CRM1- SEER EDUCATE

A new standard data item for a cancer registry typically goes into effect Response : A. At the beginning of an admission year for a hospital registry. B. At the beginning of a diagnosis year for a central registry. C. Both (a) and (b) D. Neither (a) nor (b)

. At the beginning of a diagnosis year for a central registry. Rationale: Implementation of a new standard data item typically occurs at the beginning of a diagnosis year for both hospital and central registries.

Firewalls are used to protect confidential data by Response : A. Isolating registry data from the rest of the network. B. Preventing users from accessing a particular website. C. Both (a) and (b) D. Neither (a) nor (b)

. Both (a) and (b) Rationale: A firewall is a hardware or software-based network security system used to control incoming and outgoing network traffic by analyzing the incoming data packets to determine whether they should be allowed through or not, based on an applied rule set. Firewalls are used to keep registry data self-contained by isolating the data from the external network. Firewalls can also be used to prevent users from accessing a particular website. A firewall establishes a barrier between a trusted, secure internal network and another network (e.g., the Internet) that is thought to not be secure and trusted.

The operational policies and procedures must include Response : A. Information technology use. B. Contingency/disaster recovery. C. Both (a) and (b) D. Neither (a) nor (b)

. Both (a) and (b) Rationale: Organizations need to establish operational policies and procedures in order to provide security guidance and education to all appropriate personnel and to make certain that all relevant functions are reliably performed in accordance with the organization's security needs. The operational policies and procedures must include: •Security management planning (Evaluate the flow of confidential data throughout the organization and identify unreasonable security weaknesses.) •Security configuration management (Refers to the physical layout of the security system.) •Management responsibility (Identify who has the authority and responsibility to implement and maintain the security system.) •Information handling procedures (Establish procedures to ensure control over confidential data is maintained.) •Access control (Identify employee categories that should have access to various types of confidential data.) •Personal authorization controls (Indicate actions used to verify the identity and authority of employees before granting access to confidential data.) •Information technology use policies (Relates to the use of certain technologies (e.g., e-mail and internet use) and the potential security risks associated with it.) •Employee training (Includes education related to meeting security requirements that apply to their position.) •Disciplinary action (Establish disciplinary actions related to a breach of security caused by inappropriate actions.) •Employee termination (Ensure that access to confidential information is terminated immediately after an employee leaves a position.) •Vendor/Associate control (Relates to ensuring that third parties adequately protect security of the confidential information provided.) •Internal auditing (Procedures performed to ensure security measures are sufficient and effective.) •Contingency/disaster recovery planning (Procedures are in place to routinely archive and protect confidential data needed to perform essential business functions.) •Incident handling (Formal process in place to report, investigate and resolve events that reflect a security breach.) •Compliance certification (Employ either an internal or external authority to determine and certify that adequate and effective security measures are in place.)

In 2002 Congress amended the law regulating cancer collection by enacting the Benign Brain Tumor Cancer Registries Amendment act requiring the collection of benign tumors of which sites? Response : A. Brain, meninges, spinal cord, cauda equina, and cranial nerve B. Brain, pituitary gland, pineal gland, and craniopharyngeal duct C. Both (a) and (b) D. Neither (a) nor (b)

. Both (a) and (b) Rationale: The Benign Brain Tumor Cancer Registries Amendment enacted in 2002 requires the collection of the benign tumors of the following sites: •Brain •Cauda equina •Cranial nerve or nerves •Craniopharyngeal duct •Meninges •Pineal gland •Pituitary gland •Spinal cord •Any other part of the central nervous system

The four sections of a budget include Response : A. Capital expenditures. B. Supplies. C. Both (a) and (b) D. Neither (a) nor (b)

. Both (a) and (b) Rationale: The four sections to a budget are: •Capital purchases (anything with a life expectancy of more than a year including furniture, computers) •Salaries and benefits •Supplies (disposable supplies such as paper and ink) •Fixed costs (recurring monthly items such as rent, utilities, or housekeeping)

What is the automated or semi-automated exchange of data sets between different software applications at the central registry called? Response : A. Importing files B. Exporting files C. Both (a) and (b) D. Neither (a) nor (b)

. Both (a) and (b) Rationale: The import and export of data is the automated or semi-automated input and output of data sets between different software applications. The ability to import and export data (or lack of such ability) has large economic implications, because it can be resource-intensive to input data in non-automated ways (such as manual rekeying). The central registry data management system is used for both data import and data entry. Data import includes importing new and updated case reports from a variety of reporting sources such as hospitals, other state registries, and nonhospital facilities.

A key component(s) used to determine how time is spent by the cancer registry staff is knowing what is Response : A. Required of the registry. B. Being asked of the registry. C. Both (a) and (b) D. Neither (a) nor (b)

. Both (a) and (b) Rationale: The two key components used to determine how time is spent by the cancer registry staff is knowing both what is required by the registry staff and what is being asked of the registry staff to accurately be able to draft goals and expectations that result in identifying tasks that need to be completed. When considering the first component, one needs to understand what is mandated by each of the following: •State registry. •National organizations to which you report (e.g., Commission on Cancer [CoC], National Program of Cancer Registries [NPCR] or the Surveillance Epidemiology and End Results Program [SEER]). Knowing what is being asked of the registry also involves understanding the requirements outlined by the following: •Cancer committee (i.e., knowledge of reportable-by-agreement cases, such as borderline tumors of the ovary, that are not legally required to be reported but have been requested by the cancer committee, role in planning and follow-up related to this committee's activities). •Cancer conference (i.e., role in planning and follow-up related to this committee's activities).

Challenges for standardization of data edits include Response : A. Incomplete editing during data abstraction. B. Different registry software providers. C. Both (a) and (b) D. Neither (a) nor (b)

. Both (a) and (b) Rationale: There are a number of challenges involved in standardizing data edits including: •Incomplete editing during data abstracting because of a management decision to not always run all edits at the time of data entry •Registries use different software providers •Documentation of edit algorithms used are not always available for data collectors and researchers or, if available, may not be in format that is easily interpreted •Data collected and consolidated form varied reporting sources and applications are not always uniform, therefore, data analysis may be affected •Standard changes are difficult to synchronize across software provider due to the differing release schedules of cancer software providers and their limited ability to rapidly respond to changes at a given times •Differing computer language in registry system •Standard specifications may be programmed using different computer languages that may result in possible differences in the edit detail captured due to differing translations by programming staff While standardizing data edits may prove challenging, it is an important function in order to provide data that are comparable across all registries.

With the continuing development of electronic medical records (EMRs), the registrar must proactively Response : A. Check with their vendors to see whether information from the EMR can be imported into the cancer registry abstract. B. Ensure the registry participates in the design of the EMR. C. Attend any educational meetings on how to use the EMR when it has been implemented. D. None of the above

. Ensure the registry participates in the design of the EMR. Rationale:

Which statement(s) is true regarding the National Provider Identifier (NPI)? Response : A. HIPAA covered entities must use only the National Provider Identifier (NPI) to identify covered health care providers in standard transactions. B. The NPI replaces all other identifiers used by health plans, Medicare, Medicaid, and other government programs, including state license number and tax identification number. C. Both (a) and (b) D. Neither (a) nor (b)

. HIPAA covered entities must use only the National Provider Identifier (NPI) to identify covered health care providers in standard transactions. Rationale: HIPAA covered entities (e.g., providers completing electronic transactions, healthcare clearinghouses, and large health plans) must use only the National Provider Identifier (NPI) to identify covered health care providers in standard transactions. All covered entities using electronic communications (e.g., physicians, hospitals, health insurance companies) must use a single NPI that replaces all other identifiers used by health plans, Medicare, Medicaid, and other government programs. The NPI does not replace a provider's DEA number, state license number, or tax identification number. The NPI is 10 digits (may be alphanumeric), with the last digit being a checksum. The NPI cannot contain any embedded intelligence; in other words, the NPI is simply a number that does not itself have any additional meaning. The NPI is unique and national, never re-used, and except for institutions, a provider usually can have only one. An institution may obtain multiple NPIs for different "subparts" such as a free-standing cancer center or rehab facility.

Which program addresses the privacy and security challenges presented by electronic health information exchange involving multiple states? Response : A. Health Information Security and Privacy Collaboration (HISPC) B. Cancer Bioinformatics Grid (caBIG) C. Certification Commission for Health Information Technology (CCHIT) D. None of the above

. Health Information Security and Privacy Collaboration (HISPC) Rationale: The Health Information Security and Privacy Collaboration (HISPC) originally consisted of 34 states and territories. HISPC phase 3 began in April 2008, and HISPC now includes 42 states and territories, and aims to address the privacy and security challenges presented by electronic health information exchange through multi-state collaboration. Each HISPC participant continues to have the support of its state or territorial governor and maintains a steering committee and contact with a range of local stakeholders to ensure that developed solutions accurately reflect local needs and preferences. Cancer Bioinformatics Grid (caBIG) was a U.S. government program described as a voluntary virtual informatics infrastructure that connected data, research tools, scientists, and organizations. The goal of the program was to develop an open source, open access information network using technology known as grid computing for secure data exchange of cancer research. The initiative was developed by the National Institutes of Health's National Cancer Institute. In addition to caGrid, the underlying infrastructure for data sharing among organizations, caBIG developed software tools, data sharing policies, and common standards. In 2011 a report on caBIG raised significant questions about effectiveness and oversight, and its budget and scope were significantly trimmed. In May 2012, the National Cancer Informatics Program (NCIP) was created as caBIG's successor program. The Certification Commission for Health Information Technology (CCHIT), a nonprofit organization with the public mission of accelerating the widespread adoption of health information technology to promote improvements in quality, safety, efficiency and access. Founded in 2004, and certifying electronic health records (EHRs) since 2006, the Commission established the first comprehensive definition of what capabilities were needed in these systems. The certification criteria were developed through a voluntary, consensus-based process engaging diverse stakeholders, and the Certification Commission was officially recognized by the federal government as a certifying body. In February 2009, Congress acknowledged the value of certification in the language of the American Recovery and Reinvestment Act (ARRA) aimed at stimulating the nation's economy. The law offers a multi-year series of incentive payments to providers and hospitals for the meaningful use of certified EHR technology.

