, Question 1
A health system wants to reduce alert fatigue while preserving safety for
high-risk medications. Which CDS redesign strategy best balances sensitivity
and specificity according to current human-factors evidence?
A. Suppress all drug-drug interaction alerts except those with a
documented override rate above 90%.
B. Tier alerts by clinical severity and patient-specific risk factors,
reserving interruptive alerts for high-risk scenarios and using
non-interruptive notifications for low-risk ones.
C. Convert all interruptive alerts to passive dashboard flags so clinicians
can review them at the end of each shift.
D. Require a free-text rationale for every alert override to discourage
bypassing alerts.
Correct Answer: B - Tier alerts by clinical severity and
patient-specific risk factors, reserving interruptive alerts for
high-risk scenarios and using non-interruptive notifications for
low-risk ones.
RATIONALE
Evidence supports tiering alerts by severity and patient-specific risk,
using interruptive alerts only for high-risk situations to reduce fatigue
while maintaining safety. Suppressing by override rate (A) removes
alerts based on behavior, not risk, and can eliminate important
warnings. Passive-only flags (C) risk missed critical alerts, and
mandatory free-text rationales (D) add burden without improving alert
specificity.
Question 2
A regional HIE needs to exchange discrete medication and allergy data across
disparate EHRs. Which combination of standards is most appropriate for
semantic interoperability?
A. HL7 v2 ADT messages with local code sets and PDF summaries.
Page 2
, B. FHIR resources with RxNorm for medications and SNOMED CT for
allergies, transported via RESTful APIs.
C. CDA documents with ICD-10-CM for medications and LOINC for
allergies.
D. X12 837 claims with NDC codes for medications and free-text allergy
fields.
Correct Answer: B - FHIR resources with RxNorm for
medications and SNOMED CT for allergies, transported via
RESTful APIs.
RATIONALE
FHIR with RxNorm (medications) and SNOMED CT (allergies)
supports semantic interoperability by using standardized, computable
terminologies over RESTful APIs. HL7 v2 with local codes (A) lacks
semantic consistency, CDA with ICD-10-CM/LOINC (C) misassigns
terminologies for medications/allergies, and X12 837 claims (D) are
billing transactions, not clinical data exchange.
Question 3
A breach affects 650 individuals' unsecured ePHI in a state where the entity is
not a covered entity but acts as a business associate. Which action is required
under HITECH and the HIPAA Breach Notification Rule?
A. The business associate must notify each affected individual within 60
days and notify HHS and the media.
B. The business associate must notify the covered entity within 60 days,
and the covered entity is responsible for individual, HHS, and media
notifications.
C. The business associate must notify HHS only if more than 500
individuals are affected and may skip notifying the covered entity.
D. The business associate must notify the media within 24 hours and post
a notice on its website.
Correct Answer: B - The business associate must notify the
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, covered entity within 60 days, and the covered entity is
responsible for individual, HHS, and media notifications.
RATIONALE
Under HITECH/HIPAA, a business associate must notify the covered
entity of a breach without unreasonable delay and no later than 60
days; the covered entity then handles individual, HHS, and media
notifications. Options A, C, and D misassign notification duties and
timelines to the business associate.
Question 4
A nurse informaticist is validating a sepsis prediction model. The model has
high sensitivity but low positive predictive value in the local population.
Which action best addresses this while maintaining safety?
A. Lower the alert threshold to further increase sensitivity.
B. Recalibrate the model using local data and adjust the threshold to
optimize clinical utility, then monitor outcomes.
C. Replace the model with a simple SIRS-based rule to reduce false
positives.
D. Disable the alert for patients with chronic conditions that can elevate
inflammatory markers.
Correct Answer: B - Recalibrate the model using local data and
adjust the threshold to optimize clinical utility, then monitor
outcomes.
RATIONALE
Low PPV with high sensitivity suggests poor calibration to the local
population; recalibrating with local data and optimizing the threshold
balances benefits and alert burden. Lowering the threshold (A)
worsens false positives, SIRS (C) is less accurate and not a validated
substitute, and disabling alerts for chronic conditions (D) is a blunt fix
that can miss sepsis.
