Health Care Information Systems A Practical Approach for Health Care Management, 3rd Edition test ba

Health Care Information Systems A Practical Approach for Health Care Management, 3rd Edition By Wager, Lee, Glaser

1 Chapter 1 Introduction to Health Care Information MULTIPLE CHOICE 1. The number-one reason for maintaining patient records is: a. Legal documentation b. Communication c. Patient Care d. Billing and reimbursement Answer: pg. 9 2. Which is generally not considered part of a patient’s medical record: a. Problem list b. Medication Record c. Progress Notes d. Digital images or films Answer pg. 12 3. Medical records that are created and organized around the patient’s problems are known as: a. Chronological organized medical records b. “Source – oriented” medical records c. Content Based Medical Records d. Patient Oriented Medical Records Answer pg. 14 - 15 4. A method for measuring performance that allows for the design of measurement systems that align with the organization’s strategy goals and examines multiple measures along several dimensions is known as: a. Benchmarking b. Outcome measures c. Balanced scorecard d. Clinical Value Compass Answer: pg. 37 5. The category of statistics that are routinely gathered for health care executives are: a. Census statistics b. Discharge statistics c. Mortality Statistics d. Both a and b Answer: pg. 36 6. Which standard billing form is submitted for health care provider services such as those provided by a physician’s office to third party payers: a. UB-04 b. CMS-1450 c. CMS-1500

2 d. UB-82 Answer: pg. 22 7. What is a federally mandated standard assessment tool used to collect demographic and clinical information specifically about long-term care facility residents: a. MDS b. ACDS c. UHDDS d. HEDIS Answer: pg. 28 8. The main source(s) of data that go into hundreds of aggregate reports or queries that are often developed and used by providers and executives in health care organizations are: a. Patient records b. Uniform billing information c. Discharge data sets d. All of the above Answer: pg. 33 9. HEDIS measures are specifically used to measure and compare the performance of: a. Hospitals b. Skilled nursing facilities c. Physician practices d. Health plans Answer: pg. 40 10. Which organization is responsible for investigating fraud involving government health insurance programs? a. OIG b. CMS c. AMA d. WHO Answer: pg. 33 TRUE/FALSE 1. As part of the patient’s medical record, the identification form or face sheet is considered both a clinical and administrative document True False Answer: pg. 11 2. CPT codes are published by the American Hospital Association (AHA) and updated each year True False Answer: pg. 31 (CPT codes are published by the American Medical Association (AMA))

3 3. DRGs are used as the basis for determining appropriate inpatient reimbursement for Medicare, Medicaid, and other health care insurance beneficiaries True False Answer pg. 30 4. Medicare cost reports are filed annually by all hospitals, physician offices, home health agencies, skilled nursing facilities, and hospices that accept Medicare or Medicaid.

True False Answer pg. 35 (physician offices are not required to submit) 5. Health care information systems and health care processes are unrelated and should be considered independently True False Answer: pg. 21 (processes are entwined) 6. Centers for Medicare and Medicaid Services (CMS) currently requires health providers to submit claims electronically unless the provider qualifies for a waiver True False Answer: pg. 22 7. CMS requires that all UB-04 claims include a valid 10 position unique National Provider Identifier (NPI) for each HIPAA-covered health care provider True False Answer pg. 24 8. An electronic health record (EHR) is an electronic record of health-related information on an individual that can be managed, shared, and controlled by that individual True False Answer: pg. 6 (Personal health record) 9. Medicare and Medicaid do not have the authority to access a patient’s medical record to confirm the accuracy of a filed claim by checking for documentation True False Answer: pg. 9 (CMS does have the authority to access a patient’s medical record to validate a claim) 10. ACDS is a uniform data adopted by the federal government and used as the standard for Medicare and Medicaid programs specifically in an ambulatory and outpatient care settings True

4 False Answer: pg. 28 SHORT ANSWER/ESSAY Name and describe some common sources of comparative data and explain their potential value to a health care manager.

Answer: pg. 38-43

5 Chapter 2 Health Care Data Quality MULTIPLE CHOICE 1. Raw unprocessed healthcare facts generally stored as characters, words, or symbols is known as: a. Health care data b. Health care information c. Health care text d. Health care knowledge Answer: pg. 50 2. Health care data is most useful and can be best used for decision making when processed into: a. Health care information b. Health care knowledge c. Health care statistics d. Health care trends Answer: pg. 51 3. The majority of problems with health care data content can generally be traced to: a. Clinical processes b. Documentation practices c. Employee incompetence d. Patients withholding information Answer: pg. 52 4. According to the Medical Records Institute (MRI), which is NOT listed as one of the five major functions that are negatively impacted by poor-quality documentation: a. Patient safety b. Continuity of patient care c. Employee Satisfaction d. Public safety Answer: pg. 54 5. Errors that can be attributed to a flaw or discrepancy in adherence to standard operating procedures or systems are known as: a. Systematic errors b. Random Errors c. Methodical errors d. Programming errors Answer: pg. 59 6. Illegible handwriting is an example of a: a. Systematic error b. Random error c. Methodical error

6 d. Programming error Answer: pg. 59 7. Using an abbreviation that has two different meanings is an example of a lack of: a. Data currency b. Data consistency c. Data precision d. Data granularity Answer: pg. 56 8. Handwriting, speaking, typing, touching a screen or pointing and clicking on words or phrases are all examples of: a. Data processing b. Information Capture c. Report generation d. Data recording Answer: pg. 54 9. What professional organization has developed and published a data quality management tool that defines a specific set of characteristics of health care data that should always be present? a. AHIMA b. MIO c. GAO d. CMS Answer: pgs. 55-56 10. What is an example of a way system design can help reduce errors during data collection and processing? a. Standardize data entry fields b. Build human capacity c. Institute real-time quality checking d. All of the above Answer: pg. 60 TRUE/FALSE 1. Data currency refers to the availability of medical information such as critical lab values to in a timely manner.

True False Answer: pg. 59 (the appropriate term is data timeliness – data currency is the concept that many types of health care data become obsolete) 2. Content and form are two essential components that are needed to insure data quality: True False Answer: pg.52

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3. Increased reliance on networked health care data has reduced the challenges associated with insuring and maintaining high quality data: True False Answer: pg. 52 (the increased reliance on networked health care data brings new challenges to maintaining high quality data) 4. A set of universally recognized set of health care data quality standards exists today.

True False Answer: pg. 55 (there is no universally recognized set of health care quality data standards in existence today) 5. The Markle Foundation identifies the development of a “data quality culture” within health care organizations as a way to improve data quality: True False Answer: pg. 60 6. Documenting health care information in an EHR through narrative form or unstructured fields allows for the full potential of the electronic record to be realized as a quality tool in insuring data consistency and comprehensiveness.

True False Answer: pg. 61 (Physician notes and discharge summaries are often transcribed. This lack of structure limits the ability of the EHR to be a data quality improvement tool.)

7. Data granularity refers to the fact that certain individual data elements such as a patient’s birth date or name cannot be further subdivided into individual elements and still remain useful.

True False Answer: pg. 58 8. Either information capture or report generation must occur in order to have quality documentation.

True False Answer: pg. 54 (Both must occur in order to have high quality data) 9. Sophisticated information systems can be used to overcome inherent problems associated with poor quality data sources and data collection errors.

True False Answer: pg. 63 (even the most sophisticated systems cannot overcome these problems)

8 10. IT systems alone have been shown to improve data accessibility and legibility: True False Answer: pg. 61

SHORT ANSWER/ESSAY Explain how information technology can be used as tool to improve health care data quality and name some specific elements that must be present in order for this potential to be fully realized.

