TEST BANKS for Health Informatics An Interprofessional Approach 2nd Edition Nelson Ramona and Stagge

TEST BANK FOR

Health Informatics: An Interprofessional Approach 2nd Edition

by Ramona Nelson, Nancy Staggers

Table of Contents Chapter 01: An Introduction to Health Informatics Chapter 02: Theoretical Foundations of Health Informatics Chapter 03: Evidence-Based Practice, Practice-Based Evidence, and Informatics Chapter 04: Models, Theories, and Research for Program Evaluation Chapter 05: Technical Infrastructure to Support Healthcare Chapter 06: Electronic Health Records and Applications for Managing Patient Care Chapter 07: Administrative Applications Supporting Healthcare Delivery Chapter 08: Telehealth and Applications for Delivering Care at a Distance Chapter 09: Home Health and Related Community-Based Systems Chapter 10: Clinical Decision Support Systems in Healthcare Chapter 11: Public Health Informatics Chapter 12: The Evolving ePatient Chapter 13: Social Media Tools for Practice and Education Chapter 14: Personal Health Records (PHRs) Chapter 15: mHealth–The Intersection of Mobile Technology and Health Chapter 16: Identifying and Selecting an Information System Solution Chapter 17: Project Management Principles and Clinical Systems Chapter 18: Contract Negotiations and Software Licensing Chapter 19: Implementing and Upgrading an Information System Solution Chapter 20: Health Information Systems: Downtime and Disaster Recovery Chapter 21: Improving the User Experience for Health Information Technology Products Chapter 22: Informatics-Related Standards and Standards-Setting Organizations Chapter 23: Data Science and Analytics in Healthcare Chapter 24: Patient Safety and Quality Initiatives in Informatics Chapter 25: Legal Issues, Federal Regulations, and Accreditation Chapter 26: Privacy and Security Chapter 27: The Health Information Technology for Education and Clinical Health (HITECH) Act, Chapter 28: Health Policy and Health Informatics Chapter 29: Health Information Technology Governance Chapter 30: Informatics in the Curriculum for Healthcare Professionals Chapter 31: Distance Education: Applications, Techniques, and Issues Chapter 32: Informatics Tools for Educating Health Professionals Chapter 33: Simulation in Healthcare Education Chapter 34: International Informatics Efforts Chapter 35: The Evolution of Health Informatics Chapter 36: Future Directions and Future Research in Health Informatics

Chapter 01: An Introduction to Health Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Dr. James, in studying patient safety in U.S. hospitals, found that the number of preventable

adverse events leading to serious harm fell in the approximate range of cases per year. a. 4.4 million; 8.8 million b. 440,000; 880,000 c. 1 million; 5 million d. 40,000; 100,000

to

ANS: A

Dr. James found some 440,000 cases of lethal harm each year and estimated that the incidence of serious (but not lethal) harm was 10 to 20 times that figure.

DIF: Cognitive Level: Analyze 2. Health informatics is both a a. discipline; field of study b. profession; practice c. field of study; art d. profession; discipline

REF: p. 1

as well as a(n)

.

ANS: D

Health informatics is a discipline, or field of study, in the same sense that “medicine,” “sociology,” and “pharmacy” are fields of study. It is also a profession, practiced by thousands of informaticians in a number of varied roles within the healthcare industry.

DIF: Cognitive Level: Remember

REF: p. 2

3. The top three uses of the U.S. Army’s telehealth network include all of the following EXCEPT a. b. c. d.

. behavioral telehealth cardiology otolaryngology dermatology

ANS: C

The biggest use of the U.S. Army’s telehealth network is for behavioral telehealth, followed by cardiology and dermatology. While telemedicine is making inroads in otolaryngology, it is not among the top three uses for the U.S. Army.

DIF: Cognitive Level: Remember

REF: p. 3

4. What is the main idea of the subsection titled “Why Informatics Is Needed in Healthcare: An

Example”?

a. An interoperable healthcare system that provides clear, concise patient data and

information among institutions is lacking in many facilities, and its presence would greatly facilitate things such as patient transfers. b. The quality of discharge communication during transfers of geriatric patients from hospital to nursing home is generally high. c. Skilled nursing facilities aren’t trained enough to identify the information they need to facilitate a high-quality transition of a patient into their facility. d. Healthcare informaticians alone are responsible for building interoperable systems that will facilitate communication between and among healthcare facilities.

ANS: A

This subsection takes the specific case of the transfer of geriatric patients from a hospital setting to a long-term skilled nursing facility (SNF) and uses it to illustrate the great need for an interoperable healthcare system that allows patient data to be transferred quickly, clearly, and concisely among facilities.

DIF: Cognitive Level: Analyze

REF: p. 3

5. The chapter makes the argument for increased automation for such things as managing supplies,

because studies have shown that . a. only 70% of a nurse’s day is actually spent at patients’ bedsides b. nurses waste “an hour a shift” finding equipment c. over $14 million in nurses’ wages nationwide were spent in 2011 on tasks like hunting for equipment d. patients report being comforted by the presence of robotic technology in their rooms ANS: B

The chapter focused on using health informatics and technology solutions to free up nurses’ days so they can spend more time at patients’ bedsides and less on extraneous duties. A 2011 study by the Robert Wood Johnson Foundation found that nurses do use an hour per shift of their time simply hunting down equipment.

DIF: Cognitive Level: Understand

REF: p. 3 | p. 4

6. The

is one of the oldest—and still widely used—methods for building and implementing software applications in IT arena. a. TUG b. clinical decision support system c. HIPAA d. SDLC ANS: D

Though it’s been through a number of iterations and adjustments, the software development life cycle remains the tested and tried-and-true method for studying, building, implementing, and maintaining a health information system.

DIF: Cognitive Level: Remember

REF: p. 4 | p. 5

7. Which of the following statements about EHRs is false? a. The percentage of hospitals using an EHR jumped from 59% to 75% from 2013 to

2014. b. Stage 2 is the minimum level of EHR required in order to be counted as using EHR. c. By 2014 50% of physicians in the United States had implemented an EHR, with another 13% in the process of implementing one. d. There were no EHR systems in U.S. hospitals in 2009.

ANS: C

The text gives data for physicians using EHR in 2013, stating that by that year 63% had implemented some form of EHR, with another 20% in the process of implementing one.

DIF: Cognitive Level: Apply

REF: p. 6

MULTIPLE RESPONSE 1. Internationally, healthcare delivery systems face a number of common challenges, including:

(Select all that apply.) a. cost and the need to cut costs and demonstrate value. b. a lack of new HIT advances. c. dynamic forces like workforce shortages and increased consumerism. d. an international population that is growing increasingly younger and healthier. e. increasing government regulation to protect patient health, safety, and privacy.

ANS: A, C, E

The need to contain costs, forces like workforce shortages and increased consumerism, and increasing government regulation are all challenges faced in common globally by healthcare delivery systems. There is no lack in new HIT advances; in fact adoption of such new technologies is a challenge in itself, as is an aging population that will require more healthcare than before.

DIF: Cognitive Level: Understand

REF: p. 6 | p. 7

Chapter 02: Theoretical Foundations of Health Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. What is the primary difference between an open and closed system? a. An open system has no boundary, and therefore there are no limits to the inputs

and outputs between an open system and the environment. b. An open system has a semipermeable boundary and therefore will filter both inputs

and outputs when interacting with the environment. c. A closed system has a semipermeable boundary and therefore will filter both

inputs and outputs when interacting with the environment. d. A closed system does not have a boundary and therefore will not interact with the

environment.

ANS: B

With an open system the boundary is semipermeable, thereby controlling what will be accepted as input and what will be permitted to leave the system.

DIF: Cognitive Level: Understand

REF: p. 15

2. The primary characteristics used to analyze an open system include: a. structure, purpose, and functions. b. subsystem, target system, and supersystem. c. boundary, attributes, and environment. d. hierarchical, web, and hybrid.

ANS: A

Using these three characteristics, one can determine why the system exists, what functions it performs to achieve its purpose, and how it is structured to achieve its purpose.

DIF: Cognitive Level: Remember

REF: p. 16

3. You have altered the menu of food items served to your patients. However, the change has

greatly expanded the number of refrigerated items needed on hand. You need to buy a new refrigerator, but the electric circuit in the kitchen cannot handle the extra load and needs to be upgraded at significant expense. This set of unintended consequences down the line, produced by an initial change, is called: a. dynamic homeostasis. b. semi-planned change. c. negentropy. d. reverberation.

ANS: D

Change within any part of a system will be reflected across the total system through a process termed reverberation. Reverberation can be intended or unintended consequences of change.

DIF: Cognitive Level: Analyze

REF: p. 18

4. The “butterfly effect” describes a situation in which a minor change in input (eg, a butterfly

flapping its wings in one part of the world) can have a major effect on output (eg, a windstorm developing in another part of the world). This aspect of chaotic systems illustrates their property of: a. the reiterative feedback loop.

b. linearity. c. preordained periodic behavior. d. the fractionation of outputs.

ANS: A

Chaotic systems are dynamic systems with reiterative feedback loops. A minor change in input can create a major change in output. This is often described as the butterfly effect. A butterfly’s flapping wings in California can over time become a hurricane in New York.

DIF: Cognitive Level: Analyze

REF: p. 18

5. Which statement describes the measurement of information as defined by the Shannon and

Weaver model? a. The amount of information is measured by the amount of data in the message. b. The amount of information is measured by the number of meanings that can be assigned to a message. c. The amount of information is measured by the extent the message decreases entropy. d. The amount of information is measured by the number of characters used to create the message.

ANS: C

By decreasing entropy one decreases uncertainty. Shannon, a telephone engineer, sought to overcome the technical problems of moving information across communication channels by determining how to minimize entropy.

DIF: Cognitive Level: Remember

REF: p. 21 | p. 22

6. On its own, the number 190 is an example of: a. data. b. information. c. knowledge. d. wisdom.

ANS: A

The number 190 could refer to anything such as a person’s weight, blood glucose level, or systolic blood pressure reading and therefore has no meaning by itself.

DIF: Cognitive Level: Apply

REF: p. 22

7. Knowing when and how to use knowledge is referred to as: a. procedural knowledge. b. cognitive knowledge. c. decision support system. d. wisdom.

ANS: D

Wisdom is defined as the appropriate use of knowledge in managing or solving human problems.

It is knowing when and how to use knowledge in managing patient need(s) or problem(s).

DIF: Cognitive Level: Remember

REF: p. 23

8. Which are the three general types of learned behaviors? a. Input, throughput, and output b. Adult learning theories, constructionist theories, and learning styles c. Cognitive, affective, and psychomotor d. Short, intermediate, and long-term memory

ANS: C

Learning is defined as an increase in knowledge, a change in attitude or values, or the development of new skills. Learned behaviors can be cognitive (intellectual skills), affective (values and attitudes), or psychomotor (the integration of cognitive and motor skills).

DIF: Cognitive Level: Apply

REF: p. 27

9. Which group will test out new technology but are not usually seen as leaders within an

organization? a. Innovators b. Early adopters c. Early majority d. Late majority ANS: A

Innovators will test out a new technology; however, they are too far ahead of the social group to be seen as leaders by other members of the social system. Early adopters are seen as much more discreet in their selection of new technology and are therefore better at selling a new technology to a group of potential users.

DIF: Cognitive Level: Understand

REF: p. 30

MULTIPLE RESPONSE 1. The Staggers and Nelson systems life cycle (SLC) is a guide for informatics projects. Its phases

include: (Select all that apply.) a. implementation. b. planning. c. evaluation. d. security. e. diagnosis.

ANS: A, B, C

The seven phases of the Staggers and Nelson SLC are analyze; plan; develop or purchase; test; implement or go-live; maintain and evolve; and evaluate.

DIF: Cognitive Level: Remember

REF: p. 32 | p. 33

Chapter 03: Evidence-Based Practice, Practice-Based Evidence, and Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Knowledge is the point of convergence across the areas of: a. evidence-based practice, quality assurance, and informatics. b. evidence-based practice, improvement, and informatics. c. evidence-based practice, quality assurance, and improvement. d. improvement, quality assurance, and informatics.

ANS: B

Knowledge is the point of convergence across the areas of evidence-based practice, informatics, and improvement. None of the other answers include all of these aspects.

DIF: Cognitive Level: Remember

REF: p. 38

2. Which two hurdles does the STAR Model address in employing evidence-based practice? a. The volume and form of knowledge b. The quality and form of knowledge c. The volume and outcomes of knowledge d. The adequacy and form of knowledge ANS: A

The STAR Model addresses two major hurdles in employing evidence-based practice (EBP).

These two hurdles are the volume of current professional knowledge and the form of knowledge that healthcare professionals attempt to apply in practice.

DIF: Cognitive Level: Remember

REF: p. 42

3. What is the form of knowledge gained in discovery research? a. Results from single research studies b. Results from meta-synthesis c. Results from systematic review d. Results from meta-analysis ANS: A

Discovery research represents knowledge produced in the form of single research studies. The other three choices represent synthesis of multiple studies.

DIF: Cognitive Level: Remember

REF: p. 42

4. Which type of review is considered the most rigorous? a. Literature reviews b. Systematic reviews c. Integrative reviews d. Single study reviews ANS: B

Evidence summaries include evidence synthesis, systematic reviews, integrative reviews, and reviews of the literature, with systematic reviews being the most rigorous approach to evidence

summary.

DIF: Cognitive Level: Remember

REF: p. 43

5. A facility calls in experts to review evidence developed in research and develop guidelines for

clinical practice. Which stage of EBP is represented? a. Evidence summary b. Evaluation of process and outcomes c. Practice integration

d. Translation to guidelines ANS: D

In the third stage of EBP, translation, experts are called on to consider the evidence summary, fill in gaps with consensus expert opinion, and merge research knowledge with expertise to produce clinical practice guidelines (CPGs).

DIF: Cognitive Level: Understand

REF: p. 44

6. A(n)

is considered the gold standard research design for answering questions about the efficacy of treatments. a. RCT b. PBE c. TeamSTEPP d. NQMC ANS: A

An experimental design, often called a “randomized controlled trial (RCT),” has emerged as the gold standard research design for answering questions about the efficacy of treatments.

DIF: Cognitive Level: Remember

REF: p. 51

MULTIPLE RESPONSE 1. The goal of the intersection of informatics and evidence-based practice is to transform healthcare

to be: (Select all that apply.) a. reliable. b. safe. c. effective. d. efficient.

ANS: A, B, C

The field of informatics and the concept of evidence-based practice (EBP) intersect at the crucial junction of knowledge for clinical decisions with the goal of transforming healthcare to be reliable, safe, and effective. While efficiency is always a goal in healthcare, it is not a primary goal of EBP. DIF: Cognitive Level: Remember

REF: p. 38

2. Which of the following are evidence summaries? (Select all that apply.) a. literature reviews. b. systematic reviews. c. single-study reviews. d. integrative reviews. e. focus-group reports.

ANS: A, B, D

Evidence summaries include evidence synthesis, systematic reviews, integrative reviews, and reviews of the literature.

DIF: Cognitive Level: Remember

REF: p. 43

3. Using the STAR Model, which of the following points indicate knowledge transformation has

occurred? (Select all that apply.) a. Discovery research b. Evidence summary c. Translation to guidelines d. Practice integration e. Testing the hypothesis f. Evaluation of process and outcomes ANS: A, B, C, D, F

The knowledge transformation process in the STAR Model occurs at five points, which can be conceptualized as a five-point star. These five points include discovery research, evidence summary, translation to guidelines, practice integration, and evaluation of process and outcomes.

Testing the hypothesis is not a specific point in the STAR Model.

DIF: Cognitive Level: Remember

REF: p. 42

4. Standardized terminology is requisite for: (Select all that apply.) a. naming evidence. b. classifying evidence. c. tagging evidence. d. locating evidence. e. simplifying evidence.

ANS: A, B, C, D

Standardized terminology is requisite for naming, classifying, tagging, and locating evidence in order to use it in practice.

DIF: Cognitive Level: Remember

REF: p. 39

Chapter 04: Models, Theories, and Research for Program Evaluation

Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Your organization hires you to conduct a formative evaluation of a new informatics intervention.

Which areas would you focus on in a formative evaluation? a. Cost, patient safety, and patient outcomes b. Intervention fidelity, implementation quality, and types of personnel c. Errors, change in provider decision making, and cost d. Unintended outcomes, delays in implementation, and cost ANS: B

A formative evaluation is an assessment of how well a program is being implemented.

Intervention fidelity, implementation quality, and types of personnel are areas that would be focused on in formative evaluation. Results of the formative evaluation are used as feedback to the program for continuous improvement.

DIF: Cognitive Level: Apply

REF: p. 61

2. Of the following, which of these steps in the CDC’s six-step program evaluation framework

comes first? a. Gather credible evidence b. Focus the evaluation design c. Justify conclusions d. Engage stakeholders ANS: D

The CDC’s six-step program evaluation framework is (1) engage stakeholders; (2) describe the program; (3) focus the evaluation design; (4) gather credible evidence; (5) justify conclusions; and (6) ensure use and share lessons learned.

DIF: Cognitive Level: Understand

REF: p. 67

3. Which list includes the three levels of theory relevant to evaluation? a. Program theory, summative model, and interpersonal theory b. Scientific theory, formative model, and descriptive theory c. Scientific theory, implementation models, and program theory d. Scientific model, statistical theory, and holistic models ANS: C

The three levels of theory relevant to evaluation are scientific theories, implementation models, and program theories. The other choices are either not theories or are specific theories, not levels of theory.

DIF: Cognitive Level: Remember

REF: p. 60

4. You decide to base the evaluation plan of your informatics project on the theory of planned

behavior. Which constructs will you use to develop your measurements? a. Values, normative expectations, others’ beliefs, and overall prior knowledge b. Values, beliefs about self-efficacy, normative beliefs, and intrinsic motivation c. Values, expectations of others, behaviors, and perceived self-efficacy d. Habit, normative expectations, beliefs about resources, and overall prior

knowledge ANS: C

The theory of planned behavior focuses on the ability to predict intentions and behavior as a function of beliefs about the value of an outcome, the likelihood that the outcome will occur given the behavior, beliefs about the expectations of others, and self-efficacy beliefs about the personal ability to engage in the activity.

DIF: Cognitive Level: Understand

REF: p. 63

5. The stages of change identified in diffusion of innovation theory are: a. contemplation, persuasion, action, and knowledge. b. knowledge, persuasion, decision, implementation, and confirmation. c. awareness, understanding, action, implementation, and engagement. d. contemplation, decision, action, and knowledge.

ANS: B

The stages of change identified in the diffusion of innovation theory are knowledge, persuasion, decision, implementation, and confirmation. The stages of change are one way to understand and evaluate how the change has occurred.

DIF: Cognitive Level: Remember

REF: p. 63

6. If you choose to evaluate an informatics intervention by examining the impact on a clinician’s

ability to think ahead about future events, which level of situation awareness would you be measuring? a. Social b. Perception c. Comprehension d. Projection ANS: D

Projections are expectations of outcomes in the future. Projections are driven by implicit theories and knowledge about the causal mechanisms underlying events.

DIF: Cognitive Level: Understand

REF: p. 63

7. UTAUT is a theory of: a. users’ knowledge of social networks. b. acceptance and use of technology. c. decision making skills. d. technology support options.

ANS: B

The unified theory of acceptance and use of technology (UTAUT) assesses factors associated with effective use.

DIF: Cognitive Level: Understand

REF: p. 64

8. You decide to interview all the key stakeholders involved in an informatics intervention as part

of the planning process. Together you identify the resources available, the likely barriers, and the short-term and long-term objectives. Which kind of theoretical model are you using? a. Scientific theory b. Theory of planned behavior c. Logic model d. Diffusion model ANS: C

Program theory models consist of the implicit ideas and beliefs of key stakeholders. A logic model is a representation of components and mechanisms of the program. Basically, a logic model is a systematic and visual way to present and share your understanding of the relationship among the resources you have to operate your program, the activities you plan, and the changes or results you hope to achieve.

DIF: Cognitive Level: Apply

REF: p. 67

9. In a social network analysis, each node is usually a(n): a. individual or unit of analysis. b. event. c. location. d. interaction.

ANS: A

The patterns of connection between people in a social network analysis (SNA) are displayed as a visual network of nodes and lines. Nodes are individuals, and lines are interactions between them.

DIF: Cognitive Level: Understand

REF: p. 71

MULTIPLE RESPONSE 1. Ethnography requires which of the following? (Select all that apply.) a. Blood tests of the population being studied b. Reading historical documents and exploring artifacts in current use c. Observations and interviews d. MRIs or, at the very least, x-rays and ultrasounds e. Living and working within the population if possible ANS: B, C, E

Ethnography is derived from the field of anthropology. It is a means to understand a population by immersing oneself into its culture by reading documents, performing multiple interviews and observations, and if possible, living and working among the community being studied.

DIF: Cognitive Level: Apply

REF: p. 69

Chapter 05: Technical Infrastructure to Support Healthcare Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which item is an example of information we might find in an EHR’s clinical data repository? a. A physician’s surgical schedule b. The list of medications available in a hospital’s formulary c. The result of a patient’s microbiology lab test d. Monthly billing charges for the radiology department ANS: C

The result of a patient’s microbiology lab test is an example of information we would find in a CDR. The other items would be found in other administrative databases.

DIF: Cognitive Level: Understand

REF: p. 76

2. Which factor would strongly influence the reliability of an EHR’s repository? a. The redundancy of storage hardware b. Clinician training on EHR applications c. The coding system used for laboratory results d. The use of strong passwords ANS: A

Architectural and procedural models such as the redundancy of storage hardware and access routes, contribute to the reliability of an EHR’s data repository. The other items affect application use, accessibility, and security.

DIF: Cognitive Level: Understand

REF: p. 76

3. Which statement describes a repository with central storage of a longitudinal record? a. Patient data are from a single hospital’s data for the most current encounters. b. Data from multiple hospitals are kept compact and efficient by deleting “old” data. c. Portions of a patient’s lifetime medical record are stored in databases at the facility

where the data were collected. d. The information collected by the organization is stored in a single database no matter when or where the patient was seen.

ANS: D

The information collected by an organization that is stored in a single database no matter when or where the patient was seen is an example of a repository with central storage of a longitudinal record. The other items describe aspects of distributed and/or encounter-based records.

DIF: Cognitive Level: Apply

REF: p. 77

4. Which example best describes knowledge base content? a. Standard admission order sets based on presenting problems b. Patient contact information c. Organizational structure of a healthcare enterprise d. The most recent lab results for current inpatients ANS: A

A knowledge base stores and organizes a healthcare enterprise’s information and knowledge

used by the enterprise for clinical operations. A good example is standard admission order sets based on presenting problems. The other choices would not typically be found in a knowledge base.

