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Essential Skills for Business Analysts in the Healthcare

Domain

Essential Skills for Business Analysts in the Healthcare

Domain

Presented ByMary C. Zarba, MBA

Vail, Colorado

Welcome!!One hour webinar

45 minute PowerPoint slide presentation

15 minute Q&A to follow

Webinar Agenda- Healthcare domain labor statistics

- Essential business analysis training

- Essential healthcare domain training

- Healthcare areas of knowledge for employment

- Healthcare domain resources

- Healthcare employment resources

Your Presenter30+ years of healthcare experience in the clinical, management and

information technology arenas

Implementation, training and maintenance of multiple EPM/EMR and medical software systems

Healthcare IT project planning & management

Owner of HeadFirst Consulting, LLC, independent contractor providing training through the American Society of Professional Education (ASPE) and American Health Sciences Institute (AHSI) for healthcare business

analysts and IT project managers

Healthcare Labor Statistics

* Over 32,800 new healthcare positions were added in the U.S. in May 2012

* More than 340,000 new positions were added the first half of 2012

* Healthcare jobs have increased at twice the rate as the general economy

* Creation of more than 4.2 million new healthcare jobs in the U.S. by 2020

* One in nine U.S. jobs will be in healthcare by 2020

Center for Healthcare Workforce Studies, University of Albany

Why are new U.S. healthcare positions skyrocketing?

•Increasing age of Baby Boomers

•More illness as we age

•Baby Boomers retiring from healthcare

•New treatment options becoming available

•Numerous new government regulations and security guidelines(HIT Initiative, Meaningful Use, HITECH Act, HIPAA)

•Affordable Care Act (ObamaCare)

Bureau of Labor Statistics

Healthcare is one of the least automated industries in the USA

Other industries at the bottom of the list are retail, education and construction

Healthcare IT is at least twenty years behind most other U.S. industries

Majority of healthcare organizations are using 25-30% of their Electronic Health Records (EHR) functionality

30% of EHR implementations are considered a failure by practice or hospital stakeholders

Electronic Health Records : Perspectives from the Adapters   MGMA

Additional Healthcare IT Statistics

The American Recovery & Reinvestment Act of 2009

* Signed into law February 17, 2009 by Pres. Obama

* $790 billion total

* $30 billion dedicated to healthcare (HITECH Act)

- Healthcare IT

- Training of primary care providers

- Research on chronic diseases

- Community health centres (urban and

underserviced areas)

- “Comparative Effectiveness” (what works in real

life)

Federal HIT Initiative

HITECH Act

-$17 billion earmarked as provider incentives distributed by

Medicare & Medicaid starting in 2011

-$2 billion to be used by the national health IT coordinator

- $ going to individual states

- Interoperability issues

- Regional HIT centres (RHIO)

- Telemedicine issues

-Goal of the HITECH Act

- HIT interoperability

- Establish CCHIT standards

- Government savings of $12 billion

- Strengthen federal privacy and security laws/regulations

HITECH Act

HITECH Act includes tightening of HIPAA guidelines

- Clear definition of “breach”

- Imposes restrictions and disclosures

- Requires accounting of disclosures

- Increased civil penalties for violations

- State attorneys can enforce HIPAA

HITECH Act

Essential Business Analysis Skills

-Experience with the Software Development Life Cycle (SDLC)

-CBAP or CCBA certification through the IIBA-Project management experience-Agile and/or Six Sigma training-Elicitation, scoping, requirements analysis skills

-Communication and critical thinking skills -Change Management-Conceptual modeling skills-Industry and business knowledge

Essential Business Analysis Skills

Need to establish fundamental requirements in order to control our fragmentedhealthcare system

Patient info currently remains in proprietary silos of informationIncreases duplication of workIncreases chance of errorsPerpetuates lack of coordination

Incorporate established standards that all health IT software & products must eventually conform to

Currently several government organizations are setting or enforcing standardsONCHIT - Office of the National Coordinator for HITHL7 - Health Level 7 CCHIT - Certification Commission for Healthcare Information TechnologyASTM - American Society for Testing and Materials RHIO - Regional Health Information Organization

Essential Healthcare Knowledge EDI = Electronic Data Interchange

-Ability to send & receive paperless documentation between two or

more organizations using an ANSI x 12 EDI standardized format

-Automate numerous practice/hospital business processes

-Multiple functions

- Electronic claim submission

-Electronic remittance and fund transfer

-Benefits include

Decreases the cost of doing business

Decreases paper use and storage costs

Increases data accuracy

Decreases postage costs, cost of faxes, phone calls etc.

