Health Informatics Final

C.A phone number imbedded in the alert that the provider must call to override the alert

A recent study demonstrated a reduction in inappropriate urinary cultures in ICU patients with indwelling urinary catheters through the use of clinical decision support. The study integrated several clinical decision support techniques into the process. Which technique was not utilized in this study?

C. Develop a prediction model that determines the combined effect of multiple patient-specific factors for predicting the risk, and integrate the model with the clinical decision support system

Chemotherapy‐induced nausea and vomiting (CINV) is one of the most dreadful and unpleasant sideeffects of chemotherapy. Antiemetic treatments are provided before chemotherapy to prevent CINV. There are several antiemetic guidelines for the management of CINV. However, they are solely based on the emetogenicity of the chemotherapies. Several patientrelated risk factors affect the risk of CINV but none of the guidelines considers those factors. As a result, physicians rely on their personal experiences for CINV treatment, which leads to inconsistent managements of CINV. As a clinical informatician of your hospital, you have been given the task to help the physicians with personalizing the CINV treatment recommendations based on patient‐specific risk factors. Which of the following is the most appropriate informatics solution?

D. All of the above

Clinical narratives can be structured and codified by a state‐of‐the‐art NLP system with results stored for down streaming applications. Why do we need real‐time late‐binding NLP solutions in practice?

H. Health care records

Cybercriminals are looking for commodities that can be quickly sold to the highest bidder. In 2015, what type of commodity were cyber thieves targeting for theft and receiving the highest payout for?

C. Lagged abstraction of surgical site infection due to manual chart review and delay from capture to access data.

Despite extensive efforts to monitor and prevent surgical site infections, real‐time surveillance of clinical practice has been sparse and expensive or non‐existent. Which of the following reasons best explains this?

F. Recognize

From a young age we are conditioned for the threat of physical crime, we are now faced with a whole new type of criminal activity and it happens through technology. The first step in Security Awareness is being able to ________ a security threat.

A. Clinical knowledge representation

Meaningful Use Stage 2 Rule requires use of SNOMED CT for which purpose?

A. Map similar data to concepts for research

The value of constructing information modes from flowsheet data for research is to..

C. Ask the Community Health Worker to join the development team and provide ongoing input into the agile development process

A community health worker provides clinical care to patients in her remote community. The community health worker has approached the CMIO of their base clinical hospital to inquire about possible changes to the interface to improve data collection in the field. The electronic health record was traditionally designed to facilitate the recording of community collected data using standardized human factors techniques endorsed by the vendor. What is the best way to develop and include the needs of the community health worker within the end product using an agile software development process?

B. Incorporate clinical decision support by highlighting patient history text related to the duration of ABRS symptoms and specific symptoms consistent with ABRS, and display a summary of the guideline criteria within the clinician workflow.

A health care system wishes to improve appropriate antibiotic prescribing practices for the treatment acute bacterial rhinosinusitis (ABRS) in the virtual care (e‐visit) setting by improving clinician adherence to an evidence‐based clinical guideline. The initial baseline data demonstrated clinician adherence to the ABRS 95.2% of the time. Data analysis revealed that the most common reasons for as being identified as not adherent to guidelines were short duration of patient sinus symptoms and a lack of ABRS specific symptoms. Given the above information, which is the most appropriate intervention to improve adherence to the evidence-based ABRS clinical guideline?

B. Exploratory data analysis, predictive analytics, visualization

A hospital is concerned about its Hospital Compare ratings for AMI 30‐day mortality, compared to area hospitals. They have downloaded the spreadsheet available on the Hospital Compare web site They have purchased IBM Watson Analytics. What data analytical processes can they utilize with this platform?

D. The training plan should be reviewed for adequate training time and clinical nursing practice applicability

A large community hospital is implementing a new technology system designed to improve patient engagement. Research has shown patients who are engaged in their care are more likely to have better patient outcomes and reduced health care costs. It has also been suggested that user acceptance is a significant barrier to full system adoption. This new system will be piloted on the telemetry unit where the majority of patients have been newly diagnosed with congestive heart failure. Training has been scheduled for all nursing staff. To fully utilize the benefits of the new patient technology system, which of the following is the most appropriate?

