Domain 3 RHIA Practice Questions
As part of a large PI initiative that is occurring in a hospital, the PI team is tasked with presenting their findings to hospital administration. The PI team presents data on the number of urinary tract infections (UTIs) that were documented and coded at the facility. Hospital administration finds this information interesting but are unclear as to what the data means to the organization. Why is the hospital administration unclear about this data? a. Although the data provides important information regarding infections, the context of the data was missing from the presentation. b. Although the data seems important, administration is confused about why a PI team in concerned with UTIs. c. PI teams do not typically report their findings within the organization, so this presentation confused administration. d. PI teams are rarely concerned with clinical quality metrics and are only concerned with workflow issues.
a. Although the data provides important information regarding infections, the context of the data was missing from the presentation. Data are only meaningful in context. They must be formatted, filtered, and manipulated to be transformed into information and knowledge that can be acted on for decision-making in PI programs. In this scenario, the PI team did not provide the context regarding the data to administration in their presentation. These UTIs could have been HAIs, or patients could have been admitted to the facility with the UTI, so administration does not know why they should be concerned
University Medical Center contracts with the XYZ Corporation for a clinical information system. The hospital pays a fixed monthly fee. XYZ owns the hardware and hosts the application software using the Internet. The Medical Center accesses the system through onsite workstations. In this situation, XYZ Corporation is a(n): a. Application service provider b. Neural network c. Health information system database d. Clinician portal
a. Application service provider Application service providers (ASPs) are service firms that deliver, manage, and remotely host ("remote hosting" being a common term associated with ASPs) standardized (prepackaged) applications software through centralized servers via a network that are not exclusively but more commonly the Internet
You want to graph the average length of stay by sex and service for the month of April. Which graphic tool would you use? a. Bar graph b. Histogram c. Line graph d. Pie chart
a. Bar graph Bar charts are used to display data from one or more variables. The bars may be drawn vertically or horizontally. Bar charts are used for nominal or ordinal variables. In this case, you would be displaying the average length of stay by service and then within each service have a bar for each gender
What type of data display tool is used to display discrete categories? a. Bar graph b. Histogram c. Pie chart d. Line chart
a. Bar graph Discrete data are whole numbers that may or may not be related, so a bar graph is the best data display tool to use
The surgery department is evaluating its postoperative infection rate of 6 percent. The chief of surgery asks the quality improvement coordinator to find the postoperation infection rates of 10 similar hospitals in the same geographic region to see how the rates compare. This process is called: a. Benchmarking b. Critical pathway analysis c. Internal comparisons d. Universal precautions
a. Benchmarking Benchmarking is the systematic comparison of the products, services, and outcomes of an organization with those of a similar organization. Benchmarking comparisons also can be made using regional and national standards or some combination
What is the average of the sum of the relative weights of all patients treated during a specified time period? a. Case-mix index b. Outlier pool c. Share d. Mean qualifier
a. Case-mix index Case-mix index is the weighted average of the sum of the relative weights of all patients treated during a specified time period
This data collection tool is used when one needs to gather data on sample observations in order to detect patterns. a. Check sheet b. Ordinal data tool c. Balance sheet d. Nominal data tool
a. Check sheet A check sheet is used to gather data on sample observations in order to detect patterns. When preparing to collect data, a team should consider the four W questions: Who will collect the data? What data will be collected? Where will the data be collected? When will the data be collected? Check sheets make it possible to systematically collect a large volume of data
In purchasing an EHR system from a vendor, what does due diligence refer to? a. Checking references b. Conducting product demonstrations c. Financing the investment d. Negotiating the contract
a. Checking references Due diligence can be in the form of site visits, corporate visits, reference checks, credit checks on owners of the vendor company, and other steps needing to be performed before a final contract is negotiated to ensure that the organization is getting the product it wants
Online or real-time transaction processing (OLTP) is a functional requirement for a: a. Data repository b. Data mart c. Data display d. Data dictionary
a. Data repository Data repositories in healthcare organizations require tools designed to perform intricate data searches and retrievals using online or real-time transaction processing (OLTP)
What type of authentication is created when a person signs his or her name on a pen pad and the signature is automatically converted and affixed to a computer document? a. Digital signature b. Electronic validation c. Electronic signature d. Digital authorization key
a. Digital signature A digital signature is a digitized version of a handwritten signature. A digitized signature differs from an electronic signature in that it uses handwritten signatures on a pen pad. The actual written signature is converted into an electronic image. Digitized signatures are acceptable if allowed by state, federal, and reimbursement regulations
After evaluating the following graph, what information can be determined from these data? a. Doctor X uses code 99215 less frequently than his peers. b. Doctor X's documentation doesn't support the codes submitted. c. Doctor X overutilizes code 99213 as compared with the documentation. d. Doctor X overutilizes code 99212 as compared with his peers.
