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Health Informatics: An Interprofessional Approach 2nd Edition by Ramona Nelson, Nancy Staggers
Table of Contents Chapter 01: An Introduction to Health Informatics Chapter 02: Theoretical Foundations of Health Informatics Chapter 03: Evidence-Based Practice, Practice-Based Evidence, and Informatics Chapter 04: Models, Theories, and Research for Program Evaluation Chapter 05: Technical Infrastructure to Support Healthcare Chapter 06: Electronic Health Records and Applications for Managing Patient Care Chapter 07: Administrative Applications Supporting Healthcare Delivery Chapter 08: Telehealth and Applications for Delivering Care at a Distance Chapter 09: Home Health and Related Community-Based Systems Chapter 10: Clinical Decision Support Systems in Healthcare Chapter 11: Public Health Informatics Chapter 12: The Evolving ePatient Chapter 13: Social Media Tools for Practice and Education Chapter 14: Personal Health Records (PHRs) Chapter 15: mHealth–The Intersection of Mobile Technology and Health Chapter 16: Identifying and Selecting an Information System Solution Chapter 17: Project Management Principles and Clinical Systems Chapter 18: Contract Negotiations and Software Licensing Chapter 19: Implementing and Upgrading an Information System Solution Chapter 20: Health Information Systems: Downtime and Disaster Recovery Chapter 21: Improving the User Experience for Health Information Technology Products Chapter 22: Informatics-Related Standards and Standards-Setting Organizations Chapter 23: Data Science and Analytics in Healthcare Chapter 24: Patient Safety and Quality Initiatives in Informatics Chapter 25: Legal Issues, Federal Regulations, and Accreditation Chapter 26: Privacy and Security Chapter 27: The Health Information Technology for Education and Clinical Health (HITECH) Act, Chapter 28: Health Policy and Health Informatics Chapter 29: Health Information Technology Governance Chapter 30: Informatics in the Curriculum for Healthcare Professionals Chapter 31: Distance Education: Applications, Techniques, and Issues Chapter 32: Informatics Tools for Educating Health Professionals Chapter 33: Simulation in Healthcare Education Chapter 34: International Informatics Efforts Chapter 35: The Evolution of Health Informatics Chapter 36: Future Directions and Future Research in Health Informatics
Chapter 01: An Introduction to Health Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Dr. James, in studying patient safety in U.S. hospitals, found that the number of preventable
adverse events leading to serious harm fell in the approximate range of cases per year. a. 4.4 million; 8.8 million b. 440,000; 880,000 c. 1 million; 5 million d. 40,000; 100,000
to
ANS: A
Dr. James found some 440,000 cases of lethal harm each year and estimated that the incidence of serious (but not lethal) harm was 10 to 20 times that figure. DIF: Cognitive Level: Analyze 2. Health informatics is both a a. discipline; field of study b. profession; practice c. field of study; art d. profession; discipline
REF: p. 1
as well as a(n)
.
ANS: D
Health informatics is a discipline, or field of study, in the same sense that “medicine,” “sociology,” and “pharmacy” are fields of study. It is also a profession, practiced by thousands of informaticians in a number of varied roles within the healthcare industry. DIF: Cognitive Level: Remember
REF: p. 2
3. The top three uses of the U.S. Army’s telehealth network include all of the following EXCEPT a. b. c. d.
. behavioral telehealth cardiology otolaryngology dermatology
ANS: C
The biggest use of the U.S. Army’s telehealth network is for behavioral telehealth, followed by cardiology and dermatology. While telemedicine is making inroads in otolaryngology, it is not among the top three uses for the U.S. Army. DIF: Cognitive Level: Remember
REF: p. 3
4. What is the main idea of the subsection titled “Why Informatics Is Needed in Healthcare: An
Example”?
