Part 2

Communication systems within EHRS may allow for communication between which parties?

-provider to provider, patient to provider, and provider to patient.

How does the use of the electronic health record (EHR) and the shared terminology feature it provides best support health care research?

Allows for the collection of aggregated data

The standardization of reimbursement for alternative health care has led to which set of standards?

Alternative Billing Coding (ABC) set

Which of these is an example of a way that you can help to prevent a breach of PHI?

Always secure your workstation.

When considering system interoperability, what is a standard?

An agreement to the use of specific methods of achieving interoperability

What makes a health smart card particularly attractive when attempting to meet the provisions of HIPAA?

It makes health care data portable.

Which situation is an example of how a hospital's interoperability electronic health records systems support nursing care?

The nurse determines that a patient is likely to be discharged after reviewing daily laboratory results.

When considering health information technology (HIT), what does the term interoperability mean?

Two or more health-related service providers can access and share information.

What is the key difference between an electronic medical record (EMR) and a personal health record (PHR)?

Who manages the records

Simulation scenarios support the nursing student's professional growth but overlook which highly important clinical concern?

Safety risks to patients

What is an electronic health record (EHR) composed of?

Several EMRS and the PHR

How will the informatics educator best include real-life situations into informatics training on a new information system?

Simulation case studies so learners can apply the new knowledge

Is the following statement true or false? Stage 3 of meaningful use of electronic health records involves the proof of improved patient outcomes.

True

True or false The use of simulation in educating health care professionals enables learners to practice necessary skills in an environment that allows for errors and professional growth without risking patient safety.

True

Is the following statement true or false? Consumer information including patient education should be created to assume an eighth grade reading level.

False

Considering the nurse-patient relationship, which statement best addresses the nurse's responsibility to protect a patient's privacy?

"Being sick does not make ignoring a person's privacy acceptable."

True or false Role play is a popular pedagogical learning strategy, but it doesn't work well in the health care education setting.

False.

Which of these is an information subsystem that contributes data to a patient's global EHR?

Computerized provider order entry (CPOE)

A simulation scenario for newly hired nurses would serve which purpose for the hospital educator? Select all that apply.

Encourage team work. Assess competence. Present policies and procedures. Promote communication.

How can nursing as a science-based profession most benefit from the implementation of electronic health record systems?

General information is easily accessible for research purposes.

Which organization founded in 1987 has a stated mission to provide a "comprehensive framework and related standards for the exchange, sharing and retrieval of electronic health care information"?

Health Level Seven (HL7)

Which type of simulations can be run on a desktop computer and only needs a screen, mouse, and audio inputs and outputs?

Online simulation

Which type of simulation activity is task-specific and designed to replicate a part of a system or process?

Partial task trainer

When considering staff workload, patient needs, and security issues, what is the advantage of posting commonly requested forms on the health care provider's website?

They are easily downloaded by patients without requiring staff's attention.

Patient satisfaction increases with use of EHRS due to which of these reasons?

All of the above

Which concern is most significant as a nurse determines what information will be asked for and recorded into the medical record during a patient interview?

Are the questions being asked relevant to the patient's care needs?

Which of the following are technical safeguards to keep protected health information safe? Select all that apply.

Audit trails Ensuring the person logging into the system is in fact that person Secure networks

What is a consideration when creating a password for a mobile electronic device? Select all that apply.

Avoid using personal information. Use misspelled words. Use the first letter of each word in a familiar phrase Substitute numbers or symbols for letters.

What is the greatest significance to health care when an information system lacks interoperability?

Errors related to patient care can more easily occur.

HIPAA stands for the Health Insurance Protection of Assets Act.

False

Is the following statement true or false? Most standardized terminologies for nursing are highly granular for use in documentation.

False

Is the following statement true or false? Online diagnosing has proven to be of little value to the healthcare consumer.

False

Is the following statement true or false? Consumer information including patient education should be created to assume an eighth grade reading level.

False

True or false Interoperability means that you can trade out one subsystem for another; it does not matter which one you use as long as you pick at least one.

