unit 5 cahims
Interoperability between EHR system components is more likely to be an issue if Arural Hospital chooses the --single-vendor solution/best-of-breed solution--.
best of breed solution
Arural Hospital will complicate its EHR contract negotiation efforts if it chooses the --single-vendor solution/best-of-breed solution.
best-of-breed solution.
If Arural Hospital hires a consulting firm to handle the contract negotiations with its top EHR vendor, the hospital's relationship with the vendor should be --better/worse-- after negotiations are complete and the contract is signed.
better
ICD provides a common language for diagnoses, which is important for which of the following? Billing Data exchange Clinical messaging Medical orders
billing
One step that a healthcare provider or institution can take to support meaningful use compliance is to choose an EHR system that has gone through which of the following processes? Compliance Testing Examination Certification
certification
AC Hospital plans for the EHR features to be implemented in phases. Which element of the organizational development plan (ODP) best addresses the impact of this decision? Personnel management Communication Change management Efforts to achieve end-user buy-in
change mgmt
Which of these groups will present the greatest challenge to consultants hired to provide EHR training, particularly from the perspective of scheduling? Executives Management Clinicians Administrative staff
clinicians
Dr. Steiner has requested that AC Hospital share its records for her patient's recent inpatient stay. Both AC Hospital and Dr. Steiner subscribe to an Internet EHR system. AC Hospital enters an authorization into the EHR system, and Dr. Steiner can immediately view the patient's records. This example demonstrates the --point-to-point/cloud-based/silo-- form of interoperability.
cloud-based
What type of due diligence did Arural Hospital perform when it contacted several well-known EHR vendors directly as part of its efforts to select the best EHR vendor to meet the hospital's needs? Contacting peers Cold calling Attending trade shows Contacting research firms
cold calling
Public health entities should be considered --institution/community-- stakeholders in an EHR project.
community
If AC Hospital needs EHR strategic advice, it would probably reach out to a --consultant/subject matter expert.
consultant
Which of the following should be included in an effective problem-reporting system for use during an EHR implementation? Check all that apply. Ranking problems according to how critical they are Including only problems that directly affect patient care and safety Linking problem resolution to the reporting process
-Ranking problems according to how critical they are -Linking problem resolution to the reporting process A well-defined rating system is important. Some minor problems can be addressed much later in the process. Also, it is important that problem resolution and reporting are linked and that feedback mechanisms are in place. The reporter of the problem needs periodic updates concerning the resolution of the problem. This process greatly enhances acceptance of the system by the users.
For a computerized provider order entry (CPOE) system to be most effective, it should be linked with which of the following systems? A CDSS Another CPOE system A feedback system An ADT system
A CDSS
What must be established for point-to-point interfacing to work? A single connecting hub A distinct and separate connection from a single component to every other component on the network A connectivity point monitor A connection to the interface engine
A distinct and separate connection from a single component to every other component on the network
An OMD dietary order is an example of which of the following? An HL7 message type A document standard An XML tag A custom programming interface
An HL7 message type
Which of the following is a valid definition of a contract? A standard agreement between two parties without any customization for the unique needs of one of the parties An agreement between two or more parties that is enforceable by law A detailed provision that ensures the HCO and vendor know and understand what to expect from each other A detailed provision that states one party is not liable for any injuries or damages
An agreement between two or more parties that is enforceable by law
Which of the following is an important workflow change that should be addressed through change management planning efforts? Employees must learn the new EHR system while still operating under the old system. Doctor-patient encounters will be affected by the EHR implementation. All employees should be kept informed of project dates and milestones. Project timelines must be coordinated with outside consultants
Doctor-patient encounters will be affected by the EHR implementation.
Which of the following can be used to efficiently manage message flow in a healthcare setting? Multiplexer Front-end processor Multiphase connector Interface engine
Interface engine
Which of the following standards organizations is helping to establish a common, voluntary framework that will support critical cybersecurity infrastructure? Regenstrief Institute ASTM International NIST HL7 International
NIST
AC Hospital wants to downsize the list of possible EHR vendors identified by its preliminary search. Which of these formal request documents will AC Hospital send to vendors asking them to provide general information about their organization and EHR offerings? Request for proposal (RFP) Request for information (RFI) Request for a quote (RFQ) Quick bid
RFI
CHealth Clinic prides itself on its many specialty services, including orthopedics. Recently, a new HCO facility opened nearby that specializes only in orthopedics. CHealth feels this new facility is an --internal/external-- threat to revenue. Therefore, CHealth has ranked support for orthopedic features as critical to EHR system selection.
external
True or false? A de facto standard can be translated as "in fact" and is a standard that is mandated by law or statute.
false
One of the key factors in EHR success is the support and participation of --a physician champion and SMEs/the CEO and COO executives/consultants-- as primary directors of the EHR effort.
the CEO and COO executives
The loss of vendor support for a current system, the need to replace an aging legacy system, and government regulations are three factors most likely to affect the --time/resources/money-- aspect of EHR planning and implementation.
time
The big advantage for Arural Hospital if it decides to start contract negotiations with both the top vendor and the runner-up at the same time is that if negotiations break down with one vendor, no time is lost. T or F
true
True or false? A robust organizational development plan (ODP) identifies all personnel who will be affected by the EHR implementation.
true
True or false? A use case is a scenario that explains a system interaction with end users or explains how system components interact with each other.
true
What does ICD provide? A universal code set for identifying diseases and medical conditions A method for transmitting business documents electronically A vocabulary for laboratory observations Protocols for transmitting patient information
A universal code set for identifying diseases and medical conditions
Which of the following is an accurate statement regarding the health IT certification process? Accredited testing laboratories (ATLs) post a list of certified health IT products on a public website. ANSI accredits ONC-authorized certification bodies (ONC-ACBs). NIST reviews health IT testing results and certifies the EHR systems that meet certification requirements. ANSI reviews health IT testing results and certifies the EHR systems that meet certification requirements.
ANSI accredits ONC-authorized certification bodies (ONC-ACBs).
