Domain 3 Data analytics and informatics

295. When describing the typical length of stay for patients admitted for congestive heart failure, which is the most appropriate measure of central tendency when there are a number of long stay outliers? a. Minimum b. Mean c. Median d. Mode

295. c If the sample has extreme values on either the high or low end of the scale, then the median may be the better choice for describing the center of the distribution. The median is less influenced by outliers (White 2020b, 509).

296. Which work measurement tool uses random sample observations to obtain information about the performance of an entire department? a. Performance measurement b. Work distribution c. Work sampling d. Performance controls

296. c Work sampling is a technique of work measurement that involves using statistical probability (determined through random sample observations) to characterize the performance of the department and its work (functional) units (Oachs 2020, 775).

297. In addition to bar codes on health record documents, what other forms of recognition characteristics enhance the accuracy of form indexing features? a. Access controls b. COLD c. OCR d. Workflow

297. c In addition to bar codes on medical record documents, optical character recognition (OCR) may be available to enhance the accuracy of indexing features on forms (Lee-Eichenwald 2020, 363).

298. All of the following are a kind of technology that focuses on data security except: a. Encryption b. Biometrics c. Firewalls d. Telemedicine

298. d Firewalls, encryption, and biometrics are technologies used to enable security in healthcare information systems. Telemedicine is not a technology used to enable security (Sayles and Kavanaugh-Burke 2018, 231, 233).

299. Which of the following statements is true of structured query language (SQL)? a. It is both a data manipulation and data back-up mechanism. b. It defines data elements and manipulates and controls data. c. It is the computer language associated with document imaging. d. Users are not able to query a relational database.

299. b Structured query language (SQL) includes both data dictionary language and data manipulation language components and is used to create and manipulate relational databases (Sayles and Kavanaugh-Burke 2018, 29).

300. In which of the following processes does an analyst perform exploratory data analysis to determine trends and identify patterns in the data set? a. Data quality b. Data mining c. Record analysis d. Inferential statistics

300. b In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set (White 2020b, 520).

301. A radiology department is planning to develop a remote clinic and transmit images for diagnostic purposes. The most important set of standards to implement for image transmission is: a. X12N b. LOINC c. IEEE 1073 d. DICOM

301. d The Digital Imaging and Communications in Medicine (DICOM) standard supports retrieval of information from imaging devices and equipment to diagnostic and review workstations as well as short-term and long-term storage systems (Amatayakul 2017, 404-405).

302. Protocols that support communication between applications are often referred to as: a. Application program b. Interface code c. Messaging standards d. Source code

302. c Within healthcare, standard protocols that support communication between nonintegrated applications are often referred to as messaging standards, also called interoperability standards or data exchange standards. Messaging standards provide the tools to map proprietary formats to one another and more easily accomplish the exchange of data (Amatayakul 2017, 400-401).

303. Which graph is the best choice when exploring the relationship between length of stay and charge for a set of patients? a. Line graph b. Bar chart c. Pie chart d. Scatter diagram

303. d A scatter diagram is a data analysis tool used to plot points of two variables suspected of being related to each other in some way (Oachs 2020, 789).

304. A single point of personalized web access through which to find and deliver information, applications, and services is called a(n): a. Keyhole b. Entry way c. WWW d. Portal

304. d A web portal is a single point of personalized access (an entryway) through which to find and deliver information (content), applications, and services. Web portals began in the consumer market as an integration strategy rather than a solution. Portals offered users of the large, public Internet service provider websites, fast, centralized access (via a web browser) to an array of Internet services and information found on those websites (Lee-Eichenwald 2020, 365).

213. An organization's productivity standards should reflect its: a. Goals b. Vision c. Procedures d. Affinity groupings

213. a Productivity standards should be aligned with the organization's mission and goals of the organization (Oachs 2020, 772).

214. The fact that a patient entered data into an EHR via a portal is: a. Administrative metadata b. Captured in a data model c. E-discovery d. Software programming

214. a The provenance (or source) of data is considered a form of administrative metadata. The other choices relate to metadata, but are not illustrative of any given form of metadata (Amatayakul 2020, 437-438).

215. Hospitals often use master patient indexes to do which of the following? a. Analyze population-based data b. Determine survival rates c. Evaluate physicians d. Determine whether a patient has been seen in the facility before

215. d Master patient indexes (MPI) contain important patient health information enabling facilities to retrieve patient health data quickly. The MPI allows a hospital to determine whether a patient has been seen in the facility before (Sharp and Madlock-Brown 2020, 177).

212. A coding service had 400 discharged accounts to code in March. The service coded 200 within 3 days, 100 within 5 days, 50 within 8 days, and 50 within 10 days. The average turnaround time for coding in March was: a. 3 days b. 5 days c. 6.5 days d. 9 days

212. b The average turnaround time was calculated by dividing the total response days attributed to the volume of routine requests that were responded to within the reporting period by the volume of routine requests responded to. The calculation is: (200 × 3) + (100 × 5) + (50 × 8) + (50 × 10)/400 = 5 days (Oachs 2020, 778).

216. The root cause of poor quality of data in the EHR can be determined by: a. Benchmarking against best practices b. Determining patient mortality rates c. Measuring patient care outcomes d. Observing how an EHR is used

216. d Observing how an EHR is used, such as whether comment fields are frequently used when structured data should have been used or first choice in a list is selected over a choice that is more specific, is the best way to determine root cause of poor quality of data. Other choices may be indicators of poor quality but also include other factors as well (Amatayakul 2020, 439).

217. Which statistical inference measures both the strength of a relationship between two variables and the functional relationship between them? a. Correlation b. T-test c. Simple linear regression d. Standard deviation

217. c Simple linear regression (SLR) is another type of statistical inference that not only measures the strength of the relationship between two variables, but also estimates a functional relationship between them. SLR may be used when one of the two variables of interest is dependent on the other (White 2020b, 517).

218. Which of the following is a task performed during system customization? a. Adjusting decision support rules b. Data conversion c. Testing d. Workflow and process improvement

218. a System customization enables an organization to make adjustments to how software is used and displayed. Adjusting decision support rules (such as turning them off, or narrowing the specifications for a given rule) are made possible by vendor-supplied tools that do not impact the underlying software (Amatayakul 2020, 427).

