438 terms

HIT Final

Final Exam Units 3,4,5,16,10,12
Which of the following is a prefix?
Which of the following is a word root
The term for above the kidney
Macro is a ..
in 'thermmometer "meter" is
which word part provides the general meaning of the word?
word root
toward the head or above the structure
In order to realize all the benefits of electronic health records, which of the following represents a common
medical language that allows data to be shared?
Classifications and Terminiologies
Which of the following utilizes a computer technology that allows physicians to use handheld or personal
computer devices to access drug and formularies and transmit prescriptions to a printer or local
The term used to describe the mobilization of healthcare information electronically across organizations
within a region, community or hospital systems is:
HIE Health Information Exchange
The purpose of providing guidelines to health professionals and hospitals on how to adopt and use
electronic health record technology is to improve the
quality , safety, and effieciency
Which of the following agencies is responsible for oversight of the HITECH initiatives to promote
meaningful use of electronic health records?
Which is NOT a goal of the American Recovery and Reinvestment Act?
Improve Access to healthcare in rural areas
Following the five rights of information management ensures that
clinicians always have the information they need to make a decision regarding patient care.
Which of the following is NOT true about the paper medical record?
Those accessing can be easily tracked
"An electronic record of patient health information containing care received in all health facilities" is the
definition of
A friend of a patient asks the nurse if the patient is HIV positive. If the nurse provides this information,
what is he or she guilty of?
Access codes, passwords, and key cards are examples of:
Which of the following best describes a firewall?
Hardware and software that forms a barrier between systems or parts of systems
You are asked to select the type of type of computer network that best suits your organizational needs.
What factors should you take consideration when making this choice?
Purpose of system, type of hardware, type of organization
Budget, type of information sytem, purpose of system
End user work flow, purpose of system, available infrastructure
All of the above
Which of the following is true about a standardized healthcare language?
It facilitates the measure of patient outcomes.
Health Language 7 (HL7. is an information model that is used to help systems
share information between information systems.
Which of the following supports the development of electronic health records across the lifespan?
Standardized healthcare languages
CDS Systems are designed to..
Assist the clinician in making decisions
Which of the following activities supports global healthcare networking?
interoperable clinical information systems
A computer is:
A system with a processor, memory, storage, keyboard, mouse and monitor.
A person who computes.
An electronic programmable device that inputs, processes and outputs data.
An electronic device that is embedded in objects and that controls the object based on certain inputs.
All of the above.
Which of the following are example(s) of personal computers? Select all that
Which of the following is an input device for a personal computer?
Where are programs stored when they are running?
What is the most important software that runs on your computer?
Which of the following are important factors to consider when selecting a computer?
Storage needs
Application requirements
Type of user
Mobility needs
All of the above
Where can you find up to date information about current computing systems?
Recent online reviews
Current issues of computer magazines
What was the oldest tool used for counting and calculations?
Tally Stick
What technology was used in the first general purpose electronic computers?
Mechanical gears
When was the World Wide Web first developed?
What was the first personal computer?
What was the first use of electronic medical records?
Storing dental records
All computers have a keyboard, mouse and monitor.
Dishwasher has an embedded computer?
Speakers are an example of a computer output device.
Solid state drives are now being used on some laptops because solid state drives
have moving parts and generate more heat than traditional hard disk drives.
Personal computers were first developed in the 1970s.
The ____ is a global system of computer networks that communicate using TCP/IP
and is a large network made up of many smaller networks.
The Internet began because ____.
the U. S. government wanted to be able to communicate, even in the
event of a nuclear attack
In 1995 it is estimated that ____ people were using the Internet.
The ____ is a collection of interconnected documents and other resources, linked by
hyperlinks and URLs.
World Wide Web
The WWW was created in ____ by Dr. Tim Berners-Lee and others with the
introduction of the Web browser and Web page coding.
A(n) ____ is a software program that lets a user use Web server resources over the
A browser uses ____ to communicate with Web servers.
A Web server sends ____ back to the browser, which translates it for display on a
HTML is a(n) ____.
Web page programming language
HTTP is a(n) ____.
Internet protocol used to communicate with Web servers
The Internet is owned by ____.
What is required for a device to communicate over the Internet?
An IP address and subnet mask.
Select a valid IP address and subnet mask from below: and
The Domain Naming System maps a(n) ____ to a domain name.
IP address
A domain name is a(n) ____ that defines a realm of authority on the Internet, based
on the DNS.
Identification label
The slowest type of Internet connection is the ____ connection type.
The global standard governing wireless technologies is the ____ standard.
Home networks usually connect to the Internet through the use of the services
provided by a(n) ____.
A typical home network connecting to the Internet uses ____ IP addressing
public and private
An IP address that that may change when you reboot your cable modem router is
referred to as a(n) ____ address.
Search engines search ____ using a proprietary algorithm.
web pages
A(n) ____ is a set of instructions set out logically to solve a problem.
How does a search engine provide you with a result set?
Searches its indexed data based on your search criteria.
A(n) ____ is also known as a query.
search phrase
Examples of Boolean operators include the terms ____.
NOT, AND, or
You search the Web using the term health and informatics not education. What
result below best matches your search?
Health Informatics
What does it mean when a Web site is at the top of a search results list?
Keywords on that site best matched the search terms used.
A router is a device that ____.
sends traffic from a private network to the Internet
sends traffic from the Internet to a private network
Installing ____ updates is important to securing your operating system from attack.