a. Doctor X uses code 99215 less frequently than his peers. These data are showing that Doctor X bills code 99213 primarily and not the other four service codes for established patients. However, the graph tells the reader nothing about Doctor X's documentation which would make answers b and c incorrect. Doctor X does use 99212 less than his peers, not more than his peers. A physician who consistently reports the same level of service for all patient encounters may look suspicious to claims auditors. With the exception of certain specialists, physicians treat all types of patients in their offices, and office treatment requires use of most of the levels of services
John Smith, who was treated as a patient at a multihospital system, has three health record numbers. The term used to describe multiple health record numbers is: a. Duplicates b. Overlay c. Overlap d. Integrity
a. Duplicates Duplicate health record numbers are when there is more than one unique identifier (for example, medical record number or person identifier) for the same person in the MPI. This causes one patient to have two or more different medical records within the same facility
Which of the following activities is likely to occur in the analysis phase of the systems development life cycle? a. Examine the current system and identify opportunities for improvement b. Send out RFPs to prospective vendors c. Negotiate a contract with the vendor d. Install necessary hardware and software
a. Examine the current system and identify opportunities for improvement In the analysis phase of the systems development life cycle (SDLC), it is important to examine the current system and identify opportunities for improvement or enhancement. Even though an initial assessment would be completed as part of the strategic information planning process, the analysis phase of the SDLC involves a more extensive evaluation
In assessing the quality of care given to patients with diabetes mellitus, the quality team collects data regarding blood sugar levels on admission and on discharge. This data is called a(n): a. Indicator b. Measurement c. Assessment d. Outcome
a. Indicator An indicator is a performance measure that enables healthcare organizations to monitor a process to determine whether it is meeting process requirements. Monitoring blood sugars on admission and discharge is an indicator of the quality of care delivered to the diabetes patient during the stay
A report developed by a PI team on the occurrence of methicillin-resistant Staphylococcus aureus infection in a neonatal intensive care unit was subsequently used by the perinatal morbidity and mortality committee in a monthly review of infant morbidity. Access to this report was possible because it was housed in the organization's: a. Information warehouse b. Comparative performance data c. PI database d. Computer hard drive
a. Information warehouse Information warehouses allow organizations to store reports, presentations, profiles, and graphics interpreted and developed from stores of data for reuse in subsequent organizational activities
A director of a health information services department plans to do a research project on motivation that involves rewarding some employees for achieving specified goals. A control group will not be rewarded for achieving the same goals. Which entity will need to approve this study? a. Institutional Review Board b. Administrative team c. Accreditation organization d. Medical staff
a. Institutional Review Board The Institutional Review Board (IRB) is a committee established to protect the rights and welfare of human research subjects involved in research activities. The IRB determines whether research is appropriate and protects human subjects as they participate in this research. The primary focus of the IRB is not on whether the type of research is appropriate for the organization to conduct but upon whether or not human subjects are adequately protected
The MPI manager has identified a pattern of duplicate health record numbers from the specimen processing area of the hospital. After spending time merging the patient information and correcting the duplicates in the patient information system, the MPI manager needs to notify which department to correct the source system data? a. Laboratory b. Radiology c. Quality management d. Registration
a. Laboratory As the HIM department merges two duplicate records together, the source system (laboratory) also must be corrected. This creates new challenges for organizations because merge functionality could be different in each system or module, which in turn creates data redundancy. Addressing ongoing errors within the MPI means an established quality measurement and maintenance program is crucial to the future of healthcare
Which one of the following is an example of a clinical information system? a. Laboratory information system b. Human resource management system c. Patient registration system d. Staff management system
a. Laboratory information system Clinical information systems (or applications) contain primarily clinical or health-related data that are used to diagnose, treat, monitor, and manage patient care. Examples of clinical applications include ancillary departmental systems (such as pharmacy, radiology, and laboratory medicine) as well as EMR systems, computerized provider order entry, medication administration, and nursing documentation
Working with the healthcare entity's integration team to ensure that ADT interfaces are properly built and tested is the responsibility of the: a. MPI manager b. EHR analyst c. IT manager d. Electronic forms manager
a. MPI manager Monitoring and managing a master patient index (MPI) also requires constant vigilance from the organization, including oversight, evaluation, and correction of errors. The overall responsibility of maintaining the MPI should be centralized and given to an individual who is detail oriented, is properly trained, has access to adequate tools, and is well versed in the organization's policies and procedures for MPI maintenance. Working with the organization's integration team to ensure ADT interfaces are properly built and tested is a key responsibility of the MPI manager
The key to an effective retention and retrieval system of health records in a facility is: a. Master patient index b. Terminal digit filing c. Microfilm d. Optical imaging
a. Master patient index The master patient index (MPI) is a permanent database including every patient ever admitted to or treated by the facility. Even though patient health records may be destroyed after legal retention periods have been met, the information contained in the MPI must be kept permanently
This Health Information Exchange (HIE) consent model requires the patient to give their consent for the inclusion of their data in the HIE. a. Opt-in b. Opt-out c. Automatic consent d. No-consent
a. Opt-in The opt-in model requires patients to specifically affirm their desire to have their data made available for exchange within an HIE. This option provides up-front control for patients since their data cannot be included unless they have agreed
Which of the following terms is defined as the proportion of people in a population who have a particular disease at a specific point in time or over a specified period of time? a. Prevalence b. Incidence c. Frequency d. Distribution
a. Prevalence The prevalence rate is the proportion of persons in a population who have a particular disease at a specific point in time or over a specified period of time. The prevalence rate describes the magnitude of an epidemic and can be an indicator of the medical resources needed in a community for the duration of the epidemic
Which of the following would be used to determine what the users need in an information system? a. Questionnaire b. Trouble ticket c. Source code d. Weighted system
a. Questionnaire Questionnaires allow for a large number of users to provide input about the needs of the system
To reduce the effect of a server crash in an EHR environment, it is advisable to: a. Set up redundant systems b. Have a storage area network c. Store data in RAID d. Have an inventory of all systems
a. Set up redundant systems To achieve availability, an EHR must have full redundancy as well as backup and network redundancy. This means that there is a duplication of all data, hardware, cables, or other components of the system. Should the primary server crash, the system switches over to the second server and can continue processing
Using the data in the following graph, we can see changes in this hospital's profile. What concerns might the hospital's quality council need to address based on these changes in their customer base? a. Staffing changes might be necessary to accommodate patients who have cultural differences. b. Data collection has improved. c. No changes in staffing are necessary because the patient mix is appropriate. d. The quality council should ask for more detailed data.
a. Staffing changes might be necessary to accommodate patients who have cultural differences. The graph shows that the Asian population has increased in the last five years, so the organization may need to adjust staffing, offer a wider variety in dietary choices, and ensure patient rights and safety are appropriate in the face of possible language barriers and cultural differences
A research instrument that is used to gather data and information from respondents in a uniform manner through the administration of a predefined and structured set of questions and possible responses is called a(n): a. Survey b. Interview c. Process measure d. Affinity diagram
a. Survey A survey is a common tool used in performance improvement to assess the level of satisfaction with a process by its customers. When designing a survey, the PI team must define the goal of the survey in clear and precise terms
The researcher's informed consent form stated that the patients' information would be anonymous. Later, in the application form for Institutional Review Board (IRB) approval, the researcher described a coding system to track respondents and nonrespondents. The IRB returned the application to the researcher with the stipulation that the informed consent must be changed. What raised the red flag? a. The description of the use of a coding system to track respondents and nonrespondents b. The application form for the IRB approval c. The researcher's informed consent form d. The description of the use of a coding system to track respondents
a. The description of the use of a coding system to track respondents and nonrespondents There is a discrepancy between the researcher's use of the term "anonymous" regarding informed consent and the researcher's intent to track respondents and nonrespondents. Anonymity demands that the researcher cannot link the response and the responder. The code would link the respondents to their data, so their data would no longer be anonymous
Assume you are the manager of a 10-physician group primary care practice. The physicians are interested in contracting with an application service provider to develop and manage patient records electronically. Which of the following statements is an indication that an application service provider (ASP) may be a good idea for this practice? a. The practice does not have the up-front capital or IT staff needed to purchase and implement a system from a health information systems vendor. b. The practice wants an electronic medical record system and wants to get into the IT management business as well. c. The practice would like to have the system up and running in a relatively short period of time (less than four months). d. The practice is not looking to purchase any additional hardware needed for an electronic medical record system.
