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InformaticsPro Clinical Informatics Subspecialty Board Exam Study Guide
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CLINICAL INFORMATICS BOARD EXAM OUTLINE AND STUDY GUIDE
This study guide has been made to outline key concepts within the core content for the clinical informatics subspecialty board exam. It is up to you to understand the concepts listed if you plan on taking the board exam.
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InformaticsPro Clinical Informatics Subspecialty Board Exam Study Guide
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FUNDAMENTALS
• CLINICAL INFORMATICS
! DEFINITIONS OF INFORMATICS
Define clinical informatics -
! HISTORY OF INFORMATICS
Major events in informatics and EHRs -
! THE DISCIPLINE OF INFORMATICS
Explain clinical informatics -
! DOMAINS/SUBSPECIALTIES OF INFORMATICS
Biomedical informatics –
Translational Informatics -
Imaging Informatics -
Clinical informatics –
Other domains and subspecialties -
! CAREERS IN INFORMATICS
CMIO -
CIO -
Other professions -
! PROFESSIONAL ORGANIZATIONS
AHIMA -
AMIA -
CHIMA -
HIMSS -
Etc. -
! CURRENT AND FUTURE CHALLENGES FOR INFORMATICS
Interoperability -
Usability -
Regulations -
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Etc. -
o CLINICAL INFORMATICS LITERATURE
• CORE LITERATURE
Major journals –
• CRITICAL ANALYSIS OF INFORMATICS LITERATURE
Peer review criteria -
o INTERNATIONAL CLINICAL INFORMATICS PRACTICES
The US versus other countries -
o ETHICS AND PROFESSIONALISM
AMIA code of conduct -
FTC fair information practice -
Ethical concepts -
Ethical decision-making -
o LEGAL AND REGULATORY ISSUES
HITECH/Meaningful Use -
ACA -
HIPAA -
• THE HEALTH SYSTEM
o DETERMINANTS OF INDIVIDUAL AND POPULATION HEALTH
Social and economic -
Physical environment -
Individual characteristics and behaviors -
! PRIMARY DOMAINS, ORGANIZATIONAL STRUCTURES, CULTURES, AND PROCESSES
• HEALTH CARE DELIVERY
Medicare -
Medicaid -
Organizational Structures -
Accreditation -
Licensing -
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Credentialing -
Continuum of Care -
ACOs -
• PUBLIC HEALTH
Assessment -
Policy Determination -
Assurance -
• CLINICAL RESEARCH
Clinical trial phases -
• EDUCATION OF HEALTH PROFESSIONALS
CMEs -
• PERSONAL HEALTH
Personal Health Information (PHI) -
Personal health maintenance -
Occupational health -
o THE FLOW OF DATA, INFORMATION, AND KNOWLEDGE WITHIN THE HEALTH SYSTEM
Unidirectional -
Multi-directional -
o POLICY & REGULATORY FRAMEWORK
HITECH -
ACA -
HIPAA -
ACA -
FDASIA -
o HEALTH ECONOMICS AND FINANCING
Financial Roles in the organization –
Managerial Accounting -
Financial Accounting –
Budgets
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Third-party payers –
Payment structures –
Cost minimization -
Cost-benefit -
Cost effectiveness -
Cost-utility -
o FORCES SHAPING HEALTH CARE DELIVERY
Economic factors -
Government regulations -
Demographic shifts -
Health education -
o INSTITUTE OF MEDICINE QUALITY COMPONENTS
! SAFETY
Define -
! EFFECTIVENESS
Define -
! EFFICIENCY
Define -
! PATIENT-CENTEREDNESS
Define -
! TIMELINESS
Define -
! EQUITY
Define -
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CLINICAL DECISION MAKING AND CARE PROCESS IMPROVEMENT
! CLINICAL DECISION SUPPORT
Define CDS -
o THE NATURE AND COGNITIVE ASPECTS OF HUMAN DECISION MAKING
! GENERAL
Biases –
Availability -
Outcome -
Omission -
Visceral -
Confirmation –
Other Biases –
! MEDICAL
PROACTIVE -