Antivirus software works by recognizing ____ and stopping those things from causing
harm to your computer.
patterns of bad behavior
What is the preferred method to use when closing a suspicious Web site popup
alt +F4
____ permit(s) or deny a computer the ability to connect to another computer.
Some experts recommend ____ first party, ____ third party, and ____ session cookies.
accepting, rejecting, allowing
A complex password should include at least ____ characters.
____ permit you to determine who uses your computer
User Accounts
You receive an e-mail without an attachment. The e-mail subject line reads "Bank
login required as soon as possible". What type of e-mail did you receive?
One big difference between a virus and a worm is that the virus ____.
usually cannot replicate itself
Macro viruses are usually associated with ____ files.
Microsoft Office files
You receive an e-mail with the subject line "Win a prize by forwarding this email"
and you decide not to forward this to your friends and family. Why did you take this
course of action?
Another student informs you that you can purchase a completed research paper
online and avoid doing the work yourself. This is an example of ____.
Another student informs you that you can purchase software online and avoid
paying the full retail price. This is an example of ____.
pirating intellectual property
Privacy is to ____ as confidentiality is to ____.
people, data
HIPAA requires that health care providers, insurance companies, and employers
abide by privacy and security standards
One difference between PHRs and EHRs is that PHRs are ____.
generally maintained by individuals
Patient medical records should be send electronically in a(n) ____ format.
According to HIPAA rules, who can view your medical information without a signed
Primary care physician
The hospital reports that a patient arrived at the hospital with a bullet injury. Can
the hospital be forced to reveal this patient's medical records?
The main function of a computer is to ____.
Execute Instructions
The motherboard is made up of circuitry and thousands of copper wires known as
The motherboard contains ____ slots, into which device expansion cards are inserted.
Today's computers connect the mouse and keyboard via a(n) ____ slot.
The ____ monitor port replaces the VGA port in today's computer systems.
A serial port, also known as a ____ port, can be used to connect to and manage a
network device.
Hard disk storage is known as ____ storage.
The operating system is stored ____.
n RAM when the computer is running
on the hard disk
What is a CT scan?
An x-ray, using specialized equipment, that takes cross-sectional pictures of the body.
What is a PET scan?
A nuclear medicine imaging device that produces a 3-D image.
What is an MRI?
Magnetic imaging equipment that uses a radio frequency pulse to create an image.
A binary digit value of one (1) indicates that electricity is ____.
In the binary number "01011010", the rightmost value of "0" is a placeholder for ____.
2 0
1024 bytes x 1024 x 1024 = ____.
1 GB
Microsoft Word, running on a computer, is an example of a(n) ____.
How does data differ from information?
Data has no meaning on its own merit.
Roughly how much storage does a chest x-ray require?
There are two types of software: application and _________ software.
Which of the following is NOT a form of software that is free?
Which of the following is NOT an example of word processing software?
Open office Impress
Select all of the following that are examples of communications applications
Web browsers
Select all of the following that are examples of healthcare software.
EHRs and EMRs
Health Information Systems
Which of the following is NOT true about an operating system?
There is only one operating system available for all computers.
A ________ interface is one where the user types in all the commands.
Command Line
When do you need a new device driver? Select all of the following that are reasons
you might need a new driver.
You install a new printer.
You do a major upgrade of your OS.
You buy a new computer and want to use your old printer.
Your driver was corrupted
You buy a new computer and want to use your old printer.
Your driver was corrupted
Virtual Memory
What is the latest version of Microsoft Windows OS?
Windows 7
A(n) ________ is a way of organizing files and their data.
File System
The file _______ can be used to identify the file type.
Which of the following are examples of file utilities? Select all that apply.
File compression
When a hard disk drive is being accessed, the _______ spins and the _____ moves until
the head is over the proper location on the disk.
Platter , Arm
Disks are formatted into _____, which make up tracks.
Files that are stored in non-contiguous clusters are called __________ files.
Which of the following operating systems support the NTFS file system? Select all
that apply.
Microsoft Windows Vista
Microsoft Windows 7
Microsoft Windows XP
The code used in an application is the same as the database.
The device driver for your printer will probably need to be updated when you do a
major upgrade of your operating system.
Programming languages have __________ , just like natural languages.
Algorithms are written using _________________.
___________ is an example of a third generation programming language.
The C programming language uses the _____________ programming paradigm.
The ________________ programming language is an example of a compiled language.
_______________ are programming constructs that store data.
The _________ data type in Java is used for storing whole numbers
Which of the following operators is the OR operator in Java?
_________________ are simple data structures that store multiple pieces of data
In Object Oriented Programming, __________ and ___________ are stored together.
data, methods
___________________ provides information hiding in Object Oriented Programming.
Algorithms are a sequence of steps that describe how a task is performed.
Machine code includes English words for basic computer commands.
SQL is an example of a third generation programming language.
Assembly language is unique to a particular type of computer.
LISP is a programming language that follows the functional paradigm.
Perl is a scripting language developed for web browsers.
MIIS is a language that was developed for healthcare applications.
A computer program that is compiled must be compiled separately for each different
Java uses a hybrid approach of compiling and interpreting.
A variable's value cannot be changed.
In Java, variable declarations do not have to include data types.
The equal sign is the assignment operator in Java.
In expression evaluation, multiplication has higher precedence than subtraction
When the condition of an if statement is false, the body of the if statement executes.
Python is an example of an Object Oriented Programming language
Classes and objects are exactly the same things.
UML is an example of a design tool for Object Oriented Programs
Encapsulation and modularity are important features of Object Oriented
Typically, instance variables are declared to be private.
The purposes of a database include all of the following EXCEPT . . .
Data is never repeated.
An attribute is a synonym in database terminology for which of the following?
