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ANCC Informatics Nurse study materials
ANCC Informatics Nurse study resources

ANCC Informatics Nurse practice questions

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Question 1Foundations of Nursing Informatics

A nurse documents a patient's heart rate as 88 beats per minute in the electronic record. Within the DIKW framework, this entry is best described as which of the following?

  1. An interpreted information trend
  2. A wisdom-based decision
  3. A data element Correct answer.
  4. A knowledge statement

Explanation

Data are discrete, uninterpreted facts such as a single vital sign value. Information emerges when data are organized and given context, knowledge adds relationships and rules, and wisdom applies knowledge to a specific situation with judgment.

Question 2Foundations of Nursing Informatics

Which statement best reflects the accepted definition of nursing informatics as a specialty?

  1. A hospital finance role that oversees the technology purchasing budget
  2. A computer science subspecialty that installs and repairs clinical software
  3. Integration of nursing science with information and analytical sciences Correct answer.
  4. A monitoring specialty focused on bedside physiologic devices

Explanation

Nursing informatics integrates nursing science with information science, computer science, and analytical sciences to manage data, information, knowledge, and wisdom in nursing practice. It is a nursing specialty defined by that integration, not by hardware support, budgeting, or device monitoring alone.

Question 3Foundations of Nursing Informatics

A nurse searches a clinical database, judges the credibility of the retrieved articles, and applies the findings to a practice problem. This behavior best demonstrates which competency?

  1. Information literacy Correct answer.
  2. Software proficiency
  3. Health literacy
  4. Computer literacy

Explanation

Information literacy is the ability to recognize an information need and to locate, evaluate, and use information effectively. Computer literacy concerns skill in operating hardware and software, while health literacy describes a patient's capacity to obtain and process health information.

Question 4Foundations of Nursing Informatics

What is the primary purpose of an electronic health record in a care delivery system?

  1. To replace clinical judgment with automated decisions
  2. To provide a longitudinal record of health information that is shareable across encounters and settings Correct answer.
  3. To archive scanned paper records for legal retention
  4. To store billing codes only for reimbursement purposes

Explanation

An electronic health record is designed to capture and share a patient's health information longitudinally across encounters, providers, and settings to support continuity and safe decision-making. Billing, archiving, and automation are secondary uses or capabilities, not the defining purpose.

Question 5Foundations of Nursing Informatics

A hospital implements bar-code medication administration at the bedside. Which outcome is the most direct expected benefit?

  1. Elimination of the need for independent double checks
  2. Fewer medication administration errors at the point of care Correct answer.
  3. Reduced frequency of pharmacy inventory audits
  4. Shorter orientation for newly hired graduate nurses

Explanation

Bar-code medication administration verifies the patient, medication, dose, route, and time against the electronic order at the point of care, directly reducing administration errors. It supports but does not replace verification processes such as independent double checks for high-alert medications.

Question 6Foundations of Nursing Informatics

During a busy shift, a nurse gives a colleague an EHR password so the colleague can finish charting. Which statement best explains why this is prohibited?

  1. Sharing is acceptable during short-staffed shifts if the charge nurse is told
  2. Sharing is acceptable if the nurse remains logged in at the workstation
  3. Credentials must be unique per user so every entry stays attributable Correct answer.
  4. Sharing is acceptable when both nurses are licensed on the same unit

Explanation

Each user must have a unique credential so all documentation and record access is attributable in the audit trail. Shared credentials destroy accountability, violate organizational security policy, and breach confidentiality obligations.

Question 7Foundations of Nursing Informatics

A clinician asks an informatics nurse to look up the record of a patient who is not on the clinician's service and is not part of any current treatment, payment, or operations activity. What is the appropriate response?

  1. Permit access because the EHR is a secure, password-protected system
  2. Restrict access to users with a documented treatment-related need to know Correct answer.
  3. Permit access if the clinician signs a general confidentiality statement
  4. Permit access because the clinician holds an active professional license

Explanation

Privacy regulations permit use or disclosure of protected health information only as needed for treatment, payment, or health care operations, following the minimum necessary standard. Access is granted by role and need to know, not by general licensure or system security features.

Question 8Foundations of Nursing Informatics

Why do nursing departments adopt standardized nursing terminologies for documentation in the EHR?

