Health informatics is both a ___________ as well as a(n) ____________.
discipline; field of study
profession; practice
field of study; art
profession; discipline
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.
Question 2
2 / 2 pts
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 ____________ to _____________ cases
per year.
4.4 million; 8.8 million
440,000; 880,000
1 million; 5 million
40,000; 100,000
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.
Question 3
2 / 2 pts
The top three uses of the U.S. Army’s telehealth network include all of the following EXCEPT
________________.
behavioral telehealth
cardiology
otolaryngology
dermatology
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.
IncorrectQuestion 4
0 / 2 pts
Which of the following statements about EHRs is false?
The percentage of hospitals using an EHR jumped from 59% to 75% from 2013 to 2014.
Stage 2 is the minimum level of EHR required in order to be counted as using EHR.
By 2014 50% of physicians in the United States had implemented an EHR, with another 13% in the
process of implementing one.
There were no EHR systems in U.S. hospitals in 2009.
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.
Question 5
2 / 2 pts
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:
dynamic homeostasis.
semi-planned change.
negentropy.
reverberation.
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.
Question 6
2 / 2 pts
Which statement describes the measurement of information as defined by the Shannon and Weaver
model?
The amount of information is measured by the amount of data in the message.
The amount of information is measured by the number of meanings that can be assigned to a message.
The amount of information is measured by the extent the message decreases entropy.
The amount of information is measured by the number of characters used to create the message.
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.
Question 7
2 / 2 pts
What is the primary difference between an open and closed system?
An open system has no boundary, and therefore there are no limits to the inputs and outputs between
an open system and the environment.
An open system has a semipermeable boundary and therefore will filter both inputs and outputs when
interacting with the environment.
A closed system has a semipermeable boundary and therefore will filter both inputs and outputs when
interacting with the environment.
A closed system does not have a boundary and therefore will not interact with the environment.
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.
Question 8
2 / 2 pts
On its own, the number 190 is an example of:
data.
information.
knowledge.
wisdom.
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.
Question 9
2 / 2 pts
Which group will test out new technology but are not usually seen as leaders within an organization?
Innovators
Early adopters
Early majority
Late majority
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.
Question 10
2 / 2 pts
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:
the reiterative feedback loop.
linearity.
preordained periodic behavior.
the fractionation of outputs.
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.
Question 11
2 / 2 pts
A facility calls in experts to review evidence developed in research and develop guidelines for clinical
practice. Which stage of EBP is represented?
Evidence summary
Evaluation of process and outcomes
Practice integration
Translation to guidelines
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).
Question 12
2 / 2 pts
Which type of review is considered the most rigorous?
Literature reviews
Systematic reviews
Integrative reviews
Single study reviews
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.
Question 13
2 / 2 pts
Knowledge is the point of convergence across the areas of:
evidence-based practice, quality assurance, and informatics.
evidence-based practice, improvement, and informatics.
evidence-based practice, quality assurance, and improvement.
improvement, quality assurance, and informatics.
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.
Question 14
2 / 2 pts
Your organization hires you to conduct a formative evaluation of a new informatics intervention. Which
areas would you focus on in a formative evaluation?
Cost, patient safety, and patient outcomes
Intervention fidelity, implementation quality, and types of personnel
Errors, change in provider decision making, and cost
Unintended outcomes, delays in implementation, and cost
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.
Question 15
2 / 2 pts
Of the following, which of these steps in the CDC’s six-step program evaluation framework comes first?
Gather credible evidence
Focus the evaluation design
Justify conclusions
Engage stakeholders
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.
Question 16
2 / 2 pts
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?
Values, normative expectations, others’ beliefs, and overall prior knowledge
Values, beliefs about self-efficacy, normative beliefs, and intrinsic motivation
Values, expectations of others, behaviors, and perceived self-efficacy
Habit, normative expectations, beliefs about resources, and overall prior knowledge
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.
Question 17
2 / 2 pts
In a social network analysis, each node is usually a(n):
individual or unit of analysis.
event.
location.
interaction.
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.
