JP2010503122A - Connection between consumers and service providers - Google Patents

Abstract

  A request is received from a consumer of the service to consult with a service provider having a service provider profile. The service provider profile satisfies at least some attributes of the set of attributes that define the appropriate service provider. An available service provider that satisfies at least some attributes of the set of attributes is specified. A communication channel is provided to establish communication between a consumer of the service and a designated service provider.

Description

  The present disclosure relates to connections between consumers and service providers.

  Systems have been developed to connect consumers and their consumer providers over the Internet and the World Wide Web. Some systems use email and web-based forms to improve the level of connectivity between health plan members and designated healthcare providers. Consumers send e-mails and access websites that generate and send messages (typically e-mail or e-mail type messages) to local businesses.

  This type of service is widely referred to as “e-visit”. While generally seen as an addition to the range of services desired by consumers, the benefits of such services are not clear. One of the anxiety factors associated with providing additional communication channels, such as e-mail, is that it is not better coordination, but rather can lead to excessive consumption of services.

  Until recently, the concept of electronic contact was within the standard economic legal framework used to file claims for medical expenses while preventing operators' appropriate remuneration for such contacts. Then it was not legislated. The gap has recently been introduced with the introduction of the CPT (Physician Practice Term) Act 0074T, which allows an event person to submit a medical bill for electronic contact (eg, e-visit) with the event person's patient. It was revised. However, most of the plans at this time do not include this service law as an included service (ie, an advantage) and are self-paying for the member (need to charge the member directly for such contact) ) The offer was unattractive to the operator.

  Recently, many health plans have expressed their intention to begin paying businesses for electronic visits (ie, taking some consideration with respect to claims filed under the CPT0074T Act). While there are limitations to driving the project, the plan is adopting the concept of consumer protection by providing advanced tools that are informational and learned medical services for consumers. Facilitating timely and more organized communication between members and their operators is understood as a natural investment in the new consumer-driven healthcare industry. Although at an early stage, interest in e-visits has been addressed by both the economic community and the national health care strategy committees around the country. Currently, vendors that provide health portals for health plans generally describe a roadmap for integration (or interface) with an e-visit platform.

  In general, in one aspect, a request is received from a consumer of a service to consult with a service provider that has a service provider profile that satisfies at least some of the set of attributes that define the appropriate service provider. Is done. An available service provider that satisfies at least some attributes of the set of attributes is specified. A communication channel is provided to establish communication between a consumer of the service and the designated service provider.

An implementation includes one or more of the following features.
The step of designating an available service provider comprises the step of monitoring the availability of the designated service provider, and when the designated service provider becomes available, the communication Activating the channel. Designating the available service providers includes designating a set of service providers having profiles that match at least some of the attributes, and availability of the matching service providers. And monitoring the real-time communication between the available service provider and the service consumer when the matching service provider becomes available. The designated service provider is a service provider that is a first type and a second available service provider that is a second type of service provider that satisfies at least some attributes of the set of attributes. A service provider is designated and a second real-time communication is provided for communication between the consumer of the service and the second designated service provider. The communication channel is first provided for the service provider that is initially available regardless of the designated service provider.

  If the communication channel with the first designated service provider is provided before the second communication channel, the consumer of the service and the first designated service provider Information describing the result of the communication between is provided to the second designated service provider prior to providing the second communication channel. Information describing the result of the communication between a consumer of the service and the designated service provider is provided to the second service provider associated with the consumer of the service.

  Providing the communication channel includes: specifying a communication method for contacting a consumer of the service; and instructing the designated service provider to initiate communication using the specified method. And a step of performing. Providing the communication channel includes starting a first communication channel with a consumer of the service, starting a second communication channel with the designated service provider, and the first And connecting a second communication channel. Designating the available service provider comprises receiving an indication that an available service provider that satisfies at least some attributes of the set of attributes has initiated a first communication channel. Including. Providing the real-time communication channel comprises initiating a second communication channel with a consumer of the service and connecting the first and second communication channels.

  In general, in one aspect, an indication that a member of a set of service providers is available is received, a request is received from a consumer of the service to consult with the service provider, One available member is designated and real-time communication between the consumer of the service and the designated member of the set is initiated. In some embodiments, the request includes displaying a future time, and specifying the member of the set and initiating the communication are performed at the specified time.

  In general, for a real-time consultation with a doctor on demand, a request from a patient is received, specified at least one available doctor to be consulted with the patient, and allowed the requested consultation In order to activate communication between the patient and the available physician.

An implementation includes one or more of the following features.
Designating the available doctors includes: designating at least one type of doctor to be consulted with the patient; designating a set of doctors of the designated type; and the designated set Determining a currently available doctor and designating one available doctor in the designated set. The patient is associated with an attending physician and the step of designating the set of doctors comprises the step of designating a physician other than the patient's attending physician. Information describing the result of the consultation is provided to the patient's attending physician.

  In general, a request is received from a patient for real-time consultation with a doctor upon request, a message is received specifying at least one available doctor to be consulted with said patient, said request A communication channel established between the patient and the available doctor is connected to allow a consult to be made.

The figure which shows a participating mediation service. The figure which shows the screen image of the user interface for participation mediation service. The flowchart which shows the interface of the automatic voice response system for a participation mediation service. The flowchart which shows the process used with a participation mediation system. The flowchart which shows the process used with a participation mediation system. The flowchart which shows the process used with a participation mediation system. The flowchart which shows the process used with a participation mediation system. The flowchart which shows the process used with a participation mediation system. The figure which shows the screen image of the user interface for participation mediation service. The figure which shows the screen image of the user interface for participation mediation service. The figure which shows the screen image of the user interface for participation mediation service. The figure which shows the screen image of the user interface for participation mediation service. The flowchart which shows the process used with a participation mediation system. The figure which shows the screen image of the user interface for participation mediation service. The figure which shows the screen image of the user interface for participation mediation service. The flowchart which shows the example of the reference | standard used with a participation mediation system. The figure which shows the screen image of the user interface for participation mediation service.

Overview The system described below allows service consumers to specify and prioritize service providers to consult with, and to consult with such service providers in an efficient manner. Is an integrated information and communication platform. Consumers can consult with professional service providers online at a time and place convenient to each other, even if they are geographically separated. This integrated platform is referred to herein as a participating mediation service (mediation).

  FIG. 1 illustrates an example system 100 that embodies an intermediary service. The system 100 is a computer system or server for creating a connection between a consumer at the client system 122 and a service provider 130 at the client system 13 via a network 140, such as the Internet, or other type of network. 110 is included. The computer system 110 operates as a service that runs on the web server 102.

  The computer system 110 includes an availability or presence tracking module 112 for tracking the availability of the service provider 130. Availability or presence is tracked actively or passively. In an active system, the one or more service providers 130 provide the computer system 110 with an indication that the one or more service providers 130 are reachable by the consumer and an indication of how to contact the service provider. To do. In some examples of active systems, the provider's computer, telephone, or other terminal device displays the availability of the provider and how the provider can be engaged (eg, text, audio, video, etc.) Are periodically provided to the system 110. In the passive system, the computer system 110 estimates that the service provider 130 can be used by the operation of the service provider. The operation includes connecting to the computer system 110 and registering the local phone number of the provider in the system. In some examples of passive systems, the system 110 indicates that the operator 130 is always available until the provider logs off, except when the provider is actively engaged with the consumer 120.

  The computer system 110 also includes one or more processes, such as a tracking module 112 and a scheduling module 116. The system 110 accesses one or more databases 118. The components of system 110 and web server 102 may be integrated or distributed in various combinations as is known in the art.

  Using the system 110, the consumer 120 contacts the provider 130. Consumer 120 and provider 130 connect to computer system 110 through a website or other interface on web server 102 using clients 122 and 132, respectively. The client devices 122 and 132 may be any combination of a mobile information terminal, a land phone, a mobile phone, a computer system, a media player type device, and the like. In addition to allowing the consumer 120 to contact the provider 130 with video, audio, and / or text, the client devices 122 and 132 can send and receive information.

  Because they are limited by business hours and other patients, providers struggle with the idea of adding another job engagement to their existing workload. Patients who send inquiries to providers are often asked to schedule appointments for additional visits because they cannot expect a quick answer. However, providers are often available at times that are inconvenient for their patients, for example upon sudden cancellation. The provider may also be available for e-visit during non-working hours, such as staying at home, commuting time, etc. This intermediary will allow any provider available at any given time to provide an e-visit to any consumer that needs consultation at that time. Assist the availability of existing providers. Instead of relying on a particular provider's unlikely availability to any given consumer, this brokerage provides all online offerings that are capable of addressing the consumer's needs. Connect to the other person. This mediation has unique characteristics. Its features include the ability to participate in live communication with an appropriate and selectable provider, and the ability to do so on demand.

