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Hacking Healthcare: A Guide to Standards, Workflows, and Meaningful Use 1st Edition

4.5 out of 5 stars 62 customer reviews
ISBN-13: 978-1449305024
ISBN-10: 1449305024
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Editorial Reviews

Book Description

A Guide for IT Staff in Health Care

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 thedifficult 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 theClearHealth 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 alsooversees 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.

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Product Details

  • Perfect Paperback: 248 pages
  • Publisher: O'Reilly Media; 1 edition (October 29, 2011)
  • Language: English
  • ISBN-10: 1449305024
  • ISBN-13: 978-1449305024
  • Product Dimensions: 7 x 0.6 x 9.2 inches
  • Shipping Weight: 1.1 pounds (View shipping rates and policies)
  • Average Customer Review: 4.5 out of 5 stars  See all reviews (62 customer reviews)
  • Amazon Best Sellers Rank: #59,789 in Books (See Top 100 in Books)

Customer Reviews

Top Customer Reviews

Format: Kindle Edition 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.
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Format: Perfect Paperback 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!).
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The positives: this book presents a lot of information, both current & historical, and ultimately manages to paint a picture of the healthcare IT landscape that is mostly complete.

Negatives: oh my -

There is a whole chapter describing meaningful use requirements, and specifically, outpatient clinical quality reporting measures, that could have been shortened to a tenth of the size of that chapter and taken out to a companion website. A not-so-minor nit - I understand the book was originally written in 2011 and I bought it in May 2014. It's unclear if this chapter has been updated since the original writing, because the term PQRI has since been retired in favor of PQRS, in yet another brilliant move on the part of the powers-that-be. The authors call this chapter an interactive guide - and I'm still trying to suss out how it can be interactive in the original print or the kindle version.

The chapter on Ontologies is technically weak and rambling.

Similarly, the chapter on Medical Billing, while illuminating, could have been much shorter. At times, it appeared as if the authors were being paid by the word and were taking full advantage of it.

I expected to see more detail in the surprisingly short chapter on EHR technology history, but that was not to be. And it is neither comprehensive enough (leaves out several market leaders) nor has it been updated with changes in the EHR world since original publication.


It is sad that this is arguably the best (or only) book introducing healthcare information technology to the rest of the world working in software and computers. It serves to perpetuate the notion that healthcare IT is a backwater of the software world, when instead, healthcare IT should be one of the areas leading the development of new advances in software.
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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.
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