Quiz 2
When did formalized home health and community-based systems originate in the United States? a. 1776 b. 1800s c. 1965 d. 2001
ANS: B
Which payer is the largest for home health services? a. Private insurance b. Patients and families in the form of self-pay c. Medicare d. Medicaid
ANS: C As the largest payer, Medicare, through its Conditions of Participation, represents the standard for the services provided by home health agencies and the payment for these services by many commercial insurance payers and state Medicaid programs.
Mobile health is commonly referred to as mHealth, m-Health, and more recently as "connected health"
Described as a catalyst for healthcare change mHealth "represents the evolution of eHealthsystems from traditional desktop 'telemedicine' platforms to wireless and mobile configurations
Buisness
Economic potential and cost savings ➢mHealth market accounted for nearly $13 billion in 2015 alone. ➢Growth is anticipated at nearly 40% over the next 6 years. ➢mHealth has the potential to increase healthcare quality, decrease costs, and create additional capacity for healthcare systems.
mhealth Evolution and Evidence
First era of mHealth was experimental proliferation and included a large number ofpilot studies conducted within a short time frame and not extending past the pilot phase. Evidence base for mHealth continues to grow with an increase in health outcomes research.
Policy
US Food and Drug Administration and Office of the National Coordinator for Health IThave issued guidance related to mobile apps and health IT.
Research
➢Implications for improving mHealth research include using (1) sound intervention development principles, (2) guidance from established theoretical framework/underpinning, and (3) rigorous research methodologies.
Driving Forces of mHealth
1.Technology—access, reduced cost, and its increasing 2. The consumer/patient engagement movement 3.Global health or connected health—expanding healthcare services to remote and marginalized populations 4.Research, policy, and business—both cost savings and earning potential
What are the two most commonly owned personal computing devices? a. Game device and MP3 player b. Mobile phone and laptop c. Laptop and desktop computer d. Laptop and MP3 player
ANS: B
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
What technology has been described as the next frontier for home health and related community-based systems? a. EHR b. CDS c. EMR d. BCMA
ANS: B
The first use of telehealth was documented in: a. 1897. b. 1935. c. 1999. d. 2002.
ANS: A The first use of telehealth was documented in 1897. The remaining responses are not correct.
What defines the "Google generation?" a. A person who was born after about 1989 b. A person who desires immediate access to information and is Internet savvy c. A person who uses simplified search engines rather than site-specific searches d. A person who is an epatient
ANS: B
Which is not an activity of public health? a. Direct clinical services b. Disease outbreak management c. Bariatric surgery because obesity is a national public health problem d. Rat and mosquito abatement
ANS: C
Which group would have a financial incentive to implement CDS? a. A community hospital b. An inner-city clinic c. A national insurer d. Depends on CDS and healthcare payment model
ANS: D
Global Health and Connected Healthcare
mHealth provides access to healthcare systems in rural, isolated, and resource limited settings Helps improve health outcomes particularly in low and middle incomecountries Global stakeholders supportive of mHealth initiatives
Policy issues directly impacting telehealth practice for healthcare providers include: (Select all that apply.) a. technology. b. malpractice. c. licensure. d. credentialing. e. reimbursement. f. broadband
ANS: B, C, D, E
Which incentive has the strongest potential to spur the nationwide adoption of advanced CDS? a. Freely available CDS knowledge in a machine-executable form b. Significant government funding for research efforts to share CDS c. Shift of healthcare payment from a fee-for-service model to approaches rewarding the delivery of better quality and outcomes at lower cost d. Meaningful Use Stage 1 requirements related to CDS
ANS:C
mHealth Benefits for patients:
Increasing the reach and access to healthcare services, eg, routine or emergency and information Improving efficiencies and lowering healthcare systems expenses Empowering individuals or populations for health behavior modifications and disease prevention Greater patient access to medical information to improve health outcomes Greater access to personal data Decrease in operational stresses on healthcare organizationsCopyrig
An epatient is best described as one who: a. seeks health information from various sources and uses the information for decision making with health providers. b. manages health decisions, uses the Internet and uses biosensors. c. collaborates with the health provider, has a chronic illness, and writes blogs. d. makes all decisions, prepares for doctor visits, and gathers data points.
ANS: A
The majority of healthcare delivered globally is: a. acute care. b. emergency care. c. self-care. d. primary care.
ANS: C The majority of healthcare that is delivered globally is self-care. The remaining responses are types of healthcare one finds in modernized or western countries.
What defines Health 2.0? (Select all that apply.) a. Updated versions of old health information b. Marketing health products based on the patient's Internet preferences c. Health-related mobile applications d. Mobile health-monitoring devices e. Web-based content f. Social networks
ANS: C E F
The culture of the patient-clinician partnership always includes: a. requirements found in the Patient Protection and Affordable Care Act. b. guided discovery. c. involvement of technology specialists and social media activists. d. epatients and clinicians working in collaboration towards shared goals.