a. An interoperable healthcare system that provides clear, concise patient data and
information among institutions is lacking in many facilities, and its presence would greatly facilitate things such as patient transfers. b. The quality of discharge communication during transfers of geriatric patients from hospital to nursing home is generally high. c. Skilled nursing facilities aren’t trained enough to identify the information they need to facilitate a high-quality transition of a patient into their facility. d. Healthcare informaticians alone are responsible for building interoperable systems that will facilitate communication between and among healthcare facilities. ANS: A
This subsection takes the specific case of the transfer of geriatric patients from a hospital setting to a long-term skilled nursing facility (SNF) and uses it to illustrate the great need for an interoperable healthcare system that allows patient data to be transferred quickly, clearly, and concisely among facilities. DIF: Cognitive Level: Analyze
REF: p. 3
5. The chapter makes the argument for increased automation for such things as managing supplies,
because studies have shown that . a. only 70% of a nurse’s day is actually spent at patients’ bedsides b. nurses waste “an hour a shift” finding equipment c. over $14 million in nurses’ wages nationwide were spent in 2011 on tasks like hunting for equipment d. patients report being comforted by the presence of robotic technology in their rooms ANS: B
The chapter focused on using health informatics and technology solutions to free up nurses’ days so they can spend more time at patients’ bedsides and less on extraneous duties. A 2011 study by the Robert Wood Johnson Foundation found that nurses do use an hour per shift of their time simply hunting down equipment. DIF: Cognitive Level: Understand
REF: p. 3 | p. 4
6. The
is one of the oldest—and still widely used—methods for building and implementing software applications in IT arena. a. TUG b. clinical decision support system c. HIPAA d. SDLC ANS: D
Though it’s been through a number of iterations and adjustments, the software development life cycle remains the tested and tried-and-true method for studying, building, implementing, and maintaining a health information system. DIF: Cognitive Level: Remember
REF: p. 4 | p. 5
7. Which of the following statements about EHRs is false? a. The percentage of hospitals using an EHR jumped from 59% to 75% from 2013 to
2014. b. Stage 2 is the minimum level of EHR required in order to be counted as using EHR. c. By 2014 50% of physicians in the United States had implemented an EHR, with another 13% in the process of implementing one. d. There were no EHR systems in U.S. hospitals in 2009. ANS: C
The text gives data for physicians using EHR in 2013, stating that by that year 63% had implemented some form of EHR, with another 20% in the process of implementing one. DIF: Cognitive Level: Apply
REF: p. 6
MULTIPLE RESPONSE 1. Internationally, healthcare delivery systems face a number of common challenges, including:
(Select all that apply.) a. cost and the need to cut costs and demonstrate value. b. a lack of new HIT advances. c. dynamic forces like workforce shortages and increased consumerism. d. an international population that is growing increasingly younger and healthier. e. increasing government regulation to protect patient health, safety, and privacy. ANS: A, C, E
The need to contain costs, forces like workforce shortages and increased consumerism, and increasing government regulation are all challenges faced in common globally by healthcare delivery systems. There is no lack in new HIT advances; in fact adoption of such new technologies is a challenge in itself, as is an aging population that will require more healthcare than before. DIF: Cognitive Level: Understand
REF: p. 6 | p. 7
Chapter 02: Theoretical Foundations of Health Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. What is the primary difference between an open and closed system? a. An open system has no boundary, and therefore there are no limits to the inputs
and outputs between an open system and the environment. b. An open system has a semipermeable boundary and therefore will filter both inputs
and outputs when interacting with the environment. c. A closed system has a semipermeable boundary and therefore will filter both
inputs and outputs when interacting with the environment. d. A closed system does not have a boundary and therefore will not interact with the
environment. ANS: B
With an open system the boundary is semipermeable, thereby controlling what will be accepted as input and what will be permitted to leave the system. DIF: Cognitive Level: Understand
REF: p. 15
2. The primary characteristics used to analyze an open system include: a. structure, purpose, and functions. b. subsystem, target system, and supersystem. c. boundary, attributes, and environment. d. hierarchical, web, and hybrid. ANS: A
Using these three characteristics, one can determine why the system exists, what functions it performs to achieve its purpose, and how it is structured to achieve its purpose. DIF: Cognitive Level: Remember
REF: p. 16
3. You have altered the menu of food items served to your patients. However, the change has
greatly expanded the number of refrigerated items needed on hand. You need to buy a new refrigerator, but the electric circuit in the kitchen cannot handle the extra load and needs to be upgraded at significant expense. This set of unintended consequences down the line, produced by an initial change, is called: a. dynamic homeostasis. b. semi-planned change. c. negentropy. d. reverberation. ANS: D
Change within any part of a system will be reflected across the total system through a process termed reverberation. Reverberation can be intended or unintended consequences of change. DIF: Cognitive Level: Analyze
REF: p. 18
4. The “butterfly effect” describes a situation in which a minor change in input (eg, a butterfly
flapping its wings in one part of the world) can have a major effect on output (eg, a windstorm developing in another part of the world). This aspect of chaotic systems illustrates their property of: a. the reiterative feedback loop.
