Informatics Final

32. National efforts to improve the user experience are under way in the U.S. One organization involved with this effort is the: a. Office of Technology and Disasters. b. National League for Nursing. c. National Institute of Standards and Technology. d. American Nurses Association.

ANS. C Rationale: An organization involved in national efforts to improve the user experience is the National Institute of Standards and Technology. The Office of Technology and Disasters, American Nurses Association, and National League for Nursing are not involved with the user experience.

113. Why is it difficult to establish effective health IT governance? a. So few activities within a healthcare organization involve informatics. b. No stakeholder wants to have a say in how informatics resources are leveraged. c. Fundamentally, effective governance means that some stakeholders' informatics needs will need to be de-prioritized. d. There is too much literature available on the topic, making it difficult to choose which approach to follow.

ANS. C Rationale: The fundamental reason for the difficulty of informatics governance is that there is more effort desired from informatics than resources allow.

91. Which is an example of apomediation? a. Healthcare providers state that only their web portal should be used by patients. b. Healthcare providers tell patients not to use Facebook for healthcare advice. c. Healthcare providers direct patients to websites in which they have a financial interest. d. Healthcare providers direct patients to high-quality information on the web.

ANS. D Rationale: Apomediation means standing by the patient rather than standing between the patient and the web.

81. Which group is not a major information technology research firm? a. KLAS b. Gartner c. Forrester d. HIMSS

ANS. D Rationale: HIMSS does not provide comparative research information regarding various vendors.

60. What is the first factor in deciding on an optimal health IT governance for an institution? a. Whether the organization is a for-profit or non-profit entity b. The size of the IT budget c. The EHR system in use d. The organizational culture

ANS. D Rationale: Of the listed factors, an organization's culture is the most important factor that needs to be considered.

8. A nurse is asked by the nursing manager to review electronic comments left by patients on the unit's Facebook page. The nurse examines the comments for common themes. This is an example of: Select one: a. backcasting. b. scenarios. c. trend analysis. d. content analysis.

ANS. D Rationale: This is an example of content analysis. The content of the comments left by the patients are examined for common themes.

64. When preparing to provide testimony or serve as an expert witness, the nurse should: a. interview individuals who are knowledgeable in the topic area. b. prepare detailed written notes to read during the presentation. c. prepare multiple questions to ask the committee chairperson. d. focus primarily on developing nursing-related content.

ANS. A Rationale: Interviewing knowledgeable individuals, including board members and industry, organizational, or volunteer leaders, will add credibility to the testimony by broadening the scope of expertise and experience that can be leveraged.

93. Which issue is a deterrent to global interoperability? a. Multiple terminologies used in describing and documenting healthcare b. The development of clinical data models such as HL7 CDA documents c. The development of an international standard clinical terminology d. The use of openEHR Archetypes

ANS. A Rationale: Key barriers to global interoperability include issues related to the terminologies used in describing and documenting healthcare such as cost and accessibility; gaps in exhaustiveness; and lack of granularity. The remaining options are all efforts to solve the problem.

63. When evaluating quality and patient safety, which approach defines the framework for Patient Safety and Quality Research Design (PSQRD)? a. Quality and safety are based on organization structure, management and clinical processes, and their linkages to patient outcomes. b. Consideration of current managerial processes has no effect on patient outcomes. c. Patient safety is best achieved by minimizing changes to existing processes. d. Outcomes are driven mainly by Meaningful Use directives.

ANS. A Rationale: Quality is based on organizational structure, process, and their linkages to patient outcomes. Consideration of current managerial processes in place has a latent effect on patient outcomes. The framework for PSQRD builds upon Donabedian's structure-process-outcome model to support evaluation of an intervention from the pre-implementation testing phase, through implementation, and evaluation. In the case of a health information technology (IT) intervention, the expanded framework supports understanding of where the health IT intervention is most likely to have an effect, within the organizational causal chain of quality and safety events. The PSQRD framework provides a means to categorize interventions according to areas of the causal chain targeted (e.g., the structure, the management or clinical processes, and the patient outcomes or throughput that are targeted by the intervention or that drive adoption and use of the intervention in clinical practice).

88. Which international organization organizes an international conference on nursing informatics? a. International Medical Informatics Association - Nursing Informatics SIG (IMIA-NI) b. Nursing Working Group of HL7 c. International Council of Nurses (ICN) d. International Standard Organization (ISO)

ANS. A Rationale: The International Medical Informatics Association - Nursing Informatics SIG (IMIA-NI) organizes an international conference on nursing informatics. The ICN, HL7, and ISO do not organize an international conference on nursing informatics.

40. The culture of the patient-clinician partnership always includes: a. epatients and clinicians working in collaboration towards shared goals. b. requirements found in the Patient Protection and Affordable Care Act. c. guided discovery. d. involvement of technology specialists and social media activists.

ANS. A Rationale: The culture of the patient-clinician partnership always includes epatients and clinicians working in collaboration towards shared goals. The Patient Protection and Affordable Care Act does not require patient-clinician partnerships. Guided discovery may be used in a patient-clinician partnership, but not always. Technology specialists and social media activists are not part of the patient-clinician partnership.

43. The implementation specialist, practice workflow specialist, and health information exchange specialist are informatics roles identified and described by: a. ONC's HITECH Workforce Plan. b. the Department of Labor's Bureau of Labor Statistics. c. the ANA Scope and Standards for Nursing Informatics. d. the Department of Commerce's Standard Occupation Codes.

ANS. A Rationale: The implementation specialist, practice workflow specialist, and health information exchange specialist are informatics roles identified and described by the ONC's HITECH Workforce Plan. The ANA Scope and Standards for Nursing Informatics, Department of Labor's Bureau of Labor Statistics, and Department of Commerce's Standard Occupation Codes do not delineate these positions.

25. Healthcare providers should friend patients only if: a. they check their social media policy at work. b. the patients ask them to be a friend. c. they have been their patients for at least 5 years. d. the patient has a chronic disease.

ANS. A Rationale: There is no law prohibiting friending patients. Professional guidelines and social media policies should outline the instances when friending is possible.

45. The maxim "Doctors know best": a. is the paradigm for the paternalistic care model. b. is one of the tenets of participatory medicine. c. was coined by Gilles Frydman. d. was coined by epatient Dave.