False

True or false My EHR vendor can take care of everything I need to do about privacy and security.

False

True or false One downfall of simulation modalities is that they do not allow the learner to get exposure to real life situations in a "safe" environment.

False

True or false One great advantage of EHRS is producing faster turnaround on patient data such as lab results, which leads to lengthier hospital stays.

False

True or false Physical threats to the privacy and security of protected health information are more serious than administrative threats and need to be treated with a higher level of caution.

False

True or false Software alone can protect your patients' PHI.

False

True or false To prevent faxing protected patient information to unauthorized persons, nurses should avoid faxing altogether.

False

Which simulations are also known as human patient simulators?

High-fidelity simulations

ABC codes are focused on what aspect of health care?

Reimbursement

Which of these is not an example of a classification system?

SNOMED CT

What is the greatest security risk presented by devices?

They are easily lost or stolen.

Is the following statement true or false? The major concern associated with smart card use is security.

True

Reference terminologies are considered "input" systems while classification systems are considered "output" systems.

True

In order to protect consumer privacy, health care providers and agencies must share what form of safeguard?

Data access-related protocols

Stage 1 of the meaningful use criteria in the HITECH Act focuses on which of the following objectives?

Data capture and sharing

What are the main issues associated with establishing the processes required of electronic health information management?

Data security Interoperability Workflow redesign User design

How does the use of the electronic health record (EHR) and the shared terminology feature it provides best support nursing as a profession?

Demonstrates the tangible effect nursing has on patient outcomes

How does the public benefit most from the implementation of electronic health record systems?

Increased involvement in their health care planning.

True or False Electronic transmission of patient care summaries across multiple settings is a focus of Stage 2 of the meaningful use criteria in the HITECH Act.

True

True or false PHI stands for personal health information.

True

How can you tell if a website is a secure one?

Its address will begin with "https"

What is the original focus of Logical Observation Identifiers Names and Codes (LOINC)?

Laboratory testing

When considering the patient, what is the greatest concern health care providers have about e-mail communication?

Patients' lack of computer literacy

What is PHR an abbreviation for?

Personal health record

True or false Information integrity is the assurance that the data being accessed or read has not been tampered with, altered, or damaged.

True

True or false Is the following statement true or false? A key aspect of electronic records is the ability to share data.

True

True or false Legally, every tweet, blog post, blog comment, text message, and wall entry uploaded and received by health care professionals and organizations is a piece of content that should be reviewed and managed to ensure control, decorum, and (if applicable) regulatory and records compliance.

True

True or false One of the advantages of using EHRS in health care is easier access to aggregate data.

True

True or false One of the first steps to protecting PHI is to understand how to use the Internet safely.

True

True or false The means by which privacy and confidentiality are ensured is security.

True

True or false There are two phases in protecting patient health information.

True

True or false You pose a threat to patient health information security and confidentiality.

True

True or false To define an effective EHR, the Institute of Medicine (1OM) has identified eight functions to improve quality care, chronic disease management, efficiency, and feasibility.

True

Which of the following refers to the depth of detail of a language system? A. Taxonomy B. Granularity C. Interface terminology D. Reference terminology

B. Granularity

A directory of staff names in alphabetical order is an example of a: A. Taxonomic vocabulary B. Linear list C. Postcoordinated term D. Subset

B. Linear list

Which of the following is not an administrative safeguard to provide privacy and security of health information?

Ensuring workstations are not used for personal use

Only nurses who work in the lab need to learn about the laboratory information system (LIS).

False

The purpose of the meaningful use criteria in the HITECH Act is to increase sterilization by eliminating paper from all health care facilities.

False

Which of the following are physical safeguards to keep protected health information safe?

Locks and alarms in the building Cable locks and computer monitor privacy filters

What is the greatest barrier to the acceptance of electronic health records (EHR) and personal health records (PHR) among health care providers?

Lost autonomy

EHRS usually contain which of these components?

Order entry system

True or false One of the differences between reference terminologies and classification systems is that reference terminologies attempt to define all concepts while classification systems attempt to group similar concepts.