Question 18
2 / 2 pts
The stages of change identified in diffusion of innovation theory are:
contemplation, persuasion, action, and knowledge.
knowledge, persuasion, decision, implementation, and confirmation.
awareness, understanding, action, implementation, and engagement.
contemplation, decision, action, and knowledge.
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.
Question 19
2 / 2 pts
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?
Social
Perception
Comprehension
Projection
Projections are expectations of outcomes in the future. Projections are driven by implicit theories and
knowledge about the causal mechanisms underlying events.
Question 20
2 / 2 pts
You are leading an effort to implement a clinical decision support system. In order to improve the patient
specificity of your CDS rules, you would:
make sure that rules cannot be changed once they are implemented.
give the results of the rules directly to the patient.
store rules in a knowledge base and allow clinician experts to review and update the rules.
ensure that the rules were written in the most up-to-date programming language available.
In order to improve CDS rules, you would store rules in a knowledge base and allow clinician experts to
review and update the rules. The other choices do not address patient specificity; allowing experts to
update rules and make the rules immediately available to the CDS can improve patient specificity.
Question 21
2 / 2 pts
Which example best describes knowledge base content?
Standard admission order sets based on presenting problems
Patient contact information
Organizational structure of a healthcare enterprise
The most recent lab results for current inpatients
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.
Question 22
2 / 2 pts
For healthcare infrastructures with many communicating systems, an interface engine is helpful because:
it increases the administrative overhead with maintaining interfaces.
it decreases the number of interfaces that must be maintained and lessens complexity.
there is no other way to connect systems.
interface engines automatically update and rewrite the code built within legacy systems.
An interface engine is helpful because it decreases the number of interfaces that must be maintained
and lessens complexity. The other choices do not accurately describe the use of an interface engine, the
ability to connect systems, or regulatory requirements.
Question 23
2 / 2 pts
A method for exchanging patient data among healthcare organizations that is endorsed by the federal
government is:
copying information to a secure USB drive and giving it to another organization.
providing EHR log-in accounts to providers outside the organization.
implementing a secure internet connection using components of the eHealth Exchange.
The federal government does not endorse sharing health information among organizations.
The eHealth Exchange (formerly the Nationwide Health Information Network) is a method for
exchanging data endorsed by the federal government and used by organizations from all 50 states as
well as four federal agencies. The other methods listed are not considered safe and confidential, and the
federal government does endorse health information sharing.
Question 24
2 / 2 pts
Which statement describes a repository with central storage of a longitudinal record?
Patient data are from a single hospital’s data for the most current encounters.
Data from multiple hospitals are kept compact and efficient by deleting “old” data.
Portions of a patient’s lifetime medical record are stored in databases at the facility where the data were
collected.
The information collected by the organization is stored in a single database no matter when or where the
patient was seen.
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.
Question 25
2 / 2 pts
Which system is recommended as a method to address patient safety and reduce errors that occur
during the actual administration of medicines?
Computerized provider order entry (CPOE)
Barcode medication administration (BCMA)
Electronic medication administration record (eMAR)
Electronic prescribing (ePrescribing)
Barcode medication administration (BCMA) is a method used to address patient safety and reduce errors
that occur during the actual administration of medicines. CPOE is used to decrease transcription errors
during the ordering process. ePrescribing is also used by the physician to order the medication (not
administer). The eMAR is used to document the medications that are given.
Question 26
2 / 2 pts
Which would be considered a niche application?
Computerized provider order entry (CPOE)
Laboratory information system (LIS)
Clinical decision support system (CDSS)
Surgical information system (SIS)
Some examples of specialty department niche systems include perioperative or surgical services,
maternity care, neonatal intensive care, and the emergency department. The LIS is an ancillary system.
CPOE and CDSS are basic components of the EHR.
Question 27
2 / 2 pts
A university hospital wants to implement a closed-loop medication management system. Current
systems include registration, computerized provider order entry, electronic medication administration
record, laboratory, radiology, and pharmacy. Which system is needed to complete the loop?
Clinical documentation
Clinical decision support system
Barcoding system
Electronic prescribing
A closed-loop medication management system would connect the pharmacy system to the CPOE, eMAR,
and barcoding systems.
