Abstract:
A computerized system and method allows a health care practitioner treating a patient at a point of care to comply with a variety of rules and procedures. Compliance with the rules and procedures is required for payment approval by a health care payer such as a health maintenance organization (HMO) or other health insurer.

Description:
CROSS REFERENCE TO RELATED CASE  
       [0001]    This claims priority to and the benefit of U.S. Provisional Patent Application Ser. No. 60/196,050 filed Apr. 10, 2000, the entirety of which is hereby incorporated by reference. 
     
    
     
       TECHNICAL FIELD  
         [0002]    The present invention relates to a computerized system and method for the capture, processing, and management of health care related information for the purpose of expediting payment and complying with rules and procedures enforced by various health care third party payers.  
         BACKGROUND INFORMATION  
         [0003]    In the environment of health care today there is a great demand placed upon physicians and hospitals to handle large amounts of information, such as the data required for receiving payment approval from, for example, a health maintenance organization (HMO). A health care provider or practitioner is typically required to refer to code books or manuals provided by the HMO&#39;s and other insurance companies to determine how to properly report practitioner-patient encounters in order to receive payment approval from the HMOs or other health insurance companies.  
           [0004]    These code books are often outdated, inaccurate, and extremely cumbersome to handle. Even if physicians are able to locate current and accurate information in the code books, the process is extremely time consuming and inefficient. As the patient load of physicians and other healthcare workers or staff has increased, it has become very difficult, to stay abreast of the various codes, rules, and procedures required to secure payment approval from the various different HMOs and other health insurance companies and health care payers.  
           [0005]    The conventional approaches to other health care matters, such as record keeping, practitioner referrals, and health care testing, also present similar problems, in that it is difficult to identify current and accurate information on the requirements of the different HMO&#39;s and other health insurers and payers. Physicians are often effectively unable to ascertain which specialists accept which insurance carriers and to ascertain the details of testing requirements of insurance companies and other health care payers.  
         SUMMARY OF THE INVENTION  
         [0006]    The invention provides a computerized system, including a portable device and associated software, for use by health care practitioners including physicians, hospital staff, and other health care providers at the point of patient care. The portable device facilitates compliance with rules and procedures enforced by various health care insurers as a condition for payment approval for patient care and for affiliation with the particular health care insurer. The device enables a health care practitioner to perform appropriate actions and to capture and process information relevant to health care insurer rules and procedures while interacting with a patient during a practitioner-patient encounter.  
           [0007]    In one embodiment, the invention is a system for facilitating compliance with rules and procedures required for payment approval from a health care payer in connection with an encounter between a health care practitioner and a patient. The system includes a portable device for use at a point of patient care by the health care practitioner.  
           [0008]    The portable device includes memory for storing information that facilitates the health care practitioner&#39;s compliance with the rules and procedures required for payment approval from the health care payer in connection with the encounter, and includes input mechanism for receiving input from a user at least during the encounter and at the point of care; and an output mechanism for providing output to the user at least during the encounter and at the point of care and optionally includes a processor, where the information stored in the memory includes instructions for execution by the processor, and wherein the information also includes data that represents the rules and procedures required for payment approval from at least one health care payer in connection with the encounter.  
           [0009]    The portable device enables the user to communicate to it a diagnosis, health care directive for the patient that includes drug medications and health care procedures to be applied to the patient and progress notes related information including category identification and voice or text commentary as applied to the patients health status.  
           [0010]    The portable device responds to the communicated health care directive by communicating information to the user that constitutes notice that the health care directive violates compliance with at least one rule or procedure required for payment approval by a health care payer in association with the encounter.  
           [0011]    The portable device enables the user to communicate a request for the portable device to calculate a visit level classification based at least upon one or more diagnosis&#39;s and health care directives and progress note related information input into the portable device.  
           [0012]    The portable device includes a voice input mechanism that enables capture and storage of voice information regarding at least one category or issue associated with the encounter and enables the user to identify at least one category or issue associated with the encounter, and where the user can direct the portable device to store a portion of voice information in association with the at least one category or issue.  
           [0013]    The user can communicate a query to the device for identifying remaining actions required for compliance with rules and procedures required for payment approval by a health care payer in association with the practitioner-patient encounter.  
           [0014]    The device responds to the query by communicating at least one prompt to the user, the prompt communicating a directive for performing at least one action, and where the user responds to the at least one prompt by communicating information to the device representing or constituting the performance the at least one action.  
           [0015]    The system can further include a computer connected to the portable device via a first communications channel, the computer receiving information generated by the portable device in connection with the encounter and a data store connected to the computer via a second communications channel, the data store receiving and storing information generated by the portable device in connection with the encounter.  
           [0016]    In another embodiment, the invention is a method for facilitating compliance with rules and procedures required for payment approval from a health care payer in connection with an encounter between a health care practitioner and a patient. The method includes the steps of providing at least one portable device, the portable device for use at a point of patient care by the health care practitioner, the portable device including a memory for storing information that facilitates the health care practitioner&#39;s compliance with the rules and procedures required for payment approval from the health care payer in connection with the encounter and including an input mechanism for receiving input from a user at least during the encounter and at the point of care; and including an output mechanism for providing output to the user at least during the encounter and at the point of care.  
           [0017]    In another embodiment the invention is a method for facilitating compliance with rules and procedures required for payment approval from a health care payer in connection with an encounter between a health care practitioner and a patient. The method includes the steps of receiving via a first communications channel, information generated by at least one portable device in connection with the encounter; storing the information generated by at least one portable device in connection with the encounter.  
           [0018]    In another embodiment the invention is a method for facilitating compliance with rules and procedures required for payment approval from a health care payer in connection with an encounter between a health care practitioner and a patient. The method including the steps of providing at least one portable device, the portable device for use at a point of patient care by the health care practitioner, the portable device including a memory for storing information that facilitates the health care practitioner&#39;s compliance with the rules and procedures required for payment approval from the health care payer in connection with the encounter and including an input mechanism for receiving input from a user at least during the encounter and at the point of care; and including an output mechanism for providing output to the user at least during the encounter and at the point of care. The method also including the step of receiving via a first communications channel, information generated by the at least one portable device in connection with the encounter and storing the information generated by the at least one portable device in connection with the encounter.  
           [0019]    Other features, aspects and advantages will become more apparent from the following description when taken in conjunction with the accompanying drawings. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0020]    The drawings are not necessarily to scale, the emphasis instead is placed on conveying the concepts of the invention:  
         [0021]    [0021]FIG. 1 is a diagram illustrating components of a health care payment and compliance management system according to an embodiment of the invention.  
