Informatics questions 1--use starred

Norman's theory of action

(1) Forming the goal; (2) Forming the intention; (3) Specifying an action; (4) Executing the action; (5) Perceiving the state of the world, (6) Interpreting the state of the world, (7) Evaluating the outcome (REF: Clinical Informatics Board Review and Self Assessment (p. 291). Springer International Publishing. Kindle Edition.

LR- formula

(1-sensitivity)/specificity=FNR/TNR

Given that A and B are independent events, which of the following is true? (a) P(A) + P(B) = P(A and B) (b) P(A) + P(not A) = 0 (c) P(B) = P(A and B) + P(not A and B) (d) P(A) + P(B) + P(C) = P(A and B and C) Clinical Informatics Board Review and Self Assessment (p. 249). .

(c) P(B) = P(A and B) + P(not A and B Corollary: If another event, B is related to event A, the probability of B is equal to the probability of A and B plus the probability of not-A and B. P(B) = P(A and B) + P(A′ and B) Clinical Informatics Board Review and Self Assessment (p. 38). Springer International Publishing. Kindle Edition. Corrollary of P(A) + P(-A) = 1

System review of CDS (Kawamoto). Four predictors of improved practice

1. CDS as part of clinical workflow 2. Recommendations, not just assessments 3. Provision at time/location of decision 4. Computer based decision support

Five Rights of CDS (Osheroff)

1. Right information 2. Right person 3. Right format 4. Right channel 5. Right time

Ten Commandments for CDS (Bates)

1. Speed is everything

EHR uptake

96% hospital, 75% office based

Pareto chart

A Pareto chart is a histogram which lists common problems in decreasing order of occurrence. Helps identify most common problems requiring attention. Clinical Informatics Board Review and Self Assessment (p. 289). Springer International Publishing. Kindle Edition.

What type of database access is MOST APPROPRIATE for a researcher examining secular trends in Pneumocystis jirovecii pneumonia? (a) File system access (b) Live database, read-only (c) Shadow (i.e. replica) only (d) System administrator access

A researcher looking at secular (i.e. long term, non-cyclical) data trends does not need any access to live data. In fact, giving him access to live data causes two problems. Firstly, it will slow down the system for current patients and providers. Second, if he inadvertently modifies live data, it could impugn the integrity of the whole system. Clinical Informatics Board Review and Self Assessment (p. 293). Springer International Publishing. Kindle Edition.

Complex adaptive systems (change theories)

A system which is adaptive should evolve and it should tend towards order. A system which is complex is more likely to be nonlinear than have central discipline. Characteristics: diverse agents that learn, non-linear interdependencies, self-organization, coevoluation

A network in which multiple nodes are directly connected to each other node is often called a/an (a) Mesh (b) Point-to-point (c) Snowflake (d) Star

A. A mesh network connects each node to every other node. A simple point-to-point network connects two nodes to each other. (You might argue that in a two-node network, all nodes are connected to every other node, but the question specified that there were multiple nodes). A star network contains a central hub to which all nodes connect. A star of star networks is often called a snowflake. Clinical Informatics Board Review and Self Assessment (p. 297). Springer International Publishing. Kindle Edition.

Satisficing

A. Satisficing is the act of being satisfied with a satisfactory, if not ideal answer. It is known that more research could possibly find a better answer, but the decisionmaker is trying to be decisive. Making a choice on "gut feeling" without research is not satisficing. Multifocused decisionmakers may pursue multiple opportunities until one emerges as the best. Maximizers tend to perform extensive research prior to making a decision. Clinical Informatics Board Review and Self Assessment (p. 299). Springer International Publishing. Kindle Edition.

risk acceptance, avoidance, exploitation, transference

Accepting the current level of risk without attempting any other risk modification is called Risk Acceptance. Risk exploitation is an approach to positive risk where a risk manager does everything in his power to ensure that the risk occurs. Risk transference is when the risk is transferred to another entity, such as buying insurance. Finally, Risk Avoidance involves instituting systematic changes to ensure that the risk does not occur. In the case of cancer, this is not a valid response. Clinical Informatics Board Review and Self Assessment (p. 293). Springer International Publishing. Kindle Edition.

Which one of the following is the best example of an Integrating the Healthcare Enterprise (IHE) integration profile? Select one: a. Scheduled workflow b. Diagnostic results c. Order status d. Patient discharge

An integration profile addresses a specific problem of healthcare interoperability and the details of the standards based proposed solution. Therefore, an integration profile involves coordination of a complex sequence of messages, not just a single message. Scheduled workflow in particular defines how the ADT-patient registration, order placer, order filler, acquisition modality and the image manager/image archive must behave and interact. The technical framework that supports the profile specifies a number of HL7 and DICOM transactions. Diagnostic results, order status and patient discharge are isolated HL7 messages. Branstetter BF. Editor.Practical Imaging Informatics: Foundations and Applications for PACS Professionals.Springer. 2009, pg. 93. The correct answer is: Scheduled workflow

IHI Triple Aim

Better health (outcomes), better care (experience), lower cost (higher value)

Controlled vocabulary, ontogeny, semantic encoding, taxonomy

By limiting choices to one of four options, the implementer is using a controlled vocabulary. Both a taxonomy and an ontology have a hierarchical relationship among concepts, while a classification generally does not. Semantic encoding exists when the codes have meaning in relation to the concept being encoded. In this case, the numbers actually do have some correlation to the concepts. As the numbers get higher, the patient's limitations get more severe. However, this reflects ordinality rather than semantics, which makes choice A a better answer. Clinical Informatics Board Review and Self Assessment (p. 294). Springer International Publishing. Kindle Edition.

Telemedicine--store and forward

C. Store and forward is a common form of asynchronous telemedicine. Media files are stored on a local server and then forwarded to the consultant, who often reads the studies in batches. Real time communication and remote monitoring are forms of synchronous communication. Clinical Informatics Board Review and Self Assessment (p. 291). Springer International Publishing. Kindle Edition.

The Centers for Medicare & Medicaid Services (CMS) recognizes 2 types of patient registries: qualified clinical data registries (QCDRs) and clinical data registries (CDRs).

Clinicians use QCDRs to collect and submit Physician Quality Reporting System (PQRS) and/or Quality Payment Program (QPP) data for their practice. CDRs offer limited reporting value. They're used only to report some public health data for QPP.

