Computer Applications in Health Care and Biomedicine - Assignment Example

November 11, 2008. Chapter 4 Cognitive Science and Biomedical Informatics 3. What are the ways in which we can characterize the structure of knowledge? 1. Using propositions- this knowledge represented as predicate calculus and semantic networks. This knowledge can then be used to make a decision by comparing a previous situation with the current problem. 2. Using Schemata-Constructed in form of data structure to represent the different object in the brain. Such objects are like buildings and rivers. 3. Mental models- they are built to show how humans make system models. They try to answer question on how to do something or the next step to be taken after something. 4. Procedural Knowledge- it is a rule based on conditions such as if statements. The statements compare a certain condition with specific rules to come up with solutions. 6. Describe some of the attributes of system usability. 1. learnability- this attribute tries to show how it is easy for a new user learning how to use a certain interface. The easier it is to learn the more usability is ensured. 2. efficiency- This tries to measure the productivity of the user when using the system. It is assumed if usability of a system is ensured an experienced user will have a higher productivity. 3. memorability- This measures if a user uses the system for the first time if they come back if they can remember to perform those similar steps. Systems with few steps are more memorable to users. 4. errors- system should alert users while they make errors. A record saving system should alert the users if they try to save blank records. This can be done by incorporating pop up messages. 5. satisfaction- this attributes tries to measure how user gets satisfied after using the system. Systems which perform better tend to fulfill the satisfaction of users. 7. What are the gulfs of Execution and evaluation? What role do these considerations play in system design? Gulf of Execution- This the difference in the goal of the user they want to implement with the system with what the system can offer. Gulf evaluation- This evaluation if a user can tell the status of the system. It also evaluates if user can tell if the system has met their intended goal. Importance The gulf of execution enables the reduction of the difference between the user model of the system and the system models. This reduction will enable user to tell of the status of the system at any moment. Chapter 5 -- Essential Concepts for Biomedical Computing 2. Why does a computer system have both memory and storage? The memory is used for quick access of data by the processor during computation. The storage acts as a storage which enables sharing of data to different computers that can access it. The memory is required because it is faster to read from than the data storage which would waste the CPU clock rate or make it lag behind in execution. 6. What advantages does using a database management system provide over storing and manipulating your own data directly? The sharing of information is ensured even when the machine owning the data is not present. This is ensured by having the database available all the time to other machines that access right. The database management system can run from a server making it not to be affected by the switching on or off the machines. 7. How do local area networks facilitate data sharing and communication with health care institutions? In health care information needs to be shared among the different offices. Implementation of a computer system which allows for multi users can be connected to a local area network. The local area network will allow different users to access files or programs from the servers. Data sharing is enabled by having a file in the server accessed by every user with access rights. 9. How is the internet used for medical applications? The internet acts as an interconnection for multiple local area networks. The interconnected Local area networks might have medical records that need to be shared. The internet connection will ensure the sharing of information between different medical institutions. This is enabled by its ability to transfer huge amount of data. Chapter 10 -- Ethics and Health Informatics: Users, Standards, and Outcomes 3. What are examples of appropriate and inappropriate uses and users for health related software? Appropriate use is when they are used as a supplementary in clinician judgment. Supplementary is when the clinician will make an addition to the result to make it perfect. Inappropriate use is when the clinician leaves the machine to make decision without reflecting on their knowledge. This makes them take even a wrong decision to be true. Qualified licensed health professionals should use clinical systems for the knowledge they qualify in. This is a surgeon should use those machines they hold knowledge to. Inappropriate users of the system are those people who would like to use the expert system and they do not have any knowledge in the medical fields. This would lead to feeding the wrong diagnosis in the system which ends up with wrong results. 5. Why does the system evaluation involve ethical issues? The evaluation of the information systems evaluates whether the system is used in the right way or if it meets the social norms. The evaluation also looks at whether is the system is being misused which are ethical issues being illuminated. 