Question 28
2 / 2 pts
The Health Information Management Systems Society (HIMSS) developed an EMR adoption model that
includes eight stages toward creating a paperless patient record environment. All application capabilities
within each stage must be operational before the next stage can be achieved. Your organization has
implemented systems for Stages 1 and 2. Which system should your organization consider as Stage 3
adoption?
Computerized provider order entry (CPOE) and clinical decision support
Nursing/clinical documentation (flow sheets) and clinical decision support
Closed-loop medication administration
Physician-structured documentation and clinical decision support
Stage 1 includes the installation of ancillaries (lab, radiology, pharmacy). Stage 2 includes clinical data
repository (CDR), controlled medical vocabulary, and clinical decision support system (CDSS) and may
also include document imaging and health information exchange. Stage 3 would require clinical
documentation (flow sheets), CDSS (error checking), and a picture archiving system (PACS) available
outside radiology.
Question 29
2 / 2 pts
Return on investment (ROI) in financial information systems (FISs) is challenging because:
patient accounting is considered an intangible asset.
FIS systems are very complex.
FISs often lose money due to complexity.
staff requires substantial training, which is very costly.
Decision makers may have a more challenging time realizing the return on investment or understanding
the importance of the investment in FISs, since information technology software applications, such as
patient accounting or revenue, are considered intangible assets.
Question 30
2 / 2 pts
Materials management in the healthcare environment involves all of the following EXCEPT:
inventory control of supplies and equipment.
logistics management and pipelines.
the operational management of items used in the delivery of patient care.
the storage of pharmaceuticals.
Materials management is a subset within supply chain management that focuses on the storage,
inventory and quality control, and operational management of supplies, pharmaceuticals, equipment,
and other items used in the delivery of patient care or managing the patient care system. Logistics
involves the flow of goods and services from the point of origin to the point of consumption and thus
falls outside the realm of materials management.
Question 31
2 / 2 pts
A vendor master file is:
a list of federally approved pharmaceutical companies.
a list of suppliers used by the organization.
a list of criteria for supplier compliance.
a list of EHR vendors.
The terms vendor and supplier are synonymous, so a vendor master file is a list of suppliers used by the
organization.
Question 32
2 / 2 pts
Open shift management:
refers to a theory of peer-based leadership in which no single person is in charge.
forecasts openings in the schedule using predictive models.
refers to a form of scheduling expediency in which staff qualifications are not considered when making
scheduling assignments.
is a form of web-based self-scheduling.
Open shift management uses web-based technologies to allow employee self-scheduling. Other terms
used include shift bidding systems. These systems allow employees to sign up for open shifts over the
internet.
Question 33
2 / 2 pts
Which government organization manages the largest telehealth program in the United States as of this
writing?
Department of Defense
NASA
Department of Veterans Affairs
Office for the Advancement of Telehealth
The Department of Veterans Affairs manages the largest telehealth program in the United States. The
remaining responses are incorrect.
Question 34
2 / 2 pts
The migration of informatics and telehealth toward uHealth means:
ecosystems of interoperable technologies and services organized to meet global patients’ needs in a
ubiquitous manner.
an approach toward underground installation of fiber optics and cable networks organized to meet
global patients’ needs in a ubiquitous manner.
conversion to a consumer-driven global healthcare model with localized implementation.
a sharp reduction in university programs for training healthcare providers to meet global patients’ needs.
The migration of informatics and telehealth toward uHealth means ecosystems of interoperable
technologies and services will be organized to meet global patients’ needs in a ubiquitous manner.
Question 35
2 / 2 pts
The development of telemedicine and telehealth across state lines has been most hampered by:
low levels of patient trust.
the STEP Act.
the need to obtain licenses to practice in each state in the network.
HIPAA.
Regulating the delivery of healthcare services is the domain of each individual state. A medical
professional who is licensed in one state may not be legally permitted to practice his or her profession in
another state without getting a license there as well.
Question 36
2 / 2 pts
The first use of telehealth was documented in:
1897.
