Health Informatics An Interprofessional Approach 1st Edition By Nelson Staggers – Test Bank A+

Description

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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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

1. Which issues are considered impediments to a fully functional electronic health record (EHR) system? (Select all that apply.)

a.	Cost
b.	Standardization
c.	Care coordination
d.	Organizational culture
e.	Privacy and confidentiality
f.	Education

ANS: A, B, D, E

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

DIF: Cognitive Level: Understand REF: p. 99

1. 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

1. 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

1. 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

Chapter 7: Applications for Managing Institutions Delivering Healthcare

Test Bank

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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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

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 REF: p. 115

1. 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

1. 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

Chapter 11: Public Health Informatics

Test Bank

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

1. 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

1. 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 de-identified 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

1. 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

1. 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

1. 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

1. Which social and political challenges impact public health informatics? (Select all that apply.)

a.	The limits of federal authority
b.	The evolution of public health primarily as state and local functions
c.	The lack of resources to implement health IT
d.	The presence of standards to implement health IT

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 REF: p. 183

1. 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 REF: p. 186

1. 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

1. 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 under-vaccinating
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

Chapter 13: The Evolving ePatient

Test Bank

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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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

1. 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