Component 10/Unit 3 - Application Activities, Instructor Guidelines, and Expected Outcomes

Application 1: Read the following text and use it to answer the questions that follow.

In a large private practice care facility a patient arrives with chest pain. The patient is signed-in. All data are collected and entered directly into the electronic system. During the patient assessment, signs and symptoms are also entered into the electronic system by the provider. The provider suspects an AMI (an acute condition requiring assessment in an emergency room) and triggers immediate transport to the local hospital. Information collected during the brief office visit is made available for access by the emergency department (ED).

In the local hospital ED, the Physician assesses the patient, orders cardiac lab tests, and adds additional information into the electronic system. Laboratory samples are collected and results are entered into the patient’s electronic medical record. Based on elevated cardiac enzymes and ECG changes, the patient is subsequently taken to the cardiac catheterization lab and admitted to the hospital.

1. Indicate which of the following are entities described in the text:

  1. EMR database
  2. The physician
  3. Entry of results
  4. Triggering transport

Answer: b

2. In Gane-Sarson notation, what is the correct shape to represent the patient?

  1. Rounded rectangle
  2. Rectangle
  3. Open-ended rectangle
  4. Line

Answer: b

3. In Gane-Sarson notation, what is the correct shape to represent the transfer of information from the private practice to the emergency department?

  1. Rounded rectangle
  2. Rectangle
  3. Open-ended rectangle
  4. Line

Answer: d

4. Gane-Sarson notation uses which of the following:

  1. Curved lines
  2. Diagonal lines
  3. Horizontal lines
  4. Dotted lines

Answer: c

5. In Gane-Sarson notation, which of the following is an appropriate name for a process:

  1. receive patient
  2. request and reply
  3. claims data
  4. emergency department

Answer: a

6.  In Yourdon notation, what is the correct shape to represent the patient?

  1. Rounded rectangle
  2. Rectangle
  3. Open-ended rectangle
  4. 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?

  1. Rounded rectangle
  2. Rectangle
  3. Open-ended rectangle
  4. Line

Answer: d

8.  Yourdon notation uses which of the following:

  1. Curved lines
  2. Diagonal lines
  3. Horizontal lines
  4. All of the above

Answer: d

9.  In Yourdon notation, which of the following is an appropriate name for a process:

  1. receive patient
  2. request and reply
  3. claims data
  4. emergency department

Answer: a

10. In which notation, would the decision to transfer the patient to the emergency department be represented?

  1. Yourdon
  2. Flowchart
  3. Gane-Sarson
  4. Entity-Relationship diagram

Answer: b

Read the following scenario and answer the questions.

Scenario: Patient Patty calls Suburban Family Practice to schedule an office visit. Receptionist Ronald uses a practice management system (PMS) to maintain patient demographic, insurance and contact information which he confirms with the patient at each visit. During the visit, lab tests ordered and diagnoses are recorded on a superbill sheet by Doctor Dan. On her way out after the visit, Patient Patty drops the superbill sheet off with Receptionist Ronald. At the end of each day, Receptionist Ronald enters the information from the superbill into the practice management system. The practice management system is used to submit claims to the regional clearinghouse used by the practice.

11.  In Yourdon notation, what entities would be present in the context diagram for the scenario?

  1. Patient Patty
  2. Superbill
  3. Practice Management System
  4. A and C above
  5. All of the above

Answer: e

12. In Yourdon notation, what datastores would be present in the context diagram for the scenario?

  1. Electronic Medical Record
  2. Superbill
  3. Practice Management System
  4. B and C above

Answer: d

13. In Yourdon notation, what processes does data flow between for the scenario?

  1. Patient Patty and Receptionist Ronald
  2. Doctor Dan and Record on Superbill
  3. Record on Superbill and Enter in PMS
  4. Record on Superbill and Submit claim

Answer: c

14. Which of the following data elements are NOT collected or used in the scenario

  1. Visit date
  2. Demographic information
  3. Insurance information
  4. Lab tests

Answer: a

15. In a UML class diagram for the information content in the scenario above, which of the following might appear as classes or attributes?

