RHIA Domain III Exam Prep

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

Correct Answer: A 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 (Glondys and Kadlec 2017, 488).

A computer software program that supports a coder in assigning correct codes is called a(n): a. Encoder b. Grouper c. Automated coder d. Decision support system

Correct Answer: A An encoder is used to increase the accuracy and efficiency of the coding process. Encoders promote accuracy as well as consistency in the coding of diagnoses and procedures (Amatayakul 2017, 292).

What term is used for a centralized database that captures, sorts, and processes patient data and then sends it back to the user? a. Clinical data repository b. Data exchange standard c. Central processor d. Digital system

Correct Answer: A A clinical data repository is a centralized database that captures, sorts, and processes patient data and then sends it back to the user (Amatayakul 2017, 24).

A clinic that is expanding its service offerings and needs an individual to help design a new database will be searching for a: a. Data administrator b. Database administrator c. Data governance manager d. Data technologist

Correct Answer: A A data administrator focuses on understanding interrelationships among data in order to prepare a logical design for a database. A database administrator is an information technology specialist in database implementation and maintenance. Data governance managers are, typically, users of databases. Data technologist is not a commonly used job title, but it may be one who manages metadata (Amatayakul 2020, 414).

Dr. Jones comes into the HIM department and requests that the HIM director provide a list of all of his patients from the previous year in which the principal diagnosis of myocardial infarction was indicated. Which index would the HIM director query from to provide Dr. Jones with this information? a. Disease index b. Master patient index c. Operative index d. Physician index

Correct Answer: A A disease index is a listing in diagnosis code number order for patients discharged from the facility during a particular time period. Each patient's diagnoses are converted from a verbal description to a numerical code, usually using a coding system such as the International Classification of Diseases (ICD) (Sharp and Madlock-Brown 2020, 178).

A doctor is reviewing lab results on a patient in his office. The EHR screen displays one set of results in red with a flashing asterisk and also shows that this result is three times higher than the expected value. This is an example of a(n): a. Alert b. Dashboard c. Structured data d. Unstructured data

Correct Answer: A Alerts and reminders are provided to the physician or other healthcare provider as data are entered, thus identifying problems and key information at the point of capture rather than after review by nurses, pharmacists, or others. These alerts and reminders are controlled by clinical decision support built into the system, which is able to help prevent medication errors and improve the quality of care through its validation mechanisms (Sayles and Kavanaugh-Burke 2018, 154).

A hospital allows the use of the copy functionality in its EHR system for documentation purposes. The hospital has established explicit policies that define when the copy function may be used. Which of the following would be the best approach for conducting a retrospective analysis to determine if hospital copy policies are being followed? a. Randomly audit EHR documentation for patients readmitted within 30 days. b. Survey practitioners to determine if they are following hospital policy. c. Institute an in-service program for all hospital personnel. d. Observe the documentation practices of all clinical personnel.

Correct Answer: A Auditing a random selection of EHR documentation would be the best approach for avoiding selection bias and in determining how the copy function is being used (Houser 2020, 562).

A way to assess the quality of data in the EHR is to: a. Audit structured data entries b. Compare data in the EHR to dictated documents c. Determine an acceptable error rate d. Review data against established norms

Correct Answer: A Auditing structured data can reveal a number of potential data quality issues, such as when all choices for a structured field are the same, when a structured field is often empty. Comparing data in the EHR to dictated documents is an extremely time-consuming process and would only be used after auditing structured data; there are virtually no established norms for quality specific to a given data element, and determining an acceptable error rate is not an assessment of quality (Amatayakul 2020, 439).

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

Correct Answer: A 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 (Shaw and Carter 2019, 42).

What type of data display tool is used to display discrete categories? a. Bar graph b. Histogram c. Pie chart d. Line chart

Correct Answer: A Discrete data are whole numbers that may or may not be related, so a bar graph is the best data display tool to use (Shaw and Carter 2019, 76).

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

Correct Answer: A Information warehouses allow organizations to store reports, presentations, profiles, and graphics interpreted and developed from stores of data for reuse in subsequent organizational activities (Shaw and Carter 2019, 350).

What term is used to describe the ability of one hospital's EHR from Vendor ABC to communicate flawlessly with another hospital's EHR from Vendor XYZ without any glitches or loss of data integrity? a. Interoperability b. Electronic health record c. Health information technology d. Health information exchange

Correct Answer: A Interoperability is the ability of different information technology systems and software applications to communicate; to exchange data accurately, effectively, and consistently; and to use the information that has been exchanged (Sayles and Kavanaugh-Burke 2018, 146).

Between which two health information system applications is there the least interoperability at the present time? a. EHR in a physician office and revenue cycle management b. Lab test results and personal health records c. Nurse staffing and EHR in a large health system d. Radiology information systems and picture archiving and communication systems

Correct Answer: A Making lab test results available through a PHR was one of the first functions to illustrate interoperability. More recently, technology has helped RIS and PACS become interoperable and helped the EHR support nurse staffing (a human resource function). However, few vendors for physician office EHRs have taken steps to make EHR and RCM interoperable (in part because many offices do not actually have a fully functional RCM system and many outsource this function that will ultimately need to interoperate with the EHR for VBC) (Amatayakul 2020, 411, 415, 440).

Working with the healthcare entity's integration team to ensure that registration interfaces are properly built and tested is the responsibility of the: a. MPI manager b. EHR analyst c. IT manager d. Electronic forms manager

Correct Answer: A 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 registration interfaces are properly built and tested is a key responsibility of the MPI manager (Reynolds and Morey 2020, 132-133).

An HIM professional was conducting an audit to evaluate the timeframes for the administration of painkillers in surgical patients, and the medication administration record would be reviewed. The medication administration record would be found within which clinical software? a. Nursing b. Laboratory c. Radiology d. Pharmacy

Correct Answer: A Nursing documentation traditionally includes medication administration record. These records are maintained by nursing staff for all patients and include medication given, time, form of administration, and dose and strength (Reynolds and Morey 2020, 114).

The computer abstracting system in a facility has an edit that does not allow coders to assign obstetrical codes to male patients. This edit is called a(n): a. Preventive control b. Feedback control c. Performance measure d. Audit trail

Correct Answer: A Preventive controls are front-end processes that guide work in such a way that input and process variations are minimized. Simple things such as standard operating procedures, edits on data entered into computer-based systems, and training processes are ways to reduce the potential for error by using preventive controls (Oachs 2020, 777).

An organization's productivity standards should reflect its: a. Goals b. Vision c. Procedures d. Affinity groupings

Correct Answer: A Productivity standards should be aligned with the organization's mission and goals of the organization (Oachs 2020, 772).

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

Correct Answer: A Questionnaires allow for a large number of users to provide input about the needs of the system (Sayles and Kavanaugh-Burke 2018, 53).

Prior to the implementation of the new EHR, the HIM manager is working with the IT analyst in order to improve departmental workflows. They are using structural metadata. This type of data can be used to create which of the following? a. Dataflow diagrams b. Data mapping c. Data audit d. Data architecture

Correct Answer: A Structural metadata is the process of acquiring, storing, manipulating, and displaying data. Data models, such as entity-relationship diagrams (ERD) and dataflow diagrams (DFD) are diagrammatical or graphic tools used to help program the system and to identify areas of inefficiency (Sayles and Kavanaugh-Burke 2018, 249).

Which of the following is a task performed during system customization? a. Adjusting decision support rules b. Data conversion c. Testing d. Workflow and process improvement

Correct Answer: A System customization enables an organization to make adjustments to how software is used and displayed. Adjusting decision support rules (such as turning them off, or narrowing the specifications for a given rule) are made possible by vendor-supplied tools that do not impact the underlying software (Amatayakul 2020, 427).

What initiative has the ONC been driving through the escalation of technology and implementation and optimization of EHRs? a. Health information exchange b. False Claims Act c. HIPAA d. EMTALA

Correct Answer: A The Office of the National Coordinator (ONC) has been driving the escalation of technology through its National Strategic Framework requirement of mandating the implementation of EHRs and currently toward the acceleration of health information exchange (HIE) (Palkie 2020, 312).

A physician is interested in conducting research on herniated intervertebral disc disease. She wants to compare the success of conservative medical care versus surgical intervention. The best source of this information is the: a. Disease index b. Operative index c. Master patient index d. Trauma registry

Correct Answer: A The disease index is a listing in diagnosis code number order for patients discharged from the facility during a particular period (Sharp and Madlock-Brown 2020, 178).

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

Correct Answer: A 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 (Reynolds and Morey 2020, 132).