219. An example of EHR data stewardship that would be required of the average healthcare professional is: a. Contributing to the design and development of data requirements for an EHR b. Ensuring that structured data is entered when such a choice is available in an EHR c. Maintaining EHR data in an appropriately configured information system d. Not sharing EHR data with others who have a need to know

219. b Stewardship refers to taking care of something you own or have been entrusted with. Given the choices here, EHR data stewardship is exemplified by ensuring proper data entry; contributing to design and maintaining data in an information system are beyond the requirements of the average healthcare professional and not sharing data appropriately is actually not good data stewardship (Amatayakul 2020, 438-439).

220. HIE ________ is concerned with the establishment of a shared set of behaviors and standards that enable health information exchange among a HIE's participants. a. Governance b. Trust community c. Workflows d. Interoperability standards

220 a Agreeing on standards and how they are to be implemented for successful mapping between systems is an important part of governance (Lee-Eichenwald 2020, 387).

221. In order to effectively transmit healthcare data between a provider and a payer, both parties must adhere to which electronic data interchange standards? a. DICOM b. IEEE 1073 c. LOINC d. X12N

221. d X12N refers to standards adopted for electronic data interchange. In order for transmission of healthcare data between a provider and payer, both parties must adhere to these standards (Sayles and Kavanaugh-Burke 2018, 211).

222. The surgery department is evaluating its postoperative infection rate of 6 percent. The chief of surgery asks the quality improvement coordinator to find the postoperation infection rates of 10 similar hospitals in the same geographic region to see how the rates compare. This process is called: a. Benchmarking b. Critical pathway analysis c. Internal comparisons d. Universal precautions

222. a Benchmarking is the systematic comparison of the products, services, and outcomes of an organization with those of a similar organization. Benchmarking comparisons also can be made using regional and national standards or some combination (Shaw and Carter 2019, 42).

223. The statement "Coding of inpatient records must be completed at a 98 percent accuracy rate" is an example of a: a. Goal b. Vision statement c. Qualitative standard d. Quantitative standard

223. c Qualitative standards specify the level of service quality expected from a function, such as accuracy rate. For example, assignment of diagnostic and procedure codes for inpatient records is at least 98 percent accurate (Oachs 2020, 772).

224. To ensure quality of data, the cancer committee reviews the abstracting done by the cancer registry personnel. This type of reliability check is called: a. Precision b. Recheck c. Interrater d. Construct

224. c Reliability is frequently checked by having more than one person abstract data for the same case. The results are then compared to identify any discrepancies. This is called an interrater reliability method of checking. Several different people may be used to do the checking. In the cancer registry, physician members of the cancer committee are called on to check the reliability of the data (Houser 2020, 571).

225. A clinic that is expanding its service offerings and needs an individual to help design a new database will be searching for a: a. Data administrator b. Database administrator c. Data governance manager d. Data technologist

225. a A data administrator focuses on understanding interrelationships among data in order to prepare a logical design for a database. A database administrator is an information technology specialist in database implementation and maintenance. Data governance managers are, typically, users of databases. Data technologist is not a commonly used job title, but it may be one who manages metadata (Amatayakul 2020, 414).

226. A researcher mined the Medicare Provider Analysis Review (MEDPAR) file. The analysis revealed trends in lengths of stay for rural hospitals. What type of investigation was the researcher conducting? a. Content analysis b. Effect size review c. Psychometric assay d. Secondary analysis

226. d Secondary analysis is the analysis of the original work of others. In secondary analysis, researchers reanalyze original data by combining data sets to answer new questions or by using more sophisticated statistical techniques. The work of others created the MEDPAR file (Houser 2020, 563).

227. A data model is used to: a. Define every data element in an information system b. Describe how data are used in creating information c. Display information to users in a meaningful way d. List the attributes of data

227. b A data model is an important part of describing how data will be processed. It has other uses as well, but the model itself does not define the data, show how it is displayed, or list attributes. Most of these functions are performed by a data dictionary (Amatayakul 2020, 437).

228. A way to assess the quality of data in the EHR is to: a. Audit structured data entries b. Compare data in the EHR to dictated documents c. Determine an acceptable error rate d. Review data against established norms

228. a Auditing structured data can reveal a number of potential data quality issues, such as when all choices for a structured field are the same, when a structured field is often empty. Comparing data in the EHR to dictated documents is an extremely time-consuming process and would only be used after auditing structured data; there are virtually no established norms for quality specific to a given data element, and determining an acceptable error rate is not an assessment of quality (Amatayakul 2020, 439).

229. A healthcare facility has decided to adopt a tool that helps with multidisciplinary care planning. What tool meets these criteria? a. Clinical pathways b. Clinical practice guidelines c. Clinical provider order entry d. Electronic health record

229. a Clinical pathways are a tool designed to coordinate multidisciplinary care planning for specific diagnoses and treatments (Sayles and Kavanaugh-Burke 2018, 6).

230. Which of the following statements justifies the use of a dashboard? a. It facilitates budget development. b. It manages information system projects. c. It utilizes statistical techniques. d. It monitors key measures.

230. d Dashboards are reports of process measures to help leaders follow progress to assist with strategic planning. The dashboard provides the status on key measures (Sayles and Kavanaugh-Burke 2018, 8).

231. The performance standard "Complete five birth certificates per hour" is an example of a: a. Quality standard b. Quantity standard c. Joint Commission standard d. Compliance standard

231. b Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions. In the scenario, completing five birth certificates per hour is identifying the quantity of work rather than how well the work is being performed so it is a quantity standard (Oachs 2020, 773).

232. This type of chart is used to focus attention on any variation in a process and helps the team to determine whether that variation is normal or a result of special circumstances. a. Pareto chart b. Pie chart c. Control chart d. Line chart

232. c Control charts can be used to measure key processes over time. Using a control chart focuses attention on any variation in a process (Shaw and Carter 2019, 88-89).

