Abstract: A medical information navigation engine (“MINE”) includes a medical information interface, a reconciliation engine and an intent-based presentation engine. The medical information interface receives medical information from a plurality of medical sources, which is subsequently reconciled by the reconciliation engine. The intent-based presentation engine clusters the reconciled medical information by applying at least one clustering rule to the reconciled medication information. The clustered reconciled medical information can be presented to a user.

Abstract: A medical information navigation engine (“MINE”) is provided. In some embodiments, the system computes a current patient encounter vector for a current patient encounter, and then an optimal patient encounter vector is computed by assuming a best case patient encounter in accordance with the organizational objectives. The system is then able to compute the difference between the best case encounter and the current patient encounter. This difference is used to compute a corresponding payoff using an intelligent matrix.

Abstract: Systems and methods to improve the optical character recognition of records, and in particular health records, are provided. An image of a medical record is received, and an initial optical image recognition (OCR) on the image is performed to identify text information. The OCR signal quality may be measured, and areas of insufficient OCR signal quality may be isolated. The signal quality is determined by a weighted average of semantic analysis of the resulting text, and/or OCR accuracy measures. The OCR process may be repeated on the isolated regions of lower signal quality, each time using a different OCR transform, until all regions are completed with a desired degree of signal quality (accuracy). All the regions of the document may then be recompiled into a single document for outputting.

Abstract: A medical information navigation engine (“MINE”) is capable of inferring referral activity not reported into a referral workflow system by utilizing intent-based clustering of medical information. The intent based clustering reconciles received medical data, from a variety of sources, and then clusters the data by applying one or more clustering rules. After the referrals not otherwise reported are inferred, they may be utilized to generate metrics that can be utilized to enhance patient care, and reduce costs. Metrics may be generated for both in-network and out-of-network referrals in order to distinguish differences in reporting activity.

Abstract: To achieve the foregoing and in accordance with the present invention, systems and methods for workflow management are provided. In some embodiments, a set of data elements, which are extracted from medical information, are received. The elements are bundled according to one or more similar attributes to form work items. Work items are bundles of data elements for which value is to be extracted for a particular user objective. Next the workflows are configured according to event history for the work items, current action, and user context. The work items may then be routed through the workflow based upon the work items' “energy”. Work item energy is the probability and degree to which a next action taken in a workflow to that particular work item will further a user objective.

Abstract: Systems and methods for data warehouse management for medical information is provided. The system receives a set of medical record documents. These documents include evidence for one or more findings which are identified using natural language processing of evidence. The data set is probabilistically transformed into a structured data set (often as a table). This structured data set includes embedded links that reference the source document where the evidence is located. If the finding is supported by multiple articles of evidence, the link will direct the user to the source document with the highest confidence ranking. Evidence in the source document is highlighted and may include associated annotations. Evidence, findings and annotations may be updated by the user.

Abstract: Systems and methods to automatically generate classifiers are provided. A labeled dataset is initially received. The dataset may be for a positive class, or may be a negative for a class, or a false positive class. N features that are predictive for the class (or false positive or the negative class) are identified. These features are combined within a classifier dictionary. Medical records received may be processed in order to be machine readable. Features within the medical records are identified and are compared against the dictionary of classifiers. Matches indicate classes within the medical record. The classifier dictionary may be periodically updated in response to insufficient classification accuracy, or when new data becomes available.

Abstract: Systems and methods for personalizing medicine utilizing the true state of the patient are provided. A number of medical records for a patient are subjected to predictive modeling for various conditions (known as patient ‘true state’). The patient personal information, previous care, and true state may be provided into a state machine in order to determine the resources needed for the patient. The medical resources may be any of laboratory services, diagnostics, therapies and medications. Using the true state information, and number of activities may be performed for the patient based upon the patient's needs. These activities include scheduling lab or diagnostic procedures in advance of an appointment, filling in documentation gaps, identifying items that require additional documentation using the true state, and tracking follow-up. It may also be beneficial to validate the true state.

Abstract: Systems and methods for managing audit risks utilizing the true state of the patient are provided. A number of medical records for a patient are subjected to predictive modeling for various conditions (known as patient ‘true state’). The true state is then cross referenced by the eligible Medicare documentation, and any findings that are being submitted to MediCare for reimbursement. The result of this cross referencing is the ability to classify each finding and/or true state into a “green, “yellow”, or “red zone”. The green zone is where the finding, documentation and true state are in good alignment. A red zone is where the finding and the true state are entirely at odds. The yellow zone is where the findings and the true state are in agreement, but where there is still audit risk that may be resolved through one or more “opportunities”.

Abstract: A sorter of medical findings for assessment by a medical coder is provided. In some embodiments, the sorter receives information about a user (coder), including identification, a role, and historical activity. The sorter determines whether to run in exploration or exploitation modes. Exploration is used to explore the scope of the findings and also identify variables that impact a finding. Exploitation is designed to maximize a goal (such as throughput or profitability). Lastly a finding is selected and provided to the user. The selection is based upon computing internal parameters when in exploration, or based upon optimizing for criteria when in exploitation. The sorter may also determine competency for the user, and cut them off from performing additional coding if they are found incompetent.

