public health informatics review questions

Running head: CHAPTER REVIEW QUESTIONS 1

Chapter 14 Review Questions for Public Health Informatics Mariah Delaire COH 613 May 1, 2016 Dr. Alan Smith

CHAPTER REVIEW QUESTIONS

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Chapter 1 Review Questions 1. What factors, other than a lack of education about informatics among public health professionals, might account for the fact that the field of public health lags far behind traditional health care in the effective deployment of information technology?  There are many factors that contribute to the effective deployment of information technology in public health. Firstly, many health professionals lack basic understanding of the nature and purpose of informatics as a discipline. This creates resistance to newly introduced technology. Public health informatics also differs from informatics in other areas, causing issues for an effective deployment. These areas include a focus on applications of information science and technology that promotes health of populations, not individuals, a focus on prevention rather than treatment, and a focus on preventive intervention at all vulnerable points in the casual chains leading to disease, injury and disability. Harnessing the available technology to meet the needs of public health professionals is the biggest challenge. 2. Explain why an intensive knowledge of traditional public health is insufficient by itself for developing and applying information systems in public health practice.  The scope of public health informatics includes the conceptualization, design, deployment, development, refinement, maintenance, and evaluation of communication, surveillance, information, and learning systems relevant to public health. It requires the application of knowledge from numerous disciplines, which is why intensive knowledge of tradition public health is insufficient by itself. Computer science, the theory and application of automatic data processing machines, including hardware and software design, algorithm development,


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computational complexity, networking and telecommunications, pattern recognition, and artificial intelligence are the primary underlying disciplines of public health informatics. 3. To what extent does the public health informatics focus intersect with the focus of traditional medical informatics? What do the informatics specialties have in common?  Public health informatics is related to medical informatics in many ways. Both seek to use information science and technology to improve human health. Also, there are related applications that relate both to medical and public health informatics. Those include systems for accessing public health data from EHRs or for providing patient specific prevention guidance at the clinical encounter. 4. Provide some examples of causal points that a public health professional might explore and a practitioner of traditional medicine would not.  Public health interventions have included, legislatively mandated housing and building codes, solid waste disposal and wastewater treatment systems, smoke alarms, fluoridation of municipal water supplies, redesign of automobiles, development of inspection systems to ensure food safety, and removal of lead from gasoline. Public health action is not limited to the clinical encounter.

Chapter 2 Review Questions 1. What factors account for the fact that early public health information systems developed as standalone products?  Many state public health information systems were stand-alone products with little or no interconnectivity and relatively crude data collection and data processing capabilities. They had little or no internal capability or expertise to develop core


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information systems, as the information services function of these agencies was quite new and more focused on basic computing needs. 2. What distinguished the Age of Observation from the Age of Analysis?  The Age of Observation was marked by observations of great physicians in China, Egypt, India, Greece, and Rome, who provided the foundation for preventative and curative practice. These observations led to the development and implementation of public health interventions. The Age of Observation then gave way to the Age of Analysis. Much of the writings and knowledge obtained from the observation era was lost during the age of analysis. Europe became disconnected from other cultures, causing scientific developments to be less known. After the European rediscovery of the Americas, colonization resulted in a Eurocentric New World scientific community which allowed for certain events to have profound implications on public health practice. These events range from the bubonic plague to the general recognition of the importance of a healthy population. 3. What characteristic distinguished the computer ENIAC from all the other computers during WWII?  Once the ENIAC was completed in 1945, it was capable of 360 multiplications per second and was the first multipurpose computer of its time. It could be programed to perform different functions, and it was also fast. For example, it could add 5,000 numbers or do 14 10-digit multiplications in a second. It was very advanced for its time, and could help perform the necessary calculations for gunnery charts. 4. In what sense did the cholera epidemics in 19th century England serve as a watershed in public health practice and public health information systems?  A major cholera outbreak struck in 1854, and Dr. John Snow conducted an investigation. He carefully mapped the location of each of the victims. This mapping revealed a pattern centered on a specific pump. He convinced authorities


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to handle the pump to help stop the outbreak. He continued to investigate, and was able to associate the location of the water intake that supplied the pump. The methodology that he used has become the foundation of all modern epidemiological investigations of the disease outbreak. He also was the first to use a rudimentary manual graphical information system. He pioneered what is now today public health practice using information systems.