Speeds up business processes

-Integral part of a complete and integrated EHR system

-Security TeamsAccess controlsDisaster guidelinesAudit and access controls and reportingHIPAA and state regulations

-“Need to know” basis (CRUD Matrix)-Audit controls & reporting-HIPAA and state regulations-Restricted visit types

HIV, mental health, drug abuseEmployeesVIP’s

Healthcare IT Vulnerabilities

Healthcare IT Vulnerabilities

-Remote access (home & hospital)-Internet use by staff-Backup systems-Printed documentation, research data-Exam rooms, printers, scanners, fax machines-Biometrics, proximity badges, secure computer screens

-Encryption

-EKG , PAC and Echo systems

Business Analysis OpportunitiesIn Healthcare

-Interoperability between multiple organizations and systems-Third party interfaces- EDI (Electronic Data Interchange)- IT Security/Liability from both internal and external sources- Disaster Recovery- Wireless capabilities (HIPAA)-Support and maintenance of numerous new healthcare IT systems-Implementations aligning with numerous new security guidelines and Meaningful Use requirements

Essential Healthcare Knowledge

-ICD-9 and ICD-10-Health insurance and claims process/pricing-DRG’s-Healthcare reform & recent government regulations

-EDI/Clearinghouses-4010 vs. 5010 compliance-Content Management Systems-PAC Systems

-Prescription systems/regulations-Healthcare data mining-Document management-Healthcare and medical terminology-CMS Medicare, FEP and Medicaid-Medical software (EMR/EPM etc.)-NHIN (National Health Information Network (RHIO)

Essential Healthcare Knowledge

Healthcare Experience – How Do I Get Started?

-BA experience/skills-CBAP/CCBA certification helpful-Healthcare industry knowledge-Knowledge of the inner workings of hospitals, medical practices, labs and/or healthcare R&D

-Training in latest healthcare federal guidelines-Understanding of electronic medical billing processes-Get involved in blogs, discussion groups, LinkedIn, HIMSS etc.

Healthcare Experience – How Do I Get Started??

-Involvement in your local IIBA chapter-Network with other healthcare BA’s through your state IIBA

-Training classes in medical terminology, healthcare IT

-Prep for interviewing for healthcare IT jobs-Explore the numerous healthcare employment resources

-Membership in HIMSS, MGMA etc.

CPEHR – Certified Professional in Electronic Health Records

CISSP – Certified Information System Security Professional

CPHIT – Certified Professional in Health Information Technology

CHISM – Certified Healthcare Informatics Manager

CHP – Certified HIPAA Professional

CHSS – Certified HIPAA Security Specialist

CHA – Certified HIPAA Administrator

Certifications

Business Analysis Resources

International Institute for Business Analysis (IIBA) www.theiiba@com

State IIBA Chapters www.theiiba.org

St. Louis University, St. Louis, Missouri

American Society for Professional Education (ASPE)

American Health Sciences Institute (AHSI)

http://www.himss.org/StateDashboard/

‐Grant Information – Contains information on grants awarded to communities, hospitals, providers and healthcare systems with information on funding, hiring and grant specifics.

‐Regional Health Information Organization (RHIO)  Specifics –Information on RHIOs and their current status. 

‐State Legislation Tracking – Descriptions and summaries of pending legislation and HIMSS positions on legislation.

‐Davies Award Winners (HIMSS) – recognizes excellence in the implementation and use of HIT

‐HIMSS Chapter Information – Locations of HIMSS Chapters.

State HIT Resources

Healthcare Resources

HIMSS (Health Information Management Systems Society) http://www.himss.org/ASP/index.aspMGMA (Medical Group Management Association) http://www.mgma.com/Office of the National Coordinator for Health Information TechnologyHealth IT http://healthit.hhs.gov/Center for Medicare & Medicaid Services http://www.cms.gov/Fierce Healthcare IT http://www.fiercehealthit.com/Government Healthcare IT http://www.govhealthit.com/Healthcare IT News (iPad app) http://www.healthcareitnews.com/American Association of Healthcare Administrative Managementhttp://www.aaham.org/LinkedIn (Numerous healthcare IT discussion groups)

Q & A

How to Claim Your PDU

• Go to aspe‐sdlc.com/pdu/ for instructions on submitting your PDU.

• You can submit your PDU by mail or electronically.

• The Activity code for today’s presentation is WS100912 and ASPE’s REP number is 2161.

• The seminars are Category A for one PDU