APPARATUS AND METHOD FOR CONSTRUCTING AND MANAGING CLINICAL RULES

An apparatus and method are disclosed for defining and managing clinical rules. A computer system provides access to administrators for defining and entering the details of clinical rules for various clients. The administrator selects the prescription products, or medication, for which the clinical...

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Bibliographic Details
Main Authors TOBIN, WILLIAM, D, BROWN, KENNETH, J, BRISSON, PAUL, R, STETTIN, GLEN, D
Format Patent
LanguageEnglish
French
Published 31.07.2003
Edition7
Subjects
CALCULATING
COMPUTING
COUNTING
DATA PROCESSING SYSTEMS OR METHODS, SPECIALLY ADAPTED FORADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORYOR FORECASTING PURPOSES
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
SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE,COMMERCIAL, FINANCIAL, MANAGERIAL, SUPERVISORY OR FORECASTINGPURPOSES, NOT OTHERWISE PROVIDED FOR
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Summary:An apparatus and method are disclosed for defining and managing clinical rules. A computer system provides access to administrators for defining and entering the details of clinical rules for various clients. The administrator selects the prescription products, or medication, for which the clinical rule will apply. The administrator also specifies the coverage criteria to be used for approving coverage of the prescription products. When a prescription claim is submitted to the computer system, the appropriate clinical rule is selected and applied to determine if the cost of the prescription product should be covered. L'invention concerne un appareil et un procédé de définition et de gestion de règles cliniques. Les administrateurs ont accès à un système informatique pour définir et entrer les détails des règles cliniques pour divers clients. L'administrateur sélectionne les produits prescrits, ou médicaments, auxquels s'appliquent la règle clinique. L'administrateur précise également les critères de couverture à utiliser pour approuver la couverture des produits prescrits. Lorsqu'une demande de prescription est soumise au système informatique, la règle clinique appropriée est sélectionnée et appliquée afin de déterminer si le coût du produit prescrit devrait être couvert.
Bibliography:Application Number: WO2003US01653