Answer: pg. 60-61

9 Chapter 3 Health Care Information Regulation, Laws, and Standards MULTIPLE CHOICE 1. The process that gives health care organizations the authority to participate in the federal Medicare and Medicaid programs is known as: a. Licensure b. Certification c. Accreditation d. Recognition Answer: pg. 70 2. The best-known health care accrediting agency in the United States is: a. NCQA b. CMS c. The Joint Commission d. CARF Answer: pg. 71 3. Although state regulations may vary, the AHIMA currently recommends that patient health records for adults should be retained for how many years after the most recent encounter? a. 5 year b. 10 years c. 15 years d. 25 years Answer: pgs. 83-84 4. What quality organization is the developer and overseer of HEDIS measures and is known for their work in providing quality measures for health plans? a. NCQA b. CMS c. The Joint Commission d. CARF Answer: pg. 78 5. What was the first comprehensive federal regulation that offers specific protection to private health care information? a. The Privacy Act of 1974 b. The Freedom of Information Act (FOIA) c. The HIPAA Privacy Rule d. The Patient Safety Act Answer: pg. 87 6. The expectation that information shared with a health care provider during the course of treatment will be used only for its intended purpose and not disclosed otherwise is know as: a. Privacy

10 b. Conditions of Participation c. Boundaries d. Confidentiality Answer: pg. 86 7. How often must a health care organization undergo an on-site survey review by The Joint Commission? a. 2 year b. 3 years c. 5 years d. 10 year Answer: pg. 73 8. The component of the HIPAA Privacy Rule that specifies that entities that improperly handle PHI can be charged under criminal law and punished and are subject to civil recourse is known as: a. Boundaries b. Security c. Public Responsibility d. Accountability Answer: pg. 89 9. Organizations that can work with clinicians and health care organizations to identify, analyze, and reduce the risks and hazards associated with patient care are known as: a. PSOs b. PPOs c. PSWP d. PPRS Answer: pg. 80 10. Which process tends to emphasize factors such as physical plant standards fire safety, and sanitation when assessing a health care organization? a. Licensure b. Certification c. Accreditation d. Recognition Answer: pg. 69 TRUE/FALSE 1. As a rule, the federal government oversees the licensure of healthcare facilities.

True False Answer pg. 68 (state governments oversee the licensure of healthcare facilities) 2. The Joint Commission’s IM standards apply to both non-computerized systems and systems employing the latest technology.

11 True False Answer: pg. 77 3. The documents and data considered part of a patient’s Legal Health Record (LHR) cannot exist physically separate from the actual paper or electronic medical record.

True False Answer: pg. 82 (documents and data that could be part of the LHR may exist in several physically separate paper-based and electronic systems) 4. Accreditation is a mandatory process that gives health care organizations legal approval to operate True False Answer: pg. 68 (licensure is the process that gives a facility legal approval to operate) 5. Electronic signatures are now accepted by both the Joint Commission and CMS as legitimate forms of provider authentication True False Answer: pg. 85 6. Health care providers and others must obtain written authorization from a patient prior to disclosure of health information for routine uses of treatment, payment, and health care operations.

True False Answer: pg. 96 (Providers and others must obtain a patient’s written consent) 7. The Privacy Act of 1974 was written to protect patient confidentiality in all health care facilities.

True False Answer: pg. 87 (the Act was written specifically to protect patient confidentiality only in federally operated health care facilities) 8. The HIPAA Privacy Rule defines covered entities as those individuals whose health information must be protected by health plans, health providers, and other health care organizations.

True False Answer: pg. 88 (Covered entities are those individuals and organizations that must comply to the federal standards contained within the HIPAA Privacy Rule)

12 9. In some instances patient-specific health care information can be released without the patient’s authorization.

True False Answer: pg. 95 10. Administrative records are generally not included in a patient’s Legal Health Record (LHR).

True False Answer: pg. 83 SHORT ANSWER/ESSAY Explain the distinction between licensure, certification, and accreditation and name some of the entities or organizations responsible for carrying out each of these review processes.

Answer: pg. 69-72

13 Chapter 4 History and Evolution of Health Care Information Systems MULTIPLE CHOICE 1. The type of information system that can be used to manage personnel, finances, materials supplies, or equipment is specifically known as a: a. Health care information system b. Administrative information system c. Clinical information system d. Ancillary information system Answer: pg. 106 2. Data could be entered into a mainframe computer and viewed by an end user through a: a. Shared system b. Microcomputer c. Minicomputer d. Dummy terminal Answer: pg. 112 3. The Medicare Modernization Act passed in 2003 mandated that health plans providing certain types of coverage to Medicare beneficiaries use: a. CPOE b. E-prescribing c. Electronic Health Records d. Telemedicine Answer: pg. 120 4. HIPAA was signed into law in 1996 and was intended to: a. Make health insurance more affordable and accessible b. Simplify administrative processes c. Protect the confidentiality of personal health information d. All of the above Answer: pg. 117 5. The type of reimbursement methodology primarily used in hospitals in the 60s and 70s to compensate hospitals for services provided was: a. Cost-based reimbursement b. Prospective payment system c. Per diem reimbursement d. Capitation-based reimbursement Answer: pg. 108 - 110 6. What decade did the IOM publish its landmark report, publish a report that called for the adoption of the computer-based patient record (CPR): a. 1980s b. 1990s

14 c. 2000s d. 2010s Answer: pg. 116 7. The resource-based relative value scale (RBRVS) that was introduced in the early 90s was initially designed to redistribute funds from: a. Specialty providers to primary care providers b. Primary care providers to specialty providers c. Hospitals to physician practices d. Ambulatory surgery centers to hospitals Answer: pg. 115 8. What initiative began in the early 2000s that was specifically intended to bring multiple stakeholders into formal partnerships to exchange health data electronically? a. HIEs b. ACOs c. PCMHs d. CPOE Answer: pg. 122 9. What term is often used to describe hosted services that are delivered over the internet? a. Local Area Network (LAN) b. Telemedicine c. Cloud Computing d. HIE Answer: pg. 126 10. Value-based purchasing reimburses providers based on: a. Cost of care b. Number of services provided c. Patient volume d. Quality Metrics Answer: pg. 121 TRUE/FALSE 1. An increased emphasis on preventative medicine and chronic disease management began in the 1990s.

True False Answer: pg. 115 2. Most of the early information systems in healthcare in the 60s were administrative applications.

True False Answer: pg. 110

15 3. Turnkey systems were software systems that could be easily modified to meet a hospital’s unique information needs.

True False Answer: pg. 113 (Rarely could a turnkey systems be modified to meet the unique information needs of an organization) 4. To Err is Human: Building a Safer Health Care System that was published by the IOM focused on medical errors that occur across all health care settings True False Answer pg. 120 (To Err Human focused primarily on errors that occur in hospitals) 5. By the end of 2010, it was more likely for a physician practice to have implemented a “basic” EHR system than a hospital True False Answer: pg. 122 6. The HITECH Act was the first piece of legislation that authorized Medicare to reimburse for telemedicine services.

True False Answer: pg. 118 (The Balanced Budget Act of 1997 authorized Medicare to reimburse for telemedicine services) 7. In current management literature, the terms information system (IS) and information technology (IT) are often used interchangeably.

True False Answer: pg. 104 8. Most states have a single, central organization responsible for telemedicine issues or a complete data repository containing all relevant rules, regulations, and policies for payers and programs.

True False Answer: pg. 119 (most states do not have a single central organization responsible for telemedicine) 9. Electronic health records (EHRs) are considered a clinical application or clinical information system True False Answer: pg. 107

16 10. The best-of-breed approach became prevalent in the 1980s and allowed organizations to easily interface different systems.

True False Answer: pg. 114 (The concept of selecting the best of breed among vendors became and systems became prevalent in the 1980s and still exists to some extent today. Organizations that adopted the best of bread approach then faced a challenge as they tried to build interfaces or integrate data..)

SHORT ANSWER/ESSAY Describe the evolution of health care information technology by identifying key technological advancements in each decade beginning with the 1960s that had a direct impact on healthcare administrative and clinical functions.

Answer: pg. 108-109

17 Chapter 5 Clinical Information Systems MULTIPLE CHOICE 1. Studies have shown that about half of medication errors occur during: a. Ordering b. Dispensing c. Administering d. Monitoring Answer: pg. 155 2. Monitoring patient blood sugar levels at home through a glucometer attached to a cell phone is an example of: a. Telemedicine b. Telehealth c. Home Health d. Electronic consultation Answer: pg. 158 3. What is NOT considered a function of a “basic” EHR system? a. Clinical documentation b. Diagnostic test results c. Electronic ordering of medications d. Computerized provider order entry (CPOE) Answer: pg. 138 4. What organization is responsible for testing and certifying EHR technology that can be used by a provider to qualify for EHR incentive payments through the Medicare and Medicaid programs? a. ONC b. CMS c. OIG d. HIMSS Answer: pg. 167 5. Bar coding technology is a clinical application used to promote patient safety by improving the process of: a. Medication ordering b. Certified provider order entry (CPOE) c. Chronic disease management d. Medication administration Answer: pg. 154 6. Approximately how much money did the federal government provide in total Medicare and Medicaid incentive dollars to encourage health care professionals and hospitals to become meaningful users of EHRs? a. 15 billion

18 b. 30 billion c. 40 billion d. 50 billion Answer: pg. 167 7. As part of telemedicine, Store and forward technology is used primarily to: a. Allow face-to-face consultation b. Capture and monitor data from patients at home c. Transfer digital images d. Perform surgery robotically Answer: pg. 157 8. What is NOT considered a major effect of clinical information systems on patient quality? a. Increased provider productivity b. Increased adherence to guideline-based care c. Enhanced surveillance and monitoring d. Decreased medication errors Answer: pg. 138 9. Health care information standards and implementation specifications are examples of what type of barriers to adoption: a. Financial barriers b. Organizational and behavioral barriers c. Technical barriers d. Privacy and security barriers Answer: pg. 166 10. What is NOT necessarily considered a workflow advantage of CPOE? a. Legibility of orders b. Remote access c. Turnaround time d. Provider alerts Answer: pg. 150 TRUE/FALSE 1. An adverse drug event (ADE) may or may not have involved a medication error.