         [0022]    FIGS.  2 A- 2 C are diagrams illustrating the exterior features and internal components of a portable hand held device according to an embodiment of the invention.  
         [0023]    FIGS.  4 A- 4 D are a diagrams illustrating appointment and payer information portions of the portable device software user interface according to an embodiment of the invention.  
         [0024]    FIGS.  5 A- 5 D are a diagrams illustrating diagnosis selection portions of the portable device software user interface according to an embodiment of the invention.  
         [0025]    FIGS.  6 A- 6 F are a diagrams illustrating drug selection portions of the portable device software user interface according to an embodiment of the invention.  
         [0026]    FIGS.  7 A- 7 C are a diagrams illustrating visit classification selection portions of the portable device software user interface according to an embodiment of the invention.  
         [0027]    [0027]FIG. 8 illustrates the type of information flowing between the portable device and the central data store components of the health care payment and compliance management system according to an embodiment of the invention.  
         [0028]    [0028]FIG. 9 illustrates the type of information flowing to and from the billing and transcription service components of the health care payment and compliance management system according to an embodiment of the invention.  
         [0029]    [0029]FIG. 10 is an diagram illustrating the execution of the checker program and the types and various sources of information resident inside of the central data store according to an embodiment of the invention. 
     
    
     DESCRIPTION  
       [0030]    Referring to FIG. 1, one embodiment of a system  100  according to the invention is used to capture, store, and manage information associated with an encounter between a health care practitioner  114   b  (such as a physician) and a patient  114   a  at a health care facility  110   a  (such as the physician&#39;s office) or other location. Multiple facilities  110   b - 110   n  are shown, and each typically will include some or all of the hereinafter-described aspects of the facility  110   a . The information associated with any encounter between the health care practitioner  114   b  and the patient  114   a  (for example, an office visit during which the practitioner  114   b  examines and/or diagnoses the patient  114   a ) includes information required for record keeping and required for ultimately obtaining payment approval from at least one health insurer, also referred to herein as a payer, associated with the patient  114   a.    
         [0031]    The health care practitioner  114   b  typically encounters or meets with the patient  114   a  within the vicinity of the health care facility  110   a . The location of this encounter is also referred to as “the point of care.” or “place of service”. This location actually maps to a place of service code (POS) used for billing purposes. During the meeting, the practitioner  114   b  at least assesses a health concern of the patient  114   a . The patient&#39;s health concern may be related to a minor or major or health problem. In accordance with the invention, a portable device  116  facilitates the performance of the practitioner&#39;s  114   b  responsibilities associated with the encounter.  
         [0032]    The portable device  116  can be a hand held, notebook, laptop or any other type of small portable computer that can input, output, and process the types of information that are described herein, such as data required for record keeping including, for example, voice and data required for representing compliance with rules and procedures satisfying at least one health care insurer or payer. Theses rules and procedures include but are not limited to those required for payment approval or required to acquire or maintain affiliation with the health care payer.  
         [0033]    Some health care payer required procedures involve requiring the practitioner  114   b  to provide particular information to the health care payer in a timely manner in order to ensure payment approval of payment for the patient encounter. Other health care payer required procedures may require the practitioner  114   b  to provide information to other parties, or to document his or her actions for later use during an audit, for example, by the health care payer, another health care authority or a government or law enforcement agency.  
         [0034]    Each payment for an encounter by a health care insurer or payer is typically conditioned upon the completion of certain actions or procedures. These actions are typically performed by the entity or entities, for example, the practitioner who request a payment for work performed in an encounter. These actions can include providing certain encounter related information to the payer within a limited time period defined by the payer. For example, such actions could include providing information describing the diagnosis, the drug medication, and the medical procedures prescribed by the health care practitioner  114   b  for the patient during an encounter.  
         [0035]    Such information may be required by each payer to be specified via a particular set of terminology and coding scheme and delivered to the payer in particular textual or data format. A payer may require the practitioner to provide information revealing the identity, health care specialty and affiliation of another practitioner that referred the patient  114   a  to the practitioner  114   b , resulting in the encounter. Other payer required actions made include actions by parties other than the entity or entities requesting payment, such as by an independent medical testing facility.  
         [0036]    Each payer can establish its own rules defining what procedures must be performed as condition for maintaining an affiliation with the payer or performed as a condition before payment will be approved. Some or all of these payer established rules  1082  can be adopted by a payer from another authority, such as Medicare  1081 . The payer can add to or subtract from the requirements established by Medicare. These are referred to as exceptions. Payment associated with an encounter may not be entirely for actions occurring during the encounter. For example, services performed by a medical testing facility at the request of a practitioner during or in response to an encounter with a patient may be permitted to be payment approved and paid by a payer in association with the encounter.  
         [0037]    The portable device  116  is portable in the sense that it allows the practitioner  114   b  easily to carry the device  116 , by using one or both hands, to the location of one or more patients  114   a  (i.e., to one or more “points of care”). The patients  114   a  typically are waiting in separate examination rooms. Neither the practitioner  114   b  nor the patient(s)  114   a  need to travel to the location of the device  116 . The practitioner  114   b  and/or another person or persons  114   c  (such as the practitioner&#39;s  114   b  assistant or a nurse) can directly use the device  116 .  
         [0038]    The device  116  provides a user interface  116   a  that includes an input and an output mechanism. The input mechanism, including for example a keyboard, touch sensitive display screen, pointing device, voice recording Dictaphone or trackball enables the user  114   b ,  114   c  to communicate information to the device  116 . The output mechanism, including for example a touch sensitive display screen, voice, sound or vibration generator, enables the device  116  to alert or communicate information to the user  114   b - c.    
         [0039]    The computer  112 , located within the health care facility, provides a user interface  112  and communicates with another computer  130  typically located at a central information facility  120  via another communications channel  118   a . The other health care facilities  110   b - 110   n  also communicate with the central computer  130  via communications channels  118   b - 118   n  respectively. Typically, some or all of the health care facilities  110   a - 110   n  are located remotely from the centralized health care information facility  120 . Consequently, the communications channels  118   a - 118   n  are more likely to involve the use of longer range communications mechanisms such as wide area computer networks including the Internet. In one disclosed embodiment, the Internet is the computer network linking the individual computers  112  at the various health care facilities  110   a - 110   n  to the central computer  120 .  
         [0040]    The computer  112  provides a user interface  112   a  for interaction with a user of the computer  112 , referred to in FIG. 1 as a clerk  114   d . An Internet browser program can provide a user interface for communicating over the Internet network. The clerk  114   d  could be the practitioner  114   b  or any other user  114   c  of the portable device  116  but more typically will be an administrative office worker at the facility  110   a.    