Which piece of legislation was intended to assure the workforce is properly trained and equipped to be meaningful users of certified Electronic Health Records (EHRs)? Response : A. Health Information Technology for Economic and Clinical Health Act B. Patient Safety and Quality Improvement Act C. Health Insurance Portability and Accountability Act D. None of the above

. Health Information Technology for Economic and Clinical Health Act Rationale: Health Information Technology (HITECH) for Economic and Clinical Health Act was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009. Under the HITECH Act, the United States Department of Health and Human Services (HHS) invested billions to promote and expand the adoption of health information technology in order to improve American health care delivery and patient care. The provisions of the HITECH Act are specifically designed to work together to provide the necessary assistance and technical support to providers, enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and assure the workforce is properly trained and equipped to be meaningful users of certified Electronic Health Records (EHRs). The Patient Safety and Quality Improvement Act (PSQIA) of 2005 establishes a voluntary reporting system designed to enhance the data available to assess and resolve patient safety and health care quality issues. To encourage the reporting and analysis of medical errors, PSQIA provides Federal privilege and confidentiality protections for patient safety information, called patient safety work product. Patient safety work product includes information collected and created during the reporting and analysis of patient safety events. PSQIA authorizes U.S. Department of Health and Human Services (HHS) to impose civil money penalties for violations of patient safety confidentiality. The Health Insurance Portability and Accountability Act (HIPAA) of 1996 was enacted by the United States Congress. Title I of HIPAA protects health insurance coverage for workers and their families when they change or lose their jobs. Title II of HIPAA requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers. Provisions also address the security and privacy of health data. The standards are meant to improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in the U.S. health care system.

A cancer registrar who breaches patient confidentiality may be convicted of a Response : A. Tort. B. Aggravated misdemeanor. C. Misdemeanor. D. Felony.

. Tort. Rationale: Cancer registries are involved with health information, confidentiality, and patient privacy. A breach of confidentiality is called a tort. These actions are heard in civil rather than criminal proceedings. A tort is considered an invasion of privacy, a wrongful act committed against another resulting in injury to another's person, property, reputation, or the like for which the injured person is entitled to compensation. A misdemeanor is a criminal act such as shoplifting or first conviction for drunken driving. An aggravated misdemeanor is a criminal act so classified because of the seriousness of the misdemeanor. This type of classification of a misdemeanor impacts the length of jail time handed down by the judge. A felony is a serious crime, characterized under federal law and many state statutes as any offense punishable by death or imprisonment in excess of one year.

Which term refers to the "network of networks"? Response : A. eHealth Exchange B. National Cancer Informatics Program C. Health Level Seven D. American National Standards Institute

. eHealth Exchange Rationale: The eHealth Exchange, formerly known as the Nationwide Health Information Network (often abbreviated as the NHIN or NwHIN), is an initiative for the exchange of healthcare information. The exchange is a web-services based series of specifications designed to securely exchange healthcare related data. The Office of the National Coordinator for Health Information Technology has been facilitating development of the NwHIN, which will tie together health information exchanges, integrated delivery networks, pharmacies, government, labs, providers, payers and other stakeholders into a "network of networks." Access paths to the system for healthcare providers: •Providers may use features of the electronic health record (EHR) systems of their own practice or hospital to connect to a Health Information Exchange (HIE), and the HIE, in turn, will support information exchange with other EHRs or personal health records (PHRs) on that HIE or on other HIEs through the NwHIN. •Providers may not have an EHR, so they may use the Web to access a portal operated by the HIE to access information. National Cancer Informatics Program (NCIP) was created in May 2012. The program supports the National Cancer Institute's (NCI) research initiatives through sustaining a multidisciplinary community of biomedical researchers, informaticists, and developers dedicated to improving informatics practices in the study of cancer and the translation of that knowledge into improved clinical interventions. Health Level Seven (HL7) is a non-profit organization involved in the development of international healthcare informatics interoperability standards. "HL7" also refers to some of the specific standards created by the organization. HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. HL7 is one of several American National Standards Institute (ANSI) accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most of these SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven's domain is clinical and administrative data. The American National Standards Institute (ANSI) is a private non-profit organization that oversees the development of voluntary consensus standards for products, services, processes, systems, and personnel in the United States. Though ANSI itself does not develop standards, the Institute oversees the development and use of standards by accrediting the procedures of standards developing organizations. ANSI accreditation signifies that the procedures used by standards developing organizations meet the Institute's requirements for openness, balance, consensus, and due process.

Mentoring is Response : A. A learning approach. B. Answering questions from another registrar. C. Allowing a registrar to work in your office for a few days. D. Participating in cancer registrar forums.

A. A learning approach. Rationale: Mentoring is a learning approach that supports a person who is undergoing either an initial or alternate career choice. In a mentoring situation, a relationship is created between a more experienced and knowledgeable person with a less experienced and knowledgeable person. Mentoring is more than just answering occasional questions or providing ad hoc help. It is about an ongoing relationship of learning, dialogue, and challenge. Answering questions from another registrar may or may not be mentoring. For example, if the other registrar is asking for follow-up information, the interchange would not be considered mentoring. Allowing a registrar to work in your office for a few days is helpful for a new registrar, but you must provide guidance and instruction to make this experience qualify as mentoring. Participating in cancer registrar forums is an interchange between registrars which may or may not have elements of mentoring.

What type of HIPAA security safeguard is being adhered to when a covered entity adopts a written set of privacy procedures that address access authorization, establishment, modification, and termination; and when covered entities out-source some of their business processes to a third party, they require that their vendors also have a framework in place to comply with their HIPAA requirements? Response : A. Administrative B. Physical C. Technical D. None of the above

A. Administrative Rationale: The HIPAA Security Rule deals specifically with Electronic Protected Health Information (EPHI). It lays out three types of HIPAA Security Rules required for compliance: administrative, physical, and technical. Administrative safeguards include the practice by a covered entity to adopt a written set of privacy procedures that involve the following types of procedures: •Establish access authorization, establishment, modification, and termination to confidential information. •Ensure that vendors also have an operational framework in place to comply with HIPAA requirements when out-sourcing business processes to a third party. •Designate a privacy officer to be responsible for developing and implementing all required policies and procedures. •Ensure management oversight and organizational buy-in to compliance with the documented security controls. •Identify employees or classes of employees who will have access to electronic protected health information (EPHI). Access to EPHI must be restricted to only those employees who have a need for it to complete their job function. •Establish an ongoing training program regarding the handling of PHI is provided to employees performing health plan administrative functions. •Create a contingency plan to respond to emergencies that includes backing up data and having disaster recovery procedures in place. The plan should document data priority and failure analysis, testing activities, and change control procedures. •Perform internal audits because they play a key role in HIPAA compliance by reviewing operations with the goal of identifying potential security violations. Policies and procedures should specifically document the scope, frequency, and procedures of audits. Audits should be both routine and event-based. •Indicate procedures to address and respond to security breaches identified either during the audit or the normal course of operations. Physical safeguards involve the controlling physical access to protect against inappropriate access to protected data. Technical safeguards relate to procedures that control access to computer systems and enable covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient.

The security management plan must be Response : A. Audited internally. B. Approved by hospital administration. C. Reviewed by external experts. D. Posted where patients can see and read the security precautions.

A. Audited internally. Rationale: The security management plan must be audited internally to ensure that it is effective. There is no requirement that the security management plan be reviewed by external experts, receive approval from hospital administration, or be posted where the public can see it. While it would be useful to have external personnel attempt to breach the security system, this is not considered a review of the security management plan.

Hospital and population-based cancer registries collect cancer data to Response : A. Be aggregated by a Federal agency. B. Be sent to the National Cancer Data Base (NCDB). C. Meet standards of the Commission on Cancer (CoC). D. Be sent to the State cancer registry.

A. Be aggregated by a Federal agency. Data are collected by hospital and population-based cancer registries (central registries) to be aggregated by a Federal agency. Central registries do not send data to NCDB nor do they meet standards of the CoC. Central registries may send data to a state cancer registry if there are regional cancer registries in the state, but that is true for only a few states. Not all hospital registries are CoC approved hospitals, so they do not send data to NCDB nor do they meet the standards of CoC.

What term refers to a type of computing where different services (e.g., servers, storage and applications) are delivered to your computer through the Internet? Response : A. Cloud computing B. Enterprise computing C. Both (a) and (b) D. Neither (a) nor (b)

A. Cloud computing Rationale: Cloud computing involves computing that moves away from personal computers or an individual application server to a "cloud" of computers. Cloud computing is a phrase used to describe the sharing of computing resources through a real-time communication network such as the Internet. For example, rather than using local servers or personal computers to handle application software used in your daily activities, a large number of computers connected through a real-time communication network is used. In cloud computing, the word "cloud" is used to represent "the Internet." So the phrase "cloud computing" means "a type of Internet-based computing," where different services (e.g., servers, storage and applications) are delivered to your computer through the Internet. Enterprise computing is the traditional IT system comprised of what might be a mix of conventional servers that may or may not be virtualized. In this environment, organizations buy servers (e.g., HP, Dell or IBM), specialized data warehousing solutions, and networking equipment.

