Essential Skills for Business Analysts in the Healthcare Domain

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1 #ASPEevents

2 Essential Skills for Business Analysts in the Healthcare Domain

3 Essential Skills for Business Analysts in the Healthcare Domain Presented By Mary C. Zarba, MBA Vail, Colorado

4 Welcome!! One hour webinar 45 minute PowerPoint slide presentation 15 minute Q&A to follow

5 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

6 Your Presenter 30+ 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

7 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

8 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

9 Additional Healthcare IT 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

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13 Federal HIT Initiative 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)

14 HITECH Act HITECH Act -$17 billion earmarked as provider incentives distributed by Medicare & Medicaid starting in $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

15 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

16 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

17 Essential Business Analysis Skills Need to establish fundamental requirements in order to control our fragmented healthcare system Patient info currently remains in proprietary silos of information Increases duplication of work Increases chance of errors Perpetuates lack of coordination Incorporate established standards that all health IT software & products must eventually conform to Currently several government organizations are setting or enforcing standards ONCHIT - Office of the National Coordinator for HIT HL7 - Health Level 7 CCHIT - Certification Commission for Healthcare Information Technology ASTM - American Society for Testing and Materials RHIO - Regional Health Information Organization

18 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

19 Healthcare IT Vulnerabilities -Security Teams Access controls Disaster guidelines Audit and access controls and reporting HIPAA and state regulations - Need to know basis (CRUD Matrix) -Audit controls & reporting -HIPAA and state regulations -Restricted visit types HIV, mental health, drug abuse Employees VIP s

20 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

21 Business Analysis Opportunities In 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

22 Essential Healthcare Knowledge -ICD-9 and ICD-10 -Health insurance and claims process/pricing -DRG s -Healthcare reform & recent government regulations -EDI/Clearinghouses vs compliance -Content Management Systems -PAC Systems

23 Essential Healthcare Knowledge -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)

24 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.

25 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.

26 Certifications 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

27 Business Analysis Resources International Institute for Business Analysis (IIBA) State IIBA Chapters St. Louis University, St. Louis, Missouri American Society for Professional Education (ASPE) American Health Sciences Institute (AHSI)

28 State HIT Resources 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.

29 Healthcare Resources HIMSS (Health Information Management Systems Society) MGMA (Medical Group Management Association) Office of the National Coordinator for Health Information Technology Health IT Center for Medicare & Medicaid Services Fierce Healthcare IT Government Healthcare IT Healthcare IT News (ipad app) American Association of Healthcare Administrative Management LinkedIn (Numerous healthcare IT discussion groups)

30 Q & A

31 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 WS and ASPE s REP number is The seminars are Category A for one PDU

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