Final Review HAN 364 Students (PDF)

Final Review (50 question/ MC and true/false questions) Chapter 11: Health Informatics Ethics Know the Nuremberg Code (slide 3) ○ Voluntary consent and right to withdraw from experiment and right to qualified medical experimenter Know the...

Final Review (50 question/ MC and true/false questions) Chapter 11: Health Informatics Ethics Know the Nuremberg Code (slide 3) ○ Voluntary consent and right to withdraw from experiment and right to qualified medical experimenter Know the WMA Declaration of Helsinki (slide 3): The right to privacy and confidentiality. The first HIPAA. ○ Right to privacy and confidentiality of personal information of research subjects to the Nuremberg Code Know the different views of ethics (slide 6): Ethics and law are different. ○ Ethics does not exist outside the law, and exists only for the good of a properly ordered and legal society ○ Ethics is usually strongly informed by the law, society, and the prevailing culture, and are extensions of these ○ Ethics exists entirely outside of the law, and is a matter of personal conscience Know Flesch Reading Ease test (slide 11): Can do in word and other document/writing tool ○ Assign a value of 1 (most difficult to read) to 100 (easy to read) ○ Tool used to measure how easy or difficult a piece of text is to read Chapter 12: Consumer Health Informatics Types of CHI Applications (slide 8): the way that we utilize apps for patients or physicians, but typically patient driven ○ ⅔ is for consumers while ⅓ is for physicians ○ Apps to inform, instruct, record, display, remind/alert, guide, and communicate Examples of CHI Applications (slide 9): the top 4 ○ MyFitnessPal ○ FitBit ○ MapMyRun ○ Weight Watchers Telemedicine Devices (slide 21): ○ Digital scales ○ BP monitors ○ Glucose monitors ○ Nike+shoes ○ Smart water bottles  Types of PHR (Slide 10): tethered PHR: extension of EMR; standalone:, integrated: separate application, like the standalone but can integrate with the EMR ○ Tethered PHR: extension of the healthcare provider’s EHR ○ Standalone PHR: An isolated application. not associated with EHR ○ Interconnected ot integrated PHR: It is a separate application, but it has the ability to interact with one or possibly more provider EHRs Electronic Communication Challenges (Slide 15): information overload, patients don’t want to get notifications that convey bad or life alternating decisions ○ Patient do not prefer email notifications of test results, because they think it is potentially bad news ○ Information overload (physician burnout) and no way to triage them, insecurity of standard email, and the ability to read and reply to messages in a timely manner. Chapter 13: Mobile Technology Factors that add to popularity of mobile (slide 4): faster, cheaper, more affordable, more features available, and they are all connected to the internet ○ Improved speed, memory, wireless connectivity and shrinking form factor ○ Affordable ○ Constantly improving features ○ Phone capability, email and access to internet ○ Myriad of mobile apple for consumers and clinicians Mobile Integration (slide 8): ○ Ipad was the first tablet to make the first impact on healthcare Know Text Messaging/SMS Uses in Mobile Technology (slide 10): ○ Appointment reminders ○ Education ○ Disease management ○ Behavior modification ○ Medication compliance ○ Laboratory results notification ○ Public Health - immunization Challenges of Mobile Technology (slide 17): ○ Cost ○ Distraction ○ Technical (how would they input it, screen size, and interoperability issues) ○ Security: need BYOD policies Chapter 14: Evidence Based Medicine and Clinical Practice Guidelines EBM Definition and Trials (slide 4): kNOW THE VENN DIAGRAM (The EBM TRIAD) ○ EBM (Evidence Based medicine): systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values ○ The EBM Triad: The Best External Evidence Individual Clinical Expertise Patient Values and Expectations EBM Method of Answering Clinical Questions (slide 8): ○ The patient: a clinical problem or question arises out of the care of the patient ○ The question: construct a well built clinical question derived from the case ○ The resource: select appropriate resources) and conduct a search ○ The evaluation: validity and applicability ○ The patient: integrate that evidence with clinical expertise and apply to practice ○ Self-evaluation: evaluate your performance with the patient Importance of EBM (slide 6): Much of what is considered the “Standard of care”in everyday practice has yet to be challenged and could be wrong ○ Current methods of keeping medically or educationally up-to-date do not work ○ Translation of research into practice is often slow ○ Lack of time and the volume of published material results in “information overload) ○ The pharmaceutical industry bombards clinicians and patients every day, often with misleading or biased info What is PICO? (slide 9&10): Patient, intervention, comparison, and outcomes ○ P: Patient or Problem ○ I: Intervention (e.g., treatment or test) ○ C: Comparison (if applicable, like comparing two treatments) ○ O: Outcome (what result you want, like reduced pain or faster recovery) ○ Example: For a patient with chronic back pain, "Does physical therapy (I) improve pain relief (O) compared to medication (C) in adults with back pain (P)?" Evidence Pyramid (slide 13&14). The bottom