233. The decision has been made to perform data mining to determine where the skilled nursing facility is profitable and where there is a loss. Identify a data mining technique that could be used. a. Association rule learning b. Normalization c. Computer-aided software engineering d. Data modeling

233. a Association rule learning is a type of data mining identifies interesting relationships between two concepts in the database. For example, it may identify that patients who are treated with drug A have a better outcome than patients who are treated with drug B (Sayles and Kavanaugh-Burke 2018, 38).

234. Tina is the EMPI coordinator for Smithtown Healthcare, a large medical center with many satellite clinics. Because so many patients visit the clinics, sometimes new health record numbers are mistakenly assigned to them (even though they may already have a number) when they register for a particular service. As the EMPI coordinator, Tina performs all of the following tasks as part of her regular job duties except: a. Unmerging overlays b. Merging duplicate records c. Confirming the health record contains all patient visits d. Verifying insurance status

234. d The challenge for facilities is to maintain a correct and current MPI so that each patient has a unique identifier number. Duplication and overlays and overlap are major problems. Healthcare facilities have hired HIM professionals as EMPI coordinators to clean and maintain EMPI systems to ensure that the correct information on the correct patient is available to the provider and others who need it. Verifying insurance status would not be part of the job duties of an EMPI coordinator (Reynolds and Morey 2020, 132).

235. What type of interoperability addresses the medical words, phrases, and terms used in healthcare and their definitions so that there is clear and consistent usage among all EHR systems? a. Process b. Technical c. Semantic d. Syntactic

235. c This process involves the use of standardized terminologies, such as SNOMED-CT, to provide clarity, consistency, and appropriate meaning in HIE (Sayles and Kavanaugh-Burke 2018, 183).

236. What component of an EHR provides communication between clinical and administrative staff members, offers access to various results reporting from lab and radiology, and even communicates with patients? a. Clinical messaging b. Clinical decision support c. Document management system d. Registration—admission, discharge, transfer

236. a Clinical messaging is the function of electronically delivering data and automating the workflow around the management of clinical data. Clinical messages can use e-mail, portals, virtual private networks, and other means to provide the secure means of communication needed for patient information. These messages are shared in such a way as to protect the privacy of the patient (Sayles and Kavanaugh-Burke 2018, 154).

237. The HIM director is performing a staffing analysis to determine the number of employees needed to prep, scan, index, and carry out quality control on scanned medical records. Given a turnaround time of 24 hours and an average number of 48,000 images to be captured and considering the benchmarks listed here, what is the least number of employees the department needs, with each employee working an eight-hour shift? a. 25 employees b. 36 employees c. 36.1 employees d. 37 employees

237. a The staffing level is determined by dividing the number of images by the expected productivity. An FTE is the total number of workers, including part-time, in an area as the equivalent of full-time positions. Divide 48,000 by maximum standard work per hour for each function then add up the calculated hours for each function and divide by 8 (White 2020a, 157).

294. Laboratory data are successfully transmitted back and forth from Community Hospital to three local physician clinics. This successful transmission is dependent on which of the following standards? a. X12N b. LOINC c. RxNorm d. DICOM

294. b LOINC is set of terminology standards that provide a standard set of universal names and codes for identifying individual laboratory and clinical results (Palkie 2020a, 159).

238. Keith is the supervisor of the MPI and chart deficiency review staff in the HIM department, which also includes being the liaison for the billing department and the R-ADT staff. He frequently meets with Michael, the R-ADT supervisor, to discuss methods to combat healthcare fraud and to verify that the patients are who they say they are and that they have the appropriate documentation for verification. This process is called: a. Consent management b. Identity management c. Identity matching d. Patient identification

238. c Identity matching (also known as patient matching) is the process in which the facility identifies the right person within the database to exchange information between healthcare organizations. The process examines different demographic elements from different health information technology systems to determine if they refer to the same patient (Sayles and Kavanaugh-Burke 2018, 195).

239. How are employee performance standards used? a. To communicate performance expectations b. To assign daily work c. To describe the elements of a job d. To prepare a job advertisement

239. a Standards that are measurable and relevant to an employee's overall performance are helpful in setting clear expectations. They also are useful in providing constructive feedback (LeBlanc 2020, 701).

240. What is the term for health records maintained by patients or their families? a. Electronic health records b. Mixed-media records c. Personal health records d. Longitudinal health records

240. c Personal health records electronically populate elements or subsets of protected health information (PHI) from provider organization databases into the electronic records of authorized patients, their families, other providers, and sometimes health payers and employers. A range of people and groups maintain the records, including the patients, their families, and other providers (Reynolds and Morey 2020, 117).

241. What sets the acceptable level of quantity and quality for each function of a job? a. Performance standards b. Position descriptions c. Job procedures d. Job evaluation

241. a Performance standards are often developed for the key functions of the job and set the quantity and quality for each job function (LeBlanc 2020, 700).

242. The following table shows the LOS for a sample of 11 discharged patients. Using the data listed, calculate the range. a. 29 b. 1 c. 5 d. 28

242. d The range is the simplest measure of spread. It is the difference between the smallest and largest values in a frequency distribution: Range = xmax - xmin For this scenario, the range is 1 to 29 (29 - 1) or 28 (White 2020a, 182).

243. Which application uses statistical techniques to determine the likelihood of certain events occurring together? a. Predictive modeling b. Standard deviation c. T-test d. Serial numbering

243. a Predictive modeling applies statistical techniques to determine the likelihood of certain events occurring together (White 2016a, 7-8).

244. The following question was typed into the system: How many patients were discharged on November 12, 2020? This is an example of what type of query? a. Data manipulation language b. Structured query language c. Query by example d. Natural language query

244. d Natural language queries use common words to tell the database which data are needed (Sayles and Kavanaugh-Burke 2018, 29).

