The document discusses the costs incurred from implementing the EPIC CIS across multiple St. Johns hospitals. Hardware costs included new computer workstations, servers, backups, networking equipment, and fiber optic internet connections. Software costs consisted of operating system licenses, the EPIC CIS software license, and training software. Additional expenses came from hiring outside consultants and internal staff overtime to lead the implementation over several years, totaling approximately $500 million system wide.
Clinical Information Systems and Electronic Health Records (October 18, 2021)Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 18, 2021
Clinical Information Systems and Electronic Health Records (October 18, 2021)Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 18, 2021
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
The Case Study of an Early Warning Models for the Telecare Patients in TaiwanIJERA Editor
To propose a practical early warning analysis model for the telecare patients, this study applied data mining
technology as a basis to investigate the classification of patient groups by disease severity and incidence using
data contained in a telecare database regarding the number of a clinic. The ultimate purpose of this study was to
provide a new direction for telecare system planning and developing strategies.
The subject of this case study was a private clinic which is providing telecare system to patients in Taiwan, and
we used three data mining techniques including discriminant analysis, logistic regression and artificial neural
network to construct an early warning analysis model based on several factors such as: Demographic variables,
pathological signals, health management index, diagnosis and treatment records, emergency notification signal.
According the results, the telecare system can build stronger physician-patient relationship in advance through
previously paying attention to patients’ physiological conditions, reminding them to do self-management, even
taking them to the hospital for observation. A comparison of discriminative rates showed that the artificial neural
network model had the highest overall correct classification rate, 85.52%, and thus is a tool worthy of
recommendation
E-Symptom Analysis System to Improve Medical Diagnosis and Treatment Recommen...journal ijrtem
: A wealth of data in public health care systems has been collected and meanwhile there are plenty
of new technological improvements which have considerable influence on current data pool. Nevertheless,
important obstacles are challenging to utilize existing clinical data. Enhanced technological improvements lead
patients to search their symptoms and corresponding diagnosis on online resources. In this study, it is aimed to
develop a machine learning model to suit in different availability of users. Most of the current systems allow
people to choose related symptom in web interfaces or Q&A forums. In addition to these applications it is aimed
to implement a new technique which extracts the text-based symptoms and its related parameters such as, severity,
duration, location, cause, accompanied by any other indicators. This study is applicable for patient`s everyday
language statements besides medical expression of symptoms for corresponding symptoms. Extracted terms are
used as an input of the model and analyzed for matching diagnosis where an accuracy of 72.5% has been
accomplished.
Presented at the 9th Thailand Pharmacy Congress: Smart Aging Life & Digital Pharmacy 4.0, The Pharmaceutical Association of Thailand under Royal Patronage on November 18, 2017.
Introduction to Health Informatics and Health IT in Clinical Settings (Part 3...Nawanan Theera-Ampornpunt
Presented at the 10th Healthcare CIO Certificate Program, Ramathibodi School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 19, 2020
Theera-Ampornpunt N. Global or glocal e-Health approaches in Asia: what is new or next? Presented at: Globalizing Asia: Health Law, Governance, and Policy - Issues, Approaches, and Gaps!; 2012 Apr 16-18; Bangkok, Thailand.
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
The Case Study of an Early Warning Models for the Telecare Patients in TaiwanIJERA Editor
To propose a practical early warning analysis model for the telecare patients, this study applied data mining
technology as a basis to investigate the classification of patient groups by disease severity and incidence using
data contained in a telecare database regarding the number of a clinic. The ultimate purpose of this study was to
provide a new direction for telecare system planning and developing strategies.
The subject of this case study was a private clinic which is providing telecare system to patients in Taiwan, and
we used three data mining techniques including discriminant analysis, logistic regression and artificial neural
network to construct an early warning analysis model based on several factors such as: Demographic variables,
pathological signals, health management index, diagnosis and treatment records, emergency notification signal.
According the results, the telecare system can build stronger physician-patient relationship in advance through
previously paying attention to patients’ physiological conditions, reminding them to do self-management, even
taking them to the hospital for observation. A comparison of discriminative rates showed that the artificial neural
network model had the highest overall correct classification rate, 85.52%, and thus is a tool worthy of
recommendation
E-Symptom Analysis System to Improve Medical Diagnosis and Treatment Recommen...journal ijrtem
: A wealth of data in public health care systems has been collected and meanwhile there are plenty
of new technological improvements which have considerable influence on current data pool. Nevertheless,
important obstacles are challenging to utilize existing clinical data. Enhanced technological improvements lead
patients to search their symptoms and corresponding diagnosis on online resources. In this study, it is aimed to
develop a machine learning model to suit in different availability of users. Most of the current systems allow
people to choose related symptom in web interfaces or Q&A forums. In addition to these applications it is aimed
to implement a new technique which extracts the text-based symptoms and its related parameters such as, severity,
duration, location, cause, accompanied by any other indicators. This study is applicable for patient`s everyday
language statements besides medical expression of symptoms for corresponding symptoms. Extracted terms are
used as an input of the model and analyzed for matching diagnosis where an accuracy of 72.5% has been
accomplished.
