Mometrix ALL Q's 2024 Flashcards

Question 1

Q

Which one of the following is the first phase of the
traditional project life cycle?

A. Development
B. Initiation
C. Implementation
D. Concept

Answer

A

D: Concept

Every project has a life cycle, or a series of phases during which specific types of work are carried out. Although organizations may define their own life cycles, the traditional project life cycle comprises four phases: concept, development, implementation, and closeout. Concept and development represent project feasibility and focus on planning, while the latter two phases, implementation and closeout, represent project acquisition and are when the actual work of the project is carried out. One phase should be completed before moving on to the next phase.”

Question 2

Q

The teaching model in which learning takes place outside of a formal classroom with materials provided or recommended by the instructor is:

A. Guided focus
B. Independent study
C. Cognitive apprenticeship
D. Cooperative

Answer

A

A. Guided focus

In the guided focus teaching model, learning takes place outside of a formal classroom with materials provided or recommended by the instructor. In an independent study model, the study is geared toward the needs of the individual and can be self-paced. Materials may be web-based or paper-based and may include audio-visual materials. In a cognitive apprenticeship model, instructors model and learners analyze and apply processes. In a cooperative model, small teams work together through a variety of activities to master a subject, with each member responsible for self-learning and the learning of others in the team.

Question 3

Q

The first step in strategic planning is usually to:

A. Conduct an environmental assessment.
B. Revise the previous strategic plan.
C. Review and revise the mission and vision statements.
D. Develop a values statement.”

Answer

A

A. Conduct an environmental assessment

A: Strategic planning usually begins by conducting an
environmental assessment. This may include using a strengths, weaknesses, opportunities, threats (SWOT) analysis to assess internal and external factors that may influence outcomes. The assessment reviews changes, both positive and negative, that have occurred, such as a decrease in second-party reimbursement or an increase in patient population. The information gleaned from the environmental
assessment is then used to develop or revise the mission, vision, and values statements.

Question 4

Q

According to the HL7 group, the three different types
of interoperability are:

A. Functional, ergonomic, and cognitive

B. Technical, semantic, and process/social

C. Technical, interactive, and non-interactive

D. Functional, technical, and ergonomic

Answer

A

B. Technical, semantic, and process/social

According to the HL7 group, the three different types of interoperability are:

Technical: Systems are able to connect with one other and
exchange data without error.

Semantic: Data is shared among the different systems and interpreted
and understood in the exact same manner in each system.

Process/Social: The system is able to integrate into the workflow
and promote the quality of care by providing usability through
carefully-designed interfaces and allowing users to access and input
information efficiently.

Question 5

Q

The father of information theory and the digital age is
considered to be:

A. Albert Bandura

B. Alan Turing

C. Claude Shannon

D. Kurt Lewin

Answer

A

C. Claude Shannon

In 1948, Claude Shannon, a mathematician, wrote a paper that laid out the basis for modern information theory: “A Mathematical Theory of Communication.” Shannon showed how all forms of information (including text, telephone signals, video, audio, and telephone) could be encoded through a binary system of 0s and 1s and transmitted error free; he also showed how the amount of information carried over a system of communication could be calculated mathematically. Shannon demonstrated that switching circuits could be endowed with decision-making ability (applicable to artificial intelligence).

Question 6

Q

If the nurse informatics specialist finds that nursing leaders lack essential knowledge about informatics, the first step should be to:

a. Identify informatics education needs of leaders.

b. Develop a mentoring program for leaders.

c. Complain to the board of directors.

d. Request additional training funds.

Answer

A

A. Identify informatics education needs of leaders.

If the nurse informatics specialist finds that nursing leaders lack essential knowledge about informatics, the first step should be to identify informatics education needs of leaders. Because nurse leaders serve a critical role in motivating other staff and acting as role models, the nurse informatics specialist needs a knowledgeable leadership. Assessment may include surveys, questionnaires, and interviews. Assessment must be completed before requesting funds or establishing a mentoring program because needs may vary widely.

Question 7

Q

A primary concern related to bring-your-own-device (BYOD) policies is:

A. Device damage
B. Insurance costs
C. Unequal access
D. Proprietary data misuse

Answer

A

D. Proprietary data misuse

D: Bring your own device (BYOD) is increasingly common in healthcare because the smart phone and tablet are ubiquitous and healthcare providers often use these devices to access and share information. When used for work purposes, these devices can expose proprietary data. Organizations need to have a BYOD policy that outlines acceptable use, provides security awareness training, requires device enrollment, and ensures that all stored and transmitted data are encrypted and that access is secure. Additionally, security audits should be done routinely, and the organization should have the ability to remotely wipe devices of sensitive data.

Question 8

Q

Considering computer ergonomics, when a person is using the computer, the top of the monitor should be approximately:

A. 4 inches above eye level
B. 4 inches below eye level 8 inches below eye level
C. 8 inches below eye level
D. At eye level

Answer

A

D. At eye level

Considering computer ergonomics, when a person is using the computer, the top of the computer should be approximately at eye level. While there is some variation in height, most differences relate to lengths of the lower extremities rather than the trunk, so desk placement does not usually pose a problem. However, wall-mounted computer screens (such as at point of care) should be adjustable to provide for ease of use and good visualization.

Question 9

Q

Which one of the following is protected by copyright?

A. Domain names
B. Systems
C. Ideas
D. Photographs

Answer

A

D. Photographs

Intellectual property protection is provided through copyright, which covers the following:
Artistic works: graphic designs, paintings, photographs, sculptures, maps, and posters Literary works: articles, novels, poems, plays, blogs, and some types of software Musical works: compositions and lyrics
Dramatic works: scripts, screenplays, and plays
Audiovisual works: movies, television programs, and online videos
Architectural designs
Sound recordings: music, sounds, and speeches
Choreographic works: dance moves
Copyright does not cover domain names, systems, or ideas (although the wording of ideas may be copyrighted).

Question 10

Q

Regression testing is usually done:

A. After decommission of computer equipment
B. Before decommission of computer equipment
C. After introduction of new software or other changes
D. Before introduction of new software or other changes

Answer

A

C. After introduction of new software or other changes

Regression testing is usually done after introduction of new software or other changes to determine if “regressions” or errors occur. Sometimes a change in one aspect of software may have adverse effects on other aspects. Non-regression testing,

Question 11

Q

In which area of the hospital is adding auditory display to visual display likely to be most effective?

A. Emergency department
B. ICU
C. Operating rooms
D. Pediatrics

Answer

A

C. Operating rooms

Auditory visual displays, which use sound to indicate changes in conditions, such as increased pulse or decreased blood pressure, can be distracting in areas that already have a fairly high volume of noise and/or alarms associated with displays, so the area of the hospital in which an auditory display is likely to be most effective is operating rooms. Operating rooms are usually reasonably quiet, and the auditory feedback may be especially useful to anesthesiologists.

Question 12

Q

When applying the Complex Adaptive Theory to the system design life cycle, the informatics nurse would expect:

A. Reciprocal changes to occur between user and system
B. Users to bring about changes in systems
C. Systems to bring about changes in users
D. Systems to be too complex to effectively change

Answer

A

A. Reciprocal changes to occur between user and system

When applying the Complex Adaptive Theory to the system design life cycle, the informatics nurse would expect reciprocal changes to occur between the user and the system. Thus, the user changes elements of the system depending on the type of use, and the system in turn changes the behavior of the user. Adaptive systems tend to be dynamic rather than static and are able to adjust to changes to avoid chaos. Adaptive systems generally value effectiveness over efficiency.

Question 13

Q

Which of the following processes is most useful in determining the steps required to move from a current state of performance to a new one, including the need for action and resources.

A. Cost-benefit analysis
B. Gap analysis
C. Outcomes analysis
D. Return on investment (ROI) analysis

Answer

A

B. Gap analysis

Gap analysis is used to determine the steps required to move from a current state of actual performance or situation to a new potential performance or situation, and the “gap” between the two that requires action or resources. Steps to gap analysis include:

Assessing the current situation and listing important factors, such as performance levels, costs, staffing, and satisfac-tion, and all processes
Identifying the current outcomes of processes dentitying the rarget outcomes for projected processe
Outlining the process required to achieve target outcomes
Identifying the gaps that are present
Identifying resources and methods to close the gaps

Question 14

Q

Which of the following types of data/information is primarily subjective?

A. Relevant
B. Timely
C. Flexible
D. Verifiable

Answer

A

A. Relevant

Relevant data/information is primarily subjective because the user must judge whether or not the data/information is relevant for the user’s purposes. Objective data/information is factual and unbiased, and therefore can be proven. Flexible data/in-formation can be used by a variety of users for a number of different purposes. Verifiable data/information can be proven through research to be accurate. Timely data/information is available when needed. Complete data/information contains all the information needed. Reliable data/information is clean data from a trusted source, such as a juried journal.

Question 15

Q

Which of the following applies to protection of patient data on terminal displays in publicly accessible areas?

A. No information should be displayed
B. Terminals should have privacy filters
C. Terminals should have a manual locking feature
D. All data are de-identified

Answer

A

B. Terminals should have privacy filters

To ensure protection on patient data on terminal displays in publicly accessible areas, the terminals should have privacy filters that limit indirect viewing and should be facing away from the public areas when possible. If patients’ names are displayed on computer terminals in public areas, such as a waiting room, the name must be partially masked (such as using initials only). Terminals should have automatic locking figures so that the terminal shuts down if no activity occurs for a specific period of time, such as 3 minutes.

Question 16

Q

When discussing information, utility refers to the:

A. Ability to produce the same information at another time

B. Ability of users to apply intellectual reasoning to reach a goal while the tools that produced the information disappear

C. Level of difficulty in accessing information for a particular purpose

D. Ability to provide the correct information to the correct user at the correct time for the correct purpose

Answer

A

D. Ability to provide the correct information to the correct user at the correct time for the correct purpose

Utility refers to the ability to provide the correct information to the correct user at the correct time for the correct pur-pose. Transparency refers to the ability of users to apply intellectual reasoning to reach a goal while the tools that produced the information disappear. Usability refers to the level of difficulty in accessing information for a particular purpose. Reproducibility refers to the ability to produce the same information at another time.

Question 17

Q

The field of science that attempts to create intelligent technologies and then apply these technologies to the field of informatics is:

A. Cognitive science
B. Cognitive informatics
C. Artificial intelligence
D. Information science

Answer

A

C. Artificial intelligence

The field of science that applies intelligent technologies to the field of informatics is artificial intelligence. Researchers in artificial intelligence must engineer general intelligence and reasoning skills into the artificial intelligence programs as well as the ability to develop and learn from experiences and errors and to process natural language. One example of an artificial intelligence program is Siri, which responds to verbal queries and is found on Apple devices, such as the iPhone and iPad.

Question 18

Q

Various models are available to guide healthcare organizations in applying evidence-based research to practice. If using the Iowa Model of Evidence-Based Practice to Promote Quality Care (Titler, 2001), the first step is to:

A. Identify problem- and knowledge-focused triggers (practice questions).

B. Determine the resources available for instituting evidence-based practice.

C. Develop consensus among key players regarding evidence-based practice.

D. Establish a time frame for research, analysis, and implementation.

Answer

A

A. Identify problem- and knowledge-focused triggers (practice questions).

The Iowa Model of Evidence-Based Practice to Promote Quality Care (Titler, 2001) begins with identifying problem- and knowledge-focused triggers (practice questions) and then assessing whether they are priorities. If not, other triggers should be considered. Researchers form a team to assess the research base, assemble research, analyze and synthesize the research, determine the efficacy of change, and pilot a change program with a follow-up evaluation of outcomes to determine whether the change should be adopted.

Question 19

Q

When applying Lewin’s theory of change to implementation of an EHR, during the “unfreeze” stage, the informatics nurse should expect to:

A. Deal with resistance and provide reassurance.
B. Answer questions and dispel rumors.
C. Envolve many staff members in the change process.
D. Establish systems for feedback.

Answer

A

A. Deal with resistance and provide reassurance.

When applying Lewin’s theory of change to implementation of an EHR, during the “unfreeze” stage, the informatics nurse should expect to deal with resistance and provide reassurance as well as determine the needs for change, promote the need for change, and ensure managerial support. During the change stage, communicating, answering questions, and dispelling rumors as well as encouraging involvement is important. The refreeze (last) phase requires developing methods to sustain change and provide feedback and adaptation to the changes.

Question 20

Q

The focus of the Administrative Simplification Compliance Act (2000) (ASCA) is the:

A. Transition to electronic Medicare claims submissions
B. Elimination of all paper Medicare claims submissions
C. Reduction of costs of Medicare claims submissions
D. Elimination of Medicare under- and overpayments

Answer

A

A. Transition to electronic Medicare claims submissions

The Administrative Simplification Compliance Act (2000) (ASCA) focuses on the transition to electronic Medicare claims submissions. ASCA has established penalties for failure to comply; however, the law allows exceptions for providers with fewer than 25 full-time employees, those with no internet access, and those with less than $5 million in annual income. CMS is responsible for enforcing the provisions of ASCA. Although compliance with ASCA should result in cost savings, this is not the focus.

Question 21

Q

In response to a sentinel event, the informatics nurse should advise an initial response that includes completing a:

A. Plan to avoid recurrence
B. List of potential causes
C. Root cause analysis
D. List of staff involved

Answer

A

C. Root cause analysis

In response to a sentinel event, the informatics nurse should advise an initial response that includes completing a root cause analysis. The informatics nurse may assist in obtaining necessary information from the electronic health record as automated searches are often much faster and more efficient than manual searches. Root cause analysis must be reviewed objec-tively, taking into consideration that environmental factors and indirect causes (such as decreased staff) may contribute to the direct cause (staff error) of an event.

Question 22

Q

If the informatics nurse has found a new application that may enhance the existing EHR with CPOE CDS system, the first concern before recommending the application is:

A. Cost
B. Compatibility
C. Usability
D. Safety

Answer

A

B. Compatibility

While all of these are important issues, if the informatics nurse has found a new application that may enhance the existing EHR with CPOE CDS system, the first concern before recommending the application is compatibility. If the application will not work within the existing system or it requires extensive workaround, then it is not a good choice. The informatics nurse should consult with the vendor as well as IT personnel and programmers to determine whether there are compatibility issues.

Question 23

Q

If using the SMART goal-setting system, the goals must be:

A. Authentic
B. Astute
C. Ambitious
D. Achievable

Answer

A

D. Achievable

The SMART goal-setting system helps the individual develop goals that are structured and can be tracked and measured.
The SMART goal-setting system consists of the following:

Question 24

Q

The structure of data supported by a hierarchical database is:

A. Many-to-many
B. One-to-many
C. Many-to-one
D. One-to-many and many-to-one

Answer

A

B. One-to-many

The structure of data supported by a hierarchical database is one-to-many (tree or parent-child) but not many-to-one because data connects only in descending order. Hierarchical databases are used for simple structures, such as telephone number listings, but are not adequate for the current demands of information storage; so, hierarchical databases have generally been replaced with relational databases, which are built on a table structure and allow both one-to-many and many-to-one relationships.

Question 25

Q

When notified that a costly upgrade to the EHR is scheduled for implementation within the next few months, the first step should be to:

A. Evaluate the need for the upgrade.
B. Send RFIs to other vendors.
C. Determine how long the current version will be supported.
D. Request details and a demonstration.

Answer

A

D. Request details and a demonstration.

When notified that a costly upgrade to the EHR is scheduled for implementation within the next few months, the first step should be to request details and a demonstration. Most vendors will provide a demo version so that the organization can have a clear idea of the changes. Updates, such as adding new medications to the medication list, are frequent and usually involve no disruption in workflow or utilization of the EHR, but upgrades may be more problematic so they must be thoroughly assessed. Upgrades often improve functioning or respond to changes in regulations or technology.

Question 26

Q

When a perpetrator attempts to obtain another person’s personal information (such as user name and password) through email by pretending to be an authorized individual, this is an example of:

A. Phishing
B. Spamming
C. Whaling
D. Clickjacking

Answer

A

A. Phishing

When a perpetrator attempts to obtain another person’s personal information, such as user name and password, through email by pretending to be an authorized individual, this is an example of phishing, which is a social engineering tech-nique. Additionally, phishing emails may contain infected downloads or links to malware. The emails may contain links to fake websites that are replicas of the real websites. In some cases, phishing may involve instant messaging or pop-up windows that ask for verifying data.

Question 27

Q

The purpose of a migration plan during decommissioning of the computer information system (CIS) is to ensure:

A. The computer information system is properly deactivated.
B. Necessary legacy data are transmitted to the new system.
C. The hardware storage devices are removed and destroyed.
D. All legacy data are destroyed and irretrievable.

Answer

A

B. Necessary legacy data are transmitted to the new system.

In many cases, when a computer information system (CIS) is decommissioned, legacy data, such as workflows and clinical data, may need to be transferred to the new CIS. In that case, a migration plan should be developed to outline the project, including the legacy system structure and exactly what components will be transferred. Any migration requirements for hardware and software must be included as well as strategies and quality assurances for data migration and a security overview. The migration plan should also include the impact on interfaces, testing plan, and risks.