245. The generic formula for calculating rate of occurrence is used to calculate hospital-acquired infections in an intensive care unit in a given month. If the number of hospital-acquired infections is the numerator, the denominator would be the: a. Number of patients who died of infection b. Number of deaths in the ICU c. Number of discharges (including deaths) of ICU patients d. Total number of hospital discharges

245. c Hospital-acquired (nosocomial) infection rates may be calculated for the entire hospital or for a specific unit in the hospital. They also may be calculated for the specific types of infections. Ideally, the hospital should strive for an infection rate of 0.0 percent. The formula for calculating the hospital-acquired, or nosocomial, infection rate is: Total number of hospital-acquired infections for a given period/Total number of discharges, including deaths, for the same period × 100 (Edgerton 2020, 490).

246. A hospital allows the use of the copy functionality in its EHR system for documentation purposes. The hospital has established explicit policies that define when the copy function may be used. Which of the following would be the best approach for conducting a retrospective analysis to determine if hospital copy policies are being followed? a. Randomly audit EHR documentation for patients readmitted within 30 days. b. Survey practitioners to determine if they are following hospital policy. c. Institute an in-service program for all hospital personnel. d. Observe the documentation practices of all clinical personnel.

246. a Auditing a random selection of EHR documentation would be the best approach for avoiding selection bias and in determining how the copy function is being used (Houser 2020, 562).

247. This type of data display tool is used to illustrate frequency distributions of continuous variables, such as age or length of stay (LOS). a. Bar graph b. Histogram c. Pie chart d. Scatter diagram

247. b A histogram is used to display a frequency distribution. It is different from a bar graph in that a bar graph is used to display data that fall into groups or categories (nominal or ordinal data) when the categories are noncontinuous or discrete (Marc 2020, 538).

248. How long should the master patient index be maintained? a. For at least 5 years b. For at least 10 years c. For at least 25 years d. Permanently

248. d The master patient index (MPI) is a permanent database including every patient ever admitted to or treated by the facility. Even though patient health records may be destroyed after legal retention periods have been met, the information contained in the MPI must be kept permanently (Reynolds and Morey 2020, 132).

249. Due to an influenza epidemic in Smithtown, the hospital is almost at full capacity. Which information system would be used to efficiently manage resources such as personnel, beds, and appointments of surgeries and CT scans, to coordinate equipment and staff as needed? a. Registration—admission, discharge, transfer b. Financial c. Scheduling d. Administrative

249. c Scheduling systems are used to control the use of resources throughout the healthcare facility. These resources can include staff, equipment, rooms, and more. Scheduling systems may be centralized or independent (Sayles and Kavanaugh-Burke 2020, 118).

250. An EHR system is programmed by the vendor not to release certain patient data because it is considered proprietary to the vendor and a healthcare organization. The vendor is protecting its own business interests above that of the patient. This is an example of: a. Continuity of care record b. Graphic user interface c. HIPAA security breach d. Health information blocking

250. d Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Blocking stems from healthcare providers or HIT vendors protecting their own proprietary and business interests above the interests of the patient and healthcare improvement. These efforts actively impede the progress sought by the concept of EHRs and health information exchange (Sayles and Kavanaugh-Burke 2018, 150).

251. What trend can be summarized from the line plot shown in the chart? a. The length of stay has increased for hospital A and decreased for hospital B since the first quarter. b. The length of stay for both hospitals decreased during the third quarter. c. The length of stay has decreased for hospital A and increased for hospital B since the first quarter. d. The length of stay for both hospitals increased during the third quarter.

251. c A line plot is used for two main purposes: (1) to present trends or patterns in the number of occurrences between groups or (2) to present trends or patterns in the mean of a variable between groups. Typically, the change of a variable over time is compared. In this case, the trend that can be summarized by this line plot is that the LOS for Hospital B has increased and for Hospital a has decreased since the 1st quarter (Marc 2020, 537).

252. Identify the true statement regarding training. a. A variety of methods should be used to accommodate different learning styles. b. Training should be limited to the information system only. c. Training should be performed a minimum of six months prior to implementation of the information system. d. In order to facilitate training, all employees should receive the exact same training regardless of their position.

252. a People learn best in different ways, such as auditorily and visually. To accommodate these differences, a variety of methods should be used in training (Sayles and Kavanaugh-Burke 2018, 76).

253. An HIM professional was conducting an audit to evaluate the timeframes for the administration of painkillers in surgical patients, and the medication administration record would be reviewed. The medication administration record would be found within which clinical software? a. Nursing b. Laboratory c. Radiology d. Pharmacy

253. a Nursing documentation traditionally includes medication administration record. These records are maintained by nursing staff for all patients and include medication given, time, form of administration, and dose and strength (Reynolds and Morey 2020, 114).

254. What type of data mining technique would be used to group diagnoses? a. Association rule learning b. Anomaly detection c. Regression analysis d. Classification analysis

254. d Classification analysis is a method of identifying important information about the data in the database by grouping data much like grouping diagnoses and procedures Sayles and Kavanaugh-Burke 2018, 38).

255. What term is used for a centralized database that captures, sorts, and processes patient data and then sends it back to the user? a. Clinical data repository b. Data exchange standard c. Central processor d. Digital system

255. a A clinical data repository is a centralized database that captures, sorts, and processes patient data and then sends it back to the user (Amatayakul 2017, 24).

256. Dr. Jones comes into the HIM department and requests that the HIM director provide a list of all of his patients from the previous year in which the principal diagnosis of myocardial infarction was indicated. Which index would the HIM director query from to provide Dr. Jones with this information? a. Disease index b. Master patient index c. Operative index d. Physician index

256. a A disease index is a listing in diagnosis code number order for patients discharged from the facility during a particular time period. Each patient's diagnoses are converted from a verbal description to a numerical code, usually using a coding system such as the International Classification of Diseases (ICD) (Sharp and Madlock-Brown 2020, 178).

257. What elements would you change in the following graph to make the visualization more effective? a. Present the data in a vertical orientation b. Use a dot plot c. Remove the color d. Present the data as a line plot

257. d For data that is presenting changes over time, the preferred presentation method is a line plot (Marc 2020, 537).

