The present invention offers a comprehensive solution to care management
which aggregates, integrates and stores clinical information from
disparate sources. The system finds at-risk individuals before they
experience preventable, high-cost medical events and stratifies high risk
populations according to clinical criteria, which can include severity of
disease states and co-morbidities. The system also compares the actual
care an individual is receiving to established standards of clinical
excellence and, if necessary, suggests pertinent medical care
considerations to improve the care of medically mismanaged individuals.
Another feature of the present invention may include a secure,
patient-specific Web page which is automatically populated with a
patient's own clinical information and can be personalized with
customized, relevant healthcare information. The system allows users to
design, facilitate and monitor clinical care plans and increase
communications among physicians, nurses and patients. The system also
predicts and analyzes the outcome of disease or case management for
populations and individual patients.