b. linearity. c. preordained periodic behavior. d. the fractionation of outputs. ANS: A
Chaotic systems are dynamic systems with reiterative feedback loops. A minor change in input can create a major change in output. This is often described as the butterfly effect. A butterfly’s flapping wings in California can over time become a hurricane in New York.
DIF: Cognitive Level: Analyze
REF: p. 18
5. Which statement describes the measurement of information as defined by the Shannon and
Weaver model? a. The amount of information is measured by the amount of data in the message. b. The amount of information is measured by the number of meanings that can be assigned to a message. c. The amount of information is measured by the extent the message decreases entropy. d. The amount of information is measured by the number of characters used to create the message. ANS: C
By decreasing entropy one decreases uncertainty. Shannon, a telephone engineer, sought to overcome the technical problems of moving information across communication channels by determining how to minimize entropy. DIF: Cognitive Level: Remember
REF: p. 21 | p. 22
6. On its own, the number 190 is an example of: a. data. b. information. c. knowledge. d. wisdom. ANS: A
The number 190 could refer to anything such as a person’s weight, blood glucose level, or systolic blood pressure reading and therefore has no meaning by itself. DIF: Cognitive Level: Apply
REF: p. 22
7. Knowing when and how to use knowledge is referred to as: a. procedural knowledge. b. cognitive knowledge. c. decision support system. d. wisdom. ANS: D
Wisdom is defined as the appropriate use of knowledge in managing or solving human problems. It is knowing when and how to use knowledge in managing patient need(s) or problem(s). DIF: Cognitive Level: Remember
REF: p. 23
8. Which are the three general types of learned behaviors? a. Input, throughput, and output b. Adult learning theories, constructionist theories, and learning styles c. Cognitive, affective, and psychomotor d. Short, intermediate, and long-term memory
ANS: C
Learning is defined as an increase in knowledge, a change in attitude or values, or the development of new skills. Learned behaviors can be cognitive (intellectual skills), affective (values and attitudes), or psychomotor (the integration of cognitive and motor skills). DIF: Cognitive Level: Apply
REF: p. 27
9. Which group will test out new technology but are not usually seen as leaders within an
organization? a. Innovators b. Early adopters c. Early majority d. Late majority ANS: A
Innovators will test out a new technology; however, they are too far ahead of the social group to be seen as leaders by other members of the social system. Early adopters are seen as much more discreet in their selection of new technology and are therefore better at selling a new technology to a group of potential users. DIF: Cognitive Level: Understand
REF: p. 30
MULTIPLE RESPONSE 1. The Staggers and Nelson systems life cycle (SLC) is a guide for informatics projects. Its phases
include: (Select all that apply.) a. implementation. b. planning. c. evaluation. d. security. e. diagnosis. ANS: A, B, C
The seven phases of the Staggers and Nelson SLC are analyze; plan; develop or purchase; test; implement or go-live; maintain and evolve; and evaluate. DIF: Cognitive Level: Remember
REF: p. 32 | p. 33
