Health Informatics Assignment Week 10 to 12

Week 10 Questions

1. What is meant by the standard view of appropriate use of medical information systems? Identify three key criteria for determining whether a particular use or user is appropriate.
2. Can quality standards for system developers and maintainers simultaneously safe-guard against error and abuse and stimulate scientific progress? Explain your answers. Why is there an ethical obligation to adhere to a standard of care?
   

   Answer:

   Quality standards would promote technological progress and creativity while protecting against errors including abuse of the method. Those kind of seems almost inconsistent with all these objectives and they're not. But let hypothesize a requirement that necessitates timeously revising and evaluating of the frames of understanding that decision-support technologies utilize. Consequently, the IMIA Code of Ethics for Health Informatics Professionals serves multiple purposes: aim of providing guidelines for behavior to the practitioners society in general, and provide a set of guidelines that can be assessed against both the behavior of the specialists, and also provide a strong indication of the professional principles to the general populace. In the degree that perhaps the consistency of the repository is required to maximize the consistency for observational machines, it is computationally obvious why such a requirement would hopefully prevent failures through favor of the determination. In addition, the requirement could be seen as promoting development and creativity in almost the same manner as any emphasis on the best quality possibly helps in preventing researchers and patients against following potential positives. That alone won't have to rely that database maintenance personnel do more constructive or empirically pixel intensities of strengthening, assume, the interpretation of understanding or the specification of databases. Since these activities are essential, the current format or layout does not subsume the tasks of upgrading and reviewing devices. In other words, technological and scientific requirements are outstanding. This approach can be described as cautionary socialist. Gladly, health information technology will be here to remain, however consumers and community have significant obligations to maintain one uses our resources properly. This could trigger everyone to travel more enthusiastically or gradually than most of us would prefer which also, in terms of social responsibility, is almost terrible. Ethical standards understand the state of care provision during each treatment session. Medical guidelines are primarily intended to guide and encourage proper and medically qualified nursing practices. Such principles are necessary to their practice, since they encourage our medical care and direct it. Medical ethics includes analyzing a particular problem, typically a medical event, or using principles, reason and facts to determine what might be the correct Assignment of action. Certain ethical concerns, including such deciding difference between right and wrong, are relatively simple. But many others may be much more mystifying, like distinguishing between different privileges, two principles which clash with one another or determining among two dissimilar value systems. The aim of morality in medicine is to consider, evaluate and discern correct or incorrect attitudes and behaviors. The distinction between morality and ethics is essential: morality is about right or wrong, whilst morality are about particular thoughts and behavior. Critical thinking could be used in action to guide morality however a larger body usually decides on moral decisions.

3. Identify (a) two major threats to patient confidentiality, and (b) policies or strategies that you propose for protecting confidentiality against these threats.
4. Many prognoses by humans are subjective and are based on faulty memory or incomplete knowledge of previous cases. What are the two drawbacks to using objective prognostic scoring systems to determine whether to allocate care to individual patients?
5. People who are educated about their illnesses tend to understand and to follow instructions, to ask insightful questions, and so on. How can the World Wide Web improve patient education? How, on the other hand, might Web access hurt traditional physician–patient and nurse–patient relationships?

Week 11 Questions

1. Choose any alternative area of biomedicine (e.g., drug trials) as a point of comparison, and list at least four factors that make studies in medical informatics more difficult to conduct successfully than in that area. Given these difficulties, discuss whether it is worthwhile to conduct empirical studies in medical informatics or whether we should use intuition or the marketplace as the primary indicators of the value of an information resource.
   

   Answer:

   In medical informatics, developers investigate the catalogue, processing, and communication of medical information, as well as typically establish computer components or software knowledge information to ensure such operations. Such information services comprise system for monitoring, storing and retrieving patient-specific data ( e.g., clinical workstations including databases) or mechanisms besides gathering, storing and retrieving content as well as reason for medical knowledge (e.g. clinical knowledge-acquisition techniques, information systems, decision - making support systems, and smart mentoring mechanisms); Therefore there is a broad range of tools for analyzing medical expertise. Even farther exacerbating the scenario, there are several various factors to determine within each knowledge resource. Analysis techniques in medical informatics should therefore recognize a broad variety of issues, from either the analytical characteristics of individual structures to the negative impacts of frameworks on individuals and organizations. One of the key practices of medical informatics is the creation of databases for medical knowledge utilizing computer-based software. Get a greater understanding of the association among structure, function or even implications. Of certain therapeutic decision making and behavior digital information, especially cautious assessment is required. The information gained from these researches would then help to establish the fundamentals of the restraint of medical informatics. In medical informatics, rendering this statement is equivalent to saying that even a commodity value reserve currency could always be found, and all reasonable entities.

