Test Bank for Health Informatics: An Interprofessional Approach 3rd Edition by Lynda R Hardy

TEST BANK

TEST BANK

SECTION 1 Fundamental Knowledge in Health Informatics Chapter 1 An Introduction to Health Informatics Chapter 2 Theoretical Frameworks Chapter 3 Health Systems and Information Flow Chapter 4 Informatics-Related Standards and Standard Setting Chapter 5 Evaluation of Health Information Systems—Purposes, Theories, and Methods

SECTION 2 Health Information Systems and Applications Chapter 6 Technical Infrastructure Chapter 7 The Electronic Health Record and Precision Care Chapter 8 Administrative Applications in Healthcare Chapter 9 Community Health Systems Chapter 10 Public Health Informatics

SECTION 3 Decision-Making and the Digitally Engaged Patient Chapter 11 Evidence-Based Informatics Chapter 12 Clinical Decision Support Chapter 13 The Evolving ePatient Chapter 14 Digital Health: Managing Health and Wellness Chapter 15 Personal Health Records Chapter 16 Social Media Tools for Health Informatics

SECTION 4 Lifecycle Management Chapter 17 Project Management Principles Chapter 18 Strategic Planning and Information System Selection Chapter 19 Contract Negotiations and Software Licensing

Chapter 20 Implementing and Upgrading an Information System Chapter 21 Downtime and Disaster Recovery for Health Information Systems

SECTION 5 Usability, Analytics, and Education Chapter 22 Improving the User Experience for Health Information Technology Chapter 23 Data Science and Analytics in Healthcare Chapter 24 Safety and Quality Initiatives in Health Informatics Chapter 25 Informatics in the Curriculum Chapter 26 Distance Education—A New Frontier

SECTION 6 Data Governance, Legal, and Regulatory Issues Chapter 27 Legal Issues, Federal Regulations, and Accreditation Chapter 28 Privacy and Security Chapter 29 MACRA and Interoperability Chapter 30 Health Policy and Health Informatics Chapter 31 Health Information Technology Governance

SECTION 7 Global and Future Perspectives in Health Informatics Chapter 32 Global Health Informatics Chapter 33 Informatics and the Future of Healthcare

Chapter 01: An Introduction to Health Informatics Hardy: Health Informatics: An Interprofessional Approach, 3rd 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 ANS:

to

B

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 ANS:

as well as a(n)

.

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

3. 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.

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DIF:

Cognitive Level: Analyze

4. 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. SLC 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

5. Informatics allows clinicians to see real time data and allows user to

for

public health approaches to care in healthcare. a. Meaning b. Manage c. Materialize d. Mapping ANS:

B

With continuing progression in the use of technology and healthcare, clinicians can predict and improvement healthcare outcomes.

DIF:

Cognitive Level: Understand

6. Health informaticians must be able to conceptual organize a variety of

to

better understand data analysis. a. Components b. Concepts c. Ideas d. Algorithms ANS:

A

Informaticians utilize healthcare knowledge, visualization, and outcome prediction to access raw information and turn it into meaningful use data.

DIF:

Cognitive Level: Understand

7. Achievable competencies developed by the IOM that should be achieved by clinicians to

deliver patient-centered care include: a. Collaboration, reduction of errors, patient centered, data collection b. Independent, evidence-based practice, reduction of hospital readmissions, use of informatics c. Collaboration, evidence-based practice, quality improvement, use of informatics d. Collaboration, individual practice, quality improvement, use of Informatics ANS:

C

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In 2003 the IOM identified core measures that healthcare professionals should achieve in order to deliver patient-centered care.

DIF:

Cognitive Level: Remember

MULTIPLE RESPONSE 1. Patient care tools are very popular for patients. Examples of a patient care tool is: (Select all

that apply.) a. Fitness app b. Smart watch c. Continuous glucose monitoring d. Wireless monitoring device e. Blood pressure cuff f. Triage center ANS:

A, B, C, D

Technology now allows patients to take control and monitor their health with the use of smart phones, smart watches, remote wireless monitoring that provides patient data into a cloud type device.

DIF:

Cognitive Level: Apply

2. The HITECH Act primary purpose was to encourage healthcare providers to adopt EHR

systems for what reasons: (Select all that apply.) a. Financial incentives b. Mortality reduction c. Data governance d. Decrease fraudulent billing ANS:

A, B, C

The HITECH Act that was signed into law in 2009 was enacted to promote meaningful use in technology to help lower mortality rates, increase quality patient care, reduce errors, and collection of patient health data analytics for Medicare and Medicaid patients.

DIF:

Cognitive Level: Understand

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Chapter 02: Theoretical Frameworks Hardy: Health Informatics: An Interprofessional Approach, 3rd 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

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

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

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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

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

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

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

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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

8. 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

9. When utilizing Kurt Lewing's change theory, and example of refreezing would be: a. Updated employee handbooks. b. Survey employees of thoughts of new process. c. Rounding on employees to view the newly implemented process in action. d. Display education and posters of upcoming process change.

ANS:

A

Planned process change must go threw three steps. These steps include unfreezing, moving, and refreezing. During the unfreezing step behaviors are observed and predicted for the upcoming change. This will assist in understanding potential obstacles or mind steps that may sabotage the change. During the moving step the change is implemented. During this step monitor the behaviors, feelings and thoughts of staff in order to positively move forward with the change. Lastly, refreezing involves the change becoming permeant by changing education material, employee handbooks, contracts, and protocols.

DIF:

Cognitive Level: Apply

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

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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

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Chapter 03: Health Systems and Information Flow Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. Patient medical records on paper provide fragmented or no data related to: a. Patient identity b. Patient information c. Patient decision making d. Patient communication ANS:

C

Patient medical records on paper were used prior to the electronic health record and are still used in some facilities. Paper medical records disrupt the ability to provide the patient with improved healthcare decisions that are relevant to the disease process, laboratory studies, and imaging results.

DIF:

Cognitive Level: Understand

2. A data warehouse is a type of data storage system that is beneficial to which type of setting? a. Healthcare setting b. Business setting c. Education setting d. Government setting ANS:

B

A data warehouse stores processed data that is structured with specific information. This type of data storage works well for a business setting that needs to evaluate inventory or managing customers.

DIF:

Cognitive Level: Remember

3. When a healthcare clinician scans a patient's armband, this is an example of what type of data

entry? a. Point-of-care b. Clinical intelligence c. CDS tool d. Observational research ANS:

A

Point-of-care data provides automated information into the patient electronic health record.

An example of automated instrument use is patient barcode scanning.

DIF:

Cognitive Level: Remember

4. Visualization techniques, such as dashboards, display patient data in the electronic health

record and are a by-product of: a. Algorithms b. Benchmarking c. Data flow

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d. Enterprise data warehouse (EDW) ANS:

D

The enterprise data warehouse (EDW) serves as a place to store data. This data can be transformed into visual information that can be represented in the EHR as dashboards. The EDW needs support from information technology for the data to be meaningful to the end user.

DIF:

Cognitive Level: Apply

5. The enterprise data warehouse has faced obstacles while integrating patient data. What is this

obstacle? a. Compliance b. Standardization c. Privacy d. Financial ANS:

B

Because of the lack of structure in data warehousing, it is difficult to have a standard in place to process and store data that has been collected. This lack of standardization has caused different formats being provided and supported in healthcare systems.

DIF:

Cognitive Level: Remember

6. Data mining can produce assistance to the patient's profile and improve: a. Patient outcomes b. Patient knowledge c. Patient network d. Patient interaction ANS:

A

Patient data mining is a key component for the informaticist to understand specific patient data information. This specific information can improve patient care by improving patient outcomes.

DIF:

Cognitive Level: Apply

7. An informaticist can assist the health care provider by presenting meaningful data. Which

type of usable data is a list of patients who have not filled their diabetic insulin prescription in the last 3 months? a. Illness prevention b. Promote wellness c. Aid in healthcare decision-making d. Care cohesion ANS:

A

An informaticist uncovers findings with the use of technology and data mining. When this data is analyzed, it is empowering and can make a significant impact on patient care. Illness prevention is the ability to identify patients who are at high risk of advancing their disease process.

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DIF:

Cognitive Level: Apply

MULTIPLE RESPONSE 1. Health information technology in healthcare allows health information to improve quality

patient care by: (Select all that apply.) a. Improving the clinical decision support b. Reducing medical errors c. Managing patient care d. Implementing process improvement measures e. Reducing reckless practice ANS:

A, B, C, D

The need for improved patient care was recognized by the Joint Commission after noticeable preventable patient errors were found. The electronic health record allows health information to become managed and explored.

DIF:

Cognitive Level: Understand

2. Examples of structed data include: (Select all that apply.) a. Patient phone number b. Patient medical record number c. Patient clinical summary d. Patient birth date e. Patient gender ANS:

A, B, D, E

Structured data includes numbers, dates, lab values, and medical coding. Unstructured data is free text.

DIF:

Cognitive Level: Remember

3. Accessing data and electronic health records requires permission from the IT department.

Role-based access provides which type of privileges? (Select all that apply.) a. User name b. Password c. VPN d. Email ANS:

A, B

Role-based access has the fewest privileges and is the most widely used. Therefore, it has minimum login access requirements.

DIF:

Cognitive Level: Understand

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Chapter 04: Informatics-Related Standards and Standard Setting Hardy: Health Informatics: An Interprofessional Approach, 3rd 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

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 the American Nurses Association.

DIF:

Cognitive Level: Remember

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

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

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The ICNP is a unified nursing language system into which nursing terminologies can be cross-mapped.

DIF:

Cognitive Level: Remember

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

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

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

ANS:

C

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

DIF:

Cognitive Level: Remember

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

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The terminologies that contain nursing languages include SNOMED, the Omaha System, and NANDA. DIF:

Cognitive Level: Understand

2. Which terminologies are recognized by the ANA? (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

3. Which languages does the nursing 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. The nursing 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

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Chapter 05: Evaluation of Health Information Systems—Purposes, Theories, and Methods Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. An example of an assigned nursing intervention code is: a. CAB b. CE2 c. 356 d. XXI ANS:

B

Use of nursing intervention codes are reported as an alphanumeric code.

DIF:

Cognitive Level: Apply

2. Healthcare clinical data is complex in nature. For data to be understood, which type of

terminology is used? a. CPTs b. NANDA c. Cross -mapping d. CDSS ANS:

C

Terminology harmonization allows EHR programs to understand the variations of information put in by the user. In order to blend the meaning of the inputted information, a standardization of terminology must be used. LOINC, SNOWMED, ICD-10, and HL7 allow for a cross-reference of terminology to be used.

DIF:

Cognitive Level: Understand

3. Which standard has been developed to encourage data to be integrated using a complex

computer language? a. HL7 b. XML c. Metathesaurus d. NLP ANS:

A

HL7 is a standard to regulate data exchange. It is a comprehensive framework that encourages data retrieval and data exchange.

DIF:

Cognitive Level: Understand

4. A large multilingual vocabulary database known as the UMLS Metathesaurus is updated by

the National Library of Medicine every six months for what purpose? a. Billing codes b. Procedural codes c. Concepts and research

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d. Classification changes ANS:

C

The UMLS Metathesaurus is updated every 6 months because of the rapid changes in evidence-based practice. More than 4.4 million concepts are updated. The database also cross references other unique identifiers of the same concept.

DIF:

Cognitive Level: Understand

5. Which challenge prevents the reduction of healthcare costs when implementing a nationwide

Learning Health System (LHS)? a. Substandard interface b. Substandard guidelines c. Substandard specifications d. Substandard protocols ANS:

A

With the introduction of the electronic health record, the ultimate goal was to improve patient care and reduce medical errors through the use of standardized healthcare forms. Additionally, Medicare and Medicaid would benefit with cost reductions by implementing a nationwide learning health system. This system utilizes patient electronic record data to generate predictive data to help prevent extended sick visits from occurring. The challenge is poor interoperability among the variety of software EHR systems and poor data being entered.

DIF:

Cognitive Level: Understand

6. Cognitive theoretical perspectives involve human cognition or psychological processes that

include a. Social, motivation, technical b. Cognition, motivation, behavior c. Assessment, motivation, behavior d. Plan, develop, implement ANS:

B

Cognitive framework measures how people make decisions. Cognitive theoretical perspectives involve both the cognitive and psychological processes that humans work through.

DIF:

Cognitive Level: Remember

MULTIPLE RESPONSE 1. Identifying terms and concepts that express a specific meaning and standard terminology is

necessary for standardization of a electronic health record. The identified multidisciplinary terminologies use which components to regulate these terminologies within a system? (Select all that apply.) a. LOINC b. CDSS c. NMDS d. SNOMED

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ANS:

A, D

Medical terminology within an electronic system requires standards to define entries and categories for information to be stored correctly. The American Nurses Association recognizes two specific datasets known as LOINC and SNOMED. Snomed determines global standards and health care terms for electronic language. LOINC is a database that standardizes laboratory observations.

DIF:

Cognitive Level: Apply | Cognitive Level: Understand

2. An example of quality of care monitoring includes which of the following? (Select all that

apply.) a. Wrong medication given b. Types of medications a patient is taking c. Results of a radiology report d. Medication reconciliation e. Nurse staffing ratio ANS:

A, B, D, E

Quality patient care and benchmark standards are established by examining gaps in care and practice patterns. Inputed information on a patient's health record can assist in identifying the gaps needed to improve patient care.

DIF:

Cognitive Level: Apply | Cognitive Level: Understand

3. An example of qualitative research involves: (Select all that apply.) a. One-on-one interview b. Focus groups c. Observations d. Survey percentages e. Survey responses ANS:

A, B, C, E

Qualitative studies are designed around categorical information. These types of studies allow researchers to move the data into the categories of their choice. Quantitative studies include data that is numerical.

DIF:

Cognitive Level: Apply

4. Examples of process measures are: (Select all that apply.) a. Prophylactic antibiotic therapy b. Fibrinolytic use for acute myocardial infarctions c. Satisfaction score d. Decrease in hospital readmissions e. Umbrella charges ANS:

A, B

Process measures are actions, guidelines, or responses involved in a patient's care.

DIF:

Cognitive Level: Apply

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Chapter 06: Technical Infrastructure Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. Which item is an example of information that might be found 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 laboratory test d. Monthly billing charges for the radiology department ANS:

C

The result of a patient's microbiology laboratory test is an example of information found in a CDR. The other items would be found in other administrative databases.

DIF:

Cognitive Level: Understand

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.

DIF:

Cognitive Level: Understand

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 was 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.

DIF:

Cognitive Level: Apply

4. Within the distributed model and the centralized model of data sharing networks, a network

must be able to utilize this function between organizations. a. Retrieve data b. Match patients c. Connect to internet

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d. Self-support ANS:

B

When an organization is retrieving data for a specific patient, the distributed and centralized models must be able to match a patient within the central storage repository to provide adequate information regarding a patient. The patient's MPI attributes the correct data to a specific patient.

DIF:

Cognitive Level: Understand

5. 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.

DIF:

Cognitive Level: Remember

6. A significant challenge to technical infrastructures in healthcare environments is: 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.

DIF:

Cognitive Level: Understand

MULTIPLE RESPONSE 1. 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

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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

2. The use of remote storage systems often referred to as a cloud must take extra steps to ensure

cyber security, including: (Select all that apply.) a. Data encryption b. User authentication c. Secure protocols d. Two-way authenticators e. Weak password ANS:

A, B, C, D

Security is essential for cloud-based repository storage. Regulations for HIPAA and the HITECH Act require patient security methods to be secure. Users must be mindful of phishing schemes and other social hacking concepts.

DIF:

Cognitive Level: Apply

3. EHR systems are equipped with many patient safety features. Some of these features include:

(Select all that apply.) a. Medication safeguards b. Patient safety alerts c. Disease process order sets d. Predictable behaviors ANS:

A, B, C

Tools placed within the EHR are designed to assist the clinicians in providing quality patient care. These safety features can provide medication interaction alerts, recognize trending behaviors through vital signs, and more.

DIF:

Cognitive Level: Apply

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Chapter 07: The Electronic Health Record and Precision Care Hardy: Health Informatics: An Interprofessional Approach, 3rd 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

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

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)

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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

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

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

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

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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

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

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

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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 the design, testing, and implementation of the system b. Conduct a quantitative research study to provide deeper insight into CPOE issues c. Design the new system to support communication and workflow d. Educate clinicians on how to use the system 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 the benefits and issues surrounding computerized provider order entry and some decision support capabilities. Quantitative research is helpful but would not provide the deeper content of the issues.

DIF:

Cognitive Level: Apply

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

items are perceived EHR benefits for the consumer? (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 the ability to customize care through appointment reminders, health risk assessments, and timely access to personal health information. The availability 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 the EHR has the potential to address these items, security and privacy of personal information are perceived as major concerns and, therefore are not a benefit to the consumer.

DIF:

Cognitive Level: Apply

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Chapter 08: Administrative Applications in Healthcare Hardy: Health Informatics: An Interprofessional Approach, 3rd 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 the clinical 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

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

would be used to show a snapshot of the bottom 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 the following formula: revenue – expenses = profit. This is often referred to as the bottom line. The balance sheet, on the other hand, reflects an organization's assets, liability, and equity.

DIF:

Cognitive Level: Understand

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 the return on investment or understanding the importance of the investment in FISs, since information technology software applications, such as patient accounting or revenue, are considered intangible assets.

DIF:

Cognitive Level: Apply

4. The supply item master is:

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a. b. c. d.

an electronic history of all transactions. an electronic pricing list of all supplies and services. a list of all items available to order in the organization. a list of vendors who supply items to the organization.

ANS:

C

The supply item master is the master list of supplies available to order in the organization.

DIF:

Cognitive Level: Remember

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

ANS:

B

Materials management is a subset within supply chain management that focuses on the storage, inventory and quality control, and operational management of supplies, pharmaceuticals, equipment, and other items used in the delivery of patient care or managing the patient care system. Logistics involves the flow of goods and services from the point of origin to the point of consumption and thus falls outside the realm of materials management.

