Hacking Healthcare: A Guide to Standards, Workflows, and Meaningful Use [Perfect Paperback]

Fred Trotter (Author), David Uhlman (Author)

Book Description

Publication Date: October 26, 2011

Ready to take your IT skills to the healthcare industry? This concise book provides a candid assessment of the US healthcare system as it ramps up its use of electronic health records (EHRs) and other forms of IT to comply with the government’s Meaningful Use requirements. It’s a tremendous opportunity for tens of thousands of IT professionals, but it’s also a huge challenge: the program requires a complete makeover of archaic records systems, workflows, and other practices now in place.

This book points out how hospitals and doctors’ offices differ from other organizations that use IT, and explains what’s necessary to bridge the gap between clinicians and IT staff.

• Get an overview of EHRs and the differences among medical settings
• Learn the variety of ways institutions deal with patients and medical staff, and how workflows vary
• Discover healthcare’s dependence on paper records, and the problems involved in migrating them to digital documents
• Understand how providers charge for care, and how they get paid
• Explore how patients can use EHRs to participate in their own care
• Examine healthcare’s most pressing problem—avoidable errors—and how EHRs can both help and exacerbate it

Editorial Reviews

About the Author

Fred Trotter is a hacktivist. He works for social change by coding and promoting Open Source Health Software. In recognition of his role within the Open Source Health Informatics community, Trotter was the only Open Source representative invited by congress to testify on the definition of ‘meaningful use’ for the federal health care incentives law (Meaningful Use). Trotter also represented the Open Source EHR community in negotiations with CCHIT, the leading EHR certification body.

Trotter is the original author of FreeB, the worlds first GPL medical billing engine. In 2004 Fred Trotter received the LinuxMedNews achievement award for work on FreeB. Fred Trotter was an editor for the Open Source EHR review project with the American Medical Informatics Association (AMIA), Open Source Working Group (oswg). Fred is a member of WorldVistA and is the programmer behind Astronaut Shuttle which is the first cloud-based VA VistA offering.

Fred Trotter is a recognized expert in Free and Open Source medical software and security systems. He has spoken on those subjects at the SCALE DOHCS conference, OSCON, LinuxWorld, DefCon and is the MC for the Open Source Health Conference. He has been quoted in multiple articles on Health Information Technology in several print and online journals, including WIRED, ZSnet, Government Health IT, Modern Healthcare, Linux Journal, Free Software Magazine, NPR and LinuxMedNews. Trotter has a B.S in Computer Science, a B.A in psychology and a B.A in philosophy from Trinity University. Trotter minored in Business Administration, Cognitive Science, and Management Information Systems. Before working directly on health software, Trotter passed the CISSP certification and consulted for VeriSign on HIPAA security for major hospitals and health institutions. Trotter was originally trained on information security at the Air Force Information Warfare Center.

David is CEO of ClearHealth Inc. which created and supports ClearHealth, the first and only open source Meaningful Use certified Comprehensive Ambulatory EHR. Coming from a background of supply chain systems and big business ERP for companies including DEC, Micro Systems, Motorola, and EDS, David entered health care in 2001 as CTO for the OpenEHR project. One of the first companies to try commercializing open source healthcare systems, OpenEHR met face first with the difficult realities of bringing proven mainstream technologies into the complicated and sometimes nonsensical world of health care. In 2003 David became CEO of ClearHealth and created the ClearHealth system based on VistA that was originally developed by the Veterans Health Administration.

ClearHealth’s software is open source (GPL) and powers more than 1,000 sites from small offices to mega-institutions servicing millions of patients per year. As CEO of ClearHealth Inc. David also oversees outsourced management and operations consulting of several general practice groups and in 2013 will begin operating it’s own general practice facilities.

A frequent speaker and writer David has presented and OSCON, TEPR, LinuxWorld, SCALE, OSHC, and others. You can see his work online in Modern Health Care, Wired, Linux Journal, and on his blog: Health 365.

Product Details

• Perfect Paperback: 248 pages
• Publisher: O'Reilly Media (October 26, 2011)
• Language: English
• ISBN-10: 1449305024
• ISBN-13: 978-1449305024
• Product Dimensions: 7.2 x 0.6 x 9.2 inches
• Shipping Weight: 12.8 ounces (View shipping rates and policies)
• Average Customer Review: 4.6 out of 5 stars  See all reviews (18 customer reviews)
• Amazon Best Sellers Rank: #29,110 in Books (See Top 100 in Books)
  • #14 in Books > Computers & Technology > Software > Business > Workflow
  • #21 in Books > Computers & Technology > Internet & Web Culture > Hacking

More About the Author

Fred Trotter is a hacktivist. He works for social change by coding and promoting Open Source (FOSS) Health Software. In recognition of his role within the Open Source Health Informatics community, Trotter was the only Open Source representative invited by the NCVHS to testify on the definition of 'meaningful use' under ARRA. Trotter also represented the Open Source EHR community in negotiations with CCHIT, the leading EHR certification body.