  1. They shorten the time required to complete each shift's charting
  2. They allow nursing data to be compared, aggregated, and reused across settings and systems Correct answer.
  3. They satisfy the billing requirements applied to physician services
  4. They remove the need for nursing clinical judgment in documentation

Explanation

Standardized terminologies provide consistent, coded terms so nursing diagnoses, interventions, and outcomes can be captured as retrievable data. This enables comparison, quality measurement, research, and reuse across systems, which free-text documentation cannot support.

Question 9Foundations of Nursing Informatics

Which terminology is designed specifically to identify laboratory tests and clinical observations so results can be exchanged and compared across systems?

  1. SNOMED CT
  2. LOINC Correct answer.
  3. ICD-10-CM
  4. NANDA-I

Explanation

LOINC provides standardized codes and names for laboratory tests and clinical observations, enabling result exchange and comparison across systems. It does not classify diseases, procedures, or nursing diagnoses.

Question 10Foundations of Nursing Informatics

Which terminology provides a comprehensive, concept-based clinical vocabulary with defined relationships among concepts?

  1. ICD-10-CM
  2. SNOMED CT Correct answer.
  3. CPT
  4. LOINC

Explanation

SNOMED CT is a concept-based clinical terminology in which concepts are linked by defined relationships, supporting meaning-level exchange and reuse. LOINC identifies observations, CPT describes procedures and services, and ICD-10-CM classifies diagnoses for reporting.

Question 11Foundations of Nursing Informatics

A nurse documents a care plan label of "risk for adult falls." Which terminology supplies standardized nursing diagnosis labels?

  1. Nursing Interventions Classification (NIC)
  2. LOINC
  3. NANDA International (NANDA-I) Correct answer.
  4. ICD-10-CM

Explanation

NANDA-I is the standardized terminology for nursing diagnoses that provides defined labels, definitions, and defining characteristics. NIC names interventions and NOC names outcomes, forming the complementary elements of a standardized care plan.

Question 12Foundations of Nursing Informatics

Which interoperability standard uses modular resources accessed through a RESTful application programming interface to support modern health data exchange?

  1. ANSI X12 837
  2. HL7 FHIR Correct answer.
  3. DICOM
  4. HL7 version 2 messaging

Explanation

HL7 FHIR defines discrete resources exchanged through RESTful web services, which makes it well suited to contemporary applications and mobile access. HL7 version 2 uses pipe-delimited messages, DICOM handles imaging, and X12 837 carries claims data.

Question 13Foundations of Nursing Informatics

A clinical decision support system fires so many drug-interaction alerts that nurses routinely override them without reading. Which action best addresses this problem?

  1. Tier alerts by clinical severity and retire alerts that add little value Correct answer.
  2. Route all alerts to pharmacy and remove them from the nursing workflow
  3. Disable all interaction alerts to reduce workflow interruptions
  4. Require a documented reason for every override regardless of alert severity

Explanation

Alert fatigue is reduced by prioritizing alerts according to clinical importance and eliminating low-value messages so that meaningful warnings retain their salience. Requiring documentation for every override adds burden without improving the signal-to-noise ratio.

Question 14Foundations of Nursing Informatics

During which phase of the system development life cycle are current-state workflows examined and functional requirements defined?

  1. Go-live support
  2. Design
  3. Analysis Correct answer.
  4. Testing

Explanation

The analysis phase documents the current state, identifies needs, and specifies functional and nonfunctional requirements. Design, testing, and go-live support follow and build on those approved requirements.

Question 15Foundations of Nursing Informatics

Representative staff nurses work through realistic patient scenarios on a new documentation screen before it is released, and their observations drive revisions. This activity is best described as which of the following?

  1. Usability testing Correct answer.
  2. Load testing
  3. A downtime drill
  4. Data migration validation

Explanation

Usability testing observes representative users performing realistic tasks to identify interface problems and inform design changes. Load testing measures system performance under volume, and neither migration validation nor downtime drills involve observing end users on screens.

Question 16Foundations of Nursing Informatics

Which federal legislation authorized incentive payments to eligible hospitals and professionals for meaningful use of certified EHR technology?

  1. The HITECH Act Correct answer.
  2. HIPAA
  3. The FDA Safety and Innovation Act
  4. The Affordable Care Act

Explanation

The HITECH Act of 2009 established incentive programs promoting adoption and meaningful use of certified EHR technology and strengthened privacy and security enforcement. HIPAA predates the incentive program, and the other laws address different regulatory areas.