DIF:

Cognitive Level: Understand

6. A vendor master file is: a. a list of federally approved pharmaceutical companies. b. a list of suppliers used by the organization. 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 the organization.

DIF:

Cognitive Level: Remember

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 the schedule 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 the internet.

DIF:

Cognitive Level: Remember

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MULTIPLE RESPONSE 1. When using the online billing and payment tool, which functions directly benefit the patient?

(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 the business office e. Ability to update address or demographic changes f. Automate the provider'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 the business office, and ability to update address or demographic changes are components of the online billing and payment system that benefit patients. These functions benefit patients because patients can access the system to perform the listed functions at their convenience. Though they may indirectly benefit the patient, automating the provider's day and providing the provider with a dashboard view are direct benefits for the provider.

DIF:

Cognitive Level: Understand

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 the following processes: transportation of supplies, storage of supplies, and management of supplies. It does not include a prediction of the supplies used and is not part of a facility's marketing efforts.

DIF:

Cognitive Level: Understand

3. Supply charge capture is a process that: (Select all that apply.) a. helps make sure patients are charged for supplies used in the patient's care. b. helps to manage and inventory supplies. c. accounts for pharmaceutical supplies based on federal requirements. d. closely links the supply chain to the revenue 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 the loss 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 the use of supplies doesn't fall through the cracks.

DIF:

Cognitive Level: Apply

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Chapter 09: Community Health Systems Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. Which payer is the largest for home health services? a. Private insurance b. Patients and families in the form of self-pay c. Medicare d. Medicaid ANS:

C

As the largest payer, Medicare, through its Conditions of Participation, represents the standard for the services provided by home health agencies and the payment for these services by many commercial insurance payers and state Medicaid programs.

DIF:

Cognitive Level: Understand

2. What are the two important purposes of the OASIS dataset? a. Determine payment and measure quality and outcomes b. Determine payment and standardize data c. Determine the time of visits and measure quality and outcomes d. Determine efficiency and measure quality and outcomes ANS:

A

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

DIF:

Cognitive Level: Understand

3. When did formalized home health and community-based systems originate in the United

States? a. 1776 b. 1800s c. 1965 d. 2001 ANS:

B

Early home health services originated in the United States in the 1800s and were based on the district 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

4. What technology has been described as the next frontier for home health and related

community-based systems? a. EHR b. CDS

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c. EMR d. BCMA ANS:

B

Clinical decision support (CDS) systems may be the next 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

MULTIPLE RESPONSE 1. Which of the following tools will the standardized hospice dataset probably contain? (Select

all that apply.) a. Pain assessment b. Social aspect of care c. End of life care d. Survey of missed nursing care ANS:

A, B, C

The dataset will include composite measures set by hospice and palliative care process measures. Hospice order sets must include two measures: patient related and structural. Pain assessment and end of life care are patient centered. Social aspect of care is a structural domain within a data set.

DIF:

Cognitive Level: Understand

2. What are the key tenants of the Quadruple 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 the most abstract level of healthcare services in the United States. It includes better care for individuals, better health for populations, and reduction of per capita costs.

DIF:

Cognitive Level: Understand

3. What are the primary 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 the point-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

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

Patients do not participate in the development of EHRs. DIF:

Cognitive Level: Remember

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 the nursing or problem-solving process. It consists of the Problem Classification Scheme (assessment), Intervention Scheme (service delivery/activities), and Problem Rating Scale for Outcomes (evaluation). When nurses and other clinicians use the Omaha System, they can describe, quantify, and communicate details about their practice.

DIF:

Cognitive Level: Remember

5. What are the core 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

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 the quality 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.

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DIF:

Cognitive Level: Understand

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Chapter 10: Public Health Informatics Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. All of the following 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 the health of populations before they are injured or ill; clinical care, not public health, involves treating individuals.

DIF:

Cognitive Level: Understand

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

differences? a. Public health is focused on the prevention and health of populations before they are ill. b. Public health is focused on one individual at a time to ensure the best possible outcome. c. The health of a community is measured using sophisticated technologies like MRIs. d. Public health is focused on one family at a time to ensure the best possible outcome.

ANS:

A

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

DIF:

Cognitive Level: Analyze

3. You are asked to justify the creation of the first 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 the community level. c. interoperability already exists for public health IT. d. standards already exist for PHI. ANS:

A

Although all four options are relevant issues in PHI, only the fact that PHI can identify and target clusters of diseases for treatment and action is an actual benefit to the community of adding this new program.

DIF:

Cognitive Level: Analyze

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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 the best examples of a public health system that does all of these is: a. the linkage of local electronic health records in the 50 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. The others lack one or more of the stated elements.

DIF:

Cognitive Level: Understand

5. Which event shifted the focus from public health surveillance of medical issues such as the flu

and food poisoning to using medical intelligence for situational awareness? a. Ebola outbreak b. COVID-19 pandemic c. H1N1 Influenza pandemic d. SARS ANS:

A

Global monitoring is important to notify, track, and provide valuable information to the public through data. The Ebola outbreak of 2015 resulted in improved monitoring within the CDC and the WHO. The outbreak displayed a need to improve sharing information globally to decrease public outbreaks.

DIF:

Cognitive Level: Remember

6. To reduce future pandemics, what must occur within the healthcare systems? a. Increase staff b. Update surveillance systems c. Improve global communication d. Develop global HIE ANS:

B

An outdated public health surveillance system decreases the ability to communicate globally and share data that could have a large impact on the public's health. This was on display during the COVID-19 pandemic when healthcare systems failed to provide disease surveillance, proper reporting, and monitoring the progression of the disease.

DIF:

Cognitive Level: Apply

MULTIPLE RESPONSE 1. Public health benefits using the health information exchange by: (Select all that apply.) a. Timely and complete reports

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b. c. d. e.

Reported preventive health Monitoring only specific location Providing public health alerting Laboratory reporting

ANS:

A, B, D, E

Public health agencies receive a large amount of valuable patient data that can benefit the public by using predictors, faster transmission of records, analysis of gaps in preventable health, and more.

DIF:

Cognitive Level: Apply

2. An example of an ecological threat is: (Select all that apply.) a. Irritated airway b. Increased estrogen c. Contaminants in drinking water d. Cancer ANS:

A, B, C, D

The ecological system has a great impact on the human body. Increased pollution can cause irritation of the airway triggering asthma. Pesticides and herbicides can contaminate the drinking water supply in water sheds, increasing estrogen and cancer-causing radicals in animals and humans.

DIF:

Cognitive Level: Apply

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

sent. automating patient education from electronic health records. automating 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 the use of computable logic to define where and how reports should be sent, automation of information extraction from the electronic health record, creating public health information systems to receive case reports, and standardization of message structure and content for reporting.

DIF:

Cognitive Level: Remember

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Chapter 11: Evidence-Based Informatics Hardy: Health Informatics: An Interprofessional Approach, 3rd 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 includes all these aspects.

DIF:

Cognitive Level: Remember

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

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

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

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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

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

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

7. Which program displays teamwork communication and skills among healthcare professionals

to enhance patient care? a. Healthcare Research and Quality Reports b. National Healthcare Quality Report c. Team Strategies and Tools to Enhance Performance and Patient Safety d. Star Model of Knowledge Transformation ANS:

C

A variety of models and programs have successfully integrated into EBP and improving patient safety and care. The national Team STEPPS has been the most prominent. In 1995, Team STEPPS rolled out across military healthcare and was based on engineering and solving urgent problems and working with a collaborative team approach.

DIF:

Cognitive Level: Remember

8. When performing a PBE study, researchers use which type of sample size and sources? a. Large sample, similar sources b. Small sample, diverse sources

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c. Large sample, diverse sources d. Small sample, similar sources ANS:

C

When performing PBEs, researchers use a detailed standardization of a sample but with specific parameters.

DIF:

Cognitive Level: Apply

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

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

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

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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

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 to use it in practice.

DIF:

Cognitive Level: Remember

5. For PBE research to be valid, what needs to occur? (Select all that apply.) a. Supervision from advance researchers b. Quality control checks c. Secure data entry software d. Accurate terminology ANS:

B, C

Detailed documentation is necessary for PBE to be entered into a standard secure electronic documentation system. Additionally, PBE research needs quality control measures and checks to verify the authenticity of the data.

DIF:

Cognitive Level: Understand

6. The purpose of an EBP model is to identify which potential need? (Select all that apply.) a. Problem b. Answer c. Topic d. Reply e. Question ANS:

A, C, E

A systematic approach to answering EBP models requires identifying a question that needs to be solved, the topic to solve, and/or the problem in healthcare.

DIF:

Cognitive Level: Remember

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Chapter 12: Clinical Decision Support Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. Why have most clinical decision support (CDS) systems not shown to significantly impact

patient outcomes in clinical trials, despite the fact 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 the impact 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

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 the specific CDS under consideration and the governing healthcare payment model in place.

DIF:

Cognitive Level: Apply

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

4. Which statement is not part of the Ten Commandments of CDS? a. Speed is everything.

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b. Fit into the user's workflow. c. Alerting is the most 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 the user's workflow, and ask for additional information only when you really need it. Alerting may not be the most effective approach to CDS as it may cause alert fatigue, so it is not one of the Ten Commandments of CDS. DIF:

Cognitive Level: Remember

5. Which incentive has the strongest potential to spur the nationwide 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 the delivery 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 the chapter, the shift of healthcare payment from a fee-for-service model to approaches rewarding the delivery of better quality and outcomes at lower cost appears to have the strongest potential for change.

DIF:

Cognitive Level: Apply

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

2. Why is CDS important for healthcare institutions? (Select all that apply.) a. It can reduce the need 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 the growth in use of facilities to manageable levels.

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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 the potential to improve the value of care. CDS have not been found to reduce the need for registered nurses, nor have they been tested for impact on facility use.

DIF:

Cognitive Level: Apply

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 the performance of human experts. b. Clinicians generally must go out of their routine workflows to use the systems, 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 the chapter, systems that are misaligned with the clinician'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

4. Which of the following 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 the choices 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

5. Which of the following practices are included in the CDS Five Rights? (Select all that apply.) a. Providing the right information b. Providing to the right person c. Providing at the right point in the workflow d. Providing the right reference information e. Using the right intervention format ANS:

A, B, C, E

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The CDS Five Rights include providing the right information to the right person at the right point in the workflow, using the right 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 the CDS Five Rights.

DIF:

Cognitive Level: Remember

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Chapter 13: The Evolving ePatient Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. An ePatient is best described as one who: a. seeks health information from various sources and uses the information for

decision making with health providers. b. manages health decisions, uses the internet, and uses biosensors. c. collaborates with the health 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 the information 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

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 the full continuum of care. Integrated care focuses on coordinating care between the healthcare disciplines. Authoritative care is paternalistic and does not include the patient in the decision-making process. Community care focuses on coordinating care across resources found in the community where the patient resides.

DIF:

Cognitive Level: Understand

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 the tactics of graphing data, recording lab values, and using a sleep diary; however, all of these fall under the umbrella of tracking personal metrics, which best describes what it means to be a quantified selfer.

DIF:

Cognitive Level: Remember

4. The maxim "Doctors know best":

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a. b. c. d.

is one of the tenets of participatory medicine. is a hallmark of integrated care. is the tagline for Health 2.0 websites such as WebMD. is the paradigm for a paternalistic care model.

ANS:

D

"Doctors know best" is the paradigm for the paternalistic care model. Participatory medicine includes the patient 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

5. The culture of the patient-clinician partnership always includes: a. requirements found in the Patient 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 the patient-clinician partnership always includes ePatients and clinicians working in collaboration toward shared goals. The Patient 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 the patient-clinician partnership.

DIF:

Cognitive Level: Understand

6. The goal of

has been to increase the transparency of medical documentation, by touting the benefits 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. The OpenNotes Project, begun in 2010, has fought to counter this reluctance by highlighting the many benefits of transparency.

DIF:

Cognitive Level: Remember

7. 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

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

DIF:

Cognitive Level: Remember

8. In 2013 a Health Online survey found that how many U.S. adults have gone online to find

health information? a. Two thirds b. Half c. One fourth d. One third ANS:

D

An article published in 2013 noted that nearly one third of U.S adults had searched the internet to diagnosis their medical condition.

DIF:

Cognitive Level: Remember

9. The use of patient portals is reported to be around: a. 10%-20% b. 15%-25% c. 15%–30% d. 20%–30% ANS:

C

Patient portals are an ehealth mechanism that allows patients to access records, schedule appointments, make payments, receive education, and communicate with clinicians. In 2020, the U.S. Government Accountability Office reported that only 15%–30% of patients use this online feature.

DIF:

Cognitive Level: Remember

MULTIPLE RESPONSE 1. Digital Health includes: (Select all that apply.) a. At-home test kits b. Telehealth medicine c. Professional video conferencing d. Google research e. Remote patient monitoring ANS:

A, B, C, E

During the COVID-19 pandemic, digital health and technology were heavily utilized by providers to provide patient care.

DIF:

Cognitive Level: Remember

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Chapter 14: Digital Health: Managing Health and Wellness Hardy: Health Informatics: An Interprofessional Approach, 3rd 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

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

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

4. Which is not a major driving force fueling the mHealth movement?

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a. b. c. d.

An aging society Cost savings and earning potential Consumer/patient engagement movement 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

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

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

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

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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

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 moderate-quality, 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

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

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 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

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Chapter 15: Personal Health Records Hardy: Health Informatics: An Interprofessional Approach, 3rd 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

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

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

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

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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

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

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

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

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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

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

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

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

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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

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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. 42

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: pp. 43-44

3. What is the form of knowledge in discovery research? a. Single research studies b. Meta-synthesis c. Systematic review d. 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. 44

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: pp. 44-45

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. Translation to guidelines c. Practice integration d. Evaluation of process and outcomes

ANS: B

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: pp. 46-47

6. Which indicators have been established for healthcare improvement and for public reporting? a.

Quality indicators b. Efficiency indicators c. Cost indicators d. Longevity indicators ANS: A

Evaluation of specific outcomes has risen to a high level of public interest. As a result, quality indicators are being established for health improvement and public reporting.

DIF: Cognitive Level: Knowledge

REF: p. 50

MULTIPLE RESPONSE 7.

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: Knowledge 8.

REF: p. 40

Which of the following are evidence summaries: (select all that apply.) a. Literature reviews b. Systematic reviews c. Integrative reviews d. Single study reviews

ANS: A, B, C

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

DIF: Cognitive Level: Knowledge 9.

REF: pp. 44-45

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: Knowledge

REF: pp. 43-44

10. 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: Knowledge

REF: p. 42

MULTIPLE CHOICE 1. Which measure is most important for evaluating the performance of classifiers, models that predict

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

The area under the receiver operating characteristic (ROC) curve is the most important overall measure of classifier performance.

DIF: Cognitive Level: Remember

REF: p. 62

2. Which specialized method(s) is (are) used in knowledge discovery and data mining? a. Stratified

sampling b. Conceptual analytic methods c. Selection of the optimal 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. 56

3. The process of knowledge discovery and data mining is best characterized as: a. machine learning, use of statistical methods, 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. 56

4. Which characteristic is an advantage that practice-based evidence studies have over RCTs? a. Large sample sizes can be obtained easily. b. Multiple sites are typically enrolled, resulting in greater generalizability. c. Study efficacy is greater.

d. Multiple variables can be studied.

ANS: C

Practice-based evidence (PBE) designs trade away the internal validity of RCTs for external validity. PBE designs have high external validity because they include virtually all patients with, or at risk for, the condition under study, as well as potential confounders that could alter treatment responses. PBE designs attempt to minimize threats to internal validity by trying to collect information on all patient variables – demographic, medical, nursing, functional, and socioeconomic – that might account for differences in outcome. By doing so, PBE designs minimize the need for compensating statistical techniques such as instrumental variables and propensity scoring to mitigate selection bias effects, unknown sources of variance, and threats to internal validity.

DIF: Cognitive Level: Understand

REF: pp. 62-64

5. Which is not a common step in a practice-based evidence study? a. Assemble a multidisciplinary project team b. Measure patient severity c. Obtain patient consent d. Collect data

ANS: C

It is not necessary to obtain patient consent when treatment is not altered.

DIF: Cognitive Level: Understand

REF: pp. 66-67

6. Practice-based evidence studies differ from traditional observational designs in several main ways.

What is one of those main differences? a. Exhaustive attention paid to patient characteristics b. Excluding clinicians in the study design to improve treatment efficacy c. Use of small sample sizes and specific patient sources/settings d. General, unstructured documentation of interventions

ANS: A

Practice-based evidence involves intense attention to patient characteristics; including clinicians in the design; use of large sample sizes and diverse patient sources/settings; and detailed, standardized structured documentation of interventions.

DIF: Cognitive Level: Apply

REF: p. 56

MULTIPLE RESPONSE 7. 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. 61; Table 4-2

8. Practice-based evidence requires close partnering with informatics specialists to: (select all that

apply) a. b. c. d.

design screens and terms to capture interventions. create and maintain the databases required for PBE studies. upgrade EHR modules so all sites are on the same version of software. ensure all end users are trained.

ANS: A, B

While upgrades are an informatics responsibility, sites do not have to be on the same version of software to do PBE studies.

DIF: Cognitive Level: Understand

REF: pp. 66-67

9. In which aspects does practice-based evidence differ from evidence-based practice? (select all that

apply) a. b. c. d. e.

PBE incorporates patient choices in decision-making.

EBP determines best practices using best evidence like results from RCTs. PBE includes family involvement.

PBE is prospective, while EBP is retrospective.

PBE attempts to capture the complexity and variability of actual clinical care.