A. Photo should be encrypted at rest, in flight (during transmission) and the resident needs permission from the patient to take the photo

A resident is in the emergency room and is seeing a post‐operative patient for pain and swelling at the operative site. The wound has erythema and there is drainage from the incision. She is uncertain if the patient should be admitted or simply be given oral antibiotics and sent home. She chooses to send a photo to her attending from her personal cell phone using her iPhone's native messaging app. This is a very efficient way to communicate. What are some steps that would be required to make photo sharing HIPAA compliant in this scenario?

B. The new system requires new perspectives on care, and will require changes in care processes and possibly also in staffing to improve support for chronic disease care.

After assessing the three vendor products, the practice selects System X. Features of the selected system include: integrated collaborative longitudinal care planning for individuals with a chronic disease, secure messaging for the care team and the patient, patient portal features focused on chronic disease management, and modules for collection of patient‐generated health data. The system is gradually deployed across the various clinics. Over the next few weeks, complaints are received from patients and healthcare teams about delays, miscommunications, and problems with the new system. Which of the following best explains this observation?

D. Data pre-processing, exploratory data analysis, modeling, visualization

An accountable care organization is concerned about their increased heart failure readmission rate. They have a data warehouse with two years of inpatient data. What is the standard data science process sequence to analyze their data?

D. Clinic leadership, clinical staff, and patients/families

An ambulatory clinic practice is considering several new technology options focused on improving support for individuals with a chronic disease and their healthcare teams. The clinic leadership does an initial assessment of the options and decides to have three vendors provide in‐person demonstrations of their chronic disease care modules. The vendors have agreed to present system features and allow handson interaction with their products. Which of the following groups are most appropriate to include in the systems demonstrations and further assessments?

B. test-driven development

An automated acceptance test is written before development of a clinical decision support alert, specifying the decision logic it should employ when evaluating whether to display to clinicians. The automated test is red (fails) initially, and then becomes green (passes) once the EHR analyst has successfully finished their development. Which best describes this use of automated testing?

B. Make determining "Scope" part of TOC workflow, and incorporate a statement verifying understanding by sender and receiver into the documentation process.

Another Element of the TOC Framework is "Scope." This refers to the expectations of all parties about what the receiving party is supposed to do. Confusion, error and harm result when the sending, receiving and transitioning parties are not clear about goals and contingencies. Healthcare professionals generally have a "loose" understanding about the differences between a "referral for specialized advice or testing," a "consultation with the potential for a procedure," a "transfer of responsibility for ongoing care," and similar categories. What process seems most likely to reduce misunderstandings between providers?

B. Drivers of risk for the population and individual patients

Assessing and responding to many patients' risks of chronic diseases and related complications are complex, high‐dimensional information processing problems faced by time‐constrained clinicians. Innovative algorithms and tools which combine statistical machine learning, information visualization and electronic health data may reduce clinicians' information processing load and improve their ability to assess risk of disease onset and related complications. A critical element in visualization is the incorporation of flexibility in customizing assessments to the needs of unique patient populations. Suggested by this study, which insight can be obtained via a 2‐dimensional visualization of chronic disease risk that is contextualized by the risk factors?

A. Work with your local human subjects protection committee (IRB) to obtain permission to review medical records, if required, and provide protection for the IT professionals or doctors (a.k.a. human subjects) you are interviewing to identify best practices.

Comparative effectiveness research (CER) on Electronic Health Records (EHRs) is designed to generate evidence to help inform decisions regarding the design, development, configuration, implementation, use, and evaluation of EHRs. It seeks to accomplish this by gathering evidence on the safety and effectiveness of various features, functions, uses, and outcomes associated with implementation and use of different EHRs across different healthcare organizations. Before conducting such studies one should...

C. An ontology provides a specification written in a formal language that defines a shared conceptualization and vocabulary

Drolet (2008) states that the use of a single term, "registry," to refer to databases of clinical information ranging from biomedical informatics, clinical research, public health, to evidence‐based practice impedes the ability to locate and learn from the literature about specific types of registries. In what way would an ontology help to remedy this problem?

