Hacking Healthcare Meaningful use is the focus of

文件名称: Hacking Healthcare

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详细说明： Meaningful use is the focus of this book. This book is the first candid attempt to bridge the gap between clinicians and IT staff. Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii 1. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Health IT and Medical Science 3 Meaningful Use and What It Means to Be an EHR 4 Why So Late? 5 Health IT in Health Reform 7 Evolution of Meaningful Use 7 Accountable Care Organizations 8 EHR Functionality in Context 10 2. An Anatomy of Medical Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 How Patients Reach Healthcare Organizations 14 Lab Sample Collection Before a Visit or Admission Date 17 HIPAA and Patient Identification 17 Intake, Demographics, Visits, and Admissions 20 Precertification and Prior Authorization 21 Emergency Admissions 21 Prioritization and Triage 23 Outpatient Care 24 Inpatient Care 25 Labs 27 Imaging 27 Administration and Billing 28 3. Medical Billing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Who Pays, and How 32 Claims 32 Eligibility 33 Treatment 35 Billing 37 iii The Billing Process 38 Complexities in Billing 39 Adjudication 40 The Patient’s Burden 42 4. The Bandwidth of Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Workflow Tokens 47 Why Leave Paper? 48 Step 0: Health IT Humility 49 Normalized Data 52 Good Boundaries Mean Good Data 53 Data at Peace with Itself: Linked Data 55 Flexible Data 56 Assume Health Data Changes 57 Free Text Data 57 5. Herding Cats: Healthcare Management and Business Office Operations . . . . . . . . . 61 Major Business Office Activities 63 Insurance 63 Records 64 Demographics 64 Revenue Collection 65 Auditing 65 Accounting 66 Reporting 66 Licensing, Credentials, and Enrollments 67 Nonhealthcare Interactions 68 The Evolution of the Business Office 68 6. Patient-Facing Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 The PHR as Platform 71 Sharing Data in Patient-Facing Software 75 Patients Using Normal Social Media 75 E-patients 77 The Quantified Self 78 Patient-Focused Social Media 80 Patient Privacy in PHR Systems 81 Specific PHR and Patient-Directed Meaningful Use Requirements 83 7. Human Error . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 The Extent of Error 85 Dangerous Dosing 87 Discontents of Computerization 90 iv | Table of Contents Process Errors and Organizational Change 92 Deep Medical Errors and EHR Solutions 94 Errors Caused by Human-Computer Mismatch 95 Best Practices 96 8. Meaningful Use Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Outpatient Guidelines and Requirements 100 Inpatient Guidelines and Requirements 116 9. A Selective History of EHR Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 MUMPS: The Programming Language for Healthcare 129 Where Can We Buy Some Light Bulbs? 130 Fragmentation 131 In an Environment with Gag Clauses and No Consumer Reports 131 VistA History 132 10. Ontologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 A Throw-Away Ontology 136 Learning from Our Example 138 CPT Codes, Sermo, and CMS 141 International Classification of Diseases (ICD) 144 E-patient-Dave-gate 145 Crosswalks and ICD Versions 147 Other Claims Codes 149 Drug Databases 149 SNOMED to the Rescue 154 SNOMED Example 155 SNOMED and the Semantic Web 157 UMLS: The Universal Mapping Metaontology 158 Extending Ontologies 159 Other Ontologies 160 Sneaky Ontologies 161 Ontologies Using APIs 162 Exercising Ontologies 162 11. Interoperability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Some Lessons from Earlier Exchanges 166 The New HIE Rules 168 Strong Standards 168 Winning Protocols 171 The Billing Protocols 171 HL7 Version 2 173 First-Generation and Second-Generation HIEs 182 Table of Contents | v Continuity of Care Record 182 HL7 v3, RIM, CDA, CDD, and HITSP C32 185 The IHE Protocol 189 HIE with IHE 191 Managing Patient Identifiers with IHE 192 IHE Data Exchange, the Library Model 193 IHE in the NWHIN 194 The Direct Project/Protocol 196 The PCAST Report 198 The SMART Platform 199 Technology and Policy Were Sitting in the Tree 199 12. HIPAA: The Far-Reaching Healthcare Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Does HIPAA Cover Me? 205 Responsibilities of Covered Entities 206 HIPAA: A Reasonable Regulation 213 Duct-Tape HIPAA Strategies 214 Breach Notification Rules 215 In Summary 217 13. Open Source Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219 Why Open Source? 220 Major Open Source Healthcare Projects 221 ClearHealth 222 Mirth Connect 223 VistA Variants and Other Certified Open Source EHR Systems 223 OpenMRS 224 Appendix: Meaningful Use Implementation Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . 227 vi | Table of Conten ...展开收缩

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