Four categories of workflow analysis

Computer science based Computer supported cooperative work Cognitive science Organizational science

Financial accounting produces the documents typically associated with accounting such as income statements, balance sheets and cash flow statements. Which of the following is a component of the Cash Flow Statement? Select one: a. Operating activity b. Equity c. Expenses and losses d. Revenue

Cp,The three major financial accounting documents are 1.Income statement: summarizes revenue and expenses during a specified time period 2.Balance sheet: summarizes assets, liabilities and equity during a specified time period. This is also referred to as the financial position statement. 3.Cash flow statement: summarizes cash inflow and outflow during a specified time period. With regards to this question: Equity is a Balance Sheet component that reports the company's assets, also known as the "book value" of the company. Expenses and losses are a component of the Income Statement and includes expenses from primary activities, secondary activities and any losses. Operating activity is a component of the Cash Flow Statement and deals with converting items on the income statement to cash. Revenue (often referred to as Revenues and Gains) is a component of the Income Statement and includes revenues from primary activities (operating revenues), secondary activities (non-operating revenues) and gains (proceeds from a sale). Components of cash flow statement cash from operating activities, cash from investing activities, cash from financial activities, disclosure of non cash activities

A multispecialty medical group is evaluating two proposals, A and B, for adding a new service line. Which of the following statements makes B a better investment? (a) The accounting rate of return is 5% for A and 4% for B (b) The internal rate of return is 5% for A and 4% for B (c) The net present value is $5000 for A and $4000 for B (d) The payback period is 5 years for A and 4 years for B

D. A shorter payback period indicates a better investment. For both the accounting rate of return and the internal rate of return, a higher percentage indicates a better investment. The present value (PV) of an item indicates its future value in today's money. (REF: Clinical Informatics Board Review and Self Assessment (p. 289). Springer International Publishing. Kindle Edition.

Interfacing

D. Interfacing is the process of setting up communication channels between information systems. In contrast, integration is when two or more systems use the same data store. In the case of two hospitals which would like to retain their respective EHRs, integration would be very difficult, if not impossible. Neither certification nor anonymization would help this process. Clinical Informatics Board Review and Self Assessment (p. 297). Springer International Publishing. Kindle Edition.

Technical vs. administrative controls

D. Technical safeguards are programming techniques to protect sensitive data, such as maintaining an audit log or using two factor authentication. Administrative safeguards are policies and procedures regarding data security. Physical safeguards are actual objects that block unauthorized access, such as locks on server room doors or privacy screens.

Transactions between hospitals and outpatient pharmacies are usually governed by standards established by (a) Accredited Standards Committee X12 (b) American National Standards Institute (ANSI) (c) Health Level Seven International (HL7) (d) National Council for Prescription Drug Programs (NCPDP).

D. The National Council for Prescription Drug Programs (NCPDP) is a standards development organization accredited by the American National Standards Institute (ANSI) for communications with outpatient pharmacies. Inpatient pharmacy orders are typically covered by Health Level Seven (HL7) messages. The X12 committee creates standards for electronic data interchange, and the X12N subcommittee is responsible for communications with insurers.

Key concepts in clinical informatics data-knowledge-information-wisdom information knowledge wisdom Technology Informatics Guiding Education Reform (TIGER) computer competency information literacy informatics management nursing informatics pyramid (Schwirian)

DKIW: facts becoming more useful as collected, analyzed, displayed information: data in context] knowledge: information with relationships/meaning known wisdom: appropriate use of knowledge to solve problems computer competency: skills that allow individuals to use technology to accomplish tasks (e.g. word processor) information literacy: set of cognitive processes that allow recognition of what, when, and where information is needed informatics management: process of collecting and using data nursing pyramid: raw data -> technology -> users -> goal

The Emergency Department requests a new order set for the treatment of uncomplicated skin abscesses. Several Emergency Medicine health care team members suggest content which is compiled by a team leader.They are asked to review and revise their answers based on replies from other colleagues.This process repeats several times until agreement is achieved. What is this process called? Select one: a. Nominal group technique b. Delphi method c. Consensus mapping d. Consensus building

Delphi--iterative, single leader facilitates Consensus building--discussion continues until consensus Consensus mapping--small groups evaluate parts then form larger map Nominal group technique--all give input, but not iterative

A hospital is considering adopting a new technology. Decision makers at the hospital are requesting evidence that the new technology gets results before reaching their final decision. According to the diffusion of innovation theory, this hospital is most likely to be in the following group: Select one: a. Late adopters b. Early majority c. Early adopters d. Late majority

Diffusion of Innovation (DOI) Theory identifies five adopter categories. When promoting an innovation, there are different strategies used to appeal to the different adopter categories. 1. Innovators - These are people who want to be the first to try the innovation. They are venturesome and interested in new ideas. These people are very willing to take risks and are often the first to develop new ideas. Very little, if anything, needs to be done to appeal to this population. 2. Early Adopters - These are people who represent opinion leaders. They enjoy leadership roles and embrace change opportunities. They are already aware of the need to change and so are very comfortable adopting new ideas. Strategies to appeal to this population include how-to manuals and information sheets on implementation. They do not need information to convince them to change. 3. Early Majority - These people are rarely leaders, but they do adopt new ideas before the average person. That said, they typically need to see evidence that the innovation works before they are willing to adopt it. Strategies to appeal to this population include success stories and evidence of the innovation's effectiveness. early majority evidence, late majority need to see majority using 4. Late Majority - These people are skeptical of change and will only adopt an innovation after it has been tried by the majority. Strategies to appeal to this population include information on how many other people have tried the innovation and have adopted it successfully. 5. Laggards - These people are bound by tradition and very conservative. They are very skeptical of change and are the hardest group to bring on board. Strategies to appeal to this population include statistics, fear appeals, and pressure from people in the other adopter groups.Rogers E. Diffusion of Innovations, 4th Edition. Free Press. 2001. The correct answer is: Early majority

AHQR definition of quality healthcare

Do right thing for right person at right time in the right way with best possible results

Fitt's law

Fitts Law states that the time it takes for a person to click on an item on a screen is related to the distance to the item and (inversely) to the size of the item. Hick-Hyman Law states that the time it takes to make a decision is logarithmically related to the number of choices. Model Human Processor (MHP) is a model like Goals Operators Methods Selectors (GOMS) that determines how long it takes a person to perform a certain task. Clinical Informatics Board Review and Self Assessment (p. 289). Springer International Publishing. Kindle Edition.