Trotter is the original author of FreeB, the worlds first GPL medical billing engine. In 2004 Fred Trotter received the LinuxMedNews achievement award for work on FreeB. Fred Trotter was an editor for the Open Source EHR review project with the American Medical Informatics Association (AMIA), Open Source Working Group (oswg). Fred is a member of WorldVistA and is the programmer behind Astronaut Shuttle which is the first cloud-based VA VistA offering.

Fred Trotter is a recognized expert in Free and Open Source medical software and security systems. He has spoken on those subjects at the SCALE DOHCS conference, LinuxWorld, DefCon and is an MC for the Open Source Health Conference and sometimes the healthcare track at OSCON. He has been quoted in multiple articles on Health Information Technology in several print and online journals, including WIRED, zdnet, Government Health IT, Modern Healthcare, Linux Journal, Free Software Magazine, NPR and LinuxMedNews.

Fred Trotter is deeply involved in the e-patient movement, the quantified self movement, the health 2.0 community. In all of those environments, Trotter has focused on building tools that help empower patients to improve their own health. Specifically with a focus on behavior modification. Trotter is a founder of the programmable self movement.

Trotter has a B.S in Computer Science, a B.A in psychology and a B.A in philosophy from Trinity University. Trotter minored in Business Administration, Cognitive Science, and Management Information Systems. Before working directly on health software, Trotter passed the CISSP certification and consulted for VeriSign on HIPAA security for major hospitals and health institutions. Trotter was originally trained on information security at the Air Force Information Warfare Center.

Most Helpful Customer Reviews

7 of 7 people found the following review helpful

4.0 out of 5 stars Not Great, but The Best. February 15, 2012

By Robert Cooper

Format:Kindle Edition|Amazon Verified Purchase

I just moved into "Health Informatics" (a little over a year ago) as a programmer at a startup. Most of my time is spent dealing with the kind of thing you expect to deal with as a programmer, but frequently you have to "touch" the totally messed up world of Healthcare IT, and it usually sucks. I have spent an inordinate amount of my free time attempting to Google information to get a footing, only to find worthless management-oriented information or, or specification sites *cough* HL7 *cough* locked behind outrageous IP-paywalls. The books that are out there are ALL targeted at managers or health pros, not technologists.

This book is a, pretty much fabulous, bootstrap. I wish I had found it, well, about 9 months before it was published.

The one failing of the book is the targeting of the audience. The subtitle belies the writing in the book, which is targeted at a wider audience. I would say that if it were truly a "Guide for IT Staff" the back half of the book would be twice as long as it is, and the front half as long. It shouldn't be "making apologies" to IT people and encouraging them to skip sections that explain things in "Your Mom" language, it should pony up and drop the tech. The coverage of the various specs is hand-wavy and overly conceptual. The only thing I would say was spot-on perfect was the overview of the various ontological specs in the field, which cover almost exactly what you need to know and where to get more (though the discussion of Cyc felt a bit like nerd-preening on the part of the author. We all know it is there, thanks). In my own painful experience, discussion, for instance, of HL7 without discussion of transport is worthless.... The dismissal of the conceptual problems of the HL7 XML stuff, without noting that it is an idiotically hackish shoveling of the "old" HL7 into XML presumes someone is already steeped in the idiocy of the current Health IT world before getting up to speed on "the new stuff".

In spite of how harsh that last graph seems, even to me, I told everyone in my organization to buy it. It isn't perfect, but it is definitely the best bootstrap on the topic I have seen. Read more ›

7 of 7 people found the following review helpful

5.0 out of 5 stars excellent introduction to the issues of health care IT December 15, 2011

By Frederick Hill

Format:Kindle Edition

I am in the target audience for this book, a programmer with a background in consumer electronics who now works for a company that sells medical billing, an EHR, and other health care IT. Trotter and Uhlman provide a lot of context and filled in a lot of gaps in my understanding of the practice and business of medicine, and in the specific IT issues in the medical domain. I appreciated the range of levels of abstraction, from systemic problems in U.S. health care to the nitty gritty of message data formats, all informed by authors' extensive experience. I also noted the advice along the lines of "if you are trying to do X, you will have issues of the form A and B". As an experienced programmer I regard advice of that form from other programmers knowledgeable in the problem domain as gold. Finally the book is well written and an easy read. The book is not meant to be a comprehensive reference, which I mention not as a drawback but in case someone is expecting that. I plan to recommend it to all of the programmers and development managers who come to my company from college or another industry.