What term refers to the set of information that includes the contents, format, and structure of a database and the relationship between its elements, used to control access to and manipulation of the database? Response : A. Data dictionary B. Edit check C. Edit set D. Record layout

A. Data dictionary Rationale: A data dictionary is a set of information describing the contents, format, and structure of a database and the relationship between its elements, used to control access to and manipulation of the database. The NPCR-EDITS Data Dictionary includes all data elements, or fields, edited by this tool in the metafile. An administrator defines standard attributes for each field, such as field name, field type, field length, agency, choice table, and description. These attributes may be changed only by the administrator. Edit check is a programmed instruction or subroutine designed to check input data by performing a computerized comparison of data fields for reasonableness, validity, limit and completeness. Edit set is a group of edits used to edit a data file; edits may be grouped for a specific purpose. Multiple edit sets can be used on the same data. For example, the NAACCR metafile contains edit sets for hospital registry use as well as central registry and state registry use. A record layout is a named group and organization of fields from the data dictionary into a particular file format, such as the NAACCR data exchange record. Many record layouts can be defined within the metafile, with each corresponding to a particular dataset or file format.

Semantic interoperability is defined as Response : A. Data having a common meaning. B. Data using the same coding system. C. The ability to import electronic data. D. The ability to export electronic data

A. Data having a common meaning. Rationale: Semantic interoperability refers to sharing a common meaning of a data representation among two or more organizations. Data using the same coding system across organizations is considered to have syntactic interoperability. In order to share data without the need to manipulate it prior to storing, using or exchanging it, data must be both semantically and syntactically interoperable.

Computerized edits programs were developed to promote Response : A. Data standardization. B. Interoperability. C. Both (a) and (b) D. Neither (a) nor (b)

A. Data standardization. Rationale: Computerized data edits were developed to promote data standardization. Data edits test the data against the coding rules. Through the leadership of North American Association of Central Cancer Registries (NAACCR), edit standards have been compiled for data elements within and across standard data sets. Using edits promotes data quality by encouraging standardization of the data collection processes in order to provide clear data for analysis. Interoperability refers to the ability of software and hardware on different machines from different vendors to share data without manipulation.

Security management planning involves Response : A. Evaluating the flow of data throughout the organization. B. Delegating responsibility to implement and maintain the security system. C. Establishing appropriate controls over the handling and control of confidential data. D. Verifying the identity and authority of employees before granting access to confidential information.

A. Evaluating the flow of data throughout the organization. Rationale: Security management planning involves evaluating the flow of data throughout the organization and identifying all unreasonable security weaknesses. It is management's responsibility to identify who has the authority and responsibility to implement and maintain the security system. Developing information handling procedures refers to establishing procedures to ensure control over how confidential data is maintained. Implementing access controls refers to employees that should have access to various types of confidential data.

Which non-profit organization is involved in the development of international healthcare informatics interoperability standards which provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information? Response : A. Health Level Seven B. American National Standards Institute C. National Cancer Informatics Program D. eHealth Exchange

A. Health Level Seven Rationale: Health Level Seven (HL7) is a non-profit organization involved in the development of international healthcare informatics interoperability standards. "HL7" also refers to some of the specific standards created by the organization. HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information. HL7 is one of several American National Standards Institute (ANSI) accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most of these SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. Health Level Seven's domain is clinical and administrative data.

Central registries perform record consolidation. One aspect of record consolidation includes Response : A. Identifying multiple records for the same primary cancer. B. Performing edit checks on new and existing cases. C. Generating random case samples for quality assurance. D. Generating case summary reports.

A. Identifying multiple records for the same primary cancer. Rationale: One aspect of record consolidation includes identifying and consolidating multiple reports for the same primary cancer. Edit checks and generating random case samples for quality assurance are activities for quality assurance. Creating case summaries is part of the reporting and analysis process.

Federal healthcare privacy laws were necessary because Response : A. Laws differed from state to state. B. There were no penalties for breaches of confidentiality. C. Both (a) and (b) D. Neither (a) nor (b)

A. Laws differed from state to state. Rationale: The development of initial confidential patient information protection was done on a state by state basis. Federal healthcare privacy laws later became necessary because state laws differed in their level of protection afforded to health information that varied depending on who holds the information and the state in which they are located. Penalties for specified breaches of confidentiality are included in some state statutes. However, federal laws are necessary to ensure uniform and fair health information management and security procedures are afforded to everyone in this country.

The North American Association of Central Cancer Registries (NAACCR) formed a committee, Standards Implementation Task Force, to Response : A. Make sure changes are implemented at the same time. B. Review changes to data codes. C. Review changes to data definitions. D. Review proposed new data items.

A. Make sure changes are implemented at the same time. Rationale: The North American Association of Central Cancer Registries (NAACCR) Standards Implementation Task Force was formed to make sure changes in data codes, definitions, or new data items were implemented at the same time by all standard setters. It is the NAACCR Uniform Data Standards Committee (UDSC) that is responsible for reviewing the proposed changes to data items, codes and definitions.

The caBIG was sponsored by the Response : A. National Cancer Institute (NCI). B. Commission on Cancer (CoC). C. National Program of Cancer Registries (NPCR). D. International Association of Cancer Registries (IACCR).

A. National Cancer Institute (NCI). Rationale: caBIG (the Cancer Biomedical Informatics Grid) was sponsored by the National Cancer Institute Center for Bioinformatics to develop a network of tools, data, and researchers to support the discovery of new approaches for the detection, diagnosis, treatment, and prevention of cancer, ultimately improving cancer care for patients.

The ultimate goal of analyzing cancer data is to Response : A. Prevent and control cancer. B. Develop educational programs for health care providers, patients and the general public. C. Both (a) and (b) D. Neither (a) nor (b)

A. Prevent and control cancer. Rationale: The goal of analyzing cancer data is to prevent and control cancer and to improve patient care. To that end, analyzing data makes it possible to perform the following types of activities: •Allocate financial and personnel resources at the health care facility level and regional level. •Analyze referral patterns. •Calculate survival rates by various data items. •Develop educational programs for health care providers, patients and the general public. •Evaluate effectiveness of treatment modalities. •Provide follow-up information for cancer surveillance. •Provide information for cancer program activities. •Report cancer incidence as required under state law.

What is the most popular structure of central registry database model? Response : A. Relational B. Hierarchical C. Object-oriented D. None of the above

A. Relational Rationale: A database model is a type of data model that determines the logical structure of a database and fundamentally determines the manner in which data can be stored, organized, and manipulated. The most popular example of a database model used in central registries is the relational model, which uses a related table-based format in which data is stored. Relational databases are powerful because they require few assumptions about how data is related or how it will be extracted from the database. As a result, the same database can be viewed in many different ways. An object-oriented database subscribes to a model with information represented by objects. An object-oriented based system is modeled and created through the use of objects, where each object's class instance has specific attributes and behaviors, and the relative methods or behaviors are called to manipulate or utilize such a system. The essence of this model is that each of the created objects can be reused in the same and other programs and applications. The hierarchical database model consists of a collection of records that are connected to each other through links. Each record is a collection of fields (attributes), each of which contains only one data value. A link is an association between precisely two records. A hierarchical database model is a data model in which the data is organized into a tree-like structure. The structure allows for representing information using parent/child relationships: each parent can have many children, but each child has only one parent (also known as a 1-to-many relationship). All attributes of a specific record are listed under an entity type. In a database, an entity type is the equivalent of a table. Each individual record is represented as a row, and each attribute as a column.

The role of American National Standards Institute (ANSI) in the development of healthcare information standards in the United States is to Response : A. Safeguard the integrity of assessment systems. B. Set standards for assessment systems that must be followed. C. Develop and distribute mandatory assessment systems to standard setters. D. Develop standards used by all U.S. registries.

A. Safeguard the integrity of assessment systems. Rationale: The American National Standards Institute (ANSI) safeguards the integrity of assessment systems. The participation in ANSI is voluntary and the standards and assessment systems that are developed are not mandatory. The mission of ANSI is to enhance both the global competitiveness of U.S. business (including the health care industry) and the U.S. quality of life by promoting and facilitating voluntary consensus standards and conformity assessment systems, and safeguarding their integrity. ANSI facilitates the development of American National Standards (ANS) by accrediting the procedures of standards developing organizations. These groups work cooperatively to develop voluntary national consensus standards. Accreditation by ANSI signifies that the procedures used by the standards body, in connection with the development of ANS, meet the Institute's essential requirements for openness, balance, consensus and due process. The key aspects involved in the ANSI process include: •Consensus must be reached by representatives from materially affected and interested parties •Standards are required to undergo public reviews when any member of the public may submit comments •Comments from the consensus body and public review commenters must be responded to in good faith •An appeals process is required

Duty of care refers to Response : A. Socially defined standard of care for the protection of others. B. Following the guidelines for confidentiality published by the standard-setters. C. Keeping confidential information safe in the registry. D. Practicing institutional-based policies for transfer of confidential information.

A. Socially defined standard of care for the protection of others. Rationale: In tort law, a duty of care is a legal obligation which is imposed on an individual requiring adherence to a standard of reasonable care while performing any acts that could foreseeably harm others. Duty of care is a socially defined standard of care for the protection of others against unreasonable risks. Following confidentiality guidelines published by standard-setters, keeping confidential information safe in the registry, and practicing institutional-based policies for transfer of confidential information are responsibilities of the cancer registrar and are three components of their duty of care.

Examples of central cancer registries (CCR) that are population-based are Response : A. State cancer registry and NPCR. B. SEER and NCDB. C. Both (a) and (b) D. Neither (a) nor (b)

A. State cancer registry and NPCR. Rationale: Population-based cancer registries include both state and federal registries. Examples of federal registries in the United States include the National Cancer Institute's (NCI) Surveillance Epidemiology and End Results (SEER) Program and the Centers for Disease Control and Prevention's (CDC) National Program of Central Cancer Registries (NPCR). The Commission on Cancer's (CoC) National Cancer Database (NCDB) is a large, geographically diverse hospital-based cancer registry. It is not population-based.

