Managing health care information is challenging. There are many ways that health care organizations process information and various interpretations of terms. For instance, who is the customer in health care? Is it the patient, the insured, the insurance provider that pays claims, the financially responsible party, the third-party administrator, or the employer that buys the insurance? Who is the provider of services? Is it the individual health care practitioner, the health care network, the institution or medical office, or a combination of these? Parties within health care may act in different capacities; for example, an HMO may provide its own doctors or may subcontract its personnel and facilities from other providers, labs or health care facilities. Employers may self-insure, administer their own programs or hire third-party administrators. Additionally, maintaining information on health care service deliveries and the corresponding claims is very difficult due to the many business rules that apply to different situations.
Thus, flexible models are needed to handle the many different scenarios that can occur in health care. Furthermore, data models are needed to truly understand the nature of the data within health care and build systems that can effectively handle current and future needs. Universal data models are template or generic models that offer insights and patterns to aid in understanding and designing effective systems.
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