Comp 11

Review the mission and vision to include the implementation to an EHR. Develop goals that address a reasonable, measurable, and tactical way to reach the implementation.

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Can include scanned documents and electronic systems such as pharmacy, radiology, lab.

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A legacy system is one that has been built throughout the years by the organizations IT staff. There may be some additional vendor systems or ancillary systems that have been built in to the legacy systems.

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Champions Clinical areas affected Ancillary areas affected,Non-clinical areas that use data collected,Change agents,Technology specialists,Work flow analysts

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A request for proposal (RFP) is used for helping to make a decision about a potential vendor. The project team will develop criteria related to the needs they have for an electronic health record and using a rating score will identify potential vendors to consider.

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Those enthusiastic about EHR who are willing to lead the migration to and electronic health record.

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Develop a team trained and experienced in the work flow to be analyzed. Involve the users in the work flow analysis a. Engage the users during the process asking step by step questions about work flow b. Don’t make assumptions about work flow c. Follow through by showing users the work-flow analysis report d. Adjust analysis accordingly e. Once the work flow analysis is complete and accurate, it is used for the planning of the change in the work station, setting up new equipment, and developing the training for the implementation Develop a team trained and experienced in the work flow to be analyzed. Involve the users in the work flow analysis a. Engage the users during the process asking step by step questions about work flow b. Don’t make assumptions about work flow c. Follow through by showing users the work-flow analysis report d. Adjust analysis accordingly e. Once the work flow analysis is complete and accurate, it is used for the planning of the change in the work station, setting up new equipment, and developing the training for the implementation

Develop a team trained and experienced in the work flow to be analyzed. Involve the users in the work flow analysis a. Engage the users during the process asking step by step questions about work flow b. Don’t make assumptions about work flow c. Follow through by showing users the work-flow analysis report d. Adjust analysis accordingly e. Once the work flow analysis is complete and accurate, it is used for the planning of the change in the work station, setting up new equipment, and developing the training for the implementation

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Training is important throughout the change so that workers feel ready for the implementation. During the implementation there needs to be 24/7 active support to answer questions, and hone learning of the system. During the post-implementation stage, there still needs to be 24/7 support in areas that are open 24 hours a day for patient care. But training in this phase will help to alleviate high stress and will reduce calls for help.

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• Recognition that change can be difficult • Recognition of emotional side of change • Creating buy-in through champions, super-users • Recognition that this is a process that goes beyond implementation is important to communicate. There is no easy fix or common time table; the culture of the organization determines the completion of the process

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To build trust To acclimate employees to the change To avoid sabotage or purposeful slow-down of work flow

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Celebrate with staff and users Reward with small tokens or letters of appreciation Feature a super-user in a newsletter Write an article and publish

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Many possible answers: Include the issues and concerns that have been brought up and how they were solved Look at training materials to determine if changes need to be made Develop a survey to assess the users satisfaction Etc.

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It provides information to users so that disruption of work flow is minimized. Paramount to this is patient care, and making sure that is not negatively affected.

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There needs to be ongoing maintenance of a system. Communicating well in advance to the users when it will occur is important to work flow adjustment. Training materials and all written communication needs to updated as well.

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• Continued technical support is needed to assure that the system runs smoothly • Continued one on one training is essential during this time to assure compliance and reduce any frustration

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A. will most likely change with the EHR

B. Experts and users of EHR work separately on work flow analysis

C. Work flow usually does not change with the EHR

D. B and C

A. During pre-implementation

B. During implementation

D. Post implementation

D. A and B

E. A, B and C

A. A totally electronic health record

B. A totally paper base system

C. A paper-based with some electronic systems

D. A totally scanned digital record

A. Super-Users have completed their work

B. Everyone is ready for the implementation

C. One on one training may still be needed

D. Back-up support systems are not needed

A. Reduce frustration of clinicians in using CPOE

B. Improve team relationships

C. Show appreciation to 24 hour staff

D. Provide back up for quality of patient care

Evaluate training materials Develop a survey for user satisfaction Analyze issues that have been brought to your attention

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Those enthusiastic about the electronic health record who are willing to lead the migration. This is often in reference to physician champions.

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Develop a team trained an experienced in the work flow to be analyzed. Involve users in the work flow process analysis. Once the analysis is complete, it is used for planning the change in the work station, setting up new equipment, and developing the training for the implementation. Engage the users during the process asking step by step questions about work flow Don’t make assumptions that you understand the work flow without going through the analysis Follow through by showing users the work-flow analysis report Users may suggest changes; adjust report accordingly

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Answer: Training is important throughout the EHR implementation processes so that users feel ready for the implementation and know that they will have support throughout it. During the pre-implementation process there needs to be sufficient training to meet the needs of the users. During implementation there needs to be 24 hours a day, 7 days a week active support to answer questions, and hone learning of the system. During post-implementation, there still needs to be 24/7 support in areas that are open 24 hours a day for patient care. Training will be ongoing once the system “goes live.” Each facility will need to determine the user training and support needs.

