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Clinical Informatics Board Review
Combine's Dr. Siff's with set found on AMIA site
Terms in this set (240)
Agency for Healthcare Research and Quality : A federal agency within the US Department of Health and Human Services (HHS) with a mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Formerly known as the Agency for Health Care Policy and Research, AHRQ supports research and technology assessment, including implementations of health information technology.
American Recovery and Reinvestment Act : In 2009, the Obama Administration signed the American Recovery and Reinvestment Act (ARRA) or Stimulus Package into law. It contains billions of dollars in funding for science, engineering research and infrastructure, as well as funding for education, social sciences and the arts. Its greatest relevance to informatics is its major investment in the implementation of electronic health records and support for comparative effectiveness research.
BEACON COMMUNITY PROGRAM
A federal grant program for communities to build and strengthen their health information technology (HIT) infrastructure and health information exchange (HIE) capabilities.
The study of how information is represented and transmitted in biological systems, with an emphasis on molecular biology, genomics, and proteomics.
The science that develops methods, techniques, and theories regarding how to use data, information and knowledge to support and improve biomedical research, human health, and the delivery of healthcare services.
conducted to support the diagnosis, evaluation, and treatment of patients with health conditions.
the electronic application that allows veterans the capability to download their personal health information from their VA patient portal in a very simple text file or PDF. This capability also allows veterans to self enter personal health indicators, emergency contact information, test results, family health history, military health history, and other related health information (1).
Certification Commission for Health Information Technology : A voluntary, private sector organization launched in 2004 to certify health information technology products such as electronic health records and the networks over which they interoperate. CCHIT, the original certifying body, is now one of several organizations the Office of the National Coordinator for Health Information Technology (ONC) has authorized to certify electronic health record technology and selected as an ONC:Authorized Testing and Certification Bodies (ATCBs).
Centers for Disease Control and Prevention : A part of the US Department of Health and Human Services (HHS) with a mission is to collaborate in creating the expertise, information, and tools that people and communities need to protect their health.
Clinical Decision:Support System : A computer:based system that assists a professional who must decide what actions to take in a given clinical setting, such as physicians or nurses making decisions about patient care.
Covered Entity : Under HIPAA, a health plan, a health care clearinghouse, or a healthcare provider who transmits any health information in electronic form in connection with a HIPAA:covered transaction.
Comparative Effectiveness Research : Any research program intended to determine the relative efficacy of alternate approaches to patient evaluation or treatment, intended to develop evidence that supports one approach over another in a given patient or context.
Chief Medical Information/Informatics Officer : In hospitals or health systems, a physician charged with helping to assure the success of clinical information systems, representing a clinician's perspective, and participating in system selection, implementation, evaluation, and user training.
Centers for Medicare and Medicaid Services : A federal agency within the US Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards. Formerly known as the Health Care Financing Administration (HCFA).
Chief Nursing Information/Informatics Officer : In hospitals or health systems, a nurse charged with helping to assure the success of clinical information systems, representing a clinician's perspective, and participating in system selection, implementation, evaluation, and user training.
Computer:Based Physician Order Entry : A clinical information system that allows clinicians to record patient:specific orders (tests, treatments, management plans, and the like) for communication to other patient care team members and to other information systems. Sometimes called provider order entry or practitioner order entry.
The application of biomedical informatics methods and techniques, including information technology, to deliver healthcare services. AMIA considers all informatics when used for healthcare delivery to fall in this category, regardless of the health professional group involved (dentist, pharmacist, physician, nurse, or other health professional). Clinical informatics includes a wide range of topics ranging from clinical decision support to clinical documentation to provider order entry systems, and from system design to system implementation and adoption issues.
CLINICAL RESEARCH INFORMATICS (CRI)
Involves the application of biomedical informatics methods and techniques in the discovery and management of new knowledge relating to health and disease. It includes management of information related to clinical trials, community based research, and also involves informatics related to research use of clinical data. Clinical research informatics and translational bioinformatics are the primary domains related to informatics activities to support translational research, and thus clinical research informatics lies at the intersection between bioinformatics and clinical informatics.Last updated: 11/10/2010
CONSUMER HEALTH INFORMATICS
Is the field devoted to informatics from multiple consumer:patient views. These include patient focused informatics, health literacy and consumer education. The focus is on information structures and processes that empower consumers to manage their own health; for example health information literacy, consumer:friendly language, personal health records, and Internet:based strategies and resources. The shift in this view of informatics analyses consumers' needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers' preferences into health information systems. Consumer informatics involves the intersection of clinical informatics and public health informatics, standing at a crossroads with other disciplines, such as nursing informatics, public health, health promotion, health education, library science, and communication science.
CLINICAL TRANSLATIONAL SCIENCE AWARDS : An NIH grants program that promotes more rapid and effective translation of basic science discoveries into clinical settings, culminating in facilitated adoption in the community. These awards require a significant investment in biomedical informatics to support the translational science. They have accordingly been a boon to the development of translational bioinformatics and clinical research informatics.
