Systems and Methods for Identifying and Correcting Defects in Health Care Services

The disclosure pertains to a secure intelligent networked system for identifying and correcting a defect in a health care service and method for using the same. The system receives data regarding patient care, generally obtained from commercial insurance claims, customer claims or Medicare claims. T...

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Bibliographische Detailangaben
Hauptverfasser:	Scherer, Julie A, Rains, Nicolapagos A, Smoyer, Larie H, Wikman, Charles M, Cohen, Jeanne, Klasco, Richard S
Format:	Patent
Sprache:	eng
Schlagworte:	HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATIONTECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING ORPROCESSING OF MEDICAL OR HEALTHCARE DATA INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTEDFOR SPECIFIC APPLICATION FIELDS PHYSICS
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Beschreibung
Zusammenfassung:	The disclosure pertains to a secure intelligent networked system for identifying and correcting a defect in a health care service and method for using the same. The system receives data regarding patient care, generally obtained from commercial insurance claims, customer claims or Medicare claims. The system operates on a plurality of nodes configured based on a set of metrics associated with the appropriateness of health care measures. The system may generate a determination regarding the appropriateness of the measure. The system may further produce a second determination denoting a physician's overall conformity with appropriate standards of practice. Finally, the system may generate a knowledge narrative indicating an appropriate action.