Tracking and authentication system

Description

CROSS-REFERENCE TO RELATED APPLICATION

This application claims priority to U.S. Provisional Patent Application No. 62/432,186, filed Dec. 9, 2016, and entitled “Patient Referral and Hospital Discharge Tracking System,” the entire contents of which are incorporated herein by reference.

INTRODUCTION

An exemplary aspect includes a computer system that has a client-side presentation layer processor; a server-side service layer component comprising one or more API controllers, at least one repository pattern processor, and a data layer processor; and a back-end layer component comprising at least one SQL server and a cache.

In various exemplary embodiments: (a) the presentation layer processor comprises one or more controllers; (b) the one or more API controllers provide application security and authentication; and (c) the data layer processor comprises at least one data access component.

One or more embodiments may comprise a system to track and improve referral coordination between primary-care providers and subspecialty physicians, and to provide hospitals and healthcare networks with access to referral patterns of associated providers.

In an embodiment, this system provides online access to a server-side system utilizing a secure portal, which enables primary care physicians to choose subspecialty referrals for patients from a list of pre-populated subspecialty physicians within a healthcare or hospital network.

In an embodiment, physicians may add new subspecialty physicians outside hospital or healthcare network, if a subspecialist may be not affiliated with an associated hospital or network; the added subspecialist may be considered a “leakage” referral, which may be identified to a hospital or healthcare network in a reporting module.

In an embodiment, the system also may provide notification and tracking of patients admitted to emergency departments or hospitals to primary care providers via secure email notification. Upon patient discharge, the system may contact the patient to schedule an appointment with a primary care or family practice provider, to reduce the likelihood of readmission for the same complaint within certain time period (e.g., 30 days).

Specific numerical values, time periods, codes, and messages described herein may be intended only to be illustrative, and do not limit the scope of the described system or claimed invention in any manner. Administrators and coordinators described herein may be software or hardware modules or circuits.

One or more embodiments of the system may track patient referral appointments on specific timeframes, in order to facilitate a subspecialist's report to a requesting primary care provider in a short time interval (configurable).

In an embodiment, the system automatically tracks a patient's appointment date and time, and thereafter contacts a subspecialty office via email to expedite subspecialty consult report generation for a primary care physician, in order to optimize patient care.

Additionally, in an embodiment, the system tracks patients who refuse to make an appointment with a subspecialist, or may be a no-show for a scheduled appointment. The system may notify the primary care provider automatically in such instances.

In an embodiment, the system accesses information from a subspecialty office on a secure portal, in order to retrieve notification if a patient missed or canceled an appointment.

In an embodiment, the system updates a primary care provider with updated information, which allows the primary care provider to reach out to patients based on importance of a subspecialty referral request, especially when importance of a requested referral may be paramount for disease management of a patient.

In an embodiment, the system provides a primary care provider with passive notifications via a system portal on a secure link to an affiliated hospital, when a patient may be admitted to an emergency room or hospital. Physicians may be notified on a mobile device in order to provide appropriate and timely treatment for patients that have been admitted to an emergency department (“ED”) or hospital.

In an embodiment, the system tracks patients discharged from an ED or hospital through a secure link with an associated hospital. Upon discharge notification, a referral coordinator may reach out to a patient to schedule an appointment with the patient's primary care provider.

The system therefore reduces the likelihood of a patient's readmission to an emergency department or hospital, as a consequence of enhanced care provided through the system.

In an embodiment, the system identifies referral density patterns of subspecialty referrals based on primary care provider referral requests. This allows healthcare systems and hospitals to identify areas of need for subspecialists, based on those referral density patterns. The identification and subsequent placement of subspecialists in areas identified by the system may increase patient compliance with referral requests by providing patients the opportunity to see subspecialists in close proximity to their primary care physicians' offices.

The system thus provides several technical solutions for subspecialty referral and hospital discharge coordination, and enhances disease management while reducing risks associated with patient care for primary care physicians.

One object and feature of an embodiment is to allow physicians to access all outstanding referrals which have been requested utilizing a HIPAA secure portal. Additionally, utilization of the system may provide greater reassurance that a patient will complete a referral appointment requested from a primary care provider to a subspecialty physician.

It is a further object and feature of an embodiment to provide a system which may automatically follow-up on a patient's appointment with a subspecialist to verify that the appointment has been completed, by updating a primary care physician who requested the referral. The system also may update a primary care physician if a patient refuses a referral or was a no-show.

It is a further object and feature of an embodiment to provide a system that enables authorized persons utilizing the system to track referral patterns within a healthcare network, to ascertain referral density patterns based on primary care physician requests, patient needs, and distances required for patients to travel to obtain referral appointments.

It is a further object and feature of an embodiment to enable healthcare and hospital networks to better align primary care referrals for their patients within a close geographic proximity to primary care offices. In addition the system may enhance connectivity linkage between primary-care providers and subspecialty physicians within the same healthcare or hospital network, in order to enable improved exchange of medical information among primary care providers and subspecialty physicians.

It is a further object and feature of an embodiment for the system to notify primary care and family based physicians when patients may be admitted to an emergency department or a hospital within a healthcare network. Primary-care physicians may be immediately notified upon registration of their patients via secure notification to smart phone or email devices.

It is a further object and feature of an embodiment for the system to notify primary care physicians when patients may be discharged by a hospital or healthcare network and to provide tracking of patient's status until discharge. Upon discharge, patients may be contacted by the system to schedule patients for appointments with primary care providers within, say, 48 hours of hospital discharge.

This system may maintain tracking of all hospital and emergency room admissions within a healthcare network, and provide authorized personnel within a healthcare network the ability to track admissions to emergency rooms and hospitals of patients of primary care and family practitioners.

In an embodiment, the system reduces likelihood of re-admittance of patients to emergency rooms or hospitals through its coordinated effort to align patients with their primary care providers, by coordinating appointments within, for example, a 30 day window after discharge and by contacting patients within, for example, 48 hours of discharge.

BRIEF DESCRIPTION OF THE DRAWINGS

The present invention will be better understood when considered in view of the attached drawings, in which like reference characters indicate like parts, The drawings, however, are presented merely to illustrate certain exemplary embodiments without limiting the invention in any manner whatsoever.

FIG. 1 is a workflow diagram depicting a Submit New Referral Process of an exemplary embodiment.

FIG. 2 is a workflow diagram depicting a Coordinate Referral Process of an exemplary embodiment.

FIG. 3 is a workflow diagram depicting a Follow Up Referral Appointment Process of an exemplary embodiment.

FIG. 4 is a workflow diagram depicting an ER and Hospital Admission Referral Process of an exemplary embodiment.

FIG. 5 depicts technical architecture of an exemplary embodiment.

FIG. 6 is a logical and physical design diagram of an exemplary embodiment.

FIG. 7 is a system physical and logical design diagram of an exemplary embodiment.

FIG. 8 is a diagram depicting an Authentication Process of an exemplary embodiment.

FIG. 9 defines symbols used in the other drawings.

FIG. 10 is a block diagram of a computer system of an embodiment.

DETAILED DESCRIPTION OF SELECT EXEMPLARY EMBODIMENTS

The following text sets forth a broad description of numerous different embodiments of the present disclosure. The description is to be construed as exemplary only and does not describe every possible embodiment since describing every possible embodiment would be impractical, if not impossible. It will be understood that any feature, characteristic, component, composition, ingredient, product, step or methodology described herein can be deleted, combined with or substituted for, in whole or part, any other feature, characteristic, component, composition, ingredient, product, step or methodology described herein. Numerous alternative embodiments could be implemented, using either current technology or technology developed after the filing date of this patent, which would still fall within the scope of the claims. All publications and patents cited herein are incorporated herein by reference.

An embodiment comprises a system of referral management services that provides access points between primary-care providers, subspecialists, and one or more hospital or healthcare networks.

This system may provide referral management resources to enable scheduling of patients as requested by primary care providers to subspecialists within a provider network of affiliated physicians, in order to increase the percentage of completed referrals by patients.

This system may facilitate requested subspecialty appointments by primary care provider by acting as a proxy center with the ability to provide requesting provider access through a secure portal to maintain up-to-date information and control of requested referrals

The system may generate monthly, quarterly, and/or yearly reports in order to enable primary care physicians and health-care or hospital networks to identify gaps in areas where subspecialties may be required, by analyzing referral density per requests of primary-care providers with regard to subspecialty referrals and based on geographic locations of subspecialty physicians from primary care offices.

The system may increase physician and patient compliance with completing requested referral appointments to subspecialists.

Through utilization of a secure portal the system may track emergency room and hospital admissions in order to provide physician notifications. In addition, the system may provide scheduling of patient appointments upon discharge, with primary care provider, in order to ensure appropriate follow-up care after hospital discharge and to reduce the possibility of readmission within a 30 day window, in order to improve overall disease management of patients.

• • System Processes: for each system process, the following elements may include:
    • Purpose/Scope: this section may provide a description of the purpose and scope of the entire system and system process.
    • Workflow Diagram: this section may include a visual diagram of the workflow, indicating the relationship between activities in the process.
    • Activity Description: this section may describe each of the activities of the system and system processes.
    • Inputs: inputs may be deliverables that a person responsible for initiating the process receives in either physical or electronic form. (A deliverable could be an email, a document, an updated database entry, a fax, etc.)
    • Outputs: this section may provide an explanation of the process's outputs or deliverables.
    • Roles & Responsibilities: this section may describe the roles and responsibilities; it may be also be possible that one person/module/circuit may fulfill more than one role within a process—or that multiple people modules/circuits may share the same role.
    • System Rules: this section may include a list of relevant system rules and reference the steps from the Activity description section in which they may be enforced.
    • System Requirement: this section may include a list of system requirements for the system area discussed.
  • System Description and Functional Requirement: may list all the desired system features with functional requirements. Notation: The workflow diagrams included in this description use System Process Model and Notation (BPMN) 2.0, which is an international standard for system process modeling. The symbols depicted in FIG. 9 may be used.

Embodiments described herein are intended to provide one or more of the following improvements:

• • Better Data Quality: The system provides an integrated data platform that seamlessly connects different data sources and workflows. The net result is that the system may provide a single source of data that is real time, up-to-date and accurate.
  • Automation: The system may enable easier tracking of referrals, ER/hospital admissions, communication, notes, notifications, alerts and key system process artifacts—thereby reducing the amount of duplicate work, manual labor, and unnecessary errors produced during day-to-day operations.
  • Better Reporting: The system may record and report on operations better, to generate desired reports based on criteria defined, as well as based on a centralized data set.
  • Knowledge Generation: The system improve the type of information available. The system moves beyond information capture and enables knowledge generation—helping an organization make strategic decisions, identify trends in services provided, and uncover new areas of growth.

In addition to the above stated features, the system is HIPAA Compliant. The passage of the Health Insurance Portability and Accountability Act (HIPAA) by Congress in 1996 has complicated traditional referral request systems. HIPAA establishes rigorous standards for protecting sensitive patient information.

