Review questions Flashcards
A signature in the medical record serves which of the following purposes?
Select one:
a.
Identity
b.
Ownership
c.
Authorship
d.
Completeness
Intent: an electronic signature is a symbol that signifies intent such as an approval of terms, confirmation that the signer reviewed and approved the content, or the signer authored the document and approves the content.
Identity: the signature identifies the person signing.
Integrity: a signature guards the integrity of the document against repudiation (the signer claiming the entry is invalid) or alteration
The primary organizational goal for health information technology (IT) governance is to ensure that the:
Select one:
a.
Solutions chosen meet the needs of clinicians
b.
Expenditures for health IT solutions are appropriately tracked
c.
Board of Directors are adequately informed about health IT progress
d.
Investments in health IT generate business value
d.
Investments in health IT generate business value
Innovators - These are people who want to be the first to try the innovation. They are venturesome and interested in new ideas. These people are very willing to take risks and are often the first to develop new ideas. Very little, if anything, needs to be done to appeal to this population.
Early Adopters - These are people who represent opinion leaders
Early Majority - These people are rarely leaders, but they do adopt new ideas before the average person. That said, they typically need to see evidence that the innovation works before they are willing to adopt it. Strategies to appeal to this population include success stories and evidence of the innovation’s effectiveness.
Late Majority - These people are skeptical of change and will only adopt an innovation after it has been tried by the majority
Laggards - These people are bound by tradition and very conservative. They are very skeptical of change and are the hardest group to bring on board. Strategies to appeal to this population include statistics, fear appeals, and pressure from people in the other adopter groups.
The four major functions of radiologic picture archiving and communications system (PACS) include image acquisition, image archival, image transmission and
Select one:
a.
Radiology transcriptionists for checking the report
b.
Display stations for soft-copy viewing
c.
Financial systems for billing purposes
d.
Compute engines for image compression
acquisition, image archival, image transmission and image display
Which of the following is an early example of a consulting model of computer decision-support system in which explicit effort is required to seek advice?
Select one:
a.
MYCIN
b.
HyperCritic
c.
HELP
d.
G-CARE
MyCIN
MYCIN required the user to request assistance
You are the clinical informatics project lead for a new private telepsychiatry facility in Alex, Oklahoma (a remote town of 550 persons). Which of the following is the most pertinent barrier to implementation of this project?
Select one:
a.
Concern about patient acceptance of behavioral health services via telepsychiatry
b.
Reimbursement issues related to having telepsychiatry practitioners from Norman, OK practice in Alex, OK
c.
Concern over the encroachment of telepsychiatry services on neighboring Veterans Affairs Medical Center telemedicine services
d.
Psychiatrist concern over the impact of telepsychiatry on their clinical workflow
provider barriers have been found to be a consistent and prominent barrier.
Financial accounting produces the documents typically associated with accounting such as income statements, balance sheets and cash flow statements. Which of the following is a component of the Cash Flow Statement?
Select one:
a.
Equity
b.
Operating activity
c.
Revenue
d.
Expenses and losses
1.Income statement: summarizes revenue and expenses during a specified time period
2.Balance sheet: summarizes assets, liabilities and equity during a specified time period. This is also referred to as the financial position statement.
3.Cash flow statement: summarizes cash inflow and outflow during a specified time period.
With regards to this question:
Equity is a Balance Sheet component that reports the company’s assets, also known as the “book value” of the company.
Expenses and losses are a component of the Income Statement and includes expenses from primary activities, secondary activities and any losses.
Operating activity is a component of the Cash Flow Statement and deals with converting items on the income statement to cash.
Revenue (often referred to as Revenues and Gains) is a component of the Income Statement and includes revenues from primary activities (operating revenues), secondary activities (non-operating revenues) and gains (proceeds from a sale).
The Open Systems Interconnection model (OSI) is a conceptual model that characterizes and standardizes the internal functions of a communication system by partitioning it into layers. Secure Sockets Layer (SSL) is implemented in which OSI layer?
Select one:
a.
Presentation
b.
Session
c.
Network
d.
Transport
strictly speaking is in the session layer.
There are several techniques for assessing patient preferences or utilities for health outcomes. A technique that involves choosing between an intermediate health state with certainty or a chance for a better or worse health outcome is:
Select one:
a.
Standard Gamble
b.
Quality Adjusted Life Year (QALY)
c.
Time Tradeoff
d.
Visual Analogue Scale
standard gamble is a technique in which respondents are asked to choose between a certain state of health with certainty versus a chance or gamble for the possibility of better or worse states
Time-Trade-Off is a technique used to measure the quality of life that a person or group is experiencing.