a. The practice does not have the up-front capital or IT staff needed to purchase and implement a system from a health information systems vendor. In an application service provider (ASP) model, there is much less upfront capital outlay and fewer IT staff required in-house. In fact, the ASP acquisition strategy may be considered essentially a financing model
Community Memorial Hospital discharged nine patients on April 1. The length of stay for each patient is shown in the following table. The average length of stay for these nine patients was:PatientNumber of DaysA1B5C3D3E8F8G8H9I9 a. 5 days b. 6 days c. 8 days d. 9 days
b. 6 days The average length of stay (ALOS) is calculated from the total LOS. The total LOS divided by the number of patients discharged is the ALOS. Using the data provided, the ALOS for the 9 patients discharged on April 1 is 6 days (54/9)
If an analyst wishes to predict future ancillary charges for hip replacement patients based on the age of the patient, which of the following is a correct statement? a. Age is the dependent variable; ancillary charges is the independent variable. b. Age is the independent variable; ancillary charges is the dependent variable. c. The average ancillary charge is the best estimator. d. The two variables cannot be related.
b. Age is the independent variable; ancillary charges is the dependent variable. When examining the correlation between two variables, the strength and direction of the relationship is measured. The next step in exploring the relationship between two variables is to analyze the ability of the value of one variable to predict an outcome or value of a second variable. In this scenario, the variable that is used to predict is called the independent variable (that is, age), and the outcome or variable to be predicted is called the dependent variable (that is, ancillary charges)
Which graph is the best choice to use when comparing lengths of stay across three hospitals? a. Line graph b. Bar chart c. Pie chart d. Scatter diagram
b. Bar chart Bar charts are used to display data from one or more variables. The bars may be drawn vertically or horizontally. Bar charts are used for nominal or ordinal variables. In this case, you would be displaying the average length of stay by service and then within each service have a bar for each hospital
Which of the following represents the correct sequence (from low to high) of levels of interoperability? a. Semantic, basic, functional b. Basic, functional, semantic c. Functional, process, semantic d. Functional, semantic, basic
b. Basic, functional, semantic Interoperability is often described in levels. The NCVHS has identified three levels: basic, functional, and semantic. Basic interoperability relates to the ability to successfully transmit and receive data from one computer to another. Functional interoperability refers to sending messages between computers with a shared understanding of the structure and format of the message. The use of clinical terminologies in EHRs to provide standardized data is essential to achieving semantic interoperability
Which of the following would likely be recorded on an information systems issues log? a. Alan is present every day there is a system test. b. Betty reported receiving 25 erroneous e-mail messages. c. Dr. Brown effectively uses e-prescribing. d. John requested a supply of tamperproof paper for his office.
b. Betty reported receiving 25 erroneous e-mail messages. Because of the number of tasks and their complexity and dependencies in EHR implementation, it is important to have an issues management program. An issues management program serves to receive and document issues and track them to their resolution
Community Hospital uses barcoding technology as part of its medication management processes. Barcoding is an example of: a. Automatic recognition technology b. Character and symbol recognition technology c. Voice recognition technology d. Vector graphic data
b. Character and symbol recognition technology Character and symbol recognition technologies include bar coding, optical character recognition, and gesture recognition technologies. The bar code symbol was standardized for the healthcare industry, making it easier to adopt barcoding technology. Barcoding applications have been adopted for labels, patient wristbands, specimen containers, business/employee/patient records, library reference materials, medication packages, dietary items, paper documents, and more
The relationship between patient gender and readmission to the hospital is best displayed using a: a. Frequency chart b. Contingency table c. Bar chart d. Pie chart
b. Contingency table Contingency tables are a useful method for displaying the relationship between two categorical variables. Contingency tables are often referred to by the number of rows and columns
Using the staff turnover information in this graph, determine the next action the quality council at this hospital should take. a. Do nothing, as the data is below the external benchmark b. Coordinate a PI team to look into the cause for the high employee turnover rate in year 3 c. Coordinate a PI team to look into the cause for the drop in employee turnover rate in year 4 d. Do nothing, as the data is above the internal benchmark
b. Coordinate a PI team to look into the cause for the high employee turnover rate in year 3 The employee turnover rate is over the internal benchmark for this hospital, so a performance improvement (PI) team should be formed to determine what the causes for this increase were. This increase in the turnover rate represents an opportunity for improvement
By querying the healthcare entity data, you find that patients admitted on a weekend have a mean length of stay that is 1.3 days longer than patients who are admitted Monday through Friday. This method of finding information is called: a. Structuring query language b. Data mining c. Multidimensional data structuring d. Satisficing
b. Data mining In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set. Data mining is sometimes referred to as knowledge discovery. In healthcare, data mining may be used to determine if it is cost effective to expand facilities
Using the following data, what conclusions can you draw about Dr. Jones's outcomes compared to the OB/GYN practice group?CategoryDr. JonesOB/GYN GroupCesarean section rate15.2%11.5%Hospital-acquired infection1.7%1.5%Surgical wound infection rate3.8%0.36%Mortality rate0.57%0.07% a. Dr. Jones performed better than the OB/GYN group in all four categories. b. Dr. Jones performed poorer than the OB/GYN group in all four categories. c. Dr. Jones performed better than the OB/GYN group in all categories except mortality rate. d. Dr. Jones performed poorer than the OB/GYN group in all categories except the mortality rate.