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

Correct Answer: A 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 (Biedermann and Dolezel 2017, 306).

The fact that a patient entered data into an EHR via a portal is: a. Administrative metadata b. Captured in a data model c. E-discovery d. Software programming

Correct Answer: A The provenance (or source) of data is considered a form of administrative metadata. The other choices relate to metadata, but are not illustrative of any given form of metadata (Amatayakul 2020, 437-438).

The benefits patients experience when using a patient portal include all of the following except being able to: a. Edit their medical record information b. View lab results c. Update demographics d. Send messages to their providers

Correct Answer: A Typically, provider-based portals uses include requesting prescription renewal, scheduling appointments, and asking questions of providers via secure messaging. Patients may also pay bills online or securely view all or portions of the electronic health record, such as current medical conditions, medications, allergies, and test results. Patients would not be able to edit their health record information (Lee-Eichenwald 2020, 365).

The term used to describe breaking data elements into the level of detail needed to retrieve the data is: a. Normalization b. Data definitions c. Primary key d. A database management system

Correct Answer: A When developing the data elements that go into a database, the fields should be normalized. Normalization is breaking the data elements into the level of detail desired by the facility. For example, last name and first name should be in separate fields as should city, state, and zip code (Sayles and Kavanaugh-Burke 2018, 34).

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

Correct Answer: B 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 (Shaw and Carter 2019, 85-86).

A data model is used to: a. Define every data element in an information system b. Describe how data are used in creating information c. Display information to users in a meaningful way d. List the attributes of data

Correct Answer: B A data model is an important part of describing how data will be processed. It has other uses as well, but the model itself does not define the data, show how it is displayed, or list attributes. Most of these functions are performed by a data dictionary (Amatayakul 2020, 437).

This type of data display tool is used to illustrate frequency distributions of continuous variables, such as age or length of stay (LOS). a. Bar graph b. Histogram c. Pie chart d. Scatter diagram

Correct Answer: B A histogram is used to display a frequency distribution. It is different from a bar graph in that a bar graph is used to display data that fall into groups or categories (nominal or ordinal data) when the categories are noncontinuous or discrete (Marc 2020, 538).

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

Correct Answer: B 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. Registration process improvement activities can eventually reduce work for HIM departments (Reynolds and Morey 2020, 133).

Which of the following is an example of an activity that a patient may complete using a patient portal? a. Bedside nursing care b. Appointment scheduling c. Direct patient care d. Emergency care records

Correct Answer: B A secure patient portal does allow for the communication between the provider and the patient and is not just a site for patients to access information. This is part of the effort to engage patients in their care. Patient are able to complete appointment scheduling through a patient portal (Biedermann and Dolezel 2017, 458).

Sam is the new HIM supervisor. His first assignment is to evaluate the efficiency and effectiveness of his work unit. He has met with the unit's customers to determine their expectations and met with his staff to understand their roles. In setting up systems to measure work performance, it is critical for Sam to establish: a. Proper ergonomics b. Standards c. Action plans d. Work distribution charts

Correct Answer: B A standard is performance criteria designed for the purpose of assessing factors such as quality, productivity, and performance (Oachs 2020, 771).

A community hospital looking to cut cost out of a vendor's proposal for health IT should consider: a. Acquiring its own hardware b. Conducting process improvement in advance to improve return on investment c. Extending implementation over a longer period of time d. Writing its own software

Correct Answer: B Acquiring hardware is more costly than getting hardware from the vendor, which is generally discounted based on volume. Extending implementation over a longer period of time is likely to create additional costs because of providers' poor acceptance of an "incomplete" system, a lack of return on investment, and potential cost of retrofitting components adopted earlier to those adopted later. The vendor is selling proprietary software that cannot be rewritten. Writing one's own software is an alternative to buying from a vendor, but has proven to be much more costly than a vended product. The best way to minimize cost is to gain user acceptance quickly. Doing so usually requires up front, personal process improvement support that an organization could rely on a vendor for (if the vendor has the expertise to offer process improvement support), do itself, or hire out for less than what the vendor would charge (Amatayakul 2020, 409, 433).

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.

Correct Answer: B 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 (Amatayakul 2017, 258).

Community Hospital uses barcoding technology as part of its medication management processes. Barcoding is an example of: a. Radio frequency identification technology b. Character and symbol recognition technology c. Voice recognition technology d. Vector graphic data

Correct Answer: B 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 (Lee-Eichenwald 2020, 362).

Consumer informatics is focused on: a. Consumer activation b. Information structures and processes c. Personalized medicine d. Engagement

Correct Answer: B Consumer health informatics is a field devoted to informatics from multiple consumer or patient views and includes patient-focused informatics, health literacy, and consumer education, with a focus on information structures and processes that empower consumers to manage their own health (AMIA n.d.; Sandefer 2020, 447).

Allowing different health information systems to work together within and across organizational boundaries is referred to as: a. Telehealth b. Interoperability c. Informatics d. Interfaces

Correct Answer: B Health informatics must consider the development of standards for software to be used in the EHR and the exchange of data. Compatibility and interoperability, allowing different health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities, are a key focus in health informatics (Biedermann and Dolezel 2017, 22).

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

Correct Answer: B 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 (White 2020b, 520).

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

Correct Answer: B 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 (Palkie 2020a, 157).

Which of the following is an organization that develops standards related to the interoperability of health information technology? a. National Health Information Network b. National Committee on Vital and Health Statistics c. Health Level 7 d. EHR Collaborative

Correct Answer: C Health Level 7 (HL7) is a nonprofit organization that develops standards for interoperability of health information technology (Fahrenholz 2017a, 63).

The performance standard "Complete five birth certificates per hour" is an example of a: a. Quality standard b. Quantity standard c. Joint Commission standard d. Compliance standard

Correct Answer: B Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions. In the scenario, completing five birth certificates per hour is identifying the quantity of work rather than how well the work is being performed so it is a quantity standard (Oachs 2020, 773).

The performance standard "Transcribe 1,500 lines per day" is an example of a: a. Quality standard b. Quantity standard c. Joint Commission standard d. Compliance standard

Correct Answer: B Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions. In the scenario, transcribing 1,500 lines per day is identifying the quantity of work rather than how well the work is being performed so it is a quantity standard (Oachs 2020, 773).

A requirements specification that lists what is needed from the vendor to support interoperability is necessary to: a. Create a checklist of user concerns about information systems b. Identify specific features and functions that must be in an information system c. Make a migration path for future phases of information systems d. Verify that an information system works as anticipated

Correct Answer: B Requirements refer to those elements that must exist; hence, the features and functions that must be in an information system should be included in a requirements specification (among other things) (Amatayakul 2020, 423).

An example of EHR data stewardship that would be required of the average healthcare professional is: a. Contributing to the design and development of data requirements for an EHR b. Ensuring that structured data is entered when such a choice is available in an EHR c. Maintaining EHR data in an appropriately configured information system d. Not sharing EHR data with others who have a need to know

Correct Answer: B Stewardship refers to taking care of something you own or have been entrusted with. Given the choices here, EHR data stewardship is exemplified by ensuring proper data entry; contributing to design and maintaining data in an information system are beyond the requirements of the average healthcare professional and not sharing data appropriately is actually not good data stewardship (Amatayakul 2020, 438-439).

Which of the following statements is true of structured query language (SQL)? a. It is both a data manipulation and data back-up mechanism. b. It defines data elements and manipulates and controls data. c. It is the computer language associated with document imaging. d. Users are not able to query a relational database.

Correct Answer: B Structured query language (SQL) includes both data dictionary language and data manipulation language components and is used to create and manipulate relational databases (Sayles and Kavanaugh-Burke 2018, 29).

A coding service had 400 discharged accounts to code in March. The service coded 200 within 3 days, 100 within 5 days, 50 within 8 days, and 50 within 10 days. The average turnaround time for coding in March was: a. 3 days b. 5 days c. 6.5 days d. 9 days

Correct Answer: B The average turnaround time was calculated by dividing the total response days attributed to the volume of routine requests that were responded to within the reporting period by the volume of routine requests responded to. The calculation is: (200 × 3) + (100 × 5) + (50 × 8) + (50 × 10)/400 = 5 days (Oachs 2020, 778).

Kelly, the CDI specialist, is evaluating the information used by the coding professionals when they need to code various surgeries. She is particularly interested in the time lag between the actual surgical procedure and the determination of the pathology diagnosis. In which information system would the data element "principal procedure" be found? a. Transcription system b. Encoder/grouper c. Data quality indicator d. Tumor registry

Correct Answer: B The encoder is specialty software used by coders to select the appropriate code for the diagnosis(es) and procedure(s) supported by the health record. A grouper is a computer program that uses specific data elements to assign the diagnostic and procedural codes entered into the encoder into the appropriate Medicare severity diagnosis-related group (MS-DRG) or other diagnosis-related group (DRG) (Sayles and Kavanaugh-Burke 2020, 89-90).