True

True or false According to the ECRI Institute, data integrity failures with HIT systems pose the greatest concern for patient safety this year.

True

True or false An educational simulation allows a learner to participate in an experience, often online, that models or emulates a real-world experience.

True

True or false HIPAA compliance requires EHR risk assessment through documenting how the organization will mitigate and address risks.

True

Which international organization is responsible for the codes that focus on social and environmental factors impacting the health of people?

World Health Organization (WHO)

Which of these is a benefit to using standardized terminology in health care?

documentation flexibility care coordination quality measurement nursing visibility knowledge discovery interoperability.

Which of the following is an advantage of paper records? A. Safer for patient care B. Easy to read C. Trends easily identifiable D. No down time

D. No down time

What areas of electronic information security does the Health Insurance Portability and Accountability Act (HIPAA) govern?

Disposal Transfer Removal Reuse

When considering communication between patient and health care provider, what is the most important advantage e-mail communication has over traditional telephone communication?

It provides a tangible, paper copy of the conversation for future reference.

The work done by Digital Imaging and Communications in Medicine (DICOM) on standards development has made which health care intervention possible?

A magnetic resonance image (MRI) done in London England can be reviewed by professionals in Chicago, Illinois

Which of these is an example of a patient's protected information under HIPAA?

All information about patients, including name, address, phone and fax numbers, social security number, diagnosis, treatments, and past medical history

Which of the following would a nurse identify as a positive aspect of online support groups? A. The quality of information provided B. Restrictions in group membership C. Quick response return D. Diversity of viewpoints

D. Diversity of viewpoints

Which acronym is used to identify a standardized patient classification system developed in the early 1980s for the purpose of reviewing the use of hospital resources?

DRG (diagnosis-related groups)

Which of the following choices is not an example of health data that is considered PHI?

Number of steps in a pedometer

Is the following statement true or false? There are five main formats for personal health records (PHRS).

False there are three main formats for the personal health records: software applications, web based, and hybrid.

What is the greatest advantage of an electronic health record (EHR)?

Information can be accessed wherever Internet access is available.

Standards development is vital to the ability to share health care information internationally. Which organizations are currently overseeing this development?

International Electrotechnical Commission (IEC) International Organization for Standardization (ISO)

Which of the following is not an issue related to PHI integrity?

Internet speed

The EHR is an ___________health care record.

Interoperable

What legal issue does the Stark Law address?

Medicare fraud

What is the benefit to computer-generated reporting via EHRS?

More accuracy

Which of these are methods recommended by HealthIT.gov to improve the security of your data systems?

NIST Cybersecurity Framework Education Risk assessment

What security measures can be implemented to assure privacy for patients using a smart health care card? Select all that apply.

Personal identification number (PIN) Biometric recognition Password

How can an electronic health record (EHR) and the continuity it brings to health care documentation support clinical knowledge? Select all that apply.

Provides benefits of real-world experiences Shortens the time for implementation of new evidence-based practice Encourages patients' involvement in their care Assesses information that affects clinical outcomes

The type of standardized terminology that captures clinical information and serves as the primary documentation of clinical care is

Reference terminologies

As a referenced terminology system, what is the primary strength of Systemized Nomenclature of Medicine-Clinical Terminology (SNOMED CT)?

Reference terminology

Which type of simulation activity used simulated patients or actors?

Standardized patients

What term is used to describe the process of laying the groundwork and identifying pivotal issues associated with the adoption of technological systems?

Strategic planning

What type of interoperability is intended to coordinate work processes?

Structural

Who is the nurse's best resource for policies and procedures regarding the security of mobile devices and their patient data?

The agency's Health Insurance Portability and Accountability Act (HIPAA) officer

What is the first line of security when ensuring that only authorized persons can access a particular computer system?

The computer system has a password protected login process.

What security measure is standard for health care e-mails sent via "secure message delivery"?

The information is stored on a secure server.

Which of the following is a disadvantage to EHRS?

The issue of ownership