   Promotional: If you want to promote and use of knowledge services in healthcare, users have to be able to persuade doctors that such technologies are secure and also that their support both patients and hospitals by enhancing cost efficiency.

   Scholarly: Clinical development is among the main responsibilities in medical informatics utilizing computerized techniques, the information resources.

   Pragmatic: development teams would never understand, without analyzing their frameworks, which technologies or methodologies are much more efficient or why some strategies have failed.

   Ethical: diagnostic practitioners are obliged to start practicing during an ethical context. For instance, healthcare professionals should therefore make sure that this is safe, by using an information database.

   Medicolegal: To minimize the risk of prosecution, information system managers must collect reliable information so they can ensure consumers that perhaps the system is safe and reliable. Participants require outcome measures to allow them to practice their professional judgment when using structures to recognize such clients as intermediaries taught by the legislation.

   A database of knowledge that views users essentially as automatons, despite enabling them to practice their abilities and discretion, risks are determined by stringent patent infringement rules, rather than by the extra gentle popular approaches to highly qualified service delivery. Some or all of these aspects constitute the ambition for each research. Knowledge of the primary reason for carrying out an assessment will also help researchers resolve the issues that need to be answered.

2. Assume that you run a philanthropic organization that supports medical informatics.In investing the scarce resources of your organization, you have to choose between funding a new system or resource development, or funding empirical studies of resources already developed. What would you choose? How would you justify your decision?
   

   Answer:

   I would prefer introduction of newer systems in the system or resource development. Funding for the newer systems would help in the establishment of new technologies and newer innovations that could then readily be supported and subsequently benefits would then be taken from such technologies. These innovations could progress the work being done in the system and it would accordingly lead to the opening of newer opportunities especially in case of hiring for the newer staff and professionals to operate the new system. Installing newer system would help in taking up the benefits of the old system as well. It could preferentially be considered as opting the new while keeping the already existing one would let one to have benefits to the best of both worlds. The introduction of newer innovations would definitely help in bringing onto accepting such changes and gaining new knowledge would also help in framing out the better options which could be used instead of employing the older ones. This might provide benefit of finding better cures to the problems that have not yet been recovered.

3. To what extent is it possible to be certain how effective a medical informatics resource really is? What are the most important criteria of effectiveness?
4. Do you believe that independent, unbiased observers of the same behavior or outcome should agree on the quality of that outcome?
5. Many of the evaluation approaches assert that a single unbiased observer is a legitimate source of information in an evaluation, even if that observer’s data or judgments are unsubstantiated by other people. Give examples drawn from our society where we vest important decisions in a single experienced and presumed impartial individual.
6. Do you agree with the statement that all evaluations appear equivocal when subjected to serious scrutiny? Explain your answer.
7. Associate each of the following hypothetical studies with a particular approach to evaluation:
   1. A comparison of different user interfaces for a computer-based medical record system, conducted while the system is under development.
   2. A site visit by the U.S. National Library of Medicine’s Biomedical Library Review Committee to the submitters of a competing renewal of a research grant.
   3. A noted consultant on user interface design being invited to spend a day at an academic department to offer suggestions regarding the prototype of a new system.
   4. Patient chart reviews conducted before and after the introduction of an information resource, without the reviewer being told anything about the nature of the information resource or even that the intervention is the information resource.
   5. Videotapes of attending rounds on a service where a knowledge resource has been implemented and periodic interviews with members of the ward team.
   6. Determination of whether a new version of a resource executes a standard set of performance tests at the speed the designers projected.
   7. Patients being randomly assigned such that their medical records are maintained either by a new computer system or by standard procedures, and then an investigator seeking to determine whether the new system affects clinical protocol recruitment and compliance.
   8. A mock debate at a research-group retreat.
8. For each of the following hypothetical evaluation scenarios, list which of the nine types of studies in Table 11.2 they include. Some scenarios may include more than one type of study.
   1. An order-communication system is implemented in a small hospital. Changes in laboratory workload are assessed.
   2. A study team performs a thorough analysis of the information required by psy-chiatrists to whom patients are referred by community social workers.
   3. A medical-informatics expert is asked for opinion about a doctoral student’s proj-ect. The expert requests copies of the student’s programming code and documentation for review.
   4. A new intensive care unit system is implemented alongside manual paper chartingfor one month. Then, the qualities of the computer-based data and of the data recorded on the paper charts are compared. A panel of intensive care physicians is asked to identify episodes of hypotension from each dataset, independently.
   5. A medical-informatics professor is invited to join the steering group for a clinical-workstation project in a local hospital. The only documentation available for the professor to critique at the first meeting is a statement of the project goals, a description of the planned development method, and the advertisements and job descriptions for team members.
   6. Developers invite clinicians to test a prototype of a computer-aided learning sys-tem as part of a workshop on user-centered design.
   7. A program is built that generates a predicted 24-hour blood glucose profile usingseven clinical parameters. Another program uses this profile and other patient data to advise on insulin dosages. Diabetologists are asked to prescribe insulin for the patient given the 24-hour profile alone and then again after seeing the computergenerated advice. They are also asked their opinion of the advice.
   8. A program to generate drug-interaction alerts is installed in a geriatric clinic thatalready has a computer-based medical record system. Rates of clinically significant drug interactions are compared before and after installation of the alerting resource.