DIF: Cognitive Level: Apply

REF: p. 80

5. You are leading an effort to implement a clinical decision support system. In order to improve

the patient specificity of your CDS rules, you would: a. make sure that rules cannot be changed once they are implemented. b. give the results of the rules directly to the patient. c. store rules in a knowledge base and allow clinician experts to review and update the rules. d. ensure that the rules were written in the most up-to-date programming language available.

ANS: C

In order to improve CDS rules, you would store rules in a knowledge base and allow clinician experts to review and update the rules. The other choices do not address patient specificity; allowing experts to update rules and make the rules immediately available to the CDS can improve patient specificity.

DIF: Cognitive Level: Analyze

REF: p. 80 | p. 81

6. For healthcare infrastructures with many communicating systems, an interface engine is helpful

because: a. it increases the administrative overhead with maintaining interfaces. b. it decreases the number of interfaces that must be maintained and lessens complexity. c. there is no other way to connect systems. d. interface engines automatically update and rewrite the code built within legacy systems.

ANS: B

An interface engine is helpful because it decreases the number of interfaces that must be maintained and lessens complexity. The other choices do not accurately describe the use of an interface engine, the ability to connect systems, or regulatory requirements.

DIF: Cognitive Level: Understand

REF: p. 81

7. A method for exchanging patient data among healthcare organizations that is endorsed by the

federal government is: a. copying information to a secure USB drive and giving it to another organization. b. providing EHR log-in accounts to providers outside the organization. c. implementing a secure internet connection using components of the eHealth Exchange. d. The federal government does not endorse sharing health information among organizations.

ANS: C

The eHealth Exchange (formerly the Nationwide Health Information Network) is a method for exchanging data endorsed by the federal government and used by organizations from all 50 states as well as four federal agencies. The other methods listed are not considered safe and confidential, and the federal government does endorse health information sharing.

DIF: Cognitive Level: Remember

REF: p. 83

8. Which is a significant challenge to technical infrastructures in healthcare environments? a. Implementing a data repository that will be able to handle unanticipated new

information and advances in medicine b. Arranging data entry components properly in a documentation application to

improve data collection efficiency c. Training clinicians to use EHRs effectively d. Agreeing on policies for sharing information among healthcare organizations ANS: A

A significant challenge to technical infrastructure in healthcare environments is implementing a data repository that will grow with changes in medicine and the information needed to be stored.

The other choices describe usability, user training, and organizational policy.

DIF: Cognitive Level: Understand

REF: p. 84

MULTIPLE RESPONSE 1. Which examples describe how clinical applications are tied to other components in the EHR

infrastructure? (Select all that apply.) a. Searching and extracting data from the repository for reporting purposes b. Using the data dictionary to code assessment information with a documentation application c. Utilizing clinical decision support system rules to assist with appropriate lab test ordering d. Utilizing the master person index to document vital signs e. Utilizing the financial system to determine patient insurance copays ANS: A, B, C

Examples of how clinical applications are tied to other components of the EHR infrastructure include searching and extracting data from a repository, using the data dictionary to code assessment information, and utilizing CDSS rules to assist in ordering the appropriate lab test.

The other two choices are not examples of how clinical applications use other EHR components.

DIF: Cognitive Level: Apply

REF: p. 78 | p. 79

2. Which functions are characteristic of a master person index? (Select all that apply.) a. Store the current and former names of a patient b. Store the most recent vital sign information for each patient c. Coordinate the various identifiers a patient uses, such as medical record number,

insurance account number, and driver’s license ID d. Provide a unique identifier for each patient that is used by components of the EHR

to positively identify the patient e. Report potential drug interactions from new prescriptions to the medical facility

and patient’s pharmacy ANS: A, C, D

Storing current and former names of a patient, coordinating various identifiers a patient uses, and providing a unique identifier for each patient are characteristics of a master person index (MPI).

The MPI is not used to store or report clinical information.

DIF: Cognitive Level: Remember

REF: p. 77 | p. 78

Chapter 06: Electronic Health Records and Applications for Managing Patient Care Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which description best defines the electronic health record (EHR)? a. An electronic version of the traditional paper record created and used by the

healthcare provider b. An electronic stand-alone database implemented and used in hospitals c. An electronic version of a patient’s medical record used in the clinical setting d. An electronic record of patient health information created by encounters across

multiple settings ANS: D

The Healthcare Information Management Systems Society (HIMSS) provides a definition of the EHR as a longitudinal electronic record of patient health information produced by encounters in one or more care settings. Every person will have a birth to death (and even postmortem) record of health-related information in electronic form from multiple sources, such as physician office visits, inpatient and outpatient hospital encounters, medications, allergies, and multiple other medical services to support care. All other answers refer to a single facility use, which is not the EHR but a potential component of the EHR. DIF: Cognitive Level: Remember

REF: p. 91

2. The Health Information Management Systems Society (HIMSS) developed an EMR adoption

model that includes eight stages toward creating a paperless patient record environment. All application capabilities within each stage must be operational before the next stage can be achieved. Your organization has implemented systems for Stages 1 and 2. Which system should your organization consider as Stage 3 adoption? a. Computerized provider order entry (CPOE) and clinical decision support b. Nursing/clinical documentation (flow sheets) and clinical decision support c. Closed-loop medication administration d. Physician-structured documentation and clinical decision support ANS: B

Stage 1 includes the installation of ancillaries (lab, radiology, pharmacy). Stage 2 includes clinical data repository (CDR), controlled medical vocabulary, and clinical decision support system (CDSS) and may also include document imaging and health information exchange. Stage 3 would require clinical documentation (flow sheets), CDSS (error checking), and a picture archiving system (PACS) available outside radiology.

DIF: Cognitive Level: Apply

REF: p. 93 | p. 94

3. Which system is recommended as a method to address patient safety and reduce errors that occur

during the actual administration of medicines? a. Computerized provider order entry (CPOE) b. Barcode medication administration (BCMA) c. Electronic medication administration record (eMAR) d. Electronic prescribing (ePrescribing) ANS: B

Barcode medication administration (BCMA) is a method used to address patient safety and reduce errors that occur during the actual administration of medicines. CPOE is used to decrease transcription errors during the ordering process. ePrescribing is also used by the physician to order the medication (not administer). The eMAR is used to document the medications that are given.

DIF: Cognitive Level: Apply

REF: p. 96

4. Which would be considered a niche application? a. Computerized provider order entry (CPOE) b. Laboratory information system (LIS) c. Clinical decision support system (CDSS) d. Surgical information system (SIS) ANS: D

Some examples of specialty department niche systems include perioperative or surgical services, maternity care, neonatal intensive care, and the emergency department. The LIS is an ancillary system. CPOE and CDSS are basic components of the EHR. DIF: Cognitive Level: Apply

REF: p. 97

5. A university hospital wants to implement a closed-loop medication management system. Current

systems include registration, computerized provider order entry, electronic medication administration record, laboratory, radiology, and pharmacy. Which system is needed to complete the loop? a. Clinical documentation b. Clinical decision support system c. Barcoding system d. Electronic prescribing ANS: C

A closed-loop medication management system would connect the pharmacy system to the CPOE, eMAR, and barcoding systems.

DIF: Cognitive Level: Apply

REF: p. 99 | p. 100

6. As the United States moves toward the implementation of an interoperable EHR, which

statement about the future “ownership” of the patient record is appropriate? a. The electronic medical record will be the property of the service institution. b. Provider access to the electronic record would not require consumer consent.

c. Ownership may be driven by who has control and access to the data. d. Consumers will control and own the record.

ANS: C

Traditional medical records have always been the property of the service institution, but this may not be true in the future. Consumer consent is required for health professionals to retrieve or share patient records to ensure personal information is not accessed inappropriately. Ultimately, ownership may be driven by who has control and access to the data.

DIF: Cognitive Level: Analyze

REF: p. 101 | p. 102

7. As EHR adoption expands to include data from multiple healthcare entities, more opportunities

for error exist. Which process can affect data integrity? a. System failure b. Data analysis c. Data downloading d. Data mining ANS: A

Data integrity refers to the accuracy and consistency of stored and transmitted data that can be compromised when information is entered incorrectly, deliberately altered, or the system protections are not working correctly or suddenly fail.

DIF: Cognitive Level: Analyze

REF: p. 102

MULTIPLE RESPONSE 1. Which issues are considered impediments to a fully functional electronic health record (EHR)

system? (Select all that apply.) a. Cost b. Standardization c. Care coordination d. Organizational culture e. Privacy and confidentiality f. Education ANS: A, B, D, E

Despite the many advances in technology, there are still many issues to resolve associated with implementation costs, ownership, data integrity, privacy and confidentiality, organizational culture, human factors, and development of an infrastructure to support a nationwide EHR. Care coordination is considered an advantage, and education is not a major issue.

DIF: Cognitive Level: Understand

REF: p. 101

2. The eight-stage EMR model requires which of the following to have been implemented by the

end of Stage 3? (Select all that apply.) a. A basic CDS system b. A PACS available outside Radiology

c. Closed-loop medication administration d. A full radiology-picture archiving and communication system e. Major ancillary systems including Laboratory, Radiology, and Pharmacy ANS: A, B, E

Having major ancillary systems is a requirement for Stage 1. Implementation of a basic CDS system is part of Stage 2, and having a picture archiving and communication system (PACS) outside of Radiology is part of Stage 3. A fully functional radiology-picture archiving system and closed-looped medication administration both come into play during Stage 6.

DIF: Cognitive Level: Remember

REF: p. 94

3. The university hospital is getting ready to implement computerized provider order entry and

some decision support capabilities to include drug-drug and drug-allergy alerts. Which actions should the implementation team take to increase user acceptance of the system? (Select all that apply.) a. Involve users early in thedesign, testing, and implementation of thesystem b. Conduct a quantitative research study to provide deeper insight into CPOE issues c. Design thenew system to support communication and workflow d. Educate clinicians on how to use thesystem features e. Plan for continuous safety monitoring ANS: A, C, D, E

Qualitative measures such as early involvement, ensuring design supports communication and workflow, clinician education, and continuous safety monitoring provide deeper insight into thebenefits and issues surrounding computerized provider order entry and some decision support capabilities. Quantitative research is helpful but would not provide thedeeper content of theissues.

DIF: Cognitive Level: Apply

REF: p. 95

4. The general attitude of consumers toward health information technology is positive. Which items

are perceived EHR benefits for theconsumer? (Select all that apply.) a. Collaborative interaction between patients and providers b. Security and privacy of personal information c. Timely access to personal health information d. Online access to educational materials e. Customized care through reminders ANS: A, C, D, E

From a consumer perspective, an EHR system should provide theability to customize care through appointment reminders, health risk assessments, and timely access to personal health information. theavailability of online educational resources will improve understanding of treatment choices and offer more control over personal health outcomes. Consumers also benefit from EHR technology when there is collaborative interaction between patients and physicians.

Although theEHR has thepotential to address these items, security and privacy of personal information are perceived as major concerns and, therefore are not a benefit to theconsumer.

DIF: Cognitive Level: Apply

REF: p. 99 | p. 100

Chapter 07: Administrative Applications Supporting Healthcare Delivery Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. A financial information system (FIS) includes: a. accounts receivable management, accounts payable management, and fiscal

reporting management. b. clinical systems management, accounts receivable management, and fiscal

reporting management. c. accounts payable management, accounts receivable management, and clinical systems management. d. fiscal reporting management, accounts payable management, and clinical systems management.

ANS: A

FISs are not involved with theclinical management of care. Accounts receivable management, accounts payable management, and fiscal reporting management are financial management processes and included in an FIS. DIF: Cognitive Level: Remember

REF: p. 118

2. Financial reporting is a vital part of decision making in healthcare organizations. Which report

would be used to show a snapshot of thebottom line? a. Balance sheet or statement of financial position b. Cash flow statements c. Assets, liabilities, and equity d. Income statement or statement of operations ANS: D

Income statements reflect thefollowing formula: revenue – expenses = profit. This is often referred to as thebottom line. thebalance sheet, on theother hand, reflects an organization’s assets, liability, and equity.

DIF: Cognitive Level: Understand

REF: p. 115

3. Return on investment (ROI) in financial information systems (FISs) is challenging because: a. patient accounting is considered an intangible asset. b. FIS systems are very complex. c. FISs often lose money due to complexity. d. staff requires substantial training, which is very costly.

ANS: A

Decision makers may have a more challenging time realizing thereturn on investment or understanding theimportance of theinvestment in FISs, since information technology software applications, such as patient accounting or revenue, are considered intangible assets.

DIF: Cognitive Level: Apply

REF: p. 115 | p. 116

4. The supply item master is: a. an electronic history of all transactions. b. an electronic pricing list of all supplies and services. c. a list of all items available to order in theorganization. d. a list of vendors who supply items to theorganization.

ANS: C

The supply item master is themaster list of supplies available to order in theorganization.

DIF: Cognitive Level: Remember

REF: p. 122

5. Materials management in thehealthcare environment involves all of thefollowing EXCEPT: a. inventory control of supplies and equipment. b. logistics management and pipelines. c. the operational management of items used in thedelivery of patient care. d. the storage of pharmaceuticals.

ANS: B

Materials management is a subset within supply chain management that focuses on thestorage, inventory and quality control, and operational management of supplies, pharmaceuticals, equipment, and other items used in thedelivery of patient care or managing thepatient care system. Logistics involves theflow of goods and services from thepoint of origin to thepoint of consumption and thus falls outside therealm of materials management.

DIF: Cognitive Level: Understand

REF: p. 121

6. A vendor master file is: a. a list of federally approved pharmaceutical companies. b. a list of suppliers used by theorganization. c. a list of criteria for supplier compliance. d. a list of EHR vendors.

ANS: B

The terms vendor and supplier are synonymous, so a vendor master file is a list of suppliers used by theorganization.

DIF: Cognitive Level: Remember

REF: p. 122

7. Open shift management: a. refers to a theory of peer-based leadership in which no single person is in charge. b. forecasts openings in theschedule using predictive models. c. refers to a form of scheduling expediency in which staff qualifications are not

considered when making scheduling assignments. d. is a form of web-based self-scheduling.

ANS: D

Open shift management uses web-based technologies to allow employee self-scheduling. Other terms used include shift bidding systems. These systems allow employees to sign up for open shifts over theinternet.

DIF: Cognitive Level: Remember

REF: p. 126

MULTIPLE RESPONSE 1. When using theonline billing and payment tool, which functions directly benefit thepatient?

(Select all that apply.) a. Self-management of open accounts b. Ability to pay outstanding balances c. Gives providers a dashboard to view critical clinical and financial information d. Secure communication on a 24/7 basis with thebusiness office e. Ability to update address or demographic changes f. Automate theprovider’s day as much as possible ANS: A, B, D, E

Self-management of open accounts, ability to pay outstanding balances, secure communication on a 24/7 basis with thebusiness office, and ability to update address or demographic changes are components of theonline billing and payment system that benefit patients. These functions benefit patients because patients can access thesystem to perform thelisted functions at their convenience. Though they may indirectly benefit thepatient, automating theprovider’s day and providing theprovider with a dashboard view are direct benefits for theprovider.

DIF: Cognitive Level: Understand

REF: p. 120

2. The supply chain in healthcare includes: (Select all that apply.) a. transportation of supplies. b. storage of supplies. c. management of supplies. d. prediction of supplies used. e. marketing of new pharmaceuticals or procedures.

ANS: A, B, C

The healthcare supply chain includes thefollowing processes: transportation of supplies, storage of supplies, and management of supplies. It does not include a prediction of thesupplies used and is not part of a facility’s marketing efforts.

DIF: Cognitive Level: Understand

REF: p. 121

3. Supply charge capture is a process that: (Select all that apply.) a. helps make sure patients are charged for supplies used in thepatient’s care. b. helps to manage and inventory supplies. c. accounts for pharmaceutical supplies based on federal requirements. d. closely links thesupply chain to therevenue management system. e. makes use of point-of-use technology to capture charges when supplies are used.

ANS: A, D, E

Often in healthcare settings supplies are used without being recorded or charged, causing theloss of millions of dollars in revenue each year. Supply charge capture, or supply cost capture, is a philosophy that promotes point-of-use technology and record keeping to ensure theuse of supplies doesn’t fall through thecracks.

DIF: Cognitive Level: Apply

REF: p. 123 | p. 124

Chapter 08: Telehealth and Applications for Delivering Care at a Distance Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which government organization manages thelargest telehealth program in theUnited States as of

this writing? a. Department of Defense b. NASA c. Department of Veterans Affairs d. Office for theAdvancement of Telehealth ANS: C

The Department of Veterans Affairs manages thelargest telehealth program in theUnited States. theremaining responses are incorrect.

DIF: Cognitive Level: Remember

REF: p. 134

2. What are thetwo overarching types of telehealth technologies? a. Live and real time b. Web-based and synchronous c. Asynchronous and videoconferencing d. Synchronous and asynchronous ANS: D

Synchronous and asynchronous are thetwo overarching types of telehealth technologies. theremaining responses are components of telehealth.

DIF: Cognitive Level: Remember

REF: p. 135 | p. 136

3. The development of telemedicine and telehealth across state lines has been most hampered by: a. low levels of patient trust. b. the STEP Act. c. the need to obtain licenses to practice in each state in thenetwork. d. HIPAA. ANS: C

Regulating thedelivery of healthcare services is thedomain of each individual state. A medical professional who is licensed in one state may not be legally permitted to practice his or her profession in another state without getting a license there as well.

DIF: Cognitive Level: Remember

REF: p. 142 | p. 143

4. What is themost important element for operationalizing and ensuring telehealth acceptance by

providers? a. Cost of telehealth technology b. Training c. Location of equipment d. Transmission speed ANS: B

Training is one of themost important elements in theacceptance of telehealth by providers. theremaining responses, although relevant, are not important drivers of acceptance.

DIF: Cognitive Level: Understand

REF: p. 139

5. The migration of informatics and telehealth toward uHealth means: a. ecosystems of interoperable technologies and services organized to meet global

patients’ needs in a ubiquitous manner. b. an approach toward underground installation of fiber optics and cable networks

organized to meet global patients’ needs in a ubiquitous manner. c. conversion to a consumer-driven global healthcare model with localized implementation. d. a sharp reduction in university programs for training healthcare providers to meet global patients’ needs.

ANS: A

The migration of informatics and telehealth toward uHealth means ecosystems of interoperable technologies and services will be organized to meet global patients’ needs in a ubiquitous manner.

DIF: Cognitive Level: Apply

REF: p. 148

6. The first use of telehealth was documented in: a. 1897. b. 1935. c. 1999. d. 2002.

ANS: A

The first use of telehealth was documented in 1897, when a case of croup was diagnosed over thetelephone.

DIF: Cognitive Level: Remember

REF: p. 133

MULTIPLE RESPONSE 1. Legal and regulatory issues directly impacting telehealth practice for healthcare providers

include: (Select all that apply.)

a. b. c. d. e. f.

technology. malpractice. licensure. credentialing. reimbursement. broadband.

ANS: B, C, D, E

Policy (legal and regulatory) issues directly impacting telehealth practice for healthcare providers include malpractice, licensure, credentialing, and reimbursement. Technology and broadband are both available and do not directly impact healthcare providers.

DIF: Cognitive Level: Understand

REF: p. 141 |p. 142 | p. 143 | p. 144

2. NIFTE has suggested guidelines for which content areas related to telehealth? (Select all that

apply.) a. Certification programs b. Human resources c. Organizational readiness d. Technology and equipment e. Conflict-zone telemedicine ANS: B, C, D

The National Initiative for Telehealth Framework of Guidelines (NIFTE) are designed to assist individuals and organizations develop telehealth standards, policies, and procedures. Its five overarching content areas are clinical standards and outcomes; human resources; organizational readiness; organizational leadership; and technology and equipment.

DIF: Cognitive Level: Apply

REF: p. 137

3. eHealth literacy for consumers includes which elements? (Select all that apply.) a. Visual literacy b. Computer literacy c. Financial literacy d. Business modeling literacy e. Information literacy f. Digital literacy ANS: A, B, E, F

eHealth literacy for consumers includes thefollowing elements: visual literacy, computer literacy, information literacy, and digital literacy. theother two forms of literacy are not required for consumers.

DIF: Cognitive Level: Understand

REF: p. 147

4. What are theadvantages of telehealth for patients? (Select all that apply.) a. Decreased travel time or distance and removal of travel barriers b. Ease of reimbursement for costs c. Immediate access to care

d. Early detection of disease processes or health issues e. Ownership of healthcare and feelings of empowerment ANS: A, C, D, E

The advantages of telehealth for patients include immediate access to care, decreased travel time, early detection of health issues, and ownership of healthcare. Ease of reimbursement is an advantage for providers.

DIF: Cognitive Level: Apply

REF: p. 132

Chapter 09: Home Health and Related Community-Based Systems Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which payer is thelargest for home health services? a. Private insurance b. Patients and families in theform of self-pay c. Medicare d. Medicaid ANS: C

As thelargest payer, Medicare, through its Conditions of Participation, represents thestandard for theservices provided by home health agencies and thepayment for these services by many commercial insurance payers and state Medicaid programs.

DIF: Cognitive Level: Understand 2.

REF: p. 155

What are thetwo important purposes of theOASIS dataset? a. Determine payment and measure quality and outcomes b. Determine payment and standardize data c. Determine thetime of visits and measure quality and outcomes d. Determine efficiency and measure quality and outcomes ANS: A

OASIS, or theOutcome and Information Set, is a standardized dataset with two important purposes: it is thebasis for determining payment for each 60-day episode of care, and it measures thequality and outcomes of services delivered by home health agency clinicians.

DIF: Cognitive Level: Understand

REF: p. 156

3. When did formalized home health and community-based systems originate in theUnited States? a. 1776 b. 1800s c. 1965 d. 2001 ANS: B

Early home health services originated in theUnited States in the1800s and were based on thedistrict nursing model developed in England. Often, initial programs evolved into visiting nurse associations. Home health services increased and changed considerably after Medicare was enacted in 1965.

DIF: Cognitive Level: Remember

REF: p. 154

4. What technology has been described as thenext frontier for home health and related community-

based systems? a. EHR b. CDS c. EMR d. BCMA

ANS: B

Clinical decision support (CDS) systems may be thenext frontier for home health and related community-based systems. CDS systems are applications that analyze data and help providers make clinical decisions.

DIF: Cognitive Level: Remember

REF: p. 159

MULTIPLE RESPONSE 1. Which of thefollowing tools will thestandardized hospice dataset probably contain? (Select all

that apply.) a. National Data Set for Hospice b. Family Evaluations of Care c. Survey of Team Attitudes and Relationships d. Survey of Missed Nursing Care ANS: A, B, C

The dataset will probably incorporate frequently used tools such as theNational Data Set for Hospice, Family Evaluations of Care, Survey of Team Attitudes and Relationships, and End Result Outcome Measures.

DIF: Cognitive Level: Understand

REF: p. 156

2. What are thekey tenants of theTriple Aim for Health Care? (Select all that apply.) a. Better care for individuals b. Better health for populations c. Better working conditions for nurses d. Reduction of per capita costs ANS: A, B, D

The Triple Aim for Health Care is a broad philosophy designed to address themost abstract level of healthcare services in theUnited States. It includes better care for individuals, better health for populations, and reduction of per capita costs.

