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Test Bank for Health Informatics: An Interprofessional Approach, 1st Edition

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    Chapter 1: Introduction: The Evolution of Health Informatics Test Bank MULTIPLE CHOICE 1. The historical roots of computer science can be traced to: a. language development, especially English. b. mathematics and engineering. c. library science. d. medicine and nursing. ANS: B The historical roots of computer science can be traced back to mathematics and e ngineering. The historical roots of information science began in library science. Language development and medicine and nursing are not the roots of computer science. DIF: Cognitive Level: Understand REF: p. 3 2. The historical roots of information science can be traced to: a. language development, especially English. b. mathematics and engineering. c. library science. d. medicine and nursing. ANS: C The historical roots of information science began in library science. The historical roots of computer science can be traced back to mathematics and engineering. Language development and medicine and nursing are not the roots of information science. DIF: Cognitive Level: Understand REF: pp. 3 - 4 3. The first book to include the term nursing informatics in the title was written in the: a. 1960s. b. 1970s. c. 1980s. d. 1990s. ANS: C The first book to include the term nursing informatics in the title was published in 1988. DIF: Cognitive Level: Remember REF: p. 6 4. As knowledge develops and expands within a discipline, which information source will include the oldest but best organized representation of that knowledge? a. Conference presentations b. Conference proceedings c. Journal articles d. Books ANS: D

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    The information source that includes the oldest but best organized representation of knowledge is books. DIF: Cognitive Level: Apply REF: p. 5 5. Which technical development created a tension between centralized and decentralized computer management in healthcare? a. The development of punch cards b. The elimination of punch cards c. The development of the mainframe computer d. The development of the personal computer ANS: D The development of the personal computer created tension between centralized and decentralized computer management in healthcare. The other responses highlight aspects of decentralized computer management. DIF: Cognitive Level: Apply REF: p. 3 6. Which of the following is not a member organization but rather a group of organizations? a. AMIA b. HIMSS c. AHIMA d. ANI ANS: D The Alliance for Nursing Informatics (ANI) is an organization of organizations. This is not a member group. AMIA, HIMSS, and AHIMA are all member groups. DIF: Cognitive Level: Remember REF: p. 7 7. Which statement concerning educational programs in health informatics is correct? a. All health informatics programs are offered at the graduate level. b. Informatics programs offered by medical schools always require students to have earned an MD for admission. c. All health informatics programs are located within health - related departments or schools such as nursing, medicine, or pharmacy. d. Health informatics programs range from certificate programs offered at the community college level to post - doctoral programs offered at major research institutions. ANS: D The correct response is health informatics programs range from certificate programs offered at the community college level to post - doctoral programs offered at major research institutions. Not all informatics programs require an MD, are at the graduate level, or are located within schools of health sciences. DIF: Cognitive Level: Apply REF: pp. 9 - 10 8. Which statement related to certification in health informatics is correct? a. A master’s in nursing is required to sit for the NI examination offered by ANCC. b. To be certified in clinical informatics in association with AMIA, one must first be

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    a physician. c. There are no specific educational requirements for CPHIMS certification through HIMSS, but three years of full - time clinical experience in health IT is required. d. To be certified as CPHIMS, you must be a nurse. ANS: B To be certified in clinical informatics in association with AMIA, one must first be a physician. You do not need to have an MSN to sit for the NI exam by the ANCC. There are specific requirements for CPHIMS, but being a nurse is not one of them. DIF: Cognitive Level: Apply REF: p. 11 MULTIPLE RESPONSE 9. The term informatics is derived from: (Select all that apply.) a. Dutch. b. English. c. Russian. d. Arabic. e. French. ANS: B, C, E The term informatics was derived from the following languages: English, Russian, and French. DIF: Cognitive Level: Understand REF: p. 4 10. When the AMIA model is used, which subfields are categorized as clinical informatics? (Select all that apply.) a. Medical informatics b. Nursing informatics c. Dental informatics d. Chemical informatics e. Business informatics ANS: A, B, C When the AMIA model is used, the following disciplines are categorized as clinical informatics: medical informatics, nursing informatics, and dental informatics. The other responses are not clinically related. DIF: Cognitive Level: Analyze REF: p. 14

