CPlMS CerLlfled rofesslonal ln PealLhcare lnformaLlon SysLems

1he CPlMS exam covers nlne domalns and Lhree secLlons

l Ceneral
1 PealLhcare LnvlronmenL
2 1echnology LnvlronmenL
ll SysLems
1 Analysls
2 ueslgn
3 SelecLlon lmplemenLaLlon SupporL MalnLenance
4 1esLlng LvaluaLlon
3 rlvacy SecurlLy
lll AdmlnlsLraLlon
1 Leadershlp
2 ManagemenL
Chapter I nea|thcare Lnv|ronment
Learnlng ob[ecLlves
O ArLlculaLe characLerlsLlcs of dlfferenL Lypes of healLhcare organlzaLlons
O ArLlculaLe characLerlsLlcs of Lhe lnLerrelaLlonshlps wlLhln and across healLhcare
organlzaLlons
O uescrlbe Lhe roles of Lhe healLhcare professlonals and Lhe organlzaLlonal sLrucLure
where Lhey work
O DndersLand Lhe role of governmenL ln healLhcare dellvery
1he healLhcare envlronmenL ls complex comprlsed of many dlfferenL componenLs lncludlng
numerous organlzaLlons
O CovernmenLal
O AccredlLlng and regulaLory agency
O Iarlous paymenL models varleLy of provlders of care LhaL spans Lhe enLlre medlcal
specLrum
1hls chapLer provldes a very brlef overvlew of Lhe healLhcare world and descrlbes some
maln elemenLs of hea|thcare de||very |nc|ud|ng prov|ders regu|atory structures and
mode|s of payment systems and profess|ona|s who work |n the prov|s|on of hea|thcare
1he healLhcare envlronmenL ls mu|t|faceted and Lhe currenL focus on Lhe lnformaLlon
Lechnology (l1) lnfrasLrucLure ls lnLense 1he hea|thcare sector of any country |s |nf|uenced
by the po||t|ca| c||mate cu|ture soc|a| va|ues techno|ogy f|nanc|ng and econom|cs of that
country PealLhcare servlces dellvery ls ofLen fragmenLed lnlLlaLlves Lo achleve greaLer
lnLegraLlon are dependenL on Lhe developmenL of an l1 lnfrasLrucLure and relaLed
organlzaLlonal sLrucLures and governance models LhaL can accommodaLe Lhe secure
exchange of lnformaLlon lmproved declslon maklng and greaLer quallLy of care
Conslder Lhe lssues healLhcare prov|ders face
O n|gh rap|d|y r|s|ng costs
O n|gh|y var|ab|e c||n|ca| qua||ty
O at|ent safety |ssues
O Need for ev|dence based dec|s|on mak|ng
O Comp|ex adm|n|strat|ve processes
O Increas|ng consumer|sm and he|ghtened expectat|ons
O kesearch and techno|ogy advances
1he ablllLy Lo address each of Lhese lssues effecLlvely ls largely dependenL on lnLegraLlng daLa
from mulLlple sources LhaL ls supporLed by lnLeroperable lnformaLlon sysLems (lS) PealLhcare
faces expendlLures of bllllons of dollars of lnvesLmenL Lo lmplemenL needed l1 sysLems up Lo
5276 b||||on |n Un|ted States a|one accord|ng to recent report from Center for Informat|on
1echno|ogy Leadersh|p (CI1L)
nea|thcare De||very rov|ders
1he healLhcare sysLem ls characLerlzed by an array provlder organlzaLlon LhaL spans cont|nuum
from pr|mary ambu|atory and spec|a|ty care to |ntens|ve acute care to |ong term and home
care 1he organlzaLlonal provlders ln Lhe healLh dellvery sysLem are slmllarly arrayed from large
lnLegraLed dellvery neLworks (luns) Lo small one physlclan offlce pracLlce and cllnlcs Lo home
and healLh servlces





Comment |E1]:
Pavlng many aspecLs or phases
(*
Comment |E2]:
3teroperabIe
Capable of belng used or operaLed reclprocally
lotetopetoble weopoos systems
Comment |E3]:
.o3t3::2

