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 3 - HIMS Analysis and Design
Lesson 3.1 - Systems Analysis, Planning and Design
Assessment Questions Answer Key
Lectures 1 & 2
1. Which of the following are NOT steps in process analysis as described in this unit? a. Create process inventory
*b. Conduct process redesign c. Report analysis findings d. Identify EHR functionality
Answer: b. Steps in process analysis include: 1) Start with process inventory & process diagrams (covered in units 2 and 3). These should provide a context diagram showing clinic functions and a flowchart for each process. 2) For each process, list the process variations applicable to the clinic as well as exceptions that often occur. For example, for a patient visit, a common exception would be that a patient cancels or does not show up. The last step in process analysis is
3) report findings. The findings from a process analysis would include: Major observations, a list of EHR functionality necessary to support clinic functions, and opportunities for improvement (technology assisted and otherwise).
Lecture(s)/Slide(s): 1/11
2. What is the correct order of steps for Process Analysis?
1-Create process inventory
2-Report analysis findings
3-Identify variations and exceptions
4-Identify needed EHR functionality a. 1, 2, 3, 4 b. 3, 1, 2, 4
*c. 1, 3, 4, 2 d. 4, 1, 3, 2
Answer: c. Steps in process analysis include: 1) Start with process inventory & process diagrams (covered in units 2 and 3). These should provide a context diagram showing clinic functions and a flowchart for each process. 2) For each process, list the process variations applicable to the clinic as well as exceptions that often occur. The last step in process analysis is 3) report findings. The findings from a process analysis would include: Major observations, a list of EHR
This work is funded by the National Science Foundation
Advanced Technological Education Grant 1003223
Page 1

functionality necessary to support clinic functions, and opportunities for improvement (technology assisted and otherwise).
Lecture(s)/Slide(s): 1/11
3. Choose the answer that best describes a process inventory. a. Counting and tracking available stock b. Objectifying and measuring processes c. Analyzing and improving stock processes
*d. Identifying and recording processes
Answer: d. After the processes for analysis have been identified, the analyst, working with people from the clinic creates diagrams of the processes. These graphical representations of the processes are used in the process analysis and redesign. We start with a process inventory and diagrams because sometimes they are all that is needed, and they point to areas where different types of objective information may be needed.
Lecture(s)/Slide(s): 1/12
4. Which of the following processes does NOT occur at most clinics? a. Billing b. Labs
*c. Surgery d. Prescriptions
Answer: c. Sample Practice Process List: Patient check-in, Patient visit,
Prescriptions, Assimilating received documentation, Labs, Other Diagnostic
Tests, Referral / consult, Disease Management, and Billing.
Lecture(s)/Slide(s): 1/14
5. Which of the following processes varies most by clinical specialty?
*a. Diagnostic tests b. Billing c. Office visits d. Appointment scheduling
Answer: a. There are many variations for patient office visits. A few of them are referral out needed, procedure needed, and diagnostic test needed. Depending on the type of clinic, certain diagnostic tests may or may not be performed.
Lecture(s)/Slide(s): 1/16, 2/6
This work is funded by the National Science Foundation
Advanced Technological Education Grant 1003223
Page 2

6. Which of the following would be variations of a Diagnostic test process? a. Patient cannot tolerate the test b. Patient is not compliant with preparatory instructions c. Test returns a false positive
*d. Test is conducted by referral to an external facility
Answer: d. Diagnostic tests vary widely depending on the type of practice.
Common diagnostic test variations include the following: Test done in clinic, Test done externally, Report expected, and Image or test result data expected.
Lecture(s)/Slide(s): 2/10
7. Which of the following would be variations of an appointment scheduling process? a. Miscommunication of the date or time of appointment
*b. Online appointment scheduling c. Appointment scheduling session timed out d. Appointment not found within necessary time window
Answer: b. Process variations are processes used by the clinic, i.e., the way a particular clinic does something, the clinic’s process. They are called variations because they vary from clinic to clinic. For example, some clinics only schedule appointments by phone while others use online scheduling or both online and phone.
Lecture(s)/Slide(s): 1/16
8. Which of the following would be exceptions in a prescription process? a. ePrescribing
*b. potential drug interaction identified by pharmacy c. use of online medication service/pharmacy d. prescription refill needed
Answer: b. Common exceptions or errors that can occur during a prescription process include no insurance or a non-covered service, samples provided, prescripti ons need to be sent to multiple pharmacies, and the prescription can’t be filled at a pharmacy. The identification of drug interactions by the pharmacy would fit into this category.
Lecture(s)/Slide(s): 2/7
This work is funded by the National Science Foundation
Advanced Technological Education Grant 1003223
Page 3

