Clinical Information System(CIS) According to McGonigle & Mastrain (2009), “a CIS is a technology based system that is applied at the point of care and is designed to support the acquisition and the processing of information as well as providing storage and processing capabilities” (p.193). A CIS is a complete, comprehensive electronic health record system (EHR). McGonigle, D. & Mastrian, K., 2009
What are some benefits of aCIS? Ease of obtaining patient data at the point of care Ability to search patient data easily There is no concern with legibility of charting Ability to analyze data easily Enhanced patient safety McGonigle, D. & Mastrian, K. (2009).
Who are the key players to aCIS? Administration Physicians Patient care assistants Social workers Therapy staff Nurses and many others! McGonigle, D. & Mastrian, K., 2009
Key players continued: You need to include everyone from those who will run reports, to most importantly, the end users. Ensuring everyone is involved, will provide “a consistency in the charting done by different clinicians, while enabling their pathways to be designed according to their specific needs” (McGonigle & Mastrian. 2009, p.194).
What are the components of theEHR? health information and data order entry management results management decision support electronic communication and connectivity patient support administrative processes reporting and population health management The entire health care team should have access to the EHR. McGonigle, D. & Mastrian, K. (2009).
What is a CDS? CDS is an abbreviation for the Clinical Decision System. A software program that allows health care professionals with many tasks related to health care. Diagnoses Course of treatment Statistics related to disease And much more!
What are the functions of a CDS? There are four functions of an electronic clinical decision support systems: Administrative: Supporting clinical coding and documentation, authorization of procedures, and referrals. Managing clinical complexity and details: Keeping patients on research and chemotherapy protocols; tracking orders, referrals follow-up, and preventive care. Cost control: Monitoring medication orders; avoiding duplicate or unnecessary tests. Decision support: Supporting clinical diagnosis and treatment plan processes; and promoting use of best practices, condition- specific guidelines, and population-based management. " [Perreault & Metzger, 1999]
Comparing the two types of CDS:How should it be structured? Knowledge-Based Non Knowledge-Based Provide clinicians with Also known as machine accurate data such as learning Drugs This allows clinicians to use Drug Interactions data from past experiences Patient Data Symptoms of diseases Algorithms Solutions to problems Results in more narrow results
Incorporating EBP (EvidenceBased Practice) in a CDS “EBP should be embedded in computerized documentation of a CIS, providing both prompts for intervention and/or different questions based on a charted assessment…references supporting EBP should be available for review at the click of a mouse or by a few keystrokes…the CIS prompting capabilities will reinforce the practice of looking for evidence to support nursing interventions…” (McGonigle, D. & Mastrian, K. (2009).
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Safety and Security The safety and security of a CIS is one of the most important things to keep in mind when evaluating an EHR system. The main areas of safety and security in a CIS are: Confidentiality Availability Integrity (McGonigle & Mastrian 2009)
Safety and Security:Confidentiality Shoulder Surfing is the most common problem in the confidentiality of an EHR (McGonigle & Mastrian 2009). Shoulder surfing is defined as: using direct observation techniques, such as looking over someones shoulder, to get information (TechTarget, February 2002). Be sure to observe employees and note any shoulder surfing http://techteachtoo.com/wp- content/uploads/2010/12/shouldersurfing.jpg by not only employees, but patients and visitors as well.
Safety and Security:Availability One way for organizations to protect the availability of their network is to institute an acceptable use policy. This policy outlines what employees can and cannot do on the hospital network. For example: Are employees allowed to download personal pictures or music? Limiting downloads limits the chances for downloading a virus, which could potentially compromise the information on the CIS (McGonigle & Mastrian 2009). When evaluating a CIS, read the hospitals acceptable use policy and note any areas that could use improvement.
Safety and Security: Integrity Integrity: firm adherence to a code of especially moral or artistic values (Merriam-Webster 2011) Because employees rely on the information on an EHR, the integrity of the content is crucial. When evaluating a CIS, make sure there are references for information, and that they can be verified as truthful or factual. http://i.dailymail.co.uk/i/pix/2010/03/25/article- 1260760-08DDFB31000005DC-84_233x317.jpg
Costs Involved in Implementingan EHR “…federal health information technology spending will grow from $3.2 billion in 2008 to over $4.5 billion in 2013” (McGonigle, D. & Mastrian, K., 2009) 2 Categories of costs involved System Costs Induced Costs
System Costs Vary markedly depending on software, institution, needs, contracts. Software and Hardware Training Implementation Ongoing Maintenance and Support
Induced Costs Costs involved in transitioning from a paper to an electronic system, such as the temporary decrease in productivity during the implementation phase
Cost Savings Decreased Labor Decreased billing errors Increased capture of charges Decreased medical errors Increased productivity, information sharing, and patient satisfaction Medicare and Medicaid incentives if qualify
Educating Staff Federal initiatives are pushing the adoption of electronic health records (EHRs) throughout all health care institutions by the year 2014. Staff must have the knowledge and skills to practice in a technology-rich environment. Information technology competencies must be mandatory for staff to ensure patient safety and quality of data input.
Education Who Should provide Education? Should be managed by a Nursing Informatics Specialist, defined as: “A specialist with training in Nursing science and the study/application of technology and the relationship between the technology and its use in real-world settings.” (University of California, Irvine)
Education Goals Staff training and orientation throughout institution according to department standards Staff training related to privacy and HIPAA compliance; initial as well as yearly and/or PRN refresher training Provide education and guidance to staff transitioning to the EHR
ReferencesBerner, Eta S., ed. Clinical Decision Support Systems. New York, NY: Springer, 2007Cavolo, D. Electronic medical record systems: Know the total cost of ownership. Nursing Homes. Jul 2007; 56(7): 17-20.Colpas, P. Digital Dilemma. Health Management Technology. June 2010;31(6):12. Online. Accessed October 31, 2011. "Decision support systems ." 26 July 2005. 17 Feb. 2009 <http://www.openclinical.org/dss.html McGonigle, D. & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge. Jones and Barlett: Sudbury, MA. Merriam-Webster Dictionary (2011) Definition of Integrity Retreived on Nov. 27, 2011 from http://www.merriam- webster.com/dictionary/integrity?show=0&t=1320272169 TechTarget (2002) Definition Shoulder Surfing Retrieved on Nov. 22, 2011 from http://searchsecurity.techtarget.com/definition/shoulder-surfing National League of Nursing. “Preparing the next generation of Nurses”. April 23, 2009. Retrieved from http://www.newsweekshowcase.com/Health/venues/pring/Next . Perreault L, Metzger J. A pragmatic framework for understanding clinical decision support. Journal of Healthcare Information Management. 1999;13(2):5-21. Wang, S., Blackford, M., Prosser, L., Bardon, C., Spurr, C., Carchidi, P. & Kittler, A. A cost benefit analysis of electronic medical records in primary care. The American Journal of Medicine. 2003; 114: 397-403.