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Health Informatics Assignment Week 16 to 18

Week 16 Questions


Questions for Discussion

  1. What is the utility of a linear model of patient care as the basis for a decision-supportsystem? What are two primary limitations? Discuss two challenges that a nonlinear model poses for representing and supporting the care process in an information system?
  2. Compare and contrast “segregated” versus “integrated” models of interdisciplinarypatient care. What are the advantages and disadvantages of each model as a mode of care delivery? As the basis for developing information systems to plan, document, and support patient care?

    Answer:

    Gender segregation due to cultural issues, missing partners college students, lack of school designation, devoted employees, and lack of expert accreditation and expert improvement of IPE educators were obstacles. The configuration of the fast music region can vary appreciably ranging from specific get admission to to two booths to a specially designed and segregated treatment vicinity. Research finished in segregation likely can benefit from higher infrastructure. Ultimately, without collaboration, some research may additionally bring about bad-satisfactory research. Incorporated systems—nonetheless a really perfect these days—might beautify our information of each affected person’s scenario and desires, improve choice-making, facilitate communications, resource coordination, and use clinical facts to offer remarks for improving medical approaches. Sincerely, whilst patient-care data structures fulfill their capacity, they may now not simply update oral and paper-based totally methods of recording and communicating. A few these days developed structures offer a few degrees of coordination of the records and offerings of the various medical disciplines into integrated information and plans. Facts amassed by way of one caregiver can seem, in all likelihood in a changed representation, inside the view of the affected person document designed for another area. Whilst care-planning information has been entered by way of more than one caregiver, it can be regarded because the care plan to be achieved by a subject, with the aid of a character, or via the interdisciplinary crew. Many healthcare companies have enormous funding in legacy systems and cannot certainly transfer to more contemporary technology. To make the transition from a patchwork of structures with self-contained capabilities to without a doubt incorporated structures with the capacity to meet rising information needs is even more hard. The volume to which the findings can be simply generalized to help coverage hints is open to discuss, as the to be had proof comes from some of exclusive countries, with a diffusion of health device systems, company, financing and shipping modes. It is difficult to control for those factors. Modifications observed may be attributable to factors together with health device financing or health practitioner behavior in preference to wherein and by using whom the care is delivered. Disaggregating the impact of these elements from the domain, fitness expert, or shipping mode is tough. Moving evidence or care models from one setting to some other without a clear understanding of the context and fitness gadget dynamics can produce unintentional consequences.

  3. Imagine a patient-care information system that assists in planning the care of eachpatient independently of all the other patients in a service center or patient-care unit. What are three advantages to the developer in choosing such an information architecture? What would be the likely result in the real world of practice? Does it make a difference whether the practice setting is hospital, ambulatory care, or home care? What would be the simplest information architecture that would be sufficiently complex to handle real-world demands? Explain.
  4. Zielstorff et al. (1993) proposed that data routinely recorded during the process ofpatient care could be abstracted, aggregated, and analyzed for management reports, policy decisions, and knowledge development. What are three advantages of using patient care data in this way? What are three significant limitations?
  5. A number of patient-care information systems designed in the 1970s are still in use.How do the practice models, payer models, and quality focus of today differ from those of the past? What differences do these changes require in information systems? What are two advantages and two disadvantages of “retrofitting” these changes on older systems versus designing new systems “from scratch”?

    Answer:

    Early ambulatory-care systems most often included paper-based totally, affected person come across bureaucracy that had been either computer-scannable mark-sense format or were subsequently entered into the pc by way of clerical personnel. Current computer, pc, or hand-held structures use keyboard, mouse, or pen-based access of structured statistics, with unfastened textual content kept to a minimal. These structures additionally provide for retrieval of reports and past records. Some structures provide decision guide or alerts to remind clinicians approximately wished care, including immunizations or screening examinations, and to keep away from contraindicated orders for medications or pointless laboratory analyses. Depending on network skills, systems may facilitate communications many of the professionals and settings involved within the affected person’s care. Voice-reputation technology is advancing and is starting to allow direct dictation into the document. Before dictated notes can grow to be as beneficial as dependent facts, the entry systems will need to emerge as capable of apprehend the meanings of phrases and their context and to keep the records in databases. Even though this level of clever processing of herbal language remains within the destiny, systems to support ambulatory care have simply made superb strides. Th quality provide properly guide for classic hospital therapy. Assist for complete, collaborative care that offers as plenty attention to fitness advertising as to treatment of sickness gives an assignment no longer best to the developers of information systems but additionally to practitioners and healthcare administrators who have to explicate the nature of this exercise and the situations beneath which groups will provide it. Affected person-care data systems in use nowadays constitute a huge variety within the evolution of the sector. Versions of a number of the earliest systems are still in use. Those structures have been normally designed to speed documentation and to increase legibility and availability of the records of patients currently receiving care. Maximum lack the capacity to aggregate facts throughout sufferers, to question the facts approximately subsets of patients, or to use facts amassed for clinical functions to fulfill informational desires or administrators or researchers. Greater lately evolved systems strive with varying success to reply to the edict 'collect once, use many times.' selected items of information from affected person records are abstracted manually or electronically to mixture databases in which they may be analyzed for administrative reviews, for first-rate improvement, for scientific or health-offerings research, and for required affected person protection and public fitness reporting. A few lately evolved structures provide a few degrees of coordination of the records and services of the diverse scientific disciplines into incorporated records and plans. From a fee-advantage factor of view, that physicians would be the pleasant humans to have on the keyboard. Every other gain is that it is a great deal fee-effective. The negative aspects may additionally encompass that the older machine is probably extra susceptible to insects. Nevertheless, there is issues with conventional processes to automating paper-based totally care-planning structures that resulted in lack of facts element, lack of ability to use information for multiple functions, and barriers inside the potential to mixture and question patient data.