ANS: D
The maxim "Doctors know best": a. is one of the tenets of participatory medicine. b. was coined by epatient Dave. c. was coined by Gilles Frydman. d. is the paradigm for the paternalistic care model.
ANS: D
Which of these best describes participatory medicine? a. Integrated care model b. Authoritative care model c. Community care model d. Cooperative care model
ANS: D
Which statement is true of PHRs? a. They have been used in paper form for many years, and electronic versions offer the same functionality. b. They were a new idea when proposed in the 1990s and are a now a well-established technology. c. Approximately 35% of the US population currently has one. d. They have been used in paper form for many years, but electronic versions offer new functionality.
ANS: D
Which statement is not part of the Ten Commandments of CDS? a. Speed is everything. b. Fit into the user's workflow. c. Alerting is the most effective approach to CDS. d. Ask for additional information only when you really need it.
ANS:C
Techonolgy ranges
Options range from basic phones to sophisticated smartphones ➢5G is in the very near future and will allow even faster speeds and connect "virtually any and everything
Consumer/Patient Engagement and Empowerment
Patient empowerment driven by consumers: ➢having increased access to health information and basic medical knowledge ➢being able to capture their own data Major contributor to the mHealth evolution is the development, proliferation, and use of apps and sensors
One trend that is influencing healthcare reform is: a. disruptive technology. b. Hospital Consumer Assessment of Healthcare Providers and Systems. c. Veterans Health Information System and Technology Architecture Implementation. d. Everett Rogers' theory of diffusion of innovation.
ANS: A
Public health differs from clinical practice in important ways. Which statement reflects the differences? a. Public health is focused on the prevention and health of populations before they are ill. b. Public health is focused on one individual at a time to ensure the best possible outcome. c. The health of a community is measured by the use of sophisticated technologies like MRIs. d. Public health is focused on one family at a time to ensure the best possible outcome.
ANS: A
The ONC (Office of the National Coordinator for Health Information Technology) is best described as: a. the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. b. the principal federal entity charged with promoting nationwide sales of advanced health information technology. c. a federal entity charged with increasing public awareness of the value of health information technology. d. a federal agency that regulates the contents and functions of health information technologies, including PHRs.
ANS: A
The most commonly used functions of personal health records are: a. viewing test results and secure messaging. b. reading patient education materials and renewing medication prescriptions. c. entering data (such as self-measured glucose and blood pressure) and watching educational videos. d. online appointment scheduling and reading clinical notes.
ANS: A
What are the main types of PHR? a. Tethered, untethered, stand-alone, and networked b. Integrated, tethered, untethered, and stand-apart c. Tethered, de-tethered, stand-apart, and stand-together d. USB-based, Web-based, and patient portals
ANS: A
What are the two important purposes of the OASIS data set? a. Determine payment and measure quality and outcomes b. Determine payment and standardize data c. Determine the time of visits and measure quality and outcomes d. Determine efficiency and measure quality and outcomes
ANS: A
Which statement is true regarding the continuity of care record (ASTM standard E2369-05e2)? a. It is an XML-based extract of the health record that allows for syntactically interoperable records. b. It is an XML-based extract of the health record that allows for semantically interoperable records. c. It is a tab-delimited extract of the health record that specifies constraints on the controlled vocabularies used. d. It is a tab-delimited extract of the health record that paves the way for national health information exchange.
ANS: A
The migration of informatics and telehealth toward uhealth means: a. ecosystems of interoperable technologies and services organized to meet global patients' needs in a ubiquitous manner. b. an approach toward underground installation of fiber optics and cable networks organized to meet global patients' needs in a ubiquitous manner. c. understanding of telehealth implementation barriers organized to meet global patients' needs in a ubiquitous manner. d. university programs for training healthcare providers organized to meet global patients' needs in a ubiquitous manner.
ANS: A The migration of informatics and telehealth toward uhealth means ecosystems of interoperable technologies and services will be organized to meet global patients' needs in a ubiquitous manner.
Which social and political challenges impact public health informatics? (Select all that apply.) a. The limits of federal authority b. The evolution of public health primarily as state and local functions c. The lack of resources to implement health IT d. The presence of standards to implement health IT
ANS: A, B
Blueprint Version 2.0 updates public health surveillance activities for the 21st century. Which methods exemplify these activities? (Select all that apply.) a. Analysis of population data to describe disease characteristics and risk factors b. Analysis of electronic health record data c. Biomonitoring and environmental monitoring d. Analysis of individual data to describe disease characteristics and risk factors
ANS: A, B, C
eHealth literacy for consumers includes which elements? (Select all that apply.) a. Visual literacy b. Computer literacy c. Financial literacy d. Business modeling literacy e. Information literacy f. Digital literacy
ANS: A, B, E, F
Informatics opportunities for reportable conditions include: (Select all that apply.) a. the use of computable logic to define where and how reports should be sent. b. automation of patient education from electronic health records. c. automation of information extraction from electronic health records. d. standardization of message structure and content for reporting.