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    Chapter 2: Theoretical Foundations of Health Informatics Test Bank MULTIPLE CHOICE 1. What is the primary difference between an open and closed system? a. An open system has no boundary, and therefore there are no limits to the inputs and outputs between an open system and the environment. b. An open system has a semipermeable boundary and therefore will filter both inputs and outputs when interacting with the environment. c. A closed system has a semipermeable boundary and therefore will filter both inputs and outputs when interacting with the environment. d. A closed system does not have a boundary and therefore will not interact with the environment. ANS: B With an open system the boundary is semipermeable, thereby controlling what will be accepted as input and what will be permitted to leave the system. DIF: Cognitive Level: Understand REF: p. 20 2. The primary characteristics used to analyze an open system include: a. structure, purpose, and functions. b. sub - system, target system, and super - system. c. boundary, attributes, and environment. d. hierarchical, web, and hybrid. ANS: A Using these three characteristics, one can determine why the system exists, what functions it performs to achieve its purpose , and how it is structured to achieve its purpose. DIF: Cognitive Level: Analyze REF: p. 20 3. A change made to any aspect of an open system, whether it is a health care syste m or a computer system, will produce change in other aspects of that same system. As a result, any change can produce unintended consequences. This process is called: a. dynamic homeostasis. b. semi - planned change. c. negentropy. d. reverberation. ANS: D Change within any part of the system will be reflected across the total system through a process termed reverberation. Reverberation is reflected in the intended and unintended consequences of system change. DIF: Cognitive Level: Remember REF: p. 23 4. Chaotic systems are in a constant state of change. This degree or scope of chang e that can occur has been described as the butterfly effect. The butterfly effect refers to:

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    a. a minor change in input can create a major change in output, or a major change in input can result in minor changes in output. b. a major change in input will create a major change in output, and a minor change in input will create minor changes in output. c. a minor change in input can create a minor change in output; however, a major change in input will result in minor changes in output. d. a minor change in input may create a major change in output; however, a major change in input will create a major change in output. ANS: A Chaotic systems are dynamic systems with reiterative feedback loops. A minor change in input can create a major change in output. This is often described as the butterfly effect. A butterfly’s flapping wings in California can over time become a hurricane in New York. DIF: Cognitive Level: Analyze REF: p. 24 5. Which statement describes the measurement of information as defined by the Shannon and Weaver model? a. The amount of information is measured by the amount of data in the message. b. The amount of information is measured by the number of meanings that can be assigned to a message. c. The amount of information is measured by the extent the message decreases entropy. d. The amount of information is measured by the number of characters used to create the message. ANS: C By decreasing entropy one decreases uncertainty. If a coin is thrown into the air, it may land on either of two possible sides, heads up or tails up. Once it lands, the other side of the coin can be determined. The options are coded zero (0) and one (1) and are the basis for building computer code. DIF: Cognitive Level: Remember REF: pp. 25 - 26 6. The number 190 is an example of: a. data. b. information. c. knowledge. d. wisdom. ANS: A The number 190 could refer to anything such as a person’s weight, blood glucose level, or systolic blood pressure reading and therefore has no meaning by itself. DIF: Cognitive Level: Apply REF: p. 26 7. Knowing when and how to use knowledge is referred to as: a. procedural knowledge. b. cognitive knowledge. c. decision support system. d. wisdom.

