TECHNICAL FIELD

This invention relates to a computer-implemented method for managing a consultation between a patient and a medical service provider wherein the patient is a member of a medical insurance scheme. The invention relates also a computer system for managing a consultation between a patient and a medical service provider wherein the patient is a member of a medical insurance scheme.

Any reference in this specification to a medical insurance provider must be interpreted to mean any organisation, corporate entity, fund or the like, established for the purpose of operating a medical aid scheme or a medical insurance scheme, established with the aim of providing financial cover for healthcare expenses such as hospitalisation, medical treatments and medicine incurred by members of such schemes. In South Africa, such schemes are governed in accordance with the Medical Schemes Act 131 of 1998 and regulated by the Council of Medical Schemes.

Any reference in this specification to a “consultation” must be interpreted sufficiently broadly to include a reference to an in-person or remote online or telephonic interaction between a patient and medical service provider for which a medical service is rendered to the patient by the medical service provider. BACKGROUND TO INVENTION

The medical services industry experiences high levels of fraud in transactions between patients covered by medical insurance, and medical service providers. Fraudulent claims passed on to medical insurance providers take on many forms and relate inter alia to medical insurance claims submitted by patients and/or medical service providers based on non-existent or excessively lengthy consultations between patients and medical service providers and medical service providers and/or patients submitting fraudulent claims for consumables or equipment not used during consultations. There is a need for a mechanism for auditing interactions between patients and medical service providers for identifying fraudulent transactions in the medical industry.

It is an object of the present invention to provide a method and computer system for managing and recording particulars of consultations between medical service providers and patients to deter fraudulent medical insurance claims by patients and/or medical service providers.

SUMMARY OF INVENTION

According to a first aspect of the invention, there is provided a computer-implemented method for managing a consultation between a patient and a medical service provider wherein the patient is a member of a medical insurance scheme operated by a medical insurance provider, the method including: ascertaining the status of the patient’s membership of the medical insurance scheme; if the status of a patient’s membership is confirmed as valid, a) recording a reason for the consultation; b) recording a location at which the consultation takes place; c) recording a date on which the consultation takes place; d) recording a start time at the commencement of the consultation; e) recording an end time at the conclusion of the consultation; and after the conclusion of the consultation, generating and sending to the patient a notification of the consultation at least including the information listed under items b) to e) and predetermined information on the medical service provider.

The method may include generating a unique consultation identification code associated with each consultation for which information is recorded.

The method may include permitting a medical service provider to store, remove and review medical notes on patient consultations made with, but not limited to, voice to text and audio recordings and/or other media. As such, the method may include providing a user interface permitting a medical service provider to store, remove and review medical notes on patient consultations.

The method may include reserving a bed or room for a patient in a hospital and recording in-hospital patient information such as, but not limited to, the building, floor and room number in which the patient is accommodated.

The method may include a medical insurance provider registration step including storing medical insurance provider information on medical insurance providers forming part of a medical consultation network.

The method may include a patient registration step including storing patient information on patients, including information on each patient’s membership of a particular medical insurance provider forming part of the medical consultation network. The method may include a medical service provider registration step including storing medical service provider information on medical service providers forming part of the medical consultation network.

Step b) of the method may include recording Global Positioning System (GPS) coordinates of the location of the consultation.

The stored medical service provider information may include the name and address of each medical insurance provider registered in the medical consultation management network.

The stored patient information may include one or more of the following information: a unique patient identification code, the name, identification number, address, the name of the medical insurance scheme of which the patient is a member, a number and type of the patient’s medical insurance policy under the medical insurance scheme.

The stored medical service provider information may include one or more of the following information: the name, address, medical qualification and medical practice number of the medical service provider.

The method may include a medical service provider storing cost item information associated with the consultation in a storage device, the cost item information including one or more of the following: particulars of medical equipment and/or consumables used during the consultation and medical procedure codes and/or other information relating to medical procedures performed on the patient during the consultation.

The method may include providing a user interface wherein registered medical insurance service providers are able to access one or more of the information on consultations between patients and medical service providers, recorded under items a) to e) and any cost item information stored by the medical service provider on the consultation as described hereinabove. The method may include displaying patient data obtained by third party healthcare service providers, such as patients’ Pathology results and Radiology reports and imaging etc., to medical service providers. The method may further include revoking access by medical service providers to such third party patient data where access has previously been granted.

The method may include encrypting/decrypting selected third party patient data and information listed under items b) to e) recorded during consultation.