ANS: A, C, D
The Omaha System consists of components that capture: (Select all that apply.) a. evaluation data. b. cost data. c. assessment data. d. service delivery/activity data.
ANS: A, C, D
What are the advantages of telehealth for patients? (Select all that apply.) a. Decreased travel time or distance and removal of travel barriers b. Ease of reimbursement for costs c. Immediate access to care d. Early detection of disease processes or health issues e. Ownership of healthcare and feelings of empowerment
ANS: A, C, D, E
A quantified selfer is best described as one who: a. graphs data. b. tracks personal metrics. c. records lab values. d. uses a sleep diary.
ANS: B
Despite the challenges, public health systems are now available. Good examples of these systems have implemented vocabulary and messaging standards, are used to make public health decisions in a clinical setting, and provide data for public health policy. One of the best examples is: a. the linkage of local electronic health records in the 50 states to public health reporting databases. b. immunization information systems. c. geographical informatics systems for reporting environmental issues. d. direct lab reporting of conditions and diseases such as lead poisoning.
ANS: B
The public health supply chain needs to evolve to an information ecology approach for the future direction. This would involve: a. standardizing public health supplies and suppliers. b. being partners with others to receive, reuse, and republish data. c. allowing public health departments to exclude data sharing to protect patient privacy. d. allowing public health departments to include data sharing to protect patient privacy.
ANS: B
Which statement is true of Meaningful Use? a. These are criteria created by patient advocacy groups intended to ensure that patient-facing technology is addressing users' needs. b. These are criteria created by the ONC to determine eligibility for incentives for health information technology adoption and use. c. These are criteria created by Congress that delineate appropriate uses of health data for research purposes. d. These are criteria proposed by the Institute for Healthcare Improvement to suggest ways to use health information technology to improve healthcare in the United States.
ANS: B
What is the most important element for operationalizing and ensuring telehealth acceptance by providers? a. Cost of telehealth technology b. Training c. Location of equipment d. Transmission speed
ANS: B Training is one of the most important elements in the acceptance of telehealth by providers. The remaining responses, although relevant, are not important drivers of acceptance
HIPAA (Health Information Portability and Accountability Act) requires that: (Select all that apply.) a. healthcare records be available electronically by 2014. b. healthcare providers keep an audit trail of access to an individual's record and provide copies of the individual's record upon request. c. specific privacy and security measures must be used in all electronic health records. d. healthcare providers must be able to electronically exchange health records by 2014. e. healthcare providers must be able to electronically exchange lab data by 2014.
ANS: B, C
Why are expert diagnostic decision support systems not integrated into clinical settings ? (Select all that apply.) a. They have not been shown to be comparable to the performance of human experts. b. Clinicians generally must go out of their routine workflows to use the systems, and these systems generally require time-consuming data entry. c. There are limited financial incentives to use such systems. d. The systems have been found to be detrimental to patient care.
ANS: B, C
Which of the following are challenges or barriers to CDS adoption? (Select all that apply) a. Lack of evidence of CDS effectiveness b. Misaligned financial incentives c. Inadequate EHR adoption d. Lack of widely adopted standards for CDS
ANS: B, C, D
Why is CDS important for healthcare institutions? (Select all that apply). a. It can reduce the need for registered nurses. b. It can help reduce medical errors. c. It is a required element of Meaningful Use regulations. d. It can help improve care value.
ANS: B, C, D
A healthcare system has implemented a functionality where patients who are overdue or almost due for a mammogram are sent letters notifying them to schedule a mammogram based on available data and current clinical care guidelines. Which type of CDS system is this? a. This is not a CDS. b. A personal health record system c. A reminder system d. An alerting system
ANS: C
Secure PHR messaging refers to the capacity to: a. send messages between healthcare providers within a single EHR. b. send messages between healthcare providers across healthcare systems. c. send messages from patients to providers via a tethered PHR. d. send messages from patients to providers via a stand-alone PHR.
ANS: C
The "digital divide" refers to: a. higher adoption and use of information technologies among individuals from ethnic minorities, of lower socioeconomic status, and older age. b. the gap between current adoption of PHRs and their potential use. c. lower adoption and use of information technologies among individuals from ethnic minorities, those of lower socioeconomic status, and older age. d. the difference between rates of overall cell phone ownership and "smart phone" ownership.
