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A critical early step in designing an EHR is to develop a(n)________ in which the characteristics of each data element are defined.
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In healthcare, data sets serve two purposes. The first purpose is to identify data elements to be collected about each patient. The second is to _____.
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RHIT Test Review
AHIMA Test Questions for RHIT Exam
| Question | Answer |
|---|---|
| A critical early step in designing an EHR is to develop a(n)________ in which the characteristics of each data element are defined. | data dictionary |
| In healthcare, data sets serve two purposes. The first purpose is to identify data elements to be collected about each patient. The second is to _____. | provide uniform data definitions |
| Once hospital discharge abstract systems were developed and their ability to provide comparative data to hospitals was established, it became necessary to develop ______. | data sets |
| A health information technician has been charged with the responsibility of designing a data collection form to be used on admission of a patient to the acute care hospital in which she works. The first resource that she should use is | UHDDS |
| Which of the following is NOT a characteristic of the common healthcare data sets such as UHDDS and UACDS? | They provide a complete and exhaustive list of data elements that must be collected. |
| A corporation is evaluating several health plans for its benefits package. The data set that provides comparison information about health plan performance is ______. | HEDIS |
| The name of the government agency that has led the development of basic data sets for health records and computer databases is ______? | National Committee on Vital and Health Statistics |
| The primary purpose of a minimum data set in healthcare is to ______. | recommend common data elements to be collected in health records |
| The inpatient data set that has been incorporated into federal law and is required for Medicare reporting is the ______. | Uniform Hospital Discharge Data Set |
| Both HEDIS and the Joint Commission;s ORYX programs are designed to collect data to be used for _____. | performance improvement programs |
| While the focus of inpatient data collection in the UHDDS is on principal diagnosis, the focus of outpatient data collection in the UACDS is on _____. | reason for encounter |
| In long-term care, the resident's care plan is based on data collected in the ______. | MDS Version 2.0 |
| Reimbursement for home health services is dependent on data collected from _____. | OASIS |
| Each of the three dimensions (personal, provider, and community) of information defined by the National Health Infrastructure (NHII) contains specific recommendations for _____. | core data elements |
| A core set developed by ASTM to communicate a patient's past and current health information as the patient transitions from one care setting to another is _____. | Continuity of Care Record |
| The home health prospective payment system uses the _____ data set for patient assessments. | OASIS |
| The government agency most closely involved in the development of healthcare data sets and information standards is _____. | National Centers for Health Statistics |
| The data set designed to organize data for public release about the outcomes of care is _____. | HEDIS |
| OASIS data are used to assess the _____ of home health services. | outcome |
| Which of the following indexes and databases includes patient-identifiable information? | Master patient/population index |
| A notation for a diabetic patient in a physician note reads:"Occasionally gets hungry. No insulin reactions. Says she is following her diabetic diet." In which part of a POMR progress note would this notation be written? | Subjective |
| A notation for a diabetic patient in a physician note reads: "FBS 110 mg%, urine sugar, no acetone." In which part of a POMR progress note would this notation be written? | Objective |
| A notation for a hypertensive patient in a physician ambulatory care progress note reads: "Continue with Diuril, 500 mgs once daily. Return visit in 2 weeks." In which part of a POMR progress note would this notation be written? | Plan |
| A notation for a hypertensive patient in a physician ambulatory care progress note reads: "Blood pressure adequately controlled." In which part of a POMR progress note would this notation be written? | Assessment |
| The set of all terms that may be used in a language is referred to as a _____. | Vocabulary |
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MsJRSmith
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