1-4 An Introduction to Clinical Informatics: Clinical Information Systems

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Section One: An Introduction to
Clinical Informatics
Module 1-4
Clinical Information Systems
What They Are
Types of Each
EHR Integration

What is a Clinical Information
System?
Clinical Information Systems (or Healthcare
Information Systems) are systems that
capture, store, manage, transmit, and/or
recall organizational or personal health
information

Uses of Clinical Information Systems
•  Clinical Functions
•  Patient Management
•  Practice Management
•  Health System Management
•  Public Health Management
•  Research Management
•  Payer Management

Where Clinical Information Systems
are Used
Inpatient
Outpatient
Medical Specialties
Research Trials
Laboratory
Pharmacy
Non-Clinical Settings

Electronic Health Record (EHR)
•  A systematic collection of electronic health
information about an individual patient or
population of patients
– Allows practitioners to record and share data

EHRs
•  Benefits: Eliminates paper records, decrease handwriting
errors, allows for implementation of error-reducing
technology, lays foundation for a longitudinal health
record, allows those eligible to receive meaningful use
incentives
•  Drawbacks: Additional privacy, security, cost, software,
and quality of care concerns. Possibility for unintended
consequences and changes to workflows,
communication, and data entry demands.

Clinical Decision Support & Clinical
Decision Support Systems
(CDS/CDSS)
•  Clinical Decision Support [Systems] provide
clinicians, staff, patients, and other
individual with knowledge and person-
specific information, intelligently filtered or
presented at appropriate times to enhance
health and health care
– Provides alerts, pop-ups, reminders, condition-
specific order sets, diagnostics, patient reports
and summaries, and other relevant information

CDS/CDSS
•  Benefits: Reduced clinical errors, increased
quality of care, improved efficiency,
increased patient and provider satisfaction
•  Drawbacks: Alert Fatigue, Ethics and
Malpractice

Computerized Patient Order Entry
(CPOE)
•  A system that allows physicians and medical
practitioners to electronically enter patient
treatment instructions
– Information may be sent directly to the
pharmacy, lab, or radiology departments. CPOE
can incorporate patient decision support,
patient safety features, billing codes, and more

CPOE
•  Benefits: Decreases time to order
completion, reduces prescription errors,
improves dosage timing for patients, reduces
transcription errors
•  Drawbacks: Time-consuming and
problematic usability, enforcement of
predefined relationships between clinical
tasks and between providers

Imaging / Picture Archiving and
Communication System (PACS)
•  A system that provides add to and storage of
medical image documents in electronic form
– Allows X-rays, CT, MRIs, and other images to be
reviewed and interpreted by physicians in a
timely matter
– Uses Digital Imaging and Communications in
Medicine (DICOM) standard

PACS
•  Benefits: Replaces traditional film retrieval/
distribution/display, allows for remote access,
improves image workflow, integrates with EHRs
and other CIS
•  Drawbacks: Once “filmless”, difficult to revert to
a film environment, utilizes large amounts of
bandwidth, requires high-resolution monitors
for reading “films”, expensive

Laboratory Information System (LIS)
•  Provides workflow management, data
tracking, data exchange, and other features
to support laboratory operations
– Varying levels of LIS complexity can do
everything from simply track samples to provide
lab analytics, audit trails, compliance,
calibration, maintenance, QA, and reporting

LIS
•  Benefits: Sample management, quality
control, sample data storage,
instrumentation and application integration,
limit checking
•  Drawbacks: May need custom workflow
interfaces, must use adequate validation

Inventory Management System
•  Manages supply levels and usage
throughout a health care system

LIS
•  Benefits: Real-time inventory levels, increase
charge capture for supplies, allows for lower
inventory levels
•  Drawbacks: Must be fully integrated into
providers workflow to be useful – un-
captured usage of inventory results in
inaccurate results

Personal Health Record
•  A health record where the data is managed
by the patient, not the healthcare provider
– Allows patients to share their information with
providers

Personal Health Record
•  Benefits: Improves communication between
provider and patient, covers medical history
that may otherwise be spread out between
EHRs
•  Drawbacks: Privacy concerns, patient failure
to disclose some health activities/events/
histories, not clinically detailed

EHR as the Foundation

Review Questions
1.  The CIS which helps pharmacies
electronically receive prescriptions from
physicians is a:
1.  LIS
2.  EHR
3.  CPOE
4.  PHR

Review Questions
1.  The CIS which helps pharmacies electronically
receive prescriptions from physicians is a:
1.  LIS
2.  EHR
3.  CPOE
4.  PHR
Computerized patient order entry lets physicians send
their orders electronically to the pharmacy. CPOE
combined with CDSS & EHR can check for drug-allergy
and drug-drug reactions and alert users to possible
errors.

Review Questions
1.  A system that provides alert, pop-ups, and
reminders based on clinical guidelines and
rules is known as a(n):
1.  EHR
2.  CDSS
3.  CPOE
4.  PACS

Review Questions
1.  A system that provides alert, pop-ups, and
reminders based on clinical guidelines and rules is
known as a(n):
1.  EHR
2.  CDSS
3.  CPOE
4.  PACS
CDSS provide alerts, pop-ups, and reminders, as well as
guidelines, order sets, diagnostics, reports, summaries, and
other relevant information for physicians to make informed
decisions regarding their patient’s health.

1-4 An Introduction to Clinical Informatics: Clinical Information Systems

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