Question 28

Q

In Kurt Lewin’s change theory, the first stage, motivation to change, is also referred to as:

A. Freezing
B. Unfreezing
C. Unfrozen
D. Refreezing

Answer

A

B. Unfreezing

Change theory stages:
1. Motivation to change (unfreezing): Dissatisfaction occurs when goals are not met. Previous beliefs are brought into question and survival anxiety occurs. Sometimes learning anxiety about having to learn different strategies causes resistance that can lead to denial, blaming others, and trying to maneuver or bargain without real change.

Desire to change (unfrozen): Dissatisfaction is strong enough to override defensive actions and desire to change is strong but these must be coupled with identification of needed changes.
Development of permanent change (refreezing): New behavior becomes habitual, often requiring a change in perceptions of self and establishment of new relationships.

Question 29

Q

Staff members should be advised not to open email attachments unless they:

A. Know the sender and expect the attachment.
B. Run a virus scan program on the email and attachment.
C. Are using a secure network.
D. Ask a supervisor for permission.

Answer

A

A. Know the sender and expect the attachment.

Staff members should be advised not to open an email attachment unless they know the sender and expect the attach-ment. Even running a virus scan program is not sufficient because new viruses may be undetectable. The most common method for uploading malicious coding or viruses to a computer or network is to send them through email as an attachment.
For this reason, some organizations prohibit the use of email or prohibit opening of any attachments.

Question 30

Q

For staff education, which of the following is an example of high-fidelity simulation?

A. Staff practice new EHR using real computers and software with test patients

B. Staff learn EHR skills while actually working and inputting data about real patients

C. Staff watch videos that demonstrate the proper use of the EHR

D. Staff use stereoscopic goggles to practice using the EHR in a virtual reality system

Answer

A

A. Staff practice new EHR using real computers and software with test patients

For staff education, an example of high-fidelity simulation is when staff practices a new EHR using real computers and software with test patients. High-fidelity simulations use real or realistic materials and equipment in order to learn new skills.
Low-fidelity simulations, on the other hand, are usually less expensive and utilize verbal, print, audio, or video materials, and may involve discussing processes and case studies rather than actually carrying out processes.

Question 31

Q

The agency/organization that develops standards for information systems to support documentation of nursing practice is:

A. ANSI
B. HL7
C. CMS
D. ANA

Answer

A

D. ANA

The agency/organization that develops standards for information systems to support documentation of nursing practice is the ANA (American Nurses Association) through its Nursing Information and Data Set Evaluation Center (NIDSEC). The ANA
also evaluates information systems that are voluntarily submitted to the organization to determine if they meet the standards.
The ANA Committee on Nursing Practice Information Infrastructure (CNPII) reviews and recognizes taxonomies, nomencla-tures, and vocabularies.

D: The agency/organization that develops standards for information systems to support documentation of nursing practice is the ANA (American Nurses Association) through its Nursing Information and Data Set Evaluation Center (NIDSEC). The ANA
also evaluates information systems that are voluntarily submitted to the organization to determine if they meet the standards.
The ANA Committee on Nursing Practice Information Infrastructure (CNPII) reviews and recognizes taxonomies, nomencla-tures, and vocabularies.
D: The agency/organization that develops standards for information systems to support documentation of nursing practice is the ANA (American Nurses Association) through its Nursing Information and Data Set Evaluation Center (NIDSEC). The ANA
also evaluates information systems that are voluntarily submitted to the organization to determine if they meet the standards.
The ANA Committee on Nursing Practice Information Infrastructure (CNPII) reviews and recognizes taxonomies, nomencla-tures, and vocabularies.

Question 32

Q

According to the human-computer interaction (HCI) framework (Staggers), the primary focus of HCI is:

A. Usability
B. Design
C. Efficiency of operations
D. Interoperability

Answer

A

A. Usability

The primary focus of HCI is usability related to human performance during interactions with computers in different con-texts, including concerns regarding overall ease of use, difficulty in learning, efficiency, satisfaction, ability to carry out error-free interactions, and ability of the computer system to match the tasks. Another focus is the mental model of users, the idea that the users have regarding interactions with computers based on knowledge and experience.

Question 33

Q

The primary purpose of the Nationwide Health Information Network (NwHIN) is to:

A. Ensure secure internet exchange of information through standards, policies, and services.

B. Provide servers and networks to facilitate secure exchange of information.

C. Provide licensure for healthcare facilities using the network to exchange information.

D. Provide a network for exchange of evidence-based guidelines.

Answer

A

A. Ensure secure internet exchange of information through standards, policies, and services.

The primary purpose of the Nationwide Health Information Network (NwHIN) is to ensure secure internet exchange of information through standards, policies, and services. NwHIN is funded by the Office of the National Coordinator for Health Information Technology (ONC). The primary goal is to assist healthcare providers to move from a system of paper medical records to a secure electronic health record that can be easily accessed by various healthcare providers and utilized to evaluate the quality of care.

Question 34

Q

The goal of translational research is to:

A. Decrease variability in nursing practice.
B. Search coded data for patterns.
C. Translate foreign healthcare articles into English.
D. Translate medical/nursing research into interventions.

Answer

A

D. Translate medical/nursing research into interventions.

The goal of translational research is to translate medical/nursing research into interventions so that it is a basis for evi-dence-based practice. An important factor in translational research is that the scientific aspects of the research are understood by the healthcare providers so that they comply with the recommended interventions. One problem associated with translating research into interventions is that research often presents the most positive aspects of change rather than the negative, so problems may arise during application.

Question 35

Q

User acceptance testing (UAT) should ideally be completed:

A. Immediately after a new system has gone live
B. Immediately before a new system goes live
C. During alpha or beta testing before implementation
D. During training sessions after a pilot program is completed

Answer

A

C. During alpha or beta testing before implementation

User acceptance testing (UAT) should ideally be completed during alpha testing (by the developer) or beta testing (by end users) before implementation of the system so that problems can be identified and user acceptance evaluated. Some actual end users should be included in testing, although some surrogate users may be included. If user acceptance is low, then the technology may not be used in the way in which it was intended, and this could result in errors.

Question 36

Q

When setting training objectives, they should be clearly linked to:

A. Desired learning outcomes
B. Costs of training
C. Individuals’ needs
D. A specified time frame

Answer

A

A.Desired learning outcomes

Training objectives should be clearly linked to the desired learning outcomes so that the training has a defined purpose and outlines the path that participants need to achieve mastery. For example, if a training objective is for participants to be able to properly use medication management software, a desired learning outcome may be a reduction in medication errors. Training objectives should be written with action verbs, consistent with compliance and industry standards, and should meet the specific, measurable, relevant, time-bound (SMART) goal-setting system objectives.

Question 37

Q

As part of an analysis of the interaction of people, processes, and technology, the informatics nurse creates a workflow diagram in order to:

A. Capture real-time data regarding tasks
B. Demonstrate how tasks are done and by whom
C. Create a timeline for the completion of tasks
D. Simulate workflow performance

Answer

A

B. Demonstrate how tasks are done and by whom

A workflow diagram is a visual illustration of the steps of a process and the individuals (e.g., nurse, doctor, clerk, information technologist) who carry out the process. Workflow diagrams use standardized shapes and symbols, such as arrows to indicate flow, rectangles for steps, diamonds for decision points, and ovals for beginning and ending points. Connectors (lines) join the different steps, and steps may be labeled with text. Types of workflow diagrams include flowcharts, process flow diagrams, data flow diagrams, and swim lane diagrams.

Question 38

Q

Under Meaningful Use regarding EHRs for eligible hospitals and critical access hospitals (CAHs), which of the following is a core objective?

A. Record smoking status for patients 16 years and older

B. Provide patient with paper copies of their health information on request

C. Provide clinical summaries for patients

D. Record and chart changes in height and weight

Answer

A

D. Record and chart changes in height and weight

Under Meaningful Use regarding EHRs for eligible hospitals and critical access hospitals (CAHs), a core objective is to record and chart changes in height and weight. Current core objectives include using CPOE for medication orders; implementing drug/drug and drug/allergy interaction checks; maintaining current problems, medication, and allergy lists; recording demographics; recording and charting changes in height, weight, BMI, and BP, as well as growth charts for children; recording smoking status for patients at least 13 years; implementing one clinical decision support rule of a high priority hospital condi-tion; providing electronic copies of health information and discharge instructions on request; and protecting electronic health information.

Question 39

Q

When an institution is transitioning to a CPOE, a primary role of the informatics nurse is that of:

A. System designer
B. Purchasing agent
C. Software modifier
D. Liaison

Answer

A

D. Liaison

When an institution is transitioning to a CPOE, a primary role of the informatics nurse is that of liaison to promote multidisciplinary collaboration and cooperation among the various members of the healthcare team, including nurses, physicians, and IT specialists, to ensure that the end-product has the functionality that is needed for workflow and that it meets the requirements for safety and security. Needs regarding both hardware and software must be clearly communicated to IT personal

Question 40

Q

In a computer, which of the following is considered permanent data storage?

A. CPU
B. IDE
C. RAM
D. SSD

Answer

A

D. SSD

In a computer, an SSD (solid-state drive) is a type of permanent data storage. Another type of permanent storage is a hard disk, where the information is encoded into magnetic bits. While data storage is considered permanent, hard disks and SSDs can fail, resulting in loss of data. By the same token, data that have simply been deleted can often be retrieved, posing a security risk for decommissioned equipment. As such, more drastic measures are required to completely destroy information on permanent storage. This can include strong magnets, fire, or crushing force.

Question 41

Q

The type of personal health record (PHR) that is standalone and not connected to a particular system or electronic health record EHR) is:

A. Paper/personal files
B. Untethered
C. Tethered
D. Networked

Answer

A

B. Untethered

Untethered PHRs are standalone and not connected to a particular system or EHR. Information may be carried on a smart card, flash card, CD, or DVD. These pose more security risks than tethered PHRs and require more input from the individual to maintain accurate records. In tethered PHRs, data are tied to a particular system and EHR and are often web-based. A secure patient portal is provided so the individual can access all or parts of the records. In networked PHRs, data are derived from multiple sources in a network rather than one system. This allows for more flexibility. In paper/personal files, patient-maintained paper records are contained.

Question 42

Q

The HIPAA Security Rule (2003) focuses primarily on the security of:

A. All types of medical records
B. Coding and billing procedures
C. Electronic protected health information
D. Healthcare organizations

Answer

A

C. Electronic protected health information

HIPAA established the Privacy and Security Rules, both of which took effect in 2003:

Privacy Rule: Ensures patients’ rights. Protects any information included in a medical record (paper or electronic) as well as conversations between a doctor and another healthcare provider, billing information, and any other form of heath information

Security Rule: Focuses on electronic protected health information. The rule protects the privacy of individuals but allows the adoption of new technologies, so it allows for flexibility and scaleability

Question 43

Q

When completing process mapping for workflow, which of the following is an example of a process at the micro level?

A. Admitting a patient
B. Transferring a patient from one unit to another
C. Completing a blood draw for a lab test
D. Completing wound assessment, irrigation, and dressing change

Answer

A

C. Completing a blood draw for a lab test

Process mapping may be done at three different levels:

Macro level: A general overview of a process with many component parts, such as admission procedures

Mini level: Process steps in a procedure that involves a number of different tasks, such as completing wound assess-ment, irrigation, and dressing change or transferring a patient

Micro level: Process steps in detail that one individual will take to carry out one procedure, such as completing a blood draw

Question 44

Q

During the explorative phase of selecting an information system, which of the following assessment methods is most useful in order to observe the practices in an organization and to identify those agents controlling change?

A. Field study
B. Focus group
C. Delphi
D. SWOT analysis

Answer

A

A. Field study

During the explorative phase of selecting an information system, the assessment method that is most useful in order to observe the practices in an organization and to identify those agents controlling change is a field study, which obtains data from the work environment itself. Data may be obtained by direct observation as well as one-on-one interviews, questionnaires, and surveys. Those conducting the field study may do so as a complete observer (not interacting) or as a participant.

Question 45

Q

A collection of data about one particular hospital unit to facilitate decision-making by administration is a:

A. Data mart
B. Data warehouse
C. Data file
D. Data mine

Answer

A

A. Data mart

A collection of data about one particular hospital unit or a specific topic to facilitate decision-making by administration is a data mart. This may be as small as one database or may be a compilation of databases, but is generally a subset of a data warehouse (AKA enterprise data warehouse), which is a very large database or storage depository with integrated data. The data warehouse includes all of an organization’s databases. The data warehouse may be utilized for reporting of data as well as data mining for analysis.

Question 46

Q

Which governmental agency is responsible for oversight and enforcement of HIPAA’s Privacy Rule?

A. Centers for Disease Control and Prevention (CDC)
B. Federal Communications Commission (FCC)
C. Chairman. Food and Drug Administration (FDA)
D. Office for Civil Rights (OCR)

Answer

A

D. Office for Civil Rights (OCR)

The governmental agency responsible for oversight of HIPAA’s Privacy Rule is the Office for Civil Rights (OCR), which is part of the Department of Health and Human Services (DHHS). An organization must have procedures in place to limit access to PHI and to limit disclosures to only authorized personnel. HIPAA’s Privacy Rule protects data in the EHR as well as personal communications between the patient and healthcare providers. Billing information is also protected.

Question 47

Q

When developing teams for quality improvement processes, the informatics nurse should recognize that power issues among the team members often begin with observations of the:

A. Hierarchical staff roles
B. Team leader
C. Other team members
D. Task requirements

Answer

A

B. Team leader

When developing teams for quality improvement processes, the informatics nurse should recognize that power issues among the team members often begin with observations of the team leader. The team members observe the manner in which the leader uses power and controls the meetings, and, based on these observations, usually begin to form alliances and may begin to exercise individual or group control. This often occurs early in the team-building development and can facilitate team work or hinder it.

Question 48

Q

If the informatics nurse wants to provide continuing education units for staff training courses, the first step is to:

A. Send course outlines to the state Board of Nursing.
B. Survey staff.
C. Notify the administration.
D. Query the state Board of Nursing.

Answer

A

D. Query the state Board of Nursing.

If the informatics nurse wants to provide continuing education units for staff training courses, the first step is to query the state Board of Nursing to determine rules and regulations about what an approved course must contain and how many contact hours are needed. The Boards of Nursing may vary in requirements for continuing education units and may have different procedures. For example, the state of California approves providers but not individual courses.

Question 49

Q

The informatics nurse should be aware that one of the most common problems with EHRs related to safety is:

A. Failing to document patient information
B. Disclosing passwords to unauthorized personnel
C. Displaying inaccurate ID information on screens
D. Documenting patient information on the wrong record

Answer

A

D. Documenting patient information on the wrong record

The informatics nurse should be aware that one of the most common problems with EHRs related to safety is documenting patient information on the wrong record. If undetected, this presents a serious danger to the patient. If detected and cor-rected, this takes time away from patient care. One method of assessing this problem is to review when information on one record has been removed or identified as an error and the same information is immediately applied to another record.

Question 50

Q

The purpose of a software version control system is to:

A. Manage code changes and maintain a history of revisions.
B. Ensure that the latest version of software is uploaded.
C. Identify errors in software applications.
D. Provide security features to protect software.

Answer

A

A. Manage code changes and maintain a history of revisions.

Software version control (aka source control) systems help manage code changes and maintain a history of code revi-sions, including who made the changes and when. Version control systems may be centralized (i.e., all code and history being stored in one repository) or distributed (i.e., each developer has a copy of the code and history). Software version controls systems provide backup so that code is not lost and developers can revert back to an earlier code. It can also allow multiple developers to work on the same project.

Question 51

Q

The informatics nurse may recommend gap analysis in order to determine the:

A. Cause of decreased efficiency and/or financial instability

B. Resources that resulted in increased performance and efficiency

C. Resources needed to move from the current state to a proposed state

D. Gaps in security in the electronic health system and use of mobile devices

Answer

A

C. Resources needed to move from the current state to a proposed state

The informatics nurse may recommend gap analysis in order to determine the resources (including time) needed to move from the current state to a proposed state. Gap analysis looks at the “gap” between a current state and a desired one. Steps include assessing the current situation, identifying current processes and outcomes, identifying target outcomes, outlining steps needed to achieve target goals, identifying gaps, and identifying resources and measures needed to close the gaps.

Question 52

Q

Which of the following is likely most useful for root cause analysis?

A Prioritization matrix
B. Gantt chart
C. Events and causal factors analysis (E&CFA) chart
D. Delphi technique

Answer

A

C. Events and causal factors analysis (E&CFA) chart

An events and causal factors analysis (E&CFA) chart, which is a combination of affinity diagram and flow chart, is likely most useful for root cause analysis. Steps in a sequence leading up to an event (such as a sentinel event) are outlined as in a flow chart with arrows connecting the events that are listed chronologically and then all possible causal factors are identified for each step by asking why as in am infinity diagram.

Question 53

Q

If the informatics nurse is to facilitate usability testing of an information system and applications, the informatics nurse should begin by:

A. Creating test scenarios and identifying metrics
B. Recruiting participants from various departments
C. Arranging for observers to assist with the testing
D. Securing a space for usability testing to take place

Answer

A

A. Creating test scenarios and identifying metrics

The informatics nurse should begin planning for usability testing by creating test scenarios, which typically reflect the ways in which participants will need to use the equipment, and identifying usability metrics. Then, the informatics nurse must recruit a representative group of end users to participate in the testing. Participants may be asked to think out loud and talk through the procedure, noting any problems or issues while expert observers take notes of the participants’ interactions. Collected data is then analyzed, and a usability report is completed with recommendations.

