The CPHIMS Review Guide, 4th Edition

Preparing for Success in Healthcare Information and Management Systems

Healthcare Information & Management Systems Society (HIMSS), Mara Daiker, Mara Daiker

• Publisher: Productivity Press
• Year: 2021
• ISBN:
  9780429808944
• Edition: 4
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

Whether you're taking the CPHIMS exam or simply want the most current and comprehensive overview in healthcare information and management systems today, this completely revised and updated fourth edition has it all. But for those preparing for the CPHIMS exam, this book is also an ideal study partner. The content reflects the outline of exam topics covering healthcare and technology environments; clinical informatics; analysis, design, selection, implementation, support, maintenance, testing, evaluation, privacy and security; and management and leadership. Candidates can challenge themselves with the sample multiple-choice questions given at the end of the book.

The benefits of CPHIMS certification are broad and far-reaching. Certification is a process that is embraced in many industries, including healthcare information and technology. CPHIMS is recognized as the 'gold standard' in healthcare IT because it is developed by HIMSS, has a global focus and is valued by clinicians and non-clinicians, management and staff positions and technical and nontechnical individuals.

Certification, specifically CPHIMS certification, provides a means by which employers can evaluate potential new hires, analyze job performance, evaluate employees, market IT services and motivate employees to enhance their skills and knowledge. Certification also provides employers with the evidence that the certificate holders have demonstrated an established level of job-related knowledge, skills and abilities and are competent practitioners of healthcare IT.

III HEALTHCARE INFORMATION AND SYSTEMS MANAGEMENT

Chapter 4 Analysis

DOI: 10.4324/9780429442391-7

Learning Objectives

At the conclusion of this chapter, the reader will be able to:

• Apply appropriate concepts of systems development (e.g., systems development life cycle or SDLC)
• Apply and utilize project management methodology components (e.g., needs analysis, gap analysis, defining and prioritizing requirements)
• Apply appropriate concepts of process improvement (e.g., DMAIC, PDCA)
• Utilize standard visualization tools to analyze and improve current business and clinical processes (e.g., process mapping, flow diagramming, gap analysis)
• Interpret and analyze disparate data sets
• Formulate alternate processes and potential solutions for new or improved applications and/or systems
• Evaluate if a proposed solution aligns with the organization's strategic and operational plans
• Perform cost–benefit analysis to evaluate impact on issues related to healthcare systems (e.g., customer satisfaction, patient care quality, economics, access to care, business process improvement)
• Develop proposals that include recommended approaches and solutions, and plans for realizing benefits
• Analyze and interpret business documentation to promote system changes and/or implementations (e.g., RFPs, RFIs, SLAs, SOWs, NDAs, etc.)

Introduction

Different industries have adopted the use of information technology (IT) in their various operations in order to enhance growth, conform to emerging standards, attract new customers, maximize profitability and acquire business intelligence. Different sectors, however, have adopted IT use in different capacities. The health sector, like all others, is striving to enhance the acceptance of better and easier techniques available through an IT implementation, yet the average use of IT in healthcare has lagged behind other industry sectors for the better part of the last decade. According to Deloitte's 2018 Global CIO Survey, only about 4.26% of revenues were spent on technology in the healthcare services industry. This is up three quarters of a percent since the previous survey in 2017.¹ In early 2019, Forrester Research and Gartner both released predictions that spending on healthcare would increase to nearly 9%. Gartner's report though further broke down the spending, which continues to show that, although spending is up, monies are allocated mainly on supporting and maintaining the current infrastructure, not on growing and transforming the business through IT.² Healthcare has many potential benefits from IT implementation in both managerial operations and patient-related operations. These benefits may be realized through systems implementation. A common methodology that may be followed during this pursuit is the systems development life cycle (SDLC). The SDLC is a process used to develop an information system, including requirements, validation, training and user ownership through investigation/planning, analysis, design, implementation and maintenance.³ During the planning phase of the SDLC, the phase prior to the analysis phase, the initial idea for an health information system project is first developed. The feasibility, objectives and scope are examined, current problems with the existing situation are considered and a recommended solution is proposed. If the project appears to be worth pursuing the project then moves to the analysis phase. The purpose of the systems analysis phase is to understand the business requirements and to build a logical model of the new system. Requirements modeling is going to be completed, business processes are going to be described and defined, data, process and object modeling will take place, and ultimately a systems requirements document describing the management and user requirements, alternative plans and costs and an analysis of the recommendation will be produced. During the systems analysis phase, the following objectives should be met:⁴

• Gather, analyze and validate technical, functional and nonfunctional requirements.
• Evaluate the alternatives and prioritize the requirements.
• Examine the information needs of end users and establish the systems goals.
• Create software, hardware and network requirements documentation.

Requirements gathering in this phase is key. Lack of end user input can mean a weak analysis. A weak analysis leads to poor design, which can lead to failed projects.