ANS: B, D, E

EBP refers to identifying the evidence for clinical practice and conducting practice according to the best evidence. PBE is an innovative prospective research design that uses data gathered from current practice to identify what care processes work in the real world. PBE study designs attempt to capture the complexity presented by patient and treatment differences, offering a naturalistic view of treatment by examining what actually happens in the care process, not altering or standardizing the treatment regimen to evaluate efficacy of a particular intervention, as one does in an RCT or other types of experimental designs. EBP is about using evidence to guide practice. PBE is about obtaining evidence from practice.

DIF: Cognitive Level: Analyze

REF: pp. 62-64

COMPLETION 10.

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

ANS:

Partitioning

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

DIF: Cognitive Level: Remember

REF: p. 59

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

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

DIF: Cognitive Level: Apply

REF: p. 73

2. Which statement is true regarding the differences between research and evaluation? a. Evaluation is concerned with the goals of a specific program and usually has multiple

stakeholders as compared to research, which has specific scientific hypotheses and fewer stakeholders. b. Evaluation studies have higher generalizability, whereas research is concerned with only internal generalizability. c. Evaluation studies use few methods, whereas research studies use multiple methods. d. Evaluation studies have longer timelines and more resources, compared to research with shorter timelines and fewer resources.

ANS: A

Evaluation is concerned with the goals of a specific program, whereas research focuses on a specific scientific hypothesis. There are also fewer stakeholders in research than in evaluation.

The scope of research is limited, whereas evaluation has a much broader scope. There are many components in evaluation that cannot be easily put into one category.

DIF: Cognitive Level: Understand

REF: pp. 72-74

3. Which list includes the 3 levels of theory relevant to evaluation? a. Program, summative, and interpersonal theories b. Scientific, formative, and descriptive theories c. Scientific, implementation models, and program theories d. Scientific, statistical, and 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. 75

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. 75

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 confirmation. 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. 75

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. 75

7. UTAUT is a theory of: a. user’s 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 (UTUAT) assesses factors associated with effective use.

DIF: Cognitive Level: Understand

REF: pp. 76-77

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: pp. 79-80

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

ANS: A

Nodes are individuals, and lines are connections. The size of the line is often the number of interactions between individuals, and the size of the node is the number of interactions with that unit.

DIF: Cognitive Level: Understand

REF: p. 83

MULTIPLE RESPONSE 10. You decide to conduct an evaluation of a new informatics intervention for nurses in the ICU. You

decide to use only qualitative methods. Which methods would be conducted? (Select all that apply.) a. Observing nurses in the ICU at randomly selected time periods and recording their activities b. Conducting semi-structured interviews and conducting thematic analysis c. Collecting log reports for computer access, grouping sites accessed by nurses into similar categories, and seeing what the categories look like d. Measuring the amount of time nurses spent on the computer

ANS: A, B, C

Random observations, semi-structured interviews, and categorization without counting are all examples of qualitative activities. Counting, measuring, and calibrating are quantitative activities.

DIF: Cognitive Level: Apply

REF: pp. 80-82

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: pp. 88-89

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. 92

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. Bar code medication administration (BCMA)

c. Electronic medication administration record (eMAR) d. Electronic prescribing (eprescribing)

ANS: B

Bar code 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: pp. 93-94

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. 95

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. Bar-coding system d. Electronic prescribing

ANS: C

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

DIF: Cognitive Level: Apply

REF: p. 96

6. As the U.S. 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. 99

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: pp. 99-100

MULTIPLE RESPONSE 8.

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. 99

9.

The core set of Stage 1 Meaningful Use objectives requires hospitals and providers to take which actions? (Select all that apply.) a. Use computerized provider order entry for medication orders b. Transmit prescriptions electronically c. Provide patients with discharge instructions or summary of office visit d. Record and chart changes in vital signs as structured data e. Maintain current problem and diagnoses list

ANS: A, B, C, E

Use computerized provider order entry for medication orders, transmit prescriptions electronically, provide patients with discharge instructions or summary of office visit, and maintain current problem and diagnoses list are all Stage 1 Meaningful Use objectives.

Recording and charting changes in vital signs as structured data is a Stage 2 objective because the use of structured data will not be enforced until this later stage.

DIF: Cognitive Level: Remember

REF: pp. 89-91

10. 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 the design, testing, and implementation of the system b. Conduct a quantitative research study to provide deeper insight into CPOE issues c. Design the new system to support communication and work flow d. Educate clinicians on how to use the system 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 the benefits and issues surrounding computerized provider order entry and some decision support capabilities. Quantitative research is helpful but would not provide the deeper content of the issues.

DIF: Cognitive Level: Apply

REF: p. 93

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

are perceived EHR benefits for the consumer? (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. Customize care through reminders

ANS: A, C, D, E

From a consumer perspective, an EHR system should provide the ability to customize care through appointment reminders, health risk assessments, and timely access to personal health information. The availability 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 the EHR has the potential to address these items, security and privacy of personal information are perceived as major concerns and, therefore, are not a benefit to the consumer.

DIF: Cognitive Level: Apply

REF: p. 97

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 the clinical 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: pp. 108-110

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

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

Income statements reflect the following formula: revenue – expenses = profit. This is often referred to as the bottom line. The balance sheet, on the other hand, reflects an organization’s assets, liability, and equity.

DIF: Cognitive Level: Understand

REF: p. 110

3. Return on investment (ROI) in financial information systems (FISs) is challenging because: a. patient accounting is considered an intangible asset. b. FISs 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 the return on investment or understanding the importance of the investment in FISs, since information technology software

applications, such as patient accounting or revenue, are considered intangible assets.

DIF: Cognitive Level: Apply

REF: p. 110

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 the organization. d. a list of vendors who supply items to the organization.

ANS: C

The supply item master is the master list of supplies available to order in the organization.

DIF: Cognitive Level: Remember

REF: p. 116

5. Business practices and information systems in the supply chain must: a. counterbalance each other to ensure safety. b. work together to best manage the system and support patient care. c. never work in tandem to minimize errors. d. only provide financial information for the organization.

ANS: B

Information systems must reflect an organization’s business practices.

DIF: Cognitive Level: Comprehension

REF: pp. 115-116

6. A vendor master file is: a. a list of federally approved pharmaceutical companies. b. a list of suppliers used by the organization. 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 the organization.

DIF: Cognitive Level: Remember

REF: p. 116

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 the schedule 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 the Internet.

DIF: Cognitive Level: Remember

REF: p. 120

MULTIPLE RESPONSE 8.

When using the online billing and payment tool, which functions directly benefit the patient?

(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 the business office e. Ability to update address or demographic changes f. Automate the provider’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 the business office, and ability to update address or demographic changes

are components of the online billing and payment system that benefit patients. These functions benefit patients because patients can access the system to perform the listed functions at their convenience. Though they may indirectly benefit the patient, automating the provider’s day and providing the provider with a dashboard view are direct benefits for the provider.

DIF: Cognitive Level: Understand 9.

REF: p. 115

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.

ANS: A, B, C

The healthcare supply chain includes the following processes: transportation of supplies, storage of supplies, and management of supplies. It does not include a prediction of the supplies used.

DIF: Cognitive Level: Understand

REF: p. 115

10. Supply charge capture is a process that: (Select all that apply.) a. uses the CDM to charge a patient for supplies used in the patient’s care. b. is a method to manage and inventory supplies. c. accounts for pharmaceutical supplies based on federal requirements. d. closely links the supply chain to the revenue management system.

ANS: A, D

The supply charge master assigns a charge for the care provided to a patient. Without a charge being assigned, the patient will not be billed, so this is also a critical part of the revenue cycle.

DIF: Cognitive Level: Apply

REF: pp. 117-118

MULTIPLE CHOICE 1. Which government organization manages the largest telehealth program in the United States as of

this writing? a. Department of Defense b. NASA c. Department of Veterans Affairs d. Office for the Advancement of Telehealth

ANS: C

The Department of Veterans Affairs manages the largest telehealth program in the United States. The remaining responses are incorrect.

DIF: Cognitive Level: Remember

REF: p. 128

2. What are the two 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 the two overarching types of telehealth technologies. The remaining responses are components of telehealth.

DIF: Cognitive Level: Remember

REF: p. 128

3. The majority of healthcare delivered globally is: a. acute care. b. emergency care. c. self-care. d. primary care.

ANS: C

The majority of healthcare that is delivered globally is self-care. The remaining responses are types of healthcare one finds in modernized or western countries.

DIF: Cognitive Level: Remember

REF: pp. 140-141

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

providers?

a. b. c. d.

Cost of telehealth technology Training Location of equipment Transmission speed

ANS: B

Training is one of the most important elements in the acceptance of telehealth by providers.

The remaining responses, although relevant, are not important drivers of acceptance.

DIF: Cognitive Level: Understand

REF: p. 133

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. understanding of telehealth implementation barriers organized to meet global patients’ needs in a ubiquitous manner. d. university programs for training healthcare providers organized to meet global patients’ needs in a ubiquitous manner.

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. 142

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. The remaining responses are not correct.

DIF: Cognitive Level: Remember

REF: p. 127

MULTIPLE RESPONSE 7.

Policy issues directly impacting telehealth practice for healthcare providers include: (Select all that apply.) a. technology. b. malpractice. c. licensure. d. credentialing. e. reimbursement. f. broadband

ANS: B, C, D, E

Policy 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 8.

REF: p. 138

Telehealth programs with high-quality clinical practice require which tools? (Select all that apply.) a. Standards and guidelines b. Protocols and procedures c. Evaluation/quality improvement methods d. Certification programs

ANS: A, B, C

Telehealth programs with high-quality clinical practice require the following tools: standards and guidelines, protocols and procedures, and evaluation/quality improvement methods.

Certification programs are not tools.

DIF: Cognitive Level: Apply 9.

REF: p. 131

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 the following elements: visual literacy, computer literacy, information literacy, and digital literacy. The other two forms of literacy are not required for consumers.

DIF: Cognitive Level: Understand

REF: p. 141

10. What are the advantages 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. 126

MULTIPLE CHOICE 1. Which payer is the largest for home health services? a. Private insurance b. Patients and families in the form of self-pay c. Medicare d. Medicaid

ANS: C

As the largest payer, Medicare, through its Conditions of Participation, represents the standard for the services provided by home health agencies and the payment for these services by many commercial insurance payers and state Medicaid programs.

DIF: Cognitive Level: Understand

REF: p. 149

2. What are the two important purposes of the OASIS data set? a. Determine payment and measure quality and outcomes b. Determine payment and standardize data c. Determine the time of visits and measure quality and outcomes d. Determine efficiency and measure quality and outcomes

ANS: A

OASIS, or the Outcome and Information Set, is a standardized data set with two important purposes: it is the basis for determining payment for each 60-day episode of care, and it measures the quality and outcomes of services delivered by home health agency clinicians.

DIF: Cognitive Level: Understand

REF: p. 151

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

ANS: B

Early home health services originated in the United States in the 1800s and were based on the district 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. 148

4. What technology has been described as the next 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 the next 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. 153

MULTIPLE RESPONSE 5.

Which of the following tools will the standardized hospice data set 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 data set will probably incorporate frequently used tools such as the National Data Set for Hospice, Family Evaluations of Care, Survey of Team Attitudes and Relationships, and End Result Outcome Measures.

DIF: Cognitive Level: Understand 6.

REF: p. 151

What are the key tenants of the Triple 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 the most abstract level of healthcare services in the United States. It includes better care for individuals, better health for populations, and reduction of per capita costs.

DIF: Cognitive Level: Understand 7.

REF: p. 150

What are the primary 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 the point 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 the development of EHRs. DIF: Cognitive Level: Remember 8.

REF: pp. 151-152

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 the nursing or problem-solving process. It consists of the Problem Classification Scheme (assessment), Intervention Scheme (service delivery/activities), and the Problem Rating Scale for Outcomes

(evaluation). When nurses and other clinicians use the Omaha System, they can describe, quantify, and communicate details about their practice.

DIF: Cognitive Level: Remember 9.

REF: pp. 154-155

What are the core 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: pp. 149-150

10. 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 the quality 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 thirdparty 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

MULTIPLE CHOICE

REF: p. 154

1. Why have most CDS systems not shown to significantly impact patient outcomes in clinical trials,

despite the fact that a majority of systems have been shown to significantly improve careprocesses? a. CDS systems have not been evaluated in clinical trials. b. Very few studies have assessed the impact 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. 170

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 the specific CDS under consideration and the governing healthcare payment model in place.

DIF: Cognitive Level: Apply

REF: p. 171

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: pp. 166-167 | p. 173

4. Which statement is not part of the Ten Commandments of CDS? a. Speed is everything.

b. Fit into the user’s workflow. c. Alerting is the most 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 the user’s workflow, and ask for additional information only when you really need it. Alerting may not be the most effective approach to CDS as it may cause alert fatigue, so it is not one of the Ten Commandments of CDS. DIF: Cognitive Level: Remember

REF: p. 172

5. Which incentive has the strongest potential to spur the nationwide 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 the

delivery 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 the chapter, the shift of healthcare payment from a fee-for-service model to approaches rewarding the delivery of better quality and outcomes at lower cost appears to have the strongest potential for change.

DIF: Cognitive Level: Apply

REF: p. 173

MULTIPLE RESPONSE 6.

Which tools are examples of CDS? (Select all that apply.) a. An order set b. A reminder c. A phone call d. An infobutton

ANS: A, B, D

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

REF: pp. 166-170

7.

Why is CDS important for healthcare institutions? (Select all that apply). a. It can reduce the need 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.

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 the potential to improve the value of care. CDS have not been found to reduce the need for registered nurses.

DIF: Cognitive Level: Apply 8.

REF: pp. 164-167

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 the performance of human experts. b. Clinicians generally must go out of their routine workflows to use the systems, 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.

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 the chapter, systems that are misaligned with the clinician’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.

DIF: Cognitive Level: Analyze 9.

REF: pp. 171-172

Which of the following 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

ANS: B, C, D

All of the choices 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, and a lack of widely adopted standards for CDS are challenges and barriers to adoption.

DIF: Cognitive Level: Remember

REF: pp. 171-172

10. Which of the following practices are included in the CDS Five Rights? (Select all that apply.) a.

Providing the right information b. Providing to the right person c. Providing at the right point in work flow d. Providing the right reference information

ANS: A, B, C

The CDS Five Rights include providing the right information to the right person at the right point in the work flow. Providing applicable reference information has been suggested by others to be a potential best practice for CDS. However, it is not one of the CDS Five Rights.

DIF: Cognitive Level: Remember

REF: pp. 172-173

MULTIPLE CHOICE 1. Which is not an activity of public health? a. Direct clinical services b. Disease outbreak management c. Bariatric surgery because obesity is a national public health problem d. Rat and mosquito abatement

ANS: C

Although obesity is a national public health problem, public health does not provide surgical services. Surgical services are typically provided in the acute care or outpatient care settings.

The other responses are activities of public health.

DIF: Cognitive Level: Understand

REF: pp. 179-180

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

differences? a. Public health is focused on the prevention and health of populations before they are ill. b. Public health is focused on one individual at a time to ensure the best possible outcome. c. The health of a community is measured by the use of sophisticated technologies like MRIs. d. Public health is focused on one family at a time to ensure the best possible outcome.

ANS: A

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

DIF: Cognitive Level: Analyze

REF: pp. 180-181

3. You are asked to justify the creation of the first public health informatics (PHI) program in your

jurisdiction. You will emphasize this likely benefit by ensuring: 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 deidentified at the community level. c. interoperability already exists for public health IT. d. standards already exist for PHI.

ANS: A

Emphasizing the likely benefit of a PHI program (e.g. identifying clusters of diseases) will ensure that current PHI can enhance public health surveillance. The others are still issues in public health informatics, but they do not ensure benefit.

DIF: Cognitive Level: Analyze

REF: pp. 185-187

4. Despite the challenges, public health systems are now available. Good examples of these 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 the best examples is: a. the linkage of local electronic health records in the 50 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. The others lack one or more of the stated elements.

DIF: Cognitive Level: Understand

REF: pp. 187-189

5. The public health supply chain needs to evolve to an information ecology approach for the future

direction. 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 the reuse and sharing of data.

DIF: Cognitive Level: Apply

REF: pp. 192-193

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

not a likely technology for the future? a. Service-oriented architecture (SOA) b. Software as a service (SaaS) c. Open source methods such as OpenELS or OpenMRS d. Mobile devices such as the iPhone

ANS: D

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

DIF: Cognitive Level: Remember

REF: pp. 193-194

MULTIPLE RESPONSE 7.

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

ANS: A, B

Social and political challenges impacting public health informatics include the limits of federal authority and the evolution of public health primarily as state and local functions. Public health is not nationally organized and monitored.

DIF: Cognitive Level: Apply 8.

REF: p. 183

Blueprint Version 2.0 updates public health surveillance activities for the 21st 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

ANS: A, B, C

Methods that exemplify Blueprint Version 2.0 updates for public health surveillance activities for the 21st 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 9.

REF: p. 186

Informatics opportunities for reportable conditions include: (Select all that apply.) a. the use of computable logic to define where and how reports should be sent. b. automation of patient education from electronic health records. c. automation of information extraction from electronic health records. d. standardization of message structure and content for reporting.

ANS: A, C, D

Informatics opportunities for reportable conditions include the use of computable logic to define where and how reports should be sent, automation of information extraction from electronic health record, and standardization of message structure and content for reporting.

DIF: Cognitive Level: Remember

REF: p. 191

10. Immunization information systems are used to record at least some of the immunizations for about

75% of children in the U.S. Which benefits are provided by the use 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 the country d. Integration across nations

ANS: A, B, C

Immunization information systems provide the following benefits: a high return on investment, the ability to provide consolidated immunization histories to avoid over- or under-vaccinating, and the ability to improve vaccination rates by integrating data across the country. Integration across nations is not available as yet.

