US 12,354,722 B2
Enhancing patient referral outcome through structuring data for efficient place of service utilization rate analysis
Timothy Kelly, New York, NY (US); and Zoe Yang, Brooklyn, NY (US)
Assigned to EMBLEMHEALTH, INC.
Filed by EmblemHealth, Inc., New York, NY (US)
Filed on May 5, 2023, as Appl. No. 18/143,851.
Application 18/143,851 is a continuation of application No. 16/801,710, filed on Feb. 26, 2020, granted, now 11,682,475.
Prior Publication US 2023/0274808 A1, Aug. 31, 2023
This patent is subject to a terminal disclaimer.
Int. Cl. G16H 15/00 (2018.01); G16H 10/60 (2018.01); G16H 40/20 (2018.01); G16H 80/00 (2018.01)
CPC G16H 15/00 (2018.01) [G16H 10/60 (2018.01); G16H 40/20 (2018.01); G16H 80/00 (2018.01)] 20 Claims
OG exemplary drawing
 
1. A device for structuring and processing data for efficient selection of a referral provider for a patient, the device comprising:
a processor,
a memory,
computer readable instructions that when executed extract a set of utilization logs from a log data structure comprising (i) a set of data each modeling healthcare providers and each associated by one or more referral logs, and (ii) a group of utilization logs each associated with a data from the set of data each modeling the healthcare providers,
wherein the group of utilization logs comprises a first utilization log of a different patient that was previously served by a first healthcare provider at a facility to result in a healthcare utilization log, and
wherein the first utilization log comprising a provider UID of the first healthcare provider and a place of service value that describes a type of facility associated with a healthcare utilization record;
a referral request agent comprising computer readable instructions that when executed at least one of generate and receive a referral profile generated for the patient;
a profile matching engine comprising computer readable instructions that when executed compares the referral profile to the set of utilization logs;
a dataset reduction subroutine comprising computer readable instructions that when executed generate a reduced dataset comprising a subset of utilization logs extracted from the set of utilization logs matching the referral profile,
wherein a number of healthcare providers associated with the reduced dataset is compared to a minimum threshold of healthcare providers to determine a sufficient number of healthcare providers within the reduced dataset;
a utilization rate routine comprising computer readable instructions that when executed calculates, using the subset of utilization logs in the reduced dataset, a POS utilization rate of the first healthcare provider for each instance of the place of service value,
wherein the POS utilization rate is a set of percentage values, each percentage value a number of utilization logs in the reduced dataset comprising an instance of the place of service value within a place of service range relative to a total number of utilization logs in the reduced dataset; and
a set of computer readable instructions that when executed select the first healthcare provider for inclusion in a referral data based on criteria comprising the POS utilization rate for transmission of at least one of a name of the first healthcare provider and the provider UID of the first healthcare provider to a computing device for generation of a referral selection for the patient.