         [0041]    The computer  130  has input/output access to a central data store  136 , typically located at the central information facility  120 . In one disclosed embodiment, all of the communications channels  118   a - 118   n ,  122   a - 122   n  and  124   a - 124   n  are Internet communications paths, although other types of network connections are possible.  
         [0042]    The central data store  136  stores information associated with a plurality of the patients  114   a , practitioners  114   b , health care facilities  110   a - 110   n , billing service facilities  140   a - 140   n , transcription service facilities  150   a - 150   n  and health insurance companies or payers. Health care payer associated information includes rules and procedures from a variety of health care payers regarding the requirements for maintaining an affiliation with the payer or for receiving payer payment approval for any particular health care practitioner-patient encounter. These rules and procedures can be populated into the central data store  136  manually or electronically via a secure access mechanism  134 , by central information facility personnel, by one or more of the billing service providers  140   a - 140   n  or directly from one or more health insurers, for example.  
         [0043]    The central data store  136  can be implemented from a variety of non-volatile data storage hardware, such as hard disks, read-only and write enabled CD ROMS, tape or the like. Software such as commercial database software such as sold by Oracle or Sybase for example, or custom developed software can be utilized to interface the data store  136  to software executing on the central computer  130  and to structure some or all of the contents of the data store  136  in a particular way.  
         [0044]    The computer  130  can communicate with at least one billing service provider  140   a  and with at least one transcription service provider  150   a  via communications channels  122   a  and  124   a , respectively. Typically, a billing service  140   a - n  is associated with one or more health care payers and patients affiliated with those one or more payers. The billing service actually converts portable device generated encounter forms  841  (not shown) into bills delivered to the payer. These encounter forms  841  are generated and communicated to the billing service  140   a - n  by the system  100 . Typically, a transcription service  150   a - n  is associated with one or more health care facilities  110   a - n  or practitioners  114   b . The transcription service actually converts portable device generated voice files (“WAVE” formatted files)  842 , and transcription requests  843  into transcription files  980  containing the translated text data and communicates the text data back to the central data store  136  for storage as encounter related records.  
         [0045]    The billing service  140   a  makes use of a computer  142  providing a user interface  142   a . The transcription service  150   a  also makes use of a computer  152  providing a user interface  152   a . In some embodiments, either the billing service  140   a , the transcription service  150   a  or both are provided secure access to a portion of the information residing inside the central data store  136 . This access can be provided via the Internet where each user interface  142   a  and  152   a  employs an Internet browser to allow authorized billing sand transcription service personnel secure access to a portion of the contents of the data store  136 .  
         [0046]    Health care payer payment rules and procedures are subject to change and can be revised according to a schedule, on demand, with or without notice. The health care information data store  136 , and the device  116 , are adapted to receive revised updates of the health care payer payment rules and procedures (FIG. 10). These updates can be communicated to the data store electronically or manually. A billing services  122   a - 122   n  typically provides updates to payment rules and procedures  1081  and  1082  of payers associated with that particular billing service  122   a - n.    
         [0047]    Referring to FIGS. 2A and 2B, the hand-held device  315  externally includes a touch-sensitive screen display  350   a  and  350   b  for viewing encounter related information, a stylus  360 , which is used in conjunction with the touch-sensitive screen to communicate information including commands to the device  315 , a stylus storage compartment  365 , device communications mechanisms including an infrared port  375  for communicating with a printer and an interface port  380  for communicating with a computer such as the health care facility computer  112   a , and a power button  370 . The hand-held device  315  internally includes at least a microprocessor and memory for storing encounter related information including information associated with multiple patients and multiple health care payers.  
         [0048]    Optionally, a hand held device could also provide additional user input mechanisms such as a keypad (not shown), a Dictaphone or microphone for voice or sound input (not shown) or a track ball (not shown). The hand held device could also provide additional user output mechanisms such as a sound generator (not shown) to alert the user when the device is stored within hearing distance of the user or a vibration generator (not shown) to alert the user when the device is stored in contact with the user&#39;s body.  
         [0049]    In one embodiment the touch sensitive screen  350   a  and  350   b  can be apportioned, into two or more separate windows for displaying different collections of information. The lower approximately one third of the touch-screen  350   b  of the hand-held device  315  illustrates the size and location of a separate window, sometimes referred to as a message window  350   b . The line separating the windows  350   a  and  350   b  represents the location of a line of pixels and does not represent any physical barrier between the windows  350   a  and  350   b . This message window  350   b  can be used to display additional information related to an item displayed in the upper portion of the screen  350   a . This window  350   b  can display a touch sensitive keyboard as one user input mechanism.  
         [0050]    [0050]FIG. 2C illustrates types of internal hardware components feasible to reside inside the hand held device  315 . All components communicate with each other through at least one system bus  320 . A central processing unit (CPU)  322  and memory  336  and  340  are directly connected to the system bus  320 . Central processing unit instruction information, also referred to as firmware or software, can be stored inside the read-only memory  336  and the read-write memory  340 . The CPU accesses or fetches the contents of either type of memory via the communication of the stored software information through the system bus  320 .  
         [0051]    Read-only memory (ROM)  336  is typically of the non-volatile type, meaning that it requires no constant power to preserve the information content of its memory for later use. This type of memory typically stores “bootstrap” software which is the first type of software to execute upon powering the device to the ON state via the power button  370 . Read-write memory  340 , is typically of the volatile type, meaning that it requires constant power to preserve the information content of its memory for later use. This type of memory is commonly referred to as random access memory (RAM) and it typically stores the bulk of the software and data directly accessible CPU.  
         [0052]    The CPU  322  controls at least one user input mechanism  324 , at least one user output mechanism  326  and at least one device communications mechanism  338  via communication of command and status information via the system bus  320 . The user input mechanism  324  can receive user communicated information from a variety of sources including but not limited to a touch sensitive display screen  330 , a keypad  334  or a voice or sound input component such as a Dictaphone or microphone  332 . The user output mechanism  326  can communicate information to the user in a variety ways including but not limited to a display screen  330  of either the touch sensitive or non-touch sensitive variety, a sound generator  328  or vibration generator  342  or track ball (not shown) component. The sound generator  328  enables the device  315  to alert the user when the device is stored within the hearing distance of the user. The vibration generator  342  is used to alert the user when the device is stored in contact with the user&#39;s body.  