258. Which of the following would not be done with a master patient index (MPI) system? a. Merging duplicate health record numbers b. Identifying discharge dates c. Printing outpatient general consent forms d. Looking up health record numbers

258. c The master patient index (MPI) is a patient-identifying directory referencing all patients related to an organization and which also serves as a link to the patient record or information, facilitates patient identification, and assists in maintaining a longitudinal patient record from birth to death (Sayles and Kavanaugh-Burke 2018,115-116).

259. In January, Community Hospital had 57 discharges from its medicine unit. Four patients developed urinary tract infections while in the hospital. What is the hospital-acquired infection rate for the medicine unit for January? a. 0.07% b. 2.17% c. 7% d. 217%

259. c The hospital-acquired infection rate is (4 × 100)/57 = 400/57 = 7.0%. Hospital-acquired (nosocomial) infection rates may be calculated for the entire hospital. They also may be calculated for the specific types of infections. Ideally, the hospital should strive for an infection rate of 0.0 percent (Edgerton 2020, 490).

260. The HIM director is on the design team for the CPOE system. During a user interface design session, a sample of the electronic system is demonstrated. Two of the physicians are concerned about the overuse of alerts. What problem could the alert feature pose in the new system? a. Unnecessary alerts can lead to clinicians ignoring other important alerts. b. Alerts make order entry difficult. c. Physicians do not like to be reminded how to treat patients. d. The Joint Commission discourages an alert system.

260. a The use of CPOE can lead to significant improvements in patient safety because of the reminders or alerts built into the system. Although alerts and reminders are useful, too many become frustrating to the physicians because they have to constantly stop their data entry to address the alerts and reminders (Sayles and Kavanaugh-Burke 2018, 155).

261. Prior to the implementation of the new EHR, the HIM manager is working with the IT analyst in order to improve departmental workflows. They are using structural metadata. This type of data can be used to create which of the following? a. Dataflow diagrams b. Data mapping c. Data audit d. Data architecture

261. a Structural metadata is the process of acquiring, storing, manipulating, and displaying data. Data models, such as entity-relationship diagrams (ERD) and dataflow diagrams (DFD) are diagrammatical or graphic tools used to help program the system and to identify areas of inefficiency (Sayles and Kavanaugh-Burke 2018, 249).

262. Dr. Kotter treats highly unusual medical cases requiring many laboratory, radiology, and other diagnostic tests. Hospital administration wants to determine if additional facilities, personnel, and equipment are needed to meet current and future community demands. Which information system would be helpful in this scenario? a. Decision support system b. Registration—admission, discharge, transfer c. Clinical documentation improvement d. Executive information system

262. a The decision support system (DSS) is an information system that gathers data from a variety of sources and assists in providing structure to the data by using various analytical models and visual tools in order to facilitate and improve the ultimate outcome in decision-making tasks associated with the nonroutine and nonrepetitive problems (Sayles and Kavanaugh-Burke 2018, 109).

263. Which component of the EHR is designed to track and report outbreaks of infectious diseases and childhood immunization levels to public health officials? a. Population health b. Continuity of care record c. Results reporting d. Health information exchange

263. a The population health component in an EHR is designed to capture and report healthcare data that are used for public health purposes. It allows the healthcare provider to report infectious diseases, immunizations, cancer, and other reportable conditions to public health officials. This reporting is required at the local, state, and national levels and includes infectious diseases. A population health system also can connect with public health officials to receive alerts regarding health issues (Sayles and Kavanaugh-Burke 2018, 156).

264. Kelly, the CDI specialist, is evaluating the information used by the coding professionals when they need to code various surgeries. She is particularly interested in the time lag between the actual surgical procedure and the determination of the pathology diagnosis. In which information system would the data element "principal procedure" be found? a. Transcription system b. Encoder/grouper c. Data quality indicator d. Tumor registry

264. b The encoder is specialty software used by coders to select the appropriate code for the diagnosis(es) and procedure(s) supported by the health record. A grouper is a computer program that uses specific data elements to assign the diagnostic and procedural codes entered into the encoder into the appropriate Medicare severity diagnosis-related group (MS-DRG) or other diagnosis-related group (DRG) (Sayles and Kavanaugh-Burke 2020, 89-90).

265. In which type of health information exchange architectural model does the entity operate much like an application service provider (ASP) or bank vault? a. Consolidated b. Federated—consistent databases c. Federated—inconsistent databases d. Switch

265. b The federated architectural type has become more prevalent for health information organizations. There are two forms of this architecture. The consistent federated form is very similar to the consolidated architecture in which the data repository is partitioned but centrally managed. The consistent federated form, however, takes this one step further and physically separates the data but still offers centralized management. Essentially, this is much like an application service provider (ASP) or software as a service (SaaS) model of acquiring software (Amatayakul 2017, 417-418).

266. Community Memorial Hospital discharged nine patients on April 1. The length of stay for each patient is shown in the following table. What is the median length of stay for this group of patients? a. 5 days b. 6 days c. 8 days d. 9 days

266. c The median is the midpoint of a frequency distribution and falls in the ordinal scale of measurement. It is the point at which 50 percent of the observations fall above and 50 percent fall below. If an odd number of observations is in the frequency distribution, the median is the middle number. In this data set, 8 is the middle number (White 2020a, 177).

267. Last year, 73,249 people died from diabetes mellitus in the United States. The total number of deaths from all causes was 2,443,387, and the total population was 288,356,713. Calculate the proportionate mortality ratio for diabetes mellitus. a. 0.003 b. 10.94 c. 0.09 d. 3.0

267. d The proportionate mortality ratio (PMR) is a measure of mortality due to a specific cause for a specific time period. In the formula for calculating the PMR, the numerator is the number of deaths due to a specific disease for a specific time period, and the denominator is the number of deaths from all causes for the same time period. The proportionate mortality ratio for diabetes mellitus = 73,249/2,443,387 = 0.03 × 100 = 3.0% (AHIMA 2017, 192; Edgerton 2020, 476).

268. In what condition is it more suitable to present data as a table instead of a graph? a. When the trend and the exact numeric value are important to the interpretation b. When the trend in values is most important c. When it is required to know the exact numeric value of a variable d. When the exact numeric value is not important to an interpretation

268. c A chart offers the advantage of seeing the general trend of data and comparing differences in data between groups or over time. However, the precise numeric values are more easily discerned when reading a table (Marc 2020, 529-530).