Question 54

Q

When planning staff training for EHR implementation, the informatics nurse should keep in mind that the best retention is likely to occur if the participants:

A. Read material about EHRs.
B. Listen to a lecture and audiotapes about EHRs.
C. Research and give presentations about EHRs.
D. Practice using the EHR with real equipment.

Answer

A

D. Practice using the EHR with real equipment.

When planning staff training for EHR implementation, the informatics nurse should keep in mind that the best retention is likely to occur if the participants practice using the EHR with real equipment, which includes both speaking (providing feed-back, asking questions) and doing. Retention at 24 hours is about 90% with this method of instruction. The least effective method of retention is reading, which results in only about 10% comprehension, followed by listening (20%), viewing (30%), listening and viewing (50%), and speaking and writing (70%).

Question 55

Q

According to von Bertalanffy’s systems theory, the five elements that comprise a system are:

A. Input, throughput, output, evaluation, and feedback
B. Tasks, contexts, parameters, processes, and outcomes
C. Data, resources, processes, feedback, and adaptation
D. Program, project, process, procedure, and product

Answer

A

A. Input, throughput, output, evaluation, and feedback

According to von Bertalanffy’s systems theory, the five elements in a system include:

Input: This is what goes into a system in terms of energy or materials.
Throughput: These are the actions that take place in order to transform input.

Output: This is the result of the interrelationship between input and processes.

Evaluation: This is ongoing monitoring for success or failure.

Feedback: This is information that results from the process and can be used to evaluate the end result.

Systems theory postulates that the entire system must be viewed holistically rather than concentrating on components of the systems because the interrelationships among different elements of the system must be understood.

Question 56

Q

If the informatics nurse is concerned that a computer system may not function well during peak times of access, the type of testing needed is:

A. Load/volume testing
B. System integration testing
C. Black box testing
D. Functional testing

Answer

A

A. Load/volume testing

If the informatics nurse is concerned that a computer system may not function well during peak times of access, the type of testing needed is load/volume testing. This is a non-functional testing for reliability that assesses the ability of the system to function under various loads, such as at peak times when multiple users in multiple departments are accessing the system. The purpose of load/volume testing is to determine the maximum load capacity and to identify the load at which problems begin to occur. Testing is done at both the safe working load (SWL) and above the SWL.

Question 57

Q

To facilitate the scalar chain principle of management, an organization needs to outline the:

A. Chain of command
B. Placement of resources
C. Focus of direction
D. Organizational rules

Answer

A

A. Chain of command

Fayol (1916) proposed 14 principles of management, which include the principle of the scalar chain. This principle describes the organizational hierarchy, specifically the chain of command that allows communication to flow from lower to higher in the hierarchy to reduce misunderstandings and miscommunication. Every member of an organization should understand to whom the person must report. This principle also allows for a “gangplank” (i.e., horizontal communication between different departments to save time). The next person in the chain of command should be made aware of horizontal communi-cations.

Question 58

Q

The process of “thinking aloud” is used for:

A. Post-test assessment
B. Pre-test assessment
C. Performance testing
D. User aptitude testing

Answer

A

C. Performance testing

The process of “thinking aloud” is used for performance testing.

Question 59

Q

Before committing to a cloud service provider, the organization should:

A. Sign a Service Level Agreement (SLA) outlining requirements.
B. Request permission from CMS to utilize a cloud service.
C. Advise the service that it must comply with HIPAA regulations.
D. Ensure that the organization will benefit from cost savings.

Answer

A

A. Sign a Service Level Agreement (SLA) outlining requirements.

Before committing to a cloud service provider, the organization should sign a Service Level Agreement (SLA) that outlines requirements, including the need to adhere to HIPAA Security Rules and ensure privacy of PHI, because the ultimate legal responsibility lies with the healthcare organization that owns the data. The SLA should make clear administrative controls and the types of physical and technical security utilized, as well as where data may be stored, as data that are stored overseas are

Question 60

Q

According to Benner’s stages of clinical competence, a nurse who has 2-3 years of experience and the ability to master new situations but who needs extra planning time and may lack flexibility is considered to be:

A. An advanced beginner
B. Competent
C. Proficient
D. An expert

Answer

A

B. Competent

According to Benner’s stages of clinical competence, a nurse who has 2-3 years of experience and the ability to master new situations but who needs extra planning time and may lack flexibility is competent. The 5 stages are (1) novice (little experience and rule-governed), (2) advanced beginner (some experience with new situations), (3) competent (see above), (4) proficient (thinks holistically and relies on experience, adaptable), and (5) expert (has a wealth of experience and acts intuitively).

Question 61

Q

According to the XY theory of organizational behavior (McGregor 1960), attitudes toward workers are based on:

A. Work output
B. Data
C. Observations
D. Assumptions

Answer

A

D. Assumptions

D: The XY theory (McGregor, 1960) theorizes that workers are managed according to conflicting assumptions:

X: Workers are unmotivated, resistive to change, unintelligent, and do not care about the organization; furthermore, they dislike work.

Y: Workers are basically creative and can exercise ingenuity

Question 62

Q

When utilizing the FOCUS (find, organize, clarify, uncover, start) model of performance improvement, FOCUS is usually combined with:

A. QIP (Quality Improvement Process)
B. PDCA (plan, do, check, act)
C. Six Sigma
D. FADE (focus, analyze, develop, execute)

Answer

A

B. PDCA (plan, do, check, act)

When utilizing the FOCUS (find, organize, clarify, uncover, start) model of performance improvement, FOCUS is usually combined with PDCA (plan, do check, act) to create a 9-step process because FOCUS is not complete by itself. FOCUS is used primarily to identify problems in an organization, organize a response, clarify the solution to the problems, and start the change process. The FOCUS model does not include the steps necessary to find solutions to the problems, so PDCA, a method of continuous quality improvement, helps to solve specific problems.

Question 63

Q

Which of the following is the primary reason for conducting end-user testing?

A. To identify user competencies
B. To identify errors
C. To determine volume capability
D. To determine ongoing education needs

Answer

A

B. To identify errors

The primary reason for conducting end-user testing is to identify errors. Testing is carried out by end users to ensure that the computer system functions correctly and meets the organization’s needs. Analysis may include asking end users to carry out specific tests, interviews with users, questionnaires regarding usability, comparative testing with users comparing work on two different systems, direct observation (over-the-shoulder), and indirect observation (audio/video feeds). Computer-generated data may be evaluated for accuracy and errors.

Question 64

Q

The Health Information Technology for Economic and Clinical Health (HITECH) Act under the Enforcement Interim Rule provides:

A. Criminal/civil penalties for violations of HIPAA rules
B. Funding for organizations to develop security protocols
C. Guidelines for organizations to develop security protocols
D. Guidelines for application of HIPAA privacy and security rules

Answer

A

A. Criminal/civil penalties for violations of HIPAA rules

The Health Information Technology for Economic and Clinical Health (HITECH) Act under the Enforcement Interim Rule provides criminal/civil penalties for violations of HIPAA rules. HITECH outlines 4 levels of violations and corresponding penalties, which cannot exceed $1.5 million for all violations of the same provision. Lack of awareness of the rules and regulations is not considered a defense or protection from penalties. HITECH establishes the Health IT Policy Committee, which makes recommendations regarding implementation of a national health IT infrastructure.

Answer 65

A

B. AND, OR, and NOT

If the informatics nurse is utilizing Boolean logic for a query, the three operators are AND, OR, and NOT, and they are case sensitive and must be capitalized. Two symbols-quotes (“ “) and parentheses ()—are also used. The operators can narrow results (AND) because sources with only one term are eliminated, expand results (OR) because sources with either term are returned, or exclude results (NOT). The operator NOT must always be preceded by AND (Liver AND cirrhosis AND NOT alcohol

Answer 66

A

D. Provide clinical decision support

Artificial intelligence (AI), a machine simulation of human intelligence, is increasingly used as part of clinical decision support and to provide imaging analysis but will likely have expanded uses in the near future. Al is not currently used to pre-scribe treatments, only to recommend, and it does not have the ability to resolve ethical issues. Al may be part of a robotic sys-tem, but the surgeon is still in control, so Al does not autonomously carry out surgical procedures.

Answer 67

A

B. Have less volume than standard computers.

Small form factor (“footprint”) (SFF) computers typically have less volume than standard computers so that they take up less desk space. Because of their smaller size, SFF computers may have fewer expansion slots, but usually the same features are available in this format. The shape of the computer may differ from other computers as well, with some cube-shaped, book-shaped, and box-shaped. Because there is no industry standard for SFF computers, they vary widely according to manufacturer.

Answer 68

A

A. CMS

Incentives for “meaningful use” of EHRs are provided by CMS. The American Recovery and Reinvestment Act (ARRA) and its Health Information Technology Act (HITECH) provision allocated $19 billion dollars for a 5-year period for incentives for hospitals and ambulatory care centers, beginning in 2011, and authorized the CMS to provide the incentives to hospitals and eligible providers. Five criteria for meaningful use include (1) improve healthcare quality and reduce disparities, (2) engage both patients and families, (3) improve coordination of care, (4) improve population and public health, and (5) ensure PHI is secure and private.

Answer 69

A

A. User executes the wrong sequence of steps in inputting data

An example of a low-level error in inputting of data is when the user executes the wrong sequence of steps. This type of error usually results in some type of alarm or hard stop of the program until corrected, so the error can usually be corrected fairly easily. A moderate-level error includes inputting data that are incompatible with the computer system. High-level errors include being unable to make a decision about the correct action or being unable to correctly interpret outcomes data.

Answer 70

A

C. Strategize: consider needs and future direction

Vendor analysis is carried out in a number of phases:
Strategize: Consider organizational needs, the reason for vendor analysis, and future needs. This process must be
done without bias.
• Define: Determine technical requirements, conduct market research, develop a list of vendors, and send requests for information (RFIs) and requests for proposals (RFPs).
Identify: Review the RFIs/RFPs, and narrow the list of vendors.
Evaluate: Focus on the remaining vendors with demonstrations, site visits, reference calls, and due diligence.
Partner: Enter into a contractual agreement with the selected vendors).

Answer 71

A

D. Work-around

In a hospital that uses a barcode scanning for medications, one nurse has made copies of patients’ wristbands and stached them h the top of the edicating the This probably represents one around, a ho put to the prover ethods are common with barcode scanning because barcode bracelets may become soiled, may be lost, and may be difficult to read, increasing the amount of time needed to pass medications.

Answer 72

A

C. Data table

When utilizing SAS Enterprise guide to query a database, if the derived data are to be saved permanently, the correct format is the data table format. The data are saved and not updated until a query is rerun to gain additional information. With the data view format, the data are continually updated each time the results are opened and historical data are not saved. The report format is especially formatted so that it can be presented with options including HTML, PDF, text, or RTF but tasks cannot be completed for results in this format.

Answer 73

A

B. NANDA-I

NANDA-I (NANDA International): used for standardized classification of nursing diagnoses according to a multiaxial tax-ontonomy of classes.

Answer 74

A

D. Reducing the redundancy of data

In a relational database, normalization refers to reducing the redundancy of data so that data are stored in one place and not multiple places within the database and errors in data are removed. Thus, normalization is a method of cleaning and sim-plifying. Three common forms of normalization are (1) first normal form (1NF), (2) second normal form (2NF), and (3) third normal form (3NF). Each form of normalization has more stringent requirements than the previous form.

Answer 75

A

B. Before orders are written

In an EHR with CPOE and CDS, allergy alerts should be triggered before orders are written and they should be automat-ed. Alerts that occur after orders are written are more likely to be ignored or overridden. Additional alerts, including hard stops, should occur if orders for contraindicated drugs or drugs to which the patient is allergic are ordered despite the original alert. The alerts should be carefully evaluated because excessive alerts may result in “alert fatigue” to the point that clinicians begin to ignore them.

Answer 76

A

C. The database contains errors.

Data are classified as “dirty” when the database contains errors that render the data inaccurate. This compromises the data integrity. Dirty data may result from human errors in entering data (such as misspelling a name or incorrectly entering an ID number). Dirty data may also result from viruses, worms, or other bugs installed into a system. Hackers may enter a system and alter or remove data. Hardware and software may fail, corrupting or destroying data.

Answer 77

A

A. Template

CMS provides templates, standardized structures with suggested clinical data elements, so that organizations can collect data and document patient procedures and clinical workflow more accurately. The use of templates helps to reduce risks. Templates can be integrated into existing EHRs and can be customized as needed because, although they provide a framework or blueprint for services, all sections of a template may not apply to the patient services provided by a healthcare organization.

Answer 78

A

B. Satisfying the needs of the customers

With Total Quality Management (QM), the primary focus is on satisfying the needs of the customers. The organization conducts various assessments (surveys, interviews, focus groups) to determine customer needs and engages the entire organization at all levels in the improvement process with teamwork and participation encouraged. Measurement is central to TQM’s processes, so criteria are identified through brainstorming and other methods, and quality improvement is measured. For TQM to be successful, it must be supported by top management.

Answer 79

A

C. Manages patients using the organization’s computer information system

Of the four levels of practicing nurses (beginning, experienced, informatics nurse specialist, and informatics innovator) related to informatics, the expectation of a beginning nurse regarding knowledge is the ability to manage patients using the organization’s computer information system. Other expected knowledge includes a basic comprehension about how the computer and internet functions and the understanding of how to use the computer to carry out required tasks, such as sending and receiving emails and doing internet searches for information.

Answer 80

A

A. Usability

Nonfunctional testing is associated with factors that improve the experience of the user but do not relate to actual func-tionality. Usability testing is one form of nonfunctional testing. Usability testing involves assessing the ease and efficiency of use, tolerance for errors, satisfaction with use, and successful use for the intended task. Usability testing can validate design decisions, indicate problems with use (such as unclear navigation or directions), and help develop user-friendly design deci-sions.

Answer 81

A

C. Contributory negligence

Contributory negligence involves the injured party/patient contributing to his or her own harm. Contributory negligence is a consideration in malpractice actions. In this case, the patient did not follow through with diagnostic tests that may have indicated increased risk of a myocardial infarction, so the physician did not have adequate information. Other types of negligence include negligent conduct in which an individual fails to provide reasonable care based on standards and expertise, gross negligence in which an individual willfully provides inadequate or substandard care, and comparative negligence in which the percentage of negligence is attributed to each individual involved.

Answer 82

A

D. Embed it into electronic nursing documentation.

The best method to ensure that nurses follow an evidence-based practice is to embed it into electronic nursing docu-mentation. Embedding may include alerts, pop-up boxes with clinical information, and adding interaction, which increases staff engagement. Any information should include references so that the nurses can do follow-up research. When possible, nurses should be rewarded in some way for participation, such as with continuing education credits, a certificate of comple-tion, or time off.

Answer 83

A

D. Aggregate

Aggregate data includes pharmacy transactions, required reports, demographic information, financial information, hazard and safety practices, and most things not included in the clinical record. Medical/clinical data includes patient-specific information regarding the patient, diagnosis, treatment, laboratory findings, consultations, care plans, physician orders, and information related to informed consent and advance directives. The medical record should include records of all procedures, discharge summary, and emergency care records. Knowledge based data includes methods to ensure that staff is provided training, support, research, library services, or other access to information, and good practice guidelines. Comparison data includes internal comparisons or external comparisons to benchmarks or best-practice guidelines.

Answer 84

A

B. ONC

The governmental agency that has established certification requirements for the exchange of data electronically is the
ONC (Office of the National Coordinator for Health Information Technology), which is part of the US Department of Health and Human Services and was mandated by the HITECH Act to coordinate national implementation of health information technology and data exchange. Data interfaces should be HL7 compatible, and data must be sent using secure encryption.

Answer 85

A

D. Data mining

Data mining is the analysis (often automatic) of large amounts of data to identify underlying or hidden patterns. The steps to data mining include detecting anomalies, identifying relationships, clustering, classifying, regressing, and summariz-ing. The effectiveness of data mining depends on many factors, such as hardware and software applications. Data mining may identify similar groupings in data, and these groups can then be further analyzed. Data mining may be applied to multiple patients’ electronic health records to generate information about the need for further examination or interventions.

Answer 86

A

C. Appropriate for needs

The contingency theory of organizational behavior (Fiedler, Vroom, Yetton) states that there is no one best method of organizing an organization because it is contingent on several factors; therefore, what works in one organization may not work in another. Leadership should be appropriate for the organizational needs, and different organizations require different styles of leadership. Contingency factors can include size, task complexity, environment (i.e., internal, external, market conditions), technology, organizational culture, employee characteristics, hierarchy, and strategies.

Answer 87

A

B. Evidence based research

Clinical practice guidelines are recommendations that help healthcare providers make appropriate decisions regarding specific clinical situations. Clinical practice guidelines are based primarily on evidence-based research

Answer 88

A

C. Underline

When highlighting text, underlining is more evident than italicizing and bolding because screens have different lighting and resolution. Text against a colored background, especially a deep color, is difficult to read. Colored fonts may be used sparingly to highlight different types of information. Using a variety of fonts and multiple sizes on one screen can be very distract-ing. Long paragraphs should be avoided and information broken into small chunks with adequate white space to rest the eyes.