Which term refers to a program or algorithm that spreads from computer to computer and has the capability to travel without any human action? Response : A. Worm B. Virus C. Trojan Horse D. None of the above

A. Worm A computer worm is a program or algorithm that replicates itself over a computer network and usually performs malicious actions. It is similar to a virus by design and is considered to be a sub-class of a virus. Worms spread from computer to computer, but unlike a virus, it has the capability to travel without any human action. A worm takes advantage of file or information transport features on your system, allowing it to travel unaided.

refers to making an address uniform. The U.S. Postal Service defines a standardized address as "one that is fully spelled out and only abbreviated using the postal service standard abbreviations." However, a standardized address alone does not guarantee validity

Address standardization

In 2010, the requirements for a candidate for the certification examination were changed to require Response : A. 12 credit hours of college level courses including two semesters in anatomy and/or physiology. B. An associate's degree. C. Both (a) and (b) D. Neither (a) nor (b)

B. An associate's degree. Rationale: In 2010, NCRA began to require a minimum of an associate's degree in order for a candidate to be eligible to sit for the certification exam.

Which organization produces cancer protocols as a resource to pathologists to aid in effectively reporting surgical pathology findings necessary to provide quality patient care? Response : A. LOINC B. CAP C. SNOMED D. None of the above

B. CAP Rationale: The College of American Pathologists (CAP) is a medical society serving more than 18,000 physician members and the laboratory community throughout the world. It is the world's largest association composed exclusively of pathologists certified by the American Board of Pathology, and is widely considered the leader in laboratory quality assurance. The College is an advocate for high-quality and cost-effective medical care. It is also affiliated with the American Medical Association (AMA). The College of American Pathologists produces cancer protocols as a resource to pathologists to aid in effectively reporting surgical pathology findings necessary to provide quality patient care. Logical Observation Identifiers Names and Codes (LOINC) is a universal code system for identifying laboratory and clinical observations from serum levels of hepatitis B surface antigen to diastolic blood pressure. LOINC has standardized terms for all kinds of observations and measurements that enable exchange and aggregation of electronic health data from many independent systems. The Systematized Nomenclature of Medicine (SNOMED) is a systematic, computer-processable collection of medical terms that covers anatomy, diseases, findings, procedures, microorganisms, substances, etc. It allows a consistent way to index, store, retrieve, and aggregate medical data across specialties and sites of care. Although now international, SNOMED was started in the U.S. by the College of American Pathologists.

Which program was replaced by the National Cancer Informatics Program (NCIP) in May 2012 following a 2011 report which raised significant questions about effectiveness and oversight of its program? A. Health Information Security and Privacy Collaboration (HISPC) B. Cancer Bioinformatics Grid (caBIG) C. Certification Commission for Health Information Technology (CCHIT) D. None of the above

B. Cancer Bioinformatics Grid (caBIG) Rationale: In 2011 a report on caBIG raised significant questions about effectiveness and oversight, and its budget and scope were significantly trimmed. In May 2012, the National Cancer Informatics Program (NCIP) was created as caBIG's successor program. Cancer Bioinformatics Grid (caBIG) was a U.S. government program described as a voluntary virtual informatics infrastructure that connected data, research tools, scientists, and organizations. The goal of the program was to develop an open source, open access information network using technology known as grid computing for secure data exchange of cancer research. The initiative was developed by the National Institutes of Health's National Cancer Institute. In addition to caGrid, the underlying infrastructure for data sharing among organizations, caBIG developed software tools, data sharing policies, and common standards. The Health Information Security and Privacy Collaboration (HISPC) originally consisted of 34 states and territories. HISPC phase 3 began in April 2008, and HISPC now includes 42 states and territories, and aims to address the privacy and security challenges presented by electronic health information exchange through multi-state collaboration. Each HISPC participant continues to have the support of its state or territorial governor and maintains a steering committee and contact with a range of local stakeholders to ensure that developed solutions accurately reflect local needs and preferences. The Certification Commission for Health Information Technology (CCHIT), a nonprofit organization with the public mission of accelerating the widespread adoption of health information technology to promote improvements in quality, safety, efficiency and access. Founded in 2004, and certifying electronic health records (EHRs) since 2006, the Commission established the first comprehensive definition of what capabilities were needed in these systems. The certification criteria were developed through a voluntary, consensus-based process engaging diverse stakeholders, and the Certification Commission was officially recognized by the federal government as a certifying body. In February 2009, Congress acknowledged the value of certification in the language of the American Recovery and Reinvestment Act (ARRA) aimed at stimulating the nation's economy. The law offers a multi-year series of incentive payments to providers and hospitals for the meaningful use of certified EHR technol

Which rule provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients rights with respect to that information? Response : A. HIPAA Patient Safety Rule B. HIPAA Privacy Rule C. HIPAA Security Rule D. None of the above

B. HIPAA Privacy Rule Rationale: The HIPAA Privacy Rule provides federal protections for individually identifiable health information held by covered entities and their business associates and gives patients rights with respect to that information. The HIPAA Patient Safety Rule confidentiality provisions protect identifiable information being used to analyze patient safety events and improve patient safety. The HIPAA Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities and their business associates to use to assure the confidentiality, integrity, and availability of electronic protected health information. This rule specifies a series of administrative, physical, and technical safeguards for covered entities and their business associates

What is the name the non-profit organization involved in the development of international healthcare informatics interoperability standards? Response : A. HIPAA B. HL7 C. NPCR D. NAACCR

B. HL7 Rationale: Health Level Seven (HL7) is a non-profit organization involved in the development of international healthcare informatics interoperability standards. HL7 also refers to some of the specific standards created by the organization. HL7 and its members provide a framework (and related standards) for the exchange, integration, sharing, and retrieval of electronic health information.

The wide acceptance of standards for data submission has reduced the number of problems that central registries must handle when receiving data from multiple hospital vendors. Which organization established the standards? Response : A. American College of Surgeons (ACoS) B. North American Association of Central Cancer Registries (NAACCR) C. Surveillance, Epidemiology and End Results (SEER) D. National Program of Cancer Registries (NPCR)

B. North American Association of Central Cancer Registries (NAACCR) Rationale: The organization responsible for maintaining standards for data transmissions is the North American Association of Central Cancer Registries (NAACCR). Because most of the central registry data is received from hospitals, it is not only important that the same data standards export data in a standard format. All hospital data management systems must be able to generate export files using the NAACCR data export standard format to the central registry.

What type of HIPAA security safeguard is being adhered to when the procedures involve access to hardware and software being limited to properly authorized individuals, workstations not being located in high traffic areas and monitor screens not being in direct view of the public? Response : A. Administrative B. Physical C. Technical D. None of the above

B. Physical Rationale: Physical safeguards involve controlling of physical access to protect against inappropriate access to protected data. They involve the following types of procedures: •Access to hardware and software is limited to properly authorized individuals and is carefully controlled and monitored. •Workstations are not located in high traffic areas and monitor screens are not in direct view of the public. •Controls govern the introduction and removal of hardware and software from the network. (When equipment is retired, it must be disposed of properly to ensure that PHI is not compromised.) •Required access controls consist of facility security plans, maintenance records, and visitor sign-in and escorts. •If the covered entities utilize contractors or agents, they too must be fully trained on their physical access responsibilities. Administrative safeguards include the practice by a covered entity to adopt a written set of privacy procedures. Technical safeguards relate to procedures that control access to computer systems and enable covered entities to protect communications containing PHI transmitted electronically over open networks from being intercepted by anyone other than the intended recipient.

The primary emphasis for population-based cancer registries is Response : A. Clinical care. B. Public health. C. Both (a) and (b) D. Neither (a) nor (b)

B. Public health. Rationale: Ensuring public health and the ability to perform epidemiologic studies are the emphasis of central cancer registries (e.g., state and national population-based). Because the data is population-based, it can be used to determine cancer patterns among various populations or subpopulations, monitor cancer trends over time, evaluate cancer control efforts, and assist in prioritizing health resource allocation and research. The primary focus of hospital-based cancer registries is to improve clinical care by evaluating treatment outcomes. This information can be used for physician education, for assessing the types of services needed to diagnose and treat cancer patients, and for research.

The primary emphasis for population-based cancer registries is A. Clinical care. B. Public health. C. Both (a) and (b) D. Neither (a) nor (b)

B. Public health. Rationale: Ensuring public health and the ability to perform epidemiologic studies are the emphasis of central cancer registries (e.g., state and national population-based). Because the data is population-based, it can be used to determine cancer patterns among various populations or subpopulations, monitor cancer trends over time, evaluate cancer control efforts, and assist in prioritizing health resource allocation and research. The primary focus of hospital-based cancer registries is to improve clinical care by evaluating treatment outcomes. This information can be used for physician education, for assessing the types of services needed to diagnose and treat cancer patients, and for research.

Which term refers a systematic, computer-processable collection of medical terms that allows a consistent way to index, store, retrieve, and aggregate medical data across specialties and sites of care? Response : A. CAP B. SNOMED C. LOINC D. None of the above

B. SNOMED Rationale: The Systematized Nomenclature of Medicine (SNOMED) is a systematic, computer-processable collection of medical terms that covers anatomy, diseases, findings, procedures, microorganisms, substances, etc. It allows a consistent way to index, store, retrieve, and aggregate medical data across specialties and sites of care. Although now international, SNOMED was started in the U.S. by the College of American Pathologists. Logical Observation Identifiers Names and Codes (LOINC) is a universal code system for identifying laboratory and clinical observations from serum levels of hepatitis B surface antigen to diastolic blood pressure. LOINC has standardized terms for all kinds of observations and measurements that enable exchange and aggregation of electronic health data from many independent systems. The College of American Pathologists (CAP), is a medical society serving more than 18,000 physician members and the laboratory community throughout the world. It is the world's largest association composed exclusively of pathologists certified by the American Board of Pathology, and is widely considered the leader in laboratory quality assurance. The College is an advocate for high-quality and cost-effective medical care. It is also affiliated with the American Medical Association (AMA). The College of American Pathologists produces cancer protocols as a resource for pathologists to aid in effectively reporting surgical pathology findings necessary to provide quality patient care.

