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HAN 333: exam 2 > HAN 364 FINAL > Flashcards

HAN 364 FINAL Flashcards

1
Q

What is the Nuremberg Code and its importance to Healthcare

A

Related to the Holocaust

Established:
Voluntary consent
Right to withdraw from experiment
Right to medical experimenter

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2
Q

What is the WMA Declaration of Helsinki and its importance to Healthcare

A

Right to privacy and confidentiality of personal information of research subjects in Nuremberg Code

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3
Q

Identify and Describe the Three Views of Ethics

A

Ethics does not exist outside the law, and exists only for the good of a properly ordered and legal society

Ethics is usually strongly informed by the law, society, and prevailing cultures, and are extensions of these

Ethics exists entirely outside of the law, and is a matter of personal conscience. Where there is a conflict the ethical viewpoint must prevail.

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4
Q

What are the Measures to Ensure Documents are Understood

A

(Flesch-Reading Tests and Word)

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5
Q

Flesch-Reading Test:

A

video of readability scores and tools (1-100)

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6
Q

Flesch-Kincaid Test:

A

assigns a number corresponds to US school grade (1-14)

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7
Q

Microsoft word

A

options&raquo_space; proofing&raquo_space; show readability statistics

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8
Q

Classification of CHI Applications

A

(⅔ for consumers, ⅓ for providers)

Inform patients about health topics

Instruct patients about health procedures

Display health results and doctor recommendations

remind/alert patients of medicines or prescriptions

Guide healthcare decision

Communicate with healthcare providers

CIDIRG

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9
Q

Examples of CHI Applications

A

MyFitnessPal

FitBit

MapMyRun

Weight Watchers

WebMd

Disney OralB Magic Timer

BeachBody on Demand

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10
Q

Types of Personal Health Record Applications

A

Tethered, Standalone, Interconnected

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11
Q

Tethered PHR:

A

online interface tied to an EHR with which patients may view and sometimes interact with their health data - Patient Portal

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12
Q

Standalone PHR:

A

an isolated application, may be on mobile device of website

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13
Q

Interconnected / integrated PHR:

A

separate application, but can interact with one or possibly more provider EHRs

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14
Q

Patient – Clinician Electronic Communication Challenges

A

Sometimes patients do not prefer email notifications for bad news

Overload of messages, hard to organize

Insecurity of standard email

Cannot read and reply to messages in a timely manner

BOIT (bad news, overload, insecurity, timely manner)

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15
Q

Types of Electronic Patient – Physician Communication

A

E-visits, virtual visits, tele visits

Could reduce the number of face-to-face visits with a physician

Good for the average patient

Bad for the average physician

Best for organizations not reimbursed for quantity of services delivered

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16
Q

Home Telemedicine Devices

A

Digital scales

Blood pressure monitors

Glucose monitors

Nike+ shoes

Smart water bottles

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17
Q

Patient Web Portal and Features

A

Online registration
Medication refills
Laboratory refills
Electronic visits
Patient education
Personal health records (PHR)
Online appointments
Referrals
Secure messaging
Bill paying
Document uploading
Tracking function

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18
Q

Factors That Add to Popularity of Mobile

A

-Improved speed, memory, wireless connectivity, shrinking form factor (size and shape)

-Affordable

-Constantly improving features

-Phone capability, email, and access to internet

-A myriad (many) of mobile apps for consumers and clinicians

Features
Internet
Mobile apps
afforadable
speed

FIMAS

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19
Q

Uses of Text Messaging/SMS in Healthcare

A

Appointment reminders

Education

Disease management

Behavior modification

Medication compliance

Lab results notification

Public health - immunization

AEDBLMP

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20
Q

Mobile Technology and Patients – Examples of Software Categories

A

Personal health record
Telemedicine
Medication reminders
Fitness coach
Immunization guides
Disease management
Prevention guides
Diagnostics
Vital sign monitoring
Mental health
Connect with healthcare system

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21
Q

Challenges of Mobile Technology

A

-Cost
-Distraction: at work and everywhere else
-Technical: inputting, screen size and interoperability issues
-Security: need policies/security for patient provided devices
-Lack of quality control: mobile app rating scale
-Lack of evidence: low quality studies
-Regulatory: they may need FDA clearance
-Will new sensors and devices be reimbursed by payers, or will patients have to pay?