9. Which of the following would be an exception to a document receiving process? a. receipt of fax documents b. receipt of electronic documents c. receipt of documents within a week of patient visit
*d. receipt of documents with no patient identifiers
Answer: d. Common exceptions with external documents include inadequate patient identification, inadequate source identification, and unintelligible or ambiguous information.
Lecture(s)/Slide(s): 2/8
10. Which of the following may indicate needed EHR functionality? a. Generic processes used by a clinic b. Process variations used by a clinic c. Process exceptions likely encountered by a clinic
*d. All of the above
Answer: d. The end result of a process analysis is a list of 1) clinic processes, i.e., the process variations used by the clinic, and 2) a list of common exceptions.
For example, based on the process analysis, by-phone appointment scheduling would be on the list for Suburban Family Clinic, as would the listed exceptions.
Lecture(s)/Slide(s): 2/20
Read the scenario below. Use it to answer the following questions.
Scenario: Patient Patty arrives at the clinic and is signed in by Receptionist Ronald.
Receptionist Ronald locates Patient Patty’s record on the clinic’s schedule. He notices that she is an existing patient, and marks her record as “arrived”, and confirms Patient
Patty’s contact and insurance information. Receptionist Ronald instructs Patient Patty to have a seat in the waiting room.
Nurse Ned sees that Patient Patty has arrived and pulls her chart from the filing room.
Nurse Ned goes to the waiting room entrance and calls Patient Patty. Nurse Ned escorts Patient Patty to the exam room, interviews her regarding symptoms and/or complaints and records into the Nurses/Progress notes, and takes and records vital signs in progress notes. Nurse Ned then alerts the Doctor Dan that the patient is ready to be seen.
Within a few minutes, Doctor Dan takes the chart from the box on the exam room door and glances through the first page. Doctor Dan then enters the exam room where he examines Patient Patty and records findings in the progress notes section of the chart.
This work is funded by the National Science Foundation
Advanced Technological Education Grant 1003223
Page 4

During the exam, Doctor Dan determines if a prescription, procedure, lab work or a referral is required and completes the necessary paperwork if applicable. Doctor Dan provides some additional instructions to Patient Patty and concludes the visit. Finally,
Doctor Dan provides the patient chart to the office staff to be re-filed. On the way out,
Patient Patty pays her co-pay and concludes the office visit.
11. Which of the following EHR functionality is indicated by the scenario? a. Pulling and tracking paper charts b. Receipt of lab results from external lab c. Appointment scheduling
*d. Clinical documentation
Answer: d. Some of the information gained from process analysis translates directly into EHR functionality, for example: the process variations, flow control between variations, and handling process exceptions. This is the information that we have covered thus far in this slide set. Often, there are opportunities to make process changes, including leveraging technology. Such changes are decided during process redesign (covered in Unit 6) and also result in identification of necessary EHR functionality. In-turn, an analy st’s knowledge of available EHR functionality informs process redesign, i.e., the analyst who is familiar with available functions draws on this knowledge to suggest ways in which technology can be leveraged to improve processes. Use of technology in process redesign is covered in Unit 6.
Lecture(s)/Slide(s): 2/19
12. Which of the following process variations should be further investigated, i.e., there is not enough information in the scenario to determine which variation(s) may be in use? a. Tracking and access of paper charts b. Patient payment as part of clinic exit
*c. Billing performed in practice management system d. Pre-exam data collection by Nurse
Answer: c. Billing is a core process of any practice. Some billing variations are using a paper superbill, i.e., the sheet that providers use to check off tests and write diagnoses on during the visit, as the source, electronic data recorded by providers during the visit as the source, where the coding is done, and whether or not billing and collections are done externally. Billing exceptions include: No insurance or non-covered service, claim denied, coding errors, and data errors.
Lecture(s)/Slide(s): 2/14
Read the scenario and answer the following questions.
This work is funded by the National Science Foundation
Advanced Technological Education Grant 1003223
Page 5