b. Dr. Jones performed poorer than the OB/GYN group in all four categories. The data shows that Dr. Jones' outcomes are all higher than the OB/GYN group. This data indicates that Dr. Jones should be monitored for continued poor performance compared to his peer group
How are Hospital Compare measures used by CMS? a. Hospitals that score better than average receive bonus payments. b. Hospitals that report all measures receive the full payment update. c. Hospitals that perform poorly must pay a penalty. d. Hospital payment is not impacted by hospital compare indicators.
b. Hospitals that report all measures receive the full payment update. Hospital Compare reports on 139 measures of hospital quality of care for heart attack, heart failure, pneumonia, and the prevention of surgical infections. The data available at Hospital Compare is reported by hospitals to meet the requirements of the Medicare Value Based Purchasing program. Hospitals that report all measures receive full payment updates from Medicare
What is the biggest problem with using mean length of stay as a facility statistic? a. It is not accurate. b. It is influenced by outlier values. c. It is mathematically incorrect. d. It is a dependent variable.
b. It is influenced by outlier values. The mean is sensitive to extreme measures. That is, it is strongly influenced by outliers
In the data warehouse, the patient's last name and first name are entered into separate fields. This is an example of what? a. Query b. Normalization c. Key field d. "Slicing and dicing"
b. Normalization Normalization is a formal process applied to database design to determine which variables should be grouped in a table to reduce data redundancy. In this example, entering the patient's last name and first name into separate fields is normalization
A coding manager wants to display the patient types that have the most coding errors in relationship to coder years of service. The desire of the coding manager is to display how coder years of service is responsible for coding errors. The type of graph or chart best suited for this is a: a. Bar graph b. Pareto chart c. Pie chart d. Line graph
b. Pareto chart A Pareto chart is a kind of bar graph that uses data to determine priorities in problem solving. The Pareto principle states that 80 percent of costs or problems are caused by 20 percent of the patients or staff
A health information professional is preparing statistical information about the third-party payers that reimburse care in the facility. She finds the following information: Medicare reimburses 46 percent; Medicaid reimburses 13 percent; Blue Cross reimburses 21 percent; workers' compensation reimburses 1 percent; commercial plans reimburse 15 percent; and other payers or self-payers reimburse 4 percent. What is the best graphic tool to use to display this data? a. Histogram b. Pie chart c. Line graph d. Table
b. Pie chart A pie chart is an easily understood chart in which the sizes of the slices of the pie show the proportional contribution of each part. Pie charts can be used to show the component parts of a single group or variable. In this case, the intent is to show the proportion of each payer to the whole payer mix
HIM departments may be the hub of identifying, mitigating, and correcting master patient index (MPI) errors. But that information often is not shared with other departments within the healthcare entity. After identifying procedural problems that contribute to the creation of the MPI errors, which department should the MPI manager work with to correct these procedural problems? a. Administration b. Registration or patient access c. Risk management d. Radiology and laboratory
b. Registration or patient access A review of the identified duplicates and overlays often reveals procedural problems that contribute to the creation of errors. Although health information management (HIM) departments may be the hub of identifying, mitigating, and correcting master patient index (MPI) errors, that information may never be shared with the registration department. If the registration staff is not aware of the errors, how can they begin to proactively prevent the errors from occurring in the first place? Registration process improvement activities can eventually reduce work for HIM departments. In addition, monitoring new duplicates is a critical process, and tracking reports should be created and implemented. Identifying and reporting MPI errors is important; however, tracking who made the error and why will decrease the number of duplicates
If an analyst is studying the wait times at a clinic and the only list of patients available is on hard copy, which sampling technique is the easiest to use? a. Survey sampling b. Systematic sampling c. Cluster sampling d. Stratified sampling
b. Systematic sampling A systematic random sample is a simple random sample that may be generated by selecting every fifth or every tenth member of the sampling frame. In order to ensure that a systematic random sample is truly random, the sample frame should not be sorted in an order that might bias the sample
A possible justification for building an information system in-house rather than purchasing one from a vendor is that: a. It is cheaper to buy than to build b. The facility has development teams they do not want to give up c. Integration of systems will be easier d. Vendor products are not comprehensive enough
b. The facility has development teams they do not want to give up Most organizations recognize that commercial products can meet their needs and that most of these products will far surpass the functionality that could be self-developed. Still, some organizations want to at least consider the build option. Some physicians are intrigued with developing their own perfect system, and some hospitals have development teams they do not want to give up. An organization's decision to build or buy should be based on a careful review of the marketplace. Currently, it is more expensive to undertake self-development. Unless self-development is coupled with a vendor partnership that leads to commercialization, a self-developed system can be a drawback when attempting to integrate with commercial products as the organization grows, merges, or acquires affiliates
To be successful, any information system tactical plan must align with: a. Current hardware in use in the facility b. The healthcare entity's strategic plan c. IS department strategies d. Health information management initiatives
b. The healthcare entity's strategic plan It is critical that the organization's information system (IS) plans be well aligned and integrated with its overall organizational strategic plans. To develop a tactical plan for IS technology, the healthcare organization should engage in strategic IS planning
Using the admission criteria provided, determine if the following patient meets severity of illness and intensity of service criteria for admission.Severity of IllnessIntensity of ServicePersistent feverInpatient-approved surgery or procedure within 24 hours of admissionActive bleedingIntravenous medications or fluid replacementWound dehiscenceVital signs every 2 hours or more oftenJohn Smith presents to the emergency room at 1500 hours with a fever of 101 degrees F, which he has had for the last three days. He was discharged six days ago following a colon resection. X-rays show a bowel obstruction and the plan is to admit him to surgery in the morning. a. The patient does not meet both severity of illness and intensity of service criteria. b. The patient does meet both severity of illness and intensity of service criteria. c. The patient meets intensity of service criteria but not severity of illness criteria. d. The patient meets severity of illness criteria but not intensity of service criteria.
b. The patient does meet both severity of illness and intensity of service criteria. The patient meets severity of illness with the persistent fever and intensity of service with the inpatient-approved surgery scheduled within 24 hours of admission
Given the information here, the case-mix index would be:MS-DRGMDCTypeMS-DRG TitleWeightDischargesGeometricMeanArithmeticMean19104MEDChronic obstructivepulmonarydisease w CC0.9139103.13.719204MEDChronic obstructivepulmonary diseasew/o CC/MCC0.7241202.53.019304MEDSimple pneumonia &pleurisy w MCC1.3167104.25.219404MEDSimple pneumonia &pleurisy w CC0.9002203.33.919504MEDSimple pneumonia &pleurisy w/o CC/MCC0.6868102.63.1 a. 0.09 b. 0.6488 c. 0.8808 d. 88.08
c. 0.8808 The weight of each MS-DRG is multiplied by the number of discharges for that MS-DRG to arrive at the total weight for each MS-DRG. The total weights are summed and divided by the number of total discharges to arrive at the case-mix index for a hospital. Calculation is as follows: (0.9139 × 10) + (0.7241 × 20) + (1.3167 × 10) + (0.9002 × 20) + (0.6868 × 10) = 61.66/70 = 0.8808 (White 2016a, 155-156).
