CA2847761C - Systems and methods for facilitating pharmaceutical patient assessments - Google Patents
Systems and methods for facilitating pharmaceutical patient assessments Download PDFInfo
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- CA2847761C CA2847761C CA2847761A CA2847761A CA2847761C CA 2847761 C CA2847761 C CA 2847761C CA 2847761 A CA2847761 A CA 2847761A CA 2847761 A CA2847761 A CA 2847761A CA 2847761 C CA2847761 C CA 2847761C
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- 238000000034 method Methods 0.000 title claims abstract description 37
- 229940079593 drug Drugs 0.000 claims description 57
- 239000003814 drug Substances 0.000 claims description 57
- 238000004891 communication Methods 0.000 claims description 48
- 238000012552 review Methods 0.000 claims description 15
- 230000015654 memory Effects 0.000 claims description 13
- 238000002255 vaccination Methods 0.000 claims description 7
- 238000010586 diagram Methods 0.000 description 21
- 238000007726 management method Methods 0.000 description 20
- 238000012545 processing Methods 0.000 description 18
- 230000008901 benefit Effects 0.000 description 14
- 230000006870 function Effects 0.000 description 9
- 238000002483 medication Methods 0.000 description 6
- 230000004044 response Effects 0.000 description 6
- 230000036541 health Effects 0.000 description 5
- 238000004590 computer program Methods 0.000 description 4
- 238000013500 data storage Methods 0.000 description 3
- 230000008569 process Effects 0.000 description 3
- -1 services Substances 0.000 description 3
- 238000006243 chemical reaction Methods 0.000 description 2
- 230000000694 effects Effects 0.000 description 2
- 230000003993 interaction Effects 0.000 description 2
- 230000007774 longterm Effects 0.000 description 2
- 238000012986 modification Methods 0.000 description 2
- 230000004048 modification Effects 0.000 description 2
- 230000004913 activation Effects 0.000 description 1
- 230000001684 chronic effect Effects 0.000 description 1
- 230000009849 deactivation Effects 0.000 description 1
- 206010012601 diabetes mellitus Diseases 0.000 description 1
- 238000003745 diagnosis Methods 0.000 description 1
- 238000004519 manufacturing process Methods 0.000 description 1
- 230000000474 nursing effect Effects 0.000 description 1
- 230000002093 peripheral effect Effects 0.000 description 1
- 238000003672 processing method Methods 0.000 description 1
- 238000012546 transfer Methods 0.000 description 1
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H20/00—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance
- G16H20/10—ICT specially adapted for therapies or health-improving plans, e.g. for handling prescriptions, for steering therapy or for monitoring patient compliance relating to drugs or medications, e.g. for ensuring correct administration to patients
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- G—PHYSICS
- G16—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR SPECIFIC APPLICATION FIELDS
- G16H—HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G16H10/00—ICT specially adapted for the handling or processing of patient-related medical or healthcare data
- G16H10/60—ICT specially adapted for the handling or processing of patient-related medical or healthcare data for patient-specific data, e.g. for electronic patient records
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- Chemical & Material Sciences (AREA)
- Bioinformatics & Cheminformatics (AREA)
- Medicinal Chemistry (AREA)
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Abstract
Systems and methods are provided for pharmaceutical patient assessment. A prescription fill request may be received by a computer. The prescription fill request may include a patient identifier. The computer may utilize the patient identifier to determine whether a patient is eligible for a pharmaceutical patient assessment. If the patient is eligible, the pharmacy computer may transmit a notification of the eligibility to a pharmacy device. The computer may receive, from the pharmacy device, pharmaceutical patient assessment information indicating the pharmaceutical patient assessment was performed.
Description
SYSTEMS AND METHODS FOR FACILITATING PHARMACEUTICAL PATIENT
ASSESSMENTS
TECHNICAL FIELD
[0001] Aspects of the disclosure relate generally to determining and communicating pharmaceutical patient assessments and more particularly, to systems and methods for determining and communicating an eligibility of a patient to receive pharmaceutical patient assessments.
BACKGROUND
ASSESSMENTS
TECHNICAL FIELD
[0001] Aspects of the disclosure relate generally to determining and communicating pharmaceutical patient assessments and more particularly, to systems and methods for determining and communicating an eligibility of a patient to receive pharmaceutical patient assessments.
BACKGROUND
[0002] Today, some healthcare services may be performed by a pharmacist or other healthcare professional at a pharmacy. For instance, pharmacists may be able to perform medication reviews, vaccination, pharmaceutical opinions, and other services for eligible patients. Typically, determining which patients are eligible may be a time-consuming process. Additionally, in certain cases, these pharmaceutical patient assessments may be paid for by a government entity. One or more forms may be filled out to record performance of the pharmaceutical patient assessment to report to the government entity and also to the original healthcare provider (e g , prescriber).
SUMMARY OF THE INVENTION
[0002a1 In one aspect of the invention, there is provided a computer-implemented method performed by one or more computers comprising at least one memory and a processor, an application stored in the at least one memory and having computer code wherein said computer code is executed by said processor of the one or more computers; and the processor configured to access the at least one memory and execute the computer-executable instructions comprising instructions for: receiving, by the one or more computers an electronic prescription fill request; determining, by the one or more computers, that the electronic prescription till request includes at least one patient identifier for a patient;
determining, by the one or more computers and based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment;
generating, by the one or more computers and upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
via a communications network, transmitting, by the one or more computers, the notification to a pharmacy device;
via the communications network, receiving, by the one or more computers from the pharmacy device, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment; generating, by the one or more computers, an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, transmitting, by the one or more computers, the electronic prescription transaction to one or more claims processor computers for adjudication [0002b] In another aspect of the invention, there is provided a system, comprising: at least one processor; and at least one memory storing computer-executable instructions, that when executed by the at least on processor, cause the at least one processor to: receive an electronic prescription fill request; determine that the electronic prescription fill request includes at least one patient identifier associated with a patient; determine, based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment; generate, upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
direct communication of the notification to a pharmacy device via a communications network;
receive, from the pharmacy computer, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment via the communications network;
generate an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, direct communication of the electronic prescription transaction to one or more claims processor computers for adjudication.
[0002c] In yet another aspect to the invention, there is provided a non-transitory computer-readable medium storing computer-executable instructions, that when executed by at least one processor, cause the at least one processor to: receive, from a pharmacy computer associated with a pharmacy, an electronic prescription fill request; determine that the electronic prescription fill request includes at least one patient identifier associated with a patient; determine, based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment; generate, upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible; transmit the notification to a pharmacy device via a communications network;
receive, from the pharmacy computer, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment via la the communications network; generate an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, direct communication of the electronic prescription transaction to one or more claims processor computers for adjudication.
BRIEF DESCRIPTION OF THE DRAWINGS
SUMMARY OF THE INVENTION
[0002a1 In one aspect of the invention, there is provided a computer-implemented method performed by one or more computers comprising at least one memory and a processor, an application stored in the at least one memory and having computer code wherein said computer code is executed by said processor of the one or more computers; and the processor configured to access the at least one memory and execute the computer-executable instructions comprising instructions for: receiving, by the one or more computers an electronic prescription fill request; determining, by the one or more computers, that the electronic prescription till request includes at least one patient identifier for a patient;
determining, by the one or more computers and based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment;
generating, by the one or more computers and upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
via a communications network, transmitting, by the one or more computers, the notification to a pharmacy device;
via the communications network, receiving, by the one or more computers from the pharmacy device, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment; generating, by the one or more computers, an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, transmitting, by the one or more computers, the electronic prescription transaction to one or more claims processor computers for adjudication [0002b] In another aspect of the invention, there is provided a system, comprising: at least one processor; and at least one memory storing computer-executable instructions, that when executed by the at least on processor, cause the at least one processor to: receive an electronic prescription fill request; determine that the electronic prescription fill request includes at least one patient identifier associated with a patient; determine, based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment; generate, upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
direct communication of the notification to a pharmacy device via a communications network;
receive, from the pharmacy computer, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment via the communications network;
generate an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, direct communication of the electronic prescription transaction to one or more claims processor computers for adjudication.
[0002c] In yet another aspect to the invention, there is provided a non-transitory computer-readable medium storing computer-executable instructions, that when executed by at least one processor, cause the at least one processor to: receive, from a pharmacy computer associated with a pharmacy, an electronic prescription fill request; determine that the electronic prescription fill request includes at least one patient identifier associated with a patient; determine, based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment; generate, upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible; transmit the notification to a pharmacy device via a communications network;
receive, from the pharmacy computer, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment via la the communications network; generate an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, direct communication of the electronic prescription transaction to one or more claims processor computers for adjudication.
BRIEF DESCRIPTION OF THE DRAWINGS
[0003] Reference will now be made to the accompanying drawings, which are not necessarily drawn to scale, and wherein:
[0004] FIG. 1 illustrates an example system for facilitating, among other things, pharmaceutical patient assessments, according to one exemplary embodiment.
[0005] FIG. 2 is a block diagram for receiving and communicating a healthcare transaction, according to one exemplary embodiment.
[0006] FIG. 3 illustrates a flow chart of an example method for receiving and communicating a healthcare transaction, according to one exemplary embodiment.
[0007] FIG. 4 is a block diagram for determining eligibility of patients for pharmaceutical patient assessments, according to one exemplary embodiment.
DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS
lb 100081 Exemplary embodiments will now be described more fully hereinafter with reference to the accompanying drawings, in which exemplary embodiments are shown. The concepts disclosed herein may, however, be embodied in many different forms and should not be construed as limited to the exemplary embodiments set forth herein;
rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the concepts to those skilled in the art. Like numbers refer to like, but not necessarily the same or identical, elements throughout.
100091 Exemplary embodiments described herein include systems and methods that facilitate pharmaceutical patient assessments. In some example implementations, a prescription fill request may be received by a pharmacy computer, such as from a patient visiting a pharmacy where the pharmacy computer is located. Additionally, the prescription fill request may include information that enables the pharmacy computer to identify the associated patient. Upon identifying the patient, the pharmacy computer may access patient information associated with the patient. The patient information may include, but is not limited to, active medication information, medication history information, visit history information, location information, patient demographic information (e.g., age, gender, zip/postal code, etc.) and/or other types of pharmaceutical information related to the patient.
The pharmacy computer may compare the patient information with one or more pharmaceutical patient assessment eligibility thresholds (e.g., medication review thresholds, vaccination thresholds, pharmaceutical opinion thresholds, and/or the like).
Based on the comparison, the pharmacy computer may determine whether the patient is eligible for any pharmaceutical patient assessments. If a patient is eligible for a pharmaceutical patient assessment, the pharmacy computer may transmit, to a mobile pharmacy device of a pharmacy, a notification indicating the patient's eligibility for the pharmaceutical patient assessment. The notification may be sent as part of an adjudicated response from a claims processor. Alternatively, the notification may be sent as a separate message.
