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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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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 -



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 -



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



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 -



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 -



! 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 -



! 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 -



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 -



Histogram -

Stratification -



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 –



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 -



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 –



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



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.) -



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 –



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) -



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 –



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 -



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



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 -



! 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 –



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 –



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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