According to a second aspect of the invention, there is provided a computer system for managing a consultation between a patient and a medical service provider wherein the patient is a member of a medical insurance scheme operated by a medical insurance provider, the computer system including: a status verification module operable to ascertain the status of the patient’s membership of the medical insurance scheme; a consultation recordal module operable, if the patient’s membership status is confirmed by the status verification module as valid, to: a) record a reason for the consultation; b) record a location at which the consultation takes place; c) record a date on which the consultation takes place; d) record a start time at the commencement of the consultation; e) record an end time at the conclusion of the consultation; and a notification module operable to, after the conclusion of the consultation, generate and send to the patient a notification of the consultation at least including the information listed under items b) to e) and predetermined information on the medical service provider. The computer system may be operable to generate a unique consultation identification code associated with each consultation for which information is recorded by the consultation recordal module.

The computer system may be operable to store, remove and review medical notes on patient consultations made with, but not limited to, voice to text and audio recordings and/or other media, in the consultation recordal module. As such, the computer system may include a user interface permitting a medical service provider to store, remove and review medical notes on patient consultations stored in the consultation recordal module.

The computer system may include a hospital reservation module for reserving a bed or room for a patient in a hospital and recording in-hospital patient information such as, but not limited to, information identifying the building, floor and room number in which the patient is accommodated. The computer system may additionally include a hospital discharge module for discharging a patient who has been admitted to a hospital for treatment and to record in-hospital information such as but not limited to, information identifying the building, floor and room number in which the patient was accommodated.

The computer system may include a medical insurance provider registration module for facilitating registration of medical insurance providers as part of a medical consultation network, the medical insurance provider registration module including a user interface for communication with prospective medical insurance providers wishing to register as part of the medical consultation network; and a storage module for storing medical insurance provider information on registered medical insurance providers.

The computer system may include a patient registration module for facilitating registration of patients as part of the medical consultation network; and a storage module for storing patient information on registered patients. More specifically, the user interface of the medical insurance provider registration module may be operable to permit a medical insurance provider to register patients who are members of the medical insurance provider’s medical insurance scheme. The computer system may include a medical service provider registration module for facilitating registration of medical service providers as part of the medical consultation management network, the medical service provider registration module including a user interface for communicating with prospective medical service providers wishing to register as part of the medical consultation network; and a storage module for storing medical service provider information on registered medical service providers.

The computer system may be operable to implement step b) by recording Global Positioning System (GPS) coordinates of the location of the consultation.

The stored medical insurance provider information may include one or more of the name and address of the medical insurance provider registered in the medical consultation network.

The stored patient information may include one or more of a unique patient identification code, the name, identification number and address of the patient, the name of the medical insurance scheme of which the patient is a member, a number and type of the patient’s medical insurance policy.

The stored medical service provider information may include one or more of the name, address, medical qualification and medical practice number of the medical service provider.

The computer system may be operable to permit a medical service provider to store cost item information associated with the consultation in a storage device, the cost item information including one or more of the following: medical equipment consumables used during the consultation and medical procedure codes and/or other information relating to medical procedures performed on the patient during the consultation. The computer system may further be operable to permit admission staff of a hospital or other healthcare facility or institution to which the patient is admitted, to add or remove medical procedure codes and/or other information relating to medical procedures performed on the patient on behalf of the medical service providers while the patient is admitted in the healthcare facility or institution.

The computer system may include a user interface wherein registered medical insurance service providers are able to access one or more of the information on consultations between patients and medical service providers recorded under items a) to e) and any cost item information stored by the medical service provider on the consultation as described hereinabove.

The computer system may include a user interface for displaying patient data obtained by third party healthcare service providers, such as patients’ blood test results, X-ray images, etc. to medical service providers. The computer system may further include a user interface for revoking access by medical service providers to such third party patient data where access has previously been granted.

The computer system may include an encryption/decryption module for encrypting/decrypting selected third party patient data and information recorded by the consultation recordal module.