In certain cases, upon receiving the notification, a pharmacist or other healthcare professional associated with the pharmacy may perform the eligible pharmaceutical patient assessment for the patient. The pharmacist may record the details of the service with the pharmacy computer, which may be stored as pharmaceutical patient assessment information. The pharmacy computer may transmit the pharmaceutical patient assessment information back to the pharmacy computer. The pharmacy computer may generate one or more completed forms based on the pharmaceutical patient assessment information and transmit the completed form to the healthcare provider computer. In certain implementations, the pharmacy computer may also generate a prescription transaction based at least in part on the pharmaceutical patient assessment information, and transmit the prescriptoin transaction to a claims processor computer for adjudication.
100101 System Overview 100111 FIG. 1 illustrates an example system 100 for facilitating, among other things, determining whether a patient, who is a consumer of and/or otherwise associated with a pharmacy, is eligible for one or more pharmaceutical patient assessments that may be provided at the pharmacy. As shown in FIG. 1, the system 100 may include one or more pharmacy computers 104, claims processor computers 106, and/or pharmacy mobile device(s) 108. As desired, each of the pharmacy computer 104, claims processor computer 106, and/or pharmacy mobile device 108 may include one or more processing devices that may be configured for accessing and reading associated computer-readable media having stored data thereon and/or computer-executable instructions for implementing various embodiments of the disclosure.
100121 Additionally, in one or more example embodiments of the disclosure, the pharmacy computers 104 may include or otherwise be in communication with a pharmaceutical patient assessments module 110. The pharmaceutical patient assessments module 110 may include computer-executable instructions operable for facilitating the determination of an eligibility of a patient for pharmaceutical patient assessments at a pharmacy. For example, the pharmaceutical patient assessments module 110 may facilitate creation of a prescription transaction (i.e., a predetermination of benefits transaction, healthcare claim transaction, prescription claim or billing request, healthcare order transaction, or e-prescription transaction (i.e., electronic prescription order transaction, e-script, or e-prescription)). The pharmaceutical patient assessments module 110 may facilitate storage of information related to the prescription transaction in one or more suitable databases and/or data storage devices 112. For example, the pharmaceutical patient assessments module 110 may facilitate the storage and/or access of information including, but not limited to, patient information (i.e., identifier (e.g., patient social security number, a subset of the patient social security number, health insurance claim number (HICN), cardholder ID, etc.), name, gender, date of birth), benefits provider identifier (e.g., Banking Identification Number (BIN Number), BIN Number and Processor Control Number (PCN), or BIN Number and Group ID), benefits provider name, date of service, software and/or vendor certification identification, pharmacy identification qualifier, pharmacy identification (e.g., store and/or chain name, group ID, BIN Number, or the like), medication information (i.e., medication name(s), National Drug Code (NDC) numbers, RxNorm medication identifiers, and the like).
100131 Further, the pharmaceutical patient assessments module 110 may facilitate storage of patient information including, but not limited to, medication information (e.g., total number of medications, medication name(s), NDC numbers, RxNorm medication identifiers, quantity of medication to be dispensed, days' supply, dosage), patient information (i.e., identifier (e.g., patient social security number, a subset of the patient social security number, health insurance claim number (HICN), cardholder ID, etc.), name, gender, date of birth), and prescriber identification number (ie., prescriber ID ((e.g., National Provider Identifier (NPI) number and/or a provider identification issued by the Drug Enforcement Agency (DEA))), prescriber name, and prescriber ZIP code or other postal zone identifier for a prescription.
100141 In addition to receiving and storing information, the pharmaceutical patient assessments module 110 may be further operable to access and/or be in communication with one or more suitable databases and/or data storage devices 112. In one non-limiting example, the pharmaceutical patient assessment module 110 may facilitate generation of a prescription transaction in response to receiving a prescription fill request from a patient.
Further, the pharmaceutical patient assessments module 110 may be configured to determine, based on the prescription fill request, a patient identifier associated with the patient. The pharmaceutical patient assessments module 110 may determine, based at least in part on the patient identifier, whether the patient is eligible for one or more pharmaceutical patient assessments. Pharmaceutical patient assessments may refer to any type of healthcare assessments that may be performed by a pharmacist and/or other healthcare professional including, but not limited to, medication review, vaccination, pharmaceutical opinions (e.g., data/notes/feedback regarding medication usage, frequency, dosage, effects, patient age, patient condition, patient reactions, etc.), and/or the like.
100151 Generally, network devices and systems, including one or more pharmacy computers 104, claims processor computers 106, and/or pharmacy mobile devices 108, may include or otherwise be associated with suitable hardware and/or software for transmitting and receiving data and/or computer-executable instructions over one or more communication links or networks. These network devices and systems may also include any number of processors for processing data and executing computer-executable instructions, as well as other internal and peripheral components currently known in the art or which may be developed in the future. Further, these network devices and systems may include or be in communication with any number of suitable memory devices operable to store data and/or computer-executable instructions. By executing computer-executable instructions, each of the network devices may form a special-purpose computer or particular machine.
As used herein, the term "computer-readable medium" describes any medium for storing computer-executable instructions.
100161 As shown in FIG. 1, the one or more pharmacy computers 104, claims processor computers 106, and/or pharmacy mobile devices 108 may be in communication with each other via one or more networks, such as network 114, which may include one or more independent and/or shared private and/or public networks including the Internet or a publicly switched telephone network. In other example embodiments, one or more components of the system 100 may communicate via direct connections and/or communication links.
Each of these components ¨ the pharmacy computer 104, claims processor computer 106, pharmacy mobile device 108, and the network 114¨ will now be discussed in further detail. Although the components are generally discussed as singular components, as may be implemented in various example embodiments, in alternative exemplary embodiments each component may include any number of suitable computers and/or other components.
100171 The one or more pharmacy computers 104 may be associated with a pharmacy. A
pharmacy computer 104 may include, but is not limited to, any suitable processor-driven device that is configured for receiving, processing, and fulfilling healthcare transactions relating to patient prescription information including, but not limited to, medications, medication name(s). NDC number(s), RxNorm medication identifiers, quantity of medication to be dispensed), patient information (i.e., name, gender, date of birth), and prescriber identification number (i.e., prescriber ID ((e.g., National Provider Identifier (NPI) number and/or a provider identification issued by the Drug Enforcement Agency (DEA))), prescriber name, and prescriber ZIP code or other postal zone identifier for a prescription. Any number of claims processor computers 106 and/or pharmacy computers 108 may be in communication with the pharmacy computer 104 as desired in various example embodiments.
100181 The pharmacy computer 104 may include any number of special- purpose computers or other particular machines, application-specific integrated circuits, microcontrollers, personal computers, minicomputers, mainframe computers, servers, networked computers, and/or other processor-driven devices. In certain embodiments, the operations of the pharmacy computer 104 may be controlled by computer-executed or computer-implemented instructions that are executed by one or more processors associated with the pharmacy computer 104 to form a special-purpose computer or other particular machine that is operable to facilitate the receipt, routing, and/or processing of healthcare requests or healthcare transactions. The one or more processors that control the operations of the pharmacy computer 104 may be incorporated into the pharmacy computer 104 and/or may be in communication with the pharmacy computer 104 via one or more suitable networks. In certain example embodiments, the operations and/or control of the pharmacy computer 104 may be distributed among several processing components.
100191 The pharmacy computer 104 may include one or more processors 116, one or more memory devices 118, one or more input/output ("I/O") interfaces 120, and one or more network interfaces 122. The one or more memory devices 118 may be any suitable memory device, for example, caches, read-only memory devices, etc. The one or more memory devices 118 may store data, executable instructions, and/or various program modules utilized by the pharmacy computer 104, for example, data files 124 and an operating system ("OS") 126. The OS 126 may be any operating system known in the art or which may be developed in the future including, but not limited to, Microsoft Windows , Apple OSXTm, Linux, Unix, Apple iOSTM, Google AndroidTM, or a mainframe operating system. The OS 126 may be a suitable software module that controls the general operation of the pharmacy computer 104 and/or that facilitates the execution of other software modules.
100201 According to an example embodiment, the data files 124 may store patient transaction records associated with communications received from various patient and/or pharmacy mobile devices 108, and/or various claims processor computers 106.
The data files 124 may also store any number of suitable routing tables that facilitate determining the destination of communications received from a patient, a claims processor computer 106, and/or a pharmacy mobile device 108. In one or more example embodiments of the disclosure, the pharmacy computer 104 may include or otherwise be in communication with one or more suitable databases and/or data storage devices 112.
[0021] The pharmacy computer 104 may include additional program modules for performing other processing methods described herein. Those of ordinary skill in the art will appreciate that the pharmacy computer 104 may include alternate and/or additional components, hardware, or software without departing from the scope of the disclosure. The management module 128 may be an Internet browser or other software, such as a dedicated program, for interacting with the healthcare provider device 102, and/or the claims processor computers 106, and/or the pharmacy mobile device 108. Alternatively, the management module 128 may also be implemented as computer-implemented instructions of a memory of a separate computing entity or processor-based system, according to another example embodiment of the disclosure.
[00221 With continued reference to the pharmacy computer 104, the one or more I/O
interfaces 120 may facilitate communication between the pharmacy computer 104 and one or more input/output devices, for example, one or more user interface devices, such as a display, keypad, control panel, touch screen display, remote control, microphone, etc., that facilitate user interaction with the pharmacy computer 104. The one or more network interfaces 160 may facilitate connection of the pharmacy computer 104 to one or more suitable networks, for example, the network 114 illustrated in FIG. 1. In this regard, the pharmacy computer 104 may communicate with other components of the system 100.
100231 With continued reference to FIG. 1, any number of claims processor computers 106 may be associated with any number of pharmacy benefit managers and/or processors.
Each claims processor computer may be any suitable processor-driven devices, such as, but not limited to, a server computer, a personal computer, a laptop computer, a handheld computer, and the like. In addition to having one or more processors 162, the claims processor computer 106 may further include one or more memories 164, one or more input/output (I/O) interfaces 166, and one or more network interfaces 168. The memory 164 may store data files 170 and various program modules, such as an operating system (OS) 172 and a benefits management module 174. The I/O interface(s) 166 may facilitate communication between the processors 162 and various 1/0 devices, such as a keyboard, mouse, printer, microphone, speaker, monitor, bar code reader/scanner, RFID
reader, and the like. The network interface(s) 170 each may take any of a number of forms, such as a network interface card, a modem, a wireless network card, and the like.
100241 Generally, the claims processor computer 106 may facilitate the determination of benefits, coverage, and/or extent of coverage for one or more healthcare claim transactions, such as prescription claim transactions or other healthcare service or product claim transactions. According to various embodiments, the claims processor computer 106 may be associated with, without limitation, a PBM, an insurance company, a government payor affiliated entity, another third-party payor, or a claims processor processing healthcare claim transactions and performing adjudication on behalf of one or more third-party payors and/or healthcare providers. In one embodiment, the claims processor computer 106 may be operated by, or otherwise included with, the pharmacy computer 104, such as if the pharmacy computer operates the benefits management module 174 and provides adjudication services.
