# US 2019/0172572 A1 · System and method for determining health care procedures and reimbursement

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- Number: US 2019/0172572 A1
- Document ID: US20190172572A1
- Status: Published application
- Kind: A1
- Application number: 16/323,805
- Filed: 2016-08-18
- Published: 2019-06-06
- Earliest claimed: 2016-08-18
- Assignees: Synaptive Medical (Barbados) Inc.
- Inventors: CAMERON ANTHONY PIRON; ARUN VICTOR JAGGA; MURUGATHAS YUWARAJ; THANH VINH VUONG
- Web page: https://patentgrep.com/patent/US20190172572A1

## CPC

- G16H 10/60: for patient-specific data, e.g. for electronic patient records
- G06F 21/45: Structures or tools for the administration of authentication
- G06F 21/6254: {by anonymising data, e.g. decorrelating personal data from the owner's identification}
- G06Q 30/04: Billing or invoicing
- G16H 30/20: for handling medical images, e.g. DICOM, HL7 or PACS
- G16H 30/40: for processing medical images, e.g. editing
- G16H: HEALTHCARE INFORMATICS, i.e. INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR THE HANDLING OR PROCESSING OF MEDICAL OR HEALTHCARE DATA
- G06F: ELECTRIC DIGITAL DATA PROCESSING (computer systems based on specific computational models G06N)
- G06Q: INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR

## Abstract

A method and system is provided for recording a health care event, optimizing medical procedures and calculating reimbursement. The method includes: acquiring metadata comprising a patient identifier, a practitioner identifier, a health care site identifier, an entry time and a medical reason for the health care event; receiving a reimbursement request; generating a procedures list based on the medical reason; selecting a procedure; generating a list of required data types and a list of required quality data for the procedure; acquiring raw data comprising the procedure, a medical device identifier, an entry time and one or more quality data from the medical device for the procedure; and calculating a reimbursement for the health care event based on the procedure, the medical device identifier, the required quality data and the quality data from the medical device. The method implements iterative learning using the collected data to determine optimal health care procedures.

## Claims

### Claim 1

A computer-implemented method for recording a first health care event and calculating a reimbursement, the method comprising:
Acquiring metadata for the first health care event, the metadata comprising:
i. a patient identifier;
ii. a patient identifier entry time;
iii. a two-factor authentication practitioner identifier;
iv. a practitioner identifier entry time;
v. a health care site identifier;
vi. a health care site identifier entry time; and
vii. a medical reason for the health care event;
Receiving a request for reimbursement;
Generating a list of procedures based on the medical reason;
Selecting a procedure from the list of procedures;
Generating a list of required data types for the procedure;
Generating a list of required quality data for the procedure;
Acquiring raw data for the first health care event, the raw data comprising:
the procedure;
a medical device identifier;
a medical device identifier entry time;
one or more quality data from the medical device for the procedure; and
a patient status before and after the procedure; and
Calculating a reimbursement for the first health care event based on at least the procedure, the medical device identifier, the required quality data and the one or more quality data from the medical device.

### Claim 2

A computer-implemented method for recording a first health care event and calculating a reimbursement, the method comprising:
Acquiring metadata for the first health care event, the metadata comprising:
a patient identifier;
a patient identifier entry time;
a two-factor authentication practitioner identifier;
a practitioner identifier entry time;
a health care site identifier;
a health care site identifier entry time; and
a medical reason for the event;
Receiving a request for reimbursement;
Generating a list of one or more procedures based on the medical reason;
Generating a list of required data types and a list of required quality data for each of the one or more procedures;
Acquiring raw data for the first health care event, the raw data comprising:
a procedure selected from the list of procedures;
a medical device identifier for a medical device used in the procedure;
a medical device identifier entry time;
one or more quality data from the medical device used in the procedure; and
a patient status before and after the procedure; and
Calculating a reimbursement for the first health care event based on at least the procedure, the medical device identifier, the list of required quality data and the one or more quality data from the medical device.

### Claim 3 (depends on 1)

The method of claim 1, wherein the patient identifier, the practitioner identifier and the health care site identifier are retrievably stored in one or more databases.

### Claim 4

(canceled)

### Claim 5 (depends on 1)

The method of claim 1, wherein the patient identifier is anonymized.

### Claim 6

(canceled)

### Claim 7 (depends on 1)

The method of claim 1, further comprising:
Generating a second health care event by adding additional metadata and additional raw data to the first health care event metadata and the first health care event raw data,
wherein the first health care event is immutable and the second health care event is associated with a second practitioner identifier entry time.

### Claim 8 (depends on 1)

The method of claim 1, wherein the raw data for the health care event is aggregated and analyzed to modify the list of procedures, the list of data types and the list of quality data.

### Claim 9 (depends on 1)

The method of claim 1, wherein
the procedure selected from the list of procedures is to record a radiology reading, the procedure comprising:
Providing a radiology image on a monitor;
Viewing the radiology image by a radiologist;
Capturing a screen-shot of the radiology image and a time-stamp of the viewing by the radiologist;
Providing an annotation of the radiology image by an audio or video recording; and
Storing the radiology image, the screen-shot, the time stamp and the annotation;
and
the list of required data types comprises:
the radiology image;
the screen-shot of the radiology image with the time-stamp of the viewing by the radiologist; and
the annotation of the radiology image by an audio or video recording.

### Claim 10

A health care data system to determine a reimbursement for a health care event comprising:
a database for storing metadata for the health care event, the metadata comprising:
a patient identifier;
a practitioner identifier;
a health care site identifier;
a time entry for each of the patient identifier, the practitioner identifier and the health care site identifier; and
a medical reason for the health care event;
a database for storing raw data for the health care event, the raw data including:
a list of procedures for the medical reason;
a procedure selected from the list of procedures;
a list of data types for the procedure;
a list of quality data for the procedure;
a medical device identifier;
a time entry for the medical device identifier; and
at least one quality data from the list of quality data, measured from the medical device for the health care event;
a processor in communication with the metadata database and the raw data database; and
a memory with an executable application for calculating the reimbursement quantum for the health care event based on at least the procedure, the medical device and the quality data.

### Claim 11 (depends on 10)

The health care data system of claim 10, wherein the quality data for the procedure includes a patient status before and after the procedure.

### Claim 12 (depends on 10)

The health care data system of claim 10, wherein the patient identifier is anonymized.

### Claim 13 (depends on 10)

The health care data system of claim 10, further comprising a processor and a memory with an executable application for aggregating the metadata and the raw data for analysis.

### Claim 14 (depends on 13)

The health care data system of claim 13, wherein the executable application includes a correlation of the selected procedure with a patient status after the procedure.

### Claim 15 (depends on 2)

The method of claim 2, wherein the raw data for the health care event is aggregated and analyzed to modify the list of procedures, the list of data types and the list of quality data.