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by John Mattison, Brian Gugerty, Kathleen A. McCormick
Healthcare Information Technology Exam Guide for CHTS and CAHIMS Certifications, 2nd Edition
Cover
Title Page
Copyright Page
Dedication
About the Lead Authors
Contents at a Glance
Contents
Foreword
Acknowledgments
Part I Healthcare and Information Technology in the United States
Chapter 1 Healthcare Information Technology: Definitions, Stakeholders, and Major Themes
The Explosion of Healthcare Information Technology
New Network Complexity Requires New Standards for Data Sharing and Interoperability
The Role of HIT in the Continuum of Healthcare
The Increasing Volume and Shift to Value of Healthcare IT
Increasing the Volume of EHRs
Measuring the Value of Healthcare
Preparing a Critical Mass of Certified Healthcare IT Technicians and Professionals
The Roles of HIMSS and AHIMA in Support of Healthcare Information Credentialing, Education, and Training
Healthcare Information and Management Systems Society (HIMSS)
American Health Information Management Association (AHIMA)
Chapter Review
Questions
Answers
References
Chapter 2 U.S. Healthcare Systems Overview
U.S. Healthcare Delivery Organizations and Management Structures
Private Medical Practices
Health Maintenance Organizations (HMOs)
Independent Practice Associations (IPAs)
Preferred Provider Organizations (PPOs)
Hospitals
Academic Health Centers
Specialty Hospitals
Public Health Departments
Other Healthcare Organizations
Healthcare Venues
Ambulatory Care Centers
Acute Care
Long-term Care Facilities
Home Care/Visiting Nursing Services
Community/Population Care
Hospice/Palliative Care
Types of Healthcare
Primary Care
Behavioral Health
Specialty Care
Emergency Care
Urgent Care
Acute Care vs. Chronic Care
Patient Education
Integrative Medicine
Telehealth
Healthcare Professions
Certification and Accreditation
Healthcare Reform and Quality
Costs—U.S. Expenditures Overall Compared to Other Countries
Affordable Care Act (ACA)
HITECH Meaningful Use Provision
Medicare Access and CHIP Reauthorization Act of 2015
Healthcare Regulatory and Research Organizations
Regulation
Research
Chapter Review
Questions
Answers
References
Chapter 3 An Overview of How Healthcare Is Paid For in the United States
The Nature of Health Insurance
The Structure of Health Insurance
Insurance in the United States
Insurance Products
Commercial (Private) Insurance in the United States
Medicare
Medicaid
Uncompensated Care
Chapter Review
Questions
Answers
References
Chapter 4 Healthcare Information Technology in Public Health, Emergency Preparedness, and Surveillance
Public Health Reporting
Registries
Health Alerts
Privacy and Security
Scope of Data
Clinical Information Standards
Trends and What to Expect in the Future
Chapter Review
Questions
Answers
References
Part II Fundamentals of Healthcare Information Science
Chapter 5 Computer Hardware and Architecture for Healthcare IT
Computer Hardware
Input Devices
Output Devices
System Components
Cloud Computing, ASPs, and Client-Server EMR Systems
Hardware Management
Operating Systems and Hardware Drivers
Networking Hardware
Portable Computers
Wearable Computers
Server Computers
Trends in Meeting Hardware Requirements
Computer Asset Management
Chapter Review
Questions
Answers
References
Chapter 6 Programming and Programming Languages for Healthcare IT
Languages and Virtual Machines
Operating Systems
The C Language
The C++ Language
The Java Language
Hypertext Markup Language (HTML)
Extensible Markup Language (XML)
Active Server Pages (ASP)
PHP: Hypertext Preprocessor (PHP)
Programming Languages and Development Environments for Mobile Health Application Development
Chapter Review
Questions
Answers
References
Chapter 7 Databases, Data Warehousing, Data Mining, and Cloud Computing for Healthcare
Healthcare Databases
Database Basics
Database Application Development Process
Analyzing the Business Scenario and Extracting Business Rules
Modeling Database: Entity Relationship Diagram Design and Normalization
Creating a Physical Database Using Structured Query Language
Implementing a Healthcare Database Application
Database Administration and Security
Database Administration
Database Security
Data Warehouses for Healthcare
What Is a Data Warehouse?