The primary organizational goal for health information technology (IT) governance is to ensure that the: Select one: a. Investments in health IT generate business value b. Solutions chosen meet the needs of clinicians c. Expenditures for health IT solutions are appropriately tracked d. Board of Directors are adequately informed about health IT progress

Health information technology governance is a subset discipline of corporate governance focused on Health IT systems and their performance and risk management. Of the possible responses, only generating business value is considered a primary goal of health IT governance. The other primary goal is to mitigate the risks that are associated with health IT. IT Governance - Developing a Successful Governance Strategy, A Best Practice Guide for decision makers in IT, The National Computing Centre, Manchester, UK. November 2005. Available at: https://www.isaca.org/Certification/CGEIT-Certified-in-the-Governance-of-Enterprise-IT/Prepare-for-the-Exam/Study-Materials/Documents/Developing-a-Successful-Governance-Strategy.pdf The correct answer is: Investments in health IT generate business value

Safe harbor--what remove?

Includes age > 90, very rare illness

MIPS categories

Individual providers (including audiology, psychology, etc.) Cost - 15% of MIPS Final Score Quality - 45% of MIPS Final Score Improvement Activities - 15% of MIPS Final Score Promoting Interoperability - 25% of MIPS Final Scor

Technical safeguards identified by the Security Rule for Health Insurance Portability and Accountability Act (HIPAA) compliance include which of the following: Select one: a. Facility access controls. b. Backup and recovery plan. c. Access management. d. User authentication.

It The correct answer is: User authentication. HIPAA security rules must be adhered to when transmitting medical data over telecommunications networks. The Security Rule sets standards for the management of protected health information (PHI) in electronic format including confidentiality, integrity and availability. The Security Rule also includes implementation specifications. Safeguards for compliance include: •Administrative (e.g., security management, responsibility, risk analysis, access management, training, incident procedures, backup and recovery plans); •Physical (e.g., facility access controls, device media control, data backup); and •Technical (e.g., unique user identification, user account administration, emergency access procedures, audit controls, electronic data integrity, person and entity authentication, transmission security) Branstetter IV BF Editor (2009) Practical Imaging Informatics: Foundations and Applications for PACS Professionals. Springer, New York, NY, pp 283-290. U.S. Department of Health and Human Services https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html it was asking about technical safeguards!!!

What is the LR-

It's FNR/TNR (not other way). Higher is worse LR- is how much less a negative test makes disease less likely

Which of the following Lean Six Sigma terms correctly identifies the problem-solving process that bring together stakeholders to generate rapid process improvement? Select one: a. Fishbone diagram b. Daily huddle c. Kaizen d. Muda

Kaizen events bring together relevant stakeholders to understand a problem and generate solutions in a short time frame. Daily huddles are regular short meetings to keep staff appraised of recent events and progress. Fishbone diagrams (or Ishikawa diagrams) are diagrams that are made to examine the root causes of a problem.Muda is the Lean Six sigma term for "waste."Finnell JT and Dixon BE. Clinical Informatics Study Guide: Text and Review. Springer. 2016. Chapter 7https://goleansixsigma.com/8-wastes-muda/https://www.isixsigma.com/methodology/kaizen/kaizen-adhd-therapy-using-continuous-improvement-tools-to-keep-employees-continuously-occupied/ The correct answer is: Kaizen

Being able to determine what kind of information is required and how to obtain it is part of a core competency known as (a) Computer competency (b) Controlled Vocabulary (c) Informatics management (d) Information literacy

Knowing what information is needed and how to find it is known as information literacy. Computer competency is the ability to perform basic computer functions. A controlled vocabulary is a set of concepts in a particular domain. Informatics management is the process of collecting data, analyzing it and distributing the findings. Clinical Informatics Board Review and Self Assessment (p. 292). Springer International Publishing. Kindle Edition.

Which one of the following dimensions has been shown to have the most significant impact on work and life satisfaction? Select one: a. Engaging b. Managing Energy c. Meaning d. Positive Framing

McKinsey Global identified five dimensions of effective and centered leadership. Meaning (finding meaning in one's work) has the most significant impact, thought to contribute up to 5 times more towards life satisfaction than any other dimension of this theory. Managing energy involved sustaining the energy that is the force of change. Positive framing is the process of converting fear or stress into opportunity. Engaging is acting in the face of risk. The fifth dimension, connecting, is not listed above. Barsh J, Mgelof J, Webb C. The value of centered leadership. McKinsey & Company. 2010. Available from: https://www.mckinsey.com/global-themes/leadership/the-value-of-centered-leadership-mckinsey-global-survey-results. Accessed March 3, 2018.Finnell JT and Dixon Brian E. Clinical Informatics Study Guide: Text and Review. 2016. Springer International. Pp. 318-319. The correct answer is: Meaning

Bayes theorem

P(A|B)=P(B|A) - P(A) / (B) PPV = true positives/all positives = prevalence x sensitivity/(P*sensitivity+(1-P)*(1-specificity)) NPV=TN/All negative = (1-P)*Sp/(P*(1-sensitivity + (1-P)*Sp)

Blois Funnel

Physician starts with broadest differential and narrows

Phases of SDLC

Planning Software implementation (development) Testing (verification to check code, validation to check does what it's intended to do) Documentation Deployment Maintenance

Which of the following is least likely to be an explicit part of a controlled vocabulary? (a) Concept identifiers (codes) (b) Definitions of terms (c) Post-coordinated terms (d) Relationships between terms

Pre-coordinated items in a vocabulary are those that are included explicitly. Post-coordinated items are those that are created by the combination of pre-coordinated items. Codes, definitions and relationships are an intrinsic part of any vocabulary. Clinical Informatics Board Review and Self Assessment (p. 295). Springer International Publishing. Kindle Edition.

Process mining is a specific technique of workflow analysis which involves (a) Analysing medical records to identify patients with a particular phenotype (b) Calculating the failure rate in an industrial process (c) Merging database tables using a common key (d) Reviewing the event log of an information system Clinical Informatics Board Review and Self Assessment (p. 249). Springer International Publishing. Kindle Edition.

Process mining is a method of workflow analysis which involves researching the event log of an information system to find out how effective various processes are. Merging database tables using a common key is a join. Clinical Informatics Board Review and Self Assessment (p. 287). Springer International Publishing. Kindle Edition.

According to Roger's Diffusion of Innovation theory, the rate of adoption of an innovation is determined by: (a) acceptance, tolerability, understandability (b) ease of access, maintenance, accessibility (c) likability, ease of use and cost (d) relative advantage, compatibility, complexity, trialability and observability

Roger's Diffusion of Innovation theory describes how new ideas (innovations) spread throughout a community. The rate of adoption of an innovation is determined by relative advantage, compatibility, complexity, trialability and observability.