DIF: Cognitive Level: Remember

REF: pp. 187-189

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. 198

2. Which factor would strongly influence the reliability of an EHR’s repository? a. Technical architecture, such as replication of the repository on standby servers b. Clinician training on EHR applications c. The coding system used for laboratory results d. The use of strong passwords

ANS: A

Technical architecture, such as replication of the repository on standby servers, is a factor that would contribute to the reliability of an EHR’S data repository. The other items affect application use, accessibility, and security.

DIF: Cognitive Level: Understand 3.

REF: p. 198

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. 199

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

An example of knowledge base content 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. 202

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: pp. 202-203

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. government regulations require the use of an interface engine in healthcare settings.

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. 203

7. A method for exchanging patient data between 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 Nationwide Health Information Network (NwHIN). d. The federal government does not endorse sharing health information between organizations.

ANS: C

Implementing a secure Internet connection using components of the Nationwide Health Information Network (NwHIN) is a method for exchanging data endorsed by the federal government. 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. 205

8. Which is a significant challenge to technical infrastructures in healthcare environments? a. Implementing a data repository that will grow with changes in medicine and store a patient’s

lifetime health data 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 between 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 store a patient’s lifetime health data. The other choices describe usability, user training, and organizational policy.

DIF: Cognitive Level: Understand

REF: p. 206

MULTIPLE RESPONSE 9.

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 patient 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: pp. 200-203

10. 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 signs 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

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 clinical information.

DIF: Cognitive Level: Remember

REF: p. 199

MULTIPLE CHOICE 1. An epatient is best described as one who: a. seeks health information from various sources and uses the information for decision making

with health providers. b. manages health decisions, uses the Internet and uses biosensors. c. collaborates with the health 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 the information 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: pp. 212-213

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 the full continuum of care. Integrated care focuses on coordinating care between the healthcare disciplines. Authoritative care is paternalistic and does not include the patient in the decision-making process. Community care focuses on coordinating care across resources found in the community where the patient resides.

DIF: Cognitive Level: Understand

REF: p. 218

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

Graphs data, records lab values, and uses a sleep diary are all traits of a quantified selfer; however, tracking personal metrics best describes the quantified selfer.

DIF: Cognitive Level: Remember

REF: p. 217

4. Which factor has influenced the epatient movement? a. The Internet b. The Human Genome Project c. The Association of Cancer Online Resources d. The quantified self

ANS: A

A factor that has influenced the epatient movement is the Internet. The Human Genome Project involves identifying genes in human DNA. The Association for Cancer Online Resources is a useful resource for cancer patients. The quantified self is a term used to describe people who are invested in using tools and data to quantify and monitor their daily experiences using personal metrics.

DIF: Cognitive Level: Remember

REF: p. 213

5. The maxim “Doctors know best”: a. is one of the tenets of participatory medicine. b. was coined by epatient Dave. c. was coined by Gilles Frydman. d. is the paradigm for the paternalistic care model.

ANS: D

“Doctors know best” is the paradigm for the paternalistic care model. Participatory medicine is characterized by including the patient as a partner in setting goals of care and participating in shared decision making. ePatient Dave is known for statements such as “Gimme my damn data” and promotes the maxim of “Nothing about me, without me.” Gilles Frydman is an epatient activist known for his work with the Association of Cancer Online Resources.

DIF: Cognitive Level: Remember

REF: p. 217

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

ANS: D

The culture of the patient-clinician partnership always includes epatients and clinicians working in collaboration towards shared goals. The Patient 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 the patient-clinician partnership.

DIF: Cognitive Level: Understand

REF: pp. 217-218

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’ theory of diffusion of innovation.

ANS: A

Disruptive technology and trends have drastically altered the way in which we communicate with one another. Americans are using the Internet and mobile devices in their daily lives to connect to one another and to access information.

DIF: Cognitive Level: Remember

REF: p. 219

8. Transparency of PHR data is limited due to: a. current functionality. b. anticipatory worry. c. nonparticipatory physicians. d. differing philosophies over governance.

ANS: D

Due to differing philosophies over governance, the transparency of PHR data is limited. Many policy standards do not exist for the PHR, and organizations are facing cultural, technological, legal, and privacy challenges for managing PHRs. DIF: Cognitive Level: Remember

REF: p. 219

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 the Google generation. The other choices are not characteristic of being part of the Google generation.

DIF: Cognitive Level: Remember

REF: pp. 221-222

MULTIPLE RESPONSE 10. What defines Health 2.0? (Select all that apply.) a. Updated versions of old health information b. Marketing health products based on the patient’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 the patient’s Internet preferences, and mobile health-monitoring devices do not define Health 2.0.

DIF: Cognitive Level: Understand

REF: pp. 220-221

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. The tool 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 the most appropriate. The other choices (Facebook, e-mail, and Second Life) are not appropriate for sending short messages.

DIF: Cognitive Level: Apply

REF: p. 227

2. The percentage of adults using social media to seek healthcare information is: a. less than 10%. b. between 10% and 30%. c. between 40% and 60%. d. over 75%.

ANS: C

According to the Pew Internet Study of 2011, between 40% and 60% of adults use social media to seek healthcare information.

DIF: Cognitive Level: Remember

REF: p. 228

3. Which group is allowed to share personal health information on social media sites? a. Providers who monitor the social media site b. Healthcare providers on the site 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: pp. 229-230

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 the web. 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 the patient rather than standing between the patient and the web.

DIF: Cognitive Level: Understand

REF: p. 233

5. 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 patient has a chronic disease. d. they check their social media policy at work.

ANS: D

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

DIF: Cognitive Level: Remember

REF: pp. 234-235

6. In the future, 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 by everyone including those who are reluctant now. d. widely used but with some pockets of non-users such as those lacking Internet access or

choosing to be private.

ANS: D

Even as social media expands, some will not be able to or will choose not to use these applications.

DIF: Cognitive Level: Understand

REF: p. 235

7. Which social media site was developed by healthcare agencies? a. PatientsLikeMe b. CureTogether c. WrongDiagnosis.com d. Heart.org

ANS: D

Heart.org was developed by the American Heart Association. The others were developed by consumers.

DIF: Cognitive Level: Remember

REF: p. 226 | p. 229

MULTIPLE RESPONSE 8.

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.

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 itself.

DIF: Cognitive Level: Remember 9.

REF: pp. 225-226

Using social media tools for research purposes helps: (Select all that apply.) a. develop relationships between participants. b. recruit patients. c. identify new variables to study. d. provide insight into the patient’s experience.

ANS: B, C, D

Using social media tools for research purposes helps to recruit patients, identify new variables to study, and provide insight into the patient’s experience. Researchers should be cautious of allowing research participants to communicate and create relationships with social media as this may contaminate findings.

DIF: Cognitive Level: Understand

REF: pp. 228-229

10. Social media policies should contain: (Select all that apply.) a. guidance on acceptable behavior. b. methods for handling unacceptable behaviors. c. statement to promote ethical behaviors. d. penalties for misuse.

ANS: A, B, C

Social media polices should contain guidance on acceptable behavior, methods for handling unacceptable behaviors, and a statement that promotes ethical behavior. Imposing penalties for misuse should be discussed on a case-by-case basis.

DIF: Cognitive Level: Remember

REF: p. 229 | p. 236

MULTIPLE CHOICE 1. What are the main types of PHR? 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. 248

2. What are the two most commonly owned personal computing devices? a. Game device and MP3 player b. Mobile phone and laptop c. Laptop and desktop computer d. Laptop and MP3 player

ANS: B

The two most commonly owned types of personal computing devices are mobile phones and laptop computers. The other choices are less commonly owned devices.

DIF: Cognitive Level: Remember

REF: pp. 245-246

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. 248

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

videos. d. online appointment scheduling and reading clinical notes.

ANS: A

The most commonly used functions of the PHR are viewing test results and secure messaging.

The other choices are PHR functions that are less commonly used.

DIF: Cognitive Level: Remember

REF: p. 251

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

as: a. 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. b. the principal federal entity charged with promoting nationwide sales of advanced health information technology. c. a federal entity charged with increasing public awareness of the value of health information technology. d. a federal agency that regulates the contents and functions of health information technologies, including PHRs.

ANS: A

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. 245

6. Which statement is true regarding the continuity of care record (ASTM standard E2369-05e2)? a. It is an XML-based extract of the health record that allows for syntactically interoperable

records. b. It is an XML-based extract of the health record that allows for semantically interoperable records. c. It is a tab-delimited extract of the health record that specifies constraints on the controlled vocabularies used. d. It is a tab-delimited extract of the health record that paves the way for national health information exchange.

ANS: A

The continuity of care record (ASTM standard E2369-05e2) is an XML-based extract of the health record that allows for syntactically interoperable records.

DIF: Cognitive Level: Understand

REF: p. 252

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

minorities, of lower socioeconomic status, and older age.

b. the gap between current adoption of PHRs and their potential use. c. lower adoption and use of information technologies among individuals from ethnic

minorities, those of lower socioeconomic status, and older age. d. the difference between rates of overall cell phone ownership and “smart phone” ownership.

ANS: C

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

DIF: Cognitive Level: Remember

REF: p. 252

8. Which statement is true of Meaningful Use? a. These are criteria created by patient advocacy groups intended to ensure that patientfacing

technology is addressing users’ needs. b. These are criteria created by the ONC to determine eligibility for incentives for health information technology adoption and use. c. These are criteria created by Congress that delineate appropriate uses of health data for research purposes. d. These are criteria proposed by the Institute for Healthcare Improvement to suggest ways to use health information technology to improve healthcare in the United States.

ANS: B

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

DIF: Cognitive Level: Understand

REF: p. 246

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. 245

MULTIPLE RESPONSE 10. HIPAA (Health Information Portability and Accountability Act) requires that: (Select all that

apply.) a. healthcare records be available electronically by 2014. b. healthcare providers keep an audit trail of access to an individual’s record and provide copies of the individual’s record upon request. c. specific privacy and security measures must be used in all electronic health records. d. healthcare providers must be able to electronically exchange health records by 2014. e. healthcare providers must be able to electronically exchange lab data by 2014.

ANS: B, C

HIPAA requires that healthcare providers keep an audit trail of access to an individual’s record and provide copies of the individual’s record upon request and that specific privacy and security measures must be used in all electronic health records including PHRs. The other answers are either only partially correct or incorrect.

DIF: Cognitive Level: Understand

REF: p. 245

MULTIPLE CHOICE 1. Which category of objectives contains the need for the system to be intuitive and easy to use? a.

Patient care b. Information technology c. Efficiency d. Organization

ANS: C

Ease of system use and intuitiveness promote efficiency for the end user.

DIF: Cognitive Level: Apply

REF: pp. 261-262

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: pp. 265-266

3. Which group is not a major information technology research firm? a. Forrester b. Gartner c. HIMSS d. KLAS

ANS: C

HIMSS does not provide comparative research information regarding various vendors.

DIF: Cognitive Level: Analyze MULTIPLE RESPONSE

REF: pp. 266-267

4.

What should be considered when identifying and selecting a healthcare information system?

(Select all that apply.) a. Strategic vision b. Strategic alignment c. Enterprise and information technology goals and objectives d. Operating system e. Vendor strategic planning

ANS: A, B, C

Having a strategic vision, strategic alignment, and enterprise and information technology goals and objectives should be considered when identifying and selecting a healthcare information system. Each of these items is critical to selecting an effective system that supports the organization’s goals and mission. The operating system and vendor strategic planning are not part of an organization’s goals and mission.

DIF: Cognitive Level: Analyze 5.

REF: pp. 259-260

Which methods will provide information useful in requirements identification? (Select all that apply.) a. Delphi method b. Survey c. Interview d. Direct observation e. Regression analysis

ANS: B, C, D

Methods useful in providing information for requirements identification include using surveys, interviews, and direct observation to collect data. A variety of data collection methods is necessary to define system requirements.

DIF: Cognitive Level: Analyze 6.

REF: pp. 260-261

A process of ongoing evaluation must be developed to: (Select all that apply.) a. identify areas of omission. b. validate appropriate responses. c. develop training plans for go-live. d. ensure adequate users. e. determine if any changes to the system are needed.

ANS: A, B, E

A process of ongoing evaluation must be developed to identify areas of omission, validate appropriate responses, and determine if any changes to the system are needed. Ongoing

evaluation provides the opportunity to evaluate the effectiveness of the system for current and future needs.

DIF: Cognitive Level: Analyze 7.

REF: pp. 259-260

Which considerations should be included in your system evaluation criteria? (Select all that apply.) a. Cost b. Vendor experience c. Organization devices d. Vendor’s market and industry understanding

ANS: A, B, D

It is important to include a variety of criteria, including cost, vendor experience, and the vendor’s market and industry understanding.

DIF: Cognitive Level: Analyze 8.

REF: pp. 265-266

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 9.

REF: p. 267

Which of the following describe information system functionality? (Select all that apply.) a.

System response time b. Data validation c. Accuracy d. Ease of use for end users

ANS: A, C, D

System response, accuracy, and ease of use for end users describe information system functionality. Data validation is not part of functionality, although it is required in an assessment of an information system.

DIF: Cognitive Level: Understand

REF: p. 259

10. 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. Maintenance

ANS: B, C, D

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

DIF: Cognitive Level: Remember

REF: p. 260

MULTIPLE CHOICE 1. Upon entering an order for two units of packed red blood cells into a computerized physician order

entry system, a dialog box is displayed stating that the patient is designated as “Bloodless,” meaning that the patient will refuse all blood products. This is an example of: a. clinical decision support. b. evidence-based medicine. c. Heisenberg Principle. d. minimal data set.

ANS: A

Evidence-based medicine is defined as best practices or the application of the results from the best research-based studies in clinical care in order to obtain the best results. The Heisenberg Principle is defined as the difficulty involved in explaining an existing phenomenon and predicting future phenomena when the domain being studied is always changing. A minimal data set is the state-approved resident assessment instrument, which contains a minimum set of data elements with uniform definitions and categories concerning the cost and quality of nursing care.

DIF: Cognitive Level: Apply

REF: pp. 273-274

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 also considered one of 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 not interfaced with other dissimilar applications.

DIF: Cognitive Level: Apply

REF: p. 277

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 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: pp. 284-285

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 dropdown 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: pp. 275-276

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. 281

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 has not yet implemented ICD-10 codes.

DIF: Cognitive Level: Remember

REF: p. 274

7. Which activity or intervention is the biggest deterrent to the success of an EHR implementation? a. Schedule the go-live date for a Monday when vendor support staff is most available b. Anticipate user resistance and plan for it c. Possess an understanding that there is no finish line for EHR Maintenance d. Provide ample education to all users with opportunities for practice

ANS: A

It is best to avoid Monday as the go-live date because it is usually one of the busiest days for healthcare providers.

DIF: Cognitive Level: Apply

REF: p. 287

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: pp. 273-274 | p. 276

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: pp. 276-277

MULTIPLE RESPONSE 10. Which are the most significant financial reasons to implement an EHR or upgrade to the latest

version of the current EHR? (Select all that apply.) a. Transition from ICD-9 codes to ICD-10 codes b. Migration from HIPAA 4010 Standards to 5010 Standards c. Certification of EHRs by the Office of the National Coordinator (ONC) d. ARRA Meaningful Use requirements

ANS: B, D

The ARRA Meaningful Use requirements provide a financial incentive for EHR adoption and the migration from HIPAA 4010 Standards to 5010 Standards can financially benefit an organization with increased acceptance of claims. The other options are benefits that do not have financial implications.

DIF: Cognitive Level: Remember

REF: p. 272

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. 293; Table 18-1

2. Which examples are man-made disasters that could affect IT products? a. Cyberattack, nuclear incident, bomb b. Cyberattack, blizzard, nuclear incident c. Nuclear incident, bomb, tornado d. Tornado, blizzard

ANS: A

Cyberattacks, nuclear incidents, and bombs are examples of manmade disasters. Blizzards and tornados are examples of natural disasters.

DIF: Cognitive Level: Analyze

REF: p. 293; Table 18-1

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. 293; Table 18-2

4. Which system is an example of an ancillary service application? a. Keyless entry system b. PBX switchboard c. Email d. Radiology information system

ANS: D

The radiology information system is an ancillary service application used for ancillary clinical patient care. PBX switchboard, email, and keyless entry systems are business applications supporting the business operation but are not used for patient care.

DIF: Cognitive Level: Apply

REF: p. 293; Table 18-2

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. 296; Table 18-5

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. 296; Table 18-5

7. Which backup EHR downtime application is critical to avoid disrupting nurses’ care of patients? 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. 299

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. 301; Table 18-6

MULTIPLE RESPONSE 9.

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. Email

ANS: A, B

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

DIF: Cognitive Level: Apply

REF: p. 293; Table 18-1

10. What are 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? f. When is the next Joint Commission review scheduled to occur?

ANS: A, C, D, E

Who needs to know what details, what 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. A Joint Commission announcement would be a general announcement to all personnel but is not associated with downtime communications.

DIF: Cognitive Level: Analyze

REF: pp. 302-303

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 the potential to cause harm to an informational asset

ANS: C

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

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

DIF: Cognitive Level: Remember

REF: p. 308

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, the healthcare provider is violating the fair information principle of data quality and integrity. Correction involves allowing individuals to dispute the accuracy 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. 309; Table 19-2

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. Health 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. 312

4. What is the difference between the safe harbor and expert determination methods of deidentifying

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

determination method involves the application of statistical or scientific models. b. The safe harbor method involves the application of statistical or scientific models, and the

expert determination method involves removal of 18 types of identifiers. c. The safe harbor method involves removal of all identifiers, and the expert determination method involves the removal of 18 types of identifiers. d. The safe harbor method involves securing identifiers in an encrypted database, and the expert determination specifically determines the riskiest identifiers to remove.

ANS: A

The safe harbor method involves removal of 18 types of identifiers, and the expert determination method involves the application of statistical or scientific models to de-identify data. None of the other options accurately describe these two methods.

