C LINICAL I NFORMATION S YSTEMSDeveloped By: Rachelle G. (slides 3-9) Jessica M. (slides 10-14) Rachel S. (slides 15-19, 25-27) Ragean W. (slides 20-24)
TABLE O F C ONTENTS Slide 3-9:Brief overview of CIS and key players involved in implementing it. Slide 10-14: The eight basic components of EHR Slides 15-19: The clinical decision making system in a CIS Slide 20-22: Safety/Security Slide 23-24: Cost Slide 25-27: Education
W HAT IS C LINICAL I NFORMATION S YSTEMS Clinical Information System (CIS) is a technology based system that is applied at the point of care and is designed to support the acquisition and processing of information as well as providing storage and processing capabilities. A collection of various information technology applications that provides central repository of information related to patient care across distributed locations (McGonigle & Mastrian, 2009 p193)
CONT … W HAT IS C LINICAL I NFORMATION S YSTEMS CIS is also known as Clinical documentation systems and is the most commonly used type of patient care support system within healthcare organizations. CIS is designed to collect patient data in real time. CIS is patient centered including observations, interventions, and outcomes noted by patient care team. (McGonigle & Mastrian, 2009, p 209)
T EN C OMMANDMENTS OF C LINICAL I NFORMATION S YSTEMS 1. Speed is everything. 2. Realize doctors won’t wait for the computer’s pearls. 3. Delivers “just-in-time” information 4. Fits into user’s workflow. 5. Respect physicians sense of autonomy 6. Monitor implementation in real time and respond “right now”. 7. Be aware of unintended consequences. 8. Be wary of uncovering long standing process flaws. 9. Don’t disrupt “magic nursing glue”. 10. Speed is everything. (Shabot, M., 2004)
K EY P LAYERS IN C HOOSING CIS When choosing key players to help select a CIS it depends on where the CIS is located. • Nursing • Laboratory • Pharmacy • Monitoring • Order Entry • Billing • Information Technology (IT) Department • Executive leaders/ CEO • Additional Ancillary systems to meet institution needs (McGonigle & Mastrian, 2009, p 148)
K EY P LAYERS FOR I MPLEMENTATION OF CIS Executive leadership: The single most critical element of success of implementing a CIS is the sponsorship by a senior executive within the organization. CEO- Critical role in implementation and is imperative that the CEO: • Communicate the vision • Communicate the value of CIS project • Allocate resources necessary in accordance with budgetary cycle • Arbitrate any major conflicts between physicians and various hospital disciplines (Page, C., 2011)
K EY P LAYERS FOR I MPLEMENTATION OF CIS Information Technology Department When implementing a CIS you have your key players that are involved in helping choose what types of system may be needed, but it would be important to develop committees to develop short and long term goals for CIS with measureable outcomes. These committees would also be accountable for outcomes of decisions.
K EY P LAYERS IN R EVISING A CIS Executive Leadership CEO IT Department Original Committees Staff Leaders Department Heads
E IGHT C OMPONENTS OF THEE LECTRONIC H EALTH R ECORD (HRE)… Health Information and Data Patient data, including demographics, diagnosis, medication lists, allergies, test results, etc. Results Management Manages current and historical results/reports of all types. Order Entry Management Enables clinicians to order medications and other care orders, including consultations, laboratory, nursing, etc. McGongile, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers.
E IGHT C OMPONENTS OF THEE LECTRONIC H EALTH R ECORD (HRE)… Decision Support Alerts used to improve patient care, such as screening for correct medication selection and dosing, medication interactions, vaccinations, health risk screening, etc. Electronic Communication & Connectivity Online communication between healthcare team members, colleagues and patients, allowing for collaboration within and across settings and institutions. Patient Support Patient access to education and self-monitoring tools from other settings, such as home! McGongile, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers.
E IGHT C OMPONENTS OF THEE LECTRONIC H EALTH R ECORD (HRE)… Administrative Process Electronic scheduling, billing, claims, etc. Reporting & Population Health Management Data collection tools to support public and private reporting requirements. The following slide illustrates how data is collected by many members of the health- care team and how it all fits together to create the EHR… McGongile, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers.
National Institutes of Health National Center for Research. (2006). Electronic health records overview. Retrieved from http://www.ncrr.nih.gov/publications/informatics/ehr.pdf.
T HE EHR IS AN IMPORTANT PIECE OF THE C OMPUTER I NFORMATION S YSTEM The most common benefits include: (CIS) Increased delivery of guideline-based care. Enhanced capacity to perform surveillance and monitoring for disease conditions. Reduction in medication errors. Other potential benefits include: Reduction in cost. Improved quality and outcomes. McGongile, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers.