         [0053]    The device  116 , using its device communications mechanism  338  as an input/output mechanism, can communicate with another computer, such as a desktop computer  112  (located, for example, within the health care facility  110   a ) over a communications channel  118 . The communications channel  118  can be any connection that enables the device  116  to exchange information with the computer  112 . Such connections can include, but are not limited to, the use of portable memory modules such as flash memory storage cards, a device docking station or cradle, a cable connection (supporting, for example, some communications protocol such as RS-232, IEEE-488 or other network or point to point protocol communications interfaces), a wireless connection including an infrared port  375 .  
         [0054]    One embodiment of the hand-held device  315  for accommodating the application software of the present invention is a Windows CE palm-size personal computer, such as the Casio Cassiopeia E-125 from Casio Inc. of Dover N.J. A Compaq IPAQ H3600 hand held device or other portable computing unit executing the Windows CE 3.0 operating system is capable of accommodating the encounter software program described herein. Other small, hand-hand held, portable computing devices could be used as the hand-held device  315 , and other operating systems could be used instead of Windows CE which is available from Microsoft Corporation. A commercial embodiment of a system according to the invention is available from Parkstone Medical Information Systems, Inc. and referred to as SmartEncounter Charge Capture system. The SmartEncounter system uses the Casio Cassiopeia E-125 running Windows CE as the hand-held device  315  for executing the encounter software program.  
         [0055]    FIGS.  3 A- 3 D,  4 A- 4 D,  5 A- 5 D,  6 A- 6 D and  7 A- 7 D illustrate a series of user interface screens describing an embodiment of the invention. In this embodiment, the application software program named “Encounter”  820  executes on a hand held portable device  116  supporting the Microsoft Windows CE operating system and exchanges information with a user through a series of user interface screens.  
         [0056]    [0056]FIG. 3-A illustrates the Programs screen  210  which displays icons each representing a particular software application executing on this hand held device platform. In this embodiment, each health care practitioner is separately assigned a portable device. The device used in this embodiment is assigned to the user named “Dr. Smith”. Access to the Programs Screen  210  is password protected and restricted to a password known only by Dr. Smith. Previous to the display of the Programs Screen  210 , Dr. Smith successfully passed through the password mechanism (not shown) of this device to display the Programs screen. The icon titled “Encounter”  212  represents the software application implementing this embodiment of the invention. The user selects the “Encounter” icon  212  to initiate execution of the Encounter software application.  
         [0057]    [0057]FIG. 3-B illustrates the Appointments Screen  220  which is the initial displayed screen of the Encounter software application. Each named patient name listed below a date represents a scheduled appointment or encounter for that named patient with Dr. Smith on that date. For example, the named patient “Bob Lewis”  221  is listed as having an appointment with Dr. Smith on the date “Dec. 15, 2000”  222 . Selecting a named patient listed below a date displays an Encounter screen associated with a scheduled appointment or encounter for that named patient with “Dr. Smith” on that date. The user selects the named patient “Bob Lewis” which is temporarily highlighted and listed below “Dec. 15, 2000” to display the Encounter screen associated with that scheduled encounter.  
         [0058]    [0058]FIG. 3-C illustrates the Encounter Screen  230  which is displayed upon selecting an appointment represented by a named patient, “Bob Lewis”, listed below the date “Dec. 15, 2000”  222  from the Appointments screen of FIG. 2-B. The Encounter screen  230  lists the folder names for the folders Diagnosis  232 , Drugs  234 , Visit Classification  236  and Payer Information  238  associated with the encounter patient, “Bob Lewis”. The user can choose to open any of the listed folder names by selecting a folder name from this screen. The user selects the Payer Information folder name  238  which is temporarily highlighted on the Encounter screen  230  to display the Payer Information screen  240 .  
         [0059]    [0059]FIG. 3-D illustrates the Payer Information screen  240  which is displayed upon selecting the Payer Information folder name  238  listed on the Encounter screen  230  of FIG. 2C. The Payer Information screen  240  lists the name, address and contact information  242  associated the health insurer or payer associated with the encounter patient, “Bob Lewis”. The user selects the Return Button  249  which returns the user interface to display the Encounter screen  230  and  330  as illustrated in FIG. 3-C and FIG. 4-A.  
         [0060]    [0060]FIG. 4A illustrates the Encounter screen which is displayed as a result of the user selecting the Return Button  249  located on the Payer Information screen of FIG. 3-D. The Encounter screen  430  lists the names for the folders Diagnosis  431 , Drugs  432 , Visit Classification  433  and Payer Information  434  associated with the encounter patient, “Bob Lewis”. The user can choose to open any of the listed folders by selecting a folder name from this screen. For example, the user selects the Diagnosis folder name  431  which is displayed on the Encounter screen  430 . As a result of this user selection, the Diagnostic folder name  432  is temporarily highlighted as indicated before the display of the Diagnosis screen as shown in FIG. 4B.  
         [0061]    [0061]FIG. 4B illustrates the Diagnosis Screen-A  350  which is displayed as a result of the user selecting the Diagnosis folder name  432  listed on the Encounter screen  330  of FIG. 4A. The Diagnosis screen lists the names of folders, “Patients Previous Dx”  352 , “Neoplasm Dx”  354 , “Common Hematology Dx”  356 , “Other Common Dx”  358  and “All Diagnoses”  360  each representing a grouping of diagnosis (Dx) names. The user can choose to open any of the listed folders by selecting a folder name from this screen. For example, the user selects the Common Hematology Dx folder name  356  which is temporarily highlighted as indicated. As a result various diagnosis names stored inside the Common Hematology Dx folder  356  are listed as shown in FIG. 4-C.  
         [0062]    [0062]FIG. 4-C illustrates the listing of Diagnosis Screen-B  360  various diagnosis names “Anemia, Aplastic”, “Anemia, Hemoytic”, “Anemia Iron Deficiency”, Anemia, Normocytic”, “Anemia, Pernicious” stored inside the Common Hematology Dx folder  356  which was opened from the Diagnosis Screen-A  356 . The user can choose to select one or more diagnosis names listed by selecting one or more diagnosis names listed on this screen  360 . For example, the user selects the “Anemia, Aplastic” diagnosis name  361  which is listed on this screen. As a result of this selection, the “Anemia, Aplastic” diagnostic name  361  is temporarily highlighted as indicated. This action results in the selection of the “Anemia, Aplastic” diagnostic name as at least one diagnosis made for the patient “Bob Lewis” during this encounter. The user can un-select or toggle off the selected and highlighted Anemia, Aplastic diagnostic name by re-selecting it when it is highlighted and selected. The user presses the Return Button  369  which stores the selection of the “Anemia, Aplastic” diagnosis name and returns the user interface to display the Diagnosis Screen-A  350  as illustrated in FIG. 4D.  