Question 17Foundations of Nursing Informatics

Which group of elements belongs to the Nursing Minimum Data Set?

  1. Patient satisfaction scores, nurse staffing ratios, and budget variance
  2. Nursing diagnosis, nursing intervention, nursing outcome, and intensity of care Correct answer.
  3. Vital signs, laboratory values, and diagnostic imaging results
  4. Physician orders, discharge summaries, and hospital billing codes

Explanation

The Nursing Minimum Data Set specifies nursing care elements, including nursing diagnosis, nursing intervention, nursing outcome, and intensity of nursing care, along with patient demographic and service elements. It was created to standardize nursing data for comparison across settings and populations.

Question 18Foundations of Nursing Informatics

A patient photographs a skin lesion, submits it with a history form, and a dermatologist reviews both later that day. Which telehealth modality does this represent?

  1. Store-and-forward (asynchronous) telehealth Correct answer.
  2. Remote physiologic monitoring
  3. Telephonic triage
  4. Real-time video consultation

Explanation

Store-and-forward telehealth transmits recorded clinical information, such as images and histories, for later review by a clinician rather than in real time. Live video and telephonic triage occur synchronously, and remote monitoring captures ongoing device data.

Question 19Foundations of Nursing Informatics

Which EHR capability best supports detection of unauthorized access to a patient's record?

  1. An audit trail that logs each user's access with a date and time stamp Correct answer.
  2. Single sign-on across all clinical applications
  3. Automatic spell-checking of narrative nursing notes
  4. Nightly backup of the database to an off-site location

Explanation

An audit trail records who accessed which record and when, which is the mechanism used to identify inappropriate viewing and support breach investigations. Backups protect availability, and single sign-on affects authentication convenience rather than access monitoring.

Question 20Foundations of Nursing Informatics

Before a major EHR upgrade, an informatics nurse maps every step of medication administration from order entry through documentation. This activity is best described as which of the following?

  1. Root cause analysis
  2. Benefits realization
  3. Workflow analysis Correct answer.
  4. Cost-benefit analysis

Explanation

Workflow analysis documents the sequence of tasks, decision points, and handoffs in a process so that technology changes align with actual practice. Root cause analysis investigates a specific adverse event, and the financial analyses compare costs with outcomes.

Question 21Foundations of Nursing Informatics

An organization wants clinical decision support logic that can be shared across institutions and encodes rules as Medical Logic Modules. Which formalism is designed for this purpose?

  1. LOINC
  2. Arden Syntax Correct answer.
  3. DICOM
  4. ANSI X12

Explanation

Arden Syntax is a standard representation for clinical knowledge that packages rules as Medical Logic Modules with maintenance, eligibility, and action categories, supporting portability between systems. DICOM addresses imaging, LOINC identifies observations, and X12 governs administrative transactions.

Question 22Foundations of Nursing Informatics

Two systems exchange a laboratory result, and both display the same test with identical clinical meaning. Which level of interoperability does this demonstrate?

  1. Process interoperability
  2. Foundational (technical) interoperability
  3. Semantic interoperability Correct answer.
  4. Structural (syntactic) interoperability

Explanation

Semantic interoperability exists when the receiving system interprets the exchanged data with the same meaning as the sender, typically through shared standardized terminologies and models. Technical interoperability secures the connection, and syntactic interoperability structures the message format without guaranteeing shared meaning.

Question 23Foundations of Nursing Informatics

A hospital deploys a model that estimates each inpatient's probability of unplanned readmission within 30 days so that transitional care resources can be targeted. This application is best classified as which of the following?

  1. Descriptive analytics
  2. Data warehousing
  3. Predictive analytics Correct answer.
  4. Clinical documentation improvement

Explanation

Predictive analytics uses historical data and statistical or machine learning models to estimate the likelihood of a future event such as readmission. Descriptive analytics summarizes what has already occurred, while warehousing and documentation improvement support data storage and record quality rather than risk estimation.

Question 24Foundations of Nursing Informatics

A research team plans to release a dataset under the HIPAA Safe Harbor method. Which action is required to meet that standard?