269. Which of the following basic services provided by a health information exchange (HIE) entity matches identifying information to an individual? a. Consent management b. Person identification c. Record locator d. Identity management

269. b Because there is no mandated unique patient identifier, ensuring that the HIE organization can identify the right patient as it seeks to exchange information is a process of identity matching (Amatayakul 2017, 419).

270. What type of system would look for contraindications between two medications, such as Warfarin (Coumadin) and ibuprofen, that could increase bleeding? a. Laboratory b. Radiology c. Pharmacy d. Nursing

270. c If a particular medication were prescribed to the patient, the physician may not know that it would contraindicate the use of this certain drug because of the pre-existing allergy; the PIS would alert the physician to this contraindication and suggestion another medication (Sayles and Kavanaugh-Burke 2018, 137).

271. Allowing different health information systems to work together within and across organizational boundaries is referred to as: a. Telehealth b. Interoperability c. Informatics d. Interfaces

271. b Health informatics must consider the development of standards for software to be used in the EHR and the exchange of data. Compatibility and interoperability, allowing different health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities, are a key focus in health informatics (Biedermann and Dolezel 2017, 22).

272. Providing a process's policy and procedure guide to a user who has never used the information system and then asking the user to perform the process could be used in what type of testing? a. Application b. Documentation c. Volume d. Acceptance

272. b These documents should be followed during the testing process to ensure that the instructions in the documents are accurate (Sayles and Kavanaugh Burke 2018, 75).

273. The process of taking what is known at the highest level of understanding and working downward to identify the underlying causes for the high-level observation is called: a. Dashboard b. Slicing and dicing c. Data analytics d. Data visualization

273. b Slicing and dicing refers to the process of taking what is known at the highest level of understanding and working downward to identify the underlying causes for the high-level observation. A dashboard helps facilitate a greater understanding of financial, operational, and clinical processes to identify problems and successes (Marc 2020, 539).

274. What conclusions can you draw from the graph displayed below? a. The hospitals have equal variance. b. Hospital A has the greatest value and greatest variance. c. Hospital B presents with outliers. d. Hospital C has the smallest range of values.

274. b A boxplot displays the descriptive statistics of a continuous variable including the minimum, first quartile, medium, third quartile, maximum, and potential outlier values. The line that makes the bottom of the box represents the value for the first quartile; the first quartile of a dataset is used to represent the 25th percentile of numeric data. In other words, the number representing the first quartile can be interpreted as a value at which 25 percent of the numbers in the dataset have a value equal to or less than that value. The line that makes the top of the box represents the value for the third quartile. The third quartile represents the 75th percentile. The number representing the third quartile is interpreted as a value at which 75 percent of the numbers in the dataset have a value equal to or less than that value. If there are dots above and below the boxes, these dots represent potential outliers. An outlier is a value that is distant from other values. The graph shows the widest range of values in hospital A as demonstrated by the difference between the lowest and upper whiskers. Also, hospital A displays with the highest median wait time (Marc 2020, 537).

275. Which of the following is an example of an activity that a patient may complete using a patient portal? a. Bedside nursing care b. Appointment scheduling c. Direct patient care d. Emergency care records

275. b A secure patient portal does allow for the communication between the provider and the patient and is not just a site for patients to access information. This is part of the effort to engage patients in their care. Patient are able to complete appointment scheduling through a patient portal (Biedermann and Dolezel 2017, 458).

276. Which of the following basic services provided by an HIE entity identifies participating users and systems? a. Identity management b. Person identification c. Registry and directory d. Secure data transport

276. c For whatever architecture an HIE organization may have, there needs to be a way to identify participants, which may include individual providers, representatives of payer organizations, and patients or consumers, as well as organizational entities and their information systems. This service is called registry and directory (Amatayakul 2017, 418-419).

277. Algorithms are used to match duplicate patients in which the following information systems? a. Decision support system b. Executive information system c. Master patient index system d. Grouping system

277. c Algorithms are used by organizations to determine the probability of a duplicate in order to identify potential duplicate MPI entries (Sayles and Kavanaugh-Burke 2018, 117).

278. What process must Colin, the HIM operations manager, perform to ensure that all patient information is contained within the correct electronic file in the EHR? a. Data modeling b. Data mapping c. Data audit d. Data architecture

278. c Data audit is an organizational procedure for monitoring the quality of data by analyzing reports for anomalies, inaccuracies, and missing data (Sayles and Kavanaugh-Burke 2018, 248).

279. An HIM professional takes data on denials that have been received by the healthcare facility over the past year. After manipulating the data, she learns that patients of Dr. Smith account for 30 percent of all denials. She schedules a meeting with Dr. Smith to discuss the matter. What process is the HIM professional conducting? a. Data informatics b. Data use c. Data analytics d. Data management

279. c Data analytics is analyzing data (in this case healthcare data) and turning it into information and knowledge that can be used in decision-making (Sayles and Kavanaugh-Burke 2018, 274).

280. Data mining is a process that involves which of the following? a. Using reports to measure outcomes b. Using sophisticated computer technology to sort through an entity's data to identify unusual patterns c. Producing summary reports for management to run the daily activities of the healthcare entity d. Producing detailed reports to track productivity

280. b In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set. Data mining is sometimes referred to as knowledge discovery (White 2020b, 520).

281. If the medical office manager wanted to compare the amount of time it takes for a patient to be seen by a physician versus a nurse practitioner, which information system would be helpful in this analysis? a. Materials management system b. Practice management system c. Facilities management system d. Executive information system

281. b Practice management systems are used by physician practices. Scheduling, patient accounting, patient collections, claims submission, appointment scheduling, human resources, and other functions all are built into this single information system (Sayles and Kavanaugh-Burke 2018, 119).