ANS. A Rationale: "Doctors know best" is the paradigm for the paternalistic care model. Participatory medicine is characterized by including the patient as a partner in setting goals of care and participating in shared decision making. ePatient Dave is known for statements such as "Gimme my damn data" and promotes the maxim of "Nothing about me, without me." Gilles Frydman is an epatient activist known for his work with the Association of Cancer Online Resources.

3. A healthcare provider forgets to update a patient's medications. Which fair information principle is being violated? a. Data quality and integrity b. Openness and transparency c. Safeguards d. Correction

ANS. A Rationale: By not keeping a patient's records current and up to date, the healthcare provider is violating the fair information principle of data quality and integrity. Correction involves allowing individuals to dispute he accuracy of their information, openness and transparency involve keeping patients informed on policies regarding PHI, and safeguards are actions implemented to protect sensitive data.

33. Nielsen coined the term "Discount Usability Testing" to indicate the design of tests that conserve resources, including funding and time. One example is a reduced number of users who need to participate. He indicates that as few as how many users can find 80% of design issues? a. 5 b. 15 c. 10 d. 3

ANS. A Rationale: Nielsen's work in the early 1990s noted that as few as 5 users can find 80% of design issues.

16. An agency has just implemented electronic medication administration records (eMARs). This would be an example of what level of change? a. First-level change b. No change c. Second-level change d. Third-level change

ANS. A Rationale: The implementation of eMARs is an example of a first-level change. Previously, medications were documented using a paper system, not an electronic system.

75. Which entities have the authority to enforce penalties for a breach of PHI? (Select all that apply.) a. State attorney general b. Office of Civil Rights c. Office of Inspector General d. Centers for Medicare and Medicaid Services

ANS. A, B Rationale: Pursuant to the enhanced enforcement authority granted under HITECH, both the Office of Civil Rights and the state attorney general have the authority to enforce penalties for the breach of the HIPAA laws that protect the privacy and security of PHI.

62. What should be considered when identifying and selecting a healthcare information system? (Select all that apply.) a. Strategic alignment b. Enterprise and information technology goals and objectives c. Strategic vision d. Vendor strategic planning e. Operating system

ANS. A,B,C Rationale: Having a strategic vision, strategic alignment, and enterprise and information technology goals and objectives should be considered when identifying and selecting a healthcare information system. Each of these items is critical to selecting an effective system that supports the organization's goals and mission. The operating system and vendor strategic planning are not part of an organization's goals and mission.

89. Which international organizations develop international standards? (Select all that apply.) a. International Standard Organization (ISO) b. International Health Terminology Standards Development Organization (IHTSDO) c. Health Level 7 (HL7) d. Global Health Informatics Partnership (GHIP)

ANS. A,B,C Rationale: Health Level 7 (HL7), International Health Terminology Standards Development Organization (IHTSDO), and the International Standard Organization (ISO) all develop international standards for informatics. The Global Health Informatics Partnership (GHIP) does not develop international standards for informatics.

71. Which considerations should be included in your system evaluation criteria? (Select all that apply.) a. Vendor's market and industry understanding b. Cost c. Vendor experience d. Organization devices

ANS. A,B,C Rationale: It is important to include a variety of criteria, including cost, vendor experience, and the vendor's market and industry understanding.

94. Which items are included in the IOM six aims for improvement? (Select all that apply.) a. effective b. safe c. patient-centered d. innovative

ANS. A,B,C Rationale: The six aims for improvement are safe, effective, patient-centered, timely, efficient, and equitable. Innovative is not one of the six aims for improvement.

67. Which are examples of secondary use of health information? (Select all that apply.) a. Research b. Marketing c. Surveillance d. Treatment

ANS. A,B,C Rationale: The three most common secondary uses of personal health information include public health monitoring or surveillance, research, and marketing. Treatment for an illness would be a primary use of health information.

51. To automatically track the quality of care, standardized quality measures are needed in order to: (Select all that apply.) a. standardize data collection. b. use consistent metrics. c. benchmark. d. ensure clinical efficiency.

ANS. A,B,C Rationale: To automatically track the quality of care, standardized quality measures are needed to ensure that all organizations are using consistent metrics for benchmarking and that organizations are using the same types of data to populate the quality metrics.

66. Which activities represent dimensions of the National Health Service's Informatics Capability Maturity Model? (Select all that apply.) a. Aligning business and informatics b. Using business intelligence c. Clinical documentation d. Managing information

ANS. A,B,D Rationale: Managing information, using business intelligence, and aligning business and informatics are dimensions of the National Health Service's Informatics Capability Maturity Model.

36. Social media tools include: (Select all that apply.) a. wikis and blogs. b. video and picture sharing. c. desktop computers. d. social networks and microblogging.

ANS. A,B,D Rationale: Social media is focused on not only connecting and collaborating with others but also sharing user-generated material of all types. While a desktop computer may assist a person to discover social media tools, it is not a social media tool in itself.

90. Which international organizations develop terminology? (Select all that apply.) a. International Council of Nurses (ICN) b. World Health Organization (WHO) c. International Medical Informatics Association (IMIA) d. International Health Terminology Standards Development Organization (IHTSDO)

ANS. A,B,D Rationale: The ICN, WHO, and IHTSDO all develop terminologies. International Medical Informatics Association does not develop terminology.

78. Which factors represent internal and external forces that require effective informatics governance? (Select all that apply.) a. Meaningful Use and healthcare reform b. Clinician demand c. Increasing demand for decision support and analytics d. Greater expectations for information access and transparency

ANS. A,C,D Rationale: Increasing demand for decision support and analytics, greater expectations for information access and transparency, and Meaningful Use and healthcare reform represent significant issues that increase the demand for informatics resources and subsequently require more effective health IT governance and prioritization.

98. Which of the following describe information system functionality? (Select all that apply.) a. System response time b. Data validation c. Accuracy d. Ease of use for end users

ANS. A,C,D Rationale: System response, accuracy, and ease of use for end users describe information system functionality. Data validation is not part of functionality, although it is required in an assessment of an information system.

56. What defines Health 2.0? (Select all that apply.) a. Health-related mobile applications b. Updated versions of old health information c. Web-based content d. Marketing health products based on the patient's Internet preferences e. Social networks f. Mobile health-monitoring devices

ANS. A,C,E Rationale: Health 2.0 is defined by health-related mobile applications, web-based content, and social networks. Updated versions of old health information, marketing health products based on the patient's Internet preferences, and mobile health-monitoring devices do not define Health 2.0.