Data stewardship encompasses the responsibilities and accountabilities associated with managing, collecting, viewing, storing, sharing, disclosing, or otherwise making use of personal health information. Principles of data stewardship apply to all the personnel, systems and processes engaging in health information storage and exchange within and across organizations.
The component of clinical informatics that deals with the roles and activities of individuals in the dental profession.
Electronic Health Record : A repository of electronically maintained information about an individual's health status and health care, stored such that it can serve the multiple legitimate users of the record.
Electronic Medical Record (see EHR)
United States Food and Drug Administration : A federal agency within the US Department of Health and Human Services (HHS) responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation's food supply, cosmetics, and products that emit radiation, and by regulating the manufacture, marketing, and distribution of tobacco products.
Federal Health Architecture : A collaborative body composed of several federal departments and agencies that provide a framework for linking health business processes to technology solutions and standards and for demonstrating how these solutions improve health performance outcomes. Last updated: 11/10/2010
The fields of clinical informatics and public health informatics, including both applied research and practice.
United States Department of Health and Human Services : HHS is the US government's principal agency for protecting the health of all Americans and providing essential human services.
Health Information Exchange: the electronic movement of health related information among organizations according to national guidelines (2).
Health Information Management : The practice of acquiring, analyzing, and protecting digital and traditional medical information vital to providing quality patient care.
Health Insurance Portability and Accountability Act [of 1996] : A government act to reduce fraud and abuse in health care.
Health Information Technology
Health Information Technology for Economic and Clinical Health Act : A government act to enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and assure the workforce is properly trained and equipped to be meaningful users of EHRs. HL7: Health Level 7 : An ad hoc standards group formed to develop standards for exchange of health care data between independent computer applications.
Health Resources and Services Administration : A federal agency within the US Department of Health and Human Services (HHS) responsible for improving access to health care services for people who are uninsured, isolated or medically vulnerable.
9:CM: Ninth International Classification of Diseases:Clinical Modification : A coding system for medical diagnoses, symptoms, and nonspecific complaints. It is frequently used on insurance claim forms to identify the reasons for providing medical services
10:CM: Tenth International Classification of Diseases:Clinical Modification : ICD:10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1, 2013.
Institute of Medicine : The health arm of the National Academy of Sciences.
A general term used to refer to biomedical informatics and its many areas of application and practice (e.g., bioinformatics, clinical informatics, public health informatics)
The field of study concerned with issues related to the management and retrieval of both paper:based and electronically stored informationLast updated: 11/10/2010
The ability for systems to exchange data and operate in a coordinated, seamless manner.
International Standards Organization : Developer and publisher of International Standards that forms a bridge between the public and private sectors to enable a consensus to be reached on solutions that meet both the requirements of business and the broader needs of society.
Meaningful Use : A tiered set of objectives related to the ARRA Medicare and Medicaid EHR incentive programs. Meaningful Use criteria must be met by eligible professionals and hospitals if they are to collect financial rewards for the implementation of qualified, certified EHRs to achieve health and efficiency goals.
Mobile Medical Applications
health software programs that run on software programs that run on Smartphone and other mobile communication devices (3).
National Cancer Institute : An institute at the National Institutes of Health (NIH) responsible for cancer research and training.
National Center for Health Statistics : A component of CDC, serving as the Nation's principal health statistics agency
National Committee on Vital and Health Statistics : An advisory body to HHS that deals with health data, statistics and national health information policy.
National Health Information Network : A pilot program by the Office of the National Coordinator (ONC) established to provide a nationwide health information exchange (HIE) that uses a common standard.
National Institutes of Health : A part of the US Department of Health and Human Services (HHS) responsible for conducting and supporting medical research.
National Institute for Standards and Technology : A non:regulatory federal agency within the US Department of Commerce to promote innovation and industrial competitiveness in the US by advancing measurement science, standards, and technology in ways that enhance economic security and improve our quality of life
National Library of Medicine : The world's largest medical library. The Library collects materials and provides information and research services in all areas of biomedicine and health care. It is also an NIH institute and supports research and training in areas related to biomedical and health information management and information technology.
National Center for Research Resources : A specialized center at NIH that supports research and development for multi:categorical research resources needed on an institutional, regional, national, or international basis for health:related research. This agency has organized and supported the CTSA program.
The component of clinical informatics that deals with the roles and activities of individuals in the nursing profession.Last updated: 11/10/2010
Office of the National Coordinator [also referred to as ONCHIT] : Part of HHS that oversees and encourages the development of a national, interoperable (compatible) health information technology system to improve the quality and efficiency of health care.
Office of the National Coordinator for Health Information Technology [see ONC]
a secure online website that gives patients convenient 24 hour access to personal health information from anywhere within internet connection (4).
Patient Protection and Affordable Care Act
in 2010 the Obama administration signed into law the Patient Protection and Affordable Care Act or "the Affordable Care Act" that includes provision such as the expansion of Medicaid eligibility, establishment of health insurance exchanges, and prohibiting health insurers from denying coverage due to a pre:existing conditions (5).
Personal Health Information or Protected Health Information : Information about patients that is protected from inappropriate disclosure under the privacy and security mandates of the Health Insurance Portability and Accountability Act of 1996 and subsequent related legislation.
