Clinical Informatics Board Review and Self Assessment PDF
Preview Clinical Informatics Board Review and Self Assessment
Scott Mankowitz Editor CLINICAL INFORMATICS BOARD REVIEW AND SELF ASSESSMENT 123 Clinical Informatics Board Review and Self Assessment Clinical Informatics Board Review and Self Assessment Editor Scott Mankowitz East Orange General Hospital East Orange New Jersey USA ISBN 978-3-319-63765-5 ISBN 978-3-319-63766-2 (eBook) https://doi.org/10.1007/978-3-319-63766-2 Library of Congress Control Number: 2017960810 © Springer International Publishing AG 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. 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Printed on acid-free paper This Springer imprint is published by the registered company Springer International Publishing AG part of Springer Nature The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland Foreword Congratulations on your decision to take the board examination in clinical informatics. You are entering one of the youngest and possibly broadest fields of medicine. If you are in the process of fellowship training in Clinical Informatics, you probably have a shelf full of great textbooks and years of exposure to the best minds in informatics. You should have no trouble with this test. However, for the rest of us, who have been doing informatics on a vocational or avoca- tional basis for the past few years and are just hoping to pass the test before the grandfather- ing period closes, this book is for you. What to Expect There are 200 questions on the board exam, and you have 4 h to complete the test. All ques- tions have equal weight and there is no penalty for guessing incorrectly. Do not leave any questions blank. Board questions are based on well-established core content. There are no trick questions and there are no questions on recent advances or new theories. Stick with the basics.1 The test will include many “candidate” questions, or questions that the board is working on to determine if they are clear enough to be used as actual questions. You will have no way of telling which questions are “real” and which are “candidate.” So, if you see a really hard question, just make a guess and keep going. Time and Place You should register and pay for the test with the American Board of Preventive Medicine by mid-September. The test is administered at Pearson Vue testing centers in many cities over a 2-week period during October. Results are typically mailed in December. What Are My Chances? Your chances of passing are pretty good, although the test seems to be getting harder, accord- ing to the chart below EXAM DATE CANDIDATES PASS PASS RATE % October 2013 468 432 92% October 2014 340 304 89% October 2015 400 320 80% (Source: https://www.theabpm.org/subpass_rates.cfm, accessed 1/17/17) In order to sit for the exam, there are a number of qualifications 1. You must have board certification by one of the ABMS member boards (e.g., American Board of Internal Medicine, American board of Emergency Medicine) 2. Current, unrestricted license to practice medicine 3. ONE of the following pathways 1 If you are reading JAMIA to prepare for the boards, just stop. Put it down. Pick up Shortliffe instead. V VI FOREWORD (a) Fellowship pathway: 24-month ACGME accredited fellowship in clinical informatics (b) Practice pathway: 3 years of at least 25% of a full-time practice in informatics during the 5 years preceding the test. (NOTE: the practice pathway will be deprecated in 2022) How Should I Prepare? Read this book last. This is only a review book, and it will not be useful to people who are completely unfamiliar with informatics topics. Start by reading Shortliffe, Finnel, Reston, Wager, and others. When you’re done with those, take the practice test in this book to iden- tify areas of weakness and review the text where you need to brush up. Anatomy of a Question In order to do well on the test, you have to think like a question writer. Good questions are really hard to write. The American Board of Emergency Medicine (ABEM) estimates that it spends up to $1000 for each question on the board exam in terms of researching, testing, and validating. Really great questions require you to know information from several different content areas at the same time. One of the challenges is that questions have to have a collec- tion of wrong answers that are close enough to seem plausible but still wrong enough so that the question has only one right answer. One thing that board examiners hate more than any- thing else is to withdraw a question because it was ambiguous and there were two right answers. For this reason, numerical questions are especially easy to write. Expect to see plenty of questions where the correct answer is the result of a simple mathematical calculation. It’s probably a good idea to review the Numerical Methods appendix at the end of this book. In the control group, 4 of 5 patients had vomiting. In the study group, 3 of 4 patients had vomiting. What is the relative risk reduction? (a) 6.25% (b) 12.5% (c) 25% (d) 50% Relative risk reduction is the absolute risk reduction divided by the risk in the con- trol group. 4 3 - riskreduction 5 4 0.80-0.75 5 1 RRR= = = = = =0.06625 control 4 0.80 80 16 5 It would be very difficult to answer this question if you did not know the formula for relative risk reduction. However, if you do, the math is very simple, and it would be difficult to get it wrong. Diagrams, especially those that are specific to informatics, also make for great questions. I would expect to see at least one Markov chain on the test. FOREWORD VII 0.65 0.15 0.80 Sick Healthy 0.10 0.25 0.05 Dead In the diagram above, assume that the population is 95% healthy and 5% sick. What percentage will be dead in the next cycle? (a) 2% (b) 6% (c) 25% (d) 80% To solve this question, recognize that 5% of the population is sick and, of those, 25% will be dead the following cycle. In addition, 95% of the population is healthy, and of those, 5% will be dead the following cycle. 