72. Which costs should be considered in determining the total cost of information system ownership? (Select all that apply.) a. Hardware costs b. User costs c. Supply costs d. Resource costs e. Software costs

ANS. A,D,E Rationale: The costs that should be considered in determining the total cost of information system ownership include hardware, software, and resource costs. The total cost of ownership includes all costs related to purchasing, implementing, and supporting an information system.

31. Nanoparticles appear to have a very bright and meaningful future in the world; however, what is one potential issue with nanoparticles? a. No methods exist to successfully combat cytotoxicity and clearance of nanoparticles. b. There are cytotoxicity and ethical concerns regarding the use of nanoparticles. c. Development of the field of nanoinformatics and nanomedicine is difficult. d. Creation of nanoparticles has not yet come to full fruition.

ANS. B Rationale: A potential issue with nanoparticles is that there are cytotoxicity and ethical concerns regarding the use of them. Development of the field of nanoinformatics and nanomedicine is difficult, creation of nanoparticles has not yet come to full fruition, and the lack of methods to successfully combat cytotoxicity and clearance of nanoparticles are not potential issues with nanoparticles.

47. The percentage of adults using social media to seek healthcare information is: a. between 10% and 30%. b. between 40% and 60%. c. less than 10%. d. over 75%.

ANS. B Rationale: According to the Pew Internet Study of 2011, between 40% and 60% of adults use social media to seek healthcare information.

15. Advocating for users' needs and acting as a liaison between the users, the IT staff, and the vendor are competencies for a(n): a. innovator. b. specialist. c. generalist. d. advanced practice nurse.

ANS. B Rationale: Advocating for users' needs and acting as a liaison between the users, the IT staff, and the vendor are competencies for the informatics nurse specialist (INS). The INS receives graduate training for this role.

87. Which international organization develops and maintains standards for data exchange? a. World Health Organization (WHO) b. Health Level 7 (HL7) c. International Medical Informatics Association (IMIA) d. International Health Terminology Standards Development Organization (IHTSDO)

ANS. B Rationale: Health Level 7 is an international organization that develops and maintains standards for data exchange. The WHO, IHTSDO, and IMIA do not develop and maintain standards for data exchange.

5. A hospital has just implemented bar-coded medication administration (BCMA). This would be an example of what level of change? a. No change b. Second-level change c. First-level change d. Third-level change

ANS. B Rationale: Implementing BCMA would be a second-level change. The implementation of BCMA has not only changed how medications are documented, but it has actually changed the process of medication administration.

100. Which of these best describes participatory medicine? a. Integrated care model b. Cooperative care model c. Community care model d. Authoritative care model

ANS. B Rationale: Participatory medicine is described as a cooperative model of healthcare that encourages and expects active involvement by all connected parties, including patients, caregivers, and healthcare professionals, as integral to the full continuum of care. Integrated care focuses on coordinating care between the healthcare disciplines. Authoritative care is paternalistic and does not include the patient in the decision-making process. Community care focuses on coordinating care across resources found in the community where the patient resides.

85. Which international organization deals with harmonization among standard development organizations in healthcare? a. Health Level 7 (HL7) b. International Standard Organization Technical Committee 215 (ISO/TC 215) c. Global Health Informatics Partnership (GHIP) d. World Health Organization (WHO)

ANS. B Rationale: The International Standard Organization Technical Committee 215 (ISO/TC 215) is an international organization that deals with harmonization among standard development organizations in healthcare. The WHO, GHIP, and HL7 do not deal specifically with harmonization among standard development organizations in healthcare.

48. The Quality and Safety Education in Nursing (QSEN) project developed competencies based on work completed by: a. TIGER. b. IOM. c. AMIA 10x10. d. HRSA.

ANS. B Rationale: The QSEN project developed competencies based on work completed by the Institute of Medicine (IOM). HRSA, TIGER, and AMIA 10x10 may address informatics competencies, but they did not provide the foundation for the QSEN project.

13. A unit has been experiencing a high rate of patient falls for the past three months. According to Donabedian's model, patient falls would be considered: a. effectiveness. b. outcome. c. structure. d. process.

ANS. B Rationale: The end results of the structures and processes are considered outcomes. These may include clinical outcomes. The measurement of patient falls is considered an outcome.

46. The ONC-sponsored Standards & Interoperability Framework completes its health IT standards development initiatives using: a. monthly conference calls of volunteers working on each initiative. b. consensus-based decision making through a moderated online wiki. c. surveys sent out to provider organizations working on EHR implementation. d. face-to-face work teams assembled to work on each initiative.

ANS. B Rationale: The health IT standards work is done online through a moderated wiki with over 1,300 volunteers participating in the Standards & Interoperability Framework.

58. What is a negative impact of the increased use of mobile devices in transmitting health data? a. They decrease productivity. b. They increase the risk of a security breach. c. They increase the number of medication errors. d. They support increased health data access for providers.

ANS. B Rationale: The largest downfall to the increased use of mobile devices is the increased risk for a security breach. The increased access for providers is a positive impact. Mobile devices have been proven to increase productivity rather than decrease it, and there is no evidence supporting an increase in medication errors due to mobile devices.

61. What is the primary goal of nanomedicine? a. Creation of materials, devices, and other structures at the nanoscale b. The use of nanotechnology for the prevention, diagnosis, and treatment of disease c. Development of nanomaterials used in electronics, structural materials, and commercial products d. The advancement of man through the modification of the human body with nanotechnology

ANS. B Rationale: The primary purpose of nanomedicine is the use of nanotechnology for the prevention, diagnosis, and treatment of disease. The advancement of man through the modification of the human body with nanotechnology; development of nanomaterials used in electronics, structural materials, and commercial products; and creation of materials, devices, and other structures at the nanoscale are not primary purposes of nanomedicine.

4. A hospital has an integrated clinical decision support system embedded in the EHR. According to Donabedian's model, this would be considered: a. outcome. b. structure c. effectiveness. d. process.

ANS. B Rationale: The setting and its attributes (e.g., the physical structure of buildings, staffing rations, the equipment available within an organization, and the budget to support care provision) are all part of structure. The EHR with an embedded CDS system is part of the structure of an organization.