is cheaper and quick to do and is flawed and most available, as you start to go up it is fewer and costly and takes too long to do. Randomized controlled trial (RCT) are the best, but the gold  standard is the double blinded RCT where both the researchers and subjects have no idea ○ Visual representation of the levels of evidence in medical research, ranked by their quality and reliability. At the bottom are less reliable forms of evidence, while the top contains the strongest evidence. ○ As you move up the pyramid, the evidence becomes more reliable, but also harder to obtain ○ Randomized controlled trials (RCTs): subjects are randomly assigned to a treatment or a control group that received placebo or no treatment; only difference between the two groups is the intervention being studies “Double blinded”- both the investigator and the subjects do not know whether they received an active medication or a placebo RCTs are the gold standard design to test therapeutic interventions Levels of Evidence (slide 16): GRADE- level 4 is the bottom of the pyramid (low quality, flawed result) and level 1 is high quality ○ Grading of Recommendations, Assessment, Development and Evaluation ○ Level 1: High quality evidence derived from consistent RCTs ○ Level 2: Moderate quality evidence inconsistent or less methodologically strong RCTs; or exceptionally strong observational evidence ○ Level 3: Low quality evidence, usually from observational studies ○ Level 4: Very low quality evidence from flawed observational studies, indirect evidence or expert opinion Common Types of Clinical Questions (slide 12): look at what each questions are ○ Therapy: Purpose: To determine the best treatment for a condition. Example: "Is physical therapy more effective than medication for managing chronic back pain?" ○ Prognosis: Purpose: To predict the likely outcome or course of a condition. Example: "What is the life expectancy for a patient with Stage II lung cancer?" ○ Diagnosis: Purpose: To identify the best test or method to diagnose a condition. Example: "Is an MRI more accurate than an X-ray for detecting a torn ligament?" ○ Harm/Prevention: Purpose: To identify potential harm from an intervention or how to prevent a condition. Example: "Does long-term use of proton pump inhibitors increase the risk of bone fractures?" ○ Cost: which is more cost effective to reduce hospital readmissions for heart failure, inpatient case management or home health nursing care  Barriers to CPG (slide 26): people don’t want to change what they are doing, it is costly, low initial acceptance ○ Practice setting ○ Contrary opinion ○ Sparse data ○ Expect low initial acceptance ○ CPGs can be too long, without a summary ○ Lack of local champions ○ May lack patient input with both the writing of the CPGs and the implementation ○ Incentives to adopt may be missing for clinicians Chapter 16: Medical Imaging Informatics What is Medical Imaging Informatics? (slide 3): ○ The study and application of processes of information and communication technology for the acquisition, manipulation, analysis, and distribution of medical image data What is a PACs? (slide 3): Your image storing system ○ Picture Archiving and Communication System: stores the image to allow for it to be presented Advantages of Digital Imaging System (slide 5): ○ cost saving, storage, retrieval Barriers of Transition to Filmless Radiology (slide 6 and 7): ○ extensive cost ○ you still have to print ○ still have film scanner ○ faster processors, higher capacity disk drives, higher resolution monitors, more robust hospital info systems, better servers and faster network speeds Types of Digital Detectors (slide 11): CR and DR ○ Computed radiography (CR): After x-ray exposure to a special cassette, a laser reader scans the image and converts it to a digital image. The image is erased on the cassette so it can be used repeatedly ○ Digital radiography (DR): Does not require an intermediate step of laser scanning Disadvantages of PACS Systems (Slide 19): ○ Cost ○ New legislation cutting reimbursement rates ○ expense complexity ○ lack of interoperability ○ Bandwidth limits  ○ Different vendors may use diff DICOM tags to label film ○ Slower ○ Workstations may require updates Chapter 17: Telemedicine What is Telehealth? (slide 3): ○ Use of electronic information and telecommunications of technology to support LONG-DISTANCE clinical health care, patient and professional health-related education, public health and health administration Popularity of Telemedicine (slide 4): ○ rising cost, shortage of specialist, and rise in chronic disease and aging population Telemedicine Transmission Modes (Slide 7): ○ Store and forward: Asynchronous communication Images or videos are saved and sent later ○ Real time: synchronous and two way interactive, most interactive but also most expensive A specialist views video images transmitted from a remote site and discusses the case with another physicians Barriers to Telemedicine (slide 20): ○ Limited reimbursement ○ Limited research showing reasonable benefit and return on investment ○ High initial cost ○ Limited availability of high speed telecommunications ○ Bandwidth issues ○ Need for high resolution images or video for some specialties Goals and Purposes of Telehealth (slide 4): improve access to healthcare Chapter 18: Bioinformatics Definitions (slide 3 and 4): know