Informatics Ch 7,8,10,11

Case Control study

- Analytic (looking for causes) - Retrospective - Examine disease or health condition to determine possible causes -Requires intensive research into disease characteristics. -Researcher collects data on cases and controls from past to identify possible exposure characteristics and risk factors.

Methodology

- Draft -Include a step-by-step process of what is done in research study. -Why is this process necessary for proper testing of hypothesis? You have to test the hypothesis to justify yourself throughout the whole study -Develop rough draft to determine feasibility of study.

DSM-5

- Mental Disorders - Derivation of ICD used in behavioral health settings - Includes definitions and diagnostic criteria for mental disorders with code numbers for each diagnosis

LOINC

- Used for representing lab data for ordering and naming specific test results -System of 36,000 concepts (names, codes, synonyms) used to represent laboratory and clinical measurements, survey questions, clinical documents, and diagnostic reports (has expanded) -Designed to facilitate the exchange and aggregation of results- such as blood hemoglobin, serum potassium, and vital signs- for clinical care, outcomes management, and research

Nomenclature

-A naming convention or systematic listing of names that have been assigned according to pre-established rules. -Universal medical device nomenclature system: way of naming medical devices

Classification

-A scheme for grouping similar things in a logical way, based on common characteristics -System that is clinically descriptive and arranges or organizes like or related entities

Basic Interoperability

-Allows a message from one computer to be received by another, but it does not require the receiving computer to be able to interpret the data - Technical connectivity Ex: putting letter in envelope and mailing it (letter gets from sender to recipient, it does not matter what is in the envelope)

Structured Text

-Allows users to draw from standard phrases or pick lists and pull down menus to help guide the entry and ensure that complete information is included. -These data "tools" make use of predefined text scripts, lists and terminologies -Screen already has terminology that you have to make check marks in (Ex: when you admin pain mediation: scan patient's wrist and the med and the box pops up on EHR asking questions you have to check off)

Reliability

-Assesses accuracy of measurement tools -Verifies information gained from different sources

Recall Bias

-Attributed to faulty memory or selective memory based on personal experience. Ex: mothers of children w anomalies or complications tend to know more about their deliveries than do mothers of healthy children) -Use subjects with similar experiences to collect and compare data.

"Store and Forward"

-Bandwidth: measure of how much info can be transmitted simultaneously through a communication channel -Data can be transmitted on a low bandwidth because the data would be sent and then reviewed at a later time

Sample

-Bc most populations under study are fairly large, researchers usually choose to study samples of those populations -Results obtained by studying a sample can be generalized to the population from which sample is drawn as long as sample is representative of population.

Disadvantages of cross sectional studies

-Cannot assess cause and effect. -Not effective for studying rare conditions. (Has to do w sample size- you won't have a large sample size for a condition that is rare)

Administrative Terminologies

-Classifications and coding systems that are primarily designed to support the administrative, financial, and regulatory functions associated w patient care (shouldn't use when documenting clinically) -Serve as the primary communication tool between those providing services and those paying for the services -Used by providers, payers, researchers, gov't agencies, and others to create secondary statistical reports and facilitate activities

SNOMED-CT

-Clinical terms -Considered most comprehensive, multilingual clinical healthcare terminology in the world -Offers consistent language for dealing with health data -Computer readable definitions for dealing with health data (standardized terminology that can be used as a foundation of the EHR) -Linking synonyms to a single concept allows computer systems to recognize common meaning of synonymous terms

Mortality

-Computed because they demonstrate outcome possibly related to quality of healthcare provided -Types: Gross Death Rate; Net Death Rate; Anesthesia Death Rate; Postoperative Death Rate; Maternal Death Rate; Neonatal, Infant and Fetal Death Rates When examining trends, possible reasons for differences in rates should be considered. -Three variable influences: Time, Place, Person

COSTAR

-Computer stored ambulatory record system -Developed in 1960s-70s by Octo Barnett at Massachusetts General Hospital

Systematic Random Sample

-Decide what fraction or proportion of population is to be sampled. -Can only be considered random if population list itself is in random order.