What database term involves connecting two or more tables together when a user
needs data from more than one table in the database?
A natural key is . . .
A well-known attribute value that uniquely determines a row in a table.
A foreign key is . . .
A unique key from another table.
What language is used to store and retrieve data from a database?
Which part of the database ER-diagram becomes a table in the implemented
Relationships in the database are carried out with the use of which of the following?
Primary key to foreign key matches
Attributes that contain more than one piece of data such as Address are called . .
Primary keys are most efficient for data retrieval when they are which of the
short and numeric
An example of a one-to-one relationship is which of the following?
Patient to Hospital wrist band ID
An example of a one-to-many relationship is which of the following?
Insured to dependents
An example of a many-to-many relationship is which of the following
Hospital medical procedure to patient
SQL commonly produces or projects which of the following?
record sets
Which of the following is involved in data modeling
ER- Diagram
Constraints ensure that____________.
attribute values follow rules
Which normal form is commonly considered to be all that is necessary for most
database situations?
3rd normal form
SQL is used to create tables (True or False).
The SQL statement used to retrieve data from a database is which of the following?
"Order By" is which of the following?
"Count" is which of the following?
The term used for the process of getting data out of more than one table is which of
the following?
In transaction processing changes to the database can be retracted before the end
of the transaction is reached (true or false).
HITECH addresses which of the following barriers to using health information technology?
There is a shortage of health IT support staff.
Which of the following is an example of HITECH's concept of "meaningful use" of health IT?
A primary care physician electronically exchanging a patient's laboratory data with a medical
What kind of job role is likely to be a part of a REC?
Implementation manager
HITECH's Workflow Process and Redesign specialists address which of the following problems?
Electronic health records have to fit in with a practice's workflow.
Which of the following barriers to health information exchange are NOT addressed by HITECH?
Hospitals may lose competitive advantage if they exchange information with others.
Which of the following is a major part of the HITECH vision?
Increased transparency and efficiency
The incentives for health IT are focused on getting
physicians to use health IT to improve healthcare quality
A major challenge in developing and implementing an e-prescribing system is
the need for workflow re-engineering
CPOE adoption has been low among hospital based physicians because
the ordering process has been traditionally developed to be as convenient to the doctor as
possible, and CPOE is not always convenient.
In what way are CPOE and e-prescribing systems SIMILAR?
can eliminate incomplete or lost information
According to the lecture, the e-prescribing system first used in 1977 did not "catch on" in many
organizations because
data entry, while efficient for experienced users, was cumbersome for many people
In 2000, the Leapfrog Group was launched. What exactly was this group?
A conglomerate of health insurance purchasers
According to the presentation, which of the following BEST describes why CHINs failed in the 1990s?
A lack of focus on community stakeholders resulted in competitors being unable to agree on key
Which of the following statements BEST describes the current state of the National Health Information
Network (NHIN.?
NHIN is in its early developmental stages.
According to the lecture, which of the following is the most common form of health information exchange
What is the MAJOR difference between the RHIOs of the 2000s and the CHINs of the 1990s? RHIOs
focus on
quality rather than cost savings
According to the lecture, a 2006 failure of a prominent RHIO caused a major uproar in the HIT community.
Where was this RHIO located?
Santa Barbara, CA
Which of the following is likely to result in significant progress towards realizing the goals of HIE in the
The broad federal support for HIE outlined in HITECH
Which of the following was NOT a csecurity principle for health information proposed in the 1997 "For the
Record" report?
Avoid storage on portable drives
Allowing cancer researchers to use the existing data in hospital systems, without asking each patient for
permission, illustrates which of the following principles underlying the HIPAA privacy rule?
Public Responsibility
The 1996 HIPAA legislation related to
portability of health insurance across state lines.
Which of the following is the strongest example of authentication?
Using both a password and a device with changing unique numbers
Why did Congress fail to pass privacy legislation in 1999?
The legislators could not agree among themselves about what to propose
Before the HIPAA Privacy Rule was implemented, state laws were
very variable.
Which of the following was NOT one of the factors that led to changes in HIPAA as a result of the
Which of the following was NOT one of the factors that led to changes in HIPAA as a result of the
Which of the following was a change with the HITECH Privacy Regulations?
Tracking disclosures for TPO was now required.
What is the major challenge with the changes to HIPAA in the HITECH Act?
They will require major changes in work processes.
The recommendations for sanctions for privacy or security violations relates to which principle
Which of the following is an example of "competent human intervention" as
described in the 1989 FDA policy?
A physician deciding not to follow the advice of a clinical decision
support system
Which organization was already an EHR certification organization prior to
the establishment of the current ONC Authorized Testing and Certification
What was one of the recommendations from the 1996 FDA workshop on
regulating clinical software
Software quality audits
HITECH mandates certification of EHRs to assure that
EHRs include functionality for meaningful use
FDA regulation of EHRs is UNLIKELY to reduce errors due to
implementation flaws.
Which of the following best describes a process?
A series of actions or operations that produce work
Process analysis includes which of the following?
Knowledge of process components and relationships between them
Identification of opportunities for improvement
Process redesign includes which of the following?
A change in a process
Anticipation of a good outcome
A workflow is a Process,
Workflow analysis includes which of the following?
Knowledge of process components and relationships between them
Identification of opportunities for improvement
Which of the following is NOT considered knowledge?
Beliefs that may be true
Which of the following is NOT one of the IOM characteristics of quality healthcare?
Provider centered
Which of the following is NOT a characteristic of Meaningful Use of Health IT?
