Fundamentals of Health Workflow Process Redesign

Which of the following best describes a process? Choose the best answer:
a. A small batch of work
b. A series of actions or operations that produce work
c. A group of people that undertake work
d. An organization that performs work
Answer: b. A series of actions or operations that produce work.

Process analysis includes which of the following? Choose the best answer:
a. Knowledge of process components and relationships between them
b. Identification of opportunities for improvement
c. Both
d. Neither
c both

Process redesign includes which of the following? Choose the best answer:
a. A change in a process
b. Anticipation of a good outcome
c. Both
d. Neither
c both

A workflow is a Process, True or False?
True
False
True

Workflow analysis includes which of the following? Choose the best answer:
a. Knowledge of process components and relationships between them
b. Identification of opportunities for improvement
c. Both
d. Neither
c Both

Which of the following is NOT considered knowledge? Choose the best answer:
a. True and justified beliefs
b. Declarative facts
c. Procedural facts
d. Beliefs that may be true
Answer: d. Beliefs that may be true.

Which of the following is NOT one of the IOM characteristics of quality healthcare? Choose the best answer:
a. Efficient
b. Timely
c. Provider centered
d. Equitable
Answer: c. Provider centered

Which of the following is NOT a characteristic of Meaningful Use of Health IT? Choose the best answer:
a. Refers to the use of Health IT to improve patient care
b. Includes ePrescribing and provider order entry
c. Has been in legislation for over 20 years
d. Includes incentives for meeting requirements for care and Health IT
Answer: c. Has been in legislation for over 20 years

Which of the following is NOT a Meaningful Use requirement? Choose the best answer:
a. Greater than or equal to 80% of all orders directly entered by the authorizing provider
b. Use of data standards for lab tests and diagnoses
c. Greater than or equal to 90% of eligible pneumonia patients receive antibiotics within 12 hours of an office visit
d. Use of Health IT by providers
Answer: c. Greater than or equal to 90% of eligible pneumonia patients
received antibiotics within 12 hours of an office visit.

1. Mark the symbols that are common flowchart symbols:
a. Pentagon
b. Arrow
c. Oval
d. Dodecahedron
Answer: b. Arrow

2. What symbol should be used to diagram the following process step: “If the patient is a new patient …”
a. Pentagon
b. Diamond
c. Oval
d. Rectangle
Answer: b. Diamond

3. Which of the following is used to indicate that a flowchart continues on another page?
a. Circle connector
b. Process box
c. Dotted line
d. Curved arrow
Answer: a. Circle connector

4. Which of the following should be used to diagram the following text: “…the new patient intake form is received, the information is confirmed with the patient, then entered into the EMR”.
a. Terminal symbol, then two parallel process boxes
b. Circle, process box, then a diamond
c. Document symbol, then two sequential process boxes
d. Document box, then a diamond followed by a terminal symbol
Answer: c. Document symbol, then two sequential process boxes

5. An analyst needs to show the context in which a process operates. Which of the following methodologies is the most appropriate?
a. Yourdon
b. Unified Modeling Language
c. Flowchart
d. Entity-relationship diagram
Answer: a. Yourdon

6. An analyst needs to show information movement and the order of the steps. Which of the following diagram notations should be used?
a. Use case scenario
b. Stakeholder diagram
c. Context diagram
d. Data flow diagram
Answer: d. Data flow diagram

7. An analyst needs to show information content. Which of the following notations would be appropriate?
a. Flowchart
b. E-R diagram
c. Data flow diagram
d. Workflow diagram
Answer: b. E-R diagram

8. An analyst needs to show detailed process steps. Which of the following diagrams is the most appropriate?
a. UML diagram
b. ISO data flow diagram
c. Context diagram
d. E-R diagram
Answer: b. ISO data flow diagram

9. Indicate which statement is true:
a. Information flow and Workflow are the same thing
b. Information flow and workflow can be shown on a context diagram
c. Information flow and process flow can be shown on an E-R diagram
d. Information flow and process flow can be shown on a flowchart
Answer: d. Information flow and process flow can be shown on a flowchart