The health information services department at Medical Center Hospital has identified problems with its work processes. Too much time is spent on unimportant tasks, there is duplication of effort, and task assignment is uneven in quality and volume among employees. What should the manager do? a. The manager should have each employee complete a serial work request. b. The manager should have each employee complete a work distribution chart. c. The manager should have the employees complete a use case analysis. d. The manager should develop a flow process chart.

Correct Answer: B The work distribution chart should be completed by the employee and it includes all responsible task content as well as hours spent on tasks over a designated period of time (Oachs 2020, 766).

Providing a process's policy and procedure guide to a user who has never used the information system and then asking the user to perform the process could be used in what type of testing? a. Application b. Documentation c. Volume d. Acceptance

Correct Answer: B These documents should be followed during the testing process to ensure that the instructions in the documents are accurate (Sayles and Kavanaugh Burke 2018, 75).

What must be in place to enhance the retrieval process for scanned documents? a. Electronic signature b. Indexing system c. RFID device d. Table of contents

Correct Answer: B To enhance retrieval of scanned documents, some form of indexing needs to take place in order to organize the documents. Ideally, each form that is scanned or otherwise created should have a bar code or some other forms recognition feature, or features, associated with it (Amatayakul 2017, 285).

In what condition is it more suitable to present data as a table instead of a graph? a. When the trend and the exact numeric value are important to the interpretation b. When the trend in values is most important c. When it is required to know the exact numeric value of a variable d. When the exact numeric value is not important to an interpretation

Correct Answer: C A chart offers the advantage of seeing the general trend of data and comparing differences in data between groups or over time. However, the precise numeric values are more easily discerned when reading a table (Marc 2020, 529-530).

Community Hospital just added a new system that changed the way data move throughout the facility. Which of the following would need to be updated to reflect this change? a. Data dictionary b. Entity relationship diagram c. Dataflow diagram d. Semantic object model

Correct Answer: C A data flow diagram is a diagram of how data flows in the database. The data flow diagram is a good way to show management and other nontechnical users the system design (Sayles and Kavanaugh-Burke 2018, 33).

What trend can be summarized from the line plot shown in the chart? a. The length of stay has increased for hospital A and decreased for hospital B since the first quarter. b. The length of stay for both hospitals decreased during the third quarter. c. The length of stay has decreased for hospital A and increased for hospital B since the first quarter. d. The length of stay for both hospitals increased during the third quarter.

Correct Answer: C A line plot is used for two main purposes: (1) to present trends or patterns in the number of occurrences between groups or (2) to present trends or patterns in the mean of a variable between groups. Typically, the change of a variable over time is compared. In this case, the trend that can be summarized by this line plot is that the LOS for Hospital B has increased and for Hospital a has decreased since the 1st quarter (Marc 2020, 537).

Which of the following lists represents recommended core data elements for the master patient index? a. Date of birth, revenue code, accession number, and address b. Name, address, revenue code, and accession number c. Name, gender, address, and date of birth d. Gender, address, accession number, and charge code

Correct Answer: C A master patient index (MPI) is an index of known patients within a single organization whose visits are linked together by a single identifier, typically the medical records number. Some recommended core data elements for the MPI are: name, address, gender, date of birth, and many others. Accession number, revenue code, and charge code are not recommended core data elements for the MPI (Reynolds and Morey 2020, 132).

Sue enters her daily blood sugar results into a system to allow her provider to continue monitoring her diabetes. This system is called: a. Chart conversion b. Preadmission system c. Patient portal d. Clinical database

Correct Answer: C A patient portal is a secure method of communication between the healthcare provider and the patient, just the providers, or the provider and the payer. The patient-provider portal may include secure e-mail or remote access to test results and provide patient monitoring. Monitoring may include tracking blood sugar for patients with diabetes mellitus (Sayles and Kavanuagh- Burke 2018, 154).

Algorithms are used to match duplicate patients in which the following information systems? a. Decision support system b. Executive information system c. Master patient index system d. Grouping system

Correct Answer: C Algorithms are used by organizations to determine the probability of a duplicate in order to identify potential duplicate MPI entries (Sayles and Kavanaugh-Burke 2018, 117).

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

Correct Answer: C 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 (Amatayakul 2017, 22-23).

An HIM professional takes data on denials that have been received by the healthcare facility over the past year. After manipulating the data, she learns that patients of Dr. Smith account for 30 percent of all denials. She schedules a meeting with Dr. Smith to discuss the matter. What process is the HIM professional conducting? a. Data informatics b. Data use c. Data analytics d. Data management

Correct Answer: C Data analytics is analyzing data (in this case healthcare data) and turning it into information and knowledge that can be used in decision-making (Sayles and Kavanaugh-Burke 2018, 274).

What process must Colin, the HIM operations manager, perform to ensure that all patient information is contained within the correct electronic file in the EHR? a. Data modeling b. Data mapping c. Data audit d. Data architecture

Correct Answer: C Data audit is an organizational procedure for monitoring the quality of data by analyzing reports for anomalies, inaccuracies, and missing data (Sayles and Kavanaugh-Burke 2018, 248).

The nurse manager on the internal medicine unit of the hospital noticed that Dr. Smith in the ED admits many patients to the internal medicine unit. She is wondering if he admits patients to the hospital from the ED more often than other physicians. What type of analysis should be done to answer her question? a. Data warehousing b. Data governance c. Data mining d. Data modeling

Correct Answer: C Data mining is a technique of data analytics where the analyst determines any trends and identifies patterns in the data (White 2020b, 520).

The process of integrating healthcare facility systems requires the creation of: a. Data warehouses b. E-health initiatives c. Enterprise master patient indexes d. Electronic data interchange

Correct Answer: C Enterprise master patient indexes (EMPIs) provide access to multiple repositories of information from overlapping patient populations that are maintained in separate systems and databases. This occurs through an indexing scheme to all unique patient identification numbers and information in all the organizations' databases. As such, EMPIs become the cornerstones of healthcare system integration projects (Reynolds and Morey 2020, 132).

Which of the following basic services provided by an HIE entity identifies participating users and systems? a. Identity management b. Person identification c. Registry and directory d. Secure data transport

Correct Answer: C For whatever architecture an HIE organization may have, there needs to be a way to identify participants, which may include individual providers, representatives of payer organizations, and patients or consumers, as well as organizational entities and their information systems. This service is called registry and directory (Amatayakul 2017, 418-419).

What type of graph is the following, which is used to present the frequency distribution of a single numeric variable? a. Box plot b. Bar plot c. Histogram d. Line plot

Correct Answer: C Histograms are used to present the distribution of numeric data. The numeric variable is broken down into groups based on specific ranges of values to establish the widths of each bar in a histogram. The height of each bar represents the frequency or density of each of the binned groups. The distribution can be described as normally distributed when the pattern follows a bell-shaped pattern (Marc 2020, 538).

The generic formula for calculating rate of occurrence is used to calculate hospital-acquired infections in an intensive care unit in a given month. If the number of hospital-acquired infections is the numerator, the denominator would be the: a. Number of patients who died of infection b. Number of deaths in the ICU c. Number of discharges (including deaths) of ICU patients d. Total number of hospital discharges

Correct Answer: C Hospital-acquired (nosocomial) infection rates may be calculated for the entire hospital or for a specific unit in the hospital. They also may be calculated for the specific types of infections. Ideally, the hospital should strive for an infection rate of 0.0 percent. The formula for calculating the hospital-acquired, or nosocomial, infection rate is: Total number of hospital-acquired infections for a given period/Total number of discharges, including deaths, for the same period × 100 (Edgerton 2020, 490).

What is the term for health records maintained by patients or their families? a. Electronic health records b. Mixed-media records c. Personal health records d. Longitudinal health records

Correct Answer: C Personal health records electronically populate elements or subsets of protected health information (PHI) from provider organization databases into the electronic records of authorized patients, their families, other providers, and sometimes health payers and employers. A range of people and groups maintain the records, including the patients, their families, and other providers (Reynolds and Morey 2020, 117).

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

Correct Answer: C 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 (Houser 2020, 571).

