System for management and documentation of health care decisions

Abstract

The problem with healthcare today is that clinicians are required to make time sensitive decisions without a complete, comprehensive, objective and easily accessed picture of a patient's overall condition. Healthcare data lives in multiple, unconnected silos and paper based files. The result to hospitals is lost revenue, administrative inefficiencies and increased labor costs. The tool as described above solves for these challenges by providing real time, accumulated, analyzed and scored data and corresponding and relevant workflows that can be accessed at the point of care through claim payment and finalization.

What is claimed is: 
     
         1 . A computer-implemented method for managing and documenting healthcare decisions comprising the steps of:
 providing a non-transitory computer-readable medium database for accumulating and processing information data related to a clinical care determination;   consolidating information data related to a clinical care determination in the database so that it is available to a user, wherein the information data includes administrative, financial and clinical data;   applying a customizable rules engine to the information data to generate a visual guide that links clinical care guidelines and a medical payer denials management processes in order to provide guidance to a real-time clinical care determination;   providing a visual patient dashboard adapted to display the information data, including the visual guide, in accordance with the rules engine.   
     
     
         2 . A computer-implemented method as described in  claim 1 , wherein the visual guide comprises a wellness score that is representative of the overall wellness of a patient prior to the onset of a current health issue of the patient. 
     
     
         3 . A computer-implemented method as described in  claim 2 , wherein the wellness score is calculated by assigning a numerical value to each of a plurality of health factors that impact overall wellness on a predefined wellness scale. 
     
     
         4 . A computer-implemented method as described in  claim 3 , wherein the wellness score is visually presented on the patient dashboard as green (good), yellow (fair), or red (poor) depending on a specific patient wellness score. 
     
     
         5 . A computer-implemented method as described in  claim 1 , wherein the visual guide further comprises an acuity score that is representative of the condition of a patient at the onset of the current health issue of the patient. 
     
     
         6 . A computer-implemented method as described in  claim 5 , wherein the acuity score is calculated by assigning a second numerical value to each of a plurality of diagnostic data and then combining the second numerical values to determine an acuity score. 
     
     
         7 . A computer-implemented method as described in  claim 6 , wherein the acuity score is visually presented on the patient dashboard as green (low acuity), yellow (medium acuity), or red (high acuity) depending on a specific patient acuity score. 
     
     
         8 . A computer-implemented method as described in  claim 5 , wherein the visual guide comprises a visual care level score which is a numerical indicator that assists a user with deciding a level of service for a patient,
 wherein the level of service includes an inpatient care level and an observation care level.   
     
     
         9 . A computer-implemented method as described in  claim 8 , wherein the care level score comprises a gauge on the patient dashboard, wherein the higher the numerical indicator, the closer the gauge will visually indicate an inpatient level of care. 
     
     
         10 . A computer-implemented method as described in  claim 8 , wherein the care level score is based on a calculation comprising patient wellness and patient acuity scores. 
     
     
         11 . A computer-implemented method as described in  claim 5 , wherein the visual guide further comprises condition specific mappings of clinical values related to actual patient care service diagnostic outcomes. 
     
     
         12 . A computer-implemented method as described in  claim 11 , wherein the visual guide further comprises an appeal score that is a likelihood that an unpaid or denied healthcare claim by a healthcare provider to a payer will be resolved in the favor of the healthcare provider,
 and wherein the appeal score is based on a clinical strength of the claim and a financial strength of the claim as measured by the healthcare provider's past success rate of overturning similar unpaid or denied healthcare claims.   
     
     
         13 . A computer-implemented method as described in  claim 2 , further comprising predicting the existence of a chronic condition based on at least the wellness score, a care level score, and diagnostic data, and displaying the prediction of the patient dashboard.