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Healthcare Informatics: Improving Efficiency and Productivity

An Introduction to the U.S. Healthcare Industry, Information Technology, and Informatics

by Stephan Kudyba and Richard Temple

Healthcare is probably one of the most complex business models in American industry given the uniqueness of the marketplace in which it operates. It is perhaps the only industry where the consumer does not necessarily pay for the service he receives, but rather third parties negotiate arrangements with service providers to determine payment rates and types of service that are to be paid on the consumer's behalf. The nature of the services required corresponds to a variety of ailments that are attributed to vast numbers of patients: factors that add to the mix of issues to manage.

Complexities for healthcare organizations are heightened when considering the numerous data exchanges that are involved with services provided to patients. Data exchanges can be plagued by myriad formats, captured, and stored in a variety of repositories. These exchanges introduce further complexities in the form of "vocabularies," or in other words, the coding languages that are required to identify types of services that vary considerably from payer to payer, state to state, and service type to service type. Also, data in general come from a multitude of different "niche" systems and are presented in many different ways and need to be integrated and presented to a caregiver or analyst in a consistent and coherent manner. It is the combination of all these factors that begins to describe the underpinnings of the spectrum of healthcare informatics.

Data provide the building blocks to information, a vital resource to administrators, practitioners, and decision makers in healthcare organizations. The process of transforming data into information is a daunting task, and given the complexities described above, the task is particularly challenging in this unique industry. This challenge must be managed, as healthcare is one segment of American industry where incorrect decisions or errors can cost lives or put innocent people in significant danger. The need to understand what patterns of treatment for a variety of different conditions will produce the best outcomes is profound. Adding to the challenge are the financial burdens healthcare providers are experiencing, as reimbursements are being cut and more and more conditions are being mandated in order to pay for services rendered. Healthcare organizations invariably lose money on certain classes of patients, and it is critical to understand where those areas are and how to address them.

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Healthcare Informatics
From Healthcare Informatics: Improving Efficiency and Productivity, Edited by Stephan P. Kudyba. Auerbach Publications, 2010.


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