  6. What are three advantages and three disadvantages of free text (including oral narrative entered by dictation) versus structured data for recording observations, assessments, goals, and plans? What is the impact of using free text on the ability to retrieve and aggregate data? Should developmental efforts focus on interpreting natural language or on creating data standards? Explain your position.
  7. What are four major purposes of patient care information systems? What criteriashould be used to evaluate them? What methods of evaluation could be used to assess the system with respect to these criteria?

Week 17 Questions


  1. Describe how the integration of information from multiple bedside monitors, the pharmacy, and the clinical laboratory can help to improve the sensitivity and specificity of the alarm systems used in the ICU.
  2. What factors must you consider when deciding when and how often a physiological, biochemical, or observational variable should be measured and stored in a computer’s database?

    Answer:

    Digital transmission of statistics is characteristically noise-unfastened. As an end result, more modern monitoring structures allow fitness-care professionals to study the affected person's waveform displays and derived parameters, along with heart rate and blood pressure, at the bedside, as a vital station within the ICU, or at home through modem on a laptop. Physiological measurement includes the direct or oblique observation of variables because of normative functioning of structures and subsystems inside the human body. The equipment and strategies of this method are various, but all are based on empirical remark. The variables found are derived from the measurable residences and capabilities of the biological structures and subsystems. In people, this includes phenomena inclusive of coronary heart rate, blood pressure, cortical division, and biochemical markers. In isolation, such variables are not particularly informative to conversation students. But, when paired with the social, behavioral, and mental elements related to communique, they can provide profound insights into human perception and conduct. Physiological measures are those that involve recording any of an extensive form of physiological procedures, along with heart rate and blood stress, galvanic skin response, hormone stages, and electrical hobby and blood flow inside the mind. Continuous size of physiological variables has emerged as an ordinary part of the monitoring of severely ill patients. At the equal time that advances in tracking have been made, foremost modifications within the therapy of lifestyles-threatening issues had been additionally going on. Spark off quantitative evaluation of measured physiological and biochemical variables became essential inside the decision-making system as physicians carried out new therapeutic interventions. As an instance, it is now possible and in many cases important to apply ventilators when the affected person cannot breathe independently, cardiopulmonary device whilst a patient undergoes open-heart surgical treatment, hemodialysis whilst the affected person’s kidneys fail, and intravenous (IV) nutritional and electrolyte (e.g., potassium and sodium) assist while an infected person is unable to eat or drink. Physiological signals inclusive of the ECG are derived from sensors that convert organic signals (which includes stress, drift, or mechanical motion) into electrical alerts. In modern automatic monitors, these indicators are digitized as close to the patient as feasible. It can be finished through continuously measuring certain parameters by using a medical reveal (as an example, via constantly measuring crucial signs by way of a bedside reveal), and/or through time and again performing medical assessments (consisting of blood glucose monitoring with a glucose meter in humans with diabetes mellitus).

  3. You have been asked to design part of an electronic exercise bicycle. Sensors in thehand grips of the bicycle will be used to pick up transmitted electrical signals reflecting the rider’s heart activity. Your system then will display the rider’s heart ratenumerically in a liquid crystal display (LCD).
    1. Describe the steps your system must take in converting the heart’s electrical signals(essentially a single ECG lead) into the heart rate displayed on the LCD.
    2. Describe how computerized data acquisition can be more efficient and accurate than manual methods of data acquisition.

Week 18 Questions


  1. Describe the various factors that a planner must consider when estimating the stor-age 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?