Functional Interoperability

-Defines format of messages -Ensures messages between computers can be interpreted at level of the data fields, so that the data can pass from a structured field in one system to a comparably structured field in another -Neither system, however, has understanding of the meaning of the data within the fields (Actual formatting of the message; the way the message is arranged before it is sent off; doesn't matter about interpretation of data)

Standard Deviation

-Demonstrates how values are spread around mean. -Calculation based on deviations (differences) between value of each score and value of mean. -Square root of the variance most commonly reported measure of dispersion -The greater the deviations of the values from the mean, the greater the variance.

Clinical Terminologies

-Designed to represent the information in the patient record -Ambiguity eliminated because the definitions, concepts, and relationships that represent the concepts have been predetermined -Controlled: coded vocab for medical concepts and expressions used in health care Ex: SNOMED

Diagnosis Bias

-Different health professionals may offer differing opinions -Blind reviews of slides or results by different professionals can help obtain good cases or controls for a study. (use blind reviewers w no attachment to study to reduce bias when looking at results)

Odds Ratio

-Estimate of the relative risk a person has if he or she is exposed to a certain characteristic -Only use with case-controlled studies, when the disease is rare, and when cases are true representatives of all cases and controls are true representatives of all controls

Random Sample

-Every member of population has same chance of being included in sample. -Selection of one member has no effect on selection of another member-independent selection.

Funtion and Goal of RxNorms

-Facilitates interoperability among computerized systems -Goal: enable various systems using different drug nomenclatures to exchange and share data efficiently and avoid ambiguity

Nosocomial Infection

-Facility acquired -Includes infections occurring more than 72 hours after admission -May show infections that occur as a result of the care that is provided in the facility

IBM Medical Information System

-First patient care system that claimed to automate the patient record -Lasted for 10 years (1960-1972) and then followed by Technician Data System

NIC

-Focus is on interventions

NOC

-Focus is on outcomes

Life Analysis Table

-Most appropriate for prospective studies or experimental studies when researcher has a loss of subjects as a result of follow-up or the study ends before recurrence or death has occurred in some subjects -Each subject is followed until death and during that time the subject may be lost to follow up because the researcher is not able to locate subject and cannot determine whether death has occurred -Examine subjects survival times- time subjects are free of disease after diagnosis or time of recovery or improvement after procedure

Mean

-Most common measure of central tendency -Purpose: summarize entire set of data by means of a single representative value

CDSS

-Most have become part of an existing system, such as provider or entry system -Provides computerized advice regarding drug doses, routes, and frequencies; more sophisticated can provide drug allergy checks, drug lab value checks, drug-drug interaction checks, and provide reminders about corollary orders -Helps physicians w decisions about ordering meds

Prevalence

-Number of existing cases of disease -Rate: number of existing cases of disease in a specified time period divided by population at same time

Incidence

-Number of new cases of disease

Survival Bias

-Occurs with cross-sectional studies because only those who have lived long enough to be in the study are examined -The solution is to use incident or new cases to relieve this bias

ICD-O

-Oncology -Codes based on malignant neoplasm codes in ICD-10 -Used to classify neoplasms according to: Site Behavior Morphological Characteristics How they are graded

Syndromic Surveillance System

-One of the components of comprehensive HIS -Surveillance and related population health systems can detect and monitor disease at an earlier stage for public health surveillance -Designed to recognize outbreaks based on symptoms and signs of infection -Cannot be used to establish specific diagnosis in any particular individual → must detect disease patterns within a population/area/region to report to state's dept of health -Way of collecting/analyzing/interpreting data

Chi Square Test

-One of the most commonly used test of significance appropriate for qualitative data -Can be used to assess the degree of relationship or association between two qualitative variable -Can be used to determine whether there are differences between two or more groups w respect to qualitative variable -Displayed in contingency table

Prevalence/ Cross-sectional Study

-One type of descriptive study. -Concurrently describes characteristics and health outcomes at one specific point or period in time. -Cannot answer questions about cause and effect. -It's used to generate hypotheses, not test them. (First step in study) Most likely to cause survival bias

ANOVA

-One-way analysis of variance -Used when there are three or more independent groups. -Tests for significant differences among group means. Variability among subject's scores analyzed by dividing into two components. -Variability between groups reflected in differences among group means -Variability within groups reflected in differences among subjects belonging to same group Logical underlying principle: IF true differences among group means exist, THEN between-group variability must be greater than within-group variability.

Weighted Mean

-Overall mean for total sample when separate means reported for different subdivisions.