Indicate which statement is true:
a. Multiple process aspects may be represented on some diagrams
b. There is only one type of diagram for each process aspect
c. There is not any overlap in the symbols used in different notations
d. There is only one correct representation for any process
Answer: a. Multiple process aspects may be represented on some diagrams

In Gane-Sarson notation, what is the correct shape to represent the patient?
a. Rounded rectangle
b. Rectangle
c. Open-ended rectangle
d. Line
Answer: b

In Gane-Sarson notation, what is the correct shape to represent the transfer of information from the private practice to the emergency department?
a. Rounded rectangle
b. Rectangle
c. Open-ended rectangle
d. Line
Answer: d

. Gane-Sarson notation uses which of the following:
a. Curved lines
b. Diagonal lines
c. Horizontal lines
d. Dotted lines
Answer: c

In Gane-Sarson notation, which of the following is an appropriate name for a process:
a. receive patient
b. request and reply
c. claims data
d. emergency department
Answer: a

6. In Yourdon notation, what is the correct shape to represent the patient?
a. Rounded rectangle
b. Rectangle
c. Open-ended rectangle
d. Line
Answer: b

7. In Yourdon notation, what is the correct shape to represent the transfer of information from the private practice to the emergency department?
a. Rounded rectangle
b. Rectangle
c. Open-ended rectangle
d. Line
Answer: d

8. Yourdon notation uses which of the following:
a. Curved lines
b. Diagonal lines
c. Horizontal lines
d. All of the above
Answer: d

9. In Yourdon notation, which of the following is an appropriate name for a process:
a. receive patient
b. request and reply
c. claims data
d. emergency department
Answer: a

10. In which notation, would the decision to transfer the patient to the emergency department be represented?
a. Yourdon
b. Flowchart
c. Gane-Sarson
d. Entity-Relationship diagram
Answer: b

11. Which shape is used to mean different things in a UML activity diagram and basic flowchart?
a. rectangle
b. circle
c. diamond
d. line
Answer: b. Circle

12. A terminal symbol in a flowchart is used to represent which of the following?
a. decision
b. start
c. stop
d. start and stop
Answer: d. Start and stop

13. Which symbol would be used in flowchart notation to represent the following text? “If the lab results are not within normal limits, call the patient.”
a. diamond
b. circle
c. triangle
d. pentagon
Answer: a. Diamond

14. Which symbol would be used in flowchart notation to represent the following text? “The patient called the office to schedule an appointment.”
a. diamond
b. circle
c. rectangle
d. telephone
Answer: c. Rectangle

15. Which symbol would be used in Yourdon notation to represent the following text? “The nurse calculated the patient’s body mass index.”
a. rectangle and diamond
b. diamond and circle
c. rectangle and circle
d. rectangle and rectangle
Answer: c. Rectangle and circle

16. Which symbol would be used in Gane-Sarson notation to represent the following text? “The nurse entered the patient’s weight.”
a. rounded corner rectangle and diamond
b. diamond and open-ended rectangle
c. open-ended rectangle and circle
d. rectangle and circle
Answer: c. Open-ended rectangle and double-square

1. Which best describes the goal of Knowledge Acquisition (KA)?
a. To increase the analysts clinical knowledge
b. To gather and capture process knowledge
c. To create process diagrams
d. To document clinical procedures
Answer: b. To gather and capture process knowledge

2. Which of the following is true for Knowledge Acquisition (KA) in support of EMR adoption?
a. Acquiring the software vendor is a likely means of KA
b. Clinic staff cannot acquire knowledge through technology purchase
c. Clinics will likely replace existing staff with trained experts in EMR use
d. Clinics will acquire knowledge through process analysis
Answer: d. Clinics will acquire knowledge through process analysis

3. Which of the following types of knowledge is the easiest for organizations to share with others?
a. Coded knowledge
b. Tacit knowledge
c. Sticky knowledge
d. Experiential knowledge
Answer: a. Coded knowledge

