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Cis group project


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    • 1. Healthcare Informatics Clinical Information System A. Martin S. Tipton K. Rowlett A. Warnecke
    • 2. What is a CIS?
        • A Clinical Information System (CIS) is a computer based system that is designed for collecting, storing, manipulating and making available clinical information important to the healthcare delivery process. (
        • Clinical Information Systems may be limited in extent to a single area (e.g. laboratory systems, ECG management systems) or they may be more widespread and include virtually all aspects of clinical information (e.g. electronic medical records ). (
    • 3. What is a CIS?
        • Clinical Information Systems provide a clinical data repository that stores clinical data such as the patient’s history of illness and the interactions with care providers. The repository encodes information capable of helping physicians decide about the patient’s condition, treatment options, and wellness activities as well as the status of decisions, actions undertaken and other relevant information that could help in performing those actions. (
    • 4. Who Should be involved? Key leaders in the choosing, implementing, and revising the CIS should be …… Clinical Staff Administration Staff Information technology staff
    • 5. Clinical Staff
        • Nurses
        • Physicians
        • X-ray technologist
        • Pharmacy
        • Disciplines in direct patient care
    • 6. Administrative Staff
        • Medical Director
        • Administrative Coordinator
        • CFO
        • CEO
        • Director of Nursing Services
    • 7. Computer Staff
        • Chief information Officer
        • Nursing Information Officer
        • Programmer/Analyst
      • (facilities and healthcare centers may differ on titles of computer information staff)
    • 8. Costs of an EHR
        • Calculations of costs are very difficult to obtain due to the varying type and size of the healthcare institutions and the variety of different IT systems that may be chosen to be implemented.
        • The costs to consider that we will look further into are:
          •      Purchase/Implementation
          •      Equipment needs
          •      IT support
          •      Continuing Education
    • 9. Estimated Costs of EHR/EMR
        • A 2003 and 2006 study were carried out at a teaching hospital to obtain an average figure. 
          •    On average, implementation costs for the health IT system amounted to about $14,500 per bed, and annual operating costs were about 19 percent of those one-time costs, or $2,700 per bed.
        • Hoffmann and Podgurski's scholarly study estimate the cost of purchasing is $33,000 per physician.  
        • RAND Corporation researchers estimated for a larger grouping of teaching hospitals for costs considerably higher
          •    nearly $63,000 per bed. The RAND researchers estimated that annual costs for maintaining and updating the system would equal 30 percent of acquisition costs—a figure that is higher than the corresponding proportion in other estimates and that adds $18,900 per bed per year. 
    • 10. Additional costs to consider
        • Additionally there are other common costs to consider:
          • Other training costs (computer-based tutorials, hired trainers…)
          • Office staff back fill costs (while staff are in training, assisting with design, development and/or implementation)
          • Temporary labor (initial EMR data entry, scanning the paper-based medical records)
          • Self-service kiosks including software and services 
          • Temporarily reduced income (reduced schedule at EMR go-live; amount is variable and dependent primarily on the practice and EMR functionalities installed)
          • Office construction and furniture (shelves, counters, wall mounts, power outlets, chairs, carts, tables…)
          • Technical upgrade of office infrastructure (i.e. wireless network, upgraded network connectivity)
          • Additional hardware and devices including networking devices, scanners, printers or kiosk devices
          • Consultants or project manager to facilitate the implementation (large practices in particular should strongly consider using a consultant to help manage the EMR selection, implementation and post-implementation phases
    • 11. Equipment for Implementation
        • A basic statement would be that everyone who needs access to the EHR needs to have it available.
          • This means that they must have a Windows computer available wherever and whenever they need to see the record. For the most part this will mean computer access in every examination room, at every provider's desk, at all nursing work areas, and at all other points of patient care or consultation. This might be accomplished by fixed desktop computers or by mobile workstations.
          • Computers will have to retrieve RPMS patient data, the facility needs to have a reliable network connecting all of the above locations. This network should also have a high-speed Internet connection, to facilitate the clinical decision support functions of EHR
    • 12. IT support/costs
        • Information Technology is a huge part of the healthcare practice.  It includes hardware, software, networks, internet, and problem solving.  These all need to be integrated to work effectively and efficiently.