1935.
1999.
2002.
The first use of telehealth was documented in 1897, when a case of croup was diagnosed over the
telephone.
Question 37
2 / 2 pts
When did formalized home health and community-based systems originate in the United States?
1776
1800s
1965
2001
Early home health services originated in the United States in the 1800s and were based on the district
nursing model developed in England. Often, initial programs evolved into visiting nurse associations.
Home health services increased and changed considerably after Medicare was enacted in 1965.
Question 38
2 / 2 pts
Which payer is the largest for home health services?
Private insurance
Patients and families in the form of self-pay
Medicare
Medicaid
As the largest payer, Medicare, through its Conditions of Participation, represents the standard for the
services provided by home health agencies and the payment for these services by many commercial
insurance payers and state Medicaid programs.
Question 39
2 / 2 pts
Which group would have a financial incentive to implement CDS?
A community hospital
An inner-city clinic
A national insurer
Depends on CDS and healthcare payment model
Whether a particular stakeholder group has a financial incentive to implement CDS depends on the
specific CDS under consideration and the governing healthcare payment model in place.
Question 40
2 / 2 pts
Which statement is not part of the Ten Commandments of CDS?
Speed is everything.
Fit into the user’s workflow.
Alerting is the most effective approach to CDS.
Ask for additional information only when you really need it.
The Ten Commandments of CDS include speed is everything, fit into the user’s workflow, and ask for
additional information only when you really need it. Alerting may not be the most effective approach to
CDS as it may cause alert fatigue, so it is not one of the Ten Commandments of CDS.
Question 41
2 / 2 pts
Which incentive has the strongest potential to spur the nationwide adoption of advanced CDS?
Freely available CDS knowledge in a machine-executable form
Significant government funding for research efforts to share CDS
Shift of healthcare payment from a fee-for-service model to approaches rewarding the delivery of better
quality and outcomes at lower cost
Meaningful Use Stage 1 requirements related to CDS
All of these are important elements encouraging nationwide adoption of advanced CDS. However, as
discussed in the chapter, the shift of healthcare payment from a fee-for-service model to approaches
rewarding the delivery of better quality and outcomes at lower cost appears to have the strongest
potential for change.
Question 42
2 / 2 pts
You are asked to justify the creation of the first public health informatics (PHI) program in your
jurisdiction by emphasizing its actual benefits. One such benefit is that:
current PHI can enhance public health surveillance such as identifying clusters of diseases.
privacy and security issues are avoided because public health informatics data are de-identified at the
community level.
interoperability already exists for public health IT.
standards already exist for PHI.
While all four options are relevant issues in PHI, only the fact that PHI can identify and target clusters of
diseases for treatment and action is an actual benefit (or “plus”) to the community of adding this new
program.
Question 43
2 / 2 pts
All of the following are core functions of public health except:
assessment.
policy development.
treatment.
assurance.
Public health is focused on prevention and the health of populations before they are injured or ill; clinical
care, not public health, involves treating individuals.
Question 44
2 / 2 pts
The public health supply chain needs to evolve to an information ecology approach. This would involve:
standardizing public health supplies and suppliers.
being partners with others to receive, reuse, and republish data.
allowing public health departments to exclude data sharing to protect patient privacy.
allowing public health departments to include data sharing to protect patient privacy.
Information ecology involves the reuse and sharing of data.
Question 45
2 / 2 pts
Public health systems have implemented vocabulary and messaging standards, are used to make public
health decisions in a clinical setting, and provide data for public health policy. One of the best examples
of a public health system that does all of these is:
the linkage of local electronic health records in the 50 states to public health reporting databases.
immunization information systems.
geographical informatics systems for reporting environmental issues.
direct lab reporting of conditions and diseases such as lead poisoning.
Immunization information systems exemplify public health systems that implement vocabulary and
messaging standards, that are used to make public health decisions in a clinical setting, and that provide
data for public health policy. The others lack one or more of the stated elements.
Question 46
Not yet graded / 10 pts
What actions can individual healthcare providers take in the next 3 years to advance the benefits of
telehealth for their professions?
