Health IT Test 2
Which of the following is NOT a strategy to shorten the deliverables cycle?
"Big bang" implementation
Which common financial measure is calculated by subtracting the initial investment from the future cash flows that result from the investment?
. Net present value
If users are ever to fully realize the system's value, they must have access to technical support, preferably by—
. Providing local, in-house support
Which of the following is NOT a drawback to cloud-based services?
. Slow deployment due to customizations
6 Categories of IT Investment
1. Infrastructure 2. Mandated 3. Cost Reduction 4.Specific New Products/Services 5. Quality Improvement 6. Strategic Initiative
Health IT Standard Categories
1.) Ad hoc 2.) De facto 3.) Government mandate 4.) Consensus
4 phases of Systems development life cycle (SLDC)
1.) planning and analysis 2.) design 3.)implementation 4.) support and evaluation
It is reasonable to expect that the hardware, software, and network will likely need to be replaced within how many years as advance are made in technology, the organization's goals and needs change, and the health care environment changes?
3-10 years
HL7 International
ANSI-Accredited SDO Provides framework and standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinicial practice and the management, delivery and evaluation of health services. HL7 standards related to interoperability: Clinical Document Architecture (CDA) Continuity of care document (CCD) Clinical context object workgroup (CCOW) HL7 also publishes functional EHR and PHR specifications
ASTM International
Accredited SDO Has published over 12,000 standards Standards include medical device standards and health information standards Health information standards managed by committee E31
__________ is the individual who holds overall accountability for the project and represents the area of the organization that is the major recipient of the project.
Business sponsor
Clinical Vaccines Administered
CVX
CDT
Code on Dental Procedures and Nomenclature
Digital Imaging and Communications in Medicine Standards
DICOM; Need for a standard for the electronic transfer of images between devices manufactured by different vendors.
All alternatives are considered, a cost-benefit analysis is done, a system is selected, and vendor negotiations are finalized in which phase of the system development life cycle?
Design
__________ is the extent to which the company has invested in technology-enable initiatives to change how the company operates.
Digital intensity
Digital Maturity
Digital intensity- the extent to which the company had invested in technology-enabled initiatives to change how the company operates. Examples.) advanced analytics, social media, digital design of products Transformation management intensity- extent of leadership capabilities necessary to drive digital transformation throughout the company. Examples.) vision, governance, and ability to change culture
Internal Rate of Return
Discount rate at which the present value of an investment's future cash flow equals the cost of the investment What rate of return am I going to get on this investment?
Assuming that a strategic IT plan already exists, the first step in a system acquisition process is which of the following?
Establish a project steering committee and appoint a project manager
Which of the following is a reason to conduct vendor demonstrations?
Evaluate the look and feel of the system from the programmer's point of view
Quality Improvement
Evaluation of quality initiatives is generally done in terms of service parameters that are known or believed to be important determinants of organizational success. Service quality is often necessary to protect current business
(T/F) An RFP might be used when the health care organization is considering only a small group of vendors or products or when it is still in the exploratory phase.
False
(T/F) During the implementation process, it is important to maintain current workflow so that staff is not overwhelmed with changes.
False
(T/F) Email communication should be the primary method of communicating the progress of the system implementation.
False
(T/F) Implementation is the end point of the IT initiative.
False
(T/F) Once the implementation is over and the change settles in, value will have been achieved.
False
Electronic Data Interchange (EDI)
HIPAA transaction standards apply to to every entity's EDI.
Fast Health Interoperability Resources (FHIR)
Has potential to accelerate health IT interoperability, offers tools like data exchange mechanisms to improve interoperability
What did the authors describe as a cornerstone in examining IT value?
IT project proposal
"Making an effort to materially improve the process that the system is designed to support" describes which observation of realizing value?
IT value requires innovation in business practices.
Which of the following is an example of intangible value?
Improved collaboration
All of the following are examples of factors outside of the organization's control that may dilute the IT investment except:
Inadequate resources
Which of the following was NOT discussed by the authors as a step to ensuring the delivery of value?
Invest more resources
National Drug Codes
NDC, product identifier for all drugs
A projection with great certainty that people will use the system in specific ways is an example of which common proposal problem?
Reliance on complex behavior
Of the four classes of investment identified by Ross and Beath, which involves upgrading core IT infrastructure and applications, reducing the costs, or improving the quality of IT services?
Renewal
After a system is implemented, an organization can optimize use in all of the following ways except:
Retrieving data from the former system
A best of breed architecture is most accurately described as:
Sharing data between applications
__________ is defined as the process that occurs from the time the decision is made to select a new system until the time a contract has been negotiated and signed.
System Acquisition
In which phase does the IT staff play the biggest role?
System installation
SNOMED
Systematized Nomenclature of Medicine- computer database of medical terms, providing codes, terms, synonyms, and definitions which cover care delivery.
Of the four types of IT investments in a portfolio identified by Weill and Aral, which includes applications that support core operations process?
Transactional
(T/F) CapGemini's study of digital maturity found that transformation intensity was more important than that of digital intensity.
True
(T/F) It is appropriate for the organization to hold parties to celebrate their achievements (e.g., implementation of a new system).