The Final Rule on Security Standards was issued on Feb. 20, 2003. It took effect on Apr. 21, 2003 with a compliance date of Apr. 21, 2005 for most covered entities and Apr. 21, 2006 for “small plans”. The Security Rule complements the Privacy Rule. While the Privacy Rule pertains to all Protected Health Information (PHI) including paper and electronic, the Security Rule deals specifically with Electronic Protected Health Information (EPHI). It lays out three types of security safeguards required for compliance: administrative, physical, and technical. For each of these types, the Rule identifies various security standards, and for each standard, it names both required and addressable implementation specifications. Required specifications may be adopted and administered as dictated by the Rule. Addressable specifications may be more flexible. Individual covered entities may evaluate their own situation and determine the best way to implement addressable specifications. Some privacy advocates have argued that this “flexibility” may provide too much latitude to covered entities. The standards and specifications may be as follows:

• • Administrative Safeguards—policies and procedures designed to clearly show how the entity may comply with the act
    • Covered entities (entities that may comply with HIPAA requirements) may adopt a written set of privacy procedures and designate a privacy officer to be responsible for developing and implementing all required policies and procedures.
    • The policies and procedures may reference management oversight and organizational buy-in to compliance with the documented security controls.
    • Procedures may clearly identify employees or classes of employees who may have access to electronic protected health information (EPHI). Access to EPHI may be restricted to only those employees who have a need for it to complete their job function.
    • The procedures may address access authorization, establishment, modification, and termination.
    • Entities may show that an appropriate ongoing training program regarding the handling of PHI may be provided to employees performing health plan administrative functions.
    • Covered entities that out-source some of their system processes to a third party may ensure that their vendors also have a framework in place to comply with HIPAA requirements. Companies typically gain this assurance through clauses in the contracts stating that the vendor may meet the same data protection requirements that apply to the covered entity. Care may be taken to determine if the vendor further out-sources any data handling functions to other vendors and monitor whether appropriate contracts and controls may be in place.
    • A contingency plan may be in place for responding to emergencies. Covered entities may be responsible for backing up their data and having disaster recovery procedures in place. The plan may document data priority and failure analysis, testing activities, and change control procedures.
    • Internal audits play a key role in HIPAA compliance by reviewing operations with the goal of identifying potential security violations. Policies and procedures may specifically document the scope, frequency, and procedures of audits. Audits may be both routine and event-based.
    • Procedures may document instructions for addressing and responding to security breaches that may be identified either during the audit or the normal course of operations.
  • Physical Safeguards—controlling physical access to protect against inappropriate access to protected data
    • Controls may govern the introduction and removal of hardware and software from the network. (When equipment may be retired it may be disposed of properly to ensure that PHI may be not compromised.)
    • Access to equipment containing health information may be carefully controlled and monitored.
    • Access to hardware and software may be limited to properly authorized individuals.
    • Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts.
    • Policies may be required to address proper workstation use. Workstations may be removed from high traffic areas and monitor screens may not be in direct view of the public.
    • If the covered entities utilize contractors or agents, they too may be fully trained on their physical access responsibilities.
  • Technical Safeguards—controlling access to computer systems and enabling covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient.
    • Information systems housing PHI may be protected from intrusion. When information flows over open networks, some form of encryption may be utilized. If closed systems/networks may be utilized, existing access controls may be considered sufficient and encryption may be optional.
    • Each covered entity may be responsible for ensuring that the data within its systems has not been changed or erased in an unauthorized manner.
    • Data corroboration, including the use of check sum, double-keying, message authentication, and digital signature may be used to ensure data integrity.
    • Covered entities may also authenticate entities with which they communicate. Authentication consists of corroborating that an entity may be who it claims to be. Examples of corroboration include: password systems, two or three-way handshakes, telephone callback, and token systems.
    • Covered entities may make documentation of their HIPAA practices available to the government to determine compliance.
    • In addition to policies and procedures and access records, information technology documentation may also include a written record of all configuration settings on the components of the network because these components may be complex, configurable, and always changing.
    • Documented risk analysis and risk management programs may be required. Covered entities may carefully consider the risks of their operations as they implement systems to comply with the act. (The requirement of risk analysis and risk management implies that the act's security requirements may be a minimum standard and places responsibility on covered entities to take all reasonable precautions necessary to prevent PHI from being used for non-health purposes.)

System Processes Description—Exemplary Embodiments

A Submit New Referral Process may be created to describe how the new referral may be created for a Patient, when they visited their Primary Care Provider (PCP) and needed a Specialist. See FIG. 1.

Activity Description

A Submit New Referral Process may begin when a Patient visits his Primary Care Provider (PCP), and the PCP decides that a Referral may be needed for the Patient.

In order to create a new Referral, the PCP enters the Patient's information, including Insurance and Insurance Provider information, so that Specialists within the Insurance Provider's network may be narrowed and listed.

Based on the Insurance provider defined for the Patient and the selected Specialty for the Referral, the list of Specialists will be filtered, and the listed Specialists will be within the Patient's insurance coverage. If no specialist is located under the Patient's insurance, the requesting office places the referral in a holding status until the physician approves an alternative specialist for the patient in order to complete the referral request. The system will identify that no specialists are currently loaded that meet the requirement for a particular patient's insurance. The PCP requests the Provider to choose a Specialist for the referral if a physician is not already loaded within the software.

After a Specialist is selected, the PCP enters the details of the Referral, including Referral Type and special instructions/patient history if applicable.

If this is an existing Patient, the patient information may be already in profile, which may also be updated, including the Patient's billing information—either to be paid by Insurance or by patient; if this is a new Patient, a new Patient profile may be added and saved.

At this point, the Referral may be signed and created; new Referral notifications may be sent to a Referral Coordinator Manager.

After one Referral is created for the Patient, the system may allow the PCP to create more Referrals for the same Patient by redirecting back to “Choose Specialty”.

Inputs for the Submit New Referral Process may include:

• • The Patient's Insurance information
  • The pre-defined Specialties list
  • Insurance Provider's network coverage information for Specialists
  • The Specialist's detailed information, such as Locations
  • The Patient's detailed information, which may either be entered for new Patient or selected from existing Patient profiles
  • The Patient's billing information, which may either be Insurance pay or self-pay

Outputs for the Submit New Referral Process may include the newly created Referral record(s) with unique tracking identifier code(s), and notifications sent to a Referral Coordinator Manager, which may then assign the new created Referral during the Coordinate Referral Process.

Roles & Responsibilities involved in this process may include the following:

• • Patient, who goes to PCP for unknown medical reason
  • Primary Care Provider (PCP), who decides that a referral may be needed for the Patient and submits the Referral request in the system
  • Referral Coordinator Manager, which may receive notifications for new Referral

TABLE 1
Exemplary System Rules Description

There may be two types of Networks:

Healthcare System Network: this may be used to track

whether the Specialist may be In- or Out-of- the Healthcare System's

network

Insurance Network: this may be used to identify a Specialist

that may be In- or Out-of- Patient's Insurance network

PCP (Primary Care Provider) may be associated with only one Hospital

(at a specific address), or none as individual PCP.

Specialist may be In- or Out- the selected Healthcare System's network.

Patient may see PCP first to get referral to Specialist.

Each Patient may be attached with one PCP, only that PCP has access to

this Patient's data.

Patient may be referred to more than one Specialist at one time.

Each Referral may have a unique Referral ID, even when multiple

Referrals are created for one Patient at one time.

Specialist may be selected based on Patient's insurance coverage.

TABLE 2
Exemplary Process Requirements Description

Healthcare System and Hospital may be added as a client account,

with Healthcare System Admin User created and assigned.

PCP may be attached to only one Hospital.

PCP office staff may be able to submit Referral on behalf of the

selected PCP.

PCP office staff may be associated with location, and be able to

submit Referral for PCP(s) in the same location.

Specialist may be affiliated with at least one Healthcare System.

Patient profiles may be added under PCP, and PCP users only have

access to Patients attached to them.

Patient's insurance information to be collected.

Patient's insurance information may be used to narrow down

Specialists that may be within Patient's insurance network.

Specialty may be defined.

Selection of Specialist may depend on defined Insurance and

Specialty.

PCP may be able to indicate whether the Specialist may be with

In- or Out-of- the network of the PCP's Hospital.

Report may be generated to show referred Specialists and Hospital

network information.

New Specialist may be added.

Patient's preferred language may be specified.

Patient's Diagnosis information may be defined for a Referral

record.

Patient's billing information may be specified.

Special instruction may be added for new Referral.

Multiple Referral records may be added for one Patient at once.

Notifications may be sent to Referral Coordinator Manager when a

new Referral is created.

An exemplary Coordinate Referral Process may be triggered when the new Referral is created after a Submit New Referral Process, and enables a Referral Coordinator to helps a Patient and Specialist to schedule an appointment. See FIG. 2.

The Coordinate Referral Process may be triggered when a new Referral is created after a Submit New Referral Process, which may send a notification to a Referral Coordinator Manager.

Upon receiving new Referral creation notifications, a Referral Coordinator Manager may assign each new Referral created to a Referral Coordinator.

Once a new referral is assigned, the Referral Coordinator may contact the individual Patient based on Referral Type:

• • I. Normal Referral: Patient to be contacted within 48 hours of submission.
  • II. STAT Referral: Patient to be contacted within 24 hours of submission.

If the Patient is contacted by the system, the Patient may disregard the Referral, in which case a Referral status on the system may be changed to “5—Patient Disregard”, and the system may send a notification to the PCP office automatically by end of day; otherwise, when the appointment has been scheduled, notifications may be sent to the Patient and the Specialist, and the scheduled date may be added to the Patient's calendar.

Once the appointment is scheduled: if no authorization is required, the appointment may be confirmed directly; otherwise, if authorization is required, the appointment may only be confirmed after the authorization may be generated from the Insurance company. Once the appointment may be scheduled and confirmed, the Referral status may be changed to “2—Scheduled” with sub status as “Confirmed”. When the appointment has been confirmed, notifications may be sent to the Patient and the Specialist.

In case authorization is required but denied by the Insurance company, the system may contact the PCP, which may result in the following three scenarios:

• • I. Insurance authorization generated—this may lead to the appointment confirmation.
  • II. Insurance not authorized—in this case, the Referral status may be changed to “5—Patient Disregard” and the system may send a notification to the PCP office automatically.
  • III. A new Referral may be needed, with another Specialist selected, which may trigger a Submit New Referral Process.

If the 1^st call is NOT picked up by the Patient, the Referral Coordinator or system may call the Patient for a 2^nd time; if the 2^nd call is picked up, the system may perform the same steps when the 1^st call is picked up, otherwise, the system may contact the Specialist to find out more details. If after the second attempt there is no patient contact; the system will notify the patient via a text message and then notify the PC if no contact with patient was possible.

If the Referral Coordinator/system determines that the appointment has already been scheduled, the Referral status may be changed to “2—Scheduled”. Otherwise, the Referral status may be changed to “6—Unable to Contact”.

