METHOD FOR THE PRESCRIPTION AND ADMINISTRATION OF HEALTH CARE RESOURCES
FIELD OF INVENTION
This invention relates to the prescription and administration of health care resources, including, among other things, supplies, physical facilities, health care personnel, equipment, and services, and particularly to the effective treatment of a patient at a minimum cost. BACKGROUND OF INVENTION
In the medical care industry, constant vigilance is maintained over the cost of the care provided to patients, with particular attention being given simultaneously to assuring the well-being of the patient. One method currently being practiced by some health care institutions, particularly hospitals, for cost/treatment planning is centered around the concept of clinical pathways. As used in this environment, the concept attempts to bring to bear upon the care afforded a patient all those resources of the institution which are dictated by the nature of the patient ' s illness and which will provide the dictated care, and result in the patient being restored to that state of health that permits proper release from the institution after a minimum length of stay. The use of the clinical pathway concept has been demonstrated to reduce the length of stay in an institution of a patient. It has further been demonstrated to reduce the overall cost of the treatment of the patient while in the institution by ensuring that no ill effect associated with the patient's stay in the institution caused the patient to require more that a standard regimen of treatment for a specific illness. For example, through proper care, the patient is prevented from developing decubitus ulcers which could require that the patient remain in the institution for an extended period
of time, just for treatment of the ulcers.
In health-care institutions employing the clinical pathway concept, there is developed within the institution a protocol for the treatment of a given illness, surgical procedure, or other regimen of medical care to be provided to a patient (termed a "procedure") . This protocol lists the contribution of each institutional unit (e.g. department) toward the treatment of the patient (termed a "care event") , and the sequence in which each care event is to occur. This protocol then becomes the "standard" for the care to be provided for any patient entering the institution and suffering from the particular illness (medical diagnosis) which is addressed by the protocol.
The clinical pathway concept heretofore has been applied internally of health care institutions, affecting only those services which originate within the institution and which are provided by the internal resources of the institution. No analysis of the total costs associated with the protocol, or the standardization of the resources which are brought to bear in the implementation of the protocol, is known to have been made prior to the present invention. Nor is there known to have been any attempt prior to the invention disclosed in copending application Serial No. 08/489,496, to incorporate within the clinical pathway those medical supplies which are associated with the implementation of a protocol. Because of these shortcomings of the clinical pathway concept, health care institutions have failed to achieve available significant cost savings as respects the resources allocated and/or used in the course of any given protocol .
It is therefore an object of the present invention to provide a method of enhanced prescription of health care resources .
It is another object to provide a method for enhanced control over health care resources.
It is another object to provide a method for minimization of the costs associated with health care. SUMMARY OF INVENTION
The present method includes the steps of identification of the significant epochs of health care by service, i.e. care events, for a given clinical pathway, based upon the specific use or function to be performed in each care event and outside the context of the use location of the care event, identification of the resources to be brought to bear in the performance of each care event and outside the context of the use location of the resource, assignment of unique numeric or alpha or numeric/alpha identifiers to each clinical pathway, each care event, and to each resource, assigning the care events to a pool of care events, assigning the resources to a pool of resources, selecting from the pool of care events those care events to be associated with a given pathway, selecting from the pool of resources those resources to be associated with a given care event, associating the selected care event with its selected resources, associating a series of the care events and their respective associated resource allocations with a given clinical pathway in a linear hierarchial bill of materials for the given pathway wherein the bill of materials becomes a prescription for the treatment of a patient employing a given clinical pathway. In a preferred embodiment, a "pool" is a computer database.
