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?
3. Identify (a) two major threats to patient confidentiality, and (b) policies or strategies that you propose for protecting confidentiality against these threats.
   

   Answer:

   1. This would include exploitation of workers or prejudice among third-party payers, employers and those who take full advantage of the expanding healthcare information industry; insider exploitation or electronic surveillance information by hospital or clinical staff who are also not actually interested in a patient's condition but then again who investigate a document from the concern of getting blackmail, and so forth; and malignant hackers or individuals who, through networks and perhaps other methods, copy, delete or alter the information.
   2. The appropriate solution to these problems is something that will assure that adequate practitioners and others have fast, easy access to medical information, but that other individuals have really no connection to them. In particular, individuals are categorized into physical and organizational or political methodologies:
   3. Technical methods: computer systems could provide the mechanism to maximize their own safety, which include biometric authentication, by ensuring that subscribers really are what they assume they are; by restricting individuals without the need for a specialist need on encrypting medical information; and then using audit trails or log files of individuals inspecting private information such that clinicians and others can evaluate the log files.
   4. Policy considerations: The National Research Council strongly suggested that hospitals as well as other health-care organizations set up privacy and security committee meetings and set up training and development programs. Such guidelines align with a strategy that has performed well during healthcare elsewhere because of issues stemming from preventing infection through bioethics.
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?
   

   Answer:

   The Internet has been widely used to provide healthcare. The creation of electronic medical records and clinical and administrative communication has the ability to increase the performance and quality of healthcare services. One of the Internet's principal uses is with an encyclopedic tool for knowledge. Polls indicate regularly that 60 to 80 per cent of the world's web users used it to access information related to health. The media have the potential to empower and incentivize the health consumer by supplying health and health systems composed as well as promoting self-help and questionnaire is conducted. Except if he or she can connect and then use additional data could the 'expert patient' become such a professional as well as the online world could indeed promote the growing interest of consumers in one’s health coverage. Two-thirds of those who use the online to seek knowledge about health say this has some effect on their treatment decisions. Individuals consider the amount of knowledge, simplicity and confidentiality. In the phenomena of virtual communities, the innovation in collaboration and sharing of information amongst entities is quite apparent. One instance in the healthcare industry is assistance for HIV-positive individuals. Common obstacles to entry include peer-to - peer networking in digital environments; and anonymity online may be beneficial to those with marginalizing or humiliating circumstances. The digital networks global opportunities empower learners with serious conditions to seek peer feedback and assist all participants to rely on a broad range of health insights and experiences. Treatments in health development were effectively applied electronically, and early reviews of psychosocial therapies are accessible via the internet. Areas of expertise use telemedicine including remote health monitoring as well as asynchronous contact will now exploit the Internet's improved opportunities for, for instance, interactive outreach interventions in such fields so that no much failing to have proper access could be achieved. Therefore, the Internet seems to have the ability to enhance healthcare delivery effectively and efficiently, motivate and inform patients, support decision-making, facilitate engagement amongst patients and practitioners, encourage vocational training and revalidation, and reduce morbidity and mortality.

   But attention is required about existing and growing health dangers posed by that of the network. Independent review of this emerging technology's beneficial and detrimental implications will proceed. Through use of social media by patients has been reported to stimulate the clinical and operational partnership in health insurance, contributing to more equal information exchange between patients and health professional, enhanced physician switching, maintain a positive relationship, and optimum patient-healthcare communication. The social media can be defined as pain management. This engenders their independence, for instance, by supplementing the knowledge received by health care providers by offering psychosocial help. Through use of social media among patients could also benefit health care providers by offering a platform to boost the position of the company and to promote dialogue which enhance brand awareness while delivering improved care. This can also pose a threat both for patients and health practitioners only within health service. Because anyone with access to media could express suggestions about how to cope for a certain health issue, it is essential to building effective sources of internet interaction to avoid an exacerbation of health issues. So, numerous health care professionals seem to be afraid that patients use digital platforms are more aware and believable to the misleading information published on such sites.

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.
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?
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.
   

   Answer:

   Whilst concentrating mostly on the discrepancies seems simple, such two large groups of assessment groups share several features. Proof is retrieved with considerable caution in certain scientific research, for example; the authors are often conscious of what researchers are doing and why. Then, the proof is collected, analyzed, and eventually recorded. Investigators maintain records of certain activities and all these documents are subject to scrutiny by the researchers concerned and outside the research team by entities. The member of the principal investigators or assessment team is now under perhaps spiritual professional duty to disclose their procedures. Failure to do so will ruin a report. All methodology groups often share a reliance on hypotheses that direct researchers to describe the social phenomena, and also a reliance on applicable empirical studies like studies conducted that discuss similar trend or similar facilities. There have been standards of professional exercise for both methods that have been generally recognized; hence it is necessary to divide between a great reference and a poor one. Within a republic, it is absolutely crucial that particular strategy and the judicial system overall be unbiased and autonomous among all external pressures including of one another, so those who come in front of them and the general public can trust how the cases shall be decided in a much fair as well as accordant manner within the judicial premises. An individual's honesty and impartiality were indeed significant considerations for a president in choosing a court candidate. Some administrations would certainly be aware of the actual presumption, which dates back to Alexander Hamilton's remarks in the Federalist Papers, that a defendant is a person of integrity who can investigate crimes and disputes impartially, unlike persons without personal prejudice. In the private sectors also, there are times when the knowns are favored and the chances to the fresher ones are not given. The familial links are much valued and this however, utmost times masks the talent of the talented and deserving ones. Thus, the impartialness is quite widely practiced in many professions.