0.05 × 0.25 + 0.95 × 0.05 = 0.0125 + 0.0475 = 0.06 This highlights another point. You should be good at estimating numbers. While it is quite satisfying to get an exact answer, the options will usually be far enough apart so that you could guestimate. Information that comes in lists makes great fodder for test questions. For example, Safe Harbor is a de-identification standard which specifically lists 18 pieces of information that must be excluded in order for a medical record set to be considered de-identified. If I were writing a question on Safe Harbor, I’d expect the candidate to be able to identify at least some of the more common identifiers. VIII FOREWORD Which of the following pieces of information is most likely to violate the de-identification standard of the Health Insurance Portability and Accountability Act? (a) Blood pressure (b) Number of clinic visits per year (c) Account number (d) Year of birth For this question, choices A and B are nearly impossible to use for re-identification and are not listed in Safe Harbor. Choices C and D are both listed in Safe Harbor, but year of birth is only relevant for patients older than 90 years old. Therefore, choice C, which uniquely identifies a patient, is the MOST LIKELY answer. This is not to say that choice D is a WRONG answer—it’s just that C is a better answer. If lists make for good questions, ordered lists make for even better questions. Clinical practice guidelines are based on various sources of evidence and are subject to change as new evidence becomes available. Guidelines based on which of the follow- ing sources are LEAST likely to change? (a) Editorial (b) Expert consensus (c) Randomized controlled trial (d) Systematic review This question is asking the candidate to know the ranking of sources of evidence. ALL of the question choices are on the list, but the order of the list is what is being tested. The best answer here is D (systematic review) because it is based on the largest number and variety of subjects and is therefore least likely to change. How This Book Is Set Up The format of this book is identical to the Core Content for the Subspecialty of Clinical Informatics.2 Core Content is a hierarchical list of items that the board felt to be the body of knowledge expected of a clinical informaticist. Unfortunately, there is some significant over- lap among sections, which makes writing a coherent, linear text a bit of a challenge. For example, data warehouses are mentioned in section 3.1.2.1 and again in 3.1.5.5. Ethics is mentioned in three separate sections. I have tried to break up the material into sections that seem most relevant to the headings, but you may find yourself jumping from section to section for complicated topics. If you can’t find what you are looking for, try the index. Then Google. Low Yield Chapters When looking at the core content, you will see that there are some areas that are really hard to test. For example, ethics is a really airy topic. There are no hard and fast rules, just ideas. Also, there are no definitive textbooks on informatics ethics. If you just remember that you shouldn’t broadcast people’s personal health information and sell it, you’ll be fine. On the 2 Gardner RM, Overhage JM, Steen EB, Munger BS, Holmes JH, Williamson JJ, et al. Core Content for the Subspecialty of Clinical Informatics. Journal of the American Medical Informatics Association. 2009 Jan;16(2):153–7. FOREWORD Ix other hand, chapters like the Institute of Medicine’s (IOM) quality components are a ques- tion writer’s dream. The source material is well defined by the IOM. There are exactly six pillars they want you to know. They are easily differentiable. Implementation Specific Information Even if you are a guru with your hospital’s EHR, it’s not going to help you on this exam. Don’t expect there to be any questions which target a single platform, format, or vendor (even if Epic does end up taking over the world). Similarly, if you are a coder and love writ- ing in Haskell or python or (gasp!) Visual Basic, you’re out of luck. I wouldn’t count on any language- specific programming questions on the test. The only exception that comes to mind is Standardized Query Language (SQL) which seems to appear on the test routinely. On the other hand, it’s probably a good idea to have a passing familiarity with commonly used standards like HL7 V2 and CDA. Good luck on the exam, Scott Contents Part I Fundamentals 1.1 Clinical Informatics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Scott Mankowitz 1.2 The Health System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Scott Mankowitz Part II Clinical Decision Making and Care Process Improvement 2.1 Clinical Decision Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Scott Mankowitz 2.2 Evidence-Based Patient Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Scott Mankowitz 2.3 Clinical Workflow Analysis, Process Redesign, and Quality Improvement . . . . . . . 91 Scott Mankowitz Part III Health Information Systems 3.1 Information Technology Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Scott Mankowitz 3.2 Human Factors Engineering . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Scott Mankowitz 3.3 Health Information Systems and Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Scott Mankowitz 3.4 Clinical Data Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Scott Mankowitz 3.5 Information System Lifecycle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Scott Mankowitz Part IV Leading and Managing Change 4.1 Leadership Models, Processes, and Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Scott Mankowitz 4.2 Effective Interdisciplinary Teams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Scott Mankowitz xI
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