The term "bill of materials" is used generically herein at times to represent a listing of resources (components) for a given medical treatment. It is to be recognized that, depending upon the context of its use herein, "bill of materials" may also be used in its more specific sense of representing a listing of
medical supplies. Also, when a more specific sense is required, the terms "bill of pharmacy", "bill of labor" or "bill of overhead", etc. may be employed. In this respect, for each care event there may exist a "bill of materials", a "bill of pharmacy", a "bill of labor", a "bill of overhead", etc. DETAILED DESCRIPTION OF INVENTION
Copending application S.N. 08/489,496, addresses primarily the provision of supplies to a health care institution. The present invention may include the provision of supplies, but goes much further, and includes the prescription and administration of resources, which term includes, but is not limited to, supplies, personnel, physical facilities, services such as testing, overhead, time allocations, and miscellaneous matters such as instructions, etc. In the present invention, the fundamental unit is the "care event". Each care event comprises a description of a health care event which is stated in terms of a use or function, as opposed as to specifically what or who may be involved in the performance of the care event. Each care event is a "virtual container" for one or more health care resources. A clinical pathway is constructed as a series of these care events. Thus, a clinical pathway inherits its properties from the individual care events which go to make up the clinical pathway, and each care event contains within its domain all the resources required for implementation of the care event .
In the present invention the fundamental object, i.e. a care event, is assigned an identifier, such as "91- eeeeffffggggg" , where "eeee" is a consumption point identifier code, "ffff" is a protocol identifier code, and "ggggg" is a code used to guarantee a unique number. Multiple care events comprise a clinical pathway for treatment of a given illness or for a
given medical procedure, and each clinical pathway is also assigned a unique identifier, for example, "90-xxxx" where "xxxx" is a code assigned to a clinical pathway. These identifiers are suitable for inclusion in a computer database, for example. A care event may comprise resources of several kinds and may also have innate properties, such as a duration. For example, an anesthesia care event may have instructions for who uses the prescribed supplies and how, and/or may have a prescribed duration of 10 minutes and a recovery period of an additional 10 minutes. Care events are classified by clinical area, for example, "ANES" for anesthesiology, "PROP" for preoperative, "PSOP" for post-operative, etc. Care events may also be user- specified if desired, as by "JONES" for Dr. Jones.
In accordance with a further aspect of the present method, the bill of materials may be expanded to include medical supplies as additional items. To this end, the present method contemplates a database which is the equivalent of the well-known "Doctor's Preference Card" that is commonly maintained within a health care institution and which lists thereon all the supplies, and other items such as operating room set-ups, etc., which a particular doctor requires when he performs a given surgical treatment, for example. These cards are cumbersome, frequently in need of change or updating, and otherwise worrisome to a health care institution. In the present invention, all the directions, instructions, listing of supplies, etc. (i.e. resources) which a particular doctor may require or desire are identified and recorded in a database. Each resource item is assigned an identifier which may be alpha, numeric or alpha/numeric. As disclosed in copending application S.N. 08,489,496, those items of medical supplies which a health care institution
requires for a given care event in a clinical pathway for a given medical procedure, may be expressed as a hierarchial bill of materials, employing identification codes (identifiers) which include at least an identification of the care event with which the supply is to be used, an identification of the supplier of the item of supply, and an identification of the item itself. In the present method, the identifier of an item of medical supply may further include identification of the cost of the item to the health care institution. By this means, there is added a new dimension to the usefulness of the bill of materials with respect to identification and analysis of the costs of the supplies associated with a given care event, hence with a given clinical pathway.
In like manner, each of others of the resources which are to be made available for consumption in the implementation of a care event are identified. In accordance with the present method these identified events are expressed generically as "events" without regard to their use location, or who will perform the event, or what services (such as blood testing, x- ray, etc.) will be required for the event, and assigned respective unique identifiers, and recorded in a database, a computer database, for example.
