Data mining is used in various forms by different agencies. Detecting fraud and abuse is one of the benefits of the use of data mining. The healthcare industry is big and one of the biggest payers is CMS. However, detecting fraud and abuse in healthcare claims is crucial because billions of money is being wasted in unnecessary care.
Data mining is defined as the process of data selection and studying and building models using massive data stores to disclose previously unidentified patterns in databases (Koh and Tan, 2005, p. 64). Koh and Tan have found financial institutions, marketers, manufactures and so has many other agencies have used data mining. Data mining has been of great use by various organizations. For example, data mining has been useful to detect fraudulent credit card transactions (Koh and Tan, 2005, p. 64). Koh and Tan stated, “In healthcare, data mining is becoming increasingly popular, if not increasingly essential” (Koh and Tan, 2005, p.64). In healthcare there have been reports that data mining has been successful in detecting fraud and abuse in healthcare claim (Koh and Tan, 2005, p.65). There are many factors in healthcare that have driven the use of data mining applications. One of the factors that have driven healthcare to use the data mining applications will be the medical insurance fraud and abuse. All organizations currently involved in the healthcare industry can profit from the data mining applications. For example, data mining is able to help
Some health institutions believe that all the patients have the powers to control the use of their records and before any file is accessed, the patient must be consulted by the personnel responsible. To others, however, some of the patients may not know the needs of the health industry, and therefore, at least 200 people can be allowed to access their records. According to this group, the only way to improve the patient’s privacy is by reducing the number of people who access the records. Thus, despite the fact that digital files save on cost and time, there is need to focus on some of the issues affecting the privacy of records in the health sector. Therefore, as much as the current law allows sharing of patient information during payments and treatment, caution must be taken to reduce data mining and marketing using the same
It’s a value care for U.S patient population. Back to the digital health care prediction, Dr. Brown indicated that the vast amount of untapped data could have a great impact on health that exists outside of medical systems. However, there were challenges when it came to collecting healthcare data. First, the unstructured big data which presents in medical literature. How do we know which one to read? Second, a data associated with a single patient in an electronic medical record (EMR). An electronic medical record came with a structured data and an unstructured data. There was a question about the HIPPA regulation, and Dr. Brown assured that IBM adhered to the regulation completely. All these pooled data were placed in the Watson Cloud that aggregated the data together to perform different analytics. It’s all automated system. Then, IBM acquired Truvan that tracked insurance and reimbursement data and enabled to see overall
However, health informatics is the kind of application system normally used by most hospitals and clinics to deliver high quality and cost efficient healthcare service to the community. According to Bacon County Hospital press release (2002), the informatics system was implemented to make the delivery of medical services such as surgical treatment and other general treatment faster. In this paper, therefore we look into how the informatics systems/applications has evolved since it was implemented by the Bacon County Hospital; discuss the future trends for healthcare informatics and how these trends impact the healthcare delivery system.
Removing any inaccurate information from patient records could take years and cost medical companies in all types of ways -- from administrative costs to malpractice lawsuits. High-profile breaches in personal medical data continue to increase and are often low-tech -- criminals grabbing an unguarded laptop, phishing scams or people getting access to hard copies of medical records. A study published in the Journal of the American Medical Association reported that more than 29 million breaches of information security in healthcare occurred between 2010 and 2013.[3] The recent hacking of major insurance companies Anthem and Premera Blue Cross generated record breaches that dwarfed the JAMA study figures by exposing more than 90 million records to criminals in just a few months.[4] The JAMA study also revealed that there have been more than 1,000 major breaches since 2010, and of these, one-third occurred in five populous states: Florida, California, New York, Texas and
Imagine, that you come back from a hard day’s work. You put on your favorite grey sweats with a cozy sweater. Soon after, you get a cup of hot chocolate with marshmallows. Then you lean back on the sofa, turn on the television and change the channel to the local news. Breaking news with bright red letters are plastered across the screen. The news anchor goes on explaining that an employee at the local hospital accidentally donated data of patients. This means that patient’s social security numbers, addresses, medical records, and other personal information, were given away without patients’ permission or consent. At that moment you realize that all your personal information is out there for everyone to see and use; and there is nothing you can do about it. The collection of personal information is called data mining, and is collected through large online databases. The real question is that data mining violating our privacy and rights? Why are companies still collecting our personal information without our consent and how can we protect ourselves from breaches? Data mining should be limited in the United States and needs to undergo more appropriate privacy and security policies to protect citizens privacy.