Markov -
Heuristic -
o DECISION SCIENCE
Define decision science -
! DECISION ANALYSIS
Define decision analysis –
Influence diagrams -
Decision trees -
! PROBABILITY THEORY
Define probability theory –
Pre and Post-test probability -
Bayes Theorem -
! UTILITY AND PREFERENCE ASSESSMENT
Patient preferences -
How to determine preferences -
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! COST EFFECTIVENESS ANALYSIS
Define cost-effectiveness -
! TEST CHARACTERISTICS
ROC curve -
Specificity -
Predictive values -
Likelihood ratio -
Contingency table -
o APPLICATION OF CLINICAL DECISION SUPPORT
Five rights of CDS -
Benefits -
Features -
Knowledge-based vs. non-knowledge based -
! TYPES OF DECISION SUPPORT
Alerts, reminders, & prompts -
Alert fatigue -
! USERS OF DECISION SUPPORT
Clinicians -
Patients -
! IMPLEMENTING, EVALUATING, AND MAINTAINING DECISION SUPPORT TOOLS
Workflows -
EHR Integration -
Standards & interoperability -
o TRANSFORMATION OF KNOWLEDGE INTO CLINICAL DECISION SUPPORT TOOLS
! KNOWLEDGE GENERATION
Neural networks -
Machine learning -
! KNOWLEDGE ACQUISITION
Common data sources for CDSS -
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! KNOWLEDGE MODELING
DeGel -
GEM -
! KNOWLEDGE REPRESENTATION
Arden Syntax/MLM -
Asbru -
GLIFs -
GEODE-CM -
! KNOWLEDGE MANAGEMENT AND MAINTENANCE
Knowledge maintenance cycle -
o LEGAL, ETHICAL, AND REGULATORY ISSUES
Ethical questions regarding CDS -
Legal and regulative issues -
CDS in Meaningful Use -
o QUALITY AND SAFETY ISSUES
List of issues with CDSS -
o SUPPORTING DECISIONS FOR POPULATIONS OF PATIENTS
! EVIDENCE-BASED PATIENT CARE
EBM definition -
o EVIDENCE SOURCES
EBM sites and sources -
o EVIDENCE GRADING
AHRQ USPSTF grading system -
o CLINICAL GUIDELINES
What makes “good” guidelines?
Sources of guidelines
o IMPLEMENTATION OF GUIDELINES AS CLINICAL ALGORITHMS
Define clinical algorithm –
How to implement clinical algorithms -
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o INFORMATION RETRIEVAL AND ANALYSIS
Mathematical dimensions -
Property dimensions –
Recall vs. Precisions -
! SEARCH SKILLS
Foreground vs. background questions –
Level of evidence pyramid -
! CRITICAL ANALYSIS OF BIOMEDICAL LITERATURE
Define biomedical literature –
Aspects of biomedical literature -
! CLINICAL WORKFLOW ANALYSIS, PROCESS REDESIGN, AND QUALITY IMPROVEMENT
Define workflow –
Define workflow analysis -
o METHODS OF WORKFLOW ANALYSIS
How to understand and document workflows -
o PRINCIPLES OF WORKFLOW RE-ENGINEERING
Define re-engineering –
Designing a “to-be” state -
o QUALITY IMPROVEMENT PRINCIPLES AND PRACTICES
IOM dimensions of quality -
Organizations that influence quality -
Six-sigma -
Lean -
Fishbone -
Check sheets -
Pareto diagrams -
Workflows -
Control charts -
Scatter diagram -
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Histogram -
Stratification -
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HEALTH INFORMATION SYSTEMS
o INFORMATION TECHNOLOGY SYSTEMS
! COMPUTER SYSTEMS
• PROGRAMMING
High level vs. low level -
Types of programming paradigms -
Object -
Class -
Inheritance -
Interface -
Package -
• DATA AND CONTROL STRUCTURES
Variables –
Variable types –
Control structures –
Data structures –
Syntax -
• SOFTWARE DEVELOPMENT METHODS
Waterfall -
Agile –
Prototype –
Spiral -
• SYSTEM INTEGRATION
System integration process –
Methods of system integration (vertical, star, CDF, Horizontal) -
• QUALITY
Reliability –
Efficiency –
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Security –