Inputs for a Coordinate Referral Process may include:

• • The newly created Referral request
  • Insurance company and Insurance plan policy

Outputs for the Coordinate Referral Process may include:

• • Updated Referral status
  • Notifications when Referral status gets updated

Roles & Responsibilities involved in this process may include the following:

• • Referral Coordinator Manager, whose responsibility may be to assign the new created Referrals to Referral Coordinators.
  • Referral Coordinator, whose responsibility may be to contact Patients, and coordinate among Patients, Specialists, and PCPs to schedule a Referral appointment.

TABLE 3
Process Rules Description

Referral needs to be assigned first then be worked on.

There may be two types of Referral:

Normal Referral: Patient may be contacted within 48 hours

of submission.

STAT Referral: Patient may be contacted within 24 hours of

submission.

Depends on Insurance provider and Insurance plan, some Referral

Appointment requires Insurance provider's authorization.

TABLE 4
System Requirement Description

Referral Coordinator Manager may assign new Referral to Referral

Coordinator.

Notifications may be sent to a Referral Coordinator when new

Referral may be assigned.

When Referral Coordinator contacts Patient for appointment, if the

1st call was not answered, call needs to be made in 2 days.

Referral Coordinator may conduct 3-way call between Patient and

Specialist to schedule the appointment; and once appointment scheduled,

notifications may be sent to both the Patient and the Specialist.

Notifications may be sent via Text message if cell phone may be

provided, or Email if email address may be provided.

Appointment schedule notifications may be added to Patient or

Specialist's calendar.

Reminders may be sent [X] days (configurable) before the

scheduled date.

Appointment may be confirmed, and notifications may be sent to

both Patient and Specialist when confirmed.

When Referral may be scheduled, the Referral status may be

automatically changed to “2 - Scheduled”.

When Referral is confirmed, the Referral sub status may be

automatically changed to “Confirmed”.

For Referral requires Insurance Authorization, system may

automatically update sub status to “Confirmed” only after Authorization

document uploaded.

Once Referral is Scheduled and Confirmed, the full Referral script

may be auto faxed to Specialist.

Referral status may be updated to “5 - Patient Disregard” when the

Patient disregards the call and referral.

Referral status may be updated to “6 - Unable to Contact” when

the Patient is not contacted for the referral.

Daily report may be sent to PCP office by end of day, when the

Referral status is changed to “5 - Patient Disregard” and “6 - Unable to

Contact”.

A Follow Up Referral Appointment Process may begin after the Referral is scheduled, and the system may send follow up emails to get a Report and then complete the Referral. See FIG. 3.

A Follow Up Referral Appointment Process may be triggered when an Appointment is scheduled. One week after the scheduled date, the system may send an email to the Specialist Office to follow up, including a link, clicking which may present the following emailed questions which may be used to query the Specialist to answer and submit:

• • I. Has Patient Completed the Appointment?—Yes or No
    • i. If “Yes”, go to question II
    • ii. If “No”, select from the following conditions:
      • a. Patient has rescheduled Appointment—if selected, reschedule date needs to be entered
      • b. Patient was No Show
      • c. Patient Canceled Appointment
  • II. Is the Report Ready?—Yes or No

If the Patient has completed the Appointment and the Report is ready, the system may generate a unique bar code and send it to the Specialist office, which may then attach the bar code to the Report and send the Report to the system. Upon receiving the Report, the system may read the unique bar code and attach the Report to the corresponding Referral, as well as sent the Report to the PCP Office automatically, with Referral status changed to “4—Complete with Report”.

If the Patient has completed the Appointment but the Report is NOT ready, system may send a Reminder notification one week after asking for the Report. If the Report is still not received by that time, system may send an alert to a Follow Up Coordinator, who may then contact the Specialist to find out more details.

If the Patient has NOT completed the Appointment, and:

• • a. Patient has rescheduled Appointment: The Specialist may report the reschedule date, which may restart the process and trigger a follow up Email one week after the rescheduled date.
  • b. Patient was No Show: System may send notifications to Patient to reschedule the Referral with the system, and the system may also send notifications to the PCP office, with Referral status changed to “5—Patient Disregard” with “No Show” noted.
  • c. Patient Cancelled Appointment: System may send notifications to Patient to reschedule the Referral with the system, and the system may also send notifications to the PCP office, with Referral status changed to “5—Patient Disregard” with “Cancellation” noted.
  • d. Patient has NOT rescheduled Appointment: System may send notifications to Patient to reschedule the Referral with the system, and the system may also send notifications to the PCP office, with Referral status changed to “5—Patient Disregard”.

On the other hand, if NO response is received from the 1^st follow up Email, the system may send 2 more Emails every week for 2 weeks. If a response is received from any of the emails, the process goes back to the Response received step, otherwise, if there is still no response received after the 3 Emails, the system may send an alert to a Follow Up Coordinator, who may call the Specialist to find out more details.

If the Follow Up Coordinator learns from the Patient that the Patient has already completed the Appointment, the Referral status may be changed to “3—Exam Done”, and the Follow Up Coordinator may send the system generated bar code to the Specialist, who may then send the Report with bar code attached. Afterwards, the system may send the received Report with bar code to the PCP Office automatically, with Referral status changed to “4—Complete with Report”. Similarly, if the Patient has NOT completed the Appointment, the (a)-(d) scenarios described above may be applied.

The bar code may be generated by the system, using the “Universal Product Code” format and in AVERY 8366™ size.

Inputs for the Follow Up Referral Appointment Process may include scheduled Referral Appointment information and response information received via Email from a Specialist.

Outputs for a Follow Up Referral Appointment Process may include updated Referral records and notifications sent to Patient and PCP.

Most of the activities in this process may be automatically done by the system, and the Role included may be the Follow Up Coordinator, whose responsibility may be to contact the Specialist to find out more details about the Appointment when an alert has been received.

TABLE 5
System Rules Description

Follow up Email may be sent automatically with options/link for

Specialist to respond with feedback.

Follow up Fax may be sent automatically for Specialist to fill in

feedback and fax back.

Follow Up Coordinator may contact Specialist to find out more

details when the auto Email receives no feedback.

TABLE 6
System Requirements Description

One week after the scheduled date, follow up Emails may be sent

to Specialists asking the following questions with options/link to send

the feedback back:

Has Patient Completed the Appointment? - Yes or No

If “Yes”, go to the next question

If “No”, select from the following conditions:

Patient has rescheduled Appointment -

if selected, reschedule date needs to be entered

Patient was No Show

Patient cancelled Appointment

Is the Report Ready? - Yes or No

Referral status may be updated based on answers received via a

follow up link sent in the follow up Emails.

Reschedule date may be updated to the Referral, if received.

If Patient was No Show for the appointment, the Referral status

may be updated to “5 - Patient Disregard” with sub-status as “No Show”.

If Patient cancelled the appointment, the Referral status may be

updated to “5 - Patient Disregard” with sub-status as “Cancellation”.

Notifications may be sent to Patient and PCP if Patient was No

Show or Cancelled the appointment.

If the 1st Email was not answered, 2 more emails may be sent

every week after.

If ‘Has Patient Completed the Appointment? = Yes’ and ‘Is Report

Ready? = Yes’, system may send (e.g., via email or fax) the generated

unique bar code to Specialist, who may then attach the bar code to

Report and send it back to System.

Report with bar code may be faxed back, and system may be able

to read bar code and attach received Report to corresponding Referral

record automatically.

After the Report is received from Specialist, the Referral status

may be updated to “4 - Complete with Report” automatically. Unique

bar code may be generated and attached to the report, and sent to

After the Report is received from Specialist, the Report without bar

code attached may be faxed and/or emailed to the PCP office.

If Report is NOT received, Reminder notification may be

automatically sent to Specialist one week after the 1st follow up

notification.

Alert may be sent to Follow Up Coordinator if no response

received after 3 follow up Emails, or no report received after 1 reminder.

An ER and Hospital Admission Referral Process may be triggered when notifications received from a Hospital/ER for a Patient's admission. Referral Coordinators may then keep track of the Patient's progress and contact the Patient for Referral after discharge. See FIG. 4.

When the Patient arrives to an ER, staff may ask for his PCP's information, and notifications may be sent to the PCP and the system from a hospital secure email server to an associated secure email recipient (PCP and System) for this new admission. It's also possible that the Patient is admitted at ER and then transferred and admitted to a Hospital as a normal admission. When the Patient arrives at the Hospital as a normal admission, the Patient may be added to a Hospital list, and notifications may be sent to the System for this new admission.

An ER and Hospital Admission Referral Process may be triggered when notifications received from a Hospital/ER for a Patient's admission. A Referral Coordinator may then send notifications to the Patient's PCP and add the new admission record for the Patient if the Patient already exists in the system, or if a new Patient to the system, add the new Patient's profile with the new admission record.

The Referral Coordinator may also verify the Patient's information by logging into a secure hospital Citrix portal, as well as keep track of the Patient's progress and discharge status daily. When either discharge notification may be received or discharge status changed with daily check-in, the system may contact the Patient 48 hours after his discharge.

When contacting the Patient, the system may either connect the Patient with the PCP office for further scheduling, or send a Disregard notification to the PCP if the Patient disregards the referral.

Inputs for the ER and Hospital Admission Process may include:

• • Admission notifications from Hospital and/or ER
  • Verified patient information from Hospital
  • Patient progress information from Hospital and/or ER
  • Patient discharge notification from ER

Outputs for the ER and Hospital Admission Process may include notifications sent to PCPs.

A Role involved in this process may be the Referral Coordinator/system, whose responsibility may be to keep track of the Patient's discharge status and contact the Patient for referral.

TABLE 7
System Rules Description

When Patient is admitted to an ER, the ER may ask for his PCP

information, and ER admission notifications may be sent to the PCP

and System.

When Patient is admitted to a Hospital, the Hospital may add the

Patient to a Hospital list of Patient Admission, and send to System.

When Patient is admitted to ER or Hospital, notifications may be sent

to the Patient's PCP office automatically.

System staff may login to a Citrix portal to verify the Patients'

information.

System staff may track the Patient's progress and discharge status by

communicating with the Hospital.

48 hours after Patient's discharge, System may contact Patient.

TABLE 8
System Requirement Description

Notifications may be received from ER/Hospital for Patient

Admission, with date/time captured.

System may send notifications to PCP office, through fax or email,

when Patient Admission notification is received from ER/Hospital.

Patient Admission Record may be created and attached to Patient

profile.

Patient information may be verified by logging into Citrix portal.

Patient discharge notification may be received.

Patient discharge date/time may be captured.

System may send notifications to PCP office (e.g., through fax or

email) when Patient disregards System's follow up request.