DIF: Cognitive Level: Apply

REF: p. 314; Figure 19-1

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

ANS: B

The largest downfall to the increased use of mobile devices is the increased risk for a security breach. The increased 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. 316

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 facilities 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. The remaining examples are all external events.

DIF: Cognitive Level: Apply

REF: p. 316

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: pp. 317-318

MULTIPLE RESPONSE 8.

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

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.

DIF: Cognitive Level: Understand 9.

REF: pp. 314-315

Which are examples of secondary use of health information? (Select all that apply.) a. Treatment b. Surveillance c. Research d. Marketing

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 an illness would be a primary use of health information.

DIF: Cognitive Level: Understand

REF: p. 313

10. 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 the principles of the code might be to eliminate threats, elimination of threats is not a specific principle.

DIF: Cognitive Level: Remember

REF: p. 309; Table 19-4

MULTIPLE CHOICE 1. An important component of the informatics 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 the types of data used to populate the quality metrics.

ANS: A

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

DIF: Cognitive Level: Remember

REF: pp. 324-326

2. When evaluating quality and patient safety, which approach defines the framework 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 organization structure, management and clinical processes, and their linkages to patient outcomes.

ANS: D

Quality is based on organizational structure, process, and their linkages to patient outcomes.

Consideration of current managerial processes in place has a latent effect on patient outcomes.

The framework for PSQRD builds upon Donabedian’s structure-process-outcome model to support evaluation of an intervention from the pre-implementation testing phase, through implementation, and evaluation. In the case of a health information technology (IT) intervention, the expanded framework supports understanding of where the health IT intervention is most likely to have an effect, within the organizational causal chain of quality and safety events. The PSQRD framework provides a means to categorize interventions according to areas of the causal chain targeted (e.g., the structure, the management or clinical processes, and the patient outcomes or throughput that are targeted by the intervention or that drive adoption and use of the intervention in clinical practice).

DIF: Cognitive Level: Remember

REF: pp. 327-328

3. Why is the PSQRD a useful framework for research and practice? a. It explains why using computer applications is the best way to support better patient

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

rigorous

research

ANS: B

PSQRD is a useful framework for quality and safety projects whether or not they use health information technology as a tool. While the PSQRD framework may improve communication and implementation, a critical strength of this framework is its systems approach and comprehensive strategy for ongoing monitoring and evaluation. The PSQRD 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 the causal chain. This approach supports implementation, performance improvement, and research projects with an appreciation for the effects and the limitations of health IT and other intervention components. Adoption of the PSQRD framework for both research and organizational implementations will provide a means to plan for successful implementation and to collect data on the structural and process factors that may affect adoption and use of health IT interventions and ultimately patient outcomes.

This type of measurement is appropriate for both research-based and operational implementations of health IT. DIF: Cognitive Level: Remember

REF: pp. 330-331

4. A nurse forgets to walk a patient during the nurse’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 the wrong thing would be considered an error of commission. Condition and remission are not considered error types.

DIF: Cognitive Level: Apply

REF: p. 324

5. A nurse gives a patient the wrong drug. This is an example of an error of: a. commission. b. omission.

c. condition. d. remission.

ANS: A

Doing the wrong 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. 324

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

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

ANS: A

The setting and its attributes (e.g., the physical structure of buildings, staffing rations, the equipment available within an organization, and the budget to support care provision) are all part of structure. The EHR with an embedded CDS system is part of the structure of an organization.

DIF: Cognitive Level: Apply

REF: p. 327

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 the provision of care are all included under the process component. The use of a CDS system is considered process.

DIF: Cognitive Level: Apply

REF: p. 327

8. A unit has been experiencing a high rate of patient falls for the past three 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 the structures and processes are considered outcomes. These may include clinical outcomes. The measurement of patient falls is considered an outcome.

DIF: Cognitive Level: Apply

REF: p. 327

MULTIPLE RESPONSE 9.

To automatically track the quality 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.

ANS: A, B, C

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

DIF: Cognitive Level: Understand

REF: p. 326

10. Which items are included in the IOM six aims for improvement? (Select all that apply.) a. safe b. patient-centered c. innovative d. effective

ANS: A, B, D

The six aims for improvement are safe, effective, patient-centered, timely, efficient, and equitable. Innovative is not one of the six aims for improvement.

DIF: Cognitive Level: Remember

REF: p. 324

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: pp. 335-337

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. 338

3. National efforts to improve the user experience are under way in the U.S. 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. 347

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. 342; Table 21-1

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. 339

6. Your team developed a prototype for a mobile health (mhealth) device for diabetics to track their

glucose levels, insulin, and preventive care appointments. You want to assess 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. exploratory test. c. comparison test.

d. assessment test.

ANS: B

The type of test that is appropriate is an exploratory test. Content issues are addressed in exploratory tests.

DIF: Cognitive Level: Apply

REF: p. 345

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. 346

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 80% of design issues.

DIF: Cognitive Level: Remember

REF: p. 345

MULTIPLE RESPONSE 9.

Think aloud protocol is a method for generating rich data when users talk aloud as they use a product. This method is used: (Select all that apply.) a. during initial product development. b. during mature product design.

c. after the product is released. d. after the product is used.

ANS: A, B, C

Think aloud protocol can be used during initial product development, during mature product design, and after the product is released.

DIF: Cognitive Level: Apply

REF: p. 341

10. Task analysis is a collection of many different techniques. You can use task analysis to: (Select

all that apply.) a. conduct the think aloud protocol. b. analyze users’ cognitive processes. c. observe workflow in a cardiology clinic. d. determine crucial errors with CPOE.

ANS: B, C, D

Task analysis addresses many issues in the user experience. These may include analyzing users’ cognitive processes, observing workflow in a cardiology clinic, and/or determining crucial errors with CPOE. DIF: Cognitive Level: Apply

REF: pp. 341-342

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. 360

2. Which organization recognizes nursing terminologies as supporting nursing practice?

a. b. c. d.

NANDA-I International Health Terminology Standards Development Organization (IHTSDO) American Nurses Association (ANA) Alliance for Nursing Informatics (ANI)

ANS: C

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

DIF: Cognitive Level: Remember

REF: p. 359

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 crossmapped.

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. 360

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 crossmapped.

ANS: D

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

DIF: Cognitive Level: Remember

REF: pp. 359-360

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. 352

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.

DIF: Cognitive Level: Remember

REF: p. 358

7. ISO 18104:2003, an international standard for integration of a reference terminology model for nursing, does not state specifically the nursing terminologies that should be used in systems. a.

True b. False

ANS: A

ISO 18104:2003, an international standard for integration of a reference terminology model for nursing, does not state specifically the nursing terminologies that should be used in systems.

DIF: Cognitive Level: Remember

REF: p. 354

MULTIPLE RESPONSE 8. Which terminology contains nursing problems? (Select all that apply) a. SNOMED b. Logical Observations Identifiers Names and Codes (LOINC) c. Omaha System d. NANDA

ANS: A, C, D

The terminologies that contain nursing languages include SNOMED, the Omaha System, and NANDA.

DIF: Cognitive Level: Understand

REF: pp. 354-355

9. Which terminologies are recognized by the ANA? (Select all that apply.) a. ICNP b. NOC c. LOINC d. RxNorm

ANS: A, B, C

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

DIF: Cognitive Level: Remember

REF: p. 358

COMPLETION

and

10.

are ANA recognized “multidisciplinary” terminologies.

ANS:

SNOMED, LOINC SNOMED and LOINC are ANA recognized “multidisciplinary” terminologies.

DIF: Cognitive Level: Remember

REF: pp. 354-358

MULTIPLE CHOICE 1. Who “owns” health IT governance? a. The Chief Information Officer b. The Chief Medical Information Officer c. The Chief Executive Officer d. The type of institution

ANS: D

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

DIF: Cognitive Level: Apply

REF: pp. 372-373

2. What is the first 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 the IT budget d. Whether the organization is a for-profit or non-profit entity

ANS: B

Of the listed factors, an organization’s culture is the most important factor that needs to be considered.

DIF: Cognitive Level: Analyze

REF: p. 374

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 the topic, 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 the difficulty of informatics governance is that there is more effort desired from informatics than resources allow.

DIF: Cognitive Level: Apply

REF: pp. 371-372

4. A centralized health IT governance structure is always the most effective. a. True b. False

ANS: B

The optimal health IT governance structure depends on the organization.

DIF: Cognitive Level: Apply

REF: pp. 374-375

MULTIPLE RESPONSE 5.

Why is health IT governance needed? (Select all that apply.) a. It ensures the alignment of informatics resources with institutional priorities. b. It effectively prioritizes the use of informatics resources. c. It optimizes the return on investment on informatics investments. d. It encourages clinician involvement.

ANS: A, B, C

Health IT governance is needed as it ensures the alignment of informatics resources with institutional priorities, effectively prioritizes the use of informatics resources, and optimizes the return on investment on informatics investments. All three reasons are core to the need for health IT governance.

DIF: Cognitive Level: Apply 6.

REF: pp. 371-372

Which clinical initiatives require informatics to be optimally effective? (Select all that apply.) a.

Population health management b. IT governance c. Care pathways d. Reduction in care variability

ANS: A, C, D

Population health management, care pathways, and reduction in care variability require informatics to be optimally effective. All these initiatives have a significant information management component and require informatics support to be optimally effective.

DIF: Cognitive Level: Apply 7.

REF: pp. 371-372

Which components are necessary for effective health IT governance? (Select all that apply.) a. Organizational structures for 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 the governance

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 the governance.

DIF: Cognitive Level: Remember 8.

REF: p. 372

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

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 the demand for informatics resources and subsequently require more effective health IT governance and prioritization.

DIF: Cognitive Level: Apply 9.

REF: p. 373

Which groups are relevant stakeholders for health IT governance? (Select all that apply.) a. IT department b. Quality department c. Health services researchers d. Housekeepers

ANS: A, B, C

Relevant stakeholders of IT governance include the IT department, the quality department, and health services researchers.

DIF: Cognitive Level: Understand

REF: pp. 371-372

10. Which activities represent dimensions of the National Health Service’s Informatics Capability

Maturity Model? (Select all that apply.)

a. b. c. d.

Clinical documentation Managing information Using business intelligence Aligning business and informatics

ANS: B, C, D

Managing information, using business intelligence, and aligning business and informatics are dimensions of the National Health Service’s Informatics Capability Maturity Model.

DIF: Cognitive Level: Remember

REF: p. 374

MULTIPLE CHOICE 1. Which healthcare professional is eligible to participate in the Medicare EHR Incentive Program? a. Registered nurse b. Physician assistant c. Medical doctor d. Nurse practitioner

ANS: C

The medical doctor is the only healthcare provider listed who is eligible to participate in the Medicare EHR Incentive Program. The registered nurse, physician assistant, and nurse practitioner are all ineligible for this program.

DIF: Cognitive Level: Remember

REF: p. 380

2. Which President initiated the Office of National Coordinator? a. President William Clinton b. President Barack Obama c. President George W. Bush d. President George H.W. Bush

ANS: C

The Office of National Coordinator was implemented in 2004 when President George W. Bush was in office.

DIF: Cognitive Level: Remember

REF: p. 378

3. Which metrics give providers some flexibility in meeting Meaningful Use criteria? a. Menu

elements b. Core elements c. Primary elements d. Secondary elements

ANS: A

Because individual providers have different types of practices, the Health IT Policy and Health IT Standards Committees divided the Meaningful Use metrics into “core” required elements and “menu” elements. Permitting providers an opportunity to report on required core elements and then choose to report on a select few menu elements addresses the unique aspects of each provider’s practice/facility and adds flexibility to the financial incentive program.

DIF: Cognitive Level: Understand

REF: p. 381

4. When there is a breach of one unsecured patient record, it is necessary to notify: a. the patient. b. the Department of Health and Human Services. c. the media outlets. d. the Office of National Coordinator for Healthcare Information Technology.

ANS: A

If there is only a breach of one record versus a breach of more than 500 records, only the patient must be notified within sixty (60) days upon the discovery of the breach.

DIF: Cognitive Level: Apply

REF: pp. 381, 391

5. If a hospital loses its backup tapes containing 315,000 unencrypted records, it is necessary to

notify: a. the Office of National Coordinator for Healthcare Information Technology. b. the media

outlets. c. the Attorney General. d. the Department of Justice.

ANS: B

Pursuant to the HITECH breach notification requirements, because there is a breach of more than 500 unsecured records, the media must be notified to ensure patients are made aware of the breach. In addition to the media outlets, the Department of Health and Human Services Office of Civil Rights Agency must also be notified within sixty (60) days of discovering the breach.

DIF: Cognitive Level: Apply

REF: p. 391

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 health care program. Where remuneration is paid purposefully to induce or reward referrals of items or services payable by a federal health care program, the Anti-Kickback Statute is violated.

DIF: Cognitive Level: Apply

REF: pp. 388, 392

7. The Center for Medicare & Medicaid Innovation was created by: a. the American Recovery and Reinvestment Act of 2009. b. the Health Insurance Portability and Accountability Act. c. the Patient Protection and Affordable Care Act. d. the Health Information Technology for Education and Clinical Health Act.

ANS: C

The Patient Protection and Affordable Care Act of 2010 created the Center for Medicare & Medicaid Innovation (CMI) to help transform federal and state healthcare programs by changing and redesigning the healthcare system. Ultimately, CMI intends to develop better healthcare, improve health, and reduce costs for beneficiaries to enhance the delivery of care for all recipients.

DIF: Cognitive Level: Remember

REF: pp. 394-395

MULTIPLE RESPONSE 8.

Which entities have the authority to enforce penalties for a breach of PHI? (Select all that apply.) a. State attorney general b. Office of Civil Rights c. Office of Inspector General d. Centers for Medicare and Medicaid Services

ANS: A, B

Pursuant to the enhanced enforcement authority granted under HITECH, both the Office of Civil Rights and the state attorney general have the authority to enforce penalties for the breach of the HIPAA laws that protect the privacy and security of PHI. DIF: Cognitive Level: Understand 9.

REF: pp. 390, 392

Which initiatives are a policy priority for Meaningful Use? (Select all that apply.) a. To engage patients and families b. To lower the cost of delivering healthcare services c. To improve care coordination d. To ensure adequate privacy and security of patient information

ANS: A, C, D

Engaging patients and families, improving care coordination, and ensuring privacy and security are all policy initiatives that were used as foundational elements of how the Health IT Policy Committee defined Meaningful Use to achieve the specific public policy goals. The policy initiatives created by the Health IT Policy Committee did not base the Meaningful Use measures upon the intention of lowering the costs.

DIF: Cognitive Level: Remember

REF: p. 381

10. Which safeguards are implementation specifications for security awareness and training?

(Select all that apply.) a. Security reminders b. Protection from malicious software c. Log-in monitoring d. Response and reporting

ANS: A, B, C

Security reminders, protection from malicious software, and log-in monitoring are implementation specifications for security awareness and training. Response and reporting are implementation safeguards for how to address a security incident and are not specifications of security awareness and training.

DIF: Cognitive Level: Understand

REF: p. 387

MULTIPLE CHOICE 1. The EHR incentive Meaningful Use criteria are adapted from work done by:

a. b. c. d.

the National Quality Forum. the National Priorities Partnership. the Joint Commission. 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 the National Priorities Partnership.

DIF: Cognitive Level: Remember

REF: p. 398

2. The ONC-sponsored Standards & Interoperability Framework completes its health IT standards

development initiatives using: a. consensus-based decision making through a moderated online wiki. b. monthly conference calls of volunteers working on each initiative. c. surveys sent out to provider organizations working on EHR implementation. d. face-to-face work teams assembled to work on each initiative.

ANS: A

The health IT standards work is done online through a moderated wiki with over 1,300 volunteers participating in the Standards & Interoperability Framework.

DIF: Cognitive Level: Remember

REF: p. 400

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 the details, monitoring and tracking of the unplanned or unexpected consequences are important, so we can learn moreabout the issues to inform the future.

DIF: Cognitive Level: Remember

REF: p. 401

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 expanding 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 the full extent of their capabilities.

DIF: Cognitive Level: Understand

REF: p. 406

5. To achieve the goals of the HIMSS Nursing Informatics Position Statement, all nurses should: a.

draft health IT policy. b. run for political office. c. participate in advocacy and educational efforts directed to policymakers. d. develop innovative technologies.

ANS: C

The HIMSS Nursing Informatics Position Statement states that nurse leaders should be knowledgeable and well versed in current public policy initiatives and participate in advocacy and educational efforts directed to policymakers.

DIF: Cognitive Level: Apply

REF: p. 406

6. Meaningful Use refers to: a. receiving the EHR incentive payments for Meaningful Use. b. meeting all the Meaningful Use criteria. c. leveraging the EHR to facilitate practice and payment change for healthcare transformation. d. attesting to Meaningful Use.

ANS: C

Meaningful Use is determining how to leverage the EHR implementation to accomplish other goals in an organization beyond just meeting the Meaningful Use criteria. It is not just doing the minimum and checking the Meaningful Use criteria off, but using the implementation process to create other changes needed for healthcare reform.

DIF: Cognitive Level: Remember

REF: p. 401

7. When preparing to provide testimony or serve as an expert witness, the nurse should: a. prepare detailed written notes to read during the presentation. b. interview individuals who are knowledgeable in the topic area. c. prepare multiple questions to ask the committee chairperson. d. focus primarily on developing nursing-related content.

ANS: B

Interviewing knowledgeable individuals, including board members and industry, organizational, or volunteer leaders, will add credibility to the testimony by broadening the scope of expertise and experience that can be leveraged.

DIF: Cognitive Level: Apply

REF: pp. 402-403

MULTIPLE RESPONSE 8.

Which strategies are required when nurses prepare to engage in public policy efforts? (Select all that apply.) a. Acquire knowledge of basic health policy and funding b. Demonstrate leadership skills c. Register as a lobbyist d. Leverage a professional network

ANS: A, B, D

Strategies required for nurses to engage in public policy efforts include acquiring knowledge of the basics of health policy funding, demonstrating leadership skills, and leveraging a professional network.