Which of the following organizations would be the best source for test standards for a new type of plastic that is to be used in a medical implant? NIST HL7 International Regenstrief Institute ASTM International
ASTM International
ADR alerts are an important component of an EHR system. What does ADR stand for? Admission-depart-readmission Adverse drug reaction Antigen drug reversal Admission-discharge-readmission
Adverse drug reaction
Arural Hospital has started negotiations with its top EHR vendor. The vendor gave the negotiation team a copy of the vendor's standard contract. What is the common name for such a contract? Term of agreement Contract clause Boilerplate contract Service level agreement
Boilerplate contract
Which entity provides incentive payments and assesses penalties for the implementation or nonimplementation of meaningful use measures? ANSI ONC ONC-ACBs CMS
CMS
Which entity provides incentive payments and assesses penalties for the implementation or nonimplementation of meaningful use measures? ONC-ACBs CMS ONC ANSI
CMS
A ___software package is offered by a commercial vendor on an as-is basis. The vendor does not allow its software to be customized to fit the provider's requirements.
COTS
Dr. Wong upgraded his practice management system to an EHR system in 2011 so he could take advantage of the HITECH incentives. Dr. Wong contracted with an EHR vendor to install and maintain the system. His staff modified the practice processes and workflow to fit the EHR package. Dr. Wong's EHR system would be considered --COTS/MOTS--.
COTS
Dr. Gupta runs his private practice on a personal computer with basic software such as Windows and Microsoft Office applications. He has a practice management system that he bought and installed from a CD several years ago. Dr. Gupta's software should all be considered --COTS/MOTS--.
COTS A COTS software package is offered by a commercial vendor on an as-is basis. The vendor does not allow its software to be customized to fit the provider's requirements. All of Dr. Gupta's software (as described) would be considered to be COTS.
The basic options that must be considered when choosing whether to buy or build a software solution include which of the following? Commercial vendor software, COTS, or MOTS COTS, MOTS, or freeware Commercial vendor software, in-house-built software, or freeware In-house-built software, COTS, or MOTS
Commercial vendor software, in-house-built software, or freeware
What type of due diligence did Arural Hospital perform when it contacted KLAS as part of its efforts to select the best EHR vendor to meet the hospital's needs? Contacting peers Cold calling Attending trade shows Contacting research firms
Contacting research firms
Vital signs information would be captured from an arterial line transducer and then imported to a patient's EHR most commonly in which of the following medical facilities? Hospital medical/surgical unit Physician clinic or office Long-term care facility Critical care unit (CCU)
Critical care unit (CCU)
Dr. Aberjuduan chose a commercial MOTS EMR system and had the vendor customize the software to meet her specialized practice needs. Which of these options was probably the primary reason Dr. Aberjuduan decided to buy a commercial vendor system? The system was modified to readily interface with special equipment Dr. Aberjuduan uses in her practice. Dr. Aberjuduan prepared her own training materials and testing plan. Dr. Aberjuduan saved a lot of money and time by buying. The system is tailored to meet Dr. Aberjuduan's practice workflow.
Dr. Aberjuduan saved a lot of money and time by buying.
Which of the following costly problems could most likely be lessened or eliminated by health information exchange (HIE) when a patient switches hospitals? Multiple diagnoses Use of medical specialists Duplicate laboratory tests and medical imaging Name brand medications
Duplicate laboratory tests and medical imaging
Which of the following costly problems could most likely be lessened or eliminated by health information exchange (HIE) when a patient switches hospitals? Use of medical specialists Name brand medications Multiple diagnoses Duplicate laboratory tests and medical imaging
Duplicate laboratory tests and medical imaging
Paper documents such as insurance forms that would normally have been transmitted by fax are being replaced by which of the following? HCPCS SNOMED CT HIPAA EDI
EDI EDI is used for the transmission of patient care and insurance information. EDI replaces the transmission of paper forms and contributes to greater standardization and security.
Which of the following would make a good measure for usability of an EHR system? Check all that apply. Efficiency Safety Effectiveness Affordability
Efficiency Effectiveness
Arural Hospital would like to install an EHR system. The hospital management knows that to succeed, the project must include every opportunity to encourage the clinicians and staff to take ownership of the EHR and the project. What strategy helps encourage project ownership? Managing expectations Soliciting opinions Eliciting buy-in Managing people
Eliciting buy-in
An application programming interface (API) that responds to data requests for data referenced in the Common Clinical Data Set is an example of a feature that advances which of the following? Privacy and security Improving patient safety Facilitating health information exchange
Facilitating health information exchange
The Center for Devices and Radiological Health (CDRH) is charged with monitoring and evaluating medical devices and related software. The CDRH is a division of which federal agency? American Society for Testing and Materials (ASTM) International National Institute of Standards and Technology (NIST) Centers for Medicare & Medicaid Services (CMS) Food and Drug Administration (FDA)
Food and Drug Administration (FDA)
A systems analyst for a hospital corporation is assigned a project involving the translation of messages from a number of outside entities for compatibility with the hospital's current EHR system. The analyst should become familiar with which of the following standards or standards organizations? HL7 NIST ASTM International Regenstrief Institute
HL7
A systems analyst for a hospital corporation is assigned a project involving the translation of messages from a number of outside entities for compatibility with the hospital's current EHR system. The analyst should become familiar with which of the following standards or standards organizations? NIST Regenstrief Institute HL7 ASTM International
HL7
Which of the following is a primary messaging protocol choice for the medical industry that streamlines the process of communicating among dissimilar components? EBCDIC Health Level Seven Map OSI ADE
Health Level Seven
While reviewing the vendor's boilerplate contract, Arural Hospital's negotiation team found several hold harmless contract clauses. Why should the team be concerned about those clauses? Hold harmless clauses put the vendor and the hospital at risk. Hold harmless clauses are designed to protect the hospital while the vendor takes on liability for certain system errors or breaches. The hospital negotiation team should just accept these clauses because they are not a risk for the hospital. Hold harmless clauses are designed to protect the vendor, leaving Arural Hospital at risk of liability for certain system errors or breaches.
Hold harmless clauses are designed to protect the vendor, leaving Arural Hospital at risk of liability for certain system errors or breaches.
Which of the following is a clinical data standard? XML CDER EDI ICD
ICD
Why should an HCO be concerned about end-user license agreements (EULAs) during EHR vendor negotiations, given the contract serves as an agreement between the HCO and the EHR vendor? The EHR vendor contract will cover all EHR components, even those from third-party vendors. The EHR vendor will absorb all third-party vendor liability on behalf of the HCO. The EHR vendor may incorporate a third-party software component in the EHR. The EULAs of that third-party component may affect the HCO's financial agreement with the EHR vendor. If the EHR vendor uses third-party software components in its EHR system, the HCO needs to be fully aware of that third-party vendor's EULA security, access, and resource utilization terms and conditions regardless of the EHR vendor's relationship with that third party.