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    ANS: D Wisdom is defined as the appropriate use of knowledge in managing or solving human problems. It is knowing when and how to use knowledge in managing patient need(s) or problem(s). DIF: Cognitive Level: Remember REF: pp. 26 - 27 8. Which concepts are used to describe the different types of learning outcomes and can be used to write learning objectives? a. Input, throughput, and output b. Adult learning theories, constructionist theories, and learning styles c. Cognitive, affective, and psychomotor d. Short, intermediate, and long - term memory ANS: C Learning is defined as an increase in knowledge, a change in attitude or values, or the development of new skills. DIF: Cognitive Level: Apply REF: p. 30 - 31 9. Which group will test out new technology but are not usually seen as leaders within an organization? a. Innovators b. Early adopters c. Early majority d. Late majority ANS: A Innovators will test out a new technology; however, they are too far ahead of th e social group to be seen as leaders by other members of the social system. Early adopters are seen as much more discreet in their selection of new technology and are therefore better at selling a new technology to a group of potential users. DIF: Cognitive Level: Understand REF: p. 33 MULTIPLE RESPONSE 10. The systems life cycle (SLC) is a guide for informatics projects. Typical phases of the SLC include (select all that apply): a. implementation. b. planning. c. evaluation. d. security. e. diagnosis. ANS: A, B, C According to published reports, the SLC contains between 3 and 7 stages. The three that are common in each of these reports are implementation, planning, and evaluation. DIF: Cognitive Level: Remember REF: p. 35

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    Chapter 3: Evidence - Based Practice and Informatics Test Bank MULTIPLE CHOICE 1. Knowledge is the point of convergence across the areas of: a. evidence - based practice, quality assurance, and informatics. b. evidence - based practice, improvement, and informatics. c. evidence - based practice, quality assurance, and improvement. d. improvement, quality assurance, and informatics. ANS: B Knowledge is the point of convergence across the areas of evidence - based practice, informatics, and improvement. None of the other answers include all of these aspects. DIF: Cognitive Level: Remember REF: p. 42 2. Which two hurdles does the STAR Model address in employing evidence - based practice? a. The volume and form of knowledge b. The quality and form of knowledge c. The volume and outcomes of knowledge d. The adequacy and form of knowledge ANS: A The STAR Model addresses two major hurdles in employing evidence - based practice (EBP). These two hurdles are the volume of current professional knowledge and the form of knowledge that healthcare professionals attempt to apply in practice. DIF: Cognitive Level: Remember REF: pp. 43 - 44 3. What is the form of knowledge in discovery research? a. Single research studies b. Meta - synthesis c. Systematic review d. Meta - analysis ANS: A Discovery research represents knowledge produced in the form of single research studies. The other three choices represent synthesis of multiple studies. DIF: Cognitive Level: Remember REF: p. 44 4. Which type of review is considered the most rigorous? a. Literature reviews b. Systematic reviews c. Integrative reviews d. Single study reviews ANS: B

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    Evidence summaries include evidence synthesis, systematic reviews, integrative reviews, and reviews of the literature, with systematic reviews being the most rigorous approach to evidence summary. DIF: Cognitive Level: Remember REF: pp. 44 - 45 5. A facility calls in experts to review evidence developed in research and develop guidelines for clinical practice. Which stage of EBP is represented? a. Evidence summary b. Translation to guidelines c. Practice integration d. Evaluation of process and outcomes ANS: B In the third stage of EBP, translation, experts are called on to consider the evidence summary, fill in gaps with consensus expert opinion, and merge research knowledge with expertise to produce clinical practice guidelines (CPGs). DIF: Cognitive Level: Understand REF: pp. 46 - 47 6. Which indicators have been established for healthcare improvement and for public reporting? a. Quality indicators b. Efficiency indicators c. Cost indicators d. Longevity indicators ANS: A Evaluation of specific outcomes has risen to a high level of public interest. As a result, quality indicators are being established for health improvement and public reporting. DIF: Cognitive Level: Knowledge REF: p. 50 MULTIPLE RESPONSE 7. The goal of the intersection of informatics and evidence - based practice is to transform healthcare to be: (select all that apply.) a. reliable. b. safe. c. effective. d. efficient. ANS: A, B, C The field of inf ormatics and the concept of evidence - based practice (EBP) intersect at the crucial junction of knowledge for clinical decisions with the goal of transforming healthcare to be reliable, safe, and effective. While efficiency is always a goal in healthcare, it is not a primary goal of EBP. DIF: Cognitive Level: Knowledge REF: p. 40 8. Which of the following are evidence summaries: (select all that apply.) a. Literature reviews