Has been in legislation for over 20 years
Which of the following is NOT a Meaningful Use requirement? Choose the best answer:
Greater than or equal to 90% of eligible pneumonia patients
received antibiotics within 12 hours of an office visit.
Which of the following are activities stated in the scenario?
Identify out-of-range results
Which of the following roles participate in the scenario?
Which of the following pieces of information are needed by the medical assistant in the scenario?
Patient's contact information and provider
Which of the following decisions are made in the scenario?
Whether or not the results are out-of-range
At which point in the scenario could more than one path be taken?
When the lab results are reviewed.
Mark the symbols that are common flowchart symbols:
What symbol should be used to diagram the following process step: "If the patient is a new patient ..."
Which of the following is used to indicate that a flowchart continues on another page?
Circle connector
Which of the following should be used t diagram the following text: "...the new patient intake form is received, the information is confirmed with the patient, then entered into the EMR
Document symbol, then two sequential process boxes
An analyst needs to show the context in which a process operates. Which of the following methodologies is the most appropriate?
An analyst needs to show information movement and the order of the steps. Which of the following diagram notations should be used?
Data flow diagram
An analyst needs to show information content. Which of the following notations would be appropriate?
E-R diagram
An analyst needs to show detailed process steps. Which of the following diagrams is the most appropriate?
ISO data flow diagram
Indicate which statement is true:
Information flow and process flow can be shown on a flowchart
ndicate which statement is true:
Multiple process aspects may be represented on some diagrams
Which shape is used to mean different things in a UML activity diagram and basic flowchart?
A terminal symbol in a flowchart is used to represent which of the following?
start and stop
Which symbol would be used in flowchart notation to represent the following text? "If the lab results are not within normal limits, call the patient."
Which symbol would be used in flowchart notation to represent the following text? "The patient called the office to schedule an appointment."
Which best describes the goal of Knowledge Acquisition (KA)?
To gather and capture process knowledge
Which of the following is true for Knowledge Acquisition (KA) in support of EMR adoption?
Clinics will acquire knowledge through process analysis
Which of the following types of knowledge is the easiest for organizations to share with others?
Coded knowledge
Which of the following CMM levels best describes the following organization: "There are standard operating procedures, and performance is fairly consistent. When adapted to new situations, the process performance is not predictable, and sometimes results are substandard."
Level 3
clinic that you are working with is at CMM level "Managed". Which of the following methodologies should be used to obtain process information?
Reading available procedures
A clinic that you are working with is at CMM level "Repeatable". Which of the following methodologies should be used to obtain process information?
Interviews and process walkthroughs
A context diagram is important for what reasons?
Facilitates checking information with practice providers and staff

Depicts major functions and processes
A process inventory is developed from which of the following?
A list of clinic services
Which of the following categories of processes will likely be deemed important enough to analyze?
Processes impacting patient care
b. Processes that can be improved through Health IT
c. High volume processes
Which of the following processes would you find in most clinics?
Appointment scheduling
Receiving documentation
According to the scenario, which of the following are process participants?
Which of the following would you interview or observe to acquire process information?
A Knowledge Acquisition Plan should include which of the following?
Process inventory
Which of the following is true about Knowledge Acquisition for Health IT adoption?
KA requires assimilating information.
Complete the sentence: Knowledge Acquisition ________.
Is constrained by available time and resources
Which of the following are NOT steps in process analysis as described in this unit?
Conduct process redesign.
What is the correct order of steps for Process Analysis?
1-Create process inventory
2-Report analysis findings
3-Identify variations and exceptions
4-Identify needed EHR functionality1,3,4,2
Choose the answer that best describes a process inventory
Identifying and recording processes
Which of the following processes does NOT occur at most clinics?
Which of the following processes varies most by clinical specialty?
Diagnostic tests
Which of the following would be variations of a Diagnostic test process?
Test is conducted by referral to an external facility
Which of the following would be variations of an appointment scheduling process?
Online appointment scheduling
Which of the following would be exceptions in a prescription process?
Potential drug interaction identified by pharmacy.
Which of the following is NOT a primary goal of healthcare clinic process redesign as described in this unit?
Making changes in the practice
According to Deming, which would be a good approach to address a medical error in a clinic?
Investigate possible process changes to prevent such errors
Which of the following are examples of unproductive work?
1 - A patient waiting for a clinic appointment
2 - A provider spending time talking with a patient
3 - A billing manager correcting and re-filing denied claims
4 - Providers scheduling patient appointments
1, 3, and 4
Which of the following would be an exception to a document receiving process?
receipt of documents with no patient identifiers
Which of the following may indicate needed EHR functionality?
a. Generic processes used by a clinic
b. Process variations used by a clinic
c. Process exceptions likely encountered by a clinic
d. All of the above
Which of the following EHR functionality is indicated by the scenario?
Clinical documentation.
Which of the following process variations should be further investigated, i.e., there is not enough information in the scenario to determine which variation(s) may be in use?
Billing performed in practice management system.
Which of the following is NOT a primary goal of the implementation decision-making meeting as described in this unit?
Selecting an EHR system for implementation
Which of the following is NOT a suggested approach to leading the implementation decision-making meeting?
Use Brainstorming to generate ideas for process redesign
Which of the following are examples of the meeting facilitator's role?
1 - Establish Group Norms
2 - Manage Time
3 - Incorporate changes in the Process Diagrams
4 - Provide feedback and evaluation of all changes suggested
1, 2, and 3
There is only one method that has proven to be successful in developing group consensus through group facilitation."
Identifying processes that are ripe for improvement can be facilitated by which of the following?
