Invented by Rachel Phillips, Individual
The Individual invention works as followsA system server” stores and provides access to patient information. It can also include a discharge management and/or repatriation system. The repatriation system allows for the transfer of patients from an out-of network hospital that admits a patient to a destination hospital in the network. The repatriation system includes a computer software program that analyzes patient data and candidate destination hospital information, then calculates matches between them. The discharge management system allows for the transfer of patients from acute care hospitals to remote care facilities. The discharge management system contains a computer program that analyzes patient data and determines if a patient is discharged. The system server has been networked in order to provide remote access to stored data, as well as communication between the admitting and destination hospitals, medical transport providers, and remote care facilities.
Background for Systems and Methods for Automated Repatriation of Patients from Out-of-Network Admitting Hospitals to In-Network Destination Hospitals
This disclosure is generally a hospital case management system. It includes, for example, systems and methods to automate the repatriation from out-of network hospitals to in-network facilities of a patient; or systems and methodologies for automated discharge management.
Patients often are admitted to hospitals that are not covered or are only partially covered by their insurer. In an emergency, the patient may be taken to the nearest hospital regardless of their insurance status. If the patient’s insurance does not cover the costs incurred during her stay at an out-of network hospital, or if she is unwilling to pay, the patient may be left with no way to pay. Once a patient has reached a stable medical condition, it may be desirable to move her from an out-of network hospital to a hospital in the same network. The process of repatriation is called here. To repatriate out-of network patients to in-network or other medical facilities requires a lot of planning. This often involves numerous communications back and forth between the caseworker at the admitting facility, the staff at the destination, and the medical transport provider.
Acute-care patients who are hospitalized for a medical condition but are not medically stabilized typically become medically stable enough to be discharged. However, they may still have chronic conditions and require skilled nursing care. These patients are typically transferred to medical facilities with a nursing staff that is skilled and/or doctors on call to attend to their medical needs. This discharge process involves a lot of back-and forth communication between case managers and multiple facilities. It also includes hospital visits, evaluations of patients, and reviews of evaluation reports.
The program further comprises second instructions which, when executed by the computer hardware, handle selection and repatriation requests for candidate destination hotels and repatriate the patient from the out-of network admitting hospital to the in The program also includes second instructions which, when executed by the computer hardware, handle selection and repatriation of candidate destinations hospitals, and repatriates a patient from an out-of network admitting to a The program also comprises third instructions which, when executed by the computer hardware, arranges patient transport electronically. These third instructions cause computer hardware to electronically receive an ambulance request from the admitting hospitals to schedule transport to the selected destination,
In some embodiments, a fourth set of instructions is included in the program. These instructions, when executed on computer hardware, will cause it to receive the patient-specific codes and, upon receiving them, to automatically access patient data. In some embodiments the patient-specific codes are received by a barcode or QR scanner. In some embodiments the patient’s code is used to indicate admission to an admitting facility. The fourth instruction causes the hardware to alert the insurer automatically upon receiving the code. In some embodiments the patient data includes at least one or two medical parameters, while the data about candidate destination hospital includes at least one or two clinical capabilities. The automatic matching of the patients to one or several of the destination hospitals is based on the matching of both the medical parameters and the clinical abilities of the destination hospitals. In some embodiments the information about the patient’s insurance network includes a list ambulance providers that are associated with the insurer of the person. The third instructions direct the computer hardware only to transmit the ambulance requests to those ambulance providers on the list. In some embodiments the third instructions also cause the computer to: electronically accept, from three or a greater number of ambulance providers, an acceptance of the request for ambulance services, electronically transmit these acceptances to the admitting hospitals, and then electronically receive a selection of ambulance providers from the admitting hospitals. In some embodiments the third instructions also cause the computer to notify the insurer of the patient electronically of the selected provider.
