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
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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
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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?
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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