9. What ethical issues arise at the intersection of informatics and managed care? One of the ethical issues is whether to pay an expert after carrying out a diagnosis which is later carried out by machines and seen to be wrong. The other ethical issue is whether patients should be denied treatment because the machines shows previous patients with similar characteristics did not do well under medication. Chapter 11 Evaluation and Technology Assessment 2. What challenges make studies in informatics difficult to carry out? How are these challenges addressed in practices? Challenges The different stakeholders in the information systems have different questions to be evaluated. One of the actor who is the developer will be evaluating if the system will be accepted which will be different from those of clinicians. Solution Agreement between the different stakeholders is made. This agreement is written to make it binding to the different actors of the informatics. The agreement will be representative because it will have evaluation questions from all the groups. 4. What are the major assumptions underlying objectivist and subjectivist approaches to evaluation? What are the advantages and disadvantages of each? Assumptions underlying objectivist 1. Assumption on the attributes of systems to be measured and identifying the acceptable standards by rational people. There is no predefined attributes of a system making it a every objectivist to decide on their own. 2. The assumption that when evaluators measure an information system they don’t affect the way it carries its activities. Objectivist will alter a system to fit their hypothesis which might affect the working of the system. Advantages of objectivist 1. It uses numerical data which is seen to give accurate statistical data. Numerical data can be used to produce graphs which are backed up by statistical information. Disadvantages 1. The use of hypothesis before starting research makes them not to take into consideration emerging issues as they carry their research. If they take in these changes their hypothesis might be affected. 2. Research results in scientific formulas making it hard to read. When this report is represented in a boarding meeting it has to be explained to the different people. This is because it is not self explanatory. Assumptions underlying subjectivist 1. Qualitative data can be used to make decisions similar to those made using quantitative data. Qualitative is not mostly quantifiable making hard to be accepted as a hard fact like quantitative data. 2. Individuals with different opinions about introducing system in different scenarios should not be brought to consensus. Bringing them to consensus is seen to be counterproductive. This assumption leads to arriving with multiple assessment reports. Advantages of subjectivist 1. Their investigation is always open making room to take new information that might affect their study. In future the case study might change and subjectivist do not change the case but alter their study to fit in the case. 2. Research results are written in pros form making them under stable by people without technical knowledge. Their research result when presented in a board meeting can be understood by the different people because it is written in the natural language. 10. Why is communication between investigators and clients central to the success of any evaluation? Evaluation is carried out to establish the need of the clients. These needs can only be identified by communication to the client. Systems are developed on behalf of clients and so their satisfaction should come first. Chapter 12-- Electronic Health Record Systems 1. What is the definition of an EHR? Define an EHR system. What are five advantages of an EHR over paper based record? What are three limitations of an EHR? It is information stored electronically about an individual’s life time health status to make accessible to multiple authorized users. Advantages of EHR 1. Accessibility to the records is easier not like the paper based where multiple authorization are required even if the person has rights to the records. 2. Faster retrieval not like the paper based where files have to be sorted. The EHR have a search engine within them making them fast. 3. Multiple displays of data unlike the paper based- reports can be generated in multiple forms to suit the need of the user. 4. It is cheaper mode of storage- cheapness is ensured by storing huge data in a small area unlike the file system which occupies rooms. 5. Provides integrated access to all patients’ data. Data from multiple patients is saved in one database which makes it easier to analyze. Limitations 1. Initial investment in the system is higher because it has to incorporate the cost of buying and installing the system. 2. Risk of failures which are catastrophic causing loss of almost all the data or denial of service to all people depending on the system. 3. Takes a lot of physicians time because they have to record the data immediately it’s given by the patients. Physicians who are not fast enough might end up serving few patients in a day. 5. Would a computer scan of a paper based record be an EHR? What are two advantages and two limitations of this approach? It can be a record because once it is saved a report can be reproduced from it. Advantages 1. Eliminate the problem of accessing paper based records because the scanned image can be accessed through any computer. 2. Eliminates the need of the clinicians carrying out manual data entry which is cumbersome. Disadvantages 1. It is hard to search the scanned data leading to need of developing an abstraction which takes longer time than normal search. 2. They occupy huge storage space unlike typed data. This because they take a lot bits in the memory location leading to quick fill up of the memory. 6. Identify four locations where clinicians need access to the information contained in an EHR. What are the major costs or risks of providing access from each of these locations? 1. Billing desk- This is where patients pay their medical bills. The risk is the billing person might deviate information a Doctor had saved about a patient to outsiders. 2. Pharmacy desk-The pharmacist might misread the prescription of one patient to belong to another. 