Chapter 03: Evidence-Based Practice, Practice-Based Evidence, and Informatics Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Knowledge is the point of convergence across the areas of: a. evidence-based practice, quality assurance, and informatics. b. evidence-based practice, improvement, and informatics. c. evidence-based practice, quality assurance, and improvement. d. improvement, quality assurance, and informatics. ANS: B
Knowledge is the point of convergence across the areas of evidence-based practice, informatics, and improvement. None of the other answers include all of these aspects. DIF: Cognitive Level: Remember
REF: p. 38
2. Which two hurdles does the STAR Model address in employing evidence-based practice? a. The volume and form of knowledge b. The quality and form of knowledge c. The volume and outcomes of knowledge d. The adequacy and form of knowledge ANS: A
The STAR Model addresses two major hurdles in employing evidence-based practice (EBP). These two hurdles are the volume of current professional knowledge and the form of knowledge that healthcare professionals attempt to apply in practice. DIF: Cognitive Level: Remember
REF: p. 42
3. What is the form of knowledge gained in discovery research? a. Results from single research studies b. Results from meta-synthesis c. Results from systematic review d. Results from meta-analysis ANS: A
Discovery research represents knowledge produced in the form of single research studies. The other three choices represent synthesis of multiple studies. DIF: Cognitive Level: Remember
REF: p. 42
4. Which type of review is considered the most rigorous? a. Literature reviews b. Systematic reviews c. Integrative reviews d. Single study reviews ANS: B
Evidence summaries include evidence synthesis, systematic reviews, integrative reviews, and reviews of the literature, with systematic reviews being the most rigorous approach to evidence
summary. DIF: Cognitive Level: Remember
REF: p. 43
5. A facility calls in experts to review evidence developed in research and develop guidelines for
clinical practice. Which stage of EBP is represented? a. Evidence summary b. Evaluation of process and outcomes c. Practice integration
d. Translation to guidelines ANS: D
In the third stage of EBP, translation, experts are called on to consider the evidence summary, fill in gaps with consensus expert opinion, and merge research knowledge with expertise to produce clinical practice guidelines (CPGs). DIF: Cognitive Level: Understand
REF: p. 44
6. A(n)
is considered the gold standard research design for answering questions about the efficacy of treatments. a. RCT b. PBE c. TeamSTEPP d. NQMC ANS: A
An experimental design, often called a “randomized controlled trial (RCT),” has emerged as the gold standard research design for answering questions about the efficacy of treatments. DIF: Cognitive Level: Remember
REF: p. 51
MULTIPLE RESPONSE 1. The goal of the intersection of informatics and evidence-based practice is to transform healthcare
to be: (Select all that apply.) a. reliable. b. safe. c. effective. d. efficient. ANS: A, B, C
The field of informatics and the concept of evidence-based practice (EBP) intersect at the crucial junction of knowledge for clinical decisions with the goal of transforming healthcare to be reliable, safe, and effective. While efficiency is always a goal in healthcare, it is not a primary goal of EBP. DIF: Cognitive Level: Remember
REF: p. 38
2. Which of the following are evidence summaries? (Select all that apply.) a. literature reviews. b. systematic reviews. c. single-study reviews. d. integrative reviews. e. focus-group reports. ANS: A, B, D
Evidence summaries include evidence synthesis, systematic reviews, integrative reviews, and reviews of the literature.