DIF: Cognitive Level: Apply 9.

REF: pp. 403-404

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

ANS: A, B, C

The safe use of HIT relies on many factors, including clinicians, patients, and socio-technical issues such as the interplay of people, process, and technology. Vendors, users, government, and the private sector all have roles to play.

DIF: Cognitive Level: Remember

REF: pp. 400-401

10. Well-defined policies are necessary to ensure that: (Select all that apply.) a. confidentiality of protected health information is safeguarded. b. accurate cost accounting occurs. c. data capture is being automated. d. clinical decision support is adopted.

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 the use of new and existing technologies intended to support decision making and care delivery.

DIF: Cognitive Level: Apply

REF: p. 405

MULTIPLE CHOICE 1.

Advocating for users’ needs and acting as a liaison between the users, the IT staff, and the vendor are competencies for a(n): a. generalist. b. advanced practice nurse. c. specialist. d. innovator.

ANS: C

Advocating for users’ needs and acting as a liaison between the users, the IT staff, and the vendor are competencies for the informatics nurse specialist (INS). The INS receives graduate training for this role.

DIF: Cognitive Level: Remember 2.

REF: pp. 420-421

A popular continuing education program that teaches informatics knowledge, skills, and attitudes is: a. TIGER. b. AMIA 10x10. c. HRSA. d. HIMSS.

ANS: B

A popular continuing education program that teaches informatics knowledge, skills, and attitudes is AMIA 10x10. TIGER, HRSA, and HIMSS are all organizations that advocate for continuing education but are not providers of informatics education.

DIF: Cognitive Level: Remember 3.

REF: p. 413

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 the use of electronic health records.

ANS: D

HITECH has influenced healthcare delivery because it is federal legislation that promotes the use of electronic health records. HITECH has not specifically addressed informatics training or education.

DIF: Cognitive Level: Remember 4.

REF: p. 412

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 the Institute of Medicine (IOM). HRSA, TIGER, and AMIA 10x10 may address informatics competencies, but they did not provide the foundation for the QSEN project.

DIF: Cognitive Level: Remember 5.

REF: p. 420

The implementation specialist, practice workflow specialist, and health information exchange specialist are informatics roles identified and described by: a. the ANA Scope and Standards for Nursing Informatics. b. the Department of Labor’s Bureau of Labor Statistics. c. ONC’s HITECH Workforce Plan. d. the Department of Commerce’s Standard Occupation Codes.

ANS: C

The implementation specialist, practice workflow specialist, and health information exchange specialist are informatics roles identified and described by the ONC’s HITECH Workforce Plan. The ANA Scope and Standards for Nursing Informatics, Department of Labor’s Bureau

of Labor Statistics, and Department of Commerce’s Standard Occupation Codes do not delineate these positions.

DIF: Cognitive Level: Remember 6.

REF: pp. 417-418

Evaluating data from all relevant sources, including technology, to inform the delivery of care is a competency for a(n): a. generalist. b. advanced practice nurse. c. specialist. d. innovator.

ANS: A

Evaluating data from all relevant sources, including technology, to inform the delivery of care is a competency for a generalist. The generalist receives undergraduate training for this role.

DIF: Cognitive Level: Remember 7.

REF: pp. 420-421

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 the learning theories discussed.

DIF: Cognitive Level: Remember 8.

REF: pp. 415-416

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 deals primarily working with information and communicating information to others. Therefore communication tools are a necessary component of an informatics education.

While the EBP, interprofessional teams, and patient safety can be enhanced by the use of

informatics, they are not informatics knowledge, skills, or attitudes. Informatics is about information and communicating it to others.

DIF: Cognitive Level: Remember 9.

REF: p. 416

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 the implementation support specialist. This is not a competency of the generalist, APN, or INS. DIF: Cognitive Level: Remember

REF: p. 421

10. Existing resources that promote meeting the challenge of teaching informatics in the health

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. The costs of simulation and AEHRs can be prohibitive.

DIF: Cognitive Level: Remember

REF: pp. 420-421

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 the television and cable services c. The development of Web 2.0 tools and the Internet

d. Fiber-optic cables and 2-way video communications

ANS: A

Phase one of distributive education historical developments was pushed forward by the establishment of the Society to Encourage Studies at Home and the Chautauqua College of Liberal Arts. The invention of the television and cable services, the development of Web 2.0 tools and the Internet, fiber-optic cables, and 2-way video communications relate to other events that further promoted distance education.

DIF: Cognitive Level: Remember 2.

REF: p. 425

Distributive education is: a. education that takes place in different settings and at different times. b. the use of electronic devices to deliver the instruction and by which the learners acquire their knowledge. c. customized, learner-centered education that uses technology to provide learner experiences where the learner is engaged in the learning activities that may or may not be at a distance. d. a version of distance education that requires the use of the Internet or Intranet to deliver the educational materials.

ANS: C

Distributive education is customized, learner-centered education that uses technology to provide learner experiences where the learner is engaged in the learning activities that may or may not be at a distance. The definition incorporates the main components of technology, engagement, customization, interaction, and individualization. The remaining choices are not complete enough or describe other terms like distance education, elearning, or online learning.

DIF: Cognitive Level: Understand 3.

REF: p. 426

What is the main 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 the learning institution. d. Portal-based systems are developed and customized by the learning institution, and proprietary CMS systems are products purchased or licensed by a vendor.

ANS: D

Portal-based systems are developed and customized by the learning 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 4.

REF: pp. 428-429

From a faculty perspective, the two 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, ease of use and tool set are the most important. The installed base and integration, cost and scalability, and ease of use and installed base are generally more important to the technology staff and administration.

DIF: Cognitive Level: Understand 5.

REF: pp. 431-432

Two examples of campus portal systems are: a. Moodle and Blackboard. b. Ellucian and Jenzabar e-Racer. c. Desire2Learn and Blackboard. d. Sakai and Ellucian.

ANS: B

Ellucian and Jenzabar e-Racer are portal systems. Blackboard and Desire2Learn are CMS, and Moodle and Sakai are open source examples.

DIF: Cognitive Level: Remember 6.

REF: pp. 428-429

For a successful distributive education program, the institution: a. must always offer students the option for distributed learning even if there is no faculty buyin. 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 the goals and objectives for a distributive education initiative to the mission and goals of the institution. 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 the mission and goals of the institution, 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 the institution.

DIF: Cognitive Level: Remember 7.

REF: p. 427

In a distributed learning environment, faculty members should: a. take their face-to-face lectures and turn them into a podcast. b. teach the course the same way as the face-to-face course, as all sections of the course need to be the same. c. use the same activities as the on-campus courses; there is no need to adjust them. d. develop learning activities that engage the learner with relevant real-world activities.

ANS: D

In distributive education the instructor needs to empower the learners to take charge of their learning, to be engaged, and to have a comprehensive learning experience. Podcasts of lectures do not engage the learner, and using the same learning activities does not take advantage of the tools available to engage and empower the learner.

DIF: Cognitive Level: Remember 8.

REF: p. 426

To ensure student success and engagement, faculty members should: a. make evaluative comments in the discussion forum as to the quality of each student’s post so they can improve. b. administer multiple choice tests to measure students’ progress in learning the concepts. c. provide timely feedback to students using a grading rubric through the grading center. d. use their discretion as to the amount and frequency of their feedback to the students.

ANS: C

Providing students with how their learning will be evaluated though a rubric and when this will occur should keep the students engaged and successful. The Family Educational Rights and Privacy Act (FERPA) frowns on other students having access to evaluative comments of classmates. Multiple-choice questions do not necessarily keep the student engaged. Students should know what is required, when, and how soon they will receive feedback on their progress.

DIF: Cognitive Level: Apply 9.

REF: p. 433

Critical to a successful distributive education program are the student support services. The first thing one should do is: a. make sure the library has online access to its holdings through online lending, full text literature databases, and online access to the research librarian.

b. arrange for tutoring services especially in the distribution courses such as probability and

statistics, college algebra, English, and sciences. c. arrange for the bookstore to provide delivery services for required textbooks. d. survey the students for what support services they expect from the school.

ANS: D

Faculty must determine or assess the needs of the students for support services before deciding what to provide; the other answers all relate to specific support services one might provide.

DIF: Cognitive Level: Apply

REF: p. 433

10. Faculty should clarify the intellectual property issues surrounding the creation of distributive

course materials because: a. these digital materials may have commercial value, and the institution may decide to sell them. Faculty members need to know if they share ownership and, therefore, profits. b. students may want to distribute materials to their family and friends and not have to pay for them. c. accreditation agencies, as a part of their criteria, require that ownership of these materials belongs to the faculty who developed them and must be clearly stated in intellectual property (IP) policies. d. if institutional resources were used to create these course materials, the materials belong to the institution.

ANS: A

With the digitization of class materials, there is a market for developed materials, and faculty members need to be aware of their rights to/ownership of these materials. The field is changing when it comes to ownership of materials developed to teach a course. Students distributing materials to their family and friends without paying for them relates to copyright issues.

Accreditation agencies requiring, as a part of their criteria, that ownership of these materials belongs to the faculty who developed them and must be clearly stated in IP policies is not relevant to who actually owns what and what that may mean to a faculty member. While it may be true that the institution owns the course materials if institutional resources were used to create them, this would need to be clarified as this statement has applied to patents and inventions.

DIF: Cognitive Level: Remember

REF: pp. 436-437

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 the largest proprietary learning management systems in the world. 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. 447

2. What is the process 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 the process that faculty at higher educational institutions must go through to secure a career position. The other options (security, tension, and freedom) describe how faculty members may feel during the tenure process.

DIF: Cognitive Level: Remember

REF: p. 444

3. Which generic term describes the technology that replaced the traditional chalkboard in

classrooms? a. Interactive white board b. Smart chalk board c. Advanced chalk management d. The board

ANS: A

An interactive white board is the generic term that describes the technology that replaced the traditional chalkboard in classrooms. The other answers (smart chalk board, advanced chalk management, and the board) either do not fully describe the technology or are incorrect.

DIF: Cognitive Level: Remember

REF: p. 444

4. Which is the major application for virtual world creation and interaction? a. FirstWave b. Virtual Worldz c. Second Life d. World of Warcraft

ANS: C

Second Life is the major application for virtual world creation and interaction. Second Life was the original application created for interaction between users in a virtual world. FirstWave, Virtual Worldz, and World of Warcraft are incorrect choices.

DIF: Cognitive Level: Remember

REF: pp. 449-450

MULTIPLE RESPONSE 5. What are some software examples of eportfolio creation? (Select all that apply.) a. iClickr b. ePortfolio c. eInstruction d. Desire2Learn ePortfolio

ANS: B, D

Some software examples of eportfolio creation are ePortfolio and Desire2Learn ePortfolio. iClickr and eInstruction are audience response systems.

DIF: Cognitive Level: Remember

REF: p. 448

6. Which applications might be useful for recording reflective student clinical journals? (Select all

that apply.) a. Microsoft Word b. Microsoft Excel c. Twitter d. Blackboard

ANS: A, D

Microsoft Word and Blackboard are both excellent tools for recording reflective journals for students and allow for ease of access to faculty. The functionality of Microsoft Excel makes this a poor choice for journaling, and the character limit of Twitter makes reflective journaling impossible.

DIF: Cognitive Level: Apply

REF: p. 449

7. Which examples represent proprietary applications suitable for real-time in-class student

responses? (Select all that apply.) a. iClickr b. TurningPoint c. TurnOff d. ClickMe

ANS: A, B iClickr and TurningPoint are applications currently marketed as audience response

systems. TurnOff and ClickMe are not examples of audience response systems.

DIF: Cognitive Level: Remember

REF: pp. 446-447

8. What are the limitations of employing a virtual environment as a teaching method? (Select all that

apply.) a. b. c. d.

Access Interface Creativity Cost

ANS: A, B, D

Access, interface, and cost are the most common reasons for not participating in or using this sort of technology in a course. Typically, cost is related to creation of a location in the virtual world. Interface is using a keyboard, mouse, and microphone to interact, and access relates to bandwidth available to the user.

DIF: Cognitive Level: Understand

REF: pp. 449-450

9. 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. Uncertainty about how to structure and determine costs of new courses d. Financial incentives from publishing companies to continue using traditional teaching materials

ANS: A, B, C

Reasons for the slowness of adoption of technology range from 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 (or seat time). Publishers are embracing technology and are not offering incentives for using traditional print materials.

DIF: Cognitive Level: Understand

REF: pp. 450-451

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 2.

REF: p. 460

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. 461

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. 462

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. 460

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. 460

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. 455

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 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. 456

MULTIPLE RESPONSE 8.

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

ANS: A, B, D

Terminology, debriefing process, and facilitation methods are INACSL standards for simulation best practice. The current INACSL standards address the participant objectives, not the facilitator objectives.

DIF: Cognitive Level: Remember 9.

REF: p. 460

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

ANS: B, C

Standards are necessary to create the foundational structure on which to build simulation experiences and ensure quality and control related to the scenarios.

DIF: Cognitive Level: Understand

REF: p. 460

10. Which categories of objectives can be met in a simulated clinical experience using a

computercontrolled high-fidelity mannequin? (Select all that apply.) a. Cognitive b. Sociocultural c. Psychomotor d. Affective

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.

DIF: Cognitive Level: Remember

REF: p. 455

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. 484

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. 482

3. Which region introduced ehealth initiatives such as epSOS and SEHGovIA for interoperability? a.

Asia-Pacific region b. Latin America and the Caribbean c. Europe d. Africa

ANS: C

Europe introduced ehealth initiatives such as epSOS and SEHGovIA for interoperability. The remaining choices (Asia-Pacific region, Latin America and Caribbean region, and African region) did not introduce these initiatives.

DIF: Cognitive Level: Remember

REF: pp. 474-475

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. 489

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. 489

6. Which international organization deals with harmonization 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. 486

MULTIPLE RESPONSE 7. Which organizations have relationships with the Health Informatics Building Blocks Program aimed at health informatics workforce development in Africa? (Select all that apply.) a. Health

Level 7 (HL7) b. Health Informatics in Africa (HELINA) c. American Medical Informatics Association (AMIA) d. Global Health Informatics Partnership (GHIP)

ANS: B, C, D

The HELINA, AMIA, and GHIP organizations have relationships with the Health Informatics Building Blocks Program aimed at health informatics workforce development in Africa. The HL7 does not have a relationship with the Health Informatics Building Blocks Program.

DIF: Cognitive Level: Remember

REF: pp. 480-481

8. Which international organizations develop terminology? (Select all that apply.) a. International Medical Informatics Association (IMIA) b. International Council of Nurses (ICN) c. World Health Organization (WHO) d. International Health Terminology Standards Development Organization (IHTSDO)

ANS: B, C, D

The ICN, WHO, and IHTSDO all develop terminologies. International Medical Informatics Association does not develop terminology.

DIF: Cognitive Level: Remember

REF: p. 482 | p. 484 | p. 489

9. 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)

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) does not develop international standards for informatics.

DIF: Cognitive Level: Remember

REF: pp. 484-485 | p. 489

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 2.

REF: pp. 502-503

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 3.

REF: p. 495

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 4.

REF: pp. 496-497

A hospital has just implemented bar-coded 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 5.

REF: pp. 496-497

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 are examined for common themes.

DIF: Cognitive Level: Apply 6.

REF: pp. 497-499

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 7.

REF: pp. 503-504

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 8.

REF: pp. 503-504

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 9.

REF: p. 504

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. 505

10. Which goal applies to the field of nanoinformatics? a. Development of a publicly available database of nanoparticle information, nanoparticle

structure simulation tools, and data mining techniques for nanoparticle information 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: A

A goal that applies to the field of nanoinformatics is the development of a publicly available database of nanoparticle information, nanoparticle structure simulation tools, and data mining techniques for nanoparticle information. Nanofabrication is the development of nanomaterials used in electronics, structural materials, and commercial products. Nanotechnology is the creation of materials, devices, and other structures at the nanoscale. Nanomedicine is the use of nanotechnology for the prevention, diagnosis, and treatment of disease DIF: Cognitive Level: Remember

REF: p. 505

Chapter 16: Social Media Tools for Health Informatics Hardy: Health Informatics: An Interprofessional Approach, 3rd 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. The tool 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 the most appropriate. The other choices (Facebook, e-mail, and Second Life) are not appropriate for sending short messages.

DIF:

Cognitive Level: Apply

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 the groups of people most likely to seek health information from social network sites.

DIF:

Cognitive Level: Remember

3. Which group is allowed to share personal health information on social media sites? a. Providers who monitor the social media site b. Healthcare providers on the site 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

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 the web. 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.

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ANS:

B

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

DIF:

Cognitive Level: Understand

5. 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 the instances when friending is possible.

DIF:

Cognitive Level: Remember

6. In the future, 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

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

8. Social media is unsecure and can be a high risk for security breach issues. When you accept a

friend on social media, that could be an extension of other friends. The friend extension could have malicious codes attached that affect your settings. This type of social media virus is known as: a. Phishing b. Ransom wear

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c. Malicious friending d. Malware ANS:

C

Accepting a person on social media through another person can cause malicious codes to be attached and change the settings of the user.

DIF:

Cognitive Level: Remember

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

2. A Remote Access Trojan (RAT) is a malware program that operates in the background and

can do the following: (Select all that apply.) a. Steal passwords b. Gain private information c. Take on owner identity d. Locate hardware ANS:

A, B, C

A RAT malware program is a back door entrance through an app onto an owner's computer, handheld device, or laptop. The program runs undetected but collects information and can infect the device.

