Introduction to Health Information Systems
Exam Preparation Guide
Course Introduction
Introduction to Health Information Systems provides an overview of how information technology is used to collect, manage, and utilize health data in various healthcare settings. The course explores the fundamental components of health information systems, including electronic health records (EHRs), health information exchanges (HIEs), and clinical decision support systems. Students will learn about the roles these systems play in improving patient care, increasing efficiency, and supporting healthcare delivery, as well as the challenges related to privacy, security, interoperability, and policy regulations. Through case studies and practical examples, students gain an understanding of both the opportunities and complexities of implementing and maintaining health information systems in todays healthcare environment.
Recommended Textbook
Health Information Technology 3rd Edition by Nadinia A. Davis
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14 Chapters
874 Verified Questions
874 Flashcards
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Page 2
Chapter 1: Health Care Delivery Systems
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69 Verified Questions
69 Flashcards
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Sample Questions
Q1) Community Care Center has 200 beds. It has an average length of stay of 2.5 years. Most of the patients are elderly, but there are some younger patients with serious chronic illnesses. Community Care Center is most likely a(n) _____ facility.
A) Acute care
B) Behavioral health
C) Long-term care
D) Rehabilitation
Answer: C
Q2) A synonym for "vocational nurse" is:
A) Registered nurse
B) Licensed practical nurse
C) Nurse practitioner
D) Advanced practice nurse
Answer: B
Q3) Define licensure.
Answer: Licensure is a mandatory government-regulated process. Licensure regulations define facilities, their operating requirements, their organizational requirements, and reporting requirements.
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3
Chapter 2: Collecting Health Care Data
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74 Verified Questions
74 Flashcards
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Sample Questions
Q1) If a patient's insurance company has reimbursed the physician for the appropriate amount and there is still a balance due in the patient's account, the physician must apply next for payment to the:
A) Guarantor
B) State government
C) Medicaid
D) Patient's parents
Answer: A
Q2) Authentication shows:
A) The person responsible for the data on a form
B) The name of the facility and its logo
C) The patient's name or barcode
D) The title and number of the form
Answer: A
Q3) According to your text, race is an example of ____ data.
A) Demographic
B) Socioeconomic
C) Financial
D) Clinical Answer: B
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Chapter 3: Electronic Health Records
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67 Verified Questions
67 Flashcards
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Sample Questions
Q1) An open database that stores data from various independent sources that can be integrated to enable viewers to see documents from several sources is a
Answer: data repository
Q2) The federal level authority responsible for the coordination of the implementation of a National Health Information Network is the ___________.
Answer: Office of the National Coordinator for Health Information Technology ONC
Q3) A framework that enables interoperability by using standard operating nomenclature, specifications, or protocols against geographical boundaries and among various entities is the __________.
Answer: infrastructure
Q4) Interoperability means :
A) The ability of software and hardware on different machines from different vendors to share data
B) Incentives for electronic health record (EHR) adoption
C) Computers are not able to communicate with each other
D) Physicians can operate from within a surgical unit
Answer: A
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Chapter 4: Acute Care Records
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Sample Questions
Q1) In acute care, physician's progress notes are:
A) Written at least daily to validate the need for care
B) Sometimes collected by physician residents, provided they are countersigned by the attending physician
C) Only collected by the attending physician
D) Both A and B
Q2) If there is one physical location within the hospital for all patient registration activities, the registration function is said to be:
A) Centralized
B) Decentralized
C) Admissions
D) Departmental
Q3) The physician who is primarily responsible for coordinating the care of the patient in the hospital is the ___________.
Q4) What are essential elements in the operative report? List at least five.
Q5) In caring for a patient, an attending physician may request a(n) ___________ from another physician or health care professional who specializes in the patient's problem.
Q6) Name and describe the four scenarios that inpatient admissions correspond to.
Page 6
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Chapter 5: Health Information Management Processing
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69 Flashcards
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Sample Questions
Q1) ___________ is the process of determining the cause of an error.
Q2) Developing a universal chart order will theoretically eliminate which one of the following HIM functions?