ANS: C
Why have most CDS systems not shown to significantly impact patient outcomes in clinical trials, despite the fact that a majority of systems have been shown to significantly improve care processes? a. CDS systems have not been evaluated in clinical trials. b. Very few studies have assessed the impact of CDS systems on patient outcomes. c. Many CDS system evaluation trials are underpowered to detect changes in care outcomes. d. CDS systems have been implemented and evaluated in too many diverse institutions.
ANS: C
Which government organization manages the largest telehealth program in the United States as of this writing? a. Department of Defense b. NASA c. Department of Veterans Affairs d. Office for the Advancement of Telehealth
ANS: C The Department of Veterans Affairs manages the largest telehealth program in the United States. The remaining responses are incorrect.
What are the two overarching types of telehealth technologies? a. Live and real time b. Web-based and synchronous c. Asynchronous and videoconferencing d. Synchronous and asynchronous
ANS: D Synchronous and asynchronous are the two overarching types of telehealth technologies. The remaining responses are components of telehealth.
You are asked to justify the creation of the first public health informatics (PHI) program in your jurisdiction. You will emphasize this likely benefit by ensuring: a. current PHI can enhance public health surveillance such as identifying clusters of diseases. b. privacy and security issues are avoided because public health informatics data are de-identified at the community level. c. interoperability already exists for public health IT. d. standards already exist for PHI.
ANS:A
Public health could benefit from improved technical architectures in the future. Which of these is not a likely technology for the future? a. Service-oriented architecture (SOA) b. Software as a service (SaaS) c. Open source methods such as OpenELS or OpenMRS d. Mobile devices such as the iPhone
ANS:D
Transparency of PHR data is limited due to: a. current functionality. b. anticipatory worry. c. nonparticipatory physicians. d. differing philosophies over governance.
ANS:D
What are the primary goals for using EHRs in home health and related community-based systems? (Select all that apply.) a. To provide an effective and efficient method for tracking cost and related billing b. To capture clinicians' documentation that supported interaction with patients at the point of care c. To support clinical decision making and quality of care by presenting best practices and evidence-based practice options d. To improve communication e. To teach patients how to use technology
ANS: A, B, C, D
What are the core values of nurses who work in home health and community-based systems? (Select all that apply.) a. Embrace interprofessional collaboration b. Involve patients and families in care and decision making c. Schedule home visits and travel to begin and end each work day on time d. Provide patient-centered care
ANS: A, B, D
What are the key tenants of the Triple Aim for Health Care? (Select all that apply.) a. Better care for individuals b. Better health for populations c. Better working conditions for nurses d. Reduction of per capita costs
ANS: A, B, D
Which tools are examples of CDS? (Select all that apply.) a. An order set b. A reminder c. A phone call d. An infobutton
ANS: A, B, D
Why is it important for software used by nurses who work for home health and related community-based systems to be based on a standardized terminology? (Select all that apply.) a. To support evidence-based practice b. To generate reports needed to monitor care, improve the quality of services, and track costs c. To improve patient understanding of their medical records d. To improve communication among care providers at multiple locations e. To describe and quantify practice for clinicians, managers, administrators, and third-party reviewers
ANS: A, B, D, E
Immunization information systems are used to record at least some of the immunizations for about 75% of children in the U.S. Which benefits are provided by the use of these systems? (Select all that apply.) a. A high return on investment b. The ability to provide consolidated immunization histories to avoid over- or under-vaccinating c. The ability to improve vaccination rates by integrating data across the country d. Integration across nations
ANS: A, B, C
Telehealth programs with high-quality clinical practice require which tools? (Select all that apply.) a. Standards and guidelines b. Protocols and procedures c. Evaluation/quality improvement methods d. Certification programs
ANS: A, B, C
Which of the following practices are included in the CDS Five Rights? (Select all that apply.) a. Providing the right information b. Providing to the right person c. Providing at the right point in work flow d. Providing the right reference information
ANS: A, B, C
Which of the following tools will the standardized hospice data set probably contain? (Select all that apply.) a. National Data Set for Hospice b. Family Evaluations of Care c. Survey of Team Attitudes and Relationships d. Survey of Missed Nursing Care
ANS: A, B, C
Access to Technology
Mobile phone has been cited as the most rapidly adopted technology on the planet. ➢Charging phones is done using alternative methods, such as solar energy, a car battery, or a central charging station, in many parts of the world. ➢Mobile phones replacing landlines. ➢Advent of mobile phones narrowing the "digital divide." ➢Despite popularity of smartphones, most using basic mobile phones.
Future Directions of mHealth
The use of technology is shifting from networks and hardware to software and services. Next generation of mHealth apps using 5G is likely to revolutionize and transform healthcare. Wearable technology will continue to expand. Future points to the connectivity of anything and everything.
mHealth Challenges
➢People misinterpreting their own data ➢Data privacy risks ➢Legal risks ➢Leading mHealthorganizations, key resources, and information repositories