Healthcare Problems and Opportunities for IT Implementation

Healthcare globally is going through dynamic changes in several ways. Improvements to healthcare information systems emerge from a need for change. Either the existing system does not meet the evolving needs of the program or there is an understanding that emerging technologies allow for radically better systems. In response, a small group, or a project champion, identifies this need and then tries to mobilize a larger group of stakeholders. During this phase, systems analysis, the perceived gaps and opportunities are documented, with a strong focus on describing the desired benefits and why. It may include the development of a high-level business case that compares the benefit with estimated costs. To begin, let's look generally at problems plaguing traditional healthcare systems and then potential opportunities to address these issues.

Problems with Traditional Healthcare Systems

Overall, there are some general problems with the traditional healthcare systems. These may include:

• Poor quality of health information including redundancy and inconsistent standards for the collection and sharing information.
• Inability to obtain health information at the time and place where it is needed.
• The data collected in health records is limited.
• Some registers in health exist only in paper form, which limits quick access to them.
• Inadequate procedures for the implementation of information systems not related to the relevant organizational changes.
• Existing solutions do not ensure interoperability and the lack of co-operation between systems makes management of information impossible and adversely affects the accuracy, integrity, comparability and completeness of data.
• To this point, systems have been developed primarily to support the work of the administrative unit, while to a small extent adjusted to the needs of patients, doctors and other users.
• Lack of computerized practitioner order information and histories for drugs and other substances, medical supplies, catalogs and lab test results.
• Lack an integrated, interoperable electronic health record, image and film archiving and associated communication systems, the result analysis mechanism for ordinary patient processes such as lab tests and drug prescriptions, prescription error alert systems and electronic monitoring of high care patients.

Opportunities with Advanced Healthcare Systems

As we look toward advanced healthcare systems, there are many opportunities. Hospital information system (HIS), healthcare information system and patient data management system (PDMS), all these terms refer to the integrated information systems in the healthcare sector. They are complete solutions for managing medical, administrative, financial and legal data. The overall aim of a HIS is to provide support for patient care, achieve optimal financial performance and streamline administration. These systems include the integration of clinical systems, financial systems and administrative systems. Benefits of integrated healthcare systems include:

Operational

• Increases productivity, reduces cost, improves data quality, improves data sharing/flow, provides better access to data, provides easier exchange of data, improves data presentation, reduces medical errors and helps achieve satisfaction.

Managerial

• Improves managerial control, provides more understanding and control of processes, supports decision-making, improves allocation of resources, improves quality of care provided, improves work efficiency, increases performance and increases return on investment.

Strategic

• Supports more effective planning, increases synchronous-asynchronous collaboration among actors (actor refers to all human and non-human users that interact with the healthcare system), improves relationships with suppliers, improves knowledge sharing, improves population's health and increases survival rates and quality of life.

IT Infrastructure

• Promotes reusability of objects, reduces development risk, supports the use of e-healthcare and telemedicine-based patient support models, achieves non-invasive solutions, achieves process integration, provides object/components integration, provides data integration, provides real-time integration, integrates custom systems and integrates packaged systems and integrated e-business solutions.

Organizational

• Reduces need for hospitalization or length of stay, reduces waiting times, reduces cancelled operations, achieves effective clinical and administrative management, increases business efficiency, supports clinical decision-making, results in reliable data, increases data analysis and reduces paper work processes.

The major avenues of opportunities for change are spread across clinical, administrative and financial functions as well as infrastructure.

Clinical Functions

A significant percentage of modern healthcare facilities are using IT systems in clinical operations. However, the majority of units are still dependent on traditionally used systems, such as physical patients’ document keeping, lab reports, drug administration history and other functions. While much progress has been made in these areas over the past couple of decades, we still have a long way to go before we achieve a global, interoperable healthcare system in all types of healthcare settings.

Applications for Clinical Functions

Electronic health records (EHRs) involve standardizing the way in which patients’ records are entered, stored and retrieved, not just within an organization, but across different hospitals, caregivers, government-controlled organizations and other interested parties. The biggest challenge regarding EHRs has been the establishment of an industry standard so that an efficient workflow can be realized that would allow for seamless retrieval and use of records for patients, even when patients are moved to units or facilities other than where they were initially treated.

This kind of data pool would imply a dedicated system with necessary checks and balances to prevent unauthorized access to and manipulation of patient records, while, at the same time, enabling data entry by different care providers when patients make additional visits to any facility. This concept is delicate due to the potential of malicious addition or manipulation of patient data by different staff in different facilities. Moreover, a lack of universal standards in proper coding and categorization of prescriptions and procedures has hindered the implementation of interoperable EHR systems in the last two decades. This problem can now be sufficiently handled by high-end software applications that are being developed by individual and corporate research entities.

An example of one type of system being pursued is computerized practitioner order entry (CPOE). CPOE may replace conventional order cataloging and fulfillment in a manner that will enhance tracking, logistic synchronization and cost-effectiveness. Another example of a system is a clinical decision-support system (CDSS), which, in its basic form, will give informative guidelines to practitioners regarding medication and procedures, including warning systems relating to high-risk medications and processes. In addition, the picture archiving and communication system (PACS) integrates inputs from multiple radiological and diagnostic tools to allow easy, consistent and accurate treatment of different conditions, while radio frequency identification (RFID) may help to track patients within a medical unit without the need to restrict them to a particular location or allocate a nurse to them. There are also ...