1he seL of all real numbers

nCSI1ALS
PosplLals are generally deflned as acuLe lnpaLlenL faclllLles whose prlmary funcLlons ls Lhe
dlagnosls and LreaLmenL of paLlenLs whose condlLlons ls serlous enough Lo requlre an overnlghL
sLay of one or more nlghL ln addlLlon many hosplLals provlde oLher servlces such as an
emergency deparLmenL subacuLe care ouLpaLlenL surgery longLerm care and ambulaLory
servlces PosplLals can be characLerlzed ln varleLy of ways
A 8y the |eve| of care they prov|de
O PosplLals may provlde primory core LhaL lncludes baslc servlces llke Lhose
provlded by a famlly physlclan C8/C?n edlaLrlclan or general lnLernlsL
O PosplLals may provldes econdory core LhaL offers more speclflc servlces
lncludlng surglcal procedures and lnLenslve care such as lnLenslve care unlLs
(lCDs) and neonaLal lnLenslve care unlLs (nlCDs)
O lnally Lhey may provlde eriory core LhaL focus on hlghly speclallzed complex
and Lechnologlcally advanced servlces LhaL wlll lnclude Lrauma asslsLance and
LransplanL programs
O oce core ls a level of supporL Lo paLlenLs ln any of Lhe above faclllLles buL
also offers an lnLermedlaLe level of LreaLmenL for Lhe paLlenLs who slmply needs
sllghLly longer sLay oce core unlLs may be based ln llcensed skllled nurslng
faclllLy as well as wlLhln hosplLal seLLlng and ls someLlmes called roniiono/ core
8 8y the|r ownersh|p
lndlvlduals or corporaLlons own a forproflL or Laxed hosplLal whose prlmary purpose ls
a reLurn on lnvesLmenL for Lhemselves or shareholders
orproflL hosplLals may offer any of Lhe levels of care descrlbed above Clven LhaL
lnvesLors own Lhem a porLlon of Lhelr neL revenues may be used Lo pay a reLurn on
Lhelr lnvesLmenL ln Lhe company who owns Lhe hosplLal orproflL hosplLals also pay
Laxes on Lhelr lncome and Lhelr properLy unless Lhey have speclflc exempLlons from Lhe
sLaLe munlclpallLy or oLher governmenLal enLlLy ln whlch Lhey are locaLed PCA 1he
PosplLal Company ls a an example of such as lnvesLor owned hosplLal company based
ln Lhe DnlLed SLaLes

nonproflL or LaxexempL hosplLal ls owned by a nonproflL organlzaLlon ofLen a
communlLy rellglous order or governmenL enLlLy nonproflLs do noL offer a reLurn from
neL revenues Lo any lndlvldual or organlzaLlon nor do Lhey pay Laxes on Lhelr
properLles lncome and servlces Powever some nonproflLs have forproflL subsldlarles
LhaL do pay Laxes on such Lhlngs as properLy and lncome Such forproflL subsldlarles
may be an lnvesLmenL arm LhaL lnvesLs ln nonhosplLal properLy as a way of proLecLlng
and bulldlng Lhe flnanclal asseLs of Lhe nonproflL



C 8y the|r geograph|c |ocat|on
An ron hopio/ ls as Lhe name suggesLs slLuaLed ln a large or moderaLely slzed
meLropollLan area ln DnlLed SLaLes Lhese areas are called metropo||tan stat|st|ca|
areas (MSAs) whlch are deflned as Lhose wlLh populaLlon of more Lhan 30000
resldenLs
ommniy hopio/ are usually found ln areas wlLh less dense populaLlon and serve
Lhe lmmedlaLe and surroundlng communlLles
ro/ hopio/ are locaLed ln smaller communlLles and more remoLe locaLlons 1hey are
ln areas LhaL are noL parL of an MSA CLher crlLerla are lnvolved ln Lhe rural
classlflcaLlon buL generally rural hosplLals are small faclllLles LhaL offer a wlde range of
prlmary care servlces and some more advanced or secondary level dlagnosLlc and
surglcal procedures Lo Lhelr local populaLlon

D 8y the|r payor m|x
PosplLals may be caLegorlzed by Lhelr payor mlx a descrlpLlon of Lhe welghLed source
of revenue for servlces provlded Some hosplLals may have a hlgh percenLage of paLlenLs
wlLh prlvaLe lnsurance coverage oLhers may have Lhelr revenue from a hlgher
percenLage of paLlenLs covered by governmenL or sLaLe programs 1hls varles by Lhe
flnanclng sysLem of Lhe counLry ln whlch Lhe provlder organlzaLlon exlsLs

Medlcare above 63 years
Medlcald poor people

L As teach|ng fac|||t|es or academ|c med|ca| centers
1each|ng hosp|ta|s are afflllaLed wlLh a medlcal school and/or oLher school of healLh
professlons such as a school of nurslng or pharmacy 1hey offer Lralnlng Lo lnLerns
resldenLs and oLher cllnlclans who provlde paLlenL care under Lhe supervlslon of sLaff
and Leachlng physlclans nurses or oLher allled healLh professlonals
Academ|c med|ca| centers or Lhe oLher hand lnclude a medlcal school and /or oLher
school of healLh professlonal and a LerLlary level Leachlng hosplLal under Lhe same
ownershlp raLher Lhan Lhrough an afflllaLlon agreemenL
Nonteach|ng hosp|ta| do noL formally Lraln cllnlclans and physlclan lnLernlsLs or
medlcal resldenLs
Comment |E4]:
uay 2