True
(T/F) The order of activities in system implementation projects is determined by the implementation team according to the organization's needs and resources.
True
Why should IT projects be reviewed in a forum that routinely reviews similar requests?
a. Routine review allows forum members to understand good and bad proposals. b. Routine review allows forum members to compare and contrast proposals. c. Routine review allows forum members to take a portfolio view of potential investments.
In the process of increasing accountability for investments, who should defend the IT investment?
business owners
SCRIPT
standard for e-prescriptions
An unplanned, sudden deterioration in the organization's fiscal performance that may slow a project is an example of which common proposal problem?
unwarranted optimism
The ideal project steering committee consists of how many members?
5-6
Net Present Value
= (future cash flow that results from investment- initial investment) Future cash is discounted by a standard rate to reflect the fact that a dollar earned one or more years from now is worth less than a dollar one has today If cash generated exceeds the initial investment then :-)
Which of the following statements bout cloud-based services is false?
Cloud-based options require the organization to maintain the system.
Project steering committee
Committee's function is to plan, organize, coordinate, and manage all aspects of the acquisition process. Usually includes representation from all stakeholders on committee.
All of the following are ways to get user buy-in except:
Communicate a target date for users to efficiently use the new system
__________ means that leadership takes every opportunity to present the vision throughout the organization.
Connection
Data should be cleaned before being converted. Which of the following does NOT characterize clean data?
Consistent
(T/F) If the company has adequately prepared and trained staff for the new systems, users can expect problem-free system operation from the start.
False
(T/F) The criterion used to evaluate the system's value or success depends on the individual's expectations and point of view. While not all criterion are the same, they all have equal importance to the organization in achieving its strategic goals.
False
(T/F) There can be more than one individual serving as a business sponsor of a project.
False
IT architecture
Following the architecture for the organization's information systems, the IT staff members and the organization's vendors implement the core technologies and application software and integrate them to create the information systems Two additional terms are sometimes used either as synonyms for or in describing architecture: platform and infrastructure
Specific New Products and Services
IS delivers the new service and at other times it is itself the product. New services can include: bank cash-management programs, programs that award airline mileage and credit card purchases
Cost Reduction
IS investments directed to cost reduction are generally highly amenable to ROI and other quantifiable dollar-impact analyses
Mandated
IS investments may be necessary because of mandated initiatives May involve: Reporting quality data to accrediting organizations Making required changes in billing formats Improving disaster notification systems
KLAS
IT Vendor rating organization that is the equivalent of JD Power and Associates of healthcare
__________ consists of concepts, strategies, and principles that guide an organization's technology choices and the manner in which the organization integrates and manages these choices.
IT architecture
Which of the following is NOT characteristic of IT-enabled value?
IT value is not variable across organizations
Which of the following statements is true?
In creating an infrastructure, an organization will implement platforms and be guided by its IT architecture.
Tangible Value of Health IT
Increase in revenue Reduction in labor, maintenance, and supply costs Reductions in use of patient care services Fewer errors Faster turnaround times for test results Reductions in elapsed time to get an appointment Quicker admissions process Improvement and access to data
Infrastructure
Infrastructure enables other investments or applications to be implemented and deliver desired capabilities Examples: data communication networks, workstations, and clinical data repositories.
Intangible Value of Health IT
Intangible value Improved decision making Improved communication Improved collaboration Improved compliance Being more state of the art Being more customer friendly
Integrating the Healthcare Enterprise (IHE)
Integrating the Healthcare Enterprise (IHE) Developed a series of profiles to guide health care documentation sharing These profiles are not standards, but include specific guidance for how existing standards can be implemented to meet clinical needs.
Major Strategic Initiative
Intended to significantly change the competitive position of the organization or redefine the core nature of the enterprise. Most healthcare systems do not undergo an IT-centric transformation Amazon has transformed retailing, Venmo has transformed payments, Netflix has transformed streaming of movies There can be a ROI core or component to analyses of such initiatives because they often involve major reshaping or re-engineering of fundamental organizational processes.
Which of the following organizations provides market analysis reports and listings of vendors that provide EHR systems?
KLAS
Logical Observation Identifiers Names and Codes
LOINC, Facilitates the electronic transmission of laboratory results to hospitals, physicians, third-party payers, and other users of laboratory data
Which of the following is NOT the responsibility of the project manager?
Making the final decision
International Organization for Standardization (ISO)
Members are national standards bodies from many different countries around the world. Oversees international approval of standards development.
HCIS Standards
Multiple dimensions of standards to ensure health care information systems are operating correctly.
Standards Developing Organizations (SDOs)
Must be accredited by ANSI, develop standards in accordance with ANSI criteria. Approximately 200 accreditated SDOs that make up 90% of standards.
RxNorm
Normalized naming system for generic and brand name drugs and as a tool for supporting semantic interoperation between drug terminologies and pharmacy knowledge-based systems.
Valuation of Health IT Proposal
Organizations may score proposals according to how much value it promises to deliver in each of the following areas: Revenue impact Cost reduction quality of work life Quality of care Patient or customer satisfaction Regulatory compliance Potential learning value
Which of the following was NOT identified by Ash and colleagues as an unintended consequence of implementing a CPOE.
