Marcia Howard—clinical decision making & conclusion
Putting it all together…
What is the CIS?
“Array or collection of applications and functionality; amalgamation of systems, medical equipment, and technologies working together that are committed or dedicated to collecting, storing, and manipulating healthcare data and information and providing secure access to interdisciplinary clinicians navigating the continuum of client care” (McGonigle, D., & Mastrian, K., 2009, p. 443)."
Allows patient data to be available when and where it is needed…with the click of a button.
Why a CIS? “The use of health information technology should lead to more efficient, safer, and higher quality care” (Jha et al., 2009, p. 1628) If utilized correctly, the CIS makes our jobs easier!
Who should be involved in picking a CIS?
Nurses HAVE to be involved in choosing a good CIS
“It behooves nurses to be engaged in the acquisition, design, implementation, and evaluation of CIS to assure the realization of benefits for clinical care and outcomes” (McGonigle, D., & Mastrian, K., 2009, p. 141).
Other Key Players
Administration = $$$
Performance improvement analysts
(McGonigle, D. & Mastrian, K., 2009) After all, all of these people will have to use the system!
Electronic Health Records Components
Health Information and Data
Order Entry Management
Electronic Communication and Connectivity
Reporting and Population Health management
Who can access?
Health Care team
Organizations monitoring reports of specific diseases
Administrative persons (i.e. billing and claims)
Laboratory, radiology, etc. within the hospital
Benefits of a CIS
Increased delivery of guideline-based care
Enhance capacity to perform surveillance and monitoring for disease conditions
Reduction in medication errors
Decreased utilization of care
Reduced turnaround time for lab results
Clinical Decision Making
Information management tools to help us
Net benefits for safer care and improved clinical outcomes
Acquire, manipulate, apply, distribute and display appropriate clinical knowledge to clinicians and patients
Decision Making cont... “Provides clinicians, staff, patients, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times to enhance health and health care” (McGonigle, D. & Mastrian, K., 2009, p.)
Decision Making Tools
Computerized alerts and reminders
Medications due, patient has an allergy, K+ level
Best practice for prevention of skin breakdown
Online information retrieval
CINAHL, drug information
Clinical order sets and protocols
Online access to organizational policies and procedures
Various Vendors and EHR systems
Cerner Corporation: PowerWorks EMR
Criterions LLC: The Criterions Medical Suite (TCMS)
e-MDs: e-MDs Solution Series
GE Healthcare: Centricity Electronic Medical Record
EHS Inc.: EHS CareRevolution
NextGen Healthcare Information Systems, Inc.: NextGen
Ambulatory Electronic Health Records
Health clinicians (users) can access information
username and password (policies include changing password every 30 or 60 days)
biometrics (include thumb prints, retina patterns, or facial patterns)
Limit authorization to write files to a device (cd/dvd burners, jump drives, flash drives, or thumb drives are devices with potential security risks)
Securing Information and Network Security
Security tools and Backup Storage data
Antivirus Software (that updates daily or weekly)
Firewalls(to examine all incoming messages)
Intrusion detection system (to monitor who is using the network and what files are being accessed)
Securing Information and Network Security cont.
HIPAA The Health Insurance Portability and Accountability Act (HIPPA)
“HIPAA is a collection of federal laws and regulations has wide-ranging impacts for healthcare providers, health plans, and businesses related to the healthcare industry and is administered by the U.S. Health and Human Services Department” (Health Insurance Portability and Accountability Act, 2006).
HIPPA protects patient information by prohibiting hospital employees such as physicians and nurses from disclosing the information in the chart to anyone outside of that patient’s healthcare providers.
There are penalties for violation of the law such as: Wrongful Disclosure of Individually Identifiable Health Information:
Wrongful disclosure offense: $50,000, imprisonment of not more than one year or both
Offense under false pretenses: $100,000, imprisonment or not more than 5 years, or both
Offense with intent to sell information: $250,000, imprisonment of not more than 10 years, or both “ (Health Insurance Portability and Accountability Act, 2006)
The cost of implementing a CIS system can be a big deciding factor for health systems.
“Implementation costs have been estimated to exceed $700,000 per hospital (15% of capital expenses),and hospital IEHR operating costs exceed 2% of operating expenses (about $ 1.7 million). Physician expenses are around $30,000 per doctor for implementation and $1,000 per year for operating costs”(Lockwood, 2009).