         [0063]    [0063]FIG. 4D illustrates the Diagnosis Screen A  350  which is displayed as a result of the user selecting the Return button  369  displayed with the Diagnosis Screen-B  360  of FIG. 4C. The Diagnosis Screen-A  350  lists the names of folders, each representing a grouping of diagnosis (Dx) names, as discussed in FIG. 4B. The user can choose to open any listed folders, for example a folder other than “Non-Chemo Meds” by selecting a folder name from this screen. The user elects not to select any other drugs and presses the Return Button  359  which records the selection of the “Anemia, Aplastic” diagnosis name made in Diagnosis Screen-B  360  of FIG. 4C and returns the user interface to display the Encounter screen  430  as illustrated in FIG. 5A.  
         [0064]    International Classification of Disease Codes (ICD-9 Codes) represent a standard coding schema for classifying diseases. Common Procedural Terminology (CPT) classifies medical or health care procedures via procedure codes. Drugs and supplies are classified by (HCPCS) codes. These can be used by the software for representing a physician decided diagnosis, drug prescription or application and procedures.  
         [0065]    [0065]FIG. 5A illustrates the Encounter screen which is displayed as a result of the user selecting the Return Button  359  located on Diagnosis Screen-A of FIG. 4D. The user selects the “Drugs /Procedures” folder name  432  which is displayed on the Encounter screen  430 . As a result of this user selection, the Drugs/Procedures folder name is temporarily highlighted as indicated and the Drugs/Procedures Screen-A as shown in FIG. 5B.  
         [0066]    [0066]FIG. 5B illustrates the Drugs and Procedures Screen-A  450  which is displayed as a result of the user selecting the Drugs and Procedures folder name  432  listed on the Encounter screen  430  of FIG. 5A. The Drugs and Procedures Screen-A  450  lists the names of folders, each representing a grouping of drugs, supplies, and procedures. The user can choose to open any of the listed folders by selecting a folder name from this screen  450 . For example, the user selects the “Non-Chemo Meds” folder  454  name which is temporarily highlighted and displayed on the Drugs and Procedures screen  450  to list various drug (medication) names stored inside the “Non-Chemo Meds” folder  454  as shown in FIG. 5C.  
         [0067]    [0067]FIG. 5C illustrates the display of the Drugs and Procedures Screen-B  460  which lists various drug names stored inside the Non-Chemo Meds folder  454  which was opened from the Drugs and Procedures Screen-A  450 . The user can choose to select one or more drug names listed on this screen. For example, the user selects the “Benadryl, 50 mg” drug name which is listed on this screen  460 . As a result of this user selection, the “Benadryl, 50 mg” drug name  462  is highlighted as indicated.  
         [0068]    In response to this selection, the Encounter software application program  820  displays a warning  467  with the following text “WARNING: THIS MEDICATION IS NOT APPROVED BY THE PAYER IN COMBINATION WITH 289.4 ANEMIA, APLASTIC”.  
         [0069]    The user can elect to un-select the “Benadryl, 50 mg” drug by re-selecting and untoggling the highlighted drug name Or the user can elect to select one or more other drug names other than “Benadryl, 50 mg” listed on this screen  460 . FIG. 5D illustrates the user selecting “Epogen, 1000 mg” drug name  464  from the Drugs/Procedures-Screen-B  460  as a alternative to the “Benadryl, 50 mg”  462  selection not approved by the payer. Having finished making all drugs name selections below the” folder name  432 , the user then presses the Return Button  469  which records the selection of the “Epogen, 1000 mg”  466  from the “Non-Chemo Meds” folder  454  and returns the user interface to display the Drugs/Procedures Screen-A  450  as illustrated in FIG. 5E.  
         [0070]    [0070]FIG. 5D illustrates the user selecting “Epogen, 1000 mg” drug name  466  from the Drugs/Procedures Screen-B  450  as a alternative to the “Benadryl, 50 mg”  462  selection not approved by the payer. Having finished making all drugs name selections below the “Non-Chemo Meds” folder name  454 , the user then presses the Return Button  459  which records the selection of the “Epogen, 1000 mg”  466  from the “Non-Chemo Meds” folder  454  and returns the user interface to display the Drugs/Procedures Screen-A  450  as illustrated in FIG. 5E.  
         [0071]    [0071]FIG. 5E illustrates the Drugs/Procedures Screen-A  450  which is displayed as a result of the user selecting the Return Button  469  located on Diagnosis Screen-B  460  of FIG. 5D. The user having completed all drugs name selections within the “Drugs/Procedures” folder name  432 , the user again presses the Return Button  459  which records the selection of the “Epogen, 1000 mg”  466  from the “Non-Chemo Meds” folder  454  and returns the user interface to display the Encounter Screen  430  as illustrated in FIG. 5F.  
         [0072]    [0072]FIG. 5F illustrates the re-display Encounter screen  430  as a result of the user selecting the Return Button  459  located on Drugs/Procedures Screen-A  450  of FIG. 5E.  
         [0073]    The warning of FIG. 5C notifying the user that the drug medication “Benadryl, 50 mg” is not NOT APPROVED BY THE PAYER IN COMBINATION WITH 289.4 ANEMIA, APLASTIC” was the result of the encounter software program processing payer rule and procedure information supplied to the device. The payer rule/procedure information can be encoded as software readable data that represents payment approval compliance rules specified by the payer. These payment approval compliance rules can be represented as a set of relationships between a diagnosis and a heath care directive by the practitioner. The health care directive can include for example, the prescription of drug medication or health care procedure to be applied to the patient.  
         [0074]    In one embodiment, these relationships between possible diagnosis&#39;s, possible prescribed drug medications and/or prescribed procedures can be represented by the contents of a table, referred to as a rule table. A rule table can contain payment compliance rules associated with one entity, for example a health care payer or government agency, such as Medicare. Some or all of the payment compliance rules associated with a health care payer can be adopted by that payer from another authority, such as Medicare. The payer can adjust adopted rules by adding to or subtracting from the base rule requirements established by Medicare. These are referred to as payer specific rule exceptions. Positive exceptions are more permissive and less restrictive relative to the adopted base rules. Negative exceptions are more restrictive relative to the adopted base rules.  
         [0075]    In one embodiment, a rule table is associated with a payer. The rule table is a matrix of cells. Each row is defined by series of cells where each cell residing in the row resides in a separate column. Each column is defined by a series of cells where each cell residing in the column resides in a separate row. Each row of the rule table represents a possible prescribed drug medication for a patient associated with the payer. Each column of the rule table represents a possible diagnosis for the patient for a patient associated with the payer. The intersection of each row and column of the rule table identifies a single cell residing in one row and one column. Information placed in this cell can represent the relationship between the drug medication represented by the intersecting row and the diagnosis represented by the intersecting column.  