Patient dissatisfaction
The four phases of the system development life cycle in sequential order are
Planning and analysis, design, implementation, support and evaluation
The project steering committee should compile a final report. All of the following elements should be included except:
Project repository
Which of the following is NOT a mechanism used by a steering committee when determining system requirements?
RFP
RFP vs. RFI
RFP (Request for Proposal) Includes organizational goals Key selection criteria Specific information Includes financials Normalizes comparisons Great when many vendors have similar products Instruction for vendors Costly Time consuming Up to 200-300 pages Serves as contract between health care provider organization and vendor (can be legally binding) Contender is seriously being considered Statement to current ability of EMR Can better compare systems with this information Includes financial quotes (binding) RFI (Request for Info) General Information Overview of products Less time consuming
The Investment-Performance Relationship
Spending more on IT is no guarantee that the organization will be better off. No direct correlation between spending and outcomes Factors other than the appropriateness of the tool to the task also influence the relationship between IT investment and organizational performance.
Continuity of Care Document (CCD)
Standard for the electronic exchange of patient summary information, so-called transportable patient care information. CCD standard is not solely a content standard; it includes elements of a data exchange standard.
Systems development life cycle (SDLC)
The process an organization generally goes through in planning, selecting, implementing, and evaluating a health care information system
IT Project Proposal
The proposal requests money and an organizational commitment to devote management attention and staff effort to implementing an information system. The proposal describes why this investment of time, effort, and money is worth it -- the value that will result
Which of the following is the primary problem with the train the trainer approach?
The trainer may leave the organization
Unified Medical Language System
UMLS; facilitate the development of computer systems that behave as if they 'understand' the meaning of the language of biomedicine and health
De facto
a vendor or other commercial enterprise controls such a large segment of the market and its product becomes the recognized norm
Which of the following was NOT discussed in the text as a strategy that may lead to greater organizational acceptance of a new system?
a. Create an appropriate environment b. Allocate sufficient resources c. Do not underestimate user resistance (All are strategies discussed in text)
Which of the following is NOT a pitfall in the acquisition process?
a. Not defining criteria and methods for selecting the vendor b. Assigning too little weight to the RFP process c. Turning negotiations into a blood sport (All are pitfalls)
Which of the following should be considered when determining the go-live date?
a. On a day when the patient census is low b. After staff have been trained c. When IT staff are available to monitor and assess system problems
Which of the following are methods for evaluating a vendor's product and reputation?
a. Site visits to other facilities b. Vendor user group conferences c. Market reports
Companies should employ all of the following types of training except:
a. Training before and after go-live b. Group training c. One-on-one training (should use all)
American National Standards Institute (ANSI)
accredits standards development organizations (SDOs) from a wide range of industries, including health care. Publishes tens of thousands of standards
Data should be ____________ (complete, accurate, and current) before being converted
cleaned
Chief medical informatics officers (CMIO's) or chief nursing informatics officers (CNIO's)
clinicians and nurses with training in informatics are being called on to lead clinical system acquisition
What is the final step of the system acquisition process where expectations are outlined and performance requirements are determined with the vendor?
contract negotiations
Government mandate
government mandates new standards, i.e. HIPAA
Designated standard maintenance organizations (DSMO)
have the responsibility for the development, maintenance, and modification of relevant electronic data interchange standards.
System Champions
key individuals from the clinical and administrative areas that are the focus of the system being acquired, vendor representatives, and IT professionals
Just-in-time training
occurs several times. Its purpose is to enable users to practice on the system multiple times before go-live
System Acquisition
process that occurs from the time the decision is made to select a new system (or replace an existing system) until the time a contract has been negotiated and signed.
Request for Proposal (RFP)
provides the vendor with a comprehensive list of system requirements, features, and functions and asks the vendor to indicate whether its product or service meets each need.
Interoperability Standards Advisory
published by ONC, outlines the ONC-identified "best available" standards and implementation specifications for clinical IT interoperability.
Consensus
representatives from various interested groups come together to reach a formal agreement on specifications
All of the following are examples of technical infrastructure except:
software upgrades
Vocabulary/terminology standards
standards for naming or classifying the actual data
Data interchange and messaging standard
standards for structuring the content of messages communicated across the network
Transporting standards
standards needed for basic communication across the internet or other network
Content standards
standards that describe required data elements for a particular function, such as the EHR or clinical summary
A(n) __________ is someone who is well respected in the organization, sees the new system as necessary to the organization's achievement of its strategic goals, and is passionate about implementing
system champion
Computerized Physician Order Entry (CPOE)
the process of a medical professional entering medication orders or other physician instructions electronically instead of on paper charts. A primary benefit of CPOE is that it can help reduce errors related to poor handwriting or transcription of medication orders
Profiling bodies
use existing standards to create comprehensive implementation guides. Two examples of profiling bodies are the Integrating the Healthcare Enterprise (IHE) and the ONC
Ad hoc
when a group of interested people or organizations agree on standard specs without any formal adoption process
