Deck 2: Biomedical Data: Their Acquisition, Storage, and Use

Question 1

You check your pulse and discover that your heart rate is 100 beats per minute. Is this rate normal or abnormal? What additional information would you use in making this judgment? How does the context in which data are collected infl uence the interpretation of those data?

Answer 1

Clinical data refers to the collection of data during an ongoing patient care and can be stored in clinical data management system, such as electronic health records (E.H.R.). When multiple observations are collected, it is called as clinical data whereas observation of single element is considered as clinical datum.
The heart rate between 60 to 100 beats per minute is considered as normal but if a person consistently has heart rate of 100 beats per minutes is at the risk of developing tachycardia. This can further leads to complications.
The additional information that can be used to judge the patient's condition will be measurement of temperature and blood pressure. The duration of physical activity and period of resting can also contribute to reach the particular judgment.
There are different kinds of data that are being collected and analyzed. The interpretation of recorded data depends on the context in which it has been collected. For example- the data collected for medical purposes is used for patient care whereas the data collected for weather and climate are used by meteorologist to forecast the weather.

Question 2

Given the imprecision of many medical terms, why do you think that serious instances of miscommunication among health care professionals are not more common? Why is greater standardization of terminology necessary if computers rather than humans are to manipulate patient data?

Answer 2

Clinical data refers to the collection of data during an ongoing patient care and can be stored in clinical data management system. It can be of many types, such as narrative, textual or numerical. While recording narrative data, the healthcare professional uses the shorthand conventions.
The use of shorthand conventions is most common while recording the physical examination of a patient. Sometimes, the healthcare professional used those conventions that are not universally standardized. This can lead to miscommunication if that data is used or referred by some other professional.
For example- some times while recording the data abbreviations are used that are not stand, such as "MI". it can denote both myocardial infarction or mitral insufficiency. Therefore, trained clinicians or physicians play important role in data collection and interpretation.
If computer has to interpret that data rather than humans, in such cases more standardization of terminology is required because it is inefficient to relate different shorthand conventions used to other mentioned symptoms.

Question 3

Based on the discussion of coding schemes for representing clinical information, discuss three challenges you foresee in attempting to construct a standardized terminology to be used in hospitals, physicians' offi ces, and research institutions.

Answer 3

Clinical data refers to the collection of data during an ongoing patient care and can be stored in clinical data management system, such as electronic health records (E.H.R.). When multiple observations are collected, it is called as clinical data whereas observation of single element is considered as clinical datum.
SNOMED-CT (systematized nomenclature of medicine-clinical terms) is a collection of computer accessible medical terminology that is responsible for providing codes, terms and meanings. The scientists have worked more than d decades to establish this database.
The challenges that are faced for constructing a standardized terminology are as follows:
1. The schemes are note effective unless the healthcare professional accept them.
2. It is difficult to create a coding system that is able to cover almost all the patients.
3. There are many healthcare professionals that are not used to recording the data into EHR.

Question 4

How would medical practice change if nonphysicians were to collect all medical data?

Question 5

Consider what you know about the typical daily schedule of a busy clinician. What are the advantages of wireless devices, connected to the Internet, as tools for such clinicians? Can you think of disadvantages as well? Be sure to consider the safety and protection of information as well as workfl ow and clinical needs.

Question 6

To decide whether a patient has a signifi cant urinary tract infection, physicians commonly use a calculation of the number of bacterial organisms in a mil liliter of the patient's urine. Physicians generally assume that a patient has a uri nary tract infection if there are at least 10,000 bacteria per milliliter. Although laboratories can provide such quantifi -cation with reasonable accuracy, it is obviously unrealistic for the physician explicitly to count large numbers of bac teria by examining a milliliter of urine under the microscope. As a result, one article offers the following guideline to physicians: "When interpreting … microscopy of … stained centrifuged urine, a threshold of one organism per field yields a 95 % sensitivity and fi ve organisms per field a 95 % specifi city for bacteriuria [bacteria in the urine] at a level of at least 10,000 organisms per ml." (Senior Medical Review 1987, p. 4)
(a) Describe an experiment that would have allowed the researchers to determine the sensitivity and specificity of the microscopy.
(b) How would you expect specifi city to change as the number of bacteria per microscopic fi eld increases from one to five?
(c) How would you expect sensitivity to change as the number of bacteria per microscopic fi eld increases from one to five?
(d) Why does it take more organisms per microscopic fi eld to obtain a specifi city of 95 % than it does to achieve a sensitivity of 95 %?