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Chapter 14: Information Technology in the Clinical Setting
1. Consumers are concerned with security issues related to their confidential health information being placed in an electronic health record (EHR). However, when the security of the EHR is compared with that of paper-and-pencil records, the EHR is:
a. more secure.
b. less secure.
d. not comparable with the paper-and-pencil record.
Correct: Computer-based patient record systems, such as EHRs, provide better protection than paper-based systems. The EHR allows only authorized users to view data, and access to records can be audited for inappropriate use.
b. With paper-and-pencil medical records there is no way to limit who views the health information or determine how often confidentiality is breached.
c. The EHR must comply with strict laws and regulations related to confidentiality, as well as to the aforementioned security functions.
d. The paper-and-pencil record cannot ensure the same level of security as found in computer-based systems.
DIF: Comprehension REF: p. 259
2. During a search for the term informatics, when the nurse finds the domain .edu, the site is affiliated with a(n):
a. government agency.
b. commercial site.
c. educational institution
d. Internet service provider.
Correct: The domain of an educational institution is .edu.
a. The domain of a government site is .gov.
b. The domain of a commercial site is .com.
d. The domain of an Internet service provider is .net.
DIF: Knowledge REF: p. 264
3. When paper-and-pencil medical records are compared with computer-based records:
a. paper-and-pencil records provide controls to determine who has viewed the health information.
b. information contained in a paper-and-pencil record has the capability of being more in-depth than that found in computer-based records.
c. patients have the right to know that the confidentiality of their records is strictly maintained, regardless of the type of medical record used.
d. patients must sign for each item of information released on the computer record.
Correct: Regardless of the type of record used, the Health Insurance Portability and Accountability Act (HIPAA) protects the confidentiality of the patients medical information and imposes legal consequences for those who breech confidentiality.
a. The computer-based record has security controls that limit or prohibit entry by unauthorized users and that track attempts to access the record.
b. Information in the computer-based record is more comprehensive than that found in a linear paper record.
d. Patients may sign a release one time for information to be released to entities such as an insurance company.
DIF: Application REF: p. 259
4. A nurse is preparing a scholarly publication on the prevalence of hepatitis A worldwide. The most efficient and effective means of conducting an Internet search to gather information for this publication is to use:
a. a search engine such as Google or Yahoo.
b. a consumer health website.
c. a decision support system.
d. MEDLINE database.
Correct: MEDLINE is one of the scientific and research scholarly databases, and it would be the most appropriate for use in gathering information for a scholarly publication.
a. If the information is broad and general, one would use a search engine such as Google or Yahoo.
b. If the nurse is collecting data that are to be presented to the consumer, one would use a consumer health website.
c. A decision support system allows for the input of data such as clinical manifestations and medications and, with the use of a link to a knowledge software system, is able to produce a decision.
DIF: Application REF: p. 264
5. A consumer is learning about electronic health records at a local health fair and states, I am worried that someone can read my health information and I really dont understand the difference between privacy and confidentiality. The nurse explains that an example of confidentiality would be:
a. a pledge that states, I will hold matters pertaining to my patients in strict intimacy.
b. a patient who does not tell the physician that he has been treated for a sexually transmitted disease.
c. a teenager who sustains a broken arm and in the emergency department and withholds information about her use of recreational drugs.
d. locking medical records in cabinets to prevent unauthorized users from accessing patient information.
Correct: Confidentiality is keeping private the personal information that was given to a health care provider, unless others have a legitimate need to know.
b. The right of an individual to keep information about himself or herself from being disclosed to anyone else, including the health care provider, is known as privacy.
c. The patient has chosen not to divulge personal information to the health care provider; this is privacy.
d. Locking medical records in cabinets pertains to controlled access, which is security.
DIF: Application REF: p. 259
6. A physician has installed a computer-based patient records system. An outside care provider who requests medical information must obtain the patients signed consent and then is assigned a password to gain access to the medical information. A monthly audit is conducted to determine for whom and for what purpose patient records have been accessed. This protection is referred to as:
d. data capture.
Correct: Security is the limitation of access to health care information through passwords and other precautions.
a. Privacy is the right of the patient or individual to not divulge personal information to the health care provider or others.
b. Confidentiality is keeping personal matters of a patient private from those who do not have a legitimate need to know.
d. Data capture refers to collecting and entering data into a computer system.
DIF: Application REF: p. 259
7. A nurse walks up to a computer in the hallway and presses the index finger to the sensor, thereby gaining access to patient data. A few moments later another nurse performs the same steps and is granted access. A visitor who is watching from a room walks over and places the index finger on the sensor, only to receive an error and access denied message. Security is being maintained by:
a. robot technology.
b. biometric technology.
d. ubiquitous computing.
