Health Informatics Assignment Week 4 to 6

Question Week 4

1. What are some of the assumptions of the distributed cognition framework? What implications does this approach have for the evaluation of electronic medical record systems?
2. Explain the difference between the effects of technology and the effects with technology. How can each of these effects contribute to improving patient safety and reducing medical errors?
3. Explain the significance of the representational effect. What considerations need tobe taken into account in developing representations for different populations of users and for different tasks?
   

   Answer:

   A fundamental concept of cognitive science would be that people consciously create and perceive knowledge from your surroundings. Because external feedback can assume several forms, the cognitive system needs to tweak associated forms of representation to grasp the meaning of these inputs. The representational effect is a well-documented phenomenon wherein various interpretations of a specific abstract form may have a major impact on thought and decision taking. For instance, for other tasks various forms of data visualization may be quite productive. A simple example is that, while the representations or symbols are isomorphic, Arabic numerals are much more effective for arithmetic (e.g. 37 u93) than Roman numerals (XXXVII u XCIII). Likewise, a digital clock offers an simple read-out to accurately calculate the time.

4. The use of electronic medical records (EMR) has been shown to differentially affectclinical reasoning relative to paper charts. Briefly characterize the effects they have on reasoning, including those that persist after the clinician ceases to use the system. Speculate about the potential impact of EMRs on patient care.
5. A large urban hospital is planning to implement a provider order entry system. Youhave been asked to advise them on system usability and to study the cognitive effects of the system on performance. Discuss the issues involved and suggests some of the steps you would take to study system usability.
6. What steps are involved in the process of translating internal representations (mental models) into natural and computer-representable languages and expressing them in a guideline format?
7. The development of expertise has been characterized as a “non-monotonic”process. Explain the nature of this development process using some of the findings in relation to a) diagnostic reasoning and b) memory for clinical information.

Question Week 5

Questions for Discussion

1. Why do computer systems use magnetic disks to store data and programs rather than keeping the latter in main memory where they could be accessed much more quickly?
   

   Answer:

   Computer systems including magnetic disks as well as tapes and optical disks that store data and programs on a long-term basis. Programs and data that have had to remain for extended periods of time are maintained onto storage systems, usually magnetic disks, which would provide peristent processing at lower cost per unit than storage. From these kinds of storage the necessary information is installed into working memory whenever it is required. The most common medium for effective processing is magnetic discs. A disk storage system comprises of one or more disks, a drive device for spinning the disk, mobile read or write heads for accessing data, a framework for placing the read-write head over the surface of the disk, and related components. Several disks could be installed in a disk drive, and usually all disk surfaces may be engraved upon. The read – write heads are placed on arms, so that most of surface can indeed be reached. Every magnetic disk is a flat, circular sheet of magnetizable product. The disk revolves under its read and write head; since it revolves, the read and write head will retrieve files to or from the disk surface. Data recovery from magnetic disks is pretty slow, but has not yet changed more than most other processing dimensions, like cost and power. Whilst the CPU could easily access any data item in RAM when specifically mentioning the position of the storage, in two time-consuming measures this should navigate externally encrypted data. First, the read – write head is always mechanically placed over its track which stores information. Second, they have to scan consecutively for the file, monitoring the file as the disk rotates. Magnetic tape has always been the lowest priced medium for storing data, but it is difficult to retrieve data that is stored on tape. The tape must therefore be screened sequentially from the start, until the interest data is discovered. The main benefit that use magnetic tape as storage backup is that's it's comparatively cheap and also can hold vast quantities of data.

2. What are four considerations in deciding whether to keep data in active versus archival storage?
   

   Answer:

   Active storage would be used to retain long-term accurate information that would need to be accessed with hardly any interruption (in less than a few seconds), e.g., a personal health record becoming handled inside the hospital at the moment; and archival processing has been used to store information for historical including regulatory reasons , e.g., the people's clinical history being dismissed. Archiving often decreases the amount of data needed to be corroborated on storage device. It increases efficiency in backup and recovery thereby reducing supplementary processing costs. Furthermore, libraries with search and retrieval features allow locating and accessing data far simpler whenever it needs to be used. Data that have been required quickly should be stored usually on hard disk drives in more limited accessible processing. It is possible to store certain time sensitive data on the less costly networks that have longer recommend periods. Since information is also transmitted, the designer therefore needs to understand who may choose to analyze the information as well as how to analysis the information. A common medium for processing archives is magnetic tape which is still the lowest priced medium for storing records, although it is slower to retrieve data stored on disk. Since hardware & system networks would not be completely accurate, long-term value details will indeed be transferred to storing data, and versions would be stored on remote locations to preserve records in the case of a catastrophe. The data may be recorded on multiple storage systems providing short-term security. When a remote processing is connected to being one of the storage systems, more security is bestowed. Backup copies offer a standard of software failure security; whenever a latest iteration of a program destroys the memory of the application, backups allow companies to revert back to the previous version of the app or memory. Also, archives are convenient whenever you want to contact somebody with several documents. Rather than adding a few big folders, compile everything under one file. Quickly compared to tape and optical, hard disks are generally reliable for both the short term, but if eliminated from service and stored securely, magnetic properties could last a decade or two until they decrease to the extent of generating irrecoverable failures.

3. Explain how an operating system insulates users from hardware changes.
4. Discuss the advantages and disadvantages of individual workstations linked in a LAN versus shared access to mainframe computers.
5. Define the terms data independence and database schema.How do database management systems facilitate data independence?
6. Why have so many different computer languages been developed?
7. How can you prevent inappropriate access to electronic medical record information?How can you detect that such inappropriate access might have occurred?