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22
Q

EBM Definition and Clinical Trials

A

Evidence Based Medicine

Systematic approach to clinical problem solving which allows the integration of the best available research evidence with clinical expertise and patient values

(individual clinical expertise, best external evidence, patient values and expectations)

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23
Q

EBM Method of Answering Clinical Questions

A

Patient: clinical problem or question that arises out of care of the patient

Question: construct well-built clinical question derived from the case

Resource: select appropriate resource and conduct a search

Evaluation: appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice)

Patient: return to patient, integrate evidence with clinical expertise, patient preferences and apply it to practice

Self-evaluation: evaluate performance with this patient

PQREPS

PQREPS

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24
Q

Why is EBM Important?

A

Patients should receive care based on the best available scientific knowledge
Care should not vary illogically from clinician to clinician or from place to place
We are slowly moving from anecdotal evidence to randomized controlled trials
Current methods of keeping medically or educationally up-to-date do not work
Translation of research into practice is often very slow
Lack of time and volume of published material results in information overload

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25
Q

What is PICO?

A

P: Patient or population (age, disease, gender)
I: Intervention; prognostic factor; exposure - drugs/treatment
C: Comparison: describe the main alternative being considered - placebo, standard therapy, no treatment, gold standard
O: Outcome - describe what you are trying to accomplish, measure, improve, or affect

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26
Q

what is PICO used for

A

To construct a clinical question - provides clarity in defining inclusion criteria for the literature review

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27
Q

Evidence Pyramid:

A

Systematic reviews & meta-analysis
Randomized controlled trials
Cohort studies
Case control studies
Uncontrolled studies
Animal research; basic science experiments; expert opinions

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28
Q

Randomized controlled trials

A

subjects randomly assigned to a treatment or control group that received placebo or no treatment; only difference between the two is the intervention being studied

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29
Q

Cohort studies

A

evaluate and follow patients who received same exposure, but one is not affected by the exposure while the other is

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30
Q

Case control studies

A

study patients with a specific condition compared with people who do not have the condition (less reliable than randomized controlled trials)

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31
Q

Uncontrolled studies and Animal research

A

collections of reports on treatment of patients without control groups; much less scientific significance

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32
Q

levels of evidence - level 1

A

high quality evidence derived from consistent RCT

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33
Q

levels of evidence - level 2

A

moderate quality evidence inconsistent or less methodologically strong RCTs; exceptionally strong observational evidence

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34
Q

levels of evidence - level 3

A

low quality evidence, usually from observational studies

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35
Q

levels of evidence - level 4

A

very low quality evidence from flawed observational studies, indirect evidence or expert opinion

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36
Q

Common Types of Clinical Questions:

A

diagnosis
prognosis
therapy
harm
cost

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37
Q

diagnosis

A

which is more sensitive and specific for detecting a heart attack, Creatine Phosphokinase (CPK) or troponin? (what disease/condition is affecting you)

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38
Q

Prognosis Question:

A

will lowering the average blood pressure to less than 120/80 reduce the likelihood of a stroke? (how the disease or condition is going to affect you)

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39
Q

therapy

A

does the addition of Plavix to aspirin reduce the incidence of future strokes?

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40
Q

harm

A

how many patients will have renal insufficiency due to an ace inhibitor compared to a beta blocker?

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41
Q

Cost question:

A

which is more cost effective to reduce hospital readmissions for heart failure, inpatient case management or home health nursing care?

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42
Q

clinical practice guidlines

A

systematically developed statements to assist practitioner and patient decisions about healthcare for specific clinical circumstances

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43
Q

barriers to clinical practice guidelines

A

Practice setting: are clinicians too busy or indifferent to new evidence?
Contrary opinion: do the experts agree?
Sparse data: is the evidence conclusive?
Expect low initial acceptance
CPGS can be too long, without summary
Lack of local champions
May lack patient input for both the writing of the CPGs and the implementation
Incentives to adopt may be missing for clinicians

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44
Q

What is Telehealth?