Correct: Biometric fingerprint identification uses personal characteristics to allow access to health information.
a. Robot technology includes the delivery of simulation for rehabilitation, couriers, and language translators and even can be used to interview and examine patients at a distance.
c. Telehealth involves providing health care for patients located a distance from the provider.
d. Ubiquitous computing refers to the era when computers are so immersed in everyday life that they become invisible to users.
DIF: Application REF: p. 267
8. A nurse who is teaching a class to introduce telehealth to the staff would include which example?
a. A robot performs menial housekeeping chores for an invalid patient.
b. A computer software program alerts the nurse or physician who is reviewing orders that an order for a new drug can cause synergy of the theophylline inhaler.
c. A physician speaks into a computer, and the admission history is recorded and saved in the patient file.
d. While a patient in Wyoming performs peritoneal dialysis, a nurse watches remotely from California to ensure that all steps are being followed correctly.
Correct: Telehealth is the delivery of care to a patient who is at a distance from the health care provider.
a. Robotic technology involves the delivery of sensorimotor simulation for rehabilitation; language translators can be used to interview and examine patients at distance but is typically not a component of telehealth.
b. Point-of-care drug references and alerts that can be downloaded into PDAs, and laptops may decrease drug errors. But this is not considered a component of telehealth.
c. Voice communication systems, which include voice recognition, provide security through recognition of voice in dictation of histories, physicals, and notes related to patient progression.
DIF: Application REF: p. 262
9. An advanced practice nurse inputs into a computer software program the following clinical manifestations: open wound with tibia exposed, petechial hemorrhage, and temporary loss of consciousness. The computer diagnosis of fat emboli is generated by a system known as:
a. decision support.
c. robotic technology.
d. biometric technology.
Correct: Decision support systems are computer-based information systems that include knowledge-based systems designed to support clinical decision making.
b. Telehealth allows the provider to treat patients from a distance through electronic submission of data.
c. Robotic technology includes the delivery of sensorimotor simulation for rehabilitation, language translators, and technology to interview and examine patients at a distance.
d. Biometric technology is the use of personal characteristics such as fingerprints and hair to gain access to a secure site that contains patient information.
DIF: Application REF: p. 256
10. A nurse is preparing a presentation using different websites to collect information. The nurse is concerned that contact information and the authors credentials are not listed for one of the websites reviewed. Which criterion required to establish a reputable website is missing?
Correct: Authority is the criterion that is related to the credentials and background that have prepared an author to publish on the subject.
b. Objectivity is the criterion that is related to the sites purpose, intended audience, and sponsorship and to whether the information is fact or opinion.
c. Usability is the criterion that is related to the maneuverability and overall arrangement of the website.
d. Currency is the criterion that is related to updated information required because of the dynamic state of health care.
DIF: Application REF: pp. 264-265
11. A nurse is interested in locating reliable information concerning noninvasive blood glucose monitoring. Information is located, and the author is a scientist who conducted studies within the last year on the effectiveness of a particular noninvasive blood glucose monitor. The scientist received funding from a pharmaceutical company to support the studies. The URL indicates the pharmaceutical company site.com. The nurse is concerned about this informations:
Correct: Sites sponsored by organizations such as pharmaceutical companies may influence the content.
a. The author, in this case the researcher for the pharmaceutical company, has authority on the topic.
c. Research studies are referenced.
d. The study was conducted within the last year.
DIF: Application REF: pp. 264-266
12. A nurse providing care at the bedside receives an alert that a patients stat potassium level is 2.5 and digoxin (Lanoxin) is scheduled. The nurse holds the medication and prevents a possible complication. This feature of the Electronic Health Record is available through which core function of EHR?
a. Order entry/order management
b. Decision support
c. Patient support
d. Administrative support
Correct: Decision support provides reminders about preventive practices, such as immunizations, drug alerts for dosing and interactions, and clinical decision making.
a. Order entry/order management eliminates lost orders and illegible handwriting, generates related orders automatically, monitors for duplicate or contradictory orders, and reduces time to fill orders.
c. Patient support provides computer-based patient education and home monitoring where applicable.
d. Administrative support includes functions related to scheduling systems, billing and claims management, insurance eligibility, and inventory management.