100251 The claims processor computer 106 may include the benefits management module 174. The benefits management module 174 may be an Internet browser or other software, such as a dedicated program, for interacting with the pharmacy computer 104 and/or the pharmacy mobile devices 108. The benefits management module 174 may be operable to access one or more databases in database 112. In one non-limiting example, the claims processor computer 106 may have a dedicated connection to the database 112.
However, the claims processor computer 106 may also communicate with the database 112 via the network 114 shown, or via another network.
100261 With continued reference to FIG. 1, any number of pharmacy mobile devices 108 may be associated with any number of pharmacies and/or pharmacists. Each pharmacy mobile device 108 may be any suitable processor-driven device that facilitates receiving, processing, and/or fulfilling healthcare transactions and/or prescription transactions received from the pharmacy computers 104. For example, a pharmacy mobile device 108 may be a processor-driven device associated with a pharmacy or a pharmacist including, but not limited to, a tablet computer ,a mobile phone, a personal digital assistant, a notebook, a laptop computer, a wearable device, and/or the like. As desired, the pharmacy mobile device 108 may include any number of special-purpose computers or other particular machines, application-specific integrated circuits, microcontrollers, personal computers, minicomputers, mainframe computers, servers, and the like. In certain example embodiments, the operations of the pharmacy mobile device 108 may be controlled by computer-executed or computer-implemented instructions that are executed by one or more processors associated with the pharmacy mobile device 108 to form a special-purpose computer or other particular machine that is operable to facilitate the receipt, processing, and/or fulfillment of healthcare transactions (e.g., a prescription claim or billing request, healthcare order transaction, or e-prescription transaction (i.e., electronic prescription order transaction, e-script, or e-prescription)) received from the pharmacy computer 104. The one OT more processors that control the operations of a pharmacy mobile device 108 may be incorporated into the pharmacy mobile device 108 and/or may be in communication with the pharmacy mobile device 108 via one or more suitable networks. In certain example embodiments, the operations and/or control of the pharmacy mobile device 108 may be distributed among several processing components.
100271 Similar to other components of the system 100, each pharmacy mobile device 108 may include one or more processors 176, one or more memory devices 178, one or more I/O
interfaces 180, and one or more network interfaces 182. The one or more memory devices
DETAILED DESCRIPTION OF EXEMPLARY EMBODIMENTS
lb 100081 Exemplary embodiments will now be described more fully hereinafter with reference to the accompanying drawings, in which exemplary embodiments are shown. The concepts disclosed herein may, however, be embodied in many different forms and should not be construed as limited to the exemplary embodiments set forth herein;
rather, these embodiments are provided so that this disclosure will be thorough and complete, and will fully convey the scope of the concepts to those skilled in the art. Like numbers refer to like, but not necessarily the same or identical, elements throughout.
100091 Exemplary embodiments described herein include systems and methods that facilitate pharmaceutical patient assessments. In some example implementations, a prescription fill request may be received by a pharmacy computer, such as from a patient visiting a pharmacy where the pharmacy computer is located. Additionally, the prescription fill request may include information that enables the pharmacy computer to identify the associated patient. Upon identifying the patient, the pharmacy computer may access patient information associated with the patient. The patient information may include, but is not limited to, active medication information, medication history information, visit history information, location information, patient demographic information (e.g., age, gender, zip/postal code, etc.) and/or other types of pharmaceutical information related to the patient.
The pharmacy computer may compare the patient information with one or more pharmaceutical patient assessment eligibility thresholds (e.g., medication review thresholds, vaccination thresholds, pharmaceutical opinion thresholds, and/or the like).
Based on the comparison, the pharmacy computer may determine whether the patient is eligible for any pharmaceutical patient assessments. If a patient is eligible for a pharmaceutical patient assessment, the pharmacy computer may transmit, to a mobile pharmacy device of a pharmacy, a notification indicating the patient's eligibility for the pharmaceutical patient assessment. The notification may be sent as part of an adjudicated response from a claims processor. Alternatively, the notification may be sent as a separate message.
In certain cases, upon receiving the notification, a pharmacist or other healthcare professional associated with the pharmacy may perform the eligible pharmaceutical patient assessment for the patient. The pharmacist may record the details of the service with the pharmacy computer, which may be stored as pharmaceutical patient assessment information. The pharmacy computer may transmit the pharmaceutical patient assessment information back to the pharmacy computer. The pharmacy computer may generate one or more completed forms based on the pharmaceutical patient assessment information and transmit the completed form to the healthcare provider computer. In certain implementations, the pharmacy computer may also generate a prescription transaction based at least in part on the pharmaceutical patient assessment information, and transmit the prescriptoin transaction to a claims processor computer for adjudication.
100101 System Overview 100111 FIG. 1 illustrates an example system 100 for facilitating, among other things, determining whether a patient, who is a consumer of and/or otherwise associated with a pharmacy, is eligible for one or more pharmaceutical patient assessments that may be provided at the pharmacy. As shown in FIG. 1, the system 100 may include one or more pharmacy computers 104, claims processor computers 106, and/or pharmacy mobile device(s) 108. As desired, each of the pharmacy computer 104, claims processor computer 106, and/or pharmacy mobile device 108 may include one or more processing devices that may be configured for accessing and reading associated computer-readable media having stored data thereon and/or computer-executable instructions for implementing various embodiments of the disclosure.
100121 Additionally, in one or more example embodiments of the disclosure, the pharmacy computers 104 may include or otherwise be in communication with a pharmaceutical patient assessments module 110. The pharmaceutical patient assessments module 110 may include computer-executable instructions operable for facilitating the determination of an eligibility of a patient for pharmaceutical patient assessments at a pharmacy. For example, the pharmaceutical patient assessments module 110 may facilitate creation of a prescription transaction (i.e., a predetermination of benefits transaction, healthcare claim transaction, prescription claim or billing request, healthcare order transaction, or e-prescription transaction (i.e., electronic prescription order transaction, e-script, or e-prescription)). The pharmaceutical patient assessments module 110 may facilitate storage of information related to the prescription transaction in one or more suitable databases and/or data storage devices 112. For example, the pharmaceutical patient assessments module 110 may facilitate the storage and/or access of information including, but not limited to, patient information (i.e., identifier (e.g., patient social security number, a subset of the patient social security number, health insurance claim number (HICN), cardholder ID, etc.), name, gender, date of birth), benefits provider identifier (e.g., Banking Identification Number (BIN Number), BIN Number and Processor Control Number (PCN), or BIN Number and Group ID), benefits provider name, date of service, software and/or vendor certification identification, pharmacy identification qualifier, pharmacy identification (e.g., store and/or chain name, group ID, BIN Number, or the like), medication information (i.e., medication name(s), National Drug Code (NDC) numbers, RxNorm medication identifiers, and the like).
100131 Further, the pharmaceutical patient assessments module 110 may facilitate storage of patient information including, but not limited to, medication information (e.g., total number of medications, medication name(s), NDC numbers, RxNorm medication identifiers, quantity of medication to be dispensed, days' supply, dosage), patient information (i.e., identifier (e.g., patient social security number, a subset of the patient social security number, health insurance claim number (HICN), cardholder ID, etc.), name, gender, date of birth), and prescriber identification number (ie., prescriber ID ((e.g., National Provider Identifier (NPI) number and/or a provider identification issued by the Drug Enforcement Agency (DEA))), prescriber name, and prescriber ZIP code or other postal zone identifier for a prescription.
100141 In addition to receiving and storing information, the pharmaceutical patient assessments module 110 may be further operable to access and/or be in communication with one or more suitable databases and/or data storage devices 112. In one non-limiting example, the pharmaceutical patient assessment module 110 may facilitate generation of a prescription transaction in response to receiving a prescription fill request from a patient.
Further, the pharmaceutical patient assessments module 110 may be configured to determine, based on the prescription fill request, a patient identifier associated with the patient. The pharmaceutical patient assessments module 110 may determine, based at least in part on the patient identifier, whether the patient is eligible for one or more pharmaceutical patient assessments. Pharmaceutical patient assessments may refer to any type of healthcare assessments that may be performed by a pharmacist and/or other healthcare professional including, but not limited to, medication review, vaccination, pharmaceutical opinions (e.g., data/notes/feedback regarding medication usage, frequency, dosage, effects, patient age, patient condition, patient reactions, etc.), and/or the like.
100151 Generally, network devices and systems, including one or more pharmacy computers 104, claims processor computers 106, and/or pharmacy mobile devices 108, may include or otherwise be associated with suitable hardware and/or software for transmitting and receiving data and/or computer-executable instructions over one or more communication links or networks. These network devices and systems may also include any number of processors for processing data and executing computer-executable instructions, as well as other internal and peripheral components currently known in the art or which may be developed in the future. Further, these network devices and systems may include or be in communication with any number of suitable memory devices operable to store data and/or computer-executable instructions. By executing computer-executable instructions, each of the network devices may form a special-purpose computer or particular machine.
As used herein, the term "computer-readable medium" describes any medium for storing computer-executable instructions.
100161 As shown in FIG. 1, the one or more pharmacy computers 104, claims processor computers 106, and/or pharmacy mobile devices 108 may be in communication with each other via one or more networks, such as network 114, which may include one or more independent and/or shared private and/or public networks including the Internet or a publicly switched telephone network. In other example embodiments, one or more components of the system 100 may communicate via direct connections and/or communication links.
Each of these components ¨ the pharmacy computer 104, claims processor computer 106, pharmacy mobile device 108, and the network 114¨ will now be discussed in further detail. Although the components are generally discussed as singular components, as may be implemented in various example embodiments, in alternative exemplary embodiments each component may include any number of suitable computers and/or other components.
100171 The one or more pharmacy computers 104 may be associated with a pharmacy. A
pharmacy computer 104 may include, but is not limited to, any suitable processor-driven device that is configured for receiving, processing, and fulfilling healthcare transactions relating to patient prescription information including, but not limited to, medications, medication name(s). NDC number(s), RxNorm medication identifiers, quantity of medication to be dispensed), patient information (i.e., name, gender, date of birth), and prescriber identification number (i.e., prescriber ID ((e.g., National Provider Identifier (NPI) number and/or a provider identification issued by the Drug Enforcement Agency (DEA))), prescriber name, and prescriber ZIP code or other postal zone identifier for a prescription. Any number of claims processor computers 106 and/or pharmacy computers 108 may be in communication with the pharmacy computer 104 as desired in various example embodiments.