DIF: Cognitive Level: Understand

REF: p. 150

3. What are theprimary goals for using EHRs in home health and related community-based

systems? (Select all that apply.) a. To provide an effective and efficient method for tracking cost and related billing b. To capture clinicians’ documentation that supported interaction with patients at thepoint-of-care c. To support clinical decision making and quality of care by presenting best practices and evidence-based practice options d. To improve communication e. To teach patients how to use technology ANS: A, B, C, D

Agency providers are embracing technology as an effective tool to manage all aspects of care.

Patients do not participate in thedevelopment of EHRs. DIF: Cognitive Level: Remember

REF: p. 157

4. The Omaha System consists of components that capture: (Select all that apply.) a. evaluation data. b. cost data. c. assessment data. d. service delivery/activity data.

ANS: A, C, D

The Omaha System is a standardized terminology designed to operationalize thenursing or problem-solving process. It consists of theProblem Classification Scheme (assessment), Intervention Scheme (service delivery/activities), and Problem Rating Scale for Outcomes (evaluation). When nurses and other clinicians use theOmaha System, they can describe, quantify, and communicate details about their practice.

DIF: Cognitive Level: Remember

REF: p. 159 | p. 160

5. What are thecore values of nurses who work in home health and community-based systems?

(Select all that apply.) a. Embrace interprofessional collaboration b. Involve patients and families in care and decision making c. Schedule home visits and travel to begin and end each work day on time d. Provide patient-centered care ANS: A, B, D

The core values are essential so that nurses help patients and their families increase their knowledge, gain skills, and become independent with their care. Nurses must be very flexible; they need to modify their schedules frequently.

DIF: Cognitive Level: Remember

REF: p. 154

6. Why is it important for software used by nurses who work for home health and related

community-based systems to be based on a standardized terminology? (Select all that apply.)

a. To support evidence-based practice b. To generate reports needed to monitor care, improve thequality of services, and

track costs c. To improve patient understanding of their medical records d. To improve communication among care providers at multiple locations e. To describe and quantify practice for clinicians, managers, administrators, and

third-party reviewers ANS: A, B, D, E

Software needs to be based on a standardized terminology for many reasons. A reasonable level of standardization involving practice, documentation, and information management helps home health nurses and other related community-based system clinicians provide better quality care and share details about that care with those within and outside of their organizations.

DIF: Cognitive Level: Understand

REF: p. 159

Chapter 10: Clinical Decision Support Systems in Healthcare Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Why have most clinical decision support (CDS) systems not shown to significantly impact

patient outcomes in clinical trials, despite thefact that a majority of systems have been shown to significantly improve care processes? a. CDS systems have not been evaluated in clinical trials. b. Very few studies have assessed theimpact of CDS systems on patient outcomes. c. Many CDS system evaluation trials are underpowered to detect changes in care outcomes. d. CDS systems have been implemented and evaluated in too many diverse institutions.

ANS: C

The sample sizes of many CDS system evaluation studies were too small or conducted with too short of a time period to detect changes in care outcomes.

DIF: Cognitive Level: Analyze

REF: p. 176

2. Which group would have a financial incentive to implement CDS? a. A community hospital b. An inner-city clinic c. A national insurer d. Depends on CDS and healthcare payment model ANS: D

Whether a particular stakeholder group has a financial incentive to implement CDS depends on thespecific CDS under consideration and thegoverning healthcare payment model in place.

DIF: Cognitive Level: Apply

REF: p. 177 | p. 178

3. A healthcare system has implemented a functionality where patients who are overdue or almost

due for a mammogram are sent letters notifying them to schedule a mammogram based on available data and current clinical care guidelines. Which type of CDS system is this? a. This is not a CDS. b. A personal health record system c. A reminder system d. An alerting system ANS: C

This is a classic example of a reminder system. Patients are also potential targets of CDS interventions.

DIF: Cognitive Level: Apply

REF: p. 171

4. Which statement is not part of theTen Commandments of CDS? a. Speed is everything. b. Fit into theuser’s workflow. c. Alerting is themost effective approach to CDS. d. Ask for additional information only when you really need it.

ANS: C

The Ten Commandments of CDS include speed is everything, fit into theuser’s workflow, and ask for additional information only when you really need it. Alerting may not be themost effective approach to CDS as it may cause alert fatigue, so it is not one of theTen Commandments of CDS. DIF: Cognitive Level: Remember

REF: p. 178

5. Which incentive has thestrongest potential to spur thenationwide adoption of advanced CDS? a. Freely available CDS knowledge in a machine-executable form b. Significant government funding for research efforts to share CDS c. Shift of healthcare payment from a fee-for-service model to approaches rewarding

thedelivery of better quality and outcomes at lower cost d. Meaningful Use Stage 1 requirements related to CDS ANS: C

All of these are important elements encouraging nationwide adoption of advanced CDS. However, as discussed in thechapter, theshift of healthcare payment from a fee-for-service model to approaches rewarding thedelivery of better quality and outcomes at lower cost appears to have thestrongest potential for change.

DIF: Cognitive Level: Apply

REF: p. 179

MULTIPLE RESPONSE 1. Which tools are examples of CDS? (Select all that apply.) a. An order set b. A reminder

c. A phone call d. An infobutton e. An expert system ANS: A, B, D, E

Despite CDS often being limited to alerts and reminders, an order set, a reminder, an infobutton, and expert systems are also examples that represent CDS types. A phone call is not a type of CDS. DIF: Cognitive Level: Apply

REF: p. 173 | p. 174 |p. 175

2. Why is CDS important for healthcare institutions? (Select all that apply.) a. It can reduce theneed for registered nurses. b. It can help reduce medical errors. c. It is a required element of Meaningful Use regulations. d. It can help improve care value. e. It can slow thegrowth in use of facilities to manageable levels.

ANS: B, C, D

CDS is important on multiple levels. CDS has been found to reduce medical errors, is required as part of Meaningful Use, and has thepotential to improve thevalue of care. CDS have not been found to reduce theneed for registered nurses, nor have they been tested for impact on facility use.

DIF: Cognitive Level: Apply

REF: p. 177 | p. 178 |p. 179

3. Why are expert diagnostic decision support systems not integrated into clinical settings? (Select

all that apply.) a. They have not been shown to be comparable to theperformance of human experts. b. Clinicians generally must go out of their routine workflows to use thesystems, and these systems generally require time-consuming data entry. c. There are limited financial incentives to use such systems. d. The systems have been found to be detrimental to patient care. e. The software has been shown to be insecure.

ANS: B, C

There has been a lot of attention and promise on diagnostic decision support systems, including trials showing how they could outperform clinician experts. However, as discussed in other sections of thechapter, systems that are misaligned with theclinician’s workflow and limited financial incentives are reasons for limited use of diagnostic CDS systems. Diagnostic CDS can be comparable to human experts when used appropriately. Also, these systems have not been found to be detrimental to patient care, nor have out-of-the-ordinary security concerns been shown.

DIF: Cognitive Level: Analyze

REF: p. 177 | p. 178

4. Which of thefollowing are challenges or barriers to CDS adoption? (Select all that apply.) a. Lack of evidence of CDS effectiveness b. Misaligned financial incentives

c. Inadequate EHR adoption d. Lack of widely adopted standards for CDS e. Concerns over “cookbook medicine” ANS: B, C, D, E

All of thechoices except lack of evidence of CDS effectiveness are challenges or barriers to CDS adoption. There is evidence to suggest that CDSs are effective. Misaligned financial incentives, inadequate EHR adoption, a lack of widely adopted standards for CDS, and a concern over CDS as “cookbook medicine” are challenges and barriers to adoption.

DIF: Cognitive Level: Remember

REF: p. 177 | p. 178

5. Which of thefollowing practices are included in theCDS Five Rights? (Select all that apply.) a. Providing theright information b. Providing to theright person c. Providing at theright point in theworkflow d. Providing theright reference information e. Using theright intervention format ANS: A, B, C, E

The CDS Five Rights include providing theright information to theright person at theright point in theworkflow, using theright intervention format. Providing applicable reference information has been suggested by others to be a potential best practice for CDS. However, it is not one of theCDS Five Rights.

DIF: Cognitive Level: Remember

REF: p. 178

Chapter 11: Public Health Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. All of thefollowing are core functions of public health except: a. assessment. b. policy development. c. treatment. d. assurance.

ANS: C

Public health is focused on prevention and thehealth of populations before they are injured or ill; clinical care, not public health, involves treating individuals.

DIF: Cognitive Level: Understand

REF: p. 186

2. Public health differs from clinical practice in important ways. Which statement reflects

thedifferences? a. Public health is focused on theprevention and health of populations before they are ill. b. Public health is focused on one individual at a time to ensure thebest possible outcome. c. The health of a community is measured by theuse of sophisticated technologies like MRIs. d. Public health is focused on one family at a time to ensure thebest possible outcome.

ANS: A

Public health is concerned with thehealth of populations and communities rather than theindividual, and therefore its focus is on thehealth and prevention of illness of populations.

DIF: Cognitive Level: Analyze

REF: p. 186

3. You are asked to justify thecreation of thefirst public health informatics (PHI) program in your

jurisdiction by emphasizing its actual benefits. One such benefit is that: a. current PHI can enhance public health surveillance such as identifying clusters of diseases. b. privacy and security issues are avoided because public health informatics data are de-identified at thecommunity level. c. interoperability already exists for public health IT. d. standards already exist for PHI. ANS: A

While all four options are relevant issues in PHI, only thefact that PHI can identify and target clusters of diseases for treatment and action is an actual benefit (or “plus”) to thecommunity of adding this new program.

DIF: Cognitive Level: Analyze

REF: p. 191

4. Public health systems have implemented vocabulary and messaging standards, are used to make

public health decisions in a clinical setting, and provide data for public health policy. One of

thebest examples of a public health system that does all of these is: a. the linkage of local electronic health records in the50 states to public health reporting databases. b. immunization information systems. c. geographical informatics systems for reporting environmental issues. d. direct lab reporting of conditions and diseases such as lead poisoning.

ANS: B

Immunization information systems exemplify public health systems that implement vocabulary and messaging standards, that are used to make public health decisions in a clinical setting, and that provide data for public health policy. theothers lack one or more of thestated elements.

DIF: Cognitive Level: Understand

REF: p. 193

5. The public health supply chain needs to evolve to an information ecology approach. This would

involve: a. standardizing public health supplies and suppliers. b. being partners with others to receive, reuse, and republish data. c. allowing public health departments to exclude data sharing to protect patient privacy. d. allowing public health departments to include data sharing to protect patient privacy.

ANS: B

Information ecology involves thereuse and sharing of data.

DIF: Cognitive Level: Apply

REF: p. 198

6. Public health could benefit from improved technical architectures in thefuture. Which of these is

not a likely technology architecture for building thefuture of public health? a. Service-oriented architecture (SOA) b. Software as a service (SaaS) c. Open source methods such as OpenELIS or OpenMRS d. Mobile devices such as theiPhone ANS: D

While mobile devices are popular, they are not considered infrastructure and they do not allow sharing among device manufacturers, thevery function that public health would require.

DIF: Cognitive Level: Remember

REF: p. 199 | p. 200

MULTIPLE RESPONSE 1. Which social and political challenges impact public health informatics? (Select all that apply.) a. The limits of federal authority b. The evolution of public health primarily as state and local functions c. The lack of resources to implement health IT d. The presence of standards to implement health IT e. The lack of network infrastructure ANS: A, B

Social and political challenges impacting public health informatics include thelimits of federal authority and theevolution of public health primarily as state and local functions. Public health is

not nationally organized and monitored.

DIF: Cognitive Level: Apply

REF: p. 189

2. Blueprint Version 2.0 updates public health surveillance activities for the21st century. Which

methods exemplify these activities? (Select all that apply.) a. Analysis of population data to describe disease characteristics and risk factors b. Analysis of electronic health record data c. Biomonitoring and environmental monitoring d. Analysis of individual data to describe disease characteristics and risk factors e. Birth and death certificate reporting to states ANS: A, B, C, D

Methods that exemplify Blueprint Version 2.0 updates for public health surveillance activities for the21st century include analysis of population data to describe disease characteristics and risk factors, analysis of electronic health record data, and biomonitoring and environmental monitoring.

DIF: Cognitive Level: Apply

REF: p. 192

3. Informatics opportunities for reportable conditions include: (Select all that apply.) a. enabling theuse of computable logic to define where and how reports should be b. c. d. e.

sent. automation of patient education from electronic health records. automation of information extraction from electronic health records. improving standardization of message structure and content for reporting. creating public health information systems to receive case reports.

ANS: A, C, D, E

Informatics opportunities for reportable conditions include theuse of computable logic to define where and how reports should be sent, automation of information extraction from theelectronic health record, creating public health information systems to receive case reports, and standardization of message structure and content for reporting.

DIF: Cognitive Level: Remember

REF: p. 197

4. Immunization information systems are used to record at least some of theimmunizations for

about 75% of children in theUnited States. Which benefits are provided by theuse of these systems? (Select all that apply.) a. A high return on investment b. The ability to provide consolidated immunization histories to avoid over- or undervaccinating c. The ability to improve vaccination rates by integrating data across thecountry d. Integration across nations e. Cutting by 50% theupdating of vaccine schedules ANS: A, B, C

Immunization information systems provide thefollowing benefits: a high return on investment, theability to provide consolidated immunization histories to avoid over- or under-vaccinating, and theability to improve vaccination rates by integrating data across thecountry. Integration across nations is not available as yet, and IISs don’t have any effect on vaccination schedules.

DIF: Cognitive Level: Remember

REF: p. 193 | p. 194

Chapter 12: theEvolving ePatient Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. An ePatient is best described as one who: a. seeks health information from various sources and uses theinformation for decision

making with health providers. b. manages health decisions, uses theinternet, and uses biosensors. c. collaborates with thehealth provider, has a chronic illness, and writes blogs. d. makes all decisions, prepares for doctor visits, and gathers data points.

ANS: A

Someone who seeks health information from various sources and uses theinformation for decision making with health providers is inclusive of all types of ePatients. Not all ePatients use biosensors, nor do they all write blogs. ePatients collaborate with their provider to arrive at a decision.

DIF: Cognitive Level: Understand

REF: p. 205

2. Which of these best describes participatory medicine? a. Integrated care model b. Authoritative care model c. Community care model d. Cooperative care model ANS: D

Participatory medicine is described as a cooperative model of healthcare that encourages and expects active involvement by all connected parties, including patients, caregivers, and healthcare professionals, as integral to thefull continuum of care. Integrated care focuses on coordinating care between thehealthcare disciplines. Authoritative care is paternalistic and does not include thepatient in thedecision making process. Community care focuses on coordinating care across resources found in thecommunity where thepatient resides.

DIF: Cognitive Level: Understand

REF: p. 210

3. A quantified selfer is best described as one who: a. graphs data. b. tracks personal metrics. c. records lab values. d. uses a sleep diary.

ANS: B

A quantified selfer may or may not use thetactics of graphing data, recording lab values, and using a sleep diary; however, all of these fall under theumbrella of tracking personal metrics, which best describes what it means to be a quantified selfer.

DIF: Cognitive Level: Remember

REF: p. 209

4. The emergence of social media such as Facebook, Twitter, and Instagram marked theturn

toward: a. Health 2.0.

b. Health 3.0. c. Web 3.0. d. Medicine 2.0.

ANS: A

In thefirst days of theinternet, ePatients could perform simple web searches to learn medical information, a period known as Health 1.0. When social media emerged, thenew capabilities for interaction, networking, and engagement among users marked theadvent of Health 2.0. thecurrent stage of predictive content seems to be marking yet another advance toward Web 3.0 and Health 3.0.

DIF: Cognitive Level: Remember

REF: p. 207

5. The maxim “Doctors know best”: a. is one of thetenets of participatory medicine. b. is a hallmark of integrated care. c. is thetagline for Health 2.0 websites such as WebMD. d. is theparadigm for a paternalistic care model.

ANS: D

“Doctors know best” is theparadigm for thepaternalistic care model. Participatory medicine includes thepatient as a partner in goal setting and decision making. Integrated care has to do with interdisciplinary care. Health 2.0, by its nature, assumes more of a patient-centered and nonpaternalistic approach.

DIF: Cognitive Level: Remember

REF: p. 210

6. The culture of thepatient-clinician partnership always includes: a. requirements found in thePatient Protection and Affordable Care Act. b. guided discovery. c. involvement of technology specialists and social media activists. d. ePatients and clinicians working in collaboration toward shared goals.

ANS: D

The culture of thepatient-clinician partnership always includes ePatients and clinicians working in collaboration toward shared goals. thePatient Protection and Affordable Care Act does not require patient-clinician partnerships. Guided discovery may be used in a patient-clinician partnership, but not always. Technology specialists and social media activists are not part of thepatient-clinician partnership.

DIF: Cognitive Level: Understand

REF: p. 210

7. One trend that is influencing healthcare reform is: a. disruptive technology. b. Hospital Consumer Assessment of Healthcare Providers and Systems. c. Veterans Health Information System and Technology Architecture

Implementation. d. Everett Rogers’s theory of diffusion of innovation.

ANS: A

Disruptive technology and trends have dramatically altered theway in which we communicate with one another. theinternet and now mobile devices, both disruptive technologies, are now major drivers in thenew ways Americans connect with one another and access and disseminate information.

DIF: Cognitive Level: Remember

REF: p. 211 | p. 212

8. The goal of

has been to increase thetransparency of medical documentation, by touting thebenefits of such transparency. a. HIPAA b. the Hospital Consumer Assessment of Healthcare Providers and Systems c. the Society for Participatory Medicine d. the OpenNotes Project ANS: D

Many healthcare providers have been reluctant to make their medical documentation and notes available, for fear of extra work, an inability to record candid thoughts, and perceived negative impact on their business. theOpenNotes Project, begun in 2010, has fought to counter this reluctance by highlighting themany benefits of transparency.

DIF: Cognitive Level: Remember

REF: p. 212

9. What defines the“Google generation”? a. A person who was born after about 1989 b. A person who desires immediate access to information and is internet savvy c. A person who uses simplified search engines rather than site-specific searches d. A person who is an ePatient ANS: B

A person who desires immediate access to information and is internet savvy is characteristic of an individual belonging to theGoogle generation. theother choices are not characteristic of being part of theGoogle generation.

DIF: Cognitive Level: Remember

REF: p. 215

MULTIPLE RESPONSE 1. What defines Health 2.0? (Select all that apply.) a. Updated versions of old health information b. Marketing health products based on thepatient’s internet preferences c. Health-related mobile applications d. Mobile health-monitoring devices e. Web-based content f. Social networks ANS: C, E, F

Health 2.0 is defined by health-related mobile applications, web-based content, and social networks. Updated versions of old health information, marketing health products based on thepatient’s internet preferences, and mobile health-monitoring devices do not define Health 2.0.

DIF: Cognitive Level: Understand

REF: p. 207

Chapter 13: Social Media Tools for Practice and Education Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. A case manager wants to communicate with her clients on a regular basis by sending short

messages that encourage health promotion tips. thetool best suited for this task is: a. Facebook. b. e-mail. c. microblogging. d. Second Life.

ANS: C

Clients may benefit from short, directed messages; thus microblogging (a form of short messages) is themost appropriate. theother choices (Facebook, e-mail, and Second Life) are not appropriate for sending short messages.

DIF: Cognitive Level: Apply

REF: p. 222

2. Who is most likely to seek health information from social network sites? a. Individuals about to undergo surgery b. Those seeking reviews and information about prescription drugs c. Those living with chronic conditions d. Individuals learning about friends’ diseases or medical conditions ANS: C

The text states that caregivers and those with chronic conditions are thegroups of people most likely to seek health information from social network sites.

DIF: Cognitive Level: Remember

REF: p. 234

3. Which group is allowed to share personal health information on social media sites? a. Providers who monitor thesocial media site b. Healthcare providers on thesite c. Patients/consumers d. Hospital registration clerks ANS: C

Healthcare providers are not allowed to share this information, but patients/consumers are not restricted.

DIF: Cognitive Level: Remember

REF: p. 225 | p. 226

4. Which is an example of apomediation? a. Healthcare providers tell patients not to use Facebook for healthcare advice. b. Healthcare providers direct patients to high-quality information on theweb. c. Healthcare providers state that only their web portal should be used by patients. d. Healthcare providers direct patients to websites in which they have a financial

interest.

ANS: B

Apomediation means standing by patients and guiding or directing them to quality information, rather than standing between patients and theweb.

DIF: Cognitive Level: Understand 5.

REF: p. 230

Healthcare providers should friend patients only if: a. they have been their patients for at least 5 years. b. the patients ask them to be a friend. c. the patients have a chronic disease. d. they understand their social media policy at work.

ANS: D

There is no law prohibiting friending patients. Professional guidelines and social media policies should outline theinstances when friending is possible.

DIF: Cognitive Level: Remember

REF: p. 231

6. In thefuture, social media in healthcare is likely to be: a. nothing at all. It has gone too far already. b. minimally used only by “geeks.” c. widely used and deeply integrated. d. static, as people return to in-person and lower-technology means of

communication.

ANS: C

Social media’s reach continues to expand, even to areas and demographics traditionally underserved. Social media is already deeply integrated into the“tapestry” of healthcare, and is likely to continue to be increasingly so.

DIF: Cognitive Level: Understand

REF: p. 234

7. SERMO for MDs and ANA’s NurseSpace are two examples of what kind of social media

structure? a. Advocacy Group-Consumer b. Consumer-Consumer c. Provider-Consumer d. Provider-Provider ANS: D

SERMO and NurseSpace exemplify social media resources meant to connect providers with other providers in order to exchange experiences and clinical information.

DIF: Cognitive Level: Remember

REF: p. 222

MULTIPLE RESPONSE 1. Social media tools include: (Select all that apply.) a. social networks and microblogging. b. wikis and blogs. c. desktop computers. d. video and picture sharing. e. medical reference websites.

ANS: A, B, D

Social media is focused on not only connecting and collaborating with others but also sharing user-generated material of all types. While a desktop computer may assist a person to discover social media tools, it is not a social media tool in and of itself. Medical reference websites are static and noninteractive in nature, not tools of social media.

DIF: Cognitive Level: Remember

REF: p. 221

2. Using social media tools for research purposes helps: (Select all that apply.) a. create new business cases for former “orphan” diseases. b. recruit patients. c. identify new variables to study. d. provide insight into the patient’s experience. e. promote data-sharing and communication within a disease population.

ANS: B, C, D, E

Using social media tools for research purposes helps to recruit patients, identify new variables to study, provide insight into the patient’s experience, and offer a way to disseminate data and information quickly within a targeted population. Social media used in research can help fill the gap for orphan diseases that do not make good cases in the current pharmaceutical business model.