If the EHR vendor uses third-party software components in its EHR system, the HCO needs to be fully aware of that third-party vendor's EULA security, access, and resource utilization terms and conditions regardless of the EHR vendor's relationship with that third party.
True or false? The RFP should ask vendors to document their approach to software changes.
It is important to know in advance how the vendor treats system modifications in terms of approach and cost. System updates to support regulatory requirements, healthcare and medical advances, and IT advances are likely to occur over the system's 10-year life span. And the provider might discover it needs to request changes.
The information management and reporting requirements of anatomic pathology are managed by which of the following types of system? ADT eMAR LIS CPOE
LIS
Most healthcare applications require specialized vocabularies. Which of the following is used for encoding laboratory findings? Healthcare Common Procedure Coding System Logical Observation Identifiers Names and Codes Health Insurance Portability and Accountability Act eXtensible Markup Language
Logical Observation Identifiers Names and Codes
Most healthcare applications require specialized vocabularies. Which of the following is used for encoding laboratory findings? Logical Observation Identifiers Names and Codes Healthcare Common Procedure Coding System eXtensible Markup Language Health Insurance Portability and Accountability Act
Logical Observation Identifiers Names and Codes
Dr. Aberjuduan runs a specialized oncology treatment practice. She upgraded her practice management system to an EHR system in 2011 to take advantage of the HITECH incentives. Dr. Aberjuduan contracted with an EHR vendor to modify its standard EHR package to fit her specialized practice. She also contracted with the vendor to install and maintain the EHR system. Dr. Aberjuduan's EHR would be considered --COTS/MOTS--.
MOTS
Which of the following entities certifies health IT modules? ONC-authorized certification Bodies (ONC-ACBs) Office of the National Coordinator for Health Information Technology (ONC) Accredited testing laboratories (ATLs)
ONC-authorized certification Bodies (ONC-ACBs)
Which of the following established health IT certification criteria? Accredited testing laboratories (ATLs) ONC-authorized certification bodies (ACBs) Office of the National Coordinator for Health Information Technology (ONC), a department of Health and Human Services
Office of the National Coordinator for Health Information Technology (ONC), a department of Health and Human Services
Authentication, access control features, and automatic log-off are examples of features that support which of the following certification goals? Reducing health disparities Facilitating health information exchange Privacy and security
Privacy and security
RRL Hospital plans to build its own EHR system. It feels its IT staff and subject matter experts can competently achieve meaningful use. The hospital wants complete control over the project. It received a grant from a private donor to offset much of the development costs. Which of these choice will probably prove to be the greatest disadvantage of an in-house-built system for RRL Hospital? The system will be tailored to meet RRL Hospital's business practices and workflow. RRL Hospital and staff will invest less time on the implementation. RRL Hospital's testing will be limited to in-house users. RRL Hospital will not have the advantage of the vendor's experience and healthcare industry and IT expertise.
RRL Hospital will not have the advantage of the vendor's experience and healthcare industry and IT expertise.
The ability to capture gender and sexual orientation information supports which of the following certification goals? Privacy and security Facilitating health information exchange Reducing health disparities
Reducing health disparities
AC Hospital has a psychiatric ward and a well-known psychiatrist, Dr. Patricia Behan, who heads up that area of the hospital's services. Dr. Behan should be recruited to participate on the EHR project as a --consultant/subject matter expert--.
SME
AC Hospital has a psychiatric ward and a well-known psychiatrist, Dr. Patricia Behan, who heads up that area of the hospital's services. Dr. Behan should be recruited to participate on the EHR project as a --consultant/subject matter expert.
SME
Arural Hospital would like to install an EHR system. The hospital plans to encourage users to actively participate in the project, particularly during the system selection and evaluation effort. What strategy will ensure this goal is reached? Managing people Soliciting opinions Eliciting buy-in Managing expectations
Soliciting opinions
True or false? Because HL7 standards are open standards, there is a significant fee to download them.
The HL7 Clinical Document Architecture standard and other intellectual property is available without charge to HCOs and does not require an HL7 membership.
Which of the following is an accurate statement about the role of the ONC in the certification process? The ONC established the criteria and authorized NIST to administer the laboratory testing program. The ONC reviews testing results, determines which health IT products meet certification standards, and posts the results on a public website. The ONC certifies ONC-ACBs and monitors the quality of their processes and procedures. The ONC tests and certifies health IT products.
The ONC established the criteria and authorized NIST to administer the laboratory testing program.
Which of these combinations represents a good makeup for AC Hospital's contract negotiation team? The functional and clinic representatives from the project team, with some participation from the CFO and the financial team, should conduct contract negotiations. The functional, clinic, and technical representatives from the project team, with some participation from the financial team, should conduct contract negotiations. The CEO, CFO, and CIO should conduct contract negotiations. AC Hospital should choose staff members who were not party to the system selection to ensure a new and fresh point of view for contract negotiations.
The functional, clinic, and technical representatives from the project team, with some participation from the financial team, should conduct contract negotiations.
AC Hospital has reached the EHR vendor selection phase of its EHR project. Which of the following should AC Hospital do to determine which formal request documents to use for vendor selection and evaluation? The hospital should not worry too much about vendor request documents. Vendor demonstrations and site visits will suffice. The hospital should review and compare vendor responses to formal request documents in a consistent manner. The hospital should consider the size and complexity of the EHR project in order to choose the appropriate vendor request documents. The hospital should contact several vendors and ask them for recommendations.
The hospital should consider the size and complexity of the EHR project in order to choose the appropriate vendor request documents.
