Exam: Midterm 3
                              
            (Introduction to Medical Informatics)
         (http://www.cpmc.columbia.edu/edu/textbook)

1. A hospital has had a monolithic
clinical information system for many years. Recently they
seem to be moving toward an interfaced system instead. What
might their reasons be for making the switch?

2. Outline the steps involved in the hypothetico-deductive
approach, which is the method a doctor uses to make a
diagnosis based on patients' findings.

3. A chem-7 is a battery of the following tests: sodium,
potassium, chloride, bicarbonate, BUN, creatinine, and
glucose. Below are two ways to store a chem-7 in a relation
database table (that is, these are two different schemata
for storing data). What are the relative advantages of each
approach?

  (a)
  
  +-----+-------+------+-----+-----+------+---+-----+----+
  |mrn  |time   |sodium|potas|chlor|bicarb|BUN|creat|gluc|
  +-----+-------+------+-----+-----+------+---+-----+----+
  |123  |1/3/95 |140   |3.9  |101  |24    |15 |0.9  |78  |
  |...  |       |      |     |     |      |   |     |    |
  +-----+-------+------+-----+-----+------+---+-----+----+
  
  (b)
  
  +-----+-------+-------+------+
  |mrn  |time   |code   |value |
  +-----+-------+-------+------+
  |123  |1/3/95 |sodium |140   |
  |123  |1/3/95 |potas  |3.9   |
  |123  |1/3/95 |chlor  |101   |
  |123  |1/3/95 |bicarb |24    |
  |123  |1/3/95 |BUN    |15    |
  |123  |1/3/95 |creat  |0.9   |
  |123  |1/3/95 |gluc   |78    |
  |...  |       |       |      |
  +-----+-------+-------+------+
  
4. I have clinical data that I want to send to a central
database. The central database administrator and I agree to
use the Health Level Seven (HL7) data transfer standard.
What else do we need to agree on or negotiate to get data
transfer working?

5. Which of the following would be easier to write a natural
language processor for and why: echocardiogram reports (an
echocardiogram is a very specific test with a relatively
small number of possible findings) or discharge summaries (a
broad description of all aspects of the patient's medical
history).

6. What factors effect how long it takes to send a digital
chest X-ray image over a telephone line? How can I speed up
the transfer?

7. How would a clinician (someone who takes care of
patients) and a researcher (someone who studies diseases in
patients) differ in the way they tend to look at clinical
information?

8. What are the challenges facing the development of an
electronic medical record?

9. Name three things wrong with the following portion of a
vocabulary:

                     [medical_entity]
                             |
                  +----------+------------------------------+
                  |                                         |
              [disease]                            [abnormal_growths]
                  |                                         |
     +------------+--+------------------+                   |
     |               |                  |              +----+-------+
  [cancer]    [lung_disease]   [infectious_disease]    |            |
     |               |                  |              |            |
     |     +---------+-----+            |          [cancer]       [wart]
     |     |               |            |
  [lung_cancer]       [emphysema]  [pneumonia]
                           |
                           |
                           |
                        [severe]
  
  note:
     emphysema is a disease that affects lung tissue
     pneumonia is an infection of the lung

10. Networks are often divided into layers, such as the
seven ISO layers. Why?

11. What is it about a health maintenance organization (HMO)
that would make its billing system look different than that
for traditional fee-for-service or a preferrred provider
organization (PPO).