CPHIMS Study Cards 2023 with complete solution questions and answers

Issues for health care providers High, rapidly rising costs. Highly variable clinical quality. Patient safety issues. Need for evidence-based decision making. Complex administrative processes. Increasing consumerism and heightened expectations. Research and technology advances. Fragmented delivery. Influences by politics, leadership,culture, social values, financing, economics, etc. Health care consumerism Encroaching more and more upon doctor subject matter. Also, services such as personal health records, websites, etc. Primary care Generally, provided by doctors. May be independent or within a hospital system. Secondary care Provided in a hospital. Examples include surgery, ICU services, neonatal, etc. Tertiary care Complex care such as trauma, transplant services, etc. Sub-acute care or Intermediary care E.g., skilled nursing Not-for-profit/non-profit Owned by community, religious order, government, etc.; not taxed except for for-profit subsidiaries, which are investment arms to help fund non-profit activities For profit Owned by individuals or corporations; taxed on both income and property. E.g., HCA Acute inpatient facilities Require overnight stay. MSA Metropolitan statistical area. Population 50k. One way to classify a hospital Rural Hospital Smaller, remote. Usually provide a wide range of primary and some more advanced services. Community Hospital Operate in less dense areas than MSA or urban hospitals, but not as remote or rural as rural hospitals. May provide a wide range of services. Government payor "Insurance" for health care services that are paid for by taxes. Varies by country. Example in US is Medicare or Medicaid. Private payor Insurance paid for privately, usually via an employer-provided benefit. Teaching hospital Affiliate with a medical school or other health professions school. Academic medical center Owned by a medical school. Non-teaching hospital No formal training. Ambulatory centers/clinics Provide services to patients without an overnight stay. E.g., doctors offices, outpatient treatment and surgery, diagnostic services, primary care, etc. Usually first point of entry into the healthcare system. Long term care services 30 plus day length of stay. Often called nursing homes or nursing facilities and can include skilled care, intermediate care, rehabilitation, mental health care, or even home health care. Skilled care Full time care of an RN for chronic and serious conditions. Intermediate care Personal, broad based care with assistance for activities of daily living. Rehabilitation Long term care that may range from several weeks to years. May include mental health care. Home health care Outpatient and at home. May be free standing or part of a health system. Profit or non-profit. Public health agencies and programs Funded by the government. In the USA, mostly primary care and public health services, but may affect public policy. In US mostly for folks below the poverty line, but serve a larger audience in other countries. Community health programs Usually funded by grants. Mostly for folks without access to care and who are indigent or migrant. Also for targeting key medical issues such as obesity, smoking, breast feeding, etc. Group practices Physician practices. Can be a single specialty or multiple specialties. Can be private but funded by the government at the same time. May also work under the governance of a hospital. Solo practice A single physician practice. Becoming less common and harder to sustain financially. CPOE Computerized practitioner order entry. Applies mostly to pharmacies. Decreases ordering errors. Pharmacies Key component of health care system that provides medication either in house at a hospital or as a free standing retail outlet. Pharmacists are key members of the team. Integrated Delivery Network (IDN) AKA IDS (Integrated delivery system). An organization of a variety of providers offering services across a continuum of care and integrated in administration and information sharing. Their aim is to decrease costs, increase effectiveness, improve outcomes, and improve quality. Formed through merger and acquisition, joint ventures, alliances, and networks. Merger and acquisition When two or more organizations merge their assets to create a single new organization. Joint venture When two or more organizations join to create a third, new organization. Alliance When two or more organizations share resources without owning any common assets. Network An alliance of serveral providers. Very ambitious. Key factors for IDN/IDS success Physician involvement and interoperable information systems. Private financing payment system Commericial private insurance (most common in developed countries) or out-of-pocket payments (fee for service) to pay for healthcare services. Fee-for-service Payment system based on per day or per procedure payment. The incentive for the provider is to add services or days of care, so case managers are used to manage the care episode. National health insurance system A type of public health care financing. Paid for by taxes, but the providers are private. An example is Canada, and works somewhat like Medicaid in the US. National health