DIF: Cognitive Level: Understand

REF: p. 224 | p. 225

3. Social media policies should contain: (Select all that apply.) a. guidance on acceptable behavior. b. methods for handling unacceptable behavior. c. a prohibition on using social media within the office environment. d. penalties for misuse. e. a statement to promote ethical behavior.

ANS: A, B, E

Social media polices should contain guidance on acceptable behavior, methods for handling unacceptable behavior, and a statement that promotes ethical behavior. Imposing penalties for misuse should be discussed on a case-by-case basis. And in general social media does not need to be prohibited within the office environment, as long as its proper use is understood.

DIF: Cognitive Level: Remember

REF: p. 231 | p. 232

Chapter 14: Personal Health Records (PHRs) Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. What are the main types of PHRs? a. Tethered, untethered, stand-alone, and networked b. Integrated, tethered, untethered, and stand-apart c. Tethered, de-tethered, stand-apart, and stand-together d. USB-based, web-based, and patient portals ANS: A

The main types of PHRs are tethered, untethered, stand-alone, and networked. The other choices are terms that are associated with PHRs but are not general types.

DIF: Cognitive Level: Remember

REF: p. 246

2. The Kaiser Permanente PHR mobile app lets users do all of the following EXCEPT: a. schedule and cancel appointments. b. participate in telemedicine. c. refill a prescription. d. access lab results.

ANS: B

KP’s mobile app allows users to refill prescriptions, schedule or cancel an appointment, e-mail their physicians, and even access lab results. However, the app does not yet allow for the actual performance of telemedicine.

DIF: Cognitive Level: Remember

REF: p. 246

3. Secure PHR messaging refers to the capacity to: a. send messages between healthcare providers within a single EHR. b. send messages between healthcare providers across healthcare systems. c. send messages from patients to providers via a tethered PHR. d. send messages from patients to providers via a stand-alone PHR. ANS: C

Secure PHR messaging refers to the capacity to send messages from patients to providers via a tethered PHR. DIF: Cognitive Level: Remember

REF: p. 246

4. The most commonly used functions of personal health records are: a. viewing test results and medication refills. b. reading patient education materials and renewing medication prescriptions. c. entering data (such as self-measured glucose and blood pressure) and medical

condition review. d. online appointment scheduling and reading clinical notes.

ANS: A

The most commonly used functions of PHRs are viewing test results and medication refills. The other choices are PHR functions that are less commonly used.

DIF: Cognitive Level: Remember

REF: p. 249

5. The Office of the National Coordinator for Health Information Technology (ONC) is best

described as: a. a federal entity charged with increasing public awareness of the value of health information technology. b. the principal federal entity charged with promoting nationwide sales of advanced health information technology. c. the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. d. a federal agency that regulates the contents and functions of health information technologies, including PHRs. ANS: C

The ONC is described as the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.

DIF: Cognitive Level: Remember

REF: p. 243

6. Which statement is true regarding the continuity of care record (CCR)? a. By describing the exact format of the information to be exchanged, it allows for

syntactically interoperable records. b. It is an HTML-based extract of the health record that automatically encrypts and

decrypts data that is sent and received using WPA2. c. It is a tab-delimited extract of the health record that can be viewed on simple spreadsheet software. d. It was the first effort, in 1989, by a set of healthcare facilities in the United States to create a digital language in order to share medical records and histories.

ANS: A

The continuity of care record is an extract of the health record that prescribes the exact format of the information to be exchanged, allowing for syntactically interoperable records.

DIF: Cognitive Level: Understand

REF: p. 250

7. The “digital divide” refers to: a. higher adoption and use of information technologies among individuals from

ethnic minorities, of lower socioeconomic status, and of older age. b. the gap between the current security of PHRs and the security needed for PHRs to

become more prevalent.

c. lower adoption and use of information technologies among individuals from ethnic

minorities, of lower socioeconomic status, and of older age. d. the difference between rates of overall cellphone ownership and “smartphone”

ownership.

ANS: C

The digital divide refers to lower adoption and use of information technologies among individuals from ethnic minorities, of lower socioeconomic status, and of older age.

DIF: Cognitive Level: Remember

REF: p. 249

8. Which statement is true of Meaningful Use? a. Healthcare facilities needed to meet Stage 3 requirements by October 2015 to

maintain accreditation. b. They are a set of criteria created by the ONC to determine eligibility for financial incentives for health information technology adoption and use. c. Meaningful Use criteria were created by Congress to delineate the appropriate uses of health data for research purposes. d. The term refers to the ratio of actual usefulness that patients experience with medical devices prescribed for them compared to their theoretical usefulness.

ANS: B

Meaningful Use refers to criteria created by the ONC to determine eligibility for financial incentives for health information technology adoption and use.

DIF: Cognitive Level: Understand

REF: p. 243

9. Which statement is true of PHRs? a. They have been used in paper form for many years, and electronic versions offer

the same functionality. b. They were a new idea when proposed in the 1990s and are a now a well-

established technology. c. Approximately 35% of the US population currently has one. d. They have been used in paper form for many years, but electronic versions offer

new functionality.

ANS: D

PHRs have been used in paper form for many years, but electronic versions offer new functionality.

DIF: Cognitive Level: Understand

REF: p. 242

MULTIPLE RESPONSE 1. The Health Information Portability and Accountability Act (HIPAA) requires that: (Select all

that apply.) a. individuals be granted access to their healthcare records upon request. b. healthcare providers keep an audit trail of access to an individual’s record.

c. Congress update the privacy and security measures required for health records

annually. d. healthcare providers must be able to electronically exchange health records by

2016. e. healthcare providers must be able to electronically exchange lab data by 2016.

ANS: A, B

HIPAA requires that healthcare providers grant individuals access to their healthcare records on request and that they keep an audit trail of such access to an individual’s record.

DIF: Cognitive Level: Understand

REF: p. 242

Chapter 15: mHealth–The Intersection of Mobile Technology and Health Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. In the most recent study by the IMS Institute for Healthcare Informatics, approximately what

percent of the healthcare apps tested included an ability to link the mobile device to a sensor or other healthcare device? a. 10% b. 30% c. None, 0% d. 50% ANS: A

The IMS Institute for Healthcare Informatics study examined 26,864 healthcare apps for iOS and Android systems in 2015 and found that about 10% included such capacity; most of the others only provided information and little to no interactivity.

DIF: Cognitive Level: Remember

REF: p. 258

2. According to the text, which example of the use of mHealth can be facilitated by SMS, the

simplest core mobile phone function? a. Point-of-care diagnostics b. Treatment algorithms c. Connecting patients to providers d. Maintaining healthcare facility electronic records ANS: C

SMS, a core mobile technology, can be used in many mHealth application domains, such as smoking cessation programs, real-time reporting, health surveys, and connecting patients to providers. The other choices all require greater functionality than simple text messaging.

DIF: Cognitive Level: Remember

REF: p. 256 | p. 257

3. Point-of-care decision support tools contained within a mobile device all rely on: a. accurate algorithms and protocols. b. the presence of WiFi. c. some level of real-time link to a healthcare facility. d. user credentials.

ANS: A

Point-of-care decision support tools can be used in a wide variety of settings. Some may or may not need WiFi, or a real-time link. But all will need to be programmed with accurate algorithms and protocols in order to function effectively. User credentials is not a correct answer, as many such tools are designed for use by end consumers and not healthcare workers.

DIF: Cognitive Level: Remember

REF: p. 259

4. Which is not a major driving force fueling the mHealth movement? a. An aging society b. Cost savings and earning potential c. Consumer/patient engagement movement

d. Technology functionality ANS: A

mHealth’s expansion is being fueled by ever-improving tech functionality, the consumer/patient engagement movement, and the business side of cost savings and earning potential. An aging society, while perhaps needing more healthcare, is not a major part of the expansion.

DIF: Cognitive Level: Remember

REF: p. 261

5. Which is most available throughout Africa? a. Grid-based electricity b. Piped clean water c. Mobile phone service d. Sewerage service ANS: C

Mobile phone coverage is very widespread throughout Africa, with most countries at least 80% covered by phone service. In contrast, other infrastructure such as electricity, clean water, and sewerage are lagging behind. Mobile coverage’s reach helps explain why it has become such a crucial technology for healthcare workers on the continent.

DIF: Cognitive Level: Remember

REF: p. 261

6. Which statement is true? a. In the U.S., blacks and Hispanics are three times as likely as whites to rely on their

cellphone for access to the internet. b. By 2014, 90% of Americans had smartphones. c. Only 37% of people worldwide have access to a cellphone. d. As of June 2015, a majority of all U.S. adults no longer had a land-line telephone.

ANS: A

In the U.S., 13% of Hispanics and 12% of African Americans rely on their cellphone for connection to the internet, three times as many as the 4% of whites who do. By 2014, 90% of Americans had cellphones, but not all were smartphones. Of people worldwide, 37% have a smartphone, but a much larger percent has at least a basic cellphone. And as of June 2015, 44.1% of all U.S. adults no longer had land-line telephones.

DIF: Cognitive Level: Analyze

REF: p. 261

7. The FDA has announced that it will require premarket approval for mHealth apps that: a. monitor and track blood pressure. b. act as ECG machines. c. transfer data to healthcare providers. d. generate health advice from patient-specific information.

ANS: B

A portable ECG machine is considered high-risk by the FDA and will require premarket approval. All of the other selections are considered lower risk, and the FDA will only exercise “regulatory discretion” over them.

DIF: Cognitive Level: Remember

REF: p. 262 | p. 263

8. Current research shows the lowest quality, or most limited, evidence for the usefulness of

mHealth in: a. supporting smoking cessation. b. adherence to childhood immunization schedules. c. managing asthma outcomes. d. adherence to retroviral therapy.

ANS: C

The evidence for mHealth continues to grow, and there is now high-quality, or at least moderatequality, evidence for the effectiveness of mHealth in supporting smoking cessation and adhering to immunization and other medicinal schedules. Evidence is currently low for its usefulness in managing asthma.

DIF: Cognitive Level: Understand

REF: p. 263

9. All of the following are among the three biggest mHealth challenges identified by experts in the

U.S. except: a. people misinterpreting their own data. b. making poor health decisions. c. data privacy risks and legal risks. d. interoperability.

ANS: D

Interoperability is a noted challenge with mHealth apps and software, but it is not among the top three concerns of U.S. experts.

DIF: Cognitive Level: Understand

REF: p. 264

MULTIPLE RESPONSE 1. The MARS mHealth app rating scale measures: (Select all that apply.) a. price. b. engagement. c. information. d. aesthetics. e. YPD (years-of-productive-life) added.

ANS: B, C, D

The Institute for Healthcare Informatics’s MARS scale rates mHealth apps on engagement, functionality, aesthetics, information, and subjective quality. Price is not a direct consideration (though willingness to pay does contribute indirectly to subjective quality), and YPD is not something that MARS measures.

DIF: Cognitive Level: Understand

REF: p. 265

Chapter 16: Identifying and Selecting an Information System Solution Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which of the following shows three elements of the SLC as given in the chapter, in the correct

order from earliest to latest? a. Diagnose, maintain, implement b. Develop, implement, prioritize c. Plan, test, evolve d. Organize, delegate, negotiate ANS: C

The SLC as given in the chapter consists of the following steps in order: analyze, plan, develop or purchase, test, implement, maintain/evolve, evaluate, and return to analyze.

DIF: Cognitive Level: Remember

REF: p. 273

2. Which is included in an RFP but not an RFI? a. Desired system components and functionality b. Financial considerations c. Description of the hospital or health system d. Goals of the organization ANS: B

Pricing and financial considerations are part of an RFP but not part of an RFI. DIF: Cognitive Level: Analyze

REF: p. 278 | p. 279

3. At which stage of defining requirements are tools for analyzing strengths, weaknesses,

opportunities, and threats useful? a. Review inventory of information systems b. Collect samples of system reports c. Interview and observe staff d. Identify regulatory and accreditation requirements ANS: C

The SWOT analysis is useful when preparing to interview current staff and stakeholders, to help learn what questions to ask in order to get the clearest picture of the current systems in place and the needs for the future.

DIF: Cognitive Level: Analyze

REF: p. 274

4. When evaluating responses to an RFP, which consideration would be least useful as part of

typical system evaluation criteria? a. Cost b. Vendor experience c. Vendor’s future development plans d. Vendor’s market and industry understanding ANS: C

Vendors will likely want to tout their future plans. However, when evaluating the responses to an RFP, it is important to know what can be delivered, configured, and implemented at the actual

time of need, rather than what may be possible in the months and years to come.

DIF: Cognitive Level: Analyze

REF: p. 280 | p. 281

MULTIPLE RESPONSE 1. What should be considered when identifying and selecting a healthcare information system?

(Select all that apply.) a. The organization’s strategic vision b. Organizational strategic alignment c. The information technology department’s goals and objectives d. Operating system(s) in use e. Vendor strategic planning ANS: A, B, C

Having an organizational strategic vision and strategic alignment and clear information technology goals and objectives is essential before trying to identify and select a healthcare information system. The operating system and vendor strategic planning are not part of an organization’s goals and mission.

DIF: Cognitive Level: Analyze

REF: p. 271 | p. 272

2. Which methods will provide information useful in requirements identification? (Select all that

apply.)

a. b. c. d. e.

The Delphi method Inventorying current documents and forms Interviews Direct observation Regression analysis

ANS: B, C, D

Methods useful in providing information for requirements identification include inventorying current documents and forms used by the organization, conducting interviews with stakeholders, and direct observation to collect data. A variety of data collection methods is necessary to define system requirements.

DIF: Cognitive Level: Analyze

REF: p. 274 | p. 275

3. The questions to ask and answer when determining which systems to replace or update include:

(Select all that apply.) a. Is current staff using the system? b. How are new and ongoing requirements determined? c. How will future systems be serviced or expanded? d. What parts of the system can be observed? e. Which vendors can offer what we need?

ANS: A, B, D

Questions to ask when determining which systems to replace or upgrade include those involving how the current systems are or aren’t working—such as whether staff is using them, how it’s determined what is required of them, and which parts can be observed in place. Questions about vendors and how future systems will be maintained come later in the process.

DIF: Cognitive Level: Understand

REF: p. 273

4. Which costs should be considered in determining the total cost of information system

ownership? (Select all that apply.) a. User costs b. Supply costs c. Hardware costs d. Software costs e. Resource costs ANS: C, D, E

The costs that should be considered in determining the total cost of information system ownership include hardware, software, and resource costs. The total cost of ownership includes all costs related to purchasing, implementing, and supporting an information system.

DIF: Cognitive Level: Apply

REF: p. 281

5. Which of the following describe information system functionality? (Select all that apply.) a. System response time b. Future usefulness of the current system c. Accuracy

d. Ease of use for end users e. How the system integrates with other systems ANS: A, C, D

System response, accuracy, and ease of use for end users describe information system functionality. Future usefulness and system integration with other systems are valid questions to explore but do not impact current functionality of the system as it currently stands.

DIF: Cognitive Level: Understand

REF: p. 273

6. Which of the following are phases in the systems development life cycle (SDLC)? (Select all

that apply.) a. System selection b. Design c. Implementation d. Evaluation e. Maintenance f. Prioritization ANS: B, C, D, E

Phases in the SDLC include design, implementation, maintenance, and evaluation. The initial phase of the systems development life cycle is to identify requirements. System selection and need prioritization have already taken place.

DIF: Cognitive Level: Remember

REF: p. 273

Chapter 17: Project Management Principles and Clinical Systems Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which of the following activities would be considered project management? a. Overseeing a team of eight that’s working for the next 3 months to create a new

billing form b. Directing the IT department in its day-to-day tasks c. Upgrading the network cabling for all 35 computers and servers in a clinic d. A scheduled quarterly meeting of a hospital’s board of directors to discuss

oversight of the hospital’s departments, revenues, challenges, and opportunities ANS: A

Project management is the oversight of a temporary endeavor or project to create a unique deliverable. The key points are being in charge, and the fact that the endeavor has a specific goal and a definite beginning and end. Of the above, only overseeing a team working on creating a billable form would be considered project management.

DIF: Cognitive Level: Apply

REF: p. 285

2. Which of the following typically is considered most all-encompassing? a. Project management b. Process management c. Program management d. Portfolio management ANS: D

As portfolio management involves creating and managing numerous projects and/or programs, it is the most all-encompassing of the above.

DIF: Cognitive Level: Apply

REF: p. 285

3. Which of the following is true of project process groups? a. Closing activities are optional, and planning activities consume the most resources. b. Defining a project through planning is key, and initiating activities usually take the

most time. c. Initiating activities are often undervalued, while execution activities generally take the most time and resources. d. Planning activities look at the “best case,” while initiating activities focus on “worst case.”

ANS: C

The chapter lists four basic activities in a project—initiating, planning, execution, and closing.

Initiation is the most important, yet it is often the least valued. Planning is where projects are formally defined but are often rushed for “quicker, better, faster.” Execution activities typically take the most time and resources. And closing activities are key in order to draw a line and effectively end the project and transition to maintenance/operational phases.

DIF: Cognitive Level: Analyze

REF: p. 287 | p. 288

4. Documentation for support is considered a deliverable at which stage of the project management

process? a. Initiating b. Planning c. Execution d. Closing ANS: C

The closing of a project marks the official handoff of the deliverable, and transition to ongoing operational and maintenance phases. This is the time when support documentation is typically handed over to the operational teams.

DIF: Cognitive Level: Understand

REF: p. 288

5. Your task is to study and examine precisely what the project you are involved with is trying to

accomplish, in order to set definable goals and boundaries. What aspect of the project are you working on? a. Project integration b. Scope management c. Quality management d. Procurement management

ANS: B

Scope is the “area” that a given project entails. Defining scope means defining the boundaries of what the project is meant to accomplish. Scope management means overseeing a project to ensure that it stays within its scope.

DIF: Cognitive Level: Analyze

REF: p. 288

6. Studying a project’s potential opportunities is part of what area of management? a. Scope b. Cost c. Integration d. Risk ANS: D

Risk management deals not only with the threats a project faces, but also with its opportunities.

Scenarios that help or hinder a project must be considered, and risks must be identified. Every opportunity also has its commensurate risks and trade-offs, which are aspects of the project that the risk manager analyzes.

DIF: Cognitive Level: Understand

REF: p. 289

7. The overarching purpose of portfolio management is what? a. Managing the cost of a project b. Determining the best mix of resources for scheduling and implementing numerous

projects c. Cohesively coordinating interrelated projects d. Reaching strategic goals within a planned timeline ANS: B

Portfolio management involves overseeing numerous, often unrelated, projects and programs. It involves trade-offs of “unlimited wants” and “limited resources” and can best be described as determining how to apply the resources one has in the most advantageous way, across varied projects and programs.

DIF: Cognitive Level: Understand

REF: p. 290

MULTIPLE RESPONSE 1. PMI knowledge components include which of the following? (Select all that apply.) a. Project integration b. Program alignment c. TCP/IP networks d. Procurement management e. Time management ANS: A, D, E

PMI knowledge components include project integration and the management of scope, time, human resources, cost, quality, communication, risk, and procurement.

DIF: Cognitive Level: Apply

REF: p. 288

2. A portfolio manager does what? (Select all that apply.) a. Organizes various projects to focus on, for example, patients, quality outcomes,

and financial goals b. Oversees implementation of related systems c. Looks out for scope creep d. Helps determine which projects should be given priority in terms of resource

allocation and availability e. Is responsible for centralized management of processes, methods, and structures in

order to ensure successful flow of multiple disparate projects ANS: A, D, E

A portfolio manager looks at “big-picture” items, organizing a number of different and disparate or unrelated projects in order to align them with the organization’s overall strategic goals. A portfolio manager does not usually oversee only related systems; that would be the work of a program manager. A portfolio manager also does not intimately oversee project scope creep, which is the responsibility of the individual project managers within the larger portfolio.

DIF: Cognitive Level: Understand

REF: p. 290 | p. 291

3. Which of the following are designed specifically to track project tasks and timelines and their

interrelationships? (Select all that apply.) a. Magic Quadrant b. Gantt chart c. PERT chart d. MS Access e. MS Word ANS: B, C

Gantt charts and PERT charts are two popular methods for tracking a project, including scheduling the various tasks and timelines and noting interrelationships and dependencies. Magic Quadrant does no such thing, and MS Access is a database. MS Word can be used in helping to prepare timeline charts but is not designed specifically for that purpose.

DIF: Cognitive Level: Remember

REF: p. 294

Chapter 18: Contract Negotiations and Software Licensing Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which of the following is true? a. A patent is a kind of copyright. b. Copyright protects the “invention” of an inventor. c. Patent protection applies to inventions. d. Patent applies to original works.

ANS: C

Copyright and patent are two different concepts. Copyright applies to the authors of original works. Patent protects the invention of an inventor.

DIF: Cognitive Level: Understand

REF: p. 301 | p. 302

2. When commercial software is distributed, typically: a. the source code is withheld. b. the right of ownership to the source code transfers to the buyer. c. object code, executables, and source code are bundled and shipped together. d. the software becomes “open source.”

ANS: A

Generally, commercial software companies release and distribute the executable or object code for their software but hold back the actual source code as a trade secret.

DIF: Cognitive Level: Apply

REF: p. 302

3. Using SaaS: a. software is sold directly to consumers and becomes their property. b. software is sold to consumers, who then have a license to use it. c. software applications are held by a vendor and made available to customers over a

network. d. software resides on no media.

ANS: C

SaaS stands for “Software as a Service” and is a system in which the vendor holds the application and makes it available to customers over a network, usually the internet.

DIF: Cognitive Level: Analyze

REF: p. 302

4. When negotiating an agreement between a vendor and the HCO, which entity should write the

second draft of the agreement? Which should write the third? a. Vendor; vendor b. HCO; HCO c. HCO; vendor d. Vendor; HCO ANS: D

The vendor agreement’s first draft is generally created by the vendor. By having the vendor also create the second draft, the HCO allows the agreement to move closer to the HCO’s positions and desires before the HCO starts putting its own language in. Generally the HCO should write

the third draft, as draft-writing is a mutual process with shared control.

DIF: Cognitive Level: Understand

REF: p. 302

5. In a license agreement, the questions of who the users are, whether software can be distributed,

and the number of copies that can be run all fall under the category of: a. scope.

b. definition of terms. c. specifications. d. service level agreements.

ANS: A

Scope is a wide umbrella term in license agreements. It can be subdivided into “Who are the users?” “rights,” “restrictions and license metrics” (in other words, whether or not the software can be distributed), “number of copies,” and “environments and instances.”

DIF: Cognitive Level: Understand

REF: p. 305 | p. 306

6. In a software license, a “response” to a user problem: a. is another word for a “solution.” b. may, completely legally, never be forthcoming. c. is typically guaranteed to be 24 hours or sooner. d. is independent of problem severity.

ANS: B

An HCO should be extremely careful about the wording of the license with regard to vendor response to a user problem. “Response” does not mean “solution”—it means simply response.