Chapter 3 Review Questions 1. What is the interrelationship between cost, service, and quality? How does changing one affect service or value? To what extent does an increase in investment in IT result in an increase in the value of healthcare services?  Value resides in the relationship between cost containment, customer service and satisfaction, and superior clinical results or outcomes. In other words, value is a function of cost, service, and outcome. Changing one function changes the function as a whole, because each component must work together in order to achieve value. Increasing the investment helps to receive and generate data, transform data into useful information, and transform information into knowledge. The capabilities provided by information technology function as key enablers in this process, supporting information management and knowledge creation. 2. Why does effective utilization of information technology in support of a healthcare concern’s strategic plan inevitably require (a) changes in work process (b) increased teamwork (c) emphasis on well-defined competencies?  Effective utilization of information technology requires well defined competencies because the emphasis shifts from what can be accomplished with health informatics to how information can be managed and used to improve health. Improving work processes creates more efficient practices, and is the end point for the classic three


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stage model for technology adoption. Lastly, to improve performance, IT and health professionals need to work as a team. Both need to understand the problem being addressed and both need to contribute their expertise towards the solution. 3. Aside from the obvious benefits of use of the internet to improve customer services and business to business process, what major challenges does the use of the internet for such purpose pose to physicians and other health practitioners?  Some challenges that physicians and other health practitioners face are that patients have to understand the complexity and variability of information online, and doctors have to adjust to a new role as information mediators. As patients gain access to health information, they look to their physicians for help to evaluate that information. This change requires changes in attitude and in the doctor/patient relationship itself. Chapter 4 Review Questions 1. A) To what extent is Arcadia Hospital a “public health agency” functionally? B) To what extent is Arcadia Hospital a “public health agency” if that term is defined according to delegated governmental 

authority? A) Public health functions span the spectrum from individual clinical diagnosis and treatment through population wide epidemiological studies. The common thread among these functions is that they are primarily intended to prevent the spread of disease or the worsening of a condition, or to promote some healthy behavior. In the case of Arcadia Hospital, they are granted federal funds by the ATSDR to help diagnose and treat mercury poisoning in residents near a toxic waste site. This is a prime example of clinical diagnoses and treatment for a specific population using federal funds, classifying Arcadia Hospital as a public health agency functionally. B) A public health agency can also be characterized as an organization dependent


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upon public funding and delegated public authority by a government body. In Arcadia Hospital’s case, they are a privately held corporation which gains most of its support through private donations and commercial revenues. Due to the fact they are receiving funding for the mercury testing and treatment from federal grants, it would still classify them as a public health agency as defined by a delegated governmental authority. 2. A) What characteristics will you look for in determining Comdata’s qualifications to enter such a contract? B) TO what extend do provisions of the Privacy Act of 1974 apply to Comdata, assuming you enter into the contract? C) To what extent do the provisions of HIPAA apply to Comdata under such contract, and what are your agency’s responsibilities with respect to Comdata under HIPAA? D) After Comdata has met the terms of the contract and the contract ends, to what extent do the provisions of HIPAA apply to Comdata with respect to data it has 

collected during the term of the contract? A) Contracting requires that a public health agency take care to ensure that the contractor is bound to strong, appropriate information disclosure and use restrictions consistent with the agency’s own obligations in this area. Contractors should be subject to routine audits for compliance with their contracts and should be qualified as trust worthy before they are delegated any task involving sensitive information. B) The Privacy Act requires health agencies to protect personal information about individuals. As part of the contract, Comdata would need to be trustworthy and not share any private information, which applies the Privacy Act to Comdata. It also prohibits contractors from transmitting Privacy Act- protected information over the internet without using encryption and some reasonable means


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of authenticating the identity of the parties to the transmission. C) Some provisions that apply to Comdata are ensuring the security of Protected Health Information and accountability for Protected Health information use and disclosure. The agency’s responsibilities include adopting written privacy procedures and must take the proper steps to ensure that their Business Associates protect the privacy of information. They also must train employees to understand the new privacy protection procedures. D) The data should be treated the same way it would be if the contract was still active. The data still remains Protected Health Information, therefore all the policies in regards to HIPAA shall continue to be followed. The use and disclosure of any of this information is not permitted and safeguards still need to be taken to protect that information. 3. . 4. For each situation listed, determine where under the privacy act or HIPAA, you are required to obtain voluntary and informed consent of 

individuals before releasing medical records. No consent required for the possible child abuse case. No consent required for the possible disease outbreak. No consent required for the IRB approved project. Voluntary informed consent for the class action lawsuit. Voluntary informed consent when applying for life insurance. Voluntary informed consent for the 25year-old patient. 5. What are your obligations under HIPAA with respect to sharing this

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information? HHS has explicitly recognized that public health activities require information sharing between governmental and private agencies. Examples of permitted disclosures to other public and private entities include disclosures to private medical device manufactures or to cancer registries operated by private


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universities. Public health information sharing is a permitted function that can be conducted by a wide range of public and private organizations. Under HIPAA, the public health physician has a responsibly to the patient, allowing the patient’s medical records to be viewed by the manufacturer.

References O'Carroll, P. Y. (2003). Introduction to Public Health Informatics. SpringerVerlag New York.

public health informatics review questions

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