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    b. Systematic reviews c. Integrative reviews d. Single study reviews ANS: A, B, C Evidence summaries include evidence synthesis, systematic reviews, integrative reviews, and reviews of the literature. DIF: Cognitive Level: Knowledge REF: pp. 44 - 45 9. Using the STAR Model, which of the following points indicate knowledge transformation has occurred? (Select all that apply.) a. Discovery research b. Evidence summary c. Translation to guidelines d. Practice integration e. Testing the hypothesis f. Evaluation of process and outcomes ANS: A, B, C, D, F The knowledge transformation process in the STAR Model occurs at five points, wh ich can be conceptualized as a five - point star. These five points include discovery research, evidence summary, translation to guidelines, practice integration, and evaluation of process and outcomes. Testing the hypothesis is not a specific point in the STAR Model. DIF: Cognitive Level: Knowledge REF: pp. 43 - 44 10. Standardized terminology is requisite for: (Select all that apply.) a. naming evidence. b. classifying evidence. c. tagging evidence. d. locating evidence. e. simplifying evidence. ANS: A, B, C, D Standardized terminology is requisite for naming, classifying, tagging, and locating evidence in order to use it in practice. DIF: Cognitive Level: Knowledge REF: p. 42

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    Chapter 4: Knowledge Discovery, Data Mining, and Practice - Based Evidence Test Bank MULTIPLE CHOICE 1. Which measure is most important for evaluating the performance of classifiers, models that predict class membership? a. Root mean squared error (RMSE) b. Area under the receiver operating characteristic (ROC) curve c. Percentage of correctly classified cases d. Hosmer - Lemeshow statistic ANS: B The area under the receiver operating characteristic (ROC) curve is the most important overall measure of classifier performance. DIF: Cognitive Level: Remember REF: p. 62 2. Which specialized method(s) is (are) used in knowledge discovery and data mining? a. Stratified sampling b. Conceptual analytic methods c. Selection of the optimal subset of variables/features for use in modeling d. Machine learning ANS: C Knowledge discovery and data mining (KDDM) makes use of specialized analytic methods, characteristically machine learning, to identify patterns in a semi - automated fashion. DIF: Cognitive Level: Remember REF: p. 56 3. The process of knowledge disco very and data mining is best characterized as: a. machine learning, use of statistical methods, large amounts of data. b. a process wherein patients are selected for clinical trials. c. “fishing” for information in data. d. cleaning data for further analysis using other methods. ANS: A Knowledge discovery and data mining (KDDM) is a process in which machine learning and statistical methods are applied to analyze large amounts of data. DIF: Cognitive Level: Remember REF: p. 56 4. Which characteristic is an advantage that practice - based evidence studies have over RCTs? a. Large sample sizes can be obtained easily. b. Multiple sites are typically enrolled, resulting in greater generalizability. c. Study efficacy is greater. d. Multiple variables can be studied. ANS: C

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    Practice - based evidence (PBE) designs trade away the internal validity of RCTs for external validity. PBE designs have high external validity because they include virtually all patients with, or at risk for, the condition under study, as well as potential confounders that could alter treatment responses. PBE designs attempt to minimize threats to internal validity by trying to collect information on all patient variables – demographic, medical, nursing, functional, and socioeconomic – that might account for differences in outcome. By doing so, PBE designs minimize the need for compensating statistical techniques such as instrumental variables and propensity scoring to mitigate selection bias effects, unknown sources of variance, and threats to internal validity. DIF: Cognitive Level: Understand REF: pp. 62 - 64 5. Which is not a common step in a practice - based evidence study? a. Assemble a multidisciplinary project team b. Measure patient severity c. Obtain patient consent d. Collect data ANS: C It is not necessary to obtain patient consent when treatment is not altered. DIF: Cognitive Level: Understand REF: pp. 66 - 67 6. Practice - based evidence studies differ from traditional observational designs in several main ways. What is one of those main differences? a. Exhaustive attention paid to patient characteristics b. Excluding clinicians in the study design to improve treatment efficacy c. Use of small sample sizes and specific patient sources/settings d. General, unstructured documentation of interventions ANS: A Practice - based evidence involves intense attention to patient characteristics; including clinicians in the design; use of large sample sizes and diverse patient sources/settings; and detailed, standardized structured documentation of interventions. DIF: Cognitive Level: Apply REF: p. 56 MULTIPLE RESPONSE 7. Which methods are examples of data mining? (Select all that apply.) a. Decision trees b. Stratified random sampling c. Bayesian networks d. Artificial neural networks e. Factor analysis ANS: A, C, D Decision trees, Bayesian networks, and artificial neural networks are methods commonly used in data mining. DIF: Cognitive Level: Remember REF: p. 61; Table 4 - 2

