Deck 1: Biomedical Informatics: the Science and the Pragmatics

Question 1

Discuss three society-wide factors that will determine the extent to which computers are assimilated into clinical practice.

Answer 1

Biomedical informatics (BMI) is an interdisciplinary field. It includes the studies and effective uses of biomedical knowledge, information, and data for the purpose of scientific decision making, scientific inquiry and problem-solving to improve the human health. Three society-wide factors that will determine the assimilation of computers in clinical practices are given as follows:
1. New development in the hardware and software area-The both hardware and software technologies have made the most powerful computers cheaper than earlier. Thus, they are easily available to hospital or physicians. Selection of computers with all capabilities makes application attractive and accessible.
2. Increasing in a number of professionals who are trained in both BMI and other health profession-The individual having expertise in both the fields can understand the biomedical issues and hence design more effective systems.
3. Integration of health care into the computational setting- The tendency of patient care through technology is frequently cited in the modern world. The computer is assisting physicians to a large extent, which was not possible earlier.
One of the examples of computerized settings, includes MRI (magnetic resonance imaging) and CT (computerized tomography) scans, which have allowed medical professional to visualize cross-sectional parts of the human body. ICU (intensive care unit), which provides continuous monitoring of the patients, is another example.

Question 2

Sect. 1.1 . After scientists had developed the first digital computers in the 1940s, society was told that these new machines would soon be serving routinely as memory devices, assisting with calculations and with information retrieval. Within the next decade, physicians and other health professionals had begun to hear about the dramatic effects that such technology would have on clinical practice. More than six decades of remarkable progress in computing have followed those early predictions, and many of the original prophesies have come to pass. Stories regarding the "information revolution" and "big data" fill our newspapers and popular magazines, and today's children show an uncanny ability to make use of computers (including their increasingly mobile versions) as routine tools for study and entertainment. Similarly, clinical workstations have been available on hospital wards and in outpatient offices for years, and are being gradually supplanted by mobile devices with wireless connectivity. Yet many observers cite the health care system as being slow to understand information technology, slow to exploit it for its unique practical and strategic functionalities, slow to incorporate it effectively into the work environment, and slow to understand its strategic importance and its resulting need for investment and commitment. Nonetheless, the enormous technological advances of the last three decades-personal computers and graphical interfaces, new methods for human-computer interaction, innovations in mass storage of data (both locally and in the "cloud"), mobile devices, personal health monitoring devices and tools, the Internet, wireless communications, social media, and more-have all combined to make the routine use of computers by all health workers and biomedical scientists inevitable. A new world is already with us, but its greatest influence is yet to come. This book will teach you both about our present resources and accomplishments and about what you can expect in the years ahead. When one considers the penetration of computers and communication into our daily lives today, it is remarkable that the first personal computers were introduced as recently as the late 1970s; local area networking has been available only since ~1980; the World Wide Web dates only to the early 1990s; and smart phones, social networking, and wireless communication are even more recent. This dizzying rate of change, combined with equally pervasive and revolutionary changes in almost all international health care systems, makes it difficult for public-health planners and health-institutional managers to try to deal with both issues at once. Yet many observers now believe that the two topics are inextricably related and that planning for the new health care environments of the coming decades requires a deep understanding of the role that information technology is likely to play in those environments. What might that future hold for the typical practicing clinician? As we shall discuss in detail in Chap. 12, no applied clinical computing topic is gaining more attention currently than is the issue of electronic health records (EHRs). Health care organizations have recognized that they do not have systems in place that effectively allow them to answer questions that are crucially important for strategic planning, for their better understanding of how they compare with other provider groups in their local or regional competitive environment, and for reporting to regulatory agencies. In the past, administrative and financial data were the major elements required for such planning, but comprehensive clinical data are now also important for institutional selfanalysis and strategic planning. Furthermore, the inefficiencies and frustrations associated with the use of paper-based medical records are now well accepted ( Dick and Steen 1991 (Revised 1997) ), especially when inadequate access to clinical information is one of the principal barriers that clinicians encounter when trying to increase their efficiency in order to meet productivity goals for their practices
Reread the future vision presented in Sect. 1.1 . Describe the characteristics of an integrated environment for managing clinical information. Discuss two ways in which such a system could change clinical practice.

