代做CHMEGH25 Essentials of Informatics for Healthcare Systems代写Web开发

Postgraduate Programme in Health Informatics

CHMEGH25

Essentials of Informatics for Healthcare Systems

1.    Consider the following fragment of a clinical guideline:

Patients with stage IIIB or IIIC breast cancer should be treated with primary chemotherapy. Patients with stage IIIB or IIIC disease who respond to primary chemotherapy should be treated until the response plateaus or to a maximum of 6 cycles (minimum 4 cycles). Patients with stage IIIB disease should then undergo definitive surgery and irradiation. The management of patients with stage IIIC disease who respond to chemotherapy should be individualized. Patients with stage IIIB or IIIC disease who achieve maximum response with fewer than 6 cycles can be given further adjuvant chemotherapy following surgery and irradiation. Patients whose tumours do not respond to primary chemotherapy can be treated with taxane chemotherapy or can proceed directly to irradiation followed by modified radical mastectomy, if feasible.

a) Draw an entity relationship diagram for the information that would have to be represented in a database to be used to determine which treatment was appropriate for each patient.          (14 marks)

b) In two or three short sentences, summarise some of the challenges in representing the logic inherent in this text in a computable form.          (6 marks)

Marks awarded for:

2 something recognisably an ER diagram (not a flowchart, no if statements)

6 plausible selection of entities and relationships

2 cardinalities

2 complete representation (e.g. includes properties relating to response to treatment and feasibility of surgery)

2 clear layout

ii)

Detail goes beyond what is readily standardised in terminology, (2-3 marks)

Some conditions that are relatively easy to express in language nevertheless have complex logic (2-3 marks)

2.

a) Draw and label a dataflow diagram of the system described in the following text.

The Pan European Privacy-Preserving Proximity Tracing scheme allows a user to install an app on their phone that will broadcast an encrypted ID. The app allows another nearby phone on which the app is also installed to record this ID and the promixity and duration of the contact between the two phones. If a user of the app tests positive for Covid-19, a healthcare official will provide them with a code allowing the list of IDs recorded on their phone, together with the data about proximity and duration, to be downloaded to a server. The server runs an algorithm to determine the level of risk associated with each contact and, if appropriate, adds the ID to a list. The app constantly checks this list and if it recognises the ID, the user will be notified and given suitable advice.             (16 marks)

b) The authors of a study of this kind of system wrote that: “the accuracy with which Bluetooth low energy signatures can be converted to useful proxies of transmission risk is currently uncertain” . Explain what is meant by the term ‘useful  proxies’ in this sentence and comment on the significance of this statement.     (4 marks)

Marks awarded for:

2 something recognisably an dataflow diagram (not a flowchart, no if statements)

6 plausible model of the system with all key features included

2 comprehensive model of the system with all above features included

4 correct representation (e.g. no dead ends, no datastores doing processing)

2 clear layout

ii) A  useful proxy here  is  something  that can  be  easily measured  (the strength and duration of a phone’s contact with a signal from another phone) and which can serve instead of something important but less easily measured (the risk of disease transmission between two individuals in close proximity). ( Two marks)

The value of these apps is dependent on the extent to which the proxy measurement matches the risk we care about. ( Two marks)

3)  In  no  more  than  eight  short  paragraphs  set  out  a  proposal  for  an evaluation of the effectiveness of video consultations in primary care. You should:

•    briefly explain how these consultations are booked and conducted

•   outline key research question that needs to be answered

•   describe and justify the study design

•    provide the key metrics to be measured                        (20 marks)

Accurate account of the consultation (2 marks)

Good research questions (2 marks)

e.g. Safety, Technical feasibility, Effectiveness (impact on use of GP time, other healthcare resourses), Acceptability for patients

Valid research study design (4 marks) Good justification (4 marks)

Provide the key criteria on how each research question will be evaluated (4 marks)

Good statement of limitations (4 marks)

4) A clinical team is working with a tech start-up company to develop a new software tool to help in the management of sepsis. The company would like to  access  a  wide  range  of  data  items  about  patients  who  have  been diagnosed with sepsis, and an appropriate control group, in order to develop machine learning algorithms.

a)  Does the GDPR allow the clinical team to anonymise the data in order to supply it to the tech company? Explain your answer in one or two short paragraphs. (4 marks)

b)  The  clinical  team  propose  to  supply  the  clinicians  with  software  to perform the anonymisation on the data before it leaves the hospital. Who,  in  this  example,  is  the  Data  Processor  and  who  is  the  Data

Controller? Explain your answer in one or two short paragraphs. (4 marks)

c)  Does UK law allow the company to use the anonymised data without having the consent of the patients whose treatments are recorded in the data? Explain your answer in one or two short paragraphs. (4 marks)

d)  The clinical team want to apply for appropriate ethics for the research they are doing with company. Is ethical approval required? What form. of ethical approval might they obtain? (4 marks)

e)  If the work did not involve transferring data to a tech start up but instead was done by the company who currently provide the hospital with EHR services, and therefore routinely have access to the data, would they require permission to use personal data to develop machine learning algorithms? (4 marks)

a) Expected answer is ‘yes’ or but ‘no’ is acceptable ifjustified. Key point can is whether the access is compatible with the purpose for which the data is stored. Explicit consent not required

b) Clinicians/the hospital are the data controllers and processors. Credit will be given for different answers that are well reasoned.

c) Yes, if the data is anonymised there is no data protection issue, no confidentiality issue, GDPR doesn’tapply.

d)  If the  data is anonymised, then no ethics is required but they can apply for HRA ethics to cover the use of anonymised data.

e) If this  is the development of a new product, might be considered research, which would require consent. Beyond the scope of what patients would reasonably expect the data to be used for.

5)

a)  Explain   the   terms   ‘Sustainability   and   Transformation    Plan’   and ‘ Integrated  Care  System ’.  Use  two  or  three  sentences  for  each explanation. (4  marks)

b)  Explain, in one or two short paragraphs, how thinking in terms of an ‘Integrated Care System’ might make it easier to improve digital support for healthcare. (4  marks)

c)  Describe, in one or two short paragraphs the main challenges to be met

in delivering a digital strategy for an Integrated Care System. (4  marks)

d)  Explain, in three or four short paragraphs, an approach to evaluating how much progress an organisation has made towards making effective use of digital technology. List some of the strengths and weaknesses of the approach. (8  marks)

a)

’Sustainability and Transformation Plan’ : NHS/UK government initiative regionally based, encouraging increased collaboration including social care.

‘Integrated Care System’ : approach to delivering health and social care for a region which emphasises collaboration between organisations

1 marks for broadly correct definition, 2 for a comprehensive or insightful answer

b) A range of possible answers including:

Collaboration on digital health projects across partners Purchasing shared solutions

Wider focus  enables more strategic  thinking  about investments (not limited to projects that benefit a single organisation)

c) A range of possible answers but key points are: Small budget

Limited power over the actions of component organisations Legacy systems

d) Digital maturity assessment (1 mark), structured questionnaire with themes (2 marks), self-assessment (1 mark)

Weakness: self-reported, subjective, open to gaming, not dynamic

Strengths: structured, transparent (up to a point), ensure a degree of consistency, reported by staff with knowledge of the trust

(other suggestions are possible, 1 marks for a valid point, 2 for insightful, total of 4 marks available)