• • SYSTEM DESCRIPTION AND FUNCTIONAL REQUIREMENTS
    • USER MANAGEMENT

Both Client users, including Primary Care Provider and Client Admin, and System Staff users may have direct access to the system. The following users may be created and granted with access to the system:

Client Side:

• • Healthcare System Admin User, who has access to all data within the network, including all the Hospitals; may be created by System Admin User.
  • Hospital Admin User, who has access to all data within the Hospital; may be created by System Admin User.
  • Primary Care Provider (PCP) User, who may be associated with or without Hospital(s), and have access to data of Patients under him, therefore submit the new Referral record; PCP may be able to self-register with temporary login provided by System:
  • I. System Admin User may create temporary Login (username and password) for PCP who uses the system.
  • II. PCP User logs in with the temporary credential and completes the registration information, including signing HIPAA and BAA agreements.
  • III. PCP completes the self-registration and obtains the valid credential for the system as an official user.
  • PCP Office Staff User, who preferably may only submit and check Referrals for PCPs in the same office; may be created by PCP User or System Admin User.

System Side:

• • Admin User, who has access to all system data and admin permissions
  • Referral Coordinator Manager, who has access to data of assigned Healthcare System and Hospital(s), and may generate reports for assigned network and coordinators that work underneath assigned network
  • Referral Coordinator, who coordinates between Patient and Specialist, for appointment scheduling, referral tracking and follow ups, and has access to data of assigned Hospital Network and Hospital(s)
  • Follow Up Coordinator, who may be responsible for Referral follow ups, and have access to data of assigned Hospital Network and Hospital(s)

Users may be defined as people who interact with the system in various capacities (roles) to perform respective operations in the system.

Roles may be defined as different operations that may be required to interact with the system in various capacities to perform respective operations in the system. A user preferably may use the system with a defined role only.

There may be two types of user: Client User and System Staff User. For each user type, different User Roles may be defined and assigned.

For each User added in the system, a User Account and Login may be created, so that the User may be able to login to the system, access authorized data and functions, and manage his own account information.

TABLE 9
Functional Requirement Description

System may require User Type - Client User or Staff User, to be

defined when creating new User.

System may require User Role to be defined for each User Type

when creating new User:

Client User Type:

Healthcare System Admin

Hospital Admin

PCP

PCP Office Staff

Staff User Type:

Staff Admin

Referral Coordinator Manager

Referral Coordinator

Follow Up Coordinator

System may allow list of Users to be searchable, based on logged in

User's access. For example, Healthcare System Admin User may search

and view Users within the network, Hospital Admin User may search and

view Users within the same Hospital, System Staff User may search and

view all Users in the system.

System may allow User details to be viewed.

One Client User can only be associated with one Role.

One Staff User may be associated with more than one Role.

System may display different required information fields

depending on different User Type and Role. For example, Healthcare

System Admin User may be associated with Healthcare System, PCP

Office Staff User may be associated with PCP Office location, etc.

System may allow authorized user to add/view/update Role.

A valid and unique Role name may be required.

Every Role may be associated with permission matrix.

Permission matrix may be pre-defined, consisting of process and

actions.

System may allow permission matrix to be configurable as per

requirement.

Permission matrix associated with Role may be unique.

Available Dashlets may be pre-defined for each Role.

System may allow Role to be activated and deactivated.

System may allow authorized user to search Roles.

When creating new User, System Admin needs to first select User

Type (Client User, or Staff User) and User Role.

If User Type = Client User, only one Role can be assigned to the

User; otherwise if User Type = Staff User, multiple Roles can be assigned

to the User.

Fields to be filled to create new User may be different; depends on

the entry of User Type and User Role.

When creating new User, System Admin may set up Username and

Password.

If Email is provided, it can be checked to be used as Username, but

not mandatory.

Email may be required for Staff User, but not for Client User.

If provided, Email address needs to be in valid format and unique.

If Email is provided, System may send verification email to User's

provided email address, with Username and ask Password information, so

that User can login and reset Password.

For first time log in, User may be required to reset the Password.

Password needs to be validated against standard requirements, min

characters, mixed case, mixed characters/numbers.

All authorized user may login to the system with valid credentials

System may allow user to login with Email or Username and

Password.

System may record both successful and failed login attempts of

User, with an audit log.

Account may be locked after three login failure attempts.

User may need to contact System Admin if account locked.

User may be able to click “Forgot Password”, and system will ask

user to enter Username:

1) Valid Username/Email entered:

a. Valid Email: system will send a Reset Password email to

the valid registered Email

b. Valid Username: system will ask user to provide an Email

address to send the Reset Password email; and User can choose to enter

an Email or contact the System Admin

2) Invalid Username/Email entered: since the entered

Username/Email is not valid, error message will be displayed; or user

needs to contact the System Admin for password reset

Logged in user may only access data that may be authorized for

that user, based on account settings (user type, user role, associated

entities, etc.)

System may provide HIPAA secure logins with SSL certificate.

System may allow user to reset password after logging in.

By a user clicking the reset password link, system may send reset

password link to user's email address.

The new password may not be the same as old password, and may

also be validated against standard requirements.

User may be able to update own information after being logged in.

System may send verification emails to previous and new email

addresses, if user choose to change email address.

New email address may be valid only after user verification, and

old email address may be invalid for login.

System may automatically log Users out (time out) after [X] period

of inactivity.

User may be able to click “Sign Out” to manually sign out.

System may record all the Sign In and Sign Out activities of User,

including:

User's IP address

Sign In Time

Sign Out Time

Signed in duration

A Healthcare System, including one or many Hospitals, may be considered as the System's client; so that each Healthcare system may have one record created in the system, with one or more Hospitals attached.

For each Healthcare System record, there may be Healthcare Admin User who has access to all the data within the network, including all the Hospitals attached. Under each Healthcare System, there may be one or multiple Hospitals, and for each Hospital, there may be a Hospital Admin User who has access to all the data within that Hospital. A PCP may be associated with one or multiple Hospitals.

One PCP may have multiple offices, and sometimes office staff submit Referrals on behalf of the PCP; so each PCP may be associated with one or multiple office locations. For each office, an Office Staff User may be created to only have access to Referrals under the same office.

TABLE 10
Functional Requirements Description

System may allow Healthcare System record to be created and

saved.

System may allow Healthcare System Admin User to be created

and assigned to Healthcare System.

Healthcare System Admin User may login to the system and have

access to all data under the assigned network, including:

Hospital records

PCPs accounts

PCP Offices

Patients information

Referral records

ER/Hospital Admission records

INN and OON lists

Report

Healthcare System Admin User may add/view/update Hospitals

information under its network.

Healthcare System Admin User may add/view/update Referral

records under its network.

Healthcare System Admin User may add/view/update the In-

Network Specialist list.

Healthcare System Admin User may generate and view reports

with all data under its network.

System may allow Hospital to be created and saved.

Healthcare System Admin User may add new Hospital Admin

User to Hospitals under its network.

System may allow Hospital Admin User to be created and assigned

to Hospital.

Hospital Admin User may login and only have access to data under

the assigned Hospital, including:

PCPs accounts

PCP Offices

Patients information

Referral records

ER/Hospital Admission records

Report

Hospital Admin User may add/view/update Referral records under

the assigned Hospital(s).

Hospital Admin User may generate and view reports with all data

under the assigned Hospital(s).

System may allow authorized System user to create temporary

login (temporary username and password) for PCP, who may be

maying to sign up and use the system.

The PCP temporary login may already be associated with

Healthcare System/Hospital, or without as individual PCP.

System may allow a PCP to be associated with one or more

Healthcare Systems/Hospitals, or none (as an individual PCP).

The temporary login may only be valid within 48 hours.

System may allow PCP to login with temporary login received

from System.

System may require PCP to change the temporary username and

password after logged in.

System may allow PCP to sign HIPAA and BAA agreements,

during registration.

System may require PCP to complete all the required fields to

complete the registration.

System may allow PCP to login with new credential, after

registration.

Patient profiles may be added under PCP, and only associated PCP

may add new Patient information underneath him.

PCP User may login and have access to data of Patients associated

with.

PCP User may submit new Referral for Patient associated with.

PCP User may generate and view report for Referrals submitted by

himself.

System may allow new Location to be added.

System may allow PCP User be associated with one or multiple

Office Locations.

System may allow PCP User to create PCP Office Staff User, for

associated Office Locations.

System may allow Office Staff User be created and assigned to

Office Location.

Office Staff User may only be able to submit new Referral on

behalf of PCP within the same Office Location.

On the System side, an Admin User may have access to all data in the system and be granted with all permissions, including user account management, referral management, ER/Hospital admission management, case management and reporting.

Besides Admin User, a Referral Coordinator Manager, Referral Coordinator and Follow Up Coordinator User may be created and assigned to client accounts—Healthcare System records and/or Hospital records; so that they only have access to data of assigned accounts.

TABLE 11
Functional Requirements Description

Staff Admin User may be a super user who may be granted with all

system permissions.

Staff Admin User may access all data in the system, including data

from all Healthcare Systems.

Staff Admin User may add/view/update new User to the system.

Staff Admin User may add/view/update Healthcare System record

in the system.

Staff Admin User may add/view/update Hospital record in the

system.

Staff Admin User may add/view/update PCP record in the system.

Staff Admin User may add/view/update Patient record in the

system.

Staff Admin User may add/view/update Specialty in the system.

Staff Admin User may add/view/update Specialist in the system.

Staff Admin User may add/view/update Referral in the system.

Staff Admin User may add/view/update ER/Hospital Admission

record in the system.

Staff Admin User may generate and view report with all system

data.

Referral Coordinator Manager, Referral Coordinator and Follow

Up Coordinator may be assigned to Healthcare System and/or

Hospital.

Referral Coordinator Manager, Referral Coordinator and Follow

Up Coordinator may only have access to data of assigned Healthcare

System/Hospital.

System may send notifications to assigned Referral Coordinator

Manager when new Referral submitted for the Hospital.

Referral Coordinator may only assign new Referrals to Referral

Coordinator assigned to the same Hospital.

System may send referral follow up alert to Follow Up

Coordinator assigned to the same Hospital.

After being logged in, a user may be landed in (displayed) a Dashboard page, which may be customized by each individual user with available dashlets based on the user's role.

TABLE 12
Functional Requirements Description

System may land user on the Dashboard page, after user is logged

in.

System may allow user to view assigned pre-defined dashlets as

per their role.

System may allow user to configure their Dashboard, with the

following information:

Available Pre-defined Dashlets

Shown Dashlets

Hidden Dashlets

Left Column Dashlets

Right Column Dashlets

System may allow user to configure the Dashboard page by

clicking Show or Hide assigned dashlets.

System may allow user to configure the Dashboard page by drag

and drop dashlets in “Left Column” and “Right Column” to add them

to their dashboard display.

User may save their dashlet configuration and the same may be

visible to them on their login.

A Healthcare System may be a network or group of hospitals that work together to coordinate and deliver a broad spectrum of services to their community. Under one Healthcare System, there may be one or many Hospitals associated.

For each Healthcare System, there may be one or more Healthcare System Admin User(s), who each have access to all the Hospitals under the system and may generate reports with those data.

