Mustafa Degerli - 2016 - Answers for MI 502 – Introduction to Medical Informatics Final Exam

Mustafa Değerli
Answers for MIN 502 Fall 2015-2016 Final Exam
Page 1 of 10
Introduction to Medical Informatics
MIN 502 – FINAL EXAM
FALL 2015-2016
1. After all the courses you have followed, what subject would you invest on if you decide to establish a start-up.
Please define as deep as possible your product(s), features, solution/benefits and the reason of need for such a start-
up (20 points)
I would deliberately invest on the subject of “privacy and security” of medical
informatics, provided that I decide to establish a start-up.
Today, both in our country and in many of the developed/developing countries, there
are many projects, initiatives, and efforts for the use, utilization, and exploitation of
data/information of patients in the context of medical informatics. As these
data/information are of very vital importance to us, we as patients (will) want to make
sure that privacy and security of these are fully addressed and guaranteed. For that
reason, there is/will be an unceasing need for such specialization and practice.
In my opinion, this is a very niche and promising field, at least for our country. As far
as I know and predict, there is no noteworthy efforts on the way to deal with the
privacy and security, especially privacy part, concerns of the projects, initiatives, and
efforts in the context of medical informatics in our country.
My start-up will be a service oriented company (to be) specialized in the privacy and
security of medical informatics.
My start-up will be either providing consultancy and active support to the
organizations to manage the privacy and security dimensions of their solutions or
developing and providing staff and/or tailor-made systems to be integrated into their
systems to addressed and guarantee the privacy and security concerns.
At the very beginning, my start-up will be working with (hiring) academics and high-
caliber professionals to determine, mature, accredit, and establish certain standards
and rules in the context of the privacy and security of medical informatics with
respect to laws/directions, related best practices, researches done in the field, and
target people’s concerns.
After distilling certain standards and rules in the context of the privacy and security
of medical informatics, my start-up will contact with related authorities and
associations (like the Ministry of Health and the Turkish Medical Association) to
promote my start-up’s works in this context. I envisage my start-up will succeed in
this step thanks to my start-up’s great efforts and our partners’ (academics and high-
caliber professionals) great networks.

Mustafa Değerli
Page 2 of 10
After getting promotions and even credits from related authorities and associations,
my start-up will generate an influence on target organizations (organizations
developing or maintaining medical informatics solutions). They will be coming to my
start-up to handle the privacy and security concerns of their systems/solutions.
After they come to my start-up to cooperate, we will be providing following solutions
as match to their needs and expectations:
 Analyzing their expectations regarding the privacy and security of the
pertinent systems/solutions,
 Analyzing people’s (related target people) expectations regarding the privacy
and security of the pertinent systems/solutions,
 Checking their developed systems/solutions to determine how well they do
regarding privacy and security,
 Reporting on the points which adequately toe the line and the points that need
to be enriched on the subject of privacy and security of the pertinent
systems/solutions,
 Providing consultancy and active support to the organizations to manage the
privacy and security dimensions of their solutions, and/or
 Developing and providing staff and/or tailor-made systems to be integrated
into their systems to addressed and guarantee the privacy and security
concerns.
My start-up’s efforts will be great importance as I believe that organizations
(organizations developing or maintaining medical informatics solutions) will make a
remarkable difference with their solutions’ strengths and conformance regarding the
privacy and security. They will have a comparative and competitive advantage in the
market thanks to the privacy and security features of their products and services.
Most of the systems/solutions will be wasting of time, efforts, and money if they are
not accepted and used by related people/bodies. As our people become more educated
and enlightened, they will not allow that their all info/data, especially ones related
with their health, used, operated, and even shared disregarding privacy and security
concerns. Hence, people will not accept or use the systems/solutions as they have
question marks in their minds regarding the privacy and security of the pertinent
systems/solutions. That’s why, organizations (organizations developing or
maintaining medical informatics solutions) determinedly need to address privacy and
security of the pertinent systems/solutions, and they will come to us to cooperate.