C LINICAL D ECISION S UPPORT S YSTEM Clinical decision support systems are “computer programs designed to help health care professionals make clinical decisions” (Bakken) A clinical decision making system within a CIS is the perfect way to make sure evidence based practice is being followed Can improve clinical performance for drug dosage and preventive care (Hunt)
D IFFERENT TOOLS FOR CDSS Infobuttons are a great system instituted because it allows content-specific information to be accessed (Bakken) Require up to date evidence supplied by the content providers (Bakken) Computer-based alerts to grab providers’ attention also provide valuable information (Bakken) Used for such things as drug-drug and drug-lab interactions
S TRUCTURE OF THE CDSS Structure of the clinical decision support system needs to involve a few separate aspects (Bakken) Data acquisition data is gathered from other systems in the CIS than can be accessed through a user interface Health care standards Specific guidelines set for the institution
S TRUCTURE ( CON ’ T ) Data Repositories Data can be stored and later retrieved during use of the system Digital Sources of Evidence Many internal and external sources of evidence that are linked to specific content Research is evolving best care practices at such a fast rate evidence should be updated frequently to allow the best care to be implemented
C OMPANIES WHO DESIGN CDSS Medic Exchange provides a comprehensive list of companies that design CDSS Some of these companies are: McKesson Thomson Reuters GE Healthcare Sanovia Amirsys o (MedicExchange, 2011)
S ECURITY !!!! Security is a major issue for EHR. Back-up of data must be continuous and automatic (every hour, day, or week) Storage of all of the data is essential and usually sent off campus. It also must be able to last for the length of the patients life and digital signatures must stay relevant. Security must also include protection for viruses and worms. This can be accomplished through firewalls, anti-virus software, and limiting the use of each computer to only do what is needed (no web surfing in unknown sites.) (Wainer, 2008)
S ECURITY “Confidentiality: The patient’s records are private and confidential; no unauthorized person may inspect the contents of the patient’s records.” “Control: The patient controls the access to his or her records. A patient may grant access to an HP and revoke such access rights when the treatment is over.” “Integrity: The patient’s life may depend on the data contained in the records, and therefore only authorized people can enter or change the data.” “Legal Value: The patient’s records are the unadulterated, complete record of all actions taken by the HPs on behalf of that patient and should be the definitive source of information about said actions.” • (Wainer, 2008)
S ECURITY HIPPA- The Health Information Portability and Accountability Act was signed into law by President Bill Clinton in 1996 which addresses the need for standards to regulate and safeguard health information and making provisions for health insurance coverage for employed persons who change jobs. This law basically requires that all measures must be taken to insure that no one is able to see the patients medical records that are not supposed to (limiting access), and those that see the records can not talk about it. (McGonigle, 2009)
C OST The CBO recently conducted a study and reported that, on average, EHR implementation costs for hospitals amount to approximately $14,500 per bed for implementation. Annual operating costs amount to $2,700 per bed per year. Annual net savings to the healthcare sector of about $80 billion (in 2005 dollars), relative to total spending for health care of about $2 trillion per year if all providers and hospitals appropriately implement EHRs. (Electronic Health Record Implementation: Cost and Benefits, 2010)
B ENEFITS OF EHR THAT LOWER THE COST Remind physicians about appropriate preventive care Identify harmful drug interactions or possible allergic reactions to prescribed medicines Eliminate problems associated with illegible medication orders Maximize/standardize both data and quality of patient care Increase compliance with JCAHO standards, decreasing fines. Reduce the duplication of diagnostic test (Electronic Health Record Implementation: Cost and Benefits, 2010)
E DUCATION “Nurses need to be appropriately equipped with the tools to effectively and efficiently manage data, information, and knowledge” (McGonigle, 2009, pg 136) Computer education is best done in a classroom setting to promote hands-on learning • (McGonigle, 2009)
E DUCATION (C ON ’ T ) Re-education should take place any time there are major system updates With minor updates, memos can be sent out Updates shouldn’t just take place at specific times, but only when there are significant changes that better the system • (McGonigle, 2009)
E DUCATION ( CON ’ T ) Education for the computer information systems should be done by employees from the company that created the system They know all the ins and outs Hospital IT members will not have enough time to become proficient enough to thoroughly teach If a hospital IT member was trained from the company and then trains hospital employees, some things can be lost in translation o (McGonigle, 2009)
R EFERENCES Bakken, S., Currie, L. M., Lee, N., Roberts, W. D., Collins, S. A., Cimino, J. J. (2008). Integrating evidence into clinical information systems for nursing decision support. Int J Med Inform 77(6). 413-420. Electronic Health Record Implementation: Cost and Benefits. (2010). Retrieved November 2, 2011, from Perotsystems: http://www.perotsystems.com/mediaroom/library/ServiceOverviews/Service Overview_CostsAndBenefits.pdf Hunt, D. L., Haynes, R. B., Hanna, S. E., Smith, K. (1998). Effects of computer- based clinical decision support system on physician performance and patient outcomes. The Journal of the American Medical Association 280 (15). 1339- 1346. McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Jones and Bartlett; Sudbury, MA.
R EFERENCES MedicExchange (2011). http://www.medicexchange.com/CDSS- Companies.html National Institutes of Health National Center for Research. (2006). Electronic health records overview. Retrieved from http://www.ncrr.nih.gov/publications/informatics/ehr.pdf. Page, C. (2011). Critical factors for implementing a clinical information system. Life and Health Library. Retrieved 10-2011 from 2http://findarticles.com/p/articles/mi_m0FSW/is_5_18/ai_n18610 516/ Shabot, M., (2004).Ten commandments for implementing clinical information systems. July; 17(3): 265-269. Baylor Unversity Medical Center http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200662/ Wainer, J. (2008, December 24). Security Requirements for a Lifelong Electronic Health Record System: An Opinion. Retrieved Nov 2, 2011, from The Open Medical Informatics Journal: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669643/