    Answer:

    For a computer hard disk the best place to store vast volumes of data is. It is a form of external hard disk connecting to the PC through USB. Someone could then place a backup of all documents on this and shift the hard drive to a fully separate, protected position to where the device is stored. The creation and extensive acceptance of digital era in clinical imaging has led to an exponential growth in the quantity of facts produced through the radiology department. There may be an insatiable want for storage space to archive this ever-growing quantity of photo records. Healthcare centers must plan the kind and size of the storage media that they wanted, based totally now not simply on the quantity of information but additionally on considerations which includes the rate and simplicity of access. Imaging strategies inclusive of CT experiment and MRI, which can be based totally on virtual generation, were brought and feature observed great utility in medical imaging. As the blessings of virtual images have become apparent, imaging modalities which have historically been analog primarily based have also began evolving into virtual systems. Further to pics from the radiology department, large portions of statistics from the cardiology branch or different imaging facts which include clinical snap shots and microscopic and endoscopic pix additionally find their manner into the image database. For that reason, as hospitals circulate towards a filmless, paperless surroundings, there will be a never-ending call for virtual garage area. The creation of image archiving and communications systems (percent) for archival, migration, and show of virtual images has resulted in multiplied productivity by expediting photograph-based totally workflow. The facts storage device is the coronary heart of that gadget and, most often, its most expensive factor. A dependable statistics storage gadget with a massive potential, which presents on the spot get admission to the entire imaging archive with minimum operator intervention, forms the muse of any set up. We shall evaluate the numerous sorts of media which are available for storage of photo statistics inside the P.C. Environment. Garage may be classified as online, nearline, and offline. Online garage refers to statistics storage on magnetic discs and redundant array of cheaper discs (RAID) systems. It gives get right of entry to the information in a few milliseconds. As this kind of storage is costly, pictures that do not require on the spot get right of entry to are stored in nearline storage. Gadgets which include magnetic tapes and optical jukeboxes are used for this form of garage. Offline garage media consist of magnetic tapes and optical discs which are saved someplace else. This kind of garage is normally used for lengthy-term storage and for storing returned-up facts. The magnetic disc (hard disc drive) gives the fastest way to shop and get admission to big amounts of statistics. The records are physically stored by inducing magnetic moments on a ferromagnetic disc as it's miles spinning. Redundant array of less expensive discs (RAID) is a chain of tough discs plugged collectively using shared common sense to behave like a single massive disc. It goals to gain a massive records storage potential with better input/output capability, while minimizing cost and maximizing reliability by using the use of redundancy of facts. Information is subdivided into more than one consecutive segment which are dispensed over several physical discs by way of a quick controller card. The information may be mapped the use of various patterns so one can gain numerous stages of velocity, ability, and safety in opposition to data loss. RAID configurations which are typically hired consist of RAID degree 0, RAID level 1, and RAID level five. Some of small hospitals and imaging centers still use this medium for archival. Most optical media such as CDs and DVDs are reasonably-priced and can be examine in maximum personal computers without the want for extra devoted disc drives. The essential negative aspects of optical media are the exceedingly low potential in keeping with disc, low records switch fees, and negative reliability. These discs are unprotected and are liable to physical harm and statistics loss. Magneto-optical discs provide better storage capacities but are slower in writing and having access to information. Magnetic tape affords the cheapest option for storing massive quantities of facts. It has better readout speeds than optical and magneto-optical media. However, on the grounds that statistics is read from the tape the use of sequential get admission to (while information readout from magnetic discs is by means of random get entry to), identity of person scans and sufferers is typically a lot very sluggish. Of late, magnetic tapes are getting used most effective as media for offering offline backup of facts. Conventional archives had been primarily based on a three-tier structure, with speedy, low-ability garage for on-line storage; reasonably fast, huge-ability garage for nearline garage; and a slower device with very massive ability for offline garage and backup. Lowering costs of magnetic disk storage have made the use of RAIDs increasingly famous. A software program utility defined as hierarchical garage management (HSM) robotically manages the migration of information among the online database and long-time period storage. The period for which medical facts and imaging statistics must be stored is dictated by using clinic regulations and neighborhood criminal requirements. Thinking about that the fees of magnetic disc-based totally garage will continue to fall, it could be prudent to maintain adding additional garage space as the want arises. Durability of the archiving technology must also be kept in thoughts. All storage devices are susceptible to failure over the long term. As percent era continues to adapt, more recent architectures and garage media are being experimented with, inside the attempt to provide faster and more efficient and fee-effective archival systems.