  1. Removing the 18 specified identifiers, such as dates and small geographies Correct answer.
  2. Limiting dataset access to researchers within the same institution
  3. Encrypting the dataset and keeping the decryption key with the research team
  4. Obtaining written permission from the hospital privacy officer

Explanation

The Safe Harbor method requires removal of the 18 categories of identifiers, including names, dates more specific than year, and geographic subdivisions smaller than a state. Encryption alone leaves the data identifiable to anyone holding the key, and internal access limits do not constitute de-identification.

Question 25Foundations of Nursing Informatics

A sepsis alert performs well in the overall population but triggers less often for one patient group with similar presenting signs. The informatics nurse should interpret this as which of the following?

  1. Alert fatigue affecting the entire user population
  2. Algorithmic bias warranting review of the model's training data and validation Correct answer.
  3. Expected variation that requires no further action
  4. A data entry error requiring correction of individual records

Explanation

Differential performance across patient groups suggests the model was trained or validated on data that do not represent the affected group, a form of algorithmic bias. Responsible practice includes auditing model performance by subgroup and examining training data before continued deployment.

Question 26Foundations of Nursing Informatics

Which statement best describes nursing informatics as a specialty?

  1. The delivery of patient education through printed handouts and scheduled classes
  2. The administrative process for assigning billing codes to nursing services across a hospital
  3. The repair and maintenance of hardware, software, and networks used in clinical areas
  4. Integration of nursing science with information science to manage nursing data Correct answer.

Explanation

Nursing informatics is the specialty that integrates nursing science with information and computer science to manage data, information, knowledge, and wisdom in nursing practice. Hardware repair, billing coding, and printed patient education are narrower tasks or applications, not the defining scope.

Question 27Foundations of Nursing Informatics

In the data-information-knowledge-wisdom hierarchy, which level is represented when vital signs are organized and interpreted in a patient's clinical context?

  1. Data that remain uninterpreted
  2. Wisdom that applies judgment to a situation
  3. Knowledge that synthesizes relationships and rules
  4. Information that organizes data in context Correct answer.

Explanation

Information is data that have been organized and interpreted in context. Knowledge reflects broader relationships and rules, while wisdom applies knowledge with judgment; raw data are uninterpreted.

Question 28Foundations of Nursing Informatics

A nurse enters a patient's temperature as 989°F. Which data-quality characteristic is most directly compromised?

  1. Accuracy Correct answer.
  2. Consistency
  3. Completeness
  4. Timeliness

Explanation

Accuracy means recorded values reflect the true clinical state; a temperature of 989°F is implausible and therefore inaccurate. Completeness concerns missing values, timeliness concerns delays, and consistency concerns agreement across sources.

Question 29Foundations of Nursing Informatics

Which action most directly uses barcode technology to prevent a wrong-patient medication error?

  1. Asking the patient to state the medication name after the dose has already been given
  2. Reviewing the formulary entry for the drug after the dose has already been administered
  3. Checking the medication administration record only at the end of the nursing shift
  4. Scanning the patient's wristband and medication label before administration Correct answer.

Explanation

Barcode medication administration verifies the patient and medication at the point of care, which directly prevents wrong-patient and wrong-drug errors. Retrospective record checks or post-administration actions do not interrupt the error before it reaches the patient.

Question 30Foundations of Nursing Informatics

A hospital schedules an EHR downtime for a major upgrade. Which preparation is most important for nursing documentation?

  1. Telling nurses to document from memory after the system returns to service
  2. Posting screenshots of the new EHR in the staff break room for reference
  3. Having paper downtime forms and a defined process for back-entering data Correct answer.
  4. Suspending all patient assessments until the system has been fully restored

Explanation

Downtime planning requires a reliable paper or alternate documentation method and a controlled process for entering the data into the EHR afterward so the legal record remains complete. Memory-based documentation and suspended assessments create safety and compliance risks.

Question 31Foundations of Nursing Informatics

Which patient-portal feature most directly supports patient engagement in care?

  1. Letting patients edit the clinician's progress notes and change medication orders
  2. Giving patients access to other patients' appointment schedules and progress notes
  3. Permitting patients to change medication orders without any clinician review or approval
  4. Allowing patients to view selected results and send secure messages to the care team Correct answer.

Explanation

Patient portals support engagement by giving patients access to their own information and a secure channel to the care team. Access to other patients' data, editing clinician notes, or changing orders without review would violate privacy and safety.