5 of 5 people found the following review helpful

5.0 out of 5 stars A "Must Read" for anyone in Healthcare IT April 23, 2012

By rodmax

Format:Perfect Paperback|Amazon Verified Purchase

I am a software developer working on Healthcare decision support software. I actually participated
in the Meaningful Use certification of our software, without much of an inkling of what the magic term "Meaninful Use" meant.
This book gave me a very clear understanding of what the term "Meaningful Use" means and also the surrounding context in which it exists.
I found this book very readable; it is concise, but thorough.
If you are involved in any way with Healthcare IT and don't have a clue as to what "Meaningful Use" means, please invest less than $20 in your career to get this book (and then read it!).

10 of 13 people found the following review helpful

2.0 out of 5 stars Interesting IT Perspective November 12, 2012

By NC

Format:Perfect Paperback

I am a radiologist with a BS in engineering and I have a background in programming. The authors provide an interesting overview of their experience and issues with IT in healthcare. There are some gaps in coverage which I think can be expected after reading the reviews and summaries, namely PACS (Picture Archiving and Communication System) and other systems including pathology information systems which have unique problems and workflow issues that are not covered.

I agree with many of the authors statements about needing perspective from those using IT systems and the need for collaboration between the management, billing, physicians, and the myriad other people who are involved in using IT systems: nurses, PAs, CRNAs, radiology techs, nurse practitioners, schedulers, coders, sys admins, insurance companies, other hospitals (trying to get medical history or old samples, films, or labs), etc. The list is enormous and each category has unique needs, and permission constraints.

While the authors attempts to bring in some excellent examples of errors and problems in EMR implementations their clinical information is often erroneous and sometimes wrong. For instance from pgs 92-97 the authors talk about errors related to radiation. They briefly describe a situation where "100s" of patients were subjected to inappropriately high levels of therapy. The details and proposed solution are very vague and raise concern about the truth of the matter. They also mention that no techniques were available for monitoring patient dose, which is false. There are a variety of ways of detecting radiation dose during therapy administration. (Low et al "Dosimetry tools and techniques for IMRT" Med Phys.... 38 (3), March 2011) It also does not seem plausible that such an issue was not discovered on routine quality assurance and maintenance checks which are required in all US medical institutions. The error was attributed to machine crashes and resetting of default values which may have played a role in patients receiving an increased dose but there are a myriad of other considerations. Was this a 5%, 50%, 500% increase in dose? Was it negligible? There are a number of safety systems in place to catch such errors, and in order to perform a root cause analysis a number of other issues need to be discussed, rather than this cursory glance. Also, nuclear medicine does not administer therapeutic radiation except for very specific indications such as thyroid disease. It is radiation oncology who primarily administers radiation for therapeutic purposes, and they are not closely affiliated with nuclear medicine or radiology, and use very different technology, radiation, and IT systems.

The authors also appear misinformed about a variety of radiologic practices. There are some comments about the use of the term "medio-lateral axis" as a possible substitution for the left and right sides of a patient (an axis has two extremes, in this case left and right). I'm not sure what the authors actually mean since radiologists use left and right just as anyone else would. They criticized the conventions for patient positioning and the conventions for left-sided and right-sided orientation of the patient on the film/images. This is an established convention and has pitfalls either way. The important point is that it is standardized. This is a well-known convention that radiologists, surgeons, general practitioners, and the remaining medical staff are trained in. The only exception being studies performed by nuclear medicine which usually have left and right flipped.

The authors go on to describe diagnostic imaging in the emergency setting which is a controversial issue but grossly misrepresented in this exposition. The issues relating to the overuse of imaging have filled multiple books and copious journal articles, and some of the issues include: expediency in the ER, patient concerns, climate and training in medicine in the 21st century, perceptions surrounding litigation, and self referral. the authors suggested that the added information of a patient's radiation exposure would alter the clinical decision to obtain medical imaging with ionizing radiation which is highly debatable. There currently is an effort by the American College of radiology to produce a radiation dose registry which was not mentioned. This is not to say that radiation dosing might not alter a clinicians likelihood to order a study, but in the ER this often has negligible weight in comparison to the need for an acute diagnosis. They also put forth the idea of the linear no-threshold model for radiation dosing which is the current governmental standpoint (BEIR VII), but it should be acknowledged that this model is heavily criticized, and the evidence for low level medical ionizing radiation leading to malignancy is not well-established in adults.

I believe the topics in this book are very timely and of great importance, and this book covers many important issues from a computer science perspective. However, as the authors encourage more collaboration with the clinical community, I would encourage the authors you to pursue clinical collaboration in writing this book, and it's future editions. Hopefully, that way, readers will gain a more accurate understanding of the clinical issues of the day and a better understanding of the organizational structure of medicine. Read more ›