True False Answer: pg. 148 2. Home health and hospice agencies have experienced wide spread adoption of EHRs True False Answer: pg. 139 (The first and only study found of home health and hospice agencies reported that approximately 32 percent of home health agencies and 18 percent of hospice agencies are estimated to use computerized systems for record keeping)

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3. Studies consistently show that utilizing EHRs help physicians realize time savings.

True False Answer: pg.143 (As to the impact of EHRs on clinician time, results are mixed) 4. Medline is an example of an application known as a knowledge-based reference system that allows a clinician to access the latest research findings or practice guidelines.

True False Answer: pg. 162 5. CPOE systems are easily implemented and operate in isolation.

True False Answer: pg. 151 (A CPOE system does not operate in isolation. To function properly, it requires seamless integration within a strong, dynamic health care information architecture).

6. A personal health records (PHR) is managed by a consumer and may contain both health and wellness information, such as an individual’s wellness plan.

True False Answer: pg. 160 7. It is estimated that close to 25 percent of hospitals have fully implemented CPOE systems True False Answer: pg. 150 (It is estimated that only 8 percent of hospitals have fully implemented CPOE systems) 8. The majority of studies have shown that EHRs have had no negative impact on the physicianpatient relationship.

True False Answer: pg. 144 9. Telehealth always involves the provision of clinical services.

True False Answer: pg. 156 (Telehealth refers to a broader view of remote health care, one that does not always involved the provision of clinical services) 10. EHR systems can help healthcare organizations realize higher reimbursements due to higherquality documentation and improved coding practices.

True

20 False Answer: pg. 143 SHORT ANSWER/ESSAY Provide examples of some of the primary barriers to EHR adoption and define specific strategies for overcoming these barriers.

Answer: pgs. 164 - 168

21 Chapter 6 Federal Efforts to Enhance Quality of Patient Care through the Use of Health Information Technology 1. ACOs incentivize physicians and other providers to work together to improve the quality of health care services and reduce costs for a defined population through what kind of payment model? a. Shared savings b. Bundled payments c. Pay for performance d. Episode of care payment Answer: pg. 190 2. HITECH provided funding for the development of organizations to support providers in adopting and becoming meaningful users of EHRs known as: a. Beacon Communities b. Health Information Exchanges (HIEs) c. Strategic Health IT Advanced Research Projects (SHARPs) d. Regional Extension Centers (RECs) Answer: pg. 183 3. A Patient Centered Medical Home (PCMH) is an approach to providing patient care that is facilitated through what type of health care organization? a. Hospitals b. Primary care practices c. Specialty practices d. Skilled nursing facilities Answer: pg. 191 4. Disclosure of an individual’s protected health information (PHI) due to a security breach must be reported to Health and Human Services Office of Civil Rights and the media if it is believed to involve more than how many individuals? a. 100 b. 250 c. 500 d. 1000 Answer: pg. 185 5. The most common type of HIE architecture is: a. Hybrid b. Centralized c. Federated d. Cloud based Answer: pg. 196

22 6. The initiative that identifies leading organizations that are demonstrating how health information technology can be used in innovation ways to target specific health problems within communities is known as: a. Regional Extension Center (RECs) b. Strategic Health IT Advanced Research Projects (SHARPs) c. Beacon Programs d. Innovation Center Answer: pg. 183 7. What is NOT one of the three main components of Meaningful Use explicitly specified in the HITECH Act? a. The use of a certified EHR in a meaningful manner b. The use of certified EHR technology for electronic exchange of health information c. The use of certified EHR technology to submit clinical quality measures to CMS d. The use of certified EHR to reduce costs and improve provider productivity Answer: pg. 186 8. Referral management systems and patient navigation systems are both examples of: a. Care coordination systems b. Patient engagement systems c. Disease registries d. Master patient indices Answer: pg. 200 9. The maximum amount an eligible professional can receive through the Medicaid EHR incentive program is: a. $44,000 b. $63,500 c. $100,000 d. $2,000,000 Answer: pg. 181 10. The Direct Project and CONNECT Open Source Solution are two major initiatives affiliated with what efforts to facilitate health information exchange over the internet? a. NwHIN b. NeHC c. SHARP d. Innovation Center Answer: pg. 195 TRUE/FALSE 1. Health care organizations that do not demonstrate Meaningful Use within a designated time frame will experience penalties in the form of Medicare and Medicaid payment reductions.

True False

23 Answer: pg. 182 (Reduction in Medicare payments will results for those organizations that fail to initiate meaningful use within a designated time frame) 2. Capitation or global payment places full risk with the provider organization.

True False Answer: pg. 193 3. ACOs must include a sufficient number of primary care professionals to provide services to at least three thousand beneficiaries for a three-year period.

True False Answer: pg. 190 (ACOs must include a sufficient number of primary care professionals to provide services to at least five thousand beneficiaries for a three-year period) 4. CMS is moving towards a bundled payment system where a single payment will be made to hospitals and physicians jointly for a given condition, episode of care, or procedure.

True False Answer: pg. 191 5. Eligible professionals qualifying for the Medicare EHR incentive program must have at least 30 percent Medicaid population to participate.

True False Answer: pg. 182 (No Medicare population minimum is required to qualify for Medicare EHR incentive program) 6. The criteria for Meaningful Use are to be implemented in 5 stages over a specified number of years.

True False Answer: pg. 186 (The criteria for meaningful use are to be implemented in three stages) 7. Eligible hospitals can earn over $2 million through the Medicare EHR incentive program True False Answer: pg. 181 8. CMS established an Innovation Center to test, evaluate, and expand different care models.

True False Answer: pg. 189 (CMS established an Innovation Center to test, evaluate, and expand different payment structure and methodologies)

24 9. Hospitals and eligible providers do not have to demonstrate meaningful use in the first year to qualify for Medicaid EHR incentive payments but can simply adopt, implement or upgrade an EHR. True False Answer: pg. 182 10. CMS specifies the standards, implementation specifications, and other criteria for EHR systems to be certified under HITECH. True False Answer: pg. 188 (the ONC specifies the standards, implementation specifications, and other criteria for EHR systems to be certified under HITECH) SHORT ANSWER/ESSAY Describe some of the primary initiatives contained within the Patient Protection and Affordability Care Act (PPACA) and their implications for the use of information technology as a vehicle to improve quality and reduce costs.

Page: pgs. 189 – 190

25 Chapter 7 System Acquisition MULTIPLE CHOICE 1. One of the first steps in the system acquisition process is to: a. Defining project objectives and scope of analysis b. Determine system goals c. Screen the marketplace and review vendor profiles d. Establish a project steering committee and appoint project manager Answer: pg. 214 & 218 2. What is NOT an advantage to contracting with an Application Service Provider (ASP) to host an EMR? a. Rapid deployment b. Fixed costs c. Customization d. 24/7 technical support Answer: pg. 227 3. The ideal project steering committee consists of how many members? a. 3-4 b. 5-6 c. 10-12 d. 20-25 Answer: pg. 219 4. The phase of the system development life cycle where all alternatives are considered, a costbenefit analysis is done, a system is selected, and vendor negotiations are finalized is known as: a. Planning and analysis b. Design c. Implementation d. Evaluation and support Answer: pg. 213 5. The four phases of the system development life cycle in sequential order are: a. Planning and analysis, implementation, design, support and evaluation b. Support and evaluation, implementation, planning and analysis, design c. Design, implementation, planning and analysis, support and evaluation d. Planning and analysis, design, implementation, support and evaluation Answer: pg. 212 6. Once the project steering committee has been established, one of the first things it should is to: a. Define project goals b. Determine system requirements c. Develop an RFP d. Hold vendor demonstrations

26 Answer: pg. 219 7. What is the final step of the system acquisition process where expectations are outlined and performance requirements are determined with the vendor? a. Vendor demonstrations b. Vendor analysis c. Contract negotiations d. Site visits Answer pg. 233 8. The final summary report developed by the project steering committee should include everything but? a. Systems goals and criteria b. Cost-benefit analysis c. Final recommendation and ranking of vendors d. Project repository Answer: pg. 232 9. What is an example of a research organization that produces market analysis reports listing and describing vendors that provide EHR systems? a. HIMSS b. AMIA c. ONC d. KLAS Answer: pg. 221 10. The system acquisition process consists of what two phases of the systems development life cycle: a. Planning and Analysis, Design b. Implementation, Support and Evaluation c. Support and Evaluation, Planning and Analysis d. Design, Implementation Answer: pg. 213-214 TRUE/FALSE 1. The primary focus of the planning and analysis phase is on the business problem or the organization’s strategy, independent of any technology that can or will be used.