PUBLIC HEALTH INFORMATICS
The application of biomedical informatics in areas of public health, including surveillance, reporting, and health promotion. Public health informatics, and its corollary, population informatics, are concerned with groups rather than individuals. Public health is extremely broad and might even reflect an interest in information technology with regard to ecology, architecture, climate, agriculture, and such. Generally, AMIA focuses on those aspects of public health that enable the development and use of interoperable information systems for public health functions such as biosurveillance, outbreak response, and electronic laboratory reporting.
Personal Health Record : An electronic health record that is maintained by the patient, typically combining information from a variety of encounters with multiple providers.
[Health Information Technology] Regional Extension Center : An entity that serves a defined geographical area, offering technical assistance, guidance, and information on best practices to support and accelerate health care providers' efforts to become meaningful users of EHRs and in time to enable nationwide health information exchange.
A term generally used to refer to uses of clinical data for purposes other than direct patient care (e.g., for research purposes, for public health surveillance, for billing, for analysis in disease registries).
Strategic Health IT Advanced Research Projects : An applied research grants program, funded by ONC, that supports research focused on achieving breakthrough advances to address well:documented problems that have impeded adoption of health IT and to accelerate progress towards achieving nationwide meaningful use of health IT in support of a high:performing, continuously:learning health care system.
the use of telecommunications and electronic information to support long:distance clinical healthcare (6).
Research in bioinformatics that is motivated by human health and thereby emphases the relationship of the work to human disease in areas such as diagnosis, prognosis, treatment, and management.
TN/ TN + FP
TP/TP + FN
systemized nomenclature of medicine. merged with english clinical terms project in 2000. Now owned by IHTSDO international health terminology standards development organization. multiaxial or compositional
UMLS 3 components
unified medical language system. 3 metathesaurus, semantic network, specialist lexicon (helpful with NLP). CUI (concept unique identifier- terms with same notion); LUI (term identifier- source terms of similar forms), SUI (string unique identifier - lexical variants), AUI (atomic unique identier - each string is an atom from its source). only one to one relationships. has no new terms - all from prior sources. more of a repository
information needs for office practice - Covell and Manning 1985
2 questions arose for every 3 patients. Only 30% answered during visit
elicit bids from vendors. make it objective with points.
made during planning but unable to determine all requirements. award of contract will not automatically follow
RFQ - request for quotation
used when requirements are clear cut
information technology infrastructure library. developed in UK in 1980s by central computer and telecoms agency. adopted by microsoft in 1990s for operations framework
A service that provides proof of the integrity and origin of data.
An authentication that can be asserted to be genuine with high assurance
efficacy vs effectiveness 3e3
efficacy is in controlled research setting, effectiveness- evaluation in a real world setting.
micro vs macroevaluation 3e3
microeval is evaluation of individual components of a system. macroeval is of the whole system as a "black box"
objectivist vs subjectivist research 3e3
objectivist = quantitative (most common is comparison) , subjectivist = qualitative.
dependent variable vs independent variable
dependent or outcome variable vs independent or predictor variable (does CPOE reduce death rates) death rate is outcome or dependent variable.
assessment bias 3e3
subjects allow feeling toward the system influence it
allocation bias 3e3
randomization cheated - random or purposefully
Hawthorne effect 3e3
subjects alter behavior because they know they are being observed
checklist effect 3e3
decision making more complete with checklists.
alpha vs beta error 3e3
alpha - difference is by chance and not real. beta - there is a difference but none is detected.
statistical power 3e3
ability to detect statistical difference
types of subjectivist research 3e3
ethnography- observe in their own environment, focus groups-convene individuals, usability- give task and observe, protocol analysis- ask users to "think aloud"
condition in which information is shared or released in a controlled manner
measures that organizations implement to protect imformation and systems. insures not only confidentiality but integrity and availability
individuals desire to limit the disclosure of personal information
belmont report and the common rule 1b
protection of human subjects of research 1979. respect the person, benficence, justice. outlines provisions for IRB, informed consent and assurances of compliance
difference between leadership and management 4a
management is about processes, leadership is about behavior
Health IT leadership qualities 4a
good management and project management skills, change management, process redesign. overlap of people, process and technology. knowledge of informatics
action centered leadership model 4a
meets need of task team and individual. more about behaviors than individual
function results oriented healthchare leadership model 4a
take the three of action (team, task, individual) and add/overlie "results" responsibility for leadership outcomes
healthcare quality professional leadership model 4a
foster pos change, org awareness, PI, communication, self development and management, professionalism and prof values
center for professional leadership six part model 4a
6 part model for transformative change
strategic mission should align with leadership objectives 4a
true!! on exam
McClellands human motivation theory 4a
aka three needs theory, acquired needs theory, motivational needs theory, learned needs theory. people have one dominant motivator of (achievement, affiliation and power), depends on culture and life experiience
Sirotas three factor theory of human motivation
equity/fairness, achievement, and comradarie. premise: org goals are not in conflict with workers goals, orgs should try to meet basic needs of workers
Tuckman model of team evolution 4b
forming, storming, norming and performing 1965. 5th stage adjourning added in 1970s
individuals conform to dominant view, dissent is suppressed, alternative courses not fully explored
group polarization 4b
tendency of a group to entertain more risky or extreme solutions
nominal group technique 4b
individual members develop ideas/proposals. they are discussed but not criticized publicly, group engages in discussion/analysis, rank all options and decide. best application is to finite or single problem or situation. can lead to inflexibility
consensus mapping 4b
a facillator with group reach consensus on best approach. example - implementing a new info system dept or facility wide. based on expect of compromise. see steps in lecture. small group develops "clusters" and eventually combined to develop process
delphi method 4b
RAND corporation 1950s experts weigh in using multiple rounds of questionnaires. anonymous summaries presented to allow revision of thought process. group moves to one final answer. allows face to face. dominant opinion might sway some.