100181 The pharmacy computer 104 may include any number of special- purpose computers or other particular machines, application-specific integrated circuits, microcontrollers, personal computers, minicomputers, mainframe computers, servers, networked computers, and/or other processor-driven devices. In certain embodiments, the operations of the pharmacy computer 104 may be controlled by computer-executed or computer-implemented instructions that are executed by one or more processors associated with the pharmacy computer 104 to form a special-purpose computer or other particular machine that is operable to facilitate the receipt, routing, and/or processing of healthcare requests or healthcare transactions. The one or more processors that control the operations of the pharmacy computer 104 may be incorporated into the pharmacy computer 104 and/or may be in communication with the pharmacy computer 104 via one or more suitable networks. In certain example embodiments, the operations and/or control of the pharmacy computer 104 may be distributed among several processing components.
100191 The pharmacy computer 104 may include one or more processors 116, one or more memory devices 118, one or more input/output ("I/O") interfaces 120, and one or more network interfaces 122. The one or more memory devices 118 may be any suitable memory device, for example, caches, read-only memory devices, etc. The one or more memory devices 118 may store data, executable instructions, and/or various program modules utilized by the pharmacy computer 104, for example, data files 124 and an operating system ("OS") 126. The OS 126 may be any operating system known in the art or which may be developed in the future including, but not limited to, Microsoft Windows , Apple OSXTm, Linux, Unix, Apple iOSTM, Google AndroidTM, or a mainframe operating system. The OS 126 may be a suitable software module that controls the general operation of the pharmacy computer 104 and/or that facilitates the execution of other software modules.
100201 According to an example embodiment, the data files 124 may store patient transaction records associated with communications received from various patient and/or pharmacy mobile devices 108, and/or various claims processor computers 106.
The data files 124 may also store any number of suitable routing tables that facilitate determining the destination of communications received from a patient, a claims processor computer 106, and/or a pharmacy mobile device 108. In one or more example embodiments of the disclosure, the pharmacy computer 104 may include or otherwise be in communication with one or more suitable databases and/or data storage devices 112.
[0021] The pharmacy computer 104 may include additional program modules for performing other processing methods described herein. Those of ordinary skill in the art will appreciate that the pharmacy computer 104 may include alternate and/or additional components, hardware, or software without departing from the scope of the disclosure. The management module 128 may be an Internet browser or other software, such as a dedicated program, for interacting with the healthcare provider device 102, and/or the claims processor computers 106, and/or the pharmacy mobile device 108. Alternatively, the management module 128 may also be implemented as computer-implemented instructions of a memory of a separate computing entity or processor-based system, according to another example embodiment of the disclosure.
[00221 With continued reference to the pharmacy computer 104, the one or more I/O
interfaces 120 may facilitate communication between the pharmacy computer 104 and one or more input/output devices, for example, one or more user interface devices, such as a display, keypad, control panel, touch screen display, remote control, microphone, etc., that facilitate user interaction with the pharmacy computer 104. The one or more network interfaces 160 may facilitate connection of the pharmacy computer 104 to one or more suitable networks, for example, the network 114 illustrated in FIG. 1. In this regard, the pharmacy computer 104 may communicate with other components of the system 100.
100231 With continued reference to FIG. 1, any number of claims processor computers 106 may be associated with any number of pharmacy benefit managers and/or processors.
Each claims processor computer may be any suitable processor-driven devices, such as, but not limited to, a server computer, a personal computer, a laptop computer, a handheld computer, and the like. In addition to having one or more processors 162, the claims processor computer 106 may further include one or more memories 164, one or more input/output (I/O) interfaces 166, and one or more network interfaces 168. The memory 164 may store data files 170 and various program modules, such as an operating system (OS) 172 and a benefits management module 174. The I/O interface(s) 166 may facilitate communication between the processors 162 and various 1/0 devices, such as a keyboard, mouse, printer, microphone, speaker, monitor, bar code reader/scanner, RFID
reader, and the like. The network interface(s) 170 each may take any of a number of forms, such as a network interface card, a modem, a wireless network card, and the like.
100241 Generally, the claims processor computer 106 may facilitate the determination of benefits, coverage, and/or extent of coverage for one or more healthcare claim transactions, such as prescription claim transactions or other healthcare service or product claim transactions. According to various embodiments, the claims processor computer 106 may be associated with, without limitation, a PBM, an insurance company, a government payor affiliated entity, another third-party payor, or a claims processor processing healthcare claim transactions and performing adjudication on behalf of one or more third-party payors and/or healthcare providers. In one embodiment, the claims processor computer 106 may be operated by, or otherwise included with, the pharmacy computer 104, such as if the pharmacy computer operates the benefits management module 174 and provides adjudication services.
100251 The claims processor computer 106 may include the benefits management module 174. The benefits management module 174 may be an Internet browser or other software, such as a dedicated program, for interacting with the pharmacy computer 104 and/or the pharmacy mobile devices 108. The benefits management module 174 may be operable to access one or more databases in database 112. In one non-limiting example, the claims processor computer 106 may have a dedicated connection to the database 112.
However, the claims processor computer 106 may also communicate with the database 112 via the network 114 shown, or via another network.
100261 With continued reference to FIG. 1, any number of pharmacy mobile devices 108 may be associated with any number of pharmacies and/or pharmacists. Each pharmacy mobile device 108 may be any suitable processor-driven device that facilitates receiving, processing, and/or fulfilling healthcare transactions and/or prescription transactions received from the pharmacy computers 104. For example, a pharmacy mobile device 108 may be a processor-driven device associated with a pharmacy or a pharmacist including, but not limited to, a tablet computer ,a mobile phone, a personal digital assistant, a notebook, a laptop computer, a wearable device, and/or the like. As desired, the pharmacy mobile device 108 may include any number of special-purpose computers or other particular machines, application-specific integrated circuits, microcontrollers, personal computers, minicomputers, mainframe computers, servers, and the like. In certain example embodiments, the operations of the pharmacy mobile device 108 may be controlled by computer-executed or computer-implemented instructions that are executed by one or more processors associated with the pharmacy mobile device 108 to form a special-purpose computer or other particular machine that is operable to facilitate the receipt, processing, and/or fulfillment of healthcare transactions (e.g., a prescription claim or billing request, healthcare order transaction, or e-prescription transaction (i.e., electronic prescription order transaction, e-script, or e-prescription)) received from the pharmacy computer 104. The one OT more processors that control the operations of a pharmacy mobile device 108 may be incorporated into the pharmacy mobile device 108 and/or may be in communication with the pharmacy mobile device 108 via one or more suitable networks. In certain example embodiments, the operations and/or control of the pharmacy mobile device 108 may be distributed among several processing components.
100271 Similar to other components of the system 100, each pharmacy mobile device 108 may include one or more processors 176, one or more memory devices 178, one or more I/O
interfaces 180, and one or more network interfaces 182. The one or more memory devices
8 178 may be any suitable memory devices, for example, caches, read-only memory device, random access memory devices, magnetic storage devices, removable memory devices, etc.
The one or more memory devices 178 may store data, executable instructions, and/or various program modules utilized by the pharmacy mobile device 108, for example, data files 184, an OS 186, and a pharmacy management module 188. The data files 184 may include any suitable information that is utilized by the pharmacy mobile device 108. The OS 186 may be a suitable software module that controls the general operation of the pharmacy mobile device 108. The OS 186 may also facilitate the execution of other software modules by the one or more processors 176. The OS 186 may be any operating system known in the art or which may be developed in the future including, but not limited to, Microsoft Windows , Apple OSXTM, Linux, Unix, Apple iOSTm, Google AndroidTM, or a mainframe operating system.
100281 The one or more I/0 interfaces 180 may facilitate communication between the pharmacy mobile device 108 and one or more input/output devices, for example, one or more user interface devices, such as a display, keypad, control panel, touch screen display, remote control, microphone, etc., that facilitate user interaction with the pharmacy mobile device 108. The one or more network interfaces 182 may facilitate connection of the pharmacy mobile device 108 to one or more suitable networks, for example, the network 114 illustrated in FIG. I. In this regard, the pharmacy 108 may receive healthcare transactions and/or other communications from the pharmacy computer 104 and the pharmacy mobile device 108 may communicate information associated with processing healthcare transactions to the pharmacy computer 104.
[0029] The phainiacy management module 188 may be a software application(s), including a dedicated program, for fulfilling healthcare transaction orders, reading and/or updating medical records (e.g., prescription records), facilitating patient billing, etc., receiving and/or transmitting pharmaceutical patient assessment information associated with performance of pharmaceutical patient assessments, as well as interacting with the pharmacy computer 104. For example, a pharmacist or other pharmacy employee, may utilize the pharmacy management module 188 in filling a prescription, recording and/or updating a patient's medical prescription history, billing, and preparing and providing a healthcare transaction request for information to the pharmacy computer 104. As another example, a pharmacist or other pharmacy employee may utilize the pharmacy management module 188 to enter and/or update pharmaceutical patient assessment information. For instance, if the pharmacist were to perform a medication review, the pharmacist may utilize the pharmacy management module 188 to enter information associated with the medication review (e.g.,
The one or more memory devices 178 may store data, executable instructions, and/or various program modules utilized by the pharmacy mobile device 108, for example, data files 184, an OS 186, and a pharmacy management module 188. The data files 184 may include any suitable information that is utilized by the pharmacy mobile device 108. The OS 186 may be a suitable software module that controls the general operation of the pharmacy mobile device 108. The OS 186 may also facilitate the execution of other software modules by the one or more processors 176. The OS 186 may be any operating system known in the art or which may be developed in the future including, but not limited to, Microsoft Windows , Apple OSXTM, Linux, Unix, Apple iOSTm, Google AndroidTM, or a mainframe operating system.
100281 The one or more I/0 interfaces 180 may facilitate communication between the pharmacy mobile device 108 and one or more input/output devices, for example, one or more user interface devices, such as a display, keypad, control panel, touch screen display, remote control, microphone, etc., that facilitate user interaction with the pharmacy mobile device 108. The one or more network interfaces 182 may facilitate connection of the pharmacy mobile device 108 to one or more suitable networks, for example, the network 114 illustrated in FIG. I. In this regard, the pharmacy 108 may receive healthcare transactions and/or other communications from the pharmacy computer 104 and the pharmacy mobile device 108 may communicate information associated with processing healthcare transactions to the pharmacy computer 104.
[0029] The phainiacy management module 188 may be a software application(s), including a dedicated program, for fulfilling healthcare transaction orders, reading and/or updating medical records (e.g., prescription records), facilitating patient billing, etc., receiving and/or transmitting pharmaceutical patient assessment information associated with performance of pharmaceutical patient assessments, as well as interacting with the pharmacy computer 104. For example, a pharmacist or other pharmacy employee, may utilize the pharmacy management module 188 in filling a prescription, recording and/or updating a patient's medical prescription history, billing, and preparing and providing a healthcare transaction request for information to the pharmacy computer 104. As another example, a pharmacist or other pharmacy employee may utilize the pharmacy management module 188 to enter and/or update pharmaceutical patient assessment information. For instance, if the pharmacist were to perform a medication review, the pharmacist may utilize the pharmacy management module 188 to enter information associated with the medication review (e.g.,
9 patient reaction, patient age, medication dosage, medication frequency, medication effects, patient health conditions etc.). If the pharmacist were generate a pharmaceutical opinion, the pharmacist may utilize the pharmacy management module 188 to enter the opinion. It will be appreciated that various types of information associated with various types of pharmaceutical patient assessments may be entered via the pharmacy management module 188. Such information may be stored and associated with a patient (e.g., a patient identifier), such as in a database 112, and/or may be provided to the pharmacy computer 104, such as to the pharmaceutical patient assessments module 110. Furthermore, the pharmacy mobile device 108 may utilize the pharmacy management module 188 to retrieve or otherwise receive data, messages, or responses from the pharmacy computer 104 and/or other components of the system 100.