Answer 89

A

D. Can be eliminated.

When considering improvements to workflow processes, the first issue to address is whether steps in a process can be eliminated because the goal is to simplify while still maintaining the integrity of the process. Eliminating steps may result from purchasing new equipment, altering product design, or changing the environment (such as carrying out a process at point of care rather than in another area). In some cases, steps may be simplified by combining some steps with others or by changing the order of steps.

Answer 90

A

C. An astronomical value

Rules applied to trending analysis:
Astronomical value: Data point unrelated to other points indicates sentinel event or special cause variation
Run (shift): ≥7 consecutive data points all above or all below the median (run chart) or mean (control chart)
Trend: ≥7 consecutive data points in either ascending or descending order with ≥21 total data points or ≥6 with fewer than 21 total data points

Cycle: Up and down variation forming a sawtooth pattern with 14 successive data points, suggestive of systemic effect on data; if the trend is related to common cause variation, the variation may be demonstrated with 4-11 successive data points

Answer 91

A

B. Make hasty decisions

Groupthink (Whyte, Janis) theorizes that group members avoid conflict by reaching consensus without analysis, resulting in hasty decisions that may be ill-conceived. Members tend to censor their own ideas and pressure others to conform in order to maintain consensus and may assume that if people remain silent that they agree. Some members may take on the role of
“mind guard” to protect the other members from opinions that do not conform. Members often think they are invincible and morally right, which can result in ethical or moral consequences for their poor decision making.

Answer 92

A

D. SNOMED-CT

Systematic Nomenclature of Medicine Clinical Terms (SNOMED-CT) is a multidisciplinary terminology that allows terminology from one classification system to be mapped to concepts from another, such as NANDA, NIC, and NOC. SNOMED-CT contains diagnoses, interventions, and outcomes. Other multidisciplinary terminologies are the Alternate Billing Codes (ABC), used for alternative and complementary treatments, and Logical Observations identifiers, Names, and Codes (LOINC), which includes outcomes and assessments and is used for laboratory results.

Answer 93

A

A. Entity-relationship diagram

An entity-relationship diagram (ERD) is a specific type of flowchart that visually represents the relationship between different entities and their attributes within a system. Entities can include objects (including people) and concepts, while attributes are characteristics of an entity. For example, an entity may be a nurse, and an attribute may be an identification number or name. The ERD demonstrates the type and number of relationships between entities. ERDs are often used during design of a database system.

Answer 94

A

A. Integrity

The three primary concerns regarding secure network information are (1) confidentiality, (2) availability, and (3) integrity.
An organization needs a clear confidentiality policy to ensure the privacy of data and to prevent accidental disclosures, such as may occur with badly placed monitors or shoulder surfing. Availability includes having an acceptable use policy and protecting hardware, such as keyboards from spills. Integrity is exemplified by trust that a system can be trusted to provide accurate infor-mation.

Answer 95

A

D. Labeler code

The National Drug Code (NDC) used for barcoding of medications is recommended by the FDA for use on all inpatient medications and vaccines, applied at the unit dose to decrease the risks of medication errors. An NDC is a code of 10 or 11 digits divided into 3 sections:
…
Labeler code (4-5 digits): Assigned by the FDA and represents the manufacturer, re-packager, or distributer Product code (3-4 digits): Assigned by the labeler and describes the medication, strength, and dose
Package code (1-2 digits): Assigned by the labeler and describes the package form and size

Answer 96

A

C. Patient scheduling

The financial processes that a healthcare organization uses to manage administrative and clinical processes comprises the revenue cycle. The revenue cycle represents a business transaction in healthcare and begins when the patient is scheduled and terminates with receipt of payment and reconciliation of all charges. Managing the revenue cycle requires the collection of appropriate data, verification of eligibility, accurate documentation, appropriate coding, prompt billing, collections procedures, dispute resolution, and payment posting procedures.

Answer 97

A

D. Apply to user’s needs.

Relevant data refers to data that apply to users’ needs; therefore, the determination as to whether data are relevant is relatively subjective, depending on whether the data meets the specific needs of a user at a specific time. Timely data are available when needed. Flexible data can be used for various purposes; for example, data about supplies may be accessed and utilized by various departments to obtain supplies and by others to determine budgetary or ordering needs. Reliable data provides reliable

Answer 98

A

B. A bibliographic database

If assisting a team with meta-analysis, the informatics nurse should advise the team to begin with a bibliographic data-base, such as MedlinePlus (free access), Cumulative Index to Nursing and Allied Health (CINAHL) (subscription access), or Cochrane Library (subscription access). Meta-analysis applies statistical methods to evaluate the results of multiple studies on a related topic. Once a list of articles is obtained, further sources may be gleaned from the reference list for each article. Addi-tionally, information may be gained from unpublished works, such as conference presentations.

Answer 99

A

B. LAN

The network that connects the departments in an organization is likely a LAN (local-area network). Many LANs nowadays are Wi-Fi-based: WLANs (wireless local area networks). Larger networks, such as in a city or an area of a city are MANs (met-ropolitan area networks). A network that encompasses a much larger area, such as a country, is a WAN (wide area network).

Answer 100

A

B. Written email

Email is usually the most effective means of communicating with large numbers of individuals because communication can be sent very rapidly and can be secure. Emails can be sent from almost anywhere and are asynchronous, so the sender and receiver do not need to be available at the same time. Additionally, emails have attachment support, so documents, videos, and images can be sent. Emails also provide a record of communication, which may be important for legal or accountability purpos-es.

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B. Provide honest information about the reasons for the changes and how the changes will affect staff.

When instituting changes, the best approach is to provide honest information about the reasons for changes and how staff will be affected. Resistance to change is common for many people, so coordinating collaborative processes requires anticipating resistance and taking steps to achieve cooperation. Resistance often relates to concerns about job loss, increased responsibilities, and general denial or lack of understanding and frustration. The nurse should be empathetic and patient, allowing people to express their opinions and encouraging their participation.

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D. Failure, Mode, and Effects Analysis (FMEA)

A method that can be used prior to utilizing a new process in order to identify and correct problems in the process is Failure, Mode, and Effects Analysis (FMEA). FMEA is a 12-step process that begins with describing the process in detail and developing a team that creates a flow chart listing each step in a process. Then, they brainstorm each step to determine potential causes for failure and potential adverse outcomes, which are rated according to severity, occurrence, and detection, and a risk priority number is assigned. The team then brainstorms methods to reduce potential failures and identify performance measures.

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A. Psychotherapy notes

According to HIPAA regulations, psychotherapy notes that are maintained separately from the medical record may be excluded from the designated record set. Patients or legal representatives have the right to access any elements of the designated record set, regardless of the form (i.e., paper or electronic). There is no legal right to access other records, such as requisitions for laboratory tests, duplicate records held by business associates, education records, audits, telephone messages, appointment logs, surgery logs, and notes that a covered entity records while meeting with an attorney regarding a pending lawsuit.

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A. Operating system

Operating system software is responsible for storage management. Operating software, which loads first when the computer is turned on, is the most critical, handling both hardware and software applications, and is responsible for a number of processes, including management of memory, devices, processors, application interface, and the user interface. Operating systems include Mac OS X, Unix, Linux, and Microsoft Windows. Current operating systems generally support multiple users and they can also multitask so that users can work in more than one application at a time.

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B. Monthly

Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a national standardized survey of patients’ opinions of their hospital care. The survey asks 29 questions about aspects of the patient’s experience of hospitaliza-tion. A random sample of adult patients must be surveyed each month within 48 hours to six weeks after discharge. Hospitals that are subject to the Inpatient Prospective Payment System (IPPS) must collect surveys and submit data in order to receive full reimbursement from CMS. Non-IPPS hospitals may voluntarily participate. Eleven HCAHPS measures are reported on the Hospital Compare website.

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A.Understanding how the brain functions in order to develop computer processes

Cognitive informatics focuses on understanding how the brain functions in order to develop computer processes. The field of informatics can help develop an understanding of the processes similar to those of the human brain, such as utilization of data and data storage, and the cognitive/neurological sciences can help to develop an understanding of how the computers may better process information. Cognitive informatics, then, applies knowledge gained from studying the human brain to computer applications, focusing on such factors as memory, thinking/reasoning, and learning.

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C. Takes no further action

If the CDS system recommends a therapy that the clinician ignores, the system generally takes no further action, as the CDS system only makes recommendations based on inputted data, but the clinician makes the final determination as to whether to follow the recommendation or not. CDS systems are composed of a base of knowledge, a program that utilizes this knowledge base in assessing patient-specific information, and a method of communicating the recommendations, such as through alerts.

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B. Map the current workflow.

In preparation for the workflow redesign required for the implementation of an EHR, the first step should be to map the current workflow at the macro, mini, and micro levels, focusing on areas that are likely to be most impacted by the implementa-tion. Examples of affected areas include patient admission and discharge, laboratory and medication orders, scheduling appointments, referrals, and billing for services.

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A. Medications

The Institute for Safe Medication Practices (ISMP) order set guidelines provide guidance for developing order sets for medications, both for paper-based and electronic order sets. Guidelines include checklists for format (layout, font, prompts, symbols, abbreviations), content (development, medications, exclusions, inclusions), approval and maintenance (criteria for review, changes, verification, and biannual review of listings), and specific criteria (IV/epidurals, electrolytes, compounded medications, chemotherapy, analgesics, pediatric medications, weight-based dosages, and medications for older adults).

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B. The data moved from one system to another system are understood in the same way.

Interoperability is the ability to transfer, share, and utilize information from one system to another. Aspects of interoperability include:
Technical: the ability to move data freely from one system to another.

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A. Gantt chart

The best type of display to use to demonstrate and manage schedules and time estimates needed to complete a number of tasks associated with quality improvement projects is a Gantt chart, which is created after completion of a timeline. The chart may have the timeline represented in days, weeks, or months, depending on the overall duration of the project, on the horizontal axis across the top. The tasks are listed on the left on the vertical axis. Color-coded horizontal lines or bars are then drawn from the projected beginning date to ending date for each task.

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A. Knowledge skills, and attitude.

The Quality and Safety Education for Nurses (QSEN) project’s informatics competency (“Use information and technology to communicate, manage knowledge, mitigate error, and support decision-making”) includes the three elements of KSAs:
• Knowledge: Ability to evaluate benefits and strengths and weaknesses, evaluate communication technologies, determine information essential to a patient care database, and demonstrate understanding of taxonomy and terminology.
Skills: Participation, selection, implementation, promotion, and evaluation.
Attitude: Values information/communication technologies, need for consensus and collaboration, and use of standardized terminologies.

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B.Hospital census data for the state

An example of aggregate data is hospital census data for the state. Aggregate data is derived from a compilation of data from different sources, so the data that is presented as a separate entity (census data) is derived from multiple more discrete data items, such as census reports from each hospital, city, and county. Other types of aggregate data include financial reports, demographic information, and summary reports. Aggregate data, by their nature, do not provide detailed information.

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B. Data selection

The first step to knowledge discovery in databases (KDD) is data selection. Other steps include pre-processing (assem-bling target data set and cleaning data of noise), transforming data, data mining, and interpreting results. KDD is a method to identify patterns and relationships in large amounts of data, such as the identification of risk factors or effectiveness of inter-ventions. KDD may utilize data perturbation, the hiding of confidential information (such as name) while maintaining the basic information in the database, and data mining.

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B. Providing medical care from a distance through multiple technologies

Telemedicine refers to provision of medical care from a distance through multiple technologies including, but not limited to, the telephone. Telemedicine may include distant consultations, such as through videoconferencing; remote monitoring, such as utilization of the cardiac monitor for cardiac assessment; sharing of medical information, such as through social media sites and wireless devices; and medical education, such as training or classes for clinical personnel, such as physicians and nurses. Telemedicine may be delivered through networks as well as the internet and

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D. Bureaucratic leader

When leading a team to facilitate change, an informatics nurse who follows the rules of the organization exactly and expects everyone else to do so is a bureaucratic leader. While the bureaucratic leader may be that desired by administration and may engender respect if the nurse carries out the leadership role competently, team members may not be motivated to participate or bring about change because they may feel that their input is not valued.

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A. Generate a baseline backup of data.

During the performance stage of data conversion and migration, it is critically important to generate a baseline of backup data. Stages of data conversion and migrations include the following:
Planning: inventorying the system, reviewing the types and amounts of data and the source and destination formats, considering cost-effectiveness, developing a specific plan for conversion, performing mapping, and creating conversion scripts and specification documents
Performance: generating a baseline backup of all data, extracting data, normalizing data, performing trial and test conversions, and completing data migration
Validation: ensuring that data was converted accurately and completely and formatted correctly, eliminating duplicate data, and resolving problems

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C. RFI

When doing system analysis and gathering information, the first tool is often an RFI (request for information). RFIs are often sent to a number of vendors, outlining the information needed and providing an overview of the organization’s plans for purchase. The RFI may include an RFP (request for proposal) as well as a an RFQ (request for a quote), although the RFP and RFQ may be sent after the information is received and reviewed as part of the elimination and selection process. The RFT (re-quest for tender) asks for pricing and information when contracting for a specific project.

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D. Less shoulder surfing

A primary security advantage of point-of-care documenting of the EHR as opposed to documenting in a central location (such as the nursing station) is less shoulder surfing is likely to occur. Shoulder surfing (a common cause of confidentiality compromise) occurs when someone watches the computer screen while another person is accessing records. Computer screens should be positioned so that they cannot be viewed by unauthorized personnel, and healthcare providers should always be on the alert when documenting to ensure that no one is watching the screen.

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D. Waiting areas

If nursing educators at a hospital want to set up computer stations for consumer/patient self-assessment and health education, the best placement in the facility is probably waiting areas throughout the hospital as this makes them available to the most individuals, and people in waiting areas often wait for prolonged periods and may welcome a distraction. Interactivity is an important element to include in any electronic presentation, and the subject matter should be presented in a simplified format that appeals to those with varying levels of health literacy.

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D. 55%

D: Mehrabian developed the 7-38-55 rule of communication theory:
7%: Meaning is conveyed by the spoken word-what people hear or perceive.
38%: Meaning is conveyed by the speaker’s tone of voice.
55%: Meaning is conveyed by the speaker’s body language.
For example, if a speaker stands while the receiver sits, the speaker is conveying authority. If the speaker’s voice is loud, this can be considered aggressive. Meaning is also conveyed by the receiver’s body language, such as by folding the arms as a protective mechanism when having a negative response.

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D. Include all positive cases, taking into account variables, decreasing the number of false negatives.

D: Data should include all positive cases, taking into account variables, decreasing the number of false negatives.
• Specificity: Data should include only those cases specific to the needs of the measurement and exclude those that may be similar but are a different population, decreasing the number of false positives.
Stratification: Data should be classified according to subsets, taking variables into consideration.
Validity: Data should measure the target adequately, so that the results have predictive value.
Recordability: The tool/indicator should collect and measure the necessary data.
Reliability: Results should be reproducible.
Usability: The tool or indicator should be easy to utilize and understand.

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D. Examine the ethical dilemma.

Steps to the ETHICAL model of decision making include the following:

Examine the ethical dilemma: Collect and consider the gathered information.
Thoroughly understand the alternatives: List possible alternatives and their pros and cons.
Hypothesize any ethical arguments: Consider moral principles.
Investigate, compare, and evaluate the alternatives: Review facts and assumptions.
Choose one of the alternatives: Recommend but challenge personal reasoning.
Act: Make a plan to implement the chosen alternative.
• Look and examine: Evaluate and consider the outcomes, and reevaluate as needed.

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C. Response time analysis

Response time analysis assesses the time it takes for a system to respond to a request, such as a database query.
Response time analysis includes assessment of service time (i.e., the time needed to process a request), network latency (i.e., the time needed to traverse a network), queuing time (i.e., the wait time), and client-side processing (i.e., the time to receive a response in web-based applications). Response time analysis uses benchmarks for comparison and can help identify bottlenecks in a system.

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A. Scan the medication barcode and check the patient’s ID.

Prior to being issued a unique identifier and password to access and enter data into an EHR, the staff member should have been trained and tested in the EHR system. While some self-study may be indicated, staff members should not be expected to learn on the job or teach themselves because EHR systems can be quite complex, and insufficient training increases the risk of errors. Training must be provided promptly for all new hires or staff members who indicate they need training.

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A. Been trained and tested in the EHR system

Prior to being issued a unique identifier and password to access and enter data into an EHR, the staff member should have been trained and tested in the EHR system. While some self-study may be indicated, staff members should not be expected to learn on the job or teach themselves because EHR systems can be quite complex, and insufficient training increases the risk of errors. Training must be provided promptly for all new hires or staff members who indicate they need training.

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C. Academic databases

Peer-reviewed journals are typically considered the gold standard for literature research; however, for an initial overview, journal topics may be too narrowly focused, so a better place to begin is an academic database, such as PubMed (health and biomedical sciences) and IEEE Xplore (technical literature). An academic database can link to journal articles and other types of information sources, providing many avenues of interest to follow. This can

Answer 128

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B. Providing and sharing standards for exchange of electronic health information

The primary goal of Health Level Seven (HL7) is providing and sharing standards for exchange of electronic health information (interoperability). HL7 is a nonprofit ANSI-accredited organization. Organizations must utilize the same standards if they are to share data, such as when a patient wants to transfer records from one hospital to another. HL7 is critical to the development of electronic health records. HL7 has a number of different trademarks that can be applied for to use with products and services. HL/ provides specifications but does not provide software.