Question 32Foundations of Nursing Informatics

A nurse provides a real-time video visit to a patient at home. Which term best describes this care modality?

  1. Clinical decision support
  2. Telehealth Correct answer.
  3. Health information exchange
  4. Computerized provider order entry

Explanation

Telehealth includes real-time video visits and other remote care modalities. HIE, CPOE, and CDS are information-system functions, not direct care modalities.

Question 33Foundations of Nursing Informatics

Which behavior best demonstrates information literacy in nursing practice?

  1. Memorizing every menu and screen in the electronic health record
  2. Choosing the first search result without reviewing its source or publication date
  3. Evaluating an online source's credibility before applying it to care Correct answer.
  4. Sharing login credentials with colleagues to speed up documentation during busy shifts

Explanation

Information literacy involves finding, evaluating, and applying information appropriately; credibility and relevance are central. Memorizing screens or sharing credentials reflects computer use or unsafe practice, not information literacy.

Question 34Foundations of Nursing Informatics

Which terminology was developed by the International Council of Nurses to provide a unified nursing language for use across countries?

  1. NANDA-I
  2. NOC
  3. ICNP Correct answer.
  4. NIC

Explanation

The International Council of Nurses developed ICNP as a unified nursing terminology. NANDA-I focuses on diagnoses, NIC on interventions, and NOC on outcomes.

Question 35Foundations of Nursing Informatics

A care plan includes "Fall Prevention" as an intervention and "Fall Occurrence" as a measured outcome. Which terminology pair matches these components?

  1. NOC and NANDA-I
  2. ICNP and NANDA-I
  3. NIC and NOC Correct answer.
  4. NANDA-I and NIC

Explanation

NIC standardizes nursing interventions, and NOC standardizes nursing-sensitive outcomes. NANDA-I covers diagnoses and ICNP is a broader nursing terminology.

Question 36Foundations of Nursing Informatics

Which resource provides a metathesaurus that links concepts across multiple clinical terminologies and coding systems?

  1. HL7 v2
  2. RxNorm
  3. DICOM
  4. UMLS Correct answer.

Explanation

The UMLS Metathesaurus maps concepts across many terminologies and code systems. DICOM handles images, HL7 v2 handles messages, and RxNorm handles drugs.

Question 37Foundations of Nursing Informatics

An EHR must exchange medication lists using a standard that represents clinical drugs by ingredients, strength, and dose form. Which standard is designed for this purpose?

  1. ICD-10-PCS
  2. RxNorm Correct answer.
  3. LOINC
  4. CPT

Explanation

RxNorm is designed to represent clinical drugs by ingredient, strength, and dose form for exchange and decision support. ICD-10-PCS and CPT are procedure codes, and LOINC identifies tests and observations.

Question 38Foundations of Nursing Informatics

Which messaging standard is commonly used to send admission, discharge, and transfer messages between hospital systems?

  1. DICOM image files
  2. HL7 v2 messages Correct answer.
  3. CDA clinical documents
  4. X12 claim transactions

Explanation

HL7 version 2 is widely used for ADT and other transactional messages between hospital systems. DICOM handles images, X12 handles claims, and CDA handles clinical documents.

Question 39Foundations of Nursing Informatics

Which standard governs the storage and transmission of radiology images so that they can be viewed across systems?

  1. RxNorm
  2. UMLS
  3. HL7 v2
  4. DICOM Correct answer.

Explanation

DICOM is the standard for storing and transmitting medical images and associated metadata. HL7 v2 messages, RxNorm drug concepts, and UMLS concept mapping serve other purposes.

Question 40Foundations of Nursing Informatics

Which system is designed to consolidate data from multiple operational systems for reporting and analysis?

  1. Computerized provider order entry
  2. Clinical data warehouse Correct answer.
  3. Interface engine
  4. Master patient index

Explanation

A clinical data warehouse integrates data from operational systems for reporting and analysis. An MPI identifies patients, an interface engine routes messages, and CPOE captures orders.

Question 41Foundations of Nursing Informatics

Which activity is a core function of data governance in a health system?

  1. Assigning accountability for data quality, access, and appropriate use Correct answer.
  2. Repairing broken computers and printers in clinical units throughout the hospital
  3. Selecting the hospital's uniform vendor and managing the supply inventory
  4. Writing all nursing progress notes and care plans on behalf of clinicians

Explanation

Data governance establishes accountability, policies, and standards for data quality, access, and use. Hardware repair, clinical documentation, and vendor selection are operational or procurement tasks.