True False Answer: pg. 212 2. It is generally advisable to have two or three vendors in the final ranking and recommendations made by the project steering committee: True False Answer: pg. 233

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3. An RFP might be used when the health care organization is considering only a small group of vendors or products or when it is still in the exploratory phase.

True False Answer: pg. 225 (An RFI might be used when the health care organization is considering only a small group of vendors or products or when it is still in the exploratory phase) 4. After reviewing vendor RFPs and evaluating their product demonstrations, the steering committee should prepare a summary report that includes their final recommendation.

True False Answer: pg. 231 (After reviewing the vendor’s RFPs and evaluating their product demonstration, it is advisable to make site visits and check references) 5. Working with a system developer can be a good option when the health care organization’s needs are highly predictable or commonplace.

True False Answer: pg. 228 (Working with a system developer can be a good option when the health care organization’s needs are highly uncertain or unique) 6. Concurrently with the establishment of project goals, the project steering committee should conduct its first cursory review of the EHR marketplace.

True False Answer: pg. 220 7. The use of scripts can ensure that all vendors are evaluated on the same basic or functionality during demonstrations and should be adhered to.

True False Answer: pg. 230 8. System acquisition refers to the process that occurs from the time the decision is made to select a new system until the time the system has been fully implemented True False Answer: pg. 210 (System acquisition refers to the process the occurs from the time the decision is made to select a new system until the time the contract has been negotiated and signed) 9. When conducting a cost-benefit analysis, the total cost of ownership should not include the resources needed to implement and support the system but simply the capital costs.

True False

28 Answer: pg. 232 (The total cost of ownership should factor in support costs and the costs of resources needed to implement and support the system) 10. All vendor requests and communication should be channeled through the project steering committee to manage vendor access to organizational leadership.

True False Answer: pg. 235 SHORT ANSWER/ESSAY Describe some of the common pitfalls associated with the system acquisition process and how these issues can be avoided.

Answer: pgs. 235-236

29 Chapter 8 System Implementation and Support MULTIPLE CHOICE 1. One of the first activities necessary in implementing any new system is: a. Workflow and process analysis b. Install system components c. Conversion of data d. Staff training Answer: pg. 249 2. IT staff plays the most crucial role in what phase of system implementation? a. Workflow and process analysis b. Install system components c. Conversion of data d. Staff training Answer: pg. 251 3. What are the fundamental activities that should occur during any system implementation? a. Organize implementation team and identify project champion b. Determine project scope and expectations c. Establish and institute project plan d. All of the above Answer: pg. 243 4. It is reasonable to expect that the hardware, software, and network will likely need to be replaced in how many years as advances are made in technology? a. 1-2 years b. 5-7 years c. 3-10 years d. 15 years Answer: pg. 263 5. Ensuring sufficient staff are on hand and setting up mechanisms for reporting and correcting problems are all activities associated with which phase of the implementation plan? a. Staff training b. Conversion of data c. Workflow and process analysis d. Preparation for go-live date Answer: pg. 248 6. Who would be the best person to serve as system champion for the implementation of a CPOE system? a. A nurse b. A physician c. CIO

30 d. CEO Answer: pg. 244 7. What was NOT identified as one of the unintended consequences that implementation teams should plan for and consider when implementing CPOE? a. More work or new work b. New kinds of errors c. Dependence on the system d. Patient dissatisfaction Answer: pg. 265 8. The main concern with using the train the trainer approach is that: a. The trainer may leave the institution b. The trainer may not be effective c. The training process relies on a vendor d. Training takes time away from the trainers primary role Answer: pg. 253 9. The most ideal way to deliver technical support to users during the implementation phase is by: a. Providing local support in-house b. Partnering with a neighboring organization c. Contracting with a local computer firm d. Training a current employee Answer: pg. 262 10. When considering a long-term investment in a system, the resources allocated or committed to a system include: a. Hardware/software b. People c. Maintenance and support d. All of the above Answer: pg. 264 TRUE/FALSE 1. System implementation begins once the organization has acquired the system and continues through the early stages following the go-live data.

True False Answer: pg. 243 2. In many health care organizations, the system champion is usually a non-clinical member of the staff.

True False Answer: pg. 244 (In many health care settings, the system champion is a physician)

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3. The implementation team should include all of the same people that were involved in selecting the system during the system acquisition process.

True False Answer: pg. 244 (Implementation teams often include some of the same people involved in selecting the system; however, they may also include other individuals with knowledge and skills important to the successful deployment of the new system) 4. Studies among health care organizations that have implemented clinical applications have shown that classroom training is just as effective as one-on-one coaching particularly among physicians.

True False Answer: pg. 253 (Studies among health care organizations that have implemented clinical applications have shown that classroom training is not nearly as effective as one-on-one coaching particularly among physicians) 5. CPOE is one of the most complex and challenging clinical information systems to implement.

True False Answer: pg. 264 6. Studies have shown that an information system’s value to the organization is typically realized immediately if sufficient time and resources are provided during the implementation phase.

True False Answer: pg. 262 (Providing sufficient time and resources to the implementation phase of the project is, however, only part of the overall support needed. Studies have shown that an information system’s value to the organization is typically realized over time) 7. It is always advisable to run the old and new systems in tandem (parallel conversion) for a period of time until it is evident that the new system is operating effectively.

True False Answer: pg. 255 (In some cases, it may be advisable to run the old and new systems in tandem (parallel conversion) for a period of time until it is evident that the new system is operating effectively) 8. Understanding the culture of your organization is something that should occur during the implementation process.

True False Answer: pg. 259 (Before embarking on system implementation, it is critical to know your culture. Understanding the culture is important before you make the investment)

32 9. Informal communication related to the project’s progress is less structured but can be equally as important as formal communication.

True False Answer: pg. 255 10.The components of the information system implementation plan should occur in sequential order to be effective, True False Answer: pgs. 247-248 (The order used should be determined by the institution in accordance with its needs and resources) SHORT ANSWER/ESSAY Name and describe at least five of the ten commandments of effective clinical decision support and explain how they can make the implementation process occur more smoothly Answer: pg. 256

33 Chapter 9 Technologies that Support Health Care Information Systems MULTIPLE CHOICE 1. The most common type of database in use today is a: a. Hierarchical database b. Network database c. Object-oriented database d. Relational database Answer: pg. 280 2. The phase of the Hype Cycle for health care technologies during which mainstream adoption starts to take off and criteria for assessing provider viability are more clearly defined is known as: a. Peak of inflated expectations b. Trough of disillusionment c. Slope of enlightenment d. Plateau of productivity Answer: pg. 275 3. Which type of database is specifically designed for decision support and allows data to be extracted along such dimensions as time, location or diagnosis? a. Clinical data repository b. Data warehouse c. Relational database d. Online transactional processing system (OLTP) Answer pg. 282-284 4. What is NOT a component of the WAN network? a. Routers b. Nodes c. High-speed transmission media d. Subnet Answer: pg. 287 5. A type of architecture that wraps a common browser user interface around a set of diverse applications allowing the user to use one set of screens to access data from several applications is know as: a. Visual integration b. Best of breed c. Monolithic d. Remote desktop Answer: pg. 310 6. A type of media that uses radio waves for data transmission by employing a deliberately varied signal that results in greater bandwidth is known as:

34 a. Twisted pair b. Microwaves c. Spread spectrum d. Fiber optic cable Answer: pg. 288 7. A common server-based distribution method that uses multiple servers to communicate each of which is dedicated to one or more specialized function is known as: a. File server b. Client/server c. Cloud computing d. Bluetooth Answer: pg. 293 8. Expert systems, natural language processing, and neural networks are all examples of: a. Decision-support systems (DSS) b. Artificial intelligence (AI) c. Executive information systems (EIS) d. Relational databases Answer: pg. 305 9. A type of remote access technology that provides access to applications through a locally installed client and can run on different computing devices such as tablets and phones is known as: a. Remote desktop b. Terminal services c. Citrix d. Cloud computing Answer: pg. 294 10. Herbert Simon describes decision making as a three-part process that includes: a. Intelligence, Design, and Choice b. Structure, Design, and Choice c. Program, Structure, and Choice d. Intelligence, Organization, and Design Answer: pg. 304 TRUE/FALSE 1. The most common markup language used today is XML extensible markup language.

