SBIR Phase II: A Blockchain Ecosystem for Encrypting Real World Data and Developing Artificial Intelligence to Optimize Pharmacy Prior Authorization

SBIR 第二阶段：用于加密现实世界数据和开发人工智能以优化药房预授权的区块链生态系统

• 批准号: 2200163
• 负责人: Mark Stephenson
• 金额: $ 100万
• 依托单位: RED OAK STRATEGIC, LLC
• 依托单位国家: 美国
• 项目类别: Cooperative Agreement
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-05-01 至 2025-04-30
• 项目状态: 未结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=2200163&HistoricalAwards=false
• 关键词: SBIR; Phase; II; Blockchain; Ecosystem

The broader impact/commercial potential of this Small Business Innovation Research (SBIR) Phase II project is to significantly reduce administrative inefficiency in pharmaceutical benefit management processing. The specific focus is on prior authorization processing, where payers and prescribers must reach a consensus on medical necessity. The project delivers a solution to optimize prescription authorization and provide more comprehensive patient histories for clinical authorization criteria fulfillment than other available products on the current health technology market. Lack of efficient access to reliable patient histories is the principal reason for delayed authorizations, resulting in delayed care access. A 2022 survey showed 93% of physicians reported that prior authorization often or always creates care delays; 82% reported delays that led to treatment abandonment. A secure yet progressively decentralized patient data transfer protocol would heighten transparency of clinical decision-making processes and also increase opportunities for patient engagement during prior authorization of medical prescriptions. Further, since administrative costs increase the cost of benefits, which in turn increases the cost of care access, the potential commercial impact is that payers who lower administrative costs will be better positioned to offer higher reimbursement rates for a greater range of quality treatment options, at increasingly lower cost.This SBIR Phase II project proposes to deliver a distributed ledger with smart contracts specific to the domain of pharmaceutical benefits. Since the cause of processing inefficiency lies with siloed and incomplete patient histories, this protocol resolves administrative inefficiencies through distributed ledger technology supporting fast and compliant encrypted health data sharing among prescribers, payers, and patients. Research objectives include: 1) automating criteria fulfillment to reduce administrative waste; 2) leveraging machine learning to automate simpler case reviews; and 3) designing a shared interorganizational processing protocol capable of adapting to an introduction of revised clinical standards. Smart contracts will be deployed to a distributed ledger infrastructure to formalize and enforce clinical standards as well as contractually specified financial rules and actuarial analyses at an interorganizational level. With smart contracts embedded in the authorization process to automatically curate more robust clinical histories over each prescription lifecycle, available real world data meeting contractually specified quality standards for clinical review will increase. Historical authorization data will feed back into incrementally complex cases, advancing artificial intelligence for authorization decision support. The expected result is improved real-time insight into clinical risk, affording payers the ability to financially and strategically adapt to patient needs with increasing precision and agility.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.

这项小型企业创新研究（SBIR）II期项目的更广泛的影响/商业潜力是显着降低药品福利管理处理中的行政效率低下。具体的重点是事先授权处理，付款人和处方者必须就医疗必要性达成共识。该项目提供了优化处方授权的解决方案，并与当前卫生技术市场上的其他可用产品相比，为临床授权标准履行提供了更全面的患者历史。缺乏有效访问可靠的患者历史是延迟授权的主要原因，导致护理范围延迟。 2022年的一项调查显示，有93％的医生报告说，先前的授权经常或始终会产生护理延迟。 82％的人报告延迟导致治疗放弃。安全但逐步分散的患者数据传输方案将提高临床决策过程的透明度，并在事先授权医疗处方期间增加患者参与的机会。此外，由于行政成本增加了福利成本，进而增加了护理访问的成本，因此潜在的商业影响是，较低的行政成本的付款人可以更好地适应较高的质量治疗选择范围的偿还率，以越来越较低的质量治疗方案（以越来越低的成本）。该SBIR II阶段II阶段项目提议通过智能分布式合同提供特定于药品的智能分布式税务分布式，这些分布式税收范围涉及药品公司的智能收益。由于处理效率低下的原因在于孤立且不完整的患者历史，因此该协议通过分布式分类帐技术解决了行政效率低下，从而支持快速，合规的加密数据共享共享处方者，付款人和患者。研究目标包括：1）自动化标准实现以减少行政浪费； 2）利用机器学习以自动化更简单的案例审查； 3）设计共享的组织间处理方案，能够适应修订后的临床标准。智能合约将部署到分布式分类帐基础架构，以正式化和执行临床标准，以及在组织层面上指定的财务规则和精算分析。随着授权过程中嵌入的智能合约，可以在每个处方生命周期内自动策划更健壮的临床历史，可用的现实世界数据会议会议合同指定的临床审查质量标准将增加。历史授权数据将反馈到渐进式复杂的案例中，以促进人工智能以供授权决策支持。预期的结果是改善了对临床风险的实时洞察力，使付款人能够以越来越高的精度和敏捷性在经济上和战略上适应患者需求。该奖项反映了NSF的法定任务，并被认为值得通过基金会的知识分子优点和更广泛的影响标准通过评估来进行评估。