FACHE Board of Governors Exam Study Group

1. FACHE Board of Governors ExamStudy Group Technology Module April 17, 2013 Gail B. Malcolm FACHE, LFHIMSS Director, Marketing Communications Siemens Healthcare Gail.Malcolm@siemens.com – 610-213-0064

2. Credentialing • FACHE Credential • In 2012, more than 1,100 new Fellows and Fellow designates • Award-winning campaign on the “distinction of board certification”

3. Special Offer – through June 30, 2013 • Submit your completed Fellow Application with the $250 application fee by June 30 and ACHE will waive the $200 fee to take the Board of Governors Exam once your application has been approved (the waiver is valid for six months) • You must be an ACHE Member with at least two years of healthcare management experience and must hold a master's or other advanced degree to be eligible to apply for Fellow status • All follow-up materials (e.g. references) must be submitted by August 31 for the waiver to be valid

4. Step 1 – to FACHE…. Eligibility requirements to submit an FACHE application: • Master’s or other post-baccalaureate degree (submit a copy of your degree) • Current healthcare management position and at least two years of healthcare management experience (submit organizational chart, job description, and resume) • Three references - include the names on your application (the completed reference forms can be submitted by your references after you submit an application)

5. Step 2 – after the exam… After passing the Board of Governors Exam, the other requirements you must meet, if you haven’t already, include: • In a healthcare management position with five years of healthcare management experience • Three years tenure as an ACHE Member, Faculty Associate, or International Associate (ACHE student tenure does not count toward meeting the FACHE requirements) • 40 hours of continuing education—at least 12 of which are ACHE Face-to-Face Education hours—during the five years before you become a Fellow. The remaining 28 hours can be ACHE Qualified Education hours • Participation in two healthcare and two community/civic activities during the three years before you become a Fellow

6. Agenda • Objective, Purpose and Goal • Overview and Technology Module Structure • Study material on Technology Module • Review sample questions • Additional references

7. Tonight’s Study Group • Objective • The FACHE study group will use their knowledge and experience to thoroughly study the Technology Module of the BOG Exam • Purpose • To achieve a level of comprehension valuable to both our exam prep and our professional development • Goal • Study group members will be able to pass questions from the Technology Module

8. Overview Technology This covers both management information and clinical information systems, including computer-based support for management, assessing how current technologies and major innovations are changing the way healthcare executives manage, using information systems for short- and long-range planning, using clinical information systems, and information systems acquisitions.

9. Management Module Structure Management Knowledge (10 of 200 Questions) • Knowledge of the role and function of information technology in operations • Knowledge of technology trends and clinical applications • Knowledge of technology security requirements (re: HIPAA, local governmental and organizational policies) • Knowledge of health information (e.g., data equipment, interoperability standards, decision support) • Knowledge of information systems continuity (e.g., disaster planning, recovery, backup sabotage, natural disasters) • Knowledge of information systems planning and implementation (e.g., service architecture, technology lifecycles, obsolescence

10. General Purpose of Information Systems & Definitions • An information system is an automated process of capture, transmission, and recording of information that is accessible to multiple users in an organization. • An integrated information system is a set of two or more information systems organized to provide immediate electronic access to information in each.

11. Development of Information Systems • 4 basic management principles to guide development of IS in healthcare orgs: • Treat information as an essential institutional resource that must be carefully managed. • Obtain top executive support for information systems planning and development. • Employ a user-driven focus in the information systems planning and project development process. • Begin with a strategic information systems plan that links information system priorities to the strategic goals and objectives of the organization.

12. Development of Information Systems Understand the factors in guiding the development of information services • Well managed organizations use IS investment as competitive strategy. • The information plan is used to establish priorities for the integrated effort, justify the overall investment, and identify the kinds of operational improvement that will result from the added information. • The strategy has two elements. 1) a long-term commitment, and 2) a plan to achieve operational savings and quality improvement. • Both operating & IS personnel must commit to a strategy integrating information and process.