Voice Recognition

-Primarily an alternative to a data input device -Recognizes spoken words and records the information -Offers the most efficient means for practitioners to incorporate data capture into their normal routines -The computer can record what is being said but doesn't understand what is being said -Often used in EDs and radiology where fast turnaround is required

Semantic Interoperability

-Provides common interoperability (information within the data fields can be used intelligently) -Has ability to allow info to be understood by shared systems -Depends on degree of agreement of data terminology and its quality

Pearson Correlation Coefficient

-Purpose: Assesses direction and degree of relationship between two continuous variables -Can either be positive or negative

SQL

-Relational database model's standard language -Commands allow the creation and management of a database and provide a method of retrieval of data

Median

-Represents middle value within a data set. -Number of values above is equal to number of values below -Most appropriate statistic to use for describing ordinal or ranked data (quantitative) -Useful for interval or ratio data when data set contains extreme values. (not affected by extreme values like the mean is)

Hypothesis

-Research question -Identifies the goal of the research -Educated guess about the outcome of the study; not an opinion or value judgment -Poses an assertion to be supported and may predict a relationship between two or more variables

Point of Care

-Right where the care is being delivered -Also known as clinical terminologies -Terminologies designed to: - Facilitate data collection at the point of care -Capture the detail of : diagnostic studies, H&P, ancillary dept. information, nursing notes -Allows sending and receiving of medical data in an understandable manner

Intranet

-Runs exclusively within a network -Accessible only by users who can be authenticated as being within a specific network Ex: Corporate project tracking system on intranet so all employees can update and view their project plans Ex: Post organization's employee handbook to enable employees to have an updated reference manual with search capabilities Can look up office extensions, policies and procedures of organization

How is Coded Data Used?

-Serves as a kind of shorthand for a way of conveying meaning with a minimum complexity -Used to transmit health data from one electronic system to another for analysis, aggregation or use at point of care -HIPAA mandates specific code sets for electronic transactions or diagnoses or procedures - Used for billing, finances and disease

RxNorms

-Standardized nomenclature for clinical drugs and drug delivery devices produced by the NLM. (National Library of Medicine) for clinical drugs for communication to retail pharmacies for e-prescribing along with several federal drug terminologies -Clinical drug name reflects active ingredients, strengths, and dose form for that drug. If elements vary, a new RxNorm drug name is created as a separate concept. - Exists for every strength and dose of every available combination of clinically significant ingredients.

Morbidity

-State of being diseased or unhealthy in a population -Are used to study the types of disease or conditions present within the facility and examine quality of care. -Can aid health care facilities in planning specific health care services and programs. -Complications include infections, medication allergy reactions, transfusion reactions, decubitus ulcers (bedsores), falls, burns, medical error. -Infections are most common complication. -Infection rates computed so facility can determine cause and prevention of infection.

Selection Bias

-Subject selection can be influenced by a patient's health status. (researcher picks people they want bc they think those subjects will give them their best results to support the study → may not be a true representation of the whole population) -Researchers may select people who are already under medical care. -Volunteers and paid subjects may be different from general population (may volunteer because they are very healthy or have a special interest in the study)

Frequency Distribution Table

-Table presenting number of times each category of a qualitative variable or value of a quantitative variable is observed within a sample. -Continuous variables with large number of possible values commonly reported in ranges or intervals. -Table should be self-explanatory and clearly labeled. Nominal, ordinal, discrete or continuous data

Comorbidity

-The simultaneous presence of two chronic diseases or conditions in a patient -Preexisting conditions such as diabetes, osteoporosis, hypertension. -Can increase length of stay and outcome of care.

Independent Variable

-The variable that causes change in the other variables -The Factor that may explain it Ex: Cigarette smoking or asbestos (helps explain lung cancer)

Use life analysis table when subjects are lost:

-To follow up -To death -Because study ended -Before recurrence

NIC and NOC

-Two notable nursing classification systems -Comprehensive, research-based, standardized systems used to classify the interventions that nurses perform and outcome evaluations based on those interventions Used to classify: -Interventions nurses perform -Outcome evaluations based on those interventions Useful for many areas Can be used in all settings

BioMetric Device

-Unique, measurable characteristic or trait of a human being that can be used for automatic recognition or identity verification -Capable of analyzing human characteristics for security purposes -Physical: fingerprint, handprint, retinal recognition, speech recognition -Advantage: not possible to forge identity -Disadvantage: device may fail and prevent authorized user from gaining access to the system

Coefficient of Variation

-Used to compare standard deviations between two groups with very different means -When two samples or groups have very different means, the direct comparison of their standard deviations could be misleading -Therefore, when the two groups have very different means, it is best to compare their standard deviations expressed as percentages of the mean -Also used to compare dispersion in variables that are measured in different units

Advantages of cross sectional studies

-Useful when time and resources are limited -Appropriate when little known about health condition or characteristic. -Can provide new or beginning information for further studies.