The time allowed for a response can vary widely. And the nature of the response can vary depending on the problem’s severity. If the HCO is not diligent, it is fully possible for a license to be written so that a vendor does not legally need to respond to a number of problems that arise.

DIF: Cognitive Level: Analyze

REF: p. 308 | p. 309

7. A fee of 18% of the license fee per year for vendor maintenance and support would be

considered: a. high. b. quite typical. c. barely acceptable. d. low.

ANS: B

The annual fee for maintenance and support by a vendor is most usually 15 to 22%, with a wider range of 12 to 24% being fairly typical.

DIF: Cognitive Level: Understand

REF: p. 318

MULTIPLE RESPONSE 1. On the vendor’s side, which of the following revenue recognition issues may drive or affect key

provisions of the agreement? (Select all that apply.) a. Insufficient user uptake upon implementation b. Conditions on payment c. Delivery of software not existing at the time the agreement is signed d. Payment milestones

e. Possible refunds ANS: B, C, D, E

User uptake does not generally affect the vendor’s pay—it is more an issue on the HCO’s side with ensuring that its users actually make proper use of the software being purchased.

DIF: Cognitive Level: Apply

REF: p. 312

2. Which kinds of code can a computer read? (Select all that apply.) a. Source code b. Executable code c. High-level code d. C++ e. Interpretive code ANS: B, E

Executable and interpretive code are two examples of code that has been turned into usable form by a computer. Source code (sometimes called high-level code) is written in a human-readable terminology that has to be translated into a form a computer can read. C++ is such high-level code.

DIF: Cognitive Level: Understand

REF: p. 302 | p. 303

3. From a legal perspective, which of the following serve as contractually binding statements made

by a vendor? (Select all that apply.) a. RFP material incorporated into the license agreement b. Statements by salespersons c. Marketing materials d. The license agreement e. A written memorandum of understanding that precedes the license agreement ANS: A, D

Thanks to the “Entire Agreement” clause that vendors and their attorneys will insist on including in the agreement, only material that is explicitly written into the agreement will be legally binding. The HCO should not consider any statement, verbal or written, that doesn’t appear explicitly in the license agreement as legally binding.

DIF: Cognitive Level: Analyze

REF: p. 304

Chapter 19: Implementing and Upgrading an Information System Solution Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. What has recently been a complicating factor for implementing Meaningful Use criteria to

certify EHRs? a. The 2015 change from ICD-9-CM to ICD-10-CM b. The judicial overturning of parts of the Affordable Care Act c. Slowing adoption of EHR systems by healthcare facilities after initial enthusiasm d. The conversion to HIPAA standard 4010 ANS: A

The change from the ICD-9-CM to the ICD-10-CM disease classification system has meant having to reconfigure legacy healthcare information systems that had originally been set up to handle the old codes and couldn’t cope with the new coding system.

DIF: Cognitive Level: Remember

REF: p. 321

2. A large medical practice that specializes in cancer care is weighing the advantages and

disadvantages of implementing the most recent version of a commercial EHR or building its own homegrown system for its office. The staff selects a commercial EHR from a major vendor.

Which factor best supports this decision? a. A commercial product can be easily customized to accommodate the unique needs of the hospital. b. A homegrown system cannot be certified by the Certification Commission for Healthcare Information Technology. c. The commercial version is considered one of the “Best of Breed” products. d. A homegrown system is typically interfaced with the organization’s ADT system and downstream systems.

ANS: C

Commercial electronic health systems are more expensive than homegrown systems but are also considered among the “Best of Breed” products. A homegrown system can be certified through a Certification Commission for Healthcare Information Technology (CCHIT) program called EACH. Homegrown systems are usually fully integrated using a common database and are not interfaced with other dissimilar applications.

DIF: Cognitive Level: Apply

REF: p. 325

3. A large medical center that specializes in high-risk pregnancies is implementing an entire suite of

clinical applications such as CPOE, barcode medication administration (BCMA), nursing documentation, data acquisition system to collect clinical data from cardiac and fetal monitors and ventilators, laboratory system, radiology system, PACS, and cardiology. It has a large, highly skilled, experienced IT team. The project team decided to go with a Big Bang go-live versus an incremental or phased approach. Which factor best supports this decision? a. The Big Bang approach decreases the possibility of errors. b. The incremental approach is best for hospitals with large IT departments. c. The Big Bang approach minimizes overall productivity loss. d. The incremental approach normally has lower implementation costs.

ANS: A

Big Bang decreases the possibility of errors because physicians do not have to use different workflows in different departments or units. Users also have high levels of support in the initial days. Big Bang will have a major negative impact on productivity initially with a gradual return to baseline. The incremental approach is best suited for organizations with small IT departments and minimal support personnel. It also typically will increase the overall costs of the project.

DIF: Cognitive Level: Apply

REF: p. 332

4. An unintended consequence associated with the use of an electronic health system occurs when: a. a physician places a medication order with an inappropriate drug dose for a

pediatric patient in a CPOE system. b. a physician enters orders on a patient who was incorrectly selected from a drop-

down list of the physician’s personal patient list. c. a nurse enters a telephone order from the attending physician into the electronic

health system and fails to read back the order. d. a nurse enters PRN pain medication orders on a patient and fails to record the

indications for each pain medication.

ANS: B

The physician entering orders on a patient who was incorrectly selected from a drop-down list of the physician’s personal patient list would be an example of an unintended consequence. The other responses are examples of behaviors that are not unique to orders placed in an EHR and can occur in a paper system as well.

DIF: Cognitive Level: Apply

REF: p. 323 | p. 324

5. Which activity or intervention should be avoided when implementing an EHR system? a. Public and unwavering support for the project by the organization’s leadership b. Building a large number of aliases for orders and alerts for select clinical scenarios c. Input from representatives from different disciplines over the course of the project d. Default clinical information and responses to order prompts on orders and fill in as

much as possible on order sets ANS: B

Physicians will count clicks and do not want to be stopped during order entry unless it is necessary. An overuse of alerts will cause alert fatigue.

DIF: Cognitive Level: Analyze

REF: p. 329

6. The first country to implement ICD-10 codes was: a. Denmark. b. England. c. Canada. d. the United States.

ANS: A

Scandinavian countries were the first to implement ICD-10 codes, between 1994 and 1997. The United States only implemented ICD-10 codes in October 2015.

DIF: Cognitive Level: Remember

REF: p. 322

7. Which activity or intervention is the least helpful to the success of an EHR implementation? a. Schedule the go-live date for a Monday when everyone is fresh for the new

workweek. b. Anticipate user resistance and plan extensively for it. c. Prepare for continual EHR maintenance and oversight.

d. Provide a hotline phone number for communication and troubleshooting.

ANS: A

It is best to avoid Monday or Friday as the go-live date, because the healthcare clinic may be at its busiest and vendor support personnel may be less available.

DIF: Cognitive Level: Apply

REF: p. 335

8. A system that incorporates evidence-based content and clinical decision support includes: a. building multiple aliases. b. using Tall Man lettering for select medications. c. enforcing the use of only CMS-approved abbreviations. d. providing real-time updates to the order item master.

ANS: B

Using Tall Man lettering for select medication is the only example of clinical decision support.

Building multiple aliases, enforcing CMS-approved abbreviations, and providing real-time updates to the order item master are examples of building specific safety protocols into the EHR system.

DIF: Cognitive Level: Apply

REF: p. 323 | p. 324

9. Which factor commonly interferes with the goal of successfully completing an EHR

implementation that is on time and within budget? a. Scope creep b. Big Bang go-live c. An integrated EHR system d. Delayed transition to ICD-10 codes ANS: A

A Big Bang go-live, an integrated EHR system, and delayed transition to ICD-10 codes do not impact the success of completing an EHR implementation that is on time and within budget. The only factor that impacts the success of completing an EHR implementation that is on time and within budget is scope creep.

DIF: Cognitive Level: Remember

REF: p. 324 | p. 325

MULTIPLE RESPONSE 1. Which kinds of testing are crucial when implementing a new information system solution?

(Select all that apply.) a. User testing b. Hardware testing c. Software testing d. Functional testing e. Stress testing ANS: B, C, D

Testing the hardware and software extensively are key to a successful implementation.

Functional testing, determining whether the system functions as designed and works effectively, is also critical. Stress testing is not a separate kind of testing regimen, and the end users themselves are not tested within the testing regimen, but rather educated about the new system and then supported intensively when the system first goes live.

DIF: Cognitive Level: Remember

REF: p. 329 | p. 330

Chapter 20: Health Information Systems: Downtime and Disaster Recovery Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which examples are natural disasters that could affect IT systems? a. Bomb, flood b. Earthquake, bomb, terrorist attack c. Flood, earthquake, hurricane d. Terrorist attack, hurricane, flood ANS: C

Floods, earthquakes, and hurricanes are natural disasters. Bombs and terrorist attacks are manmade disasters.

DIF: Cognitive Level: Analyze

REF: p. 340

2. Which is an example of healthcare IT physical infrastructure? a. PACS b. Biomedical devices c. Enterprise data warehouse d. Anesthesia system ANS: B

PACS, data warehouses, and anesthesia systems are all IT infrastructure; only biomedical devices are part of an IT system’s physical infrastructure.

DIF: Cognitive Level: Analyze

REF: p. 340

3. Which system is an example of a core clinical application? a. Scheduling system b. Electronic health record c. Claim scrubber d. Physiologic monitoring system ANS: B

The electronic health record is a core clinical application because it is used for every patient in every care situation. The scheduling system and claim scrubbers are revenue cycle applications.

The physiologic monitoring system is an ancillary or specialty area system.

DIF: Cognitive Level: Apply

REF: p. 342

4. Which system is an example of an ancillary service application? a. Keyless entry system b. PBX switchboard c. E-mail d. Radiology information system ANS: D

The radiology information system is an ancillary service application used for ancillary clinical patient care. PBX switchboard, e-mail, and keyless entry systems are business applications

supporting the business operation but are not used for patient care.

DIF: Cognitive Level: Apply

REF: p. 342

5. If the planned single system downtime is less than 1 hour in the middle of a Sunday night, which

downtime level should be assigned? a. Level 1 b. Level 2 c. Level 3 d. Level 4 ANS: A

A single system planned downtime at the least busy clinical time creates the lowest level of downtime risk, or level 1. Levels 2, 3, and 4 are all higher risk in this scenario.

DIF: Cognitive Level: Analyze

REF: p. 345

6. If an unplanned total network outage occurs with all systems affected during the week at 1300

hours and there is no estimated time to recovery announced, which downtime level should be assigned? a. Level 1 b. Level 2 c. Level 3 d. Level 4 ANS: D

Unplanned outage of all systems and the network at the busiest time for the business and patient care is the highest risk outage for an organization, or level 4. Levels 1, 2, and 3 are all lower risk than level 4 in this scenario.

DIF: Cognitive Level: Analyze

REF: p. 345

7. Which redundant EHR application is critical to avoid disrupting nurses’ care of patients during

downtime? a. The billing system b. The registration system c. CPOE and the MAR (medication administration record) d. The SAN (storage area network)

ANS: C

CPOE and the MAR are crucial to nurses’ care of patients. The billing system, registration system, and SAN support other operational functions.

DIF: Cognitive Level: Analyze

REF: p. 344

8. What is the primary reason to back up data entered into electronic health records? a. In the event of a system failure, the EHR system can be recovered with accurate

data. b. The work of physicians will be disrupted in the clinics if the system fails and there

is no backup. c. Administrators cannot continue to bill patients if the EHR fails and no backup

exists. d. The interface engine will not be able to function if the EHR fails and no backup is available.

ANS: A

The key reason is that if a system fails and data is lost or data integrity is in question, available backups allow the system to be recovered with accurate and complete data. The work of physicians, billing, and the interface engine all depend on a complete and accurate recovered system but are single functions rather than the overarching, key reason to do complete backups.

DIF: Cognitive Level: Analyze

REF: p. 349 | p. 350

MULTIPLE RESPONSE 1. Which examples of essential information technology physical hardware infrastructure could

cause a downtime if they fail? (Select all that apply.) a. Network cabling b. Network switches or hubs c. Financial applications d. Interface engine e. Server ANS: A, B, E

Network cables and switches, as well as computer servers, are actual hardware components of infrastructure. They are physical pieces of IT equipment. Financial applications and the interface engine are software.

DIF: Cognitive Level: Apply

REF: p. 341 | p. 342

2. What are the integral components of a downtime communication plan? (Select all that apply.) a. Who needs to know the details. b. Who has passed the annual charting review exam. c. What details are needed. d. What systems and workflows are impacted. e. Who is going to communicate the information.

ANS: A, C, D, E

Who needs to know which details, which systems and workflows are impacted, and who is going to communicate the information are critical components of a downtime communication plan.

Which personnel have passed the annual charting exam would be communicated at a unit-based level to the employees and the unit management.

DIF: Cognitive Level: Analyze

REF: p. 351

Chapter 21: Improving the User Experience for Health Information Technology Products Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Your organization acknowledges that providers want to improve their user experience with

health information technology (IT) products. You want to raise awareness of the potential benefits to the organization. You could draw on stated benefits such as: a. improved productivity, patient safety, and decreased customer support costs. b. improved cognitive support, increased maintenance costs, and patient safety. c. decreased user errors, decreased customer support costs, and increased administrative overhead. d. decreased maintenance costs and increased training.

ANS: A

Improved productivity, patient safety, and decreased customer support costs will help you raise awareness of the potential benefits to your organization.

DIF: Cognitive Level: Remember

REF: p. 359 | p. 360

2. Which of these best describes an example of usability? a. The IT department is surveying your unit to determine the placement of new

computer workstations. b. A researcher is conducting a study of how nurses interact with electronic

documentation to organize care handoffs. c. The leadership in your institution is asking for your help to determine oncology

patient flow across regional institutions. d. The administration has asked you to take responsibility for orientation of new hires

and the retraining of selected current employees on use of the automated medication administration system because there have been a consistent number of user errors.

ANS: B

An example of usability would be when a researcher is conducting a study of how nurses interact with electronic documentation to organize care handoffs. The other items describe ergonomics, non-HIT workflow, and education/training.

DIF: Cognitive Level: Analyze

REF: p. 362 | p. 363

3. National efforts to improve the user experience are under way in the United States. One

organization involved with this effort is the: a. Office of Technology and Disasters. b. American Nurses Association. c. National Institute of Standards and Technology. d. National League for Nursing.

ANS: C

An organization involved in national efforts to improve the user experience is the National Institute of Standards and Technology. The Office of Technology and Disasters, American Nurses Association, and National League for Nursing are not involved with the user experience.

DIF: Cognitive Level: Remember

REF: p. 369

4. You are asked to perform a heuristic evaluation of the new orders management module of your

inpatient system. You discover that the flow of the orders is different than the way providers are taught in school. This is an example of: a. consistency and standards. b. match between system and world. c. informative feedback. d. ergonomics.

ANS: B

Match addresses the way health practitioners think and the design of systems.

DIF: Cognitive Level: Apply

REF: p. 362

5. You want to make sure you consider crucial components as you design your first usability study.

One of these components is to consider users and their characteristics. Other components are: a. a developmental timeline, tasks, information, product, and context. b. tasks, information, projected errors, context, and interactions. c. information, a developmental timeline, context, and group interactions. d. information, testing, errors, and context.

ANS: A

Crucial components as you design your first usability study include a developmental timeline, tasks, information, product, and context. The HHCI describes elements to consider.

DIF: Cognitive Level: Remember

REF: p. 361

6. Your team is working on a mobile health (mHealth) device for diabetics to track their glucose

levels, insulin, and preventive care appointments. They have just created the very first prototype, based on their understanding of the requirements. You want to assess, fairly informally, whether the application includes the appropriate content for users (consumers). You plan to ask patients from an ambulatory clinic to participate. The kind of test you would plan is a(n): a. validation test. b. formative test. c. comparison test. d. assessment test.

ANS: B

The type of test that is appropriate is a formative test, a fairly informal test done early in the life cycle to assess the effectiveness of emerging design concepts.

DIF: Cognitive Level: Apply

REF: p. 367

7. You are part of a knowledge management team that is interested in improving the user

experience for your organization. The team members know you have taken a course in informatics and ask your advice about how to get started with usability in the organization. You recommend: a. talking to the CEO about her ideas. b. examining the support call lists and system change requests. c. working with only physicians, since they have been the most vocal about issues with the EHR. d. hiring a consultant.

ANS: B

The first step is to understand the key users’ issues, and support call lists and change requests would give that information.

DIF: Cognitive Level: Apply

REF: p. 368

8. Nielsen coined the term “Discount Usability Testing” to indicate the design of tests that conserve

resources, including funding and time. One example is a reduced number of users who need to participate. He indicates that as few as how many users can find 80% of design issues? a. 3 b. 5 c. 10 d. 15 ANS: B

Nielsen’s work in the early 1990s noted that as few as 5 users can find as many as 80% of design issues.

DIF: Cognitive Level: Remember

REF: p. 367

MULTIPLE RESPONSE 1. Task analysis may involve: (Select all that apply.) a. speaking to application users about their experiences. b. learning task-specific software. c. quietly and unobtrusively watching as a user interacts with an application. d. conducting ethnographic studies. e. hardware stress tests.

ANS: A, C, D

Task analysis looks at the human side of an application—the cognitive tasks and processes that people perform in their day-to-day work. Therefore it encompasses things like interviews, shadowing, and ethnography but has nothing to do with learning software or testing hardware.

DIF: Cognitive Level: Apply

REF: p. 364

2. Measuring user interaction, or user interaction satisfaction, is made easier by the use of which of

the following popular usability questionnaires? (Select all that apply.) a. SUS b. eMAR c. QUIS d. SEIPS e. Purdue Usability Testing Questionnaire ANS: A, C, E

eMAR is the electronic medication administration record; SEIPS is the Systems Engineering Initiative for Patient Safety. The other three are all popular usability questionnaires.

DIF: Cognitive Level: Apply

REF: p. 365

Chapter 22: Informatics-Related Standards and Standards-Setting Organizations Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. The NIC system includes: a. interventions for illness prevention. b. medication administration records (MARs). c. 30 domains with 7 classes each. d. nursing outcomes.

ANS: A

The NIC system includes interventions for illness prevention.

DIF: Cognitive Level: Understand

REF: p. 382 | p. 383

2. Which organization recognizes nursing terminologies as supporting nursing practice? a. NANDA-I b. International Health Terminology Standards Development Organization

(IHTSDO) c. American Nurses Association (ANA) d. Alliance for Nursing Informatics (ANI) ANS: C

The organization that recognizes nursing terminologies as supporting nursing practice is theAmerican Nurses Association.

DIF: Cognitive Level: Remember

REF: p. 377

3. The NANDA-I classification is a: a. standardized classification of patient/client outcomes. b. set of nursing diagnoses of actual problems, risks, and health enhancement needs. c. standardized classification of interventions. d. unified nursing language system into which nursing terminologies can be cross-

mapped.

ANS: B

The NANDA-I classification is a set of nursing diagnoses of actual problems, risks, and health enhancement needs.

DIF: Cognitive Level: Remember

REF: p. 382

4. International Classification of Nursing Practice is a: a. standardized classification of patient/client outcomes. b. set of nursing diagnoses. c. standardized classification of interventions. d. unified nursing language system into which nursing terminologies can be cross-

mapped.

ANS: D

The ICNP is a unified nursing language system into which nursing terminologies can be crossmapped.

DIF: Cognitive Level: Remember

REF: p. 382

5. Which terminology serves as a resource to represent domain knowledge of interest and thus

facilitates data collection, processing, and aggregation using computer processing? a. Ontology b. Classification c. Reference terminology d. Nomenclature ANS: C

Reference terminology serves as a resource to represent domain knowledge of interest and thus facilitates data collection, processing, and aggregation using computer processing.

DIF: Cognitive Level: Understand

REF: p. 375

6. ICD-9 and ICD-10 are examples of which category of terminology? a. Nursing terminology b. Billing code c. Clinical classification d. Multidiscipline terminology used for clinical coding within an EHR ANS: B

ICD-9 and ICD-10 are examples of billing codes—codes used for reimbursement.

DIF: Cognitive Level: Remember

REF: p. 380

7. Standard terminologies can be used to do all of thefollowing, except: a. design user interfaces using terminologies. b. support data retrieval and exchange. c. decrease system-wide susceptibility to malware and hacking. d. monitor thequality of care.

ANS: C

The use of standard terminologies brings many benefits across thehealthcare spectrum, but it does not offer any added protection against computer malware or attacks by hackers.

DIF: Cognitive Level: Remember

REF: p. 387

MULTIPLE RESPONSE 1. Which terminology contains nursing languages? (Select all that apply.) a. SNOMED b. Logical Observations Identifiers Names and Codes (LOINC) c. Omaha System d. NANDA e. eMAR ANS: A, C, D

The terminologies that contain nursing languages include SNOMED, theOmaha System, and NANDA. DIF: Cognitive Level: Understand

REF: p. 373 | p. 374 | p. 375

2. Which terminologies are recognized by theANA? (Select all that apply.) a. ICNP b. NOC c. LOINC d. RxNorm e. CCC ANS: A, B, C, E

ANA-recognized nursing terminologies include ICNP, NOC, CCC, and LOINC. RxNorm is not a nursing terminology.

DIF: Cognitive Level: Remember

REF: p. 378

3. Which languages does thenursing profession consider national and international “data standards”

that they wish to cross-map their own terminologies to? (Select all that apply.) a. LOINC b. HL7 c. SNOMED CT d. RxNorm e. ICNP

ANS: A, C

LOINC and SNOMED CT are widely adopted and are considered data standards nationally and internationally. thenursing profession has participated actively in harmonization efforts through terminology cross-mapping and integration of nursing terminologies into SNOMED CT and LOINC. DIF: Cognitive Level: Remember

REF: p. 378 | p. 379

Chapter 23: Data Science and Analytics in Healthcare Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which measure is most important for evaluating theperformance of classifiers, models that

predict class membership? a. Root mean squared error (RMSE) b. Area under thereceiver operating characteristic (ROC) curve c. Percentage of correctly classified cases d. Hosmer-Lemeshow statistic ANS: B

The area under thereceiver operating characteristic (ROC) curve is themost important overall measure of classifier performance.

DIF: Cognitive Level: Remember

REF: p. 401

2. Which specialized method is used in knowledge discovery and data mining? a. Stratified sampling b. Conceptual analytic methods c. Selection of theoptimal subset of variables/features for use in modeling d. Machine learning ANS: C

Knowledge discovery and data mining (KDDM) makes use of specialized analytic methods, characteristically machine learning, to identify patterns in a semi-automated fashion.

DIF: Cognitive Level: Remember

REF: p. 400

3. The process of knowledge discovery and data mining is best characterized as: a. machine learning, use of statistical methods, and large amounts of data. b. a process wherein patients are selected for clinical trials. c. “fishing” for information in data. d. cleaning data for further analysis using other methods.

