Assignment 3
Instructions: 1. Each question can and should be answered in one paragraph. You are to constrain each
answer to 250 words or less. So as to remove any ambiguities in this requirement, this means that your ten
questions in total will have less than 2500 words (hopefully, much, much less). Please let me know if this is not
clear. 2. Submit a Word, text, or RTF document, so I can track changes when I grade 3. Use 0.5 inch margins,
Arial 11 point 4. Exams turned in after the deadline will be penalized 10% per day late. 5. As with Homework
#1 and #2, you will be graded on content, style, and grammar. 6. If a question calls for a number of responses,
please number or letter them in your answer. e.g. (A) first answer, (B) second answer. Make your answers
easy to read. Start each question part on a new line. Make it very clear which part of the question you are
answering. 7. For specific examples, give specific examples. “A rule that tracks abnormal lab values,” is not a
specific example of CDS. “A rule that alerts the physician for a low potassium in the context of Lasix use,” is a
specific example. 8. Do your own work. ! Questions ! 1. (a) Give a specific example of a clinical practice
guideline (CPG) and briefly explain its use. (b) What are two pros and two cons of using CPGs? Relate these
to your specific example. List your pros and cons separately and number then. ! 2. Consider two men, John in
his 20s, healthy, active, fit and Bill in his 60s, with a family history of heart disease and with chest pain on
exertion. Both present to the emergency department with chest pain at rest. Both men are given exercise
stress tests that are positive and suggest coronary artery disease. (a) Are both positive test results equally
convincing? Why? (b) What is the name of the theory that accounts for these observations? (c) What other
crucial data would you like to know about the test and/or coronary artery disease to help you interpret this
positive result? (d) If you represent the insurance company, would you agree to pay for John’s test? Why or
why not? ! 3. Consider a study in a hospital where the staff is being monitored to see if new signs help improve
hand washing. Consider the different threats to validity in our textbook and online posted lectures: assessment
bias, allocation bias, the Hawthorne effect, the checklist effect, and the placebo effect. For exactly three of
these, give one sentence defining that particular effect and one sentence giving a specific example relating it to
the study described here. You answer should have exactly three parts (1,2,3) and be clearly marked with each
effect/example (a,b,c). ! 4. The Leeds abdominal pain system was devised in 1972 and was used to help
determine which patients with abdominal pain likely had appendicitis. The system was developed and verified
at the University of Leeds and was quite accurate in predicting which patients had appendicitis. But when the
developers tried to implement the system at other institutions, the prediction algorithms did not do nearly as
well. Give two possibilities as to why this might be with a brief description of each. Give each answer on a
separate line and clearly indicate them. !
5. You are developing a screening program for ovarian cancer. You have two tests you can use. Test I is highly
specific but only moderately sensitive for detecting ovarian cancer. Test II is highly sensitive but only modestly
specific for detecting ovarian cancer. (a) Which test will you use for screening (I or II)? As the sensitivity of your
screening test gets lower and lower, you will get more false (b) ____________ results. When a patient tests
positive in your screening test, you then want to use test (c) _____________ to confirm the diagnosis (I or II).
Finally, the resident wants to order one of the tests on a patient. Besides the sensitivity and specificity of the
test, you also need to know the (d) _____________ in order to calculate the positive predictive value of the
test? You answer should have exactly four parts (a-d), each with either a test (I/II) or a single word. ! 6.