Reviewing "Best Practices" in other Health care facilities
b. Some health care providers can show how much a change can improve services in specific areas and integration
c. Focusing on processes that can increase satisfaction, compliance, and meaningful use of health IT
The wrap-up / debriefing part of the meeting is designed to?
Secure management "Buy-in"
Which of the following should be included in the implementation decision making meeting report?
Complete documentation of all results
Results or plans from the meeting
Persons interviewed
Which of the following is not included in the Agenda for the Implementation decision making meeting?
BRAND is a mnemonic for remembering the steps of making a decision used in the health care field."
Which of the following identify processes as "Ripe for improvement"?
a. Processes that can increase satisfaction
b. Increase Meaningful Use of health IT
c. Appeal to patients
Which of the following is not a part of Quality Improvement methods in Health care?
Focused on the individual patient
According to Goethe, it is sufficient to know the approximate number of people who die annually in U. S. due to medical errors.
The Plan-Do-Study-Act cycle of Quality Improvement:
Can be traced back to Shewhart
Was described by Deming
Leadership involvement is essential for successful Quality Improvement. Which of the following is not a way leaders can support QI activities?
hiring more people
Which of the following methods are based on Deming's PDSA?
Six Sigma
According to Ovretveit, failing to learn and plan for sustaining the improvement is which category of mistake in Quality Improvement?
Mistake in transition and implementation
Mistakes in Purpose & Preparation include:
Choosing a subject which is too difficult or which a collaborative is not appropriate
b. Participants not defining their objectives and assessing their capacity to benefit from the collaborative.
c. Not defining roles or making clear what is expected of individuals taking part in the QI
Which of the following tools is NOT appropriate for use in the early information collection stage of a QI project?
Priorities matrix
Define, Measure, Analyze, Improve, Control in Six Sigma is used for what ?
To reduce variation
Transitioning to flow thinking causes changes in how people perceive their roles in the organization.
Pick the best explanation for the meaning of the following Chinese proverb: "...show me and I may remember; involve me and I will understand."
Most people comprehend best what they are engaged in.
In a meeting to discuss the new practice management system, it becomes clear that the front desk receptionist hasn't heard anything about the implementation planned for the next day. Application of which of the following key change concepts could have improved this situation?
A physician leader in a small practice has chosen and purchased an EMR without telling anyone in the practice. He has arranged for the vendor to install the system and explain it to the staff in two weeks. Application of which of the following key change concepts could have improved this situation?
Engagement gap
Which of the following best matches the most likely reason for the providers, nurses and medical office assistants reaction to the new system in the scenario?
They didn't understand the purpose for the extra work
For the situation in the scenario, application of which of the following change concepts may have alleviated the concerns?
Engagement gap
In the scenario, what did Support Specialist Sam do that helped the situation?
Pointed out the reason for the extra fields
An analyst is preparing for the initial meeting with practice leadership and staff which of the following should the analyst have ready for the meeting?
An agenda for the meeting
True or False: It is just as important to engage leadership as it is to engage practice staff.
True or False: Special meetings should be held to engage people not directly involved with the design.
In a practice that uses paper medical records, to capture information for performance measures, providers and nurses have to record data on a special data collection form in addition to regular documentation in the chart. In moving to an EMR, application of which change concept would improve completeness of data collected?
Design the system to run down-hill
Providers are more likely to view health care quality as
Use of computerized decision support to facilitate evidence-based practice
Patients and families are more likely to view quality as
how well the provider communicates
An example of a structure used to evaluate quality of health care information technology is
A policy describing the prescriber's role and responsibilities with respect to provider order entry.
A policy describing the prescriber's role and responsibilities with respect to provider order entry.
What quality improvement measures must eligible providers report in 2011 to quality for meaningful use incentive payments?
Must report on blood pressure, tobacco status, and adult weight screening as well as three additional measures from a list of metrics.
In your own words, explain the Institute of Healthcare Improvement's triple quality aim model and describe examples of how HIT can help to further these aims.
Answer: The student's answer should include reference to the fact that the triple aim is designed to optimize health, health care experience, and costs for populations. That is, to provide the best care, for the whole population at the lowest cost. The answer should include at least three ways in which HIT can help to achieve the triple aim, such as introducing information tools into clinical practice, using information tools to personalize care delivery, electronically connecting clinicians, or advancing surveillance and population health reporting.
In your own words, describe the goals of meaningful use of electronic health records.
Answer: The student's answer should include the five goals of meaningful use of electronic health. These goals are: to use health records in a way that improves quality, safety, & efficiency of care, engages patients and families in their care, improves coordination of care, improves population and public health and reduces disparities; and ensure privacy and security protections for all.
One example of how HIT can enhance patient-centeredness is:
Tailor care plan to individual needs through clinical decision support
An example of a workaround that can result in unintended consequences is
Having nurses enter prescriber orders because the prescriber is too busy
Man-made tools that aid or enhance the user's thinking abilities are called:
The following is a basic principle of the science of safety
The system is perfectly designed to deliver the results it gets.
The premise behind the Swiss Cheese Model is that
There are ―holes,‖ vulnerabilities, or hazards in the health care environment that have an impact on medical error
One of the following is not a system factor that has an impact on patient safety
Time factors
The following is not a principle of safe design
Add steps
An example of an independent check is
Car alarm sounds when passenger fails to put on seatbelt
Health care work should primarily be geared around
An example of an independent check is:
Requiring two signatures on high alert medications
An example of standardization is:
Using a checklist before doing a procedure
The following indicate system factors that have an impact on patient safety:
Patient and provider characteristics
task characteristics and the work environment
Institutional factors
HIT teams make wise decisions
When there is diverse and independent input.