Each Healthcare System may have its own In- and Out-of- (leakage) Network list, and PCPs and Specialists may be associated with Healthcare System(s).

TABLE 13
Functional Requirements Description

System may allow Healthcare System to be created and saved.

System may allow authorized user to search for Hospitals. For example,

Healthcare System Admin User may be able to search for Hospitals within

the same network, System Staff User may be able to search for all the

Hospitals.

System may allow Healthcare System Admin User to be created and

assigned to Healthcare System.

Healthcare System Admin User may have access to all data under the

assigned network.

Healthcare System Admin User may generate reports with all data under

the assigned network.

System may allow Hospital to be created and saved.

System may allow Hospital Admin User to be created and assigned to

Hospital.

Hospital Admin User may have access to all data under the assigned

Hospital.

Hospital Admin User may generate reports with all data under the

assigned Hospital.

System may allow one or multiple Hospital(s) be associated with one

Healthcare System.

System may allow System users, including Referral Coordinator Manager,

Referral Coordinator and Follow Up Coordinator, to be assigned to

Healthcare System.

System may allow System users, including Referral Coordinator Manager,

Referral Coordinator and Follow Up Coordinator, to be assigned to

Hospital.

System may allow PCP to be associated with Healthcare System and/or

Hospital.

System may allow Specialist to be associated with Healthcare System

and/or Hospital.

In- and Out-of (Leakage) Network list may be attached to Healthcare

System.

A primary care provider (PCP) may be a health care practitioner who sees people that have common medical problems. Patients need to visit their PCP first, then may be referred to Specialists. A PCP may need to sign up with the System in order to use the Referral platform, by signing BAA and HIPAA agreements. Once the PCP has registered with the System, a unique login may be created for that PCP.

A PCP may be associated with a Healthcare System and/or a Hospital, or without any Healthcare System/Hospital (as an Individual PCP). For most cases, one PCP may be associated with one Hospital, but the system is sufficiently flexible to allow multiple Hospitals to be associated with one PCP.

Each PCP may have its own list of Patients, only for whom the PCP may have access to view/update patient information and submit Referrals.

Each PCP may have one or many different offices, each of which may be associated with that PCP. For each PCP office, there may be at least one PCP Office Staff User who may submit Referrals on behalf of that PCP.

TABLE 14
Functional Requirement Description

System may allow a PCP account to be created and saved.

System may allow authorized users to search for PCPs. For example, a

Healthcare System Admin User may search for PCPs within the same

network, a Hospital Admin User may search for PCPs within the same

Hospital, and a System Admin User may search for all PCPs in the

system.

System may allow a PCP to be only associated with one Hospital (at a

specific address), and Healthcare System will be recognized based on

selection of Hospital.

System may allow a PCP to be created without associating it with any

Healthcare System/Hospital, as an Individual PCP.

System may allow multiple PCP Office Locations to be associated with

PCP.

For each PCP Office, at least one PCP Office Staff may be defined.

For each PCP Office, Communication Preference may be defined.

For each PCP Office, Office Hours may be defined.

System may allow a PCP Office Staff User to be created and associated

with Office location.

A PCP Office Staff User may only submit a Referral on behalf of a PCP

within the same Location.

PCP may only submit a Referral for its own Patient.

PCP may be able to generate and view a report with data of its own

Patient.

System may allow an authorized System user to create a temporary login

(temporary username and password) for PCP using the system.

The PCP temporary login may already be associated with a Healthcare

System/Hospital, or an individual PCP.

The temporary login may only be valid within 24 hours.

System may allow a PCP to login with a temporary login received from

System.

System may require PCP to change the temporary username and password

after being logged in.

System may allow PCP to sign HIPAA and BAA agreements, during

registration.

System may allow PCP office locations to be added, during registration.

System may enforce PCP to fill all the required fields to complete the

registration.

System may allow PCP to login with new credential, after registration.

Authorized Staff user may be able to review and approve PCP.

Only approved PCP may be able to log into the system.

Patient profiles may be added under PCP, and only associated PCP may

be able to add new Patient information underneath him.

TABLE 15
Functional Requirement Description - Patient Management

System may allow a Patient profile to be created and saved.

Patient profile may only be added by PCP, but may be updated by System

staff Users.

System may allow Patient profile to be updated and saved.

System may allow authorized user to search for Patients. For example,

Healthcare System Admin User may search for Patients within the same

network, Hospital Admin User may search for Patients within the same

Hospital, PCP User may search for Patients associated with him, System

Staff User may search for all Patients in the system.

Patient profile may be attached to one PCP.

Patient's preferred language may be added and updated.

Patient's insurance information, including insurance provider, insurance

plan, etc. may be added and updated.

Patient's billing information may be defined: whether self-pay, or paid by

insurance.

System may attach Referral and ER/Hospital Admission records to Patient

profile.

For each Patient profile, system may allow the history of Referral records

to be viewed.

For each Patient profile, system may allow the history of ER/Hospital

Admission records to be viewed.

TABLE 16
Functional Requirement Description - Specialty Management

System may allow the list of Specialty to be pre-defined.

System may allow new Specialty to be added.

System may allow Specialty list to be updated.

System may allow authorized user to search for Specialty, such as System

Staff Admin User.

System may allow Specialty to be selected from the pre-defined list when

adding new Referral.

System may allow Specialty to be associated with Specialist.

System may display Specialists who may be associated with selected

Specialty, when adding new Referral.

TABLE 17
Functional Requirement Description - Specialist Management

System may allow a Specialist profile to be added and saved.

System may allow a Specialist profile to be updated and saved.

System may allow a Specialist profile to be added with Specialties.

System may allow Specialist to be associated with one or more than one

Hospital.

System may allow Insurance and Insurance Plan information to be defined

for each Specialist.

System may allow authorized user (System Admin User) to add or remove

Specialists to or from INN list and ONN (Leakage) list, for selected

Hospital.

System may allow Specialist profile to be associated with multiple Office

Locations.

System may allow authorized user to search for Specialists.

System may allow Referral to be attached to Specialist profile.

System may allow authorized user to view the history of Referral records

of selected Specialist.

TABLE 18
Functional Requirement Description - Location Management

System may allow Location to be added and saved.

System may allow Location to be updated and saved.

Operation hours may be defined for each Location.

System may allow authorized user to search for Locations.

System may allow Location to be associated with PCP and Specialist.

System may allow one Location to be associated with multiple PCPs

and/or Specialists.

If the Location may be associated with PCP, system may identify it as

PCP Office and allow PCP Office Staff User to be associated.

For each Location, a Primary Contact needs to be defined, so that all

communications may be sent to this Contact.

System may allow communication preference to be set up for each

Location.

TABLE 19
Functional Requirement Description - Insurance Management

System may allow an Insurance Company record to be added and saved.

System may allow an Insurance Company record to be updated and saved.

System may allow an authorized user to search for Insurance Company

records.

System may allow added Insurance Company records to be selected when

adding new Referral.

System may allow Insurance Plan to be added under Insurance Company.

System may allow Insurance Plan to be updated and saved.

System may allow authorized user to search for Insurance Plan records.

System may allow added Insurance Plan to be selected when adding new

Referral.

System may identify whether the Insurance Plan requires authorization for

Referral Appointment scheduling.

When a Patient visits his Primary Care Provider (PCP), and the PCP decides that a Specialist needs to be referred for this Patient—and this may be when a new Referral request may be submitted into the system.

When the Referral record is in the System, a System staff user may then schedule the appointment and keep track of the Referral.

TABLE 20
Functional Requirement Description - Referral Management

System may allow a PCP to submit a new Referral for a Patient associated

with that PCP.

System may allow a PCP Office Staff User to submit a new Referral on

behalf of PCP within the same office, by selecting the PCP first.

System may allow Patient to be selected if the Patient already has a profile

in the system.

System may allow new Patient profile and information to be added and

saved, if the Patient is new.

System may allow Patient information to be updated and saved, while

adding a new Referral.

System may pre-populate a Patient's insurance company and details if

already in the Patient's profile.

System may allow a Patient insurance company to be selected and

information to be added and saved, while adding new Referral.

System may allow Patient insurance information to be updated and saved,

while adding new Referral.

System may allow Patient billing information to be added and saved,

while adding new Referral.

System may allow Patient billing information to be updated and saved,

while adding new Referral.

System may allow Patient's preferred language to be defined, while

adding new Referral, and the default language may be English.

System may allow Patient's Diagnosis Code(s) to be defined.

System may allow Specialty to be selected from the pre-defined list.

System may list Specialists based on the selection of insurance company

and Specialty - only Specialists within the insurance's network and

associated with selected Specialty may be listed.

System may allow new Specialist to be added, while adding new Referral.

System may ask to select one of the Specialist's Location, if multiple

Locations may be associated.

System may ask to select the Referral Type - Normal or STAT.

System may allow Special Instructions/Patient history to be added for the

Referral.

System may allow Notes to be added for the Referral.

System may allow the Referral request to be signed and submitted.

Once the Referral is submitted:

For STAT Referrals, system may send notifications to assigned

Referral Coordinator Manager right away.

For Normal Referrals, system may send notifications to assigned

Referral Coordinator Manager by end of day, with a count and

summary of Normal Referrals.

System may allow multiple Referrals to be submitted for the same Patient,

all at once.

System may save the Referral, but not yet submit.

System may filter Referrals by Referral Status and sub status.

Once the Referral is submitted, the Referral status may be “1 - New”.

System May allow Referral Coordinator Manager to assign the “New”

Referral to Referral Coordinator associated with the same Healthcare

System/Hospital.

System may allow Referrals to be assigned individually or in bulk.

Once the Referral is assigned, system may send notifications to an

assigned Referral Coordinator.

Once the Referral is assigned to a Referral Coordinator, the Referral status

may be updated to “1 - New” with sub status as “Assigned”.

If the 1st call Referral Coordinator made to the Patient was not answered,

system may send Reminder for 2nd call in 2 days.

Once the Referral is be scheduled with appointment date, the Referral

status may be updated to “2 - Scheduled” automatically.

System may send notifications to both Patient and Specialist when the

appointment is scheduled.

If the Patient's Insurance does NOT require Authorization, once the

Referral is scheduled it may also be automatically confirmed, with

Referral status updated as “2 - Scheduled” and sub status as “Confirmed”.

If the Patient's Insurance requires Authorization, once the Referral is

scheduled, system may ask for Insurance Authorization.

System may allow insurance authorization to be attached to the Referral.

If the Patient's Insurance requires Authorization, and the Insurance

Authorization is obtained, the Referral status may be updated as “2 -

Scheduled” and sub status as “Confirmed” automatically.

System may send notifications to both Patient and Specialist when the

appointment is confirmed.

Once the Referral is updated to status “2 - Scheduled”, the full Referral

script may be emailed and/or faxed to Specialist.

Patient may add the schedule date to Calendar when receiving the

notification.

