Clinical Informatics Board Review (AP)

micro vs macroevaluation 3e3

microeval is evaluation of individual components of a system. macroeval is of the whole system as a "black box"

ICD

10:CM: Tenth International Classification of Diseases:Clinical Modification : ICD:10 codes must be used on all HIPAA transactions, including outpatient claims with dates of service, and inpatient claims with dates of discharge on and after October 1, 2013.

information needs for office practice - Covell and Manning 1985

2 questions arose for every 3 patients. Only 30% answered during visit

center for professional leadership six part model 4a

6 part model for transformative change

ICD

9:CM: Ninth International Classification of Diseases:Clinical Modification : A coding system for medical diagnoses, symptoms, and nonspecific complaints. It is frequently used on insurance claim forms to identify the reasons for providing medical services

BEACON COMMUNITY PROGRAM

A federal grant program for communities to build and strengthen their health information technology (HIT) infrastructure and health information exchange (HIE) capabilities.

INFORMATICS

A general term used to refer to biomedical informatics and its many areas of application and practice (e.g., bioinformatics, clinical informatics, public health informatics)

non repudiation

A service that provides proof of the integrity and origin of data. An authentication that can be asserted to be genuine with high assurance

SECONDARY USE

A term generally used to refer to uses of clinical data for purposes other than direct patient care (e.g., for research purposes, for public health surveillance, for billing, for analysis in disease registries).

AHRQ

Agency for Healthcare Research and Quality : A federal agency within the US Department of Health and Human Services (HHS) with a mission to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Formerly known as the Agency for Health Care Policy and Research, AHRQ supports research and technology assessment, including implementations of health information technology.

PHI

Personal Health Information or Protected Health Information : Information about patients that is protected from inappropriate disclosure under the privacy and security mandates of the Health Insurance Portability and Accountability Act of 1996 and subsequent related legislation.

ARRA

American Recovery and Reinvestment Act : In 2009, the Obama Administration signed the American Recovery and Reinvestment Act (ARRA) or Stimulus Package into law. It contains billions of dollars in funding for science, engineering research and infrastructure, as well as funding for education, social sciences and the arts. Its greatest relevance to informatics is its major investment in the implementation of electronic health records and support for comparative effectiveness research.

CTSA

CLINICAL TRANSLATIONAL SCIENCE AWARDS : An NIH grants program that promotes more rapid and effective translation of basic science discoveries into clinical settings, culminating in facilitated adoption in the community. These awards require a significant investment in biomedical informatics to support the translational science. They have accordingly been a boon to the development of translational bioinformatics and clinical research informatics.

CDC

Centers for Disease Control and Prevention : A part of the US Department of Health and Human Services (HHS) with a mission is to collaborate in creating the expertise, information, and tools that people and communities need to protect their health.

CMS

Centers for Medicare and Medicaid Services : A federal agency within the US Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid, the State Children's Health Insurance Program (SCHIP), and health insurance portability standards. Formerly known as the Health Care Financing Administration (HCFA).

PHR

Personal Health Record : An electronic health record that is maintained by the patient, typically combining information from a variety of encounters with multiple providers.

CCHIT

Certification Commission for Health Information Technology : A voluntary, private sector organization launched in 2004 to certify health information technology products such as electronic health records and the networks over which they interoperate. CCHIT, the original certifying body, is now one of several organizations the Office of the National Coordinator for Health Information Technology (ONC) has authorized to certify electronic health record technology and selected as an ONC:Authorized Testing and Certification Bodies (ATCBs).

CMIO

Chief Medical Information/Informatics Officer : In hospitals or health systems, a physician charged with helping to assure the success of clinical information systems, representing a clinician's perspective, and participating in system selection, implementation, evaluation, and user training.

CNIO

Chief Nursing Information/Informatics Officer : In hospitals or health systems, a nurse charged with helping to assure the success of clinical information systems, representing a clinician's perspective, and participating in system selection, implementation, evaluation, and user training.

CDSS

Clinical Decision:Support System : A computer:based system that assists a professional who must decide what actions to take in a given clinical setting, such as physicians or nurses making decisions about patient care.

CER

Comparative Effectiveness Research : Any research program intended to determine the relative efficacy of alternate approaches to patient evaluation or treatment, intended to develop evidence that supports one approach over another in a given patient or context.

