Healthcare assurance system

Abstract

Systems and methods for healthcare assurance system are provided. A first set of confidential health information for an identified patient may be accessed, may be derived from a first data source, and may include first medical indicia corresponding to an indication of a first health condition and/or an indication of a first healthcare service. A second set of confidential health information may be accessed, may be derived from a second data source, and may include second medical indicia corresponding to an indication of a second health condition and/or an indication of a second healthcare service. Healthcare rules that include criteria indicating comorbidity conditions may be accessed. The first and second sets of confidential health information may be correlated to the healthcare rules. A comorbidity condition may be identified on the first medical indicia, and the correlating. A prompt regarding the comorbidity condition may be provided.

What is claimed is: 
     
         1 . A method for generating healthcare recommendations, the method comprising:
 identifying a first healthcare information source for an identified patient;   accessing a first set of confidential medical information for the identified patient from the first healthcare information source;   identifying at least a second healthcare information source for an identified patient, the second health information source residing on a remote server or data store from the first healthcare information source;   accessing a second set of confidential medical information for the identified patient from the second healthcare information source;   consolidating the first and second sets of confidential medical information for the identified patient to form a composite set of confidential medical information;   determining whether one or more information gaps or discrepancies exist in the composite set of confidential medical information;   prompting a user for additional and/or corrective information to resolve any information gaps or discrepancies in the composite set of confidential medical information; and   generating one or more care recommendations for the identified patient based on the composite set of confidential medical information, wherein the one or more care recommendations are weighted based on a reliability of one or more pieces of information underlying a particular care recommendation.   
     
     
         2 . The method of  claim 1 , wherein the user is the identified patient or a legal representative thereof. 
     
     
         3 . The method of  claim 1 , wherein the user is a healthcare provider. 
     
     
         4 . The method of  claim 1 , further comprising the step of determining whether any information gaps or discrepancies persist in the composite set of confidential medical information after the user is prompted for additional and/or corrective information. 
     
     
         5 . The method of  claim 4 , further comprising identifying pieces of information underlying a care recommendation of the one or more care recommendations, and weighing each piece of information underlying the care recommendation according to a score. 
     
     
         6 . The method of  claim 5 , further comprising scoring a piece of information underlying the care recommendation based on one or more of whether the piece of information is missing or non-missing, a source of the piece of information, and whether there are conflicting values for the piece of information in the composite set of confidential medical information. 
     
     
         7 . The method of  claim 6 , further comprising scoring missing pieces of information underlying the care recommendation with a lower score than non-missing pieces of information underlying the care recommendation. 
     
     
         8 . The method of  claim 6 , further comprising scoring pieces of information underlying the care recommendation in relation to an importance of the piece of information to the care recommendation. 
     
     
         9 . The method of  claim 8 , further comprising determining that a reliability of the care recommendation needs improvement, and prompting a healthcare provider or accessing one or more data source(s) or both to seek information needed to improve the reliability of the care recommendation. 
     
     
         10 . The method of  claim 5 , wherein the pieces of information underlying a care recommendation are based at least in part on payer reimbursement guidelines. 
     
     
         11 . A system for generating healthcare recommendations, the system comprising:
 a health information handling system communicatively coupled to a network, the health information handling system configured to identify one or more healthcare information sources for an identified patient and receive data from the one or more healthcare information sources;   a consolidation engine configured to form a composite set of confidential medical information from the data from the one or more healthcare information sources;   a data integrity engine configured to determine whether one or more information gaps or discrepancies exist in the composite set of confidential medical information;   a user interface configured to prompt a user for additional and/or corrective information to resolve any information gaps or discrepancies in the composite set of confidential medical information and receive user input of additional and/or corrective information to resolve any information gaps or discrepancies in the composite set of confidential medical information; and   a recommendation engine configured to generate one or more care recommendations for the identified patient based on the composite set of confidential medical information, wherein the one or more care recommendations are weighted based on a reliability of one or more pieces of information underlying a particular care recommendation.   
     
     
         12 . The system of  claim 11 , wherein the user interface is a device remote from a server hosting the health information handling system. 
     
     
         13 . The system of  claim 12 , wherein the one or more healthcare information sources reside in databases, repositories, websites or servers apart from the server hosting the health information handling system, and electronically accessible by the health information handling system over the network. 
     
     
         14 . The system of  claim 13 , wherein the one or more healthcare information sources comprise one or more of a healthcare provider, a healthcare payer, a personal data source, an immunization registry, a health information exchange, and a regulatory information source. 
     
     
         15 . The system of  claim 11 , wherein the recommendation engine is further configured to correlate pieces of information from the composite set of confidential medical information with care recommendations. 
     
     
         16 . The system of  claim 15 , wherein the data integrity engine is further configured to assess each piece of information underlying a care recommendation for an identified patient and assign a weight to the piece of information. 
     
     
         17 . The system of  claim 11 , further comprising a delta engine configured to identify changes in care guidelines, correlate the changes to a composite set of confidential medical information for an identified patient, identify patients potentially affected by the changes, and notify the user of the changes. 
     
     
         18 . Non-transitory computer-readable media comprising instructions thereon, which, when executed by a processor, cause the processor to:
 identify a first healthcare information source for an identified patient;   access a first set of confidential medical information for the identified patient from the first healthcare information source;   identify at least a second healthcare information source for an identified patient, the second health information source residing on a remote server or data store from the first healthcare information source;   access a second set of confidential medical information for the identified patient from the second healthcare information source;   consolidate the first and second sets of confidential medical information for the identified patient to form a composite set of confidential medical information;   determine whether one or more information gaps or discrepancies exist in the composite set of confidential medical information;   prompt a user for additional and/or corrective information to resolve any information gaps or discrepancies in the composite set of confidential medical information; and   generate one or more care recommendations for the identified patient based on the composite set of confidential medical information, wherein the one or more care recommendations are weighted based on a reliability of one or more pieces of information underlying a particular care recommendation.   
     
     
         19 . The non-transitory computer-readable media of  claim 18 , which, when executed, further cause the processor to determine whether any information gaps or discrepancies persist in the composite set of confidential medical information after the user is prompted for additional and/or corrective information. 
     
     
         20 . The non-transitory computer-readable media of  claim 19 , which, when executed, further cause the processor to score a piece of information underlying one of the one or more care recommendations based on one or more of whether the piece of information is missing or non-missing, a source of the piece of information, and whether there are conflicting values for the piece of information in the composite set of confidential medical information.