CPHIMS Review Course • Purpose: Get comfortable with the exam’s material and format Evaluate your preparation Brush up on key areas of health care IT Identify areas for study/review
The Day • Introductions About the Test Sample Questions Review Materials (Core Presentation) Additional Sample Questions (If Time is Available)
CPHIMS What: Certified Professional in Healthcare Information and Management Systems Why: Expand your career opportunities; Validate your healthcare information and management systems knowledge, competency and credibility; Demonstrate your commitment to continuing professional development; Hold a premier credential based on a sound assessment to distinguish yourself in an increasingly competitive marketplace.
Distribution of 100 Questions General (29) Healthcare Environment (19) Technology Environment (10) Systems (36) Analysis (14) Design (5) Selection, Implementation, Support and Maintenance (8) Testing and Evaluation (3) Privacy and Security (6) Administration (35) Leadership (29) Management (6) No United States Specific Content
Professional Level of CPHIMS Holders CIO, VP of IT/IS 18.0% VP, Director of other IT/IS Department 16.2% IT/IS, Business Consultant 15.0% Mgr of other IT/IS Dept 9.8% Systems Analyst 5.3% Project Manager 5.3% As of February 15, 2012
Statistics Passing score: 67/100 *subject to change Average score: 70.2 Pass rate: 75.4% Current CPHIMS: 1,609 As of February 15, 2012
Types of Questions Recall 27 Application 39 Analysis 34 Total 100
Tips Select the BESTresponse Multiple responses may be technically appropriate but only one is the best answer Evaluate the question Look for words like first, best, most, less, least, etc. Utilize your experience, best practice, lessons learned, etc. Test is scored on total correct answers Do not devote undue time to arithmetic/calculations Note: A simple, solar powered calculator is allowed. Cell phones or other electronic devices are not allowed in the testing room.
Introduction Highly complex environment Many organizations Governmental and accrediting agencies Payers Providers of care Consumers Diverse workforce Highly regulated In a state of profound transition
Healthcare Transformation and HIT • Reform Imperatives Transformation Improved Outcomes In Population Health Improved Care For Patients Lower Cost 3RD INTERNATIONAL CONFERENCE ON TRANSFORMING HEALTHCARE WITH INFORMATION TECHNOLOGY 31ST AUGUST - 1ST SEPTEMBER 2012, HYDERABAD INTERNATIONAL CONVENTION CENTER,HYDERABAD - INDIA
International Comparison of Spending on Health, 1980–2008 Total expenditures on healthas percent of GDP Average spending on healthper capita ($US PPP) Source: OECD Health Data 2010 (Oct. 2010).
Transformational Change in Health Care Delivery and Population Health - Health IT as a Critical Enabler for Health Care Transformation Technology Adoption and Use TIME
Providers of Care Hospitals Ambulatory centers/clinics Long-term care providers Home Health Public health agencies and providers Community health programs Physician practices/Medical Home Pharmacies Diagnostic Imaging Centers Dental Service (Emerging) Academic Community Critical Access Specialty Military
Integrated Delivery Network (IDN) Definition: An organization of a variety of providers offering services across the continuum of care and integrated in administration and information sharing Formed through: Merger and acquisition Joint venture Alliance Network Key factors for success: Physician involvement Interoperable information systems/standards
Payment Systems Financing Private financing Commercial private insurance Self-Pay Public financing National health insurance National health system Reimbursement models Fee for service Prospective payment (DRGs) Value-based purchasing
Highly Complex Workforce • COO • Manager (Supply Chain) • Requisitions and • Procurement • AP • Inventory • HR Director • Recruitment • Physician relations • Credentialing • Benefits Management • Staffing • Salary and Payroll • Time and Attendance • Performance assessment • VP Patient Care • Clinical Service Mgr • Physicians • Physician Extenders • Nurses • Nurse specialists • Pharmacists • Case Managers • Utilization Review • Risk Manager • Allied Health • Professionals • Dietary staff • Transport • CFO • Controller • Business Office Manager • Scheduler • Registrar • Biller • Collector • Correspondence • Contract Manager • Charge Master • MR Director • Coders • Chart analysts/clerks
Information & Management Systems Professionals Functions of the IT Department IT Administration Leadership Management (people and resources) Develop an IT governance structure Develop and implement a strategic IT plan Staffing and budget operations and technical support Systems, applications, infrastructure management Acquire, develop, implement, manage, support Provides ongoing enhancements Specialized groups, such as those engaged in process improvement
Role of Government Provider of care Public ownership of hospitals and clinics Payer Examples: Medicare/Medicaid Provincially-funded health insurance in Canada (e.g. Ontario Health Insurance Plan – OHIP) Regulator Laws and regulations (e.g. licensure of professionals) Examples: HIPAA, ARRA, and EMTALA
Themes • Complexity • Need for collaboration/cooperation • Need for stakeholder involvement • Technology will adapt and emerge to support reform and market transformation