ANS: A

Knowledge discovery and data mining (KDDM) is a process in which machine learning and statistical methods are applied to analyze large amounts of data.

DIF: Cognitive Level: Remember

REF: p. 400 | p. 401

4. As organizations mature over time in their use of data science, they progress from what to what? a. Retrospective analysis; exploratory data analyses b. Real-time analytics; retrospective analytics c. Exploratory data analyses; prescriptive analytics d. Data mining; knowledge discovery ANS: C

In its initial forays, an organization typically begins by looking back at thedata it’s collected, through retrospective (or exploratory data) analyses. It then gradually moves up thescale of

difficulty toward prescriptive analytics.

DIF: Cognitive Level: Understand

REF: p. 403

5. A health analytics professional must be skilled in all of thefollowing except: a. computer hacking. b. healthcare operations. c. management and economics. d. statistical understanding.

ANS: C

A health analytics professional must have wide skills, from knowledge of healthcare operations, to understanding computer hacking and programming enough to be able to manipulate data, to understanding mathematics and statistics. He or she, however, does not generally need management or economics training.

DIF: Cognitive Level: Understand

REF: p. 404 | p. 405

6. Assigning individual records or rows in a dataset for specific purposes (eg, model development,

model validation) is a process known as: a. partitioning. b. sampling. c. data mining. d. Bayesian networking.

ANS: A

Partitioning refers to theassignment of individual records or rows in a dataset for a specific purpose: model development (training, incremental testing of models during development) or model validation (data held out from thedevelopment process for thepurpose of unbiased performance estimation).

DIF: Cognitive Level: Apply

REF: p. 399 | p. 400

MULTIPLE RESPONSE 1. Which methods are examples of data mining? (Select all that apply.) a. Decision trees b. Stratified random sampling

c. Bayesian networks d. Artificial neural networks e. Factor analysis ANS: A, C, D

Decision trees, Bayesian networks, and artificial neural networks are methods commonly used in data mining.

DIF: Cognitive Level: Remember

REF: p. 400

2. Which of thefollowing are examples of analytics tools? (Select all that apply.) a. Graphics programs like Photoshop and 3DS Max b. Spreadsheets like MS Excel c. Database management systems like SQL Server d. Statistical analysis programs like Rapidminer e. Programming languages like R or Python ANS: B, D, E

Spreadsheets, statistical analysis programs, and some programming languages can all be analytics tools. Graphics programs may help visualize analysis, and a DBMS may help organize data so it can be found easily, but neither falls under thecategory of tools.

DIF: Cognitive Level: Understand

REF: p. 405

3. In a set of consistently coded clinical data, thedata should be analyzed using descriptive statistics

and visualization with respect to thefollowing: (Select all that apply.) a. Distribution b. Arcing c. Sparsity d. Identifiers e. Outliers ANS: A, C, D, E

All of thechoices are generally useful properties that can help in data analysis, except for “arcing,” which is not a term used in thetext.

DIF: Cognitive Level: Remember

REF: p. 399

4. Which of thefollowing data characteristics are important in understanding big data in healthcare?

(Select all that apply.) a. Variety b. Vagrancy c. Venality d. Velocity e. Volume ANS: A, D, E

The “five V’s” of data characteristics include volume (quantity of data), velocity (speed at which data are gathered), variety (the number of different data sources), veracity (accuracy and completeness), and value.

DIF: Cognitive Level: Remember

REF: p. 395

Chapter 24: Patient Safety and Quality Initiatives in Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. An important component of theinformatics infrastructure is: a. establishment and adoption of standards to support semantic interoperability. b. defined standard value sets, groupings, aligners, and attributes. c. organizations enabled to set individual standards for quality measurement and

reporting. d. variation in thetypes of data used to populate thequality metrics.

ANS: A

Establishment and adoption of standards at multiple levels are important components of theinformatics infrastructure. thestandard quality metrics must define standard value sets, taxonomies, concept codes, attributes, and data structures. Organizations must adopt thesame standards for quality measurements and reporting. Standard clinical content needs to be adopted and used in theelectronic systems, and thecontent should be represented by standard data terminologies.

DIF: Cognitive Level: Remember

REF: p. 411 | p. 412

2. When evaluating quality and patient safety, which approach defines theframework for Patient

Safety and Quality Research Design (PSQRD)? a. Outcomes are driven mainly by Meaningful Use directives. b. Consideration of current managerial processes has no effect on patient outcomes. c. Patient safety is best achieved by minimizing changes to existing processes. d. Quality and safety are based on organizational structure, management and clinical processes, and their linkages to patient outcomes.

ANS: D

According to Donabedian, quality is based on organizational structure, processes, and their linkages to patient outcomes. Consideration of current managerial processes in place has a latent effect on patient outcomes. theframework for PSQRD builds upon Donabedian’s structureprocess-outcome model to support evaluation of an intervention from thepreimplementation testing phase through implementation and evaluation. In thecase of a health information technology (IT) intervention, theexpanded framework supports understanding where thehealth IT intervention is most likely to have an effect, within theorganizational causal chain of quality and safety events. thePSQRD framework provides a means to categorize interventions according to areas of thecausal chain targeted.

DIF: Cognitive Level: Remember

REF: p. 413

3. Why is thePSQRD a useful framework for research and practice? a. It explains why using computer applications is thebest way to support better

patient outcomes. b. It supports implementation, performance improvement, and rigorous research methodologies. c. It ensures successful implementation of a clinical process change. d. It increases communication among clinical staff.

ANS: B

While thePSQRD framework may improve communication and implementation, a critical strength of this framework is its systems approach and comprehensive strategy for ongoing monitoring and evaluation. thePSQRD framework provides a means to introduce health IT interventions in a systematic way, and it serves as a reminder to incorporate measures of success across thecausal chain. This approach supports implementation, performance improvement, and research projects with an appreciation for theeffects and thelimitations of health IT and other intervention components.

DIF: Cognitive Level: Remember

REF: p. 416

4. A nurse forgets to walk a patient during thenurse’s shift. This is an example of an error of: a. commission. b. omission. c. condition. d. remission.

ANS: B

Forgetting to do something that is required for a patient would be considered an error of omission. Doing thewrong thing would be considered an error of commission. Condition and remission are not considered error types.

DIF: Cognitive Level: Apply

REF: p. 409 | p. 410

5. A nurse gives a patient thewrong drug. This is an example of an error of: a. commission. b. omission. c. condition. d. remission.

ANS: A

Doing thewrong thing would be considered an error of commission. Forgetting to do something that is required for a patient would be considered an error of omission. Condition and remission are not considered error types.

DIF: Cognitive Level: Apply

REF: p. 409 | p. 410

6. A hospital has an integrated clinical decision support system embedded in theEHR. According to

Donabedian’s model, this would be considered: a. structure.

b. process. c. outcome. d. effectiveness.

ANS: A

The setting and its attributes (eg, thephysical structure of buildings, staffing rations, theequipment available within an organization, and thebudget to support care provision) are all part of structure. theEHR with an embedded CDS system is part of thestructure of an organization.

DIF: Cognitive Level: Apply

REF: p. 413

7. A nurse uses a CDS system to make an informed clinical decision regarding a drug dosage

ordered for a patient. According to Donabedian’s model, this would be considered: a. structure. b. process. c. outcome. d. effectiveness.

ANS: B

The managerial and clinical processes in place to support theprovision of care are all included under theprocess component. theuse of a CDS system is considered process.

DIF: Cognitive Level: Apply

REF: p. 413 | p. 414

8. A unit has been experiencing a high rate of patient falls for thepast 3 months. According to

Donabedian’s model, patient falls would be considered: a. structure. b. process. c. outcome. d. effectiveness.

ANS: C

The end results of thestructures and processes are considered outcomes. These may include clinical outcomes. themeasurement of patient falls is considered an outcome.

DIF: Cognitive Level: Apply

REF: p. 413

MULTIPLE RESPONSE 1. To automatically track thequality of care, standardized quality measures are needed in order to:

(Select all that apply.) a. use consistent metrics. b. benchmark. c. standardize data collection. d. ensure clinical efficiency. e. have intuition.

ANS: A, B, C

To automatically track thequality of care, standardized quality measures are needed to ensure that all organizations are using consistent metrics for benchmarking and that organizations are using thesame types of data to populate thequality metrics.

DIF: Cognitive Level: Understand

REF: p. 411 | p. 412

2. Which items are included in theIOM six aims for improvement? (Select all that apply.) a. Safe b. Patient-centered c. Innovative d. Effective e. Unintrusive ANS: A, B, D

The six aims for improvement are safe, effective, patient-centered, timely, efficient, and equitable. Innovation and level of intrusion are not among thesix aims for improvement.

DIF: Cognitive Level: Remember

REF: p. 409

Chapter 25: Legal Issues, Federal Regulations, and Accreditation Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Powers granted to both thefederal and state governments are known as what? a. Conditional powers b. Concentric powers c. Concurrent powers d. Conflicting powers ANS: C

Concurrent powers are given to both thefederal and state governments at thesame time, such as theability to regulate theprivacy of PHI. DIF: Cognitive Level: Remember

REF: p. 423

2. By what legal code or precedent are powers not granted to thefederal government reserved by

thestates? a. HIPAA b. HITECH c. The 10th Amendment to theU.S. Constitution d. The Stark Law ANS: C

The 10th Amendment to theU.S. Constitution, known as thereserved powers clause, reads as follows: “The powers not delegated to theUnited States by theConstitution, nor prohibited by it to theStates, are reserved to theStates respectively, or to thepeople.”

DIF: Cognitive Level: Remember

REF: p. 423

3. Which is true of guidance documents? a. They are official agency publications. b. They are identical to regulations and rulemaking. c. They are legally binding. d. They come from theU.S. Congress.

ANS: A

Guidance documents may resemble rulemaking, but they are non-legally binding documents produced by agencies, in order to help subjects understand and comply with specific regulations.

DIF: Cognitive Level: Understand

REF: p. 425

4. Which of thefollowing is true regarding administrative enforcement? a. There is an additional route of appeal if a decision is issued in an administrative

proceeding as opposed to a federal court proceeding. b. There are fewer routes of appeal if a decision is issued in an administrative

proceeding as opposed to a federal court proceeding. c. Administrative settlement agreements include thefinding of liability against an

entity. d. An administrative proceeding is more formal than a court proceeding.

ANS: A

Administrative proceedings and court proceedings are functionally equivalent. thesame remedies are available to both thefederal court judge and theadministrative law judge. However, theadministrative system offers an additional route of appeal regarding decisions, when compared to thecourt system.

DIF: Cognitive Level: Apply

REF: p. 425

5. E-mailing fraudulent claims from an office in Houston, Texas, to a Medicare facility in

Washington, D.C., for medical care not actually performed would constitute what? a. A civil but not criminal infringement b. Wire fraud as well as a violation of theFalse Claims Act c. Only wire fraud d. Unbundling ANS: B

Such interstate e-mailing of fraudulent information would be wire fraud as well as a breach of theFalse Claims Act. Such a breach could be a civil as well as criminal case. Unbundling involves fraudulently increasing revenue by separately billing for individual parts of a typically bundled service, which isn’t what is happening in thequestion.

DIF: Cognitive Level: Apply

REF: p. 427

6. A vendor provided all advanced practice registered nurses with free mobile devices to stimulate

referrals. Which regulation is being violated? a. The Anti-Kickback Statute b. The Stimulus Act

c. The HITECH Act d. HIPAA ANS: A

The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal healthcare program. Where remuneration is paid purposefully to induce or reward referrals of items or services payable by a federal healthcare program, theAntiKickback Statute is violated.

DIF: Cognitive Level: Apply

REF: p. 426

7. Which of thefollowing would be regulated by theFDA? a. A health information website b. An app that functions as a medical device c. A FitBit d. Google Glasses ANS: B

Only mHealth applications that are considered medical devices, such as electrocardiograms, can be regulated by theFDA. DIF: Cognitive Level: Remember

REF: p. 432

MULTIPLE RESPONSE 1. Which agencies can accredit hospitals for participation in Medicare and Medicaid programs?

(Select all that apply.) a. The Joint Commission b. Det Norske Veritas c. Safe Harbors d. Federal Trade Commission e. National Coordinator for Health Information ANS: A, B

The Joint Commission (TJC) and Det Norske Veritas (DNV) are theonly two agencies that theCenter for Medicare and Medicaid Services has authorized to accredit hospitals.

DIF: Cognitive Level: Understand

REF: p. 429

2. The Stark Law considers which of thefollowing Designated Health Services? (Select all that

apply.) a. Physical therapy services b. Housecleaning and janitorial services c. Home health services d. Prosthetic devices and supplies e. Medical language translation services ANS: A, C, D

The Stark Law governs physician self-referral for Medicare and Medicaid patients. Its “Designated Health Services” cover a variety of topics, including physical therapy, home health, and prosthetic devices. It does not involve language translation or any kind of housekeeping services that convalescing patients may need.

DIF: Cognitive Level: Remember

REF: p. 426

3. Which of thefollowing would theFDA consider a Class II medical device? (Select all that apply.) a. A device of medium safety risk b. A callus remover c. A powered wheelchair d. Items needing premarket approval e. A titanium implant ANS: A, C

Class II devices are considered medium risk by theFDA and require general controls as well as special controls. A powered wheelchair falls in this category. A callus remover would be a Class I low-risk device, whereas an implant meant to be surgically placed inside a patient would be considered a Class III high-risk device.

DIF: Cognitive Level: Understand

REF: p. 431

Chapter 26: Privacy and Security Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which definition most accurately describes privacy? a. The means to ensure health record privacy and confidentiality b. Accuracy and completeness of health information c. The rights of individuals to control access to their person or information about

themselves d. An act that has thepotential to cause harm to an informational asset ANS: C

Privacy is therights of individuals to control access to their person or information about themselves. Security is defined as themeans to ensure health record privacy and confidentiality.

Data integrity is defined as theaccuracy and completeness of health information. A threat is an act that has thepotential to cause harm to an informational asset.

DIF: Cognitive Level: Remember

REF: p. 437

2. A healthcare provider forgets to update a patient’s medications. Which fair information principle

is being violated? a. Correction b. Openness and transparency c. Data quality and integrity d. Safeguards ANS: C

By not keeping a patient’s records current and up-to-date, thehealthcare provider is violating thefair information principle of data quality and integrity. Correction involves allowing individuals to dispute theaccuracy of their information, openness and transparency involve keeping patients informed on policies regarding PHI, and safeguards are actions implemented to protect sensitive data.

DIF: Cognitive Level: Apply

REF: p. 437 | p. 438

3. Which organization works on an international level to improve information privacy? a. Health and Human Services Office of Civil Rights b. Health Information Security and Privacy Collaboration (HISPC) c. Department of Health and Human Services (DHHS) d. Electronic Frontier Foundation (EFF) ANS: D

The Electronic Frontier Foundation (EFF) maintains a website listing international privacyrelated accords and agreements. theHealth and Human Services Office of Civil Rights, Health Information Security and Privacy Collaboration (HISPC), and Department of Health and Human Services (DHHS) are all examples of federal and/or state organizations.

DIF: Cognitive Level: Understand

REF: p. 440

4. What is thedifference between thesafe harbor and expert determination methods of de-

identifying data? a. The safe harbor method involves removal of 18 types of identifiers, and theexpert

determination method involves theapplication of statistical or scientific models. b. The safe harbor method involves theapplication of statistical or scientific models, and theexpert determination method involves removal of 18 types of identifiers. c. The safe harbor method involves removal of all identifiers, and theexpert determination method involves theremoval of 18 types of identifiers. d. The safe harbor method involves securing identifiers in an encrypted database, and theexpert determination specifically determines theriskiest identifiers to remove.

ANS: A

The safe harbor method involves removal of 18 types of identifiers, and theexpert determination method involves theapplication of statistical or scientific models to de-identify data. None of theother options accurately describes these two methods.

DIF: Cognitive Level: Apply

REF: p. 443 | p. 444

5. What is a negative impact of theincreased use of mobile devices in transmitting health data? a. They support increased health data access for providers. b. They increase therisk of a security breach. c. They decrease productivity. d. They increase thenumber of medication errors.

ANS: B

The largest downfall to theincreased use of mobile devices is theincreased risk for a security breach. theincreased access for providers is a positive impact. Mobile devices have been proven to increase productivity rather than decrease it, and there is no evidence supporting an increase in medication errors due to mobile devices.

DIF: Cognitive Level: Understand

REF: p. 447 | p. 448

6. Which example constitutes an internal security event? a. Servers containing clinical data were stolen from a facility. b. A person hacks into a facility’s server and steals PHI electronically. c. A person installs a malicious code past a facility’s firewall. d. A system administrator installed a new server without any security measures.

ANS: D

Internal events are those perpetrated (usually accidentally) by people within an institution. A system administrator not taking proper security measures would be an example of this. theremaining examples are all external events.

DIF: Cognitive Level: Apply

REF: p. 448

7. An organization implements a policy on installing software service packs on all its computers.

This is an example of which type of control? a. Administrative b. Technical c. Physical d. Electronic ANS: A

Administrative controls include establishing and adhering to security policies and procedures as well as dedicating resources to security. Implementing a policy on installing and updating service packs would be an example of administrative controls. Physical controls are actual physical methods to protect inappropriate access to PHI. Technical controls are using technology to protect against inappropriate access to PHI. Electronic controls is not an accurate term.

DIF: Cognitive Level: Apply

REF: p. 449 | p. 450

MULTIPLE RESPONSE 1. What are some examples of indirect costs to organizations that have security breaches? (Select

all that apply.) a. Lost productivity b. Expensive fines c. Damaged public trust d. Remediation costs e. Repeating medical procedures ANS: A, C, D

Indirect costs to an organization with security breaches are lost productivity, damaged public trust, and remediation costs. Fines are a direct penalty. Security breaches don’t generally cause a need for an organization’s healthcare workers to redo or repeat medical procedures.

DIF: Cognitive Level: Understand

REF: p. 445 | p. 446

2. Which are examples of secondary use of health information? (Select all that apply.) a. Treatment b. Surveillance c. Research d. Marketing e. Prevention ANS: B, C, D

The three most common secondary uses of personal health information include public health monitoring or surveillance, research, and marketing. Treatment for and prevention of illness would be primary uses of health information.

DIF: Cognitive Level: Understand

REF: p. 443

3. Which principles are included in IMIA’s Code of Ethics for informatics? (Select all that apply.) a. Information-Privacy and Disposition b. Openness c. Elimination of Threats d. Legitimate Infringement e. Accountability ANS: A, B, D, E

IMIA’s Code of Ethics for informatics includes Information-Privacy and Disposition, Openness, Security, Access, Legitimate Infringement, Least Intrusive Alternative, and Accountability.

While threat elimination is a worthy goal, it is not a specific principle.

DIF: Cognitive Level: Remember

REF: p. 438

Chapter 27: theHealth Information Technology for Education and Clinical Health (HITECH) Act, Meaningful Use (MU), and Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. The technical hurdle of successfully sharing a patient’s data between a hospital in Spokane,

Washington, and a specialist in Portland, Oregon, requires: a. interoperability, which requires standards to be in place. b. standards, which requires interoperability to be in place. c. vocabulary management, which is dependent upon reciprocity. d. policy, which requires stability.

ANS: A

To share information and data successfully, different healthcare systems need interoperability.

For interoperability to occur, there must be a framework of standards in place.

DIF: Cognitive Level: Apply

REF: p. 458

2. The main objective behind thehealth IT incentives provided by theAmerican Recovery and

Reinvestment Act is: a. getting health IT up and running in doctors’ offices. b. improving health and healthcare. c. increasing therevenue stream to small healthcare organizations. d. improving compliance with government protocols and regulations.

ANS: B

The health IT provisions of theHITECH Act and ARRA have one final goal in mind: theimprovement of Americans’ health and healthcare. Health IT is a means to that end, not theend.

DIF: Cognitive Level: Understand

REF: p. 459

3. Which of thefollowing is not part of thecriteria to determine Meaningful Use? a. Engaging patients and families b. Reducing health disparities c. Improving care coordination d. Increasing litigation victories ANS: D

The point of Meaningful Use is to improve patient care and population health. Litigation is not part of thecriteria.

DIF: Cognitive Level: Remember

REF: p. 461

4. In which year will (or did) MU incentives for providers transform to merit-based reimbursement

under MACRA? a. 2021 b. 2025 c. 2014 d. 2018

ANS: D

Stage 3, thefinal phase of theMU incentive program, rolls out in 2017 and is expected to become mandatory in 2018. As of 2018, theincentives given to healthcare organizations will transition into merit-based reimbursement.

DIF: Cognitive Level: Remember

REF: p. 466

5. The HITECH portion of ARRA was meant to do all of thefollowing EXCEPT: a. encourage health providers to adopt EHR. b. coordinate healthcare delivery standards with international healthcare bodies. c. achieve meaningful use of EHRs.

d. support theexchange of health information.

ANS: B

HITECH was focused on EHRs and supporting theexchange of health and healthcare information. It was not related to international healthcare delivery of care standardizations.

DIF: Cognitive Level: Understand

REF: p. 456

6. The Health IT Standards Committee and what body are responsible for recommending standards,

such as thenecessary infrastructure for health information exchanges? a. HITRC b. The Nationwide Health Information Network c. ONC d. CMS ANS: C

The Health IT Standards Committee works in conjunction with theOffice of theNational Coordinator for Health Information Technology (ONC) to devise and develop standards for thehealthcare industry.

DIF: Cognitive Level: Remember

REF: p. 458

7. Which is true of both HITECH and MACRA? a. HITECH offers incentives to both physicians and hospitals while MACRA is

focused on physicians. b. HITECH and MACRA both are focused on easing thecost of healthcare for end

patients. c. MACRA focuses on hospital payments while HITECH focused on physicians. d. MACRA and HITECH both focus on payment schemes for small, community-

based healthcare organizations over larger city and regional hospitals.

ANS: A

HITECH offered incentives to both individual physicians and to hospitals directly. MACRA focuses more singularly on physicians, although thehospitals that employ them may bear indirect costs.

DIF: Cognitive Level: Apply

REF: p. 472

MULTIPLE RESPONSE 1. A 2016 report found which of thefollowing about Regional Extension Centers? (Select all that

apply.) a. REC participation was negatively associated with EHR adoption among primary care physicians working with a large underserved patient base. b. REC participation was positively associated with EHR adoption among primary care physicians working in small practices. c. RECs provided needed technical assistance for physicians who were ineligible to receive assistance from health systems in their local area.

d. The REC program likely helped many physicians who were more skeptical about

EHRs. e. REC participation showed no correlation with achieving Meaningful Use at levels

required to receive financial incentives.