        • New positions are recommended by the EHR program since the point of a clinical system is to work during all hours of patient care, there also needs to be someone there to perform clinical support duties at all hours of patient care. 
        • Projections for jobs available to IT technical support/health information support shows employment in 2008 as 172, 500 and projected employment for 2018 to be 207, 600.
        • Earnings to these employers and costs to our healthcare systems
          • Federal Executive Branch  - $42,760
          • General medical and surgical hospitals  - $32,600
          • Nursing care facilities  - $30,660
          • Outpatient care centers  - $29,160
          • Offices of physicians  - $26,210
    • 13. Continuing Education   
        • Just like any profession or network there is a learning curve that is constantly changing.  This ranges from social networks and email to the EMR system and medical advances in technology.
        • The training to implement a EHR system is costly:
          • Training costs such as computer-based tutorials and hired trainers
          • Office staff back fill costs for while staff are in training to cover there originally positions
        • So when the basic training is done, the technology is still evolving and will need someone to continue to implement and teach the changes as they come.  The costs will be less then the implementation but there will still be a cost if your system is to be successful. 
    • 14. Education for the CIS HOW ? Hands on for first time users Verbal instruction during live computer lab sessions Updates-interactive computer tutorials with quick reference guide handouts. A.Martin- AAMrtin-11
    • 15. Education for CIS Formats of Learning: Amartin-2                                                                          Touch -classroom based activities and practice skills See - demonstration & observation,  handouts and resource guides Hear - verbal instruction provides increased comprehension
    • 16. Education for CIS            TIME Periodic updates should be given every few months as people become more familiar with the initial training. (ex: show one way to perform a task at the initial education then a month later show another way or a short cut method to help with user speed) Annual re-education- cover any upgrades to the software that users may not be familiar with. Amartin-3
    • 17. Education for CIS      Who Education should be done by nurses that are currently practicing and have an extensive computer background. A clinical informatics specialist team would be the most desirable educators. Amartin-4 aspx
    • 18. The Electronic Health Record (EHR)
      • Definition
      • The EHR is a computer-based data warehouse or repository of information regarding the health status of a client, replacing the former paper-based medical record; it is the systematic documentation of a client's health status and health care in a secured digital format, meaning that it can be processed, stored, transmitted, and accessed by authorized interdisciplinary professionals for the purpose of supporting efficient, high quality health care across the client's healthcare continuum. (Mastrian & McGonigle, 2009) 
    • 19. The Electronic Health Record
      • The  possible features of the EHR have  been divided into eight essential components.
      • EHR Components
      • 1. Health information and data
      • 2. Results management
      • 3. Order entry management
      • 4. Decision support
      • 5. Electronic communication and connectivity
      • 6. Patient support
      • 7. Administrative processes
      • 8. Reporting and population health management
    • 20. The Electronic Health Record
      • Components:
      • 1. Health Information and data  
      •      This is patient data required to make sound clinical decisions. 
      • Includes: Demographics
      •               Medical and Nursing Diagnoses
      •                Medication Lists
      •               Allergies
      •               Test Results
      • Access: The patient and all health care professionals involved in
      •              that patients care should have access to this component. 
      • Importance:  To have data readily available to make 
      •                     clinical decisions.                    
    • 21. The Electronic Health Record
      • Components:
      • 2. Results Management  
      •      The ability to manage all types of results electronically.
      •      This includes current and historical results.  
      • Includes: Laboratory
      •               Radiology Procedure Reports
      • Access:   Patient and all health care professional involved in care.
      • Importance: Allows health care professionals to tie patient data together. Includes patient tracking, scheduling, results reporting, and image tracking.
    • 22. The Electronic Health Record
      • Components
      • 3. Order Entry Management
      •      The ability of a clinician to enter care orders.
      • Includes: Medications
      •                 Laboratory
      •                Microbiology
      •                Pathology
      •                 Radiology
      •                Nursing
      •                Supply orders
      •                 Consultations, etc..