The information available in the several available databases may be accessed by the institution, the supplier to the institution, doctor, and others, employing a computer into the memory of which the databases are stored. From these databases, a hierarchial bill of materials is developed for a given clinical pathway level, e.g. for a given treatment regimen such as Laproscopic Gallbladder Procedure (pathway No. 15546) . A typical bill of materials is given below:
PART DESCRIPTION QTY/ASSY UOM
90- 511125A Lap Choly Procedure (protocol 25 ) EA
91 PCKG000338235 Packaging and Container Care Event 1 EA TPAK-LAB TracePak Content Label Stock 1 EA 56-11099 Box, TraceCart 20 5 x 20 5 x 35 1 EA 56-11208 TraceCart Lid /gaskets & labels 1 EA 56-11359 TraceCart Base, 32" (H) 40 Gal 1 EA
91-PROP020528134 Pre-Operative Care Event 1 EA 92-DLR3835326 Dealer Supply Bundle for Pre-op 1 EA
3642089101 Drape Half 60" x 44" 2 EA 3642089121 Drape LG 60" x 77" 1 EA 4130091045 Litton Stopcock (old #469) 1 EA 5858040532 KT BLD Gas 3cc 1 EA 93-HOS8842736 Hospital Pharmacy-Supplied Preop Items 1 EA
10087 Solution Bag 1500cc 1 EA 30045 Atropene 20 cc 94-HOS3822123 Labor Bundle for Care Event 1 EA
10100 Registered Nurse 10 mn 10120 Nurse's Assistant 10 mn 95-HOS3833234 Overhead Bundle for Care Event 1 EA
0250 Preoperative Staging Area 20 mn 1-A ES000847249 Anesthesia Care Event 1 Ea
92-DER5528312 DeRoyal Supply Bundle for Anesthesia 1 Ea
M60-023 Holder, Head Adult 1 Ea 71-2383 NS Suet Can, 1500cc 1 Ea 86-028192 Kit, Anesthesia Custom 1 Ea 92-DLR3824523 Dealer Supply Bundle for Anesthesia 1 Ea
5858197070 TB Endo Bluelme Murphy C 7 0mm 1 Ea
93-BER8842736 Bergen-Bruns ig Supplied Pharmacy Items 1 Ea
12605 Halothane 50 ml
12050 Flaxadil 20 mg
94-HOS3382835 Labor Bundle for Care Event 15 mn
10190 Anesthesiologist 1 EA
10150 Certified Registered Burse Anesthetist 1 EA
10160 Anesthesia Technician 1 EA
95-HOS3293345 Overnead Bundle for Care Event 15 mn
0250 Operating Room Suite 1 EA
0575 Laparoscopic Video Cart 1 EA 1-OPRM462076B Operating Room Care Event 1 EA
92-DER3453807 DeRoyal Supply Bundle for OR 1 EA 28-0500 Probe, Img/Aspir w/Tubing 1 EA 50-3218P Prep Tray 1 EA 50-9783P Basic Endo Pack 1 EA 71-1101 Suction Canister Set, 1500cc 1 EA 92-DLR2353872 Dealer Supply Bundle for OR 1 EA
0815135527 Electrode Adult Pre-Gelled 1 EA 22990LKR12 KT Laparoscopic Chole 1 EA 22990EEP02 Spatula Tip Electrode 1 EA 23000A184H Suture Silk 3-0 12-18" Ties 1 EA 3642089223 Drape Lap/Cholecystect 1 EA 3642090042 Gown Surgical Strl /twl XLG 3 EA 92-HOS3307857 Hospital-Provided Supply Bundle for OR 1 EA
76839218 Basin, Stainless Steel, 7000cc 1 EA 76844822 Reusable Instrument Set (minor abdominal ) 1 1 EA
93-BER26332736 Bergen-Brunswig Supplied Pharmacy Items 11 EA
12700 Albumex (100 mg) 1 EA 94-HOS2883852 Labor Bundle circulating
Anesthesiologist 10 mn
10190 Anesthesiologist 1 EA 94-HOS3352835 Labor Bundle (lap-choly team) 45 mn
10150 Certified Registered Burse Anesthetist 1 EA 10700 General Surgeon 1 EA 10725 Assisting Surgeon 1 EA 10750 Video Operator 1 EA 10800 Operating Room Registered Nurse 1 EA 95-HOS3293465 Overhead Bundle for Care Event 45 mn
0250 Operating Room Suite 1 EA 0575 Laparoscopic Video Cart 1 EA
91-PSOP3854332 Post-Operative Care Event 1 EA
92-DLR3823525 Dealer Supply Bundle for Post-OP 1 EA
41305030810 Pack-You Quilt Full Body 1 EA 94-HOS3356235 Labor Bundle (post-operative monitoring) 55 mn
10820 Post Anesthesia Registered Nurse 1 EA 95-HOS3378315 Overhead Bundle for Care Event 30 mn
0260 PACU Suite 1 EA
Inasmuch as the health care institution has available to it the cost to the institution of each item of medical supply, the cost of each service such as extracting blood from a patient for testing, each person which is scheduled to take part in each care event for the patient during their stay in the institution