70. Which components are necessary for effective health IT governance? (Select all that apply.) a. Organizational structures for clinical processes b. Organizational structures responsible for ensuring that informatics efforts are aligned with institutional priorities and optimally utilized c. Organizational structures responsible for clearly defining institutional priorities d.Accompanying processes to operationalize the governance

ANS. B,C,D Rationale: Effective health IT governance requires organizational structures responsible for clearly defining institutional priorities, organizational structures responsible for ensuring that informatics efforts are aligned with institutional priorities and optimally utilized, and accompanying processes to operationalize the governance.

37. Task analysis is a collection of many different techniques. You can use task analysis to: (Select all that apply.) a. conduct the think aloud protocol. b. observe workflow in a cardiology clinic. c. analyze users' cognitive processes. d. determine crucial errors with CPOE.

ANS. B,C,D Rationale: Task analysis addresses many issues in the user experience. These may include analyzing users' cognitive processes, observing workflow in a cardiology clinic, and/or determining crucial errors with CPOE.

49. Think aloud protocol is a method for generating rich data when users talk aloud as they use a a. after the product is used. b. during initial product development. c. after the product is released. d. during mature product design.

ANS. B,C,D Rationale: Think aloud protocol can be used during initial product development, during mature product design, and after the product is released.

53. Using social media tools for research purposes helps: (Select all that apply.) a. develop relationships between participants. b. provide insight into the patient's experience. c. recruit patients. d. identify new variables to study.

ANS. B,C,D Rationale: Using social media tools for research purposes helps to recruit patients, identify new variables to study, and provide insight into the patient's experience. Researchers should be cautious of allowing research participants to communicate and create relationships with social media as this may contaminate findings.

54. Well-defined policies are necessary to ensure that: (Select all that apply.) a. accurate cost accounting occurs. b. confidentiality of protected health information is safeguarded. c. clinical decision support is adopted. d. data capture is being automated.

ANS. B,C,D Rationale: Well-defined policies are necessary to ensure that confidentiality of protected health information is safeguarded, data capture is being automated, and clinical decision support is adopted. Policymakers should leverage these opportunities to transform nursing practice through the use of new and existing technologies intended to support decision making and care delivery.

20. An organization implements a policy on installing software service packs on all its computers. This is an example of which type of control? a. Technical b. Electronic c. Administrative d. Physical

ANS. C Rationale: Administrative controls include establishing and adhering to security policies and procedures as well as dedicating resources to security. Implementing a policy on installing and updating service packs would be an example of administrative controls. Physical controls are actual physical methods to protect inappropriate access to PHI. Technical controls are using technology to protect against inappropriate access to PHI. Electronic controls is not an accurate term.

34. One trend that is influencing healthcare reform is: a. Hospital Consumer Assessment of Healthcare Providers and Systems. b. Everett Rogers' theory of diffusion of innovation. c. disruptive technology. d. Veterans Health Information System and Technology Architecture Implementation.

ANS. C Rationale: Disruptive technology and trends have drastically altered the way in which we communicate with one another. Americans are using the Internet and mobile devices in their daily lives to connect to one another and to access information.

30. Meaningful Use refers to: a. receiving the EHR incentive payments for Meaningful Use. b. attesting to Meaningful Use. c. leveraging the EHR to facilitate practice and payment change for healthcare transformation. d. meeting all the Meaningful Use criteria.

ANS. C Rationale: Meaningful Use is determining how to leverage the Employee Health Records implementation to accomplish other goals in an organization beyond just meeting the Meaningful Use criteria. It is not just doing the minimum and checking the Meaningful Use criteria off, but using the implementation process to create other changes needed for healthcare reform.

24. Existing resources that promote meeting the challenge of teaching informatics in the health professional curriculum are: a. sufficient number of trained faculty. b. readily available technical infrastructure. c. teaching materials and assignments. d. simulation and academic electronic health records (AEHRs) software.

ANS. C Rationale: QSEN and ONC have made freely available numerous teaching materials and assignments for teaching informatics. Insufficient faculty and lack of technical support are two major barriers to teaching informatics. The costs of simulation and AEHRs can be prohibitive.

14. A vendor provided all advanced practice registered nurses with free mobile devices to stimulate referrals. Which regulation is being violated? a. The HITECH Act b. HIPAA c. The Anti-Kickback Statute d. The Stimulus Act

ANS. C Rationale: The Anti-Kickback Statute makes it a criminal offense to knowingly and willfully offer, pay, solicit, or receive any remuneration to induce or reward referrals of items or services reimbursable by a federal health care program. Where remuneration is paid purposefully to induce or reward referrals of items or services payable by a federal health care program, the Anti-Kickback Statute is violated.

38. The Center for Medicare & Medicaid Innovation was created by: a. the Health Insurance Portability and Accountability Act. b. the Health Information Technology for Education and Clinical Health Act. c. the Patient Protection and Affordable Care Act. d. the American Recovery and Reinvestment Act of 2009.

ANS. C Rationale: The Patient Protection and Affordable Care Act of 2010 created the Center for Medicare & Medicaid Innovation (CMI) to help transform federal and state healthcare programs by changing and redesigning the healthcare system. Ultimately, CMI intends to develop better healthcare, improve health, and reduce costs for beneficiaries to enhance the delivery of care for all recipients.

85. Which international organization develops and maintains a family of international classifications such as the International Classification of Diseases? a. Health Level 7 (HL7) b. International Medical Informatics Association (IMIA) c. World Health Organization (WHO) d. International Health Terminology Standards Development Organization (IHTSDO)

ANS. C Rationale: The World Health Organization develops and maintains a family of international classifications such as the International Classification of Diseases. The IHTSDO, IMIA, and HL7 do not develop and maintain a family of international classifications.

99. Which of these best describes an example of usability? a. The administration has asked you to take responsibility for orientation of new hires and the retraining of selected current employees on use of the automated medication administration system because there have been a consistent number of user errors. b. The IT department is surveying your unit to determine the placement of new computer workstations. c. The leadership in your institution is asking for your help to determine oncology patient flow across regional institutions. d. A researcher is conducting a study of how nurses interact with electronic documentation to organize care handoffs.

ANS. D Rationale: An example of usability would be when a researcher is conducting a study of how nurses interact with electronic documentation to organize care handoffs. The other items describe ergonomics, non-HIT workflow, and education/training.

96. Which metrics give providers some flexibility in meeting Meaningful Use criteria? a. Primary elements b. Core elements c. Secondary elements d. Menu elements

ANS. D Rationale: Because individual providers have different types of practices, the Health IT Policy and Health IT Standards Committees divided the Meaningful Use metrics into "core" required elements and "menu" elements. Permitting providers an opportunity to report on required core elements and then choose to report on a select few menu elements addresses the unique aspects of each provider's practice/facility and adds flexibility to the financial incentive program.