Due to an influenza epidemic in Smithtown, the hospital is almost at full capacity. Which information system would be used to efficiently manage resources such as personnel, beds, and appointments of surgeries and CT scans, to coordinate equipment and staff as needed? a. Registration—admission, discharge, transfer b. Financial c. Scheduling d. Administrative

Correct Answer: C Scheduling systems are used to control the use of resources throughout the healthcare facility. These resources can include staff, equipment, rooms, and more. Scheduling systems may be centralized or independent (Sayles and Kavanaugh-Burke 2020, 118).

System configuration refers to a process of: a. Controlling what changes are made to a system b. Creating a migration path that describes the system development life cycle c. Preparing underlying software for the specific organization in which a system is being implemented d. Writing software to modify the system to meet unique needs of a given organization's users

Correct Answer: C System configuration is a task performed by a vendor to assure that an application acquired from a vendor can then be customized by the organization that will be using it (Amatayakul 2020, 427).

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

Correct Answer: C The Federated—inconsistent databases—model for HIE includes multiple enterprises agreeing to connect and share specific information in a point-to-point manner (Amatayakul 2017, 417-418).

When adopting value-based care, what technology helps healthcare professionals appropriately use financial information that may impact their choice of drugs, referrals, need for care coordination, and other factors for their patients? a. Case management applications b. Cost accounting system c. Integration of EHR and RCM d. Patient accounting system

Correct Answer: C The choices listed here all address financial management of organizations except the integration of EHR and RCM which supports healthcare professionals in care delivery (Amatayakul 2020, 418).

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%

Correct Answer: C 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% (Edgerton 2020, 487).

Which of the following would not be done with a master patient index (MPI) system? a. Merging duplicate health record numbers b. Identifying discharge dates c. Printing outpatient general consent forms d. Looking up health record numbers

Correct Answer: C The master patient index (MPI) is a patient-identifying directory referencing all patients related to an organization and which also serves as a link to the patient record or information, facilitates patient identification, and assists in maintaining a longitudinal patient record from birth to death (Sayles and Kavanaugh-Burke 2018,115-116).

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? a. 5 days b. 6 days c. 8 days d. 9 days

Correct Answer: C 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 (Edgerton 2020, 477-478).

The distribution in this curve is: a. Skewed left b. Bimodal c. Normal d. Skewed right

Correct Answer: C 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 (White 2020b, 512).

The distinguishing feature of a results management application is that it: a. Captures charges for diagnostic studies and sends them to a billing system b. Directs the work of the departments that produce results of diagnostic studies c. Enables results of a diagnostic study to be compared and displayed with other data d. Provides diagnostic study information in viewable form

Correct Answer: C The result management application enables the results of diagnostic studies to be compared and displayed with other data (Amatayakul 2017, 14).

Which of the following is an operational element that should be included in a migration path for a hospital with an existing EHR and wishing to improve its population health data for value-based care reimbursement? a. Acquisition of a clinical data warehouse b. Building a data dictionary that encompasses data needs across the continuum c. Coordinating the collection and use of social determinants of health d. Supporting e-prescribing from computerized provider order entry systems

Correct Answer: C The sample migration path includes the applications of SDOH and population health. An operational element that should also be in place should be determining how SDOH will be collected and used (Amatayakul 2020, 416-418).

Given the information here, the case-mix index would be: a. 0.09 b. 0.6488 c. 0.8808 d. 88.08

Correct Answer: C 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).

What type of interoperability addresses the medical words, phrases, and terms used in healthcare and their definitions so that there is clear and consistent usage among all EHR systems? a. Process b. Technical c. Semantic d. Syntactic

Correct Answer: C This process involves the use of standardized terminologies, such as SNOMED-CT, to provide clarity, consistency, and appropriate meaning in HIE (Sayles and Kavanaugh-Burke 2018, 183).

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%

Correct Answer: D 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% (Edgerton 2020, 489).

Which graph is the best choice when exploring the relationship between length of stay and charge for a set of patients? a. Line graph b. Bar chart c. Pie chart d. Scatter diagram

Correct Answer: D A scatter diagram is a data analysis tool used to plot points of two variables suspected of being related to each other in some way (Oachs 2020, 789).

A single point of personalized web access through which to find and deliver information, applications, and services is called a(n): a. Keyhole b. Entry way c. WWW d. Portal

Correct Answer: D A web portal is a single point of personalized access (an entryway) through which to find and deliver information (content), applications, and services. Web portals began in the consumer market as an integration strategy rather than a solution. Portals offered users of the large, public Internet service provider websites, fast, centralized access (via a web browser) to an array of Internet services and information found on those websites (Lee-Eichenwald 2020, 365).

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

Correct Answer: D 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 (Sayles and Kavanaugh-Burke 2018, 211).

Which of the following outcomes most likely results from a data entry error in the MPI? a. John Stevenson was sent home with a prescription to continue 0.625 Digoxin instead of the 0.0625 dosage that he was initially prescribed. b. John Stevenson was assigned to room 1203 instead of 1213. c. John Stevenson was diagnosed with indigestion instead of appendicitis. d. John Stevenson was entered into the system as a new patient and assigned a new medical record number instead of being matched to the John W. Stevenson already in the system and keeping his current medical record number.

Correct Answer: D If an admission clerk is not careful about reviewing patient accounts with the same name and other identifying elements in the MPI, then a new account for the patient will be created under a new medical record number. The physician will then not have the information from any previous admissions to review and utilize for the current admission (Reynolds and Morey 2020, 132).

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

Correct Answer: D 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 (Amatayakul 2017, 106).

Hospitals often use master patient indexes to do which of the following? a. Analyze population-based data b. Determine survival rates c. Evaluate physicians d. Determine whether a patient has been seen in the facility before

Correct Answer: D Master patient indexes (MPI) contain important patient health information enabling facilities to retrieve patient health data quickly. The MPI allows a hospital to determine whether a patient has been seen in the facility before (Sharp and Madlock-Brown 2020, 177).

The root cause of poor quality of data in the EHR can be determined by: a. Benchmarking against best practices b. Determining patient mortality rates c. Measuring patient care outcomes d. Observing how an EHR is used

Correct Answer: D Observing how an EHR is used, such as whether comment fields are frequently used when structured data should have been used or first choice in a list is selected over a choice that is more specific, is the best way to determine root cause of poor quality of data. Other choices may be indicators of poor quality but also include other factors as well (Amatayakul 2020, 439).

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. 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.

Correct Answer: D 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 (Shaw and Carter 2019, 118).

A radiology department is planning to develop a remote clinic and transmit images for diagnostic purposes. The most important set of standards to implement for image transmission is: a. X12N b. LOINC c. IEEE 1073 d. DICOM

Correct Answer: D The Digital Imaging and Communications in Medicine (DICOM) standard supports retrieval of information from imaging devices and equipment to diagnostic and review workstations as well as short-term and long-term storage systems (Amatayakul 2017, 404-405).

In order for health information exchange (HIE) participants to search for health records on each of the other systems using patient indexing and identification software, the systems must be linked by a(n): a. Primary key interface (PKI) b. Application programming interface (API) c. Continuity of care record (CCR) d. Record locator service (RLS)

Correct Answer: D 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 (Lee-Eichenwald 2020, 388-389).

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

Correct Answer: D 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 (Reynolds and Morey 2020, 132-133).

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

Correct Answer: D 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 (Reynolds and Morey 2020, 132).

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 web portal

Correct Answer: D 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 (Lee-Eichenwald 2020, 365).

Using the admission criteria provided, determine if the following patient meets the severity of illness and intensity of service criteria for admission. 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.

Correct Answer: D 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 (Shaw and Carter 2019, 143).

The information system controlled by the healthcare facility that allows patients to register using their own electronic device is known as: a. Personal health record b. Wearable device c. Social media d. Patient portal

Correct Answer: D The patient portal allows a patient to access all or part of the health record that is maintained by the patient's provider (Amatayakul 2017, 15).

The performance standard to "respond to release of information requests for continuing care in one working day 95 percent of the time" is an example of a: a. Qualitative standard b. Quantitative standard c. Joint Commission standard d. Compliance standard

Correct Answer: A Qualitative standards specify the level of service from a function such as accuracy rate, error rate, turnaround time, and response time In this case, timely response to release of information requests can indirectly impact patient care. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the health information systems (HIS) functions (Oachs 2020, 772).

HIE ________ is concerned with the establishment of a shared set of behaviors and standards that enable health information exchange among a HIE's participants. a. Governance b. Trust community c. Workflows d. Interoperability standards

Correct Answer: A Agreeing on standards and how they are to be implemented for successful mapping between systems is an important part of governance (Lee-Eichenwald 2020, 387).