E. Decision Tree

Epidural catheters for pain control are frequently placed by anesthesiologists for patients primarily managed by other services. Administering anticoagulants to patients with an epidural catheter may be associated with increased risk of epidural hematoma and neurologic damage. You've been asked to create an alert for anyone ordering an anticoagulant or antiplatelet medication for a patient with an epidural catheter, to alert them of this risk. As you listen to the experts discuss when the alert should fire, you learn that exception conditions apply, e.g., for low‐dose VTE prophylaxis. You want to capture the logic to define unequivocally for which sets of conditions the alert should and should not appear The optimal model for depicting this logic is a:

B. Clinical narrative is human friendly while the primary function of EMR s to facilitate the care communication among

Even with increasing emphasis on capturing clinical information in standard and structured format to enable down streaming meaningful use of EMR applications, what is the primary reason that we still have much of the clinical information in clinical narratives in EMR?

A. Inpatient length of stay, admission type, primary diagnosis code

Fraud, waste and abuse divert significant resources away from necessary care that is covered by federal and commercial program rules. A common potential waste of the healthcare system is to admit a patient to the hospital when an observation or outpatient setting would have been sufficient. Which of the following types of information would be most appropriate to identify claims that might have been overpaid due to the patient being in an inappropriate setting?

C. All caregivers may count Grace in the numerator for this measure as long as they all have contributed at least some of the info to the shared portal, but not necessarily the particular info that was viewed, downloaded, or transmitted by Grace

Grace is a 56‐year old cancer patient. She receives care from four different specialists, local hospital, cancer center, and you, her PCP and an eligible professional by meaningful use standards. Grace frequently accesses her records, results, and medications through a patient portal that is offered through a local HIE. All of Grace's caregivers happen to be participants in this HIE and use this HIE's portal to make information available to their patients. The HIE itself has been certified as an EHR Module for this purpose and has the ability to identify and verify the information that a particular provider may have contributed. In situations such as this, where multiple eligible professionals or eligible hospitals contribute information to a shared portal, how is it counted toward the meaningful use measure of View, Download, or Transmit when the patient accesses the information on the portal?

A. Connect the entire care team to increase knowledge and visibility of the working DRG

HHS set a goal of tying 30 percent of traditional, or fee‐for‐service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements in 2016, and tying 50 percent of payments to these models by the end of 2018.This is the first time in the history of the Medicare program that HHS has set explicit goals for alternative payment models and valuebased payments. Which of the following best explains how a CDI program can impact government regulations?

A. Investigate the progression of the patient through the healthcare system, making sure all acute and chronic conditions treated during hospitalization are reported and supported via clinical indicators within the EMR for the most accurate medical record.

Historically, in the inpatient setting, data collection occurred after the patient was discharged. After discharge, HIM professionals checked the record for discrepancies that could hinder code assignment. HIM professionals would then query the provider for clarification either by paper queries or other disconnected systems that were not part of the permanent medical record. Assuming national reporting initiatives require the specificity and accuracy of clinical documentation, which is the most vital role a CDI program would play within an organization?

B. Gather data from different organizations to figure out which organizations have the best performance and then compare and contrast the configuration decisions of the best organizations with those of the lower performing organizations.

Implementing, configuring, and optimizing electronic health records (EHR) in large healthcare delivery systems involves making thousands of configuration decisions, hundreds of workflow changes, and development of hundreds of clinical content artifacts (i.e., order sets, alert logic, default values). Many of these decisions, changes, and artifacts have the potential to lead to unintended adverse effects on patient safety, clinician efficiency, and organizational performance. Which of the following is the best way to gather evidence to support various configuration decisions that your organization must make?