AM8ULA1Ck CLN1LkS Ck CLINICS
AmbulaLory cenLers and ouLpaLlenLs cllnlcs provlde healLhcare servlces Lo paLlenLs who are able
Lo reLurn home wlLhouL overnlghL sLay ln a medlcal faclllLy AmbulaLory care lncludes
prevenLaLlve dlagnosLlc and LreaLmenL servlces (lncludlng many surglcal procedures) provlded
on an ouLpaLlenL basls
Ambu|atory care can prov|de care |ess expens|ve|y than |npat|ent hosp|ta| because they do
not prov|de the h|gh|y spec|a||zed |ntens|ve and comp|ex serv|ces that are requ|red by
pat|ents adm|tted to hosp|ta|
AmbulaLory cenLers and cllnlcs Lyplcally offer prlmary care as provlded by general lnLernlsLs
famlly pracLlce physlclans nurse pracLlLloners and physlclan asslsLanLs As prlmary care
provlder Lhey Lyplcally serve as Lhe flrsL polnL of access Lo Lhe larger healLhcare sysLem
AddlLlonally advances ln Lechnology (eg Laparoscoplc Surgery) have enabled physlclans Lo
perform an array of surglcal procedures LhaL oLherwlse mlghL have requlred hosplLallzaLlon

LCNG 1LkM CAkL SLkVICLS
Long Lerm care (L1C) ls compared of a wlde range of servlces lncludlng a numbers of venues
of care L1C ervice ore ypico//y defined o hoe wih o l0doy or /onqer /enqh of oy 1he
mosL well known L1C faclllLles are nurslng homes or Skllled nurslng aclllLles (Sns) and
lnLermedlaLe Care aclllLles (lCs)
Sns provldes medlcal servlces under Lhe full Llme care of a reglsLered nurse (8n) offerlng
skllled and LherapeuLlc servlces for paLlenLs wlLh chronlc and more serlous physlcal condlLlons
lC on Lhe oLher hand provlde broadbased healLh malnLenance personal care and healLhcare
servlces Lo supporL Lhe acLlvlLles of dally llvlng of Lhelr elderly chronlcally lll dlsabled or
menLally handlcapped 8eyond whaL has LradlLlonally been known as nurslng home /onqerm
heo/h ervice ore o/o provided on inpoien oi in o rehoi/ioion foci/iy or o meno/
heo/h hopio/ L1 nrinq foci/iie hove o overoqe /enqh of oy of o /eo evero/ week
ofen o /onq o evero/ yeor
1he full range of L1C servlces lncludes home healLhcare agencles where care ls provlded on an
ouLpaLlenL or aL home basls ln Lhe laLLer servlces are provlded by a nurses 'alde LheraplsL or
oLher supporL personnel ln vlslLs Lo Lhe paLlenL's home Pome healLh agencles may be
freesLandlng or Lhey may be parL of a hosplLal or healLhcare sysLem Lhey may be organlzed as
elLher nonproflL or forproflL agencles

U8LIC nLAL1n AGLNCILS AND kCGkAMS
1he publlc healLh secLor of healLhcare dellvery provldes servlces LhaL are funded by any of Lhe
varlous levels of governmenL
CCMMUNI1 nLAL1n kCGkAMS
CommunlLy healLh programs and cenLer are a less vlslble parL of healLhcare dellvery sysLems
buL none Lhe less crlLlcal ln provldlng medlcal care 1hese cenLers are usually funded by
governmenLbased paymenLs and granL programs servlng as prlmary care safeLy
nSICAN kAC1ICLS
hyslclan may pracLlce as solopracLlLloners wlLhln slnglespeclalLy groups or mulLlspeclalLy
group pracLlces hyslclan members ln a group pracLlces share faclllLles Cver head expense
medlcal records equlpmenL and sLaff
nAkMACILS
1he prlmary role of pharmacles ls Lo prepare and dlspense pharmaceuLlcals harmacles are
under Lhe professlonal admlnlsLraLlon of one or more reglsLered pharmaclsLs
IN1LGkA1LD DLLIVLk NL1WCkk (IDN)
An lun also known as lnLegraLed dellvery sysLem (luS)ls organlzaLlon made up of varleLy of
healLhcare servlces provlders offerlng servlces across Lhe conLlnuum of care and lnLegraLed ln
admlnlsLraLlon lnformaLlon sharlng and oLher funcLlons for example and lun may own(or have
ownershlp )ln a hosplLal a large slnglespeclalLy physlclan pracLlce an L1C nurslng faclllLy a
rehablllLaLlon hosplLal and an ambulaLory care faclllLy
CrganlzaLlonally lnLegraLlon can be based on Lhe degree of ownershlp and buslness
arrangemenLs of Lhe parLles lnvolved
O A merger and acqulslLlon formaLlon lnLegraLes Lhe asseLs among organlzaLlon
O A [olnL venLure pools Lhe resources of Lwo lndependenL organlzaLlons Lo creaLe a new
enLlLy Lo pursue a common purpose
O An alllance ls a [olnL agreemenL LhaL shares resources wlLhouL [olnLly owlng asseLs
O A neLwork can lnvolve an alllance of several provlders and Lherefore may be Lhe mosL
amblLlous meLhod lnLegraLlon
O IlrLual CrganlzaLlon has conLracLual arrangemenLs beLween exlsLlng organlzaLlons Lo
form a new organlzaLlons


