Abstract: A method includes receiving an event tracking query for a patient health care transaction from a requestor; receiving state transition updates for the event from ones of a plurality of different transaction processing entities that are independently controlled with respect to each other; mapping the state transition updates to a representational workflow model, which defines a plurality of tracking states; generating an event tracking result based on the mapping of the state transition updates to the representational workflow model and the plurality of different transaction processing entities; and communicating the event tracking result to the requestor.

Abstract: A method includes receiving a patient health care benefit query from a requestor; generating a health care coverage eligibility request for the patient; communicating the health care coverage eligibility request to a payor; electronically updating a benefit rule repository with information from an eligibility confirmation response from the payor; adjudicating one or more rules, which are based on a health care coverage policy provided by the payor for the patient, contained in the benefit rule repository; determining a benefit eligibility result for the patient based on adjudicating the one or more rules; and communicating the benefit eligibility result to the requestor.

Abstract: A method includes receiving an event tracking query for a patient health care transaction from a requestor; receiving state transition updates for the event from ones of a plurality of different transaction processing entities that are independently controlled with respect to each other; mapping the state transition updates to a representational workflow model, which defines a plurality of tracking states; generating an event tracking result based on the mapping of the state transition updates to the representational workflow model and the plurality of different transaction processing entities; and communicating the event tracking result to the requestor.

Abstract: In an embodiment, systems and methods for generating and using person-controlled identifiers are provided. Coverage data for patients, received from multiple payors or collected from submitted claims, is analyzed to identify patients across payors that are the same patient. A person-controlled identifier is associated with each patient and is linked to the coverage data for the patient for each payor. Accordingly, the person-controlled identifier may uniquely identify the patient and their associated coverage at each payor. In the event that the patient changes payors, the person-controlled identifier may be linked to the new payor. Later, when the patient receives medical care from a medical provider, the patient may provide the person-controlled identifier to the medical provider instead of their payor issued card or number. The medical provider may then use the person-controlled identifier to determine the payor associated with the patient and to determine eligibility.

Abstract: A method includes receiving a request for clinical information associated with one or more patients from a requestor, the request being associated with requested values for one or more parameters associated with a plurality of network sources for retrieving the clinical information; comparing the requested values with characteristic values for the one or more parameters of each of the plurality of network sources to generate a comparison result; selecting one of the plurality of network sources based on the comparison result; and communicating the request for clinical information to the one of the plurality of network sources that was selected.

Abstract: A method includes generating a payor channel capacity model by modeling a channel capacity between a resource management system and a payor; generating a transaction request model by modeling transaction requests destined for the payor; defining a plurality of Quality of Service (QoS) bands based on the payor channel capacity model and the transaction request model, respective ones of the plurality of QoS bands being indicative of a measure of relative opportunity to establish a connection on the channel between the resource management system and the payor; receiving a current transaction request for the payor at the resource management system; assigning the current transaction request to one of the QoS bands; and establishing a current connection on the channel between the resource management system and the payor to communicate the current transaction request from the resource management system to the payor based on the QoS band assigned to the current transaction request.

Abstract: A method includes maintaining a cache of past responses from a payor to past patient eligibility confirmation requests for one or more payment plans generated by a health care service provider; receiving a present patient eligibility confirmation request from the health care service provider to determine whether a patient is eligible for a payment plan of the one or more payment plans offered by a payor; querying the cache based on demographic information associated with the patient to determine whether the cache has eligibility information for the payment plan for the patient stored therein; selecting a portion of the eligibility information for the payment plan based on health care service provider preferences or payor preferences when the cache has the eligibility information for the payment plan for the patient stored therein; an returning the portion of the eligibility information to the health care service provider.

Abstract: In one embodiment, a real-time claim processing system is provided that quickly settles received claims. At each stage of the claim processing, the real-time processing system may write some or all of the claim to a distributed ledger, which may be later retrieved and used as evidence of the claim processing. In addition, the claim may be verified by a smart contract associated with the claim that may also control the pricing and settlement of the received claim. The use of a smart contract may allow the claim to be verified and settled in real, or near-real time, which is an improvement over current methods for processing claims which are slow and costly. Smart contracts also provide consistency and transparency to claims processing.

Abstract: A healthcare information system, method and computer program product are provided to receive, process and output healthcare data in compliance with data use restrictions associated with the healthcare data, even in instances in which data projections are assembled from the data elements. In regards to a healthcare information system, processing circuitry is configured to assemble the data projection from a plurality of data elements. At least some data elements have different data use restrictions associated therewith. The processing circuitry is also configured to determine a combined data use restriction for the data projection based upon the data use restrictions of the data elements from which the data projection is assembled. The processing circuitry is further configured to associate metadata with the data projection including the combined data use restriction. Further, the processing circuitry is configured to control access to the data projection in accordance with the combined data use restriction.

Abstract: A method, computing device and computer program product are provided to define a level of assurance in one or more links between patient records that relate to the same person based upon external information. In the context of a method, one or more links are identified between a patient record associated with a person and pre-existing patient records. Each pre-existing patient record has a plurality of demographic attributes associated with a patient. The method identifies one or more links based upon an analysis of the demographic attributes of the person and the respective patients associated with the pre-existing patient records. The method receives external information regarding a relationship between the person and the respective patients associated with the pre-existing patient records or regarding confirmation of an identity of the person. The method also defines a level of assurance in the respective one or more links based upon the external information.

