Applications for Clinical, Financial and Administrative Patient Risk:

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Hilda Miles
6 years ago
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3 A Software Product for Managing Integrated Care and Risk Applications for Clinical, and Administrative Risk: Group & Personal Health, Disability, WC, EAP, OHS EMR/PHR/CDR Application for Capturing /Family Attributes Wellness and Disease Application for Program Design Mobile Healthcare Application for Care Managers and s Credentialing and Risk through UR Document and Image Application Application for Analyzing Clinical and Risk

4 A Software Product for Building Insurance & Clinical Applications Designed for Internal Development and Systems Integration One Logical Database for All Lines of Risk Scalable to Millions of Covered Lives in Oracle 11G RAC Fully 2.0 and Cloud Enabled (Sessions & SaaS) Integrated Security, Access and Control and Audit One Source Code Library for all Applications Designed and Built Using Computer-Aided Design Portable to all Operating Systems and Hardware for Oracle Applications and Source Code come with the Product

5 Integrated Applications For Insurance, Finance & Clinical Care Using One Logical Database Applications Administrative Partner Organization Researcher Medical Device Care Manager Transaction Processing --Analytics --Case --EMR/PHR/CDR --Claims & Encounters --Signal Detection --UR --Credentialing --Reporting & Research --Messages --Disease --EAP --Disability --Worker s Compensation --Reinsurance Cloud Firewall Oracle Databases - Real-time and transaction processing -Central control for all processing integrated Oracle and Perseid databases - Single logical database - Fully integrated security, access & control - Integrated financial, clinical and administrative data - Single sign-on and audit

6 Life Sciences Universe Functionality & Information Model Users Businesses Solutions Analysis Methods Applications Lines of Business Types Entities Family Member Friends Community Person Home Device Phone Computer Group & Personal Health Life Sciences & Healthcare Models Clinical Administrative Social Personal Medical Device Computer Cell Phone PDA Home Office Network Disability Short- & Long Term Integrated Care & Case Objects Rules Networks Analytics Organization HL7 Oracle Gateways Worker's Compensation Occupational Health Personal Health & Medical Home Country Region Family Person Office Plant Network Languages ECL ETL EFL Self-insurance Reinsurance QA/QC Econometrics Statistics GLM Manager Analyst Nurse Physician Researcher Web Services SMS Care Wellness Disease COE Trials Programs Protocols Episodes Analytical Rules Engine Alerts Messages Events Services Research & Clinical Trials Outcomes Effectiveneness Classifications Summaries Network Analysis Clinical Medicine Services Order Entry Image & Document Forms Reports Charts Messages Data Information Models Entities Relationships Terms Claims Encounters CDR/PHR/PHI Documents Mulit-media Vocabulary Formal & Customer Insurance & Re- Insurance Disability OHS Cohorts Families Trials Facilities Enterprise Audit Security Access Control

One Architecture for Integrated Care One Logical Database One Integrated Application Library Administrative Partner Organization Researcher

--Credentialing --Reporting & Research --Messages --Disease --EAP --Disability --Worker s Compensation --Reinsurance Web Servers Firewall

0 --Partitioning --High-volume transactions --Memory Tablespaces --Server clusters (RAC) --Portable Code and Database Oracle Database - Real-time

7 One Architecture for Integrated Care One Logical Database One Integrated Application Library Administrative Partner Organization Researcher Medical Device Transaction Processing Applications Care Manager --Analytics --Case --EMR/PHR/CDR --Claims & Encounters --Signal Detection --UR --Credentialing --Reporting & Research --Messages --Disease --EAP --Disability --Worker s Compensation --Reinsurance Web Servers Firewall Enterprise Network Architecture Oracle Servers --Oracle 11g --APEX Partitioning --High-volume transactions --Memory Tablespaces --Server clusters (RAC) --Portable Code and Database Oracle Database - Real-time and transaction processing - Central control for all processing integrated databases - Single logical database - Fully integrated security, access & control - Integrated financial, clinical and administrative data - Single sign-on and audit

8 Applications Share Pages, Functions & Databases in Oracle Clinical Processes Dictionary Entities Administrative, Insurance, & Social CDR/EHR Services -- Dictionary -- Rules -- Codes -- CDR/PHR/EMR -- Classifications -- Relationships -- Cohorts -- Real-time device data -- Incidents and Cases -- Clinical Metrics & Programs -- Quality Metrics & Programs -- Clinical Functions in ECL -- Services -- Orders -- Clinical Trials -- Surveys -- Disease -- Centers of Excellence Rules Classifications Research Systems Claims Administrative -- Claims & Encounters -- Social Networks & Forums -- s -- Credentialing -- UR -- Accounting -- Claims and Encounters -- Program Development -- Quality of Care -- Rules in EFL -- Programs -- Predictive Modelling Metadata, Security, Access & Control Foundation Systems Integration Architecture Enterprise Network Architecture Real-time Applications Transaction Processing Clinical & Research -- Security, Access & Control -- Metadata -- Databases -- Tables -- Requirements -- CAD -- Source Code Pages and Functions -- Selective Transparency -- Internal Organizations -- External Organizations -- Partners -- Regulators -- s -- Consumers and patients

9 Integrated Applications, Vocabulary, Transaction Processing, Rule Engine & One Logical Database Medical Device Webservices Care Manager Applications --Analytics --Case --EMR/PHR/CDR --Claims & Encounters --Signal Detection --UR --Credentialing --Reporting & Research --Messages --Disease --EAP --Disability --Worker s Compensation --Reinsurance Server Processes Rule engine HTML Cloud - Clinical - Adminstrative - HTML PL/SQL -- Server Processes -- APEX Processes Oracle Databases - Real-time and transaction processing -Central control for all processing - Single Audit point - PL/SQL Function Calls -Transaction Queues -- transactions -- webservices Transaction Processing -- Oracle Queues -- Real-time sessions Dictionary Rules Proceesses

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