Answer:

1. Field User effect
2. Needs assessment
3. Structure validation
4. Field function
5. Needs assessment and design validation
6. Laboratory function
7. Laboratory user effect and laboratory function
8. Problem impact

Week 12 Questions

1. What is the definition of an EHR? Define an EHR system. What are five advantagesof a EHR over a paper-based record? What are three limitations of an EHR?
2. What are the five functional components of an EHR? Think of the informationsystems used in health care institutions in which you work or that you have seen. Which of the components that you named do those systems have? Which are missing? How do the missing elements limit the value to the clinicians or patients?
   

   Answer:

   The five components of the HER system are:

   • Integrated view of patient data
   • Clinical decision support
   • Clinician order entry
   • Access to knowledge resources
   • Integrated communication and reporting

   The institution in which I am working lacks:

   • Integrated view of patient data along with integrated communication and reporting.

   These both holds immense value as:

   Integrated view of patient data- However this assignment seems almost pretty straightforward, procurement and institution of these information are significant challenges because of richness and importance of the information ranging from small percentages to graphs to images to motion images and the huge proportion and managerially utilized publications of patient information including such clinical laboratories, diagnostic departments, free-standing magnetic resonance imaging MRI centers, community pharmacies and home health agencies. Currently several medical datasets will deliver the clinical content as health level 7 (HL7) messages, and yet sender and recipient differ significantly from the norm while using code requirements as identification for clinical findings and instructions in such messages. So, several other limited fraction of message reconfiguring and a substantial quantity of code mapping is typically needed.

   Integrated communication and reporting:

   As the care component will become extremely allocated between many interdisciplinary healthcare providers, the productivity and efficiency of communication between the team members influence the general cooperation and promptness of the services given. Most of the texts are patient-specific. Communication techniques should then be embedded into the EHR system and ensure that notifications are affixed to a patient's record digitally, i.e. the patient's documentation should be accessible by clicking a button. The geographic segregation of team members creates the potential for networked communication which enters all sites in which patient care providers make these decisions. Accessibility to the household of the patient would be an effective tool for tracking and encouraging daily contact.

3. Discuss three ways in which a computer system could facilitate information transferbetween hospitals and ambulatory care facilities, thus enhancing continuity of care for previously hospitalized patients who have been discharged and are now being followed up by their primary physicians.
4. How does the health care financing environment affect the use, costs, and benefits ofan EHR system? How has the financing environment affected the functionality of information systems? How has it affected the user population?
5. Would a computer scan of a paper-based record be an EHR? What are two advantages and two limitations of this approach?
   

