
         14 . The system of  claim 11  wherein the at least one source of data for the collection module is selected from the group consisting of: (a) laboratory test result data, (b) prescription drug data, and (c) in-patient information. 
     
     
         15 . The system of  claim 11  further comprising:
 an online, interactive health risk assessment questionnaire accessible to the patient via the Web page, the health risk assessment questionnaire enabling an assessment of the patient's health status based on patient's responses to the questionnaire.   
     
     
         16 . A Web-based user interface for electronically presenting a personal health record for an individual patient comprising:
 certain elements of the patient's healthcare history automatically populated based on the contents of a medical data file for the patient, the medical data file automatically aggregated via a health care computer information system programmed to integrate a plurality of disparate medical data sources and comprising claims data reflecting clinical information obtained from at least one health care provider and submitted in connection with a claim under a health plan;   a password-protection mechanism for securely accessing the personal health record; and   a data entry section for use by the patient to enter additional healthcare information for updating the medical data file stored at a computer readable medium of the health care computer information system.   
     
     
         17 . The user interface of  claim 16  wherein the data entry section comprises a healthcare diary for recording information of a type selected from the group consisting of: (a) results of self-administered tests, (b) use of over-the-counter medications, and (c) use of dietary supplements. 
     
     
         18 . The user interface of  claim 16  wherein the certain elements include laboratory test results. 
     
     
         19 . The user interface of  claim 16  further comprising:
 an interactive health risk assessment questionnaire for enabling an assessment of the patient's health status based on patient's responses to the questionnaire.   
     
     
         20 . A method of providing a personalized health risk assessment for an individual patient comprising:
 aggregating electronic medical care information relating to the patient using an automated health care computer information system programmed to integrate a plurality of disparate medical data sources, the health care computer information system having access to at least one source of data, including claims data reflecting clinical information obtained from at least one health care provider and submitted in connection with a claim under a health plan;   organizing the aggregated medical care information into a medical data file for the patient and storing the medical data file in a computer readable medium of the health care computer information system;   providing to the patient electronic access to an interactive health risk assessment questionnaire;   receiving a response to the questionnaire from the patient, wherein the response to the questionnaire supplements the information in the medical data file to enable an assessment of the patient's health status; and   providing the assessment of the patient's health status based on the received response and the information in the medical data file.   
     
     
         21 . The method of  claim 20  further comprising:
 providing a password-protected, personal Web page for the patient, the Web page including a display of certain elements of the patient's healthcare history automatically populated based on the contents of the medical data file; and   providing the electronic access to the questionnaire via the Web page.   
     
     
         22 . The method of  claim 21  further comprising receiving a series of responses from the patient to individual questions in the questionnaire. 
     
     
         23 . The method of  claim 22  further comprising performing, via the health care computer information system, the steps of:
 determining that a question is necessary and selecting a health-related question for the patient from a database of health-related questions, the determination and selection based on information in the patient's medical data file and on at least one received response to a previous question;   presenting the selected question to the patient; and   receiving a response to the presented question from the patient.   
     
     
         24 . The method of  claim 22  further comprising:
 recording the responses to the questions in the medical data file as part of a personal health record for the patient.   
     
     
         25 . The method of  claim 24  wherein the personal health record is accessible by the patient from the Web page. 
     
     
         26 . A health care computer information system for a personalized health risk assessment for an individual patient comprising:
 an aggregation module for automatically collecting electronic medical care information relating to the patient, the module having access to at least one source of data, including claims data reflecting clinical information obtained from at least one health care provider and submitted in connection with a claim under a health plan;   a medical data file stored in a computer readable medium of the health care computer information system and comprising medical care information for the patient collected by the aggregation module;   a system portal for electronically presenting to the patient a questionnaire comprising a series of health-related questions, and for receiving patient responses to the questionnaire, wherein the responses to the questionnaire supplement the information in the medical data file to enable an assessment of the patient's health status; and   an engine for processing received responses along with the information in the medical data file to form the health risk assessment for the patient.   
     
     
         27 . The system of  claim 26  further comprising a workflow module including dynamic conditional logic for applying patient responses from previous questions to information in the medical data file in order to determine that another question in the series is necessary, the workflow module selecting a relevant health-related question for the series for presentment to the patient. 
     
     
         28 . The system of  claim 27  further comprising a personal, password-protected Web page for providing access to the questionnaire for the patient and displaying certain elements of the patient's healthcare history automatically populated based on the contents of the medical data file. 
     
     
         29 . A method of providing a personalized health risk assessment for an individual patient comprising:
 aggregating electronic medical care information relating to the patient using an automated health care computer information system programmed to integrate a plurality of disparate medical data sources, the health care computer information system having access to at least one source of data, including claims data reflecting clinical information obtained from at least one health care provider and submitted in connection with a claim under a health plan;   organizing the aggregated medical care information into a medical data file for the patient and storing the medical data file in a computer readable medium of the health care computer information system;   providing to the patient electronic access to an interactive health risk assessment questionnaire;   receiving a response to the questionnaire from the patient; and   pulling additional medical care information from the response into the medical data file for the patient for updating the medical data file, wherein the health care computer information system is further programmed to build an assessment of the patient's health status and develop an individualized care plan for the patient based on the assessment.   
     
     
         30 . The method of  claim 29  further comprising assigning a task to the patient to ensure compliance with at least one goal of the care plan. 
     
     
         31 . A method of providing a personalized health risk assessment for an individual patient comprising:
 aggregating electronic medical care information relating to the patient using an automated health care computer information system programmed to integrate a plurality of disparate medical data sources, the health care computer information system having access to at least one source of data, including claims data reflecting clinical information obtained from at least one health care provider and submitted in connection with a claim under a health plan;   organizing the aggregated medical care information into a medical data file for the patient and storing the medical data file in a computer readable medium of the health care computer information system;   providing to the patient electronic access to an interactive health risk assessment questionnaire;   receiving a response to the questionnaire from the patient; and   pulling additional medical care information from the response into the medical data file for the patient for updating the medical data file.   
     
     
         32 . A method of providing personalized health reference information to an individual patient comprising:
 aggregating electronic medical care information relating to the patient using an automated health care computer information system programmed to integrate a plurality of disparate medical data sources, the health care computer information system having access to at least one source of data, including claims data reflecting clinical information obtained from at least one health care provider and submitted in connection with a claim under a health plan;   organizing the aggregated medical care information into a medical data file for the patient and storing the medical data file in a computer readable medium of the health care computer information system; and   providing a password-protected, personal Web page for the patient, the Web page providing access to relevant health reference information based on the contents of the medical data file.   
     
     
         33 . The method of  claim 32  wherein:
 the medical data file comprises clinical information reflecting the presence of a medical condition based on an analysis of at least the claims data; and   
       the health reference information includes medical information relating to the condition.