7. A nurse gives a patient the wrong drug. This is an example of an error of: Select one: a. omission. b. condition. c. remission. d. commission

ANS. D Rationale: Doing the wrong thing would be considered an error of commission. Forgetting to do something that is required for a patient would be considered an error of omission. Condition and remission are not considered error types.

18. An important component of the informatics infrastructure is: a. variation in the types of data used to populate the quality metrics. b. defined standard value sets, groupings, aligners, and attributes. c. organizations enabled to set individual standards for quality measurement and reporting. d. establishment and adoption of standards to support semantic interoperability

ANS. D Rationale: Establishment and adoption of standards at multiple levels are important components of the informatics infrastructure. The standard quality metrics must define standard value sets, taxonomies, concept codes, attributes, and data structures. Organizations must adopt the same standards for quality measurements and reporting. Standard clinical content needs to be adopted and used in the electronic systems, and the content should be represented by standard data terminologies.

27. In the future, social media in healthcare is likely to be: a. widely used by everyone including those who are reluctant now. b. nothing at all. It has gone too far already. c. minimally used only by "geeks." d. widely used but with some pockets of non-users such as those lacking Internet access or choosing to be private.

ANS. D Rationale: Even as social media expands, some will not be able to or will choose not to use these applications.

6. A nurse forgets to walk a patient during the nurse's shift. This is an example of an error of: Select one: a. commission. b. remission. c. condition. d. omission

ANS. D Rationale: Forgetting to do something that is required for a patient would be considered an error of omission. Doing the wrong thing would be considered an error of commission. Condition and remission are not considered error types.

39. The Center to Champion Nursing in America envisions a healthcare system where: a. nurses are expanding their capabilities. b. best practices need to be developed. c. quality care is increasing in targeted areas. d. all Americans have access to high-quality care.

ANS. D Rationale: The Center to Champion Nursing in America envisions a healthcare system where all Americans have access to high-quality care, with nurses contributing to the full extent of their capabilities.

59. What is the difference between the safe harbor and expert determination methods of de-identifying data? a. The safe harbor method involves removal of all identifiers, and the expert determination method involves the removal of 18 types of identifiers. b. The safe harbor method involves the application of statistical or scientific models, and the expert determination method involves removal of 18 types of identifiers. c. The safe harbor method involves securing identifiers in an encrypted database, and the expert determination specifically determines the riskiest identifiers to remove. d. The safe harbor method involves removal of 18 types of identifiers, and the expert determination method involves the application of statistical or scientific models.

ANS. D Rationale: The safe harbor method involves removal of 18 types of identifiers, and the expert determination method involves the application of statistical or scientific models to de-identify data. None of the other options accurately describe these two methods.

68. Which category of objectives contains the need for the system to be intuitive and easy to use? a. Efficiency b. Organization c. Information technology d. Patient care

ANS. A Rationale: Ease of system use and intuitiveness promote efficiency for the end user.

103. Which President initiated the Office of National Coordinator? a. President George W. Bush b. President George H.W. Bush c. President Barack Obama d. President William Clinton

ANS. A Rationale: The Office of National Coordinator was implemented in 2004 when President George W. Bush was in office.

106. Which safeguards are implementation specifications for security awareness and training? (Select all that apply.) Select one or more: a. Security reminders b. Log-in monitoring c. Protection from malicious software d. Response and reporting

ANS. A,B,C Rationale: Security reminders, protection from malicious software, and log-in monitoring are implementation specifications for security awareness and training. Response and reporting are implementation safeguards for how to address a security incident and are not specifications of security awareness and training.

2. A centralized health IT governance structure is always the most effective. a. False b. True

ANS. A Rationale: The optimal health IT governance structure depends on the organization.

22. Educating students about informatics includes working with EHRs and: a. communication tools. b. evidence-based practice (EBP). c. patient safety. d. interprofessional teams.

ANS. A Informatics deals primarily working with information and communicating information to others. Therefore communication tools are a necessary component of an informatics education. While the EBP, interprofessional teams, and patient safety can be enhanced by the use of informatics, they are not informatics knowledge, skills, or attitudes. Informatics is about information and communicating it to others.

76. Which example constitutes an internal security event? a. A system administrator installed a new server without any security measures. b. A person hacks into a facility's server and steals PHI electronically. c. Servers containing clinical data were stolen from a facility. d. A person installs a malicious code past a facilities firewall.

ANS. A Rationale: Internal events are those perpetrated (usually accidentally) by people within an institution. A system administrator not taking proper security measures would be an example of this. The remaining examples are all external events.

41. The EHR incentive Meaningful Use criteria are adapted from work done by: a. the National Priorities Partnership. b. the National Quality Forum. c. the Institute of Medicine. d. the Joint Commission.

ANS. A Rationale: The EHR incentive program's Stage 1 criteria for meeting Meaningful Use are divided into five initiatives adapted from work done by the National Priorities Partnership.

83. Which healthcare professional is eligible to participate in the Medicare EHR Incentive Program? a. Medical doctor b. Nurse practitioner c. Registered nurse d. Physician assistant

ANS. A Rationale: The medical doctor is the only healthcare provider listed who is eligible to participate in the Medicare EHR Incentive Program. The registered nurse, physician assistant, and nurse practitioner are all ineligible for this program.

1. A case manager wants to communicate with her clients on a regular basis by sending short messages that encourage health promotion tips. The tool best suited for this task is: a. microblogging. b. Facebook. c. e-mail. d. Second Life

ANS. A Rationale: Clients may benefit from short, directed messages; thus microblogging (a form of short messages) is the most appropriate. The other choices (Facebook, e-mail, and Second Life) are not appropriate for sending short messages.

97. Which of the following are phases in the systems development life cycle (SDLC)? (Select all that apply.) Select one or more: a. Implementation b. Maintenance c. Design d. System selection

ANS. A,B,C Rationale: Phases in the SDLC include design, implementation, and maintenance. The initial phase of the systems development life cycle is to identify requirements. System selection has already taken place.

69. Which clinical initiatives require informatics to be optimally effective? (Select all that apply.) a. Population health management b. Reduction in care variability c. Care pathways d. IT governance

ANS. A,B,C Rationale: Population health management, care pathways, and reduction in care variability require informatics to be optimally effective. All these initiatives have a significant information management component and require informatics support to be optimally effective.