[0030] It will be appreciated that the pharmacy management module 188 may also be configured to facilitate various other operations of the pharmacy mobile device 108, including, but not limited to, receiving/storing electronic signatures, scheduling appointments with patients, scan and/or attach documents provided by a pharmacist or other employee, access medication history information for patients, updating medication information of patients with the pharmacy computer 104 such as the dosage, activation, and/or deactivation of medication, and/or generating billing information related to fulfilling a prescription or performing a pharmaceutical patient assessment. As such, a pharmacist and/or other employee of the pharmacy may be able to take the pharmacy mobile device 108 to locations outside of the pharmacy (e.g., to a long-term care facility, a patient's home, and/or the like) in order to collection the information described above. The pharmacy mobile device 108 may be configured to communicate the collected information back to the pharmacy computer(s) 104 (e.g., via the pharmacy management module 188) or the claims processor computer 106. In certain implementations, the collected information may be stored by the pharmacy computer(s) 104, such as in the database 112, such that other pharmacy computers 104 and/or other pharmacy mobile device(s) 108 may have access to the collected information.
[0031] The network 114 may include any telecommunication and/or data network, whether public, private, or a combination thereof, including a local area network, a wide area network, an intranet, the Internet, intermediate handheld data transfer devices, and/or any combination thereof and may be wired and/or wireless, or any combination thereof. The network 114 may also allow for real time, offline, and/or batch transactions to be transmitted between or among the pharmacy computer 104, the claims processor computer 106, and the pharmacy mobile device 108. Various methodologies as described herein, may be practiced in the context of distributed computing environments. Although the pharmacy computer 104 is shown for simplicity as being in communication with the healthcare provider device 102, the claims processor computer 106, or the pharmacy mobile device 108 via one intervening network 114, it is to be understood that any other network configurations are possible. For example, intervening network 114 may include a plurality of networks, each with devices such as gateways and routers for providing connectivity between or among the components of the system 100. Instead of or in addition to the network 114, dedicated communication links may be used to connect various devices in accordance with an example embodiment.
For example, the pharmacy computer 104 may form the basis of network 114 that interconnects the healthcare provider device 102, the pharmacy computer 104, the claims processor computer 106, and the pharmacy mobile device 108.
[0032] Those of ordinary skill in the art will appreciate that the system 100 shown in and described with respect to FIG. I is provided by way of example only. Numerous other operating environments, system architectures, and device and network configurations are possible. Other system embodiments can include fewer or greater numbers of components and may incorporate some or all of the functionality described with respect to the system components shown in FIG. 1. For example, in an exemplary embodiment, the pharmacy computer 104 (or other computer) may be implemented as a specialized processing machine that includes hardware and/or software for performing the methods described herein.
Accordingly, embodiments of the disclosure should not be construed as being limited to any particular operating environment, system architecture, or device or network configuration.
[0033] Operational Overview [0034] Certain portions of the exemplary methods below will be described with reference to determining and communicating a benefits response message generated during an adjudication or pre-adjudication process of a healthcare transaction. In one example implementation, the healthcare transaction may include a prescription, a predetermination of benefits request; a prescription claim or billing request, or a healthcare order transaction.
While the methods described below are in reference to a healthcare transaction, each form of healthcare transaction should be individually read as being used in the methods described below.
[0035] FIG. 2 illustrates an example block diagram 200 for receiving and communicating a healthcare transaction, according to an example embodiment of the disclosure. FIG. 3 illustrates an example method 300 for receiving and communicating a healthcare transaction, according to an example embodiment of the disclosure. The block diagram 200 of FIG. 2 will be discussed in conjunction with the method of 300 of FIG. 3.
100361 Referring now to FIGs. 1, 2, and 3, the exemplary method 300 begins at the START step and continues to step 302, where a pharmacy computer, such as the pharmacy computer 104, may be utilized to receive a prescription fill request 202 from a patient 201.
In one example implementation, the pharmacy computer 104 determine, from the prescription fill request 202, patient information associated with the patient. For example, the pharmacy computer 104 may provide the prescription fill request 202, and/or information included in the prescription fill request 202, to the pharmaceutical patient assessment module I 10. For example, the management module 128 may parse the prescription fill request 202 to determine a patient identifier associated with the prescription till request 202. In some implementations, the patient identifier may include, without limitation, a first name, a last name, a Personal Identification Number (PIN), a social security number, and/or the like. The management module 128 may communicate the patient identifier to the pharmaceutical patient assessments module 110. In step 304, the pharmaceutical patient assessment module 110 may utilize patient identifier and/or other information included in the prescription fill request 202 to perform a lookup in the database 112.
10037] In step 306, upon receipt of the patient identifier, the pharmaceutical patient assessments module 110 may utilize the patient identifier to access patient information. For instance, the patient information may be stored in the database 112, and the patient information may be indexed by, correspond to, and/or otherwise associated with the patient identifier. As an example, the patient information may include one or more of the following information:
Payer ID / Routing Information o Transaction Payer Identifier(s) that designates a destination for payment (e.g., Bank Information Number (BIN), BIN and PCN, or BIN Number and Group ID) Patient Personal Information o Name (e.g. Patient Last Name, Patient First Name, etc.) o Date of Birth of Patient o Age of Patient o Patient Gender Code o Patient Address (e.g. Street Address, City, State/Province, Zip Code, etc.) o Patient Contact Information (e.g. patient telephone number, email address, etc.) o Patient Health Condition Information (e.g., pregnant, diabetic, under long-term care, in a nursing home, chronic issues, other demographic information) o Patient Identifier (such as, but not limited to, patient social security number, a subset of the patient social security number, health insurance claim number (HICN), cardholder ID, etc.) Benefits Information o Cardholder Name (e.g. Cardholder First Name, Cardholder Last Name) o Cardholder ID and/or other identifier (e.g. person code) o Group ID and/or Group Information Prescriber Information o Primary Care Provider ID or other identifier (e.g. National Provider Identifier (NPI) code) o Primary Care Provider Name (e.g. Last Name, First Name) o Prescriber ID or other identifier (e.g. NPI code, Drug Enforcement Agency (DEA) number) o Prescriber Name (e.g. Last Name, First Name) o Prescriber Contact Information (e.g. Telephone Number) o Pharmacy or other Healthcare Provider Information (e.g. store name, chain identifier, etc.) o Pharmacy or other Healthcare Provider ID (e.g. NPI code) Medication Information o Active drugs, services, or product information o Inactive drugs, services, or product information o Medication history of drugs, services, or product information o Pharmacy visit history information o Prescription/Service Reference Number o Date Prescription Written o Quantity Dispensed o Days' Supply o Diagnosis/Condition o Pricing information for the drug/service/product (e.g. network price, Usual &
Customary price) o Number of Refills Authorized o One or more Drug Utilization (DUR) Codes o Date of Service.
[0038] At step 308, the pharmaceutical patient assessment module 110 may compare the patient information with one or more pharmaceutical patient assessment eligibility thresholds. The eligibility thresholds may include various types of thresholds which may determine the eligibility of the patient for various types of pharmaceutical patient assessments. For instance, the eligibility thresholds may include, but are not limited to, visit frequency thresholds, medication review thresholds, vaccination thresholds, pharmaceutical opinion thresholds, patient condition thresholds, and/or the like.
[0039] At step 310, the pharmaceutical patient assessment module 110 may determine, based at least in part on the comparison between the patient information and the eligibility thresholds, whether the patient is eligible for one or more pharmaceutical patient assessments. For instance, an example pharmaceutical patient assessment may be a medication review, and an example eligibility threshold may include a medication review threshold that includes one or more medications that would qualify the patient for a medication review. If the patient information (e.g., the information accessed by the pharmaceutical patient assessments module 110 using the patient identifier derived from the prescription fill request 202) indicates that the patient is taking at least one of the included medications in the medication review threshold (e.g., one or more of the active medications of the patient 201 match the included medications in the medication review threshold), the pharmaceutical patient assessment module 110 may determine that the patient is eligible for a medication review. Another non-limiting example of an eligibility threshold may be a pharmaceutical opinion threshold, which may indicate whether the patient and/or a medication being taken by the patient is eligible to receive a pharmaceutical opinion, such as by a pharmacist or other healthcare professional. Regardless, if the pharmaceutical patient assessments module 110 determines that the patient is eligible for a pharmaceutical patient assessment, then the YES branch is followed and processing may proceed to step 312. If the pharmaceutical patient assessments module 110 determines that the patient is not eligible for a pharmaceutical patient assessment, then the NO branch is followed and processing may proceed to step 324.
[0040] At step 312, the pharmaceutical patient assessment module 110 may transmit, to the pharmacy computer(s) 104, a notification 204 indicating the eligible service(s). For instance, the notification 204 may be transmitted as an email, simple messaging service (SMS) text, a web page pop-up, and/or the like. In certain implementations, upon receipt of the notification 204, the pharmaceutical computer(s) 104 may be configured to display the notification 204. Furthermore, the notification 204 may also be transmitted to one or more of the pharmacy mobile devices 108 (e.g., via the pharmacy computer 104 and/or the pharmaceutical patient assessment module 110).
[0041] Upon and/or after receipt of the notification 204, a pharmacist and/or another healthcare professional may elect to perform the eligible pharmaceutical patient assessment(s) for the patient 201. During and/or upon completion of the pharmaceutical patient assessment(s), the pharmacist may enter pharmaceutical patient assessment information 206 (e.g., via the pharmacy management module(s) 188) into the pharmacy mobile device 108. For example, the pharmaceutical patient assessments information 206 may include details of the assessments performed, and may include, but is not limited to, information such-as medication review information, vaccination information, pharmaceutical opinion information, patient condition information, and/or the like. The pharmaceutical patient assessment information 206 may then be transmitted back to the service provider.
[00421 At step 314, the service provider may receive the pharmaceutical patient assessment information 206, which may indicate that one or more of the eligible pharmaceutical patient assessment(s) has been performed.
[0043] At step 316, the pharmaceutical patient assessment module 110 may generate one or more completed form(s) based on the pharmaceutical patient assessments information. In other words, the forms may record the pharmaceutical patient assessment information indicating the details of the pharmaceutical patient assessments performed by the pharmacy.