Questions Week 6

Questions for Discussion

1. Reread the hypothetical case in Section 6.2.1.
   1. What are three primary benefits of the clinical system? What are three primary disadvantages?
   2. Do you think that the benefits of the system outweigh the disadvantages? Are there adequate noncomputer-based solutions to the problems with which the system was designed to help? If so, what are they?
   3. How would you change the system in your institution or in one you have read about? Among the topics you might address are the effects of the system on hospital routine, computer reliability, and terminal availability and the adequacy of user training programs.
2. Describe an outpatient clinic’s billing system in terms of inputs, outputs, and processes. Sketch a simple data-flow diagram that represents your model of the system.
3. Discuss the inherent tension between protecting the confidentiality of patient records and providing health professionals with rapid and convenient access to clinical information. What level of system security do you think provides an appropriate balance between these conflicting goals?
4. Discuss three barriers to technology transfer among health care institutions.
5. Explain the difference between outcome and process measures of system performance. Identify two outcome and two process parameters that you might use to evaluate the performance of a clinical consultation system that assists physicians in diagnosing disease. Describe an experiment that you could perform to evaluate the effect of the system on one of these parameters. What potential difficulties can you foresee in conducting your experiment? What can you do to compensate for these difficulties?
   

   Answer:

   Process measures are being used to evaluate if the insurers are continuing to follow the procedure characterized throughout the measure. Process Efficacy tests the effectiveness of the work to particular customer demands. Integration of processes tests the extent of alignment amongst consumer demand, finished product and manufacturer inputs. Process operating cycle calculates the distance necessary to purchase inputs to distribution outcomes. Outcome measures are being used to evaluate unless the procedure is having the effect premised on a diagnostic metric, including a lab or vital sign. They are indeed the medical or economic high-level results that affect health sector. Recorded outcome indicators for patients are full questionnaire survey about their health and wellbeing. The knowledge obtained from PROMs will easily detect client condition, promote contact amongst patients and practitioners and/or help improve access to health facilities. Tougher different factors affect regulation, they are simpler to reflect on causality. Features of demand-trial aware participants, can change behavior. They are thus quite easy to recreate with unnatural ambience-weak realism which is suitable for the use of sophisticated machinery. This might be low in ecological validity which is hard to generalize under several other circumstances. This is frequently inexpensive than other methodologies, and is therefore less time consuming. The outcome and process parameters that are used to evaluate the performance of the clinical consultation the healthcare system attributes to carrying out various examinations in order to evaluate the condition of the patient so that treatment plan could be outlined. Initial Medical Assessment incorporates the history of cases, physical examination, assessment of the patient's chief concern and effects, establishing a treatment options, and clinical diagnostic request while therapeutic testing incorporates the results of the test quality, interpretation, and communication.

6. In what three ways is the use of a clinical consultation system similar to the use of human consultants or static sources of health information such as textbooks? In what three ways is it different?
   

   Answer:

   There are various types of the clinical information system:

   Ambulatory or outpatient diagnostic informatics such as an electronic medical record for Ambulatory / OPD

   Inpatient Clinical Information Systems include Inpatient electronic medical records and CPOE systems.

   Specialized programs such as the Information System for the Emergency Department, ICU Information System, Cardiology Information System, and Oncology Information System;

   Laboratory information system, pharmaceutical communications network and radiology information system

   Decision makers are the medical conversation or incident monitoring equipment that are using population figures or transmit professional information to enable the healthcare professionals in testing and therapy making plans. Many other clinical systems can help patients identify individual patient's condition and therefore enable their clients distribute medical assets. Computer-assisted training offers an efficient way by which healthcare professionals could obtain information and understand from errors while jeopardizing clinicians themselves. Also performing an educational advantage is clinical decision support systems as well as other technologies which can illustrate one’s suggestions. The diagnostic system would help the doctors make the right decisions for their clients; this portion includes a software for treatment course. Doctors join the clinical symptoms of the client and therefore can correlate these with the outcomes of laboratory tests as well as the effects of X-ray examinations. The program also displays a number of probable diagnoses. Computer-based information systems must recognize health workers busy schedules and therefore should reframe as well as streamline the human – computer configuration fundamentals. By getting in client’s developers might eliminate several of the barriers to widespread success in design process. In medical practice, the system enables healthcare professionals to quickly access information that would help in the assessment of health problems or in the creation of effective treatment regimens. It may also encourage healthcare professionals to remotely contact one another to review diagnostic tests or operational requirements. Both practitioners and nurses are now seeing the advantages the above medical technologies bring with either the enhanced utilization of EMRs, telehealth services, or mobile innovations such as tablets and smart phones. Healthcare data sets have included a vast quantity of medical data, various statistics, financial information, statistics, surveys of specific populations and, to mention but a few, includes an examination taken from different sources of health records. High quality health facilities require proper appropriate treatment, reacting to the needs and desires of healthcare professionals whilst reducing damage and waste of resources. Healthcare coverage improves the probability of desirable clinical outcomes and therefore is associated with several observable traits: efficacy, protection, people's centering, promptness, affordability, care integration and performance. Consultation is the process of stealing support for medical tests, clinical treatments, and other resources which might support the client from many other doctors or medical professionals. Nonetheless, most e-consultations culminated in GPs simply following up with a phone or face-to - face consultation because there was inadequate detail in the e-consultation and notify medical judgments.