Page 4
A health system wants to reduce alert fatigue while preserving safety for
high-risk medications. Which CDS redesign strategy best balances sensitivity
and specificity according to current human-factors evidence?
A. Suppress all drug-drug interaction alerts except those with a
documented override rate above 90%.
B. Tier alerts by clinical severity and patient-specific risk factors,
reserving interruptive alerts for high-risk scenarios and using
non-interruptive notifications for low-risk ones.
C. Convert all interruptive alerts to passive dashboard flags so clinicians
can review them at the end of each shift.
D. Require a free-text rationale for every alert override to discourage
bypassing alerts.
Correct Answer: B - Tier alerts by clinical severity and
patient-specific risk factors, reserving interruptive alerts for
high-risk scenarios and using non-interruptive notifications for
low-risk ones.
RATIONALE
Evidence supports tiering alerts by severity and patient-specific risk,
using interruptive alerts only for high-risk situations to reduce fatigue
while maintaining safety. Suppressing by override rate (A) removes
alerts based on behavior, not risk, and can eliminate important
warnings. Passive-only flags (C) risk missed critical alerts, and
mandatory free-text rationales (D) add burden without improving alert
specificity.
Question 2
A regional HIE needs to exchange discrete medication and allergy data across
disparate EHRs. Which combination of standards is most appropriate for
semantic interoperability?
A. HL7 v2 ADT messages with local code sets and PDF summaries.
Page 2
, B. FHIR resources with RxNorm for medications and SNOMED CT for
allergies, transported via RESTful APIs.
C. CDA documents with ICD-10-CM for medications and LOINC for
allergies.
D. X12 837 claims with NDC codes for medications and free-text allergy
fields.
Correct Answer: B - FHIR resources with RxNorm for
medications and SNOMED CT for allergies, transported via
RESTful APIs.
RATIONALE
FHIR with RxNorm (medications) and SNOMED CT (allergies)
supports semantic interoperability by using standardized, computable
terminologies over RESTful APIs. HL7 v2 with local codes (A) lacks
semantic consistency, CDA with ICD-10-CM/LOINC (C) misassigns
terminologies for medications/allergies, and X12 837 claims (D) are
billing transactions, not clinical data exchange.
Question 3
A breach affects 650 individuals' unsecured ePHI in a state where the entity is
not a covered entity but acts as a business associate. Which action is required
under HITECH and the HIPAA Breach Notification Rule?
A. The business associate must notify each affected individual within 60
days and notify HHS and the media.
B. The business associate must notify the covered entity within 60 days,
and the covered entity is responsible for individual, HHS, and media
notifications.
C. The business associate must notify HHS only if more than 500
individuals are affected and may skip notifying the covered entity.
D. The business associate must notify the media within 24 hours and post
a notice on its website.
Correct Answer: B - The business associate must notify the
Page 3
, covered entity within 60 days, and the covered entity is
responsible for individual, HHS, and media notifications.
RATIONALE
Under HITECH/HIPAA, a business associate must notify the covered
entity of a breach without unreasonable delay and no later than 60
days; the covered entity then handles individual, HHS, and media
notifications. Options A, C, and D misassign notification duties and
timelines to the business associate.
Question 4
A nurse informaticist is validating a sepsis prediction model. The model has
high sensitivity but low positive predictive value in the local population.
Which action best addresses this while maintaining safety?
A. Lower the alert threshold to further increase sensitivity.
B. Recalibrate the model using local data and adjust the threshold to
optimize clinical utility, then monitor outcomes.
C. Replace the model with a simple SIRS-based rule to reduce false
positives.
D. Disable the alert for patients with chronic conditions that can elevate
inflammatory markers.
Correct Answer: B - Recalibrate the model using local data and
adjust the threshold to optimize clinical utility, then monitor
outcomes.
RATIONALE
Low PPV with high sensitivity suggests poor calibration to the local
population; recalibrating with local data and optimizing the threshold
balances benefits and alert burden. Lowering the threshold (A)
worsens false positives, SIRS (C) is less accurate and not a validated
substitute, and disabling alerts for chronic conditions (D) is a blunt fix
that can miss sepsis.
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