(and the amount of time to be spent by each person in implementating a given care event) , a value for the overhead to be assigned to each care event, and a value for each of other resources which are to be brought to bear in the course of implementation of a given care event, the present method may include the step of calculating the total cost of resources to the institution for a given clinical pathway. As a further aspect of the present method, there is provided a step of recording the actual resources utilized in the implementation of a given care event so that the total cost of the actual resources consumed may readily be compared to the projected total cost for the care event, and in this manner, over time, develop sufficient
historical data as will permit the institution to adjust the information in its various databases to cause the projected cost of a care event to more accurately reflect its actual cost .
In accordance with a further aspect of the present method, each item of medical supply is assigned a unique identifier (as described above) and maintained in a database. Instead of assigning the items of medical supply to a common pool of medical supplies, each possible item of medical supply is assigned to a "product tree" grouping of medical supplies. In this product tree, each item of medical supply is associated with a generic identification of items of medical supply, this generic identification being independent of the use location of the supply, but rather being based upon the use and function of the medical supply. Proceeding down the product tree, generically identified items of medical supplies are further identified into one or more increasingly less generic categories, each based on intended use and function of the supplies listed thereunder and outside the context of the use location of the medical supply. As the subdivision of the medical supplies proceeds from the most generic category to the most detailed category, the categories are subdivided to the point where each subcategory describes a group of medical supplies that are functionally equivalent. These end-points are termed "Terminal Nodes". For example, some very general categories may be "Surgical Attire", "Preparation Products", and "Needles and Syringes". These very general catagories may be subdivided with increasing detail. In a more specific example, the most general category might be "Electrosurgical Products" . This category might be subdivided into "Grounding Pads", "Cautery Pencils", etc. The category "Cautery Pencils" might be subdivided again based on "Hand-
Controlled" versus "Foot-Controlled", with "Hand Controlled" being further subdivided into "Push Button" and "Rocker" . Some users insist that all hand-controlled pencils are functionally equivalent while other users are equally passionate with the opposite opinion. By effecting a "stop" at the "Hand-Controlled" level, the default state of considering the two styles separate can be overridden in a way that is easily stored and maintained. Employing this database the end-user can readily select each item to be included in the definition of a given care event. Thereupon the care event inherits the selected item(s) and any time thereafter when the care event is called for in a clinical pathway, the care event carries with it the selection of medical supplies associated therewith. In one optional step of the present method, employing the Product Tree database, the health care institution may analyze each item of medical supply associated with each care event and determine whether there is a less expensive item available and which is functionally equivalent to the more expensive item. In like manner it may be determined whether a given medical supply item has a functional equivalent that is available from a particular supplier. Given the present disclosure, it will be evident to one skilled in the art that other data manipulations and/or analyses may be performed as an aspect of the present invention.
Whereas specific examples have been described herein, it is to be recognized that the invention is not limited to these specific examples, but rather is limited only as defined in the claims appended hereto.