  One effect that this brokerage provides is the sequential monitoring of the provider's availability for involvement. Thus, since the brokerage connects consumers to available providers, consumers receive quick attention to resolve their questions or concerns. In order to achieve such a level of availability, the system recognizes the discretionary or slight availability window supplied by individual providers as continuous availability by consumers. To absorb. Many of the services offered to consumers are on demand, so consumers rarely expect the same provider to be available at all times and are available to several providers. I expect to be there.

  In addition to connecting the consumer to the provider 130, the computer system 110 provides information and services to the consumer 120. The computer system 110 includes an access control device 114. It manages and controls whether a given consumer 120 has access to the system 110 and what level or range of features, functions, and services that the system 110 provides. The consumer 120 uses the system 100 to find out more information about topics of interest or topics of possible medical conditions, for example. The computer system 110 designates a service provider 130 that is available at any given time to contact a consumer about a particular product, service, or related topic, i.e., a theme, such as a medical condition. The computer system 110 consumes while allowing them to communicate through, for example, video or audio communication channels for data networks (eg, Voice over IP), fixed and cellular network channels, and instant messenger or chat. Communication between the provider 120 and the provider 130 is facilitated. In some examples, the availability of one or more providers 130 is tracked. Then, when the consumer 120 wishes to connect and contact the provider, the system 110 immediately determines whether the provider is available. If a particular provider 130 is available, the system 110 evaluates the various communication methods available and connects the consumer 120 and the provider 130 through one or more common communication methods.

  The system selects a communication method based in part on various forms of relative equipment. A preferred method for engagement is to use a web-based operating screen for both the consumer 120 and the provider 130. This allows each of the other methods to be used as needed. The consumer and the provider activate a chat conference, a voice call, or a video chat from within a web-based operation screen as shown in FIG. 2A below, for example. Web-based operating screens also provide access to records on demand, such as consumer medical records and other information. If only one participant in an engagement has access to the web operation screen, the system 110 connects the participant's operation screen to some form of communication available to other participants. For example, if the consumer is on the phone and the provider is using a web browser, the system 110 connects the consumer's phone call to a VoIP session that the provider can access through the web.

  If the provider 130 is not available, the system 110 designates another available provider 130 that satisfies the consumer 120 request. The system 110 allows the consumer 120 to send a message to the provider of their choice. The consumer 120 also causes the system 110 to contact the consumer 120 when the selected provider is available.

  As shown, the system 100 connects members of a healthcare plan with providers of healthcare products and services. For example, service provider 130 is a doctor and service consumer 120 is a patient. Service providers and service consumers may be lawyers and clients, contractors, and home owners, or any other combination of service providers and service consumers.

  The system allows the consumer to search for available providers at the time of the search and allows the consumer to engage with the provider based on a single procedure, i.e. for a single consultation. Even if there are specialists who are too far from the consumer to become regular clients, patients, or consumers, consumers are consulted with world-renowned experts, ie involved in the second opinion be able to. Consumers can use expert advice when considering services provided by local service providers. For example, a rarely symptomatic patient in a suburban town can consult a specialist in a distant city and then select a local doctor for treatment based on the consultation.

  FIG. 2A shows a screen 134 of the main user interface for mediation. Also, most web-based functions are provided by an automated voice response (IVR) system, described below. As mentioned, server 110 sends a web page such as screen 134 to consumer 120 and provider 130 and receives responses from consumer 120 and provider 130. In some examples, the application server provides a predefined series of web pages or voice instructions to the consumer 120 or provider 130. FIG. 2 shows an interface intended for the consumer 120. A similar interface is provided for provider 130 as shown in FIG.

  Web page 134 includes various elements that allow consumer 120 to enter information. These interface elements include buttons 136a and letters 136b that allow the consumer 120 to select information and operate the website. Other standard elements (not shown) include a text box for receiving character information and a menu (eg, a drop-down menu) that allows the consumer to select information from a menu or list.

  Here, as shown in FIG. 2B, an example of logic used in the automatic voice response system is shown. FIG. 2B is described in detail because FIG. 2B is one of many possible logic flows for such a system, and the exact details regarding the query and processing are not important to understanding the concepts disclosed herein. Not intended to be. In an automated voice response system, the voice instructions include questions or messages that draw information from the consumer 120 and the provider 130 as shown. The consumer 120 and the provider 130 enter information by speaking into a telephone or other terminal microphone, and their speech is stored as text received or converted using speech recognition. In some examples, the question is a multiple choice question and the consumer 120 or provider 130 responds verbally or by pressing a button on their telephone or terminal device keypad. . The automatic voice response system may include a menu system according to a series of flowcharts, such as the flowchart of FIG. 2B. In that case, the consumer 120 or the provider 130 advances, returns, or terminates the system by pressing a specific key.

  Here, as shown in FIG. 3, the computer system 110 tracks the availability of the provider 130 and the consumer 120 (142). When the provider 130 logs in to the system 110 (144), the provider 130 may indicate that he or she is (eg, by setting a checkbox, selecting a menu entry, or responding to a voice instruction). The tracking module 112 displays that it is available to interact with the consumer 120 (146). Also, the provider 130 (e.g., by setting a check box, selecting a menu input, or responding to a voice instruction) allows the consumer 120 to connect with the provider 130 (e.g., telephone, (Chat, video conference) may be displayed on the tracking module 112 (148). Alternatively, the tracking module 114 determines the functions of the terminals 122 and 132 used by the consumer 120 and the provider 130 to connect to the system 100 (eg, a terminal-based program for analyzing the hardware configuration of each terminal). Judgment (by use) (150). Thus, when provider 130 connects to system 100 via a desktop computer, provider 130 has a debio camera connected to the computer, and tracking module 112 allows provider 130 to provide text (eg, chat or instant messenger), voice, and so on. Determine (150) that they can be involved (eg, VoIP) or by video conference. Similarly, if the provider 130 connects to the system 100 using a mobile terminal, eg, a personal digital assistant, the tracking module 112 determines that the provider 130 can be involved by text or voice (152). In addition, the tracking module 112 infers the provider's availability and the method of participation by the provider's pre-provided profile information and the terminal that the provider connects to the system (152).

  Providers participating in the mediation network have several states of availability over time. The status of an available provider can be online, where the provider logs in and accepts new engagements in any way, and online (busy) where the provider is logged in but is currently engaged in video or telephone engagement. ) And the provider is in the office but is scheduled to be online at the specified time, and therefore is scheduled in advance. While not online, the provider can use messages when offline. Other states are offline (asynchronous involvement) where the provider is not logged in but can take message-based engagement, and outside the office where the provider is not involved or accepting messages, and the provider is in the office and is communicating If the load requires it, it includes waiting (in some examples, the consumer views this state as offline) that can be invoked by the mediation network to the online state.

  The operation of the business model for the provider network employs a reward system for the provider that helps to ensure that the consumer is looking for a provider of a specified specialty area (eg, pediatrics) that is in online mode. For example, if discretionary availability by other providers in a specialized area is low, the selected provider will be rewarded for being in standby mode to recommend the provider's online availability. receive. When a part of online (busy) providers belonging to the specialized area exceeds the threshold, the standby provider is called to the online state. In some examples, the provider's transition from standby to online and back to standby is an automated function of the system (in the case of over or over waiting personnel).

  The tracking module 112 provides information about the availability and communication capabilities of the consumer 120 and the provider 130 to one or more known presence protocols, such as instant messaging and presence service (IMPS), instant messaging and presence session establishment protocol. (144) Transfer to scheduling module 116 using (SIP) based instant message and presence extension function (SIMPLE) and extension message and presence protocol (XMPP).

  As mentioned, the system 100 controls the access control device 114 that controls how the consumer 100 accesses the system and to what extent or to what level the services provided by the system are available to the consumer. including. The system 100 may also include consumer information (e.g., contact information, credit and economic information, credit card information, health information, and other information about the consumer, as well as other information related to services purchased or used by the consumer). Information) and provider information (eg, doctor's background, product and service information, health content and information, and any information that the provider or health plan wants to make available to members) Providing access to consumer information and provider information, and the access controller 114 prevents unauthorized access to this information. In some examples, the system 100 exports consumer information for use in the provider's office or other facility.

  The system 100 communicates with the consumer and available data sources to locate and direct consumer health issues to the appropriate care provider. Consumers can use a variety of tools that evaluate doctors and donors to make a choice of providers that consumers want to contact. This mediation allows consumers to manage progress as required to establish a comfortable level in consumer care, while maintaining a relationship between consumers and their chosen providers. Facilitates communication. This brokerage supports the transfer of these communications and any other results of e-visits to non-virtual care facilities, if necessary.

  This mediation is considered as the first stage of medical care available to consumers at home or elsewhere. This first stage is performed prior to entering a common medical care facility, such as a doctor's office or emergency room. This intermediary will allow consumers to investigate concerns about new or existing medical problems, without the need for the time, expense and emotional burden typically associated with visiting a doctor's office or moving to an emergency room. To do. To provide such a comfortable level, the system provides quick access to tools to clarify health issues, in addition to providing access to appropriate automated human intervention To do. Consumers can freely participate (or level up) in the medical level necessary to gain confidence in such issues. Consumer choice in this area depends on the power (eg, method and frequency) of the contact (eg, complete video conferencing for the message) that the consumer makes, as well as the provider that the consumer contacts Qualification types (e.g., specialists qualified for nurses). This intermediary is information obtained during contact at a subsequent stage of service, such as a specific medical office or emergency room (including medical management services, hospitals, etc. if requested by the consumer's health plan) And you can export detailed inspection.