successful communiction... 4c
intended meaning is preserved from sender to receiver
two biggest mistakes in communication 4c
assumption is what I said is what you understood and failing to understand that mis communication carries costs and consequences
rich vs lean communication
rich = audio and visual, lean is no audio or visual
just in time 2 meanings 4c
training just prior to roll out and info avail when needed (seeing patient and needing clinical information)
difference between project and business operations 4c
project is temporary and operations are repetitive, permanent (semi permanent) to produce products or services
primary constraints of project management 4c
scope, time, quality and budget. also- satisfy (manage expectations)
project management life cycle 4c
initiation, planning/design, executing, monitoring/controlling, closing (closing is often overlooked) each stage has different characteristics (cost and staffing - bell shaped curve, level of uncertainty- highest at start, cost of changes - lowest at start of project and increase as project matures. SO- note opposite direction of level of uncertainty and cost of changes.
steps of project initiation 4c
define problem-- identify project requirements -- perform feasibility study -- identify product and project scope. project charter developed during this phase and approved at end of project initiation
project planning steps 4c
planning -- scheduling -- cost estimating -- budget resource allocation. The tool "work breakdown structure" (WBS) is often used here to define discrete work elements.
wbs (work breakdown structure) elements 4c
project title -- project subsystems = subprojects -- major deliverables -- sub deliverables -- work packages.
project charter elements 4c
it is a map or blueprint. project team requirements -- states project goals and objectives -- business case for project -- identifies stakeholders.
project planning resources 4c
human, material, financial. requirements do not equal resources, requirements drive resources, shorter timeline = higher resources, who is authorizing? where do resources come from (internal external)
why projects fail 4c
communication is poor; failure to recognize and manage uncertainty and risk, customer demands exceed realities and difficulty with stakeholder management, scope creep, managing expectations and balancing competing priorities. ALL OF THESE ARE THWARTED WITH GOOD PROJECT PLANNING (2ND PHASE OF LIFE CYCLE). DEFINING PROJECT SCOPE IS ALSO KEY.
scope creep 4c
scope = extent of work involved to complete the project. know boundaries of project. refer to project charter. need to define the boundaries.
scope statement elements 4c
provides common understanding of project
documents objectives and deliverables
forms basis of other planning processes
foundation for setting boundaries
contains (project justification, description, deliverables, time and cost estimates, success criteria, assumptions and constraints)
scope management plan contains... 4c
documentation of procedures to manage any proposed changes during any point of project lifecycle
operating budgeting elements
usually one year, includes P and L, cash flow and balance sheet
managerial vs financial accounting
managerial provides info to managers and financial to outside shareholders. managerial: more emphasis on future, on non monetary data, on segments of the org, NOT governed by GAAP.
strategic planning organizational pull model 4e1
organizational objectives fully driving the IT requirements
strategic planning technology push model 4e1
IT strategies "push" organization into new areas. eg wireless communication strategy and delivery model
strategic planning component alignment model - 7 components 4e1
all must be aligned
1-external environment- forces
2- emerging IT
3- org mission
4-org infrastructure and processes
5- IT infrastructure and processes
6- org business strategy
7- IT strategy
strategic plan 4 components 4e1
mission, vision, objectives, strategies
...process involves assessing present, defining future and how to get from A to B
mission statement 4e1
action oriented, purpose and primary objectives, intended to communicate to others. IT SP should align with org plan (stressed in many areas/lectures)
vision statement 4e1
stated purpose in terms of VALUES. inspirational, higher level of purpose
objectives (strategic planninc) 4e1
operationalize mission and vision. tangible steps
strategies (strategic planning) 4e1
combination of "ends" (goals) and the "means" (policies). can be considered a "roadmap" to "plow" to the end vision. insures the company is moving in the right direction to the vision.
SWOT AND PEST 4E1
you know SWOT
PEST = political, economic, socio-cultural, technological
Theories of Change 4f: diffusion of innovation
an idea or practice that is perceived by one or many. know innovation adoption lifecyle:
Theories of Change 4f: Bridges transition theory
managing situational change is faster than psychological change.
phase 1 ending losing, letting go - deal with loss before moving on
phase 2 confusion chaos attempting to realign (THE NEUTRAL ZONE)
phase 3 new beginning, embracing change
Theories of Change 4f: Lewins change theory
three stages: unfreeze, change, freeze
Kurt Lewin change model
Theories of Change 4f: precede proceed model
define quality of life and social factors around that you wish to change.
look at 'precede" predisposing concepts. then "proceed" see handout in lecture. doesn't think this will be on exam.