The cancer registry must keep a record of disclosure, (an accounting of what, where, when, to whom and for what purpose information was distributed) for what period of time? Response : A. Five years B. Six years C. Seven years D. Ten years

B. Six years Rationale: An important provision of HIPAA is the patient's right to know to whom PHI has been released without his or her consent. A record, referred to as an "accounting of disclosures" must be kept for the most recent six years. This includes data submissions to central and state registries that are legally mandated to receive this information as well as researchers conducting institutional review board (IRB) approved studies.

If two organizations agree to collect smoking information in a one character field, but each has different codes and definitions for the field (e.g., current smoker at the hospital is coded to 1 [in a range that goes from 1-4], whereas at the central registry it is coded to 2 [in a range that goes from 1-4]), this situation is considered to be Response : A. Semantically interoperable. B. Syntactically interoperable. C. Both (a) and (b) D. Neither (a) nor (b)

B. Syntactically interoperable. Rationale: In this example, while the data are syntactically interoperable because they have the same type of numeric coding values for a scheme (range is 1-4), they are not semantically interoperable because the meanings associated with each value differ between the institutions. As a result, the two data standards are not interoperable. As such, data from the hospital cannot be stored or changed using the central registry definition. Interoperability refers to the ability of software and hardware on different machines from different vendors to share data without manipulation. Interoperability is described as both semantically and syntactically interoperable. Interoperability is an issue for both hospital and central registries because it represents the ease with which central registries can incorporate electronic data from hospitals and the ease in which hospitals can incorporate central registry data for their usage.

The most critical area needing physical barriers to protect confidential information is Response : A. The admissions office. B. The network administration control room. C. The HIM department. D. The desk clerk's office in each section of the hospital floors.

B. The network administration control room. Rationale: The network administration office is the most critical area needing safeguards to protect confidential information. While all four areas (network administration office, admissions office, the HIM department, and the desk clerk's office in each section of the hospital floors) in the hospital require safeguards to protect confidential areas, the network administration office is the most critical area requiring protection.

What term refers to technology that employs encryption to provide secure access to a remote computer over the Internet? Response : A. Firewall B. VPN C. LAN D. None of the above

B. VPN Rationale: Virtual private network (VPN) refers to technology that employs encryption to provide secure access to a remote computer over the Internet. A local area network (LAN) supplies networking capability to a group of computers in close proximity to each other such as in an office building. A LAN is useful for sharing resources like files, printers or other applications. A LAN in turn often connects to other LANs, and to the Internet or other wide area networks (WAN). A firewall is defined as a system designed to prevent unauthorized access to or from a private network. Firewalls can be implemented in both hardware and software, or a combination of both.

Specialty cancer registries may collect data A. From specific facilities. B. On familial cancers. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Specialty cancer registries can collect and maintain data from: •Specific facilities, as NCDB does from only ACoS approved facilities •Specific cancer sites, such as the Central Brain Tumor Registry of the United States (CBTRUS) •Specific familial cancers, such as the Gilda Radner Familial Ovarian Cancer Registries

Which statement(s) is correct regarding interoperability and compatibility? Response : A. A hospital registry's database should be compatible with industry standards. B. A hospital registry's database should be interoperable with the State registry's database. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: A hospital registry's database should be compatible with industry standards and interoperable with the State registry's database." Interoperability is the ability of a system or a product to work with other systems or products without special effort on the part of the customer. Compatibility is a related term. The hospital registry data is collected in a way that is compatible with industry standards and interoperable with other registry systems that meet the same standard.

A patient may recover damages from a healthcare institution when Response : A. Confidential data was unintentionally released. B. The institution did not use reasonable procedures to protect confidential data. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: A patient may recover damages from a healthcare institution when confidential data was unintentionally released and also when the institution did not use reasonable procedures to protect that confidential data.

A UPS (uninterruptable power supply) is used to protect computers from power Response : A. Surges. B. Outages. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: A uninterruptable power supply (UPS) is used to protect computers from power surges and power outages. Typically, a UPS keeps a computer running for several minutes after a power outage, enabling you to save data that is in RAM and perform an orderly shutdown of the computer. Many UPS's now offer a software component that enables you to automate backup and shut down procedures in case there's a power failure while you're away from the computer.

The cancer registrar must keep a record of disclosure (an accounting of what, where, when, to whom and for what purpose information was distributed) when records are made available to Response : A. The state/central cancer registry. B. Researchers conducting special studies. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: Although medical record information can be released to state/central registries and researchers conducting special studies without the patient's consent, there must be an internal record maintained of all disclosures to each of these entities.

What term(s) describes the situation in which a hospital cancer registrar exploits the relationship between their hospital and an outside consulting company for personal financial gain? Response : A. Conflict of interest B. Duality of interest C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: Both terms, conflict of interest or duality of interest, may be used to describe a situation in which a hospital cancer registrar exploits the relationship between their hospital and an outside consulting company for personal financial gain. When an individual has the responsibility to represent one agency, a clash between professional obligations and personal interests arises if the individual tries to perform that duty while at the same time trying to achieve personal gain. For example, a registrar may not join a consulting firm doing business with the hospital without making full disclosure of his/her potential conflicts. Incompatibility of professional duties and personal interests has led Congress and many state legislatures to enact statutes defining conduct that constitutes a conflict of interest and specifying the sanctions for violations.

C-Change has members from Response : A. Federal and state governmental agencies. B. The motion picture industry. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: C-Change was organized in 1998 and is comprised of the nation's key cancer leaders from government, business (including the motion picture industry), and nonprofit sectors. The vision they share is a future where cancer is prevented, detected early and cured, or is managed successfully as a chronic illness. C-Change's intention is to leverage the leadership and expertise of all sectors of society to eliminate cancer as a major public health problem at the earliest possible time. C-Change shares information; helps identify barriers, gaps, and opportunities related to its mission; seeks agreement on critical national priorities and supportive actions; and facilitates independent and collaborative efforts to achieve common goals of C-Change members.

When a patient requests their confidential data Response : A. The request and the registry's response should be sent to the patient's attending physician. B. The registry can release information directly to an individual patient if the registrar's state law allows for such disclosure. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: Generally, when a patient requests their confidential data, the request and the registry's response should be sent to the attending physician. However, the registry staff can release information directly to an individual patient if the registrar's state law allows for such disclosure.

Internal review boards (IRB) are set up to Response : A. Review ethics. B. Review confidentiality. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: IRBs review confidentiality and ethics. An institutional review board (IRB) is a committee designated to approve, monitor, and review biomedical and behavioral research involving humans. They often conduct a form of risk-benefit analysis in an attempt to determine whether or not research should be done. The number one priority of IRBs is to protect human subjects from physical or psychological harm. Regulations have empowered IRBs to approve, require modifications in planned research prior to approval, or disapprove research.

For which electronic device(s) might there be difficulty controlling access to confidential data? Response : A. Laptop computers B. Wireless devices C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: It might prove equally difficult to control access to confidential data using either laptops or wireless devices. Laptops can hold large quantities of confidential information which is often unprotected, accessible by simply turning on the computer and are often and easily stolen. A wireless device connects to the host network via a wireless transmitter and receiver. The lack of access controls will result in full access to the computer network. Wireless communications can be captured and easily read if not encrypted.

Which goal(s) is hoped to be achieved through Meaningful Use compliance? Response : A. More robust research data on health systems B. Empowered individuals C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: Meaningful use requires implementing certified electronic health record (EHR) technology to: •Improve quality, safety, efficiency, and reduce health disparities •Engage patients and family •Improve care coordination, and population and public health •Maintain privacy and security of patient health information Ultimately, it is hoped that the meaningful use compliance will result in: •Better clinical outcomes •Improved population health outcomes •Increased transparency and efficiency •Empowered individuals •More robust research data on health systems

The HIPAA "minimum necessary" standard does not apply to Response : A. Healthcare facilities for the purpose of providing treatment. B. Uses or disclosures that are required by other law. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: The minimum necessary standard is one of the protections under the HIPAA Privacy Rule which is derived from confidentiality codes and practices in common use today. It is based on the practice that protected health information should not be used or disclosed when it is not necessary to satisfy a particular purpose or carry out a function. The minimum necessary standard requires covered entities to evaluate their practices and enhance safeguards as needed to limit unnecessary or inappropriate access to and disclosure of protected health information. The minimum necessary standard does not apply to the following: •Disclosures to or requests by a health care provider for treatment purposes. •Disclosures to the individual who is the subject of the information. •Uses or disclosures made pursuant to an individual's authorization. •Uses or disclosures required for compliance with the Health Insurance Portability and Accountability Act (HIPAA) Administrative Simplification Rules. •Disclosures to the Department of Health and Human Services (HHS) when disclosure of information is required under the Privacy Rule for enforcement purposes. •Uses or disclosures that are required by other law.

Time and motion studies done by the registry can play a part in the budgeting process by Response : A. Validating the need to retain current staffing. B. Demonstrating good use of current funding. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: Time and motion studies demonstrate that the registry optimally uses current funding by effectively managing the overall workload with available personnel. These studies can also forecast growth of the registry's workload, providing the necessary documentation to support justifications for retaining current staff positions and for requesting additional staff positions.

Central registries perform record consolidation. An example(s) of a record consolidation includes Response : A. Identifying multiple primaries. B. Tracking conflict resolution among multiple reports. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: Two aspects of record consolidation include identifying case reports that represent multiple primaries and identifying, tracking and resolving conflicts identified among multiple reports for each primary.

Without administrative permission, data may not be transmitted to Response : A. The central registry. B. NCDB. C. Both (a) and (b) D. Neither (a) nor (b)

C. Both (a) and (b) Rationale: Unless there is administrative permission, data may not be transmitted by phone, paper, or electronically to the central cancer registry or any other entity. Administrative permission is required even though state law requires transmission to central registries.

