System and method for laboratory-based authorization of genetic testing

Abstract

System and methods for providing laboratory-based authorization of genetic testing are disclosed. An order for genetic testing is received from an electronic health record (“EHR”) system at a laboratory information system (“LIS”). A prior authorization request is automatically generated at the LIS from data parsed from the order and retrieved from the EHR and sent to a prior authorization provider. If a patient responsibility amount returned to the LIS is below a threshold, testing proceeds. If the patient responsibility amount is above the threshold, an electronic call center request is generated and the patient is contacted to obtain payment. If a billing consent is not obtained, the specimen for the order is destroyed.

What is claimed is: 
     
         1 . A system for laboratory-based authorization of genetic testing, said system comprising:
 a healthcare provider office system comprising an electronic health record (“EHR”) system;   a laboratory system comprising a laboratory information system (“LIS”), wherein said LIS is in electronic communication with said EHR system;   software instructions, stored at one or more electronic storage devices of the LIS, which when executed, configure one or more processors of the LIS to:
 receive an electronic order from the healthcare provider office system, wherein said electronic order comprises a patient identifier, insurance information, and genetic testing to be performed for a patient; 
 query the EHR system to retrieve active medications and diagnosis associated with the patient identifier; 
 automatically parse data from the electronic order and the EHR system to generate an electronic prior authorization request; 
 transmit, to a prior authorization provider associated with the received insurance information, the electronic prior authorization request; 
 receive, from the prior authorization provider, a reference number and patient responsibility amount for the electronic prior authorization request; 
 where the patient responsibility amount is above a predetermined threshold:
 generate and transmit an electronic call center notice to a call center system in electronic communication with the LIS, said electronic call center notice comprising a patient name, patient contact information, and the patient responsibility amount; and 
 contacting the patient by way of the contact information to obtain payment for the patient responsibility amount; 
 
 where no payment is received at the call center system, receiving, from the call center system, an electronic notification to destroy a specimen associated with the electronic order; 
 where an indication of received payment is received from the call center system or the patient responsibility amount is below the predetermined threshold:
 electronically instructing a genetic sequencing machine to perform the genetic testing on the specimen; and 
 electronically integrate results from the genetic testing into the EHR system. 
 
   
     
     
         2 . The system of  claim 1  wherein:
 the genetic testing comprises medication efficacy testing. 
 
     
     
         3 . The system of  claim 2  further comprising:
 a database in electronic communication with the LIS and comprising medications known to be wholly or partially ineffective in persons having particular genetic markers; 
 additional software instructions, stored at the one or more electronic storage devices of the LIS, which when executed, configure the one or more processors of the LIS to a report of said results of said genetic testing provided electronically by said LIS to said EHR system comprises instructions for said EHR system to automatically and electronically flag medications identified as ineffective in said report based on a genetic makeup of said patient as an allergy in the EHR system for the patient. 
 
     
     
         4 . The system of  claim 3  further comprising:
 an alternatives database comprising alternative medications; and 
 additional software instructions, stored at the one or more electronic storage devices of the LIS, which when executed, configure the one or more processors of the LIS to:
 query the alternatives database to retrieve alternative medications for each of the identified ineffective medications; and 
 transmit the retrieved alternative medications to the EHR system. 
 
 
     
     
         5 . The system of  claim 1  further comprising:
 the call center system; and 
 a payment processing system in electronic communication with the call center system and configured to receive and process credit card information, electronically return payment confirmation to the call center system, and electronically transmit funds to a financial intuition associated with the laboratory system. 
 
     
     
         6 . The system of  claim 5  further comprising:
 software instructions, stored at the one or more electronic storage devices of the LIS, which when executed, configure the one or more processors of the LIS to determine that a denial has been received from the call center system when an electronic notification from the call center system is received that a predetermined number of attempts have been made to contact the patient without success. 
 
     
     
         7 . The system of  claim 1  wherein:
 the electronic order comprises an HL7 order; and 
 the call center notice comprises an attachment to an encrypted email. 
 