  As such, the intermediary functions as a comprehensive tool that manages the consumption (demand management) of higher-cost medical services and affects basic medical care and progress management, and is independent of the customer population. Promote proper health.

  There are various ways of how consumers gain access to the system. Consumers purchase access to the system through a variety of methods, including direct payments or part of consumer insurance coverage. Health plans may provide access to their members as part of their services or as an optional value add. In some examples, for example, to improve overall management of resource allocation and member health care consumption, health plans receive information about their members' use of this mediation. The employer may purchase access to the broker for the employer's employees, either on the offer of the health plan or the employer. A self-insurance employer may purchase access for the employer's employees directly from the brokerage. The provider may be rewarded in some way and the provider may provide the service independently or as part of a framework such as a provider network.

  Similarly, there are a number of ways in which this mediation can be involved. As an advantage of the health plan, this brokerage extends the health plan function to manage the consumption of healthcare services by health plan members. The health plan may provide access to this intermediary through an existing web portal where members have access to useful information and interact with the member's health plan. As an employee benefit, the brokerage supplements the employee health insurance and may be provided, for example, through a talent website. When directly with the consumer, the consumer accesses the broker directly through his web page. In some examples, the intermediary is embodied as an enterprise software system for a call center, eg, a call center operated by a healthcare provider. In connection with users of other organizations in the system (eg participating providers), services that the provider cannot provide to the patient themselves, such as 24-hour expert diagnosis Can be provided. The intermediary may also be used in provider training to allow trainers to provide diagnosis to members of the intermediary during off-hours or as a preliminary step in an office visit. This also reduces the need to visit the attending physician for an introduction only to a specialist.

  The broker provides compensation for the products and services provided. Access to the system 100 may be provided on a subscription basis. Consumers pay a fee (directly or indirectly through another organization, such as a health care plan or health insurer) to receive a certain level of access to the system. In exchange for providing a product or service, the service provider receives compensation from the consumer or from an organization that pays for the product or service on behalf of the consumer, such as a health plan or health insurance company. In the case where the consumer pays directly, the operator who is the window to the system connecting the consumer to the service provider receives a reward. In one embodiment, the consumer pays a certain portion of the fee (eg, a percentage, a flat rate, or a flat fee self-pay) to the operator and the rest to the service provider. In another embodiment, the consumer or service provider pays the operator a flat fee or a percentage of the fee for engagement. Service provider fees are paid from the health plan or insurance company, while operators are paid a flat fee or a percentage of the fee from the health plan or insurance company for the execution of the engagement. Alternatively, the consumer or service provider, or both, pay a fee (fixed self-pay or service fee) to the operator for providing the connection.

Consumer interface
The initiating consumer 120 engages with the brokerage system 100 to access the service provider 130. There are several types of involvement. These examples will be described with reference to the flowcharts of FIGS. 4A to 4D and the user interface screens of FIGS. 5A to 5D.

  Now referring to FIG. 4A, a process 160 for establishing consumer-initiated engagement is shown. In a consumer-led engagement, the consumer logs in (162) and exchanges new matters, such as health issues, that the consumer desires for assistance or guidance over the mediator (164). For example, as shown in FIG. 5A, this is done on a web page. Components of the brokerage system 100, such as the consumer advisor described below, assist the consumer in compiling the questions (168) and helping to select (170) the appropriate providers to answer those questions. To do. The web page 166 includes a number of initial questions 172, and another web page 174 of FIG. 5B provides a user interface for entering additional criteria 176 to search for providers. The results page 178 of FIG. 5C allows the consumer to select a particular provider 180 from the list of providers specified based on the search criteria. Once a provider is selected and an engagement method is selected (184) (see below), the scheduling module 116 establishes a new engagement (186). In some examples, the intermediary associates a unique identifier used in subsequent interactions with the intermediary with the participating consumer (188). For example, a number of engagement records and associations. The membership number of the consumer's health plan or other similar existing identification number may be used (190). If the consumer does not yet have a number (192), a number is generated (194). The unique identifier is used by the consumer to save the consumer's planned engagement for later retrieval.

Referring now to FIG. 4B, a process (196) for establishing progress management or pre-planned engagement is shown. Once an engagement such as that shown in FIG. 4A is probable (186) or a specific engagement is completed (198), the established or progress management involvement is either on a predefined schedule or at a future point in time. To continue with
Both instruct a component of system 100, eg, scheduling module 116 (200). The system uses e-mail, auto-answer telephone communication, or other communication methods to establish a time that is convenient for both to schedule (204) to schedule progress (206) as planned. Use (202).

  Referring now to FIG. 4C, a process 208 for standby engagement is shown with a user interface on the web page of FIG. 5D. Waiting engagement is similar to consumer-driven engagement. In standby engagement, the consumer selects provider 180 or the type of provider (212) and when the selected provider is online to accept engagement with a component of system 100, eg, scheduling module 116. Request to be notified by appropriate communication, e.g., e-mail, text message, or auto answer phone call. In the example of FIG. 5D, the user has chosen to be called and has entered a phone number 216 and a limit on how long she will wait. Consumer requests are placed in a queue for a particular requested provider that is offline (or a type of provider that is offline for all eligible providers) (220). When the system determines that the provider is available (222), the system notifies the consumer (224). When notified, the consumer logs in (226) and is connected to the provider (228).

  As an option, the waiting list for providers provides a priority queue for some consumers. For example, a priority queue may be based on prior engagement with a provider (eg, priority is given to progress management engagement) or based on the consumer's service phase (eg, frequent user status). Provided. The intermediary is configured so that the intermediary collects consumer information (eg, answers to initial introductory questions) and provides the specific service provider with the information collected before going through any additional involvement May be. For example, consumers store information during consumer-driven engagement as described above, retain that information, or wait for contact when a particular selected provider is available.

  Now referring to FIG. 4D, a process for intervention involvement is shown. In addition to consumer-initiated engagement, the health plan (or other qualified organization) automatically instructs the system to schedule (234) an engagement with one of its members (232). . For example, this plan is adopted when a member of the health plan is consuming (236) a high cost or showing a high risk score. The system is also authorized to automatically track progress management over a simple phone call with a member if contact is not made for progress management (eg, a Medicare or Medicaid patient).

Provider Choice One function of the brokerage is to extend the retail-like experience to consumers. Consumers spend time on the system to investigate participating providers as to whether the provider is currently available or can be expected to be available at other times. be able to. The system assists the consumer in identifying the most appropriate provider (see Consumer Advisor feature below) while allowing the consumer to filter the provider list based on his preferences, and It is possible to access the browsing screen of the provider availability matrix that changes when the provider appears or goes offline.

  As mentioned above, an example of a possible interface for a consumer to select a provider in various ways is shown in FIG. 5B. On page 174 illustrated based on healthcare, various search criteria 176 can be used to filter available physicians. The basic detailed information 240 indicates the consumer's preference for the provider type 240a and gender 240b and the communication method 240c that the consumer wants to use. The user can also specify a profile that includes the location 242a and the spoken language 244b. Qualifications 244 include education 244a, years of experience 244b, and various other conditions 244c. The consumer's health plan may also provide additional search criteria, such as whether the provider must be in the network 246 or whether the consumer can consult with the provider 246b outside the network. Good. The consumer can also use a search box 248 to search for providers by name.

  The consumer is responsible for the provider's attributes, such as the geographic region in which the provider is located, or which specialized agency has certified the provider (eg, a physician has approval by a technical committee in cardiology) The provider may be selected according to Any metric in the provider's profile (described below) may be used to define a list of providers that meet consumer preferences.

  Once the consumer enters search criteria 176, it is shown on web page 178 in FIG. 5C. As mentioned, a list of providers 182 is presented. This list shows each provider's name 250 and rating 252 and whether or not the provider is available 254. For the selected provider 180, additional details are displayed including her photo 256, discipline 258, regional information 260, connection type 262 she can use for engagement, and personal information 264. Tool 266 allows consumers to initiate or schedule engagement.

  Providers already associated with consumers are displayed in a short list of consumers. The association is based on past involvement and extends to the input of a health plan claim (ie, all providers who have submitted a claim for that consumer). When looking at the past engagement list, the consumer has access to an audit of the engagement and an assessment that the consumer considers thanks to any past involvement.