   Answer:

   The monitoring and eradication with paper-based medical records seems to be possible, but the scanned data acquisition system should really be deemed as an intermediate stage towards completely electronic medical records. When a paper record is converted, personnel should only use the paper version as a reference. Practices will clearly record those standards and convey them to workers. Unlike a standard medical record which flexibility is bound to a single copy of the data stored in a central platform for data processing and recovery, an EHR is versatile and adaptable because of the relative unimportance of document. Data might well be managed to enter in a template that vastly simplifies of input and displays it in various formats appropriate for explanation. In addition, the EHR will incorporate visual details such as diagnostic photos and echocardiographic video clips which have never been part of conventional medical records. Data could be used to direct treatment for a particular hospital, or in unstructured format, to assist managers in designing legislative measures. A common downside to paper documents is lack of availability. In big enterprises, while the clinician completes documentation of an interaction, the conventional record might become inaccessible to anyone for days. During this time the record must be found and retrieved with specific approval and additional work. Independent physicians also lend records with same result, for their comfort. For computer-stored documentation all approved workers can quickly access patient information whenever the need emerges. The EHRs can also be controlled remotely. Information reusability becomes the way an EHR improves the productivity of companies. Documents promoting patient health, quality control, and legislative or certification standards can also reuse information entered as part of the clinical care phase.

   Advantages of this approach: Encoded knowledge, nevertheless, isn't really structured, and fragmented usage of medical jargon restricts the opportunity to discover through data, however as everyone who has would use a web search tool recognizes, clever need for descriptors and statistics increases the know. The use of such a standardized, predetermined terminology enables computer-supported decision taking as well as medical trials, although at the expense of predetermined level to the professional who's still encoding these data.

   However, limitations to this encompass: This needs a higher initial expenditure than its paper equivalent attributable to equipment, software, training, and support expenses. The individual and material considerations also control the technical problems. Health professionals and other main staff might just have to take a lot of time off their jobs to understand how to use another program and to change their working environment using the process efficiently.

6. Among the key issues for designing an EHR system are what information should becaptured and how it should be entered into the system.
   1. Physicians may enter data directly or may record data on a paper worksheet(encounter form) for later transcription by a data-entry worker. What are two advantages and two disadvantages of each method?
   2. Discuss the relative advantages and disadvantages of entry of free text instead ofentry of fully coded information. Describe an intermediate or compromise method.
7. Identify four locations where clinicians need access to the information contained inan EHR. What are the major costs or risks of providing access from each of these locations?
8. What are three important reasons to have physicians enter orders directly into anEHR system? What are three challenges in implementing such a system?
   

   Answer:

   Doctors as well as other key staff would need to take some time out of their jobs to understand when to use the program and to change their processes to allow better use of the system. Another danger related to computer-based systems is the possibility for both subtle and catastrophic errors. If the computer system breaks down, data processed might not have been available for even an unspecified amount of time. Through their history, physical evaluation, and performance reviews, doctors document vast volumes of medical skills. Capturing this information from either the doctor is a serious medical information system aim, as it offers the most timely, reliable, and valuable material. The time cost of physician consultation could be significant, and in some situations, the feedback from the practitioner might well be unfeasible. While this takes information to improve how and when to use program and adjust workflows, there is increasing awareness that improving the care process requires an EHR program, and also the business and regulatory side of healthcare services. Scanning and maintaining progress notes in an EHR fixes the paper chart's accessing various, and the approach can indeed be extended to any file. Yes, several hospitals are now scanning for quick retrieval into the entire paper chart at discharged. Furthermore, there is no alternative to discover or analyze the contents of a scanned document without the need for a phase of abstract concept.

9. Consider the task of creating a summary report for clinical data collected over timeand stored in an EHR system. Clinical laboratories traditionally provide summary test results in flowsheet format, thus highlighting clinically important changes over time. A medical record system that contains information for patients who have chronic diseases must present serial clinical observations, history information, and medications, as well as laboratory test results. Suggest a suitable format for presenting the information collected during a series of ambulatory-care patient visits.
10. The public demands that the confidentiality of patient data must be maintained inany patient record system. Describe three protections and auditing methods that can be applied to paper-based systems. Describe three technical and three nontechnical measures you would like to see applied to ensure the confidentiality of patient data in an EHR. How do the risks of privacy breaches differ for the two systems?