Reliability science allows organizations to improve the consistent and standard delivery of high quality, safe healthcare through each of the following except
Using processes that perform as intended function under favorable conditions
The three-tier IHI framework for reliability begins with
Preventing failure
The following are traits of high reliability organizations, except
rely on the leaders for final decisions
Five concepts that create a sense of mindfulness within the context of reliability are sensitivity to operations, preoccupation with failure, deference to expertise, resilience and
reluctance to simplify
The blame game leads to a cycle that includes which one of the following
less is learned
Each of the following describes a high-reliability organization except
Single authoritative decision-maker
Describe ways in which HIT teams in high reliability organizations are sensitive to operations.
Answer: The student's answer should include examples in which the HIT team supports more than just checks of patient identity, vital signs, and medications. It includes awareness by staff, supervisors, and management of broader issues that can affect patient care, ranging from issues of human-computer interface, to the availability of needed supplies, to potential distractions.
Describe ways in which HIT teams operate within ultra-safe organizations
Answer: The student's answers should include such things as learning to recognize potentially risky situations and speaking up if you see that something is not right so that action can be taken to reduce risk. The answer could also include promoting a blame-free culture, being preoccupied with failure, and viewing near misses as opportunities to improve HIT design.
Illustrate how teams make wise decisions by describing how teams can learn from honey bees.
Answer: The student's answer should describe how bees can teach us a lot about teamwork and a culture of safety. Bees work exceptionally well in teams and are considered some of the best decision makers alive. They have grasped the concept that shared wisdom is imperative to making good decisions. Advocating for usability testing by users is one way that HIT professionals gather shared wisdom.
Deference to expertise supports recognizing
a family member's contribution to decision-making
Human factors is:
The study of the interactions of humans and other elements of a system
Describe problems that can arise with the design of HIT that relate to human factors
Answer: The student's answer should include such things as problems that arise from mismatches among the 5 elements of a system: persons (e.g., doctors, nurses, patient), task and job design (e.g. medication prescribing, dispensing, administering), tools and technology (CPOE, flow sheets, task lists). environment (inpatient, outpatient, school), and/or organizational characteristics (structure, nursing practice model, policies).
Cognitive ergonomics is concerned with
Mental processes
The following is relevant to physical ergonomics
Workplace layout
The following is a relevant to organizational ergonomics
Mental workload
A ―person approach‖ to error
Blames the individual
The following statement is true about systems
The system is responsible for about 95% of the cause of the outcome; the human only 5%.
Active failures
Occur at the sharp end and their effects are felt almost immediately
An example of a latent error is
a design flaw that causes alerts to fire inappropriately
Describe use of the SEIPPS model of work system design in the context of HIT.
Answer: The student's answer should describe the SEIPPS model. This could include defining the acronym for System Engineering Initiative for Patient Safety as a model of work system and patient safety. It could include: a detailed model of work systems leading to processes which lead to outcomes and specification of the components and elements of the model to include the person, the environment and the organization as well as the technologies, tools, and tasks that are used. The student could discuss these components with respect to any of a wide variety of HIT applications, including patient portal, CPOE, notes, flow sheets, clinical summaries, to name a few.
Care coordination
Has been identified as the top priority for national action
The following is not an example of a transition of care
Change in patient room without change in providers
Are transfers of care from one provider to another provider
Studies show that the following is true about most hospital discharges
Direct communication between hospital and primary care providers is low
A technique that examines relations among providers and looks to see patterns among groups to inform information technology decision making is
Social Network Analysis
The following is an example of a social function meaning to a speech act
―It's crowded in here means ―I want to leave‖
Describe three types of barriers to communication and identify how HIT design can actually enhance barriers.
Answer: The student's answer should include ways that HIT design can contribute to at leas t three of the following barriers: perceptual differences, cultural differences, language barriers, information overload, organizational complexity, inattention/memory limits, time pressures, distraction/noise, interruptions, and emotions. Examples include: alert designs that are not consistent with work flow, computer systems that do not interact with each other leading to gaps in information, or designs that do not take into account the types of communications that are needed to ensure safe delivery of care
Describe the differences between synchronous and asynchronous communication, how these types of communication can hinder effective communication, and examples of each.
Answer: The student's answer could address the fact that synchronous communication, such as face-to-face discussion and telephone communication, occurs simultaneously and places the speaker at risk for interruption and distraction due to the disruptive health care environment. Frequent interruptions during communication increase the likelihood that the message will be misinterpreted or lost. Asynchronous communication, which occurs at different times, such as voice mail, email, and computerized records, fails to provide the opportunity for questions and clarification, potentially rending communication ineffective.
Describe what is meant by basic components and processes of communication (encoding, communication channels, decoding) in the health care setting and how the message can get lost in translation. Discuss how HIT can help to alleviate these barriers.
Answer: The student's answer should include the concepts of encoding by the person who initiates the message, barriers that occur in the channels through which that message is conveyed via verbal, written, or electronic means and decoding by the recipient of the message. Attention should be paid to the problems created by background noise, either external noise such as the paging system, alarms, cluttered work spaces (which are a form of visual noise and can be just as distracting as auditory noise) OR internal noise, such as the provider's own mental state that can make message transmission unclear. Examples of ways HIT can help to alleviate these barriers are: judicious use of alerts, electronic whiteboards, clinical summaries, automated notifications, hand-off notes, and discharge summaries.
Explain how at least three HIT tools can be used to facilitate multi-disciplinary rounding.