  In certain deployment methods, there are functional attributes that affect consumer choices. In most health plan distribution methods, consumers accept (limited) to view only providers that are “in the network” according to their insurance product. Selecting a provider that is “out of the network” results in higher self-pay costs. Another example relates to system deployment in disease management and health guidance settings (eg, call centers). In this case, the plan requires that the consumer be able to select only nurses associated with the disease management with which the consumer is associated. A regulation introduced by the federal government in August 2006 is that all federal agencies (Medicare, Medicaid, and the military, and federal government plans) that provide health care coverage are rated public health care providers by the general public Request to be announced. The system allows consumers to automatically search for such locations for providers that the consumer has selected prior to involvement. Other sources of reference data include state government publications on mortality, number of deaths, and litigation against businesses, or databases maintained by third parties.

  Once the consumer defines a set of search criteria for filtering and searching for providers, the system can provide tools to shorten future processing. The consumer can save a set of conditions as a named search. Convenience can be obtained by receiving notification when the list of search results exceeds a predetermined level of availability. The predetermined level may prompt the consumer to log in and contact the provider.

Engagement method This brokerage allows consumers to engage with providers, eg, health care workers, on request based on the availability of providers. Involvement can be established in various ways:

  Passive browsing-Reference medical content is accessed on this intermediary website. Websites support the use of content packages licensed from other vendors to meet the changing preferences of health plans. For example, important content vendors include Healthwise (R), ADAM (R), Mayo Clinic (R), and HealthDay (R). A library of content provided by such vendors provides a combination of articles, images, interactive tutorials, and related tools that allow consumers access to similar content about their health issues To do. Many health plans and key employers already have a license to use one of these content packages.

  Health Risk Assessment-The system embodies consumer demands (eg, medical risks) and informs consumers through automated interactions (eg, rules-based interactions) to better direct consumers. Get. The assessment follows a series of questions that range from general health to very specific medical conditions and dynamically adjust the questions themselves based on information already extracted (using pre-defined rules). As the assessment progresses, build a suggestion of engagement that consumers can practice. Each proposal represents both a question to the provider and the type of provider to answer that question appropriately. The consumer may choose to initiate such engagement easily or may apply at his or her own discretion regarding the choice of representation and recipient provider. This will be explained in more detail in the description of the consumer advisor below.

  Asynchronous communication—The lowest level native provider interaction is via secure messages. Engagement questions or topics are sent to the selected provider (whether online or not) and answered by the provider at their free time. Response time is part of the provider's credentials that are monitored by the system and used for selection by the consumer. If the consumer requires a quicker response time, once the response is received, the system informs the consumer and allows the consumer to direct attention to the question. For example, common types of asynchronous communications are e-mail, instant message, text message, voice mail message, VoIP message (ie, leave a message using VoIP), and paper letter (eg, US Postal Service) Included).

Synchronous communication-Some methods of synchronous communication allow consumers and providers to engage in real-time discussions.
Synchronous text communication-This is referred to as a "chat" module where both sides of an engagement type both inputs with a keyboard in response to each other's input. The communication method is performed on a character basis as a whole, but is still live communication. Examples include instant messaging and short message service (SMS) messages.

  Web-based conferencing—The use of a broadband network connection is referred to as full-duplex communication (ie, both audio channels are simultaneously connected) and allows real-time audio communication over the Internet. Consumers can accept voice conversations with their providers using, for example, their computer speakers and microphones. Web-based video conferencing may use VoIP, SIP, and other standard or proprietary technologies.

  Conference calls—Consumers who want a direct phone call with a provider, or consumers who are uncomfortable using their computer, can use a traditional telephone to interact with the provider. Good. The consumer uses a dial-in number and an access code that connect to the mediation server. Providers are connected to the server via VoIP, other data network based voice systems, or their own phones. Teleconference also allows the consumer to request a “call now” feature (directly or via an intermediary) that the provider calls the consumer.

  Video conferencing-The system supports video conferencing that allows consumers to show physical findings to the provider when needed. Also, consumers and providers simply prefer face-to-face communication even when they are remote. A small digital camera called a webcam attached to or built in a personal computer or notebook computer can be used for this purpose. Video conferencing may be provided by standard software or by special software provided by the present intermediary. Instead, a dedicated video conference communication device or a telephone with a built-in TV function may be used.

  Semi-synchronous communications-Some involvement between consumers and online providers includes both synchronous and asynchronous communications. Part of the engagement is through rapid message communication between the two, but the provider may ask the provider to make occasional asynchronous access, for example when a generic drug query is required. Thereby, the provider can engage with one or more consumers at any time while regularly engaging with each consumer. For example, semi-synchronous communications include a combination of electronic mail, instant messages, text messages, voice calls, voice mail messages, and VoIP calls, and VoIP messages.

Involved automatic voice response (IVR) system of an automatic voice response device allows the installation of a two-way voice menu over the phone. The caller operates between choices, listening for data-driven information, providing meaningful input, and engaging system functions. Involvement of automated voice response devices extends the scope of the system to a phone as a portable consumer interface to activate engagement in addition to a web-based interface. When the consumer makes a call, the consumer selects a personal identification number on the application to authenticate the consumer's identity. Some types of involvement are performed through an automated voice response system using logic as shown in FIG. 2B. For dial-in engagement, the consumer calls to call the telephone engagement with an available provider. The automated voice response system extends the consumer's ability to select a provider to the phone. As such, consumer interactions are similar to those performed on the web.

  Automatic voice response systems are also actively used to track consumers who need progress management. At the time of progress management, the system reminds the provider about who wants progress management, identifies the provider is available for engagement, and calls to establish a connection for engagement. Attempt to contact consumers. Once contacted, the consumer can ask to decline the call or postpone the call. If the consumer receives a call, a connection is made. If the consumer is seeking to engage with a busy or offline provider (eg, few specific providers, or some type of provider), an automated voice response system can be used by the provider. Allows the consumer to stay in standby mode until it becomes available. If the provider is available, the system calls the consumer, identifies the provider to that consumer, and indicates that the consumer is still interested in continuing the call with the provider. Check. If the consumer is still interested, engagement is established.

  In addition to establishing engagement, the automated voice response interface allows consumers to interact with other services provided by the broker. For example, the consumer can instruct the system to send a transcript of the consumer's information by facsimile to a facsimile machine where the consumer identifies a telephone number by keying in or speaking verbally. . By using such functions, consumers create important information that is available to, for example, emergency room personnel or providers on an office visit. Consumers do not need to plan, collect, print, or carry that information for visits. The hardware of the automatic voice response device is readily available from the telecommunications carrier and can be programmed to operate according to the circumstances of the intermediary framework. Authentication is provided through an authentication number or by other standard methods.

In some instances audit involved, in order to establish a consumer test recording, elements involved are audited by the intermediary. Such consumer input records, recordings, and provider notes, along with time stamps and registrant IDs, are always available to consumers for future reference. The consumer may choose to share this record with other providers in the intermediary, or the record may be external medical facilities such as the provider's office, emergency room, care manager, Alternatively, you may choose to export to an external records management system, such as a regional health information network (RHIO) (and similar institutions with non-medical practices). In addition, audits include various degrees of standard encryption of automatic entry to allow for efficient rule-based management of the system based on medical (eg) aspects obtained during engagement. . In some examples, the auditing and regulatory methods comply with the Health Insurance Interoperability and Accountability Act (HIPAA).

Engagement recording and transcription system 110 allows recording engagements made using voice technology, eg, telephone, VoIP, or videophone on the web. When the system generates an audio file, the system provides the consumer with services associated with the file. Based on the consumer requesting or setting up to create a transcript, the system performs the transcript of the file and forwards the file to a third-party vendor to return the textual representation involved. To do. Such text is included in consumer records, communicated with external organizations, or used as a basis for future involvement. In some examples, transcription is performed by speech recognition software. Transcription services may be combined with encryption and translation services. The consumer may also request a voice recording made available over the phone, or may request it as a data file that is sent to a third party (eg, a consumer's personal provider). . In some examples, a consumer can play a voice recording from a web client or phone as part of an automated voice response system.

In some examples of changing the consumer, the consumer changes the active engagement to another provider or provider type. Consumers also change their involvement to adopt a different communication method than the current provider (eg, move from text chat to phone conversation). Pre-change information and audits of inspections established before the change are the basis for new involvement. In some examples, the consumer changes past involvement as a way to continue progress management on the same issue.

Consumer Advisor Consumer Advisor, another utility in this mediation, assists consumers in determining what action to take, for example, what type of provider to consult. Consumer advisors function as facilitating engagement between consumers and providers, just as nurses interact with patients in a healthcare organization. In some examples, the consumer advisor is operated using an engine that executes based on rules built into the system 110. The engine derives from both consumer input data and programmed medical knowledge. Consumer advisors help consumers confirm that consumers should discuss with the providers in the system, collect data to explain the situation, and reduce the time required for discussion , Helping to coordinate the engagement with the appropriate type of provider while presenting the input information collected before starting the engagement to the provider.