Consider the term dependent and independent as they relate to variables in a clinical trial. Explain each of
these terms using one sentence each (a,b), the caveat being that your explanation should be easily
understandable by anyone (i.e. without jargon). Consider a clinical trail where several different doses of
chemotherapy will be tested and both side effects and survival will be measured. In this study, the
chemotherapy dose is the [c] variable, while side effects and life expectancy are [d] variables. a. b. c. d. ! 7. A
staff member comes to you with an idea for a mobile health application she wants to develop and asks for your
guidance as to whether or not she has to obtain approval of the Federal Drug Administration (FDA) of the
application as a mobile health device. State (a) the three types of devices the FDA regulates, (b) give
examples of each, and based on this information (c) describe what key pieces of information you would
consider before you would advise the staff member. ! 8. For each of the following commonly used medical
coding systems, indicate what the acronym stands for, a concise one (full) sentence description (in your own
words) of what these codes are used for, and provide a specific example of each code. Give each answer on a
separate line with the letter designation (a,b, etc.) ! a - CPT b - ICD c - SNOMED d - LOINC e- UMLS ! 9. A
patient asks you how she can tell if a particular health information website is a reliable resource. Briefly
describe three criteria for evaluating health information online. Give an example of a website that meets these
three criteria and explain why. Label your answers (a,b,c) and put each on a separate line. ! !
10. Match. Please number your answers according to the convention in the figure below. !
! a. Highly accurate, Highly precise b. Not accurate, Highly precise c. Highly accurate, Not precise d. Not
accurate, Not precise e. Highly accurate, highly sensitive ! Place one letter (a,b,c,d,e) for each question (1-4). !
1. _______ (a,b,c,d,e) 2. _______ (a,b,c,d,e) 3. _______ (a,b,c,d,e) 4. _______ (a.b.c.d.e) 5. For a test to
be valid, it must be _________ (enter word or words) ! ! ! ! ! 1. Bonus - 5 points ! Please submit a question and
answer to be used on a future problem set. Any topic from the entire term can be used.
1.
A. PSA testing measures levels of prostate-specific antigen (PSA), a substance produced by the
prostate gland. Elevated levels of this antigen can be an indication of prostate cancer, as cancer cells
produce more PSA than normal cells.
B.
Pros1. PSA screening may help detect prostate cancer early and cancer is easier to treat
when caught in the early stages.
2. A simple blood test can be done for PSA testing and the number of deaths have
gone down since this testing has become available.
Cons
1. It is possible for a PSA level to be elevated when cancer isn’t present and can also
be within normal ranges if cancer is present.
2. Some prostate cancers are slow growing and may not need treatment, but with an
elevated PSA level, some may experience anxiety and confusion about the diagnosis.
2. 1.
a. No. I would expect the positive stress with Bill, as he has a family history
and exhibits chest pain with exertion. John does not have a family history
or complaint of chest pain on exertion, so his chest pain at rest most likely
is caused by another disease such as acid reflux. John has no risk factors
to indicate cardiac disease.
b. Bayes Theorem
c. Positive and negative prevalence values.
d. No. Other tests, such as cardiac blood work should have been performed
before a more expensive test such as an exercise stress test.
3. 1. The Hawthorne effect
a. The Hawthorne effect is the thought that workers will improve their
behavior and work harder when they are participants of an experiment.
b. Staff are washing their hands after helping turn a patient.
2. Checklist effect
c. The checklist effect is seen when structure data collection forms are used
and an improvement is seen decision making.
d. Nurses on a medsurg ward, now required to document hourly rounding on
a new form, have less calls for pain medication.
3. Placebo effect
a. The placebo effect is seen when patient’s think a therapy is helping with
treatment, when in fact, there are no proven results that the therapy will
help at all with their symptoms.
b. Nurses are stating that they have noticed an increase in hand washing,
stating the signage is encouraging more hand washing, when in fact,
there has not been an increase in hand washing based on pre-study
metrics.
4.
1. One possible explanation is the variation of data that was entered by clinicians in the
new facility. The system was built based on information entered by clinicians at the University of Leeds.
Clinicians at other institutions may have entered data differently, but the system was expecting the data
to be entered in the same manner as entered by the clinicians that developed the system.
2. Another possible explanation is reporting bias. Reporting bias is when those who are
reporting the data, may not be doing so correctly based on the fact that they do not
want a computer more accurately diagnosing abdominal pain causes than the
clinicians who were testing the system.
5.
a.
b.
c.
d.
I
Positive
II
probability
6. .
1.
2.
3.
4.
A dependent variable is the result or outcome being studied.
Independent variables can be modified to influence the dependent variables.