AMLN1 SS1LMS
lnanclng of healLhcare servlces ls done Lhrough elLher commerclal prlvaLe lnsurance or publlc
flnanclng or a comblnaLlon of Lhese approaches
nPl naLlonal PealLh lnsurance programs are offered Lhrough a mechanlsm where Lhe
governmenL flnances healLhcare Lhrough general Laxes ln DnlLed SLaLes where ,edicore
cover o// poricipon oqe 5 ond over ond where ,edicoid cover peron who fo// e/ow
predefined income /eve/ ,edicoid coveroqe moy vory from oe ooe
aymenL sysLems vary ln Lhe way Lhey deLermlne Lhe amounL of coverage Lhey wlll provlde for
dlagnosLlc and LreaLmenL servlces and procedures ln some lnsLances a feefor servlce
approach ls used where paymenL ls calculaLed on a perday or per procedure raLe ln Lhls
sysLem payor ls aL rlsk for Lhe charges LhaL are made Lhe provlder on Lhe oLher hand ls
lnherenLly lncenLlvlzed Lo add servlce and days of care
1he nea|thcare Workforce 1he ko|e of nea|thcare Systems rofess|ona|s
Llcensed healLh professlonal work ln hosplLals physlclans's offlces ouLpaLlenL faclllLles cllnlcs
and oLher healLhcare provlder seLLlngs 1hey lnclude physlclans nurses pharmaclsLs denLlsLs
physlcal LheraplsLs and many oLher speclallzed pracLlLloner Lhese professlonal are requlred Lo
have earned speclflc academlc credenLlals and pass compeLency exam llcensure
nSICIANS
hyslclans are generally classlfled as prlmary care physlclans (C) or as speclallsL wlLhln an
array of dlsLlncL speclalLles WlLhln each of Lhese classlflcaLlons Lhere are subclasslflcaLlons
Cs are mosL commonly found ln famlly pracLlce famlly medlclne general lnLernal medlclne
and general pedlaLrlcs
SpeclallsLs on Lhe oLher hand lnclude a wlde range of cllnlcal areas such as surgery
orLhopedlcs neurology cardlology gasLroenLerology eLc
Mlu LLILL 8AC1l1lCnL8S
Mld level pracLlLloners works under Lhe dlrecLlon of physlclans 1hese lnclude physlclan
asslsLanLs and advance pracLlce nurses hyslclan asslsLanLs or A s ofLen serve as hyslclan
LxLenders" Lo provlde prlmary care servlces Lo paLlenL
O Many of Lhem work ln rural areas or ln ambulaLory cllnlcs
O As Lyplcally recelve 2436 monLhs of Lralnlng
Advance pracLlce nurses are cllnlcal professlonals among whose ranks are cllnlcal nurse
speclallsL nurse mldwlves nurse pracLlLloners and C8nAs (CerLlfled 8eglsLered nurse
AnesLheLlsLs)
nD8SLS
1he largesL caLegory of healLhcare provlder ls Lhe reglsLered nurse (8n) and mosL of Lhls
professlonal work ln hosplLal seLLlngs
1he professlon of nurslng lnformaLlcs (nl) has grown wlLh expanslon of l1 ln healLhcare nl ls
deflned by Amerlcan nurslng AssoclaLlon (AnA)

