True False Answer: pg. 298 (The most common markup language used today is HTML hypertext markup language) 2. One common way to distinguish a WAN from a LAN is that the WAN will have its network hardware and software under the control of a single organization.

35 True False Answer: pg. 285 (One common way to distinguish a LAN from a WAN is that the LAN will have its network hardware and software under the control of a single organization) 3. The building blocks of the World Wide Web are web pages.

True False Answer: pg. 296 4. Broadband is the term used to describe media that is capable of carrying multiple transmissions simultaneously: True False Answer: pg. 288 5. Wireless Ethernet is the most popular LAN system in use today, both in health care and in business.

True False Answer: pg. 291 (Wired Ethernet is the most popular LAN system in use today, both in health care and in business) 6. Unstructured problems are also referred to as programmable problems, because a computer program can be written with relative ease to solve this kind of problem.

True False Answer: pg. 304 (Structured problems are also referred to as programmable problems, because a computer program can be written with relative ease to solve this kind or problem) 7. The Internet is the means by which the majority of users interact with the World Wide Web (WWW).

True False Answer: pg. 295 (The WWW is the means by which the majority of users interact with the internet) 8. Architecture refers primarily to the organization’s computer networks and to the applications running on those networks True False Answer: pg. 308 (Infrastructure as we use it refers primarily to the organization’s computer networks, and perhaps to the applications running on those networks)

36 9. Wikis are used for collaborative sharing and editing of information and are included under the umbrella of Web 2.0.

True False Answer: pg. 301 10. An extranet is similar to an intranet except that the network of users includes business partners of the healthcare organization, such as suppliers, customers, or other health care provider.

True False Answer: pg. 299 SHORT ANSWER/ESSAY Describe the distinct components of stand-alone decision support systems (DSS) and provide some specific examples of these systems and how they may be used in the health care environment.

Answer: pg. 306 – 307

37 Chapter 10 Health Care Information System Standards MULTIPLE CHOICE 1. The most common method of developing health care IT standards is: a. Ad hoc b. De facto c. Government mandate d. Consensus Answer: pg. 319 2. Which organization has the responsibility under a HIPAA mandate, to recommend uniform data standards for patient medical record information (PMRI)? a. ONC b. NCVHS c. ANSI d. IHTSDO Answer: pg. 325 3. Which standards are specifically related to the electronic transfer of digital diagnostic images between devices manufactured by different vendors? a. DICOM b. CVX c. LOINC d. SNOMED –CT Answer: pg. 332 4. The standard for the electronic exchange of patient summary information or “transportable” patient care information is known as: a. CCD b. CCR c. CDA d. XML Answer: pg. 340 5. Which is NOT a specific code set for diagnoses and procedures mandated by HIPPA to be used in any transaction by a covered entity? a. HCPCS b. NDC c. CDT d. UMLS Answer: pg. 322 6. A comprehensive clinical terminology developed specifically to facilitate the electronic storage and retrieval of detailed clinical information is known as: a. SNOMED CT

38 b. LOINC c. CVX d. UMLS Answer: pg. 325 7. What standards are specifically related to the secure exchange of health information over the Internet? a. DICOM b. UMLS c. NwHIN d. NCPDP Answer: pg. 344-345 8. Which organization produces RxNorm that serves as a normalized naming system for generic and brand name drugs? a. NLM b. ANSI c. NCPDP d. NCIRD Answer: pg. 326 9. What UMLS knowledge source contains all of the common health care information vocabularies with a goal of incorporating and mapping them into a single system? a. UMLS Metathesaurus b. UMLS Semantic Network c. SPECIALIST Lexicon and Lexical Tools d. All of the above Answer: pg. 328 10. CDT codes are designed to support accurate recording and reporting of treatments and procedures related to? a. Orthopedics b. Dentistry c. Cardiology d. Diagnostic testing Answer: pg. 323 TRUE/FALSE 1. In recent years, a single vocabulary has emerged to meet all of the information exchange needs of the health care sector.

True False Answer: pg. 324 (No single vocabulary has emerged to meet all of the information exchange needs of the health care sector)

39 2. Although there is no requirement that providers write prescriptions electronically, those who chose to do so must comply with specific electronic prescribing standards.

True False Answer: pg. 343 3. The LOINC system was developed to facilitate the electronic transmission of laboratory results.

True False Answer: pg. 325 4. All SDOs share the responsibility for the development, maintenance, and modification of relevant electronic data interchange standards as designated by HIPAA. True False Answer: pg. 343 (DSMOs have the responsibility for the development, maintenance, and modification of relevant electronic data interchange standards) 5. The FDA is responsible for assigning a unique three-segment NDC as the universal product identifier for all human drugs True False.

Answer: pg. 323 6. The SQL database language and Windows operating system are examples of standards that were developed ad hoc.

True False Answer: pg. 319 (The SQL database language and the Windows operating system are examples of de facto standards) 7. HIPAA transaction standards only apply to certain covered entities’ electronic data interchange (EDI).

True False Answer: pg. 341 (HIPAA transaction standards apply to all covered entities’ electronic data interchange (EDI).

8. All SDOs must be accredited by ANSI and develop standards in accordance with ANSI criteria.

True False Answer: pg. 320

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9. CVX was developed as a table for use with HL7 messaging standards related to clinical vaccines.

True False Answer: pg. 326 10. HL7 v3 messaging standards incorporate the root elements of HTML. True False Answer: pg. 330 (HL7 v3 messaging standards incorporate the root elements of XML) SHORT ANSWER/ESSAY Describe some key components of ONC’s mission as it relates to the implementation of HITECH. Answer: pg. 343-344

41 Chapter 11 Security of Health Care Information Systems MULTIPLE CHOICE 1. Under the HIPAA Security Rule, which is NOT considered a covered entity (CE)? a. A health plan b. A business associate c. A health care provider d. All are considered covered entities Answer: pg. 362 2. HITECH gave the responsibility for enforcing the HIPAA Privacy and Security Rules to: a. ONC b. OCR c. CMS d. NCQA Answer: pg. 362 3. Password system, PINS, and biometric identification systems are all specific examples of: a. Entity authentication b. Encryption c. Audit trails d. Firewall protection Answer: pg. 375 4. One of the key components of applying administrative safeguards to protect an organization’s health care information is: a. Risk analysis b. Access controls c. System security evaluation d. Developing a contingency planning Answer: pg. 363 5. The most stringent type of access control is: a. User-based b. Role-based c. Context-based d. Password-based Answer: pg. 373 6. The policies and procedures that govern the receipt and removal of hardware, software, and devices such as disks and tapes are known as: a. Media controls b. Physical access controls c. Technical safeguards d. Remote Access Security

42 Answer: pg. 370 7. Security management functions, assigned security responsibility, and information access management are all standards included in which safeguard category of the HIPAA Security Rule? a. Administrative b. Physical c. Technical d. All of the above Answer: pg. 357-358 8. A type of software that protects computing resources and is most commonly found between the health care organization’s internal network and the Internet is known as a(n): a. Encryption algorithm b. Public key infrastructure (PKI) c. WEP d. Firewall Answer: pg. 379 9. A common type of computer virus that resides in a removable media device such as a flash drive is known as a: a. Botnet b. Macro virus c. Polymorphic virus d. Boot sector virus Answer: pg. 382 10. According to the National Institute for Standards and Technology (NIST), what type of contingency-related plan is typically IT focused and used in the event of a major hardware or software failure? a. Continuity of operations plan b. Contingency plan c. Disaster recovery plan d. Business continuity plan Answer: pg. 367 TRUE/FALSE 1. External breaches of security are far more common than internal breaches.

True False Answer: pg. 355 (Internal breaches of security are far more common than external breaches) 2. The most common encryption algorithm in use today is RSA; however, the AMA recommends AES as a better choice for encrypting electronic protected health information (ePHI).

43 True False Answer: pg. 380 3.The HIPAA Security Rule governs all protected health information (PHI).

True False Answer: pg. 356 (The HIPAA Security Rule governs only electronic health information (ePHI)) 4. Password and PIN systems are the most common forms of entity authentication and provide the strongest form of security True False Answer: pg. 376 (Although password and PIN systems are the most common forms of entity authentication, they also provide the weakest form of security) 5. Computer viruses are among the most common and virulent forms of intentional computer tampering.