Healthright Clinic, a large IDS, is evaluating the processes of patient care and patient outcomes in pediatrics. It is using software to help solve problems and check if the care given meets established guidelines. What method or tool is in the software that helps in this process? a. Algorithms b. Data warehouses c. Data repositories d. Scheduling

Correct Answer: A Algorithms are used by healthcare facilities and are relatively short computer programs of rules or procedures containing conditional logic for solving a problem or accomplishing a task. There are also guideline algorithms concerning rules for evaluating patient care against published guidelines (Sayles and Kavanaugh-Burke 2018, 117).

The decision has been made to perform data mining to determine where the skilled nursing facility is profitable and where there is a loss. Identify a data mining technique that could be used. a. Association rule learning b. Normalization c. Computer-aided software engineering d. Data modeling

Correct Answer: A Association rule learning is a type of data mining identifies interesting relationships between two concepts in the database. For example, it may identify that patients who are treated with drug A have a better outcome than patients who are treated with drug B (Sayles and Kavanaugh- Burke 2018, 38).

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

Correct Answer: A Bar graphs 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 (White 2020a, 209).

What component of an EHR provides communication between clinical and administrative staff members, offers access to various results reporting from lab and radiology, and even communicates with patients? a. Clinical messaging b. Clinical decision support c. Document management system d. Registration—admission, discharge, transfer

Correct Answer: A Clinical messaging is the function of electronically delivering data and automating the workflow around the management of clinical data. Clinical messages can use e-mail, portals, virtual private networks, and other means to provide the secure means of communication needed for patient information. These messages are shared in such a way as to protect the privacy of the patient (Sayles and Kavanaugh-Burke 2018, 154).

A healthcare facility has decided to adopt a tool that helps with multidisciplinary care planning. What tool meets these criteria? a. Clinical pathways b. Clinical practice guidelines c. Clinical provider order entry d. Electronic health record

Correct Answer: A Clinical pathways are a tool designed to coordinate multidisciplinary care planning for specific diagnoses and treatments (Sayles and Kavanaugh-Burke 2018, 6).

How are employee performance standards used? a. To communicate performance expectations b. To assign daily work c. To describe the elements of a job d. To prepare a job advertisement

Correct Answer: A Standards that are measurable and relevant to an employee's overall performance are helpful in setting clear expectations. They also are useful in providing constructive feedback (LeBlanc 2020, 701).

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.

Correct Answer: A 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 (Shaw and Carter 2019, 348).

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

Correct Answer: A 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 (Reynolds and Morey 2020, 132-133).

A network made accessible to trusted individuals outside of the facility is called a(n): a. Extranet b. Intranet c. VPN d. LAN

Correct Answer: A Extranets are networks that connect a given organization to its customers and business partners or suppliers (business associates in healthcare). Although extranets send information over public networks, requiring a greater level of security, access to them is still restricted to the services and persons authorized (Lee-Eichenwald 2020, 366).

For an EHR to provide robust clinical decision support, what critical element must be present? a. Structured data b. Internet connection c. Physician portal d. Standard vocabulary

Correct Answer: A If an EHR is to provide clinical decision support it requires two things: structured data and a clinical data repository (Sayles and Kavanaugh Burke 2018, 114).

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.

Correct Answer: A 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 (Amatayakul 2020, 424).

Which of the following is the goal of an MPI ongoing maintenance program? a. To maintain low creation rates for duplicates, overlaps, and overlays b. To maintain the readmission rate for the facility c. To carry out treatment, payment, and operations d. To ensure appropriate state regulations of insurance and health plans

Correct Answer: A MPI management must include continuous maintenance and correction of data integrity problems. Ongoing education of registration and scheduling staff is critical to maintaining low creation rates for duplicates, overlays, and other EMPI data integrity problems (Reynolds and Morey 2020, 132-133).

Identify the true statement regarding training. a. A variety of methods should be used to accommodate different learning styles. b. Training should be limited to the information system only. c. Training should be performed a minimum of six months prior to implementation of the information system. d. In order to facilitate training, all employees should receive the exact same training regardless of their position.

Correct Answer: A People learn best in different ways, such as auditorily and visually. To accommodate these differences, a variety of methods should be used in training (Sayles and Kavanaugh-Burke 2018, 76).

What sets the acceptable level of quantity and quality for each function of a job? a. Performance standards b. Position descriptions c. Job procedures d. Job evaluation

Correct Answer: A Performance standards are often developed for the key functions of the job and set the quantity and quality for each job function (LeBlanc 2020, 700).

Which application uses statistical techniques to determine the likelihood of certain events occurring together? a. Predictive modeling b. Standard deviation c. T-test d. Serial numbering

Correct Answer: A Predictive modeling applies statistical techniques to determine the likelihood of certain events occurring together (White 2016a, 7-8).

The MPI has had numerous errors in which the last name field is filled with a date of birth. What is a preventive control that may help this situation? a. An edit allowing only alphabetic entries could be added to the name field. b. A report could be run showing which name fields had a number in them, and those errors could be fixed. c. A report could be run showing which staff member entered the numeric data in the last name field; the supervisor could then discuss with the staff. d. An audit could be performed to validate the issue.

Correct Answer: A Preventive controls are front end processes that guide work in such a way that input and process variations are minimized. In the list of possible answers, only adding an edit occurs at the front end to prevent the error from happening. The reporting and audit are after the error occurred and considered feedback controls (Oachs 2020, 777).

A super user of health IT has complained to her supervisor that she is being asked by a physician to perform his data entry. What should the super user's role be? a. Aid others in using a new system during go-live and getting to adoption b. Serve as a scribe for physicians who are new to data entry c. Train users to learn how to use the system prior to go-live d. Troubleshoot issues with the system that did not come to light during testing

Correct Answer: A Super users are individuals with normal jobs who happen to be skilled at learning new information technology and can help others master new technology; they are not intended to replace scribes, trainers, or technicians (Amatayakul 2020, 421).

A quality coding review that is based on specific problems identified during an initial baseline review in a hospital is called a(n): a. Focused coding review b. Compliance initiative c. Internal audit d. Concurrent review

Correct Answer: A The HIM department can plan focused reviews based on specific problem areas after the initial baseline review has been completed. This would be called a focused coding review (Schraffenberger and Kuehn 2011, 314-315).

Dr. Kotter treats highly unusual medical cases requiring many laboratory, radiology, and other diagnostic tests. Hospital administration wants to determine if additional facilities, personnel, and equipment are needed to meet current and future community demands. Which information system would be helpful in this scenario? a. Decision support system b. Registration—admission, discharge, transfer c. Clinical documentation improvement d. Executive information system

Correct Answer: A The decision support system (DSS) is an information system that gathers data from a variety of sources and assists in providing structure to the data by using various analytical models and visual tools in order to facilitate and improve the ultimate outcome in decision-making tasks associated with the nonroutine and nonrepetitive problems (Sayles and Kavanaugh-Burke 2018, 109).

A physician office is implementing a vendor's personal health record system to be used by a majority of patients in order to help improve the office's achievement of value-based care. What technology would help facilitate this goal? a. Patient portal b. Preadmission system c. Clinical database d. Chart conversion

Correct Answer: A The patient portal allows a patient to access all or part of the health record that is maintained by the patient's provider (Amatayakul 2017, 15).

Which component of the EHR is designed to track and report outbreaks of infectious diseases and childhood immunization levels to public health officials? a. Population health b. Continuity of care record c. Results reporting d. Health information exchange

Correct Answer: A The population health component in an EHR is designed to capture and report healthcare data that are used for public health purposes. It allows the healthcare provider to report infectious diseases, immunizations, cancer, and other reportable conditions to public health officials. This reporting is required at the local, state, and national levels and includes infectious diseases. A population health system also can connect with public health officials to receive alerts regarding health issues (Sayles and Kavanaugh-Burke 2018, 156).

The HIM director is performing a staffing analysis to determine the number of employees needed to prep, scan, index, and carry out quality control on scanned medical records. Given a turnaround time of 24 hours and an average number of 48,000 images to be captured and considering the benchmarks listed here, what is the least number of employees the department needs, with each employee working an eight-hour shift? a. 25 employees b. 36 employees c. 36.1 employees d. 37 employees

Correct Answer: A The staffing level is determined by dividing the number of images by the expected productivity. An FTE is the total number of workers, including part-time, in an area as the equivalent of full-time positions. Divide 48,000 by maximum standard work per hour for each function then add up the calculated hours for each function and divide by 8 (White 2020a, 157).