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B. Optimize safety and the safe use of EHRs.

The Office of the National Coordinator for Health Information Technology’s Safety Assurance Factors for EHR
Resilience (SAFER) Guides provide assistance in optimizing safety and the safe use of EHRs. There are nine different guides available in three categories:
Foundational guides: High Priority Practices and Organizational Responsibilities
Infrastructure guides: Contingency Planning, System Configuration, and System Interfaces Clinical process guides: Patient Identification, Computerized Provider Order Entry with Decision Support, Test Results Reporting and Follow-up, and Clinician Communication

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D. Determine the system response if a component fails.

System testing that involves fault injection is done to determine the system response if a component fails. Faults are purposely introduced into the system to cause one or more components to fail, and then test cases or a series of actions are

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D. The “think aloud” procedure

Cognitive walkthrough is one method to assess the users’ abilities to understand the model and its purpose, to produce the desired actions, and to determine if users understand which is the right action and whether they understand system feed-back. The “think aloud” procedure is used while participants utilize a product and carry out the steps in a process, noting any usability problems, including the ability to learn the process without formal training. Sessions may be audiotaped or videotaped for later evaluation.

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B. A SWOT analysis

As part of gathering data and conducting internal and external analysis for short-term strategic planning, the organization may derive insight from SWOT analysis:

Strengths, Weaknesses, threats, & opportunities

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D. Healthcare providers may not activate the alert

The primary disadvantage to an alert that requires manual activation for viewing is that the healthcare providers may not activate the alert unless failing to do so results in a hard stop. However, if the information is critical or should be read in all circumstances, then the alert should be automated to save the user the extra step of activating the alarm. Alerts should be carefully designed so that they are meaningful because excessive alerts tend to be ignored or overridden.

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D. Aggregate data

Types of healthcare-associated data include the following:

• Aggregate: pharmacy transactions, hazard and safety practices, financial information, and most things not included in the clinical record

• Medical/clinical: all patient-specific medical records, including diagnoses, laboratory findings, physician orders, and informed consent
Knowledge-based: training, support, research, library services, good practice guidelines, drug information databases, clinical decision support system, medical literature and journals, disease registries, coding resources, and medical calculators and tools
Comparison: internal or external comparisons to benchmarks or best-practice guidelines

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D. Active radio frequency identification (aRFI)

The type of system that would be most efficient to track the movement of equipment and supplies through the hospital is active radio frequency identification (aRFI). With RFI, equipment contains embedded digital memory chips with codes unique to the piece of equipment. Sensors then receive signals from the chips. In passive RFI, signals are only transmitted when the chip is in close proximity to the sensor. However, in active RFI, continuous transmission of signals between the chip and the sensor occurs, allowing for more accurate tracking.

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A. Community engagement

Community engagement is the best method of promoting health equity because it allows the person to interact with key players who are involved in decision making in the community. Community engagement may include attending meetings of the governing body; serving on committees; engaging in volunteer work; hosting community forums; organizing cleanup drives and fundraisers; offering skills and expertise; and collaborating with schools, businesses, and organizations. Additionally, the person may engage in social media and join local groups on Nextdoor and/or Facebook.

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A. Attribute

In a database, each field in a table is an attribute, with fields being columns and records being rows. A data file (collec-tions of different related records) comprises a table, which is also referred to as an entity. In each record, one field is the primary or key field, which contains the unique identifier for that particular record. A database contains one or more entities. The entity relationship diagram (one-to-one, one-to-many, or many-to-many) indicates the relationships that exist among the different entities.

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C. CMS

The governmental agency responsible for enforcing the electronic transactions and code sets for the Administrative Simplification provisions of HIPAA is the Centers for Medicare & Medicaid Services (CMS). CMS is not responsible for enforcing security or privacy regulations, which are enforced by the Office of Civil Rights.

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B. Return on investment

The profit margin in healthcare organizations are other quite narrow

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B. Birthdate

B: In addition to name, birthdate is an acceptable unique identifier. Other unique identifiers include alphanumeric strings (such as those used for ID numbers) and social security numbers. A unique identifier should not be readily changeable (al-though names alone can be changed). Factors such as hair color (which is easily changeable) or age (which changes with time) are not reliable for identification. Additionally, gender is not sufficient as a unique identifier because gender may be fluid in some individuals, may be faked, and may not be obvious.

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D. Ergonomic problem

If during observational testing for the adaptation phase of an information system, the informatics nurse observes users taking notes of data to enter into the system later when they have more time, this suggests an ergonomic problem in dialoging with the system and requires further assessment to determine if the user interface is not adequately intuitive, if too many screen actions (scrolling, clicking) are required, or if the system responds too slowly.

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A. Before going live

A chart migration plan should be formulated before going live with an EHR to ensure that important patient data are not lost or are unavailable. The migration plan should outline the steps to transferring data from paper charts to the EHR, including the timeframe, who is responsible, and what data are to be transferred. Because of the changing nature of patients’ conditions and census, much data must be transferred in a short period of time and this can pose numerous logistical prob-lems.

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D. Dashboard

D: A dashboard is an easy-to-read and understand visual display that includes a number of different performance measures in one display, typically with charts, tables, or graphs, to aid understanding. Dashboards should be updated frequently so that the information is current. Dashboards are easily customizable and help provide broad involvement of all departments.
Negative trends can easily be identified and targeted for improvement. Dashboards can also help with making informed decisions about necessary changes or use of resources.

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D. Transferred intact

When transferring data from one system to another free text data as well as coded data must be transferred intact and not truncated.

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B. An alert to an alternate clinician

If an alert regarding a patient’s laboratory tests is forwarded to a clinician who does not respond during the three-hour window of specified time, the system should be set up to send an alert to an alternate clinician. The organization should also have a procedure in place for notifying clinicians about critical information that is in addition to the automated alerts generated.

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D. System integration testing

When interfacing a new cardiac monitoring system with the EHR, critical initial testing includes system integration testing, which tests whether or not the interface between software programs (such as cardiac monitoring and the EHR)

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A. Allows user interaction with technology

The human-technology interface (HTI) allows user interaction with technology, so HTI may include touch (as with touch screens), keyboards, light pens, barcodes, ID badges, or voice (for voice-activated devices or applications). HTIs vary widely according to the hardware and software involved and may include various levels of security. In some cases, there is virtually no security because the interaction may be activated by simply turning on a switch. In other cases, the interaction may be predicated on the use of a user name and password or other method of identification.

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D. Facility/non-facility payment rates

Place of service (POS) codes are used by Medicare to determine facility (F) or non-facility (NF) payment rates. POS codes have two digits and indicate the setting in which a service was provided. POS codes are used to ensure correct reimbursement, facilitate processing of claims, and collect data. POS codes include the following:

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B. Dashboard

A dashboard (also called a digital dashboard), like the dashboard in a car, is an easy to access and read computer program that integrates a variety of performance measures or key indicators into one display (usually with graphs or charts) to provide an overview of an organization. It might include data regarding patient satisfaction, infection rates, financial status, or any other measurement that is important to assess performance. The dashboard provides a running picture of the status of the department or organization at any point in time, and may be updated as desired, such as daily, weekly, or monthly.
150. A: The timing of health messages is important. People are more likely to respond when a threat is imminent. Therefore,

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A. Before and at the beginning of flu season

The timing of health messages is important. People are more likely to respond when a threat is imminent. Therefore, communicating about the need for the annual flu vaccine is best done immediately before and at the beginning of flu season in order to reduce risk. Messages at other times of the year are often ignored, and new flu vaccines may not be available yet. If the message is given only before flu season, people may not feel that the need is urgent, and if given in the middle of flu season, many people may already have contracted the flu.

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B. ICD-10

The classification system used for mortality statistics is ICD-10 (International Classification of Diseases, tenth revision).
Both the underlying (primary) cause of death and non-underlying causes (other causes) are coded. ICD-9 was used between 1979 and 1998 for reporting of mortality statistics. ICD-9-CM (Clinical Modification) is usually just referred to as ICD-9 and is used for classification of diseases and procedures associated with hospitalization. ICD-9-CM was replaced with ICD-10-CM on October 1, 2015. ICD-10-CM/PCS is a transitional system.

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C: Available

Devices can be in four different states when connected to a system:

Undefined: The system does not recognize the device.

Defined: Information about a specific device is present in the database but not available to the system.

Available: Information about a device is present in the database and configured to the operating system.

Not available/Stopped: Information about the device is present in its driver but the device is not available.

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B. The degree to which encryption persists when encrypted data are moved

With encryption of data, stickiness refers to the degree to which encryption persists when encrypted data are moved from one site to another, such as from one disk to another. Many types of encryption are only valid when the data are “at rest” or stored in one location or within one network. For example, a file that is encrypted in a network may lose encryption if it is sent as an email attachment, so the stickiness of encryption is an important consideration when data must be transmitted outside

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C. WPA3

To ensure network security, the best current Wi-Fi encryption is WPA3. Wireless Equivalent Privacy (WEP) is the oldest security algorithm but has many security flaws and was retired in 2004; however, it may be present in older systems. Wi-Fi Protected Access (WPA) was adopted in 2003 and contained Temporal Key Integrity Protocol (TKIP), which provided better security than WEP, but again had security flaws. Wi-Fi Protected Access 2 (WPA2) was adopted in 2006 and contained the Advanced Encryption Standard (AES) and Counter Mode Cipher Block Chaining Message Authentication Code Protocol (CCMP) to replace TKIP. WPA3, the most recently adopted security algorithm in 2018, is considered the gold standard for Wi-Fi encryption and is recommended as the most protective security setting.

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C. Weekly

Data should be encrypted, backed up, and transferred to an offsite data storage area at least weekly.

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B. Electronic scheduling of outpatient visits

An example of an administrative process is electronic scheduling for outpatient and inpatient visits. Other administrative processes include billing and claims management. The essential components of an EHR include health information/data (de-mographics, diagnoses, medication lists, allergies), results management (radiology and laboratory reports), order entry management (physician’s orders), decision support (alerts, reminders), electronic communication/connectivity (emailing and web messaging), patient support (education, home telemonitoring), administrative purposes, and reporting/population health management (tools to support mandatory reporting).

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D. Defragmentation is not recommended.

Hard drives with solid-state technology do not require defragmentation, and it is not recommended, although it will not harm the drive. Defragmentation is required for traditional hard disk drives to rearrange large files in order to speed up pro-cessing. Defragmentation should be done for these drives when processing slows and on a regularly scheduled basis, such as monthly. However, solid-state drives access files rapidly, so there is no benefit to defragmentation, which may actually slow processing.

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C.10%

When an EHR system is in place, the percentage of verbal or paper orders should be below 10%. While it is not possible to completely eliminate verbal or paper orders, the potential for error is always increased if orders are entered into the system by ancillary personnel. Physicians should be encouraged to use the COE CDS system for orders whenever possible, but the efficiency of the CPOE CDS system may vary, and problems can arise if the system is insufficient.

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D. Increased overhead

A system with fine granularity generally has increased overhead, which refers to a greater investment of time, effort, and/or resources to carry out a process, such as retrieving data. Granularity is based on the metaphor of sand, so a system with coarse granularity has data in larger entities (components) while a system with fine granularity has the same entities subdivid-ed. For example, with coarse granularity, all identifying information (name, birthdate, ID number) may be contained in one field, but with fine granularity each item is contained in a separate field.

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A. Download and share noncommercially but credit the author.

Creative Commons licenses allow free distribution of copyrighted works under specific conditions, depending on the type of Creative Commons license. The Attribution-NonCommercial-NoDerivs license allows users to download and share a work, but the work cannot be used commercially nor can it be changed, and the author must be credited. With a Public Domain Dedication and License, the author waives all copyright and places the work in the public domain.

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C. Reduced medication errors.

A common benefit derived from the use of the EHR is reduced medication errors. Other benefits include increased use of guideline-based care because the guidelines are embedded in the EHR. The EHR also facilitates surveillance and monitoring because the databases can be more easily searched for information than when manual searches are required. An additional benefit is decreased utilization of care. Research does not clearly indicate that there are cost savings because the initial outlay to convert to an EHR and to perform maintenance may be very costly.

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C. Assessment

Data validation is the process that ensures that data is correct and meets all requirements. Date validation may be intrinsic (within the system itself), internal (in clinical use), or external (via outside auditing).

Steps to data validation include the fol-lowing:
Assessment of the tools, resources, content, and sources.
Planning, including methodology and approach.
Implementation includes looking for problems, defects, and patterns in a workflow.
Analysis includes categorizing problems, tracking issues, and communicating regarding findings.
Evaluation aims to improve validation, develop solutions for problems, and facilitate standardization.

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C. IT, informatics, nursing, pharmacy, administration, and medical staff

When utilizing FMEA (failure modes and effect analysis) to determine how a CPOE may fail, the interdisciplinary team should include at least personnel from IT, informatics, nursing, pharmacy, administration, and medical staff because all of these departments have a role in ensuring that orders are correctly entered and carried out. The process to be examined should be narrowed as much as possible because interdepartmental processes that involve many departments and personnel may be difficult to adequately assess.

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D. Perceptual dimension

According to Gerbner’s General Model of Communication, a received message is not understood in the same way that the sent message intended. This exemplifies the perceptual dimension. For example, if the informatics nurse transmits a message to staff members (receivers), the receiver cannot understand or receive all of the elements that went into the message— the negotiations, the research, the meetings, the thought processes-so the receivers, in fact, only receive part of the message, so they may interpret it differently.

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D. Refer to “Suggested Sources of Input.”

If the informatics nurse does not understand the recommended practice or worksheet on a SAFER guide, the next step is to refer to “Suggested Sources of Input.” For example, in the “High Priority Practices” SAFER guide, phase 1 is “Safe Health IT” and the first recommended practice is related to backing up data and application configurations. A rationale is given as well as a list of useful practices. Suggested sources of input include a list of those who may be able to provide useful information, such as clinicians, support staff, and health IT staff.

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C. Promote staff development.

The primary purpose of performance appraisal should be to promote staff development by communicating the appraiser’s perception of the staff member’s strengths as an employee and helping the person to identify areas that need further devel-opment. The focus should remain positive rather than negative. The performance appraisal may be utilized to determine compensation and to establish a basis for promotion or demotion as well because these actions, especially demotion or firing, require a paper trail that shows interventions.

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D. Determine if steps can be reduced.

If a new EHR system requires three additional steps to document a medication, resulting in increased errors, the first step to reducing errors should be to determine if steps can be reduced because the greater the number of steps needed to carry out a process, the greater the chance of error. The number of steps as well as the number of different screens and hard stops should be carefully assessed. The system may also need to be modified in such a way as to more accurately predict and prevent errors.

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D. Reverse allergy checking

An appropriate CDS function or feature is reverse allergy checking; that is, when a new patient allergy is entered into the system, it should check existing orders for the new allergy. Other CDS functions and features include checking for drug-drug interactions as well as food-drug interactions, abnormal laboratory results alerts, alerts for inappropriate drug-conditions (such as drugs contraindicated with pregnancy), inappropriate drug-age interactions (such as medications contraindicated for older adults), and maximal doses.

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C. Tasks are identified, and members explore their roles.

Group process phases:
• Orientation: Tasks are identified and members explore roles, depending on the leader at first and then exploring personal roles in the group.
• Organization: Members make group decisions regarding rules, limits, criteria, and jobs. Some resistance may occur.
• Flow of information: Members are able to express opinions and feelings, and interpersonal conflicts lessen.
Problem solving: Members are able to work collaboratively and think that goals can be met, while some may resist change.

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D. A malicious insider

The primary threat to the security of a network is a malicious insider, such as an unhappy employee or an employee who has been fired. Once a person is no longer employed, the person’s access to the computer system must be terminated immediately and the ID and password deactivated. Any ID badges issued by the organization should also be obtained so that the person is unable to gain access to secure areas of the organization.

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D. Review work schedules and venues

When setting up meetings for an interdepartmental work group, practical matters need to be dealt with first. This includes reviewing work schedules to determine a meeting time that is convenient for the majority of the group. Additionally, the leader needs to review meeting rooms or venues to determine which one will meet the needs of the group and allow members to sit around a table or in a circle to encourage communication. The leader must also determine what types of equipment or supplies are needed for meetings and whether the venue can provide for those.

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B. Continuous improvement mindset

Process excellence requires a continuous improvement mindset to improve processes, reduce waste and costs, and improve efficiency. Process excellence may involve the use of a methodology, such as total quality management (TQM). Key factors in process excellence include a focus on the needs of the customer, making decisions based on data, using standardized procedures, empowering employees, and adapting to market changes. Although cost cutting is important, it can lead to short-

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D. Ensure market demand continues.

The business concept of “planned obsolescence” is utilized in the field of technology primarily to ensure market demand for products continues. Thus, after a period of time (usually a few years), products may be sunsetted, or phased out, so that they are no longer supported by the vendor. Because of this, healthcare organizations are almost constantly in a planning phase for acquiring new technology-hardware and/or software—in order to maintain functionality.