The Differences Between a DW and OLTP
Data Warehouse Models
A Healthcare Data Warehouse Life Cycle
Data Mining in Healthcare
What Is Data Mining?
Applications of Data Mining in Healthcare
Cloud Computing in Healthcare
Cloud Computing Models
Cloud Computing Deployment Models
Examples of Cloud Computing in Healthcare
Pros and Cons of Cloud Computing in Healthcare
Chapter Review
Questions
Answers
References
Chapter 8 Networks and Networking in Healthcare
Telecommunications and Healthcare
From Voice to Data Networks and the Global Internet
Data Communications Concepts
Connectivity: The Geometrical Nature of Networks
Communication Models
Communications Protocols
Data and Signals
Digitization
Throughput
Addressing in Data Networks
The World Wide Web as an Example of a Network Application
PANs, LANs, MANs, and WANs
How a Network Works
Application Architectures
Network Architectures and Implementations
Device Configuration
Wireless Networks
Wireless Applications and Issues in a Healthcare Setting
WLAN Topology
802.11 Standards
Security
Bluetooth
WAP, WML, and HTML5
Cellular
Sample Network
Purpose of a Network
Components of the Sample Network
Network Address Translation
Port Forwarding
Router Configuration
Wireless Access Points and WLAN Controllers
Firewalls
Cabling
Transmission of Healthcare Data (HL7)
HL7 v2
HL7 v3
HL7 FHIR
EHR Outbound Communication
Chapter Review
Questions
Answers
References
Chapter 9 Systems Analysis and Design in Healthcare
Systems Analysis and Design in HIT
The Systems Development Life Cycle (SDLC)
Trends and Issues in HIS Analysis and Design
Chapter Review
Questions
Answers
References
Chapter 10 Fundamentals of Health Workflow Process Analysis and Redesign
Life Cycle of Major Information Technology Implementation and Organizational Change
Process Management and Process Improvement
Process Hierarchy: Levels of Mapping Processes
Methodologies for Understanding Processes
Observation
Modeling Workflows for Scope of Professional Practice Standards
Simulation
Lean Strategy
Business Process Management
Workflow Mapping Tools
Workflow Diagram Example
Role-Based Swim-Lane Workflow
Value Stream Mapping
Success Factors for Implementing Clinical Process Change
Additional Techniques
Identification and Prioritization of Targets for Workflow Improvement
Change Management
Change Management Principles
Chapter Review
Questions
Answers
References
Chapter 11 Healthcare IT Project Management
Projects, Project Management, and Healthcare IT
Critical Success Factors for Healthcare IT Projects
The Project Management Institute, PMBOK, and PMP
Major Project Management Constraints/Objectives
Project Team Roles and Stakeholders
Effective Communication in Projects
Process Groups and the Project Life Cycle
Project Initiation
Project Charter and Scope
Project Problem/Vision/Mission Statements
SMART Project Objectives
Planning a Healthcare IT Project
The Work Breakdown Structure (WBS)
Estimating Time, Cost, and Resources
Developing the Project Schedule
Scheduling Resources in Projects
Executing, Monitoring, and Controlling HIT Projects
Execution Principles, Issues, and Opportunities
Monitoring Progress in Projects
Changing the Plan
Closing the Project
Chapter Review
Questions
Answers
References
Chapter 12 Assuring Usability of Healthcare IT
Usability of Healthcare IT
Usability Engineering Approaches
Usability and HIT Safety
Human Factors and Human–Computer Interaction in Healthcare
User Interface Design and Human Cognition
Importance of Considering Cognitive Psychology
Approaches to Cognition and HCI
Technological Advances in HIT and User Interfaces
Input and Output Devices and the Visualization of Healthcare Data
Approaches to Developing User Interfaces in Healthcare
Methods for Assessing HIT in Use
Challenges and Future Issues
Chapter Review
Questions
Answers
References
Part III Healthcare Information Standards and Regulation
Chapter 13 Navigating Health Data Standards and Interoperability
Introduction to Health Data Standards
Standards Categories
Health Data Interchange and Transport Standards
Vocabulary and Terminology Standards
Content and Structure Standards
Security Standards
Standards Coordination and Interoperability
Health IT Standards Committee
International Organization for Standardization
Integrating the Healthcare Enterprise
eHealth Exchange and the Sequoia Project
The Business Value of Health Data Standards
Chapter Review
Questions
Answers
References
Additional Study
Chapter 14 Interoperability Within and Across Healthcare Systems
User Identity
Provisioning
Identity Proofing
Role Assignment
Deprovisioning
User Account Support
Internal Directory vs. External Directory
Authentication
The Multiple Factors of Authentication
Secondary Authentication
Automatic Logoff
Authentication vs. Claims About Authentication (Federated Identity)
Accountability
Access Control
Audit Control
Balanced Access Control and Audit Control
Roles and Permissions
What Are Permissions?