The HIM director is on the design team for the CPOE system. During a user interface design session, a sample of the electronic system is demonstrated. Two of the physicians are concerned about the overuse of alerts. What problem could the alert feature pose in the new system? a. Unnecessary alerts can lead to clinicians ignoring other important alerts. b. Alerts make order entry difficult. c. Physicians do not like to be reminded how to treat patients. d. The Joint Commission discourages an alert system.

Correct Answer: A The use of CPOE can lead to significant improvements in patient safety because of the reminders or alerts built into the system. Although alerts and reminders are useful, too many become frustrating to the physicians because they have to constantly stop their data entry to address the alerts and reminders (Sayles and Kavanaugh-Burke 2018, 155).

What conclusions can you draw from the graph displayed below? a. The hospitals have equal variance. b. Hospital A has the greatest value and greatest variance. c. Hospital B presents with outliers. d. Hospital C has the smallest range of values.

Correct Answer: B A boxplot displays the descriptive statistics of a continuous variable including the minimum, first quartile, medium, third quartile, maximum, and potential outlier values. The line that makes the bottom of the box represents the value for the first quartile; the first quartile of a dataset is used to represent the 25th percentile of numeric data. In other words, the number representing the first quartile can be interpreted as a value at which 25 percent of the numbers in the dataset have a value equal to or less than that value. The line that makes the top of the box represents the value for the third quartile. The third quartile represents the 75th percentile. The number representing the third quartile is interpreted as a value at which 75 percent of the numbers in the dataset have a value equal to or less than that value. If there are dots above and below the boxes, these dots represent potential outliers. An outlier is a value that is distant from other values. The graph shows the widest range of values in hospital A as demonstrated by the difference between the lowest and upper whiskers. Also, hospital A displays with the highest median wait time (Marc 2020, 537).

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

Correct Answer: B 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 (Marc 2020, 537).

Which graph is the best choice to use when comparing lengths of stay across three hospitals? a. Line graph b. Bar graph c. Pie chart d. Scatter diagram

Correct Answer: B Bar graphs are used to display data from one or more variables. The bars may be drawn vertically or horizontally. Bar graphs 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 (White 2020a, 209).

Which of the following basic services provided by a health information exchange (HIE) entity matches identifying information to an individual? a. Consent management b. Person identification c. Record locator d. Identity management

Correct Answer: B Because there is no mandated unique patient identifier, ensuring that the HIE organization can identify the right patient as it seeks to exchange information is a process of identity matching (Amatayakul 2017, 419).

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

Correct Answer: B 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 (White 2016a, 64).

A physician is concerned that the data patients enter into an EHR is not as reliable as data entered by another provider. What function serves to distinguish the source of data in an EHR? a. Data dictionary b. Data provenance c. Data quality d. Data registry

Correct Answer: B Data provenance refers to the ability to track the source of data; the other choices are functions that describe or help maintain data (Amatayakul 2020, 407).

In which of the following processes does an analyst perform exploratory data analysis to determine trends and identify patterns in the data set? a. Data quality b. Data mining c. Record analysis d. Inferential statistics

Correct Answer: B In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set (White 2020b, 520).

Data mining is a process that involves which of the following? a. Using reports to measure outcomes b. Using sophisticated computer technology to sort through an entity's data to identify unusual patterns c. Producing summary reports for management to run the daily activities of the healthcare entity d. Producing detailed reports to track productivity

Correct Answer: B 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 (White 2020b, 520).

Follow-up data about a patient's progress or status collected at regular intervals is primarily associated with a(n): a. Patient index b. Disease registry c. Enterprise master patient index d. Patient medical record

Correct Answer: B In this case, the disease registry is the correct answer. Registries usually follow-up with patients at regular intervals to prevent complications (Sharp and Madlock-Brown 2020, 179).

The best way to ensure that elements of a health information system work together is to: a. Adopt all components from a single vendor b. Ensure standards are applied to software development that support interoperability c. Use an application service provider that supports all vendors d. Verify that a vendor applies a systems' view to its product development

Correct Answer: B It is often not feasible to adopt all components from a single vendor, but even when it is, interoperability with other providers is not assured. Only adoption of standards provides the greatest (though not absolute) interoperability. An application service provider does not address interoperability across vendors. A systems view is very helpful, but does not afford the same level of assurance that application of cross-industry standards provides (Amatayakul 2020, 412, 415, 439).

Laboratory data are successfully transmitted back and forth from Community Hospital to three local physician clinics. This successful transmission is dependent on which of the following standards? a. X12N b. LOINC c. RxNorm d. DICOM

Correct Answer: B LOINC is set of terminology standards that provide a standard set of universal names and codes for identifying individual laboratory and clinical results (Palkie 2020a, 159).

A hospital is conducting an analysis of its existing health information systems and is looking at potential areas that need attention. This step is typically referred to as: a. Identify needs b. Monitor results c. Record feedback d. Specify requirements

Correct Answer: B Monitoring results enables a hospital to understand if the present system is currently supporting the needs of the organization and whether the next step, identify needs, will set in motion new or further development or acquisition of health IT (Amatayakul 2020, 434).

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

Correct Answer: B 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 selfdeveloped system can be a drawback when attempting to integrate with commercial products as the organization grows, merges, or acquires affiliates (Amatayakul 2017, 191).

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

Correct Answer: B 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 (Johns 2015, 132).

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.

Correct Answer: B One disadvantage of the mean is that it is sensitive to outliers, extreme statistical values that fall outside the normal range, and may distort its representation of the central tendency of a set of numbers (White 2020a, 176).

The HIM manager is developing performance standards for the analysts. The manager will use these performance standards in order to: a. Assign daily work b. Communicate performance expectations c. Describe the elements of a job d. Prepare a job advertisement

Correct Answer: B Performance standards establish how well and how much work must be accomplished which guides performance expectations (LeBlanc 2020, 700).

If the medical office manager wanted to compare the amount of time it takes for a patient to be seen by a physician versus a nurse practitioner, which information system would be helpful in this analysis? a. Materials management system b. Practice management system c. Facilities management system d. Executive information system

Correct Answer: B Practice management systems are used by physician practices. Scheduling, patient accounting, patient collections, claims submission, appointment scheduling, human resources, and other functions all are built into this single information system (Sayles and Kavanaugh-Burke 2018, 119).

The department of surgery has acquired an analytics engine to enable it to provide predictive information at the point of care via the EHR. However, the department is struggling to get physicians to use the functionality because it does not have support staff to program or train users. This situation refers to the fact that the project plan did not illustrate: a. Conflicts b. Dependencies c. Environmental issues d. Policy decisions

Correct Answer: B Project plans are key to correctly implementing new systems because a key part of their functionality is to identify dependencies among tasks (Amatayakul 2020, 417).

The process of taking what is known at the highest level of understanding and working downward to identify the underlying causes for the high-level observation is called: a. Dashboard b. Slicing and dicing c. Data analytics d. Data visualization

Correct Answer: B Slicing and dicing refers to the process of taking what is known at the highest level of understanding and working downward to identify the underlying causes for the high-level observation. A dashboard helps facilitate a greater understanding of financial, operational, and clinical processes to identify problems and successes (Marc 2020, 539).

Over the last 10 years, the number of ICU beds in your state decreased by 20 percent. How might this trend impact your tertiary-level healthcare facility? a. There would be no impact as the number of inpatient beds at your facility remains the same. b. The volume of patients in your ICU has the potential to increase. c. There would be no impact because inpatient stays are no longer reimbursed by Medicare. d. The volume of patients in your ICU has the potential to decrease.

Correct Answer: B The ICU bed count in the state has realized a decrease of 20%. Bed count is a component needed to calculate occupancy rates for any facility. In this situation the reduction of ICU beds at any healthcare facility in the state has the potential to increase the volume of patients in this hospital's ICU (Edgerton 2020, 483).

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: Patient Number of Days A 1 B 5 C 3 D 3 E 8 F 8 G 8 H 9 I 9 a. 5 days b. 6 days c. 8 days d. 9 days

Correct Answer: B 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) (Edgerton 2020, 485).

In which type of health information exchange architectural model does the entity operate much like an application service provider (ASP) or bank vault? a. Consolidated b. Federated—consistent databases c. Federated—inconsistent databases d. Switch

Correct Answer: B The federated architectural type has become more prevalent for health information organizations. There are two forms of this architecture. The consistent federated form is very similar to the consolidated architecture in which the data repository is partitioned but centrally managed. The consistent federated form, however, takes this one step further and physically separates the data but still offers centralized management. Essentially, this is much like an application service provider (ASP) or software as a service (SaaS) model of acquiring software (Amatayakul 2017, 417-418).

