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(12) United States Patent (10) Patent No.: US 7,917,525 B2 Rawlingswi Et All E 45) Date of Patent : Mar.E 29, 2011

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(12) United States Patent (10) Patent No.: US 7,917,525 B2 Rawlingswi Et All E 45) Date of Patent : Mar.E 29, 2011 USOO791 7525B2 (12) United States Patent (10) Patent No.: US 7,917,525 B2 RawlingsWi et all e 45) Date of Patent : Mar.e 29, 2011 (54) ANALYZING ADMINISTRATIVE 5,956,689 A 9/1999 Everhart, III ..................... 705/3 HEALTHCARE CLAMS DATA AND OTHER 5,970,463 A 10/1999 Cave et al. ..... ... TOS/3 5,970.464 A 10/1999 Apte et al. ......... ... TOS/4 DATASOURCES 6,014,631 A 1/2000 Teagarden et al. ... TOS/3 6,137,911 A 10/2000 Zhilyaev ............ 382,225 (75) Inventors: Jean Rawlings, Roy, UT (US); David 6,151,581. A 1 1/2000 Kraftson et al. ... TOS/3 Anderson, Chaska, MN (US); Carl 6,223,164 B1 4/2001 Seare et al. .... ... TOS/2 Kraus, Raleigh, NC (US); Andrew 6.253,186 B1 6/2001 Pendleton, Jr. ... TOS/2 r s s 6,370,511 B1 4/2002 Dang ............. ... TOS/3 Paris, Victor, NY (US) 6,732,113 B1 5/2004 Ober et al. .................... 707/102 (73) Assignee: Ingenix, Inc., Eden Prairie, MN (US) (Continued) (*) Notice: Subject to any disclaimer, the term of this FOREIGN PATENT DOCUMENTS patent is extended or adjusted under 35 EP 1420344 A2 * 5, 2004 U.S.C. 154(b) by 357 days. OTHER PUBLICATIONS (21) Appl. No.: 11/567,577 Grunwald et al., “Analysis of Genotypic Diversity Data for Popula (22) Filed Dec. 6, 2006 tions of Microorganisms.” Phytopathology, 93:738-746, 2003. 1C ec. O, (Continued) (65) Prior Publication Data US 2007/O174252A1 Jul 26, 2007 Primary Examiner — John R. Cottingham s Assistant Examiner — Susan F Rayyan Related U.S. Application Data (74) Attorney, Agent, or Firm — Fulbright & Jaworski L.L.P. (60) Synal application No. 60/742,774, filed on Dec. (57) ABSTRACT s Techniques suitable for identifying potential Subjects for a (51) Int. Cl. clinical trial and other applications are disclosed. One or more G6F 70 (2006.01) exclusion or inclusion criteria are defined for the clinical trial. GO6F 17/30 (2006.01) One or more specialized searching tables are pre-generated (52) U.S. Cl. ............................. 707f758. 707/941, 705/2 using administrative healthcare claims data and the one or (58) Field of Classification Search s 707f1-3 more exclusion or inclusion criteria. The specialized search See application file for complete search historv. ing tables are searched.- 0 Through the searching step, Subjects pp p ry are identified within the administrative healthcare claims data (56) References Cited who match the one or more exclusion or inclusion criteria. Through the searching step, a geographical area is identified U.S. PATENT DOCUMENTS corresponding to the Subjects who match the one or more 5,191.522 A 3, 1993 Bosco et al. ...................... 705/4 exclusion O inclusion criteria. A customized report is gener 5,197,024 A 3, 1993 Pickett ......... 708/517 ated using the identified Subjects and geographical area. 5,557.514 A 9, 1996 Seare et al. ...7052 5,835,897 A 1 1/1998 Dang ................................ 