DIF: Cognitive Level: Remember
REF: p. 43
3. Using the STAR Model, which of the following points indicate knowledge transformation has
occurred? (Select all that apply.) a. Discovery research b. Evidence summary c. Translation to guidelines d. Practice integration e. Testing the hypothesis f. Evaluation of process and outcomes ANS: A, B, C, D, F
The knowledge transformation process in the STAR Model occurs at five points, which can be conceptualized as a five-point star. These five points include discovery research, evidence summary, translation to guidelines, practice integration, and evaluation of process and outcomes. Testing the hypothesis is not a specific point in the STAR Model. DIF: Cognitive Level: Remember
REF: p. 42
4. Standardized terminology is requisite for: (Select all that apply.) a. naming evidence. b. classifying evidence. c. tagging evidence. d. locating evidence. e. simplifying evidence. ANS: A, B, C, D
Standardized terminology is requisite for naming, classifying, tagging, and locating evidence in order to use it in practice. DIF: Cognitive Level: Remember
REF: p. 39
Chapter 04: Models, Theories, and Research for Program Evaluation
Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Your organization hires you to conduct a formative evaluation of a new informatics intervention.
Which areas would you focus on in a formative evaluation? a. Cost, patient safety, and patient outcomes b. Intervention fidelity, implementation quality, and types of personnel c. Errors, change in provider decision making, and cost d. Unintended outcomes, delays in implementation, and cost ANS: B
A formative evaluation is an assessment of how well a program is being implemented. Intervention fidelity, implementation quality, and types of personnel are areas that would be focused on in formative evaluation. Results of the formative evaluation are used as feedback to the program for continuous improvement. DIF: Cognitive Level: Apply
REF: p. 61
2. Of the following, which of these steps in the CDC’s six-step program evaluation framework
comes first? a. Gather credible evidence b. Focus the evaluation design c. Justify conclusions d. Engage stakeholders ANS: D
The CDC’s six-step program evaluation framework is (1) engage stakeholders; (2) describe the program; (3) focus the evaluation design; (4) gather credible evidence; (5) justify conclusions; and (6) ensure use and share lessons learned. DIF: Cognitive Level: Understand
REF: p. 67
3. Which list includes the three levels of theory relevant to evaluation? a. Program theory, summative model, and interpersonal theory b. Scientific theory, formative model, and descriptive theory c. Scientific theory, implementation models, and program theory d. Scientific model, statistical theory, and holistic models ANS: C
The three levels of theory relevant to evaluation are scientific theories, implementation models, and program theories. The other choices are either not theories or are specific theories, not levels of theory. DIF: Cognitive Level: Remember
REF: p. 60
4. You decide to base the evaluation plan of your informatics project on the theory of planned
behavior. Which constructs will you use to develop your measurements? a. Values, normative expectations, others’ beliefs, and overall prior knowledge b. Values, beliefs about self-efficacy, normative beliefs, and intrinsic motivation c. Values, expectations of others, behaviors, and perceived self-efficacy d. Habit, normative expectations, beliefs about resources, and overall prior
knowledge ANS: C
The theory of planned behavior focuses on the ability to predict intentions and behavior as a function of beliefs about the value of an outcome, the likelihood that the outcome will occur given the behavior, beliefs about the expectations of others, and self-efficacy beliefs about the personal ability to engage in the activity. DIF: Cognitive Level: Understand
REF: p. 63
5. The stages of change identified in diffusion of innovation theory are: a. contemplation, persuasion, action, and knowledge. b. knowledge, persuasion, decision, implementation, and confirmation. c. awareness, understanding, action, implementation, and engagement. d. contemplation, decision, action, and knowledge. ANS: B
The stages of change identified in the diffusion of innovation theory are knowledge, persuasion, decision, implementation, and confirmation. The stages of change are one way to understand and evaluate how the change has occurred. DIF: Cognitive Level: Remember
REF: p. 63
6. If you choose to evaluate an informatics intervention by examining the impact on a clinician’s
ability to think ahead about future events, which level of situation awareness would you be measuring? a. Social b. Perception c. Comprehension d. Projection ANS: D
Projections are expectations of outcomes in the future. Projections are driven by implicit theories and knowledge about the causal mechanisms underlying events. DIF: Cognitive Level: Understand
