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Hacking Healthcare

Book Description

Ready to take your IT skills to the healthcare industry? This concise book provides a candid assessment of the US healthcare system as it ramps up its use of electronic health records (EHRs) and other forms of IT to comply with the government’s Meaningful Use requirements. It’s a tremendous opportunity for tens of thousands of IT professionals, but it’s also a huge challenge: the program requires a complete makeover of archaic records systems, workflows, and other practices now in place.

This book points out how hospitals and doctors’ offices differ from other organizations that use IT, and explains what’s necessary to bridge the gap between clinicians and IT staff.

  • Get an overview of EHRs and the differences among medical settings
  • Learn the variety of ways institutions deal with patients and medical staff, and how workflows vary
  • Discover healthcare’s dependence on paper records, and the problems involved in migrating them to digital documents
  • Understand how providers charge for care, and how they get paid
  • Explore how patients can use EHRs to participate in their own care
  • Examine healthcare’s most pressing problem—avoidable errors—and how EHRs can both help and exacerbate it

Table of Contents

  1. Preface
    1. Audience
    2. Organization
    3. Conventions Used in This Book
    4. Using Code Examples
    5. Safari® Books Online
    6. How to Contact Us
    7. Acknowledgments
  2. 1. Introduction
    1. Health IT and Medical Science
    2. Meaningful Use and What It Means to Be an EHR
    3. Why So Late?
    4. Health IT in Health Reform
    5. Evolution of Meaningful Use
    6. Accountable Care Organizations
    7. EHR Functionality in Context
  3. 2. An Anatomy of Medical Practice
    1. How Patients Reach Healthcare Organizations
    2. Lab Sample Collection Before a Visit or Admission Date
    3. HIPAA and Patient Identification
    4. Intake, Demographics, Visits, and Admissions
    5. Precertification and Prior Authorization
    6. Emergency Admissions
    7. Prioritization and Triage
    8. Outpatient Care
    9. Inpatient Care
    10. Labs
    11. Imaging
    12. Administration and Billing
  4. 3. Medical Billing
    1. Who Pays, and How
    2. Claims
    3. Eligibility
    4. Treatment
    5. Billing
      1. The Billing Process
      2. Complexities in Billing
    6. Adjudication
    7. The Patient’s Burden
  5. 4. The Bandwidth of Paper
    1. Workflow Tokens
    2. Why Leave Paper?
    3. Step 0: Health IT Humility
    4. Normalized Data
    5. Good Boundaries Mean Good Data
    6. Data at Peace with Itself: Linked Data
    7. Flexible Data
    8. Assume Health Data Changes
    9. Free Text Data
  6. 5. Herding Cats: Healthcare Management and Business Office Operations
    1. Major Business Office Activities
      1. Insurance
      2. Records
      3. Demographics
      4. Revenue Collection
      5. Auditing
      6. Accounting
      7. Reporting
      8. Licensing, Credentials, and Enrollments
      9. Nonhealthcare Interactions
    2. The Evolution of the Business Office
  7. 6. Patient-Facing Software
    1. The PHR as Platform
    2. Sharing Data in Patient-Facing Software
    3. Patients Using Normal Social Media
    4. E-patients
    5. The Quantified Self
    6. Patient-Focused Social Media
    7. Patient Privacy in PHR Systems
    8. Specific PHR and Patient-Directed Meaningful Use Requirements
  8. 7. Human Error
    1. The Extent of Error
    2. Dangerous Dosing
    3. Discontents of Computerization
    4. Process Errors and Organizational Change
    5. Deep Medical Errors and EHR Solutions
    6. Errors Caused by Human-Computer Mismatch
    7. Best Practices
  9. 8. Meaningful Use Overview
    1. Outpatient Guidelines and Requirements
    2. Inpatient Guidelines and Requirements
  10. 9. A Selective History of EHR Technology
    1. MUMPS: The Programming Language for Healthcare
    2. Where Can We Buy Some Light Bulbs?
    3. Fragmentation
    4. In an Environment with Gag Clauses and No Consumer Reports
    5. VistA History
  11. 10. Ontologies
    1. A Throw-Away Ontology
    2. Learning from Our Example
    3. CPT Codes, Sermo, and CMS
    4. International Classification of Diseases (ICD)
    5. E-patient-Dave-gate
    6. Crosswalks and ICD Versions
    7. Other Claims Codes
    8. Drug Databases
    9. SNOMED to the Rescue
      1. SNOMED Example
      2. SNOMED and the Semantic Web
    10. UMLS: The Universal Mapping Metaontology
    11. Extending Ontologies
    12. Other Ontologies
    13. Sneaky Ontologies
    14. Ontologies Using APIs
    15. Exercising Ontologies
  12. 11. Interoperability
    1. Some Lessons from Earlier Exchanges
    2. The New HIE Rules
    3. Strong Standards
    4. Winning Protocols
    5. The Billing Protocols
    6. HL7 Version 2
    7. First-Generation and Second-Generation HIEs
    8. Continuity of Care Record
    9. HL7 v3, RIM, CDA, CDD, and HITSP C32
    10. The IHE Protocol
    11. HIE with IHE
      1. Managing Patient Identifiers with IHE
      2. IHE Data Exchange, the Library Model
      3. IHE in the NWHIN
    12. The Direct Project/Protocol
    13. The PCAST Report
    14. The SMART Platform
    15. Technology and Policy Were Sitting in the Tree
  13. 12. HIPAA: The Far-Reaching Healthcare Regulation
    1. Does HIPAA Cover Me?
    2. Responsibilities of Covered Entities
    3. HIPAA: A Reasonable Regulation
    4. Duct-Tape HIPAA Strategies
    5. Breach Notification Rules
    6. In Summary
  14. 13. Open Source Systems
    1. Why Open Source?
    2. Major Open Source Healthcare Projects
      1. ClearHealth
      2. Mirth Connect
    3. VistA Variants and Other Certified Open Source EHR Systems
    4. OpenMRS
  15. A. Meaningful Use Implementation Assessment
  16. About the Authors
  17. Copyright