Which of the following data standards include social determinants of health information? Select one: a. RxNORM b. DICOM c. CVX d. LOINC

RxNorm does not include social determinants of health information. RxNorm is a pharmacy terminology standard that includes medication information. CVX is the immunization coding standard. DICOM is a radiology standard. LOINC includes SDOH codes such as Adverse Childhood Events. LOINC. Represent Social Determinants of Health with LOINC. https://loinc.org/sdh/. Accessed March 26, 2019 The correct answer is: LOINC

National Drug Codes (NDCs) are superior to RxNorm identifiers for prescription reporting because they: Select one: a. contain information on drug strength and quantity b. uniquely identify a pharmaceutical substance c. are endorsed by the Department of Health and Human Services d. are structured in a way that facilitates drug reconciliation

RxNorm is substance-oriented, i.e., the information on how many tablets are in a given NDC-identified bottle/prescription is not available for all drugs. However, it does exist for drug delivery devices, the so-called branded or generic packs. http://www.fda.gov/Drugs/InformationOnDrugs/UCM142438.htm The correct answer is: contain information on drug strength and quantity

Crossing the Quality Chasm: A New Health System for the 21st Century. Care should be

Safe Effective Patient-centered Timely Efficient Equitable

The Open Systems Interconnection model (OSI) is a conceptual model that characterizes and standardizes the internal functions of a communication system by partitioning it into layers. Secure Sockets Layer (SSL) is implemented in which OSI layer? Select one: a. Network b. Transport c. Session d. Presentation

Session Protocol data unit (PDU) TCP/IP 3, 4 Application--data PDU, high level API including remote access Presentation--data PDU, translation between networking and application (compression, encryption) Session--data PDU, managing communication sessions (information exchange between nodes) Transport--segment/datagram (TCP), reliable transmission of data segments Network--packet, managing network (addresing, routing, traffic control) Data link---frame, transmission f data between notes Physical---bit, transmission and reception of raw bits over network)

Which of the following models, theories, and frameworks seeks to define usability in the context of electronic health record design? (a) Distributed Cognition (b) Goals, Operators, Methods, and Selectors (GOMS) (c) Learning Healthcare Systems (d) Task, User, Representation, Function (TURF)

TURF is a unified framework for EHR usability. Distributed Cognition is a theory that states that decisionmaking is not solely an individual activity, but distributed across objects, individuals, artefacts, and tools in the environment. GOMS is a cognitive model of human-computer interaction that seeks to measure complexity of tasks. A Learning Health System is an EHR which continuously incorporates new information to build a more robust and adaptive system. Clinical Informatics Board Review and Self Assessment (p. 297). Springer International Publishing. Kindle Edition.

You have joined a project aimed at developing a strategy to improve patient compliance with preoperative instructions. The team leader has circulated a questionnaire to all participants, the results of which were summarized, re-distributed and each input ranked. This was repeated until consensus was formed. The team leader was practicing: Select one: a. Reference class forecasting b. Human swarming c. The Delphi method d. Nominal group technique

The Delphi method uses an open-ended questionnaire about a certain topic, which is used to solicit independent opinions which are then combined, ranked and distributed. This process is repeated typically three to five times until consensus is achieved. Human swarming refers to "distributed populations of networked users to congregate online in real-time swarms and tackle problems as an Artificial Swarm Intelligence (ASI). Modeled after biological swarms, the UNU platform enables online groups to work together in synchrony, forging a unified dynamic system that can quickly answer questions and make decisions by exploring a decision-space and converging on a preferred solution." Nominal group technique is a highly structured face-to-face group interaction that enables participants to express their opinions and have them considered by the group.Reference class forecasting is a method for predicting the future by looking at similar past situations and their outcomes.Conceptually. Reference Class Forecasting. Undated. Accessed March 10, 2018. https://conceptually.org/concepts/reference-class-forecasting/ McMillan, S.S., King, M. & Tully, M.P. How to use the nominal group and Delphi techniques. Int J Clin Pharm (2016) 38: 655. https://doi.org/10.1007/s11096-016-0257-x. Rosenberg LGB. Human swarming, a real-time method for parallel distributed intelligence. HBI 2015 - Proceedings of IEEE, 2015 Swarm/Human Blended Intelligence, Cleveland OH, USA. http://unu.ai/wp-content/uploads/2015/10/Human-Swarming-IEEE-SHBI-2015.pdf The correct answer is: The Delphi method

Which one of the following organizations governs the International Classification of Diseases (ICD)? Select one: a. International Organization for Standardization (ISO) b. American National Standards Institute (ANSI) c. National Library of Medicine (NLM) d. World Health Organization (WHO)

The International Classification of Diseases (ICD) originated from the International List of Causes of Death which was created by a French physician, Jacques Bertillon, and which was adopted by the International Statistical Institute in 1893. On the sixth edition of this classification in the 1940s, morbidity was included and the title was modified to International Statistical Classification of Diseases, Injuries, and Causes of Death. In 1948 the World Health Organization took responsibility for ICD maintenance and revisions. http://www.who.int/classifications/icd/en/HistoryOfICD.pdf The correct answer is: World Health Organization (WHO)

The System Development Life Cycle has been described by many authors. Which of the following is LEAST likely to be one of the phases? (a) Analysis (b) Design (c) Disposal (d) Payment

The SDLC generally includes an initiation phase followed by requirements, analysis, design (or acquisition), development, testing, implementation, maintenance and support, and feeds back into analysis. If the system is no longer valuable, there is a decommissioning or disposal phase. Payment is not usually part of the SDLC.

Which of the following budget items is LEAST affected when implementing an Application Service Provider model? (a) Data center (b) Network infrastructure (c) Printers (d) Workstations

The benefit of an ASP model is that the heavy computing is performed off-site by the vendor, so investment in a data center is not needed. However, since some of the computing requirements will be shared between client and server, printers, workstations and networks will require additional resources. Clinical Informatics Board Review and Self Assessment (p. 298). Springer International Publishing. Kindle Edition.

The figure presents two approaches for interfacing 3 EHR systems. In the fully connected model, each EHR has a direct bidirectional interface to each other system. In the common shared standard model, each EHR has an interface to a centralized "universal" standard. Assuming a bi-directional interface costs $1 million to implement, what is the expected cost difference of building interfaces supporting a fully connected system versus a system with a common shared standard for 8 EHR systems?

