Evaluation of A CIS

Three Health Care Informatics Junkies

Here we are…
First up is Susan Griffitts. She presented the portion on the overview of the CIS and also did education related to the CIS.
Second up was Michelle Boswell. She did the portion on the components of the EHR and clinical decision making system in the CIS
Third up was me, Twila Chambers. I did the portion on the safety and cost of the CIS.
Welcome to our presentation…

Clinical Information System Overview

Clinical Information System (CIS) Overview
Chosen representatives from all areas of the healthcare team should have access to, and be involved with, the CIS development including doctors, nurses, nurse assistants, ward secretaries, financial office personnel, coders, etc. as they must be able to use the CIS effectively to deliver all aspects of care to the patient.

Components of the Electronic Health Record

What is the EHR?
The EHR, or Electronic Health Record, is a way to ensure that a patient’s health information is easily accessible to many different care providers in order to reduce cost and increase the efficiency of care that the patient will receive.
At this time, there are different definitions of what makes up an EHR. Nursing Informatics and the Foundation of Knowledge tells us that the most widely used definition comes from the Institute of Medicine (p. 220).
This definition takes all the parts that can be a part of the EHR and puts them into eight basic components.

1: Health Information and Data
This consists of all the information that has been entered about the patient, such as lab work, x-rays, and vital signs. It is all objective information that has been obtained from the patient. Any person who is caring for the patient should be able to access this information and add their own information as it is obtained from the patient.
2: Results Management
This component does exactly what it’s title says- managing results that have been obtained from the patient. This can include lab values, radiology images, and any other test that has been performed such as EKG, EEG, etc. Only the care providers who need to know these results should have access to them. For example, billing/pastoral care does not need access to this information because it doesn’t effect the care they give.
3: Order Entry Management
This component is for ordering anything that can be obtained for the patient. I think that the only care providers who should have access to ordering medications are the physicians, nurse practitioners, anesthetists, and pharmacists.

4: Decision Support
These are alerts that the computer gives us to remind us about overdue tasks, medication dosages, drug interactions, and other reminders. These are guidelines to follow in order to treat the patient as thoroughly as possible. Any care provider should have access to these if it helps them give more adequate care.
5: Electronic Communication and Connectivity
This component gives the ability to the health care team members to communicate between one another through electronic means. If the health record is integrated, care providers from different institutions can gain access to the EHR without having to fax records.
6: Patient Support
This includes tools for patient education and monitoring the patient. Some examples the text gives are computer-based patient education, home telemonitoring, and telehealth systems (222). This may also include templates for discharge education when sending the patient home. All fields should have access to this, because many different care givers work together to educate the patient while they are in the hospital so that they will be ready when they leave.

7: Administrative Processes
This component deals with the scheduling of appointments and billing aspect of health care. Any clerical person in the health care field should have access to these features. Also, any nurse involved in a procedure in the hospital that is not covered by insurance. For example, in the Newborn Nursery, the RN checks for insurance eligibility for male babies whose parents want them to receive a circumcision while in the hospital.
8: Reporting and Population Health Management
This is a large component of the EHR. These are “data collection tools used to support public and private reporting requirements” (223). Each area of the hospital/clinic has specialized features and templates that can be added to most effectively take care of that specific patient. In EPIC, on the Doc flow sheet, there is a Newborn WDL Template, a Pediatric WDL Template and an Adult one as well.
These eight basic components encompass an enormous amount of features of the EHR. They are essential to the proper functioning of the EHR. They are all important, and if one was omitted, some part of the EHR would not be covered.

The Clinical Decision Making in a CIS
The clinical decision making system in a CIS should be structured in a way that is simple and easy to use.
It also must be easy to get to within the system itself.
The software should be updated every time new EBP research comes out. The CIS being used should send automatic updates to download when new information is available.

Representation of work flow within a CIS
(http://www.itl.nist.gov/div897/docs/EHR.html)

Clinical decision making systems in a CIS
There are many companies out there that design these decision making systems specifically for a CIS. Here are some examples:
TheraDoc, Inc.
VisualDx
Dxplain
QMR (Quick Medical Reference)
DiagnosisPro
Iliad
(http://www.informatics-review.com/decision-support/index.html)

Clinical decision making systems in a CIS
Health care is modernizing every day. The EHR is an amazing tool that has helped health care providers have access to the same information, and a history is kept on each patient. It is important for health care providers to have a support system in the CIS for medication administration, ordering, and diagnosing. Since EBP comes out with new research all the time, it is important for the CIS to stay current in order to give the best and most complete care possible to every patient.