The American Recovery and Reinvestment Act was created in 2009 to try and help multiple systems in the failing economy. The main goal of this Act is to promote economic recovery, spur technological advances in health and to stabilize state and local budget. The clinical business intelligence improves the patient care process, this data analytics provide the quality data which is timelier, and it also helps in billing and supports clinical
There is no doubt in that technology has multifaceted benefits but, at the same time, it has forced mankind to feel insecure. Every industry depends upon the data of the customers and the health industry is no more an exception here. The data of each patient is shared to facilitate health itself and for more rigorous and authentic research. Hence, protecting patient data is very important. It is so important that in 1996, the federal government introduced the Health Insurance
An additional component of healthcare is data. This is important because this allows health professionals to gather and analyze information to complete the task at hand the best way possible. This would allow doctors and nurses to be able to treat patients the most efficient way while trying to keep cost relatively low at the same time. Moreover, if the health
Worldwide use of computer technology in medicine began in the early 1950s with the rise of the computers. In 1949, Gustav Wagner established the first professional organization for informatics in Germany. Medical informatics research units began to appear during the 1970s in Poland and in the U.S. Since then the development of high-quality health informatics research, education and infrastructure has been a goal of the U.S. and the European Union. (NYU graduate training program, 2010) Changes in the healthcare environment produced fundamental shifts in the delivery of healthcare. The altering landscape of healthcare is creating a huge demand for health data analytics. The growth and maturity of healthcare informatics over the past decade has been a prime catalyst in positioning the healthcare industry for the changes posed by reform measures. By understanding the process of analytics, clinical informatics specialists say healthcare providers have the insight necessary to make the process adjustments in the future.(Riskin, 2013)
The rising costs of healthcare have increased the need for centralized and secure data for organizations to proactively control costs and to continue to improve the quality of care for patients. Many healthcare organizations have been working towards tackling and complying with this issue but have a variety of complex situations due to limited resources (both technology and financial), geographic limitations, and even political issues from organizational setups. Healthcare has become a competitive market as well which makes the limitations become more prevalent to those who can’t keep up.
This increase of sensitive data available online, commonly accessed through usernames and passwords, has produced a dramatic jump in healthcare information compromised by data breaches. In 2015, the IRTC reported that a staggering 66.7% of all records compromised in data breaches were in the healthcare industry; in 2014, this number was only 9.7%.
There is a constant change and upgrade in technology that is being used not only in the Healthcare setting but in everything we have and everywhere we go. Since healthcare is a big business, the healthcare fraud and abuse is becoming a national issue. We should be aware of it in order to avoid such abuses and fraud.
One of the top priorities of any practice is to maintain a healthy revenue cycle by processing and submit health insurance claims with speed and accuracy. But when daily claims management challenges like dealing with obsolete technology, scattered data sources and
Privacy of health information has become an area of emphasis across the healthcare industry. It is important to understand what data is protected under federal regulations, how it can be shared, and how to prevent any accidental exposure of protected data. It is possible that data that should be protected can be exposed without anyone even realizing a violation has occurred. Exposure of protected healthcare data can result in medical identity theft and is therefore a very important and hot topic. The security and privacy of healthcare data is necessary to ensure consumer confidence in the healthcare industry and to prevent medical identity theft.
Health information is a fundamental piece of data which represents a person, business, organization, or a community. This data is vital in monitoring and coordination of care for individuals and communities. It not only monitors and coordinates patient care, but reduces costly mistakes and prevent duplication of treatments as well as taking a pivotal role in preserving, securing, and protecting personal health information. Since, this information is extremely essential and sensitive, it must remain secure and safe to prevent frauds and cyber-attacks. First of all, this paper discusses vitality of the health information in regards to individuals, professionals, and organizations along with its benefits to improve overall quality of life. Secondly, it discusses the role of information technology in various aspects of the industry and the what the future holds within IT.