6. Do you agree with the statement that all evaluations appear equivocal when subjected to serious scrutiny? Explain your answer.
   

   Answer:

   When considering for the first time, the strategies to assessment that emerge from such a subjectivistic philosophical viewpoint might seem unusual, inaccurate and unsubstantiated. This interpretation derives primarily from the universal popularity of biomedicine of the objectivist worldview. That being said, the significance and utility of subjectivistic methods in appraisal is growing. There is significant support for these strategies in the medical informatics field. The first four evaluation themes comprise of objectivist position whereas the rest four come up with being as subjectivist. The evaluation themes encompass evaluations that are entirely based upon comparison, objectives, facilitation of the decisions, goal free, quasi-legal, art criticism, professional review, and responsive illuminative. As previously mentioned, there is methodological eclecticism in the assessment mentality. To perform completely insightful evaluation studies, it is necessary for practitioners skilled in classical analytical methods at minimum to understand, or probably perhaps accept, the subjectivist worldview. Though most real-world research studies can indeed be explicitly connected to each of these methods, the definitions are not necessarily synonymous. Some experiments enhance the properties of many methods and therefore are not categorized smoothly.

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.

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?
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.
   

   Answer:

   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. Interaction can also be "pushed" to the consumer via e-mail and/or pager facilities, or "pulled" by providers during their regular equipment encounters.

   An EHR system can also help with routine handoffs of patients, where care responsibility is transferred from one clinician to another. A relatively short orally or in writing interchange typically helps the concealing clinician identify the situation of the physician.

   eHealth apps may provide people with adequate exposure to their EHR and offer strong communications mechanisms to ask health questions or conduct such diagnostic procedures as a medication or administrative renewal, if a consultation is easily planned digitally.

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?
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.

   Answer:

   1. The phase of data entry is cumbersome due to the time needed for the staff. The data must be interpreted or translated by men, and inserted into the machine. The information can be converted in either a free-text form, in a coded form, or in a form incorporating editable domain and codes. There are trade-offs regarding coding use and statistical analysis. Immediate encoding by physicians provides codes that could be used by the EHR to direct the judgments of doctors. When methods of selection are carefully planned, coding of doctors can become more reliable than labeling of other staff. The big downside to coding is the human time needed for the source text to be converted into correct code. Also, there is the possibility for system failures which have been harder to identify, unlike inconsistencies in free-text entry, since adding functional lacks the inbuilt continuity of text. For example, a transposition error causing code 392 to 329 to be substituted may not have been detected because if the device shows the corresponding text as well as the data input technician discovers the inaccuracy.
   2. The phase of data processing is burdensome compared to limited time needed for the staff. The details must be interpreted or translated by men, and inserted into the machine. The information can be converted in a free-text format, in such a format file, or even in a pattern incorporating free text and codes. There are trade-offs among coding usage and statistical analysis. The information can be converted in either a free-text form, in a coded form, or in a form incorporating editable domain and codes. There are trade-offs regarding coding use and statistical analysis. Test compromise is a problem in cognitive ability assessment, as these assessments are commonly used during selection of employees but are continually conducted. It modeled and tested standard experiments on different test type quantities might be one, two, or four and different sizes like either 30 or 60 items. Longer tests, and much more sample aspects augmented test safety for conventional tests. Product selection criteria have had a strong impact on CAT's reaction to make concessions under certain environments. The findings of our studies have legal implications also for varieties of evaluation systems used during choosing workers to perform analyzing relevant.
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?
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.
   

   Answer:

   Data might well be submitted in a format whereby streamlines the input process that involves electronic interfaces to many other machines whereby patient data is processed and presented in various formats convenient for analysis. Many clinical datasets will present the professional knowledge currently as HL7 messages; however, senders deviate from the norm, and then use code requirements as clinical observative signatures orders in such messages. Clinicians need much more than interconnected access to medical data; individuals will need different views of such data so that suppliers can conveniently find the latest individual outcomes, in a flowsheet genre to illustrate adjustments all over numerous variables over time, and also in oriented opinions customized to specializations and configurations. Clinician statistics show active patient issues, effective medicines, allergic reactions to medicines, health-care reminders, as well as other pertinent quickly replaced. Such a perspective provides an actual overview of the patient context, which is generated automatically at each interaction; such a refresh is not feasible in a report on document. The need for enhanced protection features (e.g., Secure Socket Layer (SSL)) make sure that patient details distributed over the public Internet stay private. If doctors prescribe their documentation using traditional formats (e.g. current disease, prior history, clinical exams, and course of treatment), therefore the transcriptionist preserves the framework in the report annotated. Speech recognition software provides another very appealing 'dictating' method against processing costs or delays. When higher computing speeds accelerate the technology has improved. Failure to encrypt therefore limits the advantages and using an EHR. The concern with specific doctor admission via prototypes and transcription of their observations is the expense of doctor's resources. The second aspect of data-entry is to make practitioners choose a standard experience format through which their observations are translated and probably screened in which situation some of the contents can be digitally interpreted by an optical character reader (OCR) and/or mark-sense interpretation while others are retained as scanned text, as is performed at Regenstrief and Mayo.

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?