Systems Have Roles
Truth Tables
Multilevel Data Confidentiality
Data Tagging with Sensitivity Codes
Coding of Restricted Data
Medical Records Regulations
Other Sources of Access Control Rules
Data Treated at the Highest Level of Confidentiality
Purpose of Use
Patient Privacy
Privacy Consent Related to Purpose of Use and Access Control
Hint
Summary of Basic Access Control
Patient Information
User Information
Resource Information
Context Information
Policies: Where the Logic Resides
Healthcare Information Exchange
Push vs. Pull in an HIE
Enforcement of Access Controls in an HIE
The First Rule of HIE Access Control
The Second Rule of HIE Access Control
HIE Access Control Information
Metadata
User Identity in an HIE
Access Control Languages
Chapter Review
Questions
Answers
References
Chapter 15 Assuring the Health Insurance Portability and Accountability Act Compliance
Introduction to the Healthcare Legal Environment
HIPAA, HITECH Act, and Omnibus Rule Overview
Legal Documents Review
HIPAA Administrative Simplification Provisions
HIPAA Privacy Rule: 45 CFR Part 164, Subpart E
Use and Disclosure of PHI: 45 CFR 164.502(a)
Minimum Necessary: 45 CFR 164.502(b)
BA Contracts: 45 CFR 164.504(e), 45 CFR 164.308(b), 45 CFR 164.314(a)
Consent: 45 CFR 164.506
Authorization Requirements: 45 CFR 164.508
Release Without Consent or Authorization: 45 CFR 164.512
Avert a Serious Threat to Safety: 45 CFR 164.512(j)
Disclosure for Specialized Government Functions: 45 CFR 164.512(k)
Limited Data Set: 45 CFR 164.514(e)
Notice of Privacy Practices: 45 CFR 164.520
Patient Privacy Rights
Privacy Official and Security Official: 45 CFR 164.530(a), 45 CFR 164.308(a)(2)
Workforce Training: 45 CFR 164.530(b), 45 CFR 164.308(a)(5)
Standard Safeguards: 45 CFR 164.530(c)
Sanctions: 45 CFR 164.530(e), 45 CFR 164.308(a)(1)
Privacy and Security Policies and Procedures: 45 CFR 164.530(i), 45 CFR 164.316
HIPAA Security Rule: 45 CFR Part 164, Subpart C
Administrative Safeguards: 45 CFR 164.308
Physical Safeguards: 45 CFR 164.310
Technical Safeguards: 45 CFR 164.312
Breach Notification Rule: 45 CFR Part 164, Subpart D
Breach Definition: 45 CFR 164.402
General Breach Description Notification Requirements: 45 CFR 164.404(a–c) 38
Methods of Notification: 45 CFR 164.404(d)
Notification Delay for Law Enforcement Purposes: 45 CFR 164.412
Specific CE Requirements: 45 CFR 164.404
Specific BA Requirements: 45 CFR 164.410
HIPAA Enforcement Rule: 45 CFR Part 160
Additional Guidance
Chapter Review
Questions
Answers
References
Chapter 16 Health Information Technology and Health Policy
The Linkage Between Health Policy and Health IT: Why It’s Important
Precision Medicine Initiative
Interoperability
New Payment Models
Computable Privacy
EHR Incentive and Certification Programs
Quality Measures
Chapter Review
Questions
Answers
References
Chapter 17 The Electronic Health Record as Evidence
Sources and Structure of U.S. Law
Three Branches of U.S. Government Responsible for Carrying Out Government Powers and Functions
Executive Branch: President, Vice President, and Cabinet
Legislative Branch: The Senate and the House of Representatives
Judicial Branch: Structure and Function of the U.S. Court System
The Medical Record
EHR Standards for Records Management and Evidentiary Support
The Role and Use of the Medical Record in Litigation and/or Regulatory Investigations
Paper-based Medical Records vs. Electronic Health Records in Discovery
Discovery and Admissibility of the EHR
The Federal Rules of Evidence (FRE)