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A. The effort needed to document in the EHR while interviewing a patient

During the phase of technical development, a constructive assessment of the cognitive aspects could evaluate the response to the effort needed to document in the EHR while interviewing a patient because the user’s attention must be focused in two different areas-the patient and the computer terminal. Ergonomic aspects include direct dialog with the sys-tem, the number of screens that must be accessed in order to carry out an activity, and the number

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D. Content is presented in multiple ways

If applying the theory of cognitive flexibility to interactive technology used for training end users, the informatics nurse should ensure content is presented in multiple ways, such as through interactive computerized instruction and instructors who contribute and facilitate learning. This theory focuses on the individual’s ability to construct knowledge. Information should be contextual and avoid oversimplification, and knowledge should be built rather than transferred. Instructional sources should be interconnected rather than independent.

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D. Configuration

A configuration report contains data about the system, hardware, software, workstations, and servers. Because system information is stored in various areas, a utility is utilized to automatically generate a configuration report. An informational report includes data derived from databases. An error/exception report is issued for faults or abnormal data results. A baseline report (usually generated automatically) shows how the system or parts of the system compare

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D. Determining measures of equivalency

Steps to conducting usability studies include:

Defining purpose
Evaluating constraints such as time, staff, and resources
Refining components based on evaluation of human-computer interaction (HCI) framework, determining each component and to whom or what it applies, including choosing the most appropriate staff, determining the most important step in a process, determining measures of equivalency, and choosing the setting Determining emphasis, which may focus on one or more aspects
Selecting methods, which must match purpose and take account of constraints and HCI

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B. 30 to 60 days

Passwords used to access patient data should be changed every 30 to 60 days. More frequent changes make it hard for people to remember their passwords, so they are more likely to write them down, increasing the risk of security breaches.
Strong passwords should be required because they are more difficult to break than dictionary words. Strong passwords include combinations of letters (capital and lower case), numbers, and symbols/signs, such as the ampersand (&).

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B. Performance appraisal

In 2008, the ANA revised The Scope and Standards of Nursing Informatics Practice, which includes standards of professional performance and standards of practice. Informatics Nurse Specialist Standards of Professional Performance include (I) quality of practice, (II) performance appraisal, (III) education, (IV) collegiality, (V) ethics, (VI) collaboration, (VII) research, (VIII) resource utilization, and (IX) communication. Informatics Nurse Specialist Standards of Practice include (1) Identify the issue or problem, (II) identify alternative solutions, (III) choose and develop a solution, (IV) implement solutions, and (V) evaluate and adjust solution.

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D. Printer to a computer

A parallel port is an interface that connects a printer to a computer (although it is being surpassed by the USB port or Bluetooth enabled printers). Serial ports connect a computer to an external modem. Universal serial bus (USB) ports are an industry standard that connects various types of plug-in devices to a computer, including keyboards, digital cameras, graphic tablets, and light pens. FireWire is an interface for fast connection often used to connect video devices.

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A. Self-directed

According to research, the majority (70%) of adult learning is self-directed learning, with 9 out of 10 adults engaged in some self-directed learning every year. Adults are motivated to learn because of interests or needs, which may be personal, work related, or family related, and choose the materials and methods independently. Adults with low levels of literacy are less likely to engage in self-directed learning than others. When planning education, the informatics nurse should consider helping learners assess their need for information and should provide materials for self-directed learning.

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C. Healthcare providers, health plans, healthcare clearinghouses

The Standards for Privacy of Individually Identifiable Health Information (“privacy rule”) in support of HIPAA applies to healthcare providers, health plans, and healthcare clearinghouses. The privacy rule was issued by HHS in order to implement requirements of HIPAA and regards use and disclosure of protected health information (PHI). PHI includes the person’s physical or mental health condition (past, present, future), provision of health care, and payment for provision of care (past, present, future). Restrictions do not apply to de-identified health information.

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A. When benefits will exceed costs

Payback analysis is carried out to determine when the benefits that are accrued exceed the costs of the project, helping determine the potential return on investment and whether the project is viable. Payback analysis helps determine how long it will take to recoup costs and gives insight into risk assessment because a shorter payback period poses fewer risks than a longer one. Payback analysis can help project managers make decisions and assess the ability of an investment to generate income.

Answer 184

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B. Entities within a database

An entity relationship diagram is used to show the relationship of entities in a database. An entity is a table and the fields within the table are the attributes of that specific entity. A database is a collection of one or more related entities. Relationships demonstrated in an entity relationship diagram may be one-to-one (one entity is used by another), one-to-many (an entity is used frequently by other entities), or many-to-many (all entities are frequently used by other entities).

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A. Clearly identified “test” patients

When testing hardware and software in the “live” environment, the informatics nurse should include clearly identified patients. Both hardware and software must undergo testing before and after going live. When the system first goes live, a command center should be available to provide communication, exercise control, and coordinate all activities.

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A. Contain locking and tracking software

When confidential patient data are contained on mobile devices, such as smartphones or PDAs, these devices should contain locking and tracking software so that the data cannot be accessed, and the device can be located. Some software is also available that allows distance deletion of data if the device is misplaced or stolen.

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A. Limits on abilities to access or input data

“Role-based access” refers to limits on abilities to access or input data according to the person’s role. For example, a physician should be able to access and input data more extensively than unlicensed assistive personnel, who may only be able to access the plan of care to document vital signs and personal care provided. Each person with access to the EHR or any part of the computer information system should be assigned role-based access in order to protect patient data, and these roles should be reassessed at least annually.

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D. 60 days

CMS must be notified within 60 days of identification of overpayment, and the overpayment must be reimbursed. The Medicare Administrative Contractor sends a demand letter for overpayments of $25 or more. The demand letter explains the reason for overpayment, interest that will accrue if the amount is not repaid in full within 30 days of receipt of the demand let-ter, options for extended repayment, and rights to rebuttal and appeal.

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D. Assess the effects of an organizational change.

System-wide impact analysis is carried out to assess the effects of an organizational change, especially negative effects or unexpected consequences. System-wide impact analysis may be done before a change to assess the potential problems or after a change has occurred. Additionally, routine system-wide impact analyses may be done as part of risk management. Systemwide impact analysis may be used to improve decision making, mitigate risks, enhance system reliability, optimize resource uti-lization, and improve stakeholder confidence.

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D. Multiple displays on one screen

The effective display of patient data for clinical decision-making requires that information be rapidly available with minimal cognitive effort. Multiple displays on one screen are distracting and slow cognitive processing of data. The decision tree is a common presentation with potential options, consequences, and expected outcomes. Other types of presentations include tables, various types of graphs, and icons. In most cases, multiple modes of presentation of data provide the best information.
Visual indicators, such as colors, may be used to highlight information, such as abnormal lab results, and pictorial displays can be effective.

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A. Inform staff what computer use is permitted.

The purpose of an “acceptable use” policy is
to inform staff what computer use is permitted. The acceptable use policy should outline use related to accessing the internet and emails. Internet access may be prohibited because of security concerns, and email access should always be limited to work-related communications. Staff should have guidelines about appropriate work-related email communications as the emails are the property of the organization and do not include a presumption of privacy.

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A. Has greater read range

A primary difference between radiofrequency identification (RFID) and barcode is that RFID has greater read range.
While the read range for barcode ranges from inches to a few feet, passive ultra-high frequency (UHF) RFID ranges up to 40 feet if readers are fixed or up to 20 feet if readers are handheld. Active RFID has a read range hundreds of feet. Active RFID tags are battery powered and emit a signal while passive RFID tags require activation by a reader.

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C. Support

C: The primary role of a mentor is to provide support to new hires through listening and encouraging. The role of mentor should not include direct supervision because the resulting power dynamic can prevent the new hire from expressing concerns or frustrations or asking for help. The mentor may give advice if asked; however, he or she should focus on helping the new hire understand the culture of the workplace. The duration of mentorship varies but often ranges from 2-6 months.

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D. Define the audience or the user manual.

Defining the audience for a user manual is especially important because it will be of little help to the user if it is written in the wrong tone or if it is too technical or too simplified. Once the audience is defined, the informatics nurse can begin to develop a general outline of the topics and the order of the material that needs to be covered. As the manual develops, screen-shots, illustrations, and diagrams should be added to help users understand what needs to be done. When a rough draft is com-pleted, the informatics nurse should ask for feedback from selected users before publishing and sharing the manual.

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A. Brings network data together

A hub serves as a connecting device and brings network data together. For example, a typical configuration is a hub connecting workstations, printers, and a server. A bridge connects networks at the data link level. A router determines data’s desti-nation. Another communication device is a gateway, which is utilized to connect different networks operating under different protocols. A switch, which may comprise a router or a gateway, sends data to the correct destination.

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A. Object-oriented DBMS

The database management system (DBMS) (software utilized to manage databases) best suited to handle a variety of data types, which include graphics, audio, and video files, is object-oriented DBMS. While expensive, object-oriented DBMSs have superior multi-media functionality. The choice of DBMS depends on the type of database.

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B. Gross negligence

Negligence indicates that proper care has not been provided, based on established standards. Reasonable care uses rationale for decision-making in relation to providing care. Types of negligence:

• Negligent conduct indicates that an individual failed to provide reasonable care or to protect/assist another, based on standards and expertise.
• Contributory negligence involves the injured party contributing to their own harm.
Comparative negligence attempts to determine what percentage amount of negligence is attributed to each individual involved.

Answer 198

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C. Binary digit

Binary digits (i.e., bits) are used to represent information in a digital communication system. The binary digits, which are values of 0 or 1, encode different types of data, such as text, audio, and video. Information is transmitted along with control information to detect and correct errors so that transmitted information is accurate. Communication protocols, such as transmission control protocol and internet protocol, are used to ensure that different devices and systems have interoperability.

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A. Backup data and verify data recovery procedures.

When a system upgrade is scheduled and will require downtime, immediately before beginning the downtime, data should be backed up and data recovery procedures should be verified in the event that something goes wrong with the update and data is lost. Planning should begin well in advance of the downtime, and it should be scheduled when patient activity is low
-for example, at night or on weekends. Staff should be notified and prepared for any alternate procedures that will be necessary during the downtime. The upgrade should be tested in a small isolated environment before applying it to the entire sys-

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A. Only the patient enters information.

A disadvantage of a freestanding personal health record (PHR) is that only the patient enters information, so the information may not always be accurate. Freestanding PHRs are sometimes offered to patients by insurance companies, physicians, or local hospitals. A PHR linked to the patient’s EHR at the hospital allows the provider to view not only the information the patient has entered into the PHR but also the EHR. In some cases, a PHR may be linked to several EHRs so that the patient and multiple healthcare providers can access the information.

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D. Safety/security needs

According to Maslow’s Hierarchy of Needs, a nurse who is fearful of new technology and is experiencing anxiety about losing employment because of this is probably acting to fulfill safety/security needs because loss of employment may pose a real threat to the person’s way of life. Until the nurse feels safe and secure, these issues may be expressed in hostility and/or lack of cooperation as defense mechanisms. Some may overcompensate by trying to work extra hard to overshadow their technical deficits.

Answer 202

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A. Force field analysis

A: Force field analysis (Lewin) is used to analyze factors that drive and restrain certain changes:
Driving forces: forces responsible for instigating and promoting change, such as leaders, incentives, and competition Restraining forces: forces that resist change, such as poor attitudes, hostility, inadequate equipment, or insufficient
Steps to using force field analysis include (1) list the proposed change, (2) create two subgroups (of the driving and restraining forces), (3) brainstorm and then list the driving and restraining forces, (4) discuss the value of the change, and (5) develop a plan to eliminate or diminish the restraining forces.

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C. 90 degrees

When a person is sitting and working at a computer, the elbows should be bent at a 90-degree angle and wrists held straight. The seat of the chair should be adjusted so that the person’s feet are flat on the floor (or on a foot stool if the person is short) with the knees also bent at a 90-degree angle. The chair should provide support in the lower back, and the angle of the back of the chair to the seat should be 90 degrees.

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D Conducting a one-on-one interview

A one-on-one interview is an example of a qualitative approach to obtaining user feedback about a computer information system. Qualitative data are narrative rather than numerical (quantitative) although some quantitative approaches may be applied to qualitative data. Qualitative feedback is utilized to determine the users’ perceptions of the information system and to help provide cause. For example, if quantitative data show increased documentation errors, qualitative research may be able to help ascertain the reason.

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D. Data that were originally collected for another purpose

While primary data are those data collected for a specific purpose, secondary data used for analysis and research are data that were originally collected for another purpose, such as census data, governmental statistics, and Worker’s Compensation data. Secondary data is often readily available and free of charge or inexpensive and may cover multiple years. Research often involves a combination of primary data, which can provide targeted information, and secondary data.

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A. Outline clearly defined roles and responsibilities.

A team leader must outline clearly defined roles and responsibilities for all team members so that the members understand exactly what they need to do, and accountability is established at the beginning of the team process. All members should understand the goals and objective as well as the timelines and deadlines for tasks. The leader’s role is to provide ongoing constructive feedback regarding accountability. Mutual respect and collaboration are essential to ensuring that team members carry out their responsibilities.

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C. System design not congruent with work processes

The most common reason for staff developing workarounds for aspects of technical implementation in an EHR is the system is not congruent with the workflow

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C. computer to a network

The purpose of the Network Interface Card (NIC) (also known as network interface controller or LAN adapter), which is installed or built into the motherboard of a computer, is to allow the computer (and its modem) to connect to a network. NICs may be configured for a specific type of network or may allow access to multiple net-works. Networks within a hospital, usually local area networks (LANs), may be open to the internet or closed.

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B. Specialty

An encoding program is an example of a specialty software designed for a specific type of business or indus-try. Productivity software includes applications for word processing, accounting, database management, and most office and home applications. Education and reference software includes such things as encyclopedias and library search programs, such as Medline. Entertainment software includes all different types of gaming, audio, and video applications.

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D. Provision of care with cost-effectiveness

In most organizations, the primary ethical dilemma is balancing provision of care with cost-effectiveness, often pitting clinical ethics (which focuses on providing high quality care to patients) and organizational ethics (which focuses on maintaining the viability of the organization through management of costs). This dilemma may result in understaffing or excessive floating of staff from one unit to another for which they are not adequately trained. Both of these practices may result in increased patient adverse events, which may increase costs because of liability.

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a. Lock-in

If data stored in one provider’s cloud service must be moved back to the organization’s site and unmodified before the data can be transmitted to another cloud service, this is an example of data lock-in (AKA vendor lock-in). This lack of interoperability, which prevents easy transfer of information from one vendor to another, is a problem not only with cloud services but also with many EHRs. Data lock-in may occur because of the use of proprietary technology, inadequate contractual agreements, or inadequate processes.

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c. Software as a service (SAS)

Considering cloud architecture, if software applications are hosted by the vendor and then distributed to the organization via the internet, this model is referred to as software as a service (SAS). (The SAS designation can be confusing because it can also refer to storage or security as a service.) With infrastructure as a service, the vendor hosts not only the software applications but also hardware, servers, and storage. With platform as a service, the vendor provides hardware and software tools needed for running or developing applications.

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a. Planning care of patients

According to research, from the clinical nurse’s perspective, NANDA-I (North American Nursing Diagnosis Association International) is generally found to be most useful for planning care of patients. NANDA-I is a terminology that allows nurses to identify and classify patient problems in terms of nursing diagnoses. Utilizing this information to generate appropriate interventions and to ensure appropriate outcomes are other uses, although retrieving information is found to be less useful because many EHRs do not allow this type of information retrieval.

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a. Financial status review

Before conducting a clinical information system (CIS) needs assessment, the informatics nurse should complete a financial status review, including the current information system budget and analysis of cash flow to determine if the organization has the financial means to obtain a clinical information system. Policies, controls, and infrastructure needs should be considered as well. An assessment of computer literacy and needs for training may also be done as part of preliminary planning.

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c. The determining factor in the amount of information that can be transmitted with the smallest rate of error

Channel capacity determines the amount of information that can be transmitted with the smallest rate of error. Signal-to-noise (S/N) indicates the ratio between a signal’s magnitude and the magnitude interfering “noise”. Entropy refers to the amount of energy, code or bits, required to communicate or store one symbol in the communication process. The lower the entropy, the more efficient the process of communication. The information theory (Shannon) identified three steps in communication: encoding, transmitting, and decoding.

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A. With patient data that can be activated within 8 hours

A “warm” site is a site with patient data that can be activated within 8 hours. This backup system should be capable of running the EHR if the home system fails. This warm site should be located at a distance as part of disaster planning, such as system failure that may result from natural events, such as hurricane, tornado, and flooding, as well as terrorist attacks. The location should be more than 50 miles away and more than 20 miles from the coast to lessen the chance that the same disaster would strike both facilities.

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A. Insurance verification and authorization

Insurance verification and authorization involve the revenue cycle because they ensure that services provided to patients are covered and will be reimbursed. Other clinical processes that involve the revenue cycle include patient registration, scheduling of procedures, accurate and timely documentation, submission of claims, and management of claims denials. Almost all aspects of care can affect the revenue cycle. Organizational financial strategies, facilities management and operation, and administrative processes may also affect the revenue cycle, but they are not clinical processes.