If a health plan analyst wanted to determine if the readmission rates for two hospitals were statistically different, what is the null hypothesis? a. The readmission rates are not equal. b. The readmission rates are equal. c. The readmission rate for one hospital is larger than that of the other. d. The readmission rate for one hospital is smaller than that of the other.

Correct Answer: B The first step in statistical hypothesis testing is defining the null and alternative hypotheses. The null hypothesis is the status quo. In this example the readmission rates are equal would be the null hypothesis showing no relationship between the two hospitals (White 2016a, 65).

Using the admission criteria provided, determine if the following patient meets severity of illness and intensity of service criteria for admission. John 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.

Correct Answer: B 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 (Shaw and Carter 2019, 143).

Protocols that support communication between applications are often referred to as: a. Application program b. Interface code c. Messaging standards d. Source code

Correct Answer: C Within healthcare, standard protocols that support communication between nonintegrated applications are often referred to as messaging standards, also called interoperability standards or data exchange standards. Messaging standards provide the tools to map proprietary formats to one another and more easily accomplish the exchange of data (Amatayakul 2017, 400-401).

An analyst wishes to use the CMI for a set of MS-DRGs to determine if a documentation improvement program is having an impact. Use the MS-DRG volumes and weights in the following table to calculate the CMI for the three MS-DRGs. a. 2.3234 b. 2.8594 c. 2.9000 d. 3.5998

Correct Answer: B To calculate the case mix index from the volume of cases from MS-DRG calculate the weighted average MS-DRG weight by completing these steps: (1) Multiply the number of discharges in each MS-DRG by the relative weight of that MS-DRG; (2) Sum the relative weights from step 1; (3) Sum the number of discharges in the MS-DRGs chosen to be evaluated; (4) Divide the total relative weights from step 2 by the total number of discharges from step 3. Step 1:3.5998 × 100 = 359.982.2203 × 52 = 115.45561.726 × 36 = 62.136Step 2:359.98 + 115.4556 + 62.136 = 537.572Step 3:100 + 52 + 36 = 188Step 4:537.572 ÷ 188 = 2.8594(White 2016a, 155-156)

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.

Correct Answer: B 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) (White 2016a, 122).

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

Correct Answer: C 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 (Marc 2020, 537).

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

Correct Answer: C 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 (White 2020a, 198).

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

Correct Answer: C Control charts can be used to measure key processes over time. Using a control chart focuses attention on any variation in a process (Shaw and Carter 2019, 88-89).

When a physician office acquires a new EHR in place of its old EHR, the old EHR data will require: a. Chart conversion b. Chart transition c. Data conversion d. Data processing

Correct Answer: C Data conversion refers to the fact that data is already automated in one system but needs to be put into another, most often new, system—which is not always an easy task depending on the nature of the software and application programming language used. Chart conversion or transition refer to converting data on paper to electronic form and data processing refers to processing any data in a computer (Amatayakul 2020, 427).

Keith is the supervisor of the MPI and chart deficiency review staff in the HIM department, which also includes being the liaison for the billing department and the R-ADT staff. He frequently meets with Michael, the R-ADT supervisor, to discuss methods to combat healthcare fraud and to verify that the patients are who they say they are and that they have the appropriate documentation for verification. This process is called: a. Consent management b. Identity management c. Identity matching d. Patient identification

Correct Answer: C Identity matching (also known as patient matching) is the process in which the facility identifies the right person within the database to exchange information between healthcare organizations. The process examines different demographic elements from different health information technology systems to determine if they refer to the same patient (Sayles and Kavanaugh-Burke 2018, 195).

What type of system would look for contraindications between two medications, such as Warfarin (Coumadin) and ibuprofen, that could increase bleeding? a. Laboratory b. Radiology c. Pharmacy d. Nursing

Correct Answer: C If a particular medication were prescribed to the patient, the physician may not know that it would contraindicate the use of this certain drug because of the pre-existing allergy; the PIS would alert the physician to this contraindication and suggestion another medication (Sayles and Kavanaugh-Burke 2018, 137).

When describing the typical length of stay for patients admitted for congestive heart failure, which is the most appropriate measure of central tendency when there are a number of long stay outliers? a. Minimum b. Mean c. Median d. Mode

Correct Answer: C If the sample has extreme values on either the high or low end of the scale, then the median may be the better choice for describing the center of the distribution. The median is less influenced by outliers (White 2020b, 509).

In addition to bar codes on health record documents, what other forms of recognition characteristics enhance the accuracy of form indexing features? a. Access controls b. COLD c. OCR d. Workflow

Correct Answer: C In addition to bar codes on medical record documents, optical character recognition (OCR) may be available to enhance the accuracy of indexing features on forms (Lee-Eichenwald 2020, 363).

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

Correct Answer: C In data mining, the analyst performs exploratory data analysis to determine trends and identify patterns in the data set (White 2020b, 520).

Which work measurement tool uses random sample observations to obtain information about the performance of an entire department? a. Performance measurement b. Work distribution c. Work sampling d. Performance controls

Correct Answer: C Work sampling is a technique of work measurement that involves using statistical probability (determined through random sample observations) to characterize the performance of the department and its work (functional) units (Oachs 2020, 775).

When performing an internal audit for coding compliance, which of the following would be suitable case selections for auditing? a. Infrequent diagnosis and procedure codes b. Medical and surgical MS-DRGs by low dollar and low volume c. Medical and surgical MS-DRGs by high dollar and high volume d. Low-volume admission diagnoses

Correct Answer: C Part of a coding compliance plan is to identify areas of risk through audits and monitoring. Selecting the types of cases to review is also important. Examples of various case selection possibilities include medical and surgical MS-DRSs by high dollar and volume. Auditing cases with infrequent diagnosis and procedure codes, low dollar and low volume, and low admission diagnoses would not be as suitable (Hunt and Kirk 2020, 296).

The HIM manager is reviewing third-quarter data from the previous year to identify patterns of patient admissions. The manager then uses this data to forecast expected patient admissions in order to determine coding and analyst staffing needs for this year. What technique is the HIM manager using? a. Descriptive statistics b. Inferential statistics c. Predictive modeling d. Data modeling

Correct Answer: C Predictive modeling is a process used to identify patterns that can be used to predict the odds of a particular outcome based on the observed data. Predictive models use historical data in order to predict what is likely to happen in the future. For example, it might be used to predict the number of inpatient beds needed (Sayles and Kavanaugh-Burke 2018, 8).

An audit of the document imaging process reveals that the HIM department staff is scanning 250 pages per hour and indexing 114 pages per hour. If the department is meeting its productivity standard for scanning but is only meeting 60 percent of the indexing standard, how many more pages per hour must be indexed to meet the indexing standard? a. 45.6 pages b. 68.4 pages c. 76 pages d. 190 pages

Correct Answer: C Productivity standards should be based on both accuracy and volume. In this situation, 114 / 0.60 = 190; 190 - 114 = 76 more pages will need to be indexed to meet the productivity standard (Kelly and Greenstone 2020, 183-184).

The statement "Coding of inpatient records must be completed at a 98 percent accuracy rate" is an example of a: a. Goal b. Vision statement c. Qualitative standard d. Quantitative standard

Correct Answer: C Qualitative standards specify the level of service quality expected from a function, such as accuracy rate. For example, assignment of diagnostic and procedure codes for inpatient records is at least 98 percent accurate (Oachs 2020, 772).

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

Correct Answer: C 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 (Sayles and Kavanaugh- Burke 2018, 75).

Which statistical inference measures both the strength of a relationship between two variables and the functional relationship between them? a. Correlation b. T-test c. Simple linear regression d. Standard deviation

Correct Answer: C Simple linear regression (SLR) is another type of statistical inference that not only measures the strength of the relationship between two variables, but also estimates a functional relationship between them. SLR may be used when one of the two variables of interest is dependent on the other (White 2020b, 517).

Which model for health information exchange stores patient records in a single database built to allow queries into the system? a. Federated b. Hybrid c. Centralized d. Decentralized

Correct Answer: C The centralized HIE model stores patient records in a single database built to allow queries into the system. This model tends to return results quicker than other models (Lee-Eichenwald 2020, 387-388).

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.

Correct Answer: C 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 (Oachs 2020, 795).

In January, Community Hospital had 57 discharges from its medicine unit. Four patients developed urinary tract infections while in the hospital. What is the hospital-acquired infection rate for the medicine unit for January? a. 0.07% b. 2.17% c. 7% d. 217%

Correct Answer: C The hospital-acquired infection rate is (4 × 100)/57 = 400/57 = 7.0%. Hospital-acquired (nosocomial) infection rates may be calculated for the entire hospital. They also may be calculated for the specific types of infections. Ideally, the hospital should strive for an infection rate of 0.0 percent (Edgerton 2020, 490).

