Health care database design and management

Health Care Database Design and Management

This report is an analysis of how the healthcare and insurance industries have adopted relational database and other related applications software technology to manage physician information. The United States healthcare system is a compilation of insurance companies, health plans, physicians, hospitals, clinics, consumers, governmental agencies and public health programs. Unnerved by the continuous runaway costs and pricing inflation, the healthcare system and private businesses are on a constant search for viable solutions that are capable of reducing these skyrocketing costs. Another concern is privacy. "A public health authority that conducts health care as part of its activities is a covered health-care provider if it also performs electronic transactions covered by the HIPAA Transactions Rule as part of these activities." (Administrative Simplification in the Health Care Industry) the entire healthcare system has begun to adopt Information Technology as an answer for cutting back. Information Technology provides an efficient and cost effective way to stop the bleeding.

The healthcare system should be efficient because of the nature of contract medicine. Consider that today's healthcare system has become a contract driven process. For example, when a private company hires a new employee, that employee then becomes eligible for healthcare coverage through the Health Maintenance Organizations (HMO) contracted with the employer. The employee is required to choose a physician who will then act on behalf of the employee and the HMO in the role of a Primary Care Physician. That HMO has already established a contract with that doctor as well as hundreds or even thousands of other doctors, hospitals, clinics and other various healthcare related organizations such as a local gym or a physical therapist's office. These contracted agreements entail a great deal of information that is in constant flux. Therefore, the process of managing these contracts comes down to managing the abundance of information for each of these entities. This control has become possible through the use of modern database technology.

Within the healthcare environment, the need to track physicians and all of the data that is related to physicians has become an ongoing challenge. To make this challenge even more difficult, the before mentioned example of a new employee having to chose a primary care physician makes this challenge more difficult exponentially. Although there are associated rules, an employee or family member can request to change a primary care physician for almost any reason including the notion of doing it just for the heck of it. Couple that with the fact that physicians only have a finite amount of hours or staffing which limits the number of patients they can accept and still remain capable of providing quality service expected by both the patient and the HMO. Also consider the fact that doctors are human so they are in need of vacations from time to time; they have fires, lose their licenses or simply decide to retire. All of these informational details about physicians and their associated patients must be entered accurately and then maintained by insurance providers and governmental agencies such as Medicare and Medicaid.

In the not so distant past, insurance providers and governmental agencies only provided physician information for consumers and other healthcare entities through the traditional medium of phone book like printed directories. The problems stemming from these directories were to numerous to count. For one, the directories were often out of date because the books had associated printing deadlines. Thus, if a new physician moved into the area or an existing physician retired after the printing deadline, those doctors' information would not be updated until the next printing - of course, that next printing could be months away. Even if directories were up-to-date, that was not a guarantee that an employer distributing a directory to employees was using the updated copy. Maintaining this constantly changing directory was simply not cost effective and certainly not efficient.

Today, privacy requirements as well as governmental mandates like the HIPAA laws have begun to force holdout organizations to adopt more efficient computer hardware and software technologies. "The shift of medical records from paper to electronic formats has increased the potential for individuals to access, use, and disclose sensitive personal health data. Although protecting individual privacy is a long-standing tradition among health-care providers and public health practitioners in the United States, previous legal protections at the federal, tribal, state, and local levels were inconsistent and inadequate. A patchwork of laws provided narrow privacy protections for selected health data and certain keepers of that data." (Administrative Simplification in the Health Care Industry) Therefore, new technologies such as relational databases have simplified the data gathering and maintenance processes of all types of healthcare related data like the physician information process. It is not unheard of today for healthcare and insurance providers matching or 'sinking data' on a monthly or quarterly basis because of the availability of better communication capabilities as well as compatible database comparison processes.

Even the doctors themselves have access to providers' systems and databases today. Through automatic telephone systems, business to business Internet portals, and tape or disk delivery processes, all of a physician's personal, office and patient information can be updated easily. In many cases, the entire process including security and confirmation is a completely hands free operation. In other words, without human intervention, providers are kept up-to-date in an efficient and cost effective manner. As a result, the once traditional directories that became out of date as soon as they were printed have been replaced by very accurate databases full of information that can be easily be converted into any medium including: insurance plan participation directories, referral confirmation lists, distribution reports and/or results, employer/employee physician selection forms for new patients or even office contact lists for the annual profit party.

Through database technologies, physician information is more accurate and use of that data has become unlimited. An excellent example on how the industry has become more efficient with physician information because of database technology is the typical Internet web site portal for employees. Today, employees literally can go online and chose their doctor, OB/GYN or dentist and a few days later that member will receive the updated card(s) in the mail complete with physician information and co pay deductible. "This expansion of the RelayHealth program to additional Blue Shield network providers and members comes as market demand grows for solutions that improve cost-efficiencies and convenience in healthcare delivery, while protecting patient privacy - as required by the Health Insurance Portability and Accountability Act (HIPAA)." (HMO Patients Can Contact Their Doctors Electronically as Blue Shield of California Expands Online Communication Services) the cards are often a product of robotic systems that have little to no human intervention.