Case Study Of Health Care

*Case Study Of Health Care *

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Health is not only absence of disease [1].

Good Health confers on a person or group freedom from disease.

Healthcare is the maintenance or improvement of health via the diagnosis,

treatment, and prevention of disease, illness and other physical and mental

impairments in human.

Health care is delivered by health professionals in allied health professions, physicians, dentistry, nursing, medicine, optometry, pharmacy, psychology, and other health professions.

The issue of health care assumes prime importance for the society and is a

significant indicator of social development.

The public healthcare system consists of healthcare centers run by central and state government that offer free services or at a subsidized rates to low income group

The delivery of health care services assumes greater proportion, and the role played by information and communication technology has certainly a

greater contribution for its effective delivery mechanism.

The application of data mining is specifically has been successfully applied in medical needs for its reliable accuracy and beneficial result.

The health of populations is akey issue in public policy discourse in every mature society .

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*Case Study Of Health Care *

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*Definitions of Health Care *

• * Health care or healthcare is the maintenance or improvement of health via the

diagnosis, treatment, and prevention of disease, illness, injury, and other physical

and mental impairments in human beings. Health care is delivered by health

professionals

A major challenge facing healthcare organizations is the provision of quality services at affordable costs.

Quality service means correct diagnosis and management effective

treatments to patients.

Poor clinical diagnosis can certainly lead to disastrous consequences which are unacceptable [2].

Hospitals must also minimize the cost of clinical tests.

It can achieve these results by employing appropriate computer-based

information and/or decision support systems [3].

Health care data is massive and includes patient centric data, resource

management data and transformed data [4].

Health care organizations must have the ability to computationally analyze data that is stored from treatment records of millions of patients.

Thereby, data mining techniques may help in answering several important and

critical questions related to health care.

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[*First Section : (Background of the Health Care) *]

 Data Mining

 The Data Mining applications[* *]in the Health Care

 The Role of Data Mining in Healthcare

 Why Data Mining Can Aid Healthcare

 Important role of data mining in Healthcare Application

 Limitations of DM

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*DATA MINING *

[* *]Data mining can be considered as a relatively recent developed methodology and technology, coming into prominence [5].

Data mining techniques can be broadly classified based upon what they can do, viz: (a) description and visualization; (b) association and clustering; and © classification and estimation; and thus can be a predictive modeling. [6]

*The Data Mining applications in the Health Care *

Data mining can be defined as “the process of finding previously unknown

patterns and trends in databases and using that information to build predictive models” [7].

Data mining techniques has been used intensively and extensively by many

organizations.

In healthcare, data mining is gradually increasing popularity, and becoming increasingly essential.

Data mining applications can greatly benefit all parties involved in the

healthcare industry [8].

For example, data mining can help healthcare insurers detect fraud and abuse.

healthcare organizations can make customer relationship management

decisions; physicians can identify effective treatments and best practices.

and patients receive better and more affordable healthcare services .

• The Role of Data Mining in Healthcare *

• huge and complex volumes of data are generated by healthcare activities,

un-automated analysis has become impractical.

• Data Mining can generate information that can be useful to all

stakeholders in health care, including patients by identifying effective

treatments and best practices.

• the existence of insurance fraud and abuse impels insurers to use Data

Mining .

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• Why Data Mining Can Aid Healthcare *

In healthcare, data mining is becoming increasingly popular, if not, increasingly essential.

Several factors have motivated the use of data mining applications in

healthcare.

Existence of medical insurance fraud and abuse [9], for example, has led “many healthcare insurers to reduce their losses by using data mining tools to help them find and track offenders” [10].

Fraud detection using data mining applications is prevalent in the commercial sector, [11]

for example, “in the detection of fraudulent credit card transactions” [12].

Recently, many cases of successful data mining applications in healthcare

insurance fraud and abuse have been detected and reported.Hence,

it can be pointed that data mining can lead to the following deliveries:

• Healthcare insurer‟s fraud and abuse detection;

• Healthcare organization‟s decisions for customer relationship management;

• Physician‟s can identify effective treatments and best practices; and

• Patient‟s receive better and more affordable healthcare service

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*Important role of data mining in Healthcare Application *

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The health sector has more need for data mining today.

There are several arguments that could be advanced to support the use of data mining in the health sector, covering not just the concerns of public health but also the private health sector [13].

There is a wealth of knowledge to be gained from computerized health records.

[14].

Yet the overwhelming bulk of data stored in these databases make it

extremely difficult, if not impossible, for humans to sift through it and discover knowledge [15].

In fact, some experts believe that medical breakthroughs have slowed down,

attributing this to the prohibitive scale and complexity of present-day medical information.

Computers and data mining are best-suited for this purpose.

There is evidence-based medicine and prevention of hospital errors. [16].

When medical institutions apply data mining on their existing data, they can

discover new, useful and potentially life-saving knowledge that otherwise would have remained inert in their databases.

For example, an on-going study on hospitals and safety found that about 87%

of hospital deaths in the United States could have been prevented, had hospital staff been more careful in avoiding errors. [17].

*Limitations of DM *

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 DM can be limited by the accessibility to data that often is distributed in different settings (clinical, administration, insurers, labs, etc.).

 data may be incomplete, corrupted, noisy, or inconsistent.

 ethical, legal and social issues (data ownership, privacy concerns).

 many patterns find in DM may be the result of random fluctuations, so

many such patterns may be useless.

 DM of medical data requires specific medical knowledge as well as

knowledge of DM technology.

 DM requires institutional commitment and funding.