The chemotherapy dose is the independent variable in this trial.
Side effects and life expectancy are the dependent variables in this trial.
7. .
1. Hippomsg
a. Hippomsg, a mobile app, is a free secure messaging network that allows
healthcare providers to text and remain HIPAA compliant.
b. If the mobile app is generic and will allow healthcare providers to
communicate patient data on a secure network, the app does not have to
be registered with the FDA.
2. iPharmacy
a. iPharmacy is a mobile app that allows users to input the shape, color, and
numbers or letters on a pill to identify the name of the pill.
b. If the mobile app is only used for general patient information or commonly
used reference information, it does not have to be regulated by the FDA.
3. AirStrip OB
a. AirStrip OB is a mobile medical app that allows providers to view data
fetal monitoring systems from their mobile device.
b. If the medical app proposed displays patient-specific data from a
connected device, the app must be registered with the FDA.
8.
1. CPT-Current Procedural Terminology.
2.
3.
4.
5.
a. CPTs, 5-digit codes assigned to diagnostic/ therapeutic procedures, are
used to assign a reimbursement amount for each procedure that
physicians and insurance companies can use to establish their
reimbursement amounts.
b. 54150 is the CPT code for newborn circumcision.
ICD-International classification of Disease.
a. ICD is an international system of coding that organizes data into standard
disease groups for medical professionals to compare data to identify
trends, to be used in research and to share health information globally.
b. E1042 is the ICD Code for Type 1 diabetes mellitus with diabetic
polyneuropathy.
SNOMED-Systematized Nomenclature of Medicine.
a. SNOMED, a standardized system that uses numbers to represent clinical
terminology in an effort to minimize ambiguity found with other coding
systems, is used in the exchange of health information to disparate EHR
systems.
b. 233604007 is the SNOMED code for Pneumonia.
LOINC-Logical Observation Identifiers Names and Codes.
a. LOINC, 3-7 character length names/codes that stand laboratory tests and
clinical results, are used for exchange of results for clinical quality
measures, research and outcome measures.
b. 2862-1 is the LOINC code for Albumin (mass/volume) in serum or plasma
by electrophoresis.
UMLS-Unified Medical Language System.
a. UMLS is a free, comprehensive list of biomedical terms created to assist
healthcare system developers in build and enhancement of electronic
health systems.
b. The UMLS knowledge sources are distributed on CD-ROM and by FTP,
updated quarterly, and are free for research purposes within an
institution.
9.
a. The source of the website should be considered. For example, the
Federal and Drug Administration (FDA) is a branch of government that is
commonly known to the general public. Their website (www.fda.gov)
clearly lists on every page that this site and all of the information
contained on it, belongs to the FDA.
b. The information should be up to date. American Cancer Society’s
webpage (American-cancer.com) has articles that can be accessed by
consumers on a number of cancer related items. There articles include
dates indicating medical review date as well as last revision data.
c. The information should be accurate. Information provided by .edu sites
are run by universities and medical schools and should be considered a
good source of health information. The Mayo Clinic’s website
(http://www.mayoclinic.org/diseases-conditions) is a comprehensive guide
to a variety of conditions.
10. L
1. d
2. c
3. b
4. a
5. reliable
BonusYou are the CIO of a Regional Medical Center. The server room was recently flooded and your security analyst
has recommended moving the server to room to a military-grade data center. What are 2 pros and 2 cons that
should be considered when making this type of decision for an entire facility?
1.
Pros
a. Security is often layered in these centers, ensuring that as persons go deeper into the facility,
the security is increased.
b. Most military-grade facilities such as this conduct multiple testing protocols, including security,
disaster back-up systems and alarm systems.
2. Cons
a. Cost-Organizations will have to consider the increase cost to accommodate the monthly fees
associated with storage room, security and data center day-to-day costs.
b. Location-These centers are not going to be close to the facility, so when access to server room
is needed, one will have to travel and this may be somewhat of an inconvenience if a server has
gone off-line and cannot be accessed remotely.