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    8. Practice - based evidence requires close partnering with informatics specialists to: (select all that apply) a. design screens and terms to capture interventions. b. create and maintain the databases required for PBE studies. c. upgrade EHR modules so all sites are on the same version of software. d. ensure all end users are trained. ANS: A, B While upgrades are an informatics responsibility, sites do not have to be on the same version of software to do PBE studies. DIF: Cognitive Level: Understand REF: pp. 66 - 67 9. In which aspects does practice - based evidence differ from evidence - based practice? (select all that apply) a. PBE incorporates patient choices in decision - making. b. EBP determines best practices using best evidence like results from RCTs. c. PBE includes family involvement. d. PBE is prospective, while EBP is retrospective. e. PBE attempts to capture the complexity and variability of actual clinical care. ANS: B, D, E EBP refers to identifying the evidence for clinical practice and conducting prac tice according to the best evidence. PBE is an innovative prospective research design that uses data gathered from current practice to identify what care processes work in the real world. PBE study designs attempt to capture the complexity presented by patient and treatment differences, offering a naturalistic view of treatment by examining what actually happens in the care process, not altering or standardizing the treatment regimen to evaluate efficacy of a particular intervention, as one does in an RCT or other types of experimental designs. EBP is about using evidence to guide practice. PBE is about obtaining evidence from practice. DIF: Cognitive Level: Analyze REF: pp. 62 - 64 COMPLETION 10. ___________________ refers to the assignment of individual records or rows in a data set to a specific purpose: model development (training, incremental testing of models during development) or validation (data held out from the development process for the purpose of unbiased performance estimation). ANS: Partitioning Partitioning refers to the assignment of individual records or rows in a data set to a specific purpose: model development (training, incremental testing of models during development) or validation (data held out from the development process for the purpose of unbiased performance estimation). DIF: Cognitive Level: Remember REF: p. 59

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    Chapter 5: Program Evaluation and Research Techniques Test Bank MULTIPLE CHOICE 1. Your organization hires you to conduct a formative evaluation of a new informati cs intervention. Which areas would you focus on in a formative evaluation? a. Cost, patient safety, and patient outcomes b. Intervention fidelity, implementation quality, and types of personnel c. Errors, change in provider decision - making, and cost d. Unintended outcomes, delays in implementation, and cost ANS: B Intervention fidelity, implementation quality, and types of personnel are areas that would be focused upon in formative evaluation. Results of the formative evaluation are used as feedback to the program for continuous improvement. DIF: Cognitive Level: Apply REF: p. 73 2. Which statement is true regarding the differences between research and evaluation? a. Evaluation is concerned with the goals of a specific program and usually has multiple stakeholders as compared to research, which has specific scientific hypotheses and fewer stakeholders. b. Evaluation studies have higher generalizability, whereas research is concerned with only internal generalizability. c. Evaluation studies use few methods, whereas research studies use multiple methods. d. Evaluation studies have longer timelines and more resources, compared to research with shorter timelines and fewer resources. ANS: A Evaluation is concerned with the goals of a specific program, whereas research f ocuses on a specific scientific hypothesis. There are also fewer stakeholders in research than in evaluation. The scope of research is limited, whereas evaluation has a much broader scope. There are many components in evaluation that cannot be easily put into one category. DIF: Cognitive Level: Understand REF: pp. 72 - 74 3. Which list includes the 3 levels of theory relevant to evaluation? a. Program, summative, and interpersonal theories b. Scientific, formative, and descriptive theories c. Scientific, implementation models, and program theories d. Scientific, statistical, and models ANS: C The three levels of theory relevant to evaluation are scientific theories, implementation models, and program theories. The other choices are either not theories or are specific theories, not levels of theory. DIF: Cognitive Level: Remember REF: p. 75

