Collection, arrangement, linkage and allocation of longitudinal cost, reimbursement and clinical data at the patient encounter level

An apparatus for securely linking together patient treatment data and in a first format with health care provider data in a plurality of data standards for a treatment that a healthcare provider provided to a plurality of patients for an ailment during a patient encounter for each patient to enable data-driven evaluation of the financial and medical effectiveness of that treatment, the apparatus comprising:

• an engine including a first processor and a first memory storing first computer-executable instructions that, when executed by the first processor, cause the first processor to perform at least:
• receiving an encounter detail file associated with the treatment that the healthcare provider provided to the patient during the patient encounter, wherein the encounter detail file includes the health care provider data in a plurality of data standards;
• determining, by the engine, a unique identifier corresponding to the healthcare provider data of the encounter detail file;
• retrieving, by the engine, event data, time/date stamp data, and a utilization proxy from the encounter detail file based on the unique identifier, wherein the event data and time/date stamp data from the encounter detail file are in one or more of the plurality of data standards that are different from the encounter detail file;
• updating, by the engine, a Longitudinal Patient Administration Record (LAR) database with the retrieved event data and time/date stamp data from the encounter detail file;
• linking, by the engine, the LAR and a master file via the utilization proxy from the encounter detail file;
• determining that the master file indicates cost and revenue data for an item was utilized in the patient encounter corresponding to the encounter detail file, wherein the item includes one or more of a supply item and a drug item and the master file includes cost and revenue data for the item and is maintained by a system that is separate from the engine;
• and
• in response to determining that the master file indicates the item was utilized in the patient encounter corresponding to the encounter detail file, automatically sending a plurality of control signals that link the encounter detail file with at least one other file associated with the patient encounter wherein, the system that is separate from the engine includes a second processor and a second memory storing second computer-executable instructions that, when executed by the second processor, cause the second processor to perform at least:
• receiving the plurality of control signals from the engine at the system, the plurality of control signals causing the second processor to execute second computer-executable instructions stored in the second memory including:
• generating, by the engine, a first linkage between the master file and the encounter detail file, the first linkage indicating that the item specified in the encounter detail file was used in the patient encounter,
• generating, by the engine, a second linkage between an electronic medical record for the patient and a plurality of transaction files for other patient encounters that each have the item in common with the electronic medical record, wherein the plurality of transaction files each include the cost and revenue data for the item,
• updating, via the computer network, the master file at the system with the first linkage, and
• updating the LAR with both the first linkage and the second linkage;
• wherein, in response to the system storing the linkages in a longitudinal patient administration record, the engine executes further first computer-executable instructions that, when executed by the first processor, cause the first processor to perform at least:
• determining a metric based on the LAR and the master file using the first linkage and the second linkage, wherein the metric indicates whether the item is on an approved list for the treatment the healthcare provider provided to the patient during the patient encounter and is a statistical measure of a clinical outcome for the patient encounter that used the item;
• selecting the item for use during a patient encounter based on the metric;
• comparing the selected item to an approved list of items for the patient encounter the treatment that the healthcare provider provided to the patient during the patient encounter;
• identifying an equivalent item for the selected item from the comparing step;
• and
• generating and communicating, via the computer network, an order to a supplier for the equivalent item to cause delivery of the equivalent item to a desired location to effect the treatment.

A non-transitory computer readable medium storing computer-executable instructions for securely linking together patient treatment data in a first format with health care provider data in a plurality of data standards for a treatment that a healthcare provider provided to a plurality of patients for an ailment during a patient encounter for each patient to enable data-driven evaluation of the financial and medical effectiveness of that treatment, the instructions, when executed, cause at least one processor to perform at least:

• receiving, via a computer network by an engine comprising a first processor and a first memory storing first computer-executable instructions, an encounter detail file associated with the treatment that the healthcare provider provided to the patient during the patient encounter, wherein the encounter detail file includes the health care provider data in a plurality of data standards;
• determining, by the engine, a unique identifier corresponding to the healthcare provider data of the encounter detail file;
• retrieving, by the engine, event data, time/date stamp data, and a utilization proxy from the encounter detail file based on the unique identifier, wherein the event data and time/date stamp data from the encounter detail file are in one or more of the plurality of data standards that are different from the encounter detail file;
• updating, by the engine, a Longitudinal Patient Administration Record (LAR) database with the retrieved event data and time/date stamp data from the encounter detail file;
• linking, by the engine, the LAR and a master file via the utilization proxy from the encounter detail file;
• determining, by the engine, that the master file indicates cost and revenue data for an item was utilized in the patient encounter corresponding to the encounter detail file, wherein the item includes one or more of a supply item and a drug item and the master file includes cost and revenue data for the item and is maintained by a system that is separate from the engine, the system including a second processor and a second memory;
• in response to determining, by the engine, that the master file indicates the item was utilized in the patient encounter corresponding to the encounter detail file, automatically sending, by the engine, a plurality of control signals to the system that is separate from the engine, the plurality of control signals causing the second processor to execute second computer-executable instructions stored in the second memory, the second computer-executable instructions including:
• generating, by the engine, a first linkage between the master file and the encounter detail file, the first linkage indicating that the item specified in the encounter detail file was used in the patient encounter,
• generating, by the engine, a second linkage between an electronic medical record for the patient and a plurality of transaction files for other patient encounters that each have the item in common with the electronic medical record, wherein the plurality of transaction files each include the cost and revenue data for the item,
• updating, via the computer network and by the engine, the master file at the system with the first linkage, and
• updating, via the computer network and by the engine, the LAR at the system with both the first linkage and the second linkage;
• determining, by the engine, a metric based on the LAR and the master file using the first linkage and the second linkage,
• wherein the metric indicates whether the item is on an approved list for the treatment the healthcare provider provided to the patient during the patient encounter and is a statistical measure of a clinical outcome for the patient encounter that used the item;
• selecting, by the engine, the item for use during a further patient encounter based on the metric;
• comparing, by the engine, the selected item to the approved list of items for the treatment that the healthcare provider provided to the patient during the patient encounter;
• identifying, by the engine, an equivalent item for the selected item from the comparing step based on the metric;
• and
• generating and communicating, via the computer network and by the engine, an order to a supplier for the equivalent item to cause delivery of the equivalent item to a desired location to effect the treatment.