DIF:

Cognitive Level: Understand

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

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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

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Chapter 17: Project Management Principles Hardy: Health Informatics: An Interprofessional Approach, 3rd 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

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

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

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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

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

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

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

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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

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

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

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

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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

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Chapter 18: Strategic Planning and Information System Selection Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. When planning for a new project it is imperative for the implementation to run smoothly. This

can only be done with the help of which key individuals? a. Physicians b. Leadership c. Stakeholders d. Patient care leaders ANS:

C

The complex nature of implementing any project require the support of all stakeholders. This support will allow a positive push for all. Without the stakeholders championing the project, the project manager may feel pushback from the organization during implementation.

DIF:

Cognitive Level: Apply

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

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

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

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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

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

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

apply.) a. The Delphi method b. Inventorying current documents and forms c. Interviews d. Direct observation e. 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

3. When reviewing various EHR systems, which six items should be evaluated? (Select all that

apply.) a. Current framework is sufficient b. Charting a patient encounter c. Secure network d. Importing data e. Workflow processes f. Downtime policies

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g. End users ANS:

A, B, D, E, F, G

It is important to review characteristics of various EHR systems and consider the result when researching vendors. Key characteristics to consider for the end process include: training, data, underlying models, Infrastructure, policies, and patient experience.

DIF:

Cognitive Level: Understand

4. When evaluating the security of an EHR system, project managers need to consider these

items: (Select all that apply.) a. Who will access the system b. How will authentication be performed c. Who will monitor the system d. What encryption will be used e. What training is provided to users ANS:

A, B, D, E

Consideration should be given to onsite and offsite system access. Onsite, most facilities are secured within their network through a VPN. Strong passwords, reporting phishing emails, and utilizing organizational technology will reduce security risk. Outside of a secure network, two-factor authentication provides a layer of security to the user.

DIF:

Cognitive Level: Remember

5. When considering a new EHR system, a team should be assembled to evaluate the various

vendors. The team should consist of users such as: (Select all that apply.) a. Environmental Services b. Physicians c. Patients d. Pharmacist e. Therapist f. Chief Executive Office g. Nutritionist h. Security ANS:

B, C, D, E, G

Assembling a team with direct users of the EHR will allow a variety of workflows to be evaluated. This detailed evaluation will provide various functionalities and potential stumbling blocks.

DIF:

Cognitive Level: Remember

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Chapter 19: Contract Negotiations and Software Licensing Hardy: Health Informatics: An Interprofessional Approach, 3rd 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

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

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

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

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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

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

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

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

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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

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

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

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Chapter 20: Implementing and Upgrading an Information System Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. 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 through and alternative program. c. The commercial version is considered more robust in function. 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

2. 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

3. 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

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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

4. 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

5. 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

6. 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

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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

7. 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

8. Anything that obstructs a network's ability to exchange or access information in an electronic

health record is known as: a. Tall man lettering b. Big bang c. Information blocking d. Information influence ANS:

C

Information blocking as identified in The Cures Act, section 4004, that allows patients the ability to securely access their electronic health record.

DIF:

Cognitive Level: Remember

9. A term for in-person education and support to the end user during a go-live is known as; a. Training modalities b. Video -based learning c. Migration d. At the Elbow support ANS:

D

Go-live activities involve many moving parts. "At the elbow" support refers to a superuser or trainer to support the end user in person, side by side to any staff that may have difficulties with a new system. This support is typically given for the first few days during go-live.

DIF:

Cognitive Level: Remember

10. A go-live plan is specifically broken down into task and phases by the? a. Stakeholders b. Project manager

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c. Vendor d. IT department ANS:

B

A project manager will break down a go-live plan into critical tasks and a specific schedule for the timing of the migration of systems to be implemented as smoothly as possible.

DIF:

Cognitive Level: Understand

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

2. What are some of the challenges that occur with the integration of technology in health care?

(Select all that apply.) a. Voice dictation b. Patient portals c. Remote patient monitoring d. Telehealth e. Remote chart reviews ANS:

A, B, C, E

During the global pandemic, healthcare systems moved at record speed to adapt to patient needs. Telehealth was a platform that was being delivered securely but voice assistants, patient portals, and remote monitoring provided a cyber security headache.

DIF:

Cognitive Level: Understand

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Chapter 21: Downtime and Disaster Recovery for Health Information Systems Hardy: Health Informatics: An Interprofessional Approach, 3rd 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 man-made disasters.

DIF:

Cognitive Level: Analyze

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

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

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

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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

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

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

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

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

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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

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

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

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Chapter 22: Improving the User Experience for Health Information Technology Hardy: Health Informatics: An Interprofessional Approach, 3rd 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

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

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

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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

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

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

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

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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

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

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

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

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b. c. d. e.

eMAR QUIS SEIPS 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

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Chapter 23: Data Science and Analytics in Healthcare Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. Which measure is most important for evaluating the performance of classifiers, models that

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

B

The area under the receiver operating characteristic (ROC) curve is the most important overall measure of classifier performance.

DIF:

Cognitive Level: Remember

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

C

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

DIF:

Cognitive Level: Remember

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 (CRISP-DM) is a process in which machine learning and statistical methods are applied to analyze large amounts of data.

DIF:

Cognitive Level: Remember

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

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In its initial forays, an organization typically begins by looking back at the data it's collected, through retrospective (or exploratory data) analyses. It then gradually moves up the scale of difficulty toward prescriptive analytics.

DIF:

Cognitive Level: Understand

5. A health analytics professional must be skilled in all of the following 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

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 the assignment 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 the development process for the purpose of unbiased performance estimation).

DIF:

Cognitive Level: Apply

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

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2. Which of the following 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 the category of tools.

DIF:

Cognitive Level: Understand

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

statistics and visualization with respect to the following: (Select all that apply.) a. Distribution b. Arcing c. Sparsity d. Identifiers e. Outliers ANS:

A, C, D, E

All of the choices are generally useful properties that can help in data analysis, except for "arcing," which is not a term used in the text.

DIF:

Cognitive Level: Remember

4. Which of the following 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

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Chapter 24: Safety and Quality Initiatives in Health Informatics Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. An important component of the informatics 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 the types of data used to populate the quality metrics.

ANS:

A

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

DIF:

Cognitive Level: Remember

2. When evaluating quality and patient safety, which approach defines the framework 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. The framework for PSQRD builds upon Donabedian's structure-process-outcome model to support evaluation of an intervention from the preimplementation testing phase through implementation and evaluation. In the case of a health information technology (IT) intervention, the expanded framework supports understanding where the health IT intervention is most likely to have an effect, within the organizational causal chain of quality and safety events. The PSQRD framework provides a means to categorize interventions according to areas of the causal chain targeted.

DIF:

Cognitive Level: Remember

3. Why is the PSQRD a useful framework for research and practice? a. It explains why using computer applications is the best 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.

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d. It increases communication among clinical staff.

ANS:

B

While the PSQRD framework may improve communication and implementation, a critical strength of this framework is its systems approach and comprehensive strategy for ongoing monitoring and evaluation. The PSQRD 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 the causal chain. This approach supports implementation, performance improvement, and research projects with an appreciation for the effects and the limitations of health IT and other intervention components.

DIF:

Cognitive Level: Remember

4. A nurse forgets to walk a patient during the nurse'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 the wrong thing would be considered an error of commission. Condition and remission are not considered error types.

DIF:

Cognitive Level: Apply

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

ANS:

A

Doing the wrong 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

6. A hospital has an integrated clinical decision support system embedded in the EHR.

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, the physical structure of buildings, staffing rations, the equipment available within an organization, and the budget to support care provision) are all part of structure. The EHR with an embedded CDS system is part of the structure of an organization.

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DIF:

Cognitive Level: Apply

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 the provision of care are all included under the process component. The use of a CDS system is considered process.

DIF:

Cognitive Level: Apply

8. A unit has been experiencing a high rate of patient falls for the past 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 the structures and processes are considered outcomes. These may include clinical outcomes. The measurement of patient falls is considered an outcome.

DIF:

Cognitive Level: Apply

MULTIPLE RESPONSE 1. To automatically track the quality 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 the quality of care, standardized quality measures are needed to ensure that all organizations are using consistent metrics for benchmarking and that organizations are using the same types of data to populate the quality metrics.

DIF:

Cognitive Level: Understand

2. Which items are included in the IOM six aims for improvement? (Select all that apply.) a. Safe b. Patient-centered c. Innovative

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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 the six aims for improvement.

DIF:

Cognitive Level: Remember

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Chapter 25: Informatics in the Curriculum Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. Advocating for users' needs and acting as a liaison among the users, the IT staff, and the

vendor 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 the users, the IT staff, and the vendor 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

2. Which organization spearheaded the development of informatics competencies across the

nursing 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 the way for developing informatics competencies across the nursing curriculum.

DIF:

Cognitive Level: Remember

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 the use of electronic health records.

ANS:

D

HITECH has influenced healthcare delivery because it is federal legislation that promotes the use of electronic health records. HITECH has not specifically addressed informatics training or education.

DIF:

Cognitive Level: Remember

4. The Quality and Safety Education in Nursing (QSEN) project developed competencies based

on work completed by: a. HRSA.

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b. TIGER. c. IOM. d. AMIA 10x10.

ANS:

C

The QSEN project developed competencies based on work completed by the Institute of Medicine (IOM). HRSA, TIGER, and AMIA 10x10 may address informatics competencies, but they did not provide the foundation for the QSEN project.

DIF:

Cognitive Level: Analyze

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 the work of a healthcare provider to take full advantage of meeting the Meaningful Use criteria. This role requires university-based education and training.

DIF:

Cognitive Level: Remember

6. Evaluating data from all relevant sources, including technology, to inform the delivery 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 the delivery of care is a fundamental building-block competency for a generalist. The generalist receives undergraduate training for this role.

DIF:

Cognitive Level: Remember

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 the learning theories discussed.

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DIF:

Cognitive Level: Remember

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 the EBP, interprofessional teams, and patient safety can be enhanced by the use of informatics, they are not informatics knowledge, skills, or attitudes. Informatics is about information and communicating it to others.

DIF:

Cognitive Level: Analyze

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 the implementation support specialist. This is not a competency of the generalist, APN, or INS. DIF:

Cognitive Level: Remember

10. Existing resources that promote meeting the challenge of teaching informatics in the health

professional curriculum are: a. a sufficient number of trained faculty. b. readily available technical infrastructure. c. collaborative practice and simulation. d. simulation and academic electronic health records (AEHRs) software.

ANS:

C

Today's learner is driven by immersion in their environment and hands on. New tools and approaches are now incorporated into education for a better learning experience.

DIF:

Cognitive Level: Analyze

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Chapter 26: Distance Education—A New Frontier Hardy: Health Informatics: An Interprofessional Approach, 3rd 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 the television and cable services c. The development of web 2.0 tools and the internet d. Fiber-optic cables and 2-way video communications ANS:

A

Phase one of distributive education historical developments was pushed forward by the establishment of the Society to Encourage Studies at Home and the Chautauqua College of Liberal Arts. The invention of the television and cable services, the development of web 2.0 tools and the internet, fiber-optic cables, and 2-way video communications relate to other events that further promoted distance education.

DIF:

Cognitive Level: Remember

2. Distributive education is: a. education that takes place in different settings and at different times. b. the use of electronic devices to deliver the instruction and by which the learners

acquire their knowledge. c. customized, learner-centered education that uses technology to provide learner experiences where the learner is engaged in the learning activities that may or may not be at a distance. d. a version of distance education that requires the use of the internet or an intranet to deliver the educational materials.

ANS:

C

Distributive education is customized, learner-centered education that uses technology to provide learner experiences where the learner is engaged in the learning activities that may or may not be at a distance. The definition incorporates the main components of technology, engagement, customization, interaction, and individualization. The remaining choices are not complete enough or describe other terms like distance education, elearning, or online learning.

DIF:

Cognitive Level: Understand

3. What is the main 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 the learning institution. d. Portal-based systems are developed and customized by the learning institution, and

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proprietary CMS systems are products purchased or licensed by a vendor.

ANS:

D

Portal-based systems are developed and customized by the learning 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

4. From a faculty perspective, the two 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 the most critical in the above list. Ease of use, tool set, stability, and support are the things that would impact a faculty member's decision the most. The installed base and integration, cost and scalability, and ease of use and installed base are generally more important to the technology staff and administration.

DIF:

Cognitive Level: Understand

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

6. For a successful distributive education program, the institution: a. must always offer students the option 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 the goals and objectives for a distributive education initiative to the

mission and goals of the institution. 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 the mission and goals of the institution, 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 the institution.

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DIF:

Cognitive Level: Remember

7. In a distributed learning environment, faculty members should: a. take their face-to-face lectures and turn them into a podcast. b. teach the course the same way as the face-to-face course, as all sections of the

course need to be the same. c. use the same activities as the on-campus courses; there is no need to adjust them. d. develop learning activities that engage the learner with relevant real-world

activities.

ANS:

D

In distributive education the instructor needs to empower the learners to take charge of their learning, to be engaged, and to have a comprehensive learning experience. Podcasts of lectures do not engage the learner and using the same learning activities does not take advantage of the tools available to engage and empower the learner.

DIF:

Cognitive Level: Remember

8. To ensure student success and engagement, faculty members should: a. make evaluative comments in the discussion forum as to the quality of each

student's post so they can improve. b. administer multiple-choice tests to measure students' progress in learning the concepts. c. provide timely feedback to students using a grading rubric through the grading center. d. use their discretion as to the amount and frequency of their feedback to the students.

ANS:

C

Providing students with information that their learning will be evaluated through a rubric and when this will occur should keep the students engaged and successful. The Family Educational Rights and Privacy Act (FERPA) frowns on other students having access to evaluative comments of classmates. Multiple-choice questions do not necessarily keep the student engaged. Students should know what is required, when, and how soon they will receive feedback on their progress.

DIF:

Cognitive Level: Apply

9. Critical to a successful distributive education program are the student support services. The

first thing one should do is: a. make sure the library has online access to its holdings through online lending, full text literature databases, and online access to the research librarian. b. arrange for tutoring services especially in the distribution courses such as probability and statistics, college algebra, English, and sciences. c. arrange for the bookstore to provide delivery services for required textbooks. d. survey the students for what support services they expect from the school.

ANS:

D

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Faculty must determine or assess the needs of the students for support services before deciding what to provide; the other answers all relate to specific support services one might provide.

DIF:

Cognitive Level: Apply

MULTIPLE RESPONSE 1. The Higher Education Opportunity Act of 2008 stipulates which of the following? (Select all

that apply.) a. Faculty must select and submit textbook requirements to the campus bookstore before posting the next semester's schedule and registration. b. Institutions must verify that the enrolled student is actually the person completing the course. 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 the change 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

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Chapter 27: Legal Issues, Federal Regulations, and Accreditation Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. Powers granted to both the federal 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 the federal and state governments at the same time, such as the ability to regulate the privacy of PHI. DIF:

Cognitive Level: Remember

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

the states? a. HIPAA b. HITECH c. The 10th Amendment to the U.S. Constitution d. The Stark Law ANS:

C

The 10th Amendment to the U.S. Constitution, known as the reserved powers clause, reads as follows: "The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people."

DIF:

Cognitive Level: Remember

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 the U.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

4. Which of the following 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 the finding of liability against an

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

ANS:

A

Administrative proceedings and court proceedings are functionally equivalent. The same remedies are available to both the federal court judge and the administrative law judge.

However, the administrative system offers an additional route of appeal regarding decisions, when compared to the court system.

DIF:

Cognitive Level: Apply

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 the False 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 the False 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 the question.

DIF:

Cognitive Level: Apply

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, the Anti-Kickback Statute is violated.

DIF:

Cognitive Level: Apply

7. Which of the following would be regulated by the FDA? 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 the FDA.

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DIF:

Cognitive Level: Remember

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 the only two agencies that the Center for Medicare and Medicaid Services has authorized to accredit hospitals.

DIF:

Cognitive Level: Understand

2. The Stark Law considers which of the following 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

3. Which of the following would the FDA 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 the FDA 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

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Chapter 28: Privacy and Security Hardy: Health Informatics: An Interprofessional Approach, 3rd 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 the potential to cause harm to an informational asset ANS:

C

Privacy is the rights of individuals to control access to their person or information about themselves. Security is defined as the means to ensure health record privacy and confidentiality. Data integrity is defined as the accuracy and completeness of health information. A threat is an act that has the potential to cause harm to an informational asset.

DIF:

Cognitive Level: Remember

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, the healthcare provider is violating the fair information principle of data quality and integrity. Correction involves allowing individuals to dispute the accuracy 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

3. If a breach of protected health information has been discovered, to which agency does the

breach need to be disclosed? a. The Joint Commission b. U.S. Department of Health and Human Services c. U.S. Code of Federal Regulations d. Office of Civil Rights ANS:

B

If an organization breaches protected health information, it should be reported immediately to the U.S. Department of Health and Human Services.

DIF:

Cognitive Level: Understand

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4. An organization reviews its data security policies and procedures to ensure the security for its

patients protected health information (PHI). Which analysis is this organization undergoing? a. Breach notification b. Right to access c. Risk assessment d. Denial of service ANS:

C

A risk assessment provides organizations with a roadmap to prepare for cyber threats and potential vulnerability. By ensuring that electronic PHI is protected, the organization is implementing HIPAA Right to Access Rule.

DIF:

Cognitive Level: Remember

5. A nurse received an email that an update to the software system was needed to be able to

chart. The signature line was signed by the IT department but the sender's address was from outside of the organization. This type of cyber threat is known as: a. Ransomware b. Keylogging c. Malware d. Spear phishing ANS:

D

Emails sent to a member of an organization with the use of a fraudulent page to encourage the user to click on something to install is known as phishing. After clicking on the link, malware can be loaded into the computer.

DIF:

Cognitive Level: Apply

6. An organization that loses the ability to access its computers for patient care information is

known as what type of cyber attack? a. Ransomware b. Keylogging c. Malware d. Spear phishing ANS:

A

Ransomware infects and disables computers, rendering the organization unable to retrieve patient data for patient care.