3. Diagnosis room- The risk is the time taken to attend to a patient might increase leading to a longer queue of patients. 4. Reception desk- the risk of the receptionist diverting some of the patients details for personal use. 8. What are three important reasons to have physicians enter orders directly into an EHR system? 1. The direct entry eliminates chances of error existing in data unlike in dictation where the notes have to be error checked and signed. 2. The data can be checked with a previous stored record and also suggest questions that the physician should ask the patient. 3. Need of hiring extra people to do the data entry is eliminated. These extra people add the cost to the institution because of their salaries and allowances. What are three challenges in implementing such a system? 1. Change in working environment might be taken negatively by different workers. These workers have to be convinced the system is for their benefit. 2. Clinicians might reject using the system making it useless. If the system is not used in carrying out the activity stipulated then it is of no importance to the institution. 3. Training and hiring of experts to enable the institution take up the new system. This training becomes a challenge to the administration. Chapter 13 -- Management of Information in Healthcare Organizations 4. What are the clinical, financial, and administrative functions provided by a healthcare information system (HCIS), and what are the potential benefits of implementing such a system? The HCIS provide data about the day to day running of the clinic to the administrators to enable them make long term and short term decisions. The system performs the financial purpose of automation of patients billing, payroll management and inventory management. Clinical functionalities it helps in integration of the all the clinical data. Benefits 1. There is cost reduction in running the clinic. This ensured by automation of most managerial activities. 2. Improved service delivery to the different clients by improving quality of services. Systems are seen to provide uniform services to the different clients who are satisfied by them. 3. Reduction in time taken to serve each client making service delivery faster. This reduction ensures more patients are served in a day which is a positive image to the institution. 5. What are the major challenges to implementing and managing healthcare information systems? 1. Whether information management should be centralized or decentralized to the different department in a hospital. Centralized system will be run from one office while decentralized once will be run from different offices making sure employees are employed for each office. 2. Allocation of the institution limited resources to the different projects. The systems have to be purchased and administrators have to make choices whether to commit funds on them. 6. How are ongoing healthcare reforms, technological advances, and changing social norms likely to affect HCIS requirements in the future? Health care reforms are making hospital to take up more use to HCIS and increase more budget allocation on their development. Technological advances might lead to some of the systems becomes obsolete before they are implemented. Changing social norms are leading to need of improvement in system to one that will replace the traditional diagnosis of patients by it being carried in homes. Chapter 14-- Computer Health Informatics and Telehealth 1. What factors contribute to the increasing pressure for lay people to actively participate in health care? To reduce the cost of visiting the doctor every time lay people have to carry out some activities at home and send the data to the doctor for analysis. This eliminates need of them paying fare to visit the doctor. 2. How does direct access to health information technologies assist patients in participating in their own health care? Patients can eliminate fears they have and also get the correct medication for their illness without having to visit a health facility. 4. How can lay people determine the value of a telehealth innovation such as a health related Web sit or an on-line disease management service? The website should be credited or certified by recognized health bodies. This ensures that the innovation is under professional review every time. The accredited body will also ensure no incorrect data is on the site. Chapter 15 --Public Health Informatics and the Health Information Infrastructure 1. What are the three core functions of public health, and how do they help shape the different foci of public health and medicine? 1. Surveillance –it will display changes in patterns of certain illness. It shapes the foci of medicine by leading to development of new medicine to tackle this new illness. 2. Provide information on prevention of diseases to avoid a situation where corrective measure is being found after the disease takes toll. This help in developing immunizations. 3. It helps in ensuring population health eliminating individual focus on health issues. The population health will enable in planning for all the people in an area. 4. What is the vision and purpose of the National Health Information Infrastructure? What kinds of impacts will it have, and in what time periods? Why don’t we have one already? What are the political and technical barriers to its implementation? What are the characteristics of any evaluation process that would be used to judge demonstration projects? The goal is to provide good health care by using information technology. The impact will be institution will align their visional and objectives with the national governments making it comprehensive. The lack of one is because each institution is developing its own health information infrastructure which cannot be used in another institution. This leads to lack of one formalized national health. The political barrier is that federal governments are not taking it up in their areas. Their rejection makes it hard for other institution to come up with a comprehensive infrastructure. Evaluation should be tailored towards different strategies on their characteristics because no one strategy resembles another. Each strategy has some unique characteristics which must be evaluated. Chapter 16-- Patient-Care Systems 2. What are the four major information management issues in patient care? 1. Coordination of care given to a patient by multiple caregivers is a challenge. Each care taker gives some instruction to the patient which have to be coordinated to see if they have effect on the patient. 