Mustafa Değerli
Page 3 of 10
2. Imagine that you are the Health Minister. Which IT tools/solutions would you deploy in the next 10 years that are
not being used at your country? (20 points)
This sort of list may have no end and may take many pages.
Yet, below, I have listed the four (4) prominent ones to me, taking strictly into account
the Turkey’s current systems, budgets, and current infrastructures. Surely, many and
much more sophisticated, advanced, and costly solutions and services can be
introduced and deployed, but I have limited mines regarding the Turkey’s current
systems, budgets, and current infrastructures.
 Medical Computers, Tablets for Doctors, Nurses, and Patients
o This can be rarely seen at some (very few) hospitals in our country, but
I would definitely make them more widely available, in the large and big
hospitals, at least.
o In my opinion, this is a very good means for automation and
digitalization. By these, I am to improve the effectiveness and efficiencies
of the many processes in the hospitals.
o Additionally, these instruments provide handwriting recognition via a
digital pen, built-in camera to document wounds, etc., barcoding and
RFID capability, wireless and Bluetooth capability, biometric
fingerprint reader, programmable buttons, light weight, ability to be
wiped clean for disinfection, and long battery life and switching batteries
rapidly.
o All these factors make me to widely deploy this technology.
 Devices of Voice over Wireless Fidelity (VoIP), Like “Vocera”
o I would deploy this to increase the “mobility” of the staff (doctors,
nurses, etc.) in the hospital.
o This decreases the dependence on phone lines and pagers. For example,
“Vocera” offers a hands-free device and Avaya and Cisco offer typical
handsets. This is a wireless device worn around the neck that follows
commands throughout voice recognition. This device can also send and
receive telephone calls. The system can also include a nurse call button
integration feature.
o By this way, I am to provide more “access” to related staff in the
hospitals.

Mustafa Değerli
Page 4 of 10
 24/7 Patient Tracking via Wearables
o I would deploy “24/7 Patient Tracking via Wearables” especially for
patients with diseases who need to be 24/7 tracked but not necessarily to
be in the hospitals at all time.
o By this means, I would eliminate that that they occupy the rooms and
beds in the hospital and let them enjoy their time with their lovers. Yet,
as we are able to monitor them via wearables, we also ensure their
wellbeing and health, and know what we can as long as needed.
o These are good means to let people enjoy their lives and gives us chances
to manage their wellbeing simultaneously.
 Smartcards, Chips Integrated into the New ID Cards in Turkey
o In Turkey, we will be having new ID Cards.
o The Scientific and Technological Research Council (TÜBİTAK) works
on this project. As the authority, I would include chips integrated into
the New ID Cards in Turkey to store, process, and exchange basic
medical data that can be used for emergencies and authentication.
o I believe this sorts of deployment will be really meaningful and
purposeful.
Note: While answering this question, I have benefited from the course material,
“Emerging Trends in HIT” slides (Chp 6 - Emerging Trends.pdf).

Mustafa Değerli
Page 5 of 10
3. Answer the following questions based on the following study published in BMJ by Lawton et al. titled
“Development of an evidence-based framework of factors contributing to patient safety incidents in hospital
settings: a systematic review”:
a) Where would you place the above study on the pyramid for evidence based medicine, explain? (5 points)
According to the course material, “Evidence Based Medicine and Clinical Support
Systems” slides (2016_Week11_EBM_CDSS.pdf), I would place the subject study
(Rebecca Lawton, R., McEachan, R. R. C., Giles, S. J., Sirriyeh, R., Watt, I. S., and
Wright, J. (2012). Development of an evidence-based framework of factors
contributing to patient safety incidents in hospital settings: A systematic review. BMJ
Quality & Safety [Quality & Safety in Health Care], 21, 369-380.) in the category of
“Systematic Reviews.”
I would place the subject study in the category of “Systematic Reviews” owing to
 The subject study was a protocol-driven, wide-ranging, and reproducible
(repeatable) searches to answer the dedicated question (factors contributing to
patient safety incidents in hospital settings),
 The authors noted that “The Preferred Reporting Items for Systematic
Reviews and Meta-Analyses (PRISMA) guidelines were followed in conducting
this systematic review,”
 The title (Development of an evidence-based framework of factors contributing
to patient safety incidents in hospital settings: A systematic review) of the work,
itself, says this is a systematic review, and
 More precisely, I would categorize this work as “Systematic Review and Meta-
Analysis” as defined by the web site (http://hsls.pitt.edu/resources/ebm#). With
“Systematic Review and Meta-Analysis,” The authors do ask an explicit
clinical question, do perform a wide-ranging literature search, do remove the
poorly done or fairly inappropriate studies, do combine all the results of all the
studies into a particular statistical analysis of results, and as a result do attempt
to make practice recommendations. In fact, these are the exact steps followed
by the authors in the subject study.
b) Explore the http://www.tripdatabase.com/. What is TRIP stands for, what is the main purpose of this database?
(5 points)
As defined on the website (https://www.tripdatabase.com/about), the TRIP stands for
“Turning Research Into Practice.”

