Systems and methods for assessing and optimizing healthcare administration

Abstract

A comprehensive patient data assessment system and method for use in generating, tracking and analyzing medical data related to healthcare administered by a group of physicians to a specified patient population. The system is operative to track data related to the claims history, case management, pharmacy data, and lab tests/results for each patient treated by each patient's primary care physician preferably through electronic medical records that are accessible over a computer network. The system is operative to generate data indicative of the utilization of healthcare resources utilized to treat each patient within the patient population, as well as ensure that each primary care physician utilizes appropriate codes for each diagnosis and procedure/test administered to each patient. The system further provides for categorization of patients afflicted with chronic conditions that require high-cost care. The systems are exceptionally effective in conserving medical resources, ensuring uniformity in administering healthcare, and achieving optimal patient outcomes.

1 . A method of administering healthcare comprising the steps:
 a. identifying a patient population to which healthcare is administered;   b. identifying a group of physicians responsible for administering care to said patient population identified in step a;   c. receiving a request from a patient within said patient population for medical services to be rendered by a respective one of said physicians identified in step b;   d. implementing a coding practice in response to said request made in step c wherein said physician requested to render medical services in response to said request inputs in to an electronic medical records system a diagnosis code indicative of the physician's diagnosis of the patient's condition and a code indicative of the medical services rendered to treat the patient's condition;   e. assessing said diagnosis code input in step d for accuracy and appropriateness of the code input in step d for the prescribed medical services tendered; and   f. statistically tracking any incidence of inaccurate diagnosis or inappropriate medical services rendered in step e.   
     
     
         2 . The method of  claim 1  wherein in step d, additional medical information is input into said electronic medical record, said additional information comprising the identity of the patient, the identity of the physician, the facility where medical services were rendered and the date said medical services were rendered. 
     
     
         3 . The method of  claim 2  wherein in step d, said medical information input into said electronic medical records further comprises information identifying any laboratory tests ordered in connection with the treatment of said patient, results of such laboratory tests, and the date such arbitrary tests were ordered. 
     
     
         4 . The method of  claim 2  wherein in step d, said medical information input into said electronic medical records further comprises pharmacy data related to any prescription medications prescribed to said patient in connection with the medical services rendered by said physician, said pharmacy data comprising identifying the prescribing physician, identifying the medication prescribed, indicating the strength of the medication prescribed, indicating the dosage of the medication prescribed, identifying the quantity of medication prescribed, and indicating the date such medication was prescribed. 
     
     
         5 . The method of  claim 1  wherein said method further comprises repeating steps a-f such that electronic medical records are generated for each patient within the patient population corresponding to each time each patient has requested medical services from physicians specified within the group of physicians. 
     
     
         6 . The method of  claim 5  further comprising the step of periodically reviewing and evaluating said electronic medical records to determine the accuracy of diagnoses and utilization of healthcare resources as administered by said physicians amongst said patients within the patient population. 
     
     
         7 . The method of  claim 1  wherein in step b, said group of physicians comprises primary care physicians. 
     
     
         8 . The method of  claim 1  wherein in step d, said coding practice further comprises identifying a high-cost chronic condition code to the extent said patient seeking medical services is diagnosed with a high-cost chronic condition. 
     
     
         9 . The method of  claim 8  wherein said high-cost chronic condition is selected from the group of conditions consisting of cancer, cardiovascular disease, diabetes, dialysis condition, HIV/opportunistic infection, liver disease, pulmonary disease and quadriplegia/extensive paralysis. 
     
     
         10 . The method of  claim 9  wherein when said patient is diagnosed with a high-cost chronic condition, step e further comprises reviewing and confirming said diagnosis of said high-cost chronic condition, periodically reviewing said patient's condition to determine whether further coding is required, and reviewing said patient's condition to determine whether said patient needs to be diagnosed as having a related medical condition. 
     
     
         11 . The method of  claim 10  wherein in step d, said medical treatment administered to said patient conforms to a standardized criteria of care. 
     
     
         12 . The method of  claim 11  wherein said standardized criteria of care substantially conforms to criteria established by the National Committee for Quality Assurance. 
     
     
         13 . The method of  claim 12  wherein in step d, said electronic medical records are accessible over a computer network. 
     
     
         14 . The method of  claim 13  wherein said electronic medical records are accessible over the Internet. 
     
     
         15 . The method of  claim 12  wherein in step e, a standardized evaluation is implemented to ensure that patients afflicted with a high-cost chronic condition are continuously evaluated according to a standardized medical criteria consisting of clinical questions regarding the progression of the patient's disease and a review of the patient's medical records. 
     
     
         16 . A system for facilitating the administration of healthcare comprising:
 a. a computer network operative to receive, generate, store, retrieve and transmit data;   b. an electronic medical records system operative to receive, generate, store, retrieve and transmit medical data indicative of medical diagnoses and services rendered by individual physicians to individual patients, said electronic medical records system being operatively interfaced with said computer network;   c. a standardized criteria of care integrated within said electronic medical records system for comparing a standardized criteria of care to care rendered by said physicians to said patients as documented by said electronic medical records; and   d. a review authority for comparing said differences in said standardized criteria of care and said care identified in said electronic medical records.   
     
     
         17 . The system of  claim 16  wherein said electronic medical records system is operative to receive coding information corresponding to diagnostic information and coding information corresponding to medical treatment information as rendered by said individual physicians to said individual patients. 
     
     
         18 . The system of  claim 17  wherein said electronic medical records system is further operative to receive data indicative of the diagnosis and treatment of patients afflicted with a high-cost chronic condition and said standardized criteria of care integrated within said electronic medical records system is operative to provide an indication to the physicians treating said patients with said high-cost chronic condition to determine whether treatment of said patient requires further coding and whether said patient requires diagnosis of a related medical condition.