Such forms may be completed a format that adheres to standards used by the healthcare provider and/or healthcare provider device(s) 102. In certain implementations, the forms may also adhere to a government issued format.
[0044] At step 318, the pharmacy computer 104 may transmit the completed form to one or more healthcare provider device(s), such as devices associated with a healthcare provider (e.g., a doctor's office, a hospital, and/or any other type of medication prescriber). For instance, the complete form(s) may be transmitted via email, SMS text, fax, mail, and/or any other communications method.
[0045] At step 320, the pharmacy computer 104 may utilize the pharmaceutical patient assessment information 206 to generate a prescription transaction 208. In certain implementations, the pharmacy computer 104 may be configured to store the pharmaceutical patient assessment information 206 in the prescription transaction 208.
[0046] At step 322, the phatinacy computer 104 may be configured to communicate the prescription transaction 208 to the claims processor computer(s) 106 for adjudication. Upon adjudicating the prescription transaction 208, the claims processor computer(s) 106 may communicate the adjudicated prescription transaction 210, and/or the results thereof, back to the pharmacy computer(s) 104.
100471 At step 324, if the pharmaceutical patient assessment module 110 determines that the patient is not eligible for pharmaceutical patient assessments, the pharmaceutical patient assessment module 110 may communicate, to the pharmacy computer(s) 104 and/or the pharmacy mobile devices 108, an indication that the patient is ineligible. The method 300 may end after step 324.
[0048] FIG. 4 illustrates an example method 400 for determining patient eligibility for pharmaceutical patient assessments, according to an example embodiment of the disclosure.
100491 The exemplary method 400 begins at the START step and continues to step 402, where the pharmacy computer 104 may determine and/or identify one or more patients associated with a pharmacy and/or the pharmacy computer(s). For instance, the identified patients may be patients that have visited the pharmacy or are scheduled to visit the pharmacy. In certain implementations, and as described above with reference to FIGS. 1-3, the identified patients may be associated with respective patient information.
Additionally, associations(s) between the pharmacy, the identified patients, and the respective patient information may be stored in the database 112.
10050] At step 404, the pharmacy computer 104 may access the respective patient information associated with the identified patients. For instance, in certain implementations, each of the identified patients may be associated with patient identifiers.
The pharmaceutical patient assessments module 110 may utilize the patient identifiers to access the respective patient information.
100511 At step 406, the pharmaceutical patient assessments module 110 of the pharmacy computer 104 may compare the respective patient information with one or more pharmaceutical patient assessment eligibility thresholds.
100521 At step 408, the pharmaceutical patient assessments module 110 may determine for each patient, based at least in part on the comparison, whether the patient is eligible for a pharmaceutical patient assessment. For instance, the pharmaceutical patient assessments module 110 may determine for each patient, whether any of the pharmaceutical patient assessments thresholds are met. If the pharmaceutical patient assessments module 110 determines that a patient is eligible for one or more pharmaceutical patient assessments, then the YES branch is followed and processing may proceed to step 410. If the pharmaceutical patient assessments module 110 determines that a patient is not eligible for one or more pharmaceutical patient assessments, then the NO branch is followed, and the method may end.
[0053] At step 410, the pharmaceutical patient assessments module 110 may store one or more indications of the eligible services for the patient. For instance, the pharmaceutical patient assessments module 110 may associate a flag, value, and/or any other type of indicator with the patient identifier of the patient. The indicator may indicate the type of pharmaceutical patient assessments the patient is eligible to receive.
Furthermore, the association between the patient identifier and the indicator may be stored in the database 112 and/or any other storage device in communication with the pharmacy computer 104.
100541 In step 412, the pharmacy computer 104 may transmit a notification of the eligible service(s) for the patient to the pharmacy mobile devices 1 08. For instance, the notification may be transmitted via email, SMS text, fax, instant message, and/or any other type of communication method. In certain cases, the pharmacy mobile device 108 may be configured to display the notification, thereby providing an indication that a pharmacist and/or other healthcare professional employee of the pharmacy may perform the eligible service(s) for the patient. The method 400 may end after step 412.
[0055] It will be appreciated that the method 400 illustrated in FIG. 4 may be performed periodically by the pharmacy computer 104. For instance, in certain implementations, the pharmacy mobile device 108 may periodically request the pharmacy computer 104 to poll and/or identify which patients may be eligible for certain pharmaceutical patient assessments.
In other implementations, the method 400 may be performed in response to one or more prescription fill requests provided by one or more patients. In yet other implementations, the method 400 may be performed in response to a reporting request (e.g., from a pharmacist and/or other employee of a pharmacy) to determine which patients may be eligible for pharmaceutical patient assessments.
[0056] Various block and/or flow diagrams of systems, methods, apparatus, and/or computer program products according to example embodiments of the disclosure are described above. It will be understood that one or more blocks of the block diagrams and steps of the flow diagrams, and combinations of blocks in the block diagrams and combinations of steps in the flow diagrams, respectively, can be implemented by computer-executable program instructions. Likewise, some blocks of the block diagrams and steps of the flow diagrams may not necessarily need to be perfoinied in the order presented, or may not necessarily need to be performed at all, according to some embodiments.
[0057] These computer-executable program instructions may be loaded onto a special-purpose computer or other particular machine, one or more processors, or other programmable data processing apparatus to produce a particular machine, such that the instructions that execute on the computer, processor, or other programmable data processing apparatus create means for implementing one or more functions specified in the flow diagram step or steps. These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means that implement one or more functions specified in the flow diagram step or steps. As an example, various embodiments of the disclosure may provide for a computer program product including a computer-usable medium having a computer-readable program code or program instructions embodied therein, said computer-readable program code adapted to be executed to implement one or more functions specified in the flow diagram step or steps.
The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational elements or steps to be performed on the computer or other programmable apparatus to produce a computer-implemented process such that the instructions that execute on the computer or other programmable apparatus provide elements or steps for implementing the functions specified in the flow diagram step or steps.
[0058] Accordingly, blocks of the block diagrams and steps of the flow diagrams support combinations of means for performing the specified functions, combinations of elements or steps for performing the specified functions, and program instruction means for performing the specified functions. It will also be understood that each block of the block diagrams and step of the flow diagrams, and combinations of blocks in the block diagrams and steps of the flow diagrams, can be implemented by special-purpose, hardware-based computer systems that perform the specified functions, elements or steps, or combinations of special-purpose hardware and computer instructions.
[0059] Many modifications and other embodiments of the disclosure set forth herein will be apparent having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is to be understood that the invention is not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended claims. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for purposes of limitation.
,
[0030] It will be appreciated that the pharmacy management module 188 may also be configured to facilitate various other operations of the pharmacy mobile device 108, including, but not limited to, receiving/storing electronic signatures, scheduling appointments with patients, scan and/or attach documents provided by a pharmacist or other employee, access medication history information for patients, updating medication information of patients with the pharmacy computer 104 such as the dosage, activation, and/or deactivation of medication, and/or generating billing information related to fulfilling a prescription or performing a pharmaceutical patient assessment. As such, a pharmacist and/or other employee of the pharmacy may be able to take the pharmacy mobile device 108 to locations outside of the pharmacy (e.g., to a long-term care facility, a patient's home, and/or the like) in order to collection the information described above. The pharmacy mobile device 108 may be configured to communicate the collected information back to the pharmacy computer(s) 104 (e.g., via the pharmacy management module 188) or the claims processor computer 106. In certain implementations, the collected information may be stored by the pharmacy computer(s) 104, such as in the database 112, such that other pharmacy computers 104 and/or other pharmacy mobile device(s) 108 may have access to the collected information.
[0031] The network 114 may include any telecommunication and/or data network, whether public, private, or a combination thereof, including a local area network, a wide area network, an intranet, the Internet, intermediate handheld data transfer devices, and/or any combination thereof and may be wired and/or wireless, or any combination thereof. The network 114 may also allow for real time, offline, and/or batch transactions to be transmitted between or among the pharmacy computer 104, the claims processor computer 106, and the pharmacy mobile device 108. Various methodologies as described herein, may be practiced in the context of distributed computing environments. Although the pharmacy computer 104 is shown for simplicity as being in communication with the healthcare provider device 102, the claims processor computer 106, or the pharmacy mobile device 108 via one intervening network 114, it is to be understood that any other network configurations are possible. For example, intervening network 114 may include a plurality of networks, each with devices such as gateways and routers for providing connectivity between or among the components of the system 100. Instead of or in addition to the network 114, dedicated communication links may be used to connect various devices in accordance with an example embodiment.
For example, the pharmacy computer 104 may form the basis of network 114 that interconnects the healthcare provider device 102, the pharmacy computer 104, the claims processor computer 106, and the pharmacy mobile device 108.
[0032] Those of ordinary skill in the art will appreciate that the system 100 shown in and described with respect to FIG. I is provided by way of example only. Numerous other operating environments, system architectures, and device and network configurations are possible. Other system embodiments can include fewer or greater numbers of components and may incorporate some or all of the functionality described with respect to the system components shown in FIG. 1. For example, in an exemplary embodiment, the pharmacy computer 104 (or other computer) may be implemented as a specialized processing machine that includes hardware and/or software for performing the methods described herein.
Accordingly, embodiments of the disclosure should not be construed as being limited to any particular operating environment, system architecture, or device or network configuration.
[0033] Operational Overview [0034] Certain portions of the exemplary methods below will be described with reference to determining and communicating a benefits response message generated during an adjudication or pre-adjudication process of a healthcare transaction. In one example implementation, the healthcare transaction may include a prescription, a predetermination of benefits request; a prescription claim or billing request, or a healthcare order transaction.
While the methods described below are in reference to a healthcare transaction, each form of healthcare transaction should be individually read as being used in the methods described below.
[0035] FIG. 2 illustrates an example block diagram 200 for receiving and communicating a healthcare transaction, according to an example embodiment of the disclosure. FIG. 3 illustrates an example method 300 for receiving and communicating a healthcare transaction, according to an example embodiment of the disclosure. The block diagram 200 of FIG. 2 will be discussed in conjunction with the method of 300 of FIG. 3.
100361 Referring now to FIGs. 1, 2, and 3, the exemplary method 300 begins at the START step and continues to step 302, where a pharmacy computer, such as the pharmacy computer 104, may be utilized to receive a prescription fill request 202 from a patient 201.
In one example implementation, the pharmacy computer 104 determine, from the prescription fill request 202, patient information associated with the patient. For example, the pharmacy computer 104 may provide the prescription fill request 202, and/or information included in the prescription fill request 202, to the pharmaceutical patient assessment module I 10. For example, the management module 128 may parse the prescription fill request 202 to determine a patient identifier associated with the prescription till request 202. In some implementations, the patient identifier may include, without limitation, a first name, a last name, a Personal Identification Number (PIN), a social security number, and/or the like. The management module 128 may communicate the patient identifier to the pharmaceutical patient assessments module 110. In step 304, the pharmaceutical patient assessment module 110 may utilize patient identifier and/or other information included in the prescription fill request 202 to perform a lookup in the database 112.