ANS: B, C, D

The 2016 report highlighted many positives of theRegional Extension Centers program, including positive association with EHR adoption by physicians in large underserved patient bases and working in small practices, providing assistance to physicians who were otherwise ineligible to receive such assistance, likely helping many who had initially been skeptical of thechangeover to EHRs, and a positive correlation with achieving Meaningful Use. DIF: Cognitive Level: Apply

REF: p. 459

2. Which of thefollowing are categories of measurements that MACRA will use with theMerit-

Based Incentive Payment System (MIPS)? (Select all that apply.) a. Quality b. Resource use c. Clinical improvement d. Recidivism e. EHR use ANS: A, B, C, E

MACRA’s four categories of measurements are quality, resource use, clinical improvement, and EHR use. Recidivism, or lapsing into pre-HER ways, is not a measurement.

DIF: Cognitive Level: Understand

REF: p. 471

3. Stage 3 of Meaningful Use includes which of thefollowing? (Select all that apply.) a. Recording vital signs and demographic information b. Instituting computerized provider order entry c. Maintaining an active medication allergy list d. Providing education resources identified by CERHT to patients e. Using computerized provider order entry for a majority of medication orders ANS: B, D, E

Stage 3 of Meaningful Use requires higher standards and goes beyond exchanging data toward improvements in general population health. Items like recording vital signs and demographic information, as well as maintaining an active medication allergy list, from Stage 1 will no longer be sufficient to show that healthcare practices are moving forward with true Meaningful Use of their EHR systems.

DIF: Cognitive Level: Analyze

REF: p. 461 | p. 462 | p. 463 | p. 464 | p. 465 | p. 466

Chapter 28: Health Policy and Health Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. The EHR incentive Meaningful Use criteria are adapted from work done by: a. the National Quality Forum. b. the National Priorities Partnership. c. The Joint Commission. d. the Institute of Medicine.

ANS: B

The EHR incentive program’s Stage 1 criteria for meeting Meaningful Use are divided into five initiatives adapted from work done by theNational Priorities Partnership.

DIF: Cognitive Level: Remember

REF: p. 482

2. What is theoffice of theDepartment of Health and Human Services that is charged with

overseeing nationwide efforts to implement and use health IT and electronic exchange of health information? a. MARCA b. The Institute of Medicine (IOM) c. The Office of theNational Coordinator (ONC) d. The American Medical Informatics Association (AMIA) ANS: C

The ONC is theonly governmental agency reporting to theDHHS; its role is to coordinate implementation of health IT and electronic information exchange.

DIF: Cognitive Level: Remember

REF: p. 476

3. It is important to monitor and track unintended consequences of health IT implementation

because: a. reporting is mandatory. b. not much is known and we need to learn more. c. the federal government is interested in this information. d. this is a prevalent issue.

ANS: B

Research in this area is just beginning, but even without knowing all thedetails, monitoring and tracking of theunplanned or unexpected consequences are important, so we can learn more about theissues to inform thefuture.

DIF: Cognitive Level: Remember

REF: p. 481 | p. 482

4. The Center to Champion Nursing in America envisions a healthcare system where: a. best practices need to be developed. b. quality care is increasing in targeted areas. c. nurses are discernibly expanding and strengthening their capabilities. d. all Americans have access to high-quality care.

ANS: D

The Center to Champion Nursing in America envisions a healthcare system where all Americans

have access to high-quality care, with nurses contributing to thefull extent of their capabilities.

DIF: Cognitive Level: Understand

REF: p. 487 | p. 488

5. To achieve thegoals of theHIMSS nursing informatics position statement, all nurses should: a. have a central role in drafting health IT policy. b. run for political office or sit on a healthcare board. c. participate in advocacy and educational efforts directed to policy-makers. d. develop innovative and disruptive technologies.

ANS: C

The HIMSS Nursing Informatics Position Statement states that nurses, as leaders, should be knowledgeable and well versed in current public policy initiatives and participate in advocacy and educational efforts directed to policy-makers.

DIF: Cognitive Level: Apply

REF: p. 488

6. The Future of Nursing report listed all of thefollowing opportunities to transform nursing

practice through technology EXCEPT: a. implications for time and place of care. b. expanding opportunities for nurses to share information in collaborative efforts. c. fast-tracking nurse education to grow theranks of nurse practitioners. d. enabling nurses to lead change to advance health.

ANS: C

The Future of Nursing report lists many opportunities for transforming nursing practice with technology, such as its implications for time and place of care, new opportunities to share information in collaborative efforts, and thechance for nurses to lead change. While increased education and training are always laudable goals, fast-tracking nursing education is not part of a new technology opportunity.

DIF: Cognitive Level: Remember

REF: p. 486 | p. 487

7. John T. James’s recent study, published in 2013, found how many premature deaths associated

with preventable harm to patients in theUnited States every year? a. 88,000 b. 400,000 c. 17,000 d. Nearly 100,000 ANS: B

The James report revealed some 400,000 premature deaths due to preventable harm to patients in U.S. healthcare facilities every year. thereport also suggests that some 10 to 20 times that number of patients received serious, but sublethal, preventable harm.

DIF: Cognitive Level: Apply

REF: p. 481

MULTIPLE RESPONSE 1. Which recommendations did theIOM make to address health IT safety concerns and make

patient care safer? (Select all that apply.) a. HHS should fund a new Health IT Safety Council. b. HHS should establish a mechanism for vendors and patients to report health IT– related deaths, serious injuries, or unsafe conditions.

c. Health IT should be moved from private, for-profit organizations into a

nationalized central agency with strict oversight. d. Every patient should download and use thefederal government’s MyHealthIT

mobile app to document healthcare safety concerns. e. ONC should work with theprivate sector to make comparative user experiences

publicly available.

ANS: A, B, E

The IOM made a series of recommendations including a new Health IT Safety Council, a way for vendors and patients to report health IT–related problems, and making comparative user experiences public. theIOM did not recommend any kind of nationalized IT system, nor is there a federal MyHealthIT app.

DIF: Cognitive Level: Apply

REF: p. 481

2. The IOM report, HIT and Patient Safety: Building Safer Systems for Better Care, documented

that safe use of health IT relies on: (Select all that apply.) a. the interplay of people, process, and technology. b. vendors, users, and government. c. clinicians and patients. d. commercial interests. e. luck.

ANS: A, B, C

The safe use of HIT relies on many factors, including clinicians, patients, and sociotechnical issues such as theinterplay of people, process, and technology. Vendors, users, government, and theprivate sector all have roles to play.

DIF: Cognitive Level: Remember

REF: p. 481

3. Well-defined health IT policies are necessary to ensure that: (Select all that apply.) a. confidentiality of protected health information is safeguarded. b. the DHHS receives its monthly report in a timely manner. c. data capture is being automated. d. clinical decision support is adopted. e. the retail value of confidential information can be maintained.

ANS: A, C, D

Well-defined policies are necessary to ensure that confidentiality of protected health information is safeguarded, data capture is being automated, and clinical decision support is adopted. Policymakers should leverage these opportunities to transform nursing practice through theuse of new and existing technologies intended to support decision making and care delivery. theDHHS does not receive a monthly report, and confidential information is not sold.

DIF: Cognitive Level: Apply

REF: p. 486 | p. 487

Chapter 29: Health Information Technology Governance Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. According to theInformatics Capability Maturity Model, thedegree to which IT is innovatively

leveraged to enable leaner processes and seamless information flows represents which dimension? a. Managing information b. Using business intelligence c. Aligning business and informatics d. Using information technology ANS: D

The ownership of health IT governance, as with other aspects of governance, depends on theinstitution.

DIF: Cognitive Level: Remember

REF: p. 497

2. What is thefirst factor in deciding on an optimal health IT governance for an institution? a. The EHR system in use b. The organizational culture c. The size of theIT budget d. Whether theorganization is a for-profit or non-profit entity ANS: B

Of thelisted factors, an organization’s culture is themost important factor that needs to be considered.

DIF: Cognitive Level: Analyze

REF: p. 497

3. Why is it difficult to establish effective health IT governance? a. Fundamentally, effective governance means that some stakeholders’ informatics

needs will need to be de-prioritized. b. There is too much literature available on thetopic, making it difficult to choose

which approach to follow. c. So few activities within a healthcare organization involve informatics. d. No stakeholder wants to have a say in how informatics resources are leveraged.

ANS: A

The fundamental reason for thedifficulty of informatics governance is that there is more effort desired from informatics than resources allow.

DIF: Cognitive Level: Apply

REF: p. 495

4. The trend in healthcare IT is shifting from what to what? a. Data warehouses developed by third-party vendors to infrastructure developed in-

house b. IT infrastructure being developed in-house to data warehouses developed by

vendors and in-house resources c. A wide array of decision support tools to more closely defined transaction-based

applications d. Litigation avoidance costs to operational productivity costs ANS: B

After many decades in which healthcare organizations developed in-house transaction-based IT applications, thetrend has now opened up toward more robust data warehouses developed by vendors as well as in-house resources.

DIF: Cognitive Level: Apply

REF: p. 496

5. The Informatics Capability Maturity Model: a. has been overtaken by a newer generation of assessment tools. b. was developed by a partnership of theCDC and National Institutes of Health. c. is a qualitative model that measures an organization’s capabilities along five

dimensions. d. is intended to be administered by an outside, and thus neutral, agency.

ANS: C

The Informatics Capability Maturity Model, developed by theUK’s National Health Service, measures an organization’s capabilities along five dimensions, rating them from 1 to 5, and can be self-administered by an organization.

DIF: Cognitive Level: Apply

REF: p. 497

MULTIPLE RESPONSE 1. Why is health IT governance needed? (Select all that apply.) a. It ensures thealignment of informatics resources with institutional priorities. b. It effectively prioritizes theuse of informatics resources. c. It optimizes thereturn on investment on informatics investments. d. It encourages clinician involvement. e. It can prevent malpractice litigation.

ANS: A, B, C

Health IT governance is needed as it ensures thealignment of informatics resources with institutional priorities, effectively prioritizes theuse of informatics resources, and optimizes thereturn on investment on informatics investments. All three reasons are core to theneed for health IT governance.

DIF: Cognitive Level: Apply

REF: p. 495

2. Which components are necessary for effective health IT governance? (Select all that apply.) a. Organizational structures for assessing clinical processes b. Organizational structures responsible for clearly defining institutional priorities

c. Organizational structures responsible for ensuring that informatics efforts are

aligned with institutional priorities and optimally utilized d. Accompanying processes to operationalize thegovernance e. Proper procedures for punishing transgressions ANS: B, C, D

Effective health IT governance requires organizational structures responsible for clearly defining institutional priorities, organizational structures responsible for ensuring that informatics efforts are aligned with institutional priorities and optimally utilized, and accompanying processes to operationalize thegovernance. Though theterm used is “governance,” thefield is concerned with oversight and guidance rather than rulemaking and enforcement.

DIF: Cognitive Level: Remember

REF: p. 495

3. Which factors represent internal and external forces that require effective informatics

governance? (Select all that apply.) a. Increasing demand for decision support and analytics b. Greater expectations for information access and transparency c. Clinician demand d. Meaningful Use and healthcare reform e. An increase in theuse of internally produced, transaction-based applications to support back-office functions and thedelivery of clinical care ANS: A, B, D

Increasing demand for decision support and analytics, greater expectations for information access and transparency, and Meaningful Use and healthcare reform represent significant issues that increase thedemand for informatics resources and subsequently require more effective health IT governance and prioritization.

DIF: Cognitive Level: Apply

REF: p. 496

4. Which groups are relevant stakeholders for health IT governance? (Select all that apply.) a. Specialists refining clinical processes b. Institutions working on payment reform and personalized medicine c. Health services researchers d. Actual healthcare providers e. Senior organizational leadership ANS: A, B, C, D, E

All of these are relevant stakeholders who have a key and generally direct interest in effective health IT governance.

DIF: Cognitive Level: Understand

REF: p. 495

5. Which activities represent dimensions of theNational Health Service’s Informatics Capability

Maturity Model? (Select all that apply.) a. Clinical documentation b. Managing information c. Using business intelligence

d. Aligning business and informatics e. Cost control ANS: B, C, D

Managing information, using business intelligence, and aligning business and informatics are dimensions of theNational Health Service’s Informatics Capability Maturity Model. While clinical documentation and cost control are parts of an overall Healthcare IT system, these specific elements are not part of theMaturity Model.

DIF: Cognitive Level: Remember

REF: p. 497

Chapter 30: Informatics in theCurriculum for Healthcare Professionals Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Advocating for users’ needs and acting as a liaison among theusers, theIT staff, and thevendor

are competencies for a(n): a. generalist. b. data scientist. c. consultant. d. implementation support specialist.

ANS: C

Learning how to advocate for users’ needs and act as a liaison among theusers, theIT staff, and thevendor are specialist traits, not generalist; they are competencies for consultants whose role is to analyze and recommend solutions for HIT implementation problems.

DIF: Cognitive Level: Remember

REF: p. 502 | p. 503 | p. 504

2. Which organization spearheaded thedevelopment of informatics competencies across thenursing

curriculum? a. TIGER b. AMIA 10x10 c. HRSA d. HIMSS ANS: A

The Technology and Informatics Guiding Education (TIGER) initiative, launched in 2005 along with Quality and Safety Education in Nursing, helped pave theway for developing informatics competencies across thenursing curriculum.

DIF: Cognitive Level: Remember

REF: p. 500

3. The Health Information Technology for Economic and Clinical Health (HITECH) Act has

influenced healthcare delivery because it is: a. a training program for informatics specialists. b. an organization that develops informatics competencies. c. an academic electronic health records software. d. federal legislation that promotes theuse of electronic health records.

ANS: D

HITECH has influenced healthcare delivery because it is federal legislation that promotes theuse of electronic health records. HITECH has not specifically addressed informatics training or education.

DIF: Cognitive Level: Remember

REF: p. 499 | p. 500

4. The Quality and Safety Education in Nursing (QSEN) project developed competencies based on

work completed by: a. HRSA. b. TIGER. c. IOM.

d. AMIA 10x10.

ANS: C

The QSEN project developed competencies based on work completed by theInstitute of Medicine (IOM). HRSA, TIGER, and AMIA 10x10 may address informatics competencies, but they did not provide thefoundation for theQSEN project.

DIF: Cognitive Level: Analyze

REF: p. 500 | p. 501 | p. 502

5. The practice workflow and information management redesign specialist role requires what kind

of education and training? a. Community-college based b. Ph.D.-level focus c. University-based d. In-service training and certification ANS: C

A practice workflow and information management redesign specialist assists in reorganizing thework of a healthcare provider to take full advantage of meeting theMeaningful Use criteria.

This role requires university-based education and training.

DIF: Cognitive Level: Remember

REF: p. 510 | p. 511

6. Evaluating data from all relevant sources, including technology, to inform thedelivery of care is a

competency for a(n): a. generalist. b. advanced practice nurse. c. specialist. d. implementation project manager.

ANS: A

Evaluating data from all relevant sources, including technology, to inform thedelivery of care is a fundamental building-block competency for a generalist. thegeneralist receives undergraduate training for this role.

DIF: Cognitive Level: Remember

REF: p. 502

7. Cognitive psychology claims that learning involves memory, motivation, thinking, reflection,

and abstraction. Which question is instrumental in teaching critical thinking? a. What? b. How? c. Why? d. Who? ANS: B

“Knowing how” involves memory, motivation, thinking, reflection, and abstraction. These skills are useful in teaching critical thinking. “Knowing what” represents behaviorism, and “knowing why” represents constructivism. “Knowing who” is not part of thelearning theories discussed.

DIF: Cognitive Level: Remember

REF: p. 507

8. Educating students about informatics includes working with EHRs and: a. evidence-based practice (EBP). b. interprofessional teams. c. patient safety. d. communication tools.

ANS: D

Informatics primarily involves working with information and communicating information to others. Therefore communication tools are a necessary component of an informatics education.

While theEBP, interprofessional teams, and patient safety can be enhanced by theuse of informatics, they are not informatics knowledge, skills, or attitudes. Informatics is about information and communicating it to others.

DIF: Cognitive Level: Analyze

REF: p. 507

9. Incorporating usability principles into software configuration and implementation is a

competency of: a. the generalist. b. the advanced practice nurse (APN). c. the nursing informatics specialist (INS). d. the implementation support specialist.

ANS: D

Incorporating usability principles into software configuration and implementation is a competency of theimplementation support specialist. This is not a competency of thegeneralist, APN, or INS. DIF: Cognitive Level: Remember

REF: p. 502

10. Existing resources that promote meeting thechallenge of teaching informatics in thehealth

professional curriculum are: a. sufficient number of trained faculty. b. readily available technical infrastructure.

c. teaching materials and assignments. d. simulation and academic electronic health records (AEHRs) software.

ANS: C

QSEN and ONC have made freely available numerous teaching materials and assignments for teaching informatics. Insufficient faculty and lack of technical support are two major barriers to teaching informatics. thecosts of simulation and AEHRs can be prohibitive.

DIF: Cognitive Level: Analyze

REF: p. 507

Chapter 31: Distance Education: Applications, Techniques, and Issues Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which two instrumental movements pushed correspondence courses forward? a. The Society to Encourage Studies at Home and Chautauqua College of Liberal

Arts b. The invention of thetelevision and cable services c. The development of web 2.0 tools and theinternet d. Fiber-optic cables and 2-way video communications ANS: A

Phase one of distributive education historical developments was pushed forward by theestablishment of theSociety to Encourage Studies at Home and theChautauqua College of Liberal Arts. theinvention of thetelevision and cable services, thedevelopment of web 2.0 tools and theinternet, fiber-optic cables, and 2-way video communications relate to other events that further promoted distance education.

DIF: Cognitive Level: Remember

REF: p. 517

2. Distributive education is: a. education that takes place in different settings and at different times. b. the use of electronic devices to deliver theinstruction and by which thelearners

acquire their knowledge. c. customized, learner-centered education that uses technology to provide learner

experiences where thelearner is engaged in thelearning activities that may or may not be at a distance. d. a version of distance education that requires theuse of theinternet or an intranet to deliver theeducational materials.

ANS: C

Distributive education is customized, learner-centered education that uses technology to provide learner experiences where thelearner is engaged in thelearning activities that may or may not be at a distance. thedefinition incorporates themain components of technology, engagement, customization, interaction, and individualization. theremaining choices are not complete enough or describe other terms like distance education, elearning, or online learning.

DIF: Cognitive Level: Understand

REF: p. 518

3. What is themain difference between a portal approach and a proprietary course management

system (CMS) approach in distance education? a. Portal-based systems can only be accessed by faculty of an institution, and proprietary CMS systems can be accessed by students and faculty. b. Portal-based systems can be accessed by students and faculty of an institution, and proprietary CMS systems can only be accessed by faculty. c. Portal-based systems are products purchased or licensed by a vendor, and proprietary CMS systems are developed and customized by thelearning institution. d. Portal-based systems are developed and customized by thelearning institution, and proprietary CMS systems are products purchased or licensed by a vendor.

ANS: D

Portal-based systems are developed and customized by thelearning institution, and proprietary CMS systems are products purchased or licensed by a vendor. Both systems allow access to students and faculty alike.

DIF: Cognitive Level: Understand

REF: p. 521 | p. 522

4. From a faculty perspective, thetwo critical criteria for a CMS/LMS are: a. ease of use and tool set. b. installed base and integration. c. cost and scalability. d. ease of use and installed base.

ANS: A

While all of these criteria are important, for faculty a CMS/LMS’s ease of use and tool set (the included features) are themost critical in theabove list. Ease of use, tool set, stability, and support are thethings that would impact a faculty member’s decision themost. theinstalled base and integration, cost and scalability, and ease of use and installed base are generally more important to thetechnology staff and administration.

DIF: Cognitive Level: Understand

REF: p. 524 | p. 525

5. Two examples of campus portal systems are: a. Moodle and Blackboard. b. Ellucian and Jenzabar. c. Desire2Learn and Blackboard. d. Sakai and Ellucian.

ANS: B

Ellucian and Jenzabar are portal systems. Blackboard and Desire2Learn are CMS, and Moodle and Sakai are open source examples.

DIF: Cognitive Level: Remember

REF: p. 521

6. For a successful distributive education program, theinstitution: a. must always offer students theoption for distributed learning even if there is no

faculty buy-in.

b. should move forward with an initiative to offer distributive learning in order to

stay competitive even when resources may not be in place. c. must match thegoals and objectives for a distributive education initiative to

themission and goals of theinstitution. d. should offer distributive education as a way of making money and lowering

operating costs.

ANS: C

Without matching goals and objectives of distributive education to themission and goals of theinstitution, resources will not line up correctly, which is a recipe for failure. A successful program requires commitment from faculty and appropriate institutional resources and will cost money; it may or may not make money for theinstitution.

DIF: Cognitive Level: Remember 7.

REF: p. 518 | p. 519

In a distributed learning environment, faculty members should: a. take their face-to-face lectures and turn them into a podcast. b. teach thecourse thesame way as theface-to-face course, as all sections of thecourse need to be thesame. c. use thesame activities as theon-campus courses; there is no need to adjust them. d. develop learning activities that engage thelearner with relevant real-world activities.

ANS: D

In distributive education theinstructor needs to empower thelearners to take charge of their learning, to be engaged, and to have a comprehensive learning experience. Podcasts of lectures do not engage thelearner, and using thesame learning activities does not take advantage of thetools available to engage and empower thelearner.

DIF: Cognitive Level: Remember

REF: p. 518

8. To ensure student success and engagement, faculty members should: a. make evaluative comments in thediscussion forum as to thequality of each

student’s post so they can improve. b. administer multiple-choice tests to measure students’ progress in learning

theconcepts. c. provide timely feedback to students using a grading rubric through thegrading

center. d. use their discretion as to theamount and frequency of their feedback to thestudents.

ANS: C

Providing students with information that their learning will be evaluated through a rubric and when this will occur should keep thestudents engaged and successful. theFamily Educational Rights and Privacy Act (FERPA) frowns on other students having access to evaluative comments of classmates. Multiple-choice questions do not necessarily keep thestudent engaged. Students should know what is required, when, and how soon they will receive feedback on their progress.

DIF: Cognitive Level: Apply

REF: p. 528

9. Critical to a successful distributive education program are thestudent support services. thefirst

thing one should do is: a. make sure thelibrary has online access to its holdings through online lending, full text literature databases, and online access to theresearch librarian. b. arrange for tutoring services especially in thedistribution courses such as probability and statistics, college algebra, English, and sciences. c. arrange for thebookstore to provide delivery services for required textbooks. d. survey thestudents for what support services they expect from theschool.

ANS: D

Faculty must determine or assess theneeds of thestudents for support services before deciding what to provide; theother answers all relate to specific support services one might provide.

DIF: Cognitive Level: Apply

REF: p. 528 | p. 529

MULTIPLE RESPONSE 1. The Higher Education Opportunity Act of 2008 stipulates which of thefollowing? (Select all that

apply.) a. Faculty must select and submit textbook requirements to thecampus bookstore before posting thenext semester’s schedule and registration. b. Institutions must verify that theenrolled student is actually theperson completing thecourse. c. Colleges and universities must give students access to their educational records. d. Institutions must post a net price calculator as well as security and copyright policies on their websites. e. Schools must pay attention to thechange in terminology from distance learning to distance education.