The method further comprises handling, using computer hardware a request to repatriate the patient from the out-of network admitting hospital to the in-networkdestination hospital. The method also comprises handling, with computer hardware, a demand to repatriate a patient from an out-of network admitting to a destination in-network hospital. This handling includes: electronically transmitting to the admitted hospital a list of one or two candidate destination hotels matched to patient; electronically requesting a repatriation from the admitted hospital, which indicates a selected hospital from the list of one or more candidates destination hospitals matched patient; electronically transmitting this request The method also comprises electronically arranging patient transport using computer hardware. This electronically arranging includes: electronically receiving from the admitting hospitals an ambulance request for scheduling transport of the patient from the out-of-network admitting hospital to the in-network destination hospital; electronically transmitting this request to one or more of the hospital providers and then electronically transmitting that acceptance to the admitting.
In some embodiments, a QR code or barcode is scanned to obtain a patient specific code. The patient data are then automatically accessed in response. In some embodiments the patient’s code is used to indicate admission to an admitting facility. The method also includes automatically alerting the patient’s insurer upon receipt of the code. In some embodiments the patient data includes additional medical parameters, while the data about candidate destination hospital includes one of more clinical capabilities. The automatic matching of the patient with one of more candidate destination is based on the matching of medical parameters and clinical capabilities. In some embodiments the patient’s insurance network includes a list ambulance providers that are associated with the patient?s insurer. The method then consists of sending the ambulance request to only ambulance providers on the list. In some embodiments the method also comprises receiving acceptances from at least three ambulance providers and transmitting them electronically to the admitting hospitals; receiving a selection of ambulance providers from the admitting hospitals; and notifying the insurer of the patient electronically of the selected provider.
The system further comprises an admitting hospital module comprising instructions stored on one or more computer memory devices that, when executed by one or multiple hardware processors, cause the admitting hospital module to: provide an interface for receiving a request to match a patient admitted to the admitting hospital with at least candidate destination hospital information; candidate destination hotel data including at most insurance network data for candidate destination hospitals. The system also includes an admitting-hospital module that comprises instructions stored on one of more computer memory devices. When executed by one of more hardware processors the admitting-hospital module will: provide an interface for receiving a request for matching a patient admitted at the admitting-hospital to one of more candidate destinations hospitals. This matching is based, at least, upon matching insurance network data of the patients and insurance network data of candidate destination hotels; automatically match one of more candidate destinations hospitals to a patient; list one of more candidatedestinations hospitals that are matched with The system also includes a destination module that consists of instructions stored on computer memory devices. When executed by one of more hardware processors the destination module is able to: receive a request for repatriation from the admitting facility; and accept the request for repatriation from the destination facility. The system also comprises a module for the medical transportation provider, which comprises instructions stored on computer memory devices. When executed by one of more hardware processors the module will: indicate receipt of a repatriation request from an admitting hospital, and receive acceptance from the destination hospital.
In some embodiments the admitting module also comprises instructions that are stored on one of more computer memory devices. When executed by one or multiple hardware processors, these instructions cause the admitting module to display a message that a code specific to a patient can be entered via a barcode or QR code to obtain patient data automatically. In some embodiments the insurance network data of the patient contains a list of providers of medical transportation associated with their insurer. The medical transport provider module displays only an indication that the transport request is from the admitting hospitals for providers of medical transportation associated with the insurer. In some embodiments the admitting module also includes instructions stored on one computer memory device that, when executed via one or multiple hardware processors cause the module to: indicate the acceptances of transport requests from three or four medical transport provider; and receive a selection of a medical transport provider accepting the request. In some embodiments the admitting module also comprises instructions stored on computer memory devices which, when executed by hardware processors, causes the module to receive an alert to inform the insurer of the patient about the acceptance of a medical transport provider. The medical transport provider module may also include instructions that are stored on memory devices. When executed by hardware processors they cause the module to notify the medical transport module that the request for transport from the admitting facility has been cancelled.
Additional embodiments of the present invention provide a case management system and method to place a patient in a remote facility for recuperating care from an acute-care hospital environment. It is a function to use a secure interactive online computerized system in order to plan, arrange and execute the placement of a non-hospitalized patient, but who still needs some health care assistance. This would typically be at a remote facility.