What is the overall role of the steering committee during the EHR vendor selection process? To advise and approve the vendor selection To perform all steps in the planning, evaluation, and selection of the EHR vendor To ensure the EHR system is certified To backfill end-user positions and provide EHR expertise not available within the HCO
To advise and approve the vendor selection
What is the overall role of consultants as project team members during the EHR vendor selection process? To advise and approve the vendor selection To perform all steps in the planning, evaluation, and selection of the EHR vendor To ensure the EHR system is certified To backfill end-user positions and provide EHR expertise not available within the HCO
To backfill end-user positions and provide EHR expertise not available within the HCO
A computerized provider order entry with clinical decision support (CPOE/CDSS) would most likely check a patient's weight for which of the following reasons? To initiate a weight management education protocol To help determine which diet order the physician should choose To help prevent dosing errors To filter and use the weight metric in public health studies
To help prevent dosing errors
What is the overall role of the project team during the EHR vendor selection process? To advise and approve the vendor selection To perform all steps in the planning, evaluation, and selection of the EHR vendor To ensure the EHR system is certified To backfill end-user positions and provide EHR expertise not available within the HCO
To perform all steps in the planning, evaluation, and selection of the EHR vendor
Which of the following options represents a major goal for certification of EHR systems? Check all that apply. To promote certain vendor products above others To reduce the financial risks to investment in EHR systems To ensure providers have all the functionality they need to meet meaningful use requirements
To reduce the financial risks to investment in EHR systems To ensure providers have all the functionality they need to meet meaningful use requirements
What is the overall role of the technical representatives on the project team during the EHR vendor selection process? To advise and approve the vendor selection To drive the selection of the EHR vendor To ensure the EHR system is certified To verify the selected system meets all regulatory requirements and will efficiently and effectively support the goals and requirements.
To verify the selected system meets all regulatory requirements and will efficiently and effectively support the goals and requirements.
Sam Vincente works in an acute care hospital as a critical care nurse. All of the devices that monitor a patient's vital signs automatically populate the vital signs data to the patient's electronic record except for one. The hospital has purchased new respirometers, which automatically measure a patient's respiratory rate. The devices function well. They have display panels and also produce digital data that could automatically populate the part of the patient's record called a flowsheet, but it is in the wrong format and is incompatible with the patient's EHR. At 10-minute intervals, Sam has to manually calculate a patient's respiratory rate and then enter it into the record. Based on this scenario, what would be a solution to this problem? Leave things as they are. Entering the respiration is not that big a task. Replace respiration monitors with monitors that are compatible with the EHR. Replace the EHR software with a system that is more compatible with patient monitoring devices. Use middleware to format the data so that the EHR system will accept it.
Use middleware to format the data so that the EHR system will accept it.
Which of the following is used by HL7 version 3 to structure data? SCD SSU XML DTD
XML
Which of the following is a common data standard for exchanging data over the Internet? SNOMED CT XML ICD LOINC
XML XML, or eXtensible Markup Language, is a common data standard for exchanging data over the Internet. XML provides the means for both storing and presenting data.
End users often come into an EHR project with preconceived ideas, good and bad, about EHR systems. The participation of --a physician champion and SMEs/the CEO and COO executives/consultants-- can clarify the end users' understanding of the value an EHR system offers to the end user and to the HCO as a whole
a physician champion and SMEs
The function of the steering committee is --decision making/advisory/technical--.
advisory
Which of following would provide a comprehensive list of names, definitions, and attributes for data elements that are recorded in an information system or database? Encryption log Data dictionary Code set Taxonomy
data dictionary
The function of the EHR project team is --decision making/advisory/technical--.
decision making
True or false? AC Hospital faces serious deadlines and is concerned that all the time it spends in negotiations might be wasted if negotiations deteriorate. Therefore, AC Hospital should initiate single-vendor negotiations with its top vendor immediately.
false
True or false? AC Hospital has had friendly relations with the top vendor during the system selection effort. The hospital's contract negotiation team should make it a priority to maintain that friendly relationship throughout negotiations.
false
True or false? AC Hospital plans to acquire an EHR system. Its first step in the strategic planning process should be to review the hospital's project timeline.
false
True or false? Although cost concerns should be included in the contract, they are relatively minor compared with other issues.
false
True or false? An admission-discharge-transfer (ADT) system is used for auditing financial transactions in a healthcare environment.
false
True or false? An interface engine is used solely for messaging within a hospital's internal systems.
false
True or false? As a general rule, healthcare financial applications and clinical applications do not need to be integrated.
false
True or false? Deciding how data should be encoded for transmission is not a data standard.
false
True or false? Determining requirements is fairly straightforward, so this step is often overlooked or ignored even though it is a mistake to skip the effort.
false
True or false? Educational vendor demonstrations are very detailed and should be attended only after the HCO project team has evaluated the target vendors thoroughly and the selection is down to no more than three possible vendors.
false
True or false? Functional requirements provide critical elements for inclusion in the RFP. The nonfunctional requirements are informative but not necessary to the RFP content.
false
True or false? No matter how effectively planned and organized the system selection process may be, the stakeholders are unlikely to understand and accept the impact the EHR system might have on processes and workflow.
false
True or false? Nonfunctional requirements describe the capabilities of the system and specify what the user should be able to do with the system but with less detail than provided by the functional requirements.
false
True or false? Order duplication checking is normally reserved for medication orders.
false
True or false? Purchasing a certified EHR system ensures that a healthcare organization will have a system that is user-friendly and aligns with its standard clinical workflows.
false
True or false? The EHR system is one of the largest capital expenditures an HCO will ever make, although the annual maintenance fees are relatively small.
false
True or false? The project manager serves on either the project team or the steering committee.
false
True or false? The provider should ensure there is a way for the vendor to get out of the contract if the vendor is unhappy.
false
True or false? When condensing the list of vendors to whom to send an RFP, the provider should choose only vendors who can meet the provider's specified RFP response deadline.
false
True or false? When thinking about change management, the HCO leadership should identify all costs associated with the EHR system implementation.
false
True or false? Adverse drug reactions and events are usually tracked in the radiology information system (RIS)
false Adverse drug reactions are NOT tracked in the RIS. The RIS contains components that schedule and track patients as well as report results and manage medical images.
True or false? Once the requirements are determined, the request for proposal (RFP) can be written.
false After the functional and nonfunctional requirements are determined and documented, the use case technique is utilized to finalize the requirements. Then the RFP is written. System selection step 3, determine requirements and write the RFP, includes each of those activities.
True or false? The organizational development plan (ODP) includes an accurate and flexible EHR project timeline.
false Although a project timeline is important, the ODP does not directly address the timeline. The project timeline is developed by the project manager on the basis of completion of the requirements gathering effort.
True or false? Documenting use case scenarios is very time consuming. Therefore, use cases should be used on a limited basis.
false Correct. Use case scenarios are time consuming but are also a strong determinant for requirements. The time devoted to use cases during systems selection will save significant time and money in the implementation and will better ensure system adoption.
True or false? AC Hospital faces serious deadlines and is concerned that all the time it spends in negotiations might be wasted if negotiations deteriorate. Therefore, AC Hospital should initiate single-vendor negotiations with its top vendor immediately.
false Dual negotiations is the best approach if there are significant deadlines because if negotiations with one vendor deteriorate, negotiation with the other is already underway.