The correct answer is $20 Million. A fully connected system requires (N*(N-1))/2 bidirectional interfaces to implement compared to N bidirectional interfaces using a common shared standard. Hence, interfaces in the fully connected model for 8 systems would require 28 interfaces at a cost of $28 million compared to 8 interfaces at a cost of $8 million using the common shared standard model. A difference of $20 million. Complete graph. (2016, June 29). In Wikipedia, The Free Encyclopedia. Retrieved 14:32, August 23, 2016, from https://en.wikipedia.org/w/index.php?title=Complete_graph&oldid=727500870 Cost difference-pay attention to wording

Meaningful facts Select one: a. Data b. Knowledge c. Wisdom d. Information

The correct answer is Information. There are four levels in the DIKW (Data-Information-Knowledge-Wisdom) pyramid or information hierarchy model. The bottom level consists of data which are symbols, signals, or facts without meaning. Computers are able to process data, but without meaning, reasonable conclusions cannot be drawn from data. The second level is information, or data with meaning (i.e., meaningful facts). For example, the number 98.6 is data, whereas 98.6° F is meaningful information. The third level of the model consists of knowledge, which is information with context, such as "My body temperature is 98.6° F." Lastly, the top level, wisdom, is applied knowledge. For example, "My body temperature is within the normal range." Wisdom is what humans bring, and maybe someday artificial intelligence (AI). Usually in informatics, we refer to the Data to Knowledge Spectrum. Shortliffe EH, Barnett GO. Biomedical Data: Their Acquisition, Storage and Use. In Shortliffe EH, Cimino JJ, Eds. Biomedical Informatics: Computer applications in health care and biomedicine. 4thEdition. 2014. Springer-Verlag, London. Hoyt, R. E., & Yoshihashi, A. K. (2014). Health Informatics: Practical guide for healthcare and information technology professionals. Lulu. com. p 2. DIKW Pyramid. (2015, November 15). In Wikipedia, The Free Encyclopedia. Retrieved 14:39, December 29, 2015, from https://en.wikipedia.org/w/index.php?title=DIKW_Pyramid&oldid=690798425 data--no meaning information--data with meaning knowledge-information with context (e.g. body temperature) wisdom: applied knowledge

You are evaluating a scheduling process failure in an outpatient clinic where wait times have suddenly increased by 60%. In performing a cause and effect analysis, which tool would be the most appropriate for the first portion of the analysis? Select one: a. Fishbone diagram b. Gantt chart c. Pareto chart d. Run chart

The correct answer is a fishbone diagram. Fishbone diagrams are causal diagrams that show the causes of specific events. They may also be called cause and effect diagrams and are often used in Root Cause analyses. Gantt charts are used to illustrate project schedules. Pareto charts contain both bar and line graphs where individual values are represented by descending order by parts and cumulative total by lines. Run charts display observed data in a time sequence.

You are worried that you might have a rare disease. The test for this disease is accurate 99 percent of the time (regardless of whether the results come back positive or negative). This disease occurs in the general population in one of every 10,000 people. If the tests are positive, what are the chances that you actually have the disease? Select one: a. 0.001 b. 0.01 c. 0.1 d. 0.99

The correct answer is: 0.01 Bayes' theorem helps us find the probability of event A given event B, written P(A|B), in terms of the probability of B given A, written P(B|A) and the probabilities of A and B: P(A|B)=P(A)P(B|A) / P(B) In this case, event A is the event you have this disease, and event B is the event that you test positive. Here, P(B|A)=.99, P(A)=.0001, and P(B) may be derived by conditioning on whether event A does or does not occur: P(B)=P(B|A)P(A)+P(B|not A)P(not A) or .99*.0001+.01*.9999, which is less than 1 percent.

How many rows will be included in the result of an INNER JOIN between Table 1 and Table 2 on the Color_ID field which includes Make and Color variables? Select one: a. 2 b. 3 c. 4 d. 5

The correct answer is: 3 Join functions are used to combine fields from multiple tables to produce a new table. An inner join is similar to the intersection of a Venn diagram. Only values of the joining variable which are represented in both source tables will be included in the result table following an inner join. An inner join includes 3 rows of data, and each resulting row contains non-null values for both variables from the joined tables. Joins may produce duplicate rows which will be present in the result unless an additional "distinct" command is used. The result of a left join includes all of the rows from the left table. When there is not a match in the right table corresponding to a value of the joining variable in the left table, null values will be linked to the left table. A left join of these tables would produce a result with 4 rows, but the Color value corresponding to the Toyota would have a null value. A full outer join includes all rows from both source tables. Like the left join (or a right join), when the joining variable has a value in only one table, the corresponding row will be linked with null valued data. A full outer join would include 5 rows but the Color value corresponding to the Toyota would have a null value and the Make value corresponding to Blue would have a null value. Wikipedia contributors. "Join (SQL)." Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 6 Jul. 2015. Web. 4 Aug. 2015. What is a SQL Join. http://www.sql-join.com/. Accessed 17 Sept 2015.

Under the HIPAA Privacy Rule, a limited data set may be shared by a covered entity without authorization only when Select one: a. A data use agreement is established between entities b. Key protected health information (PHI) has been removed c. The recipient does not further disclose the data to a third party d. The data are to be used strictly for health care operations

The correct answer is: A data use agreement is established between entities A Limited Data Set is an exception to the Privacy Rule requirement which allows protected health information (PHI) to be used for health care operations as well as for research or public health without obtaining either an individual's authorization or a waiver or an alteration of authorization for its use and disclosure, as long as a data use agreement is established between entities. In addition to disclosure for the purpose of health care operations, limited data sets may be used or disclosed for research or public health. Some protected health information elements may be included in a Limited Data Sets including dates of birth, dates of death, dates of service, as well as postal information elements including town or city, state, and, zip codes. The data use agreement must contain a provision including specific permitted uses and disclosures of the limited data set by the recipient. The recipient may further share the limited data set with a third party as long as the disclosure is specified in the data use agreement and does not violate the stipulations of the Privacy Rule. HIPAA Privacy Rule, (2018, Mar. 21) from: https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html A "limited data set" is information from which "facial" identifiers have been removed. Specifically, as it relates to the individual or his or her relatives, employers or household members, all the following identifiers must be removed in order for health information to be a "limited data set": name, address, social security number, others

Which of the following organizations developed the Code of Professional and Ethical Conduct for informatics professionals practicing in the United States? Select one: a. ACMI b. HIMSS c. ONC d. AMIA

The correct answer is: AMIA AMIA developed the Code of Professional and Ethical Conduct for informaticians in 2007. It was updated in 2013. Descriptions are taken from organization websites listed in references: ACMI, the American College of Medical Informatics, is a college of elected fellows who have made significant and sustained contributions to the field of biomedical informatics. The College exists as an elected body of fellows within AMIA. AMIA, (formerly known as the American Medical Informatics Association), \is the professional home of leading informaticians: clinicians, scientists, researchers, educators, students, and other informatics professionals who rely on data to connect people, information, and technology.\" HIMSS, Health Care Information Management and Systems Society, \"is a global, cause-based, not-for-profit organization focused on better health through information technology (IT). HIMSS leads efforts to optimize health engagements and care outcomes using information technology.\" The Office of the National Coordinator for Health Information Technology (ONC) \"is the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. The position of National Coordinator was created in 2004, through an Executive Order, and legislatively mandated in the Health Information Technology for Economic and Clinical Health Act (HITECH Act) of 2009. ONC is organizationally located within the Office of the Secretary for the U.S. Department of Health and Human Services (HHS).\" Goodman et al. AMIA's Code of Professional and Ethical Conduct. JAMIA. Available at: https://academic.oup.com/jamia/article/20/1/141/728741. Accessed March 23, 2018.