CPOE

Computer:Based Physician Order Entry : A clinical information system that allows clinicians to record patient:specific orders (tests, treatments, management plans, and the like) for communication to other patient care team members and to other information systems. Sometimes called provider order entry or practitioner order entry.

CE

Covered Entity : Under HIPAA, a health plan, a health care clearinghouse, or a healthcare provider who transmits any health information in electronic form in connection with a HIPAA:covered transaction.

DATA STEWARDSHIP

Data stewardship encompasses the responsibilities and accountabilities associated with managing, collecting, viewing, storing, sharing, disclosing, or otherwise making use of personal health information. Principles of data stewardship apply to all the personnel, systems and processes engaging in health information storage and exchange within and across organizations.

EHR

Electronic Health Record : A repository of electronically maintained information about an individual's health status and health care, stored such that it can serve the multiple legitimate users of the record.

EMR

Electronic Medical Record (see EHR)

FHA

Federal Health Architecture : A collaborative body composed of several federal departments and agencies that provide a framework for linking health business processes to technology solutions and standards and for demonstrating how these solutions improve health performance outcomes. Last updated: 11/10/2010

HIE

Health Information Exchange: the electronic movement of health related information among organizations according to national guidelines (2).

HIM

Health Information Management : The practice of acquiring, analyzing, and protecting digital and traditional medical information vital to providing quality patient care.

HIT/Health IT

Health Information Technology

HITECH

Health Information Technology for Economic and Clinical Health Act : A government act to enable coordination and alignment within and among states, establish connectivity to the public health community in case of emergencies, and assure the workforce is properly trained and equipped to be meaningful users of EHRs. HL7: Health Level 7 : An ad hoc standards group formed to develop standards for exchange of health care data between independent computer applications.

HIPAA

Health Insurance Portability and Accountability Act [of 1996] : A government act to reduce fraud and abuse in health care.

HRSA

Health Resources and Services Administration : A federal agency within the US Department of Health and Human Services (HHS) responsible for improving access to health care services for people who are uninsured, isolated or medically vulnerable.

IOM

Institute of Medicine : The health arm of the National Academy of Sciences.

ISO

International Standards Organization : Developer and publisher of International Standards that forms a bridge between the public and private sectors to enable a consensus to be reached on solutions that meet both the requirements of business and the broader needs of society.

CLINICAL RESEARCH INFORMATICS (CRI)

Involves the application of biomedical informatics methods and techniques in the discovery and management of new knowledge relating to health and disease. It includes management of information related to clinical trials, community based research, and also involves informatics related to research use of clinical data. Clinical research informatics and translational bioinformatics are the primary domains related to informatics activities to support translational research, and thus clinical research informatics lies at the intersection between bioinformatics and clinical informatics.Last updated: 11/10/2010

CONSUMER HEALTH INFORMATICS

Is the field devoted to informatics from multiple consumer:patient views. These include patient focused informatics, health literacy and consumer education. The focus is on information structures and processes that empower consumers to manage their own health; for example health information literacy, consumer:friendly language, personal health records, and Internet:based strategies and resources. The shift in this view of informatics analyses consumers' needs for information; studies and implements methods of making information accessible to consumers; and models and integrates consumers' preferences into health information systems. Consumer informatics involves the intersection of clinical informatics and public health informatics, standing at a crossroads with other disciplines, such as nursing informatics, public health, health promotion, health education, library science, and communication science.

MU

Meaningful Use : A tiered set of objectives related to the ARRA Medicare and Medicaid EHR incentive programs. Meaningful Use criteria must be met by eligible professionals and hospitals if they are to collect financial rewards for the implementation of qualified, certified EHRs to achieve health and efficiency goals.

NCI

National Cancer Institute : An institute at the National Institutes of Health (NIH) responsible for cancer research and training.

NCHS

National Center for Health Statistics : A component of CDC, serving as the Nation's principal health statistics agency

NCRR

National Center for Research Resources : A specialized center at NIH that supports research and development for multi:categorical research resources needed on an institutional, regional, national, or international basis for health:related research. This agency has organized and supported the CTSA program.

NCVHS

National Committee on Vital and Health Statistics : An advisory body to HHS that deals with health data, statistics and national health information policy.