BRIEF DESCRIPTION OF THE DRAWINGS

Further features of the method and computer system for managing patient consultations are described in more detail hereinafter, by way of a non-limiting example of the invention, with reference to the accompanying diagrammatic drawings. In the drawings:

Figure 1 is a schematic block diagram providing an overview of a computer system for managing a consultation between a patient and a medical service provider wherein the patient is a member of a medical insurance scheme;

Figure 2 is a schematic block diagram illustrating the registration process for registering medical insurance providers, patients and medical service providers as part of a medical consultation network in a method of managing a patient consultation, in accordance with the invention;

Figure 3 is a schematic block diagram providing an overview of the method and a computer system for managing a patient consultation, in accordance with the invention;

Figure 4 is a schematic flow diagram illustrating interaction between patients, medical service providers and medical insurance providers in accordance with the method and computer system of the invention; and

Figure 5 is a schematic flow diagram illustrating interaction between patients, medical service providers and medical insurance providers and further illustrates interaction with a medical institute such as a hospital or other healthcare facility to which the patient has been admitted in accordance with the method and computer system of the invention.

DETAILED DESCRIPTION OF THE INVENTION

With reference to Figure 1 of the drawings, a computer system for managing a consultation between a patient and a medical service provider wherein the patient is a member of a medical insurance scheme operated by a medical insurance provider, is designated by the reference numeral 10. The computer system 10 comprises, broadly, a consultation management server or distributed computer network (hereinafter referred to as a “consultation management server”) 12 for managing a consultation between a patient and a medical service provider; and a registration management server or distributed computer network (hereinafter referred to as a “registration management server”) 14 providing for registration of medical insurance providers, patients and medical service providers as part of a medical consultation network.

The computer system 10 is operable to implement the method of managing a consultation between a patient and a medical service provider wherein the patient is a member of a medical insurance scheme, in accordance with the invention. The consultation management server 12 comprises a status verification module 16 operable to ascertain the status of patients’ membership of medical insurance schemes offered by medical service providers; a consultation recordal module 18 operable to record predetermined information on consultations between medical service providers and patients; a notification module 20 operable to, after the conclusion of a consultation, generate and send to the patient a notification of the consultation including predetermined information on the consultation; and a hospital reservation module 21 for reserving a bed or room for a patient in a hospital and recording in-hospital patient information such as, but not limited to, the building, floor and room number in which the patient is accommodated.

The consultation recordal module 18 is operable, if the patient’s membership status is confirmed by the status verification module 16 as valid, to: a) record a reason for the consultation; b) record GPS co-ordinates of a location at which the consultation takes place; c) record a date on which the consultation takes place; d) record a start time at the commencement of the consultation; e) record an end time at the conclusion of the consultation.

The notification module 20 is operable to generate and send the patient a notification of the consultation at least including the information listed under items b) to e) and predetermined information on the medical service provider.

The computer system 10 is operable to generate a unique consultation identification code associated with each consultation for which information is recorded by the consultation recordal module 18.

The computer system 10 is operable to allow multiple concurrent consultations by medical service providers. The computer system operable to store, remove and review medical notes on patient consultations made with, but not limited to, voice to text and audio recordings and/or other media, in the consultation recordal module. As such, the computer system includes a user interface 23 permitting a medical service provider to store, remove and review medical notes on patient consultations stored in the consultation recordal module.

The registration management server 14 includes a medical insurance provider registration module 24 for facilitating registration of medical insurance providers as part of the medical consultation network; a patient registration module 26 for facilitating registration of patients as part of the medical consultation network; and a medical service provider registration module 28 for facilitating registration of medical service providers as part of the medical consultation network.

The medical insurance provider registration module 24 includes a user interface 30 for communication with prospective medical insurance providers wishing to register as part of the medical consultation network; and a storage module 34 for storing medical insurance provider information on registered medical insurance providers. The stored medical insurance provider information includes one or more of the name and address of the medical insurance provider registered in the medical consultation network.

The user interface 30 of the medical insurance provider registration module is operable to permit a medical insurance provider to register patients who are members of the medical insurance provider’s medical insurance scheme. The patient registration module 26 includes a storage module for storing patient information on registered patients. The stored patient information includes one or more of a unique patient identification code, the name, identification number, address, the name of the medical insurance scheme of which the patient is a member, a number and type of the patient’s medical insurance policy.

Once registered, the Applicant envisages that patients will be issued with a Near Field Communication (“NFC”) device such as a wearable bracelet or card on which an identification code unique to the patient, is stored, the NFC device being operable to communicate with a NFC-enabled reader device including a timer, operated by a medical service provider. Alternatively, patients may be issued with a device such as a card or slip of paper having a two-dimensional quick reference (“QR”) marked thereon, which incorporates an identification code unique to the patient, which can be read by a QR code-enabled reader device including a timer, operated by a medical service provider. The NFC or QR code devices are used to identify patients prior to commencement of a consultation with a medical service provider. The NFC or QR code devices are operable to allow for on-going storage of parts of consultations wherein such consultations are conducted in parts. The computer system 10 is operable to store the aforesaid parts of off-line or interrupted consultations on a local storage device.