         [0076]    For example, the value of “1” stored in this cell can represent that prescribing the drug medication represented by the intersecting row is permissible for the diagnosis represented by the intersecting column according to the rules of the payer associated with this rule table. Alternatively, a value of “0” stored in this cell would represent that prescribing the drug medication represented by the intersecting row is NOT permissible for the diagnosis represented by the intersecting column according to the rules of the payer associated with this rule table.  
         [0077]    When a payer adopts rules from another entity, then the payer rule table could be interpreted as an exception rule table, that is interpreted relative to the rule table from the other entity from which rules are adopted. An exception rule table typically only contains information that differs from the adopted base rule table. For example, a value of “1” stored in a cell representing a diagnosis-drug medication pair in the exception rule table, represents a permissive relationship between the diagnosis-drug medication pair that differs from the rule of the base rule table. Alternatively, a value of “0” stored in a cell representing a diagnosis-drug medication pair in the exception rule table, represents a NONE permissive relationship between the diagnosis-drug medication pair that differs from the rule of the base rule table. A value of “2” stored in a cell representing a diagnosis-drug medication pair in the exception rule table, represents that the relationship between the diagnosis-drug medication pair is the same as that found in the base rule table. The base rule table can then be searched to determine whether the relationship is permissive or NOT permissive.  
         [0078]    Rule tables can represent relationships between diagnosis&#39;s and health care procedures, between drug medication and health care procedures, between practitioners-and affiliated payers, between practitioners and patients, between appointments, patients and practitioners and so forth. Many health care compliance rules can be modeled via one or more rule tables. Rule tables can be combined to show relationships between more than two entities. For example, a first rule table could relate appointments to patients, a second rule table could relate appointments to practitioners and the combination of the first and second rule table could relate patients and practitioners to common appointments and so forth.  
         [0079]    Rule tables can be implemented as one or more spreadsheets, such as those provided by the Microsoft Excel product or as one or more database tables such as provided by the Microsoft SQL, Oracle or Sybase database products. Database tables can be combined or joined by data base provided software to reveal relationships between different rule tables and to reveal relationships between the entities that each table relates, such as between a table that relates appointments to patients and another table that relates appointments to practitioners. The combination of these two tables for example, reveals the relationship between practitioner&#39;s and patient with respect to appointments.  
         [0080]    The portable device can enable a practitioner to input separate collections of voice information via a microphone  332 . These separate collections or portions of voice information can be stored into one or into separate voice or “Wave files”  842 . The practitioner can tag or associate a category or issue describing the patient&#39;s health status with a separate portion of voice information, store in a voice file  842 . These categories or issues can be expressed as text entered into the device  116   a  from a touch screen keyboard or from selection of issue from a list displayed on the device  116   a.    
         [0081]    These tagged voice files  842  can collectively contain some or all of what is referred to as the practitioner&#39;s progress notes concerning the patient&#39;s visit and health status. The contents of these progress notes can be categorized according to Medicare&#39;s mandated documentation requirements. The health care financing administration (HCFA) describes standard categories for documenting specific findings identified during an encounter. HCFA provides guidelines outline an algorithm for determining a visit level based on what is identified in these standard categories. The system calculates the visit classification based upon this algorithm.  
         [0082]    In one embodiment, the encounter software program can provide list of progress notes related categories or issues compliant with HCFA guidelines to be selected by the practitioner. These categories, issues or items can be “specialty specific” (e.g cardiology, orthopedics, etc.) and the categories they fall within can be Medicare mandated. Medicare mandated categories are often required for payment by third party health care payers. Health insurance companies typically follow rules set by Medicare.  
         [0083]    Categories, also referred to as issues or items, are selected by checking or selecting choices provided to the user in templates (not shown). Templates can contain user interface components including but not limited to text entry boxes, check boxes, push buttons etc. These categories can include Chief Complaint, History of Present Illness, Review of Systems, Medical Decision Making etc. The practitioner can select categories that are negative or do not apply to the health status of the patient and can otherwise elect to input voice commentary associated with a subset of these categories that do apply to the health status of the patient. Transcription request files  843  aid in associating the voice files  842  with the progress notes related categories.  
         [0084]    After completing the encounter, these voice files  842  and associate transcription requests  843  are then communicated to the data store  136  via the central computer  130  and the health care delivery computer  110   a . From the data store  136 , these voice files  842  and transcription requests  843  are delivered to a transcription service  150   a - 150   n , via the central computer  130  and the communications channel  124 , for example via an Internet Web site located on the central computer  130 .  
         [0085]    The transcription service  150   a - 150   n  translates the voice files  842  into text files, referred to as transcription files  980  and then transmits the transcription files back to the central computer  130  for storage into the data store  136 . The practitioner located at the health care facility can access these transcription files  980  and either print them as paper records for storage into the patient&#39;s health care chart, or allow these forms  980  to remain on-line accessible from the data store  136  via the central computer  130   a . The central computer  130  can provide an Internet Web site for access to these forms.  
         [0086]    [0086]FIG. 6A illustrates the Encounter screen  530  which is displayed as a result of the user selecting the Return Button  459  located on Drugs/Procedures Screen A  450  of FIG. 5F. The user selects the “Visit Classification” folder name  533  which is displayed on the Encounter screen  530 . As a result of this user selection, the “Visit Classification” folder name  533  is temporarily highlighted as indicated and the Visit Classification screen is displayed as shown in FIG. 6B.  
         [0087]    [0087]FIG. 6B illustrates the Visit Classification Screen  550  which is displayed as a result of the user selecting the Visit Classification folder name  533  listed on the Encounter screen  530  of FIG. 5-A. The Visit Classification Screen  550  lists the names of various visit classification names “LEVEL 1”  551 , “LEVEL 2 SIMPLE PROBLEM”  552 , “LEVEL 3 LOW COMPLEXITY”  553 , “LEVEL 4 DISEASE &amp; COMPLICATION”  554  and “LEVEL 5 HIGH COMPLEXITY”  555 . The visit classification chosen affects the payment amount a payer will approve. Typically, a payer will approve larger payments for a “LEVEL 5 HIGH COMPLEXITY”  555  visit classification than for “LEVEL 2 SIMPLE PROBLEM” visit classification.  