True or false? The 12-step system selection process is more like a menu of choices than like a checklist.
false Each step is essential, and the combination of these steps helps ensure the most effective result of the system selection process, which means time and cost savings and more likely success and adoption of the system.
True or false? Although the 12-step system selection process is helpful in choosing an EHR that fits the clinical needs of the practice, the selection process offers little monetary value.
false Following an organized and effective system selection process such as the 12 step system will save time and expense.
True or false? Training starts after the EHR system is selected.
false From the beginning of the EHR project, staff should be given opportunities to participate in trade shows, online learning, vendor demonstrations, and site visits. These opportunities provide essential information about EHR systems and occur before a specific vendor is chosen. Of course, formal training is provided directly on the chosen EHR system.
True or false? Health information exchanges (HIEs) are created for information exchange among regional hospitals.
false HIEs are created for information exchange among regional hospitals but also include other providers such as physician practices.
True or false? Arural Hospital has decided to lease rather than purchase its computer hardware. This decision has no advantages for the hospital other than that the lease fees will be posted as an operating expense rather than capital expense.
false Leasing its hardware is advantageous to the HCO. The HCO is not in the IT business, so it is not likely to budget to upgrade hardware regularly. With a hardware lease, the hospital has the opportunity to upgrade its computer technology regularly at the end of each lease period.
True or false? An effectively organized, studied, and informed system selection process will educate the stakeholders about all the possible EHR vendor offerings on the market.
false One of the goals of an effective system selection process is to narrow the list of potential vendor offerings to those that best fit the provider's needs, particularly given the many available EHR systems on the market.
True or false? Because HL7 standards are open standards, there is a significant fee to download them.
false The HL7 Clinical Document Architecture standard and other intellectual property is available without charge to HCOs and does not require an HL7 membership.
True or false? Functional requirements provide critical elements for inclusion in the RFP. The nonfunctional requirements are informative but not necessary to the RFP content.
false The RFP will be incomplete without nonfunctional requirements. Nonfunctional requirements may be general in nature but address critical aspects of user and system service
True or false? Vendor reference checks are not important when compared to the RFP response and vendor demonstration evaluations.f
false The average system life span is 10 years. That is a long time to be tied to a vendor who provides poor customer support or who goes out of business halfway through the contract term. Careful reference checks can help prevent such issues by eliminating vendors who present risks.
True or false? When an organization decides to buy or build a software solution, that decision primarily affects the organization up to and during system implementation.
false The buy-or-build decision affects the organization throughout system's life cycle because ongoing maintenance is impacted significantly. A decision to buy means an ongoing relationship with the vendor. A decision to build means in-house IT staff and subject matter experts will be needed.
True or false? Only the system selection committee should attend the vendor demonstrations.
false The provider should strive for all stakeholders to view the vendor demonstrations. The participation of all stakeholders will provide more robust feedback and help ensure a successful system implementation and adoption.
True or false? Use cases are critical to the effort to negotiate the vendor contract.
false The requirements extracted from the use case scenarios will be represented as features and functions that must be identified in the vendor contract. However, it makes no difference at all that a particular requirement was sourced from a use case.
True or false? Because Dr. Wong leased a COTS EHR system, he does not need any IT expertise during implementation, nor does he need anyone on his staff who deals with IT issues postimplementation.
false The vendor will absorb all the IT development time and effort for a commercial vendor EHR system. However, Dr. Wong learned it was necessary to have his office manager learn some basic IT skills and act as liaison with the vendor. Dr. Wong also contacted his state-run regional extension center (REC) to assist with vendor selection and coordination during the implementation.
True or false? There are so many vendors at an EHR trade show that the HCO project team should split up and visit all of them to strengthen their efforts to select the best EHR vendor to meet their needs.
false Trade shows are a good opportunity for members of the HCO project team to attend demonstrations and talk with a variety of EHR vendors. However, these shows can be overwhelming, so prior to attending, the team should identify target vendor candidates and design a simple tool for recording findings.
True or false? When request for proposal (RFP) responses, vendor demonstrations, and site visits are evaluated as part of the system selection process, the usability tasks and measures should be defined.
false Usability tasks and measures should be documented in the RFP, so they must be defined before the RFP responses, vendor demonstrations, and site visits occur.
True or false? Cost is the greatest barrier to EHR system utilization.
false Usability, not cost, is the biggest barrier to EHR system utilization. An EHR system might perform all the functions necessary to allow the provider to achieve meaningful use, but if the features and functions are not efficient, effective, and satisfactory to the provider, the system may not be used. As many as 30 percent of all private-practice EHR systems are uninstalled after installation at a tremendous loss of time and money to the provider.
True or false? Use case scenarios assist in the process of ranking requirements prior to writing the RFP.
false Use case scenarios are a source for determining requirements. Once those requirements are added to this list, they are ranked according to the provider's priorities. Use cases do not aid that effort.
True or false? The system selection team will give more weight to the demonstration ratings submitted by members of their own group.
false Each member of the system selection team will probably have a favorite vendor before they view the vendor demonstrations. That brings a bias to their findings. Therefore, opinions from participants not on that team should be given more weight because they are probably more open-minded.
The missing option from this choice is ___systems, which are usually cloud-based offerings for which the vendor offsets the cost of development with some form of Internet advertising. ____ software is either COTS (as-is) or MOTS (modifiable). In-house-build software might be a completely unique software solution developed by in-house staff or might start with an open source software product that is modified by in-house staff.
freeware commercial
This is a ____ requirement because the analysis could impact specific features and functions of the EHR system.
functional
Clinicians should be considered --institution/community-- stakeholders in an EHR project.
institution
Project leaders should be considered --institution/community-- stakeholders in an EHR project.
institution Project leaders, as direct participants in the EHR project, are institutional stakeholders.
