Health Informatics Assignment Week 22 to 24

Week 22 Questions

Questions for Discussion

1. In what ways will bioinformatics and medical informatics interact in the future? Will the research agendas of the two fields merge, or will they always remain separable?
2. Will the introduction of DNA and protein sequence information change the way that medical records are managed in the future? Which types of systems will be most affected (laboratory, radiology, admission and discharge, financial, order entry)?
3. It has been postulated that clinical informatics and bioinformatics are working on the same problems, but in some areas one field has made more progress than the other. Identify three common themes. Describe how the issues are approached by each subdiscipline.
4. Why should an awareness of bioinformatics be expected of clinical informatics professionals? Should a chapter on bioinformatics appear in a clinical informatics textbook? Explain your answers.
5. One major problem with introducing computers into clinical medicine is the extreme time and resource pressure placed on physicians and other health care workers. Will the same problems arise in basic biomedical research?
6. Why have biologists and bioinformaticians embraced the Web as a vehicle for disseminating data so quickly, whereas clinicians and clinical informaticians have been more hesitant to put their primary data online?

Week 23 Questions

1. Define the following terms, each of which is relevant to current health care financing:
   • Usual, customary, and reasonable fees
   • Health maintenance organization
   • Diagnosis-related group
   • Preferred-provider insurance
2. Compare HMOs, PPOs, POS plans, and high deductible plans. What are the strengthsand potential limitations of each with respect to cost and quality of care?
3. How will the differences in incentives for providers under each of the following payment systems affect providers’ assessments of new medical technologies, such as patient-monitoring systems?
   • An HMO
   • An individual physician participating in a PPO arrangement
   • A hospital with a large number of patients treated under Medicare’s prospectivepayment system
   • A standard fee-for-service arrangement
4. Compare information system needs in a hospital that treats mostly private-paypatients with those in one that accepts capitated payments.
5. You are the new administrator of the Center for Medicare and Medicaid Services, theagency responsible for Medicare and for the federal component of Medicaid. You are about to authorize a new program for health care financing for the elderly. The program offers elderly beneficiaries a choice of all health plans on the market.
   • With what information do you think it is important to provide beneficiaries so thatthey can choose among plans?
   • What data would you want to collect to evaluate the performance of plans?
   • What mechanisms would you implement to collect these data?
6. Describe at least three ways in which health care organizations can use the Internet to improve patient care.

Week 24 Questions

1. Select an area of biomedicine with which you are familiar. Based on what you havelearned in this book, propose a scenario for that area that takes place 20 years in the future. Be sure to think about how issues of system integration, networking, and changes in workflow will affect the evolution of computers in the setting you describe.
2. Imagine that you are a patient visiting a health care facility at which the physicianshave made a major commitment to computer-based tools. How would you react to the following situations?
   • Before you are ushered into the examining room, the nurse takes your blood pres-sure and pulse in a work area and then enters the information into a computer terminal located in the nursing station adjacent to the waiting room.
   • While the physician interviews you, he or she occasionally types information intoa computer workstation that is facing the physician; you cannot see the screen.
   • While the physician interviews you, he or she occasionally uses a mouse-pointingdevice to enter information into a computer workstation located such that, when facing the physician, you cannot see the screen.
   • While the physician interviews you, he or she occasionally uses a mouse-pointingdevice to enter information into a computer workstation that you both can see. While doing so, the physician explains the data being reviewed and entered.
   • While the physician interviews you, he or she enters information into a clipboard-sized computer terminal that responds to finger touch and requires no keyboard typing.
   • While the physician interviews you, he or she occasionally stops to dictate a phrase. A speech-understanding interface processes what is being said and stores the infor mation in a medical record system.
   • There is no computer in the examining room, but you notice that between visits,the physician uses a workstation in the office to review and enter patient data.

Now imagine that you are the physician in each situation. How would you react in each case? What do your answers to these questions tell you about the potential effect of computers on patient–physician rapport? What insight have you gained regarding how interactive technologies could affect the patient–physician encounter? Did you have different reactions to scenarios c and d? Do you believe that most people would respond to these two situations as you did?

3. You are the medical director of a 30-physician multispecialty group practice. Thepractice is physician-owned and managed and maintains a tight affiliation with a nearby academic medical center. You are considering implementing an ambulatory medical record system to support your practice operations. Discuss at least eight significant challenges you will face, considering technology, user, legal, and financial factors. How will you address each issue?
4. Defend or refute the following proposition: “Knowledge-based clinical systems willbe widely used and generally accepted by clinician users within the next 5 years.”
5. You are asked to design a pharmacogenetic system that can help to understand whichpatients will respond to particular medicines. You need to design a database of studies that relate descriptions of the medical conditions, medications, and genetic sequences. Which terminologies would you choose for each of these data types? What are some key elements that would need to be included in the database schemas? What problems do you anticipate having in the design of the data structures for this task?