         [0088]    The user selects the “LEVEL 3 LOW COMPLEXITY”  553  visit level calculation which is highlighted. Having completed the visit level classification selection, the user selects the Return button  559  which records the selection of the “LEVEL 3 LOW COMPLEXITY” from the “Visit Classification” folder  533  and returns the user interface to display the Encounter Screen  530  as illustrated in FIG. 5-C.  
         [0089]    In one embodiment, the system will automatically calculate the visit classification based upon previous user selected diagnosis names, drugs, procedures made in association with the encounter and based upon progress notes, the issues or categories identified in association with voice input via dictation into the device. These progress notes can be categorized according to Medicare&#39;s mandated documentation requirements. The health care financing administration (HCFA) describes standard categories for documenting specific findings identified during an encounter. HCFA provides guidelines that outline an algorithm for determining a visit level based on what is identified in these standard categories. The system calculates the visit classification based upon this algorithm and stores the result in an associated encounter form.  
         [0090]    In another embodiment, the user can manually elect to select a “LEVEL CALCULATE” visit classification button (not shown) which would perform the previously described automatic calculation upon user demand to determine an appropriate visit classification as described for the automatic calculation described previous to this embodiment.  
         [0091]    [0091]FIG. 6C illustrates an alternative Encounter screen  580  which is displayed as a result of the user selecting the Return Button  559  located on the Visit Classification of FIG. 6B. The user now having completed all diagnosis name selections below the “Diagnosis” folder name  431 , and having completed all drug and procedure name selections below the “Drugs/Procedures” folder name  432 , and having completed the visit classification selection  533  below the “Visit Classification” screen  550 , the user elects to select the Done button  558  completes the encounter for “Bob Lewis”.  
         [0092]    Upon selecting the Done button  558 , the Encounter software application records the selection of the “Anemia, Aplastic” diagnosis name selection from the “Diagnosis” folder name  231  and records the “Epogen, 1000 mg” drug name from the “Non-Chemo Meds” folder  432  and records visit classification name from the “Visit Classification” folder. The user interface then returns to display the Appointment Screen  520  as illustrated in FIG. 6D.  
         [0093]    [0093]FIG. 7A illustrates a Drug Quantity popup screen  580  used to further specify the quantity of the selected drug if different that the quantity listed with the drug in the Drugs/Procedures Screen-B  460 . This popup screen displays when the user selects the quantity text displayed next to the drug name. A popup screen or window is displayed over and above existing information displayed on the screen. When the popup screen or window is un-displayed, the existing information displayed on the screen just before the popup window was displayed, is re-displayed as before the display of the popup window.  
         [0094]    [0094]FIG. 7B illustrates a keyboard in the message window of the touch sensitive screen.  
         [0095]    [0095]FIG. 8 illustrates some of the information stored in the memory  336  and  340  of the portable device  116 . Practically, all of the herein described information is stored in read-write (RAM) memory  340 . The portable device  116 , is not limited to storing encounter related information. The portable device  116  contains memory  340  for storing operating system software and data  810 . This portion of memory can store for example, the Microsoft Windows CE or the Palm OS operating system software and data.  
         [0096]    This memory  340  also stores the encounter software program and data  820 . The encounter software program, as application software  820 , directs the operating system software  810  to control the portable device hardware for facilitating a practitioner-patient encounter. Some application software data  810 , although stored in read-write memory, is only read by application software  810 . Read only data can include configuration or user preference parameterized information. This type of information enables the application software to be customized with respect to one or more entities. This type of customization can be with respect to a related entity, such as customized to the central information facility  120 , to the health care facility  110   a - n , or customized to a particular user  114   b  or  114   c  such as the practitioner etc.  
         [0097]    The application software  820  generates information  840  in response to how the software  820  is exercised by the user  114   b  or  114   c . This information  840  represents encounter activity, including information describing actions taken by the practitioner during or associated with practitioner-patient encounter. The source of some of the information processed into generated information  840  is selected or entered into the portable device  116  by the user  114   b  or  114   b.    
         [0098]    This generated information  240  can include the encounter forms  841 , voice files  842  and transcription requests  843 . An encounter form  841  is designed to include as sufficient information, including the association of the patient to a health care insurer or payer, to request payment approval from the health care payer. An encounter form  841  is provided to the billing service  140   a - 140   n  as sufficient information to generate and deliver a bill to the health care payer.  
         [0099]    Encounter forms  841  can vary by specialty and health care facility (medical office). Encounter forms  841  can also be referred to as charge tickets, routing slips or superbills. Customized encounter forms  841  can be accommodated via associated software tools that can create customized forms  841 . The billing service  140   a - 140   n  receives encounter forms  841  from the central computer  130  and formats at least a portion of the information contained in these forms  841  into an HCFA 1500 form which is mandated by Medicare and which is accepted by the majority of health insurance companies or payers for payment. The HCFA 1500 form applies to office visits and not hospital billing which uses a different form (UB 92).  
         [0100]    Voice files capture voice information via a Dictaphone or microphone  332  and store practitioner-user  114   b - 114   c  comments regarding subject matter associated with the encounter. A transcription request contains textual and/or numeric information that associates each voice file with the subject matter that the practitioner-user  114   b - 114   c  voice file comments are directed towards.  
         [0101]    The portable device memory  340  provides storage for health care insurer or payer specific rule and procedure information  830 . This information is communicated from the central data store  136  via the central computer  130  and optionally via the health facility computer  112   a.    
         [0102]    This information  830  is processed by the application software program to enforce compliance with health care payer rules and procedures during the practitioner-patient encounter. The program  820  reads and processes payer specific rule and procedure data at appropriate times during the execution of the program  820 . For example, payer specific rules are processed when the user  114   b - c  selects a drug or procedure after selecting a diagnosis. The relationship between all 3 selections, the selected diagnosis, the selected drug-medication and the selected medical procedure is checked for compliance with the procedures or rules encoded into the payer rule/procedure information  830 , specified by the associated health care payer for the patient.  
         [0103]    The application software  820  provides an interactive user interface that notifies the practitioner-user  114   b - 114   c  of actions that are not consistent with the patient associated health care payer rules required for payer policy compliance, affiliation or payment approval. The application software  820 , can also notify and sequentially prompt the practitioner-user  114   b - 114   c , via the use of a series of popup windows, to take actions to satisfy rules and complete procedures required for payer policy compliance, affiliation or payment approval. Each popup window can identify and describe an action that the practitioner-user  114   b - 144   c  represents as complete by communicating information to the popup window, for example via text entry, or a button selection. Information communicated to the popup window can constitute the popup window described action or represent that such an action was performed.  