705/2 13 Claims, 11 Drawing Sheets zoo 2O2 Pre-generate factorial table 204 w Search administrative healthcare claims data 2O6 w Compare one subset wersus others 208 w Calculate hypergeometric statistical result 210 w Detect fraud/rate physician etc. US 7,917,525 B2 Page 2 U.S. PATENT DOCUMENTS 2004/0260577 Al 12/2004 Dahlin et al. ..................... 705/2 6,799,124 B2 9/2004 Perdue et al. ................... TO2/34 2005/00 10443 A1 1/2005 Zammitt ...... 705/2 2005, 0071189 A1 3/2005 Blake et al. .. 705/2 6,826,536 B1 1 1/2004 Forman ....... 705/4 2005.0114334 A1 5/2005 Ober et al. ........................ 707/9 2001/00 16842 A1* 8, 2001 Umen et al. 707/1 2005/02O3776 A1 9/2005 Godwin et al. ................... 705/3 2001/0034631 A1 10, 2001 Kiselik .......... 705/8 2005/0228593 A1 10, 2005 Jones .............. 702/19 2002fOOO2474 A1 1/2002 Michelson et al. 705/3 2005/0228808 A1 10, 2005 Mamou et al. .. 7O7/1OO 2002/01383.06 A1 9, 2002 Sabovich ........... 705/3 2005/023474.0 A1*ck 10/2005 Krishnan et al. .................. 705/2 2002fO165762 A1 11/2002 Goldman et al. 70.5/10 ck 2002/0173990 A1 11/2002 Marasco ........ 705/2 2005/0234968 A1*ck 10/2005 Arumainayagam et al. .. 707/102 2005/0283466 A1* 12/2005 Dettinger et al. ...... 707 3 2003/004.6114 A1 3/2003 Davies et al. 705/3 2006, OO15325 A1 ck 1/2006 Moore ............ 704/9 2003, OO65740 A1 4, 2003 Allen .......... 709/217 2007/0271214 A1* 11/2007 Sumino et all 707/1 2003/0191664 A1 10, 2003 Blumenfeld ...................... 705/2 . 2004/0044654 A1 3/2004 Ballenger et al. 707/3 OTHER PUBLICATIONS 2004f0078216 A1 4/2004 Toto .................................. 705/2 2004f0078220 A1 4/2004 Jackson ............................ 705/2 Wu, "An Accurate Computation of the Hypergeometric Distribution 383-8658 A. 2. Sisley et al. 293 Function.” ACM Transactions. On Mathematical Sofiware, 19:33-43, 2004/0153435 A1* 8/2004 Gudbartsson et al. 707/1 1993. 2004/0172293 A1 9/2004 Bruschi et al. ..... 705/2 PCT International Search Report and Written Opinion, issued in 2004/0210457 A1 10, 2004 Sameh ........ 705/2 International Application No. PCT/US 06/61691, dated Feb. 14. 2004/O220831 A1* 11, 2004 Fabricant .... 705/2 2008. 2004/0236601 A1 11/2004 Summers et al. 705/2 2004/024.9677 A1* 12/2004 Datta et al. ........................ 705/3 * cited by examiner U.S. Patent Mar. 29, 2011 Sheet 1 of 11 US 7,917,525 B2 100 102 Define exclusion/inclusion Criteria 104 Pre-generate specialized searching table(s) 106 108 ldentifyh patients/ professionals & geography 110 Generate Customized report FIG. 1 U.S. Patent Mar. 29, 2011 Sheet 2 of 11 US 7,917,525 B2 200 202 Pre-generate factorial table 204 Search administrative healthCare claims data 2O6 Compare one subset Versus others 208 Calculate hypergeometric Statistical result 210 Detect fraud/rate physician etc. FIG. 2 U.S. Patent Mar. 29, 2011 Sheet 3 of 11 US 7,917,525 B2 304 if it, it did, if fy if f f 4Riyadiyyyyaf f yy ys FFF Fif F if FR FF 44RyfyFyfyiyyid AR fyly, AR 4 y H FIG. 3 U.S. Patent Mar. 29, 2011 Sheet 4 of 11 US 7,917,525 B2 Enter title here Enter title here U.S. Patent Mar. 29, 2011 Sheet 5 of 11 US 7,917,525 B2 Enter title here 88 : U.S. Patent Mar. 29, 2011 Sheet 6 of 11 US 7,917,525 B2 Acute Coronary Syndrome Diaetic acareera Non-Hodgkins lyinphona Acte LekaeriaS Diabetic Meuropathy