Answer: The student's answer could include patient-centric information tools such as patient health records, variance tracking forms, progress notes, flow sheets, bedside monitoring devices; process oriented tools, such as rounding lists, sign-out tools, daily goals form, or discharge assessment tools; or decision support tools such as electronic evidence resources, clinical pathways, or graphic dislay of test results. Multi-disciplinary rounds allow the diverse members of the patient's care team to meet and communicate, coordinate patient care, make joint decisions, and manage their work.
Which one of the following is not an example of clinical decision support?
The computer system times out after a period of inactivity
A clinician has been using a system that has a reminder system. When the clinician performs an action even when not prompted by the reminder system, this response is called
Which one of the following is not a right of clinical decision support?
Right dose
The following statement is a myth regarding clinical decision support:
Clinicians will use stand-alone decision-support tools.
Which of the following is NOT a recommendation of the consensus panel for effective use of clinical decision support.
Maximizing the use of active data capture
Clinical decision support is most appropriate for
a. Inpatient settings
b. Ambulatory care settings
c. Public health settings
The following is a decision support rule that can enhance efficiency
Rules that trigger alerts for high cost drugs and suggest lower cost alternatives
All of the following statements are correct EXCEPT:
Alerts should never be overridden
Basic medication order guidance is
an alert that provides dosing information with default dosing being the most appropriate initial dosing.
Describe at least two important considerations that should be taken into account prior to CDSS implementation
Answer: The student's answer should include one of the following: workflow integration, such as ensuring that structure and work system features and processes support care; data entry and output considerations such as who enters the data and who receives the CDSS advice; standards and transferability such as whether the CDSS is ready to be used ―off the shelf‖ or needs to have some degree of local customization; and knowledge maintenance, such as maintaining accuracy by ensuring that imbedded knowledge is kept current.
Clinical decision-making is a systematic way to handle data and clinical algorithms to
decide on the best course of action
A step-by-step procedure for solving a problem is
an algorithm
Each of the following is a type of uncertainty in clinical decision-making EXCEPT:
Contextual: the clinician does not know when to document in the EHR
An example of direct use of HIT to deal with uncertainty is:
establishing what is known about best practice and incorporating this into ―smart order sets‖
The initial phase of HIT development in a human-centered design cycle is:
specify context of use
An example of a quantitative workflow analysis method is
video recording
Describe the types of information to be collected during the observation of current work flow processes when planning to implement HIT.
Answer: The student's answer should include most of the following types of information: name of process, process owner, process output/product, who is involved in delivering the process, who cares about the process, extent of the process to be mapped, activities to define the process, start and end points of the process, waster (non-value-added time), bottlenecks, redundancies, points of dissatisfaction, and inefficient use of workforce skills.
There are four phases of human- centered design cycle (specify context of use, analyze requirements, design prototype and evaluate prototype). Discuss the concept of workflow and describe qualitative and quantitative methods of workflow analysis.
Answer: The student's answer should include a discussion of the two main components of the workflow integration matrix, current and future workflow. The student should also discuss the concept of workflow as a description of sequenced activities performed by various clinicians and staff. The answer should include a description of at least one qualitative (ethnographic observation, shadowing, surveys) and one quantitative ( sensor technologies, video recordings) method of workflow analysis
A rectangle is used in a process flow chart to depict.
an action or instruction
Mapping of current processes should include all of the following except:
process redesign recommendations
Is situational whereas transition is a psychological process
The following is an important structural characteristic of effective teams:
Appropriate culture
Effective implementation teams learn from mistakes. The following is essential to support teams in learning from mistakes.
Culture of transparency
There are a number of strategies used by implementation teams to manage go-live support. Describe one way and indicate the benefits and potential risks of this method.
Answer: The student's answer should include use of either external or internal consultants Mention should be made of the role that these consultants play during go-live, and any risks or benefits to the selection of this particular support strategy. Discussion should include such things as their expertise in use of the software application, their experience on go-live teams, their knowledge of specific organizational policies and work flow, and their cost.
Effective change and transition management are critical to effective implementation planning. Each of the following strategies ensures effective change and transition management EXCEPT:
Ensuring that professionals work side-by-side
There are a variety of strategies for effective implementation planning. The following is a limitation of the single vendor strategy:
If it fails, the organization can incur significant losses
To enhance implementation team effectiveness,
Regular meetings should be scheduled and a standard agenda set
One of the advantages of ―best of breed‖ approaches over single vendor options is that
Massive process reengineering is avoided
Two approaches that have been used successfully for HIT implementations are the big bang and staggered, or incremental, approaches. The following correctly depicts big bang implementation strategies
High risk, high anxiety
The following is true of incremental implementation strategies
They have higher training costs.
Efforts to improve patient safety over the past decade have been largely competitive, rather than cooperative. One success story involves an initiative that improved central line blood stream infections. The reason for its success was largely due to:
Using a simple checklist to remind people of best practices.
Use of the central line BSI checklist was an example of the application of the science of safety to improve health care quality. Each of the following strategies is promoted as principles of the science of safety except
Individualizing care
A proven effective strategy to ensure that best practices in central line insertion are standardized throughout organization is:
Including use of a central line cart to increase compliance with the checklist
This module describes the experiences of a research team trying to implement best practices. When the team began its work on central line blood stream infections, it experienced:
A culture that did not allow questioning physicians
One key premise of failure in HIT quality improvement initiatives is that the reason for failure is:
because they fail in the adaptive component
Describe why the central line blood stream infection story is relevant to HIT work. Include reference to principles of the science of safety in your explanation. Give an example of how using these principles in HIT design or implementation can lead to success.