Theories of Change 4f: social influence theory
people's behavior is intentionally or unintentionally affected by others and therefore affects ability or refusal to accept change. social norms exert pressure of conformity.
Theories of Change 4f: complex adaptive systems
aka complexity science. complex systems are about relationships within the system.
Kotters 8 steps to transformation 4f
1-establish sense of urgency
2- form a powerful guiding coalition
3-create a vision
4-communicate the vision
5-empowers others to act on the vision
6-plan and create short term wins
7-consolidate improvements and create more change
8-institutionalize new approaches
bayes theorem 1a
P A/B = P B/A * P A OVER P B
limitations: findings in disease usually not conditionally independent. diseases may not be mutually exclusive.
Metcalfs law 1a
power of network equals square of nodes.
curly braces 1a
generic rules difficult to apply in local settings
public health core functions 1c
assessment -- policy development -- assurance
translational research 1-c
bench to bedside. T1 molecules to humans most common category. T2 how it gets to community (real world)- clinical trials, T3 how well do we deliver healthcare
expected value vs expected utility 2a-1
expected value = total value x chance. expected utility factors exp value and risk aversion ie personal preferences and circumstances
Blois funnel 2a-1
breadth of dx possibilities is refined and restricted given course of interaction between patient and practitioner
heuristics availability 2a-1
overestimating prob of events given recent or remote instances
heuristics representativeness 2a-1
overestimating rare disease by matching patients to typical picture. this is insensitive to pretest probabilities. zebras and horses
heuristics anchoring 2a-1
failure to adjust dx or prob based on new information. premature closure.
heuristics value induced bias 2a-1
overestimate probability based on value associated with outcome. obtaining a CT for headache not wanting to miss a horrible tumor
decision tree symbols 2a-1
square = decision, circle = chance node, triangle = outcome node
time trade off. 4 years of perfect health = 10 years of current state. TTO = 0.4. three years in current state = 3x0.4= 1.2 QALY
incremental cost effectiveness ratio. measure of the change in cost with change in a unit of effectiveness (usually QALY). Formula (C1-C2)/(E1-E2).
screening test 2a-1
SnOUT. sensitive tests rule things out. you can trust a negative. good for screening tests
confirmatory test 2a-1
SpIN - specific tests rule things in. good for confirmatory
Receiver Operating Characteristic 2a-1
graph of sensitivity vs 1- specificity (TPR, FPR)
relative risk 2a-1
prob of disease|exposure / disease|no exposure
Likelihood ratio 2a-1
related to odds and has elements of sensitivity and specificity in it. Post test odds = pre test odds x LR. LR+ = sensitivity / 1-specificity. LR- = 1-sensitivity / specificity
probability vs odds 2a-1
probability is "chance" = number of successes divided by the total. Odds is a "ratio" Prob goes from 0-1 (or 0-100%). The denominator in prob = total possibilities. DON'T turn odds into percentage. Odds = p(x) / 1- p(x)
5 rights of CDS 2a-2
right person (target of CDS)
right channel (mode of CDS)
right time (workflow integration)
Open CDS 2a-2
uses HL7 standard. built using open source tools. integrates with standard terminologies.
rule based systems forward vs backward chaining 2a-3
backward - pursue goal and ask questions to reach goal. forward = similar to clinical algorithms. Shortliffe's MYCIN first system = backward chaining.
evoking strength vs frequency (findings in disease) 2a-3
evoking- likelihood of disease given a finding, frequency = likelihood of finding given a disease.
Hierarchy of evidence 2b-1
studies (medline), syntheses (systematic reviews, Cochrane, medline), synopses (textbooks, compendia, guidelines), systems (guidelines, rules, order sets)
Background vs Foreground questions 2b-1
foreground questions are answered using EBM techniques. PICO (patient or problem, intervention, comparator, outcome). background ask general knowledge about a disorder.
4 categories of foreground question 2b-1
intervention or therapy
diagnosis - test
harm - etiology or cause
Control event rate CER 2b-1 vs Experimental event rate EER
CER risk of event from control intervention. EER risk of event from experimental intervention
relative risk and relative risk reduction. 2b-1
RR = EER/CER
RR reduction = 1-RR
absolute RR reduction, NNT 2b-1
ARR = CER - EER
NNT = 1 / ARR
two main tasks of IR 2b2
indexing (assign metadata) and retrieval (boolean and natural language)
SMART approach workflow - Goals
health effectiveness data and information set. NCQA. required of medicare advantage
leapfrog 4 leaps 2c2
evidence based hosp referral- to high volume high quality
ICU physician staffing
leapfrog safe practice score
IOM 6 characteristics 2c2
describe what happens if process fails
rate each failure using three criteria
calculatr rpn. risk priority number
attribute vs tuple vs element in database 3a2
attribute = column (can also have constraints), and tuple = row element = cell
object databases 3a2
data are data objects. support for more data types such as web pages and video. increasingly used with web apps
ACID mnemonic for DB transactions 3a2
atomicity- transaction is indivisable
consistency - transaction meets all constraint rules (cant have date to INT field eg)
isolation - must be able to sequence simultaneous transactions- cant write at the same time write write failure
durability- must be tolerant to failure.
