A clinical information system (CIS) is a technology-based system used at the point of care to support information acquisition, processing, storage and retrieval. It provides a complete electronic health record. Key benefits include easy access to patient data, ability to search and analyze data. Key players who use the CIS include administrators, physicians, nurses and other clinical staff. It is important for all stakeholders to be involved in selection and use. Components of an electronic health record include health information, order management, decision support and administrative functions. Clinical decision support systems can be knowledge-based, providing accurate clinical data, or non-knowledge based, using machine learning from past data. Safety, security, costs and staff education must all be considered for successful

3. 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

4. What are some benefits of a
CIS?
 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).

5. Who are the key players to a
CIS?
 Administration
 Physicians
 Patient care assistants
 Social workers
 Therapy staff
 Nurses
 and many others!
McGonigle, D. & Mastrian, K., 2009

6. 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).

7. What are the components of the
EHR?
 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).

8. 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!

9. 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]

10. 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

11. Incorporating EBP (Evidence
Based 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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13. 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)

14. 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 someone's 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.

15. 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.

16. 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

17. Costs Involved in Implementing
an 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

18. System Costs
Vary markedly depending
on software, institution,
needs, contracts.
Software and Hardware
Training
Implementation
Ongoing Maintenance and Support

19. Induced Costs
 Costs involved in transitioning from a paper
to an electronic system, such as the
temporary decrease in productivity during
the implementation phase

20. 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

21. 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.

22. 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)

23. 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

24. References
Berner, Eta S., ed. Clinical Decision Support Systems. New York, NY: Springer, 2007
Cavolo, 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.