Answer: The student's answer reflects an understanding that the principles of the science of safety (standardize, eliminate steps, independent redundancies, culture of safety) are relevant to all quality improvement work, including HIT work. Examples can
include such things as: use of alerts, imbedding evidence-based practice recommendations in order sets, standardizing the way in which hand-offs are documented in the EHR.
Most transitions
require the entire team
Ensuring a culture of safety
applies to all teams regardless of clinical or technical roles
The following is essential to decoding resistance:
Frequent, clear communication
People do not generally fear change; they fear
Loss of the old ways of doing
In the absence of a valid and transparent measurement system, most people.
Are over-confident in their performance
A valid model for reporting and measuring quality and safety in health care includes attention to structure, process, and outcome measures. An example of a structural measure in health care is the:
percentage of time providers spend with patients
Donebidian's model of structure- process-outcome addresses each of the following except:
dynamic interdependencies among structure, process, and outcome
An example of an outcome measure is:
The percentage of patients with central lines who develop a blood stream infection
In order to calculate a fall rate, you need to have:
a clear definition of the population that is at risk for falls
An example of something that we put forth in health care as a rate that is not really a rate is:
Medication error rate
Although selection bias is often associated with research methodologies, this concept is also appropriate for quality improvement since organizations often seek to generalize results of quality improvement studies to other areas within the organization. Selection bias is highly dependent on
who is in the sample that is being measured
The following is true of ―missing data‖
It is important to account for missing data before communicating results of analyses.
HIT design can facilitate the collection and reporting of both rate- and non-rate based quality measures. Give an example of how HIT design can facilitate the collection and reporting of quality measures such as central line blood stream infection rates or hospital acquired pressure ulcer rates.
Answer: The student's answer should include the collection of observations such as dates and times of central line placement, central line care or other parameters that indicate the continued presence of central lines, or date/time of central line discontinuation, blood culture values, whether or not a pressure ulcer was present on admission, documentation of pressure ulcer assessments, etc. The answer should also discuss reporting of these measures through analysis of EHR data.
When looking at rates of urinary catheter- related urinary tract infections the denominator would be
the number of patients that had a urinary catheter
The customer service of healthcare professionals can be measured by
the results of customer satisfaction surveys.
What two departments share a similar customer base in the healthcare setting?
Physician's offices and hospitals
The culture of healthcare IT can be described primarily as __________
Customer service-driven EHR implementation success factors differ by customer role and include
for administration, a return on their investment.
The definition of customer service, in terms of the assistance and courtesy granted to those who patronize a business, includes the word
An important goal of understanding contextual norms is
An important goal of understanding contextual norms is
A professional appearance is an important part of professionalism. The goal of maintaining a professional appearance can best be described as
ensuring that the focus is on your work and message
Information technology staff's role in healthcare is to
develop, implement and maintain electronic medical records.
To be successful in their roles, the most important thing IT professionals need to do is
exhibit professional demeanor and deportment
The purpose of maintaining a professional appearance is
that it allows others to know how to behave toward you.
Using an emotional tone in communications is a good idea when
you are talking to a distressed user
What is the most important method for preventing the spread of infection?
Frequent hand washing with soap or alcohol gel
The goal of infection control is to
prevent the spread of infection from you to others and from others to you.
A Hospital Acquired Condition (HAC) means that
the healthcare organization must absorb the cost of care for the HAC.
Standard precautions means
all human body fluids should be treated as if they are infected
Sharing your computer access codes with a co-worker is
unacceptable under any circumstance.
HIPAA is a federal law that protects patient privacy and prevents unauthorized release of medical Information. HIPAA includes which rule?
Security Rule
Infection control is the responsibility of
all healthcare workplace professionals
Penalties you may experience for breaching HIPAA include
civil penalties such as a fine.
One of your co-workers, while reviewing electronic medical records, sees the record of his ex-spouse and wants you to look at it. You should respond,
"Remember that showing that to anyone or talking about it is a HIPAA violation."
You are in the Emergency Department working with a nurse on a problem with her EHR menu. During your time there, the rescue squad brings in a neighbor. When you get home, your spouse says, "Did they bring Bill to the Emergency Department today? I saw an ambulance at his house." You should respond,
You know that I am not allowed to answer you."
What are the three perspectives that support the conflict stool?
Personal, interpersonal, social
Which of the following are ways of distinguishing major types of conflict?
Content issues and relationship issues
The preferred way to resolve conflict is to use
win-win strategies.
Which one of the following statements is true?
The first step in Filley's model addresses antecedent conditions
In conflict resolution, which of the following is often used?
Win-lose strategies
Which of the following refers to a conflict resolution approach?
Relates to the outcome of the resolution process
Which of the following statements is correct?
Conflict creates a need for change and conflict also occurs as a result of change.
Identify the developer of conflict resolution theory and the number of steps it contains.
Filley, 6
Ethics are considered to be
behaviors based on social standards
Policing smoking behavior in enclosed environments for public health reasons would be an ethical practice based on which of the following approaches?
Which of the following is NOT a major role of the medical ethics committee?
Disciplinary action
Which of the following is considered an external or secondary diversity dimension?
The following statement is TRUE with respect to diversity
Diversity can be leveraged with the appropriate leadership.
__________________ represents a preference for one's own culture that results in critical evaluations of people from another culture.
An emphasis on family involvement in healthcare decision making is characteristic of
collectivist cultures.
An emphasis on building relationships in communication is characteristic of
high context cultures.
The Civil Rights Act of 1964 prohibits discrimination based on
All of the following represent important elements of cultural competency EXCEPT
Ethnocentric care