The computer system may be operable to allow medical service providers to generate the slips of paper for patients and to mark the slips with additional information such at the start time and date of the consultation.

The medical service provider registration module 28 includes a user interface 32 for communicating with prospective medical service providers wishing to register as part of the medical consultation network; and a storage module 38 for storing medical service provider information on registered medical service providers. The stored medical service provider information includes one or more of the name, address, medical qualification and medical practice number of the medical service provider.

The computer system 10 is operable to permit a medical service provider to store cost item information associated with the consultation in a storage device, the cost item information including one or more of the following: medical equipment and/or consumables used during the consultation and medical procedure codes and/or other information relating to medical procedures performed on the patient during the consultation. The computer system 10 is operable to allow a medical service provider to generate and store notes on aspects of the consultation. The computer system 10 is operable to allow a medical service provider to approve information recorded for a completed consultation. This approval acts as an approval process for data added to the consultation by persons other than the medical service provider. The computer system is operable to lock the approved consultation information against removal or editing.

The computer system 10 may include one or more patient slip print outs created by the medical service provider. This slip may contain but not limited to a two-dimensional quick reference (“QR”) identifying the patient, as well as the consultation start date and time.

The computer system 10 includes a user interface permitting the medical service provider to store, create, remove and review medical notes made with but not limited to, voice to text as well as audio recordings or media.

The registration process for registering medical insurance providers, patients and medical service providers as part of a medical consultation network in a method of managing a patient consultation, in accordance with the invention, is illustrated in the schematic block diagram of Figure 2.

An overview of the method in accordance with the invention and the computer system 10, for managing a consultation between a patient and a medical service provider wherein the patient is a member of a medical insurance scheme, is illustrated in the schematic block diagram of Figure 3.

The computer system includes a user interface for displaying patient data obtained by third party healthcare service providers, such as patients’ Pathology results and Radiology reports and imaging etc., to medical service providers. The computer system further includes a user interface for revoking access by medical service providers to such third party patient data where access has previously been granted. The computer system includes an encryption/decryption module for encrypting/decrypting selected third party patient data and information recorded by the consultation recordal module.

As such, the method includes displaying patient data obtained by third party healthcare service providers, such as patients’ Pathology results and Radiology reports and imaging etc., to medical service providers, via the user interface. The method further includes the functionality of revoking access via the user interface by medical service providers to such third party patient data where access has previously been granted.

Figure 4 shows a schematic flow diagram illustrating interaction between patients, medical service providers and medical insurance providers in accordance with the method and computer system of the invention.

Figure 5 shows a schematic flow diagram illustrating interaction between patients, medical service providers and medical insurance providers in accordance with the method and computer system of the invention and further illustrates interaction with a medical institute such as a hospital or other healthcare facility to which the patient has been admitted.

The method may include encrypting/decrypting selected third party patient data and information listed under items b) to e) recorded during consultation.

Information for each consultation recorded for each consultation via a computer device operated by the medical service provider in the consultation recordal module, comprises the reason for the consultation; the GPS co-ordinates of a location at which the consultation takes place; the date on which the consultation takes place; the start time at the commencement of the consultation; the end time at the conclusion of the consultation: and cost item information associated with the consultation, is captured by the medical service provider and uploaded to the consultation recordal module 18, together with the unique patient and consultation identification codes. In addition, medical notes on patient consultations made by a medical service provider in the form of, but not limited to, voice to text and audio recordings and/or other media, may also be stored in the consultation recordal module.

The invention extends to a software application executable on a computer device of a medical service provider including the medical service provider interfaces 23 and 32 and including a sharing module for sharing predetermined patient consultation information with other medical service providers. The invention also extends to a computer device of a medical service provider having the software application executable thereon.

The computer system may include a user interface 40 allowing registered medical insurance service providers to access the information on consultations between patients and medical service providers recorded under items a) to e) and any cost item information stored by the medical service provider on the consultations stored in the consultation recordal module, as described hereinabove. By having access to this information, registered medical insurance providers are able to scrutinise essential details of consultations and expense items raised by medical service providers, before approving medical claims for payment. Furthermore, as patients are provided with notifications containing the information recorded for each consultation, the patients are able to verify the accuracy of the recorded information.