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.
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

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.

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?

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?

Do you believe that independent, unbiased observers of the same behavior or outcome should agree on the quality of that outcome?

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.

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

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.

Week 12 Questions

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?

Limitations of the system: 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. These other problems involved with computer-based systems is indeed the capacity for noticeable and also failures. When the software system breaks down, encryption method can be inaccessible for an unspecified time. Digital records collapse one map at a time. And from the other side, if the typical journal graph were inaccessible up to 10 percent of cases, this will be equal to a 10 percent offline in case of average patient. Acquire of this knowledge explicitly from the practitioner is a major objective of health imaging as it offers another very timely, accurate, and valuable information. Nevertheless, the target is obscure. The time charge of doctor input might become high, so the physician input might be difficult or impossible in certain environments. While new hardware components are developed or enhanced each year none of which has been time-competitive with dictation or handwriting.

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?

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.

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?

Would a computer scan of a paper-based record be an EHR? What are two advantages and two limitations of this approach?

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.

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?

What are three important reasons to have physicians enter orders directly into anEHR system? What are three challenges in implementing such a system?

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.

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?