282. What type of graph is the following, which is used to present the frequency distribution of a single numeric variable? a. Box plot b. Bar plot c. Histogram d. Line plot

282. c Histograms are used to present the distribution of numeric data. The numeric variable is broken down into groups based on specific ranges of values to establish the widths of each bar in a histogram. The height of each bar represents the frequency or density of each of the binned groups. The distribution can be described as normally distributed when the pattern follows a bell-shaped pattern (Marc 2020, 538).

283. The information system controlled by the healthcare facility that allows patients to register using their own electronic device is known as: a. Personal health record b. Wearable device c. Social media d. Patient portal

283. d The patient portal allows a patient to access all or part of the health record that is maintained by the patient's provider (Amatayakul 2017, 15).

284. The MPI has had numerous errors in which the last name field is filled with a date of birth. What is a preventive control that may help this situation? a. An edit allowing only alphabetic entries could be added to the name field. b. A report could be run showing which name fields had a number in them, and those errors could be fixed. c. A report could be run showing which staff member entered the numeric data in the last name field; the supervisor could then discuss with the staff. d. An audit could be performed to validate the issue.

284. a Preventive controls are front end processes that guide work in such a way that input and process variations are minimized. In the list of possible answers, only adding an edit occurs at the front end to prevent the error from happening. The reporting and audit are after the error occurred and considered feedback controls (Oachs 2020, 777).

285. The physical therapy department keeps a separate database on patient outcomes for physical therapy. The workflow for most of the other health professionals is impeded because they do not have access to this physical therapy database. This is an example of: a. A data model b. Data blocking c. Data cleansing d. A data silo

285. d Prior to the implementation of EHRs, radiology, lab, and other departments reported results but kept their own information. These "data silos" of information created fragmentation that still haunts some EHR systems. A data silo is a separate database or system within a department that does not integrate into the main organizational system nor can others outside of that specific department access it (Sayles and Kavanaugh-Burke 2018, 251).

286. The term used to describe breaking data elements into the level of detail needed to retrieve the data is: a. Normalization b. Data definitions c. Primary key d. A database management system

286. a When developing the data elements that go into a database, the fields should be normalized. Normalization is breaking the data elements into the level of detail desired by the facility. For example, last name and first name should be in separate fields as should city, state, and zip code (Sayles and Kavanaugh-Burke 2018, 34).

287. What initiative has the ONC been driving through the escalation of technology and implementation and optimization of EHRs? a. Health information exchange b. False Claims Act c. HIPAA d. EMTALA

287. a The Office of the National Coordinator (ONC) has been driving the escalation of technology through its National Strategic Framework requirement of mandating the implementation of EHRs and currently toward the acceleration of health information exchange (HIE) (Palkie 2020, 312).

288. Consumer informatics is focused on: a. Consumer activation b. Information structures and processes c. Personalized medicine d. Engagement

288. b Consumer health informatics is a field devoted to informatics from multiple consumer or patient views and includes patient-focused informatics, health literacy, and consumer education, with a focus on information structures and processes that empower consumers to manage their own health (AMIA n.d.; Sandefer 2020, 447).

289. If a health plan analyst wanted to determine if the readmission rates for two hospitals were statistically different, what is the null hypothesis? a. The readmission rates are not equal. b. The readmission rates are equal. c. The readmission rate for one hospital is larger than that of the other. d. The readmission rate for one hospital is smaller than that of the other.

289. b The first step in statistical hypothesis testing is defining the null and alternative hypotheses. The null hypothesis is the status quo. In this example the readmission rates are equal would be the null hypothesis showing no relationship between the two hospitals (White 2016a, 65).

290. Fifty percent of patients treated at our facilities have Medicare as their primary payer. This is an example of what type of information? a. Patient-specific b. Expert knowledge c. Comparative d. Aggregate

290. d Data about patients can be extracted from individual health records and combined as aggregate data. Aggregate data are used to develop information about groups of patients. In this case, the fact that 50 percent of patients treated at our facilities have Medicare as their primary payer is data about patients combined together, so it is aggregate data (Sharp and Madlock-Brown

291. The probability of making a Type I error based on a particular set of data is called the: a. Sampling value b. Hypothesis test c. A-probability d. P-value

291. d The probability of making a Type I error based on a particular set of data is called the p-value (White 2020b, 504).

292. What must be in place to enhance the retrieval process for scanned documents? a. Electronic signature b. Indexing system c. RFID device d. Table of contents

292. b To enhance retrieval of scanned documents, some form of indexing needs to take place in order to organize the documents. Ideally, each form that is scanned or otherwise created should have a bar code or some other forms recognition feature, or features, associated with it (Amatayakul 2017, 285).

293. Which of the following lists represents recommended core data elements for the master patient index? a. Date of birth, revenue code, accession number, and address b. Name, address, revenue code, and accession number c. Name, gender, address, and date of birth d. Gender, address, accession number, and charge code

293. c A master patient index (MPI) is an index of known patients within a single organization whose visits are linked together by a single identifier, typically the medical records number. Some recommended core data elements for the MPI are: name, address, gender, date of birth, and many others. Accession number, revenue code, and charge code are not recommended core data elements for the MPI (Reynolds and Morey 2020, 132).

305. The process of integrating healthcare facility systems requires the creation of: a. Data warehouses b. E-health initiatives c. Enterprise master patient indexes d. Electronic data interchange

305. c Enterprise master patient indexes (EMPIs) provide access to multiple repositories of information from overlapping patient populations that are maintained in separate systems and databases. This occurs through an indexing scheme to all unique patient identification numbers and information in all the organizations' databases. As such, EMPIs become the cornerstones of healthcare system integration projects (Reynolds and Morey 2020, 132).

306. The performance standard "Transcribe 1,500 lines per day" is an example of a: a. Quality standard b. Quantity standard c. Joint Commission standard d. Compliance standard

306. b Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions. In the scenario, transcribing 1,500 lines per day is identifying the quantity of work rather than how well the work is being performed so it is a quantity standard (Oachs 2020, 773).

307. For an EHR to provide robust clinical decision support, what critical element must be present? a. Structured data b. Internet connection c. Physician portal d. Standard vocabulary

307. a If an EHR is to provide clinical decision support it requires two things: structured data and a clinical data repository (Sayles and Kavanaugh Burke 2018, 114).