Community Memorial Hospital had 25 inpatient deaths, including newborns, during the month of June. The hospital had a total of 500 discharges for the same period, including deaths of adults, children, and newborns. The hospital's gross death rate for the month of June was: a. 0.05% b. 2% c. 5% d. 20%
c. 5% The gross death rate is the proportion of all hospital discharges that ended in death. It is the basic indicator of mortality in a healthcare facility. The gross death rate is calculated by dividing the total number of deaths occurring in a given time period by the total number of discharges, including deaths, for the same time period: 25/500 = 0.05 × 100 = 5%
Community Memorial Hospital discharged nine patients on April 1st. The length of stay for each patient is shown in the following table. What is the mode length of stay for this group of patients?PatientNumber of DaysA1B5C3D3E8F8G8H9I9 a. 5 days b. 6 days c. 8 days d. 9 days
c. 8 days The mode is used to indicate the most frequent observation in a frequency distribution. In this data set there are three occurrences of the value 8 and only two or less occurrences of any other value, so 8 is the mode
HIPAA mandated that healthcare business partners and covered entities implement a common standard for data and information transfer. That standard is: a. ICD-10-CM b. HL7 c. ASC X12 N d. CPT
c. ASC X12 N HIPAA mandates that healthcare-covered entities and business partners implement a common standard (ASC X12N) for the transfer of information and accept the standard-based electronic transaction. This regulation does not apply to the transfer of data and information within a healthcare organization, but it does apply to the transfer of data and information external to and between healthcare organization
In which stage of the system life cycle would data be collected from system users regarding their needs? a. Implementation b. Design c. Analysis d. Initiation
c. Analysis Systems analysis is generally the first step in the systems development life cycle after the decision to implement the system has been made. It helps determine the needs for data, storage, reporting, and functionality
Which of the following are phases of the systems development life cycle (SDLC)? a. Design, analysis, and alignment b. Maintenance, implementation, and improvement c. Analysis, design, and implementation d. Analysis, alignment, and improvement
c. Analysis, design, and implementation Although there are many different models of the SDLC, all generally include a variation of the following four phases: analysis, design, implementation, and maintenance and evaluation. Alignment and improvement are not included in the four phases of the SDLC
Which of the following is an effective method of evaluating responses to a request for proposal (RFP)? a. Testing the new system b. Negotiating contracts with all vendors and assessing the best price c. Attending user group meetings d. Visiting sites that use the systems of product competitors
c. Attending user group meetings Formal and informal mechanisms should be used to evaluate each vendor and its products. For example, the project team may hold vendor presentations, check references, attend user group meetings, and make site visits to other facilities that use the product. The purpose of these activities is to gather as much relevant information as possible to make an informed decision
If an analyst wishes to determine the root cause of claim denials during June via a random sample, what is the sampling unit? a. Patient b. Hospital c. Claim d. Payer
c. Claim Sampling is used when examining the entire population is either too time consuming or too expensive. A sample is the subset of the population or universe. The universe is the set of all units that are eligible to be sampled. A listing of all of the subjects in the universe is called the sampling frame. The universe in a sampling plan may be patients, physicians, health records, or any other unit of analysis that is studied. In this case, the sample unit is the claim
Dr. Smith orders 500 mg of penicillin by mouth three times a day for Jane Doe, who is being seen in the hospital emergency department. The computer sends an alert to Dr. Smith to tell her the patient, Jane Doe, is allergic to penicillin. What type of computer system is Dr. Smith using? a. Clinical data repository b. Data exchange standard c. Clinical decision support d. Health informatics standard
c. Clinical decision support Clinical decision support systems refer to software that processes information to help users make a clinical decision. Clinical decision support systems can identify a potential problem (for example, a drug interaction or drug allergy) and issue an alert or a reminder that includes a recommendation for specific corrected action
It is impossible to have health information interoperability or health information exchange without the following: a. 100 percent adoption of EHRs b. A federally mandated Data Use and Reciprocal Support Agreement c. Complete, publicly available standards d. ONC and CMS regulations
c. Complete, publicly available standards Complete, publicly available standards are required to be able to exchange data and information effectively. The market needs to focus on interoperability, the ability of different systems to work seamlessly. In health information, interoperability is expected to include transmitting the meaning of data
Technology that electronically stores, manages, and distributes documents that are generated in a digital format and whose output data are report-formatted and print-stream originated is called: a. Business process management (BPM) technology b. Automated forms processing technology c. Computer output laser disk (COLD) technology d. Digital signature management technology
c. Computer output laser disk (COLD) technology Computer output laser disk/enterprise report management (COLD/ERM) technology electronically stores, manages, and distributes documents that are generated in a digital format and whose output data are report-formatted and print-stream originated. COLD/ERM technology not only electronically stores the report-formatted documents but also distributes them with fax, e-mail, web, and traditional hard copy print processes
This type of chart is used to focus attention on any variation in a process and helps the team to determine whether that variation is normal or a result of special circumstances. a. Pareto chart b. Pie chart c. Control chart d. Line chart
c. Control chart Control charts can be used to measure key processes over time. Using a control chart focuses attention on any variation in a process
The computer-based process of extracting, quantifying, and filtering data that reside in a database is called: a. Autocoding b. Bar coding c. Data mining d. Intelligent character recognition
c. Data mining In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set
What architectural model of health information exchange allows participants to access data in point-to-point exchange? a. Consolidated b. Federated—consistent databases c. Federated—inconsistent databases d. Switch
c. Federated—inconsistent databases The Federated—inconsistent databases—model for HIE includes multiple enterprises agreeing to connect and share specific information in a point-to-point manner
The application of information science to the management of healthcare data and information through computer technology is referred to as: a. Data definitions b. Data resource management c. Healthcare informatics d. Clinical information systems
c. Healthcare informatics Healthcare informatics is the field of information science concerned with the management of all aspects of health data and information through the application of computers and computer technologies