DIF:

Cognitive Level: Apply

7. As healthcare delivery and technology continue to expand, who can assist in the development

of safeguards while working with legislation? a. Chief Medical Officer b. State Representatives c. Health Informaticists d. College Professors ANS:

C

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Health informaticists strive to improve and develop methods, processes, and the collection of patient data. This experience provides talking points and experience to assist in developing regulations that will provide safe and secure measures for protected health information.

DIF:

Cognitive Level: Understand

MULTIPLE RESPONSE 1. Biometric identifiers are now commonly used in many settings. Which identifiers are

considered biometric? (Select all that apply.) a. Facial scan b. Voice typing c. Chip scan d. Eye scan ANS:

A, B, D

State laws now include an individual's biometric information privacy. Biometric identifiers allow users to access technology devices through physical or biological characteristics such as fingerprints, face and voice recognition, and iris scans.

DIF:

Cognitive Level: Understand

2. A patient's informed consent must include: (Select all that apply.) a. Capacity to make a decision on their own behalf. b. Sufficient information to understand the decision being made. c. Information of possible consequences of the decision. d. Wording that the consent is given voluntarily.

ANS:

A, B, C, D

Informed consent is the right of the patient to have control of the healthcare they are receiving. Patients should be given all information and have all questions answered before signing a consent form for a procedure or treatment.

DIF:

Cognitive Level: Remember

3. Examples of access to patient health information records referred to as a designated record set

include: (Select all that apply.) a. CPT codes b. Radiology report c. Lab report d. Demographics e. Hospital bill ANS:

A, B, C, E

A designated record set that is maintained by a physician consists of medical records, billing records, health insurance claims, and any record that the provider utilizes in the decision-making process.

DIF:

Cognitive Level: Apply

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Chapter 29: MACRA and Interoperability Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. For standardized data to be collected, what must first be in place? a. One EHR system b. One data warehouse c. Unified claims data d. Unified charting method ANS:

C

A patient's claim consists of historical data that describes procedures, diagnosis, prescriptions, service, and more. This information is an opportunity to identify gaps in care or chronic high-risk patients. Without a standardized method to collect specific data, the historical value of the data is useless.

DIF:

Cognitive Level: Apply

2. Which of the following is part of the criteria to prevent information blocking? a. Standardized API b. Any Health Plan c. Physician funded API d. Public access to computers ANS:

A

To share information with providers, payers, and patients, a standardized API must be in place to allow data to move bilaterally through a variety of software platforms to allow for interoperability. Having interoperability will allow patients to have access to their own medical records without requesting it from a third party.

DIF:

Cognitive Level: Understand

3. Merit-based Incentive Payment Systems (MIPS) focus on which type of data from an

electronic health record? a. Certified EHRs b. Meaningful use c. Applicable health plans d. Payer directory ANS:

B

Meaningful use data is a direct result of technical system interoperability. This type of data is needed to understand the type of care that is being provided by physician for reimbursement purposes.

DIF:

Cognitive Level: Apply

4. All physicians are recognized through: a. National provider enumeration system b. Public attestation

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c. National provider identifier d. Provider directory ANS:

C

Physicians are registered and given a unique identifier known as a national provider identifier (NPI). This unique number allows data to move effectively through health care plans for billing purposes.

DIF:

Cognitive Level: Remember

5. A penalty for non-compliance in promoting interoperability could be up to how much per

violation? a. $100,000 b. $500,000 c. $1 million d. $2 million ANS:

C

When congress passed the Cures Act, a penalty of up to $1 million per violation for information blocking was attached to verify developers of certified IT networks were not intentionally preventing interoperability.

DIF:

Cognitive Level: Remember

6. The use of an application programming interface (API) allows information to pass to and from

software platforms. This type of application is beneficial for: a. Transfer of data b. Efficient billing c. Data exchange d. Staff organization ANS:

A

Patients having access to their healthcare information is an essential piece to the need for API. Additionally, access to the patient's data will provide a better story of what the patient's healthcare needs have been historically throughout the healthcare system. Having the transfer of data can show inconsistency with patient compliance that the physician may not know without the transferring of data.

DIF:

Cognitive Level: Apply

MULTIPLE RESPONSE 1. An example of a payer is: (Select all that apply.) a. Aetna Health Care b. Blue Cross Blue Shield c. Medicare d. United Health Care e. Aflac ANS:

A, B, C, D

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Health plans are coordinated among payers to exchange health plan rates for patients. There are many health insurance carriers that work with physicians, hospitals, clinics, etc. to arrange negotiated rates for health services. Medicare is a government funded health plan provided to persons older than 65 years. Aflac is not considered a part of an individual's healthcare coverage, only supplemental coverage. Supplemental coverage is not considered a payer.

DIF:

Cognitive Level: Apply

2. A provider directory for API must have which requirements to standardized information?

(Select all that apply.) a. Public access on a payer's website b. Multiple login identifiers c. Physician demographics d. Technical safeguards ANS:

A, C, D

Health plans are required to meet specific information through a provider directory API. By meeting these requirements, information blocking is reduced.

DIF:

Cognitive Level: Understand

3. Under the Information Blocking Rule, which conditions are required for a hospital to follow?

(Select all that apply.) a. Records personnel b. Records maintenance c. Certified EHR d. Provider directory ANS:

A, B, C

There are four basic conditions a hospital must meet to prevent financial penalties as stated in the Cures Act and the Information Blocking rule. These conditions allow facilities to participate in Medicare and Medicaid programs and receive financial reimbursement for services provided.

DIF:

Cognitive Level: Understand

4. The CMS Interoperability and Patient Access Rule provides standards for the following areas

(Select all that apply.) a. Patient access b. Provider directory c. Payer-to-payer data exchange d. Information blocking e. Data management ANS:

A, B, C, D

To improve healthcare information and interoperability, many factors must be implemented to reduce the burden from physicians and health plans.

DIF:

Cognitive Level: Remember

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Chapter 30: Health Policy and Health Informatics Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. The EHR incentive Meaningful Use criteria are adapted from work done by: a. the National Quality Forum. b. the HITECH Act. 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 through legislation policy of the HITECH Act. DIF:

Cognitive Level: Remember

2. Which office of the Department of Health and Human Services 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 the National Coordinator (ONC) d. The American Medical Informatics Association (AMIA) ANS:

C

The ONC is the only governmental agency reporting to the DHHS. Its role is to coordinate implementation of health IT and electronic information exchange.

DIF:

Cognitive Level: Remember

3. James received a new job and was required to turn in his notice to his current employer. What

should James review to understand his obligation to his employer to resign from his position? a. Procedure b. Policy c. Codes d. Instruction manual ANS:

B

A policy provides guidance on what to do or what is expected from an employee. Procedures will provide the steps on how to do something. A code has an underlying meaning. An instruction manual is irrelevant to the question.

DIF:

Cognitive Level: Understand

4. Which agency focuses on how to improve the value in healthcare in the U.S.? a. Agency for Healthcare Research and Quality b. Institute of Medicine c. Department of Health and Human Services d. Joint Public Health Informatics

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ANS:

A

The Agency for Healthcare Research and Quality (AHRQ) is a government sponsored agency that investigates the evidence to make healthcare safer and improve quality. AHRQ works with academic institutions, hospitals, physicians, and a variety of healthcare systems to research the best measures.

DIF:

Cognitive Level: Remember

5. In what year were penalties began for non-compliance of the use of certified EHR systems? a. 2014 b. 2015 c. 2016 d. 2017 ANS:

C

The HITECH began levying penalties for non-compliance of certified EHR systems in 2016.

DIF:

Cognitive Level: Remember

6. What are the responsibilities of the U.S. Department of Health and Human Services? a. Fund and regulate b. Investigate and respond c. Policy and procedures d. Policy and protection ANS:

D

The U.S. Department of Health and Human Services' two responsibilities contain various roles but ultimately encompass setting policies that ensure effective delivery of care and protection of community health.

DIF:

Cognitive Level: Apply

MULTIPLE RESPONSE 1. Which recommendations did the IOM 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 the federal government's MyHealthIT mobile app to document healthcare safety concerns. e. ONC should work with the private sector to make comparative user experiences publicly available.

ANS:

A, B, E

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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. The IOM did not recommend any kind of nationalized IT system, nor is there a federal MyHealthIT app.

DIF:

Cognitive Level: Apply

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 the interplay of people, process, and technology. Vendors, users, government, and the private sector all have roles to play.

DIF:

Cognitive Level: Remember

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 using new and existing technologies intended to support decision making and care delivery. The DHHS does not receive a monthly report, and confidential information is not sold.

DIF:

Cognitive Level: Apply

4. The future in healthcare technology includes: (Select all that apply.) a. Artificial medical intelligence b. Nanotechnology c. Electronic health records d. VR e. Machine learning ANS:

A, B, D, E

The future in healthcare technology has surpassed the electronic health record and now encompasses medical intelligence for predictive modeling, wearable technology that provides real-time vital signs and data, robotics, and more.

DIF:

Cognitive Level: Understand

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Chapter 31: Health Information Technology Governance Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. According to the Informatics Capability Maturity Model, the degree 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 the institution.

DIF:

Cognitive Level: Remember

2. What is the first 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 the IT budget d. Whether the organization is a for-profit or non-profit entity ANS:

B

Of the listed factors, an organization's culture is the most important factor that needs to be considered.

DIF:

Cognitive Level: Analyze

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 the topic, 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 the difficulty of informatics governance is that there is more effort desired from informatics than resources allow.

DIF:

Cognitive Level: Apply

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

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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, the trend has now opened up toward more robust data warehouses developed by vendors as well as in-house resources.

DIF:

Cognitive Level: Apply

5. The health IT governance Model: a. has been overtaken by a newer generation of assessment tools. b. was developed by a partnership of the CDC 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 the UK'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

MULTIPLE RESPONSE 1. Why is health IT governance needed? (Select all that apply.) a. It ensures the alignment of informatics resources with institutional priorities. b. It effectively prioritizes the use of informatics resources. c. It optimizes the return 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 the alignment of informatics resources with institutional priorities, effectively prioritizes the use of informatics resources, and optimizes the return on investment on informatics investments. All three reasons are core to the need for health IT governance.

DIF:

Cognitive Level: Apply

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 the governance e. Proper procedures for punishing transgressions ANS:

B, C, D

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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 the governance. Though the term used is "governance," the field is concerned with oversight and guidance rather than rulemaking and enforcement.

DIF:

Cognitive Level: Remember

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 the use of internally produced, transaction-based applications to support back-office functions and the delivery 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 the demand for informatics resources and subsequently require more effective health IT governance and prioritization.

DIF:

Cognitive Level: Apply

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

5. Which activities represent dimensions of the health IT governance? (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 the National 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 the Maturity Model.

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DIF:

Cognitive Level: Remember

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Chapter 32: Global Health Informatics Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. A digital device that collects, sends, and stores data without the need of human interaction is

known as: a. PaaS b. IaaS c. SaaS d. Internet of things ANS:

D

Health data is recorded and connected using the internet resulting in the ability to track and monitor patient information. Items such as wearable sensors, mobile phones, and computing devices. These all provide a patient's health data to be processed and stored.

DIF:

Cognitive Level: Remember

2. Global health informatics (GHI) focuses on the use of technology and research to provide data

and resources on a global perspective. In which countries is this type of research most successful? a. Affluent b. Poverty c. Regency d. Laborer ANS:

B

GHI commissions the use of appropriate technology for global solutions particularly those in low resource countries. Low income, low resource countries have limited access to health care because of limited financial resources. Because of these challenges, a focus on digital incentives has improved access to quality healthcare services.

DIF:

Cognitive Level: Understand

3. Medical artificial intelligence can be established by evaluation of large data that then applies

the information to predict and provide treatment decisions. Such treatment interventions have been predicted in the treatment of: a. Smallpox b. Shingles c. Tuberculosis d. Diabetes ANS:

C

Artificial intelligence (AI) is a resource that is seen predominately in high-income countries.

Research shows that in low income settings tuberculosis and malaria have shown advancement for treatments with the use of AI. DIF:

Cognitive Level: Remember

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4. An example of SaaS web-based service model is: a. Google App b. Apache c. Dropbox d. Microsoft Azure ANS:

C

There are three types of cloud computing services that allow remote storage of data. These include SaaS, PaaS, and IaaS. SaaS utilizes the internet to deliver all applications and run directly through a web browser that is managed by a third-party vendor.

DIF:

Cognitive Level: Apply

5. To sustain a global digital health initiative ,human and technical factors must function to

scope with financial and regulatory efforts that include: a. Healthcare ecosystem b. User-centered design c. Technical factors d. Health innovators ANS:

A

A healthcare ecosystem provides balanced healthcare support that includes doctors, hospitals, businesses, and clinics providing quality care with a variety of choices for care. Telehealth is one example of a digital healthcare ecosystem that is offered through many major health insurance companies.

DIF:

Cognitive Level: Understand

6. For global health informatics to move forward, what impact will provide the biggest change? a. Corporate leadership b. Policies c. Government support d. Staffing ANS:

B

Global digital health informatics in challenging because of the prosperities and understanding of needs within the world. Policies and funding will shape the future of how digital informatics will be used.

DIF:

Cognitive Level: Remember

7. Telemedicine technology barriers may include: a. Low bandwidth b. Low literacy c. Myopia d. Presbycusis ANS:

A

Telemedicine can have technical and cultural barriers.

DIF:

Cognitive Level: Apply

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MULTIPLE RESPONSE 1. Examples of digital health categories include (Select all that apply.) a. VR headset b. Smart watch c. Insulin therapy pump d. Robots e. Patient portal ANS:

A, B, C, D, E

Digital health includes anything that is mobile, part of health information technology, wearable devices, telehealth, and personal information that is presented digitally.

DIF:

Cognitive Level: Apply

2. Internet of Things (IoT) architecture has three levels that include (Select all that apply.) a. Sensors b. Cloud computing c. Cable networks d. Technology department ANS:

A, B, C

The three basic layers for IoT in healthcare delivery are the processed layer, network layer, and application layer. Examples of processed layer is including how the data will be collected.

Network level includes how the data will get to the end user. Application layer includes how the data will be interpreted.

DIF:

Cognitive Level: Apply

3. Adoption of an electronic health record poses many challenges. What specific tasks are

included (Select all that apply.) a. Effective computer training b. Undeveloped infrastructure c. Insufficient technical support d. Satisfactory funding ANS:

B, C

Challenges to implementing an EHR include poor infrastructure, inadequate computer skills and training, inadequate technical support, and limited funding.

DIF:

Cognitive Level: Understand

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Chapter 33: Informatics and the Future of Healthcare Hardy: Health Informatics: An Interprofessional Approach, 3rd Edition MULTIPLE CHOICE 1. Data science includes data analytics. The role of the healthcare data analyst role is to discover: a. patterns in care b. gaps in the system c. technology problems d. revenue opportunities ANS:

A

Collected healthcare data and analyzing big data sets can be challenging regarding understanding and stripping away the data that is meaningless. Meaningful healthcare data must have actionable insight to be useful.

DIF:

Cognitive Level: Knowledge

2. Which term is analogous to future research? a. Futuristics b. Futurology c. Foresightology d. Rationalists ANS:

B

Futurist research includes foresight, prospective studies, and prognostic studies that are rational and systematic to state what is possible, probable, and preferable.

DIF:

Cognitive Level: Knowledge

3. Strategic planning for health informatics to implement technology applications should take

how long? a. 6 months to 1 year b. 1 to 2 years c. 1 to 3 years d. 5 to 10 years ANS:

C

A professional health and informatics specialist should utilize the traditional forecasting and planning method for future implementation for 1 to 3 years to vet the process. Long-range planning can take 5 to 10 years before incorporating.

DIF:

Cognitive Level: Remember

4. Becky has been asked to review the historical data for patients in the Dallas, Texas area who

have been diagnosed with Varicella in the last six months. This type of analysis is known as? a. Trend b. Predictive c. Visual d. Extrapolation

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ANS:

A

Trend analysis involves looking at historical data to identify trends over time. Some trends Becky may see includes specific zip codes with higher rates, specific months with higher rates, and specific populations with higher rates.

DIF:

Cognitive Level: Apply

5. Machine learning strengthens health care by providing research and predictability. In the

future, machine learning may provide: a. Incentives b. Normalization c. Supplementation d. Development ANS:

B

Machine learning allows establishing models that can analyze data and deliver results quickly, providing historical and real-time data. Machine learning in health care will allow providers to make better decisions on patient's treatment options, which lead to improved quality patient care.

DIF:

Cognitive Level: Understand

6. An example of a newer data visualization tool used for large data sets is: a. UpSet plot b. Pie chart c. Bar graph d. Data map ANS:

A

UpSet is a new data visualization tool that focuses on large data and displays information in a storylike manner, intersecting numerous data points. Pie charts, bar graphs, and data maps are typically used for small data sets with a confined sampling of data.

DIF:

Cognitive Level: Apply

7. A society trend that health informaticians are tracking is: a. Aging population b. Chronic diseases c. Healthcare costs d. Healthcare shortage ANS:

C

Healthcare trends in society include costs. Costs for health care continue to rise and are predicted to reach $6.2 trillion by 2028.

DIF:

Cognitive Level: Remember

MULTIPLE RESPONSE 1. Which factors lead to the increased cost of healthcare? (Select all that apply.)

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a. b. c. d. e.

Aging population Longer life spans Chronic health conditions High insurance premiums Healthcare provider shortage

ANS:

A, B, C, E

It is costing more to care for an increased number of chronically ill patients. This has placed a strain on the healthcare system including healthcare burnout rates.

DIF:

Cognitive Level: Understand

2. Futurist research focuses on what type of change? (Select all that apply.) a. Existing b. Systemic c. Transformational d. Incremental ANS:

B, C

Futurist research focuses on systemic and transformational change and provides an alternative to a preferred future. Forecasters focus on existing trends and incremental changes.

DIF:

Cognitive Level: Remember

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