84. Which initiatives are a policy priority for Meaningful Use? (Select all that apply.) a. To engage patients and families b. To improve care coordination c. To lower the cost of delivering healthcare services d. To ensure adequate privacy and security of patient information

ANS. A,B,D Rationale: Engaging patients and families, improving care coordination, and ensuring privacy and security are all policy initiatives that were used as foundational elements of how the Health IT Policy Committee defined Meaningful Use to achieve the specific public policy goals. The policy initiatives created by the Health IT Policy Committee did not base the Meaningful Use measures upon the intention of lowering the costs.

11. A process of ongoing evaluation must be developed to: (Select all that apply.) a. identify areas of omission. b. validate appropriate responses. c. develop training plans for go-live. d. ensure adequate users. e. determine if any changes to the system are needed.

ANS. A,B,E Rationale: A process of ongoing evaluation must be developed to identify areas of omission, validate appropriate responses, and determine if any changes to the system are needed. Ongoing evaluation provides the opportunity to evaluate the effectiveness of the system for current and future needs.

82. Which groups are relevant stakeholders for health IT governance? (Select all that apply.) a. Health services researchers b. Housekeepers c. IT department d. Quality department

ANS. A,C,D Rationale: Relevant stakeholders of IT governance include the IT department, the quality department, and health services researchers.

44. The IOM report, HIT and Patient Safety: Building Safer Systems for Better Care, documented that safe use of health IT relies on: (Select all that apply.) a. the interplay of people, process, and technology. b. commercial interests c. clinicians and patients. d. vendors, users, and government.

ANS. A,C,D Rationale: The safe use of HIT relies on many factors, including clinicians, patients, and socio-technical issues such as the interplay of people, process, and technology. Vendors, users, government, and the private sector all have roles to play.

10. A popular continuing education program that teaches informatics knowledge, skills, and attitudes is: a. HRSA. b. AMIA 10x10 c. HIMSS. d. TIGER.

ANS. B Rationale: A popular continuing education program that teaches informatics knowledge, skills, and attitudes is AMIA 10x10. TIGER, HRSA, and HIMSS are all organizations that advocate for continuing education but are not providers of informatics education.

74. Which description best defines nanofabrication? a. The use of biomedical informatics techniques and tools for nanoparticle data and information to improve research in the field of nanotechnology b. The development of materials used in structures, electronics, and commercial products c. A subdiscipline of nanotechnology centering on the application of nanoparticles and nanoscience techniques to healthcare and clinical research d. The study of controlling and altering matter at the atomic or molecular level

ANS. B Rationale: Nanofabrication is the development of materials used in structures, electronics, and commercial products. Nanotechnology is the study of controlling and altering matter at the atomic or molecular level. Nanomedicine is a subdiscipline of nanotechnology centering on the application of nanoparticles and nanoscience techniques to healthcare and clinical research. Nanoinformatics is the use of biomedical informatics techniques and tools for nanoparticle data and information to improve research in the field of nanotechnology.

29. It is important to monitor and track unintended consequences of health IT implementation because: a. reporting is mandatory. b. not much is known and we need to learn more. c. the federal government is interested in this information. d. this is a prevalent issue.

ANS. B Rationale: Research in this area is just beginning, but even without knowing all the details, monitoring and tracking of the unplanned or unexpected consequences are important, so we can learn more about the issues to inform the future.

17. An epatient is best described as one who: a. collaborates with the health provider, has a chronic illness, and writes blogs. b. seeks health information from various sources and uses the information for decision making with health providers c. manages health decisions, uses the Internet and uses biosensors. d. makes all decisions, prepares for doctor visits, and gathers data points.

ANS. B Rationale: Someone who seeks health information from various sources and uses the information for decision making with health providers is inclusive of all types of epatients. Not all epatients use biosensors, nor do they all write blogs. Epatients collaborate with their provider to arrive at a decision.

50. To achieve the goals of the HIMSS Nursing Informatics Position Statement, all nurses should: a. develop innovative technologies. b. participate in advocacy and educational efforts directed to policymakers. c. run for political office. d. draft health IT policy.

ANS. B Rationale: The HIMSS Nursing Informatics Position Statement states that nurse leaders should be knowledgeable and well versed in current public policy initiatives and participate in advocacy and educational efforts directed to policymakers.

19. An organization decides to utilize a silver nanoparticle in the production of a product in order to make the product antimicrobial. This is an example of: a. nanomedicine. b. nanofabrication c. health information exchange. d. nanoinformatics.

ANS. B Rationale: The purpose and goal of nanofabrication is to utilize nanoparticles to improve existing structures, devices, products, etc.

42. The Health Information Technology for Economic and Clinical Health (HITECH) Act has influenced healthcare delivery because it is: a. a training program for informatics specialists. b. an academic electronic health records software. c. federal legislation that promotes the use of electronic health records. d. an organization that develops informatics competencies.

ANS. C Rationale: HITECH has influenced healthcare delivery because it is federal legislation that promotes the use of electronic health records. HITECH has not specifically addressed informatics training or education.

80. Which group is allowed to share personal health information on social media sites? a. Providers who monitor the social media site b. Hospital registration clerks c. Patients/consumers d. Healthcare providers on the site

ANS. C Rationale: Healthcare providers are not allowed to share this information, but patients/consumers are not restricted.

65. When there is a breach of one unsecured patient record, it is necessary to notify: a. the Office of National Coordinator for Healthcare Information Technology. b. the media outlets. c. the patient. d. the Department of Health and Human Services.

ANS. C Rationale: If there is only a breach of one record versus a breach of more than 500 records, only the patient must be notified within sixty (60) days upon the discovery of the breach.

26. If a hospital loses its backup tapes containing 315,000 unencrypted records, it is necessary to notify: a. the Attorney General. b. the Office of National Coordinator for Healthcare Information Technology. c. the media outlets. d. the Department of Justice.

ANS. C Rationale: Pursuant to the HITECH breach notification requirements, because there is a breach of more than 500 unsecured records, the media must be notified to ensure patients are made aware of the breach. In addition to the media outlets, the Department of Health and Human Services Office of Civil Rights Agency must also be notified within sixty (60) days of discovering the breach.