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    4. You decide to base the evaluation plan of your informatics project on the theory of planned behavior. Which constructs will you use to develop your measurements? a. Values, normative expectations, others’ beliefs, and overall prior knowledge b. Values, beliefs about self - efficacy, normative beliefs, and intrinsic motivation c. Values, expectations of others, behaviors, and perceived self - efficacy d. Habit, normative expectations, beliefs about resources, and overall prior knowledge ANS: C The theory of planned behavior focuses on the ability to predict intentions and behavior as a function of beliefs about the value of an outcome, the likelihood that the outcome will occur given the behavior, beliefs about the expectations of others, and self - efficacy beliefs about the personal ability to engage in the activity. DIF: Cognitive Level: Understand REF: p. 75 5. The stages of change identified in diffusion of innovation theory are: a. contemplation, persuasion, action, and knowledge. b. knowledge, persuasion, decision, implementation, and confirmation. c. awareness, understanding, action, implementation, and confirmation. d. contemplation, decision, action, and knowledge. ANS: B The stages of change identified in the diffusion of innovation theory are knowledge, persuasion, decision, implementation, and confirmation. The stages of change are one way to understand and evaluate how the change has occurred. DIF: Cognitive Level: Remember REF: p. 75 6. If you choose to evaluate an informatics intervention by examining the impact on a clinician’s ability to think ahead about future events, which level of situation awareness would you be measuring? a. Social b. Perception c. Comprehension d. Projection ANS: D Projections are expectations of outcomes in the future. Projections are driven b y implicit theories and knowledge about the causal mechanisms underlying events. DIF: Cognitive Level: Understand REF: p. 75 7. UTAUT is a theory of: a. user’s knowledge of social networks. b. acce ptance and use of technology. c. decision - making skills. d. technology support options. ANS: B

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    The unified theory of acceptance and use of technology (UTUAT) assesses factors associated with effective use. DIF: Cognitive Level: Understand REF: pp. 76 - 77 8. You decide to interview all the key stakeholders involved in an informatics intervention as part of the planning process. Together you identify the resources available, the likely barriers, and the short - term and long - term objectives. Which kind of theoretical model are you using? a. Scientific theory b. Theory of planned behavior c. Logic model d. Diffusion model ANS: C Program theory models consist of the implicit ideas and beliefs of key stakeholders. A logic model is a representation of components and mechanisms of the program. Basically, a logic model is a systematic and visual way to present and share your understanding of the relationship among the resources you have to operate your program, the activities you plan, and the changes or results you hope to achieve. DIF: Cognitive Level: Apply REF: pp. 79 - 80 9. In a social network analysis, each node is usually a(n): a. individual or unit of analysis. b. event. c. location. d. attitude. ANS: A Nodes are individuals, and lines are connections. The size of the line is often the number of interactions between individuals, and the size of the node is the number of interactions with that unit. DIF: Cognitive Level: Understand REF: p. 83 MULTIPLE RESPONSE 10. You decide to conduct an evaluation of a new informatics intervention for nurses in the ICU. You decide to use only qualitative methods. Which methods would be conducted? (Select all that apply.) a. Observing nurses in the ICU at randomly selected time periods and recording their activities b. Conducting semi - structured interviews and conducting thematic analysis c. Collecting log reports for computer access, grouping sites accessed by nurses into similar categories, and seeing what the categories look like d. Measuring the amount of time nurses spent on the computer ANS: A, B, C Random observations, semi - structured interviews, and categorization without coun ting are all examples of qualitative activities. Counting, measuring, and calibrating are quantitative activities.

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