System may send Reminder to Patient [X] days (configurable) before the

scheduled date.

System may allow Referral status to be changed to “5 - Patient

Disregard”.

System may allow Referral status to be changed to “6 - Unable to

Contact”.

For the Referrals with status changed to “5 - Patient Disregard” and “6 -

Unable to Contact”, system may send daily report to the PCP Office.

System may send follow up Email to Specialist, one week after the

Appointment date automatically.

The follow up Email may include a link allowing a Specialist to select and

respond with answers to the following questions:

I. Has Patient Completed the Appointment? - Yes or No

i. If “Yes”, goes to the II question

ii. If “No”, select from the following conditions:

a. Patient has rescheduled Appointment - if

selected, reschedule date needs to be entered

b. Patient was No Show

c. Patient cancelled Appointment

II. Is the Report Ready? - Yes or No

System may read the answers sent back via the follow up link and update

Referral automatically.

System may read the reschedule date sent back by the Specialist and

update the Referral with the new date.

System may log all the Referral schedule history, including appointment

date/time and change date/time.

If NO response received one week from the 1st follow up Email, system

may send 2nd follow up Email in one week.

If NO response received one week from the 2nd follow up Email, system

may send 3rd follow up Email in one week.

If NO response received after 3 follow up Email sent, system may send

Alert to Follow Up Coordinator(s) that are assigned to the same

Healthcare System/Hospital, after three weeks since 1st follow up Email.

System may flag the Referral as “Follow Up” needed.

System may allow Follow Up Coordinator to assign Referral to itself.

System may display “Follow Up” Referrals by Specialist Office Location,

so that the Follow Up Coordinator may follow up multiple Referrals with

the same Location within one call.

Once the Referral receives feedback as “Patient has completed the

Appointment” but Report may be still NOT ready, the Referral status may

be updated to “3 - Exam Done” automatically.

Once the Referral receives feedback as “Patient has completed the

Appointment” but Report may be still NOT received after one week,

system may send Reminder to Specialist asking for Report.

If after one week since the Report Reminder sent, the Report may be still

NOT received, system may send Alert to Follow Up Coordinator(s) that

assigned to the same Healthcare System/Hospital.

System may send follow up Alert to all Follow Up Coordinators assigned

to the same Healthcare System/Hospital with the Referral, and one Follow

Up Coordinator may assign itself to the Referral.

System may log all Referral assignment history.

Once the Referral receives feedback as “Patient has completed the

Appointment” and “Report may be Ready”, the Referral status may be

updated to “4 - Complete with Report” automatically.

Once system has received “Yes” for “Is the Report Ready?”, system may

send the generated unique bar code to the Specialist, who may then attach

it to the Report and send the Report to System.

System may also allow authorized user (Follow Up Coordinator) to click

and generate the unique bar code for every Referral, and send it to

Specialist who may then attach it to the Report.

Once the Report is received with bar code attached, system may send (fax

and/or email) the Report to PCP Office and updated to “4 - Complete with

Report” automatically.

System may also save the Report with bar code and attach it to the

Referral in the system, so that it may be accessed by an authorized user.

System may be able to generate bar code with the “Universal Product

Code” format and in AVERY 8366TM size.

Once the Referral receives feedback as “Patient has NOT completed the

Appointment” and “No Show”, the Referral status may be updated to “5 -

Patient Disregard” with sub status as “No Show” automatically.

Once the Referral receives feedback as “Patient has NOT completed the

Appointment” and “Cancellation”, the Referral status may be updated to

“5 - Patient Disregard” with sub status as “Cancellation” automatically.

Once the Referral status may be changed to “5 - Patient Disregard” with

sub status as “No Show” or “Cancellation”, system may send notifications

to the Patient asking the Patient to call back and reschedule.

System may allow Referral status to be changed to “5 - Patient Disregard”

with or without sub status.

System may allow Referral status to be changed to “6 - Unable to

Contact”.

System may allow Referral to be flagged as “Management Attention”,

which may send notifications to System Admin User and Referral

Coordinator Manager automatically.

System may allow Notes to be added for Referral, with date/time captured.

System may allow Document to be attached to Referral.

Referral Coordinator Manager may assign Referral Coordinator to the

Referral; and Follow Up Coordinator may be able to assign himself to the

Referral.

Referral Coordinator and Follow Up Coordinator may be assigned and

work on the same Referral.

System may allow Referrals to be searched by Healthcare System and

Hospital.

System may allow Referrals to be searched by PCP and PCP Office.

System may allow Referrals to be searched by Patient information,

including Patient Last and First Name, Patient DOB and Patient Insurance

provider.

System may allow Referrals to be searched by Specialty, Specialist and

Specialist Office.

System may allow Referrals to be searched by submission date range.

System may allow Referrals to be searched by appointment schedule date

range.

System may allow Referral search criteria to be saved by naming it.

System may allow saved Referral search criteria to be retrieved and

edited.

ER/Hospital Admission Management

When Patient has been admitted to an ER or Hospital, notifications may be sent to System. Therefore, an ER/Hospital Admission record may be added in the system for the Patient, and System staff may keep track of it.

TABLE 21
Functional Requirements Description

System may allow new ER/Hospital admission record to be added and

saved.

System may allow new ER/Hospital admission record to be updated and

saved.

System may allow authorized user to search for ER/Hospital admission

record.

System may attach added ER/Hospital admission record to Patient profile.

System may send notifications to PCP Office when new ER/Hospital

admission record added.

System may allow Patient Discharge date/time to be added.

System may send notifications to PCP Office when the Patient may be

discharged.

System may allow Notes to be added for ER/Hospital admission record

with date/time captured.

System may send notifications to PCP office, through fax or email, when

Patient disregard System's follow up request.

Invoices may be generated based on number of Referrals and ER/Hospital Admission records created, applied with rates. Invoices may be generated for each Healthcare System account monthly.

TABLE 22
Functional Requirements Description

System may generate invoice for each Healthcare System account

monthly.

Invoice may include total number of Referrals created, with rates applied,

for each account.

Invoice may include total number of ER/Hospital Admission records

created, with rates applied, for each account.

Invoice may be exported and printed.

Communication Management

TABLE 23
Functional Requirements Description

System may allow communication preferences to be set up for Patient,

PCP, Specialist and Location - PCP Office and Specialist Office.

Communication preferences may include:

Email, when selected Email address is required

Text, when selected Cell Phone number is required

Fax, when selected Fax number is required

Mail, when selected Mailing address is required

System may send all communications, including notifications, reminders

and alerts based on preferences and information provided.

System may report back if the Email failed to send.

System may report back if the Text failed to send.

System may report back if the Fax failed to send.

Report Management

There may be pre-defined reports that may be viewed by authorized users, who may also edit and save the new search criteria as a new report, as well as create new search criteria and generate reports periodically.

TABLE 24
Functional Requirements Description - Reports

System may allow user to view pre-defined reports, based on user roles.

System may allow user to change the search criteria for existing reports

and save them as new ones.

System may allow user to create new search criteria to generate new

reports and save them.

System may generate all the reports with real time data.

Report may be printed and exported as a “pdf' or “csv” or “excel” file.

End of Month Report - This may list a Referral count with PCP and

Leakage information associated for each Specialty/Specialist end of

month, for every Healthcare System. It may include:

Referral Totals by PCP

Referral Count by Status (both table and pie chart)

Leakage Referral by Specialty

In-/Out- Network Referral Count by Specialist and

Specialty

In-/Out-of- Network Referral Totals (both table and pie

chart)

Mid-Month Report - This may list Referral count for PCP and totals, until

the middle of each month, for every Healthcare System/Hospital. It may

include:

Referral Totals by PCP

Referral Grant Total

Leakage Trend Report - This may list Referral leakage trend by Specialty

and Location, for every Healthcare System. It may include:

Leakage Count summary: display number of leakage by

Year or Month for each Healthcare system (both table and column

chart)

Leakage Count by Specialty: display number of leakage

based on Specialty by Year for each Healthcare system (both table

and column chart)

Leakage Count by Zip and Specialty: display number of

leakage based on Zip code for each Specialty, by Year for each

Healthcare System

Leakage Cluster: display request cluster vs. leakage cluster

on a map

Referral Density Report - This report may visualize the referral density

based on criteria of PCP referrals to any Specialist, which may show

where the referrals may be coming from and where the referrals may be

going with numbers, on map. The Referral Density Report also may

identify distance from the PCP to the Specialists, in miles. Thus, the

hospital or healthcare system will be able to identify areas of need based

on the number of referrals and distances patients are required to travel to

place specialists in closer proximity to the PCP as required. This

information may be obtained by reviewing the density report, the number

of referrals, the distance of the patient's travel, and the specialist

identified.

Healthcare System Summary Report - This may list Referral totals for

each Healthcare System, for selected data range, so that System Admin

may have an overview of all the systems.

New Referral Report - This may list all new Referrals that are submitted

in the system but have not been taken care of.

Referral Assignment Report - This may list Referral count by assigned

Referral Coordinator, including total number of Referrals assigned,

number of Referrals scheduled, number of Referrals with status changed,

number of Notes added for assigned Referrals, for each RC.

Daily Referral Submission Report - This may list Referrals submitted for

the day, and may be sent to the Referral Coordinator Manager at end of

the day.

Report Status Report - This may list Referrals based on status, including

communication status, for selected Date Range, by Specialty; and System

Admin User may also view it by Healthcare System.

TECHNICAL DESCRIPTION

The purpose of this Technical Description is to describe the technical design of the exemplary embodiments of the system and of exemplary system implementation. This description describes the modules of the system, and includes architecture and class diagrams, along with DB tables.

The description details functionality provided by each component or group of components of exemplary embodiments and shows how the various components interact.

An exemplary embodiment may comprise a website may be built using HTML 5 with JQuery1.1x. Data may be pulled from the SQL Database server using the Web API Controller. The Service Layer may be built using .NET C#. For all data-related needs, the Restful Service may be called, which in turn may fetch the data from the SQL Server and send the data back to the website.

An exemplary technical stack utilized for this system comprises the following five languages/APIs:

• • 1. Front End development over HTML 5.0
  • 2. Bootstrap (CSS)
  • 3. JQuery 1.1x based Data binding/validation
  • 4. .Net C# Based RESTful APIs
  • 5. MS SQL Server 2014

Exemplary technical architecture is depicted in FIG. 5:

The system may be deployed on Cloud/web servers and may work in part as a web application. Other components such as Database and Services may also be deployed on secure (SSL) cloud/web servers. To use the system, a user may be within the domain network and may have appropriate credentials to login and perform certain operations.

Logical and Physical High Level Design Diagram—FIG. 6

UI Module: Presentation layer which may be implemented with MVC 5 framework and HTML UI components.

Authentication: Login and Authentication may be done through System database and password may be encrypted through MD5 Hash.

Web API: Web API exposes restful end points. Depending upon the payload, it executes the corresponding system process and send out back to the client in JSON over HTTP.