  1. Patient contact information
  2. Superbill
  3. Provider contact information
  4. Emergency department

Answer: a

16. In a UML class diagram for the information content in the scenario above, which of the following might appear as attributes?

  1. Diagnosis
  2. Superbill
  3. Patient contact information
  4. Emergency department

Answer: a

17. In a UML class diagram for the information content in the scenario above, which of the following might have direct associations?

  1. Patient contact information and clearinghouse
  2. Superbill and patient
  3. clearinghouse and payer
  4. Receptionist Ronald and Doctor Dan

Answer: b

18. In an Entity-relationship diagram representing the information content from the scenario, which of the following relationships would you find?

  1. One patient per provider
  2. One order per provider
  3. One superbill per patient
  4. One patient per superbill

Answer: d

19. In an Entity-relationship diagram representing the information content from the scenario, which of the following relationships would be incorrect?

  1. A practice can be associated with zero to many patient visits
  2. A lab test order can be associated with one and only one patient
  3. A provider can be associated with zero to many orders
  4. A patient can have one and only one lab test order

Answer: d

Instructor Guidelines for Application 1: The questions cover the subunits and are labeled according to which sub-unit they assess. These questions can be used as test question or as self-assessment questions for students.

Expected Outcomes for Application 1: The correct answer is marked on each item above.

Application 2: Watch the video titled How Life Should Be After You’ve Implemented Electronic Medical Records.

http://www.youtube.com/watch?v=97v5p9Nk2_I&feature=related

Watch the video, diagram the entire process from the patient/guardian contacting the physician’s office to the end of the patient visit. Be prepared to share (or turn in) and discuss your work.

Discussion questions:

What are the steps in the process?

Develop a process diagram for the steps in the video.

Instructor Guidelines for Application 2: A different video or a written scenario may be substituted for the How Life Should Be After You’ve Implemented Electronic Medical Records video.

http://www.youtube.com/watch?v=97v5p9Nk2_I&feature=related

This application exercise will be most beneficial if it is done in a healthcare setting similar to those likely to be encountered by the workforce you are training.

The instructor should assign (or explicitly indicate student’s choice) for the diagramming notation to be used. This application can also be used as a synthesis application where the student is asked to create the diagram using more than one notation OR diagramming different process aspects, e.g., a data flow AND a process flow.

As with all process diagramming exercises, the students need an indication of the detail level expected. As an instructor, I usually accomplish this by setting a page limit and a font size, and explicitly explain to the students that if the information won’t fit on the page, they are working at too low a detail level.

Expected Outcomes for Application 2: 1) the student should identify a set of process steps at a consistent level of detail that comprehensively covers the depicted process. The process steps described should correspond to those in the video used for this application. 2) the diagram symbols and conventions should be conformant with the method chosen. 3) the diagram should contain no logic errors that could have been caught with the rules in the subunit slide sets.

Application 3: Recall the process for scheduling a visit to a healthcare facility. List the data elements that are used or generated in this process.

Discussion Questions for Application 3:

1.  What data elements did you identify?

2.  Where does the data value for each data element come from (practice database or the patient or elsewhere?

3.  What information does the receptionist (or web-based system) need in order to schedule the visit?

Instructor Guidelines for Application 3: Another video or a written scenario may be substituted for the exercise. The goal of this learning application is for the students to get practice extracting information needs from observed processes or from written scenarios. This is applicable to both data flow diagramming and to interpreting and using ERDs and UML class diagrams.

The exercise could be augmented by providing an ERD or UML class diagram and asking the students to analyze what data elements from the scenario are present, which are missing, and what extra data elements are there.

Expected Outcomes for Application 3: The student should identify the majority of the data elements explicitly mentioned in the scenario.

Component 10/Unit 3 Health IT Workforce Curriculum 1

Version 2.0/Spring 2011

This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.