Maintainability –
Size –
Identifying Critical Errors -
• INFORMATION SYSTEMS DESIGN AND ANALYSIS
Logical schema –
Normalization –
Denormalization -
Process Modeling -
o ARCHITECTURE
! SYSTEMS
Define Systems architecture –
Distributed systems –
Centralized systems –
Relational systems –
Object-oriented systems –
Data warehouse architecture (ETL) -
! NETWORKS
OSI Network Model –
The 7 levels of OSI –
Function of each layer -
! DATA/DATABASE
Define DBMS –
Types of databases (OO, NoSQL, Flat, etc.) –
Attribute/tuple/relation –
ACID –
Primary and foreign keys –
Normal forms –
Tiered architectures -
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o NETWORKS
! TOPOLOGIES
Point to point -
Bus -
Ring -
Star -
Mesh -
Tree -
! TELECOMMUNICATIONS
Metcalfe’s law –
Internet standards (IP, DNS, TCP/IP, SSL/TLS, etc.) –
LANS/WANS -
o SECURITY
! THE HIPAA SECURITY RULE AND OTHER GOVERNMENT REGULATIONS
Administrative controls –
Technical controls –
Physical controls
Meaningful use security requirements –
Preemption analysis -
! FIREWALLS
Define firewall –
! VIRTUAL PRIVATE NETWORKS
Define VPN -
! ENCRYPTION
Encryption/Decryption keys –
Three states of data -
o DATA
! INTEGRITY
Physical integrity –
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Logical integrity –
Database integrity -
! MAPPING
Define data mapping –
Target/source –
Reverse/Forward mapping -
! MANIPULATION
Define query –
Define SQL –
Common SQL commands and their uses (SELECT, FROM, WHERE, GROUP BY, etc.)
How to read and interpret SQL -
Reporting -
! REPRESENTATION AND TYPES
Binary –
Data types -
! WAREHOUSING
Define data warehousing -
Define data mart -
! DATA MINING AND KNOWLEDGE DISCOVERY
The data mining process –
Finding and selecting data –
Validating results -
o TECHNICAL APPROACHES THAT ENABLE SHARING DATA
! INTEGRATION VERSUS INTERFACING
Define integration -
Define interface –
Data exchange –
Data exchange languages -
! DEALING WITH MULTIPLE IDENTIFIERS
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Personal identifiers –
ID sets -
! ANONYMIZATION OF DATA
HIPAA requirements for de-identification
Expert determination –
Safe harbor -
! HUMAN FACTORS ENGINEERING
o MODELS, THEORIES, AND PRACTICES OF HUMAN- COMPUTER INTERACTION
Predictive models –
Descriptive models –
Mental models –
Information Processing Theory -
GOMS -
KLM -
o HCI EVALUATION, USABILITY TESTING, STUDY DESIGN AND METHODS
Usability testing -
Usability testing methods (A/B, expert review, heat mapping, hallway, etc.) -
o INTERFACE DESIGN STANDARDS AND DESIGN PRINCIPLES
Nielsen’s Heuristics –
OAI/AOI –
Human interface guidelines -
o USABILITY ENGINEERING
ISO 9241 –
ISO/TR 16982 -2002 –
Section 508 -
! HEALTH INFORMATION SYSTEMS AND APPLICATIONS
Define EHRs, CPOE, CDS, Imaging/PACS, LIS, PHR, and Practice management -
o TYPES OF FUNCTIONS OFFERED BY SYSTEMS
Types of functions (clinical, patient management, practice management, public health, etc.) -
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o TYPES OF SETTINGS WHERE SYSTEMS ARE USED
Clinical –
Non-clinical -
o ELECTRONIC HEALTH/MEDICAL RECORDS SYSTEMS AS THE FOUNDATIONAL TOOL
How the EHR integrates into different functions and different settings -
o TELEMEDICINE
Define telemedicine –
Uses and benefits of telemedicine –
Remote monitoring technologies -
! CLINICAL DATA STANDARDS
o STANDARDS DEVELOPMENT HISTORY AND CURRENT PROCESS
General timeline of standards-
The development process (preliminary " review and withdrawal) -