Email Module: Mailing engine to send emails for forgot password, reset request, unlock user request etc.

Unit Testing Module: Unit tests may be written on a MS Unit testing framework.

Exception Logging: Class library for exception handling and logging to the database and sending notification to admin by email as well.

Database Layer: Data module uses Microsoft Enterprise Library 6.0 to interact with SQL Server 2014. Stored procedure and user defined function may interact to data layer.

An exemplary System Physical and Logical High Level design diagram (FIG. 7) explains various components and their interactions in context of the system. The system may comprise a number of basic layers:

• • 1. Backend
  • 2. Web Layer (server)
  • 3. Client Layer

Backend: includes the database (SQL Server 2014) of the system along with server side caching. Data Layer may consume the data provided by Backend Layer. Database interactions happen in the system through the help of the Repository System. All the repositories in the system may be derived from a Repository Interface. All other components of the system may use the repository interfaces to do any sort of data manipulation.

Web Layer (Server): may comprise the following layers:

Data Layer: This layer provides access to data hosted within the boundaries of the system. The data layer exposes generic interfaces that the components in the system layer may consume. It consists of Data Access Component (Enterprise Library 6.0), Data Helper and Other Utilities.

System layer: This layer implements the core functionality of the system, and encapsulates the relevant system logic. It consists of components, workflow and entities.

Presentation layer: This layer contains the user oriented functionality responsible for managing user interaction with the system, and comprises components that provide a common bridge into the core system logic encapsulated in the system layer.

In addition, Security and Operational Management may be provided on all the layers. Security includes Permissions, membership, xss attack, etc. Operational Management includes Logging information, Configuration, tracing, caching, etc.

Client Layer:

Client may access the web layer through Internet. This layer may be tightly coupled with view, model, and view models. Validations may be placed through JQuery.

Exemplary Security Features

1. Secure Login: Password may be saved an encrypted form in System database.

2. Access control and Authentication: Users may be restricted within the boundary of their role and permissions to access the component of the application. Each user has to be associated with some role and certain privileges of that role may be applicable on that user.

3. Brute force attack: Application blocked in case of more than 3 consecutive wrong password try to avoid brute force attack or automatic script login attack.

4. SQL injection: it's a common attack where attacker may append some sql script element with input to expose the internals of the application or damage the data. We verify every freeform input from the user.

5. Server side authentication and authorization: Even if attacker changes the UI elements or URL injection (appending the URL with id) to gain access the restricted information, still application do authorization of the request on server side and only grant access if user has right to access some resource.

6. Cross Site Scripting: The success of this attack requires the victim to execute a malicious URL which may be crafted in such a manner to appear to be legitimate at first look. When visiting such a crafted URL, an attacker may effectively execute something malicious in the victim's browser. Some malicious Javascript, for example, may be run in the context of the web site which possesses the XSS bug. Along with .NET framework's inbuilt functionality to validate the incoming Request and malformed URL, we have implemented a proper validation process of the input and anti-forgery token.

Users must be authenticated. Then a token gets generated by the system. All the subsequent calls may be verified by matching the Authentication Token, failing which the request gets terminated, with the attempting user being shown an appropriate message.

Platform Support

The website aspect may run on popular browsers available in the market, such as:

TABLE 25:
Browser/Platforms

Internet Explorer v-10 or higher /Chrome v-54 or higher /Firefox v-50

or higher /Safari v-5.1 or higher

All different mobile devices including IPhone, Samsung, LG and other

models using the iOS, Android and Windows platforms

APPENDIX

TABLE 26
Dashboard - Dashlet Examples

Dashlet Name	Type	User Role	Description
Healthcare System	Table	Healthcare	Display “Number of Referrals” categorized by
Referral Summary		System	Hospital, for selected date range - system may
		Admin	display data for current month by default,
			including:
			Hospital Name
			Total of Referrals
			In-Network Referrals #
			Leakage Referrals #
Leakage by	Table	Healthcare	Display “Number of In-Network Referrals” and
Specialty/Specialist		System	“Number of Leakage Referrals” by Specialty
		Admin	and Specialist, for selected date range - system
			may display data for current month by default,
			which also allows user to select All or One
			Hospital from the network; for each Specialty,
			Total In- and Out- Network Referrals # may
			first be displayed, then for each Specialist,
			including:
			Specialty Name
			Specialist Last, First Name
			In-Network Referrals #
			Specialty Name
			Specialist Last, First Name
			Leakage Referrals #
			* Clicking “More. . .” may redirect user to the
			Report - Leakage by Specialty/; Specialist
			Report page, with more details displayed.
Leakage Trend	Column	Healthcare	Display “Number of Leakage Referrals” by
Summary	Chart	System	Year or Month, for selected Year/Month range
		Admin	in a column chart format for this Healthcare
			System, which also allows user to select All or
			One Specialty from the list; system may
			display “Number of Leakage Referrals” by
			Month for current year for All Specialty in
			total.
Referral by PCP	Table	Healthcare	Display “Number of Referrals” by PCP
		System	associated with this Healthcare System, which
		Admin	also allows a user to select All or One Hospital
			from the list, for selected data range - system
			may display data for current month by default,
			including:
			PCP Name
			# of Referrals
			* Clicking “More. . .” may redirect user to the
			Report - Referral by PCP Report page, with
			more details displayed.
Referral Status	Table,	Healthcare	Display “Number of Referrals” by Referral
Summary	Pie	System	Status for this Healthcare System, which also
	Chart	Admin	allows user to select All or One Hospital from
			the list, for selected date range - system may
			display data for current month by default,
			including:
			Referral Status
			# of Referrals
			Percentage
			* Clicking “Chart” icon may display the data in
			a pie chart format
			* User may be able to switch between Table
			and Chart display
			* Clicking “More. . .” may redirect user to the
			Report - Referral Status Report page, with
			more details displayed.
Top 10 Referral	Table	Healthcare	Display top 10 Specialties that get referred
Specialty		System	within this Healthcare System, for selected date
		Admin	range, including:
			Specialty Name
			# of Referrals
New Referral	Table	Healthcare	Display new referrals for the Healthcare
		System	System, which also allows user to select All or
		Admin	One Hospital from the Hospital list within the
			network, including:
			Referral #
			PCP
			Patient
			Specialty
			Specialist
			In/Out Network
			* Clicking “More. . .” may redirect user to the
			Report - New Referral Report page, with more
			details displayed.
Hospital Referral	Table,	Hospital	Display “Number of Referrals” for this
Summary	Pie	Admin	Hospital, for selected date range - system may
	Chart		display data for current month by default,
			including:
			Total of Referrals
			In-Network Referrals #
			Leakage Referrals #
			* The data may also be displayed in a pie chart
			format, with In-Network and Leakage Referrals
			Percentage
Leakage by	Table	Hospital	Display “Number of In-Network Referrals” and
Specialty/Specialist		Admin	“Number of Leakage Referrals” by Specialty
			and Specialist, for selected date range - system
			may display data for current month by default;
			for each Specialty, Total In- and Out- Network
			Referrals # may first be displayed, then for
			each Specialist, including:
			Specialty Name
			Specialist Last, First Name
			In-Network Referrals #
			Specialty Name
			Specialist Last, First Name
			Leakage Referrals #
			* Clicking “More. . .” may redirect user to the
			Report - Leakage by Specialty/; Specialist
			Report page, with more details displayed.
Leakage Trend	Column	Hospital	Display “Number of Leakage Referrals” by
Summary	Chart	Admin	Year or Month, for selected Year/Month range
			in a column chart format for this Hospital,
			which also allows user to select All or One
			Specialty from the list; system may display
			“Number of Leakage Referrals” by Month for
			current year for All Specialty in total.
Referral by PCP	Table	Hospital	Display “Number of Referrals” by PCP
		Admin	associated with this Hospital, for selected data
			range - system may display data for current
			month by default, including:
			PCP Name
			# of Referrals
			* Clicking “More. . .” may redirect user to the
			Report - Referral by PCP Report page, with
			more details displayed.
Referral Status	Table,	Hospital	Display “Number of Referrals” by Referral
Summary	Pie	Admin	Status for this Hospital, for selected date range
	Chart		system may display data for current month by
			default, including:
			Referral Status
			# of Referrals
			Percentage
			* Clicking “Chart” icon may display the data in
			a pie chart format
			* User may be able to switch between Table
			and Chart display
			* Clicking “More. . .” may redirect user to the
			Report - Referral Status Report page, with
			more details displayed.
Top 10 Referral	Table	Hospital	Display top 10 Specialties that get referred for
Specialty		Admin	the Hospital, for selected date range, including:
			Specialty Name
			# of Referrals
New Referral	Table	Hospital	Display new referrals for the Healthcare
		Admin	System - Hospital, including:
			Referral #
			PCP
			Patient
			Specialty
			Specialist
			In/Out Network
			* Clicking “More. . .” may redirect user to the
			Report - New Referral Report page, with more
			details displayed.
New Referral	Table	PCP	Display new referrals submitted by this PCP,
			which also allows user to select All or One of
			PCP Office Location from the Locations list
			associated with the PCP, including:
			Referral #
			PCP Office
			Patient
			Specialty
			Specialist
			In/Out Network
			* Clicking “More. . .” may redirect user to the
			Report - New Referral Report page, with more
			details displayed.
My Notifications	Table	PCP	Display notifications sent to this PCP,
			including:
			Notification Date
			Notification Description
Referral Status	Table,	PCP	Display “Number of Referrals” by Referral
Summary	Pie		Status submitted by this PCP, for selected date
	Chart		range - system may display data for current
			month by default, including:
			Referral Status
			# of Referrals
			Percentage
			* Clicking “Chart” icon may display the data in
			a pie chart format
			* User may be able to switch between Table
			and Chart display
			* Clicking “More. . .” may redirect user to the
			Report - Referral Status Report page, with
			more details displayed.
New Referral	Table	PCP Office	Display new referrals submitted by this PCP
		Staff	Office Staff for the PCP Office, including:
			Referral #
			PCP
			Patient
			Specialty
			Specialist
			In/Out Network
			* Clicking “More. . .” may redirect user to the
			Report - New Referral Report page, with more
			details displayed.
My Notifications	Table	PCP Office	Display notifications sent to this PCP Office,
		Staff	including:
			Notification Date
			Notification Description
Referral Status	Table,	PCP Office	Display “Number of Referrals” by Referral
Summary	Pie	Staff	Status submitted by this PCP Office Staff, for
	Chart		selected date range - system may display data
			for current month by default, including:
			Referral Status
			# of Referrals
			Percentage
			* Clicking “Chart” icon may display the data in
			a pie chart format
			* User may be able to switch between Table
			and Chart display
			* Clicking “More. . .” may redirect user to the
			Report - Referral Status Report page, with
			more details displayed.
Healthcare System	Table	System	Display “Number of Referrals” categorized by
Referral Summary		Staff	Healthcare System, for selected date range -
		Admin	system may display data for current month by
			default, including:
			Healthcare System Name
			Total of Referrals
			In-Network Referrals #
			Leakage Referrals #
Leakage by	Table	System	Display “Number of In-Network Referrals” and
Specialty/Specialist		Staff	“Number of Leakage Referrals” by Specialty
		Admin	and Specialist, for selected date range - system
			may display data for current month by default,
			which also allows user to select All or One
			Healthcare System; for each Specialty, Total
			In- and Out- Network Referrals # may first be
			displayed, then for each Specialist, including:
			Specialty Name
			Specialist Last, First Name
			In-Network Referrals #
			Specialty Name
			Specialist Last, First Name
			Leakage Referrals #
			* Clicking “More. . .” may redirect user to the
			Report - Leakage by Specialty/; Specialist
			Report page, with more details displayed.
Leakage Trend	Column	System	Display “Number of Leakage Referrals” by
Summary	Chart	Staff	Year or Month, for selected Year/Month range
		Admin	in a column chart format for All or One
			Healthcare System, and All or One Specialty
			from the list; system may display “Number of
			Leakage Referrals” for current year for All
			Healthcare Systems and All Specialty in total.
Top 10 Referral	Table	System	Display top 10 Healthcare Systems with the
Healthcare System		Staff	most Referrals submitted, for selected date
		Admin	range - system may display data for current
			month by default, including:
			Healthcare System Name
			# of Referrals
Top 10 Referral	Table	System	Display top 10 PCP with the most Referrals
PCP		Staff	submitted, for selected date range - system may
		Admin	display data for current month by default,
			including:
			PCP Name
			Healthcare System Name
			# of Referrals
Top 10 Referral	Table	System	Display top 10 Specialties that get referred for
Specialty		Staff	All or One Healthcare System, for selected date
		Admin	range, including:
			Specialty Name
			# of Referrals
Referral Status	Table,	System	Display “Number of Referrals” by Referral
Summary	Pie	Staff	Status for All or One Healthcare System from
	Chart	Admin	the list, for selected date range - system may
			display data for current month by default,
			including:
			Referral Status
			# of Referrals
			Percentage
			* Clicking “Chart” icon may display the data in
			a pie chart format
			* User may be able to switch between Table
			and Chart display
			* Clicking “More. . .” may redirect user to the
			Report - Referral Status Report page, with
			more details displayed.
New Referral	Table	System	Display new referrals submitted in the system,
		Staff	which also allows user to select All or One
		Admin	Healthcare System from the Hospital list within
			the network, including:
			Healthcare System Name
			Referral #
			PCP
			Patient
			Specialty
			Specialist
			In/Out Network
			* Clicking “More. . .” may redirect user to the
			Report - New Referral Report page, with more
			details displayed.
New Referral	Table	System	Display referrals that newly get assigned to
Assignment		Staff	Referral Coordinator, for All for One
		Admin	Healthcare System, including:
			Healthcare System Name
			Referral #
			Assigned By
			Assigned To
			Assigned Date
Legacy Referral	Table	System	Display referrals that have not been Closed for
		Staff	[X time period] since submitted, for All or One
		Admin	Healthcare System, including:
			Healthcare System Name
			Referral #
			Referral Status
			Assigned To
			Submitted Date
			* Clicking “More. . .” may redirect user to the
			Report - Legacy Referral Report page, with
			more details displayed.
My Notifications	Table	Referral	Display notifications sent to this PCP,
		Coordinator	including:
		Manager	Notification Date
			Notification Description
New Referral	Table	Referral	Display new referrals for the assigned
		Coordinator	Healthcare System and Hospital, which allows
		Manager	user to select All or One Healthcare System
			from the assigned list and All or One Hospital
			from the assigned list, including:
			Referral #
			PCP
			Patient
			Specialty
			Specialist
			In/Out Network
			* Clicking “More. . .” may redirect user to the
			Report - New Referral Report page, with more
			details displayed.
Referral Status	Table,	Referral	Display “Number of Referrals” by Referral
Summary	Pie	Coordinator	Status for All or One assigned Healthcare
	Chart	Manager	System/Hospital from the list, for selected date
			range - system may display data for current
			month by default, including:
			Referral Status
			# of Referrals
			Percentage
			* Clicking “Chart” icon may display the data in
			a pie chart format
			* User may be able to switch between Table
			and Chart display
			* Clicking “More. . .” may redirect user to the
			Report - Referral Status Report page, with
			more details displayed.
Legacy Referral	Table	Referral	Display referrals that have not been Closed for
		Coordinator	[X time period] since submitted, for All or One
		Manager	assigned Healthcare System/Hospital from the
			list, including:
			Healthcare System Name
			Referral #
			Referral Status
			Assigned To
			Submitted Date
			* Clicking “More. . .” may redirect user to the
			Report - Legacy Referral Report page, with
			more details displayed.
Referral	Table	Referral	Display number of Referrals assigned by
Assignment		Coordinator	Referral Coordinator and Follow Up
Summary		Manager	Coordinator that assigned with the same
			Healthcare System/Hospital, including:
			Staff User Name
			Staff User Role - Referral Coordinator or
			Follow Up Coordinator
			# of Referrals assigned to
My Notifications	Table	Referral	Display notifications sent to this PCP,
		Coordinator	including:
			Notification Date
			Notification Description
New Referral	Table	Referral	Display new referrals for the assigned
		Coordinator	Healthcare System and Hospital, which allows
			user to select All or One Healthcare System
			from the assigned list and All or One Hospital
			from the assigned list, including:
			Referral #
			PCP
			Patient
			Specialty
			Specialist
			In/Out Network
			* Clicking “More. . .” may redirect user to the
			Report - New Referral Report page, with more
			details displayed.
My Assignment	Table	Referral	Display referrals that assigned to this user,
		Coordinator	including:
			Referral #
			PCP
			Patient
			Specialty
			Specialist
			Referral Status
My Notifications	Table	Follow Up	Display notifications sent to this PCP,
		Coordinator	including:
			Notification Date
			Notification Description
New Referral	Table	Follow Up	Display new referrals for the assigned
		Coordinator	Healthcare System and Hospital, which allows
			user to select All or One Healthcare System
			from the assigned list and All or One Hospital
			from the assigned list, including:
			Referral #
			PCP
			Patient
			Specialty
			Specialist
			In/Out Network
			* Clicking “More. . .” may redirect user to the
			Report - New Referral Report page, with more
			details displayed.
My Assignment	Table	Follow Up	Display referrals that assigned to this user,
		Coordinator	including:
			Referral #
			PCP
			Patient
			Specialty
			Specialist
			Referral Status

