ifsm305 final exam latest 2015

Question 1

What is the federal act that empowers the Centers for Medicare and Medicaid Services to create shared accountability for Medicare shared savings across groups of physicians, hospitals, and other healthcare providers?

Question options:

A)

American Recovery and Reinvestment Act

B)

Patient Protection and Affordable Care Act

C)

Federal Employees Health Benefits Program

D)

Health Insurance Portability and Accountability Act

E)

Medicare Prescription Drug Improvement and Modernization Act

Question 2

All of the following are considered a transition of care where a summary of care must be provided except which?

Question options:

A)

Discharge of the patient to home without expectation of follow-up to another provider

B)

Discharge of the patient to home with a follow-up to the patient’s regular physician

C)

A referral of the patient to another care provider within the same setting of care

D)

A patient is sent to the emergency room from the primary-care office

E)

A and C

F)

C and D

Question 3

Which of the following is not an electronic tool by which clinicians can engage consumers?

Question options:

A)

Personal health record

B)

Secure messaging

C)

Practice management system

D)

Physician web site and blog

E)

All of the above represent electronic tools by which clinicians can engage consumers

Question 4

Which of the following is a significant driver for the use of EHRs?

Question options:

A)

Rising healthcare costs

B)

Concerns about quality

C)

Concerns about coverage (access to health insurance)

D)

Concerns about inaccurate billing

E)

All of the above

F)

A and B

Question 5

Which of the following is considered by the Institute of Medicine to be functionality in an electronic record?

Question options:

A)

Results management

B)

Population health management

C)

Administrative support

D)

Communication tools

E)

All of the above

F)

A and C

G)

A and D

Question 6

The electronic entry of orders by the ordering clinician is referred to as which of the following?

Question options:

A)

Online entry system (OES)

B)

Computerized practitioner order entry (CPOE)

C)

Computerized ordering (CO)

D)

Medication ordering system (MOS)

Question 7

Which of the following is generally not considered demographic information?

Question options:

A)

Age

B)

Allergies

C)

Address

D)

Insurance carrier

Question 8

Which of the following national identifiers was not mandated by the Health Insurance Portability and Accountability Act (HIPAA) of 1996?

Question options:

A)

National Employer Identifier

B)

National Provider Identifier

C)

National Clearinghouse Identifier

D)

National Health Plan Identifier

Question 9

Which organization created and maintains the Current Procedural Terminology (CPT) code set?

Question options:

A)

American Medical Association

B)

American Hospital Association

C)

American Academy of Professional Coders

D)

American Health Information Management Association

Question 10

Which is a method to articulate the tasks, time, manual work, delays, and multiple variations that exist within care processes for a discipline or with reporting processes associated with many departments?

Question options:

A)

Modeling workflow based on scope of professional practice standards

B)

Simulation

C)

Observation of daily activities

D)

Lean strategy, Six Sigma, and continuous improvement

E)

Business process management and modeling tools

Question 11

Analyzing workflows can help discover which of the following?

Question options:

A)

Underuse of the EHR

B)

Clinician workarounds

C)

Need to aggregate information or reports for decision making

D)

Need to extract health information for exchanges

E)

All of the above

F)

A, B, and D

G)

C and D

Question 12

In general, what does role-based security in EHRs help maintain the principle of?

Question options:

A)

Minimum necessary requirement

B)

Meaningful use

C)

Diagnosis-related groups

D)

Accountable-care organizations

Question 13

What is covered by the term "personal health information"?

Question options:

A)

Any piece of information that the patient deems private

B)

Electronic information that is gathered in an EHR

C)

Information defined by each provider’s Bill of Patient Rights

D)

Any information that can personally identify a patient

E)

A, B, and D

F)

All of the above

Question 14

What is a value set?

Question options:

A)

A range of numbers that are normal results for laboratory tests

B)

A set of codes chosen by a measure developer to define a data element in a measure

C)

The relative strength of recommendations as supported by evidence for the interventions expected in a quality measure

D)

The combination of a measure’s validity, reliability and feasibility that describes its potential use in value-based purchasing programs

Question 15

Which of the following is the acronym for the standard used to write an eMeasure?