o DATA STANDARDS AND DATA SHARING
HL7 –
HL7 RIM –
HL7 v2, v3 –
Arden Syntax –
CCOW –
CDA –
CCD –
EHR-S FM –
SPL -
o TRANSACTION STANDARDS
X12 –
D.0 –
EFT -
o MESSAGING STANDARDS
HL7 –
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DICOM –
SCRIPT –
CEN ISO/IEEE 11073 -
o NOMENCLATURES, VOCABULARIES, AND TERMINOLOGIES
SNOMED –
LOINC –
ICD –
Other naming standards (HCPS, CPT-4, CDT, NCD, RxNorm, UMDNS, DRG) -
o ONTOLOGIES AND TAXONOMIES
Define ontology –
Define taxonomy –
Meta-thesaurus and UMLS -
o INTEROPERABILITY STANDARDS
Levels of interoperability (foundational, structural, semantic) -
FHIR -
! INFORMATION SYSTEM LIFECYCLE
o INSTITUTIONAL GOVERNANCE OF CLINICAL INFORMATION SYSTEMS
Define IT governance -
ISO 38500 standards –
Commons rules and agreements (BAA, SLA, DUA, OLA, etc.) –
The clinical information system lifecycle -
o CLINICAL INFORMATION NEEDS ANALYSIS AND SYSTEM SELECTION
! METHODS FOR IDENTIFYING CLINICIAN INFORMATION SYSTEM NEEDS
PMI requirements process inputs, tools, techniques, and outputs -
! ASSESSMENT OF CLINICAL PROCESS CHANGES THAT WILL BE REQUIRED
How to gather feedback from clinicians -
! ELEMENTS OF A SYSTEM REQUIREMENTS SPECIFICATION DOCUMENT
Technical vs. functional specs –
Intellectual property (patents, copyrights, licensing) -
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Other elements (Contracting, confidentiality, organizational needs) –
! RISK ANALYSIS AND MITIGATION
Define risk management –
Define risk identification –
Qualitative risk analysis techniques –
Quantitative risk analysis techniques –
Types of risk response -
! THE COSTS OF HEALTH INFORMATION AND COMMUNICATIONS TECHNOLOGIES
True cost of ownership –
Most costs come in the phase -
o CLINICAL INFORMATION SYSTEM IMPLEMENTATION
! ELEMENTS OF A SYSTEM IMPLEMENTATION PLAN
The system selection process (requirements, RFP, vendor selection, contract negotiation) –
Evaluating RFPs –
Elements of a system implementation plan -
! MODELS OF USER TRAINING AND SUPPORT PROCESSES THAT CAN MEET CLINICIAN NEEDS
Types of user training -
! PROCESSES AND MECHANISMS THAT OBTAIN AND RESPOND TO CLINICIAN FEEDBACK
User feedback techniques (dashboards, surveys, usability testing, informal/formal feedback) -
o CLINICAL INFORMATION SYSTEM TESTING, BEFORE, DURING AND AFTER IMPLEMENTATION
DTAP –
White box –
Black box –
Grey box –
Testing levels –
Types of testing -
o CLINICAL INFORMATION SYSTEM MAINTENANCE
! DISASTER RECOVERY AND DOWNTIME
DLP –
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Planned vs. unplanned downtime -
! CLINICAL INFORMATION SYSTEM TRANSITIONS AND DECOMMISSIONING OF SYSTEMS
Elements of a transition/decommissioning plan -
o CLINICAL INFORMATION SYSTEM EVALUATION
! OUTCOMES RELEVANT TO THE CLINICAL GOALS AND QUALITY MEASURES
How to define the relevant outcomes to your organization -
! QUALITATIVE AND QUANTITATIVE METHODS FOR EVALUATING CLINICAL INFORMATION SYSTEMS
Qualitative methods (focus groups, case studies, interviews, etc.) -
Quantitative methods (surveys, structure interviews, testing, etc.) -
! EVALUATION PLAN DESIGN
How to measure expectations vs. results –
Verification vs. validation -
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o
LEADING AND MANAGING CHANGE
! LEADERSHIP MODELS, PROCESSES, AND PRACTICES
Trait theory –
Behavioral theory –
Situational/contingency theory –
Functional theory –
The leadership process –
Styles of leadership -
o DIMENSIONS OF EFFECTIVE LEADERSHIP
The 8 dimensions –
1.
2.
3.
4.
5.
6.
7.