A patient's medical record information Response : A. Cannot be disclosed without the consent of the patient. B. Can be disclosed to physicians requesting data without the consent of the patient. C. Can be disclosed to state/central cancer registries without the consent of the patient. D. Can be disclosed to anyone as long as records are kept showing when and what was disclosed.

C. Can be disclosed to state/central cancer registries without the consent of the patient Rationale: While records must be kept showing when and what was disclosed, that record keeping does not mean confidential data may not be disclosed without patient consent. Generally, while confidential data may not be released without the patient's consent, there are exceptions. Medical record information can be sent to state/central registries without the patient's consent. The law also states that data can be released to researchers conducting special studies if an exception has been granted by an institutional review board (IRB), an independent ethics committee, or ethical review board. The IRB is a committee that has been formally designated to approve, monitor, and review research involving humans. They often conduct some form of risk-benefit analysis in an attempt to determine whether or not research should be done.

How often should a registry plan to replace desktop computers? Response : A. Annually B. Biennially C. Every 3-5 years D. Every 6-7 years

C. Every 3-5 years Rationale: Based upon experience with the continuing changes and improvements in desktop computing capabilities, it is recommended that a three to five year replacement cycle will create an adequate platform to support standard business applications. However, each computer should be assessed on a regular basis to ensure that it continues to support the unique work applications of its user. For tax purposes, the depreciation of computers is written off over a 5 year period.

All states and the District of Columbia have laws, regulations or statutes requiring healthcare facilities and providers to report cancer data to Response : A. The Surveillance, Epidemiology, and End Results (SEER) program. B. National Program of Cancer Registries (NPCR). C. Both (a) and (b) D. Neither (a) nor (b)

Correct Answer : D. Neither (a) nor (b) All states and the District of Columbia have laws, regulations or statutes requiring healthcare facilities and providers to report cancer data to either the state registry or the central registry in their region.

Disciplinary actions for breaches of confidentiality are Response : A. Up to the manager's discretion. B. Do not apply to upper management. C. Both (a) and (b) D. Neither (a) nor (b)

Correct Answer : D. Neither (a) nor (b) Disciplinary actions for breaches of confidentiality are defined in the policies and procedures and are not up to the manager's discretion. Disciplinary action must apply to all levels of the organization, which includes upper management.

HIPAA provides individuals with the right to review their records. State registries may Response : A. Refer the individual to the original point of care (physician's office, hospital, etc.) to obtain this information. B. Honor the request to view records immediately if the only record of care is at the state registry. C. Both (a) and (b) D. Neither (a) nor (b)

Correct Answer : D. Neither (a) nor (b) Rationale: State cancer registries must review applicable state law related to the access of information to an individual's own records to determine which requirements apply to them. If applicable, the state registry should define the following: •Acceptable means for providing the contents of the applicable medical records •Procedures for filing the requests for information •Timelines for supplying the information (within regulatory requirements) •Format used to supply the information •Cost to be charged to provide the information

Continuity of data over time means that Response : A. Data definitions and codes change to reflect advances in the clinical field. B. Data definitions and codes do not change. C. Data definitions and codes become obsolete when advances in the clinical field make significant changes in how the data are collected. D. A mapping can be done between the historic data items and the new data items.

D. A mapping can be done between the historic data items and the new data items. Rationale: Cancer registry data set continuity is preserved when there can be an effective mapping between historic data items to new data items. Not changing data definitions and codes is not possible when we live in a world of clinical advances. Managing data set continuity protects the information you need to do your work and will provide researchers the ability to investigate the same issue over a longer period of time without the need to worry about the impact of changing definitions for a data item over time.

The best way to determine how much time to allocate registry staff is to Response : A. Identify all the tasks performed by each member in the registry. B. Compare staff productivity to the performance benchmarks outlined by Commission on Cancer (CoC). C. Compare staff productivity to the performance benchmarks from a hospital of a similar size. D. Conduct a step assessment and time-motion study.

D. Conduct a step assessment and time-motion study. Rationale: The best way to determine how much time is spent by the registry staff is to conduct a step assessment for each activity and a time-motion study involving all activities performed by the entire staff. The use of these techniques is helpful in establishing both performance standards associated with each task and planning work assignments for each staff member. A step assessment documents the amount of time and the series of actions involving a particular activity (e.g., follow-up, abstracting). From this information, you can obtain a productivity rate for this specific activity. A time-motion study takes into account the entire work flow and workload (i.e., all activities). To project staffing needs, it is important to understand how the work flows through the registry and how much time each activity takes to accomplish in order to be able to calculate the overall registry productivity rate. Knowing the productivity rate will allow you to determine the number of staff members required to complete all the necessary work expected of the registry staff. Using benchmarks from a hospital of a similar size is not the best way to determine how time is spent in your registry because there may be differences between the facilities in terms of registry goals and expectations that impact how staff members spend their time at each hospital. For example, the other hospital may have a different patient load (e.g., the other facility treats primarily hematopoietic patients while your facility treats patients with solid tumors). The registry staff in each hospital may have different duties (e.g., they may not have to organize cancer committee and cancer conferences as is expected at your facility). The other hospital may be CoC approved while your hospital may not. The Commission on Cancer (CoC) does not set performance benchmarks for any category of facility.

A necessary element for a real-time reporting system is Response : A. Adequate cancer registry staff. B. Efficient transmission of data from the hospital to the central registry. C. Cooperation between the hospital and central registry. D. Data source streams from key departments of the facility.

D. Data source streams from key departments of the facility. Rationale: A necessary element for real-time reporting is the availability of data source streams from the key departments within the facility (e.g., admissions, radiology, oncology, pathology). These data streams must be brought together in a single structured, standardized database or a data stream that can be transmitted to the hospital or central registry. Without this capability, real-time reporting would be very difficult and time-consuming to implement. Adequate staffing of the registry is not a requirement of real-time reporting but is the responsibility of management. Staffing needs must be addressed regardless of the reporting system in place. Cooperation between most hospital and central registries and the efficient transmission of data between these organizations already exist. Transmission requirements are met by the major cancer registry software vendors.

Syntactic interoperability is defined as Response : A. The ability to import electronic data. B. The ability to export electronic data. C. Data having a common meaning. D. Data using the same coding system.

D. Data using the same coding system. Rationale: Syntactic interoperability refers to using the same coding system among two or more organizations. Semantic interoperability refers to sharing a common meaning of a data representation among all the organizations. In order to share data without the need to manipulate it prior to storing, using or exchanging it, data must be both semantically and syntactically interoperable.

By law and regulation, each organization should protect confidential data by Response : A. Following HIPAA guidelines. B. Following state regulations. C. Educating employees on privacy and confidentiality. D. Documenting policies and procedures for routine usage and dissemination of confidential data.

D. Documenting policies and procedures for routine usage and dissemination of confidential data. Rationale: By law and regulation, the organization must have a documented system of procedures and policies that provide for all routine privileged use and disclosure of confidential information. Educating employees regarding privacy and confidentiality and adhering to HIPAA guidelines and state regulations are topics included in the organization's policies and procedures.

NCRA has special interest groups for networking, including Response : A. Yahoo members' group. B. The NCRA website. C. Special Interest Group (SIG) website. D. Facebook and Twitter.

D. Facebook and Twitter. Rationale: NCRA used Yahoo members' groups for networking in the past. Currently, NCRA uses Facebook and Twitter. There is no SIG website, nor are there any networking opportunities on the NCRA website.

Data set reliability refers to Response : A. Measures taken to protect confidential information. B. Cases that successfully pass intrarecord and interrecord edits. C. The list of terms that defines the data items, coding instructions, code definitions, and allowable codes. D. How likely different people will use the same code for a data item when reviewing the same source documents.

D. How likely different people will use the same code for a data item when reviewing the same source documents. Rationale: Data set reliability is measured by how likely different people will use the same code for a data item when reviewing the same source documents and there are few unknown values recorded. Coding reliability can be achieved by requiring: •Good documentation from the source record to support codes used •Unambiguous code categories •Clear rules for assigning codes •Relevant training Data security refers to measures taken to protect confidential information about patients in electronic, paper or film form from the unauthorized viewing by others. Some measures of data security include locked cabinets and file rooms, encrypted files and the required use of passwords. Data dictionary refers to the list of terms that defines the data items used in the cancer registry, coding instructions, code definitions, and allowable codes. Some data dictionaries also include applicable edits and changes to the data item over time.

Cancer Incidence in Five Continents is published by Response : A. North American Association of Central Cancer Registries (NAACCR). B. National Program of Cancer Registries (NPCR). C. Surveillance, Epidemiology, and End Results (SEER) program. D. International Association of Cancer Registries (IACR).

D. International Association of Cancer Registries (IACR). Rationale: The International Association of Cancer Registries (IACR) publishes Cancer Incidence in Five Continents every five years. It is recognized as the best reference source on the incidence of cancer in populations and subpopulations living in the same geographic area around the world.

All states and the District of Columbia have laws, regulations or statutes requiring healthcare facilities and providers to report cancer data to A. The Surveillance, Epidemiology, and End Results (SEER) program. B. National Program of Cancer Registries (NPCR). C. Both (a) and (b) D. Neither (a) nor (b)

D. Neither (a) nor (b) Rationale: All states and the District of Columbia have laws, regulations or statutes requiring healthcare facilities and providers to report cancer data to either the state registry or the central registry in their region.

Registry staffing needs can be assessed by Response : A. Caseload divided by staff. B. Comparison with like facilities. C. Both (a) and (b) D. Neither (a) nor (b)

D. Neither (a) nor (b) Rationale: Determining staffing levels by simply dividing the caseload by the number of staff fails to take into consideration that there are a number of other activities involved in registry operations that involve time such as • Casefinding • Follow-up • Chart location logistics • Cancer committee meetings and preparation • Cancer conferences • Audits • Patient care studies • Data requests • Other administrative duties A comparison with like facilities may also not be accurate because the goals and mission of individual facilities may be different which will impact the staffing level at each facility. Registry staffing needs are better determined when the following is considered: • Understand the facility type to help determine the registrar's role in achieving its mission. • Calculate the ease of access to and use of the facility's health records. • Determine the training, hardware/software and maintenance costs associated with using a registry specific software application to collect cancer data. • Conduct time and motion studies to identify all tasks performed by the registry and associated times for those tasks (e.g., casefinding, abstracting, follow-up, ease of moving around in the electronic medical record (vs chart location logistics), cancer committee meetings and preparation, cancer conferences, audits, patient care studies, data requests, and other administrative duties. • Determine the type of staff (e.g., CTRs, clerical support, contractors) needed to perform the various activities identified.