  Consumer advisors walk consumers through processing using this intermediary while minimizing consumer time and expense in deciding which services to use, and consumers get the right services. To help In some instances, even if the consumer did not complete in engagement, the consumer advisor would export information to a non-virtual provider (e.g., the consumer physician) for further follow-up treatment. Summarize or format the information collected by consumer advisors. Consumer advisors work directly with consumers while working as donor assistants while involved.

  FIG. 6 illustrates an example process 280 used to embody a consumer advisor. The input stage 282 asks the consumer for a series of questions that pinpoint the area of interest or grasp similar information about the consumer's desire (eg, health) in that area (284). In some examples, this process is equivalent to what the healthcare industry calls health risk assessment (HRA). The input stage 282 identifies or defines one or more consumer desires or problems (286). The result of the input stage 282 includes a list of questions or discourse summaries to be presented to the provider. The input stage allows the consumer to eliminate topics that he does not want to discuss or to add topics manually. The result of the processing is what the doctor or lawyer calls the input and is the desired stage in the first office visit or client engagement. This frees the provider from performing a general and wide range of input processing while involved. This is because the information that the provider intends to collect has already been collected in the input stage 282. In the health care example, the input stage 282 includes a general health and health assessment analysis (eg, the patient is a woman over 40 years old, has not undergone a mammogram screening, the patient is overweight, and the patient is Includes topics that cover both medical conditions and problems (eg, left shoulder pain not related to exercise).

  Information obtained from the input stage 282 is analyzed 288 in an analysis stage 286 to determine a list of topics related to health issues. The consumer advisor presents a list of topics related to the consumer's desires to the consumer (290), allowing the consumer to further improve the list by adding or deleting topics. In the health care example, listing should organize patient health and health symptoms, problems, and general conditions to allow internal analysis of the patient and facilitate future engagement. including. Once the list of topics is defined, the analysis stage 286 performs engagement with consumers, proposing the most appropriate type of provider to discuss each topic, and the comparative priority of such topics. A plan or plan is determined (294). A web page 296 presenting a plan 298 is shown in FIG. The consumer advisor supplements the suggestions associated with the consumer's content information to educate the consumer about symptoms or problems before the consumer engages with the provider (300). The execution plan is output 302 in several ways. In some cases, the consumer prints (or downloads or saves) the execution plan and brings it to his raw provider. In some cases, the execution plan is automatically sent to the consumer's live or primary provider.

  The execution plan is also output (302) to the scheduling module 116 that locates the provider and establishes engagement, as described above with respect to FIG. 4A, for the most appropriate provider available for each item of the execution plan. ). Consumers can use system 100 to engage with such providers, find other available providers, and later engage with the appropriate provider on each topic related to the execution plan for consumer engagement. Use. The consumer can also prioritize the items in the execution plan and save the execution plan for future use at the same time. The consumer may use the list as a basis for entering during multiple engagements (with multiple providers), or the first provider involved (or the consumer's personal provider, eg , The attending physician) may be allowed to view and coordinate the management of all issues in the list. The scheduling module 116 may engage with a provider available in any suitable manner (e.g., chat, video conferencing, or voice communication) or enter a waiting list for a provider that is not currently online. Allow consumers to use the system 100.

  In a particular engagement, the provider uses a re-evaluation process 304 to improve consumer interaction to obtain further information about the consumer's condition. During involvement 306, the provider invokes a re-evaluation process 304 to cause the consumer advisor to interact with the consumer for one or more specific input evaluations or evaluation forms (308). For example, if the initial input determines the possibility of a specific problem or symptom, the doctor performing treatment after diagnosis with the consumer may require that specific input processing be given or performed again. Yes (for example, if a consumer omits an important symptom). Once the reassessment is complete, the treating physician or new physician (in the healthcare example) may have a new live engagement with the consumer.

  This evaluation process 304 may be repeated with additional evaluation or re-evaluation of the consumer to collect additional information for the provider. In some examples, the input stage 282 determines, for example, that the consumer needs a re-evaluation and re-evaluation function based on information provided by the previous provider. In this case, when the consumer returns to the input stage 282, the consumer is prompted whether he wants to proceed with the reassessment, perform a new engagement, or enter a different condition or disease. In some examples, the consumer advisor may use a consumer patient's current overall health and well-being, a specific area of that health and well-being, or health to assess treatment for a particular condition, problem, or symptom. Includes improvements. The profiling process 312 is performed using the data collected in the input stage 282 to perform patient analysis. This data includes the consumer's ultimate goal. The end goal is that consumers seek their own health and well-being, changes in their overall health and well-being, or their health and well-being (eg, weight, body mass index (BMI), A change in a specific region (such as cholesterol level) or treatment for a specific condition, problem or symptom. After performing the analysis (314) and analyzing it (316), the consumer advisor lists (318) the actions that consumers should take to achieve their ultimate goal, and the actions are Include in the execution plan. In addition to recommending treatments, the health improvement function facilitates behavior in the educational field including static content and dynamic engagement.

  The health improvement function also determines the controls for consumers to follow to achieve the final goal. If necessary, the consumer is directed to a scheduling module 116 for connecting with a provider that assists in performing its management. For example, a consumer meets a dietitian who assists in performing nutritional management, or meets a personal trainer regarding exercise management practice. Consumers can regularly interact with health improvement functions to track progress toward their final goals. Information about consumer progress and updates regarding consumer profile information is collected using the input stage 282.

  The steps of process 280 are embodied in a single module or a number of functional elements, ie, a module that includes an input module and an advisor module. The consumer advisor may be embodied as a module within the server 110 as well as the tracking module 112 or schedule module 116, or it may be a self-contained module. Scheduling may be performed by the scheduling module via an interface to the module that is performing the advisor process. In order to provide continuity for consumers, the interface may be embodied as part of the interface shown in FIGS. 5A-5D.

  Consumer information collected by the input process is stored in the database 118 as part of the overall brokerage. In some examples, consumer information is protected or secured from unauthorized access and complies with various requirements for storing personal consumer information (eg, carrying and liability for medical insurance). (HIPPA) governs access to personal healthcare information). The database 118 also includes processing logic and rule data including rules relating to the entire business logic of the application or rules that embody the consumer advisor module.

  The system 110 keeps track of the location of any processing that the consumer is performing, so as soon as the consumer logs out and returns, it is moved to the point where the consumer has exited. When the consumer 120 finishes part of its execution plan, for example, when the patient has been successfully treated for a symptom, the system 110 saves the relevant data and stores it in the virtual database 118. Store as part of the consumer record system. In some examples, the virtual patient recording system is used as a data source for various health assessment and health risk studies. Patient data can be accessed anonymously, for example, so that a researcher can study patient data without identifying the patient at all.

Auxiliary services and other services may be incorporated into the overall brokerage. Such ancillary services may extend to the completeness of service delivery or enable advanced features that can improve the end user experience in an essential way. The intermediary architecture allows the incorporation of such auxiliary services as part of the intermediary framework or as a plug-in using third party vendor components. Such ancillary services may ultimately be placed in the intermediary operating screen to facilitate an enhanced user experience independent of the vendors that provide them.

  Consumer data storage locations include collection of parameter and non-parameter data. In addition, the storage location holds consumer information, such as health and health information. For prescription filing, the provider prescribes the drug to the patient via the web and submits the prescription to the local pharmacy for receipt. Such services include components of a prescription clearing house, eg, SureScript® or RxHub®. Where appropriate, the system is designed to couple with such services. Of course, there are legal restrictions on the provision of such services.

  In a targeted self-sustained program, for consumers involved in specific action plans that are only used by intermittent providers and focused primarily on ongoing interactions between computerized modules and consumers The provider advises. In addition to general information about the program and, for example, proposals to subscribe to special products offered by the health plan that provides this mediation to members, the intermediary may Information on current eligibility may be provided. In addition, this information may be derived from a privilege service operated by the employer. When a consumer subscribes to a health-related economic product such as a health spending account, various updates regarding current spending are presented through the operation screen. This information may be updated, associated, or grouped by partner economic institutions that manage plans, employers, or consumer accounts. Similarly, retirement plans or brokerage accounts are linked if, for example, the brokerage is provided by a consumer employer or a bank that provides economic planning advice. The consumer may be given access to equivalent and targeted medical content from packages included in the particular service that the consumer subscribes to or subscribes on behalf of the consumer. These include packages related to medical, health, health (eg, diet and exercise), preventive drugs, medications, instruction, mental health, and other training.

Portability of Information This mediation extends to any place of care outcome for care medical locations, ie service providers, to allow continuation or level-up from services provided in electronic contact. For example, the transcription of interest is transferred to the desired provider. If the provider is a participant in this brokerage, the provider accesses the document directly. If the provider is not a participant in this mediation, other methods for accessing the document are used. For example, e-mail or facsimile, or temporary access may be given to non-subscribers. In some examples, the service may reward the provider for viewing a summary of online engagement with another provider and his consumer. This keeps the primary provider informed and makes the e-visit system more comfortable for the primary provider while providing better service to the consumer.

