Health Informatics Assignment Week 4 to 6

  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?

    Answer

    The quotation from Fitts, a cognitive technology visionary, illustrates an omnipresent argument that designers systematically ignore fundamental assumptions more about human cognitive system. While cognitive guidelines had made considerable inroads in the culture of design, there continues to be a significant disparity in the application of cognitive fundamental research. The application of basic research and theory inevitably poses challenges. A general principle of embodied cognition is whether adaptive structures composed of even more than one person require cognitive properties different from those of the participating individuals. Another important component in the functional framework seems to be the allocation of access to knowledge. That being said, there seems to be a widespread perception about the need for an extra human-centered prototype, as well as cognitive research could even make a significant contribution integrative to such an endeavor. Expertise advancement usually follows a rather unusual flight path. The direction from novice to expert has often been presumed to go into a constant process of gradual acquisition of knowledge as well as fine-tuning of abilities. That is, as an individual is becoming more acquainted with a realm, he helps to increase his or her level of performance (e.g., validity, performance). Investigation however has displayed that such a presumption is sometimes untrue. The cognitive walkthrough (CW) is a perceptual task-analytic technique utilized to the research of functionality and learning of multiple different medical communications technologies. Both cognitive or functional acts are encoded, like mouse clicks as well as conceptual acts (e.g., inference required to perform a physical action). The primary principle underpinning this technique is that a particular task has a specific structure for purpose of intervention. In this, the presumption is that professionals would also integrate the newest relevant evidence and therefore this documentation is helpful to enhance the practise. But the quality of the proof may not always be appropriate. Evidently, the template of guideline demonstration is a second problem likely to influence the usage of CPGs which is usually overlooked. The electronic exchange of medical information is critical to improving access to health care, safety and patient experience. Making care more efficient is vitally important. This could be accomplished by decreasing unnecessary testing and resources and enhancing treatment quality by suggesting that the same data is received by almost everyone involved in a patient 's care. Cognitive approaches in health information technology seek to understand the mechanisms involved in health care workers' decision-making or even rationale, as individuals communicate with information technology to perform a variety of tasks.

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

    Answer:

    Data Independence is described as a DBMS attribute which lets one modify the Database scheme through one standard of a database system while changing the schema after the next greater level. Independence of information probably keeps data separate from across all initiatives that are using it. Software independence is the power to make adjustments to collected data while needing to manage adjustments to the data accessing services. It's necessary because of it's time savings and possible errors generated by reducing changes to the program for accessing data. The need for data independence, i.e. maintaining the applications with one groups of participants apart from adjustments implemented by yet another group of application areas, seems to be the chief factor while using a shared information database management system. A database schema is the layout of the database which reflects the conceptual view of the whole server. It determines how the data is structured and how it integrates the relationships among both. It establishes all the restrictions to be placed on the results. A database schema is a conceptual process of combining objects including tables, views, documented protocols etc. Think of a structure as an object-container. It can be portrayed in a pictorial diagrams show the items in the database and their partnership with each other. A database schema seems to be the complicated structure which represents the rational stance of all the databases establishing how well the information is represented as well as how the relationships between them are related. Although the condition of the Database relates to a server material at a certain particular moment in time. A database management system (DBMS) is an embedded collection of systems which enable readers to efficiently and conveniently store and handle data. The programs enclosed from changing the way information is managed by the DBMS, as the software obtain information by number field instead of address. For a distributed system, data independence seems to be the method of data openness that counts. This corresponds to client interfaces' tolerance to adjustments in the interpretation and structure of the data. Optimally, software requirements shouldn't be attributed to data representation and processing information.

  6. Why have so many different computer languages been developed?

    Answer:

    The response to why we even have various programming languages is that to a certain degree, individuals do separate stuff. In addition, there have been cases in which something might have been composed in several languages the very same manner, and they selected one of that is to be desired. Multiple languages fit different manner than others and the prior to that date assignments. Also, some scripting languages are far easier to understand than the others. Programming language is a programming language and a system of regulations ordering a program, appliances, programs to function as per the codes and standards. The programming language helps anyone to compose effective mechanisms and create online implementations including such mobile phones, web applications, games, etc. Computer phrases are designed to handle different types of computer challenges, but all of these languages are versatile enough to handle them almost any question. Languages that concentrate on a basic, specific computational framework such as C or Java need to be extended with wide sets of processes repositories, and it takes longer to learn specific databases than what it does. Non-programmers can use specialist languages specifically with well-understood tasks, since these languages describe additional study for particular functions and conceal even more information. For instance, the Structured Query Language (SQL) of database management systems allows the user to search for it and collect knowledge from multiple datasets. Allows users to perform advanced empirical computations, like regression analysis as well as correlation, with aid of numerical language families like SAS or SPSS. Certain users can use a spreadsheet program like Lotus 1-2-3 or Excel to document and manipulate information throughout the cells of a spreadsheet matrix with equations. For each situation the consumer is shielded from the physical information of the data storage systems and the access mechanisms. Each one of these programs provides its very own specialized language to direct a machine to achieve the necessary operations at the substantial stage. If the language promotes trying to move organized information from individual memory to exterior, prolonged storage, data management is made much easier. For example, information can be analyzed as a flow, a prototype that exactly fits data generated by some equipment, TCP communications over the Internet, or a ticker tape. Data could also be interpreted as documents, corresponding well with dimension tables. When the language doesn't really explicitly endorse the best data structure for interacting with a request, extensive development must be carried out to build the manufacturing method from the facilities available. Even so, the resulting extra layer usually requires money and creates discrepancies between applications which attempt to share data.

