Data Management, Privacy, and Security
Management of Health Information Systems and Processes
Health Informatics Training
Additional information regarding the credential’s eligibility re-
quirements, exam application process, and study guide informa-
tion can be found online at www.ahima.org/certification/CPHI.
The two most prevalent roles in informatics are data analytics
and workflow engineering.
The science of examining raw data with the purpose of drawing
conclusions about that information is referred to as data analytics. This includes data mining, machine language, development
of models, and statistical measurements. Analytics can be descriptive, predictive, or prescriptive. 8
The application of data analytics is critical to the health information professional in today’s environment of increased
external payer, regulatory, and government compliance audits.
External agencies and individuals are using publicly available
healthcare data to apply data analytics tools to identify relationships between clinical outcomes reporting, services reimbursed, and disease tracking. By and large, analytics tools are an
effective way of identifying potentially false claims and discrepancies in clinical outcomes reporting.
The Office of Inspector General (OIG) reports that it is increas-
ing its efforts in using data analytics to better detect potential
Recent financial and economic conditions have prompted
greater scrutiny of government spending, highlighting the im-
portant role that oversight and law enforcement agencies play in
identifying and eliminating fraud, waste, and abuse. A number of
these agencies are increasing their ability to do their work by using
data analytics, which uses a variety of techniques to analyze and
interpret data. For example, predictive analytic technologies can
identify fraud and errors before payments are made, while data-
mining and data-matching techniques can identify fraud or im-
proper payments that have already been awarded so that agencies
can work to recover those dollars. 9
As both government and private payors continue developing data analytics to enhance their audits, health information
professionals should implement similar analytic tools and applications. Applications should be developed to automate the
analysis of data to a large extent through the implementation
of user-defined rules, logic relationship checks, etc. The health
information professional has the unique advantage of understanding the rules and relationships to assist business informaticists in implementing those rules into program-based logic.
Business Process Re-engineering: Workflow Management
The Agency for Healthcare Research and Quality (AHRQ) defines workflow as follows: “Workflow is the sequence of physical and mental tasks performed by various people within and
between work environments. It can occur at several levels (one
person, between people, across organizations) and can occur
Figure 3: Using Data for Decision-Making