Question options:

A)

QRDA

B)

Consolidated CDA

C)

HQMF

D)

S&I Framework

E)

QUERYHEALTH

Question 16

Systems analysis involves which of the following?

Question options:

A)

Designing the components of a system

B)

Testing a system for correctness

C)

Obtaining system requirements

D)

Constructing a system

Question 17

Why is the implementation of EHRs on the rise?

Question options:

A)

Hospitals need to find better ways to use their employees

B)

Due to the government's prompting, with regulatory requirements that have been accompanied by financial incentives

C)

All of the above

D)

None of the above

Question 18

What is the key to a successful implementation of an EHR?

Question options:

A)

It is done as quickly as possible

B)

It uses a lot of a hospital’s resources

C)

It supports clinical care

D)

It doesn’t bother the hospital staff

Question 19

The term “health data standards” is generally used to describe those standards having to do with which of the following?

Question options:

A)

Structure and content of health information

B)

Privacy and security rule

C)

Document architecture and network

D)

Claims, enrollment, and eligibility

Question 20

Through meaningful use incentives, patient portals have been developed where patients can often access which of the following?

Question options:

A)

Laboratory results

B)

Medication lists

C)

Upcoming appointments

D)

All of the above

E)

A and B

Question 21

What kind of analysis needs to take place before a new EHR can be integrated?

Question options:

A)

Workflow analysis

B)

System requirements analysis

C)

Deployment analysis

D)

None of the above

Question 22

Of the traditional information security concerns, which is uniquely and exceedingly important within healthcare?

Question options:

A)

Confidentiality

B)

Integrity

C)

Availability

D)

Accountability

Question 23

Which of the following statements is correct?

Question options:

A)

Authorization is a way of identifying a user before the access is granted

B)

Integrity controls keep the data consistent and correct by means of controls that a data base administrator puts on the database

C)

Data breaches mean the data, applications or networks are unavailable to database users

D)

Data security is not important in the database system design

Question 24

What are the privacy rights afforded patients pursuant to the HIPAA Privacy rule (45 CFR Parts 160 and 164)?

Question options:

A)

The maximum rights of quality, efficiency and effectiveness

B)

Patients must be informed of disclosed PHI other than for treatment, payment, and healthcare operations

C)

There are no rights afforded to patients

D)

These are security provisions that do not protect patient privacy

E)

The security and privacy provisions apply only to national health care clearinghouses

Question 25

What are the operations on a class of objects that make up permission?

Question options:

A)

Identity, authentication, authorization, and consent

B)

Authentication, authorization and identity

C)

Consent, identity and authorization

D)

Create, read, update, delete and execute

Question 26 8 / 10 points

Assume you are a malpractice lawyer specializing in medical error injury. Dr. Joan Thomas visits your office asking you to represent her in a medical negligence case. She says she will email you the electronic medical records of the patient who filed the complaint so you can use them in court (What information is protected: http://www.hhs.gov/ocr/privacy/hipaa/understanding/summary/). When you receive the records, you email them to your paralegal for analysis and filing. Instead of filing the electronic document on the firm’s file server, your paralegal accidentally forwards the document to the defendant’s attorney, who happens to be a personal friend. Did anyone violate HIPAA? Why/ not? If a complaint was filed, who would file it? What could the potential penalty be? Who would be penalized? Why?

Question 27 8 / 10 points

Again, assume you are the same malpractice lawyer as in the previous case. Assume your paralegal filed the patient’s medical records on the firm’s file server appropriately. Your firm excels in disaster recovery such that it has an automatic nightly backup system that saves all new files to the cloud using an internet file backup system. However, unknown to you, and your firm, a technician at the backup firm likes to look at random new files as they are being uploaded to the service’s servers. As luck would have it, the technician knows the patient who filed the complaint, calls her and asks how she is recovering from the medical error injury. Did anyone violate the HITECH Act? If so, who and to what extent? If not provide a rationale.