Answer 2

The main characteristics of the clinical information managements in an integrated manner involve that it is easily accessible at appropriate quality and cost. The information can be retrieved easily, it is confidential and secure.
The computer-based information management proves to be acceptable to the patients and the clinicians alike. It also integrates the information to the other resources such as, research purposes in order to help in the decision making and problem solving.
The clinical data management can help reduce the time in the drug development process, which can take even decades for a drug to be in the market. It has provided us attempts to resolve the complexity of biological system also.
Finding a conclusive pattern for any specific study on the clinical data, such as deviation by comparing normal and diseased data can help to reduce time for development of drugs.

Question 3

Do you believe that improving the technical quality of health care entails the risk of dehumanization? If so, is it worth the risk? Explain your reasoning.

Answer 3

It is predicted that the entry of HIT (health information technology) in the health care system may make the medical practice less humane and impersonal. It is well known that the technology can cause depersonalization of the health care.
For example, the availability of the CT (computerized tomography) scan might encourage the physician to neglect neurological examinations and history of the patient for evaluation of the headache of the patient. Technology in healthcare industries has revolutionized the field, from a stethoscope to sphygmomanometer in helping physicians.
The advancement of technology has the predicted risk of dehumanization. In early nineteen's doctors were concerned about using this technology as it was thought to intervene with the doctors and patient relationship. The EHR (electronic health records) is documented in order to reduce the human error and facilitate the exchange of information whenever required.
This has effectively reduced the cost, time, and medical errors. New technologies are simple tools; it has nothing to do with humanity. The computer takes over human is not likely to occur. The patients have emotions, which looks for reassurance from his physician.

Question 4

Consider Fig. 1.19 , which shows that bioinformatics, imaging informatics, clinical informatics, and public health informatics are all application domains of the biomedical informatics discipline because they share the same core meth ods and theories:
(a) Briefl y describe two examples of core biomedical informatics methods and theories that can be applied both to bioinformatics and clinical informatics.
(b) Imagine that you describe Fig. 1.19 to a mathematics faculty member, who responds that "in that case, I'd also argue that statistics, computer science, and physics are all applica tion domains of math because they share the same core mathematical methods and theories." In your opin ion, is this a legitimate argument? In what ways is this situation similar to, and different from, the case of bio medical informatics?
(c) Why is biomedical informatics notsimply computer science applied to biomedicine, or the practice of medicine using computers?
(d) How would you describe the rele vance of psychology and cognitive science to the fi eld of biomedical informatics? [Hint: See Fig. 1.22 ]

Question 5

In 2000, a major report by the Institute of Medicine entitled "To Err is Human: Building a Safer Health System" (see Suggested Readings) stated that up to 98,000 patient deaths are caused by pre ventable medical errors in American hospitals each year.
(a) It has been suggested that electronic health record (EHR) systems should be used to address this problem. What are three specific ways in which they could reduce the num ber of adverse events in hospitals?
(b) Are there ways in which computer based systems could increase the incidence of medical errors? Explain.
(c) Describe a practical experiment that could be used to examine the impact of an EHR system on patient safety. In other words, the study design should address whether the com puter-based system increases or decreases the incidence of prevent able adverse events in hospitals - and by how much.
(d) What are the limitations of the experimental design you proposed in (c)?

Question 6

It has been argued that the ability to cap ture "nuance" in the description of what a clinician has seen when examining or interviewing a patient may not be as crucial as some people think. The desire to be able to express one's thoughts in an unfettered way (free text) is often used to argue against the use of structured data-entry methods using a controlled vocabulary and picking descriptors from lists.
(a) What is your own view of this argu ment? Do you believe that it is important to the quality and/or efficiency of care for clinicians to be able to record their observations, at least part of the time, using free text/natural language?
(b) Many clinicians may be unwilling to use an electronic health record (EHR) system requiring structured data entry because of the increased time required for documentation at the point of care. What are two strategies that could be used to address this problem (other than "designing a better user interface for the system")?

Question 7

How do you interpret the phrase "logi cal behavior"? Do computers behave logically? Do people behave logically? Explain your answers.

Question 8

What do you think it means to say that a computer program is "effective"? Make a list of a dozen computer applications with which you are familiar. List the applications in decreasing order of effectiveness, as you have explained this concept. Then, for each application, indicate your estimate of how well human beings perform the same tasks (this will require that you determine what it means for a human being to be effective). Do you discern any pattern? If so, how do you interpret it?