Medical Records as Hearsay
Physician-Patient Privilege
Incident Report Privilege
The Scope and Procedures of E-Discovery Process
Impact of the 2015 Amendments to the E-Discovery Process
Duty to Preserve Relevant Evidence and Establishing Legal Holds
The Path Forward: A Coming Together of Laws, Rules, and Regulations
The HITECH Act
The Health Insurance Portability and Accountability Act
The Convergence of E-Discovery and Release of Information Processes
The Concept of the Legal Health Record
A New Era in the Nation’s Health Information Infrastructure
Cures Act
NIST
Chapter Review
Questions
Answers
References
Part IV Implementing, Managing, and Maintaining Healthcare IT
Chapter 18 Effective Organizational Communication for Large-Scale Healthcare Information Technology Initiatives
Importance of Communications in Health IT Initiatives
Leadership and Governance
Rules for Governance
Focus on Customers and Players
Patients and Communities
Physicians
Nursing Workforce
IT Departments and Multidisciplinary Project Teams
Healthcare System Leadership
Components of a Communications Plan
Project Phases and the Communication Functions
Communication Metrics
Key Industry Considerations
The Expanding World of Media
Role of Federal Healthcare Agencies
Role of Regulatory Standards and the Evolution of Health Information Exchange
Chapter Review
Questions
Answers
References
Chapter 19 Non-EHR HIT: From Architecture to Operations
The Healthcare IT Organization: Challenges, Structures, and Roles
HIT Major Non-EHR HIT Systems and Applications
Working with Enterprise HIT Systems
Vendor-Specific Systems: Acquisition, Installation, and Maintenance of HIT Systems
Radiology Systems
Pharmacy Systems
Lab Systems
Patient Monitoring Systems
Supply Chain Systems
ERP Software Systems
Finance and Operations Systems
Clinical Decision Support (CDS)
Patient Relationship Management Systems
Application Data Interchange Systems
Chapter Review
Questions
Answers
References
Chapter 20 EHR Implementation and Optimization
Using HIT and EHRs for Organizational Transformation
Banner Health
Emory Healthcare
Governance of Large HIT and EHR Initiatives
Change Management
Managing the Project
A Good Product and Team
The Orders Catalog and Order Sets
Documentation Templates and Note Hierarchy
Migrating Data
Extraction, then Conversion
Develop Workflows
Policies Affect Workflows
Testing
Training
Reduce Schedules for Go-Live
Downtime Procedures
Go-Live Support
During and Post Go-Live Communication
Monitoring Success
Chapter Review
Questions
Answers
References
Chapter 21 Training Essentials for Implementing Healthcare IT
Models and Principles
Assessing Basic Skill Level
Design Elements
The Adult Learner
Constructing a Lesson Plan
Multimedia as a Method of Delivery
Current Internet Technologies
Training Delivery and Accommodation
Evaluating Learning
Program Evaluation
Utilizing a Learning Management System
New Directions
Chapter Review
Questions
Answers
References
Chapter 22 Using Healthcare IT to Measure and Improve Healthcare Quality and Outcomes
Why Measure Quality?
Defining Quality Measures for EHR Queries
What Makes a Quality Measure Worth Measuring?
Evidence-Based Clinical Practice Guidelines
What Is the Connection Between Clinical Decision Support and Quality Measurement?
What Is the Measure of a Measure?
What Are the Types of Measures, and How Are They Different?
What Are the Expectations for the EHR to Perform Measurement?
What Changes Are Needed to Enable Electronic Clinical Quality Measures?