The difference between sites displayed using http and https is Response : A. Https shows limited information. B. Http is a secure website. C. Both (a) and (b) D. Neither (a) nor (b)

D. Neither (a) nor (b) Rationale: HTTP stands for Hypertext Transfer Protocol. It's the first element you see in any URL protocol used by the World Wide Web. HTTP defines how messages are formatted and transmitted, and what actions web servers and browsers should take in response to various commands. For example, when you enter a URL in your browser, this actually sends an HTTP command to the web server directing it to fetch and transmit the requested Web page. Most web browsers use an encrypted protocol called Secure Sockets Layer (SSL) to access secure webpages. These pages use the prefix HTTPS. The "s" stands for secure. If you're browsing the web and not entering any sensitive information, http:// is just fine. However, on pages that you enter your password, credit card number, or other financial information, you should always look for the https:// prefix. If you don't see the "s," don't enter any information that you want to keep secure. Use of HTTPS does not limit the information shown.

What expression(s) is used to describe the capability of different registries being able to read, write and exchange data via a common set of exchange formats? Response : A. Standard data item B. Data submittals C. Both (a) and (b) D. Neither (a) nor (b)

D. Neither (a) nor (b) Rationale: Interoperability is the term used to describe the capability of different registries being able to read, write and exchange data via a common set of exchange formats. Maintaining interoperability is dependent upon the use of the same coding instructions, code values and code options to avoid any special effort on the part of registry organizations to use one another's files. A standard data item refers to a data item whose coding instructions, code values and definitions are shared among the registry organizations. Data submittals refer to the process of extracting data from the registry database system for submission to another entity (e.g., funding agency).

Which body reviews charges of unethical behavior against a cancer registrar? Response : A. NCRA Council on Certification B. NCRA Executive Board C. Both (a) and (b) D. Neither (a) nor (b)

D. Neither (a) nor (b) Rationale: The NCRA Ethics Committee investigates charges of violations of the Professional Practices Code of Ethics of the organization alleged against a member of NCRA. This committee may recommend action be taken by the NCRA Board of Directors as well. If found guilty of a violation of the Code of Ethics, an NCRA member may face the following: •Not be eligible for nomination for an election to office in the association. •Suspension of NCRA membership. •Revocation of NCRA membership. •Revocation of CTR credential.

What term refers to the organization of fields from the data dictionary into a particular file format? Response : A. Edits B. Edit check C. Edit set D. None of the above

D. None of the above Rationale: A record layout organizes fields from the data dictionary into a particular file format, such as the NAACCR data exchange record. Different record layouts can be defined within the metafile, with each corresponding to a particular dataset or file format. Edits contain logic for editing fields. Both single- and multiple-field edits can be written on any field or combination of fields in the data dictionary. Descriptions and error correction help may be stored with each edit. The Edit Name must be unique and consist of as many as 50 characters. An edit check is programmed instruction or subroutine designed to check input data by performing a computerized comparison of data fields for reasonableness, validity, limit and completeness. An edit set is a group of edits used to edit a data file; edits may be grouped for a specific purpose. Multiple edit sets can be used on the same data. For example, the NAACCR metafile contains edit sets for hospital registry use as well as central registry and state registry use.

What term refers to the temporary holding location where the operating system keeps text and/or graphics after a "Cut" or "Copy" operation has been executed? Response : A. Bookmark B. Cache C. Cookie D. None of the above

D. None of the above Rationale: Clipboard refers to a temporary holding location where the operating system keeps text and/or graphics after a "Cut" or "Copy" operation has been executed. Retrieving data from the clipboard is usually done with a "Paste" operation. Bookmark refers to a collection of direct links to predefined web pages which is stored in your web browser. Cache refers to temporary storage space on your hard disk where recently viewed web pages are held. Cache allows you to quickly load a previously visited web page without having to reload the page and its images from the web server on subsequent visits. Cookie is a message passed from a web server to a web browser which is stored on the user's local hard drive in a small text file. A cookie can have many uses, the main one allowing a web server to identify a user and serve up customized web pages and/or login information to the user's web browser when revisiting a web page.

What feature in the Edits package allows a user to note that while data might be unusual, it is correct? Response : A. Item edits B. Multi-field edits C. Multi-record edits D. None of the above

D. None of the above Rationale: Edit Over-ride flags allow the registry staff to indicate that questionable data is actually correct. Setting over-ride flags on cases can eliminate the need to review the same case multiple times for the same issue that would continue to fail one or more edits should such a flag not exist. If a case has an over-ride flag set involving selected fields, the case should not have to be manually reviewed again unless there is a change in the coding values involving the fields that triggered the edit failure initially. Single Field Edits (also known as Item Edits) are those that verify and validate the field values for only one data item at a time. For example, a single field edit for the item "Birthplace" would verify that only valid codes for birthplace are used in the field. Keep in mind that single field edits are simply range checks (i.e., these edits indicate a valid code was used); they cannot identify whether the fields were actually coded correctly. In this example, a case will pass the birthplace single field this edit if a coder uses the code for the state of Oregon as the birthplace for a patient that should have had California coded as the birthplace. While a valid code was used, the correct one was not. Inter-field Edits (also known as Multi-field Edits) compare the codes recorded for one data item with codes recorded for related data items to assess correctness in coding all involved fields. For example, an inter-field edit would identify a male (Sex = 1) coded as having an ovarian primary (C569). At least one of these fields is incorrect because males cannot have ovarian primaries. It is possible for these types of edits to confirm upon review that both fields were incorrectly coded. For example, the actual case may involve a female (Sex = 2) with a renal pelvis primary (C659). Inter-record Edits (also known as Multi-record Edits) compare data on more than one record. These types of edits are run across records for patients that have multiple primaries. These edits compare codes recorded in the same data item(s) between each of the tumor records for the patient. For example, sex and birthplace should be coded the same for all primaries for a specific patient.

What term refers to an element in a document on the web that links to a whole document or to a specific element within a document? Response : A. Collaborative software B. Encryption C. File extension D. None of the above

D. None of the above Rationale: Hyperlink is an element in an electronic document on the web that links to a whole document or to a specific element within a document. Hypertext is text with hyperlinks. In hypertext, a hyperlink is reference to another web page, document, or other file type. Clicking on a link will usually take you to said page, document, or file. Collaborative software is application software designed to help people involved in a common task achieve goals by incorporating knowledge management into business processes so employees can share information and solve business problems more efficiently. Using this type of software (e.g., Microsoft Sharepoint, Google Apps, WebEx) a group of individuals are allowed the use of shared calendars, surveys, document libraries and shared task lists. Encryption is the process of encoding data into a scrambled and virtually useless form. An encryption key is usually required to decrypt said data. Encryption is normally utilized to ensure secure data transmission. A file extension is the set of characters following the right-most period in a filename. It is often used to determine a file's type, which in turn assists the operating system in determining which application to use to open said file.

What type of edits compare data on more than one record? Response : A. Item Edits B. Inter-Field Edits C. Over-Ride Edits D. None of the above

D. None of the above Rationale: Inter-record Edits (also known as Multi-record Edits) compare data on more than one record. These types of edits are run across records for patients that have multiple primaries. These edits compare codes recorded in the same data item(s) between each of the tumor records for the patient. For example, sex and birthplace would expect to be coded the same for all primaries. Single Field Edits (also known as Item Edits) are those that verify and validate the field values for only one data item at a time. For example, a single field edit for the item "Birthplace" would verify that only valid codes for birthplace are used in the field. Keep in mind that single field edits are simply range checks (i.e., these edits indicate a valid code was used); they cannot identify whether the fields were actually coded correctly. In this example, a case will pass the birthplace single field edit if a coder uses the code for the state of Oregon as the birthplace for a patient that should have had California coded as the birthplace. While a valid code was used, the correct code was not. Inter-field Edits (also known as Multi-field Edits) compare the codes recorded for one data item with codes recorded for related data items to assess correctness in coding all involved fields. For example, an inter-field edit would identify a male (Sex = 1) coded as having an ovarian primary (C569). At least one of these fields is incorrect because males cannot have ovarian primaries. It is possible for these types of edits to confirm upon review that both fields were incorrectly coded. For example, the actual case may involve a female (Sex = 2) with a renal pelvis primary (C659). Edit Over-ride flags allow the registry staff to indicate that questionable data is actually correct. Setting over-ride flags on cases can eliminate the need to review the same case multiple times for the same issue that would continue to fail one or more edits should such a flag not exist. If a case has an over-ride flag set involving selected fields, the case should not have to be manually reviewed again unless there is a change in the coding values involving the fields that triggered the edit failure initially.