    • 23. The Electronic Health Record
      • 3. Order Entry Management Continued
      • Access:   Patient may view their orders. Physicians and proper licensed personal may enter orders.
      • Importance: Permits proper clinical  providers to electronically enter orders. This system offers a range of functionality, from pharmacy ordering to more sophisticated systems such as complete ancillary service  ordering, alerting, customized order sets, and result reporting.
    • 24. The Electronic Health Record
      • Component
      • 4. Decision Support
      •      This is computer reminders and alerts used to improve the
      •       care and diagnosis of a patient.
      • Includes: Screening for.. Correct drug and dosing
      •                                       Medication interactions
      •                                       Preventive health reminders (vaccinations)
      •                                       Clinical guidelines
      •                                      Health risk screening & detection
      •                                      Patient allergies
    • 25. The Electronic Health Record
      • 4. Decision Support Continued
      • Access: Patient may view this component. All health care
      •               professionals involved in direct patient care may use this
      •              component.
      • Importance: To better protect the patient and make the appropriate
      •                     decisions.
    • 26. The Electronic Health Record
      • Component
      • 5. Electronic Comminucation & Connectivity  
      •      Online communication among healthcare team members and
      •      patients.
      • Includes: E-mail
      •                Web messaging
      •               Integrated health record
      • Access: Patient and healthcare team involved in direct care.
      • Importance: Allows connection & comminication across settings
      •                    & institutions.
    • 27. The Electronic Health Record
      • Component
      • 6. Patient Support
      •      Patient education and self- monitoring tool.
      • Includes: Computer-based patient education
      •                Home telemonitoring (monitoring patient from a distance)
      •                Telehealth (telecommunication)
      • Access:  Patient and health care providers involved in direct patient
      • Importance: To increase efficiency, quality of health care, service,
      •                    education, surveillance, and research.cCccc
    • 28. The Electronic Health Record
      • Component
      • 7. Administrative Processes
      •      Electronic scheduling, billing, admission, transfer, discharge,
      •       claims management, etc...
      • Includes: Inpatient/Outpatient visits & procedures
      •                Personal patient identifier (numerical or alphanumeric)
      •               Insurance eligibility validation
      • Access: Patient and healthcare team involved in direct patient care.
      • Importance: Allows patient information to be organized and used for
      •                   clinical analysis and research.
    • 29. The Electronic Health Record
      • Component
      • 8. Reporting & Population Health Management
      •      Data collection tools to support public and private reporting
      •      requirements.
      • Includes: Standardized terminology
      •                Machine- readable format
      •                Care delivery functions
      • Access: Patient and healthcare professionals involved in direct
      •              patient care.
      • Importance: To promote the ability to share patient information
      •                    and to assure users that these technology systems work.
    • 30. Conclusion of CIS
      • When evaluating for an EMR/EHR system points to consider are: 
        •   Knowing what a Clinical Information System is and who the                    decision makers should be
        • A full understanding of the EHR and all of the components contained within the system
        • The cost factors of implementation, equipment, IT support and education
        • Education requirements for staff and how to deliver education in order to meet users needs
      •                                                                                                                            AMartin
    • 31. References
        • Biohealthmatics (2010) Clinical Information System . technologies/his/cis.aspx . Retrieved April 1, 2010
        • Electronic health record . (n.d.). Retrieved from
        • Glaser, J. (2009) Success Factors for Clinical Information System Inplementation. . Retrieved April 1, 2010
        • Hagen, S, & Richmond, P. (2008, May).  Evidence on the costs and benefits of health information technology . Retrieved from
    • 32. References
        • Hoffmann, S, & Podgurski, A. (2008, October 30).  Case western reserve university professors call for regulation of electronic health records . Retrieved from
        • Mastrian, K., & McGonigle, D. (2009). Nursing informatics and the foundation of knowledge . Sudbury, MA: Jones and Bartlett Publishers, LLC.
        • Occupational outlook handbook , 2010-11 edition . (2009, Dec 17). Retrieved from
        • Zytkowski, M, & Oblack, M. (n.d.).  Nursing informatics . Retrieved from s.aspx