Key attributes of patient identifiers 3a4
unique- only one person has a particular identifier
non disclosing- no PI
permanent- never re used
ubiquitous- everyone has one
canonical - each only has one
invariable- will not change over time
Hick Hyman law HCI 3b
user response time is function of number of choices.
Buxton three state model of graphical input HCI 3b
three states of mouse-- out of range, tracking and dragging
Guiard model HCI 3b
hands are not used equally. why lefties have disadvantage given asymmetry of keys
Jakob Nielsen heuritstic list
recall vs precision
prescision = ppv = relavent / retrieved
recall = sensitivity = retrieved / relavent
enrollment standards ARRA
Enrollment Standards develops interoperable and secure standards and protocols that facilitate enrollment of individuals in federal and state health and human services programs.
NDC vs RXNorm
RxNorm is substance-oriented, i.e., the information on how many tablets are in a given NDC-identified bottle/prescription is not available for all drugs. However, it does exist for drug delivery devices, the so-called branded or generic packs.
SDLC key steps
The key lifecycle phases in the software development process include specification, implementation, iteration, and maintenance.
What three network values are required to configure a picture archiving and communication system (PACS) to accept an association from a fluoroscopic unit?
PACS hostname, application entity title, and Transmission Control Protocol (TCP) port number are three network values required to configure a picture archiving and communication system (PACS) to accept an association from a fluoroscopic unit.
What is the best source of information to locate literature closely linked to a key article
The best source of information to locate literature closely linked to a key article is references cited in the article
limited data set in 45 CFR 164.514(e)
Dates of diagnosis are allowed, even when the diagnosis is of a potentially sensitive nature (e.g. Human Immunodeficiency Virus [HIV] serologic testing).
SNOMED allows users to build more complex terms from simpler ones.
clinical informatics definition from test
Clinical Informatics best defined as the intersection of basic informational sciences with biomedical applications.
what PHI is not...
Dates consisting only of years, ages below 89, and geographical subdivisions larger or equal to a State are not considered PHI.
A formal ontology is a controlled vocabulary expressed in an ontology representation language. This language has a grammar for using vocabulary terms to express something meaningful within a specified domain of interest. The grammar contains formal constraints (e.g., specifies what it means to be a wellformed statement, assertion, query, etc.) on how terms in the ontology's controlled vocabulary can be used together. Ontologies describe concepts and relationships in programmatic ways and enable arbitrary relationships. Because ontologies describe concepts and relationships, they are somewhat like thesauri but different because there are often no preferred terms and the concepts and relationships are described in machine readable ways. This supports semantic interoperability. Thus, ontologies generally adhere to one of the standard XMLbased languages accepted by the W3C (RDF and OWL). Ontologies support "faceted" classification, where a resource is classified independently on multiple characteristics. Also, resources can be classified at any level of abstraction, so that future divisions of a class into subclasses does not mean the parent class disappears.
Constraints on the services provided by an information system are the
Constraints on the services provided by an information system are non-functional requirements.
CDA in a nutshell
Health Level 7 version 3 Clinical Document Architecture is a document markup standard that specifies the structure and semantics of clinical documents. The intent of the HL7 version 3 is to provide an on ramp for adoption of coded data and interoperability, but to preserve the original clinical meaning and to preserve clinical information in a way that is backwards compatible with legacy systems and makes information accessible to clinicians even when interoperability between systems is absent.
What is the interoperability standard source for integrating two different types of radiology information systems (RIS)
Integrating the Healthcare Enterprise published handbooks is the interoperability standard source for integrating two different types of radiology information systems (RIS)
Which organization certifies standards development in the United States
ANSI coordinates all standard development organizations (SDOs) and activities. ISO is an international organization. ANSI directs TAGs (tech advisory group) to work with ISO. NIST is a branch of the US Department of Commerce responsible for coordinating use of standards in US Government agencies.
Which of the following best addresses the challenge of accurate and comprehensive data when creating and implementing a national disease surveillance database
Quality control and error checking are crucial for users to have faith in the accuracy and comprehensiveness of the data. Encryption of data refers to privacy and data protection before the transmission of the information. Standards for data transmission address the need for developers of electronic health records and clinical databases to adopt a single standard for communicating and transmitting the information. Standards for data definitions refer to the adoption of standards for clinical terminology and for schemas used to store clinical information in databases.