DIF: Application REF: p. 256
13. A nurse works on a unit where electronic health records (EHR) are being initiated and asks, What is meant by meaningful use standards that are in our education packet? The best answer is that meaningful use:
a. identifies a set of EHR proficiencies and benchmarks that EHR systems must meet to be certain that they are functioning to their maximum capacity and meeting this standard allows companies/organizations to qualify for funds to defray cost of the EHR from Medicare.
b. refers to training competencies that all users must achieve to be able to access and transfer patient data/information.
c. refers to a requirement that at least 50% plus one of all patients have data entered into the EHR.
d. the requirement that rigorous confidentiality security is in place to protect all patient information from sources which have no right to the data.
Correct: Meaningful use is A defined set of EHR capabilities and standards that EHR systems must meet to ensure their full capacity is realized and for the users (hospitals and physician practices) to qualify for financial incentives from Medicare.
b. Training is one part of operationalizing meaningful use.
c. It is expected that all patient records will be entered into a HER, but as of yet, a set number of patients has not been determined.
d. Confidentiality is a requirement for EHRs, along with security and privacy.
DIF: Application REF: p. 260
14. A nurse is caring for a patient who is to receive an antibiotic drug that causes severe skin damage when infiltrated. The order reads, infuse over 1 hour by portacath. The nurse accesses the Personal Digital Assistant for software that lists the steps to access a portacath. The nurse is using:
a. electronic health records.
b. point of care technology.
c. data management.
Correct: Using a Personal Digital Assist device to access information at the bedside is considered point-of-care technology. The nurse was able to retrieve the steps for accessing a portacath electronically while remaining at the bedside.
a. Electronic health record is the longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.
c. Data management is the recording, storing, and presentation of a piece of patient data.
d. Telehealth is use of telecommunications technology to assess, diagnose, and, in some cases, treat persons who are at a distance from the health care provider.
DIF: Application REF: p. 262
15. The Institute of Medicine (IOM) (2003) recommends that EHR systems offer eight functionalities. A patient has a severe allergy to eggs and penicillin. Which of the eight functions of the EHR would address sharing this information?
a. Health information and data capture
b. Results/data management
c. Provider order entry management
d. Clinical decision support
Correct: The health information and data capture function includes information such as medical history, laboratory tests, allergies, current medications, and consent forms.
b. Results/data management function provides electronic reports of laboratory results and radiology procedures.
c. Provider order entry management function eliminates lost orders and illegible handwriting, generates related orders automatically, monitors for duplicate or contradictory orders, and reduces time to fill orders.
d. Clinical decision support function provides reminders about preventive practices, such as immunizations, drug alerts for dosing and interactions, and clinical decision making.
DIF: Application REF: p. 256; Table 14-1
1. A new nurse asks, Since Electronic Medical Records can improve quality care by having seamless data available for a patient, why doesnt everyone just replace paper and pencil charts? Barriers to a universal health information infrastructure include the fact that: (Select all that apply.)
a. competition from individual companies to build EMR prevent a universal infrastructure.
b. cost is prohibitive even with federal funding for larger health care systems.
c. preventive health reminders for immunizations and yearly screenings such as mammograms are used in clinical decision making.
d. insurance companies have halted sharing of some patient data due to fear of law suits.
e. the full capacity of EHRs has not been realized with only Stage 1 of 3 nearing completion.
ANS: A, E
a. It has been recommended that only a federal-based EMR would provide an infrastructure that allows access to comprehensive patient information.
e. The first stage, years 2011 and 2012, forms the foundation for electronic data capture and information sharing.
b. Smaller organizations find cost to be a barrier even with federal funding.
c. Clinical decision making is an opportunity rather than a barrier.
d. Coordinated insurance billing and claims management and insurance eligibility are benefits rather than barriers.
DIF: Application REF: pp. 260-261
2. A nurse interested in quality improvement tools performed a search for cause and effect diagrams using www.ishikawa.com. A page opened that provided images and templates for performing fishbone diagrams. Which type of search did the nurse conduct?
a. Quick and dirty
c. Brute force
d. Link searching
Correct: Brute force is a method of searching where you type in what you think might logically be a web address and see what happens.
a. Quick and dirty searching can be useful when looking for information in an unfamiliar area. The search term is typed into a search engine such as Google (www.google.com) and results are reviewed to see which ones sound most promising.
b. Advanced searching allows you to set specific limits on your searches such as by language, file type, and date.
d. Link searching explores links from a reliable site found that connect to other relevant sites.
DIF: Application REF: p. 263
1. Software programs that process data to produce or recommend valid choices are known as ______________.
decision support systems
Decision support systems use software programs that process data to produce or recommend decisions by linking with an electronic knowledge base.
DIF: Knowledge REF: p. 256
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