Chapter 1 Clinical Informatics

Question 1

Flexner Report

Answer 1

-Released in 1910
-Chastised American medical education for having lax admission and graduation criteria and for not adhering to established principles of science
-Had tremendous impact on medical education
-Small medical schools closed, clinical teaching in hospitals now under control of medical schools, requirements for medical licensure became stricter

Question 2

International Classification of Causes of Sickness and Death

Answer 2

-1910
-Published in US
-Became shortened to International Classification of Disease

Question 3

MUMPS

Answer 3

-Massachusetts General Hospital Utility Multi-Programming System
-AKA M
-1970
-Specialized health care programming language that was dominant platform for hospitalized-based application development
-Hospital Information System (HIS) was huge application run on 1 mainframe computer with many terminals for time-shared access

Question 4

CPT

Answer 4

-Current Procedural Technology
-First released by American Medical Association (AMA)
-1966

Question 5

Personal Computers

Answer 5

-Came into market in 1980s

Question 6

HITECH Act

Answer 6

-Health Information Technology for Economic and Clinical Health Act
-2009
-Part of American Recovery and Reinvestment Act
-Established “meaningful use” of electronic health records
-Listed total of 25 capabilities EHRs were expected to have
-Offered cash awards for implementing certified EHR technology (certified by Office of the National Coordinator ONC)
-Managed by the Center for Medicare and Medicaid Services (CMS)
-First stage 2011-2012: data capture and sharing, divided into core requirements and menu options (e.g., Computerized Provider Order Entry, medication lists, drug-drug or drug-allergy checks, clinical decision support, provide patient copies of medical record and discharge instructions)
-Second stage 2012-2014: improve clinical processes (upgraded thresholds from Stage 1, track medication orders like bedside barcode scanning, electronic transmission of medical record in Consolidated Clinical Document Architecture, eRx, and recording progress notes)
-Third stage 2016: improve outcomes, will be replaced by Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (known as MACRA) with 8 requirements
=PHI (risk analysis to identify vulnerabilities that lead to breaches of PHI), eRX, CDS, CPEO, Patient Portal, Patient Engagement, HIE, Public Health

Question 7

Clinical informatics (definition)

Answer 7

-application of informatics to delivery of health care services

Question 8

Clinical research informatics (definition)

Answer 8

-management of information related to clinical trials or secondary research use of clinical data

Question 9

Consumer health informatics (definition)

Answer 9

-analyzes information from perspective of health care consumes (health literacy, patient education, access to personal records)

Question 10

Public health informatics (definition)

Answer 10

-health of communities (surveillance, prevention, preparedness, health promotion)

Question 11

Translational bioinformatics

Answer 11

-translation of large amounts of data into smaller chunks

Question 12

American Health Information Management Association (AHIMA)

Answer 12

-Primary goal is to provide the knowledge, resources and tools to advance health information professional practice and standards for the delivery of quality healthcare

Question 13

Healthcare Information and Management System Society (HIMSS)

Answer 13

-Global, cause-based, not-for-profit organization focused on better health through information technology

Question 14

American Medical Informatics Association (AMIA)

Answer 14

-Represents healthcare providers
-Was driving force in creating the ACGME certified fellowships and board exams in Clinical Informatics

Question 15

American Nursing Informatics Association (ANIA)

Answer 15

-Represents nurses

Question 16

Health Level Seven International (HL7)

Answer 16

-Not-for-profit, American National Standards Institute (ANSI)-accredited standards developing organization
-Dedicated to providing a comprehensive framework and related standards for teh exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery, and evaluation of health services

Question 17

DIWK framework

Answer 17

Data-Knowledge-Information-Wisdom framework
-Data: single measurement in time
-Information: series of data points, data with context, answers who what when and where questions
-Knowledge: analysis of information, answers why or how
-Wisdom: appropriate use of knowledge to manage and solve human problems, implies ethical considerations

Question 18

Technology Informatics Guiding Education Reform (TIGER) Summit

Answer 18

-Competencies in informatics
-Computer competency: how to use computer technology to accomplish task
-Information literacy: recognize hat information is needed and how to obtain it
-Informatics management: process of collecting, process, presenting/communicating data

Question 19

Nursing Informatics Pyramid

Answer 19

-After Schwirian model
-Raw data -> Technology -> Users -> Goal

Question 20

Primum non nocere

Answer 20

-Latin phrase means “first, do no harm”
-In clinical informatics: the cardinal sin is inappropriate disclosure of personal information

Question 21

Privacy

Answer 21

Right of an individual to control disclosure of his personal information

Question 22

Confidentiality

Answer 22

Responsibility to protect information

Question 23

Security

Answer 23

set of policies and procedures which safeguard the integrity of information systems

Question 24

Broad categories of inappropriate disclosures

Answer 24

(in decreasing order of occurrence): Insider accidental disclosure, insider curiosity, insider criminality, outsider criminality

Question 25

Non-malfeasance

Answer 25

Do no harm

Question 26

Autonomy

Answer 26

patient’s right to make his own decisions

Question 27

Beneficence

Answer 27

Provider should only act in best interest of the patient

Question 28

Justice/equality

Answer 28

fair distribution of limited resources

Question 29

Dignity

Answer 29

Patients have a right to be treated respectfully

Question 30

Honesty

Answer 30

Providers must be completely truthful with their patients at all times

Question 31

Integrity

Answer 31

Person should fulfill their obligations to the best of their ability

Question 32

Integrity

Answer 32

Person should fulfill their obligations to the best of their ability

Question 33

Patient Protection and Affordable Care Act

Answer 33

-PPACA, also known as Obamacare
-2010
-Intent to decrease number of Americans without health insurance
-By creating state-wide insurance exchanges, and increase eligibility for Medicaid
-Encouraged formations of Accountable Care Organizations (ACOs) which would be reimbursed based on achieving certain benchmarks in patient care

Question 34

Patient Protection and Affordable Care Act

Answer 34

-PPACA, also known as Obamacare
-2010
-Intent to decrease number of Americans without health insurance
-By creating state-wide insurance exchanges, and increase eligibility for Medicaid
-Encouraged formations of Accountable Care Organizations (ACOs) which would be reimbursed based on achieving certain benchmarks in patient care

Question 35

Merit-Based Incentive Payment System (MIPS)

Answer 35

-new payment mechanism that started in 2019
-Reimbursement is defined by grades for providers based on quality, resource use, clinical practice improvement, and meaningful use

Question 36

Health Insurance Portability and Accountability Act (HIPAA)

Answer 36

-1996
-Provides data privacy and security provisions for safeguarding medical information