True False Answer: pg. 354 6. The proxy server is a more complex firewall device than the packet filter and runs on a computer.

True False Answer: pg. 381 7. Ciphertext is a computer program that converts plaintext into an enciphered form.

True False Answer: pg. 379 (An encryption algorithm is a computer program that coverts plaintext into an enciphered form) 8. The primary challenge of developing an effective security program in a health care organization is balancing the need for security with the cost of security.

True False Answer: pg. 353 9. All of the specifications contained within the HIPAA Security Rule are considered required.

True False Answer: pg. 356 (The specifications contained in the Security Rule are designated as either required or addressable)

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10. Time limit, availability, and updates are all implementation specifications contained within the Policies, Procedures, and Documentation section of the HIPAA Security Rule.

True False Answer: pg. 361 SHORT ANSWER/ESSAY Describe the steps involved in risk analysis and management and the ultimate goal of conducting such an assessment.

Answer: pg. 363-365

45 Chapter 12 Organizing Information Technology Services 1. Data center management, network engineers, and help desk personnel are all examples of roles that would fall under: a. Operations and technical support b. Applications management c. Specialized groups d. IT administration Answer: pg. 398 2. What is an example of an infrastructure service metric that can be used to formally measure services levels? a. The percentage of help desk calls that are repeat calls b. The time that elapses between ordering a workstation and its installation c. The percentage of time that systems have unscheduled downtime d. All of the above Answer: pg. 428-429 3. An advantage to managing IT in a health care organization with a decentralized structure is: a. Innovative use of information systems b. Better staffing c. Efficient administration of resources d. Easier strategic IT planning Answer: pg. 420 4. Managing contracts with vendors, and developing and monitoring the IT budget are all tasks that are likely be performed by: a. Operations and technical support b. Applications management c. IT administration d. Network engineers Answer: pg. 400 5. According to Agarwal and Sambamurthy, what core IT process involves identifying new ways for IT to improve business operations and ensure that IT investments deliver value? a. Value innovation b. Solutions delivery c. Platform management d. Financial management Answer: pg. 433 6. An IT professional that would be responsible for identifying information system needs and problems, evaluating workflow, and determining strategies for optimizing the use and effectiveness of particular systems is a: a. System analyst

46 b. Programmer c. Database administrator d. Network administrator Answer: pg. 411 7. IT staff and services that are organized to support a particular application such as a billing system or clinical area are structured according to? a. Service areas b. Product lines c. Critical organizational processes d. Functional dimensions Answer: pg. 417 8. All are characteristics of a high-performing IT staff except: a. They execute well b. They stay current in their field of expertise c. They are good consultants d. They have a clinical background Answer: pg. 413 - 414 9. Asking questions such as ‘To what degree are IT strategies well aligned with the organization’s overall strategic goals?’ are related to what key area of evaluating IT effectiveness? a. Governance b. Budget development and resource allocation c. System Acquisition d. IT service levels Answer: pg. 427 10. A member of the IT team that is concerned with leading clinical information system initiatives is likely the: a. CIO b. CTO c. CSO d. CMIO Answer: pg. 404 TRUE/FALSE 1. On average, hospitals spend 5 percent of their operating budget and 25 percent of their capital budget on IT. True False Answer: pg. 427 (On average, hospitals spend 2.7 percent of their operating budget and 15 percent of their capital budget on IT)

47 2. Organizing IT staff according to critical organizational processes is a common approach because most organizations are structured this way.

True False Answer: pg. 417 (Despite the conceptual appeal of this approach, it is not common. Its rarity is due largely to the fact that most organizations are organized by departments and not cross-organization processes) 3. The role of CMIO is usually held by a physician and may be filled through a part time commitment.

True False Answer: pg. 404 4. Applications programmers write programs to maintain and control infrastructure software, such as operating systems, networked systems, and database systems.

True False Answer: pg. 411 (System programmers write programs to maintain and control infrastructure software, such as operating systems, networked systems, and database systems) 5. In recent years, health care organizations have shown a growing interest in outsourcing part or all of their IT services.

True False Answer: pg. 423 6. It general, over half of all health care provider CIOs report directly to the CEO of their health care organization.

True False Answer: pg. 403 (In general about one-third of all health care provider CIOs report to the CEO, one-third report to the CFO, and one-third report to the COO.) 7. Network administrators and telecommunications specialist often work closely together to manage a healthcare organization’s communication network.

True False Answer: pg. 412 8. Tracking emerging technologies, and identifying the ones that might provide value to the organization are tasks commonly carried out by the CTO. True False Answer: pg. 404

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9. The organization or form of the IT department in an integrated delivery system (IDS) is sometimes matrixed.

True False Answer: pg. 417-418 (The form of the IT department in an IDS is invariably matrixed) 10. Despite the advantages of a more centralized approach to managing IT services, many health care organizations have moved in recent years to a relatively decentralized structure.

True False Answer: pg. 419 SHORT ANSWER/ESSAY Explain the purpose of evaluating IT service levels and some of the measures or benchmarks used to assess the organization’s performance in this area?

Answer: pg. 427-433

49 Chapter 13 IT Alignment and Strategic Planning MULTIPLE CHOICE 1. The development of an organization’s strategy has two major components known as: a. Assessment and Planning b. Formulation and Implementation c. Assessment and Implementation d. Formulation and Application Answer: pg. 440 2. What term refers to broad properties of the organization’s infrastructure such as reliability and agility? a. Capabilities b. Characteristics c. Applications d. Assets Answer: pg. 448 3. What vector of IT strategy development can be highly speculative and may not require any immediate action? a. Organizational strategy b. Continuous improvement of core processes and information management c. Examination of the role of new information technologies d. Assessment of strategic trajectories Answer: pg. 446 4. Strategy discussions surrounding the application asset as a whole focus on all of these key areas EXCEPT: a. Sourcing b. Application uniformity c. Application implementation d. Application acquisition Answer: pg. 447 5. What is an objective of the IT strategic planning process? a. To ensure that the organization has not missed a strategic IT opportunity b. To develop a communication tool to inform the organization of IT initiatives c. To develop a tactical plan that details approved project descriptions d. All of the above Answer: pg. 438 – 439 6. The IT asset is composed of what four components? a. Infrastructure, technology, interfaces, and IT staff b. Applications, software, data, and hardware c. Infrastructure, processors, data, and interfaces

50 d. Applications, infrastructure, data, and IT staff Answer: pg. 447 7. The determination of the basic long-term goals and objectives of an organization, the adoption of the course of action, and the allocation of resources necessary to carry out those actions is known as: a. Strategy b. Formulation c. Implementation d. Alignment Answer: pg. 440 8. All of the reasons are attributed to the persistent difficulty many health care organization’s face in achieving IT alignment EXCEPT: a. IT opportunities are poorly understood b. The complexity of the IT alignment process c. Business strategies are often not clear or are volatile d. The organization is unable to resolve the differing priorities of different parts of the organization Answer: pg. 459 9. All of the following are considered members of the IT staff who are responsible for the day in and day out management of information technology systems EXCEPT: a. Analysts b. Programmers c. CIO d. Computer operators Answer: pg. 449 10. What process centers on discussions of ideas and issues that lead to the determination of goals and initiatives and the definition of organizational capabilities and competencies needed to implement these goals and initiatives? a. Strategic thinking b. IT alignment c. Strategic decisions d. IT strategy vectors Answer: pg. 463 TRUE/FALSE 1. Formulation involves understanding competing ideas and choosing between them True False Answer: pg. 440 2. Organizations that have a history of IT excellence have evolved to a state where their alignment process is methodology-less.

51 True False Answer: pg. 460 3. The implementation component of strategy development includes the development of project plans and budgets.

True False Answer: pg. 441 (The implementation component of strategy development is not the development of project plans and budgets.)

4. An effective IT alignment requires the integration of the organization’s strategic context, environment, IT strategy, and IT portfolio True False Answer: pg. 459 5. IT alignment done correctly will guarantee the effective application of IT. True False Answer: pg. 460 (Although alignment is important, it will not guarantee effective application of IT) 6. Strategic decisions rarely involve changes in the core understandings that guide organizational activity.

True False Answer: pg. 463 (Strategic decisions often involve changes in the core understandings that guide organizational activity) 7. The process of developing IT strategy should be similar in approach and nature to the process used for overall strategic planning.

True False Answer: pg. 450 8. The alignment process should produce a number of results including a high-level analysis of the budget needed to carry out any IT initiatives.