Question 42Foundations of Nursing Informatics

Which function allows a patient's records to be shared among unaffiliated providers in a region?

  1. Computerized provider order entry
  2. Health information exchange Correct answer.
  3. Clinical decision support
  4. Barcode medication administration

Explanation

A health information exchange supports sharing patient information among unaffiliated organizations. Barcode administration, CPOE, and CDS are point-of-care or decision-support functions.

Question 43Foundations of Nursing Informatics

A new sepsis alert requires nurses to complete five separate clicks during an emergency. Which human-factors principle is most directly violated?

  1. Increasing the number of alert types displayed on the screen during an emergency
  2. Minimizing cognitive workload and streamlining workflow Correct answer.
  3. Adding more mandatory data fields to the alert screen before it can be dismissed
  4. Requiring users to memorize more passwords and complete extra security training

Explanation

Human-factors design seeks to reduce unnecessary cognitive load and fit the workflow, especially in emergencies. Adding alerts, passwords, or fields increases burden and error risk.

Question 44Foundations of Nursing Informatics

Which strategy best supports nurse adoption before an EHR go-live?

  1. Training only the information technology staff and not the clinical nurses
  2. Recruiting unit-based superusers and providing role-specific training Correct answer.
  3. Limiting communication about the change to a single email sent on go-live day
  4. Waiting until after go-live to identify and address workflow problems

Explanation

Change management uses communication, role-based training, and peer superusers to build competence and ownership before go-live. Late or limited communication and delaying problem identification undermine adoption.

Question 45Foundations of Nursing Informatics

Which system is used to identify and manage duplicate patient records across registration systems?

  1. Master patient index Correct answer.
  2. Interface engine software
  3. Patient portal application
  4. Enterprise data warehouse

Explanation

The master patient index matches and manages patient identities across systems, helping detect duplicates. A data warehouse stores data for analysis, an interface engine moves messages, and a portal is a patient-facing application.

Question 46Foundations of Nursing Informatics

Which approach separates clinical content models from technical implementation by using reusable archetypes?

  1. openEHR Correct answer.
  2. HL7 v2 messaging
  3. X12 claims
  4. DICOM imaging

Explanation

openEHR uses reusable clinical archetypes and templates to separate clinical content from technical implementation. DICOM, X12, and HL7 v2 address imaging, claims, and messaging respectively.

Question 47Foundations of Nursing Informatics

Which language is used to express quality-measure logic in a computable, shareable form for electronic clinical quality measures?

  1. SQL database query
  2. DICOM image standard
  3. CQL Correct answer.
  4. X12 claim format

Explanation

Clinical Quality Language (CQL) expresses quality-measure logic in a computable, shareable form for eCQMs. SQL queries databases, DICOM handles images, and X12 carries claims.

Question 48Foundations of Nursing Informatics

Which method can extract fall-risk concepts from unstructured nursing notes for a quality dashboard?

  1. Bar-code medication administration
  2. Barcode scanning
  3. Radio-frequency identification
  4. Natural language processing Correct answer.

Explanation

Natural language processing analyzes unstructured free text, such as nursing notes, to identify concepts like fall risk. Barcode scanning, RFID, and BCMA capture identifiers or medication events, not narrative meaning.

Question 49Foundations of Nursing Informatics

A dashboard shows different values for the same measure from two source systems. Which data attribute best helps trace the origin and transformations of each value?

  1. Data timeliness
  2. Data completeness
  3. Data provenance Correct answer.
  4. Data granularity

Explanation

Data provenance, or lineage, documents the source, ownership, and transformations of a data value, which supports reconciliation. Completeness, timeliness, and granularity describe other quality attributes.

Question 50Foundations of Nursing Informatics

An analyst wants to release a limited dataset that includes dates and ZIP codes. Which HIPAA pathway may permit release if a qualified expert determines that re-identification risk is very small?

  1. Minimum necessary standard
  2. Expert determination Correct answer.
  3. Safe Harbor de-identification
  4. Accounting of disclosures

Explanation

HIPAA expert determination permits use or disclosure of de-identified data when a qualified expert determines that re-identification risk is very small. Safe Harbor removes specified identifiers, minimum necessary limits uses, and accounting tracks disclosures.