Which data collection program is the basis for the CMS value-based purchasing program? a. Leapfrog b. HEDIS c. Hospital Compare d. HCUP
c. Hospital Compare
In which of the following examples does the gender of the patient constitute information rather than a data element? a. As an entry to be completed on the face sheet of the health record b. In the note "50-year-old white male" in the patient history c. In a study comparing the incidence of myocardial infarctions in black males as compared to white females d. In a study of the age distribution of lung cancer patients
c. In a study comparing the incidence of myocardial infarctions in black males as compared to white females Data are the raw elements that make up our communications. Humans have the innate ability to combine data they collect and, through all their senses, produce information (which is data that have been combined to produce value) and enhance that information with experience and trial-and-errors that produce knowledge. In this example, the gender is tied to race in the data collection that constitutes information and not a data element
During an influenza outbreak, a nursing home reports 25 new cases of influenza in a given month. These 25 cases represent 30 percent of the nursing home's population. This rate represents the: a. Distribution b. Frequency c. Incidence d. Prevalence
c. Incidence The incidence rate is a computation that compares the number of new cases of a specific disease for a given time period to the population at risk for the disease during the same time period
To ensure quality of data, the cancer committee reviews the abstracting done by the cancer registry personnel. This type of reliability check is called: a. Precision b. Recheck c. Interrater d. Construct
c. Interrater Reliability is frequently checked by having more than one person abstract data for the same case. The results are then compared to identify any discrepancies. This is called an interrater reliability method of checking. Several different people may be used to do the checking. In the cancer registry, physician members of the cancer committee are called on to check the reliability of the data
You want to graph the number of deaths due to prostate cancer from 2010 through 2017. Which graphic tool would you use? a. Frequency polygon b. Histogram c. Line graph or plot d. Pie chart
c. Line graph or plot A line graph or plot is used to display time trends. The x-axis shows the unit of time from left to right, and the y-axis measures the number of prostate cancer deaths
Which of the following indexes and databases includes patient-identifiable information? a. MEDLINE b. Clinical trials database c. Master population/patient index d. UMLS
c. Master population/patient index Master patient index (MPI) contains patient-identifiable data such as name, address, date of birth, dates of hospitalizations or encounters, name of attending physician, and health record number
The distribution in this curve is: a. Skewed left b. Bimodal c. Normal d. Skewed right
c. Normal The normal distribution is actually a theoretical family of distributions that may have any mean or any standard deviation. It is bell-shaped and symmetrical about the mean. Because it is symmetrical, 50 percent of the observations fall above the mean and 50 percent fall below it. In a normal distribution, the mean, median, and mode are equal
Which of the following allows a patient to access all or part of the health record that is maintained by the provider? a. Clinical decision support b. Digital dictation c. Patient portal d. WebMD
c. Patient portal The patient portal allows a patient to access all or part of the health record that is maintained by the patient's provider
The following data have been collected by the hospital quality council. What conclusions can be made from the data on the hospital's quality of care between the first and second quarters? Measure 1st Qtr 2nd Qtr Medication errors 3.2% 10.4% Patient falls 4.2% 8.6% Hospital-acquired infections 1.8% 4.9% Transfusion reactions 1.4% 2.5% a. Quality of care improved between the first and second quarters. b. Quality of care is about the same between the first and second quarters. c. Quality of care is declining between the first and second quarters. d. Quality of care should not be judged by these types of measures.
c. Quality of care is declining between the first and second quarters. This type of data would be found on a dashboard report provided to the hospital's board of directors. The measures show a dramatic change in patient safety issues at this organization. The board would now need to investigate to determine why these changes occurred
In carrying out the strategic plan for health IT, the step that describes what is needed to achieve the plan's goals is: a. Environmental scan b. Project plan c. Requirements analysis d. Risk analysis
c. Requirements analysis Requirements analysis is the step that identifies, in detail, the precise requirements needed for both health information technology (that is, hardware and software) and operational components (people, policy, and process) of the health information system to meet the goals specified in the strategic plan
General Hospital is performing peer reviews of its medical providers for quality outcomes of care. The hospital has over 500 providers on its medical staff. The peer review process is quite extensive to review even 10 cases for each provider. The quality department has concluded that, to accomplish this review process, it will review 20 percent of each provider's inpatient admissions to the hospital on an every-other-year rotation. In this situation, the quality department has applied which of the following techniques to its review process? a. Benchmarking b. Data analysis c. Sampling d. Skewing
c. Sampling Sometimes, the organizational characteristic or parameter about which data are being collected occurs too frequently to measure every occurrence. In this case, those collecting the data might want to use sampling techniques. Sampling is the recording of a smaller subset of observations of the characteristic or parameter, making certain, however, that a sufficient number of observations have been made to predict the overall configuration of the data
In which of the following phases of systems selection and implementation would the process of running a mock query to assess the functionality of a database be performed? a. Initial study b. Design c. Testing d. Operation
c. Testing Running a mock query would be part of application testing that ensures every function of the new computer system works. Application testing also ensures the system meets the functional requirements and other required specifications in the RFP or contract
What is the formatting problem in the following table? Medical Center Hospital Admission Types Elective 2,843 62.4 Emergency admission 942 37.6 Total 3,785 100.0 a. The variable names are missing b. The title of the table is missing c. The column headings are missing d. The column totals are inaccurate
c. The column headings are missing A table is an orderly arrangement of values that groups data into rows and columns. It should have specific, understandable headings for every column and row
The following graph of data security breaches shows a range of breaches from year one (YR-1) to year seven (YR-7). In year four (YR-4), a law came into effect for the mandatory reporting of security breaches. Given this information, which of the following is the best interpretation of the graph? a. Between YR-2 and YR-3, there were very few data security breaches. b. Security breaches were less prevalent from YR-4 to YR-7. c. The volume of security breaches cannot be adequately estimated prior to YR-4. d. In YR-4 there were more security breaches than YR-7.
