Healthcare IT Decoded - Domain Basics

Explore how health insurance eligibility works for individuals and hospitals using electronic data interchange (EDI), clearinghouses, and TPAs, including I-270/271 transactions and Medicare advanced beneficiary notification.

Understand how registration differs from admission and what clinical details accompany admitted patients. See how financial counselling estimates costs and guides patients to aid within front office revenue cycle management.

Explore the outpatient care journey in the OPD space, covering appointment, registration, nursing intake, diagnosis, tests, lab reports, radiology outputs, and prescriptions.

Explore medical transcription and medical coding, including ICD diagnosis codes and diagnosis related grouping, and their role in standardizing billing and revenue cycle management.

Explore how health care codes and standards, from ICD and SNOMED to LOINC and RxNorm, shape EMR modules, data transmission, and interoperability across front, middle, and back office.

Explore the back office of revenue cycle management, turning patient data into charges, applying hold days, validating claims, sending 837 files, and interpreting 835 remittance advice and EOB.

Explore a simulated medical billing scenario within a revenue cycle management workflow, illustrating front, middle, and back office processes, insurance eligibility, coordination of benefits, coding, and charge master management.

Trace the history of health insurance from ancient payments and sliding scales to modern insurance contracts, blue cross and blue shield, workers' compensation, and UB-04 forms.

Explore the history of health insurance, from early physician payments and sliding scales to Blue Cross Blue Shield, Medicare and Medicaid, and the evolution of claim forms.

Explore the UB04 overview and its role in healthcare IT, covering institutional claims, 837 formats, ICD codes, and data elements that drive coverage decisions.

Explore UB04 data elements, including fields for hospital name and address, patient and medical record numbers, type of bill, admission details, discharge status, and patient condition, with practical examples.

Explore UB04 data elements, including revenue codes, service data and units, payer information, the national provider identifier, and ICD diagnosis and procedure codes to understand hospital charge reporting.

Explains medical transcription, editor's role, and medical coding with ICD-9/10, modifiers, and audits, plus chargemaster, revenue codes, and benefits concepts like assignment, coordination, coinsurance, deductibles, denials, and explanations of benefits.

Explore the history of electronic medical records, tracing the shift from source-oriented notes to problem-oriented medical records (POMR) as Dr. Lawrence Weed advocates structured, problem-based data and integrated planning.

Explore soap notes—subjective, objective, assessment, and plan—for documenting patient records, illustrated by an ICU case and practical considerations for efficient medical documentation.

Explore how medical records become electronic by digitizing data on devices, creating emrs and cross-clinic ehrs. Understand clinical data repositories, vocabulary standards, and a clinical decision support system.

Design an electronic medical record allergy screen by translating paper allergy data into a digital form, using demographics navigation and an allergy section with dropdowns, checkboxes, and auto-populated patient names.

Explore how EMR system validation and certification work, focusing on allergy information capture, decision support criteria, and how certification bodies shape testing standards.

Explore regulatory milestones shaping healthcare IT, from EMR digitization and billing code changes to ICD-10 adoption and ARRA incentives, and information blocking under the 21st century cures act.

Explore the American Recovery and Reinvestment Act (ARRA) and its role in digitizing health care, investing billions to drive electronic capture of patient information and EMR adoption.

Explore meaningful use in healthcare information technology, detailing stage one and stage two criteria, data capture and sharing, and the Medicare and Medicaid incentives for providers and hospitals.

Explore the ICD-10 migration, contrasting ICD-9 diagnosis and procedure codes, highlighting greater specificity and laterality, expanded code sets, and mapping challenges.

Explore how ICD-10 migration affects people, processes, and technology across care teams, coding workloads, insurance, and revenue workflows, with real-world cost and reporting implications.

Reviews shoppable services under CMS rules, including 70 mandated items and a potential minimum of about 300, with price estimates and required data displayed on the hospital website.

The lecture explains how CMS monitors hospital price transparency for non-compliance via complaints, reviews, and audits, and covers notices, corrective action plans, bed-count based penalties, and hearings.

Understand healthcare data transmission standards as the language of medical information exchange, including HL7 and FHIR messaging across hospital to insurer, internal and external labs, and 270/271 and 837.

Decode HL7 messages by examining segments, fields, and subfields delimited by pipes, interpreting patient demographics, vaccination data, and message types.

Explore health level seven fundamentals, trigger events, and the message architecture including segments, fields, and headers, with real-world examples of admits, labs, transfers, and acknowledgments.

explores privacy, confidentiality, and security of protected health information under HIPAA, including when to share data, role-based access, encryption, and EDI standards for secure electronic transmission.

Learn to read and interpret EDI transactions by translating star-delimited segments into readable patient, insurer, and provider data. See how envelopes and the 270 eligibility workflow reveal payer-provider-subscriber roles.

Describe how electronic data interchange (EDI) standardizes healthcare business messages between buyers, suppliers, and insurers via value-added networks, enabling efficient 850 purchase orders and 270/271 benefits inquiries.

Explore the continuity of care document (ccd), a snapshot of patient data used across transactions to ensure up-to-date transfer, including identifying information, insurance, allergies, medications, labs, and directives.

Explore the FHIR-based patient viewer to add patients, search records, and view comprehensive data including conditions, observations, medications, heart rate, temperature, and encounter timelines.

Understand how the national drug code (ndc) encodes medications, with the first five characters identifying the manufacturer and the remainder detailing product and package.

RxNorm provides a standardized drug naming system with deeper data than NBC, detailing function, mechanism, interactions, packaging, and manufacturer information; demonstrated via the NLM Orix tool using aspirin and amoxicillin.

Explore how NDF-RT and MED-RT medication codes organize data, including mechanism of action, oral capsule forms, sedative effects on the central nervous system, and post-2018 changes to code structure.

Explore how SNOMED-CT connects ICD codes, enabling mapping of myocardial infarction across systems and APIs for clinical text mining to identify drugs or disorders.

Map laboratory observations to standardized loinc codes to unify diverse terms like glucose tests and systolic blood pressure across hospitals, enabling consistent lab terminology and reporting.

Explore personal health records and the shift from paper to electronic health information, and how health information exchange and patient portals enable consent-based sharing across local to global scales.

Explore how hospitals use quality measures and coding to report performance. Learn how numerator and denominator logic, exclusions, and antithrombotic therapy and diabetes control drive these reports.

This lecture explains Singapore's healthcare facilities structure, including private vs government beds, polyclinics as primary care hubs, and acute, long-term, and dialysis services.

Explore Singapore's universal health coverage, subsidies by per-capita income, and schemes like medisave, medishield life, medifund, eldershield, plus ward subsidies for B2 and C classes.

Explore Singapore's terminology and data transmission standards, including ICD, SNOMED CT, LOINC, and Singapore drug dictionary (SDD) with HSA DB, plus GMDN for medical devices and MDM nomenclature.

Explore Singapore's data transmission standards, highlighting HL7, FHIR, and CDA/CCD for clinical documents and DICOM for medical images, while noting no mandated HL7/CCD regulations or EDI use.

Examine Singapore's electronic medical records landscape, focusing on Synapse, Epic, and Allscripts deployments across 46 health institutes and the role of adverse event reporting in the critical medical information store.