B. Define workflow using a definition focused on how much time tasks consume

In accordance with public policy and private groups, the use of health information technology is tightly related to improving patient safety and quality(1). The growth of mobile health information technology, in particular, shows promise for streamlining clinical workflow. Despite these promises there are concerns and a lack of research demonstrating the impact of health information technology (HIT) on clinical workflow(2). Concurrently, the existing research is difficult to interpret as there are over one hundred definitions of workflow (3). The definition of workflow used in HIT research and implementation is important as it guides the investigator in selecting the appropriate measurement tool (4). You are chartered to conduct a constructive analysis of workflow to inform the design and implementation of a body‐worn mobile device for continuous vital sign capture in general care wards. The focus is on "efficiency" in vital sign data capture as measured by time savings. What are the most appropriate steps to define workflow?

C. "Summary" information generated by EHRs is generally poorly formatted, inadequately filtered, usually incomplete and often untrustworthy; a reliable "transition of care message" must be manually created, involving significant provider effort.

In the Transition of Care Framework, the Element labeled "Information Payload" refers to relevant information that should accompany the person being transferred. This item is among the most often deficient in practice. Missing information during transitions is a significant cause of patient harm, provider inefficiency and irritation for everyone. Which best explains why this component of care transitions is so difficult to execute?

B. Health care data is not big data in a strict sense, but the big data technology stack helps in processing data to deliver near real-time solutions for clinical care needs.

Is health care data "big data"? If not, why do we need a big data environment to process health care data?

B. A patient satisfaction study consisting of randomly selected samples from each nursing unit of a hospital within a two-year period

Modelbased statistics depend on the specification of a probability model for the random process that generates the data (for example, a Normal Distribution). On the other hand, design‐based statistics depend on a researcher specifying a fixed population and the random process of selecting a sample is completely under the control of the researcher. Which of these studies would require a design‐based statistical approach?

C. Use a single, consolidated report that explains relevant history, current health information, the x-rays and MRI ahead of the visit through a personal health record app and/or care coordination service.

Morgan is a patient who has 9 different providers who each have their own portal login. She is being referred to a specialist and wants to be involved in her care coordination. She does not want to rely on her memory, fill out a lot of forms, or find out that the new doctor doesn't have any of her recent xrays, MRIs or primary doctor's records. She has seen three other doctors for issues that are related to her upcoming visit. She cannot imagine logging into so many portals to try to figure out how to share that information with her new doctor. She does not want to have tests repeated or have her treatment delayed due to coordination issues. What is the best advice for her to prepare for the visit?

B. When the observations in the data are systematically correlated.

Most classification methods assume that the training data are drawn independently and identically from an unknown distribution (i.i.d), although this assumption is violated in in many real life situations. The implicit assumption by the machine learning and data mining communities is that even if the i.i.d assumption is violated, the algorithms would work well in practice. When would this not be the case?

C. He should close infrequently‐used portals, such as the one with the out of state hospital. He should keep the portal with you, his PCP; your staff will work with him to make it as complete and accurate as possible. His multispecialty group portal is optional.

Mr. Grant is an 82‐year old retired mechanic. He sees you, his PCP, at a community health center. A year ago, you started managing his care via a portal, and you both agree that it has been helpful. He also has separate portals with: ophthalmology at a specialty eye center; cardiology and orthopedics at a multispecialty group; and walk‐in clinic in his neighborhood. Recently, his healthcare insurance company and his pharmacy each gave him online access, too. Today, Mr. Grant is in your office after being admitted to a community hospital while traveling out of state. He knows that he had some medication changes. At discharge, they gave him a new portal. When he logged in for the first time, he noted that much of the information on the portal was wrong or missing. He has decided to close every portal, stating "If I close them all, then at least the records won't be wrong." After listening to his concerns, the best advice for him is which?

C. Anyone

ONC is offering three major funding opportunities for FHIR developers, including the creation of FHIRbased solutions and an open FHIR Registry. Who is eligible for these grants?

B. the clinician who will see and use the CDS tool

On rapid‐cycle agile development projects, requirements are often kept lightweight, for example, with a User Story and associated Acceptance Criteria. The most typical template for a User Story is: "As an X , I want Y, so that Z ".