A

the use of electronic information and telecommunications technologies to support long-distance clinical healthcare, patient and professional health-related education, public health, and health administration

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45
Q

defintion of telemedicine

A

the use of medical information exchanged from one site to another via electronic communications to improve patient’s health status (remote delivery of healthcare)

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46
Q

Reasons for popularity of Telemedicine

A

Rising cost of healthcare worldwide
Shortage of specialists in rural areas
Rise in chronic diseases and aging of population
Improved collaboration among physicians and disparate healthcare organizations
Raises patient satisfaction when it results in better access to specialty care
COVID-19 happened

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47
Q

Difference between Telehealth and Telemedicine

A

Telehealth: broader scope of remote health care services (ex: mobile health apps)
Telemedicine: specifically remote clinical services (telehealth can refer to non-clinical services - ex: skype visit with doctor)

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48
Q

Barriers to Telemedicine

A

Limited reimbursement
Limited research showing reasonable benefit
High initial cost
Limited availability of high-speed telecommunications
Bandwidth issues
Need for high resolution images or video for some specialties
Licensure laws
Lack of standards
Lack of evaluation by a certifying organization
Fear of malpractice as a result of telemedicine

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49
Q

Available Sensors and Devices

A

Weight
Blood pressure
Glucose: blood sugar
Oximeter: oxygen level
Spirometry: breathing capacity
Temperature
Medication tracker
Prothrombin time and international normalized ratio (PT/INR): how thin blood is
Motion detectors
fitness

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50
Q

Benefits of Telehealth and Telemedicine

A

Improve access to services in rural and underserved areas; reduced travel time and lowers the cost for specialists and patients alike

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51
Q

Bioinformatics:

A

computational biology, biology, computer science and information technology merge to form a single discipline

52
Q

Transformational bioinformatics

A

the specialization of bioinformatics for human health

53
Q

Genomics:

A

field that analyzes genetic material from species

54
Q

Proteomics:

A

study at the level of proteins (through gene expression)

55
Q

Pharmacogenomics:

A

study of genetic material in relationship with drug targets

56
Q

Metabolomics:

A

the study of genes, proteins or metabolites (low molecular weight molecules found within cells and biological systems)

57
Q

Metagenomics:

A

the analysis of genetic material derived from complete microbial communities harvested from natural environments

58
Q

Phenotype:

A

observable characteristic, structure, function, and behavior of a living organism

59
Q

Genotype:

A

based on the raw genetic information that is associated with a phenotype or regulation of biological function

60
Q

Personal genomics:

A

to have “tailor made” medications and treatments that target the individual and not a group having little in common with the patient

61
Q

Chromosomes:

A

consist of double twisted helices of DNA

62
Q

Genes:

A

regions on chromosomes that encode instructions

63
Q

Genome:

A

complete set of genes

64
Q

Genome-wide association studies

A

two groups of participants are studied; those with a disease of interest, compared with those without the disease.

65
Q

Phenome-wide association studies:

A

comparing genes to disease associations, most recently using the electronic health record for phenotypical information

66
Q

importance of bioinformatics:

A

Diagnosing hereditary diseases
Discovering future drug targets (mRNA - covid vaccine)
Developing personalized drugs based on genetic profiles
Developing gene therapies to treat diseases with a strong genomic component

67
Q

importance of pharmacogenomics

A

New indications for an old drug (drug repurposing)
New targets for existing drugs (treatment of tongue cancer using RET inhibitors)
Drugs to work better in certain patient groups (gender, age, race, ethnicity) with possible genetic variants
What drugs to avoid due to higher incidence of side effects that are genetically modulated
Improve clinical decision support for EHR

68
Q

Human Genome Project:

A

Determining the base pairs that make up humans
International collaborative started in 1990
3 million SNP discovered - variations
Ethical, legal, social issues also discussed
Huge relational databases are necessary to store and retrieve this massive information
New technologies such as DNA arrays speed up analysis
Significant drop in cost along the way

69
Q

Ethical questions related to genetic testing

A

Not regulated, lacks external standards for accuracy, has not demonstrated economic viability or clinical benefits

Patients must be sure of accuracy before undergoing (ex: prophylactic mastectomy)