system A health care delivery system where the government is responsible for both the delivery and payment of health care. This is the European Union model. Public health care financing Either national health insurance system or national health system. It leads to a more widespread provision and use of primary care and increased life expectancy. Primary care physicians Pediatrics, family care, general practitioners, internists Specialist physicians Non primary care such as oncology, ophthalmology, endocrinology, etc. Some do not have direct patient care, such as radiologists, pathologists, anethesthiologists, and research doctors. Other roles for physicians administration, board members, government and payor organizations, vendor companies, consultants, informatics (CMO). Mid level practitioners Physician assistants and advanced practice nurses Physician assistants 24-36 months training; usually rural. Advanced practice nurses Clinical nurse specialists, nurse practitioners, midwives, nurse anesthetists; can prescribe limited meds Nurses Largest category of health care professionals, especially in hospitals. RNs make up more than 50% of the health care workforce. Includes nursing informaticists. Functions of the IT department Operations and technical support Applications management Specialized groups IT administration IT operations and technical support Help desk IT applications management Acquires, develops, and implements new systems (rarely new development); provides ongoing enhancements. IT specialized groups E.g., process improvement and management engineers IT administration Oversees functions of the IT department; provides IT governance and structure; develops and implements a strategic IT plan; manages staffing and budget. Chief Information Officer (CIO) Usually an IT executive (rarely an MD) who manages all the infrastructure (phones, help desk, medical and non medical applications such as HR, accounting, finance, etc.); manages the department and provides leadership. Chief Technology Officer (CTO) Mostly a vendor role. Guides the organization's technical architecture and tracks emerging technologies. Patents and sells technology. Chief Security Officer (CSO) Responsible for security of systems and information. Often the CIO will take on this function. Chief Medical Information Officer (CMIO) Usually an MD/physician champion/executive who works with and represents physicians in the design and implementation of systems. Systems analyst Mid-management/staff role. Assesses IT needs and assists in definition of the system. Programmers Mid-management/staff role. Writes, tests, and maintains software. Database administrators Mid-management/staff role. Organize and access data Network administrators Mid-management/staff role. Manage network infrastructure Telecommunications specialists Mid-management/staff role. Phones. Management engineers Mid-management/staff role. Analyze and redesign processes to achieve process improvement Mid management and staff IT roles Report to CIO. Systems analysts, programmers, database administrators, network administrators, telecommunications specialists, management engineers. Government as a provider of care Public ownership of clinics and hospitals (e.g., VA in the US and NHS in Great Britain). Government as a payer of care National health insurance. E.g., Medicare/Medicaid in the US. Provincially funded health insurance in Canada. Uses tax revenue. Government as regulator Government creates laws and regulations that affect health care systems. E.g., HIPAA, EMTALA (Emergency Medical Treatment and Active Labor Act) in the US; UK Data Protection Act of 1998 (UK version of HIPAA); European Union Data Protection Directive (EUDPD; European HIPAA). JCAHO and JCAHO International Voluntary, private, non profit organization that eastablishes uniform, achievable expectations for structures, processes, and outcomes within health care organizations. Includes legal, religious, and cultural factors. Funded by major health care organizations. Audits organizations to measure their adherence with standards and guidelines. JCAHO sentinel event policy Voluntary reporting of medical errors. Anonymous. ICD-10 Updated version of ICD-9 (International Statistical Classification of Disease and Related Health Problems). Is an international standard diagnostic classification for general epidemiological and many health management purposes. It is an analysis of the general health situation of a population. It monitors the incidence and prevalence of disease and other health problems. It is also used for record keeping and is a basis for compilation of national mortatlity statistics. ICD-10 vs. ICD-9 ICD-10 is three volumes (vs. two), is alphanumeric rather than just numeric. There are changes in the chapters, titles, and conditions. It has twice as many categories. And there are minor changes in the coding rules relating mostly to mortality. Factors affecting the future of health care IT Need for greater productivity (e.g., to address nursing shortage), concerns about medical errors and variation in care patterns, merization of medicine, quality incentives (e.g., pay for performance), advances in information technologies (e.g. internet and wireless); the genetic revolution.