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.

该小企业创新研究 (SBIR) 第二阶段项目的更广泛影响/商业潜力是显着减少药品效益管理处理中的行政低效率。具体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。该项目提供的解决方案可以优化处方授权，并提供比当前健康技术市场上其他可用产品更全面的患者历史记录，以实现临床授权标准。无法有效获取可靠的患者病史是授权延迟的主要原因，从而导致护理服务延迟。 2022 年的一项调查显示，93% 的医生表示，事先授权经常或总是会造成护理延误； 82% 的人报告延误导致放弃治疗。安全且逐步分散的患者数据传输协议将提高临床决策过程的透明度，并增加患者在医疗处方事先授权期间参与的机会。此外，由于管理成本增加了福利成本，进而增加了获得护理的成本，潜在的商业影响是，管理成本较低的付款人将能够更好地为更广泛的优质治疗选择提供更高的报销率， SBIR 第二阶段项目建议提供一个带有特定于制药效益领域的智能合约的分布式账本。由于处理效率低下的原因在于孤立且不完整的患者历史，该协议通过分布式账本技术解决了管理效率低下的问题，支持处方者、付款人和患者之间快速且合规的加密健康数据共享。研究目标包括：1）自动执行标准以减少行政浪费； 2）利用机器学习来自动化更简单的案例审查； 3) 设计一个共享的组织间处理协议，能够适应修订后的临床标准的引入。智能合约将部署到分布式账本基础设施中，以在组织间正式制定和执行临床标准以及合同规定的财务规则和精算分析。通过嵌入授权流程中的智能合约，可以在每个处方生命周期中自动管理更可靠的临床历史，满足合同规定的临床审查质量标准的可用真实世界数据将会增加。历史授权数据将反馈到日益复杂的案例中，推进人工智能以支持授权决策。预期结果是提高对临床风险的实时洞察力，使付款人能够在财务和战略上以更高的精度和敏捷性适应患者需求。该奖项反映了 NSF 的法定使命，并通过使用基金会的知识进行评估，被认为值得支持。优点和更广泛的影响审查标准。