2. Coordination the giving of care to different patients dispersed in different locations is also a challenge to the care giver. Care takers sometime have to attend to patients in different location in the health centre. 3. Caregivers have to take into consideration the activities of other caregivers in service deliver to ensure effectiveness and efficiency which is a hard activity. 4. Each care taker is responsible of managing multiple patients making it hard to plan on each patients need. The different patient may require medication or help of the care taker at the same time which is a challenge. 3. How have patient care systems influence the process and outcomes of patient care? They have led to improvement on coordination on services delivered to the different patients at different time. This through have alert message of when patients should visit the doctor, take medication or attend an x ray. This reduces the workload on the caregivers. 4. How can they be differentiated from the computer based patient record itself? Patient care systems help physician make decision on care to be provided on a patient. It carries record of physician’s prescription on a patient and steps to be taken to ensure patient well being. The patient’s record contains historical data about patients which can be used to generate reports. Chapter 17 -- Patient-Monitoring Systems 1. What is patient monitoring and why is it done? It is the continuous measurement of health status of a patient. This can be done by measuring blood sugar levels, heart beat rates and salts in the urine. It is done to provide timely information on critically ill patient. 5. What are the important issues for collecting high-quality data either automatically or manually in the intensive care unit? This will help management in knowing when to make critical decision in the intensive care unit. The data will show when these patient is not responding to medication. They are required because patients cannot express themselves. 6. Why is integration of data from many sources in the hospital necessary if a computer is to assist in critical-care-management decisions? It can display life threatening conditions on patients which will be averted as quickly as possible. This is noted faster than how a human being would do it. Chapter 18 -- Imaging Systems in Radiology 1. Describe the various factors that a planner must consider when estimating the storage requirements for image data in an all-digital radiology department. What are the major factors that reduce the volume of data that are maintained in on-line storage? 1. Contrast and resolution required on images stored. Images with higher resolutions tend to occupy a bigger space. 2. The number of images to be stored. The bigger the number of images the bigger the storage space. 3. Whether the department will use data compression technologies. These technologies allow for reduction of the size of the image making storage to carry many images. Factors that lead to reduction of online images 1. The cost of buying the storage space for all the images is very high making institutions to have just a sample of the total images online. 2. The backing up of some images in local storages eliminating need of storing them on storage space accessible online. 3. What are the economic and technological factors that determine how quickly hospitals and clinics can adopt all-digital radiology departments? The development of radiology equipments which are easy to use by providing clear images will encourage the adoption of radiology. These developments have also to be cost effective to make them affordable on part of institutions. 4. What are the ways in which radiology reports of examination interpretations can be generated, and what are the advantages and disadvantages of each approach, in terms of ease and efficiency of report creation, timeliness of availability of report to clinician’s usefulness for retrieval of cases for research and education? Free text-this is where radiologist writes a report may be by dictating on a free text. Advantage Radiologist writes a report in the structure suitable for the current situation but not with a pre defined structure. The system provides fill up spaces limiting the information filled. Disadvantage The report cannot be accessed quickly if they are many reports produced in a single day. This is because they are pilled in forms which do not have an easy search way. Structure report This where a radiologist writes a report following a certain well defined structure may be guided by a system. Advantage Searching and retrieving of reports by clinicians is easy because of indexing. The indexing of the images makes sure search is done referring to the index but not the whole image making it fast. Disadvantage It limits the details the radiologist provides on the report. The report left out might be of great importance in future but it is left out. Chapter 19 -- Information Retrieval and Digital Libraries 2. What are the major components of the information retrieval process? 1. Acquisition of the information from the different sources. It can be retrieved from online journals, books or databases. 