What type of edits checks one data field at a time? Response : A. Inter-field edits B. Inter-record edits C. Over-ride edits D. None of the above

D. None of the above Rationale: Single Field Edits (also known as Item Edits) are those that verify and validate the field values for only one data item at a time. For example, a single field edit for the item "Birthplace" would verify that only valid codes for birthplace are used in the field. Keep in mind that single field edits are simply range checks (i.e., these edits indicate a valid code was used); they cannot identify whether the fields were actually coded correctly. In this example, a case will pass the birthplace single field edit if a coder uses the code for the state of Oregon for a patient who should have had California coded as the birthplace. While a valid code was used, the correct code was not. Inter-field Edits (also known as Multi-field Edits) compare the codes recorded for one data item with codes recorded for related data items to assess correctness in coding all involved fields. For example, an inter-field edit would identify a male (Sex = 1) coded as having an ovarian primary (C569). At least one of these fields is incorrect because males cannot have ovarian primaries. It is possible for these types of edits to confirm upon review that both fields were incorrectly coded. For example, the actual case may involve a female (Sex = 2) with a renal pelvis primary (C659). Inter-record Edits (also known as Multi-record Edits) compare data on more than one record. These types of edits are run across records for patients that have multiple primaries. These edits compare codes recorded in the same data item(s) between each of the tumor records for the patient. For example, sex and birthplace would expect to be coded the same for all primaries. Edit Over-rides flags allow the registry staff to indicate that questionable data is actually correct. Setting over-ride flags on cases can eliminate the need to review the same case multiple times for the same issue that would continue to fail one or more edits, should such a flag not exist. If a case has an over-ride flag set involving selected fields, the case should not have to be manually reviewed again unless there is a change in the coding values involving the fields that triggered the edit failure initially.

Which organization maintains the NPCR-EDITS metafile written for the Surveillance, Epidemiology and End Results (SEER) Program participants to use to test their data against SEER cancer registry standards? Response : A. National Program of Cancer Registries (NPCR) B. North American Association of Central Cancer Registries (NAACCR) C. American College of Surgeons Commission on Cancer (CoC) D. None of the above

D. None of the above Rationale: The National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) Program actively maintains the quality standards distributed in their metafile to their participating registries to use to test their local data. NPCR-EDITS metafiles have also been written for cancer registry data standards of National Program of Cancer Registries (NPCR), the American College of Surgeons Commission on Cancer (CoC), and the North American Association of Central Cancer Registries (NAACCR). These standards are also maintained actively by the respective organizations.

Must a registry enter into a data use agreement when sharing de-identified data? Response : A. Always B. Never C. Only to prohibit re-identification of the individual patient D. Only if there is access to files with known disclosure risk

D. Only if there is access to files with known disclosure risk Rationale: No. The registry is not required to enter into a data use agreement when releasing de-identified data. However, the registry may require that the recipient of their de-identified data enter into a data use agreement to access files with known disclosure risk. Such an agreement may contain clauses designed to protect the data (e.g., prohibiting applying processes/procedures which might lead to the re-identification of individual patients in the dataset).

The primary purpose of cancer registry standards is to Response : A. Provide references for cancer registrars. B. Allow reports to be written in a standard language. C. Provide information to researchers using the data. D. Protect the integrity of the data.

D. Protect the integrity of the data. Rationale: To be useful, uniform data collection and coding standards are necessary. Shared standards across various organizations help: •Ensure clarity of communication •Protect the integrity of the data when pooled or compared across multiple institutions •Focus attention on key aspects of cancer control and care Standards do provide a reference for cancer registrars and information to researchers about what is intended by the data items and codes collected, which then allows reports to be written using terms that have been consistently applied; however, the primary purpose of standards is to protect the integrity of the data.

The field that reflects the coding standard used for the stage fields in a NAACCR exchange record layout is an example of what type of data item in a cancer registry? Response : A. Stage/Prognostic Factors B. Cancer Identification C. State/Requestor D. Record Identification

D. Record Identification Rationale: The following includes some of the categories used by NAACCR to classify data items: Record identification items include those fields used to recognize the layout and content of the record being transmitted (e.g., record type, patient ID number, tumor record number, coding standards used for particular fields). Stage/Prognostic Factors fields include all fields associated with coding stage, tumor markers and secondary diagnoses but they do not include the field associated with the coding standard applied. The latter is classified under the Record Identification data item set. State/Requestor data items include optional registry specific or special use fields that are not in the standard NAACCR data dictionary but are maintained by the receiving registry when a data exchange is performed using the NAACCR record layout. For example, a facility might opt to capture exposure to potentially cancer causing agents or events. While these data items are not part of the standard NAACCR layout, they can be transmitted to another registry in this section of the NAACCR record. Cancer Identification data includes such items as the primary site, histology, tumor sequence and screening information.

Congress granted regulatory powers to the following agencies Response : A. The Surveillance, Epidemiology, and End Results program (SEER) and the North American Association of Central Cancer Registries (NAACCR). B. The National Program of Cancer Registries (NPCR) and the North American Association of Central Cancer Registries (NAACCR). C. The National Program of Cancer Registries (NPCR) and the Commission on Cancer (CoC). D. The Surveillance, Epidemiology, and End Results program (SEER) and the National Program of Cancer Registries (NPCR).

D. The Surveillance, Epidemiology, and End Results program (SEER) and the National Program of Cancer Registries (NPCR). Rationale: The National Cancer Institute's (NCI) SEER program and the Centers for Disease Control and Prevention's (CDC) NPCR program both have congressional regulatory powers that impact cancer registry work. Congress has empowered these two federal administrative agencies to make laws by passing "enabling legislation." When these agencies, which are both part of the U.S. Department of Health and Human Services, make such laws they are referred to as regulations. The NCI oversees the SEER program which is a national system of population-based registries established in 1971 when Congress passed the National Cancer Act. SEER data collection began in 1973 with a limited amount of registries and continues to expand to include even more areas and demographics today. Currently the following areas are covered by the SEER program:

Which term refers to a collection of software tools that allows the different standard setters the ability to create rules to test and improve data quality? Response : A. EDITS Metafile B. Exchangeable-edits, Data-dictionary, and Information Translation Standard C. EditWriter D. None of the above

Exchangeable-edits, Data-dictionary, and Information Translation Standard Rationale: Exchangeable-edits, Data-dictionary, and Information Translation Standard known as EDITS refers to a collection of tools that allows the different standard setters (CoC, SEER, NPCR and NAACCR) the ability to create rules to test and improve data quality. The NPCR-EDITS product includes the Metafile, EditWriter, GenEDITS Plus and EDIT Engine (also known as the Application Program Interface [API] or Dynamic-Link Library [DLL]). EDITS Metafile contains rules expressed in the EDITS language that are embedded in a binary file object. The metafile contains everything needed to edit a data file except the data. The metafile contains all of the logic, tables, constants, and messages needed to test data items, one at a time or in groups, and report their agreement or disagreement with the established standard. Metafiles provide portability of edits so that the same edits may be used for different purposes. The Metafile is modified using EDITWriter. GenEDITS Plus is a software program that allows a user to run sets of edits against a data file of cancer records and produce an error report. The edits and edit sets are typically created by the standard setters. The data file of cancer records is an extract of records from a registry's database written out into a text file using the NAACCR data exchange record layout for abstracts. EDITWriter is a component of EDITS that allows standard setters to create rules in an executable form. The EDITWriter is used to define data items, maintain reference tables, specify algorithms, logic, and documentation; and create record layouts. The EDIT Engine is an application program interface (API) that contains a library of C language functions which can be incorporated into many kinds of programs, including programs for data entry, data verification, recoding, reformatting, and vertical or horizontal subsetting. Software developers can use the NPCR-EDITS API to apply the standard contained in a metafile at any point in the process, from interactive, real-time editing at the moment of data capture to the analysis phase.

is the process of assigning geographic information such as latitude/longitude and census tract or block number to the cancer patient's address.

Geocoding

Which statement regarding web applications is not true? Response : A. The latest release of the application is generally the only version of the application available to users on a given browser. B. Web applications can be accessed by devices with a web browser including desktops, laptops, tablets, and smart phones. C. Either the internet or network connection is required to use/access a web application. D. None of the above

None of the above Rationale: The following three statements are true regarding web applications: The latest release of the application is generally the only version of the application available to users on a given browser. Web applications update themselves automatically resulting in the latest version appearing with all the newest features and improvements included. Occasionally, web applications maintain slightly different versions of the product if there are browser incompatibility issues that have yet to be resolved prior to the release of latest version of the product. All electronic devices with a browser including desktops (PC or MAC), laptops, tablets and smart phones can access the same web application because the web is an open platform. However, tablets and/or smart phones may not be able to provide the user with sufficient screen display or navigational means to use some or all of the functionality of the web application. Web applications are dependent on a server to deliver the application to your web browser. Without an internet or network connection, the browser will not be able to load the web application.

What type of budget requires that every line item of a new budget be justified, even if those items were approved in a previous year's budget? Response : A. Top-down budget B. Zero-based budget C. Bottom-up budget D. None of the above

Rationale: A zero-based budget requires that every line item of the budget be approved, rather than only changes to the budget from one year to the next. During the review process, no reference is made to any line item expense in past budgets. Zero-based budgeting requires the budget request be re-evaluated thoroughly, starting from scratch. This type of budgeting process does not take into account whether the total budget or specific line items costs are increasing or decreasing. Top-down budgeting is the term used to describe a budget-drafting process in which upper management makes key decisions about company expenditures without input from middle managers or lower-level employees. The top-down approach is less time-intensive, as it includes only the input of key decision-makers. Bottom-up budgets prepared by the managers of all departments are combined to compute the financial resources needed for the entire organization. These budgets should contain better information because employees most familiar with the department and its operations set the budget that will then be sent to the senior managers for approval. The disadvantage to this budgeting technique is it is more time-consuming and could result in department heads setting production targets that are too easy to achieve. Another disadvantage is that budgets may not be in line with the organizational objectives, as department heads may lack a strategic perspective and may tend to focus on their departmental concerns. Top-down or bottom-up budget preparation methods are typically used by registries and take into account previous funding allocations.

Record linkage involves Response : A. Linking multiple records for the same primary cancer. B. Linking information from death certificates to existing records. C. Linking pathology laboratory reports with the correct case record. D. Linking records from other states with records within the state

b. Linking information from death certificates to existing records. Rationale: Record linkage refers to linking external data sources, such as death certificates, with existing records. Linking multiple records for the same primary cancer, linking records from other states, and linking pathology reports are all a part of the record consolidation process.