There are financial programs available for the implementation costs of a CIS system.
“The American Recovery and Reinvestment Act of 2009 (i.e., the Stimulus Act) has made implementation of health system IT a priority, authorizing approximately $19 billion in incentives between 2009 and 2019” (Lockwood, 2009).
This program will help increase the number of hospitals using a CIS.
Although the implementation costs are high, the system will save money in the long term! Cost cont…
Cost cont... “Evidence suggests that an IEHR system could reduce aggregate healthcare costs. A cost-benefit study of IEHR use in primary care practice settings estimated a net savings over 5 years of $86,400 per clinician,' and a recent study estimated that the United States could save $77 billion per year in healthcare costs when IEHR use reaches 90% of providers” (Lockwood, 2009). “Implementing IEHRs should decrease administrative costs to payers and providers by generating complete and accurate billing data exchanges. The reduction in healthcare insurance premiums could reduce expenses for employers who provide medical insurance and increase the number of firms offering such benefits. It would also reduce Medicaid and Medicare costs” (Lockwood, 2009).
Educational Tools "Implementation of systems within health care team is the responsibility of many people and department systems require a collaboration and knowledge sharing to successfully implement and maintain successful standards of care" (McGonigle, D., & Mastrian, K., 2009, p. 214).
Education cont.. How should users be educated on the system and updates?
Implementing a new system can take some time and should be introduced gradually.
Institution should evaluate missions and goals as to why a new system is needed.
-efficiency and easier access to patient data -structure legibility of information standardization -reducing cost -improve safety and quality care
Who should be doing the education? Team from clinical specialty areas and support service.
NURSES!! Nurses must be involved with design, development, education, and the implementation process to ensure that the system meets the needs of staff. This will result in user satisfaction and will help determine when more education is needed.
How often should a CIS be updated?
Customization or configuration to CIS is required when errors are identified
Creation of a template is often made specific to various units’ workflow.
"Maintenance of the systems requires ongoing efforts to keep them up to date as operational and clinical requirements and process change" (Shortliffe and Camino p. 261)
Conclusion Clinical Information Systems (CIS) may represent one of the most important roles in delivery and management of healthcare… “The integration of technology within healthcare organizations has limitless possibilities…success will be achieved when health care incorporates technology systems in a way that they are not viewed as separate tools to support healthcare practices, but necessary instruments to provide healthcare” (McGonigle, D., & Mastrian, K., 2009, p. 215).
Health Insurance Portability and Accountability Act (2006,August 9). Retrieved October 15, 2010 from http://www.biohealthmatics.com/ technologies/his/cis.aspx Jha, A., BesRoches, C., Campbell, E., Donelan, K., Rao,S.,Ferris, T., Shields, A., Rosenbaum, S., Blumethal, D. (2009). Use of electronic health records in U.S. Hospitals. New England Journal of Medicine, 360:1628-38. References
Lockwood, C. (2009). A national integrated electronic health record system would benefit everyone. Contemporary OB/GYN, 54(12), 8. Retrieved from CINAHL Plus with Full Text database McDonnell C., Werner K., Wendel L. (May 2010). Electronic health record usability: Vendor practices and perspectives. AHRQ Publication No. 09(10) 0091-3-EF. Rockville, MD: Agency for Healthcare Research and Quality. References
McGonigle, D., Mastrain, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, Massachusetts: Jones and Bartlett Publishers. Shortliffe, E. H., & Camino, J. J. (Eds.). (2006). Biomedical Informatics: Computer Applications in Health and Biomedicine (3rd ed., ). New York: Springer Science+BusinessMedia, LLC. Retrieved October 19, 2010, from http://books.google.com/books?id=Wn- fFVuUguMC&pg=PA571&lpg=PA571&dq=shortliffe+and+ camino&source=bl&ots=UbImBXl_5g&sig=4yD8dvr2sQn rC6NyN6TJbbplvTU&hl=en&ei=30O- TK_mKIWZnAfR1vSwAg&sa=X&oi=book_result&c References
Sittig, D., Hazelhurst, B., Palen, T., Hsu, J., Jimison, H., Hornbrook, M. (n.d.). A clinical information system research agenda for Kaiser Permanente. Retrieved from Xnet.kp.org/ permanentejournal/springo2/landscape.html References