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A. Certification provides the user with reasonable assurance that the EHR system will be able to store the required data, perform necessary functions, and exchange information with other systems.

B. EHR certification is required to qualify for CMS financial incentives.

C. EHR certification is required by law in order for a vendor to market their system.

D. EHR certification represents an evaluation by an independent and knowledgeable 3rd party.

E. EHR certification provides some assurance that the expected benefit of improved patient care can be

F. All of the above

A. CMS – Centers for Medicare and Medicaid Services

B. ONC - Office of the National Coordinator

C. CCHIT-Certificate Commission for Health Information Technology

D. HIMSS – Health Information Management

E. AHIMA – American Health Information Management Association.

F. All of the above

A. Provide summary of record for at least 80% of transitions of care and referrals.

B. Insurance eligibility checked electronically for 80% of all unique patients seen by the EP or admitted to the EH.

C. Reminder sent to at least 50% of all unique patients seen by the EP that are at least 50 or over

D. At least 75% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology

E. All of the above

F. Only a. and c

A. The date, time, patient identification (name or number), user identification (name or number), and a description of the disclosure must be recorded.

B. The EP/EH has enabled all drug-drug, drug-allergy, drug-formulary checks (available through the EHR).

C. An encrypted and integrity protected link must be implemented (e.g., TLS, IPv6, IPv4 with IPsec).

D. None of the above.

E. All of the above.

F. Only a and c.

A. At least 80% of all unique patients age 2 and over seen by the EP or admitted to the EH, record blood pressure and BMI (calculated from height and weight); additionally plot growth chart for children age 2 – 20.

B. Able to generate lists of patients by specific conditions to use for quality improvement, reduction of disparities and outreach (at least one report for a specific conditions)

C. At least 80% of all claims filed electronically by the EP or EH (both public and private payers).

D. For EPs, CPOE is used for at least 80% of all orders.

E. Both a and c.

F. None of the above.

A. HIE can be both bi-directional and uni-directional.

B. HIE can only be achieved if the EHR is certified.

C. HIE supports the mobilization of health care information electronically.

D. HIE only refers to hardware and software components of the health information system.

E. Only b and c

F. Only a and c.

A. Improving quality, safety and efficiency

B. Engaging patients in their care

C. Increasing coordination of care

D. Improving the health status of the population

E. Ensuring privacy and security

F. None of the above

A. Encouraging patients to be interested.

B. Increasing coordination of care

C. Supporting a variety of protocols (and hence systems) through which the information can be communicated.

D. Using pull technologies.

E. Enforcing stringent security that prevents information from moving between EHRs

F. None of the above

A. Only refers to hardware and software components of an information system

B. Can only occur within an organizations health information system.

C. Principles at work in the health care system will produce the same basic result as implementing Health Information Exchange principles.

D. Would not include standardized coding.

E. Both B and c

F. None of the above

A. Improving quality, safety and efficiency

B. Engaging patients in their care

C. Increasing coordination of care

D. Improving the health status of the population

E. Ensuring privacy and security

F. None of the above

A. Certification of Health Records

B. Quality Measures

C. Stage One Meaningful Use

D. Stage Two Meaningful Use

A. 30%

B. 50%

C. 70%

D. 80%

A. Hospitals measures

B. Pediatric measures

C. Long-term care measures

D. All of the above

E. B, C only

A. 60

B. 70

C. 80

D. 90

A. 15

B. 25

C. 35

D. 45

A. A high evoking strength

B. A low evoking strength

C. A high frequency

D. A low frequency

A. Its use in US hospitals is widespread

B. A majority of overridden lab tests are not justifiable

C. Implementation success is not related to institutional support

D. Custom order sets do not make it more acceptable to physicians

A. Information display

B. Reminder

C. Alert

D. Clinical practice guideline

E. Computerized physician order entry

A. Notify the physician

B. The serum creatinine level has doubled in one day (indicating rapid kidney function deterioration)

C. The patient has had a serum creatinine level checked to assess kidney function

D. The insurance company is billed

A. Notify the physician

B. The serum creatinine level has doubled in one day (indicating rapid kidney function deterioration)

C. The patient has had a serum creatinine level checked to assess kidney function

D. The insurance company is billed

A. Individual, i.e., let every clinician manage his or her order sets

B. Departmental, i.e., let every specialty group manage their order sets

C. Institutional, i.e., have sets developed for an entire hospital

D. National, i.e., have order sets developed in a standardized way for the entire country

A. Data architecture

B. Data infrastructure

C. Unstructured data

D. Structured data

A. Data

B. Data sets

C. Structured data

D. Unstructured data

A. Registration Data

B. Document imaging

C. Transcribed reports

D. Videos

A. Supports interoperability of systems within the organization

B. Supports movement towards national interoperability

C. Provides clarity on the meaning for collection

D. All of the above

A. coding systems that are used for billing

B. used to retrieve information for research

C. used for pulling secondary information

D. a, c

E. all of the above