Running head: CHAPTER REVIEW QUESTIONS

Chapter14ReviewQuestionsforPublicHealthInformatics
MariahDelaire
COH613
May1,2016
Dr.AlanSmith

CHAPTER REVIEW QUESTIONS

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,

CHAPTER REVIEW QUESTIONS

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

CHAPTER REVIEW QUESTIONS

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

CHAPTER REVIEW QUESTIONS

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
concerns 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

CHAPTER REVIEW QUESTIONS

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

CHAPTER REVIEW QUESTIONS

upon public funding and delegated public authority by a government body. In

Arcadia Hospitals 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 Comdatas
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 agencys 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 agencys 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

CHAPTER REVIEW QUESTIONS

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
agencys 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

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

CHAPTER REVIEW QUESTIONS

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 patients
medical records to be viewed by the manufacturer.

References
O'Carroll,P.Y.(2003).IntroductiontoPublicHealthInformatics.SpringerVerlagNewYork.