         [0104]    All the above described information  810 ,  820 ,  830  and  840  is communicated to the portable device  116  from the central data store  136  via the central computer  130  and optionally via the health care facility computer  110   a - 110   n  (not shown). The application software and data  830  will typically be communicated at times and frequencies due to application software version availability or configuration changes. The health care payer rule/procedure information  830  will typically be communicated at times and frequencies in response to health care payer rule/procedure changes. The operating system software and data  810  will typically be communicated at times and frequencies based upon availability of operating system software version updates.  
         [0105]    Application software generated encounter forms  841  would be communicated from the device  116  to the central data store  136  via the health care facility computer  112   a - n  (not shown) and via central computer  130   a - n  at times a frequencies appropriate to administer billing and transcription activity. This would typically be communicated at least every 24 hours, preferably after the end of the work day and before the start of the next work day. For example, at 11:00 PM each work day evening.  
         [0106]    Referring to FIG. 9, as discussed in FIG. 8, the portable device generated information  240  can be transferred to the central data store  136  via the health care facility computer  112   a - n  (not shown) and the central computer  130 . From the central data store  136 , the encounter form can be further processed by a checker program  1032  and communicated to an appropriate or designated billing service  140   a - n  that is associated with the health care payer. In response, the billing service  140   a - n  will generate a bill to the health care payer for charges associated with the practitioner-patient encounter as indicated by the encounter form  841 . In some embodiments, the billing service has secure Internet access to all checker program processed encounter forms it is designated to process. The billing service  140   a - n  can be notified when newly processed encounter forms  841  are available in the data store  136  and will be able to view, print and process the encounter forms  841  to generate a payment request or bill to the payer associated with the encounter form  841 .  
         [0107]    Likewise, voice files  842  stored by the application software  820  in association the encounter, and transcription requests generated by the device for each voice file, can be communicated to the central computer  130  via the health care facility computer  112  (not shown). From the central computer  130 , the voice files and the associated transcription requests can be communicated to a designated translation service  150   a - n . Such a designation can be determined by the policy of the central information facility  120 , the health care facility  110   a - n  or as preferred by the practitioner  114   b.    
         [0108]    In one embodiment, both the billing service  140   a - n  access the encounter forms and the transcription services  150   a - n  access the transcription requests via the Internet. An Internet Web site (not shown) is provided by the central health care information facility computer  130 . Both types of services have authorized users who must be authenticated when accessing the Web site.  
         [0109]    In one embodiment, device generated information can include the identification of new patients and new appointments, or for example walk-n patients. This information can be added via the portable device user interface (not shown). Such device generated information would be communicated to the data store. Software tools, for example Active Sync 3.1 provided by Parkstone Medical Information Systems, Inc is designed to synchronize data between the hand held device and the data store  136  to promote the most up-to date storage of information on the central computer  130  or data store. This enables later downloads of information, such as software and data to the hand held device to contain recently uploaded information from the portable device  116   a.    
         [0110]    [0110]FIG. 10 illustrates information stored inside the central data store  136  and the operation of the checker program  1032  which executes on the central computer  130  to process and verify consistency and compliance between the portable device generated information  840  and payer rule/procedure information  830  residing inside the data store  136 .  
         [0111]    This data store  136  contains large amounts of memory storage, for example arrays of hard disks, for storing one or more versions of portable device operating system software  810 , one or more versions of application software  820  and multiple versions of health care payer rule/procedure information  830 .  
         [0112]    Multiple versions of operating system software  810  are stored for support of a particular type of device  116 , or for support of multiple device types, such as for supporting Casio and Palm manufactured hand held devices. Multiple versions of operating system software  810  for a particular type of device  116  can be stored, for example when unexpected defects are found in newly released operating system software versions. The system administrator  133  can opt to delay widespread installation of a newer version until it is sufficiently tested, or opt to re-install an earlier more predictable/reliable version over a newer less predictable/reliable operating system software version when defects in a newer version are discovered after installation. The system administrator can opt to re-install the earlier more predictable or reliable application software version replacing the newer less predictable or less reliable application version.  
         [0113]    The data store  136  also stores one or more versions of the application software  820  for similar reasons as for operating system software  810 . Multiple versions of application software  810  are stored for support of a particular type of device  116 , or for support of multiple device types, such as for supporting Casio and Palm manufactured hand held devices, or for supporting different versions of operating system software  810  resident on those devices  116   a - n . Multiple versions of application software  810  for a particular type of device  116  can be stored, for example to test new versions of the application software  820  or when unexpected defects are discovered in newly released application software versions. The system administrator  133  can opt to delay widespread installation of a newer version until it is sufficiently tested, or opt to re-install an earlier more predictable/reliable version over a newer less predictable/reliable version of application software when defects in a newer version are discovered after installation.  
         [0114]    The data store  136  can also store one or more versions of the configuration data (not shown) resident inside the application software  820  for similar reasons as for the application software  820 . The behavior of the application software can be adjusted simply by modifying configuration data processed by the software  820  Multiple versions of configuration data can be customized for each user  114   b - 114   c , each health care facility  110   a - 110   n  or for the central information facility  120 . Backup versions of configuration data for each type of entity, for example a user  114   b - 114  or health care facility can also be stored here.  
         [0115]    Multiple versions of rule/procedure information  830  are stored for support of multiple sources of rules/procedures, such as from Medicare  1081 , from specific health insurers or payers  1082   a - 1082   n  or from the health care facilities  110   a - 110   n . Multiple versions of rule/procedure data can also be stored for each source entity. This can be useful to ensure that older records, such as older portable device generated information  840  have matching rule/procedure data for complete and consistent historical archiving.  
         [0116]    Like the application software  820 , the checking program  1032  is designed to process portable device generated information  840  and payer rule/procedure information  830  inside the data store  136 , to verify health care payer policy compliance, affiliation or payment approval. The checking program  1032  executes on the central computer  130  while inter-operating with the central computer operating system  1031  via an operating system applications programming interface (API)  1033 . The checking program can act operate to verify the correct operation of various installed versions of the application software or to perform compliance and consistency checks outside the scope of some or all installed versions of the application software  820 . Some consistency or compliance checks may be too complicated or time consuming for the device to perform without interfering with the efficient interaction between the practitioner-user  114   b - 114   c  and the patient  114   a  during the encounter.  
         [0117]    Problems found by the checker program  1032  can be corrected with central computer resident software tools (not shown) before access to encounter forms  841  by billing services  140   a - 140   n  or to voice  842  and transcription requests  843  transcription services  150   a - 150   n.    
         [0118]    Although the present invention has been described and illustrated in detail, it is clearly understood that the same is by way of illustration and example only and is not to be taken by way of limitation of the spirit and scope of the present invention.