Data Modeling: Example from the International Health Information Terminology Standards Development Organization
How Are Value Sets Standardized?
Moving Forward: Retooling vs. Creating Measures de Novo Based on Data in EHRs
Chapter Review
Questions
Answers
References
Part V Optimizing Healthcare IT
Chapter 23 Big Data and Data Analytics
Innovation in Healthcare IT: The Creative Reconstruction of Health and Wellness
Which Technologies Are Creating Big Opportunities for Innovation?
How Do We Optimize the Human-Machine Interface?
How Do We Accelerate Continuous Learning and Innovation?
A Simple Taxonomy for Innovation
The Different Communities Engaged in Healthcare Delivery
Person-Centric Communities
Professional Care-Delivery Teams
Personal Caregiver Networks
What Can the Impact of Innovations Be on the Future Technologies?
Key Gaps and How Technology Can Help Close Them
The Empathy Gap Is the Most Important Gap to Close
Gap Between Evidence and Behavior for Disorders of Lifestyle
Environmental Disruption Gap (Chemical, Thermal, Microbial)
Learning/Education/Communication Gap
AI/Robotics Robotics Gap
Gap in Seamless and Reliable Human Data Entry
Gap in Evidence-Based Virtual Care
The Science vs. the Application of –omics (Genomics, Microbiomics, Proteomes, etc.) Gap
Gap in Drones and Healthcare
Gap in 3D Printing
Gap in Chatbots, AI, Trust, and Health
Gap in Transcranial Magnetic Stimulation and Health
Gap in New Psychopharmacology Research and Previously Refractory Psychiatric States
Gap in Harnessing Exponential Technology
Chapter Review
Questions
Answers
References
Chapter 24 Innovations in Healthcare Impacting Healthcare Information Technology
Innovations in Genetics/Genomics/Pharmacogenomics
Genetics/Genomics Throughout the Healthcare Continuum
New Major Sources of Evidence with a Focus on Pharmacogenomics
The IT Volume Challenge of Monitoring Genetics/Genomics/Pharmacogenomics in Healthcare
Innovations in Mobile Devices in Healthcare
Wireless Communication Technologies and Standards
Mobile Devices Connected to the Internet
Mobile Device Security Protocols
How Mobile Networks Are Being Used in Healthcare
The Most Popular Mobile Health Apps
Healthcare Professionals’ Use of Mobile Devices
Major Barriers to Advancing Mobile Devices
Steps to Institutionalizing Genomic and Mobile Technologies
Innovative Institutions Pushing Advances in Genomics and Mobile Devices
Nine Technologies for Future Innovation Using Devices
Social Media Being Used in Healthcare
Innovations in Telehealth
Major Services of Telehealth
Delivery Mechanisms Used for Telehealth
Chapter Review
Questions
Answers
References
Part VI Making It All Secure: Healthcare IT Privacy, Security, and Confidentiality
Chapter 25 Framework for Privacy, Security, and Confidentiality
When Things Go Wrong
HIT Trust Framework
Layer 1: Risk Management
Layer 2: Information Assurance Policy
Layer 3: Physical Safeguards
Layer 4: Operational Safeguards
Layer 5: Architectural Safeguards
Layer 6: Technology Safeguards
Layer 7: Usability Features
Chapter Review
Questions
Answers
References
Chapter 26 Risk Assessment and Management
Definitions
Risk Management in Healthcare IT
The Risk-Management Process
Risk Identification
Risk Assessment
Risk-Mitigation Planning
Risk-Mitigation Tracking
Documentation and Communication
Domains of Risk Analysis
Security Risk Analysis
Application and Data Criticality Analysis
Privacy Risk Analysis
Safety Risk Assessment
Chapter Review
Questions
Answers
References
Chapter 27 Physical Safeguards, Facility Security, Secure Systems and Networks, and Securing Electronic Media
Physical Safeguard Requirements
Locating Storage Devices, Network Hardware, Printers, and Other Devices
Securely Handling Protected Health Information (PHI)
Monitor Placement
Privacy Screens
Printer, Fax Machine, and Scanner Placement
Screensavers
Time Lockout
Access to Servers, Offices, and Data Closets
Access-Control Devices
Building Secure Systems
Office Hardware
Locks
Door Locks
Environmental Controls