Abstract: A method, computer system and computer program product are provided to associate a record of a person and pre-existing records utilizing multiple matching strategies. The implementation of a plurality of matching strategies includes identifying link(s) between the record of the person and pre-existing records based upon an analysis pursuant to the respective matching strategy of demographic attributes of the person and respective individuals associated with the pre-existing records. The implementation of the plurality of matching strategies also includes associating the record of the person and a set of pre-existing records based upon the respective matching strategy. A relationship is then defined between the person and respective individuals associated with one or more sets of pre-existing records as defined by at least one of the plurality of matching strategies.

Abstract: An event-driven system, method and computer program product are provided to selectively generate events in response to receipt of data elements. The event-driven system includes processing circuitry configured to identify, in response to receipt of one or more data elements, an event that is impacted by the one or more data elements. The processing circuitry is also configured to determine whether at least a threshold number of consumers are currently listening for the event. In an instance in which at least a threshold number of consumers are currently listening for the event, the processing circuitry is configured to perform one or more computations based upon the one or more data elements to generate the event. Otherwise, however, the processing circuitry is configured to at least defer the one or more computations that would be performed upon the one or more data elements to generate the event.

Abstract: A health care information system, method and computer program product are provided to transform health care data in an efficient manner. In the context of a health care information system, the health care information system includes processing circuitry configured to define a transformation pipeline that includes a plurality of ordered transform elements. The processing circuitry is also configured to ingest health care data with the transformation pipeline in order to transform the health care data. The processing circuitry is further configured to track propagation of data representative of or associated with the health care data through the transformation pipeline. The processing circuitry is configured to track the propagation by identifying one or more completed transform elements that have completed processing of the data and by also identifying one or more ongoing transform elements that have begun processing of the data but for which the processing is incomplete.

Abstract: A method, computer system and computer program product are provided to associate a record of a person and pre-existing records utilizing multiple matching strategies. The implementation of a plurality of matching strategies includes identifying link(s) between the record of the person and pre-existing records based upon an analysis pursuant to the respective matching strategy of demographic attributes of the person and respective individuals associated with the pre-existing records. The implementation of the plurality of matching strategies also includes associating the record of the person and a set of pre-existing records based upon the respective matching strategy. A relationship is then defined between the person and respective individuals associated with one or more sets of pre-existing records as defined by at least one of the plurality of matching strategies.

Abstract: An event-driven system, method and computer program product are provided to selectively generate events in response to receipt of data elements. The event-driven system includes processing circuitry configured to identify, in response to receipt of one or more data elements, an event that is impacted by the one or more data elements. The processing circuitry is also configured to determine whether at least a threshold number of consumers are currently listening for the event. In an instance in which at least a threshold number of consumers are currently listening for the event, the processing circuitry is configured to perform one or more computations based upon the one or more data elements to generate the event. Otherwise, however, the processing circuitry is configured to at least defer the one or more computations that would be performed upon the one or more data elements to generate the event.

Abstract: A health care information system, method and computer program product are provided to transform health care data in an efficient manner. In the context of a health care information system, the health care information system includes processing circuitry configured to define a transformation pipeline that includes a plurality of ordered transform elements. The processing circuitry is also configured to ingest health care data with the transformation pipeline in order to transform the health care data. The processing circuitry is further configured to track propagation of data representative of or associated with the health care data through the transformation pipeline. The processing circuitry is configured to track the propagation by identifying one or more completed transform elements that have completed processing of the data and by also identifying one or more ongoing transform elements that have begun processing of the data but for which the processing is incomplete.

Abstract: A health care information system and method are provided to securely store and control access to health care data. A key management and decryption system includes processing circuitry configured to receive encrypted health care data, representations of a health care context and a time value associated with the health care data, and authorization information associated with a requestor that has requested access to the health care data. The processing circuitry is also configured to determine whether the requestor is authorized to access the health care data based upon an analysis of the authorization information relative to the health care context and the time value associated with the health care data. In an instance in which the requestor is authorized to access the health care data, the processing circuitry is configured to decrypt the health care data and to provide the decrypted version of the health care data.

Abstract: A healthcare information system, method and computer program product are provided to receive, process and output healthcare data in compliance with data use restrictions associated with the healthcare data, even in instances in which data projections are assembled from the data elements. In regards to a healthcare information system, processing circuitry is configured to assemble the data projection from a plurality of data elements. At least some data elements have different data use restrictions associated therewith. The processing circuitry is also configured to determine a combined data use restriction for the data projection based upon the data use restrictions of the data elements from which the data projection is assembled. The processing circuitry is further configured to associate metadata with the data projection including the combined data use restriction. Further, the processing circuitry is configured to control access to the data projection in accordance with the combined data use restriction.

Abstract: Methods, apparatuses, and computer program products are provided for providing facilitating searching. A method may include determining a search term. The method may further include searching a database having at least one codified terminology set. The searching may be performed based at least in part upon the search term and historical search data. The method may additionally include determining one or more search results from the search. Each search result may include a codified term from the at least one codified terminology set. Corresponding apparatuses and computer program products are also provided.

Abstract: A method, apparatus and computer program product are provided to permit a patient to provide their preferences with respect to the consent required for and the rules that would govern any sharing of health information. In the context of a method, a patient is permitted to view a central patient identifier, one or more data locations at which health information of the patient is stored and respective local patient identifiers associated with the one or more data locations. The method also receives input from the patient regarding the patient's preferences with respect to consent for sharing of the health information or with respect to one or more rules that govern the sharing of the health information. Further, the method translates the patient's preferences based upon technology utilized by the one or more data locations to implement the patient's preferences at each of the one or more data locations.