CPHIMS (Jason) Exam Study Guide with Complete Solutions

CPHIMS (Jason) Exam Study Guide with Complete Solutions Issues facing healthcare providers (7) - Answer--Costs Rising -Quality variations in clinical care -safety (patient) -evidence decision making -administrative process complexity -consumerish/heightened expectations -research & tech advances Providers of care (7) - Answer--Hospitals -Ambulatory centers/clinics -Long term care providers (30+ days) -Public health agencies -Community health programs -physician practices -pharmacies Hospital characteristics (5) - Answer--Level of care provided (primary, secondary, tertiary, sub-acute) EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 2/21 -Ownership (profit / non) -Geographic location (urban/metropolitan MSA 50k+ / rural) -Payor mix (Govt, private) -Teaching status (teaching hosp, academic med cntr, non-teaching hosp) Ambulatory centers/clinics - Answer-Services withOUT overnight stay Long Term Care Services (4) - Answer-30+ days -Nursing Home -Rehab -Mental Health -Home Health Physician Practice types (2) - Answer--Group practices -Solo practices CPOE - Answer-Computerized Practitioner Order Entry (used at pharmacies) Integrated Delivery Network (IDN) - Answer-Variety of providers organized to provide a continuum of care (with integrated administration and information sharing) Formed through -Merger/Acquisition EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 3/21 -Joint venture -Alliance -Network (e.g. virtual organization... IPA) Key factors to IDN success (2) - Answer--Physician involvement -Interoperable info systems Payment Systems (2) - Answer-Private Financing -private insurance -out of pocket (fee for service) Public financing -National Health Insurance System.. private providers (Canada) -National HEAlth system (Britain) govt providers Healthcare Workforce (4) - Answer-Physicians -Primary care -Specialists Mid-Level practitioners -Physician Assistants EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 4/21 -Advanced practice nurses Nurses -RNs -Nursing Informatics Other -Administration -Board members -Government/payor organizations -Vendors -Consultants -Informatics Functions of IT Department (4) - Answer--Operations & tech support -Applications -Specialized groups (e.g. process improvement) -IT Administration (oversee, governance, strategy, staffing, budget) IT Professionals (Executive) - Answer-CIO (Manages dept, leadership) EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 5/21 CTO (guides tech architecture, tracks new technologies) CSO (security) CMIO (Represents physicians in system design) IT Professionals (Mid-mgmt and Staff) - Answer--Analysts -Programmers -Database admins -Network admins -Telecom specialists -"Management Engineers" Role of Government (3) - Answer--Provider of care (Veterans Affairs) -Payor National Health Insurance 1) Medicare 2) ontario health insurance plan OHIP -Regulator 1) Licensure EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 6/21 2) HIPAA and EMTALA.. emergency med treatment and active labor act 3) UK Data protection act of 1998 4) European Union Data Protect Directive EUDPD Standardization (2) - Answer-ACCREDITATION: Joint Comission & Intl PRIVATE NON-PROFIT ICD-10 -world health organization -international standard diagnostic classification for all general epidemiological and many health management purposes ICD-10 (vs. ICD-9) - Answer-1) Three volume set 2) Alphanumeric categories rather than numeric 3) changes in chapters, titles, conditions 4) Twice as may categories 5) Changes in coding rules Future of Healthcare IT (6) - Answer--Need for greater productivity (nursing shortage!) -Medical errors/variations in care patterns -Cost-shifting/consumerization of medicine -Pay for performance medicine -Advances in IT (internet... wireless) EMILLECT 2024/2025 ACADEMIC YEAR ©2024 EMILLECT. ALL RIGHTS RESERVED. FIRST PUBLISH OCTOBER 2024. Page 7/21 -Genetic revolution Types of structural changes (4) - Answer-MERGER = Assets integrated under contract JOINT VENTURE= two orgs assets pooled ALLIANCE=shared, but not jointly owned NETWORK=ambition alliance of several providers VIRTUAL ORG=geographically dispersed but loosely structured for specific/limited purpose such as referals/shared overhead Care level services (4) - Answer-primary care (PCP, ob/gyn, general internish) secondary care (specialized... surgical.. intensive care) tertiary (HIGHLY specialized and tech advanced transplants) sub-acute:patients needing a slightly longer stay "transitional" teaching hospital vs. academic medical center - Answe