     
     
         8 . The system of  claim 1  further comprising:
 a number of additional healthcare provider systems, each comprising an EHR system comprising medical information for the patient; 
 a healthcare information exchange (“HIE”) interposed between the LIS, the EHR, and each of the number of additional EHRs; 
 software instructions, stored at the one or more electronic storage devices of the LIS, which when executed, configure the one or more processors of the LIS to integrate the test results into the EHR systems for each of the number of additional healthcare provider systems by way of the HIE. 
 
     
     
         9 . The system of  claim 4  further comprising:
 a treatment protocol database comprising medications associated with diagnoses, wherein said medications are those commonly prescribed to treat the associated diagnosis; and 
 additional software instructions, stored at the one or more electronic storage devices of the LIS, which when executed, configure the one or more processors of the LIS to:
 query the EHR system to retrieve diagnoses for the patient; 
 query the treatment protocol database to retrieve medications associated with the retrieved diagnoses; and 
 treat the retrieved medications as additional active medications. 
 
 
     
     
         10 . A method for laboratory-based authorization of genetic testing, said method comprising the steps of:
 sending a specimen comprising a genetic material gathering device comprising genetic material for a patient from a healthcare provider office to a laboratory;   electronically transmitting an order for genetic testing of the specimen from an electronic health record (“EHR”) system associated with the healthcare provider office to a laboratory information system (“LIS”) associated with the laboratory, wherein said order comprises a patient identifier, insurance information, patient contact information, and genetic testing ordered;   electronically transmitting a patient consent document from the EHR to the LIS, wherein the patient consent document is associated with the order;   querying the EHR system by way of the LIS to retrieve diagnoses and active medications associated with the patient identifier;   generating, at the LIS, an electronic prior authorization request comprising the genetic testing ordered, the patient identifier, the insurance information, the retrieved diagnoses, and the retrieved active medications;   electronically transmitting, from the LIS, the electronic prior authorization request to an insurance or prior authorization provider associated with the insurance information; and   electronically receiving, from the insurance or prior authorization provider, a reference identifier and patient responsibility amount in response to the electronic prior authorization request.   
     
     
         11 . The method of  claim 10  further comprising the steps of:
 determining, at the LIS, that the patient responsibility amount exceeds a predetermined threshold described in the patent consent document; 
 generating, at the LIS, a call center notice comprising the patient contact information and the patient responsibility amount; 
 electronically transmitting the call center notice to a call center system; 
 obtaining payment from the patient by way of the call center system and a payment processing center; 
 providing electronic payment confirmation to the LIS from the call center system; 
 instructing a genetic sequencing device, by way of the LIS, to perform the ordered genetic testing on the specimen; and 
 electronically integrating the results of the ordered genetic testing into the HER system. 
 
     
     
         12 . The method of  claim 11  wherein:
 the ordered genetic testing comprises genetic efficacy testing; 
 the results of the order genetic testing identify effective and ineffective medications based on the patient's genetic makeup; and 
 ineffective medications for the patient are electronically flagged as allergies at the EHR system. 
 
     
     
         13 . The method of  claim 12  further comprising the steps of:
 querying a database to retrieve an alternative medication for each of the ineffective medications; and 
 identifying, at the EHR system, the alternative medication for each ineffective medication. 
 
     
     
         14 . The method of  claim 13  further comprising the steps of:
 transmitting the results of the ordered genetic testing to a healthcare information exchange (“HIE”); and 
 electronically integrating the results of the ordered genetic testing into each of a number of additional EHR systems, wherein each of the number of additional EHR systems are associated with another healthcare provider treating the patient. 
 
     
     
         15 . The method of  claim 10  further comprising the steps of:
 determining, at the LIS, that the patient responsibility amount exceeds a predetermined threshold assigned in the patent consent document; 
 generating, at the LIS, a call center notice comprising the patient contact information and the patient responsibility amount; 
 electronically transmitting the call center notice to a call center system; 
 attempting contact, by way of the call center system, to the patient contact information a predetermined number of times without success; 
 transmitting a notification to the LIS that consent was not obtained; and 
 destroying the specimen. 
 