Scenario: Every morning in Doctor Jon es’ practice, Big City Family Practice, Medical
Assistant Grant logs onto their account with the local lab and prints lab result sheets.
Basic demographic information (from the sample requisition form) for each patient is included on the lab sheet, along w ith the provider’s name. Mr. Smith’s lab results are in those available first thing in the morning. Medical Assistant Grant gives Nurse Adams the printed lab results for Mr. Smith. Nurse Adams glances through the results and sees that all of the tests are within normal clinical limits. Nurse Adams asks Medical
Assistant Grant to phone Mr. Smith and let him know that the lab results are normal, and to let him know that the office will phone in a prescription for the oral antifungal to his pharmacy on record, which of course, Medical Assistant Grant will confirm while on the phone with Mr. Smith. Following the request the day before from Dr. Jones, Nurse
Adams also asks Medical Assistant Grant to schedule Mr. Smith for a Follow-up appointment and blood draw in two weeks. After calling Mr. Smith, Medical Assistant
Grant files the lab results in his chart.
13. Which of the following would be exceptions in the lab result receipt process? a. Lab results received
*b. Practice account is locked out c. Abnormal lab results received d. Receipt of lab results by mail
Answer: b The receiving and communicating lab results indicate the following processes: Variations in lab scenarios include lab sample processing at external lab, lab sample acquisition, receiving lab results, and communicating lab results.
Lab process exceptions include: No results received, results not matchable to a patient, results not matchable to a provider, results abnormal and require action, and patient not contactable / not responsive to contact attempts. Having the practice account locked out would be an exception to normal process.
Lecture(s)/Slide(s): 2/9, 2/24
14. Which of the following EHR functionality is indicated by the scenario? a. Lab sample tracking b. Lab sample acquisition c. Referral to external lab
*d. Interface with the local lab
Answer: d. Some of the information gained from process analysis translates directly into EHR functionality, for example: the process variations, flow control between variations, and handling process exceptions. This is the information that we have covered thus far in this slide set. Often, there are opportunities to make process changes, including leveraging technology. Such changes are decided
This work is funded by the National Science Foundation
Advanced Technological Education Grant 1003223
Page 6

during process redesign (covered in Unit 6) and also result in identification of necessary EHR functionality.
Lecture(s)/Slide(s): 2/19, 24
Lecture 3
15. A user-centered approach is characterized by ALL these elements EXCEPT for: a. Considers users’ tasks and goals from inception through development
*b. Uses a linear lifecycle model to clearly delineate tasks c. Is based on empirical measurements of user performance d. Is developed via an iterative design process
Answer: b
Lecture(s)/Slide(s): 3/7
16. Which of the following is NOT a lifecycle model of software development? a. Waterfall b. Spiral c. Star
*d. Cluster
Answer: d
Lecture(s)/Slide(s): 3/15
17. A central problem with the waterfall model is that: (multiple choice) a. It does NOT allow for iterative design with user feedback b. It does NOT allow for changes in requirements that ensue during development c. It does NOT consider software designers’ work practices d. a and b only
*e. All of the above
Answer: e
Lecture(s)/Slide(s): 3/16
This work is funded by the National Science Foundation
Advanced Technological Education Grant 1003223
Page 7