Components of the HIT Environment Today’s HIT environment consists of three components: • Application softwarethat consists of computer software to acquire, process and output data and information • Hardware that consists of processors, memory and data storage to run the application software • Network connectivitythat connects hardware and enables the transmission of information among applications and between organizations
Trends in Healthcare Applications Application Integration -The ability for applications to share information and work more or less seamlessly to deliver the desired functionality to the end-user Tools and Approaches (Examples) Enterprise master person index Interface engine Product suite (Best of Cluster) Single sign-on CCOW Adoption of standards essential to integration and interoperability
Trends in Healthcare Applications Vendor Application Delivery Healthcare IT increasingly a “buy” (COTS) as opposed to “build” Certification requirements Products highly configurable Movement to “cloud” Preference for single-vendor solutions Focus on health data exchange and interoperability Emerging consumer applications Security and Privacy Increasingly Important Increased stored and shared data Government standards US – Health Insurance Portability and Accountability Act (HIPAA) European Union – Directive on Data Protection
End-User Devices Personal Computers Continue to be the device of choice Connected via cable to network or wireless Point-of-Care Devices Handheld, tablet, mobile-cart PCs, phones Support clinician workflow Wireless connection Device Integration Integrated into software applications Cable or wireless connection to common network
End-User Devices(continued) Tracking technology Bar codes and RFID Audio and video Voice over IP Telemedicine Remote monitoring
Hardware Servers Manage: Applications Network Databases Data Storage External device – Storage Area Network (SANs) Models Single Server or Distributed Blade technology Virtualization • Requirements: • Redundancy • Architecture to support 24X7 • Disaster Recovery • - Hot Site: minutes to hours • - Warm Site • -Cold site: hours to days
Application Service Providers Alternative – Application Service Provider (ASP) Houses and manages back-end application and database remotely Advantages Usually provides strategy for back-up and recovery Provides “currency” in terms of upgrades Reduces IT resource requirement May run at lower Total Cost of Ownership May provide more robust security May reduce overall requirements and cost for local data center (space, electricity, security, etc.) AKA: Remote Hosting, Cloud
Connectivity • LAN (Local Area Network) • WLAN (Wireless Local Area Network) • WAN (Wide area network) • ISP (Internet Service Provider) • VPN (Virtual Private Network) • Leased Line for high volume exchanges
Applications and Suites Revenue Cycle Clinical Point of Care ERP Ancillary and Departmental Infrastructure Environments: - Production - Test - Train
Revenue Cycle EMPI, Scheduling, Admissions, Eligibility Charge Management Billing Denial Management AR Management Contract Management • Examples of Metrics: • Days in AR • % Bad Debt • % of Claim Rejections • Rate of Denials • % of accounts with late • charges • Variance from Expected • reimbursement • Cost to collect • % of accounts with • Insurance Verification Getting to Zero Balance
Clinical – Point of Care EMR/EHR Demographic and Clinical Data Clinical documentation Nursing and physician documentation Assessments, care plans, vital sign flowsheets Medication reconciliation and Medication Administration (MAR) Clinical Decision Support capabilities CPOE (Computerized Provider Order Entry) and E-Prescribing (Assumes Pharmacy) Outcomes generation Examples of Metrics: % CPOE Orders % Patients with Problem List % Patients with verified allergies % Patients with discharge inst. % Readmissions % Physicians using EMR
Terminology • EHR • longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.“ • EMR • Refers to one provider’s data; e.g., an EMR derived from data in a hospital or IDN • PHR • Consumer oriented and controlled • Increasingly tied to chronic disease management programs • Consumer controlled • Legal Medical Record • Content mandated by states • Must be in a format that supports disclosure of information • Often documents stored in a document imaging system that can support business functions of disclosure. • CPR (Computerized Medical Record) • Older term for record consisting of scanned documents
ERP General Ledger (Balance Sheet and Income Statement) Budgeting Accounts Payable Materials Management Inventory EDI Capabilities HR/Payroll • Examples of Metrics: • EBITDAR • Operating Margin • Days Cash on Hand • FTEs Per Patient Day • Inventory Turnover • Personnel expense • as a percent of • operating revenue
Infrastructure Document Imaging PACS Interface Engine Business Intelligence and Financial Decision Support Network and storage E-Mail and paging Portal technologies Component of Patient Engagement or Patient Activation
E-Health and Consumer Access • Interactive Portals • Provider: schedule appointments, view test results, e-visits, pay bills • Payer: research and choose health plan, reorder medications, find a physician • Informational • Searchable access to symptoms, disease information, medication information, interactive assessments, comparison of provider organizations for quality and cost • Personal Health Record • Maintain an electronic record of health history, medications, lab results, encounters, etc.