     
     
         16 . The method of  claim 10  further comprising the steps of:
 determining, at the LIS, that the patient responsibility amount exceeds a predetermined threshold assigned in the patent consent document; 
 generating, at the LIS, a call center notice comprising the patient contact information and the patient responsibility amount; 
 electronically transmitting the call center notice to a call center system; 
 contacting the patient by way of the call center system; 
 recording a denial of consent from the patient at the call center system; 
 transmitting a notification to the LIS that consent was denied; and 
 destroying the specimen. 
 
     
     
         17 . The method of  claim 11  further comprising the steps of:
 electronically transmitting the payment information to a payment processor, wherein the payment information comprises credit card information; and 
 electronically transmitting funds to a financial institution associated with the laboratory. 
 
     
     
         18 . The method of  claim 17  wherein:
 the call center comprises an automatic dialer; 
 the call center notice comprises an attachment; 
 the step of electronically transmitting the call center notice to the call center comprises sending an encrypted email comprising the attachment to the call center; and 
 the step of obtaining payment from the patient by way of the call center and a payment processing center comprises the sub-steps of:
 electronically and automatically parsing the contact information from the attachment, wherein the contact information comprises a phone number; 
 automatically dialing the phone number; and 
 electronically recording the credit card information provided by the patient. 
 
 
     
     
         19 . The method of  claim 10  wherein:
 the reference number and the patient responsibility amount are received prior to receipt of the specimen at the laboratory. 
 
     
     
         20 . A system for laboratory-based authorization for genetic based medication efficacy testing, said system comprising:
 a number of electronic health record (“EHR”) systems, each comprising diagnoses and active medications for a number of patients;   a laboratory information system (“LIS”) in electronic communication with the EHR systems and a number of genetic sequencing devices, said LIS comprising an automated pre-approval request engine;   a database in electronic communication with the LIS and comprising medications known to be wholly or partially ineffective in persons having particular genetic markers;   a prior authorization provider system in electronic communication with the LIS;   a communications system in electronic communication with the LIS; and   a payment processing system in electronic communication with the communications system;   wherein said automated pre-approval request engine is configured to, for each of a number of received electronic orders:
 query the EHR system associated with an ordering healthcare provider office to retrieve all of the active medications and diagnoses associated with a patient identifier provided in the order; 
 automatically parse the patient identifier, insurance information, and ordered testing information from the electronic order and the diagnoses and active medications from the EHR system to generate a prior authorization request; 
 electronically transmit, from the LIS to the prior authorization provider system, the prior authorization request; 
 receive, from the prior authorization provider system at the LIS, a patient responsibility amount for the prior authorization request; 
 for each of the number of received electronic orders where the patient responsibility amount is above the predetermined threshold:
 transmit an encrypted message comprising patient contact information and the patient responsibility amount from the LIS to the communication system; 
 contact the patent contact information by way of the communication system to request payment for the patient responsibility amount; 
 where payment is not received from the patient, provide a notification to the LIS to destroy a specimen for the respective order; and 
 
 for each of the number of received electronic orders where the patient responsibility amount is below a predetermined threshold or where payment is received by way of the payment processing system for the patient responsibility amount:
 instructing, by way of the LIS, one of the number of genetic sequencing devices to perform the ordered testing on a specimen received for the respective electronic order to determine at least a partial genetic makeup of the patient; 
 query the database to retrieve any of the medications known to be wholly or partially ineffective in persons having a same relevant portion of genetic makeup as the patient; 
 determine, at the LIS, if one or more of the active medications retrieved from the EMR system match the retrieved medications from the database; 
 integrate testing results into the EHR system of the ordering healthcare provider office by flagging the ineffective mediations as allergies.