C. Requires prescribers to choose a drug first and then add the indication from a pull down list of indications

Physicians have long been urged to place the indication for the medication on the prescription for drugs they are ordering. With paper prescriptions, physician acceptance has been poor, but with near universal adoption of electronic ordering (CPOE) there are renewed opportunities to promote utilization of this feature. However, there remain numerous challenges in designing and incorporating indications into prescribers' workflow.

C. the burden of the healthcare provider

Potentially Avoidable Complications (PAC) include events such as post‐surgical infections, blood transfusions, pressure ulcers, or unplanned readmissions, and associated costs can contribute to the overall cost of an acute care episode. With respect to creating a payment bundle, the financial risk associated with PAC costs is considered:

D. These professionals have knowledge, education, training and skillsets in common

RBH has physician, nursing, pharmacy, and dental CCIOs (Chief Clinical Informatics Officers). The leadership of RBH wants to create an Office Of Clinical Informatics because:

D. All of the above

Screening for early signs of dementia in the absence of an effective treatment is advantageous because early diagnosis of dementia can:

E. It is essentially impossible to reconcile separate Task Lists among multiple providers without some kind of "master list" that can be continuously updated on a shared network

Task‐Oriented Medicine is the approach to care management that organizes patient care plans around future needs. To be effective, the Task List must be attached to the patient, rather than tethered to any provider. While each provider may have a local reminder ("Tickler") system to track follow up items for its own purposes, the Task List must be visible to the patient, caregivers and all providers. What is the biggest challenge in transmitting a Task List to the receiving provider, as part of a care transition?

D. Clinical Informatician educated in and experienced with Informatics

The CIO of RBH (Really Big Hospital) calls you into her office. She tells you the hospital is going to select a new EHR (Electronic. Health Record), implement it, and then optimize it. All to be done within the span of 24 months. She wants to hire a Chief Medical Informatics officer (CMIO). You advise her that the best candidate is:

B. Is a bundled payment model that is mandatory in 67 geographic regions, and aim to support better and more efficient care for Medicare beneficiaries undergoing the most common inpatient surgeries

The Centers for Medicare and Medicaid (CMS) Comprehensive Joint Replacement (CIR) Initiative:

C. Possess an advanced degree in nursing informatics

The Chief Nursing Officer of RBH wants to hire a Chief Nursing Informatics Officer (CNIO). She wants this person to be highly qualified. The CNIO must have:

D. All of the above

The IOM Charter and Vision Statement for the Learning Healthcare system states, "that, by the year 2020, ninety percent of clinical decisions will be supported by accurate, timely, and up‐to‐date clinical information, and will reflect the best available evidence." What types of health IT were deployed at the local level that supported the HIV quality outcomes predictive of a public health impact?

C. A framework developed by the Institute for Healthcare Improvement (HI) for optimizing health care including improvement patient experience and population health, and reducing the cost of care

The Triple Aim is:

C.Average typing speed was 42 wpm, ranging from 19 - 101 wpm. A notable increase in success was noted if the provider typed more than 50 wpm

The average typing speed of primary care providers measured in a small study in a multi‐clinic health system was ____ wpm. The range was _____ to _____. The number of documents that were generated using self entry/structured documentation doubled in the providers that had a keyboarding speed measured at above _____ wpm.

D. In a typical primary care office the transcription costs for a document average about $5 per document/encounter

The costs for transcription are a significant percentage of overhead in running a medical clinic. These costs need to be analyzed as the healthcare dollar becomes increasingly tight. Which one of the following statements is true regarding the costs of transcription?

E. the dissatisfaction rate was significantly higher for the sub-groups with lower adoption and skill level (laggards and late mortality)

The distribution of EHR skill scores from an EHR skill assessment tool in a primary care health system resembles the predictable pattern as described by Everett Rogers in his "Diffusion of Innovation" theory. This theory describes sub‐groups as innovators, early adopters, early majority, late majority and laggards. When evaluating these subgroups of providers in this study the authors found which one of the following statements to be true?