  2. Refer to Table 18.1. How many bytes are needed to store a digitized chest X-ray image? How many bytes are needed to store a 15-image CT study? If you have a com-munication line that transmits 56,000 bits per second, how long will it take to trans-mit each of these images to the display workstations within the hospital? What are the implications of your answer for widespread transmission of image data?
  3. What are the economic and technologic factors that determine how quickly hospitals and clinics can adopt alldigital radiology departments?
  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 clini-cians, usefulness for retrieval of cases for research and education?

    Answer:

    Workflow management in a radiology department is an intricate activity which involves not just the maintenance of the film library and the electronic database as well as the planning of assessments, appointment scheduling, investigation and assessment of radiology studies, perception formation, translation of controlled reports, production of radiology reports to reference physicians and the services supplemented upon billing. Additionally, department managers must acquire and evaluate process control and investment information in order to plan budgets, make reasonably informed choices about personnel rates and the procurement of special equipment, and discuss problems, like overly massive groups of photo captures, many such demands for mobile or immediate analysis, unreasonable waiting times for patients, poor picture quality and unnecessary delays in the recording of reports or signatures. Many essential management styles include inventory management, quality management, radiation levels tracking and routine maintenance coordination. It is advantageous to publish understandings utilizing specific methods that express research results in datasets to promote the extraction for scientific studies. It also manages to avoid the translation and consequent encoding / signing requirements. For several decades constructed monitoring using computer communication has indeed been investigated. The idea here seems to be that radiologists would write reports by combining prestored sentences, while enhancing the use of phrases with limited free-text keyboard as well as while doing voice entry. In other types of tests, individuals could have used prototypes that imitate standard report templates, which could then be customized, and then they could probably write de novo reports by choosing phrases via centralized or alphabetic menus. For instance, this technique has been successfully used in certain fields, in obstetric ultrasound, whereby collected data on fetal size may be increased and in case of other types of tests, individuals could have used prototypes that imitate standard report templates, which could then be customized, and then they could probably write de novo reports by choosing phrases via centralized or alphabetic menus. For instance, this technique has been successfully used in certain fields, in obstetric ultrasound, whereby collected data on fetal size may be increased. Published reporting on radiology is the most important aspect of a radiologist 's work. This is the systematic recording and communication of the results of a radiological test or procedure. The reports are usually dictated by a trained radiologist but the style, format, and effectiveness of reports may vary greatly. A major cause of radiology litigation is lack of results in order to effectively communicate with each other. Being radiologists, it is necessitated to peep over the issues with renewed intelligence. Main problem with radiology reports occurs since we don't really realize how hard this documentation has become in the carer who is not a radiologist. This delay seems to be more plausible when one knows that many other important textbooks on radiology don't really discuss the topic of the structure of the study. These careers take a lot of time to collect information and data and then disclose that the material shall be written in the form of which is in the interest of the reader. Poor communication is an important excuse patient like to prosecute their physician. For other cases, just like mammograms, it is beneficial to send the patient a copy of the report immediately, thereby making it much more crucial that perhaps the document is transparent and intuitive. To get direct communication, the radiologist ought to be informed of the report's intended audience and whether that individual can interpret what's been written. The reader including its radiology report is quite frequently the person responsible for delivering appropriate treatment to patients. The radiology report could provide important information for medical safety; however, these results will only be beneficial if the reader comprehends the information what is written. The art and technology of deciphering radiologic examinations, an ability that is received over years of training, is on show in every radiology record. It's miles critical that these reviews be crafted in an effort to each mirror the radiologist’s understanding and capability and do away with any elements that might result in accidental harm to the affected person. Unfortunately, a poor file may also result in felony motion against the radiologist; therefore, a radical knowledge of the litigious ability of the language used in radiology reviews is important. It's miles essential that ambiguous vocabulary, undefined modifiers, double negatives, and generalizations be prevented. Errors in radiology reports may also end result from irrelevant terminology, transcription errors, or poor or inadequately documented communique. Vital findings that may have a direct impact on patient control have to be promptly communicated to the referring health practitioner and such communication completely documented. A meticulous and properly-written record is the satisfactory way for radiologists to take care of their patients. Similarly, a well-worded file can be the finding out thing in a success defense against a malpractice declare. Expertise the felony implications of radiology reports will permit radiologists to broaden techniques for fending off malpractice suits. Errors in radiology reviews can also result in complaints for plenty distinct reasons. Inappropriate wording and incorrect terminology may additionally result in wrong impressions, resulting in patient mismanagement. Transcription errors may completely regulate a record, although the error is restricted to a unmarried word. For example, no proof of acute appendicitis may be erroneously transcribed as proof of acute appendicitis, probably ensuing in useless surgical operation. The importance of proofreading one’s reports cannot be overestimated. Inadequate communication or even inadequate documentation of suitable communique (which include suitable tips) within the final report may additionally bring about grievances.

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