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 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 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 for a coder marketplace are provided. The system has procedures for certification of a number of medical coders. The proficiency of the coders is subsequently measured. When the system receives medical records in need of coding, the documents can be routed to one or more coders based upon proficiency of the coders, payment model, availability, or some other criteria. Lastly, the system can facilitate a financial transaction between the coder and the provider who supplied the medical records for coding. Proficiency includes the speed of a coder, as well as accuracy, and can be measured by providing the coder a medical record for which the coding is already established and comparing the coder's output to the known values.

Abstract: A medical information navigation engine is useful in association with at least one electronic health record system. The engine decouples identifying information from clinical data from electronic health records. The clinical data includes clinical narrative having discrete data and textual data. The identifying information is stored. Additionally, the identifying information is associated with a token in the clinical data. The clinical data may then be indexed. The discrete data and the textual data in the clinical data may then be mined. Mining includes extracting at least one relevant event from the discrete data and the textual data. Next, the clinical data and identifying information may be reintegrated using the token. The event associated with the mined discrete data and textual data may then be exported. The system may also provide a validation tool for users, including clinicians, to search and view clinical data. The exported event may be used to alter treatment of a patient.

Abstract: A health information management system is provided which includes the ability to identify explicit referral activity reported into a referral workflow system, infer referral activity not reported into the referral workflow system utilizing intent-based clustering of medical information, and generate reporting metrics from the inferred and explicit referral activity. Additionally, a referral suggestion may be generated for an identified condition. Physicians are selected within a geographic area who are properly specialized for the condition. This group is then filtered based upon patient preferences and default preferences in order to generate physician referrals.

Abstract: A medical information navigation engine (MINE) for transacting medical information by receiving medical information from a medical sources, identifying, mapping, and consolidating the received medical information by a back-end medical processor, presenting access to specific relevant data, based on a user's security privileges, within the identified, mapped, and consolidated medical information, based on user-specific functions or roles by a front-end medical processor, and generating user-customized processed medical information to a plurality of users, with at least a portion of the user-customize processed medical information being provided to each of the plurality of users based on its relevancy to each user's specific function or role and each user's associated security privileges.

Abstract: A medical information navigation engine is useful in association with at least one electronic health record system. The engine decouples identifying information from clinical data from electronic health records. The clinical data includes clinical narrative having discrete data and textual data. The identifying information is stored. Additionally, the identifying information is associated with a token in the clinical data. The clinical data may then be indexed. The discrete data and the textual data in the clinical data may then be mined. Mining includes extracting at least one relevant event from the discrete data and the textual data. Next, the clinical data and identifying information may be reintegrated using the token. The event associated with the mined discrete data and textual data may then be exported. The system may also provide a validation tool for users, including clinicians, to search and view clinical data. The exported event may be used to alter treatment of a patient.