Healthcare Fraud: Auditing and Detection Guide, 2nd Edition

Chapter 21

Clinical Content Data Analysis

Genius is one percent inspiration and ninety-nine percent perspiration.

–Thomas Alva Edison (1847–1931)

Healthcare is about the restoration and or maintenance of the individual’s health. Restoration and maintenance of health includes the body and the mind. That is the easy part (the 1%). How we understand what we do and why to a patient at some point is recorded. Data is aggregated at the individual, community, and global level. The data is recorded and or exchanged in the form of a narrative, verbal communication, or collaborative effort. The data is utilized for continuity of care or other avenues such as research, health, expense, resource monitoring systems, and so forth. Managing all of this information requires complex efficient organization (99% perspiration).

The level of technology varies significantly. In fact, criteria to determine, the appropriate standards for housing the data and its use are an ongoing development. Regardless, when it comes to healthcare, at some point in the process, a patient inevitably appears on the scene. It is very easy to lose focus of what healthcare is all about—the patient. As complex as the entire primary healthcare continuum (P-HCC) may be, it is important not to forget the patient’s direct and indirect role within this P-HCC. The patient may initiate a service, or it may be initiated by one provider to another (for example, in ordering a consult). He or she may do so as a part of an employer-sponsored ...