*Case Study Of Health Care *

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[*Second Section : (Overview of the Electronic medical record technology) *]

 About medical records

 Ddefinition of electronic medical record

 Advantages

 Disadvantages

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[*About medical records : *]

The medical records of one of the central points that depend on the delivery of health care within hospitals and between different types of medical institutions, The importance of those records of the importance of their role in keeping all patient information from key medical data, for all that has been done from the tests and diagnoses, treatment and follow-up reports and medical decisions

important.

For a long period of time medical records remained steady in the form of a file or group of papers have been written on the information by hand, so there was

tremendous developments in information technology science led these

developments scientists and specialists in the field of health care and information technology together to design of medical records electronic depend on computer with all its possibilities of information storage, processing and transfer of data through what we know today of information networks .

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[*Ddefinition of electronic medical record : *]

Is an electronic file that contains medical and nursing and administrative

information covering all aspects of the pathological situation experienced by the patient, and include this information usually symptoms, medical history, and the results of clinical diagnostic tests and the final diagnosis sick and procedures of medical, surgical and therapeutic interventions and the case was given to the patient and the progress of the patient’s condition The response to these

interventions and treatments as well as a private patient identifiable information .

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[*Advantages : *]

1- Get rid of paper that threatens health organizations because of its numerous drawbacks such as slowness of movement, difficulty retrieving his information, and the large losses in its statements.

2- Electronic health record is a confluence of all the systems point, because the electronic health file, which is stored the medical findings and diagnoses,

treatments and medications that were conducted for the patient.

3- Provides an opportunity create communication between individuals and teams to provide health services from doctors and nursing technicians and

administrators

4- It contains a lot of information that contribute to the development of scientific research, and is providing medical and administrative reports and statistics

that serve the hospital’s activities.

5- It helps to improve the health care quality provided to patients by providing the necessary information in a timely manner

6- Raising the efficiency of health services and cost savings through speed in the exchange of information and the provision of employment and the effort by the staff.

[*Disadvantages : *]

[*1-. Much Skill Required *]

Any problem that may occur at any time lead to a cessation of work the system so it needs maintenance, and this requires the presence of skilled technicians constantly, as well as raising the efficiency of workers on the system

*2. Minimal Error Could Mean Big Loss *

If something as simple as a wrong has occurred that could lead to lost a large amount of data, and this is a big problem, especially in the world of medicine

Where the patient data are very sensitive and if lost would be difficult to recover *3. Privacy Is Key *

Medical records is not just the data for the number of times the disease but contain personal data if penetrated will lead to discomfort the patient to deal with electronic records system

*4. Better Have A Back Up Plan *

The system user Permanent keep backup copies of data and this requires paying an extra fee for external storage space, and if this is not done there will be a problem if I lost the basic data copy

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Third Section : (Summary of the case study)

• Summary

• Challenges

• The main challenges facing the medical records systems

• Conclusion

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*Challenges *

Healthcare processes are either diagnosis / treatment processes or of

organizational nature (such as the scheduling of appointments). The biggest

challenges for applying process mining to healthcare processes are their

complexity, their multi-disciplinarity, that they are changing often, and the log data from the IT systems.

[*The main challenges facing the medical records systems in the key points are: *]

 The need for the users to the information, which is one of the basic components that guide the process of developing the systems, experience has shown that

successful systems have been developed either by or with the help of doctors

and specialists in health care, where the convergence between the developers

of these systems and between doctors and specialists provides a deeper

understanding and recognizing the most comprehensive when you need the

process to provide medical care properties regarding the nature of information and how it is used. * *

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 Ease of use, which is also one of the most important ingredients that help doctors and specialists on the use of information systems without constraints, and system developers must take several points into consideration the most

important the nature of doctors and their needs and the difference between

them and the work on the computer professionals.

 Social and legal challenges, regarding the extent of the privacy and security of electronic medical information, the more increased ease of access to that

information has increased the importance of creating more security and

privacy rules that the process of the use of information and the right of access to them

 Costs versus features, higher the required characteristics and features

increased production costs on the other hand, it is necessary to reach a proper balance between them.

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*Conclusion *

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Electronic medical records data integration comes to serving physicians and health care providers and helps them to accuracy your decision to treat a patient or to recommend certain tests or reach an accurate diagnosis of his condition, and enables them to the nature of electronic records and relates to information networks to manage the entire health care operations , Where he became able to describe the treatment or request the tests, as well as follow-up results and see the evolution and comparing this patient’s condition or results of different types of diagnostic Kalocap or even surgery reports and devices careful monitoring other tests in addition to taking notes and diagnoses, all that information has become one unit integrated accessible them from anywhere by the applicable rules of safety systems on a network of medical institutions information.

Since all that information in electronic form has become the subject of each data analysis and excavated operations to reach more knowledge, as it has been possible to control the means of introduction of these data and means of presentation and application of IT standards special medical ensure the validity of data to support further analysis, research and studies that attempt arrive at the causes of disease or diagnosed, it also serves as the administrative and economic purposes of medical institutions, so he headed attention to what really deserves attention without wasted effort or money to provide these institutions the opportunity really to provide care and treatment to more patients

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[*Forth Section : (References) *]

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 References

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References

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15- Syed SibteRazaAbidi, “Knowledge management in healthcare: towards „knowledge-driven‟ decision-support services”, International Journal of

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17- Hyunjung Shin, Hayoung Park, Junwoo Lee and Won ChulJhee “A scoring model to detect abusive billing patterns in health insurance claims”, Expert Systems with Applications, Vol. 39, pp. 7441–7450, 2012.

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