Mustafa Değerli
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As explained on the website (https://www.tripdatabase.com/about), the TRIP’s main
purpose is “to let users quickly and easily find and use high-quality research
evidence(s) on the way to support their practice and/or care.” Besides, in addition to
research evidence(s), the TRIP also makes is possible for clinicians to search across
other content types, such as images, videos, patient information leaflets, educational
courses, and news to support their practice and/or care.
c) List three of the “contributory factors” identified in table 2, most directly related to the patient safety, discuss
briefly. (5 points)
I have chosen “active failures,” “communication systems,” and “individual factors.”
 Active Failures
o These are any failures in performance and behavior of the health
professionals.
o Regarding methods of incident reporting with 22.6%, interviews and
focus groups with 9.8%, observational with 12.6%, and other with
18.2%, this factor is quite remarkable and notable.
o For sure, these quite high numbers reflect that active failures are of vital
importance for patient safety.
 Communication Systems
o These are effectiveness of processes and systems to exchange and share
information.
o These are written and verbal commination systems.
focus groups with 5.4%, observational with 8.4%, and other with 10.9%,
this factor is quite noteworthy and important.
o Definitely, these quite high numbers say that communication systems
are actually significant regarding patient safety.
 Individual Factors
o These are characteristics of persons delivering care leading to failures.
o These are like inexperience, stress, personality, and attitudes.
focus groups with 24.1%, observational with 6.3%, and other with
8.3.9%, this factor is quite remarkable and essential.
o Unquestionably, these quite high numbers claim that individual factors
are truly major regarding patient safety.

Mustafa Değerli
Page 7 of 10
d) Which of the “contributory factors” listed can benefit most from medical informatics solutions? Discuss briefly
describing and comparing the solutions available / or you are proposing. (10 points)
To me, “Communication Systems” is the one that can benefit most from medical
informatics solutions.
Medical informatics solutions are thankfully there meant for the effectiveness of
processes and systems to exchange and share information in both written and verbal
forms.
In this context, we can talk about two main medical informatics solutions. These are:
“Medical Computers, Tablets for Doctors, Nurses, and Patients” and “Devices of
Voice over Wireless Fidelity (VoIP), Like Vocera.”
 Medical Computers, Tablets for Doctors, Nurses, and Patients
o These are very good means for automation and digitalization. By these,
there will be improvements regarding the effectiveness and efficiencies
of the many processes in the hospitals. Especially in the communication
systems, we will have remarkable improvements. Furthermore, these
instruments provide handwriting recognition via a digital pen, built-in
camera to document wounds, etc., barcoding and RFID capability,
wireless and Bluetooth capability, biometric fingerprint reader,
programmable buttons, light weight, ability to be wiped clean for
disinfection, and long battery life and switching batteries rapidly. All
these factors are promising and valuable regarding the effectiveness of
processes and systems to exchange and share information.
 Devices of Voice over Wireless Fidelity (VoIP), Like “Vocera”
o To increase the “mobility” of the staff (doctors, nurses, etc.) and improve
communication in the hospital. This meaningfully decreases the
dependence on phone lines and pagers. For instance, “Vocera” offers a
hands-free device and Avaya and Cisco offer typical handsets. This is a
wireless device worn around the neck that follows commands
throughout voice recognition. This device can also send and receive
telephone calls. The system can also include a nurse call button
integration feature. This instrument ensures more reliable, sudden and
timely “communication” and “access” to related staff in the hospitals.
All these features are favorable and appreciated regarding the
effectiveness of processes and systems to exchange and share
information in the hospitals.

Mustafa Değerli
Page 8 of 10
4. Based on the study published on SmartHealth (Raghu et al. BMC Medical Informatics and DecisionMaking, 2015)
a) What is “evidence based medicine”? Describe briefly and comment on how it is utilized in the SmartHealth system.
(10 points)
According to the course material, “Evidence Based Medicine and Clinical Support
Systems” slides (2016_Week11_EBM_CDSS.pdf), evidence based medicine can be
defined as the adoption of cynical guidelines, protocols, or pathways which have been
developed by means of research(es) and/or other formal analysis of best practice(s).
Evidence based medicine happens passing through five chief steps itemized below:
 See a patient and generate a question,
 Formulate a well-constructed question,
 Seek the best evidence(s) for that question,
 Appraise evidence(s) using tools, and
 Apply the evidence(s) to the subject patient concerning contextual issues.
In the subject study [Raghu, A., Praveen, D., Peiris, D., Tarassenko, L., and Clifford,
G. (2015). Engineering a mobile health tool for resource-poor settings to assess and
manage cardiovascular disease risk: SMART health study. BMC Medical Informatics
and DecisionMaking, 15:36.], evidence based medicine is realized based on the
following facts mentioned in the subject study:
 At the outset, the CDS (Clinical Decision Support) tool was part of an mHealth
system comprising a mobile application made up of an evidence-based risk
prediction and management algorithm, and a server-side electronic medical
record system.
 Firstly, through an agile development process and user-centered design
approach, key features of the mobile application that fitted the requirements
of the end users and environment were obtained.
 Besides, an all-inclusive analytics framework facilitated a data-driven
approach to investigate four areas (system efficiency, end-user variability,
manual data entry errors, and usefulness of point-of-care management
recommendations to the healthcare worker).
 What is more, a Likert scale (four-point) was utilized at the end of every risk
assessment to scale ease-of-use of the system.
 Furthermore, the system was field-tested with eleven village healthcare
workers and three Primary Health Centre doctors, who screened a total of 292
adults aged 40 years and above.