E-Business and Health Information Exchanges Major types E-Business Eligibility, Claim submission, Remittances Consumer Portals, Payer Portals, Physician Portals, E-prescribing Health Information Exchange (HIE) and Regional Health Information Organizations (RHIO) May be geographically-based Emphasis on sharing clinical information Seek to provide more comprehensive view of the patient’s health and service Variety of business models (primary risk)
Role of Standards Example: NHIN
Standards Accreditation: The Joint Commission and Joint Commission International Standards and guidelines ICD-10-CM World Health Organization Definition: International standard diagnostic classification for all general epidemiological and health management purposes
Other Standards Types Supporting HIE (MU) Vocabulary ICD-10-CM LOINC SNOMED-CT Content Exchange CDA R2 (Clinical Document Architecture) ASTM CCR (Continuity of Care Record) Privacy/Security AES encryption (Adv. Encryption Std.) IPsec (Internet protocol for encryption) TLS Transport (Cryptographic Internet Protocol) SOAP (Simple Object Access Protocol) REST (Representational State Transfer – architecture) • Examples • HL7 • RX Norm • DICOM ANSI ASC X12 US. Standards Body for EDI
Business Intelligence • Increasingly important in new delivery models oriented around pay for performance and service value • Transforming data from disparate systems into meaningful information • Data Warehouse • Data Transformation • Metadata • End user presentations targeted to end-user needs • Dashboard with alerts • Data sets for end-user analysis • Reports • Spreadsheets • Trends • Increasing use of visual displays • Use of natural language processing • Predictive analytics
Systems Development Life Cycle (SDLC) • Creation of new capability • Creation of a new application, system, module, etc. • Implementation of a new system • Tailoring vanilla software to requirements of future state and optimized business processes • Business process redesign for an existing system • Support quality and process improvement initiatives • System selection • Requirements development (Reflected in an RFI) Will utilize a subset of QI tools and concepts.
Quality in the System Design Life Cycle • Standards • Which types of documents, what format, which approvals, where stored? • Coding/design standards • Tools • Process • Governance • Change management • System acquisition methodology • Principles (Examples) • Service orientation (customers first) • Single vendor platform application preference • Projects MUST align with organizational strategic and tactical plans
Methodologies • Waterfall • Sequential • Assumption: requirements are known, stable • Incremental • Project broken out into sections • Series of mini-waterfalls and prototypes
Waterfall Methodology • Project • Management • PMBOK • Initiating • Planning • Proposal/ • Approval • Proposal • Executive • Presentation • Enthusiastic • Endorsement • Enables • Preliminary • Investigation • Needs • Assessment • Feasibility • Analysis • Report of • Findings • Requirements • Analysis • Current State • Future State • Prioritize • Stakeholder • Sign-Off • Alternative • Analysis • Alternatives • Cost Benefit • Analysis • Problem • Analysis • Definition • Cause • Solution Systems Analysis Process
Methodologies • Agile • Methodology promotes adaptability • Deliver working software quickly (weeks to months) • Welcomes changing requirements • Business experts and developers work together daily • Use of Sprints to create a usable set of functions that meet the user’s most pressing needs. • Each iteration selects the highest priority items from a backlog of features • Works through the development cycle in a fashion that emphasizes collaboration over written documentation.
Problem Analysis and Definition • Getting to a succinct statement of the problem • current state • future state and desired outcomes • Methodology • Interviews • Focus groups • Questionnaires • Observation • Evaluation • Literature • Documentation • QI Tools: • Brainstorming • Delphi • Nominal Group Technique • Fishbone diagrams • Pareto Chart • Histograms
Preliminary Investigation:Needs Assessment Provided information needed to continue; e.g., funding for a formal requirements effort Definition of benefits Estimate of cost and timeframe Risk assessment Organizational readiness Does not recommend a specific solution Feasibility study Important for larger or more expensive efforts