What is the best source of information to locate literature closely linked to a key article? Select one: a. Author provided key words in the article b. Cited references included c. Other publications by the same author(s) d. The words included in the title of the key article

The correct answer is: Cited references included The best source of information to locate literature closely linked to a key article is references cited in the article.

Which of the following is an SQL keyword which can be used to eliminate duplicate rows from a query result? Select one: a. SELECT b. DROP c. DISTINCT d. UNIQUE

The correct answer is: DISTINCT The DISTINCT keyword eliminates duplicate rows from the results of a SELECT statement. Each row in the remaining query result, including null valued rows will be unique. Although the SELECT keyword is needed in the SQL statement, the SELECT keyword returns all relevant rows including repeated redundant rows from the specified data tables. DROP is equivalent to DELETE. UNIQUE restricts a table, but is not a SQL keyword. Select (SQL). (2014, November 23). In Wikipedia, The Free Encyclopedia. Retrieved 16:57, May 26, 2015, from https://en.wikipedia.org/w/index.php?title=Select_(SQL)&oldid=635083976 SQL DISTINCT. (2015) In SQL Tutorial. Retrieved Mar. 23, 2018, from https://www.w3schools.com/sql/sql_distinct.asp Unique constraint in SQL is used to check whether the sub query has duplicate tuples in it's result. It returns a boolean value indicating the presence/absence of duplicate tuples. Unique construct returns true only if the sub query has no duplicate tuples, else it return false

Protected health information is to be sent from a secure system to one that is less secure. The most appropriate action to take is: Select one: a. De-identify and re-identify using assigned codes b. Encrypt the information in transport. c. Transmit information only on secure networks d. Encrypt the information at rest

The correct answer is: De-identify and re-identify using assigned codes The Privacy Rule was designed to protect individually identifiable health information through permitting only certain uses and disclosures of PHI provided by the Rule, or as authorized by the individual subject of the information. However, in recognition of the potential utility of health information even when it is not individually identifiable, §164.502(d) of the Privacy Rule permits a covered entity or its business associate to create information that is not individually identifiable by following the de-identification standard and implementation specifications in §164.514(a)-(b). These provisions allow the entity to use and disclose information that neither identifies nor provides a reasonable basis to identify an individual. The Privacy Rule provides two de-identification methods: 1) a formal determination by a qualified expert; or 2) the removal of specified individual identifiers as well as absence of actual knowledge by the covered entity that the remaining information could be used alone or in combination with other information to identify the individual. A covered entity may assign a code or other means of record identification to allow information de-identified under this section to be re-identified by the covered entity, provided that: (1) Derivation. The code or other means of record identification is not derived from or related to information about the individual and is not otherwise capable of being translated so as to identify the individual; and (2) Security. The covered entity does not use or disclose the code or other means of record identification for any other purpose, and does not disclose the mechanism for re-identification U.S. Department of Health and Human Services. Health Information Privacy. Available at: https://www.hhs.gov/hipaa/for-professionals/privacy/special-topics/de-identification/index.html#preparation. Accessed April 2016.

Gantt, start to finish, etc.

The correct answer is: Finish to Finish. In Gantt charts, there are three main relationships between sequential tasks: •Finish to Start (FS) - FS tasks can't start before a previous (and related) task is finished. However, they can start later. •Start to Start (SS) - SS tasks can't start until a preceding task starts. However, they can start later. •Finish to Finish (FF) - FF tasks can't end before a preceding task ends. However, they can end later. •A fourth type, Start to Finish (SF), is very rare. A Gantt chart shows the relationships between the tasks in a project. Some tasks will need to be completed before you can start the next one, and others can't end until preceding ones have ended. For example, if you're creating a brochure, you need to finish the design before you can send it to print. These dependent activities are called \sequential\" or \"linear\" tasks. Other tasks will be \"parallel\" - i.e. they can be done at the same time as other tasks. You don't have to do these in sequence, but you may sometimes need other tasks to be finished first. So, for example, the design of your brochure could begin before the text has been edited (although you won't be able to finalize the design until the text is perfect.) Bove LA, Kennedy RD, Houston SM. Project Management. In Finnell JT and Dixon BE Eds. Clinical Informatics Study Guide: Text and Review. Pp: 377-414. New York: Springer. 2016. Gannt Charts. https://www.mindtools.com/pages/article/newPPM_03.htm. Accessed April 3, 2017. Heerkens G. Project Management. 2nd Ed. New York: McGraw-Hill. 2013. What is a Gantt Chart? https://www.gantt.com/. Accessed April 3, 201

Which United States Act enhanced enforcement of patient privacy law by instituting mandatory penalties for willful neglect and requiring institutions to notify patients of data breaches? Select one: a. HIPAA (Health Insurance Portability and Accountability Act) b. MMA (Medicare Modernization Act) c. HITECH (Health Information Technology for Economic and Clinical Health Act) d. PPACA (Patient Protection and Affordable Care Act)

The correct answer is: HITECH (Health Information Technology for Economic and Clinical Health Act) The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted under the American Recovery and Reinvestment Act of 2009. Although the HITECH Act had a primary focus on the promotion of health information technology, the Act was also designed to add significant enforcement to the privacy and security provisions established by the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Specifically, the HITECH Act instituted mandatory penalties for willful neglect, and mandated notification of breaches of protected health information to all affected individuals and to Health and Human Services in the breach exceeds 500 individuals. The 2010 Patient Protection and Affordable Care Act (PPACA), or Affordable Care Act (ACA) was primarily concerned with increasing quality and affordability of health insurance, with expansion of public and private insurance coverage, and reducing healthcare costs. It introduced mechanisms like mandates, subsidies, and insurance exchanges. The 2003 Medicare Modernization Act overhauled Medicare by introducing prescription drug benefits, and health savings accounts. Hoyt, R. E., & Yoshihashi, A. K. (2014). Health Informatics: Practical guide for healthcare and information technology professionals (Sixth Edition). Lulu. com. p 99-100. AHRQ. What is the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) https://archive.ahrq.gov/policymakers/section-1013.html. Accessed March 21, 2018.