The most complex network switch is a:
A network router is the most technically sophisticated switch and is capable of examining the contents of data passing through it, identifying the sender and receiver, and providing a higher level of security using the Internet protocol (IP) address.Switches provide a point of connection among devices on a network. They vary in the degree of functionality by which they manage data traffic that passes through them. The hub is the simplest and least expensive device providing passive transmission or receipt of data from one computer at a time. A bridge performs the functions of a hub and in addition can limit the sending of data to specific known hosts thereby providing a level of security. A repeater is a device that receives a signal and retransmits it at a higher level, simply extending a network.
Which one of the following Change Theories is concerned with compliance, identification, internalization, conformity, obedience, and persuasion?
Social Influence Theory is concerned with compliance, identification, internalization, conformity, obedience and persuasion.
Which of the following statements is an accurate description of an heuristic user interfaces?
An accurate description of an heuristic user interface is one that reviews the user interface against a set of design guidelines.
Which of the following is one of the five key factors associated with successful clinical information system implementation?
The five key factors are: having organizational leadership, commitment and vision; improving clinical processes and patient care; involving clinicians in the design and modification of the product; maintaining or improving clinical productivity; and building momentum and support amongst clinicians
Documents created with word processing software (e.g., Office) are widely used to transmit information from one system or entity to another. This is an example of what type of standard?
Microsoft Office is an example of a de facto standard where one company controls the industry.
barriers to negotiation
Barriers to negotiation include the following:
- Die hard bargainers
- Lack of trust
- Informational vacuums and negotiator's dilemma
- Structural impediments
- Cultural and gender differences
- Communication problems
- The power of dialogue
Which of the following is a primary goal of health information technology (IT) governance?
Health IT Governance focuses specifically on health information technology systems, their performance and risk management. It is a subset discipline of Corporate Governance. The primary goal of Health IT Governance is to assure that the investments in Health IT generate business value, and to mitigate the risks that are associated with these capabilities. This can be done by implementing an organizational structure with well-defined roles for the responsibility of information, business processes, applications and infrastructures
The preferred method for organizing laboratory information system results is:
Source-oriented EHRs organize content according to the method by which the information was obtained (Labs, Radiology reports, etc). Time-oriented EHRs organize data presented in chronological order. Problem-oriented EHRs organize data by each problem assigned to the patients (ICD, ICPC, plain text, etc). There is no formal classification of 'data-oriented' EHRs.
The Quality Data Model is an ontology for quality measurement in healthcare. The organization responsible for administering the information model is the:
What percentage of US healthcare expenditures is attributed to improper utilization of guidelines protocols and standards?
The four areas typically considered when performing an environmental scan are:
Environmental scanning can be defined as 'the study and interpretation of the political, economic, social and technological events and trends which influence a business, an industry or even a total market'. PEST mnemonic
The following are the eight leadership principles that are considered stronger, more long-term motivators than money:
1. Energize your team.
2. Exemplify that there's more to life than work
3. Put your people first
4. Act with integrity
5. Be a great communicator
6. Be a great listener
7. Be a problem solver
8. Lead through experience and competence, not through title or position
Which one of the following options best describes the elements of Managerial Accounting?
Management accounting or managerial accounting is concerned with the provisions and use of accounting information to managers within organizations, to provide them with the basis to make informed business decisions that will allow them to be better equipped in their management and control functions. In contrast to financial accountancy information, management accounting information is:
• primarily forward-looking, instead of historical;
• model based with a degree of abstraction to support decision making generically, instead of case based;
• designed and intended for use by managers within the organization, instead of being intended for use by shareholders, creditors, and public regulators;
• usually confidential and used by management, instead of publicly reported;
• computed by reference to the needs of managers, often using management information
systems, instead of by reference to general financial accounting standards.
ore generally, much of managerial accounting involves gathering information about costs for planning and control decisions. (Ref: http://sites.csn.edu/bgutschick/mgr_ch01.pdf)
Managerial accounting information is ultimately based on internal specifications for data accumulation and presentation. These internal specifications should be clear and consistent. Great care must be taken to insure that resulting reports are sufficiently logical to enable good decisions. Specific reporting periods may be replaced with real-time data that enable quick response. And, forecasted outcomes become critical for planning. Further, cost information should be disseminated in a way that managers can focus on (and be held accountable for!) their business components ("segments")
The translation of the message from your electronic health record (EHR) system using Health Level (HL) 7 v2.3.1 to the desired HL7 v2.5.1 is most efficiently accomplished by using:
Common Information Model (CIM).HL7 messaging standards are designed to have backwards compatibility. This requires transformation of messages to accommodate added fields and data elements in newer versions. Such transformation must occur at the implementation level.
Which of the specifications listed is a Standards Development Organization balloted standard?
Only the CDA specifications went through a formal ballot process. The other specifications are produced by the government (NEISS), the World Health Organization (ICD-10) and the AMA (CPT).
Which standards body oversees the development of HyperText Markup Language (HTML), Extensible Markup Language (XML), and Web Ontology Language (OWL)?
Software standards for the Internet and World Wide Web such as hypertext markup language (HTML), extensible markup language (XML) and the web ontology language (OWL) are developed and maintained by the World Wide Web Consortium, otherwise known as W3C.