2. Organization of information in an under stable manner. Structural arrangement of data is a requirement to enable easier retrieval. 3. Searching of specific information from the gathered information- searching enable clinicians locate different information with typing some words in the search engine. 5. How effectively do searches utilize information retrieval systems? The development of huge databases to hold huge information led for a need to have a way of searching specific data. Search reduces the time taken to retrieve certain information. Searches can utilize indexing of the data to make it faster. 7. What are the major challenges to making digital libraries effective for health and biomedical users? 1. Making decision on quality of data accessed online because of multiple opinions. People might give contradicting opinion. 2. The medical journals not adopting to open online printing. This makes accessibility a problem because they have to be accessed through the traditional way. Chapter 20 -- Clinical Decision-Support Systems 1. What are the three requirements for an excellent decision making system? 1. They should provide an interface that is understable to the users. This make easier for user to use it and tell the status of the system. 2. They should allow easier access to encourage users to use them. Easier accesses encourage memorability of the system by frequent users. This user will come back because they are sure how to carry a certain activity. 3. They should give high quality decisions to the users. Correct decisions will make users continue using the system. Correct decision reduces the stress users have to go through to make a decision. 3. How has the use of computers for clinical decision support evolved since the 1960s? In the 1960 and 1970 decision support systems were not widely used and were viewed with skepticism. After this period, pressure to health providers to provide cost effective services make them start agreeing to use the decision support systems. 5. What influences account for the gradual improvement in professional attitudes toward use of computers for clinical decision support? The professional in medical fields are held for negligence for a wrong decision they made and it would have been made correctly by the decision support system. To limit their liability they use the decision support systems. 8. What are the principle scientific challenges in building useful and acceptable clinical decision-support tools? 1. Representation of the medical experts’ knowledge in the system is a problem. Knowledge base has to be fed with knowledge how physicians carry out their activities. Representing this knowledge as rules is a problem to programmers. 2. Validating of the huge amount of data to make it up to date because of many changes taking place in medical field. Data has to be kept up to date every time making to prevent the system from becoming obsolete. Chapter 22 – Bioinformatics 3. What are two problems encountered in analyzing biological sequence, structure, and function? 1. Researchers carrying out the analysis have a problem of predicting structure of proteins. 2. The analysis of genomics is a challenge and also gene finding. 4. How has the age of genomics changed the landscape of bioinformatics? It has allowed deciphering of information on its study to see how genomes affect human beings. Accurate detection and genotyping which is enabled by analyzing the protein structure of cells. 6. What are two computational challenges in bioinformatics for the future? 1. Construction of models to represent the different biological structures and their DNA make up. Some protein DNA structures have a higher complexity than others making them hard to incorporate in models. 2. The high speed scientific researchers are providing new information. This research is revealing new information each day which has to be represented in Bioinformatics. This change is becoming a challenge to incorporate all of it. Chapter 23 -- Health Care financing and Information Technology: A Historical Perspective 2. How has healthcare financing influence the development of health care information technology? Health care financing was open ended making the cost to rise quickly. This led to need of controlling and reduce the cost of health care. The budget spending on health care was increasing each year and to control this technology was involved. 4. How have employers and managed care organizations acted to improve health care quality and health care spending? Employers have taken insurance cover for their workers. This is seen to be cheaper because of the collective bargaining by the large number. Employers are also taking the option of insuring their own workers to reduce on the cost of health care. 6. How can health care information systems help health care institutions to respond to the changing financial environment? The changing financial environment necessitates the reduction of cost of offering health services. Information systems can automate most services in health centers reducing on cost. This is necessitated to reduce the stress on health care workers. Chapter 24 -- The Future of Computer Applications in Biomedicine 3. Define or refute the following proposition: “Knowledge based clinical statements will be widely used and generally accepted by clinician users within the next 5 years.” The knowledge based clinical statements are expected to reduce the workload on clinician. They will also reduce the time they take to make decisions. Decisions made with these systems are also correct always. These positive factors will make clinicians in the future to accept the knowledge based system. This is also supported by great take up of technology from 1990 to today such as using sophisticated tools to perform surgeries. References Shortllife, E and James Cimino. Biomedical Informatics: Computer Applications in Health Care and Biomedicine. New York: Springer, 2006. Read More