8.
o GOVERNANCE
Elements of a governance structure -
o NEGOTIATION
Goal of negotiation –
Dos and Don’ts of negotiation -
o CONFLICT MANAGEMENT
Types of conflicts (relationship, task, process) -
o COLLABORATION
Define collaboration -
o MOTIVATION
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Define motivation –
Common theories of motivation –
Maslow’s –
Herzberg’s –
Self-determination
Goal-setting
Intrinsic vs. Extrinsic -
o DECISION MAKING
The decision making process -
! EFFECTIVE INTERDISCIPLINARY TEAMS
o HUMAN RESOURCES MANAGEMENT
Hiring and firing –
Performance reviews –
Providing feedback -
o TEAM PRODUCTIVITY AND EFFECTIVENESS
Tuckman’s stages –
Determining team goals –
Rules of operation (group norms)-
Individual roles within the group (task, maintenance, disruptor)-
o GROUP MANAGEMENT PROCESSES
Nominal group technique –
Consensus decision-making –
Delphi method -
o MANAGING MEETINGS
Determining why/who/when of the meeting –
Writing an agenda and minutes -
o MANAGING GROUP DELIBERATIONS
Managing the “types” of meeting attendees –
Robert’s Rules of Order -
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! EFFECTIVE COMMUNICATIONS
o EFFECTIVE PRESENTATIONS TO GROUPS
Elements of an effective presentation (purpose, audience, credibility, logistics, content, organization,
delivery) -
o EFFECTIVE ONE-ON-ONE COMMUNICATION
SBAR/STICC –
Active listening –
o WRITING EFFECTIVELY FOR VARIOUS AUDIENCES AND GOALS
Effective writing skills -
o DEVELOPING EFFECTIVE COMMUNICATIONS PROGRAM TO SUPPORT SYSTEM
IMPLEMENTATION
Understanding users and communicating plans -
! PROJECT MANAGEMENT
o BASIC PRINCIPLES
Define “project” –
The triple constraint –
The five process groups –
Essential project document -
o IDENTIFYING RESOURCES
How to determine project skills –
How to determine project goods -
o RESOURCE ALLOCATION
Time-constrained projects –
Resource-constrained projects –
Leveling –
Slack –
o PROJECT MANAGEMENT TOOLS
Gantt chart –
Performance monitoring/EVM –
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Critical path -
o INFORMATICS PROJECT CHALLENGES
! SCOPE CREEP
How to mitigate scope creep -
! MANAGING EXPECTATIONS
How to set and keep expectations under control -
! BALANCING COMPETING PRIORITIES
How to prioritize activities and resources of a project -
! STRATEGIC AND FINANCIAL PLANNING FOR CLINICAL INFORMATION SYSTEMS
Define strategic plan -
o ESTABLISHING MISSION AND OBJECTIVES
Define objectives –
Define mission -
o ENVIRONMENTAL SCANNING
Define environmental scanning –
STEEP/PEST challenges -
o STRATEGY FORMULATION
SWOT –
Long/short term planning –
Scenario planning –
KPIs -
o ACTION PLANNING AND STRATEGY IMPLEMENTATION
Elements of the strategic plan –
Questions to answer in a strategic plan -
o CAPITAL AND OPERATING BUDGETING
Operating vs. capital budget –
NPV –
IRR –
DCF –
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Payback period –
Profitability index -
o PRINCIPLES OF MANAGERIAL ACCOUNTING
Financial vs. managerial accounting –
Define financial plan -
o EVALUATION OF PLANNING PROCESS
Define implementation gap -
! CHANGE MANAGEMENT
o ASSESSMENT OF ORGANIZATIONAL CULTURE AND BEHAVIOR
Define organizational culture –
Subcultures –
Organizational behavior –
How to assess the corporate environment -
o CHANGE THEORIES
PRECEDE-PROCEED –
Social influence –
Complex Adaptive Systems –
Lewin’s change process -
o CHANGE MANAGEMENT STRATEGIES
Greatest challenges to effective change management –
How to get change to stick -
o STRATEGIES FOR PROMOTING ADOPTION AND EFFECTIVE USE OF CLINICAL INFORMATION
SYSTEMS
Reasons for physician hesitance –
Strategies for promoting adoption -
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