Every product listed in the National Drug Code (NDC) Directory is
Neither inclusion in the NDC directory nor assignment of an NDC number is a determination that a product is a drug as defined by the FD&C Act, nor does either denote that a product is covered or eligible for reimbursement by Medicare, Medicaid or other payers. Each listed product is assigned a unique 10-digit, 3-segment number. This number, known as the NDC, identifies the labeler, product, and trade package size.
There are three basic kinds of negotiators: soft, hard and principled. Which of the following is characteristic of principled negotiators?
Principled negotiators seek integrative solutions, and do so by sidestepping commitment to specific positions. They focus on the problem rather than the intentions, motives, and needs of the people involved. They separate people from the problem, explore interests, avoid bottom lines, and reach results based on standards (which are independent of personal will). They base their choices on objective criteria rather than power, pressure, self-interest, or an arbitrary decisional procedure.
Which statement best depicts the impact of an Electronic Health Record (EHR) in legal malpractice cases?
Metadata and audit trails that supplement EHR documentation can be used to both defend and impeach a physician in a malpractice case is a true statement. Metadata is structured information that describes, explains, locates or otherwise makes it easier to retrieve, use or manage an information resource. An audit trail as a "record that shows who has accessed a computer system, when it was accessed and what operations were performed."
Which one of the following statements applies to controlled terminologies and vocabularies?
A controlled vocabulary is a list of terms that have been enumerated explicitly. This list is controlled by and available from a controlled vocabulary registration authority. All terms in a controlled vocabulary should have an unambiguous, non-redundant definition. A controlled vocabulary may have no meaning specified (it could be just a set of terms that people agree to use, and their meaning is understood), or it may have very detailed definitions for each term.
Controlled vocabularies provide a way to organize knowledge for subsequent retrieval. In library and information science, controlled vocabulary is a carefully selected list of words and phrases, which are used to tag units of information (document or work) so that they may be more easily retrieved by a search.
Massachusetts General Hospital Utility Multi-Programming System (MUMPS)
MUMPS is a programming language created in the 1960s specifically for data-driven medical applications and still in use by several healthcare organizations in the private and federal domains.
An object-oriented software application describes a class for "Patient," which represents patients in a research registry. Which of the following is an example of inheritance in object-oriented programming languages? The Patient class:
Patient class is a a subclass of Person and the basic structure of Patient is derived from the Person class, so this is an example of inheritance.
What is the primary focus of Integrating the Healthcare Enterprise (IHE)?
IHE is a member organization that promotes the use of information technology standards to solve specific complex problems of healthcare information system interoperability. It is not a standards body per se, but develops frameworks that utilize standards to solve problems.
Which of the following is the most important component in a distributed model of information technology (IT) governance?
IT governance is defined as the processes that ensure the effective and efficient use of IT in enabling an organization to achieve its goals. As it refers to Clinical IT systems, institutional governance occurs at the acquisition, implementation, sustainment and support phases. During and after implementation, it is essential that the organization maintains an EHR steering committee.
An ontology is distinguished from a terminology systems by:
Ontologies are distinguished by the use of relationships between terms
Four key components included in Strategic Planning are:
Vision, Mission, Values, Strategy
Strategic Planning is an important component of successful management for almost any organization as it goes forward. Properly conducted Strategic Planning helps the organization focus on its future to develop a strategy for moving forward, taking into account its vision, mission, and values. Health IT is no different. As noted in a HIMSS document1, "a good IT Strategy document tells a logical, compelling story about where the organization is headed and how IT will help it get there."
Which one of the following Quality Improvement programs is a combined private industry initiative?
HEDIS is a non-governmental Quality Monitoring Program supported by America's health plans. The other answers are all governmental programs.
When working with Systematized Nomenclature of Medicine—Clinical Terms (SNOMED - CT) in electronic health record (EHR) systems, the term Post-Coordination refers to:
Linking SNOMED Terminology with another terminology system.--
Which of the following strategies would most likely promote adoption of a newly planned clinical information system?
Include respected clinical leaders on the team that oversees system planning--Including on planning and/or implementation teams representative leaders from groups that will be most affected by the project is the most effective way to encourage participation and adoption of project goals.
Sensitivity is the same as
True Positive Rate
given the patient has disease what is the probability of a positive test
Specificity is the same as
True Negative Rate
given the patient does not have the disease what is the probability of a negative test
Sensitivity and Specificity are measures of
Test performance. they assume you know the DISEASE state and help determine if the test performs as intended
Positive predictive value
PPV = TP/TP+FP = A/(A+B)
Given a positive test what is the probability the patient has the disease
PPV formula contains all the positives (and P's)
Negative predictive value
NPV = TN/(TN+FN) = D/(C+D)
Given a negative test what is the probability the patient does not have the disease
NPV formula contains all the negatives (and N's)
PPV and NPV are influenced by ________ of the condition in the population
PPV and NPV assume you know _______
the test result
this is more useful in clinical practice you know the test result and you are trying to figure out the disease state
Recall is the same as ________ in information recall
Precision is the same as _______ in information recall
(Precision and PPV all with P's)
False negative rate
false negative rate and sensitivity have the N's
False positive rate
false positive and specificity have the P's
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