  The intermediary also supplements the record of engagement with additional information. For example, tell the physician which treatment option in the patient's health plan to prioritize for the disease indicated in the record, or what preventive treatment the patient should be given.

  The consumer, for example, accepts or transfers all of the consumer's records on the brokerage system as part of storage or transfer of records to another provider when the consumer changes health plans. In some examples, the intermediary allows consumers to request that such documents be sent in electronic form or stored on the media of choice. Outbound communication, for example, to comply with Protected Health Information (PHI), or Health Insurance Interoperability and Accountability Act (HIPAA) requirements to manage other consumer privacy policies or rules Explicitly granted by the consumer.

Ensuring continuity of treatment If consumers understand that it is a valid connection in their relationship with their provider, they are more likely to use this brokerage, whether live or online Regardless, if there is continuity in involvement, that is more likely. The work-up performed on this mediation facilitates consumer non-virtual relationships (not redundant or conflicting) and encourages participation by both consumers and providers. This mediation provides several features to achieve this end goal. In some instances, the intermediary engages consumers in a concierge operation at key geographic locations. Otherwise, the consumer is managed only through mediation-based engagement.

  Any work-up performed on the system at the consumer's service provider (eg, the consumer's attending physician) or at a medical location requested in writing within an electronically set business day or another business day Service guarantees are made available to consumers that they can be used. The consumer can also receive a written confirmation of each action for his / her own storage.

  For providers who do not participate in this brokerage, referral guarantees are provided to the local service provider of the consumer (eg, the attending physician) so that the role of the provider in coordinating healthcare for consumers is not adversely affected. Provided. As such, the system visually informs both the consumer and any participating providers that interact with the consumer of the role of the local service provider. Designating a particular local service provider, for example, as the consumer's attending physician, will automatically continue the behavior in the system to continue to update the local provider regarding the activities surrounding the “attending physician” consumer. To cause. Another feature that further strengthens the role of the local provider is an automated referral where the participating provider introduces the consumer to the office visit only to the local service provider if additional work-up is required. . For this reason, by providing the consumer of the provider to cooperate with the use of this intermediary, the local service provider can increase visits and receive more hospital visits.

  In some examples, the reward function extends to the continuity of treatment provided to the consumer once the engagement information has been transferred to the non-virtual service provider. Enable consumers to continue virtual engagement (or progress management) with participating providers doing real-world operations. Participating providers have access to the broker's online interface, so the transition between online and live providers is more informative. It is advantageous for the consumer to ensure continued documentation of non-virtual visits in records based on the consumer's services that are picked up where online engagement has ceased.

Consumer incentives In some instances, health plans or other institutions that provide this mediation to consumers incorporate automatic incentives. Such incentives reward consumers for activities that have favorable health outcomes (examples of services provided by health plans). Incentives are provided to encourage consumers. For example, online progress on conditions where consumers are educated about the functioning of chronic conditions diagnosed, engage in conversations that reward early detection of critical health problems, or warrant it (coronary artery disease or diabetes) Manage and even participate in remuneration for more advanced dosing plans in selected medical conditions. The system is automatically distributed with such incentives and promoted to appropriate consumers, for example, to promote the desired health status and medical management.

Interface with external data sources To facilitate engagement between consumers and providers, the system automatically obtains information from available systems and prepares the provider at the start of engagement. Use information. Such an interface includes both synchronization (eg, a web server) and batch updates. Examples include healthcare, eligibility data, billing data, drug benefits management (PBM) information, predictive modeling, consumer feed provider analogs such as ICD, CPT, Healthcare Common Procedure Coding System (HCPCS) , SNOMED (Systematized Nomenclature of Medicine), or other standard code feeds using LOINC (Laboratory Observation Identifier Names and Codes), method-similar information on prescription drug selection decisions and preferences, customer relationship management (CRM), and external messages There are systems as well as queues (eg, My Yahoo! ®, individual RSS feeds).

Management and analysis of raw data input In some examples, the brokerage is generally used to input raw data from various sources, eg, billing, pharmaceutical data, used by large clients (eg, health plans, care management companies). And accept laboratory data. The system validates the correlation between accidental input in the raw data and the consumer profile. To do this, the system applies customizable analysis rules. Tests were done to rule out diabetics (eg if the text ICD code does not indicate the result), rather than simply giving consumers attention as a diabetic, for example based on laboratory results , Tag consumers as diabetics.

Service provider
Provider Role A service provider is an individual who participates in an engagement in response to a consumer inquiry. For example, a healthcare setting includes service providers, doctors, nurses, and other medical professionals. Such providers will participate in this brokerage while maintaining alliances with any kind of professional involvement in non-virtual worlds (eg hospital reservations, clinics or personal operations, law firm partnerships). . Providers on this intermediary network are confirmed to retain eligible credentials before being allowed to engage with consumers. Once confirmed, the provider agrees to the terms of this brokerage, such as payment for the time it takes to perform the engagement, the desired method of execution, and the adverse effects and dispersion of reliability if that method is disrupted. These are similar to the contracts that providers make when joining group operations or hospitals in a non-virtual world. An example web page 330 for one stage of role processing is shown in FIG.

  Prior to joining the intermediary network, the provider establishes a profile so that the consumer can select as the intended service provider of engagement. In addition to self-introduction, the provider can confirm information from the provider's registration information (for example, the American Medical Association (AMA) for doctors or the American Bar Association (ABA) for lawyers). A profile is created using. Profiles are used for several purposes. Their purpose is to determine the provider's relative hourly rate relative to the consumer or sponsor of this intermediary (eg, a health plan that pays for services), involving one provider with another provider Providing consumers with information similar to a choice for. Some information about the provider is confirmed by the broker (eg, tax ID, education, professional certificate, demographic, and contact information), and some information is obtained during the provider's participation in the broker. It is done. Such data includes service length, number of engagements, consumer satisfaction, estimated availability, and the like. In addition, the provider may provide a general introductory text, a photograph, a sound, and a welcome message of a video. The provider may also add other information that it considers relevant to the consumer (eg, a list of publications and honorary titles). Table 340 of FIG. 9 lists examples of profile criteria compiled while engaged in the medical field. Table 340 includes example criteria 342, a specific example 344 of each criteria, and an indication 346 of whether the criteria have an impact on engagement costs.

  The providers who participate in this mediation come from one or more service providers. Each service provider may be an independent service provider, not affiliated with the provider network, or a service provider affiliated with this intermediary and a provider network that is not itself affiliated. Also good. This allows a service provider (or service provider network) outside the selected service provider network to participate in the system.

Introducing the Provider As part of the provider selection process described above, the consumer benefits from having access to introductory material from the provider. When a consumer seeks a provider that meets their needs, the consumer can choose to view only those providers for which such information is available to the provider in favor of such capabilities. Provide incentives. The example of page 330 in FIG. 8 allows a provider to upload such information. The referral material includes a photograph 332 of the provider, a welcome message 334, a welcome audio recording 336, a video self-introduction 338, or a link (not shown) to the provider's home page in the clinic or hospital. The introductory material may also include an internet link (not shown) indicating the credentials of the provider on the public site provided and recognized by the broker.

Provider credentials In some examples, the system verifies the service provider (or network of service providers) to join and participate in the system. This may use certificate standards established by external organizations such as the American Medical Association (AMA) or the American Bar Association (ABA). Providers wishing to join the system register with the system and provide credentials, for example, approval by a technical committee, years of experience, work experience, whereabouts, and education. The system checks this information and evaluates the provider as a potential provider in the system. In addition, the system communicates with existing providers in the system, for example, providers with the same discipline or expert committee approval, or providers working or attending school with candidate providers. You may take them or ask them to provide a peer review of the candidate provider. In some examples, the credential processing may be provided by a third party or may be provided by the same organization that provides the system for connecting service providers and consumers.

  In some instances, the credential process is a service provider expert who has low average availability or is in high demand for the consumer market to join and participate in this brokerage. Consider the load balance of available or participating service providers. In addition, the intermediary has a high average availability or a relatively low demand for service providers who meet or exceed the qualifications of service providers already participating in the system. Limit service provider subscriptions in certain specialized areas. The system holds information about the consumer's specific needs and information about the availability of service providers who specialize in areas that meet the consumer's needs. This information can be used to determine which areas of expertise are available from additional service providers, which areas are not fully utilized, reduce the number of service providers, and add additional consumers. The system identifies whether or not Since the system connects consumers with service providers who are far away and do not normally interact with each other, the system can be used by service providers that are not fully utilized in the current location. It makes it possible to make up for the existing shortages.

Provider Evaluation To further improve the consumer's ability to select an appropriate provider, the intermediary includes a utility for evaluating goods and services provided by the service provider or service provider network. . Consumers provide feedback (positive and negative) to the system about goods and services provided by a particular service provider. For example, in a healthcare system, the patient can provide a quality assessment of the treatment provided by the doctor or the doctor's approach to the inpatient. In addition, service providers provide feedback and evaluation of goods and services provided by other service providers. For example, the attending physician can provide an assessment of the goods and services offered by the specialist to one of his patients introduced by the attending physician.

