This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 The CAHIMS Exam Preparation Course and the CAHIMS exam are the result of collaboration between the Life Science Informatics Center at Bellevue College and the Healthcare Information and Management Systems Society (HIMSS). Significant content found in the CAHIMS Exam Preparation Course stems from the Office of the National Coordinator for Health Information Technology. Creation of the CAHIMS Exam Preparation Course and the CAHIMS exam was made possible through support from the National Science Foundation (NSF). Curriculum Team: Margaret Schulte, DBA Michèle Royer, PhD Nathan Savage, MLIS This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Section 5 - HIMS Selection and Acquisition Lesson 5.1 - Systems Implementation Assessment Question Answer Key Lecture 2 1. SDLC stands for: a. System Development List Creation b. System Depreciation Lifetime Cost c. Software Depreciation Listed Costs *d. Software Development Life Cycle Answer: d. SDLC stands for Software Development Life Cycle. Slide: 2 2. The SDLC covers creation of the product, but routine maintenance and ultimate decommissioning are addressed in different models. a. True *b. False Answer: False. The SDLC covers the entire lifecycle of the product, from creation to maintenance to decommissioning. Slide: 3 3. Which is NOT commonly considered a phase of the SDLC? *a. Requisition phase b. Requirements analysis phase c. Concept development phase d. Operations and maintenance phase e. Testing phase Answer: a. The SDLC commonly addresses phases of concept development, requirements analysis, testing, and operations and maintenance. Requisition is not commonly addressed, however. Slides: 6-17 This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 1 4. Which statement accurately describes a SDLC model? a. The waterfall model emphasizes sequential development. b. The iterative model emphasizes that the product may need to pass through the same phase multiple times, in a cyclical fashion. c. The spiral model emphasizes prototyping as part of the cyclical process. d. Both B and C *e. All of the above (A, B, and C) Answer: e. Waterfall models emphasize sequential development in a single pass through phases, contrasting with the multiple passes of the iterative model. The spiral model puts special emphasis on prototyping. Slides: 19-24 5. Which is NOT a reason why the SDLC is important for EHR systems? *a. Because poorly designed software has not yet been linked to security risks. b. Need for user satisfaction and high quality c. In-house development or integration of an EHR d. Because failure to plan adequately for software integration can limit efficiency and be costly in project over-runs and lost productivity. Answer: a. The SDLC is important for EHR systems because user satisfaction, high quality, and project success are critical. Some healthcare institutions will use the SDLC to build or modify their own EHR software. Good software design is important for all of these factors, as well as other goals such as system security. Slide: 2 Lecture 3 6. Which is NOT a reason why integration is an important consideration when installing an EHR? *a. Existing systems can usually share data with newer systems without additional programming or configuration. b. Many existing systems are too expensive to replace. c. Many different isolated systems currently exist within healthcare infrastructures. d. Many existing systems are tailored to meet specific departmental needs and not easily duplicated. Answer: a. Integration is an important consideration when installing an EHR because pre-existing systems, for several reasons, often must be kept by the This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 2 organization and will not exchange with the EHR without significant configuration or even programming. Slide: 4 7. Which definition is incorrect? a. An interface is a point of interaction between components. *b. Point-to-point interfacing involves connecting systems end to end, as if in a chain, so that each connects to no more than two others. c. Integration is the process of connecting various subsystems into the larger system, ensuring that subsystems function together as a whole. d. An interface engine routes data through a centralized location. Answer: b. Point-to-point interfacing involves connecting each system directly to all other systems with which it needs to communicate, which can result in a large number of such connections with a single system. Slides: 3, 7, 8 8. Which statement is true of the point-to-point interface method? a. It is a newer, less traditional method. b. Data is routed through a centralized location. *c. Its direct linkages can provide secure transmission. d. Both b and c Answer: c. Secure linkages are an advantage of point-to-point interfacing. It is an older, more traditional method, and data are routed directly, without going through a central location. Slide: 7 9. Which statement is true of an interface engine? a. More separate connectivity points than point-to-point b. More flexible and scalable than point-to-point c. Easier to install and maintain than point-to-point *d. Both b and c Answer: d. An interface engine adds flexibility and scalability over point-to-point, and it is generally easier to install and maintain. It has fewer connectivity points. Slide: 8 This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 3 10. Which statement is NOT true of an HIE? *a. “HIE” stands for Health Improvement Enterprise. b. It