True False Answer: pg. 458 9. A strategic decision has clear and illuminating ramifications for many other decisions.

True False Answer: pg. 463

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10. Scoring or ranking can be used as a method of prioritizing recommendations by the leadership team and should be accepted as definitive output.

True False Answer: pg. 455 (The leadership should not feel compelled to accept the rankings as a definitive output) SHORT ANSWER/ESSAY Describe some of the major IT strategy and alignment challenges and what successful organizations have done to make this process more effective.

Answer: pg. 458-461

53 Chapter 14 Strategy Considerations MULTIPLE CHOICE 1. Phase II as part of the evolution of IT strategy has three major classes of activity including all EXCEPT: a. Continuous improvement of processes b. Leveraging of data c. Systems extensions d. Quality assessment Answer: pg. 472 2. Foundation replacement should only occur under what circumstances? a. The vendor goes out of business b. There has been a serious failure of the foundation to incorporate new technologies c. A new vendor arrives with products that have dramatically superior capabilities d. All of the above Answer: pg. 478 3. What source of advantage is realized when IT is used to monitor an organization’s plans, operations, and environment? a. Leverage of organizational processes b. Rapid and accurate provision of critical data c. Product and services differentiation d. All of the above Answer: pg. 479 4. The way an organization views a particular IT challenge or opportunity is known as: a. Governing concepts b. Complementary strategies c. Competitive advantage d. Strategy evolution Answer: pg. 475 5. The type of strategies that result from an understanding that a set of IT strategies points to the need to elevate some aspects of organizational IT-related competency are specifically known as: a. Broad leverage strategies b. Initiative-specific strategies c. Competitive strategies d. Growth strategies Answer: pg. 468 6. Using an EHR to implement systems such as personal health records (PHRs) and to remotely monitor chronically ill patients are examples of initiatives that would occur during what part of Phase II? a. Continuous improvement of processes

54 b. Leveraging of data c. Systems extensions d. Quality assessment Answer: pg. 474 7. The pursuit of IT as a source of competitive advantage can result in competitive baggage such as: a. Eroding profit margins b. IT dependency c. IT rigidity from poor architecture design d. All of the above Answer: pg. 482-483 8. According to Jim Collins seminal book Good to Great, all of the following are general observations of ‘great’ companies orientation to IT EXCEPT: a. Avoided IT fads b. Became pioneers when technology showed great promise c. Often mentioned IT as being critical to their success d. Responded to technology change with thoughtfulness and creativity Answer: pg. 487 9. A source of advantage that requires a solid understanding of the needs of patients, providers, and other customers is: a. Leverage of organizational process b. Rapid and accurate provision of critical data c. Product and services differentiation d. All of the above Answer: pg. 480 10. Factors that can limit the utility of IT technology as a tool include all of the following EXCEPT: a. Experimenting with new technologies b. Having an inadequate understanding of buying dynamics across market segments c. Introducing applications too early d. Being too far ahead of the customer’s comfort level Answer: pg. 484-485 TRUE/FALSE 1. Complementary strategies are organizational initiatives that do not involve the IT asset per se but are needed for the IT strategy to succeed True False Answer: pg. 468

55 2. The competitive advantage obtained from an IT application or technology rarely comes from the actual IT system but rather from skilled process changes that distinguish an organization from its competitors.

True False Answer: pg. 481 3. Initiative specific strategies are developed through discussions about how to make the organization more effective in its IT efforts True False Answer: pg. 471 (Broad complementary strategies are developed through discussions about how to make the organization more effective in its IT efforts) 4. Assessing the return on investment (ROI) of a foundation is an easier exercise than determining the ROI or net present value (NPV) of an application.

True False Answer: pg. 477 (Assessing the ROI of a foundation is a more difficult exercise than determining the ROI or NPV of an application) 5. In many ways, the architecture, technologies, and tools that enable ongoing implementation may be more important than the current functionality of the application.

True False Answer: pg. 476 6. Improved organizational competitive position through process gains is usually an automatic result of IT implementation.

True False Answer: pg. 479 (Improved organizational competitive position through process gains is not an automatic result of IT implementation) 7. Planning for Phase II must start while the organization is in Phase I but should not begin until Phase I is completed.

True False Answer: pg. 474 (Planning for Phase II must start while the organization is in Phase I; aspects of Phase II need not wait for Phase I to be completed) 8. Organizations that have been effective in the strategic application of IT over a long period of time generally have a series of ‘singles’ or small successes punctuated by an occasional leap, or grand slam.

True False

56 Answer: pg. 485 9. Information technology itself can provide a competitive advantage that is sustainable for a long time True False Answer: pg. 487 (Information technology itself cannot provide a competitive advantage that is sustainable for a long time) 10. An organization should realistically be able to define all of their functionality requirements during the RFP process.

True False Answer: pg. 477 (The RFP process implies that all functionality ever needed must be understood and defined. Although one should try to understand up front as much as one can about functionality that is needed, there is little likelihood one can anticipate all that will be needed) SHORT ANSWER/ESSAY Explain how organizations can obtain and sustain a competitive advantage using IT technology as a tool and some of the common pitfalls that organizations often experience.

Answer: pg. 481 - 486

57 Chapter 15 IT Governance and Management MULTIPLE CHOICE 1. Ensuring that the IT issues and needs of a function of the organization are understood and communicated to the IT department and the executive committee is a responsibility of the: a. IT liaison b. CIO c. Senior management d. IT staff Answer: pg. 505 2. According to Peter Weill and Jeanne Ross, which of the five major areas that form the foundation of IT governance deals with an integrated set of technical choices used to guide the organization in satisfying business needs? a. IT principles b. IT architecture c. IT infrastructure strategies d. It investment and prioritization Answer: pg. 493-494 3. One of the most critical management undertakings that involves the commitment of resources to carry out strategic initiatives is: a. Developing budgets b. Defining polices and procedures that govern the use of IT c. The linkage of governance to strategies d. Distribution of IT responsibilities Answer: pg. 513 4. Ensuring that the organization has a comprehensive, thoughtful, and flexible IT strategy is a responsibility of: a. IT users b. The IT department c. Senior management d. All of the above Answer: pg. 499 5. Well-developed governance mechanisms have all of these characteristics EXCEPT: a. They are efficient and timely b. They make authority clear c. They rarely change d. They are perceived as objective and fair Answer: pg. 494-495 6. What is the second step of IT budget development? a. IT leadership reviews the strategic initiatives with senior leadership

58 b. The organization decides which new and ongoing initiatives will be funded c. The IT department submits an operating budget to support the application and infrastructure that will be in place as of the beginning of the fiscal year. d. The operations and strategic budget recommendations are reviewed and discussed at an executive committee meeting Answer: pg. 517 - 518 7. Participating in developing and maintaining the IT agenda and priorities and understanding the scope and quality of IT initiatives within a specific department are responsibilities of: a. IT users b. The IT staff c. CIO d. Senior Management Answer: pg. 498-499 8. According to Carol Brown and Vallabh Sambamurthy, which of the five mechanisms used by IT groups to improve their coordination and working relationships involves actions such as training IT staff on team building or offering user feedback during their reviews? a. Informal relationship building b. Human resource practices c. Integrators d. Processes Answer: pg. 505-506 9. All are considered characteristics of an organization that aspire to high levels of IT effectiveness EXCEPT: a. The organization must encourage innovation b. Relationships are critical c. The IT asset is critical d. True innovation occurs rapidly Answer: pg. 509-510 10. Despite the size of a health care organization effective management at a minimum requires: a. A senior management forum where major IT decisions are made b. A person responsible for day-to-day management of the IT function c. Mechanisms for ensuring that IT relationships have been established d. All of the above Answer: pg. 506-507 TRUE/FALSE 1. The fundamental accountability for the performance of the health care organization, including the IT function is held by the organization’s senior leadership.

True False Answer: pg. 502 (The health care organization’s board holds the fundamental accountability for the performance of the organization, including the IT function)

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2. Developing an IT steering committee to address all IT issues and decision is generally a good idea.

True False Answer: pg. 504 (If an organization has an IT steering committee that works well, it should leave it alone. In general, however, such committees are not a good idea) 3. Too much user responsibility can lead to insufficient attention to infrastructure, resulting in application instability.

True False Answer: pg. 501 4. Governance structures and the distribution of responsibilities should be some what influenced by basic strategic objectives.

True False Answer: pg. 495 (Governance structure and the distribution of responsibilities should be heavily influenced by basic strategic objectives) 5. Some of the responsibilities of the IT group may be delegated to others for example a non-IT department may be permitted to have their own IT staff and manage their own systems.