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

Correct Answer: C 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 (Edgerton 2020, 494).

Community Memorial Hospital discharged nine patients on April 1. The length of stay for each patient is shown in the following table. What is the median length of stay for this group of patients? a. 5 days b. 6 days c. 8 days d. 9 days

Correct Answer: C The median is the midpoint of a frequency distribution and falls in the ordinal scale of measurement. It is the point at which 50 percent of the observations fall above and 50 percent fall below. If an odd number of observations is in the frequency distribution, the median is the middle number. In this data set, 8 is the middle number (White 2020a, 177).

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

Correct Answer: D 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 (Amatayakul 2017, 420).

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

Correct Answer: D 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 (Marc 2020, 537).

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

Correct Answer: D 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 (Sayles and Kavanaugh-Burke 2018, 29).

What type of data mining technique would be used to group diagnoses? a. Association rule learning b. Anomaly detection c. Regression analysis d. Classification analysis

Correct Answer: D Classification analysis is a method of identifying important information about the data in the database by grouping data much like grouping diagnoses and procedures Sayles and Kavanaugh- Burke 2018, 38).

When a healthcare professional complains that the EHR produces too many alerts, action should be taken to: a. Dismiss the complaint because data quality will be impacted without the alerts b. Eliminate some of the alerts about which most professionals have complained c. Retrain the professional on how to use alerts correctly and monitor for future issues d. Set up a process to evaluate and correct alert fatigue overall for the EHR

Correct Answer: D Complaints such as "too many alerts" should not be dismissed because the frustration caused by the problem can lead to other issues exacerbating the results. On the other hand, taking immediate action to eliminate some of the alerts also poses risk that some important alerts will not be provided. Retraining one professional is also not likely to improve that individual's complaint, especially since it is likely many professionals have the same complaint. Instead, a formal data quality discovery process should be set up to evaluate and take corrective action relative to what we now call alert fatigue, or whatever other frequent complaint occurs (Amatayakul 2020, 437).

All of the following are necessary to maintain an accurate MPI in an EHR environment except: a. Standardizing registration procedures b. Training all registration staff c. Identifying registration entry points d. Assigning registry accession numbers

Correct Answer: D Controls for accuracy of the MPI include limiting access to the index and limiting the ability to make changes to a few key personnel. The first step to maintaining an accurate index is to obtain the correct information at admission or registration (Reynolds and Morey 2020, 133).

Which of the following statements justifies the use of a dashboard? a. It facilitates budget development. b. It manages information system projects. c. It utilizes statistical techniques. d. It monitors key measures.

Correct Answer: D Dashboards are reports of process measures to help leaders follow progress to assist with strategic planning. The dashboard provides the status on key measures (Sayles and Kavanaugh- Burke 2018, 8).

Fifty percent of patients treated at our facilities have Medicare as their primary payer. This is an example of what type of information? a. Patient-specific b. Expert knowledge c. Comparative d. Aggregate

Correct Answer: D Data about patients can be extracted from individual health records and combined as aggregate data. Aggregate data are used to develop information about groups of patients. In this case, the fact that 50 percent of patients treated at our facilities have Medicare as their primary payer is data about patients combined together, so it is aggregate data (Sharp and Madlock-Brown 2020, 176).

All of the following are a kind of technology that focuses on data security except: a. Encryption b. Biometrics c. Firewalls d. Telemedicine

Correct Answer: D Firewalls, encryption, and biometrics are technologies used to enable security in healthcare information systems. Telemedicine is not a technology used to enable security (Sayles and Kavanaugh-Burke 2018, 231, 233).

What elements would you change in the following graph to make the visualization more effective? a. Present the data in a vertical orientation b. Use a dot plot c. Remove the color d. Present the data as a line plot

Correct Answer: D For data that is presenting changes over time, the preferred presentation method is a line plot (Marc 2020, 537).

An EHR system is programmed by the vendor not to release certain patient data because it is considered proprietary to the vendor and a healthcare organization. The vendor is protecting its own business interests above that of the patient. This is an example of: a. Continuity of care record b. Graphic user interface c. HIPAA security breach d. Health information blocking

Correct Answer: D Health information blocking occurs when persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information. Blocking stems from healthcare providers or HIT vendors protecting their own proprietary and business interests above the interests of the patient and healthcare improvement. These efforts actively impede the progress sought by the concept of EHRs and health information exchange (Sayles and Kavanaugh-Burke 2018, 150).

The following question was typed into the system: How many patients were discharged on November 12, 2020? This is an example of what type of query? a. Data manipulation language b. Structured query language c. Query by example d. Natural language query

Correct Answer: D Natural language queries use common words to tell the database which data are needed (Sayles and Kavanaugh-Burke 2018, 29).

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

Correct Answer: D 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 (Sayles and Kavanaugh-Burke 2018, 211).

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

Correct Answer: D 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 (White 2016a, 7; White 2020b, 521).

The physical therapy department keeps a separate database on patient outcomes for physical therapy. The workflow for most of the other health professionals is impeded because they do not have access to this physical therapy database. This is an example of: a. A data model b. Data blocking c. Data cleansing d. A data silo

Correct Answer: D Prior to the implementation of EHRs, radiology, lab, and other departments reported results but kept their own information. These "data silos" of information created fragmentation that still haunts some EHR systems. A data silo is a separate database or system within a department that does not integrate into the main organizational system nor can others outside of that specific department access it (Sayles and Kavanaugh-Burke 2018, 251).

The performance standard to "assign the correct health record number to a returning patient with 99 percent accuracy" is an example of a: a. Compliance standard b. Quantity standard c. Joint Commission standard d. Quality standard

Correct Answer: D Quantity standards (also called productivity standards) and quality standards (also known as service standards) are generally used by managers to monitor individual employee performance and the performance of a functional unit or the department as a whole. To properly communicate performance standards, managers need to make the distinction between quantitative and qualitative standards and identify examples of each for the HIS functions (Oachs 2020, 773).

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

Correct Answer: D 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 (Houser 2020, 563).

Which of the following is not a statistical technique used to create a model to assess the probability that current Medicare claims are fraudulent? a. Logistic regression b. Cluster analysis c. Decision trees d. Database warehousing

Correct Answer: D Statistical techniques are used in predictive modeling to create a model to assess the likelihood or probability of fraudulent claims. These statistical techniques include logistical regression, cluster analysis, or decision trees. A data warehouse is not a statistical technique that would be used for this purpose (White 2020b, 521).

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

Correct Answer: D 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 (Lee-Eichenwald 2020, 370).

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

Correct Answer: D 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 (Lee-Eichenwald 2020, 388-389).

How long should the master patient index be maintained? a. For at least 5 years b. For at least 10 years c. For at least 25 years d. Permanently

Correct Answer: D 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 (Reynolds and Morey 2020, 132).

The probability of making a Type I error based on a particular set of data is called the: a. Sampling value b. Hypothesis test c. A-probability d. P-value

Correct Answer: D The probability of making a Type I error based on a particular set of data is called the p-value (White 2020b, 504).

Last year, 73,249 people died from diabetes mellitus in the United States. The total number of deaths from all causes was 2,443,387, and the total population was 288,356,713. Calculate the proportionate mortality ratio for diabetes mellitus. a. 0.003 b. 10.94 c. 0.09 d. 3.0

Correct Answer: D The proportionate mortality ratio (PMR) is a measure of mortality due to a specific cause for a specific time period. In the formula for calculating the PMR, the numerator is the number of deaths due to a specific disease for a specific time period, and the denominator is the number of deaths from all causes for the same time period. The proportionate mortality ratio for diabetes mellitus = 73,249/2,443,387 = 0.03 × 100 = 3.0% (AHIMA 2017, 192; Edgerton 2020, 476).

The following table shows the LOS for a sample of 11 discharged patients. Using the data listed, calculate the range. a. 29 b. 1 c. 5 d. 28

Correct Answer: D The range is the simplest measure of spread. It is the difference between the smallest and largest values in a frequency distribution: Range = 𝒳max - 𝒳min For this scenario, the range is 1 to 29 (29 - 1) or 28 (White 2020a, 182).

Systems linked by ________ allow HIE participants to search for health records on each of the other systems using patient indexing and identification software. a. ADTs b. APIs c. CCDs d. RLSs

Correct Answer: D The record locator service (RLS) provides the ability to identify where records are located based on registered information about a person (Lee-Eichenwald 2020, 397-398).