Which of the specifications listed is a Standards Development Organization balloted standard? Select one: a. World Health Organization (WHO) International Statistical Classification of Diseases and Related Health Problems 10th revision (ICD-10) b. American Medical Association (AMA) Current Procedural Terminology (CPT) c. Health Level 7 (HL7) Clinical Document Architecture d. Consumer Product Safety Commission (CPSC) National Electronic Injury Surveillance System (NEISS

The correct answer is: Health Level 7 (HL7) Clinical Document Architecture Only the CDA specifications went through a formal ballot process. The other specifications are produced by the government (NEISS), the World Health Organization (ICD-10) and the AMA (CPT). Shortliffe EH and Cimino JJ. Biomedical Informatics: Computer Applications in Health Care and Biomedicine. London: Springer-Verlag. 2014. Pp. 215-222.

A commonly employed method to assess a patient's utility preferences is the visual analog scale. The visual analog scale: Select one: a. Presents the respondents with a minimum of restraints b. Is poorly accepted by patients and their families c. Has less reliable results than a Likert Rating or other rating scales d. Can not be collapsed down to discrete categories for analysis

The correct answer is: Presents the respondents with a minimum of restraints In contrast to discrete scales (e.g., Likert), the visual analog scale is continuous and thus presents the respondents with a minimum of restraints. Neurman PJ, Goldie SJ, Weinstein MC. Preference-based measures in economic evaluation in health care. Annu. Rev. Public Health. 2000. 21:587-611.

Under the Health Insurance Portability and Accountability Act (HIPAA) Privacy rule, which one of the following is an example of Protected Health Information (PHI)? Select one: a. Pregnancy Status b. Social Security Number c. Laboratory Test Result d. Discharge Diagnosis

The correct answer is: Social Security Number PHI includes individually identifiable health information. The list below covers all 18 identifiers under the Privacy rule. 1. Names; 2. All geographical subdivisions smaller than a State, including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the initial three digits of a zip code, if according to the current publicly available data from the Bureau of the Census: (1) The geographic unit formed by combining all zip codes with the same three initial digits contains more than 20,000 people; and (2) The initial three digits of a zip code for all such geographic units containing 20,000 or fewer people is changed to 000. 3. All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, date of death; and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older; 4. Phone numbers; 5. Fax numbers; 6. Electronic mail addresses; 7. Social Security numbers; 8. Medical record numbers; 9. Health plan beneficiary numbers; 10. Account numbers; 11. Certificate/license numbers; 12. Vehicle identifiers and serial numbers, including license plate numbers; 13. Device identifiers and serial numbers; 14. Web Universal Resource Locators (URLs); 15. Internet Protocol (IP) address numbers; 16. Biometric identifiers, including finger and voice prints; 17. Full face photographic images and any comparable images; and 18. Any other unique identifying number, characteristic, or code (note this does not mean the unique code assigned by the investigator to code the data) https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html

Which one of the following may produce a "technology-induced" error? Select one: a. Hardware bugs b. System and user interaction c. Data mapping errors d. Logical programming errors

The correct answer is: System and user interaction Technology-induced errors are a new type of error that result from the complex interaction of health information systems and end users, when systems are used in complex healthcare settings. Traditional software testing is unlikely to detect such errors and they may only become apparent when a system is used under real conditions. Technology-induced errors may affect patient safety and lead to safety hazards. Patel, V.L., & Kaufman, D.R. (2006). Chapter 4: Cognitive science and biomedical informatics. In Shortliffe, E.H. & Cimino, J.J. (Eds.) Biomedical Informatics: Computer applications in health care and biomedicine. (page 136) Third edition. New York NY: Springer Science

Which of the following is a transaction standard? Select one: a. HL7 2.X b. CDA c. X12 d. DICOM

The correct answer is: X12 Clinical Informatics Standards involve: 1. Identifiers (for physicians, the NPI, National Provider Identity or a patient identifier-birthdate, name, social security number) 2. Transactions ASC X12N transactions: Health claims and equivalent encounter information (837), Enrollment and disenrollment in a health plan (834), Eligibility for a health plan (request 270/response 271), Healthcare payment and remittance advice (835) 3. Data exchange:HL7 2.x, HL7 3.0, FHIR, DICOM (Digital Imaging and Communications in Medicine), Devices-IEEE 1073/ISO 11073 + others, ePrescribing: NCPDP and SCRIPT. The HL7 Clinical Document (CDA) standard specifies the structure and semantics of clinical documents. 4. Terminology-diagnoses (ICD-9, ICD-10), Diagnosis Related Groups (DRGs), Laboratory-LOINC, Unified Medical Language System (UMLS) etc. Imler TD, Vreeman DJ, and Kannry J. Healthcare data standards and exchange pp. 233-253 in Clinical Informatics Study Guide: Text and Review, Finnell JT and Dixon BE, eds. New York: Springer. 2016. www.springer.co

Determining slack in Gantt chart

The critical path of a project is the longest path from start to completion, which defines the minimum time required to complete the project. Slack or float is the degree to which a task can be postponed without delaying the end of the project. Tasks that fall along the critical path have no float. In this diagram, the critical path includes tasks B and E, so B has no float. Clinical Informatics Board Review and Self Assessment (p. 288). Springer International Publishing. Kindle Edition.