Mustafa Değerli
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 At the same juncture, 34% of participants screened by health workers were
identified by the CDS tool to be high CVD risk and referred to a doctor.
Detailed analysis of user interactions found the CDS tool practical for use and
it can straightforwardly be integrated into the workflow of healthcare workers.
 Subsequently, following completion of the pilot, further technical
enhancements were applied to increase uptake of the mHealth platform.
 To end with, it will be evaluated on behalf of effectiveness and cost-effectiveness
in a cluster randomized controlled trial involving 54 southern Indian villages
and over 16000 individuals at high CVD risk.
When all these are deliberated and evaluated together, it can simply be decided that
all necessities of the evidence based medicine are wholly implemented and achieved
in the subject study.
b) What type of a project development and design approach is applied while building SmartHealth. Top-down or
bottom-up? What are the main benefits of the approach mentioned in the article? (10 points)
The “bottom-up” project development and design approach was applied while
building the SmartHealth in the subject study.
More precisely, the agile development methodology as a kind of bottom-up project
development and design approach was applied in the subject study.
The main benefits of the approach can be itemized as follows:
 It is the agile development methodology which underlines iterative
development with constant feedback from the stakeholders whereby
requirements emerge along the process. This has the benefit of evolving to
changes in a live and vibrant environment.
 The requirements of the end-users compounded with the uncertainties in
technical infrastructure (such as the availability of uninterrupted 2G/3G
internet connectivity) could not be determined thoroughly through a needs
assessment. But this was smoothly handled by the use of agile, the bottom-up
approach.
 This approach made it conceivable to iteratively design prototypes and elicit
views from the end-users. This was still another pro to make a successful
product/service.

Mustafa Değerli
Page 10 of 10
 This approach works (worked) fine in the settings where the end users had little
or no experience with using information and communication technology and
for sure could not drive the design.
 In the subject study, this approach made it possible that the researchers
employed a multidisciplinary team comprising an engineer, local physician,
sociologist, and a physician to balance system requirements (for designing
features for an effective intervention, such as understanding the local clinical
practice for ways of conveying recommendations for managing CVD risk, or
assessing accuracy of ASHAs asking questions like medical history) with user
requirements. This was yet another benefit realized in the applied approach.
 The applied approach provides (provided) chances to have phases of
prototyping and user assessment where the multidisciplinary team evaluated
the end user interactions with the mobile application through observations and
post-procedure interviews. This feature also makes the applied approach
favorable for developer(s) and end-users in the pertinent appropriate settings.
c) Think about and explain two challenges in the adaptation of mobile disease management tools like SmartHealth.
Support your statement briefly. (15 points)
For such tools to be adapted, there are mainly two dimensions that have to be
addressed very well. These tools/systems shall be planned, designed, and deployed in
a way so that their “perceived ease of use” and “perceived usefulness” are
satisfactorily attained and ensured for end-users. By “perceived ease of use,” I mean
the users’ perceptions that using the pertinent system(s) will be free of effort. People
don’t accept complicated, confusing, and complex things. They, at least the majority
of them, should find the pertinent systems easy to use. Or else, they will not use, in
fact can’t use, the pertinent systems. By “perceived usefulness,” I mean the users’
perceptions that using the pertinent system(s) will enhance performance. Majority of
the users should find the system functional and beneficial. They should see and
appreciate that the system is useful. Otherwise, it will not take much time for users to
drop and leave the use of pertinent systems. For such tools, the another possible
problem with the adaptation is the exceptions case. Although such systems are well
refined and established, sometimes there are exceptional cases that violates the
reliability of the tools/systems. In such cases, the adaptation becomes more difficult
as there will be question marks caused by the exceptions. Yet, as long as the users are
justified and informed well, the chances for adaptation will remarkably rise and the
promised and expected benefits of the pertinent tools/systems will be accomplished.

Mustafa Degerli - 2016 - Answers for MI 502 – Introduction to Medical Informatics Final Exam

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Mustafa Degerli - 2016 - Answers for MI 502 – Introduction to Medical Informatics Final Exam