c. The volume of security breaches cannot be adequately estimated prior to YR-4. Because mandatory reporting of breaches was not required until YR-4, the number of breaches cannot be adequately estimated before that time, therefore, comparisons cannot be made between data before YR-4 and data after YR-4. Practitioners and other health professionals are faced with almost insurmountable amounts of data. This information is ultimately utilized for decision making. However, given the volume, variety, and complexity of the data, there is the potential for errors in decision making. Charts and graphs can help supplement human information processes to maximize the efficiency of interpreting data while minimizing interpretation errors
At Medical Center Hospital, the master patient index system is not meeting facility needs. There are duplicate numbers and errors in patient identification information. The IS director replaces the system with a newer system from a different vendor. After several months, the new system is exhibiting many of the same problems as the old system, and the facility staff is frustrated and angry. What is the most likely cause of the problem? a. The new system has the same design flaws as the previous system. b. The old system was not properly disabled and has infected the new system. c. Underlying human and process problems were not identified and corrected prior to making a system change. d. Human error is the cause of all of the problems with both systems.
c. Underlying human and process problems were not identified and corrected prior to making a system change. The delivery of healthcare is increasingly complex; therefore, the related workflows are also increasingly complex. As the use of technology becomes critical in all aspects of patient care, understanding how the workflows within and between processes is critical. The success of information technology projects is not solely dependent on the technology, but also on the people and the process. Workflow analysis would uncover the human and process problems and should be done any time work involves multiple departments or functions and prior to identifying an information technology (IT) solution
There were 25 inpatient deaths, including newborns, at Community Memorial Hospital during the month of June. The hospital performed five autopsies during the same period. The gross autopsy rate for the hospital for June was: a. 0.02% b. 0.2% c. 5% d. 20%
d. 20% A gross autopsy rate is the proportion or percentage of deaths that are followed by the performance of autopsy. Using this data, five patients had autopsies performed out of the 25 deaths; therefore, 5/25 = 0.2 × 100 = 20%
Which of the following examples illustrates data that have been transformed into meaningful information? a. 45 percent b. 3,567 units of penicillin c. $5 million saved d. Average length of stay at Holt Hospital is 5.6 days
d. Average length of stay at Holt Hospital is 5.6 days Data are the raw elements that make up our communications. Humans have the innate ability to combine data they collect and, through all their senses, produce information (which is data that have been combined to produce value) and enhance that information with experience and trial-and-errors that produce knowledge. The average length of stay is specific to 5.6 days at Holt Hospital. This is meaningful information because it is a statistic for a specific location. The other distractors are merely data as they have no context
The user needs a list of all of the patients that were diagnosed a cerebral infarction or a cerebral hemorrhage. This is an example of a situation in which what type of search should be used? a. Structured query language b. Wildcard search c. Truncation d. Boolean search
d. Boolean search Boolean search capabilities such as "and," "or," and "not" may be used in the QBE database to narrow down the data to specifically what the user needs. In this example the query could retrieve patients who had a diagnosis cerebral infarction or cerebral hemorrhage and find all of them
Physicians use the ________ to access multiple sources of patient information within the healthcare organization's network. a. Data repository b. Clinical information system c. Data warehouse d. Clinician portal
d. Clinician portal The clinician or physician web portals were first seen as a way for clinicians to easily access (via a web browser) the healthcare provider organizations' multiple sources of structured and unstructured data from any network-connected device. Like clinical workstations, clinician or physician web portals evolved into an effective medium for providing access to multiple applications as well as the data
As a preliminary step in designing an IS strategy, it is important for the steering committee to conduct a scan of the external environment and to: a. Build security and privacy constraints b. Contact vendors for system bids c. Purchase hardware and software components d. Conduct an internal environmental assessment
d. Conduct an internal environmental assessment Challenges are those inevitable elements that pose barriers to achieving success with a health information system. Without recognizing them as early in the planning process as possible, it becomes very difficult to overcome them. An environmental scan is a process to formally identify challenges that considers both internal and external factors
The director of the health information department wanted to determine the level of physicians' satisfaction with the department's services. The director surveyed the physicians who came to the department. What type of sample is this? a. Direct b. Positive c. Guided d. Convenience
d. Convenience Researchers use convenience samples when they "conveniently" use any unit that is at hand. For example, HIM professionals investigating physician satisfaction with departmental services could interview physicians who came to the department
The technology commonly utilized for automated claims processing (sending bills directly to third-party payers) is: a. Optical character recognition b. Bar coding c. Neural networks d. Electronic data interchange
d. Electronic data interchange Electronic data interchange (EDI) allows the transfer (incoming and outgoing) of information directly from one computer to another by using flexible, standard formats. This technology was first used in healthcare for the billing function
This type of data display tool is a plotted chart of data that shows the progress of a process over time. a. Bar graph b. Histogram c. Pie chart d. Line graph or plot
d. Line graph or plot A line graph or plot may be used to display time trends. The x-axis shows the unit of time from left to right, and the y-axis measures the values of the variable being plotted
The MPI includes which of the following? a. Patient's date of birth, height, and gender b. Patient's health record number, blood pressure reading, and age c. Patient's gender, height, and weight d. Patient's date of birth, gender, and health record number
d. Patient's date of birth, gender, and health record number The MPI includes data elements necessary to identify a patient. These elements include date of birth, complete address, phone numbers, health record number, billing or account number, name of attending physician, dates of admission and discharge, disposition, marital status, gender, race, and patient's emergency contact
This analytic technique is being used by CMS to assist in prepayment audits? a. Descriptive statistics b. Graphical analysis c. Exploratory data analysis d. Predictive modeling
d. Predictive modeling Predictive modeling applies statistical techniques to determine the likelihood of certain events occurring together. Statistical methods are applied to historical data to learn the patterns in the data. These patterns are used to create models of what is most likely to occur
A request for proposal (RFP) serves two important purposes: it solidifies the planning information and healthcare entity requirements into a single document, and it: a. Allows one vendor an advantage over the other potential vendors b. Delineates the entity's system requirements in such a way that a vendor is selected without review of the entire RFP pool c. Enables the healthcare entity to make decisions quickly d. Provides valuable insights into the vendors operations and products and levels the playing field in terms of asking all the vendors the same questions