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C. Annually

Downtime drills should be carried out at the organization at least annually so that the staff members know how to manage patient documentation, orders, admissions, and discharges if the system is down. The drills should be scheduled and announced ahead of time. Staff training should include use of the read-only backup EHR as well as use of the paper-based orders and documentation so that the information can be easily entered into the system when the system is back up and running.

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B. Professional experience

When evaluating staff members’ readiness to learn in preparation for training, the four factors to consider include (1) physical factors (ability to see and hear, physical abilities and impairments, manual dexterity, pain), (2) knowledge and education (general, cognitive ability, topic-specific knowledge, general literacy, health literacy), (3) psychological and emotional status (stress, confidence, anxiety, depression, ability to cope with stress), and (4) experience (various life factors, such as cultural background, work history, and personal experiences as well as previous experience with learning).

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C. Validation

Information systems manage and process data into a useful form that can be used for decision making. Information system activities include:
• Input: Data entry, data acquisition, validation (i.e., ensuring accurate data and format), and transformation into a usable format.
• Processing: Use data to make calculations, comparisons, and selections.
• Output: Display information, print, export data, communicate, visualize data (e.g., with charts or graphs), and report.
• Storage: Hard disk or cloud.
• Controlling: Monitor the performance of the system.

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A. Ensure disposition of data corresponds to federal/state regulations.

When decommissioning a computer information system (CIS), one of the purposes of the Records Management Plan (RMP) is to ensure disposition of data corresponds to federal/state regulations so that data are retained or disposed of correctly. All stored data must be evaluated and disposition determined and outlined in a plan that includes policies and procedures. Intellectual property rights should be evaluated to determine if these rights will affect disposition of data.

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C. Tethered

If a personal health record (PHR) is web-based and tied to one specific system and EHR, the PHR is classified as tethered. A secure portal is provided to the patient so the patient can access information (which may include all or part of the patients’ records), usually including laboratory tests and medication lists. Patients may be able to upload data and add to the PHR. Non-tethered PHRs are usually carried on some type of storage device, such as a flash drive or DVD.
Personal files, AKA paper files, are the least efficient as data may be unreliable and difficult to access.

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D. Regression testing

When changes have been made to a computer system, such as updates to the software, it is most important to conduct regression testing to ensure that errors in the new code do not interfere with functioning. Regression testing is done to ensure that functions available in the older version of the software are still viable with the new version. A series of test cases (also known as test bucket) are run utilizing the new version of the software and then evaluated to ensure that the new program performed correctly.

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B. Keep records of all calls and requests.

The help desk for computer problems should keep records of all calls and requests so that the informatics nurse can review them to determine if a pattern emerges, such as similar repair issues or an increase in problems. The informatics nurse should advise on the use of a standardized request form that can be filled out online, which can help track and quantify issues of con-cern. The informatics nurse should interview help desk staff and end users for their input in order to make recommendations.

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D. Two years

Under CMS regulations, a healthcare organization must fulfill Meaningful Use criteria for 2 years at one stage before moving on to the next stage, although the criteria actually only has to be verified for a 90-day reporting period during the first year. For example, for stage 1, Meaningful Use requires that eligible professionals and eligible hospitals meet 13 core objectives and 10 additional objectives. Stage 1 focuses on implementation of the EHR with CPOE and CDS.

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C. Incentives

When utilizing force field analysis (Lewin) to analyze proposed change, a driving force would be incentives. Lewin proposed that change is accompanied by driving forces (promoting change) and restraining forces (interfering with change). Restraining forces include outdated equipment, resistance, and financial instability because these issues must commonly be dealt with in order to proceed with change. Steps to force field analysis include listing proposed change, brainstorming opposing (driving and restraining) forces, and developing a plan to deal with restraining forces.

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A. Cost effectiveness

A primary advantage of tiered archival storage is cost effectiveness. With tiered storage, different storage devices are used for different data with data most important to an organization stored on faster equipment and older or less important data stored on slower and less expensive equipment. Software programs are used to automate movement of data from one tier to another or to remove data, such as when federal or state regulations no longer require storage of the data.

Answer 228

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C. Fingerprint, retina, or facial patterns

Biometric authentication of employees requires a device that recognizes biological infor-mation, such as fingerprint, retina, or facial patterns. Some biometric devices also recognize signatures based on pressure and speed of writing. Eye scanners tend to be expensive and inconvenient. Facial pattern scanners assess basic facial features, such as the location and structure of the eye sockets and cheekbones. Fingerprint (the most commonly used biometric authentication method) and palm scanners are easy to use, and the hardware has a small footprint.

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A. Document exchange

HL7 CDA (Clinical Document Architecture) is a standard utilized for document exchange and is appropriate for any clinical document that might contain a signature, such as the discharge summary, prescriptions, and history and physical examination. HL7 CDA utilizes XML language, which allows for documents to be read by human beings (textual) or processed electronically (structured). However, use of HL7 CDA is not currently mandated in the United States, so its use is limited but expected to expand.

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B. 10-15 years

Long-term strategic planning should look at the needs of the organization for the next 10 to 15 years but should also include short-term strategic planning for the next 2 to 5 years. Planning for longer periods of time is difficult because too many changes (social, technical, environ-mental, medical) may occur to make planning realistic. Strategic planning should include both internal and external assessments, attempting to identify key issues, such as the strengths and weaknesses of the organization.

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B. ADA regulations

The purpose of assistive technology compatibility testing of software and hardware is to ensure compliance with Americans with Disabilities Act (ADA) regulations that require that people with disabilities be able to access and utilize hardware and software. Testing should include the use of screen readers (such as Jaws), screen magnifiers (such as Mac Screen Magnification), speech input devices/programs (such as Siri), as well as input devices (such as one-hand keyboards and keyboard control pedals), and text-to-speech tools (such as Natural Reader).

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C. USB

C: IDE (Integrated Drive Electronics Controller), also known as ATA, was the primary parallel interface for the hard drive, CD-ROM, and DVD drive first created in 1986, but has been replaced with more advanced Serial ATA (SATA). SCSI (Small Computer System Interface) was a parallel interface introduced in 1986 that provided the means for attachment of additional hardware devices, such as a scanner, to a computer. It was then replaced by Serial Attached SCSI (SAS) that allows controllers to link directly to up to 128 devices and functioned at a higher speed (3 Gb/s).
While SAS is still used in some formats, most common and effective is the USB interface, first created in 1996, with updated versions released since. USB is economical and self-configuring, allowing for more universality and ease of use. It can be used with a wide variety of devices and is a standard in all modern computers.

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C. Top down

System integration testing is done to assess whether hardware and software applications can work together effectively. Types include the following:
Big bang: All components of the system are tested at the same time.
• Top down: Higher-level components are tested before lower-level components.
• Bottom up: Lower-level components are tested before higher-level components.
Stubs are simplified implementations of low-level components, and drivers are simplified implementations of high-level components. Stubs and drivers are sometimes used to test simulations of components that have not yet been integrated.

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D. Regulatory compliance

When considering transitioning to cloud storage and assessing vendors, the most critical assessment relates to compliance with regulatory requirements because if the vendor cannot verify that the company meets HIPAA requirements and satisfies the Code of Federal Regulations Title 21, Part 11 (which provides regulations regarding electronic records and electronic sig-natures), then security of patient data may be inadequate. Other important considerations include cost analysis (including cost of implementation and ongoing costs), monitoring mecha-nisms, and interoperability.

Answer 235

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A. Assist healthcare organizations to adopt EHRs.

As part of the American Recovery and Reinvestment Act (ARRA), the Office of the National Coordinator for Health Information Technology (ONC) established 62 Regional Extension Centers (RECs) in order to assist healthcare organizations to adopt EHRs. The REC assists healthcare providers to enroll in the REC program, implement an EHR, and achieve stage 1 of meaningful use. The REC assists in health IT training, selection of vendors, workflow redesign, privacy and security issues, and technical issues.

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A. Password and security token

An example of two-factor authentication utilized for access to a system is a password and security token. Two-factor authentication requires use of two identifiers of different types. The three types include something that the person accessing knows, such as a user name or pass-word; something the person has or carries, such as a security token or ID badge; and something intrinsic to the person, such as a thumbprint or a retina scan.

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A. Automated cloud-based hosted service

For a large healthcare organization with multiple satellite offices and clinics and many mobile devices, the best choice for help desk is probably an automated cloud-based hosted ser-vice. The advantage to an automated system is that help tickets are automatically generated to fit the request for service and sent to the appropriate person with requests ordered in accordance

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D. 60 days

According to HIPAA’s Breach Notification Rule, individuals must be notified of a breach of protected health information within 60 days by First-Class Mail or email if the individual has agreed to electronic notices. If unable to reach 10 or more individuals, then a notice must be posted on the organization’s website for a minimum of 90 days or a notice must be placed in a major print or broadcast media outlet, listing a toll-free number to call for further information about the breach.

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B. Feedback

In the Foundation of Knowledge model (Mastrian), the element that interacts with all other elements is feedback. The base of the model is random data, bits, bytes, and information.
Out of this base, the four primary elements, expressed as transparent expanding cones of light, develop the following: knowledge acquisition, knowledge generation, knowledge dissemination, and knowledge processing. The model is dynamic and interacting, constantly evolving, with feedback critical to all of the elements of the model.

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B. Self-directed

According to Knowles theory of andragogy, adult learners are self-directed (needing little direction from an instructor), practical and goal-oriented (wanting to know the end goal), knowledgeable (having many years of varied experience to draw from), relevancy-oriented (needing to understand how education is to be used), and motivated (wanting to learn for the sake of achievement or to meet a goal). Adult learners like to be actively involved and are able to relate new information to that previously learned but need a clear understanding of how information will be applied and clear objectives.

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A. Supports analysis of data

An important difference between an operational database and a data warehouse is that the data warehouse supports analysis of data. The data warehouse may draw data from a number of different applications, systems, and/or databases and usually exists as a separate layer from operational databases, such as the operational database that is used to run an EHR. While operational databases allow transactions and interactions, data warehouses collect data, which can be mined

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A. User ability to reconfigure some aspects

Ensuring that a user interface has optimal usability requires user ability to reconfigure some aspects. For example, the user should be able to zoom in or out to make text larger or smaller. The brightness of the screen should be adjustable so that the brightness may be decreased during nighttime, and the color scheme should have some options to accommodate those with different types of color blindness (such as red/green blindness).

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D. Quality planning, quality control, and quality improvement

In Juran’s four-step (defining, diagnosing, remediating, and holding) Quality Improvement Process (QIP), the quality trilogy that is necessary to manage for quality comprises three parts:
• Quality planning: Identifying and assessing needs of internal and external customers, determining how to meet those needs, and designing the processes needed to do so.
• Quality control: Choosing controls and measures, interpreting results, and taking corrective action.
• Quality improvement: Identifying needs, organizing, assessing for problems and causes, and providing solutions.

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B. Storming

Tuckman’s group development stages:

Forming: The group leader takes an active role, lists goals and rules, and encourages communication.
• Storming: There is a divergence of opinions related to management, power, and authority and increased stress and resistance.
• Norming: The group becomes attached, and members express positive feelings.
• Performing: The leader’s input decreases.
• Mourning: Members feel sad at discontinuation or at the loss of the leader or team mem-bers.

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B. High fidelity simulation

High fidelity simulation involves use of actual target equipment such as computers and test software as part of training so that the users have a realistic training experience. High fidelity simulations usually provide the best learning experience but are the most expensive because of equipment costs. To reduce costs, the test software may be placed on computers that also use a live version of the software and are utilized for patient care. However, the test software and user interface must be easily identifiable and distinguishable from the live version.

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C. Determine the goal/product to be completed in each phase of the project

C: In project management, the purpose of the work breakdown structure is to determine the goal/product to be completed in each phase of the project. The goal/product must be approved at the end of the phase, and then the team moves on to the next phase. Projects vary somewhat, but they are temporary by nature and time-limited, so the phases should be carefully planned so that every phase is completed by the target completion date.

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A. Processes and individual/departmental responsibilities

As a project manager, the informatics nurse may use a swim lane diagram (Rummler-Brache) to show the processes and individual/departmental responsibilities. The horizontal rows indicate individuals/departments and both horizontal and vertical lines and arrows are used to show the workflow separating tasks, which are named in rectangles on the horizontal planes.
The diagram clearly indicates steps to the processes and responsible individuals. Before creating the swim lane diagram, it is necessary to determine the purpose and the process or processes to focus on.

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C. To determine if the system complies with the work processes

The purpose of a functionality assessment of an information system is to determine if the system complies with the work processes and if it supports the workflow of the users. If, for example, the system is unable to adequately handle a particular kind of data, this may jeopardize the entire system. Testing for functionality may include validating software through third parties as well as conducting integration tests and non-regression tests. All different functions should be tested.

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B. Browsing through an alphabetical listing

In an EHR, orderable items, such as radiology tests and medications, should be requested by browsing through an alphabetical listing. Queries and key word searches using free text should not be necessary. For medications, the listings should include both generic names and brand names, and various word orders should be used for treatments, such as “ultrasound, blad-der” or “bladder ultrasound.” Users should be able to simply click on the item of choice to generate an order.

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D. Shaper

Belbin’s team role theory states that there are three categories of teams and nine team roles:
• Action-oriented: implementer (turns ideas into action), shaper (pushes the team to achieve its goals), and completer/finisher (pays attention to detail, prevents errors)
• Thought-oriented: monitor/evaluator (makes decisions based on facts and figures), plants (generate unconventional ideas), and specialist (provides expert knowledge)
• People-oriented: resource investigator (connects team to outside resources), teamworker (maintains harmony), and coordinator (sets objectives, delegates, and resolves conflicts)

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D. Explaining behavior

The primary focus of Weiner’s attribution theory is on explaining behavior. Weiner believed that people attribute cause for behavior on (1) observing behavior, (2) judging that the behavior was intentional, and (3) attributing the cause for the behavior on internal or external causes. Weiner attributed achievement to individual effort, ability, task difficulty, and luck (good or bad). Weiner further classified attributions according to three factors: locus of control, stability of behavioral causes, and ability to control causes.

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B. Executing

Projects typically comprise a number of process groups:
• Initiating: identifying key stakeholders and doing initial planning
Planning: developing a team, preparing schedules, planning a budget, prioritizing, and
creating the Gantt chart
• Executing (the most resource intensive): carrying out the work of the project, doing sur-veys, designing, constructing, promoting, and implementing
• Monitoring: producing progress reports
• Closing: presenting the final project, preparing a report

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A. Performance

A digital dashboard (so-called because it may resemble the dashboard of a car) usually utilizes various diagrams and charts and is typically used to provide staff members information about performance data, such as patient satisfaction, census, and surgical site infection rates.
The data may be unit or department-specific or may reflect the entire organization. Data should be updated on a regular basis, such as weekly or monthly, so that staff members remain interested and engaged, especially if provided as part of a quality improvement process.

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D. Clinicians

Alerts that restrict or limit clinical practice, such as hard stops or alerts that cannot be overridden, should be developed for an EHR with clinicians who will be using the system because they are in the best position to determine what is necessary and appropriate for their clinical environment. It’s important to avoid including elements into an EHR that result in workarounds, as this may increase risk to patients and result in inaccurate outcomes data.

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A. Whether hardware and software can adequately function together

The primary purpose of system integration testing is to determine whether hardware and software can function together adequately. Unit testing is done before system integration testing and system integration testing is followed by system testing and acceptance testing. System integration testing is a type of black box testing (functional testing done to determine if an input results in the correct output) and is conducted to identify problems within the component parts of a system or with the system itself. System integration testing should evaluate load, volume, and usability, and may utilize test cases and test data.

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B. Cybersecurity threats

Cybersecurity threats related to the security of patient data and information systems include data breaches, ransomware, phishing, insider threats, medical device vulnerabilities, internet of things vulnerabilities, distributed denial-of-service attacks, supply chain attacks, social engineering attacks, and zero-day exploits. In order to mitigate these threats, the healthcare organization must carry out ongoing risk assessment, use intrusion detection systems and encryption, conduct routine safety audits, use email filtering systems and multifactor authenti-cation, and assess third-party security.

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A. Encrypted

The HIPAA and HITECH Acts require that clinical data that is to be transmitted over the internet must first be encrypted in order to protect confidentially and protected health information (PHI). Because patient health records often contain not only health information but also other identifying information, such as address, telephone number, birthdate, social security number and sometimes even credit card numbers, patients may be very vulnerable if data are obtained and misused.

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B. Coach and educate the individual.

A just culture considers the need to change the system rather than the individual and differentiates among the following:

Human error: Inadvertent actions, mistakes, or lapses in proper procedure (e.g., wrong medication/dosage/patient). Consider processes, procedures, training, and/or design to determine the cause of the error and console the person.

At-risk behavior: Unjustified risk or choice (e.g., failure to wear appropriate personal protective equipment). Provide incentives for correct behavior and disincentives for incorrect behavior, and coach and educate the person.

Reckless behavior: Conscious disregard for proper procedures (e.g., drunk on duty). Insti-
tute remedial action and/or punitive action.