NHIN

National Health Information Network : A pilot program by the Office of the National Coordinator (ONC) established to provide a nationwide health information exchange (HIE) that uses a common standard.

NIST

National Institute for Standards and Technology : A non:regulatory federal agency within the US Department of Commerce to promote innovation and industrial competitiveness in the US by advancing measurement science, standards, and technology in ways that enhance economic security and improve our quality of life

NIH

National Institutes of Health : A part of the US Department of Health and Human Services (HHS) responsible for conducting and supporting medical research.

NLM

National Library of Medicine : The world's largest medical library. The Library collects materials and provides information and research services in all areas of biomedicine and health care. It is also an NIH institute and supports research and training in areas related to biomedical and health information management and information technology.

ONC

Office of the National Coordinator [also referred to as ONCHIT] : Part of HHS that oversees and encourages the development of a national, interoperable (compatible) health information technology system to improve the quality and efficiency of health care.

TRANSLATIONAL BIOINFORMATICS

Research in bioinformatics that is motivated by human health and thereby emphases the relationship of the work to human disease in areas such as diagnosis, prognosis, treatment, and management.

SHARP

Strategic Health IT Advanced Research Projects : An applied research grants program, funded by ONC, that supports research focused on achieving breakthrough advances to address well:documented problems that have impeded adoption of health IT and to accelerate progress towards achieving nationwide meaningful use of health IT in support of a high:performing, continuously:learning health care system.

specificity

TN/ TN + FP

sensitivity

TP/TP + FN

INTEROPERABILITY

The ability for systems to exchange data and operate in a coordinated, seamless manner.

PUBLIC HEALTH INFORMATICS

The application of biomedical informatics in areas of public health, including surveillance, reporting, and health promotion. Public health informatics, and its corollary, population informatics, are concerned with groups rather than individuals. Public health is extremely broad and might even reflect an interest in information technology with regard to ecology, architecture, climate, agriculture, and such. Generally, AMIA focuses on those aspects of public health that enable the development and use of interoperable information systems for public health functions such as biosurveillance, outbreak response, and electronic laboratory reporting.

CLINICAL INFORMATICS

The application of biomedical informatics methods and techniques, including information technology, to deliver healthcare services. AMIA considers all informatics when used for healthcare delivery to fall in this category, regardless of the health professional group involved (dentist, pharmacist, physician, nurse, or other health professional). Clinical informatics includes a wide range of topics ranging from clinical decision support to clinical documentation to provider order entry systems, and from system design to system implementation and adoption issues.

DENTAL INFORMATICS

The component of clinical informatics that deals with the roles and activities of individuals in the dental profession.

NURSING INFORMATICS

The component of clinical informatics that deals with the roles and activities of individuals in the nursing profession.Last updated: 11/10/2010

INFORMATION SCIENCE

The field of study concerned with issues related to the management and retrieval of both paper:based and electronically stored informationLast updated: 11/10/2010

HEALTH INFORMATICS

The fields of clinical informatics and public health informatics, including both applied research and practice.

HHS

United States Department of Health and Human Services : HHS is the US government's principal agency for protecting the health of all Americans and providing essential human services.

BIOMEDICAL INFORMATICS

The science that develops methods, techniques, and theories regarding how to use data, information and knowledge to support and improve biomedical research, human health, and the delivery of healthcare services.

BIOINFORMATICS

The study of how information is represented and transmitted in biological systems, with an emphasis on molecular biology, genomics, and proteomics.

FDA

United States Food and Drug Administration : A federal agency within the US Department of Health and Human Services (HHS) responsible for protecting the public health by assuring the safety, efficacy, and security of human and veterinary drugs, biological products, medical devices, our nation's food supply, cosmetics, and products that emit radiation, and by regulating the manufacture, marketing, and distribution of tobacco products.

REC

[Health Information Technology] Regional Extension Center : An entity that serves a defined geographical area, offering technical assistance, guidance, and information on best practices to support and accelerate health care providers' efforts to become meaningful users of EHRs and in time to enable nationwide health information exchange.