maintains the meaning of healthcare information as it moves between disparate systems. c. It can be used for integration between EHRs. d. It can be set up privately or regionally. Answer: a. “HIE” stands for Health Information Exchange, which can act as an interface engine between whole groups of healthcare institutions. Slides: 20, 22 11. Which is NOT an advantage of integrating EHRs? a. Enables hospitals to share patient information. b. Enables providers to meet the HITECH “meaningful use” criteria. c. Enhances billing/payment and reform initiatives. *d. Improves security and privacy of patient data. e. Streamlines workflows between hospitals and clinics. Answer: d. Integrating EHRs can bring many advantages, such as sharing of patient information, demonstrating “meaningful use”, enhancing billing, and streamlining workflows, but it can pose risk for security and privacy. Slide: 19 12. Which is NOT true of HL7? *a. Creates communication standards for use only in American healthcare applications. b. Promotes open system architecture. c. Created a structured, message-oriented framework for communication between healthcare applications. d. Created a messaging standard that uses segment headers and delimiters to communicate information. Answer: a. HL7 works with standards organizations internationally to promote messaging standards and framework for use in healthcare systems worldwide. Slides: 10, 11, 13 This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 4 Lectures 8 & 9 13. Which of the following is an important structural characteristic of effective teams? a. individual contribution b. trust *c. appropriate culture d. flexibility Answer: c. Structural characteristics of effective EHR teams include clear purpose, appropriate culture, specified task, distinct roles, suitable leadership, relevant members, and adequate resources. Individual contribution is another type of team characteristic, and trust and flexibility are types of individual characteristics that contribute to team effectiveness. Lecture/Slide: 8/4 14. Effective implementation teams learn from mistakes. Which of the following is essential to support teams in learning from mistakes? a. safety committee b. risk management c. quality improvement *d. culture of transparency Answer: d. The organizational culture must value transparency in order to learn from its mistakes. Unless there is openness to reporting mistakes, the organization is not able to learn from them. This is a basic principle of the science of safety. Although having a safety committee is helpful, it is not essential. Risk management and quality improvement activities support identification of root causes and implementation of strategies to improve but they will not facilitate learning unless there is a culture of transparency. Lecture/Slide: 8/17 15. Effective change and transition management are critical to effective implementation planning. Each of the following strategies ensures effective change and transition management EXCEPT: *a. ensuring that professionals work side-by-side b. understanding and respecting team member roles c. communication d. recognizing that teamwork requires work This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 5 Answer: a. Contact is not enough to promote team effectiveness. Just because individuals work side-by-side does not mean that they will embrace change and effectively manage transition. Lecture/Slide: 8/4 16. There are a variety of strategies for effective implementation planning. Which of the following is a limitation of the single vendor strategy? a. It requires a wide range of skills to manage the applications. *b. If it fails, the organization can incur significant losses. c. It is a fragmentation of work. d. A single contract makes it difficult to manage initial capital outlays and ongoing operating costs. Answer: b. The single vendor strategy results in putting all of one’s eggs in a single basket; if the vendor fails, there are significant financial losses to the organization. Having a single contract makes it less difficult to manage finances. With a single vendor, HIT staff can build competency in a single product and work is less fragmented. Lecture/Slide: 8/13-15 17. To enhance implementation team effectiveness: a. regular meetings should be scheduled, but unstructured agendas are desirable since they allow for free-flowing conversation b. regular meetings are not required, just as long as the team gets its work done *c. regular meetings should be scheduled and a standard agenda set d. meetings should only be conducted when the chair has something to communicate to the team Answer: c. Once the implementation team is convened, regular meetings should be scheduled and a standard agenda set. Having a standard agenda for each team meeting ensures that all critical touch-points are addressed by each of the working sub-groups. Scheduled meetings and a standardized agenda ensures that status updates can be made by all parties involved and that all are made aware of any threats to the project timeline. Lecture/Slide: 8/5 This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 6 18. One of the advantages of “best of breed” approaches over single vendor options is that: *a. massive process reengineering is avoided b. contract management is streamlined c. software maintenance is easier d. competency development is facilitated Answer: a. Best of breed strategies avoid the massive reengineering of business processes that often occurs with single vendor solutions. In