  7. How can you prevent inappropriate access to electronic medical record information?How can you detect that such inappropriate access might have occurred?

    Answer:

    Digital signatures are the remedy for avoiding PHI violations as patients display sensitive data. This approach has been shown to be a safety precaution of safety violations. Furthermore, methods of encryption process are effective when used to protect PHI obtained through mobile agents. Network management devices, such as passwords and PIN codes, to further restrict approved individual’s accessibility to certain details. Encrypted data is achieved on the information stored. Legislative differences, lack of confidence in the program and level of clinical control over medical electronic information. Federal laws, like HIPAA and the HITECH Act, aim to safeguard PHI. This is comparable with when an institution constrains access to various addresses of the Internet Protocol (IP). A packet filtering firewall is regarded to be static, and the benchmark encryption to be enforced to ensure the lives of EHRs. A second type of firewalls is firewalls for state examination. Application layer access points have indeed been effective in protecting EHRs, as hackers will be unable to explicitly access the network to acquire protected health information.

    Security concerns from cyber criminals in criminal proceedings.

    Bottlenecks of data because of such a poorly designed interface.

    Education requires for workers to move from document to electronic medical records.

    Human beings with limited style skills can be slowed and used an EHR.

    Making preparations one’s institution to implement a structure of electronic health records.

    The only drawback is that deferral will lead to data conflicts being identified late in time. Resolving disputes which are observed after usually occurring. Therefore, policies with high abortion rates could be problematic for purchases that do not run simultaneously obtain a certain information. To this effect, a program has recently implemented simulated supervised learning, like SVMs and logistic regression. Since these methods have advantages over manually auditing, they disregard the privacy of the users and patients involved in a database access. Consequently, they could not leverage the fact that an individual whose records has never been implicated in an infringement has an elevated risk of involvement in future. Although, the implementation for staff and patients of both obvious and pathological features, the latter trying to act as an individualized "fingerprint" looking at historical trends of connectivity. When applied to specific EHR accessibility data, the proposed approach not only demonstrates dramatically better performance relative to modern approaches, and also offers insights at what suggests an improper access.


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?

      Answer:

      A computer information system will patient interactions as well as physicians by strengthening cooperation amongst many healthcare workers who care about each individual. Delivering all the details clinicians need during making decisions. Attempting to make x-rays and scanners simpler for clinicians, when required. In addition, hospitalization, emergency and economic operations are funded in several countries by independent organizations. Healthcare professionals need to incorporate operational and economic knowledge in order to evaluate expenses and assess healthcare delivery system productivity. Comparably, physicians might have to evaluate data obtained from several other medical facilities or might just want to check medical evidence provided. Communications systems that allow for information can be shared between individual servers and globally diverse sites have become readily accessible. The actual incorporation of the knowledge found in them involves additional technology, compliance to requirements, and operating personnel to ensure everything running as technology and implementing new. Price savings, raising client experience, rising home care, and alternative treatments have been the most significant benefits. The main downside was decreasing accessibility, rising hospitalization rates by increasing the complexity and frustration of personnel.

    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?

      Answer:

      Yes, definitely the benefits of the system outweigh the disadvantages as the introduction of appropriate health care system have helped the patients in better managing the care thus by enhancing appropriate care to the patients. The patient engagement in the treatment process has been increased with the healthcare professionals which has thus led to practice person centered care which thus enhanced to supplement better care to the patients. There are health care professionals wherein the accuracy of the outcomes is essential but for whom time is continually pressured. There are managers who will make staffing and economic choices that are vital and the well-being of the institutions. A number of the evidence is entered and collected by clerical staff. Many programs also ensure that patients have direct interactions. Additionally, there have been technical personnel who manage the network and guarantee its consistency. Originally there are trained system developers, implementers, and integrators, however as the projects go through daily service their quantities and accessibility decline. There needs to be appropriate documentary evidence and coaching well before system is switched over to another consumers. The aggregate health care program not only defines the information system needs (e.g., which data ought to be interpreted as well as which documents will have to be produced), and also the infrastructure operating procedures.

    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.

      Answer:

      The very first approach in integrating computers into healthcare environments is to recognize the need for ineptitude or ineffectiveness in healthcare provision for a medical, operational, or science. The determination to install or upgrade a computer network might well be motivated by a desire to improve the validity of treatment, to reduce medical costs, to increase access to healthcare or to gather the essential knowledge required so that proper documentation as well as evaluation of the healthcare system in delivering the services could certainly be evaluated. For illustration, a new computer-based system will address flaws in the existing scheme by interpreting barcode labels onto packages to minimize the amount of drug-administering failures. Those certain computer networks, such as allowing interconnected access to medical information, could provide processes that are not feasible with a manual process. Health information technology increases patient safety and reduce prescription mistakes, minimizing adverse drug reactions and increasing compliance with requirements for practice. There must be no question that healthcare technology is an indispensable tool for increasing the quality and protection of healthcare. New program architects are progressing by drawing on experiences learned from previous activities, trying to imitate the achievements, and seeking to avoid the pitfalls of previous systems. As the discipline progressed, researchers and consumers developed a higher knowledge of the characteristics of computer software problems that can be solved as well as the criteria for unit effectiveness. Today connectivity with the other elements of the project is seen as important. Implementing regional task effectively in a community hospital but just not reporting the results with several other components will simply mean more problems and delays. A thorough process review before undertaking computer-based changes helps program developers and health care workers to explain reform criteria and also to define corrective steps so that the network deficiencies in the system could be changed.

  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.

    Answer:

    data-flow diagram that represents 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?
  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?
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