13. Information Systems Purpose & Definitions • Information Services (IS) is accountable for the development of integrated information systems and for continuous improvement in information availability and use. • IS stimulates the selection, design and operation of information systems. • IS ensures organization wide access to reliable information. • IS supports the infrastructure of communication

14. Categories of Information Systems • Three categories of Information Systems: • Clinical information systems • Administrative/financial systems • Decision support systems for strategic management

15. Categories of Information Systems • Clinical Information Systems • An Institute of Medicine committee recommended developing a national system of computerized medical records in 1991. • Improve patient care quality and cost control. • Support medical records storage and retrieval, medical instrumentation, computer-aided diagnosis and treatment planning, nursing care, clinical education, and research. • Electronic linkages to computers in MD offices to access clinical data and establish closer bonds with MD’s on the medical staff. • Bedside or point-of-care terminals for direct entry of information and voice recognition systems being further developed to reduce labor and to improve system utilization by physicians

16. Categories of Information Systems • Administrative/Financial Information Systems • Include payroll, human resources and materials management; patient, general and cost accounting; facilities management and scheduling systems; and office automation. • Increases in managed care contracting give added priority to development of good financial systems. • Decision Support Systems (DSS) • Designed to provide information for strategic planning and decision making. • Information on MD practice and referral patterns, patient satisfaction, net revenue by product or service line and other key indicators can be produced by DSS if executives are actively involved in defining requirements.

17. Information Systems Planning • The strategic information systems plan should: • Establish goals & objectives linked to the organizations priorities. • Specify priorities for individual computer applications and resources required for systems development and implementation. • An important element of planning is specification of requirements for system integration (the ability of individual computer applications to share information and communicate electronically with one another).

18. Information Systems Planning • Should be guided by a management information systems steering committee with representation from: • Medical staff, • Administration, • Major systems users, and • The information systems department • Broad representation to offer participation and ensure effective systems design & integration and acceptance. • The committee should not be dominated by technical personnel.

19. Individual Information Systems • The development of individual information systems should begin with analysis of functional requirements. • Representatives from departments who will use the proposed new system should be heavily involved in specifying these functions. • Systems analysis will result in process improvements even if a decision is made not to proceed with installation of a computerized system.

20. Role of the Chief Information Officer • Guide the information systems planning process. • Should be a member of the executive management team. • Serves as advisor to the executive management team on effective use of information for management and patient care support. • Oversees organizational units responsible for information systems and telecommunications.

21. Evaluation of Vendors • Must be carefully managed. • Must always begin with a detailed statement of system requirements. • In evaluating software packages, it is essential to obtain information on system performance directly from other healthcare organizations that are using the product under consideration. • After proposals from vendors have been evaluated, negotiations with the vendor of first choice should be carried out. • The CIO or other administrator responsible for information management should head the negotiating team.

22. Evaluation of Vendors • Negotiating team should be kept small and include legal counsel and representatives from the finance office. • Standard vendor contracts should not be considered since the contract terms are designed to favor the vendor in the negotiations. • The RFP should be included as part of the contract. • All aspects of an information system should be evaluated by a thorough system test prior to final acceptance from the vendor. • All operational systems should be periodically evaluated by the CIO or persons designated by the CEO to ensure original system objectives are efficiently realized

23. Role of the IS/IT Department • The Information Services (IS)/Information Technology (IT) Department is accountable for five (5) functions: • Maintain the information services plan • Ensure the integrity, quality, and security of data • Integrate information capture and processing • Archive and retrieve data • Train and support users

24. Role of Outside Contractors Integrated software support –companies develop & maintain software • Finance – consolidate financing through leases/lease purchases on system • Consultation and Planning – accounting firms/consultants can provide assistance in selecting software/hardware, analyze capabilities, benchmark and develop a plan for improvement • Facilities Management – on site data processing services contract • Joint Development Ventures – for development of new or improved applications

25. Data Security • Protecting confidentiality of information is an important design criteria for health information systems, particularly with those dealing with patient data. • Data security must include management policies and procedures linked to technical system controls such as passwords, terminal interlocks, and user logs for retrospective auditing.

26. Integrated Delivery Systems andManaged Care • Mergers, acquisitions, and joint ventures have created provider networks which in turn have increased need for electronic communications. • It is not necessary that all organizations in a network use the same computer hardware and software. • Careful analysis of the business, clinical, and operating requirements of the network will drive the development of network systems. • Managed care contracting places a priority on financial forecasting and modeling by healthcare organizations. • The need to measure outcomes and continuously improve service and patient care quality will continue.