d. Provides valuable insights into the vendors operations and products and levels the playing field in terms of asking all the vendors the same questions A well-constructed RFP serves two important purposes. One is to solidify the planning information and organizational requirements into a single document, and the other is to provide valuable insights into the vendor's operations and products and to level the playing field in terms of asking all the vendors the same questions. This process requires skill and time
Which of the following do HIE participants use to search for health records on other healthcare organization systems using patient indexing and identification software? a. Admit, discharge, transfer b. Advance patient identifier c. Continuity of care document d. Record locator service
d. Record locator service The HIE's record locator service (RLS) manages the pointers to the information on the servers of the HIE participants. The pointers in a RLS can include a person identification number (person ID) and metadata. The RLS does not provide information about the record, it merely points to where it might be found. Data are not stored in a centralized database and records are only provided when queried
A researcher mined the Medicare Provider Analysis Review (MEDPAR) file. The analysis revealed trends in lengths of stay for rural hospitals. What type of investigation was the researcher conducting? a. Content analysis b. Effect size review c. Psychometric assay d. Secondary analysis
d. Secondary analysis Secondary analysis is the analysis of the original work of others. In secondary analysis, researchers reanalyze original data by combining data sets to answer new questions or by using more sophisticated statistical techniques. The work of others created the MEDPAR file
Which of the following basic services provided by an HIE entity ensures that information can be retrieved as needed? a. Consent management b. Person identification c. Registry and directory d. Secure data transport
d. Secure data transport A basic service provided by an HIE organization must be the actual transmission of the data, which is the technical networking service that provides appropriate bandwidth, latency, availability, ubiquity, and security
The use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration is called: a. Secure messaging b. Consumer informatics c. Personalized medicine d. Telehealth
d. Telehealth Telehealth is the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration
Using the admission criteria provided, determine if the following patient meets the severity of illness and intensity of service criteria for admission. Severity of Illness: Persistent fever, Active bleeding, Wound dehiscence Intensity of Service: Inpatient-approved surgery/procedure within 24 hours of admission, Intravenous medications or fluid replacement, Vital signs every 2 hours or more often Sue presents with vaginal bleeding. An ultrasound showed a missed abortion so she is being admitted to the outpatient surgery suite for a D&C. a. The patient does not meet both severity of illness and intensity of service criteria. b. The patient does meet both severity of illness and intensity of service criteria. c. The patient meets intensity of service criteria but not severity of illness. d. The patient meets severity of illness criteria but not intensity of service.
d. The patient meets severity of illness criteria but not intensity of service. The patient meets the severity of illness with the vaginal bleeding but does not meet intensity of service because the surgery is not being performed as an inpatient. She would not meet the admission criteria provided
For the following excerpt from a patient satisfaction survey, determine if in the development of this survey the designer is adhering to good survey design principles.What is your zip code? ________Sex (circle one):MaleFemaleWhat is your age?0-17 ________________________ 18-35 ________________________36-45 ________________________46-60 ________________________ a. All survey design principles were applied in the development of this survey. b. The survey design principle of consistent format was applied in the development of this survey. c. The survey design principle of mutually exclusive categories was applied in the development of this survey. d. The survey design principles were not applied in the development of this survey.
d. The survey design principles were not applied in the development of this survey. Surveys should be written at the reading level of the respondents, consistent formats should be used, all possible responses should be mutually exclusive, and terminology that the respondents understand should be incorporated. This survey used inconsistent formatting and did not have mutually exclusive responses in the age question
Which of the following is included in a request for proposal (RFP)? a. Preparing and training managers b. General product information c. Establishing an IT infrastructure d. The timeline for implementation
d. The timeline for implementation Once all requirements are determined for functionality, vendor strategy, and other elements being sought from a vendor, an organization typically compiles all of this information into a request for proposal (RFP). This solicitation to vendors usually also includes basic information about the healthcare organization, such as how many users will be using the system, the timeline for implementation, and any special contractual issues that must be addressed
A hospital is undergoing a major reconstruction project and a new director of nursing has been hired. At the same time, the nursing documentation component of the EHR has been implemented. The fact that nursing staff satisfaction scores have risen is: a. A result of anecdotal benefits of EHR b. A result of qualitative benefits of EHR c. A result of reconfiguration of the nursing units d. Uncertain due to existence of confounding variables
d. Uncertain due to existence of confounding variables In this situation there are too many changes occurring at the same time to determine what is improving the nursing staffing satisfaction scores. Any one item could be the reason for the improvement. To evaluate the impact of the electronic health record (EHR) nursing documentation component, a benefits realization study should have been utilized. This would have studied the impact of the EHR component before and after implementation
Which request for proposal (RFP) component would fit the following description: Describe how your product supports the ability to register a patient in the clinic, admit the patient using the same health record number and demographic information, and share the medication list for medication reconciliation with the nursing home to which the patient is discharged. a. Application support b. Operational requirements c. Technical specifications d. Use case
d. Use case The use case is based on the organization's redesigned processes and ask the vendor how its products would perform the inherent functions. The approach is useful for avoiding yes and no responses
Tina is the EMPI coordinator for Smithtown Healthcare, a large medical center with many satellite clinics. Because so many patients visit the clinics, sometimes new health record numbers are mistakenly assigned to them (even though they may already have a number) when they register for a particular service. As the EMPI coordinator, Tina performs all of the following tasks as part of her regular job duties except: a. Unmerging overlays b. Merging duplicate records c. Confirming the health record contains all patient visits d. Verifying insurance status
d. Verifying insurance status The challenge for facilities is to maintain a correct and current MPI so that each patient has a unique identifier number. Duplication and overlays and overlap are major problems. Healthcare facilities have hired HIM professionals as EMPI coordinators to clean and maintain EMPI systems to ensure that the correct information on the correct patient is available to the provider and others who need it. Verifying insurance status would not be part of the job duties of an EMPI coordinator
In order to effectively transmit healthcare data between a provider and a payer, both parties must adhere to which electronic data interchange standards? a. DICOM b. IEEE 1073 c. LOINC d. X12N
d. X12N X12N refers to standards adopted for electronic data interchange. In order for transmission of healthcare data between a provider and payer, both parties must adhere to these standards
