The Data Model Resource Book, Vol. 2: A Library of Data Models for Specific Industries

CHAPTER 4

Health Care

To provide a more global view of health care, this chapter addresses enterprises that provide treatment for any types of illnesses and/or injuries, non-preventative treatments, and all types of health care categories including hospitals, institutions, medical offices, ambulatory surgery facilities, alternative medicine providers, vision specialists, dentists, and any enterprise treating patients for health care.

Health care organizations are concerned with such issues as these:

• How can we treat people most effectively?
• How can we ensure that we will get reimbursed for most of our health care treatments?
• How can we reduce administrative costs such as claims processing?
• How can we effectively record and track patients’ medical history?
• How can we best manage health care delivery schedules for practitioners as well as patients?

To answer these types of questions, health care enterprises need to track information about the following:

• The people and organizations they are concerned with, namely, patients, health care provider organizations, individual practitioners, insurance companies
• Relationships between parties such as patient relationships with their practitioners, with which health care networks the provider is associated, and which practitioners are associated with which health care provider organizations
• The types of services and goods available from the health care providers
• The types of agreements that exist between various parties such as patient ...