10037] In step 306, upon receipt of the patient identifier, the pharmaceutical patient assessments module 110 may utilize the patient identifier to access patient information. For instance, the patient information may be stored in the database 112, and the patient information may be indexed by, correspond to, and/or otherwise associated with the patient identifier. As an example, the patient information may include one or more of the following information:
Payer ID / Routing Information o Transaction Payer Identifier(s) that designates a destination for payment (e.g., Bank Information Number (BIN), BIN and PCN, or BIN Number and Group ID) Patient Personal Information o Name (e.g. Patient Last Name, Patient First Name, etc.) o Date of Birth of Patient o Age of Patient o Patient Gender Code o Patient Address (e.g. Street Address, City, State/Province, Zip Code, etc.) o Patient Contact Information (e.g. patient telephone number, email address, etc.) o Patient Health Condition Information (e.g., pregnant, diabetic, under long-term care, in a nursing home, chronic issues, other demographic information) o Patient Identifier (such as, but not limited to, patient social security number, a subset of the patient social security number, health insurance claim number (HICN), cardholder ID, etc.) Benefits Information o Cardholder Name (e.g. Cardholder First Name, Cardholder Last Name) o Cardholder ID and/or other identifier (e.g. person code) o Group ID and/or Group Information Prescriber Information o Primary Care Provider ID or other identifier (e.g. National Provider Identifier (NPI) code) o Primary Care Provider Name (e.g. Last Name, First Name) o Prescriber ID or other identifier (e.g. NPI code, Drug Enforcement Agency (DEA) number) o Prescriber Name (e.g. Last Name, First Name) o Prescriber Contact Information (e.g. Telephone Number) o Pharmacy or other Healthcare Provider Information (e.g. store name, chain identifier, etc.) o Pharmacy or other Healthcare Provider ID (e.g. NPI code) Medication Information o Active drugs, services, or product information o Inactive drugs, services, or product information o Medication history of drugs, services, or product information o Pharmacy visit history information o Prescription/Service Reference Number o Date Prescription Written o Quantity Dispensed o Days' Supply o Diagnosis/Condition o Pricing information for the drug/service/product (e.g. network price, Usual &
Customary price) o Number of Refills Authorized o One or more Drug Utilization (DUR) Codes o Date of Service.
[0038] At step 308, the pharmaceutical patient assessment module 110 may compare the patient information with one or more pharmaceutical patient assessment eligibility thresholds. The eligibility thresholds may include various types of thresholds which may determine the eligibility of the patient for various types of pharmaceutical patient assessments. For instance, the eligibility thresholds may include, but are not limited to, visit frequency thresholds, medication review thresholds, vaccination thresholds, pharmaceutical opinion thresholds, patient condition thresholds, and/or the like.
[0039] At step 310, the pharmaceutical patient assessment module 110 may determine, based at least in part on the comparison between the patient information and the eligibility thresholds, whether the patient is eligible for one or more pharmaceutical patient assessments. For instance, an example pharmaceutical patient assessment may be a medication review, and an example eligibility threshold may include a medication review threshold that includes one or more medications that would qualify the patient for a medication review. If the patient information (e.g., the information accessed by the pharmaceutical patient assessments module 110 using the patient identifier derived from the prescription fill request 202) indicates that the patient is taking at least one of the included medications in the medication review threshold (e.g., one or more of the active medications of the patient 201 match the included medications in the medication review threshold), the pharmaceutical patient assessment module 110 may determine that the patient is eligible for a medication review. Another non-limiting example of an eligibility threshold may be a pharmaceutical opinion threshold, which may indicate whether the patient and/or a medication being taken by the patient is eligible to receive a pharmaceutical opinion, such as by a pharmacist or other healthcare professional. Regardless, if the pharmaceutical patient assessments module 110 determines that the patient is eligible for a pharmaceutical patient assessment, then the YES branch is followed and processing may proceed to step 312. If the pharmaceutical patient assessments module 110 determines that the patient is not eligible for a pharmaceutical patient assessment, then the NO branch is followed and processing may proceed to step 324.
[0040] At step 312, the pharmaceutical patient assessment module 110 may transmit, to the pharmacy computer(s) 104, a notification 204 indicating the eligible service(s). For instance, the notification 204 may be transmitted as an email, simple messaging service (SMS) text, a web page pop-up, and/or the like. In certain implementations, upon receipt of the notification 204, the pharmaceutical computer(s) 104 may be configured to display the notification 204. Furthermore, the notification 204 may also be transmitted to one or more of the pharmacy mobile devices 108 (e.g., via the pharmacy computer 104 and/or the pharmaceutical patient assessment module 110).
[0041] Upon and/or after receipt of the notification 204, a pharmacist and/or another healthcare professional may elect to perform the eligible pharmaceutical patient assessment(s) for the patient 201. During and/or upon completion of the pharmaceutical patient assessment(s), the pharmacist may enter pharmaceutical patient assessment information 206 (e.g., via the pharmacy management module(s) 188) into the pharmacy mobile device 108. For example, the pharmaceutical patient assessments information 206 may include details of the assessments performed, and may include, but is not limited to, information such-as medication review information, vaccination information, pharmaceutical opinion information, patient condition information, and/or the like. The pharmaceutical patient assessment information 206 may then be transmitted back to the service provider.
[00421 At step 314, the service provider may receive the pharmaceutical patient assessment information 206, which may indicate that one or more of the eligible pharmaceutical patient assessment(s) has been performed.
[0043] At step 316, the pharmaceutical patient assessment module 110 may generate one or more completed form(s) based on the pharmaceutical patient assessments information. In other words, the forms may record the pharmaceutical patient assessment information indicating the details of the pharmaceutical patient assessments performed by the pharmacy.
Such forms may be completed a format that adheres to standards used by the healthcare provider and/or healthcare provider device(s) 102. In certain implementations, the forms may also adhere to a government issued format.
[0044] At step 318, the pharmacy computer 104 may transmit the completed form to one or more healthcare provider device(s), such as devices associated with a healthcare provider (e.g., a doctor's office, a hospital, and/or any other type of medication prescriber). For instance, the complete form(s) may be transmitted via email, SMS text, fax, mail, and/or any other communications method.
[0045] At step 320, the pharmacy computer 104 may utilize the pharmaceutical patient assessment information 206 to generate a prescription transaction 208. In certain implementations, the pharmacy computer 104 may be configured to store the pharmaceutical patient assessment information 206 in the prescription transaction 208.
[0046] At step 322, the phatinacy computer 104 may be configured to communicate the prescription transaction 208 to the claims processor computer(s) 106 for adjudication. Upon adjudicating the prescription transaction 208, the claims processor computer(s) 106 may communicate the adjudicated prescription transaction 210, and/or the results thereof, back to the pharmacy computer(s) 104.
100471 At step 324, if the pharmaceutical patient assessment module 110 determines that the patient is not eligible for pharmaceutical patient assessments, the pharmaceutical patient assessment module 110 may communicate, to the pharmacy computer(s) 104 and/or the pharmacy mobile devices 108, an indication that the patient is ineligible. The method 300 may end after step 324.
[0048] FIG. 4 illustrates an example method 400 for determining patient eligibility for pharmaceutical patient assessments, according to an example embodiment of the disclosure.
100491 The exemplary method 400 begins at the START step and continues to step 402, where the pharmacy computer 104 may determine and/or identify one or more patients associated with a pharmacy and/or the pharmacy computer(s). For instance, the identified patients may be patients that have visited the pharmacy or are scheduled to visit the pharmacy. In certain implementations, and as described above with reference to FIGS. 1-3, the identified patients may be associated with respective patient information.
Additionally, associations(s) between the pharmacy, the identified patients, and the respective patient information may be stored in the database 112.
10050] At step 404, the pharmacy computer 104 may access the respective patient information associated with the identified patients. For instance, in certain implementations, each of the identified patients may be associated with patient identifiers.
The pharmaceutical patient assessments module 110 may utilize the patient identifiers to access the respective patient information.
100511 At step 406, the pharmaceutical patient assessments module 110 of the pharmacy computer 104 may compare the respective patient information with one or more pharmaceutical patient assessment eligibility thresholds.
100521 At step 408, the pharmaceutical patient assessments module 110 may determine for each patient, based at least in part on the comparison, whether the patient is eligible for a pharmaceutical patient assessment. For instance, the pharmaceutical patient assessments module 110 may determine for each patient, whether any of the pharmaceutical patient assessments thresholds are met. If the pharmaceutical patient assessments module 110 determines that a patient is eligible for one or more pharmaceutical patient assessments, then the YES branch is followed and processing may proceed to step 410. If the pharmaceutical patient assessments module 110 determines that a patient is not eligible for one or more pharmaceutical patient assessments, then the NO branch is followed, and the method may end.
[0053] At step 410, the pharmaceutical patient assessments module 110 may store one or more indications of the eligible services for the patient. For instance, the pharmaceutical patient assessments module 110 may associate a flag, value, and/or any other type of indicator with the patient identifier of the patient. The indicator may indicate the type of pharmaceutical patient assessments the patient is eligible to receive.
Furthermore, the association between the patient identifier and the indicator may be stored in the database 112 and/or any other storage device in communication with the pharmacy computer 104.
100541 In step 412, the pharmacy computer 104 may transmit a notification of the eligible service(s) for the patient to the pharmacy mobile devices 1 08. For instance, the notification may be transmitted via email, SMS text, fax, instant message, and/or any other type of communication method. In certain cases, the pharmacy mobile device 108 may be configured to display the notification, thereby providing an indication that a pharmacist and/or other healthcare professional employee of the pharmacy may perform the eligible service(s) for the patient. The method 400 may end after step 412.
[0055] It will be appreciated that the method 400 illustrated in FIG. 4 may be performed periodically by the pharmacy computer 104. For instance, in certain implementations, the pharmacy mobile device 108 may periodically request the pharmacy computer 104 to poll and/or identify which patients may be eligible for certain pharmaceutical patient assessments.
In other implementations, the method 400 may be performed in response to one or more prescription fill requests provided by one or more patients. In yet other implementations, the method 400 may be performed in response to a reporting request (e.g., from a pharmacist and/or other employee of a pharmacy) to determine which patients may be eligible for pharmaceutical patient assessments.
[0056] Various block and/or flow diagrams of systems, methods, apparatus, and/or computer program products according to example embodiments of the disclosure are described above. It will be understood that one or more blocks of the block diagrams and steps of the flow diagrams, and combinations of blocks in the block diagrams and combinations of steps in the flow diagrams, respectively, can be implemented by computer-executable program instructions. Likewise, some blocks of the block diagrams and steps of the flow diagrams may not necessarily need to be perfoinied in the order presented, or may not necessarily need to be performed at all, according to some embodiments.