The pulse information for Shara Bevs is inaccurate and you remove the row from the database. In the process, you lose the phone and address information. How is this best described? Select one: a. Missing Value b. Delete anomaly c. Update anomaly d. Normalization

The table represented is insufficiently normalized, and it is ripe for modification anomalies. A delete anomaly occurs when one piece of data is lost because another is deleted. An insert anomaly occurs when a row cannot be added to the table because information is missing. An update anomaly occurs when one instance of duplicated data is changed but other data is not. Normalization is the process of restructuring a table so that each row refers to an indivisible fact. Missing value refers to situations where no data is recorded for a variable in an observation. Pratt PJ and Adamski JJ. Concepts of Database Management, 7th ed. Cengage Publishing. 2011. http://en.wikipedia.org/wiki/Database_normalization The correct answer is: Delete anomaly

Which of the following represents "knowledge" as described in the information hierarchy model? Select one: a. Preeclampsia is a risk factor for preterm birth b. ICD-10 code of 060.10 c. 60.1 d. Early aspirin therapy reduces risk for preeclampsia and preterm birth

There are four levels in the DIKW (Data-Information-Knowledge-Wisdom) pyramid or information hierarchy model. The bottom level consists of data which are symbols, signals, or facts without meaning. Computers are able to process data, but without meaning, reasonable conclusions cannot be drawn from data. The number 60.1, without any other detail is data. ICD-10 is a terminology which provides meaning to data. Thus, a specific IDC-10 code such as 060.10 (preeclampsia) is information. Information with context provides knowledge. For example, an identified statistical association between preeclampsia and preterm birth is a clinical knowledge. Application of clinical knowledge, such as an intervention aimed at reducing preterm birth by preventing preeclampsia represents wisdom in the information hierarchy. Hoyt, R. E., & Yoshihashi, A. K. (2014). Health Informatics: Practical guide for healthcare and information technology professionals. Lulu. com. p 2, 42-7. DIKW Pyramid. (2016, January 15). In Wikipedia, The Free Encyclopedia. Retrieved 14:39, January 15, 2016, from https://en.wikipedia.org/w/index.php?title=DIKW_Pyramid&oldid=690798425 Shortliffe EH, Barnett GO. Biomedical Data: Their Acquisition, Storage and Use. In Shortliffe EH, Cimino JJ, Eds. Biomedical Informatics: Computer applications in health care and biomedicine. 4thEdition. 2014. Springer-Verlag, London. The correct answer is: Preeclampsia is a risk factor for preterm birth Cause and effect-wisdom

Data centers--tier 1 through IV

Tier 1 (basic)-single path for power and cooling (99.67% available) Tier 2 (redundancy)-single path for power and cooling with redundancy (99.74% available) Tier 3 (concurrently maintainable)-multiple power and cooling but only one path active, redundancy (9.98% available) Tier 4 (Fault tolerant)-multiple active power and cooling, redundancy (99.995% available)

API level required

Transport Layer Security 1.2 or higher

The first step in a user-centered design process for a new information system is: Select one: a. Summative evaluation with usability assessment b. User and task analysis c. Design of a low-fidelity prototype for user feedback d. Formative evaluation with think aloud

User and task analysis: For a new system, user centered design requires developing an understanding of users and their tasks to determine what goals the system needs to support and what information the users need in order to successfully achieve those goals. Both the mock-up of prototypes and various forms of evaluation, including formative evaluation methods, occur later in the design process. Patel V et al., A Primer on Aspects of Cognition for Medical Informatics. JAMIA, Volume 8(4) July 2001, Pages 324-343, https://doi.org/10.1136/jamia.2001.0080324 The correct answer is: User and task analysis

You are the clinical informatics project lead for a new private telepsychiatry facility in Alex, Oklahoma (a remote town of 550 persons). Which of the following is the most pertinent barrier to implementation of this project? Select one: a. Reimbursement issues related to having telepsychiatry practitioners from Norman, OK practice in Alex, OK b. Concern over the encroachment of telepsychiatry services on neighboring Veterans Affairs Medical Center telemedicine services c. Psychiatrist concern over the impact of telepsychiatry on their clinical workflow d. Concern about patient acceptance of behavioral health services via telepsychiatry

While regulatory and reimbursement issues are concerns for telemedicine, provider barriers have been found to be a consistent and prominent barrier. For the problem specifically, this is reinforced, as a clinical informatics project lead does not typically solve regulatory and reimbursement problems. Whitten, Pamela S., and Michael S. Mackert. "Addressing telehealth's foremost barrier: provider as initial gatekeeper." International journal of technology assessment in health care 21, no. 4 (2005): 517-521. The correct answer is: Psychiatrist concern over the impact of telepsychiatry on their clinical workflow

Which of the following is LEAST likely to result in successful workflow reengineering? (a) Analyze the process from the perspective of the desired outcome instead of the individual tasks (b) Hiring a product line supervisor to ensure that all protocols are correctly followed (c) Relieve a process bottleneck by employing more resources (d) Using a stepwise (i.e. graduated) approach to revise workflows Clinical Informatics Board Review and Self Assessment (p. 250). Springer International Publishing. Kindle Edition.

Workflow reengineering involves finding different paths to the same goal. reengineering, production simply reinforces the original protocols. Similarly, hiring new employees to relieve a bottleneck may ultimately be a part of process reengineering, but not necessarily. Workflow reengineering can not be accomplished in a stepwise fashion, It is an all-or-none proposition. Clinical Informatics Board Review and Self Assessment (p. 288). Springer International Publishing. Kindle Edition.

Running this script results in the following value for Y: Select one: a. 64 b. 128 c. 256 d. 0

X goes to 0, but Y still doubles one more time

Preventive maintenance

any activity designed to prevent failure of a system

Which U.S. government software would be most suitable for an HIE based on secure email (push) approach? Cancer Biomedical informatics Grid (caBIG) CONNECT Direct Project PubMed

cabig: tools, data, to support research and transalation in oncology connect: : DCAA compliant software for government contractors Direct Project: standards based way to send authenticated, encrypted health information over internet. ONC. Technical standards to securely push content from sender to receiver.

OSI vs. DOD model, protocols, devices/apps

device order (decreasing) servers/mail client gateway router/layer 3 switch bridge/layer 2 switch hub

IOM clinical practice guidelines.

include: development and funding process transparent process to minimize bias multidisciplinary panel (not just specialists) rigorous systemic evidence review summarizes evidence about benefits and harms explains role of values and opinions rating of evidence external review process for revision

Integrated vs. interfaced

integrated shares tables, interfaced uses HL7 integrated cheaper at signing, not long-term interfaced may not support genomics, cytogenetics, highly specialized

Bridge's 4 P's of Transition Communications (change theory)

purpose (why we are doing this) picture (what it will look and feel like when we get there) plan (details on how we will get there) part (what you can do to help) Transition theory, 3 phases saying goodbye neutral zone moving forward 4 P's to communicate

LR+ formula

sensitivity/(1-specificity)=TPR/FPR p(person with condition has certain test result)/p person without condition has certain test result

Agile vs. spiral software

spiral is sequential (small waterfall), vs. Agile is lightweight (less reliance on detailed documentation, steps of spiral)

Business Case Analysis

structured methodology to aid decision making by identifying and comparing alternatives

Consent not required

treatment, payment, operations