  In some examples, this information is used to reconsider the qualifications of service providers participating in the system. Periodically, the system will perform a re-evaluation process for each service provider participating in the system, and service providers that do not meet specific criteria or the minimum level of consumer and peer ratings. Eliminate or lock out. Newer service providers will only be able to continue during a trial period that is allowed to continue if their product and service rating is satisfactory or exceeds a predetermined threshold for capacity. Joined to join the system.

  As part of the provider's profile (and as a way for consumers to limit their searches), the system continually works with metrics that reflect the quality of the provider's consumer interaction. Update the provider profile. The metrics are updated at the end of each engagement so that providers can allow quick feedback regarding their service level. In some examples, all search results for providers on the system are sorted by provider's rating order by default, while recommending higher quality providers. Examples of parameters that should be updated and taken into account in the assessment settings include the overall rating by the consumer of the provider's quality of engagement, the number of engagements made by this provider over the last 30 days or all, and all the This includes the number of engagements that were reinitiated as part of the engagement, the number of engagements that were directed from this provider to another provider, and the average response time for messages while not “out of office”. In addition to the evaluation, each provider that interacts with consumers on the system has a provider statistics manifest describing the operational statistics, for example, the provider's availability for conference calls over the past 30 days.

  The consumer is asked to evaluate the provider at the end of the engagement as part of the disconnection process. In order to encourage consumers to provide such feedback, the fee for engagement continues until the consumer completes the ranking. Such a process facilitates the provider's involvement in the ranking while recommending a higher quality of service for the intermediary consumer.

Provider Operation Screen The provider interacts with the consumer through the provider operation web page 350 shown in FIG. This interface is similar to that used by consumers. The provider's operation screen provides various tools used by the provider. The window shows a raw image 352 of the consumer along with tools 354a, 354b for controlling or stopping the video supply. Phone control 356 allows the provider to initiate a phone call with the consumer. An ongoing chat log 358 is displayed above the input 360 for the provider's next comment. Access to other tools, such as operating conditions and legal terms of the system, such as disclaimers, is available in the tab 362 on the side. The status setting allows the provider to change the status of availability, for example, between offline, online, and out of the office. Scheduling allows providers to update their availability calendar with future times that are expected to be available on the system. This results in the consumer recognizing that such a provider is in a “scheduled” state.

  The message tool allows the provider to respond with the consumer in a message-based engagement. The operation screen also enables the provider to participate in chat involvement. The chat participation is one in which the consumer and the provider perform two-way communication in real time by typing, for example, the chat 358 in FIG. This brokerage allows a single provider to engage in more than one chat at a time to maximize provider rewards while consumers type their input. The chat function also allows the provider to forward a specific list of questions to further reduce the time to obtain information from consumers at the start of engagement. Tools available to assist providers in chat or message communication include thread viewers, consumer medical overviews, consumer engagement history, communication timeline charts, and built-in and self-created for quick response. Contains a message template. Such templates also include references in related topics, links, and built-in graphical educational content. In some examples, the broker scans outgoing messages for inappropriate language based on sponsor preferences.

  The operation screen allows the provider to retain an audio conference engagement with the consumer when the consumer is using a computer or telephone. The provider can be used to direct the end of the conference to the phone, for example if the bandwidth or other considerations indicate it or simply based on personal preferences. The operation screen also allows the provider to participate in the video conference with the consumer. Voice may be provided through the operation screen or directed to the phone. In order to confirm the identity of the provider when using the phone for voice involvement, the system provides the security code to the provider through the provider's operation screen. When a provider makes a call to the system or answers a phone called by the system, the provider checks to make sure that the person on the phone is the same person who is logged into the operation screen Enter your PIN. This method is also used to leave a secure voice message. If the provider wants to leave a message for the consumer, the provider enters the PIN and leaves the message. Then, the provider receives a call from the system, inputs a personal identification number, and leaves a message. The message is then sent to the consumer with the belief that it is left by the provider.

  At any time during the engagement, the provider may add notes to the consumer's engagement audit (consumer records) or to their own involvement in the engagement. The accounting audit tracking allows the provider to view a complete accounting audit of consumer interactions through the operating screen. This audit includes the nature and timing of past involvement and the associated credit with which the provider has an obligation to engage.

  In areas that depend on the detailed code of work performed or analysis, for example in this intermediary version of healthcare, an encoding function is provided via involvement. Encoding allows the provider to add a medical code that describes the outcome of the engagement. The code is used to further characterize the consumer as well as based on the transmitted communication to progress the medical location or connected medical system. The encoding supports a range for classification of diseases, drugs, and surgery, for example.

  The system is provided by the provider according to the consumer's circumstances (for example, consultation or introduction) or without conforming to the consumer's circumstances (for example, the provider's meeting, discussion board, etc.) Exchange is possible. Based on the provider's license to prescribe the drug to involved consumers in accordance with health care circumstances, the operation screen allows the provider to use an electronic prescription and replenishes the service Make it possible. Assuming that you are eligible, the provider will be able to instruct the system to forward the prescription or other information of interest to another recipient outside the system. Such exports include various methods, such as electronic (eg, facsimile, email, SMS) or non-electronic (eg, printing, mail).

  Providers can view their account status, system settings, and preferences. Providers also have access to their profiles and user satisfaction and statistics so that they are available to consumers. In addition, the operation screen connects to an economic service associated with the participation of the provider in this mediation. This includes the status of the reward (eg, for the CPT method 0074T for an e-visit in healthcare settings), the submission of a plan request, and the status of the billing process. In some examples, real-time billing information may be available depending on the method of deployment of this intermediary from a health plan perspective.

  This intermediary provides the provider with the ability to forward a message or reservation request to an SMS compatible mobile phone. In this method, the provider associates a mobile phone number in his account and establishes a type of information that the system can send to the mobile device. Such information can be used for notifications related to the system (eg, guidance on a very busy communication state that asks the provider to make it available and suggests higher rewards for doing so). In addition, notifications related to engagement are included.

Public Access Discussion In some examples, the system includes a public discussion that supports free form involvement on different topics among all members. Public discussion allows consumers to post anonymously on any issue specified by the consumer advisor or manually post questions to publicly accessible discussions. When a consumer posts his / her problem anonymously, a thread that responds or unfolds by other users answering or discussing the problem is forwarded to the consumer who posted the first problem. The In some examples, the system monitors the identity of the person responding to the post and notifies the consumer individually when a user known as the provider posts the response. In some examples, the intermediary pays the provider to post a response to input that it considers important for public discussion. Unlike consumer input, the provider input is identified and allows the consumer to initiate engagement with the provider who posted the answer that he found useful and effective.

  In some examples, a consumer posts one or more engagement accounting audits for public debate that is beneficial to other consumers. This intermediary provides consumers with the ability to extract any data that identifies a participant (ie, it anonymizes the data) and browse the anonymized data before posting it.

In case of use in medical field
In one example of a generally healthy consumer , the consumer logs on to the system to explore the benefits recommended by his employer. Consumers are advised on the use of the platform to improve consumer health management understanding in return through incentive programs provided by employer-provided health plans. A consumer advisor engages with the consumer and initiates an “unreported issue” assessment. At the end of the evaluation, consumers are surprised to find some areas that benefit from engagement. In this example, these areas represent a lack of significant cancer screening, inappropriate gynecological progress management, unaccounted family risk factors, and increased risk and markedly her stress and sleep quality. Includes a collection of lifestyle issues that increase the level of problems. The intermediary displays a list and then connects the consumer with the gynecologist's provider and nurse leader. Each obstetrician / gynecologist provider and nurse instructor is knowledgeable about the corresponding gaps that are already recognized. A summary report along with a detailed appointment request is forwarded to the consumer's registered attending physician for scheduling examinations and referrals. The consumer receives educational material regarding specific tests and identified risk factors.

In another example of newborn parents , two parents are worried about a rash on the left buttock of their child. Parents are connected to pediatric nurses. The nurse will explain the characteristics of the rash step by step and determine that it is a diaper rash that can be treated by simply moistening the ointment. Parents are advised that such rashes go away in 2-3 days without treatment. In this example, the parents accept further confirmation through a pediatrician visit. The connected pediatrician confirms the diagnosis of the nurse and gives advice after viewing the online memo. After the diagnostic document has been faxed to the pediatrician's office, the parents manage the progress with their pediatrician the following week.

In another example of a chronic diabetic patient with mobility restrictions , the patient is a chronic overweight home diabetic patient. The patient has pain in the shin on the ankle and is involved in this mediation that directs him to the physician. The patient chooses to be involved over the phone and is connected with a specialist through the brokerage switchboard. The specialist asks the patient questions to determine where the foot ulcers may have occurred, and instructs the patient to warm and compress the affected area very hygienically. The specialist advises the patient not to wait for the pain to subside. Patient providers and health plan care managers will be notified of the next day's approval for engagement and examination and scheduled debridement. Early ulcers identified by specialists during telephone involvement are addressed. This prevents the deterioration of the patient's life-threatening condition.

