Domain III – Information Technology & Systems (20%)

1. Domain III – Information Technology & Systems (20%) RHIA Prep Workshop Test Year 2014

2. Objectives Implement and manage use of technology application Develop data dictionary and data models for database design Manage and maintain databases Apply data and functional standards to achieve interoperability of healthcare information systems

3. Objectives 5. Apply data/record storage principles and techniques associated with the medium 6. Evaluate and recommend clinical, administrative, and specialty service applications 7. Manage master patient index

4. Hardware • Physical equipment of computers and computer systems • CPU • Scanner • Printer • Consists of both electronic and mechanical equipment

5. Software • Set of instructions required to operate computers and their applications • Operating system software: • OSX, Windows, Linux, UNIX • Application software • E.H.R., Microsoft Word, auto-back-up, etc.

6. File Sizes Kilobyte (KB) = 1,000 bytes Megabyte (MB) = 1,000 kilobytes Gigabyte (GB) = 1,000 megabytes Terabyte (TB) = 1,000 gigabytes

7. Categories of Computers • Supercomputers • Used in large scale activities • Mainframe systems • Only available until 1960s • Midrange systems • Minicomputers – introduced in 1960s • Workstations

8. Categories of Computers • Microcomputers • AKA Personal Computers (PC) • Variety of sizes [desktop, laptop, tablet, etc.] • Web appliances • Used in conjunction with the Internet

9. Computer Peripherals • Input devices: keyboard, scanner, microphone, mouse, etc. • Output devices: monitor, printer, speakers • Processing and memory: CPU (central processing unit); RAM, ROM

10. Computer Peripherals Storage Devices: hard disk drive, jump drive, CD Rom, DVD, etc. Communications devices: modems

11. Information Systems A process that refines raw facts into meaningful information Integration of several elements of a business process Create competitive advantage by improving operations and improving patient care delivery

12. System Characteristics • Components that act together to accomplish a specific objective • Adapt and respond to environmental changes • People • Data • Work processes • Information technologies

13. Health Information System (HIS) Patient scheduling, admission/discharge processes, and patient transfers Business and financial systems: Patient accounting and billing] Communications and networking: interdepartmental communications

14. Health Information System (HIS) Department-specific systems: Radiology, pharmacy, etc. Documentation systems: collect, store, and retrieve patient data Reminder and advice systems: evidence-based medicine, patient care activities

15. System Development Life Cycle Request for development Requirements and system analysis System design Specific functions

16. System Development Life Cycle Computer program coding Testing of systems Development of system documentation User training

17. System Development Life Cycle User conversion Operating of the system System maintenance System changes and upgrades

18. Nolan’s Six-Stage Theory Initiation of automation Expansion of automation Control of information technology Integration of systems Data administration Maturity of system’s involvement with organizational strategic planning

19. Database Management System (DBMS) Integrated set of programs to manage access Software that supports the operation of database Personal DBMS: small projects Server-based DBMS: links multiple tables and maintains consistency

20. Databases Organized integrated collection of data segmented into fields, records, and files Structured file to store data as well as edit, query, and retrieval of data

21. Levels of Data Organization Item - data that describes an object Record – items related to each other File – records related to each other Database – structured file for data storage

22. Database Models • Relational • Data stored in pre-defined tables with columns and rows (e.g. spreadsheet) • Heirarchial • Treelike structure of parent/child relationships • Network • Treelike structure, child with many parents • Object-oriented: stores objects like pictures • Object-relational: relational + object-oriented

23. Types of Organizational Databases • Transactional • AKA operational or production database • Detailed data to support facility organization • Analytical • Supports strategic and tactical decision-making • Extracted pieces of data • Distributed • Support specific local applications

24. Types of Organizational Databases • External • Obtain information from sources outside the organization • Data Warehouse • Integrate organization-wide data into single repository • Sets up large stores of data • Data Mart • Subset of data warehouse • Data Mining • Data used to explore relationships within existing data

25. Information Security • Privacy • Right to limit access by others to some aspects of personal information • Confidentiality • Information collected will be used for purpose for which it was gathered • Security • Control access and protect information • Informational Privacy • Keep information from begin disclosed to anyone

26. Security Fundamentals Protect privacy of patient-related data from intrusion Ensure integrity of information Ensure availability of information to authorized users in a timely fashion