B. Deep Neural Networks can learn representations of data

The increasing volume, detail, and availability of digital health data offers an unprecedented opportunity to learn richer, data‐driven descriptions of health and illness. This principle has driven the rapid development of computational phenotyping, i.e., discovering meaningful data‐driven characteristics and patterns of diseases from increasingly large and complex medical data sets. Deep learning models, such as deep neural networks, are an emerging solution for many computational phenotyping problems Which of the following is true in general for deep neural networks?

B. Longitudinal data

The investigation of change over time is key to empirical research in many disciplines. Is systolic blood pressure related to the development of coronary heart disease? What factors are associated with the risk of progression of type 2 diabetes? How do different groups of students in my state compare to each other in terms of academic achievement over the course of college? Does my data exhibit distinct trajectory patterns? These research questions are best answered through the collection and analysis of what type of data?

D. Inconsistent data structure

There are many Continuity of Care Document (CCD) software vendors that sell Electronic Health Record (EHR) products for an outpatient setting. While HL7 provides coding standards, it has been noted that there are vast inconsistencies with how data are reported among vendors. Furthermore, each software package is proprietary. What is likely the most difficult challenge in integrating data from a CCD?

C. Requirements are likely to be discovered and undergo change during order set and note template development.

To promote more consistent care of patients undergoing colorectal surgery, you've been asked to lead a project to develop new pre‐op and post‐op note templates and order set(s) in your EHR specifically for these patients. The targeted go‐live date is in 3 months. Several surgeons are important stakeholders, and although they've all agreed to the idea of using the same set of EHR tools to help standardize care and collect better data, no unanimity exists yet about note or order set content. On previous projects you've taken a traditional method of getting up‐front "sign‐off" on all exact requirements before beginning work. For this project, you decide instead to use an iterative, incremental development approach, with time‐boxed development "sprints"; you plan to demonstrate the latest version of EHR tools to a surgeon's meeting every 2 weeks for feedback.

A. Negotiated total cost that is less than the sum of the disparate services

Under the traditional fee‐for‐service (FFS) health care reimbursement models, doctors and other health care providers are paid for each service performed. Alternatively, bundled payment models cover all aspects of the care that a patient receives during the course of treatment for a specific illness, condition or medical event. Which of the following can be a source of savings if using a bundled payment model instead of a FFS reimbursement model?

B. Use the CIRCLE mailing list to conduct surveys regarding important EHR-related issues.

We have formed the Clinical Informatics Research Collaborative (CIRCLE) to address EHR issues by creating a network of applied clinical informatics researchers who are committed to improving our understanding of these issues. CIRCLE members are involved in various aspects of the design, development, implementation, use and evaluation of all aspects of health information technology with a particular emphasis on EHRs. CIRCLE members are encouraged to...

D. All of the above.

What are challenges for screening and diagnostics of congenital heart diseases in low and middle income countries?

E. All the above

What are some of the challenges of investigating drug interaction signals using large medical record databases?

A. FHIR is provided through a creative commons license

What are the requirements for use of FHIR in open-source or commercial products?

D. All of the above.

What are the training opportunities for FHIR implementers?

C. FHIR development is open to anyone who registers

What individuals may contribute to FHR development?

A. The credibility of healthcare knowledge extracted from social media is not high.

What is the biggest concern when we do healthcare knowledge extractions from social media?

H. End Users

What is the biggest vulnerability to computer information security?

B. Provide a collaborative environment for FHIR implementation.

What is the principle objective of the FHIR Foundation?

A. Existing ISO standards

What technical standards were included in FHIR 2.0 to . enable security and authentication?

C. Still's murmur

What was the most common murmur that was heard in the "heartLink" Project?

B. Having all patient information together in one place

Which is NOT one of the major factors physicians commonly report about health information and communications technologies that contribute to their job stress:

D. Trigger event, complication codes, provider assignment

Which of the following are components of any episode construction logic:

C. Pain management for patients

Which of the following are examples of research that an be facilitated by inclusion of nursing flowsheet data?

B. Pattern discovery and hypothesis generation are primary goals

Which of the following is true about the fundamental shift to the 4th paradigm or big data research?