Other Controls
Securing and Preserving Electronic Media Storage Devices
Flash Drives
Personal Computers (PCs)
Laptops
Secure Digital (SD) Card
External Drives
Servers
Network-Attached Storage (NAS)
Storage Area Network (SAN)
Encryption
Symmetric Encryption
Asymmetric or Public Key Infrastructure (PKI)
TLS/SSL
DES
AES
3DES
PGP
Secure Disposal of Electronic Media
Secure Shredding, Degaussing, and Sanitizing
Determining the Level and Type of Destruction
Chapter Review
Questions
Answers
References
Chapter 28 Healthcare Information Security: Operational Safeguards
Operational Safeguards: A Component of Information Security
Operational Safeguards in Healthcare Organizations
Security Management Process
Information Management Council
Identity Management and Authorization
Awareness and Training Programs
Risk Assessment
Software and System Development
Configuration Management
Consent Management
System Activity Review
Continuity of Operations
Incident Procedures
Sanctions
Evaluation
Business Associate Contracts
Healthcare-Specific Implications on Operational Safeguards
Networked Medical Devices
Multiple-Tenant Virtual Environments
Mobile Device Management
Operational Safeguards in Emerging Healthcare Trends
Healthcare in the Cloud
International Privacy and Security Concerns
Health Information Exchanges
Workforce Information Security Competency
Accountable-Care Organizations
Meaningful Use Privacy and Security Measures
Chapter Review
Questions
Answers
References
Chapter 29 Architectural Safeguards
Reliability
Relationship Between Reliability and Security
Reliability Implications for Healthcare Systems
Availability
Availability as a Component of Data Security
Maintainability
Scalability
Safety
Considerations for Healthcare IT Systems
Considerations for Medical Devices
Considerations for Design of High-Reliability Healthcare Systems
Fail-Safe Design
Fault Tolerance
Redundancy and Failover
Simplicity
Chapter Review
Questions
Answers
References
Chapter 30 Healthcare Cybersecurity Technology
Healthcare Cybersecurity Threat
Think Like a Bad Guy
The Big Four: Cybercrime, Cyber Espionage, Hacktivism, and Advanced Persistent Threats
Staying Abreast of the Threat
Planning for Outcomes: Cybersecurity Frameworks and Standards
Building a Secure Architecture
Maintaining a Current Environment
Managing Privileges
Thwarting Cyber Exploitation
Isolating Cyber Threats
Detecting Cyber Intrusions
Detecting Web-Based Threats
Detecting the Unknown
Addressing the Ubiquitous Threat of IoT
Monitoring Activity
Conducting Information Correlation and Analysis
Looking for Vulnerabilities
Vulnerability Testing
Penetration Testing
Red Teaming for Readiness
Chapter Review
Questions
Answers
References
Chapter 31 Cybersecurity Considerations for Medical Devices
Medical Device Cybersecurity and Cybersafety: An Introduction
Medical Device Vulnerabilities and Risks: A Review
Medical Device Regulation: Impact on Cybersecurity
Regulatory Background
Changes in the Regulatory Landscape
Implementing Medical Device Cybersecurity
A Shared Responsibility
Risk Analysis, Assessment, and Management: Laying the Foundation
Chapter Review
Questions
Answers
References
Part VII Appendixes
Appendix A AHIMA CHTS Exams Domain Maps
CHTS-CP: Clinician/Practitioner Consultant Examination
CHTS-IM: Implementation Manager Examination
CHTS-IS: Implementation Support Specialist Examination
CHTS-PW: Practice Workflow & Information Management Redesign Specialist Examination
CHTS-TR: Trainer Examination
CHTS-TS: Technical/Software Support Staff Examination
Appendix B HIMSS CAHIMS Exam Domain Map
Appendix C About the Download
System Requirements
Installing and Running Total Tester Premium Practice Exam Software
Total Tester Premium Practice Exam Software
McGraw-Hill Education Media Center Download
Glossary and Appendix
Risk Register and Example Risk Map from Chapter 26
Technical Support
Appendix D Healthcare Professional and Workforce Roles
Glossary
Index
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