The bedside nurse can monitor and enter the clinical data and the medical parameters of a patient into a portable terminal every day during the shift report. This system doesn’t require the involvement of a hospital case manager. The clinical data entered can be wirelessly transmitted to a remote system server located off-site for storage and access in the future. The system server can analyze the data entered and the patient’s condition using a computer program. The analysis of entered data can identify abnormal readings, identifying issues with patient placement and discharge. The medical staff can be alerted by flagging these patient medical issues and hospital discharge problems. The hospital staff can then formulate solutions to these problems and implement them so that patients can be discharged. The clinical data may be stored in a system memory for data storage and then retrieved on demand. A network of electronic communications can be used to communicate electronically with the system server, and multiple remote health care facilities in order to access the data stored within the system data memory. Once the patient’s case is offered to a distant care facility, the entered and stored data are accessible both from the portable data entry devices and remote care facilities. Additionally, cyber communications over the network between remote care facilities and portable data entry terminals can facilitate placement of the patients in remote care facilities after discharge from acute-care hospitals.
In one embodiment, portable data entry terminals may include laptop computers, smartphones or personal digital assistants. These devices are portable, allowing the nurse to take the data entry terminals from patient to patient during her morning visits. Wirelessly, the data entered manually into the notebook computer can be transferred to an off-site server. The data can be transferred to a desktop computer using a cable connection or a cradle that is attached to the desktop computer. By using the network interactively, the data in the system memory can be accessed securely via a password. This allows cyber communication between the components of the Case Management System. The case management system can be linked to typical components, such as a scanner, printer and photocopier. The system can be set up to match hospital patients with real-time available discharge facility beds, based, at least partially, on the details entered by the staff of the discharge facility. These include the gender of the patient, the insurance payer and the acceptable isolation combinations. This increases the chance of capturing beds more quickly. The facility can receive matched case information, a clinical summary and the needs of the patient. The system can be configured to alert a hospital case manager when entered clinical data is not compatible with a doctor’s order for grading of the discharge facility. The system can also create a list of all inappropriate clinical conditions for the hospital case manager, and provide problem-solving algorithms to resolve these clinical issues. This allows the physician to fulfill the order and avoid unsafe transfers of patients into discharge facilities that do not offer the right level of medical treatment. The discharge facility can confirm acceptance of a patient through a series proprietary electronic interactions with multiple hospitals. This eliminates the need for further faxes or phone calls. The system can notify non-chosen patients that the bed is reserved or closed to submissions, so the case manager can then submit to other beds available on the system. The hospital case manager can electronically withdraw acceptance of the bed in the event that the patient’s health deteriorates prior to transfer. They can also request a short term hold, which will keep the facility bed reserved for a specified period. The facility can tag patients who need to be returned from their facility to a hospital for temporary high-level medical care. This will ensure that they return to the facility when the discharge process is completed. The system can alert the facility when the hospital case manager has entered a submission for their tagged patient, allowing them to open a bed. The discharge facility can assign a hold to a patient’s bed if they need to return to hospital for a higher level of care. This will alert hospital nurses and/or the case manager that the bed is being held. The system can also be used by the discharge facility in order to communicate to the case manager or nurse the desired arrival time of the patient for admission to discharge facility. The system allows the nurse or case manager to request online transfers of ambulances from multiple ambulance companies, with information like desired arrival times to the designated discharge facility and the level of transport required. To ensure that hospital-contracted ambulance services are used efficiently, it is possible to highlight contracted ambulance companies. Then, multiple ambulance companies can respond electronically with the available times to transport the patient. The hospital case manager, nurse or other staff member can select the ambulance company to transport the patient and confirm it electronically. No phone calls or faxes are required. The ambulance company may be able to notify hospital case managers, nurses, patients, family members, and/or physicians electronically of delays in transport or cancellations of transport. A hospital case manager or a nurse may be able to cancel or withdraw the ambulance transport through an online interface.