A) Chart analysis
B) Deficiency detection
C) Chart assembly
D) Retrospective review
Q3) All of the following are routinely identified during quantitative analysis EXCEPT:
A) Missing signature on a physician progress note
B) Discharge report has not been dictated
C) Requested cardiology consultation was not performed
D) H&P was dictated and transcribed on the third day of the admission
Q4) In a paper environment, records must physically move from the patient care area to the HIM department for processing and storage. Give two examples of how that movement can occur.
Q5) Is a computer-based record completely paperless? Why or why not?
Q6) Since the HIM department is primarily concerned with postdischarge processing, of what use is the admission register to this department?
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Chapter 6: Code Sets
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Sample Questions
Q1) SNOMED-CT is designed for use in and support of the EHR. SNOMED-CT's design does NOT include:
A) Codes embedded in the EHR
B) All of the detail needed to derive ICD-10-CM codes
C) Codes assigned during the course of patient care
D) All of the above are included.
Q2) HCPCS is composed of Level I and Level II codes; the differences between the two levels are:
A) Level I codes are used to report outpatient procedures and services, whereas Level II codes are used to report products, supplies, and services not included in Level I.
B) Level I codes are maintained by the AMA, whereas Level II codes are developed by hospitals as part of their chargemaster.
C) Level I codes are submitted separately from Level II codes for reimbursement.
D) Insurance companies need Level II codes to process claims; insurers do not process Level I codes.
Q3) Describe the difference between nomenclature and classification.
Q4) In a multi-axial code structure, such as ICD-10-PCS, each position of a ___________ has specific meaning.
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Page 8
Chapter 7: Reimbursement
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Sample Questions
Q1) Which of the following is NOT a way in which managed care organizations may influence and/or control the patient's choices in selecting health care services:
A) The patient's PCP must be a participating provider.
B) Only approved services may be reimbursed.
C) The managed care organization decides what services are "medically necessary."
D) The managed care organization only pays for services provided by the PCP.
Q2) The major benefit of a flexible benefit (medical savings) account is:
A) Funds are set aside on a pretax basis.
B) Nondisbursed funds are rolled over to the next year.
C) It enables employees to participate in an HMO.
D) It decreases health care costs.
Q3) The process of determining the most accurate DRG payment is ___________.
Q4) What is meant by "resource intensity"?
Q5) CMS's prospective payment system for hospital-based ambulatory care is based on
Q6) Referring to health care provider fees, the rate established by an insurance company, based on the regional charges for the particular service, is called
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Chapter 8: Health Information Management Issues in Other Care Settings
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Sample Questions
Q1) The physical location of the specialists who analyze body fluids is the ________.
Q2) What is the first step in the patient encounter?
A) Making the appointment
B) Collecting health insurance information
C) Being examined by triage nurse
D) Being examined by primary health care provider
Q3) Describe the unique data collection issues in rehabilitation.
Q4) The following are types of physician specialties that can be found in a primary care group practice EXCEPT:
A) Dermatologist
B) Pediatrician
C) Gynecologist
D) Anesthesiologist
Q5) All of the following services may be provided in a physical medicine and rehabilitation facility EXCEPT:
A) Industrial rehabilitation
B) Recreational therapy
C) Substance abuse rehabilitation
D) Vocational counseling
Page 10
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Chapter 9: Managing Health Records
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Sample Questions
Q1) If you have 12,000 records to file, averaging 2 inches per chart, how many inches of file space do you need? How many shelf units (eight shelves per unit, 36 inches wide) would you need?
Q2) Patient health records, whether in paper or electronic form, should be retained for all of the following purposes EXCEPT:
A) Physician's licensing
B) Facility accreditation
C) Insurance reimbursement
D) Continuation of patient care
Q3) To prepare for unexpected events such as a bomb threat, hurricane, or flood, a facility should routinely exercise:
A) Confidentiality
B) Release of information
C) Disaster planning
D) Code blue
Q4) A _____________is used to identify the location of records within a facility.
Q5) ______________ is a method for planning and preparing to handle catastrophes and other emergencies that can adversely affect the normal performance of the health care environment.