In another example of a 46-year-old bank employee , a consumer logs on and undergoes a health risk assessment. The system recognizes that the consumer has a question about a particular cosmetic surgery. The system explains the questions to be mentioned and proposes to connect with the plastic surgeon for the consumer. The consumer receives a list of names and functions of the surgery that they want to look for for beauty concerns. A link to reference information about each surgery is added to her record. A link will be added to assist the consumer in comparing the cost and potential providers within her area of performing the surgery.

Embodiments may be embodied in digital electronic circuitry, i.e., in computer hardware, firmware, software, or a combination thereof. The apparatus of the present invention may be embodied in a tangible computer program product that is embodied or stored in a machine-readable storage device for execution by a programmable processing device. The operation of the method is performed by a programmable processing device that executes program instructions to perform the functions of the present invention by operating on input data and generating output. The invention is advantageously embodied in one or more computer programs executable on a programmable system. The programmable system receives at least one programmable data from the data storage system, at least one input device, and at least one output device, and is connected to transmit the data and instructions to the devices. Processing equipment. Each computer program may be embodied in a procedural or object-oriented high-level language. Alternatively, if desired, it may be embodied in assembly language or machine language. In any case, the language may be a compiled language or an interpreted language.

  Suitable processing devices include, by way of example, both general purpose and special purpose microprocessors. Generally, a processing unit receives instructions and data from a read-only memory and / or a random access memory. Generally, a computer includes one or more mass storage devices for storing data files. Such devices include magnetic disks such as internal hard disks and removable disks such as magneto-optical disks and optical disks. Storage devices that are tangible and suitable for executing computer program instructions and data include all forms of non-volatile memory, such as semiconductor storage devices such as EPROM, EEPROM, and flash memory devices, magnetic disks, For example, a built-in hard disk and a removable disk, a magneto-optical disk, and a CD-ROM disk are included.

  Other embodiments are within the scope and spirit of the claims. For example, due to the nature of software, the functions described above may be implemented using software, hardware, firmware, wiring, or any combination thereof. Also, features that embody functions may be physically located at various locations, including being distributed such that some of the functions are embodied at different physical locations.

Claims (33)

A method performed by a computer,
Receiving a request from a consumer of a service to consult with a service provider having a service provider profile that satisfies at least some of the set of attributes that define an appropriate service provider;
Designating available service providers that satisfy at least some attributes of the set of attributes;
Providing a communication channel to establish communication between a consumer of the service and the designated service provider. The method of claim 1, wherein designating the available service provider comprises monitoring the availability of the designated service provider. The method of claim 2, further comprising activating the communication channel when the designated service provider becomes available. The step of designating the available service provider includes:
Designating a set of each service provider having a profile that matches at least some of the attributes;
Monitoring the availability of the matching service provider;
2. The method of claim 1, comprising initiating real-time communication between the available service provider and a consumer of the service when the matching service provider becomes available. The designated service provider is a service provider of a first type, and the method includes:
Designating a second available service provider that is a second type of service provider that satisfies at least some attributes of the set of attributes;
Providing a second real-time communication for communication between a consumer of the service and the second designated service provider. 6. The method of claim 5, wherein the communication channel is initially provided for a service provider that is initially available from any designated service provider. If the communication channel with the first designated service provider is provided prior to the second communication channel, the method comprises:
Information describing the result of the communication between the consumer of the service and the first designated service provider, before providing the second communication channel, the second designated service. 6. The method of claim 5, further comprising providing to a provider. Providing information describing a result of the communication between the consumer of the service and the designated service provider to the second service provider associated with the consumer of the service; The method of claim 1. Providing the communication channel comprises:
Designating a communication method for contacting the consumer of the service;
The method of claim 1, comprising instructing the designated service provider to initiate communication using the designated method. Providing the communication channel comprises:
Initiating a first communication channel with a consumer of the service;
Initiating a second communication channel with the designated service provider;
Connecting the first and second communication channels. Designating the available service provider comprises receiving an indication that an available service provider that satisfies at least some attributes of the set of attributes has initiated a first communication channel. The method of claim 1 comprising: Providing the real-time communication channel comprises:
Initiating a second communication channel with a consumer of the service;
12. The method of claim 11, comprising connecting the first and second communication channels. A method performed by a computer,
Receiving an indication that a member of the set of service providers is available;
Receiving a request from a consumer of the service to consult with the service provider;
Designating an available member of the set;
Initiating real-time communication between a consumer of the service and the designated member of the set. The request includes displaying a future time;
14. The method of claim 13, wherein the steps of designating the members of the set and initiating the communication are performed at the designated time. A method performed by a computer,
Receiving a request from a patient for real-time consultation with a doctor upon request;
Designating at least one available doctor to be consulted with the patient;
Activating communication between the patient and the available physician to allow the requested consultation. The step of designating the available doctor is:
Designating at least one doctor to be consulted with the patient;
Designating a set of doctors of the designated type;
Determining currently available physicians in the designated set;
16. The method of claim 15, comprising designating one available doctor in the designated set. The patient is associated with an attending physician;
17. The method of claim 16, wherein designating the set of doctors comprises designating a doctor other than the patient's attending physician. The method of claim 17, further comprising providing information describing a result of the consultation to an attending physician of the patient. A method performed by a computer,
Sending the patient's request for real-time consultation with the doctor on request,
Receiving a message specifying at least one available doctor to be consulted with the patient;
Connecting an established communication channel between the patient and the available physician to allow the requested consultation. A computer program product residing on a computer readable medium for providing an intermediary service to consumers and service providers comprising:
Receiving a request from a consumer of a service to consult with a service provider having a service provider profile that satisfies at least some of the set of attributes that define an appropriate service provider;
Designating available service providers that satisfy at least some attributes of the set of attributes;
A computer program product comprising instructions for causing a computer to perform a communication channel to establish communication between a consumer of the service and the designated service provider. 21. The computer program product of claim 20, further comprising instructions for performing a step of monitoring availability of the designated service provider. 21. The computer program product according to claim 20, wherein the instruction for performing the step of designating the service provider includes an instruction for performing a step of determining whether or not the service provider is available. Designating a set of each service provider having a profile that matches at least some of the attributes;
Monitoring the availability of the matching service provider;
21. The computer of claim 20, further comprising instructions for initiating real-time communication between the available service provider and a consumer of the service when the matching service provider becomes available. Program product. Instructions for providing information describing a result of the communication between a consumer of the service and the designated service provider to the second service provider associated with the consumer of the service 21. The computer program product of claim 20, further comprising: The instructions for performing the step of providing the communication channel are:
Initiating a first communication channel with a consumer of the service;
Initiating a second communication channel with the designated service provider;
21. The computer program product of claim 20, comprising instructions for performing a step of connecting the first and second communication channels. A computer program product residing on a computer readable medium for providing an intermediary service to consumers and service providers comprising:
Receiving an indication that a member of the set of service providers is available;
Receiving a request from a consumer of the service to consult with the service provider;
Designating an available member of the set;
A computer program product comprising instructions for causing a computer to initiate real-time communication between a consumer of the service and the designated member of the set. An apparatus comprising a processing device and a computer program product residing on a computer readable medium for providing an intermediary service to consumers and service providers, the computer program product comprising:
Receiving a request from a consumer of a service to consult with a service provider having a service provider profile that satisfies at least some of the set of attributes that define an appropriate service provider;
Designating available service providers that satisfy at least some attributes of the set of attributes;
An apparatus comprising instructions for causing the processing unit to provide a communication channel to establish communication between a consumer of the service and the designated service provider. 28. The apparatus of claim 27, wherein the computer program product further comprises instructions for performing a step of monitoring availability of the designated service provider. 28. The apparatus of claim 27, wherein the instruction to perform the step of designating the service provider by the computer program product includes an instruction to determine whether the service provider is available. The computer program product designating a set of each service provider having a profile that matches at least some of the attributes;
Monitoring the availability of the matching service provider;
28. The apparatus of claim 27, further comprising instructions for initiating real-time communication between the available service provider and a consumer of the service when the matching service provider becomes available. . The computer program product sends information describing a result of the communication between a consumer of the service and the designated service provider to the second service provider associated with the consumer of the service. 28. The apparatus of claim 27, further comprising instructions for performing the providing step. The instructions for performing the step of providing the communication channel are:
Initiating a first communication channel with a consumer of the service;
Initiating a second communication channel with the designated service provider;
28. The apparatus of claim 27, further comprising instructions for connecting the first and second communication channels. An apparatus comprising a processing device and a computer program product residing on a computer readable medium for providing an intermediary service to consumers and service providers, the computer program product comprising:
Receiving an indication that a member of the set of service providers is available;
Receiving a request from a consumer of the service to consult with the service provider;
Designating an available member of the set;
An apparatus comprising instructions for causing the processing device to perform real-time communication between a consumer of the service and the designated member of the set.

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