ANS: A, B, D, E

All of these are encompassed by HEOA, except for student access to their educational records, which is a provision of FERPA. DIF: Cognitive Level: Remember

REF: p. 531 | p. 532

Chapter 32: Informatics Tools for Educating Health Professionals Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. An example of a learning management system is: a. Blackboard. b. Merlot. c. Soarian. d. Smartboard.

ANS: A

Blackboard is one of thelargest proprietary learning management systems in theworld. Merlot is a collection of resources for faculty working in online learning. Soarian is an electronic health record application for acute care institutions. Smartboard is a white board with features such as a touch interface.

DIF: Cognitive Level: Remember

REF: p. 544

2. What is theprocess that faculty members at higher educational institutions must undergo to

secure a career position? a. Tenure b. Security c. Tension d. Freedom ANS: A

Tenure is theprocess that faculty at higher educational institutions must go through to secure a career position. theother options (security, tension, and freedom) describe how faculty members may feel during thetenure process.

DIF: Cognitive Level: Remember

REF: p. 540

3. Which generic term describes thetechnology that replaced thetraditional chalkboard in

classrooms? a. Interactive whiteboard b. Smart chalkboard c. Advanced chalk management d. The board ANS: A

An interactive whiteboard is thegeneric term that describes thetechnology that replaced thetraditional chalkboard in classrooms. theother answers (smart chalkboard, advanced chalk management, and theboard) either do not fully describe thetechnology or are incorrect.

DIF: Cognitive Level: Remember

REF: p. 540

4. Which is themajor application for virtual world creation and interaction? a. FirstWave b. Virtual Worldz c. Second Life d. World of Warcraft

ANS: C

Second Life is themajor application for virtual world creation and interaction. Second Life was theoriginal application created for interaction among users in a virtual world. FirstWave, Virtual Worldz, and World of Warcraft are incorrect choices.

DIF: Cognitive Level: Remember

REF: p. 546

MULTIPLE RESPONSE 1. What are some software examples of eportfolio creation? (Select all that apply.) a. iClicker b. BrightSpace c. eInstruction d. Desire2Learn e. Moodle ANS: B, D

Some software examples of eportfolio creation are BrightSpace and Desire2Learn. iClicker and eInstruction are audience response systems, Moodle is an LMS. DIF: Cognitive Level: Remember

REF: p. 545

2. Which applications might be useful for recording reflective student clinical journals? (Select all

that apply.) a. Microsoft Word b. Spreadsheet software c. Twitter d. Blackboard e. Google Drive ANS: A, D, E

Microsoft Word, Blackboard, and Google Drive are all strong tools for recording reflective journals for students, with the ability to record written thoughts, share, annotate, and provide a record of reflection. Spreadsheet software is not designed for journaling, and the character limit of Twitter greatly inhibits reflective journaling.

DIF: Cognitive Level: Apply

REF: p. 545 | p. 546

3. Which examples represent proprietary applications suitable for real-time in-class student

responses? (Select all that apply.) a. iClicker b. Turning Technologies c. TurnOff d. ClickMe e. AvayaLive ANS: A, B, E

iClicker, AvayaLive, and Turning Technologies are applications currently marketed as audience response systems. TurnOff and ClickMe are not examples of audience response systems.

DIF: Cognitive Level: Remember

REF: p. 543 | p. 544

4. What are the limitations of employing a virtual environment as a teaching method? (Select all

that apply.) a. Access b. Interface

c. Creativity d. Cost e. Technology limits ANS: C, D, E

The need for deep and broad creativity to create a compelling virtual space can be a limiting factor in a virtual environment’s usefulness. Costs can be both direct and indirect and can be prohibitive. And even the best virtual worlds still have significant limitations. Lack of sensory feedback such as odor or touch can be a barrier.

DIF: Cognitive Level: Understand

REF: p. 546

5. What are some reasons institutions are hesitant to adopt information management and technology

tools? (Select all that apply.) a. Prohibitive costs of purchasing technologies b. Fear of change among faculty and students c. The impermanence of electronic records d. Financial incentives from publishing companies to continue using traditional teaching materials e. The need to create a new model for education other than student credit hours ANS: A, B, E

Reasons for the slowness of adoption of technology include purchasing costs of technologies; dislike or fear of change from administration, staff, faculty, and students; a parochial view that traditional education will always be with us; and how to determine the cost of education based on something other than student credit hours. Publishers are embracing technology and are not offering incentives for using traditional print materials, and impermance of electronic information is not listed among the major reasons.

DIF: Cognitive Level: Understand

REF: p. 553

Chapter 33: Simulation in Healthcare Education Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. The best practice starting point for developing a simulation scenario is: a. the equipment available. b. the goals or objectives to be achieved. c. the facilitator’s choice. d. the commercially based scenarios available.

ANS: B

Simulation Standard III: Participant Objectives of the Standards of Best Practice states simulations should be developed based on the goals or objectives to be achieved by the participants, not on the technology available.

DIF: Cognitive Level: Apply

REF: p. 566

2. The purpose of the debriefing process is: a. to provide additional lecture time. b. to provide time for the facilitator to critique the student’s performance. c. to promote self-reflection. d. to provide time for participants to critique other participants’ performances.

ANS: C

Simulation Standard IV: Debriefing Process of the Standards of Best Practice states that debriefing is reflecting on one’s thoughts, performance, and actions. Self-reflection can be taught.

DIF: Cognitive Level: Understand

REF: p. 556 | p. 567

3. When SBAR communication is used, the B represents: a. baseline. b. breath sounds. c. bottom line. d. background.

ANS: D

SBAR stands for situation, background, assessment, and recommendation.

DIF: Cognitive Level: Remember

REF: p. 568 | p. 569

4. Which organization created the first set of published standards to guide simulation experiences? a. International Nursing Association for Clinical Simulation and Learning b. Society for Simulation in Healthcare c. National League for Nursing d. American Association for Colleges of Nursing ANS: A

The Standards of Best Practice: Simulation was created by the International Nursing Association for Clinical Simulation and Learning (INACSL) in response to a growing need for standardization and guidelines related to simulation educational methodologies.

DIF: Cognitive Level: Remember

REF: p. 562 | p. 563

5. As a simulation facilitator, you develop a confidentiality form that all learners must sign prior to

simulation experiences. Which standard does this represent? a. Standard I: Terminology b. Standard II: Professional Integrity of the Participants c. Standard VI: The Debriefing Process d. Standard VII: Evaluation of Expected Outcomes ANS: B

Asking all learners to sign a confidentiality form prior to simulation experiences ensures that all learners will receive the same opportunity for learning. This confidentiality form states that the learners will not share the details of the simulation experience with any other students and ensures the professional integrity of the participant.

DIF: Cognitive Level: Analyze

REF: p. 566

6. Which simulator model is most appropriate for learning to obtain an arterial blood gas? a. Standardized patient b. Computer-controlled mannequin c. Arm model from elbow to fingers d. Computer model ANS: C

Asking a learner to obtain an arterial blood gas is an example of a psychomotor skill. This skill can be practiced on an arm model. The arm model is the most realistic model to be used without placing the patient in any dangerous situation, such as the use of the standardized patient.

DIF: Cognitive Level: Analyze

REF: p. 559

7. The evaluation data collected after a simulation experience related to care of the heart failure

patient demonstrated a decrease in hospital admissions related to heart failure exacerbations.

This type of evidence supports training outcomes in which level of Kirkpatrick’s Model? a. Level 1 b. Level 2 c. Level 3 d. Level 4 ANS: D

This type of training impact demonstrates the result—the organizational impact (improved patient outcomes) related to a training experience. This is an example of a Kirkpatrick level 4 training outcome.

DIF: Cognitive Level: Analyze

REF: p. 560 | p. 561

MULTIPLE RESPONSE 1. Which of the following are INACSL standards for best practice for simulation? (Select all that

apply.) a. Terminology b. Debriefing process c. Facilitator objectives d. Facilitation methods e. Professional integrity

ANS: A, B, D, E

Terminology, debriefing process, facilitation methods, and integrity are INACSL standards for simulation best practice. The current INACSL standards address the participant objectives, not the facilitator objectives.

DIF: Cognitive Level: Remember

REF: p. 565

2. What is the purpose for creating standards to guide simulation experiences? (Select all that

apply.) a. To regulate all simulation activities nationwide b. To provide standardized experiences for the learners c. To enhance quality of the simulation experience d. To ensure funding for simulation programs e. To test new models of care delivery ANS: B, C

Standards are necessary to create the foundational structure on which to build simulation experiences and ensure quality, control, and standardization related to the scenarios.

DIF: Cognitive Level: Understand

REF: p. 565

3. Which categories of objectives can be met in a simulated clinical experience using a computer-

controlled high-fidelity mannequin? (Select all that apply.) a. Cognitive b. Sociocultural c. Psychomotor d. Affective e. Refractive ANS: A, C, D

Objectives are designed to meet learning needs in the categories of cognition, psychomotor development, and affective or emotional feelings. Sociocultural cues used within the simulated learning experience can help to achieve those objectives. There is no refractive objective category.

DIF: Cognitive Level: Remember

REF: p. 559 | p. 560

Chapter 34: International Informatics Efforts Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which international organization organizes an international conference on nursing informatics? a. International Council of Nurses (ICN) b. International Medical Informatics Association – Nursing Informatics SIG (IMIA-

NI) c. Nursing Working Group of HL7 d. International Standard Organization (ISO) ANS: B

The International Medical Informatics Association – Nursing Informatics SIG (IMIA-NI) organizes an international conference on nursing informatics. The ICN, HL7, and ISO do not organize an international conference on nursing informatics.

DIF: Cognitive Level: Remember

REF: p. 583

2. Which international organization develops and maintains a family of international classifications

such as the International Classification of Diseases? a. International Health Terminology Standards Development Organization (IHTSDO) b. World Health Organization (WHO) c. International Medical Informatics Association (IMIA) d. Health Level 7 (HL7) ANS: B

The World Health Organization develops and maintains a family of international classifications such as the International Classification of Diseases. The IHTSDO, IMIA, and HL7 do not develop and maintain a family of international classifications.

DIF: Cognitive Level: Remember

REF: p. 586

3. The eHealth network is a voluntary network of representatives from where? a. State medical societies within the United States b. Latin America and the Caribbean c. Europe d. Africa, the Americas, Europe, Asia, and Australia ANS: C

The eHealth network is made of up EU member states, with representatives meeting annually to discuss how to enhance interoperability between eHealth systems and ensure access to safe and high-quality healthcare.

DIF: Cognitive Level: Remember

REF: p. 579 | p. 580

4. Which issue is a deterrent to global interoperability? a. Multiple terminologies used in describing and documenting healthcare b. The development of an international standard clinical terminology c. The development of clinical data models such as HL7 CDA documents d. The use of openEHR Archetypes

ANS: A

Key barriers to global interoperability include issues related to the terminologies used in describing and documenting healthcare such as cost and accessibility, gaps in exhaustiveness, and lack of granularity. The remaining options are all efforts to solve the problem.

DIF: Cognitive Level: Understand

REF: p. 592

5. Which international organization develops and maintains standards for data exchange? a. World Health Organization (WHO) b. Health Level 7 (HL7) c. International Health Terminology Standards Development Organization

(IHTSDO) d. International Medical Informatics Association (IMIA) ANS: B

Health Level 7 is an international organization that develops and maintains standards for data exchange. The WHO, IHTSDO, and IMIA do not develop and maintain standards for data exchange.

DIF: Cognitive Level: Remember

REF: p. 592

6. Which international organization deals with compatibility and interoperability among standard

development organizations in healthcare? a. World Health Organization (WHO) b. Global Health Informatics Partnership (GHIP) c. Health Level 7 (HL7) d. International Standard Organization Technical Committee 215 (ISO/TC 215) ANS: D

The International Standard Organization Technical Committee 215 (ISO/TC 215) is an international organization that deals with harmonization among standard development organizations in healthcare. The WHO, GHIP, and HL7 do not deal specifically with harmonization among standard development organizations in healthcare.

DIF: Cognitive Level: Remember

REF: p. 590

MULTIPLE RESPONSE 1. Which of the following are member nations of HELINA? (Select all that apply.) a. South Africa b. France c. Vietnam d. Kenya e. Nepal ANS: A, D

HELINA is the Pan African Health Informatics Association, the IMIA’s African regional arm. It has 10 member countries, including South Africa and Kenya, and several “corresponding members,” all also within the African continent.

DIF: Cognitive Level: Remember

REF: p. 584

2. Which international organizations develop terminology? (Select all that apply.)

a. b. c. d.

International Medical Informatics Association (IMIA) International Council of Nurses (ICN) World Health Organization (WHO) International Health Terminology Standards Development Organization (IHTSDO) e. HELINA ANS: B, C, D

The ICN, WHO, and IHTSDO all develop terminologies. International Medical Informatics Association and its African regional arm HELINA do not develop terminology.

DIF: Cognitive Level: Remember

REF: p. 590 | p. 591 | p. 592

3. Which international organizations develop international standards? (Select all that apply.) a. Health Level 7 (HL7) b. International Health Terminology Standards Development Organization

(IHTSDO) c. Global Health Informatics Partnership (GHIP) d. International Standard Organization (ISO) e. Pan American Health Organization (PAHO) ANS: A, B, D

Health Level 7 (HL7), International Health Terminology Standards Development Organization (IHTSDO), and the International Standard Organization (ISO) all develop international standards for informatics. The Global Health Informatics Partnership (GHIP) and PAHO do not develop international standards for informatics.

DIF: Cognitive Level: Remember

REF: p. 590 | p. 592

Chapter 35: The Evolution of Health Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition

MULTIPLE CHOICE 1. The historical roots of computer science can be traced to: a. language development, especially English. b. mathematics and engineering. c. library science. d. medicine and nursing.

ANS: B

The historical roots of computer science can be traced back to mathematics and engineering. The historical roots of information science began in library science. Language development and medicine and nursing are not the roots of computer science.

DIF: Cognitive Level: Understand

REF: p. 597

2. The historical roots of information science can be traced to: a. language development, especially English. b. mathematics and engineering. c. library science. d. medicine and nursing.

ANS: C

The historical roots of information science began in library science. The historical roots of computer science can be traced back to mathematics and engineering. Language development and medicine and nursing are not the roots of information science.

DIF: Cognitive Level: Understand

REF: p. 597

3. The first book to include the term nursing informatics in the title was written in the: a. 1960s. b. 1970s. c. 1980s. d. 1990s.

ANS: C

The first book to include the term nursing informatics in the title was published in 1988.

DIF: Cognitive Level: Remember

REF: p. 599

4. What was the first professional association to express interest in accreditation for health

informatics–related educational programs? a. AMIA b. AHIMA c. ANCC d. HIMSS ANS: B

The American Health Information Management Association (AHIMA) first expressed interest in accreditation, in 2003.

DIF: Cognitive Level: Apply

REF: p. 604

5. Which technical development created a tension between centralized and decentralized computer

management in healthcare?

a. b. c. d.

The development of punch cards The elimination of punch cards The development of the mainframe computer The development of the personal computer

ANS: D

The development of the personal computer created tension between centralized and decentralized computer management in healthcare. The other responses highlight aspects of decentralized computer management.

DIF: Cognitive Level: Apply

REF: p. 597

6. Which of the following is not a member organization but rather a group of organizations? a. AMIA b. HIMSS c. AHIMA d. ANI ANS: D

The Alliance for Nursing Informatics (ANI) is an organization of organizations. This is not a member group. AMIA, HIMSS, and AHIMA are all member groups.

DIF: Cognitive Level: Remember

REF: p. 601

7. Which statement concerning educational programs in health informatics is correct? a. All health informatics programs are offered at the graduate level. b. Informatics programs offered by medical schools always require students to have

earned an MD for admission. c. All health informatics programs are located within health-related departments or

schools such as nursing, medicine, or pharmacy. d. Health informatics programs range from certificate programs offered at the

community college level to post-doctoral programs offered at major research institutions.

ANS: D

The correct response is health informatics programs range from certificate programs offered at the community college level to post-doctoral programs offered at major research institutions. Not all informatics programs require an MD, are at the graduate level, or are located within schools of health sciences.

DIF: Cognitive Level: Apply

REF: p. 603 | p. 604

8. Which statement related to certification in health informatics is correct? a. A master’s in nursing is required to sit for the NI examination offered by ANCC. b. To be certified in clinical informatics in association with AMIA, one must first be

a physician. c. There are no specific educational requirements for CPHIMS certification through

HIMSS, but 3 years of full-time clinical experience in health IT is required. d. To be certified as CPHIMS, you must be a nurse.

ANS: B

To be certified in clinical informatics in association with AMIA, one must first be a physician.

You do not need to have an MSN to sit for the NI exam by the ANCC. There are specific requirements for CPHIMS, but being a nurse is not one of them.

DIF: Cognitive Level: Apply

REF: p. 605

MULTIPLE RESPONSE 1. The term informatics is derived from: (Select all that apply.) a. Dutch. b. English. c. Russian. d. Arabic. e. French.

ANS: B, C, E

The term informatics was derived from the following languages: English, Russian, and French.

DIF: Cognitive Level: Understand

REF: p. 598

2. When the AMIA model is used, which subfields are categorized as clinical informatics? (Select

all that apply.) a. Medical informatics b. Nursing informatics c. Dental informatics d. Chemical informatics e. Business informatics ANS: A, B, C

When the AMIA model is used, the following disciplines are categorized as clinical informatics: medical informatics, nursing informatics, and dental informatics. The other responses are not clinically related.

DIF: Cognitive Level: Analyze

REF: p. 608

Chapter 36: Future Directions and Future Research in Health Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE

1. Which two events led to the expansion of the field of nanotechnology? a. A lecture titled “There’s Plenty of Room at the Bottom” and development of

carbon nanotubes b. Creation of the Project on Emerging Nanotechnologies and use of quantum dots c. Development of the subdisciplines of nanofabrication and nanomedicine d. Invention of the scanning tunneling microscope and the discovery of fullerenes ANS: D

The invention of the scanning tunneling microscope and the discovery of fullerenes were the two events that led to the expansion of the field of nanotechnology.

DIF: Cognitive Level: Knowledge

REF: p. 623

2. Which term is analogous to futures research? a. Futuristics b. Futurology c. Foresightology d. Rationalistics ANS: B

Futures research, or futurology, refers to the study of the future with the goal of identifying possible, probable, and preferable futures. The remaining terms do not exist.

DIF: Cognitive Level: Knowledge

REF: p. 612

3. An agency has just implemented electronic medication administration records (eMARs). This

would be an example of what level of change? a. First-level change b. Second-level change c. Third-level change d. No change ANS: A

The implementation of eMARs is an example of a first-level change. Previously, medications were documented using a paper system, not an electronic system.

DIF: Cognitive Level: Apply

REF: p. 613 | p. 620

4. A hospital has just implemented barcoded medication administration (BCMA). This would be an

example of what level of change? a. First-level change b. Second-level change c. Third-level change d. No change ANS: B

Implementing BCMA would be a second-level change. The implementation of BCMA has not only changed how medications are documented, but it has actually changed the process of medication administration.

DIF: Cognitive Level: Apply

REF: p. 613

5. A nurse is asked by the nursing manager to review electronic comments left by patients on the

unit’s Facebook page. The nurse examines the comments for common themes. This is an example of: a. trend analysis. b. scenarios. c. content analysis. d. backcasting.

ANS: C

This is an example of content analysis. The content of the comments left by the patients is examined for common themes.

DIF: Cognitive Level: Apply

REF: p. 615

6. Which description best defines nanofabrication? a. The study of controlling and altering matter at the atomic or molecular level b. The development of materials used in structures, electronics, and commercial

products c. A subdiscipline of nanotechnology centering on the application of nanoparticles

and nanoscience techniques to healthcare and clinical research d. The use of biomedical informatics techniques and tools for nanoparticle data and

information to improve research in the field of nanotechnology ANS: B

Nanofabrication is the development of materials used in structures, electronics, and commercial products. Nanotechnology is the study of controlling and altering matter at the atomic or molecular level. Nanomedicine is a subdiscipline of nanotechnology centering on the application of nanoparticles and nanoscience techniques to healthcare and clinical research. Nanoinformatics is the use of biomedical informatics techniques and tools for nanoparticle data and information to improve research in the field of nanotechnology.

DIF: Cognitive Level: Remember

REF: p. 623

7. An organization decides to utilize a silver nanoparticle in the production of a product in order to

make the product antimicrobial. This is an example of: a. nanofabrication. b. nanomedicine. c. health information exchange. d. nanoinformatics.

ANS: A

The purpose and goal of nanofabrication is to utilize nanoparticles to improve existing structures, devices, products, etc.

DIF: Cognitive Level: Analyze

REF: p. 623

8. What is the primary goal of nanomedicine? a. The advancement of man through the modification of the human body with

nanotechnology b. Development of nanomaterials used in electronics, structural materials, and

commercial products c. Creation of materials, devices, and other structures at the nanoscale d. The use of nanotechnology for the prevention, diagnosis, and treatment of disease

ANS: D

The primary purpose of nanomedicine is the use of nanotechnology for the prevention, diagnosis, and treatment of disease. The advancement of man through the modification of the human body with nanotechnology; development of nanomaterials used in electronics, structural materials, and commercial products; and creation of materials, devices, and other structures at the nanoscale are not primary purposes of nanomedicine.

DIF: Cognitive Level: Remember

REF: p. 624

9. Nanoparticles appear to have a very bright and meaningful future in the world; however, what is

one potential issue with nanoparticles? a. Development of the field of nanoinformatics and nanomedicine is difficult. b. Creation of nanoparticles has not yet come to full fruition. c. There are cytotoxicity and ethical concerns regarding the use of nanoparticles. d. No methods exist to successfully combat cytotoxicity and clearance of nanoparticles.

ANS: C

A potential issue with nanoparticles is that there are cytotoxicity and ethical concerns regarding the use of them. Development of the field of nanoinformatics and nanomedicine is difficult, creation of nanoparticles has not yet come to full fruition, and the lack of methods to successfully combat cytotoxicity and clearance of nanoparticles are not potential issues with nanoparticles.

DIF: Cognitive Level: Remember

REF: p. 624 | p. 625

MULTIPLE RESPONSE 1. Which goals apply to the field of nanoinformatics? (Select all that apply.) a. Enhancing the quality of data about nanoparticles b. Enhancing the availability of data about nanoparticles c. Combating the negative imagery of nanotechnology d. Expanding nanotechnology theory, modeling, and simulation e. Developing an informatics infrastructure ANS: A, B, D, E

The NNI’s document lists enhancing quality and availability of data, expanding nanotechnology theory and simulation, and developing an informatics infrastructure as goals for the field. While, as with any technology, there are potential challenges and downsides, there is no overt public aversion to the idea of nanotechnology that needs to be managed or combated.

DIF: Cognitive Level: Remember

REF: p. 624 | p. 625