Clinical Information System (CIS) Education
Education of the CIS should be done on several levels and at continuous intervals.
Initial education should be performed in a classroom setting with the developers of the CIS to answer technical questions and provide basic training of the system.
The users of the CIS should be allowed a safe “playground” to use new skills on fake patients/charts prior to trying to chart or enter orders on an actual patient.

The CIS should have integrated “pop up” windows to alert to you possible problems with orders entered.
The system should be updated as often as needed to include new standards of care and also integrate improvements suggested by clinicians that have been deemed appropriate and make the system more “user friendly”.
Users should be allowed to view the updates prior to implementation either by physical training sessions or through a “playground” setting.

For technical updates, the education should come from the creators of the CIS. These would include functional changes in the system.
Other education could be provided by users of the system that have expertise in the area. Such as having a lab technician that has been involved with implementing an upgrade provide education to other lab employees.
There should be at least one employee in each area that stays current on all upgrades and can be a resource for their department.

Safety of the EHR
The Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996 under the leadership of President Bill Clinton. This act was brought to the forefront when people begin to realize and recognize the need to safeguard information.
This law put consequences into place for those who violated the HIPAA act.
In November of 1999 proposed rules specific to health information privacy and security were released. The purpose was to balance patient’s rights to privacy and provider’s needs for access to information (McGonigle 170).

Safety of the EHR continued
“One of the biggest stumbling blocks to implementation of comprehensive standards for privacy was the associated cost (McGonigle 170).”
A study by Blue Cross/Blue Shield projected the cost to comply and make the changes under the HIPAA act would be $43 billion over 5 years (McGonigle 171.)
Health information technology continues to try and safeguard patient information. They have added additional security measures such as encryption, passwords, firewalls, retinal recognition, dedicated phone lines just to name a few.

According to the United States Department of Health and Human Services over 150 people have access to one patient’s chart during a brief hospital stay.
One facility learned a lesson a hard way after losing information they had inputted over the last four months. It was in Idaho and the facility had 60 providers that saw over 46,000 patients a year. Their backups were not occurring and it took them 11 weeks to get all of their data back.

The facility came up with five things they learned.
Availability: they felt their information should be available 24/7/365 even in the loss of power or equipment failure
Redundancy: they have now multilevel, overlapping systems that work to protect the data even while it is being used
Security: have tape backups with extra security measures, a disc storage system and logs of backups
Accountability: everyone is held accountability for the safety and security of the system
Transparency: everyone should know what is expected about the system and have a basic overview of how it functions (www.aafp.ord).

Costs Associated with the EHR
At an American Health Information Management Association Conference in October of 2006, people there estimated that the cost for the purchasing and installing of an EHR was $32,000 per physician. To maintain the EHR, provide education, etc… would cost $1200/month/physician. They also said that vendors would be 60-80% of the additional costs (www.enwikipedia.org).

Costs with the EHR cont…
Some of the additional costs associated with the implementation and maintaince of having an EHR include:
Software costs, hardware, scanners, PCs, tablets, digital equipment are a few of the software costs.
Upgrades as well as extra hours spent in training for those upgrades
Training costs both for those already employed and those who you will hire after the implementation of the system.
Additional IS help is needed and some will need to stay on as help with upgrades and new products, etc…
Physicians were finding they were spending more time in the office trying to get used to the new system and less patient time. (library.ahima.org).

Conclusion
There are many components to the EHR.
It is not “just” a computer system, nor does it just involve a few people. It’s not just a computer monitor and a few wires.
The EHR can affect a nation, it can change a life with just a few mouse strokes.
It takes all of us working together to make the EHR the best thing for the patient and to enable us to provide safe and competent care and documentation for whoever we care for.

References
McGonigle, D., Mastrian,K. Nursing Informatics and the Foundation of Knowledge (2009).
Sonnenberg, F., M.D., University of Medicine and Dentistry of New Jersey, Informatics Institute at http://informatics.umdnj.edu/clinical/information_systems.htm

References
McGonigle, D., Mastrian,K. Nursing Informatics and the Foundation of Knowledge (2009).
Rosenthal, L. (2004, January 15). Electronic Health Record. Retrieved April 9, 2010, from http://www.itl.nist.gov/div897/docs/EHR.html
The Informatics Review. (2003, November 15). Clinical Decisions Support System. Retrieved April 9, 2010, from http://www.informatics-review.com/decision-support/index.html

References
Small Practice, Big Decision. Retrieved April 10, 2010 from http://library.ahima.org
The EHR. Retrieved April 9, 2010 from http://enwikipedia.org.
EHR and Lessons Learned. Retrieved April 12, 2010 from www.aafp.ord.

Evaluation of A CIS

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Evaluation of A CIS Presentation Transcript