INICkMA1ICN AND MANAGLMLN1 SS1LMS kCILSSICNAL
Iour core funct|ons of the hea|thcare I1 departments
O CperaLlons and Lechnlcal supporL LhaL manages Lhe l1 lnfrasLrucLure
O AppllcaLlon ManagemenL LhaL ls responslble for acqulrlng developlng and lmplemenLlng
new sysLems and provlde ongolng enhancemenLs
O Speclallzed groups such as Lhose engaged ln process lmprovemenL
O l1 admlnlsLraLlon who oversees Lhe l1 deparLmenL's funcLlons provldes Lhe l1
governance sLrucLure develop and lmplemenL a sLraLeglc l1 plan and manage sLafflng
and Lhe budgeL
Sen|or |eadersh|p ro|es
O Chlef lnformaLlon Cfflcer (ClC) who manages Lhe deparLmenL and provldes leadershlp
for successful l1 sLraLegy and lmplemenLaLlon
O Chlef 1echnology Cfflcer(C1C) who guldes" Lhe deflnlLlon and lmplemenLaLlon of Lhe
organlzaLlon 's Lechnlcal archlLecLureand Lrack emerglng Lechnologles
O Chlef SecurlLy Cfflcer (CSC) who ls responslble for prlvacy and securlLy of sysLems and
lnformaLlon
O Chlef Medlcal lnformaLlon Cfflcer(CMlC) who works wlLh and represenLs physlclans ln
Lhe deslgn and lmplemenLaLlon of sysLems
I1 m|d management and staff ro|es
O SysLem analysLs who work wlLhln Lhe deparLmenL and wlLh endusers Lo assess l1 needs
and Lo asslsL ln Lhe deflnlLlon of sysLems funcLlonallLles LhaL wlll meeL Lhose needs
O rogrammers who wrlLe LesL and malnLaln sofLware
O uaLabase admlnlsLraLors who are responslble for assesslng ways Lo organlze and access
daLa LhaL ls sLored
O neLwork admlnlsLraLors who manages Lhe neLwork lnfrasLrucLure
O 1elecommunlcaLlon speclallsLs who manage Lhe Lelephone communlcaLlon sysLems
O ManagemenL englneers whose role ls Lo analyze and redeslgn processes Lo achleve
process lmprovemenL




ko|e of Government kegu|at|on rofess|ona| and Accred|tat|on Agenc|es |n nea|thcare
De||very
SLaLe provlnclal reglonal and federal governmenLs assume varlous roles ln healLhcare dellvery
O 1hey may be a provlder of servlces (eg 1he DS ueparLmenL of IeLerans Affalrs 1he
publlc healLh cllnlcs ln rural and underserved areas) As a provlder of medlcal servlces
Lhe governmenL enLlLy owns and operaLes Lhe faclllLles where servlces are dellvered
employs Lhe admlnlsLraLlve and cllnlcal sLaff lncludlng physlclans who provlde servlces
and provlde sLraLeglc dlrecLlons
O 1hey may be ayor of servlces Lhrough such nPl programs as Medlcare and Medlcald ln
Lhe DnlLed SLaLes
O As a payor of medlcal servlces governmenLs uLlllze general Lax revenues or speclal Laxes
(eg payroll Laxes) Lo collecL funds for dlsbursemenL Lo medlcal provlders for servlces
dellvered Lo Lhose who are covered by Lhe program
O 1hey may be a regulaLor of servlces Lhrough laws cllnlcal/faclllLy llcensure and
lnsurance As payor Lhe governmenL lnherenLly esLabllshes Lhe rules and regulaLlons
under whlch lL wlll pay for medlcal care or example Lhe DS has enacLed laws such as
Lhe PlAA (PealLh lnsurance orLablllLy AccounLablllLy AcL) and LM1ALA(Lmergency
Medlcal 1reaLmenL AcLlve Labor AcL) LhaL provldes respecLlvely dlrecLlves on how
medlcal lnformaLlon
ACCkLDI1A1ICN
1he !olnL Commlsslon and !olnL Commlsslon lnLernaLlonal
1he [olnL commlsslon and lLs subsldlary !olnL Commlsslon lnLernaLlonal (!Cl) ls a prlvaLe non
proflL accredlLlng body for healLhcare based ln Lhe DnlLed SLaLes lL ls noL a governmenL agency
raLher lL ls a prlvaLe organlzaLlon whose foundlng members are ma[or professlonal healLhcare
assoclaLlons
ICD10 Standard|zat|on (Internat|ona| C|ass|f|cat|on of D|seases)
1he sLandardlzaLlon ls relaLed Lo achlevlng lnLeroperablllLy ln healLhcare l1


























#.e 2: |1] Comment |E1] Eclipsys S/1/2003 6:S0:00 #

Pavlng many aspecLs or phases