What is the name of a software interface that allows disparate clinical or business systems to connect more efficiently by translating, decoding, and recoding information from each system? Interface engine Data standard HL7 Identifier standards
interface engine
CHealth Clinic is proud to have a superior patient-safety ranking. It would like to further enhance this area of its practice, which also might decrease its malpractice insurance expense. CHealth hopes to address this --internal/external-- concern with new features of the EHR system, particularly clinical decision support system alerts and e-prescribing.
internal
CHealth has a capitated billing agreement with a third-party payer (insurance company). That payer offers a significant annual financial incentive if CHealth physicians meet pre-established cost-control and quality criteria. The third-party payer sends a quarterly status, but CHealth would like to monitor monthly. This --internal/external-- need for improved reporting ability is ranked as an important feature for the EHR system CHealth will choose.
internal
What is lacking when a device such as a ventilator does not interface with an EHR? Open systems architecture Convergence Interoperability Compatibility
interoperability
St. Knox Hospital decides to buy a commercial EHR system. It has an in-house IT staff, but the hospital is concerned that its own IT staff and subject matter experts might not have sufficient knowledge of HITECH meaningful use, so it wants the vendor to implement and continue to maintain the system after implementation. The most likely form of contractual relation with the vendor for St. Knox would be a --purchase/lease-- agreement.
lease
When reading HL7 conformance criteria, the verb --shall/should/may-- indicates an optional or permissible action for an EHR system.
may
Which of the following terms would be most often associated with HL7? Message Patient safety Data element EDI
message
One of the solutions to connecting disparate devices and systems to a hospital information system is to contract with a third-party vendor to provide which of the following? Enterprise connectivity XML Middleware Proprietary protocols
middleware
Dr. Mendez has a very small practice and is shocked when she reviews the numbers and types of EHR vendor offerings and the dramatic differences in the investment required. Dr. Mendez will need robust due diligence when considering the --time/resources/money-- the system will require relative to her practice's true requirements.
money
Arural Hospital has established its goals for the EHR project. It is ready now to identify the requirements so the project timeline can be finalized. What process is the hospital is ready to begin? Workflow analysis Needs assessment Gap analysis Project scope
needs assessment
Potowa Hospital is a small rural facility with about 100 beds. It serves several counties. The hospital wants to take advantage of the HITECH incentives and install an EHR system. The clinicians and administrators at the hospital have been asked to educate themselves in preparation for the system selection process. Which of these sources would be useful? Select Yes or No for each option. Talk with patients to get their input. --YesNo Read trade publications. --YesNo Ask peers what they know or have experienced. --YesNo
no yes yes
Which of the following would be considered an essential aid to the EHR vendor evaluation process? Select Yes or No for each option. Educational vendor demonstrations --YesNo Vendor customer references --YesNo Vendor customer site visits --YesNo Request for information (RFI) responses --YesNo
no yes yes no
Which of these questions apply to the process Potowa Hospital will follow when determining the functional specification for their EHR system? Select Yes or No for each option. How often is the vendor helpdesk available for user support? --YesNo What patient data is required to support the EHR system? --YesNo What impact will the system have on existing workflow? --YesNo What existing problems should the new system correct? --YesNo
no yes yes yes
Which of these questions apply to the process Potowa Hospital will follow when documenting the nonfunctional specification for its EHR system? Select Yes or No for each option. What impact will the system have on existing workflow? --YesNo How will the EHR system allow for 99.5 percent uptime? --YesNo Does the EHR system comply with HIPAA and CMS requirements? --YesNo How often will the vendor issue new software releases and provide ICD and HCPCS code updates? --YesNo
no yes yes yes
Which of these items is a capital expense, and which is an operating expense? Select Capital expense or Operating expense for each option. Vendor maintenance and support fees --Capital expenseOperating expense Consultant travel expenses and hourly billing --Capital expenseOperating expense Time spent developing training --Capital expenseOperating expense Time spent by staff in training or participating in project effort --Capital expenseOperating expense
operating capital capital operating
Each usability measure should be assigned a --percentage/function/goal--.
percentage
The technical nonfunctional requirement that defines how well the system works for the user in measurable degrees is called --usability/performance/scalability/security--.
performance
Dr. Drake is a specialist treating a patient who was referred to her office by Dr. Tomas. Dr. Drake and Dr. Tomas practice in a state that has implemented a health information exchange (HIE). When Dr. Drake requests access to the patient's radiology images, Dr. Tomas asks his EHR system to share those images, and the system sends them across the HIE to Dr. Drake's EHR system. Now the images are stored on both Dr. Drake's and Dr. Tomas's EHR systems. This example demonstrates the --point-to-point/cloud-based/silo-- form of interoperability.
point-to-point
AC Hospital establishes the EHR project goals according to guidelines it has identified that lead to successful EHR implementation. AC Hospital also wants to be confident that it has sufficient funds and that the money will be spent wisely, so it must prepare to address --project costs/the project timeline/multidisciplinary buy-in.
project costs
AC Hospital has completed the analysis and assessment steps that precede the system selection effort. What is the term for all of the accumulated documentation? Workflow analysis Needs assessment Gap analysis Project scope
project scope
Clinicians will serve on the --project team/steering committee-- for the EHR project effort.
project team
The CIO at AC Hospital has hired an HIT consulting team to work with the IT staff during EHR system selection and implementation. A representative from that group should probably participate on the --project team/steering committee--.
project team
AC Hospital establishes the EHR project goals based on guidelines it has identified that lead to successful EHR implementation. The hospital needs to establish a firm date for implementation by establishing an appropriate --needs assessment/multidisciplinary buy-in/project timeline.
project timeline
Health information exchange (HIE) that supports real-time surveillance and notification for such things as influenza, diabetes pervasiveness, care, and complications would be most useful for which of the following? Hospital executives Individual health providers Public health agencies Public schools
public health agencies
AC Hospital decides to buy a commercial EHR system but wants its own in-house IT staff to modify and implement the system and to maintain the software after it is implemented. The hospital believes its own IT staff and subject matter experts have sufficient knowledge to ensure the system can meet HITECH meaningful use. The most likely form of contractual relation with the vendor for AC Hospital would be a --purchase/lease-- agreement.
purchase AC Hospital wants control over the software, so it would most likely enter a purchase agreement with the EHR vendor.