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Chapter 10: Statistics
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Sample Questions
Q1) What is the mean for the following frequency distribution: 10, 15, 20, 25, 25?
A) 25
B) 10
C) 20
D) 19
Q2) A measure of variance called the ______________ shows how closely the observations are distributed around the mean.
Q3) The result of a query is also known as a _____________.
Q4) The blood pressure of patients discharged in June 2011 with a diagnosis of hypertension was reviewed. The 36 samples are below. The diastolic pressures (in mm Hg) were as follows:
88 98 78 84 77 81 90 82 75 72 100 92
85 92 77 84 77 82 92 87 74 80 95 90
87 80 83 77 86 80 88 90 79 82 93 88
What is the mode?
A) 77
B) 85
C) 28
D) 100
Q5) The length of stay for Patient E is _______________.
Page 12
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Chapter 11: Quality and Uses of Health Information
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Sample Questions
Q1) A quality improvement effort regarding completion of the patient advance directive would require an _______________ team.
Q2) The review of the record performed postdischarge is known as _________.
Q3) Some HIM departments sometimes choose to perform concurrent review instead of retrospective review, most likely because:
A) Concurrent review is more time efficient.
B) Retrospective review is more time efficient.
C) Retrospective review cannot affect care for patients who have already been discharged.
D) Concurrent review cannot affect care for patients who have already been discharged.
Q4) Which of the following is an internal use of health information?
A) To develop health care products.
B) To influence national policy on health care issues through legislation.
C) To support and collect reimbursement.
D) To supply vital statistics to public health agencies.
Q5) The level of detail with which data is collected is known as __________.
Q6) Define and explain the three quality management theory methods.
Q7) What is the NCQA and its mission?
Page 13
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Chapter 12: Confidentiality and Compliance
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Sample Questions
Q1) Compare and contrast privacy, security, and confidentiality. Provide an example of each in a health care situation.
Q2) What is jurisdiction? List examples of issues over which municipal, state, and federal courts may have jurisdiction.
Q3) What are the five major categories of HIPAA legislation? What is the difference between the Privacy rule and the Security rule?
Q4) Some of the following are common safeguards that prevent confidentiality breaches EXCEPT:
A) Automatic log-offs
B) Sharing of passwords among health care providers
C) Screen saver
D) Mandatory password updates
Q5) How are security breaches in electronic health records tracked?
A) Audit trails
B) Indexing
C) All health care personnel should have access to all patient medical records.
D) None of the above
Q6) Under what circumstances will a release of information be denied? Name at least four.
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Chapter 13: Him Department Management
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Sample Questions
Q1) All of the following administration chiefs are subordinate to the Chief Executive Officer EXCEPT the:
A) COO
B) CIO
C) CNO
D) CEO
Q2) Managers perform __________ to look for ways to streamline tasks and functions in the HIM department.
A) workflow analysis
B) systems development life cycle
C) performance improvement plans
D) employee evaluation
Q3) ____________ is the amount of work produced by an employee in a given time frame.
Q4) To maintain a high-quality HIM department, the supervisors and managers should:
A) Monitor employee dress code.
B) Continually evaluate the functions of the HIM department on the basis of the goals and standards set.
C) Convert to concurrent processing.
D) Never promote from within.
Page 15
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Chapter 14: Training and Development
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Sample Questions
Q1) What subjects has AHIMA deemed core content for the HIM profession? Name at least five and detail how to obtain continuing education for these core content subjects.
Q2) An excellent way to keep track of everything that must be covered with a new employee is to complete an __________.
Q3) Patient health information should be _________ in an appropriate method to employees on a need-to-know basis in accordance with HIPAA regulations and health care facility policy.
Q4) Many facilities require a training session before new employees are given access to their computer systems, and TJC requires that new employees complete this training within _____ days.
Q5) HIM department employees are in constant need of continuing education. Identify specific continuing education needs for the following HIM employees: credentialed employees, coding employees, release of information.
Q6) The first item on the monthly HIM department meeting agenda is:
A) Call to order
B) Review of old business
C) New business
D) Adjournment
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