that it finds gene, predicts structures or functions ○ Bioinformatics uses computer science to develop algorithms for facilitating the development and testing of biological hypothesis finding genesis of various organisms Predicts structure or function of newly developed protein Developing protein models and examining evolutionary relationship Difference between Phenotype and Genotype (slide 7): ○ Phenotype: observable ○ Genotype: down to the raw genetic structure  Genomic Primer (slide 8): ○ Humans have 23 pair of chromosomes ○ Offspring inherits one pair from each parent ○ Chromosomes are listed by size with chromosome 1 being the largest and 23 being the smallest Importance of Bioinformatics (slide 9) ○ Diagnosing hereditary diseases ○ Discovering future drug targets ○ Developing personalized drugs based on genetic profiles (personalized medicine) ○ Developing gene therapies to treat diseases with a strong genomic components Personal Genomics (slide 12): ○ Goal is to have “tailor made” medication that targets the individual and not the group Ethical questions related to genetic testing (slide 15): testing is not regulated and also genetic counseling ○ Genetic testing is not regulates, lacks external standards for accuracy, no economic viability, clinical benefits and mislead customers ○ Patients need accuracy before going through a treatment ○ Patients need genetic counseling as most physicians have not had this training ○ Genetic information nondiscrimination Act of 2008: protects patients against discrimination by employers and healthcare insurers based on genetic information Chapter 19: Public Health Informatics Example of Syndromes that are currently monitored (slide 15) Botulism Febrile (fever) illnesses (influenza-like illness) Gastrointestinal (Stomach) symptoms Hemorrhagic (bleeding) illnesses Neurological syndromes Rash associated illnesses Respiratory syndromes shock or coma Clinical Outcomes Surveillance (slide 20): Looks at conditions and then the outcomes and then says “where is this disease going”. Study disease progression or regression in a population. Meaningful Use and Public Health Surveillance (slide 24)  The capability to electronically transmit immunization data to immunization registries or immunization information systems The capability to electronically transmit reportable lab results The capability to electronically transmit syndromic surveillance data from an EHR The capability to report cancer cases to a state registry from a certified EHR The capability to report specific cases to a non-cancer state registry from a certifies EHR Uses of Geographic Information Systems(GIS) in public health (slide 28): GIS map has hotspots where you can see certain diseases in certain regions and then allows you to target those areas What are GIS systems? (slide 27) Used for the mapping and analysis of geographic data Provides access to large volume of data; the ability to select, query, merge and spatially analyze data; and visually display data through maps Chapter 22: Introduction to Data Science Skill Set required (slide 6): ○ Mathematics and statistics ○ Domain expertise ○ Programming language Cardinality (slide 12): ○ Cardinality means uniqueness ○ 1 to 1: one row in a table relates to 1 row in another table ○ 1 to many relationships: one row in a table may relate to multiple rows in another table Normalization (slide 13): normalization of tables to prevent duplication of data. ○ Prevents duplication of inputted data ○ First normal form” Prevents each row from having duplicate data ○ Second normal form: prevents the repetition of data within a tables column ○ Third normal form: requires that every column have a dependency on the tables primary key and independent from remaining non-key column in the table Three Data Analytical Approaches (Slide 25): ○ Statistical modeling: Use statistics ○ machine learning: used by computer scientist: association, regression, classification, and clustering ○ programming language: used by computer scientist Group Project Key Terms Scope: Tells us what we are doing in the project, inclusion and exclusion, it has boundaries Timeline: gives us a chronological date format Stakeholders/Sponsors: people that are involved/invested in the project. can be internal or external Vendor Matrix: like comparing features on a car. look at all the different features and compare and contrast different products Needs Assessment: Asking and figuring out what you need and how you want it to be accomplished. This is after the survey questions. It’s basically a confirmation to the customer that you understand what they are looking for in their system Survey Questions: I write before the need assessment to get me the answers before the start of the project. Asking the customers what they want Project/Executive Summary: high level, 1 page summary that gives a high overview of the project. Latent, quick Access Lab Key Terms Primary Key: unique identifiers that can't be repeated in that one column (like social security Tables: store the information for us; excel spreadsheet Queries: to bring back data. pull the data back; extract data Reports: a clear document that can be sent to a printer, emailed, shown or screen that allows me to share it to other people in the department and organization Forms: used to input data, allowed you to quickly enter data one form at a time