The statement "The EHR system will have redundant backups allowing for 99.5 percent uptime" represents a technical nonfunctional requirement called --reliability/supportability/system requirements/ legal/regulatory---.
reliability
Dr. Moreno has a vendor who handles her practice management service for billing and collections. When considering an EHR system, she would like to keep that service because she would rather not have her office staff engaged in collecting money from patients or from insurers. Therefore, the system she chooses must provide an interface, or the vendor will need to build one for her practice. This is an example of a --use case before EHR/requirement/use case after EHR.
requirement
Dr. Mendez has a very small practice with one office manager and two nurses. She may experience issues with --time/resources/money-- during her office's EHR implementation.
resources
Which of the following attributes of an EHR system is evaluated as part of the EHR certification process? Security Cost Usability Financial stability of the vendor
security
Which of the following attributes of an EHR system is evaluated as part of the EHR certification process? Security Financial stability of the vendor Usability Cost
security
The ONC includes --security/interoperability/security and interoperability-- in a list of items that providers and patients should be confident are provided by EHR systems.
security and interoperability
An HL7 version 2 message is composed of a series of what kind of element? Tags Segments Modules Sections
segments
When reading HL7 conformance criteria, the verb --shall/should/may-- indicates a mandatory requirement for an EHR system to achieve conformance with the standard.
shall
When reading HL7 conformance criteria, the verb --shall/should/may-- indicates an optional or recommended action for an EHR system.
should
Arural Hospital should experience seamless access to data across EHR components if it chooses the --single-vendor solution/best-of-breed solution--.
single-vendor
The physician champion serves on the --project team/steering committee-- for the EHR project effort.
steering committee The physician champion is an EHR project leader who serves best on the EHR steering committee acting in an advisory capacity and overseeing the clinical elements EHR process.
Exchanged data is most often which of the following? Structured Free text Nonstandard Unencoded
structured
True or false? AC Hospital completed contract negotiations with its top EHR vendor. The negotiation team feels the final contract leaves the hospital at risk, and the vendor is unwilling to renegotiate on the issues of concern. The hospital is facing serious deadlines and is concerned that the time spent in negotiations might be wasted. AC Hospital should walk away and begin negotiations with the runner-up vendor.
true
True or false? AC Hospital expects a great deal of resistance to a new EHR system from the physicians and staff. A good guideline for the hospital to follow is to strategically plan for how change will be managed in a deliberate, reasoned fashion throughout the EHR project.
true
True or false? An effectively organized, studied, and informed system selection process save significant time and money during the subsequent EHR installation process.
true
True or false? Attorneys and IT experts are essential participants in the contract negotiation and review effort.
true
True or false? Because St. Knox Hospital has decided to lease an EHR system from a commercial vendor, it will spend less time and money hiring and retaining in-house IT staff.
true
True or false? Communications is considered a fundamental element of an HCO's organizational development plan (ODP).
true
True or false? Cost is the greatest barrier to EHR system installation and implementation.
true
True or false? Due diligence should reflect appropriate care to avoid harm and control risk for the HCO during the system selection effort.
true
True or false? Functional requirements describe the capabilities of the system and specify what the user should be able to do with the system.
true
True or false? HCO leadership should spend some time gauging the organization's readiness for the changes associated with an EHR system effort.
true
True or false? Most training occurs during the EHR implementation effort.
true
True or false? One of the first steps in the standardization of data is deciding which data should be collected.
true
True or false? One of the obstacles to sharing information across systems is not lack of standards but lack of commonly adopted standards.
true
True or false? Potowa Hospital should refer to the HL7 EHR System Functional Model to ensure all the necessary and desirable EHR functions are included in its functional requirement specifications.
true
True or false? Scripted vendor demonstrations are very detailed and should be attended only after the HCO project team has evaluated the target vendors thoroughly and the selection is down to no more than three possible vendors.
true
True or false? System integration can refer to either physical integration or functional integration.
true
True or false? The 12-step system selection process suggested by K. G. Adler ensures a better fit when the provider chooses an EHR system.
true
True or false? The RFP should include a request for the vendors to outline their system maintenance schedule and customer support infrastructure.
true
True or false? The big advantage for Arural Hospital if it decides to start negotiations with just the top vendor is that the negotiations will be less stressful and less confusing for the hospital's negotiation team.
true
True or false? The contract should include language stating whether the vendor will customize its system at the provider's request and, if so, at what cost.
true
True or false? The contract should include service level agreement (SLA) terms and conditions for each EHR system requirement with a definition of how the requirement will be measured.
true
True or false? The contract should provide for the contingency that the vendor system might not perform as expected during or after implementation, and the vendor's liability in that event should be detailed.
true
True or false? The provider's goals are relevant to determining functional and nonfunctional requirements.
true
True or false? The provider's system selection team uses an RFP response evaluation checklist to scrutinize the RFP responses to identify the vendors that most closely match the provider's requirements.
true
True or false? The system selection team creates a demonstration rating form derived from the RFP response evaluation checklist to record the vendor demonstration ratings
true
True or false? Two elements that information standards address are structure and content.
true
True or false? Usability measurement goals should be utilized when the request for proposal (RFP) responses, vendor demonstrations, and site visits are evaluated.
true
True or false? Use case scenarios are a valuable tool for evaluating vendor responses to the RFP.
true
True or false? When an EHR system is unavailable for any reason, users resort to an alternative plan, which is usually reverting to paper charting, at least temporarily.
true
True or false? When choosing vendors who are good candidates to receive an RFP, the provider can refer to the state regional extension center (REC) for vendor system recommendations.
true
True or false? Because St. Knox Hospital has decided to lease an EHR system from a commercial vendor, it will spend less time and money hiring and retaining in-house IT staff.
true Correct. St Knox Hospital will still need capable IT and subject matter experts on staff. However, the primary effort to stay up to date on new information technologies and on healthcare trends will fall to the vendor. St. Knox can keep less expensive IT and subject matter experts than would be needed if it built a system in-house.
True or false? Use case scenarios can be used to identify software, hardware, data, and data transmission requirements, particularly before and after scenarios are described.
true Correct. Use cases are a valuable source for determining requirements. Each use case scenario depicts system and user interactions before or after an EHR installation. The software, hardware, data, and data transmission differences between the two scenarios can be used to discern requirements.
True or false? Organizations are legally required to conform to de jure standards.
true De jure standards are those required by law.
True or false? The 12-step system selection process may reveal the first glimpse of changes that might be required in the provider's procedures and workflow.
true Early identification of the EHR system's impact on the provider's internal processes, procedures, and workflow allows informed preparation to minimize the negative aspects of these factors.
True or false? A sole source vendor request replaces the RFP if there is only one vendor who offers a particular large-scale computer system solution.
true If a particular computer resource is available from only one vendor, a sole source request will be sent to the vendor. If the request is related to a large-scale product such as an EHR system, it will be quite detailed. If used for minor purchases such as add-ons to an existing product, it will be simplified.