In some embodiments, a patient or family member may be provided with an access code that allows them to visit designated sites within the system to find resources for selecting a facility. Such sites could, for example, provide video modules on the levels of care and service provided by discharge facilities, as well as marketing materials, and the ability to search multiple facilities. videos. The system allows patients and their families to rate the discharge facility they prefer using a numeric ranking system. This can alert the hospital case manager, or the nurse of these preferences. The system can provide patients and families with the name and contact details of their designated hospital case manager. It can also update this information if the case manager’s assignment changes during the hospital stay. The system can allow the patient or family to request an online meeting with the case manager. The system may also inform the patient or family about the change in status of discharge, and finally the name of accepting discharge facility and contact information of the physician assigned.
The system allows physicians to view discharge clinical data off-site, which allows them to accept or reject referrals from discharge facilities. The system will also notify physicians when the hospital case manager’s assignment changes and provide them with the name and contact details of that person. It can also inform the doctors of the placement status, accepting facility and arrival time once the placement is complete.
Another feature includes a program that instructs the server system to automatically transmit a signal over the network to mobile communication devices to indicate when a threshold has occurred, and the corresponding data have been entered into system data storage memory in clinically sensitive cases. The system server’s signal can be audio beeps, text messages or directed at one or more doctors practicing in relevant medical specialties. The subject of the text can also be displayed on the ‘general menu’ for the physician. The subject matter of the text message can also be listed on the?general menu? Referring to a specific medical case. A mobile communication device can be a smart-phone, PDA or cell phone carried by a physician who is responding to the signal. A second feature allows the computer program automatically instructs the system server in order to recognize the secure password sent to the server via the network by one of the remote facilities to gain access to data stored on the system data memory to investigate the condition of the patients.
Another feature allows the payer or provider of medical care, such as an insurance company, Independent Physician Association, etc., to have daily access patient clinical information, and case management forms. The system server is also able to compare the data stored in the memory of the system and entered by the portable data entry devices with the criteria profile of an insurance company. The criteria profile outlines the requirements for determining if a patient is insured by the insurance company, what limitations are in the policy of the insured and whether a policy is enforceable. The criteria profile will then automatically approve or deny patient expenses or send the decision to an Independent Physician Association or medical review panel at the insurance company. The design eliminates the need for ongoing telephone conferences to discuss authorizations of expenses and denials between the case manager of the hospital and case manager of the insurance company. A second feature focuses on electronic billing of services rendered. The financial records of the treatment program for the patient can be used to generate a billing statement that will be sent from the hospital to an appropriate managed care provider, or insurance company to reimburse the expenses and charges related to treating the patient. Billing statements can be sent electronically or on paper. Billing statements can also be generated to present to other medical insurance programs, such as the California State Medi-Cal or Federal Medicare. The original data entered by nursing staff can contain all the information needed to generate a bill for the federal or state medical programs.
In one embodiment, the interactive/integrated case management system and method for use in an acute care hospital environment for placement of a patient upon discharge from the acute care hospital environment to a remote care facility including a plurality of portable data entry terminals for entering data for monitoring medical parameters of a patient in a hospital environment. Wirelessly connecting the portable data entry devices to a remotely located system is used to receive, store and provide access to entered data. The system server includes a computer software for analyzing entered data and determining whether and at what level he will be discharged. The system server has a system data memory for storing and retrieving entered data. A network is in secure online interactive cyber communication with a system server and multiple remote care centers in order to enable access to data stored in the memory of the system.
Although specific embodiments are described here, the inventive subject matter goes beyond these examples to include other alternative embodiments, uses, modifications, and equivalents. The claims are not restricted by the embodiments below. In any disclosed method or procedure, for example, the acts or processes of the method or the process can be performed in a suitable order and are not limited to a particular disclosed sequence. The order in which certain operations are described may help to understand some embodiments. However, this does not imply that the operations must be performed in that order. Structures, systems and/or devices may also be implemented as integrated components, or separate components. To compare different embodiments, some aspects and benefits of each embodiment are described. Some embodiments may not achieve all of these aspects or benefits. “For example, different embodiments can be implemented in a way that optimizes or achieves one or a group of benefits as described herein, without necessarily achieving or achieving any other aspects or features as suggested or taught herein.
Case Management System” Overview
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