Embodiments comprise computer components and computer-implemented steps that will be apparent to those skilled in the art. For example, calculations and communications are performed electronically, and results can be displayed using a graphical user interface.

An exemplary such system is depicted in FIG. 10. Computers 100 communicate via network 110 with a server 130. A plurality of sources of data 120-121 also communicate via network 110 with a server 130, processor 150, and/or other components operable to calculate and/or transmit information. Server(s) 130 may be coupled to one or more storage devices 140, one or more processors 150, and software 160.

Calculations described herein, and equivalents, are, in exemplary embodiments, performed entirely electronically. Other components and combinations of components may also be used to support processing data or other calculations described herein as will be evident to one of skill in the art. Server 130 may facilitate communication of data from a storage device 140 to and from processor(s) 150, and communications to computers 100. Processor 150 may optionally include or communicate with local or networked storage (not shown) which may be used to store temporary or other information. Software 160 can be installed locally at a computer 100, processor 150 and/or centrally supported for facilitating calculations and applications.

For ease of exposition, not every step or element of the exemplary embodiments is explicitly described herein as part of a computer system, but those skilled in the art will recognize that each component, module, process, step, or element may have a corresponding computer system hardware component. Such computer system and/or software components are therefore enabled by describing their corresponding steps or elements (that is, their functionality), and are within the scope of the invention.

Moreover, where a computer system is described or claimed as having a processor for performing a particular function, it will be understood by those skilled in the art that such usage should not be interpreted to exclude systems where a single processor, for example, performs some or all of the tasks delegated to the various processors. That is, any combination of, or all of, the processors specified in the description and/or claims may be the same processor. All such combinations are within the scope of the invention.

Alternatively, or in combination, processing and decision-making may be performed by functionally equivalent circuits such as a digital signal processor circuit or an application specific integrated circuit.

FIG. 10 illustrates a block diagram of an example computer system that is suitable for use with exemplary embodiments. However, embodiments are operable in any of several computing environments that can include a variety of hardware, operating systems, and program modules. Program modules may include, but are not limited to, processors, routines, programs, components, data structures, and the like that perform particular tasks and/or implement particular data types.

Moreover, those skilled in the art will understand that embodiments may be practiced with other computer system configurations including, but not limited to, hand-held devices, network computers, multiprocessor based systems, microprocessor-based or other special purpose or proprietary programmable consumer electronics, minicomputers, mainframes, and the like. Exemplary embodiments may also be practiced in distributed computing environments where tasks are performed by remote processing devices that are linked through communications networks. In a distributed computing environment, program modules may be located in and/or executed from local and/or remote memory storage devices.

Exemplary embodiments and any other necessary programmed instructions and/or commands may be executable on processor 150. Processor 150 stores and/or retrieves programmed instructions and/or data from memory devices that can include, but are not limited to, Random Access Memory (RAM) and Read Only Memory (ROM) by way of a memory bus (not shown). User input to computer system 100 may be entered by way of a keyboard and/or pointing device. Human readable output from processor 150 may be viewed on an electronic display or in printed form on a local printer. Alternatively, processor 150 may be accessible by remote users for purposes that can include debugging, input, output and/or generating human readable displays in printed and/or display screen output form, or any other output form, by way of a Local Area Network (LAN) or Wide Area Network (WAN).

Many routine program elements, such as initialization of loops and variables and the use of temporary variables, are not described herein. Moreover, it will be appreciated by those of ordinary skill in the art that unless otherwise indicated, the particular sequence of steps described is illustrative only and can generally be varied without departing from the scope of the invention. Unless otherwise stated, the processes described herein are unordered—that is, the processes can be performed in any reasonable order.

The foregoing description relates to select exemplary embodiments. Those skilled in the art will understand that certain modifications may be made without departing from the spirit and scope of the invention.

Every document cited herein, including any cross referenced or related patent or application, is hereby incorporated herein by reference in its entirety unless expressly excluded or otherwise limited, The citation of any document is not an admission that it is prior art with respect to any invention disclosed or claimed herein or that it alone, or any combination with any other reference or references, teaches, suggests, or discloses any such invention. Further, to the extent conflicts with any meaning or definition of a term in this document conflicts with any meaning or definition of the same term in a document incorporated by reference, the meaning or definition assigned to that term in this document shall govern.

While particular embodiments of the present invention have been illustrated and described, it would be obvious to those skilled in the art that various other changes and modifications can be made without departing from the spirit and scope of the invention. It is therefore intended to cover in the appended claims all such changes and modifications that are within the scope of this invention.