27. Integrated Delivery Systems andManaged Care • Outcomes assessment requires good information on costs, quality and access to service. • Healthcare organizations will be seeking the lowest cost treatment protocols shown to have atleast equal medical effectiveness to other available treatment modalities. • Effective information systems must be user driven rather than technology driven to succeed. • Information is essential forstrategic planning, cost control, productivity management, continuous quality improvement, and evaluation of programs and services

28. Basic Approaches for Measuring Productivity Measuring Productivity which can be used to compare to history, competition and benchmarks. • Productivity is the ratio of inputs (resources) to outputs, or vice versa. • Productivity is measured in both physical and dollar units. • Productivity measures can be calculated for components of cost such as variable, fixed, direct and/or indirect. • Load & capacity ratios are productivity measures for fixed resources, i.e., bed occupancy. • Typical measures include: • Lab tests/hour worked or lab cost/test • Length of stay (days of care consumed/patients treated) • Cost/case (cost of care/patients treated) • Film cost/examination

29. Know How to Measure Information Systems Performance Performance measures for IS should cover full set of six dimensions. • Output Oriented: • Productivity: treatment, services rendered, productivity • Quality: clinical outcomes, procedural quality, structural quality • Customer Satisfaction: patient satisfaction, referring physician satisfaction, other customer satisfaction, access • Input Oriented: • Demand: requests for services, market share, appropriateness, logistics • Cost/Resources: physical counts, costs, resources condition • Human Resources: supply, satisfaction, training

30. Know How to Measure Information Systems Performance Global measures for IS (dept) performance • Output Oriented: • Productivity: cost per hour/contract, cost per consultation, cost per patient • Quality: machine failures, timely implementation of improvements, JCAHO audit • Customer Satisfaction: peek access delay, user satisfaction, clinical service satisfaction, technical support satisfaction • Input Oriented: • Demand: peak load systems users, requests for consultations, requests for training, requests for records • Cost/Resources: labor supply costs/activity, equipment costs/activity, improvement costs • Human Resources: employee satisfaction, training & certification of coding personnel

31. Technology Study Guidelines • Understand the purposes of automated information systems. • Review basic approaches for measuring productivity. • Understand factors in guiding the development of information services, including the planning process. • Know how to measure the performance of the management information system. • Understand the role of outside contractors in establishing a management information system. • Understand the process for selecting an information system vendor. • Understand the role of the management information systems steering committee. • Understand the need for electronic data interchange as a result of managed care expansion and the development of integrated delivery systems

32. Sample Questions http://www.ache.org/mbership/credentialing/EXAM/govselftest.cfm

33. References Management and Business • Haimann's Healthcare Management, Eighth Edition, by Rose T. Dunn, FACHE • Healthcare Strategic Planning, Second Edition, by Alan M. Zuckerman, FACHE, FAAHC • Health Services Management: Readings and Commentary, Eighth Edition, by Anthony R. Kovner, Ph.D., and Duncan Neuhauser, Ph.D. • The Leader's Change Handbook, by Jay A. Conger, Gretchen M. Spreitzer, and Edward E. Lawler III (This book contains chapters covering several knowledge areas.) • Leadership for the Future: Core Competencies in Healthcare, by Austin Ross, LFACHE; Frederic J. Wenzel; and Joseph W. Mitlyng • Managing Health Services Organizations and Systems, by Beaufort B. Longest, Jr.; Jonathon S. Rakich; and Kurt J. Darr, J.D., Sc.D., FACHE • Mastering the Negotiation Process: A Practical Guide for the Healthcare Executive, by Christopher L. Laubach • The Well-Managed Healthcare Organization, Sixth Edition, by John R. Griffith, FACHE, and Kenneth R. White, Ph.D., FACHE

34. References All Modules: • http://www.ache.org/mbership/credentialing/EXAM/booklist.cfm Exam Prep three-book Study Set: • The Financial Management of Hospitals and Healthcare Organizations, Fourth Edition, by Michael Nowicki, EdD, FACHE, FHFMA • The Well-Managed Healthcare Organization, Sixth Edition, by John R. Griffith, FACHE and Kenneth R. White, PhD, FACHE • Human Resources in Healthcare: Managing for Success, Third Edition, by Bruce J. Fried, PhD and Myron D. Fottler, PhD • http://www.ache.org/pubs/redesign/productcatalog.cfm?pc=WWW1-2115S