Abstract: Systems and methods for generating customized annotations of a medical record are provided. The system receives a medical record and processes it using a predictive model to identify evidence of a finding. The system then determines whether to have a recall enhancement or validation of a specific finding. Recall enhancement is used to tune or develop the predictive model, while validation is used to rapidly validate the evidence. The source document is provided to the user and feedback is requested. When asking for validation, the system also highlights the evidence already identified and requests the user to indicate if the evidence is valid for a particular finding. If recall enhancement is utilized, the source document is provided and the user is asked to find evidence in the document for a particular finding. The user may then highlight the evidence that supports the finding. The user may also annotate the evidence using free form text.

Abstract: A medical information navigation engine (“MINE”) is provided. In some embodiments, the system computes a current patient encounter vector for a current patient encounter, and then an optimal patient encounter vector is computed by assuming a best case patient encounter in accordance with the organizational objectives. The system is then able to compute the difference between the best case encounter and the current patient encounter. This difference is used to compute a corresponding payoff using an intelligent matrix.

Abstract: A computerized Medical Information Navigation Engine (“MINE”) extracts clinical knowledge, by identifying coded elements with reimbursement potential contributing to payoff based on clinical history, and subtracting coded elements documented in an encounter from the coded elements, based on business logic. The MINE sorts the remaining coded elements in accordance with one optimization criteria to payoff based on clinical history.

Abstract: Systems and methods for personalizing medicine utilizing the true state of the patient are provided. A number of medical records for a patient are subjected to predictive modeling for various conditions (known as patient ‘true state’). The patient personal information, previous care, and true state may be provided into a state machine in order to determine the resources needed for the patient. The medical resources may be any of laboratory services, diagnostics, therapies and medications. Using the true state information, and number of activities may be performed for the patient based upon the patient's needs. These activities include scheduling lab or diagnostic procedures in advance of an appointment, filling in documentation gaps, identifying items that require additional documentation using the true state, and tracking follow-up. It may also be beneficial to validate the true state.

Abstract: Systems and methods for managing audit risks utilizing the true state of the patient are provided. A number of medical records for a patient are subjected to predictive modeling for various conditions (known as patient ‘true state’). The true state is then cross referenced by the eligible Medicare documentation, and any findings that are being submitted to MediCare for reimbursement. The result of this cross referencing is the ability to classify each finding and/or true state into a “green, “yellow”, or “red zone”. The green zone is where the finding, documentation and true state are in good alignment. A red zone is where the finding and the true state are entirely at odds. The yellow zone is where the findings and the true state are in agreement, but where there is still audit risk that may be resolved through one or more “opportunities”.

Abstract: Systems and methods to code medical records using weighted belief networks are provided. Medical records are received, and may be subjected to pre-processing which includes deduplication of records, indexing the records, meta-tagging the records, and annotating the records. An entity extractor then generates entity dictionaries from public sources. A network creator generates a belief network based on medical relationships. An annotation aligner receives normalized annotations of historical medical records, and a network weighter assigns probability values to the belief network using the normalized annotations to generated a weighted belief network. A health care code classifier utilizes the weighted belief network to classify the medical records by comparing entities within the medical records.

Abstract: A sorter of medical findings for assessment by a medical coder is provided. In some embodiments, the sorter receives information about a user (coder), including identification, a role, and historical activity. The sorter determines whether to run in exploration or exploitation modes. Exploration is used to explore the scope of the findings and also identify variables that impact a finding. Exploitation is designed to maximize a goal (such as throughput or profitability). Lastly a finding is selected and provided to the user. The selection is based upon computing internal parameters when in exploration, or based upon optimizing for criteria when in exploitation. The sorter may also determine competency for the user, and cut them off from performing additional coding if they are found incompetent.

Abstract: Systems and methods for generating customized annotations of a medical record are provided. The system receives a medical record and processes it using a predictive model to identify evidence of a finding. The system then determines whether to have a recall enhancement or validation of a specific finding. Recall enhancement is used to tune or develop the predictive model, while validation is used to rapidly validate the evidence. The source document is provided to the user and feedback is requested. When asking for validation, the system also highlights the evidence already identified and requests the user to indicate if the evidence is valid for a particular finding. If recall enhancement is utilized, the source document is provided and the user is asked to find evidence in the document for a particular finding. The user may then highlight the evidence that supports the finding. The user may also annotate the evidence using free form text.

Abstract: Systems and methods for efficient medical chart review are provided. In some embodiments, medical records are received. The admissibility of each record is then determined. Next, a condition and MEAT assessment is generated for the medical records. The condition and MEAT determination each have a corresponding confidence. A determination may be made whether human quality assurance is required. If so, the medical records may be routed to one or more coders for human review. In addition, the systems and methods may also perform an audit analysis on the records, which identifies codes which have been submitted and have insufficient evidence. Lastly, a cost metric for the patient based upon the condition and MEAT determination may be generated.

Abstract: A medical processor computes concept associations by mining aggregated data from patient documents thereby reducing risk of PHI exposure. The processor identifies clinically relevant terms in patient documents, compute associations between pairs of clinically relevant terms using co-occurrences, and filter out random associations. A knowledge provider receives user query concepts, retrieves patient concepts, and extracts relevant apixions from an association matrix. The knowledge provider intersects relevant apixions with patient concepts, ranks and provides the results to the user.