[0057] These computer-executable program instructions may be loaded onto a special-purpose computer or other particular machine, one or more processors, or other programmable data processing apparatus to produce a particular machine, such that the instructions that execute on the computer, processor, or other programmable data processing apparatus create means for implementing one or more functions specified in the flow diagram step or steps. These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means that implement one or more functions specified in the flow diagram step or steps. As an example, various embodiments of the disclosure may provide for a computer program product including a computer-usable medium having a computer-readable program code or program instructions embodied therein, said computer-readable program code adapted to be executed to implement one or more functions specified in the flow diagram step or steps.
The computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational elements or steps to be performed on the computer or other programmable apparatus to produce a computer-implemented process such that the instructions that execute on the computer or other programmable apparatus provide elements or steps for implementing the functions specified in the flow diagram step or steps.
[0058] Accordingly, blocks of the block diagrams and steps of the flow diagrams support combinations of means for performing the specified functions, combinations of elements or steps for performing the specified functions, and program instruction means for performing the specified functions. It will also be understood that each block of the block diagrams and step of the flow diagrams, and combinations of blocks in the block diagrams and steps of the flow diagrams, can be implemented by special-purpose, hardware-based computer systems that perform the specified functions, elements or steps, or combinations of special-purpose hardware and computer instructions.
[0059] Many modifications and other embodiments of the disclosure set forth herein will be apparent having the benefit of the teachings presented in the foregoing descriptions and the associated drawings. Therefore, it is to be understood that the invention is not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended claims. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for purposes of limitation.
,
Claims (18)
1. A computer-implemented method performed by one or more computers comprising at least one memory and a processor, an application stored in the at least one memory and having computer code wherein said computer code is executed by said processor of the one or more computers; and the processor configured to access the at least one memory and execute the computer-executable instructions comprising instructions for:
receiving, by the one or more computers an electronic prescription fill request;
determining, by the one or more computers, that the electronic prescription fill request includes at least one patient identifier for a patient;
determining, by the one or more computers and based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment;
generating, by the one or more computers and upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
via a communications network, transmitting, by the one or more computers, the notification to a pharmacy device;
via the communications network, receiving, by the one or more computers from the pharmacy device, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment;
generating, by the one or more computers, an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, transmitting, by the one or more computers, the electronic prescription transaction to one or more claims processor computers for adjudication.
receiving, by the one or more computers an electronic prescription fill request;
determining, by the one or more computers, that the electronic prescription fill request includes at least one patient identifier for a patient;
determining, by the one or more computers and based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment;
generating, by the one or more computers and upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
via a communications network, transmitting, by the one or more computers, the notification to a pharmacy device;
via the communications network, receiving, by the one or more computers from the pharmacy device, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment;
generating, by the one or more computers, an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, transmitting, by the one or more computers, the electronic prescription transaction to one or more claims processor computers for adjudication.
2. The method of claim 1, wherein the determining whether the patient is eligible for the pharmaceutical patient assessment comprises:
accessing, by the one or more computers, patient information associated with the patient identifier;
comparing, by the one or more computers, the patient information to one or more eligibility thresholds; and determining, by the one or more computers and based on the comparison, whether at least one eligibility threshold of the one or more eligibility thresholds is met.
accessing, by the one or more computers, patient information associated with the patient identifier;
comparing, by the one or more computers, the patient information to one or more eligibility thresholds; and determining, by the one or more computers and based on the comparison, whether at least one eligibility threshold of the one or more eligibility thresholds is met.
3. The method of claim 2, wherein the patient information comprises at least one of active medication information, medication history information, visit history information, patient condition information, or location information.
4. The method of claim 1, wherein the pharmaceutical patient assessment information comprises at least one of medication review information, vaccination information, or pharmaceutical opinion information.
5. The method of claim 1, further comprising:
generating, by the one or more computers and based at least in part on the received pharmaceutical patient assessment information, a completed pharmaceutical patient assessment form; and transmitting, by the one or more computers, the completed pharmaceutical patient assessment form to a healthcare provider computer associated with a healthcare provider.
generating, by the one or more computers and based at least in part on the received pharmaceutical patient assessment information, a completed pharmaceutical patient assessment form; and transmitting, by the one or more computers, the completed pharmaceutical patient assessment form to a healthcare provider computer associated with a healthcare provider.
6. The method of claim 1, further comprising transmitting, by the one or more computers, the notification to a patient device associated with the patient.
7. The method of claim 1, further comprising:
determining, by the one or more computers, a plurality of patients associated with the pharmacy;
accessing, by the one or more computers, respective patient information associated with the plurality of patients;
comparing, by the one or more computers, the respective patient information with one or more pharmaceutical eligibility thresholds; and determining, by the one or more computers and based at least in part on the comparison, that a second patient is eligible for one or more pharmaceutical patient assessments.
determining, by the one or more computers, a plurality of patients associated with the pharmacy;
accessing, by the one or more computers, respective patient information associated with the plurality of patients;
comparing, by the one or more computers, the respective patient information with one or more pharmaceutical eligibility thresholds; and determining, by the one or more computers and based at least in part on the comparison, that a second patient is eligible for one or more pharmaceutical patient assessments.
8. The method of claim 7, further comprising:
generating, by the one or more computers, a second notification indicating that the second patient is eligible for the one or more pharmaceutical patient assessments;
and transmitting, by the one or more computers, the notification to the pharmacy device.
generating, by the one or more computers, a second notification indicating that the second patient is eligible for the one or more pharmaceutical patient assessments;
and transmitting, by the one or more computers, the notification to the pharmacy device.
9. A system, comprising:
at least one processor; and at least one memory storing computer-executable instructions, that when executed by the at least on processor, cause the at least one processor to:
receive an electronic prescription fill request;
determine that the electronic prescription fill request includes at least one patient identifier associated with a patient;
determine, based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment;
generate, upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
direct communication of the notification to a pharmacy device via a communications network;
receive, from the pharmacy computer, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment via the communications network;
generate an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, direct communication of the electronic prescription transaction to one or more claims processor computers for adjudication.
at least one processor; and at least one memory storing computer-executable instructions, that when executed by the at least on processor, cause the at least one processor to:
receive an electronic prescription fill request;
determine that the electronic prescription fill request includes at least one patient identifier associated with a patient;
determine, based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment;
generate, upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
direct communication of the notification to a pharmacy device via a communications network;
receive, from the pharmacy computer, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment via the communications network;
generate an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, direct communication of the electronic prescription transaction to one or more claims processor computers for adjudication.
10. The system of claim 9, wherein the computer-executable instructions to determine whether the patient is eligible for the pharmaceutical patient assessment comprises further comprises instructions to:
access patient information associated with the patient identifier;
compare the patient information to one or more eligibility thresholds; and determine, based on the comparison, whether at least one eligibility threshold of the one or more eligibility thresholds is met.
access patient information associated with the patient identifier;
compare the patient information to one or more eligibility thresholds; and determine, based on the comparison, whether at least one eligibility threshold of the one or more eligibility thresholds is met.
11. The system of claim 10, wherein the patient information comprises at least one of active medication information, medication history information, visit history information, patient condition information, or location information.
12. The system of claim 9, wherein the pharmaceutical patient assessment information comprises at least one of medication review information, vaccination information, or pharmaceutical opinion information.
13. The system of claim 9, wherein the computer-executable instructions further cause the at least one processor to:
generate, based at least in part on the received pharmaceutical patient assessment information, a completed pharmaceutical patient assessment form; and direct communication of the completed pharmaceutical patient assessment form to a healthcare provider computer associated with a healthcare provider.
generate, based at least in part on the received pharmaceutical patient assessment information, a completed pharmaceutical patient assessment form; and direct communication of the completed pharmaceutical patient assessment form to a healthcare provider computer associated with a healthcare provider.
14. The system of claim 9, wherein the computer-executable instructions further cause the at least one processor to direct communication of the notification to a patient device associated with the patient.
15. The system of claim 9, wherein the computer-executable instructions further cause the at least one processor to:
determine a plurality of patients associated with the pharmacy;
access respective patient information associated with the plurality of patients;
compare the respective patient information with one or more pharmaceutical eligibility thresholds; and determine, based at least in part on the comparison, that a second patient is eligible for one or more pharmaceutical patient assessments.
determine a plurality of patients associated with the pharmacy;
access respective patient information associated with the plurality of patients;
compare the respective patient information with one or more pharmaceutical eligibility thresholds; and determine, based at least in part on the comparison, that a second patient is eligible for one or more pharmaceutical patient assessments.
16. The system of claim 15, wherein the computer-executable instructions further cause the at least one processor to:
generate a second notification indicating that the second patient is eligible for the one or more pharmaceutical patient assessments; and direct communication of the notification to the pharmacy device.
generate a second notification indicating that the second patient is eligible for the one or more pharmaceutical patient assessments; and direct communication of the notification to the pharmacy device.
17. A non-transitory computer-readable medium storing computer-executable instructions, that when executed by at least one processor, cause the at least one processor to:
receive, from a pharmacy computer associated with a pharmacy, an electronic prescription fill request;
determine that the electronic prescription fill request includes at least one patient identifier associated with a patient;
determine, based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment;
generate, upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
transmit the notification to a pharmacy device via a communications network;
receive, from the pharmacy computer, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment via the communications network;
generate an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, direct communication of the electronic prescription transaction to one or more claims processor computers for adjudication.
receive, from a pharmacy computer associated with a pharmacy, an electronic prescription fill request;
determine that the electronic prescription fill request includes at least one patient identifier associated with a patient;
determine, based at least in part on the patient identifier, whether the patient is eligible for a pharmaceutical patient assessment;
generate, upon determination that the patient is eligible for the pharmaceutical patient assessment, a notification indicating that the patient is eligible;
transmit the notification to a pharmacy device via a communications network;
receive, from the pharmacy computer, pharmaceutical patient assessment information indicating performance of the pharmaceutical patient assessment via the communications network;
generate an electronic prescription transaction based at least in part on the pharmaceutical patient assessment information; and via the communications network, direct communication of the electronic prescription transaction to one or more claims processor computers for adjudication.
18. The non-transitory computer readable medium of claim 17, wherein the computer-executable instructions further cause the at least one processor to:
determine a plurality of patients associated with the pharmacy;
access respective patient information associated with the plurality of patients;
compare the respective patient information with one or more pharmaceutical eligibility thresholds; and determine, based at least in part on the comparison, that a second patient is eligible for one or more pharmaceutical patient assessments.
determine a plurality of patients associated with the pharmacy;
access respective patient information associated with the plurality of patients;
compare the respective patient information with one or more pharmaceutical eligibility thresholds; and determine, based at least in part on the comparison, that a second patient is eligible for one or more pharmaceutical patient assessments.
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| CA (1) | CA2847761C (en) |
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2014
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| Publication number | Publication date |
|---|---|
| CA2847761A1 (en) | 2015-09-30 |
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