Patients will need genetic counseling (most physicians have not had this training)

Genetic information nondiscrimination act of 2008 - protects patients against discrimination by employers and healthcare insurers based on genetic information

70
Q

Public health:

A

the art of prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals

71
Q

Public health informatics

A

systematic application of information, computer science and technology to public health practice, research and learning

72
Q

Public health surveillance

A

ongoing systematic collection, analysis, and interpretation of health-related data essential to planning, implementation and evaluation of public health practice, closely integrated with the timely dissemination of these data for prevention and control

73
Q

Syndromic surveillance

A

surveillance using health-related data that precedes diagnosis and signal a sufficient probability of a case or an outbreak to warrant further public health response - focuses on early symptom before clinical or laboratory confirmation of particular disease

74
Q

Public health core functions

A

Assessment, Policy Development, Assurance

75
Q

Assessment:

A

public health agencies spend most of their time and resources on investigations of potential threats to public’s health

Ex: testing and monitoring of water quality, laboratory examination of diseases, food-borne illnesses, testing for environmental hazards

76
Q

Policy development:

A

public health agencies also create policies and regulations to protect the health of populations

Ex: children required to have certain immunizations before they can attend school to prevent disease outbreaks

77
Q

Assurance:

A

once laws and regulations are passed to protect health, public health agencies are tasked with ensuring compliance with them

Ex: local health departments may perform housing inspections to assure landlords comply.

78
Q

Indicator based surveillance:

A

monitoring of a specific disease/health condition, or class of disease/health conditions that are of interest to public health

79
Q

Event based surveillance:

A

monitors data from specific events where large number of people gather in one place

80
Q

case surveillance

A

Collect data on individual cases of a health event or disease with previously determined case definitions in respect to criteria for person, time, place, clinical & laboratory diagnosis
Analyze case counts and rates, trends over time
Ex: NEDSS base system

81
Q

Syndromic surveillance:

A

Collect data on clusters of symptoms and clinical features of an undiagnosed disease or health event in near real time allowing for early detection and rapid response mobilization

82
Q

sentinel surveillance

A

Collect and analyze data from designated agencies selected for their geographic location, medical specialty and ability to accurately diagnose and report high quality data.

83
Q

behavioral surveillance system

A

Collet data based on health-risk behaviors, preventative health behaviors, and health care access in relation to chronic disease and injury
Analyze prevalence of behaviors as well as trends in prevalence
Data collected by personal interview

84
Q

Integrated disease surveillance

A

Incorporates epidemiologic and laboratory data in systems designed to monitor communicable diseases at all levels of public health jurisdiction, particularly in Africa

85
Q

clinical outcomes surveillance

A

Monitors clinical outcomes to study disease progression or regression in a population
Analyzes the rates of and factors associated with clinical outcomes using descriptive and inferential methods such as incidence rates from probability samples

86
Q

laboratory surveillance

A

Collects data from public health laboratories, which routinely conduct tests for viruses, bacteria, and other pathogens
Used to detect and monitor infectious and food-borne diseases

87
Q

Example of Syndromes that are currently monitored

A

Botulism-like illnesses
Febrile (fever) illnesses (influenza-like illnesses)
Gastrointestinal (stomach) symptoms
Hemorrhagic (bleeding) illnesses
Neurological syndromes
Rash associated illnesses
Respiratory syndromes
Shock or coma

88
Q

GIS (geographic information systems)

A

A system of hardware, software and data used for the mapping and analysis of geographic data

89
Q

uses of GIS (geographic information systems)

A

Provides access to large volumes of data

90
Q

World Health Organization

A

Specialized agency of the United Nations responsible for international public health

91
Q

WHO public health programs

A

Global Alert Response
International Health Regulations
Early warning surveillance
Global public health intelligence network

92
Q

Global Alert Response (GAR)

A

the integrated infectious disease surveillance program within WHO

93
Q

Early warning surveillance:

A

surveillance mechanism to effectively identify disease outbreaks and other health issues immediately following acute emergencies

94
Q

Global public health intelligence network

A

to electronically monitor infectious disease outbreaks

95
Q

Global outbreak alert and response network:

A

provide a rapid identification and response to outbreaks and alert the international community

96
Q

eResearch

A

use of information technology to support research

97
Q

Major contributing factors to growth of eResearch

A

adoption of electronic medical records and electronic research platforms - will have a major impact on evidence-based medicine in the future

98
Q

Describe what are Research Collaboration Networks

A

Web-based applications which include features such as a personal profile, opportunities to connect with others with similar interest and the ability to post status updates

99
Q

EHR recruiting:

A

ability to evaluate adequate pools of patients to be recruited into the study. Requires clinical data repository from EHR data with a query tool to search de-identified information

100
Q

Explain how researchers take advantage of EHR/EMR Recruiting

A

By modifying inclusion and exclusion criteria, researcher can find the appropriate cohort for recruitment based on reasonable recruitment rate

101
Q

Electronic grant process:

A

researcher can search for grant opportunities and grant submission is now common for government and civilian agencies

102
Q

how Clinical Trial Management (CTM) systems support Clinical Trials

A

Mange the planning, preparation, performance, and reporting of clinical trials
Budget management, study calendar of patient visits, and create electronic case report forms

103
Q

examples of CTMS

A

research electronic data capture (REDCap) and OpenClinica

104
Q

Data science:

A

the scientific study of the creation, validation and transformation of data to create meaning

105
Q

Data analytics:

A

the discovery and communication of meaningful patterns in data

106
Q

Skills required for Data Scientists

A

Mathematics and statistics
Domain expertise (business, healthcare)
Programming (R, Python)
Database and data warehousing
Predictive modeling and descriptive statistics
Machine learning and algorithms
Big data
Communication and presentation

107
Q

Database:

A

organized collection of data

108
Q

Database table:

A

collection of related data

109
Q

Primary key:

A

unique value that identifies uniquely a database record (patient ID)

110
Q

Input mask:

A

a string of characters that indicates the format of valid input values (ex: time, phone number - ways to write numbers in correct format)

111
Q

Data type:

A

text, integer, alphanumeric, floating point

112
Q

Query

A

a request for data result from database (to perform calculation/answer simple question)

113
Q

What is database Cardinality

A

A relational database system concept that means uniqueness

114
Q

1 to 1 relationship

A

(each row of table relates to only one row in another table - Student ID)

115
Q

1 to many relationship

A

(each row may relate to more than one row in another table - class to students)

116
Q

Many to many relationship

A

(multiple rows may relate to multiple rows - user belongs to multiple communities, community can have multiple users)

117
Q

What is Normalization

A

The process applied to database tables to prevent duplication of data

118
Q

First normal form:

A

prevents each row from having duplicate data - ROW

119
Q

Second normal form:

A

prevents the repetition of data within a table’s column - COLUMN

120
Q

Third normal form:

A

requires every column to have dependency on the table’s primary key and be independent from the remaining non-key columns in the table - EVERYTHING DEPENDS ON PRIMARY KEY

121
Q

What are the 5 basic steps of Data Analysis

A

Define the problem (raw data)
Perform data pre-processing (cleaning; missing data - deleting; integration; reduction)
Begin exploratory data analysis (descriptive stats used to look at distribution)
Conduct analysis with statistical modeling
Utilize data visualization

122
Q

3 Data Analytical Approaches

A

Statistical modeling (statistics)
Machine learning (association, regression, classification, clustering) - analyze data with multiple algorithms
Programming language

123
Q

Describe how a survey can support the information gathering process for your project

A

Survey: A list of questions you are asking to assist in reaching the project outcome.
It will help the project team listen to the voice of the customer
Questions could be related to training, technology, process, access, or facility

124
Q

Project timeline:

A

tracks order of events

125
Q

Needs assessment:

A

identify gaps between current and future state

126
Q

Vendor matrix:

A

It is an evaluation tool used to compare multiple vendors based on the functions the organization seeks to obtain

127
Q

Executive summary:

A

Document that summarizes the project in less than a page and is usually geared towards organizational leaders (Problem Statement and Project Benefits, Project Goals and Objectives, Project Scope, Project Background)

HAN 333: exam 2 (10 decks)

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