27. Security Protocols • Establish a security organization • chief security officer, privacy officer, etc. • Implement employee awareness program • Conduct risk analysis and assessment • Establish access control • Tracking system

28. Security Protocols • Implement physical and management controls • passwords, locked doors, limited access • Develop a disaster recovery and business community plan • disaster plan • Implement network controls • virus protection

29. Prevention and Control • Personnel • Employee access based on “need to know” • Physical • Secure equipment from any threats • Hardware • Temperature-controlled, power outage protection

30. Prevention and Control • Software • Audit trails, integrity controls • External • Firewalls, encryption, SSL protocols, etc. • Communication • Authentification, system knows user is authorized

31. New & Emerging Technologies • Videoconferencing • Skype, FaceTime, GoTo Meeting • Groupware • Integrated work flow (e.g. Google Documents) • Information kiosk • Patients and visitors have access to variety of data • Speech recognition • Voice controls, dictation (voice-to-print)

32. New & Emerging Technologies • Telephone interface systems • Computer-telephone integration • VOIP (Voice Over Internet Protocol) • Website support: customer service or tech • Telemedicine • Electronic exchange of clinical data

33. New & Emerging Technologies • 3D imaging • All three spatial dimensions • PDA/Smartphones • Portable computing, faster access to data • Wireless networking • Smart Cards

34. Network Architecture • Local Area Network (LAN) • Connects computers in small area • Client-server network • Peer-to-peer network • Hybrid network (client-server + peer-to-peer) • Wide Area Network (WAN) • Connects computers over large area • Two or more LANs connected together

35. Internet Protocols Thousands of loosely connected WANs Relies on software called “browsers” (eg. FireFox, Safari, Internet Explorer) IP = Internet Protocol, a unique address for each and every computer TCP/IP = protocol for transmission of data HTTP = hypertext transfer protocol HTTPS = hypertext transfer protocol secure

36. Internet Language HTML = hypertext markup language SGML = standard generalized markup language XML = extensible markup language JAVA = programming language

37. Intranet Special type of LAN Uses Internet to connect members of one organization Accessible to only authenticated users

38. E-Commerce • Marketing, buying, selling, and support of products and services using the Internet • Supports patient education initiatives • May include EFT (electronic funds transfer) for payments • Enhance convenient patient/provider services • Physician referral services • Requests for ROI, etc.

39. Information Resources Management (IRM) • All management concepts related to • Creation • Usage • Storage • Disposal Of business-related information

40. Information Resources Management Integration strategies for data information processes: computer and manual Identifies information as a valuable organizational and industrial resource CIO = Chief Information Officer

41. Practice Questions

42. Practice Question #1 Which of the following is an example of a clinical information system? Executive information system Test results reporting ADT Master patient index

43. Practice Question #2 Which job title is most appropriate to manage the information resource management in a health care institution? Chief Information Officer Health Information Manager System Analyst Data Administrator

44. Practice Question #3 The pharmacy department requests a focused information system that will allow it to research its historical data in great detail. Which system should the pharmacy use? Data warehouse Data mining Data mart Expert system

45. Practice Question #4 The health information department is going to store 2,500 discharge summaries on optical disk. Each discharge summary is about 3,072 bytes in length. How many kilobytes of space are need to store the data? 3K 30.7K 7,500K 7,680,000K

46. Practice Question #5 Workshop Hospital has been collecting data on physician credentialing for 4 years. The credentials specialist wants to retrieve all the physicians in the database who are pediatricians. Which tool should be used to run the report? XML HTML HTTP SQL

47. Practice Question #6 Which of these represent a Record in a relational database? Smith, Jones, Carter, Langston Smith, Female, Age 31, Chicago Age 31, Age 27, Age 42, Age 51 Name, Gender, Age, Home town

48. Practice Question #7 Which of these represent a Field in a relational database? Smith, Jones, Carter, Langston Smith, Female, Age 31, Chicago Age 31, Age 27, Age 42, Age 51 Name, Gender, Age, Home town

49. Practice Question #8 Joan was reading her e-mail and this popped up: HIM department meeting today, 2:30 pm This is an example of: Reminder Alert JAVA GUI

50. Practice Question #9 Dr. Reiner was entering an order for Zithromax for his neonate patient and this popped up: Patient is 4-days old. Do you want to continue with this medication order? This is an example of: Reminder Alert JAVA GUI