57. What defines the "Google generation?" a. A person who was born after about 1989 b. A person who uses simplified search engines rather than site-specific searches c. A person who is an epatient d. A person who desires immediate access to information and is Internet savvy

ANS. D Rationale: A person who desires immediate access to information and is Internet savvy is characteristic of an individual belonging to the Google generation. The other choices are not characteristic of being part of the Google generation.

52. Transparency of PHR data is limited due to: a. differing philosophies over governance. b. anticipatory worry. c. nonparticipatory physicians. d. current functionality.

ANS. A Rationale: Due to differing philosophies over governance, the transparency of PHR data is limited. Many policy standards do not exist for the PHR, and organizations are facing cultural, technological, legal, and privacy challenges for managing PHRs.

12. A quantified selfer is best described as one who: a. tracks personal metrics b. records lab values. c. graphs data. d. uses a sleep diary.

ANS. A Rationale: Graphs data, records lab values, and uses a sleep diary are all traits of a quantified selfer; however, tracking personal metrics best describes the quantified selfer.

21. Cognitive psychology claims that learning involves memory, motivation, thinking, reflection, and abstraction. Which question is instrumental in teaching critical thinking? Select one: a. How? b. Who? c. What? d. Why?

ANS. A Rationale: "Knowing how" involves memory, motivation, thinking, reflection, and abstraction. These skills are useful in teaching critical thinking. "Knowing what" represents behaviorism, and "knowing why" represents constructivism. "Knowing who" is not part of the learning theories discussed.

23. Evaluating data from all relevant sources, including technology, to inform the delivery of care is a competency for a(n): a. specialist. b. advanced practice nurse. c. innovator. d. generalist.

ANS. D Evaluating data from all relevant sources, including technology, to inform the delivery of care is a competency for a generalist. The generalist receives undergraduate training for this role.

73. Which definition most accurately describes privacy? a. Accuracy and completeness of health information b. The means to ensure health record privacy and confidentiality c. An act that has the potential to cause harm to an informational asset d. The rights of individuals to control access to their person or information about themselves

ANS. D Rationale: Privacy is the rights of individuals to control access to their person or information about themselves. Security is defined as the means to ensure health record privacy and confidentiality. Data integrity is defined as the accuracy and completeness of health information. A threat is an act that has the potential to cause harm to an informational asset.

9. A nurse uses a CDS system to make an informed clinical decision regarding a drug dosage ordered for a patient. According to Donabedian's model, this would be considered: a. outcome. b. structure. c. effectiveness. d. process

ANS. D Rationale: The managerial and clinical processes in place to support the provision of care are all included under the process component. The use of a CDS system is considered process.

35. Social media policies should contain: (Select all that apply.) a. guidance on acceptable behavior. b. methods for handling unacceptable behaviors. c. penalties for misuse. d. statement to promote ethical behaviors.

ANS. A,B,D Rationale: Social media polices should contain guidance on acceptable behavior, methods for handling unacceptable behaviors, and a statement that promotes ethical behavior. Imposing penalties for misuse should be discussed on a case-by-case basis.

77. Which factor has influenced the epatient movement? a. The Internet b. The Human Genome Project c. The Association of Cancer Online Resources d. The quantified self

ANS. A Rationale: A factor that has influenced the epatient movement is the Internet. The Human Genome Project involves identifying genes in human DNA. The Association for Cancer Online Resources is a useful resource for cancer patients. The quantified self is a term used to describe people who are invested in using tools and data to quantify and monitor their daily experiences using personal metrics.

28. Incorporating usability principles into software configuration and implementation is a competency of: a. the implementation support specialist. b. the advanced practice nurse (APN). c. the generalist. d. the nursing informatics specialist (INS).

ANS. A Rationale: Incorporating usability principles into software configuration and implementation is a competency of the implementation support specialist. This is not a competency of the generalist, APN, or INS.

92. Which is included in an RFP but not an RFI? a. Financial considerations b. Desired system components and functionality c. Description of the hospital or health system d. Goals of the organization

ANS. A Rationale: Pricing and financial considerations are part of an RFP but not part of an RFI.

55. What are some examples of indirect costs to organizations that have security breaches? (Select all that apply.) a. Lost productivity b. Damaged public trust c. Remediation costs d. Expensive fines

ANS. A,B,C Rationale: Indirect costs to an organization with security breaches are lost productivity, damaged public trust, and remediation costs. Fines are a direct penalty.

79. Which goal applies to the field of nanoinformatics? a. Development of a publicly available database of nanoparticle information, nanoparticle structure simulation tools, and data mining techniques for nanoparticle information b. The use of nanotechnology for the prevention, diagnosis, and treatment of disease c. Creation of materials, devices, and other structures at the nanoscale d. Development of nanomaterials used in electronics, structural materials, and commercial products

ANS. A Rationale: A goal that applies to the field of nanoinformatics is the development of a publicly available database of nanoparticle information, nanoparticle structure simulation tools, and data mining techniques for nanoparticle information. Nanofabrication is the development of nanomaterials used in electronics, structural materials, and commercial products. Nanotechnology is the creation of materials, devices, and other structures at the nanoscale. Nanomedicine is the use of nanotechnology for the prevention, diagnosis, and treatment of disease

107. Which social media site was developed by healthcare agencies? a. Heart.org b. WrongDiagnosis.com c. CureTogether d. PatientsLikeMe

ANS. A Rationale: Heart.org was developed by the American Heart Association. The others were developed by consumers.

95. Which methods will provide information useful in requirements identification? (Select all that apply.) a. Survey b. Interview c. Regression analysis d. Delphi method e. Direct observation

ANS. A,B,E Rationale: Methods useful in providing information for requirements identification include using surveys, interviews, and direct observation to collect data. A variety of data collection methods is necessary to define system requirements.

111. Who "owns" health IT governance? a. The type of institution b. The Chief Information Officer c. The Chief Executive Officer d. The Chief Medical Information Officer

ANS. A Rationale: The ownership of health IT governance, as with other aspects of governance, depends on the institution.

119. Your team developed a prototype for a mobile health (mhealth) device for diabetics to track their glucose levels, insulin, and preventive care appointments. You want to assess whether the application includes the appropriate content for users (consumers). You plan to ask patients from an ambulatory clinic to participate. The kind of test you would plan is a(n): a. exploratory test. b. comparison test. c. validation test. d. assessment test.

ANS. A Rationale: The type of test that is appropriate is an exploratory test. Content issues are addressed in exploratory tests.