Simple Random Sample

-Usually carried out by randomization programs -Can also use a table of random numbers

Dependent Variable

-Value dependent on one or more of the other variables -Cannot affect other variables by itself -Dependent variable is the variable to be explained Ex: Lung cancer

Mode

-Value that occurs most frequently in given set of values -Only measure of central tendency that can be used with nominal data (qualitative) -Only one you can use in a qualitative study

Steps in a research proposal

1. Hypothesis 2. Review literature 3. Draft research methods 4. Develop research plan or study design 5. Develop research budget 6. Design appendix

Omaha System Problem Classification Scheme

4 Levels: Level 1 - Domain Level 2 - Problems Actual problems Potential problems Level 3- Modifiers Level 4- Signs and Symptoms

Vocabulary

All terms that are recognized for communications within a certain domain (particular to nursing); collection of words and phrases

Validity

Assesses relevance, completeness, accuracy, and correctness

Stratified Random Sample

Divide population into groups & taking random samples from each stratum

Hypertext

Embedded object within the webpage that enables direct access to another, related web page Reference materials are not included directly on web page but a hypertext link is available so that if the user wishes to go to the reference page website, it is one click away

Point Prevalence Rates

Evaluating health condition at a specific point in time

Period Prevalence Rates

Evaluating health condition over a specific period of time

Classification Systems in Healthcare

Group together similar diseases and procedures into manageable, predetermined categories for external reporting purposes, including reimbursement for health care services and statistical data analysis, such as epidemiologic analysis or trending of disease incidence.

Initial Adopters of Omaha System

Home care Public health School health practice settings Some educators

Outcome

Measurable individual, family, or community state, behavior or perception that is measured along a continuum and is responsive to nursing interventions

Only measure that can be used w nominal (qualitative) data

Mode

Wi-Fi Protected Areas (WPA)

Most popular method for securing wireless networks. Requires authentication code dynamically changes as the system is used

Interventions

Nursing actions included in direct care and health promotion may be used for individual patients, families on behalf of patients or entire communities

Omaha System

One of the first terminologies recognized by the ANA A research-based, comprehensive, standardized terminology designed to enhance practice, documentation, and information management Problem Classification scheme - patient assessment Intervention scheme- service delivery Problem rating scale for outcomes- client change or evaluation Not under copyright In LOINC and SNOMED

Wired Equivalent Privacy (WEP) System

Provides encryption scheme so that the info transmitted over a wireless network is protected as it is sent from one device to another

Classification Systems Serve and Administrative Purpose

Provides the ability to aggregate the terms in a reference terminology for administrative purposes.

How Administrative Terminologies are Used:

Quality, safety and efficacy of care, managing care and disease processes, tracking public health risks, providing data to consumers (costs and outcomes for treatment options), payment system design and processing of claims for reimbursement, research, epidemiology studies and clinical trials, designing health care delivery systems and monitoring resource utilization, identifying fraudulent practices and setting health policy

Controlled Vocabulary

Terms are selected particularly for each domain -Two rules- 1. if the same term is commonly used to mean different things in similar context, it qualifies 2. if there are multiple terms that are used to mean the same thing, they take one term and make it the master term and all the rest are used as synonyms (Ex: heart attack is chiefly called myocardial infarction; stroke is called cerebrovascular accident- CVA)

Omaha System Integrated Into

The NLMS Metathesaurus ABC Codes LOINC SNOMED-CT

Controls

Those who are similar to the cases but do not have the disease that is under study

Cases

Those who have the disease that is under study

Free Text

Unstructured: anything that you just write in manually (nursing/doctor's notes)

Clinical Terminologies (Point of Care)

Use codes provide a way to combine the expressiveness and flexibility of free text information with the clarity and computability of encoded information Example - SNOMED-CT standardized system

Best way to ensure sample is representative

Use random sample

Code

unique identifier assigned to a specific term, description or concept