4. Which of the following CMM levels best describes the following organization: “There are standard operating procedures, and performance is fairly consistent. When adapted to new situations, the process performance is not predictable, and sometimes results are substandard.”
a. Level 1
b. Level 2
c. Level 3
d. Level 4
Answer: c. Level 3

5. A clinic that you are working with is at CMM level “Managed”. Which of the following methodologies should be used to obtain process information?
a. Reading available procedures
b. Interviews only
c. Interviews and process walkthroughs
d. Observation of key processes
Answer: a. Reading available procedures

6. A clinic that you are working with is at CMM level “Repeatable”. Which of the following methodologies should be used to obtain process information?
a. Reading available procedures
b. Interviews only
c. Interviews and process walkthroughs
d. Observation of key processes
Answer: c. Interviews and process walkthroughs

7. A context diagram is important for what reasons?
a. Facilitates checking information with practice providers and staff
b. Only takes one page and saves analyst time
c. Depicts major functions and processes
d. a and c
Answer: d. a and c

8. A process inventory is developed from which of the following?
a. UML diagram
b. A list of clinic services
c. Clinic stakeholder diagram
d. Patient and family services
Answer: b. A list of clinic services

9. Which of the following categories of processes will likely be deemed important enough to analyze?
a. Processes impacting patient care
b. Processes that can be improved through Health IT
c. High volume processes
d. All of the above
Answer: d. All of the above

Which of the following processes would you find in most clinics?
a. Appointment scheduling
b. Outpatient surgery
c. Receiving documentation
d. a and c
Answer: d. a and c

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. Conduct process redesign.

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. 1,3,4,2

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. Identifying and recording processes

4. 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. Test is conducted by referral to an external facility

5. 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. Online appointment scheduling.

6. 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. receipt of documents with no patient identifiers.

7. 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. All of the above.

1. According to Deming, which would be a good approach to address a medical error in a clinic?
a. Create and enact a new clinic policy
b. Impose a stiff penalty on clinic staff for medical errors
c. Investigate possible process changes to prevent such errors
d. Provide more training to the individual who made the error
Answer: c. Investigate possible process changes to prevent such errors

2. Implementing a self-service appointment scheduling system is an example of which of the following?
a. Control relocation
b. Control addition
c. Automation
d. Exception handling
Answer: a. Control relocation

3. Implementing a system that enables ordering lab tests and results receiving from a central lab is an example of which of the following?
a. Knock-out and flexible assignment
b. Automation and integration
c. Task composition and task elimination
d. Integration and interfacing
Answer: d. Integration and interfacing

4. Implementing ePrescribing for a practice that used paper and phone is an example of what type of change?
a. Breakthrough
b. Incremental
c. Knock-out
d. Exception handling
Answer: a. Breakthrough

5. Which of the following is a good candidate for complete automation?
a. Clinical diagnoses
b. Checking patients in to the clinic
c. Making referrals to specialists
d. Processing incoming documents
Answer: b. Checking patients into the clinic

6. Which of the following is the best reason to use human-centered-design principles in process redesign?
a. Software will be developed custom for each clinic
b. Clinic software systems impact patient care
c. People interact with clinic software systems
d. Patient care needs to be automated
Answer: c. People interact with clinic software systems

7. Is the following statement True or False? “In keeping with human-centered-design principles, clinic processes should be examined from two perspectives: 1. providers/clinic staff and 2. patients.”
True
False
Answer: True

8. Which of the following are likely to benefit from a lab interface?
1 – Clinic that performs dipstick tests only, and does not use an external lab
2 – Clinic that uses all internal lab analyzers
3 – Clinic that performs some in-house tests and uses an external lab for others
4 – Clinic that sends all samples to an external lab

a. 1 only
b. 2 only
c. 3 only
d. 3 and 4 only
e. 2, 3, and 4
f. 1, 2, 3, and 4

Answer: e. 2, 3 and 4

9. Is the following statement True or False? “If a clinic has a Practice Management System, they already have all of the functionality of an EHR.”
True
False
Answer: False

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