True or false? Because St. Knox Hospital has decided to lease an EHR system from a commercial vendor, it will spend less time and money hiring and retaining in-house IT staff.
true St Knox Hospital will still need capable IT and subject matter experts on staff. However, the primary effort to stay up to date on new information technologies and on healthcare trends will fall to the vendor. St. Knox can keep less expensive IT and subject matter experts than would be needed if it built a system in-house.
True or false? The RFP should include a request that the vendor specify its organization size, customer base, and length of time in business.
true The average life span of an EHR system is 10 years. A vendor offering may be attractive, but a young and/or small vendor might have issues with stability and longevity. Vendors with longevity and a large customer base might be more stable. But size and age are just two factors that should be considered when choosing a vendor.
True or false? An organized, studied, and informed system selection process improves the probability of successful adoption of the EHR system after implementation.
true The years of EHR system use that follow the system implementation are the real test of success. If the system is not adopted, the provider potentially loses all the time and money spent on implementation and may find it necessary to start again. If stakeholders are engaged from the start of the system selection effort, adoption is more likely at all levels of the provider's organization.
True or false? With EHR/device integration, transfusion orders can be sent directly to an infusion pump.
true With EHR/device integration, a transfusion order is sent directly to the infusion pump; the nurse then checks the settings against an electronic order.
The technical nonfunctional requirement that defines the ease with which a system can be learned and used is called --usability/performance/scalability/security--.
usability
Which of the following EHR system attributes do providers need to evaluate independently, as it is not evaluated in the EHR certification process? Usability Functionality that supports meaningful use requirements Interoperability Security of patient health data
usability
Dr. Jefferson sees a patient with a severe sore throat. He takes a saliva sample and uses a CPOE application to enter an order for a specimen laboratory test. Dr. Jefferson tells the patient he believes the test result will show strep throat. Dr. Jefferson looks at the patient record and asks the patient to confirm that she has no allergies to medications, as indicated on the screen. A nurse enters and takes the specimen. Dr. Jefferson tells the patient that an alert will appear on the screen when the results are available. They talk about the patient's other concerns while they wait. This is an example of a --use case before EHR/requirement/use case after EHR--.
use case after EHR
Nurse Allemeier has night duty on her ward. She has received the medication cart from the hospital pharmacy and has just entered Mr. Cramer's room to give him his pills. She picks up the patient's chart from the foot of the bed and compares the names on the pill vial and on the chart to ensure this patient is Mr. Cramer and that the pills are Mr. Cramer's correct medications. Nurse Allemeier then consults the paper chart to verify the medication and the dosage between the chart and the vial. It is the same. She wakes Mr. Cramer and gives him his medication with a drink of water. This is an example of a --use case before EHR/requirement/use case after EHR.
use case before EHR
Arural Hospital is ready to document its current processes and procedures in the units where the EHR will be implemented. What process is the hospital about to undertake? Workflow analysis Needs assessment Gap analysis Project scope
workflow analysis
Does each item represent an action that Potowa Hospital should undertake as it utilizes the HL7 EHR System Functional Model to complete its EHR functional requirements? Select Yes or No for each option. Learn the meaning of HL7 keywords such as shall, should, and may. --YesNo Concentrate on the direct care and supportive sections of HL7. --YesNo Learn to read the HL7 hierarchical model. --YesNo Limit research to the information infrastructure aspects of each HL7 function. --YesNo
yes no yes no Feedback Part 1 Correct. It is essential to learn the keywords and what they mean in the HL7 vernacular and to understand, for example, the difference between a feature that shall be and one that may be included. Part 2 Incorrect. Providers should use all of the HL7 data relevant to their practice. If they concentrate solely on the direct care and supportive sections of HL7, relevant information infrastructure concepts might be missed. Part 3 Correct. Information in HL7 is organized as a hierarchy, which sounds straightforward, but HL7 is also huge, so it is important to understand the hierarchy when reading and interpreting a standard. Part 4 Correct. Provider should use all of the HL7 data relevant to their practice. If they concentrate solely on the information infrastructure sections, clinical and administrative EHR features and functions will probably be missed.
Which of these options represents a major goal of certification of EHR systems? Select Yes or No for each option. Certification ensures health data security and privacy. --YesNo Certification ensures the EHR system will have basic functionality and interoperability that allows providers to focus on their unique needs. --YesNo Certification ensures providers will invest the least possible amount of time and money in implementing an EHR system. --YesNo
yes yes no
Austin Regional Clinic hired an outside consulting group to develop and conduct its training during the EHR implementation effort. Which option presents a viable method of training the clinic might have used? Select Yes or No for each option. Train internal staff members to be trainers. --YesNo Have internal staff members learn the system and develop a training plan. --YesNo Hire temporary staff to be on hand at implementation and to show the staff how to operate on a one-on-one basis. --YesNo Send the staff in groups to vendor training sessions.
yes yes no yes
Dr. Takahashi wants an EHR system in his office, and he has narrowed his choices to a cloud-based vendor system and an in-house EHR system popular among his peers. Both options are endorsed by his state's regional extension center. The cloud-based vendor provides Internet-based training and implementation support. These services are provided in-house by the in-house EHR system vendor for an extra fee. If he decides on the in-house EHR, which of these costs will Dr. Takahashi incur that would be absorbed by the vendor if he chose the cloud-based system? Select Yes or No for each option. EHR system hardware/software infrastructure costs --YesNo EHR system hardware/software ongoing maintenance costs --YesNo EHR annual subscription or leasing fees --YesNo Regular EHR system backup costs --yesNo
yes yes no yes Part 1 Incorrect. All hardware and software that supports an in-house EHR system is purchased or leased by the provider. The cloud alternative would require only desktop PCs. Part 2 Correct. Dr. Takahashi will have to pay for ongoing maintenance of the hardware and software that supports the in-house EHR system. For a cloud-based solution, the vendor would absorb these costs. Part 3 Incorrect. Dr. Takahashi probably does not realize any savings with this item. An in-house EHR system vendor will charge an annual leasing fee. A cloud vendor will probably charge an annual subscription fee. Part 4 Correct. Dr. Takahashi will have to pay for regular backups of the in-house EHR system. For a cloud-based solution, the vendor would absorb this cost.
St. Knox Hospital has decided to acquire an EHR system rather than build one. Which of the following represent system options the hospital should now consider? Select Yes or No for each option. COTS systems --YesNo Cloud-based freeware --YesNo MOTS systems --YesNo
yes yes yes