In strategic planning, an organization’s “mission” is best described as
Select one:
a.
the purpose of an organization.
b.
the goals and policies of the organization.
c.
what an organization wants to become.
d.
the set of beliefs that are shared among the stakeholders.
Goals and policies constitute an organization’s strategy.
purpose of an organization is the mission.
The set of beliefs shared among stakeholders constitute an organization’s values. Vision is what an organization wants to become
Which one of the following leadership qualities would be most important for a Chief Medical Information Officer (CMIO) to display when implementing new systems and applications?
Select one:
a.
Charismatic
b.
Transformational
c.
Task-oriented
d.
Supportive
b.
Transformational
Which of the following Lean Six Sigma terms correctly identifies the problem-solving process that bring together stakeholders to generate rapid process improvement?
Select one:
a.
Muda
b.
Fishbone diagram
c.
Daily huddle
d.
Kaizen
Kaizen events bring together relevant stakeholders to understand a problem and generate solutions in a short time frame.
Muda is the Lean Six sigma term for “waste.”
A job description that identifies a position as having “exempt status” indicates that the incumbent is
Select one:
a.
Part of the executive management team
b.
Not mandated to join a union
c.
Not eligible for overtime pay
d.
A clinician, such as a nurse or physician
“Exempt” is a federal wage and hour term meaning not eligible for overtime pay over 40 hours of work per week.
When process mapping, what symbol does the process start and end with?
Select one:
a.
Square
b.
Diamond
c.
Triangle
d.
Oval
beginning and ending step of a process map is designated by using an oval shape.
Squares are used for middle steps in the process, and
diamonds are used at points where a decision needs to be made.
The first step in a user-centered design process for a new information system is:
Select one:
a.
Summative evaluation with usability assessment
b.
Design of a low-fidelity prototype for user feedback
c.
Formative evaluation with think aloud
d.
User and task analysis
You are evaluating a scheduling process failure in an outpatient clinic where wait times have suddenly increased by 60%. In performing a cause and effect analysis, which tool would be the most appropriate for the first portion of the analysis?
Select one:
a.
Pareto chart
b.
Gantt chart
c.
Run chart
d.
Fishbone diagram
correct answer is a fishbone diagram. Fishbone diagrams are causal diagrams that show the causes of specific events. They may also be called cause and effect diagrams and are often used in Root Cause analyses.
Gantt charts are used to illustrate project schedules.
HIPAA vs Hitech
HIPAA –privacy and security provisions
HItech (ARRA)- Penalties for security breaches, ONC, promotion of HIT
Protected health information is to be sent from a secure system to one that is less secure. The most appropriate action to take is:
Select one:
a.
Transmit information only on secure networks
b.
Encrypt the information at rest
c.
De-identify and re-identify using assigned codes
d.
Encrypt the information in transport.
Protected health information is to be sent from a secure system to one that is less secure. The most appropriate action to take is:
Select one:
a.
Transmit information only on secure networks
b.
Encrypt the information at rest
c.
De-identify and re-identify using assigned codes
d.
Encrypt the information in transport.
A covered entity may assign a code or other means of record identification to allow information de-identified under this section to be re-identified by the covered entity, provided that:
(1) Derivation. The code or other means of record identification is not derived from or related to information about the individual and is not otherwise capable of being translated so as to identify the individual; and
(2) Security. The covered entity does not use or disclose the code or other means of record identification for any other purpose, and does not disclose the mechanism for re-identification
Your CIO asks you to draft a plan for replacing several departmental clinical information technology (IT) systems currently in use with a single new system. Which of the following do you consult first? The
Select one:
a.
Department’s clinical and IT leaders
b.
IT department’s strategic plan
c.
Organization’s financial plan
d.
Organization’s strategic plan
Organization’s strategic plan
A commonly employed method to assess a patient’s utility preferences is the visual analog scale. The visual analog scale:
Presents the respondents with a minimum of restraints (T/F)
true
The critical path of a project schedule is the specific sequence of serial (dependent) activities, each of which must be completed on time, to ensure the entire project also remains on schedule. A delay in any one or more of the activities along a critical path will result in a delay in the overall project. It is also equivalent to the longest path.
It is also equivalent to the longest path.
Clinical Informatics is the domain of biomedical informatics that seeks to address clinical care issues. It involves the application of informatics and health information technology to health care delivery. Other domains of biomedical informatics include bioinformatics, imaging informatics, and public health informatics.
intersection of basic informational sciences with biomedical applications
Which of the following is a transaction standard?
Select one:
a.
X12
b.
CDA
c.
HL7 2.X
d.