True False Answer: pg. 498 6. As a general ground rule, the IT budget should be discussed in the same conversations that discuss or involve non-IT budget requests.

True False Answer: pg. 517 7. Capital budgets are the funds associated with using and maintaining the asset.

True False Answer: pg. 514 (Operating budgets are the funds associated with using and maintaining the asset) 8. Effective application of IT involves the thoughtful distribution of IT responsibilities between the IT department, users of applications and IT services, and senior management.

True False Answer: pg. 497

60 9. An IT committee of the board can be composed of committee members other than board members such as IT professionals.

True False Answer: pg. 503 10. The IT staff or CIO should be asked to defend infrastructure investments but should not be asked to defend applications.

True False Answer: pg. 518 SHORT ANSWER/ESSAY Describe the five core structures for governing IT and name some of the primary responsibilities of each.

Answer: pg. 502 - 506

61 Chapter 16 Management’s Role in Major IT Initiatives MULTIPLE CHOICE 1. Changes that leave the organization and its core mission intact but significantly alter the way the organization carries out its business are: a. Incremental changes b. Step-shift changes c. Radical changes d. Fundamental changes Answer: pg. 524 2. What individual generally holds overall accountability for a project? a. Business owner b. Business sponsor c. Project manager d. IT manager Answer: pg. 530 3. What tool or document provides an overview of the project and is used by the project team during the day-to-day management of the project ? a. Project charter b. Project plan c. Project status report d. All of the above Answer: pg. 535 4. It is estimated that around what percentage of IT projects are successful? a. 25 percent b. 35 percent c. 50 percent d. 65 percent Answer: pg. 542 5. All are considered necessary aspects of change management EXCEPT: a. Universal buy-in b. Connection and trust c. Leadership d. Incentives Answer: pg. 526 6. What committee generally focuses on a subset of IT projects and determines if the project is proceeding well or likely to be heading into trouble? a. Project steering committee b. Project team c. Project review committee

62 d. Executive committee Answer: pg. 533 7. The project status report that documents and communicates the current condition of the project is generally prepared and distributed: a. Weekly b. Bi-weekly c. Monthly d. Every 6 weeks Answer: pg. 538 8. The two major categories of risk that confront significant IT investments are: a. Planning and implementation failure b. Leadership and change management c. Strategy failure and change management d. Strategy and implementation failure Answer: pg. 542 9. Maintaining the project plan and communicating progress to sponsors, stakeholders, and team members are responsibilities of the: a. Business owner b. Business sponsor c. Project manager d. IT manager Answer: pg. 531 10. What aspect of change management deals with helping the staff understand the nature of the change and how their roles and work life will be different? a. Language and vision b. Connection and trust c. Planning, implementing, and iterating d. Incentives Answer: pg. 526 TRUE/FALSE 1. Fundamental change is common in health care and carries less risk than other forms of change.

True False Answer: pg. 525 (Fundamental change is rare in healthcare. Incremental change carries less risk and hence requires less management.)

2. Project management places an emphasis on many of the “softer” aspects of management and leadership such as communicating vision and establishing trust.

True False

63 Answer: pg. 529 (Changes management places an emphasis on many of the “softer,” although still critical, aspects of management and leadership: communicating vision, establishing trust, and developing incentives) 3. Project phases and tasks including the sequence of these phases and tasks are generally included in the project plan.

True False Answer: pg. 535 4. If a change affects the entire organization, then it is advisable for the CEO to chair the leadership committee.

True False Answer: pg. 526 5. Management strategies should be the same regardless of the type of project being undertaken.

True False Answer: pg. 529 (Different projects require different management strategies) 6. Change initiatives and IT projects need to communicate their progress regularly but only when that progress is largely seen or apparent to the organization.

True False Answer: pg. 547 (Change initiatives and IT projects need to communicate their progress regularly even if that progress is largely unseen by the organization).

7. One outcome of continuous change may be the recognition that current application systems are progressively becoming a poor fit with the evolving organization.

True False Answer: pg. 524 8. The project team generally manages the performance of the project work and allocates resources as necessary to do the work.

True False Answer: pg. 533 9. Excellent project management always ensures project success.

True False Answer: pg. 534 (Excellent project management does not ensure project success. However, without such project management the risks of failure skyrocket)

64 10. For very complex projects, it is not unusual to see 20 to 25 percent of the budget and the duration of some tasks labeled as “unknown” or “unclear.”

True False Answer: pg. 538 SHORT ANSWER/ESSAY Describe the type of factors that determine project complexity and some actions leadership can take to ensure the project is not a failure.

Answer: pg. 545 - 549

65 Chapter 17 Assessing and Achieving Value in Health Care Information Systems MULTIPLE CHOICE 1. Of the four types or classes of IT investment, which involves upgrading core IT infrastructure and applications or is intended to reduce the cost or improve the quality of IT services? a. Transformation b. Renewal c. Process improvement d. Experiments Answer: pg. 561 2. A common financial measure that is calculated by subtracting the initial investment from the future cash flows that result from the investment is known as: a. Internal rate of return (IRR) b. Return on investment (ROI) c. Net present value (NPV) d. Gross revenue Answer: pg. 566 3. During what step related to increasing accountability for IT investments, should the project sponsors and business owners be defined and develop an understanding of the accountability they now have for the successful completion of the project? a. First b. Second c. Third d. Fourth Answer: pg. 576 4. Fewer errors, faster turnaround times for tests results, and a quicker admission process are all examples of tangible values that can be measured in terms of: a. Dollars b. Process improvements c. Operational and market outcomes d. All of the above Answer: pg. 557 5. A common proposal problem that occurs when it is projected that people will use the system in a specific way is: a. Unwarranted optimism b. Shaky extrapolations c. Reliance on complex behavior d. Underestimating the effort Answer: pg. 571-573 6. What is described as a cornerstone in examining the value of an IT project?

66 a. IT project proposal b. Formal financial analysis c. Comparing different types of value d. Strategic thinking and discussion Answer: pg. 565 7. What is intended to significantly change the competitive position of the organization or redefine the core nature of the enterprise? a. Infrastructure b. IT-enabled value c. Value realization d. Strategic initiatives Answer: pg. 564 8. According to Ross and Johnson, prerequisites for effective IT prioritization include: a. Explicit operating vision of the business b. Business process owners c. Transparent IT operating costs d. All of the above Answer: pg. 569 9. All of the following are examples of intangible values EXCEPT: a. Increase in brand awareness b. Improving in compliance c. Improving in decision making d. Becoming more customer friendly Answer: pg. 557-558 10. Steps to improve value realization include all of the following EXCEPT: a. Require formal project proposals b. Conduct post implementation audits c. Increase accountability for investment results d. Lengthen deliverable cycles Answer: pg. 574-579 TRUE/FALSE 1. Many studies have found that there is no overall obvious direct relationship between IT expenditures and organizational performance.

True False Answer: pg. 587 2. Information system infrastructure is hard to evaluate, as evaluation is often instinctive and experientially based.

True False

67 Answer: pg. 562 3. Organizations commonly revisit their IT investments to determine if the promised value was actually achieved.

True False Answer: pg. 578 (Rarely do organizations revisit their IT investments to determine if the promised value was actually achieved) 4. IT’s economic impact comes from incremental innovations rather than from ‘big bang’ initiatives.

True False Answer: pg. 589 5. Information system investments directed at improving the quality of service or medical care are generally evaluated in terms of service parameters.

True False Answer: pg. 563-564 6. An organization can determine the ROI of an investment in a tool only if it knows the task to be performed and the skill level of the participants who are to perform the task.

True False Answer: pg. 582 7. In health care it is common that information systems are the centerpiece of a redefinition of the organization.

True False Answer: pg. 564 (In health care it is rare that information systems are the centerpiece of a redefinition of the organization) 8. Statements about specific numerical goals are commonly included in IT project proposals True False Answer: pg. 583-584 (Statements about the positive contribution IT investments will make to organizational performance often accompany IT proposals. Statements about specific numerical goals for this improvement are less common) 9. IT investments that have different objectives and value propositions have different value assessment techniques.

True False Answer: pg. 556

68

10. When different organizations implement the same system and have comparable implementation skill levels, the value achieved is usually the same.

True False Answer: pg. 558-559 (Even when they implement the same system, not all organizations experience the same value. Even when the organizations have comparable implementation skill levels, the value achieved can vary because different organizations decide to focus on different objectives) SHORT ANSWER/ESSAY Explain the concept that IT can be understood as a commodity and some general observations associated with this statement related to the value of IT. Answer: pg. 589-590