104. Which principles are included in IMIA's Code of Ethics for informatics? (Select all that apply.) a. Legitimate Infringement b. Information-Privacy and Disposition c. Accountability d. Elimination of Threats e. Openness

ANS. A,B,C,E Rationale: IMIA's Code of Ethics for informatics includes Information-Privacy and Disposition, Openness, Security, Access, Legitimate Infringement, Least Intrusive Alternative, and Accountability. While the principles of the code might be to eliminate threats, elimination of threats is not a specific principle.

108. Which strategies are required when nurses prepare to engage in public policy efforts? (Select all that apply.) a. Demonstrate leadership skills b. Register as a lobbyist c. Acquire knowledge of basic health policy and funding d. Leverage a professional network

ANS. A,C,D Rationale: Strategies required for nurses to engage in public policy efforts include acquiring knowledge of the basics of health policy funding, demonstrating leadership skills, and leveraging a professional network.

117. You want to make sure you consider crucial components as you design your first usability study. One of these components is to consider users and their characteristics. Other components are: a. information, a developmental timeline, context, and group interactions. b. a developmental timeline, tasks, information, product, and context. c. information, testing, errors, and context. d. tasks, information, projected errors, context, and interactions.

ANS. B Rationale: Crucial components as you design your first usability study include a developmental timeline, tasks, information, product, and context. The HHCI describes elements to consider.

105. Which region introduced ehealth initiatives such as epSOS and SEHGovIA for interoperability? a. Asia-Pacific region b. Europe c. Latin America and the Caribbean d. Africa

ANS. B Rationale: Europe introduced ehealth initiatives such as epSOS and SEHGovIA for interoperability. The remaining choices (Asia-Pacific region, Latin America and Caribbean region, and African region) did not introduce these initiatives.

109. Which term is analogous to futures research? a. Rationalistics b. Futurology c. Futuristics d. Foresightology

ANS. B Rationale: Futures research, or futurology, refers to the study of the future with the goal of identifying possible, probable, and preferable futures. The remaining terms do not exist.

118. Your organization acknowledges that providers want to improve their user experience with health information technology (IT) products. You want to raise awareness of the potential benefits to the organization. You could draw on stated benefits such as: a. decreased maintenance costs and increased training. b. improved productivity, patient safety, and decreased customer support costs. c. decreased user errors, decreased customer support costs, and increased administrative overhead. d. improved cognitive support, increased maintenance costs, and patient safety.

ANS. B Rationale: Improved productivity, patient safety, and decreased customer support costs will help you raise awareness of the potential benefits to your organization.

115. You are asked to perform a heuristic evaluation of the new orders management module of your inpatient system. You discover that the flow of the orders is different than the way providers are taught in school. This is an example of: a. informative feedback. b. match between system and world. c. ergonomics. d. consistency and standards.

ANS. B Rationale: Match addresses the way health practitioners think and the design of systems.

116. You are part of a knowledge management team that is interested in improving the user experience for your organization. The team members know you have taken a course in informatics and ask your advice about how to get started with usability in the organization. You recommend: a. hiring a consultant. b. examining the support call lists and system change requests. c. talking to the CEO about her ideas. d. working with only physicians, since they have been the most vocal about issues with the EHR.

ANS. B Rationale: The first step is to understand the key users' issues, and support call lists and change requests would give that information.

112. Why is health IT governance needed? (Select all that apply.) a. It encourages clinician involvement. b. It ensures the alignment of informatics resources with institutional priorities. c. It optimizes the return on investment on informatics investments. d. It effectively prioritizes the use of informatics resources.

ANS. B,C,D Rationale: Health IT governance is needed as it ensures the alignment of informatics resources with institutional priorities, effectively prioritizes the use of informatics resources, and optimizes the return on investment on informatics investments. All three reasons are core to the need for health IT governance.

102. Which organizations have relationships with the Health Informatics Building Blocks Program aimed at health informatics workforce development in Africa? (Select all that apply.) a. Health Level 7 (HL7) b. Health Informatics in Africa (HELINA) c. Global Health Informatics Partnership (GHIP) d. American Medical Informatics Association (AMIA)

ANS. B,C,D Rationale: The HELINA, AMIA, and GHIP organizations have relationships with the Health Informatics Building Blocks Program aimed at health informatics workforce development in Africa. The HL7 does not have a relationship with the Health Informatics Building Blocks Program.

114. Why is the PSQRD a useful framework for research and practice? a. It increases communication among clinical staff. b. It explains why using computer applications is the best way to support better patient outcomes. c. It ensures successful implementation of a clinical process change. d. It supports implementation, performance improvement, and rigorous research methodologies.

ANS. D Rationale: PSQRD is a useful framework for quality and safety projects whether or not they use health information technology as a tool. While the PSQRD framework may improve communication and implementation, a critical strength of this framework is its systems approach and comprehensive strategy for ongoing monitoring and evaluation. The PSQRD framework provides a means to introduce health IT interventions in a systematic way, and it serves as a reminder to incorporate measures of success across the causal chain. This approach supports implementation, performance improvement, and research projects with an appreciation for the effects and the limitations of health IT and other intervention components. Adoption of the PSQRD framework for both research and organizational implementations will provide a means to plan for successful implementation and to collect data on the structural and process factors that may affect adoption and use of health IT interventions and ultimately patient outcomes. This type of measurement is appropriate for both research-based and operational implementations of health IT.

101. Which organization works on an international level to improve information privacy? a. Department of Health and Human Services (DHHS) b. Health Information Security and Privacy Collaboration (HISPC) c. Health and Human Services Office of Civil Rights d. Electronic Frontier Foundation (EFF)

ANS. D Rationale: The Electronic Frontier Foundation (EFF) maintains a website listing international privacy-related accords and agreements. Health and Human Services Office of Civil Rights, Health Information Security and Privacy Collaboration (HISPC), and Department of Health and Human Services (DHHS) are all examples of federal and/or state organizations.

110. Which two events led to the expansion of the field of nanotechnology? a. Creation of the Project on Emerging Nanotechnologies and use of quantum dots b. A lecture titled "There's Plenty of Room at the Bottom" and development of carbon nanotubes c. Development of the subdisciplines of nanofabrication and nanomedicine d. Invention of the scanning tunneling microscope and the discovery of fullerenes

ANS. D Rationale: The invention of the scanning tunneling microscope and the discovery of fullerenes were the two events that led to the expansion of the field of nanotechnology.