Obesity ADH Eri Stage Renal Disease O3Sessive-Compulsive disorder Allergic Riinitis Epilepsy Oriopharyngeal Candidiasis Allergy Erectile Dysfunctio Osteoarthritis eire's sease Gastric Symptoms Overactive Bladder (OAB) Area Gastreiteitis Painful Diabetic Neuropathy Aeria in Cance Faents 6astroesophageal Reflux Disease Paisle Argirls Generalized Anxiety Disorder Pakirs risisease Anisometropia and for Amblyopia acca Post-Operative Pain orthopedic) Asia Healthy Wolunteers (Analgesia Premenstral Dysphoric Disorder Benign Prostac Hyperplasia (BPH) Her philia Postate Carcer Bipolar Disorder Hepatitis B Fariasis Bore farrow Transpart Hepatis C Rigrati Atrig Brains Harmone Replacement Therapy Riritis Breast Carcer Adjuvant) Haar immunodeficiency Wirus (HIW Schizophrenia Breast Cancer (Advanted Metastatic Hypercholesterolena SeaStral Affectiye Disorder Brocits Hyperlipidemia Sexual sysfunction Chronic Immune Thrombocytopenic Purpura irritable Bowe Syndrone Small Celling Cancer (SCLC) Chronic Inflammatory Demyelinating Polyneuropathy Major Depressie Disorder Sroking Cessation Chronic, Non-alignant Pain Soelia Sgia Pi Congestive Heart failure Migraine Strike CFD Mild Cognitive impairment Systeris Luptas Erythematosis Cronary Artes isease Multiple Sclerosis Ps Dementia titley Bodies Myocarcial triarction Ulcerative Colts O3es Non Small Ceil Larg Carcer (NSCLC) Urinary Tract infection FIG. 5 U.S. Patent Mar. 29, 2011 Sheet 7 of 11 US 7,917,525 B2 DC Codes DX: 042:HIV DISEASE (23718) OX: 042.0:HIV & SPECIFIC INFECTION (68) DX: 043:HIV INFECTION (3) DX: 043,2HIV-CAUSED IMMUN DISEASE (1) DX 043.3:HIV CAUSING DISEASE NEC (13) DX 0440 HIV WITH ACUTE INFECTION (4) DX 044.9 HIV INFECTION NOS (71) DX W08 ASYMPTOMATIC HIV STATUS (5634) Female FIG. 6 U.S. Patent Mar. 29, 2011 Sheet 8 of 11 US 7,917,525 B2 Age Distribution s s ts scies, sississ & S 3 is Age it. Years as if Today Top 22ip 3 regions ric Patiers is ... : : :::: 3:33. 3rtists es; eiser: ,3: ... ck:Fix's is : ...a 53ds is s: sri:"... skiss rise Assis is Fists as U.S. Patent Mar. 29, 2011 Sheet 9 of 11 US 7,917,525 B2 HW Patient Distributior H. Ragicins 2::1: its 2 its 'i & S. its ( fries: sy lar is sigs: as: 25. FIG. 8 U.S. Patent Mar. 29, 2011 Sheet 10 of 11 US 7,917,525 B2 - Figars : 28; 3. is 73: 3 S. e. g. 3: is a 3: 3 *(iii:S sit.: fast's s s | r s : ore sever : : : 8. 3 U.S. Patent Mar. 29, 2011 Sheet 11 of 11 US 7,917,525 B2 100 75 50 25 Billing Code X FIG 10 US 7,917,525 B2 1. 2 ANALYZING ADMINISTRATIVE classes of analysis that are impractical or impossible to per HEALTHCARE CLAIMS DATA AND OTHER form on very large data sets, no matter how powerful the DATASOURCES database engine. Administrative Healthcare Claims Data for Clinical Trials This application claims priority to, and incorporates by 5 Clinical trials rely on voluntary participation of study sub reference in its entirety, U.S. Provisional Patent Application jects to evaluate new drugs, medical devices, or other inter Ser. No. 60/742,774 entitled, “Analyzing Administrative ventions. Trials may also be directed to, among other things, Healthcare Claims Data and Other DataSources, which was evaluating procedures for detecting or diagnosing a particular filed on Dec.
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