DICOM
Clinical Informatics Standards involve:
- Identifiers (for physicians, the NPI, National Provider Identity or a patient identifier-birthdate, name, social security number)
- Transactions ASC X12N transactions: Health claims and equivalent encounter information (837), Enrollment and disenrollment in a health plan (834), Eligibility for a health plan (request 270/response 271), Healthcare payment and remittance advice (835)
- Data exchange:HL7 2.x, HL7 3.0, FHIR, DICOM (Digital Imaging and Communications in Medicine), Devices-IEEE 1073/ISO 11073 + others, ePrescribing: NCPDP and SCRIPT. The HL7 Clinical Document (CDA) standard specifies the structure and semantics of clinical documents.
- Terminology-diagnoses (ICD-9, ICD-10), Diagnosis Related Groups (DRGs), Laboratory-LOINC, Unified Medical Language System (UMLS) etc.
Using a screening test on a population of patients reduces the risk of developing a disease from 10% to 5% providing a relative risk reduction of 50%. How many patients need to be screened to avoid one patient developing the disease?
Select one:
a.
10
b.
20
c.
50
d.
75
Number Needed to Treat = 1/Absolute Risk Reduction = 1/.05 = 20.
ICER
ICER is (C1-C2)/(E1-E2) = 80/5 = $16 PER QALY.
You are worried that you might have a rare disease. The test for this disease is accurate 99 percent of the time (regardless of whether the results come back positive or negative). This disease occurs in the general population in one of every 10,000 people. If the tests are positive, what are the chances that you actually have the disease?
Select one:
a.
0.001
b.
0.01
c.
0.1
d.
0.99
P(A|B)=P(A)P(B|A) / P(B)
In this case, event A is the event you have this disease, and event B is the event that you test positive. Here, P(B|A)=.99, P(A)=.0001, and P(B) may be derived by conditioning on whether event A does or does not occur: P(B)=P(B|A)P(A)+P(B|not A)P(not A) or .99.0001+.01.9999, which is less than 1 percent.
The correct answer is: 0.01
Bayes’ theorem helps us find the probability of event A given event B, written P(A|B), in terms of the probability of B given A, written P(B|A) and the probabilities of A and B:
Which of the following statements is an accurate description of an heuristic evaluation of user interfaces?
Select one:
a.
Determines usability through user surveys and focus groups
b.
Requires specialized eye-tracking and click-tracking software
c.
Reviews the user interface against a set of design guidelines
d.
Involves five to eight users performing a task completion test
correct answer is: Reviews the user interface against a set of design guidelines
Within the discipline of human computer interaction (HCI), heuristic evaluation (HE) is a type of usability evaluation that is performed by experts and does not typically involve system users. HE compares an application or system to a small set of well-tested design principles.
S
NPV
PPV
Sens
Spec
in doctor language
Negative predictive value: given a negative test, the patient does not have the disease in question
Positive predictive value: given a positive test, the patient has the disease under consideration
Sensitivity: the patient with the disease has a positive test
Specificity: a patient without the disease has a negative test
What is the best approach to avoid overfitting when developing machine learning algorithms?
b.
Penalize overly complex models and test for generalizability.
Which of the following is an SQL keyword which can be used to eliminate duplicate rows from a query result?
Select one:
a.
DISTINCT
b.
DROP
c.
SELECT
d.
UNIQUE
DISTINCT keyword eliminates duplicate rows from the results of a SELECT statement
DROP is equivalent to DELETE
UNIQUE restricts a table, but is not a SQL keyword.
a “technology-induced” error?
Select one:
a.
Hardware bugs
b.
System and user interaction
c.
Logical programming errors
d.
Data mapping errors
Technology-induced errors are a new type of error that result from the complex interaction of health information systems and end users, when systems are used in complex healthcare settings.
specifications listed is a Standards Development Organization balloted standard?
Health Level 7 (HL7) Clinical Document Architecture
Only the CDA specifications went through a formal ballot process. The other specifications are produced by the government (NEISS), the World Health Organization (ICD-10) and the AMA (CPT).
Accuracy =
Accuracy =(True Positives + True Negatives)/Total).
Positive predictive value equals a/(a+b).
Prevalence equals (a+c)/(a+b+c+d).
Sensitivity or true positive rate equals a/(a/(a+c)
fully connected system requires (N*(N-1))/2 bidirectional interfaces to implement compared to N bidirectional interfaces using a common shared standard
To calculate the prevalence of a disease, one would calculate the:
Select one:
a.
Positive Likelihood ratio
b.
Post Test Probability
c.
Pretest Probability
d.
Negative Likelihood ratio
= prevalence=Pre-test pronb
Availability heuristic
belief bias is “an effect where someone’s evaluation of the logical strength of an argument is biased by the believability of the conclusion”.
The bandwagon effect refers to the tendency to make decisions based on others’ beliefs, which is not the case here.
Hindsight bias is the tendency to reframe past events as predictable, even if they were not at the time.
