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Introduction

In this chapter, you will learn to

  • Identify the organization of healthcare in the United States and select international systems

  • Comprehend common elements of the healthcare relationships

  • Understand the financial components of healthcare

  • Recognize specific technology as it relates to healthcare

  • Be aware of healthcare terminology and data standards

  • Categorize foundational health data management principles

To begin the discussion of protecting information in the healthcare industry, it is necessary to introduce you to the healthcare organization and some of the information management considerations. Appreciation for the impact of applying general information protection practices without regard to the requirements of providing patient care is the foundation of this book. It is what separates healthcare information protection from any other information protection practice.

This chapter presents a general overview of the major components of typical healthcare organizations. After reading it, you will understand the concepts of patient, payer, provider, and stakeholder. Our focus includes international frameworks for healthcare delivery, which you will be able to identify and compare with the U.S. model. We introduce the basic financial operation within healthcare because payment and billing are imperatives regardless of what nation the system serves. From there, we move into a discussion of the typical technologies of healthcare. Finally, we explore ways data flows within a healthcare organization and externally between multiple providers. Throughout the chapter, we emphasize the standards and characteristics unique to healthcare. By no means is the intention of this chapter to be comprehensive; there are numerous sources of more detailed information, which we recommend at the appropriate places in the text.

The Organization and Financing of Healthcare Delivery

To be successful in protecting information in the healthcare industry, you must understand what healthcare is and is not. Words such as unique, specialized, sensitive, and autonomous, among others, are used to imply healthcare is different from other industries. These words are used appropriately because healthcare is a unique industry. Still, it is imperative to not accept that claim without examining the facts. How healthcare tends to be organized and financed is a good starting point.

The organization of any healthcare system originates from the interactions of several distinct groups. Generally speaking, a healthcare system consists of patients, providers, payers, and other stakeholders (such as vendors). These groups (see Figure 1-1) play certain roles that generally follow the supply-and-demand process. For instance, patients and providers exchange information in the attempt to keep, restore, or maintain health for the patient.

Patients

At the core of any healthcare scenario, the patient is a person who seeks assistance with matters of health (physical and mental), improvement of health status, or treatment of illness. The care they seek can be preventive ...

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