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B. Ensuring the links are to valid sources

When developing an interactive website for a healthcare organization and including links to other sources of information, the most important consideration is ensuring that the links are to valid sources, such as government sites or healthcare organization sites. Fair use allows linking to another organization’s home page without permission, but if deep linking (linking to content beyond the home page) or framing (importing information from another website into one’s own), then the person linking or framing should ask permission because copyright laws are less clear about this type of linkage.

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C. Arithmetic-logic unit

The central processing unit (CPU) or “brains” of a computer contains the arithmetic-logic unit, which is necessary to carry out operations related to both arithmetic and logic. The CPU also contains cache memory, a fast memory that holds data and memory that is being used, and the control unit, which controls operations of all other parts of the computer and allows other computer components to respond to instructions. The CPU is located on the computer’s mother-

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D. 75

For renewal of American Nurses Credentialing Center certification, the informatics nurse must complete 75 contact hours of continuing education. At least 60 of these hours must be formally approved by an accredited provider. A course can only be counted one time even if taken multiple times (such as a cardiopulmonary resuscitation class). Academic courses that apply to informatics nursing may be converted to contact hours. One semester unit is equal to 15 contact hours, and one academic quarter credit is equal to 12.5 contact hours. Certification is good for five years.

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C. Collaboration between the nurse and patient

Peplau’s theory of nursing stresses the importance of collaboration between the nurse and patient. Peplau’s interpersonal relations model of nursing (1952) focused on the relationship and interactions between the nurse and patient, stating that patients should be cared for by educated nurses who show them respect. The nurse is to serve as a “maturing force” to help the patient deal with illness as a maturing opportunity. The phases of the nurse-patient relationship include orientation, problem identification, explanation of possible solutions, and problem reso-lution.

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A. Operating system software

The most critical software on a computer is the operating system software because if the operating system is not functioning properly, nothing else will work. The operating system software loads first when a computer is turned on and manages both hardware and software applications. Software must be compatible with the type of operating system in order to func-tion. Operating systems include Apple Mac OS X, Unix, Microsoft Windows, and Linux.

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C. CCC

The standardized nursing terminology system that includes nursing diagnoses, outcomes, interventions, and actions is the Clinical Care Classification (CCC), which was initially developed to document home health care. CCC is used for documenting at point-of-care in all types of healthcare settings. CCC combines two terminologies, one for diagnoses and outcomes and the other for interventions and actions. CCC was the first national nursing terminology recognized by HHS and is accepted by the ANA.

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D. At the beginning of the design process

When designing a human-technology interface and considering usability, a focus group is most useful at the beginning of the design process. The focus group should be presented with

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D. Computer-assisted instruction (CAI)

Over-the-shoulder instruction is a learner-centered strategy in which the instructor moves about the classroom monitoring the learner’s progress rather than standing at the front of the classroom and lecturing or providing instructor-focused teaching. Most instruction is per computer-assisted instruction (CAI). This strategy allows for one-on-one instruction with individual learners as the instructor sees the need or the learner requests, and the instructor is better able to monitor individual progress. However, many learners may have the same questions, so the instructor may waste time answering the same questions multiple times to individual stu-dents.

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D. Collecting only necessary data

Data minimization means to collect only as much data as is necessary for the intended purpose, in order to protect patients’ privacy—an ethical concern. For example, forms and questionnaires should be designed to collect only essential personal information (i.e., privacy by design), and data should be deidentified when possible. Personal data should be secured, and informed consent should be obtained regarding the use of data. Data minimization is an element of data protection laws and regulations.

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B. Develop an acceptable use policy for personal devices.

Smartphones are ubiquitous, and trying to ban them from a hospital is not practical; how-ever, an acceptable use policy for personal devices should be developed with strict guidelines.
Numerous informational applications (such as drug guides) are available for smartphones and these pose little risk, but texting a physician with a patient update may violate not only federal regulations but State Board of Nursing regulations. Most personal smartphones do not have adequate passwords or encryption or the ability to remotely destroy data if the phone is stolen or lost.

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D. Regulatory/accrediting requirements

Working standards are most often changed because of regulatory/accrediting require-ments, such as those instituted by the Joint Commission or CMS. These new working standards should be disseminated in a variety of ways and, when necessary, training should be initiated before the change in standards occurs so that staff is informed and prepared. Procedural changes are likely to occur as the result of a need to improve efficiency or safety measures, often because of outcomes analysis. Policy changes occur because of a change of administrative focus.

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B. Potentially identifiable

Considering ethical implications for data dissemination, data that contain ID codes that are linked to names, which are not divulged, would be classified as potentially identifiable because a data user could ostensibly obtain a list of codes and names to identify individuals.
Anonymous data contain no identifying information whatsoever because none was collected.
Identifiable data contain names and/or other identifying information. De-identified data has had identifying information removed.

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B. Preparing process flowcharts

The informatics nurse is expected to have computer competencies in many areas, including preparing process flowcharts, conducting searches, and retrieving patient data. Additionally, the informatics nurse must be knowledgeable about the use of telecommunication devices and various types of information technologies, computers, and networks and should be able to develop new methods of interpreting data. The informatics nurse is not expected to carry out diagnostic coding, develop computer programs, or enable data sharing.

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A. Preventive care

Case management information systems focus on providing preventive care. Case management systems look at both current and historical case files and search for trends to which preventive measures can be applied. For example, if a patient has had repeated rehospitalization for nonadherence, the preventive plans may focus on educating the patient, providing home health supervision, or simplifying medication regimens. Case management information systems

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D. Mammography results

BI-RADS (Breast Imaging Reporting and Data System) criteria, developed by the American College of Radiology, are used to store and report mammography results so that the results are standardized. BI-RADS provides mammography assessment categories that range from 0 (in-conclusive) to 6 (proven malignancy with biopsy). BI-RADS also has categories for breast compo-sition: (a) fatty, (b) scattered density, (c) dense, and (d) extremely dense.

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C. “wound” AND “povidone-iodine” NOT “antibiotics”

The query must include both wound and povidone-iodine and exclude antibiotic. This can be accomplished with the use of AND operator in conjunction with the NOT operator.

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C. Personal identification number (PIN)

A PIN is an example of a disconnected token because no additional equipment is required. Smart cards and USB tokens are connected tokens and an RFID device is contactless.
Tokens are items used to authenticate a person’s identity and allow access to a system. They commonly require the use of not only the token but also a PIN or user name and password Some devices, such as the SecurelD token by RSA generate one-time passwords (OTPs). Tokens may be in the form of access cards, which may utilize different technologies such as photos, optical coding, electric circuits, and magnetic strips.

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B. Deidentify the data.

When carrying out data mining, the informatics nurse is using data that is protected by Health Insurance Portability and Accountability Act (1996) (HIPAA) regulations regarding privacy and confidentiality, making it imperative that the data be deidentified. The HIPAA Privacy Rule allows two forms of deidentification:

• Expert determination: applying statistical or scientific principles
• Safe harbor: removing 18 types of identifiers including names, geographic information, zip codes, telephone numbers, license numbers, account numbers, fax numbers, serial numbers of devices, email addresses, URLs, full-face photographs, dates (except the year), and biometric identifiers

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D. Problem resolution

According to Peplau’s Interpersonal Relations Model of nursing, the nurse-patient relationship goes through overlapping phases that include orientation, problem identification, explanation of potential solutions, and problem resolution. Peplau believed that collaboration between the nurse and patient was especially important and that the nurse acts as a “maturing force” to help the patient. Peplau also stressed the importance of the patient being treated with dignity and respect and believed that a positive or negative environment could affect a patient accordingly.

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B. Analyzing the basic requirements of the system and the organization

User acceptance testing (UAT) is done to determine the end user’s willingness to utilize computer technology and software in the way in which they are designed, and should begin with analyzing the basic requirements of the system and the organization. Subsequent steps include:
• Identifying the end-user acceptance scenarios
• Describing a testing plan, including different severity levels based on real-world conditions
• Designing the testing plan and test cases, considering risks and the skills of the end users
• Conducting the tests
• Evaluating and recording results

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D. A pharmacist reviews and validates new orders before medications are dispensed.

If an automated dispensing cart (ADC) for medications is “profiled,” this means that a pharmacist reviews and validates new orders before medications are dispensed and that this validation is entered into the pharmacy computer. This is especially important for orders that are outside of standardized order sets in order to prevent medication errors. The Institute for Safe Medication Practices (ISMP) recommends that all ADCs be profiled and that any non-profiled ADCs contain only limited types and amounts of drugs.

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A. Total-Person Systems Model (Neuman)

The nursing theory that focuses on how people react to stress through mechanisms of defense and resistance is the Total-Person Systems Model of Betty Neuman (1972). According to this theory, stressors may be intrapersonal, interpersonal, or extrapersonal, and the nurse carries out primary (preventive steps taken before reaction to stress), secondary (facilitation of the internal ability to resist and to remove the stressor), and tertiary interventions (supportive actions) to assist the patient to stabilize and to avoid negative effects resulting from stressors.

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D. Security

In respect to patient data in a database, the most important factor is security, although accessibility, relevance, and transferability are also important factors. Unauthorized users must be blocked from gaining access to patients’ records in order to protect confidentiality, but authorized users must be able to easily access those same records. Both physical security (preventing damage to or loss of equipment) and informational security (protecting the data) must be con-sidered. Data must be protected during storage and during transfer.

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B. One high resolution 5”x7” printed photograph

2 megabytes of memory are sufficient to produce 1 high resolution 5”x7” printed photograph while 2 kilobytes can produce a typewritten page of text, 10 megabytes can produce 1 minute of high-fidelity sound, and 50 megabytes can produce 1 digital mammogram.

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B. Social organizational analysis

In Cognitive Work Analysis (CWA), the specific type of analysis that identifies the different responsibilities of various users so human-computer interaction can support collaboration is social organizational analysis. CWA was designed for complex environments in which staff members need some degree of flexibility. Strategies analysis evaluates the manner in which work is actually carried out by users. Worker competencies analysis considers design restraints associated with the users. Control task analysis considers the control structure with which the user must interact. Work domain analysis evaluates system functions and the information needed by users.

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C. Utilizes a universal language

When instituting an EHR, it’s important to ensure that the system utilizes a universal language so that it can interface with other systems and so that data can be shared from one system to another without corruption. Use of only proprietary hardware and software may impair interoperability and limit upgrades. All EHR system should allow some modifications to account for differences in workflow and changes in regulations, requirements, and information.

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A. A standalone unit with minimal interaction with other units

If planning to use pilot implementation for conversion from paper documentation to
EHR at an acute hospital, the best choice for the pilot program is a standalone unit with minimal interaction with other units because units with extensive interactions will be unable to use some features of the EHR, such as importing or exporting data to other units that are not live. Pilot implementation requires ongoing evaluation and interviews with users to determine what problems may exist in the systems before full implementation. In some cases, those initially trained for the pilot implementation may be used to train others.

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C. User cannot make a decision regarding correct action.

When conducting a user modeling study (which determines the number and types of errors occurring in human computer interaction) a high-level error would be if a user cannot make a decision regarding correct action or is unable to interpret outcomes. Low-level errors include errors in executing steps or misunderstanding of outcomes affecting perceptions. Moderate level errors include input that is incompatible with computer system.

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D. Assessing the progress a healthcare organization is making on 30 safe practices

Leapfrog Safe Practices Score assesses the progress a healthcare organization is making on 30 safe practices that Leapfrog has identified as reducing the risk of harm to patients.
Leapfrog is a consortium of healthcare purchasers/employers and has developed a number of initiatives to improve safety. Leapfrog provides an annual Hospital and Quality Safety Survey to assess progress, releases regional data, and encourages voluntary public reporting. Leapfrog has instituted the Leapfrog Hospital Recognition Program (LHRP) as a pay-for-performance program to reward organizations for showing improvement in key measures.

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D. SNOMED CT

SNOMED CT (Systemized Nomenclature of Medicine - Clinical Terms) provides the core medical terminology used in recording clinical data in the EHR. SNOMED CT (1999) was created from a merger and further development of two previous terminologies: SNOMED RT (Reference Terminology) by the College of American Pathologists and Clinical Terms Version 3 (CTV3) by the National Health Service of the UK. Property rights now rest with the International Health Terminology Standards Development Organization (IHDTSO), which promotes use of SNOMED CT internationally. Components of SNOMED CT include concepts (clinical meanings arranged hierarchically), descriptions (linking to concepts), and relationships (linking concepts).

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C. Coded text ensures consistent and standardized vocabulary.

A primary advantage of coded data over free text is that coded data ensure consis-tent/standardized vocabulary. The coded entries allow improved capture for data mining with no loss of data, such as may occur with illegible or incomplete narrative documentation or lost paper documents. However, the limitations of the vocabulary may result in a less complete picture than free text narrative documentation. While systems generally allow the option of free text, this information is not coded, so this may affect data analysis.

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B. Patient-centered

According to the Institute of Medicine’s STEEP principles for redesigning healthcare, principles include Safe, Timely, Effective, Efficient, Equitable, and Patient-centered. These recommendations were proposed in Crossing the Quality Chasm, the second IOM report, which outlined deficiencies in medical care in the United States. Crossing the Quality Chasm followed publication of the first report To Err is Human, which focused on the high numbers of Americans that die each year because of medical errors.

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B. Provide inadequate documentation.

Use of free text (narrative form) for documentation on the EHR can provide inadequate documentation because the user may avoid making coded entries (which would require double documentation), but the EHR and CDS system are set up in such a way that the system responds to the coded entries, so it may be difficult to analyze the patient care. Additionally, since coded entries are retrieved when accessing information for outcomes assessment, excessive use of free text may alter end results.

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B. Creating flow sheets to illustrate steps in data processing

High-level system design (aka logical, or macrolevel, design) is used in the beginning of a project in order to develop a plan for a system that meets the requirements of an organization.
High-level system design includes defining an overview of the system architecture, creating flow sheets to illustrate steps in data processing, and determining system-wide specifications and interactions. The informatics nurse must also consider performance issues, such as processing speed. Low-level design (aka physical design), on the other hand, focuses on physical details, such as detailed specifications of components and interfaces, plans for handling errors, allocation of resources, and security concerns.

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B. 6 years

For archiving data, both federal and state regulations (which sometimes require longer storage than federal regulations) may apply, and they may be different. Federal regulations per the HIPAA Privacy Rule require that clinical health records of living adults be maintained securely for at least 6 years, although records must be maintained for only 2 years after a patient’s death. Records of infants born in a healthcare facility must be maintained until the child is 18 years old. The FDA requires that mammography records be stored for 10 years or until the time another mammogram is taken.

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C. Assessment, diagnosis, outcomes/planning, implementation, and evaluation

According to the ANA, the steps to the nursing process include:
• Assessment: Collecting and analyzing patient data, including physical as well as psychosocial and economic data.
• Diagnosis: Nursing diagnosis based on the clinical judgment of the nurse.
• Outcomes/Planning: Identifying expected outcomes and developing the plan of care.
• Implementation: Acting on the plan of care and documenting provisions of care.
• Evaluation: Determining the patient’s status and effectiveness of the plan of care.

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C. Unicode Standard code

The Unicode Standard coding scheme, used with the Universal Character Set (UCS), is a standardized coding system that has a larger capacity and can be used to represent text for most languages, including Asian languages. Coding is available to represent technical characters, punctuation, and mathematic symbols. Unicode provides a specific numeric value for each character and can be used across multiple platforms. Unicode comprises approximately 110,000 characters representing all alphabets in the world languages, ideographic sets, and symbols, as well as 100 scripts, and is particularly valuable for making coding accessible internationally. Unicode is utilized in many technologies and operating systems.

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A. Clinicians

Oversight and decision-making regarding changes in the clinical decision support system
(CDSS) should primarily lie with clinicians, including physicians, nurses, and pharmacists, because they are in the position to understand the needs of the organization and the staff. Support from the board of directors and administration is essential in ensuring a culture of safety.
Responsibilities should be clearly outlined and committee structures in place.

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D. Bluetooth

The wireless technology standard that utilizes UHF radio waves (ISM band, 2.4-2.485 GHz) to transmit data from mobile devices is Bluetooth. Bluetooth transmission has a short range, from 3 feet (class one) to 33 feet (class 2) and 300 feet (class 3) with most devices in class
2. Bluetooth technology may be utilized with Bluetooth enabled devices to add external keyboards and to allow hands-free telephone communications. Other applications include head-phones, intercoms, wireless connection to a printer, and transfer of health data (such as cardiac monitoring) to a device, such as a cell phone.

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C. Instant message

A communication tree is the hierarchical system used to notify staff during an emer-gency. Instant messaging is an effective method of rapidly reaching employees because almost everyone has a smart phone, people often do not read emails promptly, and telephone calls are time-intensive and may be unanswered. Additionally, an instant message can be directed to many people at one time and allows for rapid acknowledgement of receipt of the message so that administration can make plans based on the response.

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A. A recommendation for immunization

The CDS intervention that targets preventive care is a recommendation for immuniza-tion. Immunization recommendations may target all patients or specific types of patients. CDS may also provide a list of possible diagnoses associated with patient symptoms, reminders of drug interactions, alerts that a prescribed medication is not in the formulary (a cost reduction intervention), planning guides (such as treatment guidelines and drug alerts), and care plans and order sets (to improve efficiency).