A. A patient or family perspective of safety threats may differ from a clinician's perspective of safety threats

Which of the following related to the patient and family perspective of care concerns and safety reporting is true:

B. Variables that are statistically significant in univariate statistical models may lose statistical significance in a multivariate model consisting of additional variables

Which of the following statements is accurate?

C. Low-nursing-to-patient staffing ratios decreases risk of hospital acquired adverse events (including falls, hospital acquired infections, pressure ulcers) and readmssions

Which of the following statements is false with regard to the measuring unit-based risk to patient safety?

B. The Patient safety dashboard is a patient centered communication tool to provide actionable plans for patients and family to prevent adverse events during their hospital stay

Which of the following statements is true with regard to the Patient safety checklist?

A. The Program will provide a link between referring providers in communities and cardiology specialists in the LMIC cardiac center

Why did CHL think that the stethoscope program will help develop cardiac services in LMIC?

D. structured data need to be reconciled with information in unstructured data sources to provide the right context to make the right care recommendations

Why is information in unstructured data sources such as clinical notes important for a clinical decision support system like MayoExpertAdvisor?

A. Percent of inpatients on risk-appropriate VTE prophylaxis

You are embarking on a redesign of your hospital's venous thromboembolism (VTE) prevention order set. The new version will dynamically tailor the prophylaxis options to be presented to the clinician based on the patient's VTE risk category, using an accepted risk scoring system. You have the following User Story: "As a clinician, I want to be provided guidance on the most appropriate VTE prophylaxis measures to order for a given patient, so that I can institute the recommended DVT prophylaxis interventions, and ultimately reduce my patients' chances of suffering a DVT and/or pulmonary embolus." You want to measure effectiveness of the redesigned order set as part of your CDS Benefits Realization program, by selecting one or more metrics to measure before and after implementation.

A.Build consensus and create a pressure ulcer information model

You are the chief nursing information officer (CNIO) of an integrated system of seven hospitals all of which store their electronic health record data in a system wide centralized data repository (CDR). The CDR (approximately 10 million patient records covering a span of 8 years) is comprised of structured data from discrete fields such as demographics, flow sheets, vital signs, provider orders, and test results. Narrative nursing notes are present, but in unstructured text format and not coded using a standardized nursing language. As the CNIO you are interested in developing a model that predicts patients at high risk for developing pressure ulcers and alerts providers through the EHR. However, the pressure ulcer data is stored in a mix of structured flowsheets and unstructured text in notes. And the health system does not have data scientists with the skills to build such models. As the CNIO which of the following is the most appropriate first course of action to take?

B. Real time analytics must include indicators aligned to the strategic/performance goals and have built-in signals to suggest that an actin is needed.

You have been asked to constitute a division of analytics that will support quality improvement initiatives across your health care system. Which of the following is an accurate statement regarding data, analytics and quality improvement?

A. Simply computerizing existing (manual practices) leading to unnecessary sequencing of tasks

Your department is migrating from a predominantly paper‐based to an electronic system for triaging patients. You have been tasked with mapping the current workflows and determining how best to implement them using electronic means. One of the goals of implementing this electronic system is to improve operational efficiency. Which of the following may jeopardize this goal?

D. radiology has begun using a new orderaable in your EMR which is not contained in the "Liver imaging" procedure list used by the CDS alert, causing it to display inappropriately.

Your liver specialists want to increase the rate at which patients with cirrhosis are screened for hepatocellular carcinoma, in line with published guidelines. Accordingly, a clinical decision support alert has been reminding providers to order a liver imaging test if one has not been performed within the recommended screening interval. The alert checks for presence of cirrhosis on the Problem List, and for a completed order in your EMR for any of a list of imaging procedures. Your CDS monitoring program recently detected a sharp rise in the frequency at which this alert is displaying to providers. What is the most likely cause for the abrupt increase in frequency of alert display?

D. Optum Labs Data Warehouse (commercial health insurance claims linked to inpatient and outpatient EHR data - all ages)

practitioners comply with evidence based guidelines for outpatient care of type II adult onset diabetes on a national level. Of the following databases available to you, which database is the best to conduct your analysis?