There are two parts of this project:
We receive medical information from different insurance carriers on their members. Types of medical information received; claims data, prescription data, hedis gaps, MLR Scores, Revenue, member master lists. Different carriers provide the information in different formats; some Access databases, some CSV files. We get new files from the carriers every month. There are currently 4 different carriers we receive this kind of data. The job is to create a master MSSQL database of all this information, and then create the ability to merge newer files from different carriers into the master database, thereby normalizing the data so we can query across multiple carriers. This will require mapping the data from the different files in the carrier files provided us to the master database tables. Typically the files we receive are cumulative, meaning when we receive a new file, it contains data from all previous files given to us, plus new data.
After merging the data into the master database (we'll call it the Carrier Tracking database), a patient matching process must be executed against our Practice Management system, to match up the patient in our PM system to the Carrier Tracking database and record the Patient ID in the Carrier Tracking database. This will make it possible, among many other things, to identify new patients that we may have never seen before.
We can then query all the carrier data we receive from different carriers as we need.
After accomplishing Part 1, we will work to extend the capabilities by creating standardized reporting and graphs within a desktop program written in Delphi 2007. Some of the work will involve standard reports and graphs, and some work will be providing a unique user interface with resulting data based on patients that are being accessed by the EHR on the same desktop. We already have a basic framework laid out, including event notification of a patient change with the EHR via a TCP/IP inbound message with patient identifier. The goals will be to provide clinical staff information relevant to what is needed for the patient, which includes what the patient insurance carrier needs there are - which will be in the Carrier Tracking database.
All work will be done in a test environment with no real patient information.