Question 28 8 / 10 points

Monica is the Office Manager at a busy surgical practice located in a hospital. The doctors have just decided to implement EHRs and have joined the EHR system that is part of the hospital's IT infrastructure. The doctors want to provide patients with a printout of their visit as they leave the examining room. To allow them to be able to move the printer around, they asked Monica to order a wireless printer like the one that one of the doctors uses at home (he knows that it was not expensive, that it was easy to get up and running, and that he has had no problems with it). She has received the printer and it is sitting on a cabinet outside the examining rooms. Monica called the hospital IT department and when the technician arrived, he told her he could not hook up the wireless printer for use, as it is not supported by the hospital. When Monica called for further assistance, she was told that she would have to talk to the IT security manager about getting it onto the wireless network and that since it was not a printer purchased by the hospital that the hospital IT department could not support it. Monica is frustrated because the doctors want to use the printer and she cannot figure out how to get it connected to the EHR system. What could Monica do at this point? What should she have done when the doctors told her to order the wireless printer? Why?

Question 29 18 / 20 points

The Maxum Care Health Group (MCHG) is a group of healthcare providers, with 10 general practitioners (GPs) who also function as family physicians for many in their town of about 50,000 people. As GPs, the group functions as primary care physicians, which means they are the first point of contact for many in the community. MCHG accepts all patients that carry health insurance, including Medicare and Medicaid.

MCHG has been in operation for over 25 years. Drs. Thomas and Sims founded the group, but since then have hired the balance of the medical staff. Aside from Drs. Thomas and Sims, the medical staff is relatively young, and well oriented to modern medicine and its management and organization.

The office staff at MCHG is comprised of several job positions. These include a receptionist, several secretaries, several medical coders/billers, several transcriptionists, nine medical assistants, two laboratory technicians, and an office manager.

Because the MCHG was established before the Internet revolution, use of computers is limited. The front desk uses four terminals to schedule patients and to complete billing tasks. The terminals are connected to two central personal computers that run an old version of the Linux operating system. They are also connected to several dot-matrix printers used to print billing forms and other pertinent financial information.

All patient information including the medical record is maintained by paper files. When a doctor examines a patient, all of the pertinent chart information is recorded either by the doctor writing directly in the paper chart, or by voice dictation, which is then later transcribed into the chart.

Drs. Thomas and Sims developed MCHG to be as vertically integrated as possible, so they own and manage some of their medical equipment. Therefore, they have a small laboratory where routine blood and urinalysis can be completed on-site. As laboratory equipment becomes obsolete quickly, all the lab equipment is less than one year old. They also have a small x-ray suite for chest x-rays, broken bones, and so on. Unfortunately, x-ray equipment is very large, expensive, and hasn’t really changed much for the simpler examination as those conducted by MCHG. Thus, all of the x-ray equipment is original. For cardiac concerns, they have their own EKG equipment, but only half of the machines are current, the other half are original to the group.

Drs. Thomas and Sims recently learned of something new from the government called the HITECH Act. They are concerned that new government regulations will constrain their business without significant improvement in their ability to deliver quality health care.

Assume you are the new office manager for MCHG. When hired, you were tasked with the following goals: to bring the group into the present, increase efficiency, improve healthcare delivery, and to increase net revenues. In order to accomplish these goals, you are determined to introduce an EHR. When you present the idea to the group physicians, they have the following comments:

1. We don’t need an EHR. Our system works fine. Why should we spend money on something we don’t need?

2. EHRs only increase the likelihood we will run afoul of the HITECH Act. Paper systems are inherently more secure than electronic systems.

3. We already have an electronic system. What will an EHR do that our current system will not?

4. Instead of meeting HHS requirements, maybe we should stop taking Medicare patients.

Using the case above,

A) How would you respond to each physician comment above? Be sure to provide a solid rationale and address each comment separately. (10 points)

B) Assume the physicians agree with your recommendations. Identify and describe the regulators and regulations in order to meet the stated goals. Be sure to identify each of the major federal regulators and regulations in the United States and how they would impact the EHR implementation. (10 points)