308. The computer abstracting system in a facility has an edit that does not allow coders to assign obstetrical codes to male patients. This edit is called a(n): a. Preventive control b. Feedback control c. Performance measure d. Audit trail

308. a Preventive controls are front-end processes that guide work in such a way that input and process variations are minimized. Simple things such as standard operating procedures, edits on data entered into computer-based systems, and training processes are ways to reduce the potential for error by using preventive controls (Oachs 2020, 777).

309. Community Hospital just added a new system that changed the way data move throughout the facility. Which of the following would need to be updated to reflect this change? a. Data dictionary b. Entity relationship diagram c. Dataflow diagram d. Semantic object model

309. c A data flow diagram is a diagram of how data flows in the database. The data flow diagram is a good way to show management and other nontechnical users the system design (Sayles and Kavanaugh-Burke 2018, 33).

310. The benefits patients experience when using a patient portal include all of the following except being able to: a. Edit their medical record information b. View lab results c. Update demographics d. Send messages to their providers

310. a Typically, provider-based portals uses include requesting prescription renewal, scheduling appointments, and asking questions of providers via secure messaging. Patients may also pay bills online or securely view all or portions of the electronic health record, such as current medical conditions, medications, allergies, and test results. Patients would not be able to edit their health record information (Lee-Eichenwald 2020, 365).

311. Which of the following is not a statistical technique used to create a model to assess the probability that current Medicare claims are fraudulent? a. Logistic regression b. Cluster analysis c. Decision trees d. Database warehousing

311. d Statistical techniques are used in predictive modeling to create a model to assess the likelihood or probability of fraudulent claims. These statistical techniques include logistical regression, cluster analysis, or decision trees. A data warehouse is not a statistical technique that would be used for this purpose (White 2020b, 521).

312. A quality coding review that is based on specific problems identified during an initial baseline review in a hospital is called a(n): a. Focused coding review b. Compliance initiative c. Internal audit d. Concurrent review

312. a The HIM department can plan focused reviews based on specific problem areas after the initial baseline review has been completed. This would be called a focused coding review (Schraffenberger and Kuehn 2011, 314-315).

313. Which of the following is the goal of an MPI ongoing maintenance program? a. To maintain low creation rates for duplicates, overlaps, and overlays b. To maintain the readmission rate for the facility c. To carry out treatment, payment, and operations d. To ensure appropriate state regulations of insurance and health plans

313. a MPI management must include continuous maintenance and correction of data integrity problems. Ongoing education of registration and scheduling staff is critical to maintaining low creation rates for duplicates, overlays, and other EMPI data integrity problems (Reynolds and Morey 2020, 132-133).

314. Which model for health information exchange stores patient records in a single database built to allow queries into the system? a. Federated b. Hybrid c. Centralized d. Decentralized

314. c The centralized HIE model stores patient records in a single database built to allow queries into the system. This model tends to return results quicker than other models (Lee-Eichenwald 2020, 387-388).

315. Which of the following is an organization that develops standards related to the interoperability of health information technology? a. National Health Information Network b. National Committee on Vital and Health Statistics c. Health Level 7 d. EHR Collaborative

315. c Health Level 7 (HL7) is a nonprofit organization that develops standards for interoperability of health information technology (Fahrenholz 2017a, 63).

316. A network made accessible to trusted individuals outside of the facility is called a(n): a. Extranet b. Intranet c. VPN d. LAN

316. a Extranets are networks that connect a given organization to its customers and business partners or suppliers (business associates in healthcare). Although extranets send information over public networks, requiring a greater level of security, access to them is still restricted to the services and persons authorized (Lee-Eichenwald 2020, 366).

317. When performing an internal audit for coding compliance, which of the following would be suitable case selections for auditing? a. Infrequent diagnosis and procedure codes b. Medical and surgical MS-DRGs by low dollar and low volume c. Medical and surgical MS-DRGs by high dollar and high volume d. Low-volume admission diagnoses

317. c Part of a coding compliance plan is to identify areas of risk through audits and monitoring. Selecting the types of cases to review is also important. Examples of various case selection possibilities include medical and surgical MS-DRSs by high dollar and volume. Auditing cases with infrequent diagnosis and procedure codes, low dollar and low volume, and low admission diagnoses would not be as suitable (Hunt and Kirk 2020, 296).

318. An analyst wishes to use the CMI for a set of MS-DRGs to determine if a documentation improvement program is having an impact. Use the MS-DRG volumes and weights in the following table to calculate the CMI for the three MS-DRGs. a. 2.3234 b. 2.8594 c. 2.9000 d. 3.5998

318. b To calculate the case mix index from the volume of cases from MS-DRG calculate the weighted average MS-DRG weight by completing these steps: (1) Multiply the number of discharges in each MS-DRG by the relative weight of that MS-DRG; (2) Sum the relative weights from step 1; (3) Sum the number of discharges in the MS-DRGs chosen to be evaluated; (4) Divide the total relative weights from step 2 by the total number of discharges from step 3. Step 1: 3.5998 × 100 = 359.98 2.2203 × 52 = 115.4556 1.726 × 36 = 62.136 Step 2: 359.98 + 115.4556 + 62.136 = 537.572 Step 3: 100 + 52 + 36 = 188 Step 4: 537.572 ÷ 188 = 2.8594 (White 2016a, 155-156)

319. All of the following are necessary to maintain an accurate MPI in an EHR environment except: a. Standardizing registration procedures b. Training all registration staff c. Identifying registration entry points d. Assigning registry accession numbers

319. d Controls for accuracy of the MPI include limiting access to the index and limiting the ability to make changes to a few key personnel. The first step to maintaining an accurate index is to obtain the correct information at admission or registration (Reynolds and Morey 2020, 133).

211. A computer software program that supports a coder in assigning correct codes is called a(n): a. Encoder b. Grouper c. Automated coder d. Decision support system

a An encoder is used to increase the accuracy and efficiency of the coding process. Encoders promote accuracy as well as consistency in the coding of diagnoses and procedures (Amatayakul 2017, 292).