Patient Portal

a secure online website that gives patients convenient 24 hour access to personal health information from anywhere within internet connection (4).

statistical power 3e3

ability to detect statistical difference

McClellands human motivation theory 4a

aka three needs theory, acquired needs theory, motivational needs theory, learned needs theory. people have one dominant motivator of (achievement, affiliation and power), depends on culture and life experiience

alpha vs beta error 3e3

alpha - difference is by chance and not real. beta - there is a difference but none is detected.

confidentiality 1b

condition in which information is shared or released in a controlled manner

BIOMEDICAL RESEARCH

conducted to support the diagnosis, evaluation, and treatment of patients with health conditions.

checklist effect 3e3

decision making more complete with checklists.

dependent variable vs independent variable

dependent or outcome variable vs independent or predictor variable (does CPOE reduce death rates) death rate is outcome or dependent variable.

efficacy vs effectiveness 3e3

efficacy is in controlled research setting, effectiveness- evaluation in a real world setting.

RFP

elicit bids from vendors. make it objective with points.

Sirotas three factor theory of human motivation

equity/fairness, achievement, and comradarie. premise: org goals are not in conflict with workers goals, orgs should try to meet basic needs of workers

types of subjectivist research 3e3

ethnography- observe in their own environment, focus groups-convene individuals, usability- give task and observe, protocol analysis- ask users to "think aloud"

Tuckman model of team evolution 4b

forming, storming, norming and performing 1965. 5th stage adjourning added in 1970s

healthcare quality professional leadership model 4a

foster pos change, org awareness, PI, communication, self development and management, professionalism and prof values

Health IT leadership qualities 4a

good management and project management skills, change management, process redesign. overlap of people, process and technology. knowledge of informatics

Mobile Medical Applications

health software programs that run on software programs that run on Smartphone and other mobile communication devices (3).

Patient Protection and Affordable Care Act

in 2010 the Obama administration signed into law the Patient Protection and Affordable Care Act or "the Affordable Care Act" that includes provision such as the expansion of Medicaid eligibility, establishment of health insurance exchanges, and prohibiting health insurers from denying coverage due to a pre:existing conditions (5).

groupthink 4b

individuals conform to dominant view, dissent is suppressed, alternative courses not fully explored

privacy 1b

individuals desire to limit the disclosure of personal information

ITIL

information technology infrastructure library. developed in UK in 1980s by central computer and telecoms agency. adopted by microsoft in 1990s for operations framework

RFI

made during planning but unable to determine all requirements. award of contract will not automatically follow

difference between leadership and management 4a

management is about processes, leadership is about behavior

security 1b

measures that organizations implement to protect imformation and systems. insures not only confidentiality but integrity and availability

action centered leadership model 4a

meets need of task team and individual. more about behaviors than individual

objectivist vs subjectivist research 3e3

objectivist = quantitative (most common is comparison) , subjectivist = qualitative.

belmont report and the common rule 1b

protection of human subjects of research 1979. respect the person, benficence, justice. outlines provisions for IRB, informed consent and assurances of compliance

allocation bias 3e3

randomization cheated - random or purposefully

assessment bias 3e3

subjects allow feeling toward the system influence it

Hawthorne effect 3e3

subjects alter behavior because they know they are being observed

SNOMED

systemized nomenclature of medicine. merged with english clinical terms project in 2000. Now owned by IHTSDO international health terminology standards development organization. multiaxial or compositional

function results oriented healthchare leadership model 4a

take the three of action (team, task, individual) and add/overlie "results" responsibility for leadership outcomes

group polarization 4b

tendency of a group to entertain more risky or extreme solutions

Blue Button

the electronic application that allows veterans the capability to download their personal health information from their VA patient portal in a very simple text file or PDF. This capability also allows veterans to self enter personal health indicators, emergency contact information, test results, family health history, military health history, and other related health information (1).

Telehealth

the use of telecommunications and electronic information to support long:distance clinical healthcare (6).

strategic mission should align with leadership objectives 4a

true!! on exam

UMLS 3 components

unified medical language system. 3 metathesaurus, semantic network, specialist lexicon (helpful with NLP). CUI (concept unique identifier- terms with same notion); LUI (term identifier- source terms of similar forms), SUI (string unique identifier - lexical variants), AUI (atomic unique identier - each string is an atom from its source). only one to one relationships. has no new terms - all from prior sources. more of a repository

RFQ - request for quotation

used when requirements are clear cut