REF: p. 63
7. UTAUT is a theory of: a. users’ knowledge of social networks. b. acceptance and use of technology. c. decision making skills. d. technology support options. ANS: B
The unified theory of acceptance and use of technology (UTAUT) assesses factors associated with effective use. DIF: Cognitive Level: Understand
REF: p. 64
8. You decide to interview all the key stakeholders involved in an informatics intervention as part
of the planning process. Together you identify the resources available, the likely barriers, and the short-term and long-term objectives. Which kind of theoretical model are you using? a. Scientific theory b. Theory of planned behavior c. Logic model d. Diffusion model ANS: C
Program theory models consist of the implicit ideas and beliefs of key stakeholders. A logic model is a representation of components and mechanisms of the program. Basically, a logic model is a systematic and visual way to present and share your understanding of the relationship among the resources you have to operate your program, the activities you plan, and the changes or results you hope to achieve. DIF: Cognitive Level: Apply
REF: p. 67
9. In a social network analysis, each node is usually a(n): a. individual or unit of analysis. b. event. c. location. d. interaction. ANS: A
The patterns of connection between people in a social network analysis (SNA) are displayed as a visual network of nodes and lines. Nodes are individuals, and lines are interactions between them. DIF: Cognitive Level: Understand
REF: p. 71
MULTIPLE RESPONSE 1. Ethnography requires which of the following? (Select all that apply.) a. Blood tests of the population being studied b. Reading historical documents and exploring artifacts in current use c. Observations and interviews d. MRIs or, at the very least, x-rays and ultrasounds e. Living and working within the population if possible ANS: B, C, E
Ethnography is derived from the field of anthropology. It is a means to understand a population by immersing oneself into its culture by reading documents, performing multiple interviews and observations, and if possible, living and working among the community being studied. DIF: Cognitive Level: Apply
REF: p. 69
Chapter 05: Technical Infrastructure to Support Healthcare Nelson and Staggers: Health Informatics: An Interprofessional Approach, 2nd Edition MULTIPLE CHOICE 1. Which item is an example of information we might find in an EHR’s clinical data repository? a. A physician’s surgical schedule b. The list of medications available in a hospital’s formulary c. The result of a patient’s microbiology lab test d. Monthly billing charges for the radiology department ANS: C
The result of a patient’s microbiology lab test is an example of information we would find in a CDR. The other items would be found in other administrative databases. DIF: Cognitive Level: Understand
REF: p. 76
2. Which factor would strongly influence the reliability of an EHR’s repository? a. The redundancy of storage hardware b. Clinician training on EHR applications c. The coding system used for laboratory results d. The use of strong passwords ANS: A
Architectural and procedural models such as the redundancy of storage hardware and access routes, contribute to the reliability of an EHR’s data repository. The other items affect application use, accessibility, and security. DIF: Cognitive Level: Understand
REF: p. 76
3. Which statement describes a repository with central storage of a longitudinal record? a. Patient data are from a single hospital’s data for the most current encounters. b. Data from multiple hospitals are kept compact and efficient by deleting “old” data. c. Portions of a patient’s lifetime medical record are stored in databases at the facility
where the data were collected. d. The information collected by the organization is stored in a single database no matter when or where the patient was seen. ANS: D
The information collected by an organization that is stored in a single database no matter when or where the patient was seen is an example of a repository with central storage of a longitudinal record. The other items describe aspects of distributed and/or encounter-based records. DIF: Cognitive Level: Apply
REF: p. 77
4. Which example best describes knowledge base content? a. Standard admission order sets based on presenting problems b. Patient contact information c. Organizational structure of a healthcare enterprise d. The most recent lab results for current inpatients ANS: A
A knowledge base stores and organizes a healthcare enterprise’s information and knowledge
used by the enterprise for clinical operations. A good example is standard admission order sets based on presenting problems. The other choices would not typically be found in a knowledge base. DIF: Cognitive Level: Apply
REF: p. 80