best of breed strategies, the organization may have different vendors, each of whom has developed a product that is highly effective in addressing particular business needs. However, given that there are multiple vendors, contract management, software maintenance, and competency development are more labor-intense. Lecture/Slide: 8/13, 16, 17 19. Two approaches that have been used successfully for HIT implementations are the big bang and staggered, or incremental, approaches. Which of the following correctly depicts big bang implementation strategies? *a. high risk, high anxiety b. high risk, low anxiety c. low risk, high anxiety d. low risk, low anxiety Answer: a. Big bang approaches are characterized by fast implementations and short-lived but high anxiety. They have the potential to erupt and may be difficult to management due to their large scope. Lecture/Slide: 9/3, 5 20. Which of the following is true of incremental implementation strategies? a. They have a quicker return on investment. b. They are high risk, high anxiety. c. They require greater numbers of resources. *d. They have higher training costs. Answer: d. Incremental implementation strategies are slower; they take a longer time to see a return on investment. They are less likely to erupt and incur less anxiety. They are accompanied by higher training costs since training is distributed over time. With a higher potential for stagnation, they are often characterized by a lag between when users are initially trained and actual implementation, thus requiring retraining. This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 7 Lecture/Slide: 9/3, 5 Lecture 6 21. Which is NOT an important step in creating a testing strategy? a. Identify testing environment. *b. Create test scenarios and scripts. c. Identify participants. d. Identify required equipment. Answer: b. All of the elements are important steps for creating a test strategy except the creation of test scenarios and scripts. These are defined after you have put a strategy in place Lecture(s)/Slide(s): 9-11 22. The procedure for sign-off for testing activities identifies the person who will manage defects in the project. a. True *b. False Answer: b. The procedure for sign-off for testing activities identifies the person who will be responsible finalizing each testing activity; including all initial testing and any re-testing needed mitigate defects that have been identified. Lecture(s)/Slide(s): 12-13 23. End user testing is best suited for less-experienced staff and should represent a cross-section of the end-user environment. *a. True b. False Answer: a. End user testing is best suited for less-experienced staff and should represent a cross-section of the end-user environment. This diversity will help draw out any hidden workflow or functionality obstacles not previously discovered. Lecture(s)/Slide(s): 19 This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 8 24. The user acceptance testing phase of a project usually occurs immediately before: *a. Rollout. b. Project description. c. System backup. d. Project sign-off. Answer: a. The user acceptance testing phase of a project usually occurs immediately before software rollout. It gives both the end users and the software manufacturer one last chance to be sure that the product being delivered fully meets their expectations, project objectives and is free of any defects (or bugs). Lecture(s)/Slide(s): 3 25. Designing the test scenarios is best performed by: a. Less-experienced staff. b. Program experts. c. Workflow experts. *d. b and c. e. All of the above Answer: d. Designing the test scenarios is best performed by subject matter experts and more experienced testers to define testing scenarios. This would include clinic/ organizational workflow experts. Lecture(s)/Slide(s): 16 Lecture 7 26. All of the following should be considered in selection of the pilot group EXCEPT: a. Advice of the steering committee. b. Representativeness of a cross-section of the user community. c. Readiness for the technology. *d. Age. Answer: d. Age is irrelevant to selection, all others should be considered Lecture(s)/Slide(s): 2 27. What is an appropriate length of time for staff education and training before system implementation? This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 9 a. Two hours b. Two days *c. Two weeks d. Two months e. Two years Answer: c. Two weeks is appropriate in normal circumstances. Lecture(s)/Slide(s): 4 28. The most appropriate training strategy is: a. Classroom-style. b. Web-based. c. One-on-one. d. Train the trainer. *e. All of the above. Answer: e. Each strategy may be appropriate to a different user community or deployment. Specific training will be tuned to each environment. Lecture(s)/Slide(s): 5 29. Survey data from the pilot users should include all of the following EXCEPT: a. What changed? b. What went wrong? c. What are suggestions for interface changes? *d. Would you like to go back to the old system? Answer: d. Inappropriate question because most people are reluctant to change because of the cost of learning a new system. Lecture(s)/Slide(s): 9 30. The success of the implementation and roll-out is most evidenced by the: *a. End users. b. Expert analysis. c. Technical staff. d. Professional evaluators. Answer: a. End users will use a system effectively in a successful system. Others will only guess or monitor usage. Lecture(s)/Slide(s): 13 This work is funded by the National Science Foundation Advanced Technological Education Grant 1003223 Page 10