Presented at the 9th Thailand Pharmacy Congress: Smart Aging Life & Digital Pharmacy 4.0, The Pharmaceutical Association of Thailand under Royal Patronage on November 18, 2017.
Introduction to Health Informatics and Health IT in Clinical Settings (Part 3...Nawanan Theera-Ampornpunt
Presented at the 10th Healthcare CIO Certificate Program, Ramathibodi School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 19, 2020
Theera-Ampornpunt N. Global or glocal e-Health approaches in Asia: what is new or next? Presented at: Globalizing Asia: Health Law, Governance, and Policy - Issues, Approaches, and Gaps!; 2012 Apr 16-18; Bangkok, Thailand.
Cis evaluation final_presentation, nur 3563 sol1SBU
An overview of a Computer Information System (CIS) and considerations that need to be taken with implementing an Electronic Health Record (EHR) in a healthcare setting.
CANCER DATA COLLECTION6The Application of Data to Problem-SoTawnaDelatorrejs
CANCER DATA COLLECTION 6
The Application of Data to Problem-Solving PEER RESPONSES
PEER NUMBER 1: Luis Arencibia
Top of Form
Clinical data is fundamental in the medical field. It is from this data that change and efficiency are made possible. Clinical data forms the basis of clinical care given to patients and research studies and is also used by the administration for decision-making and influencing change (Deckro et al., 2021). Modernization has come up with better ways of processing and storing clinical data, popularly known as informatics. This has led to the increased utilization of computers and information technology in clinical data management. The informatics results have increased efficiency in managing patients' data (McGonigle & Mastrian, 2022). It is crucial to ensure proper data management because it is from clinical data that crucial decisions and problems are solved in healthcare.
An example of a scenario where data can be helpful in problem-solving is the case where a healthcare facility wants to determine the average number of patients they receive in a day and use that information to establish whether the staff to patient ratio is satisfactory. This data can be obtained by registering all patients who attend the facility for a certain period, for example, three months, and stored electronically. The average is then done to get the approximate number of clients in a day. Additionally, the data should capture the age of patients, significant complaints, and the departments where the patients were attended. It is vital to secure this data to avoid unauthorized access to promote patients' privacy and compliance with the HIPAA to avoid legal consequences.
The knowledge derived from the data described above is the number of patients visiting the facility and their health needs. From this, the healthcare center will be able to critically analyze and evaluate whether the facility's staffing and resources are enough to meet the patients' demands. Suppose the number of patients is higher compared to the resources. In that case, the facility will be able to tell there is a shortage and the staff is being overworked, which is likely to compromise the services given to the patients.
From the data, a nurse leader can use clinical reasoning and judgment to explain why the health facility could be performing less efficiently and not meeting its goal of providing optimum medical services to patients. Additionally, the nurse could judge that the patients are not satisfied with the services provided from the data (Zhu et al., 2019). With that information, a nurse leader can successfully convince the management that there is a need for more staffing and resources to meet the patients' needs more successfully.
In conclusion, data management is crucial in the healthcare practice. With proper informatics, nurses and other healthcare providers will function optimally, and the results will be better quality ...
The Remote Monitoring System
Michelle L. Wallace
Sentara College of Health Sciences
Pro Phillips
The Remote Monitoring System
Internationally, patient care facilities and healthcare systems are steadily executing organizations that record the patient health in the home setting. The patient avoids unnecessary doctors’ visits, hospital stays and visits to emergency care department (Emani, 2017). Healthcare is providing your patient the best quality of life possible. Concerning individuals particularly patients with heart failure problems, remote monitoring plays a major role in the being afforded to live somewhat of a normal life. Also, with the increase in the baby boomer generation attaining retirement age, there is high demand for the availability of enough and quality home health care (McGonigle & Mastrian, 2017). Unfortunately, heart failure affects many people in the United States. Subsequently, the incidence and prevalence are increasing even with the option of heart failure therapy. The admission of a patient with heart failure is trending daily. Sadly, this effects the elderly more than any other population. The consequence of heart failure is increased instances of disease and or death. Increased debt is also a precipitating factor of heart failure, due to an influx of necessary treatment. To decrease the instances of the over population in the acute care setting, meanwhile eliminating the significant load of substantial cost to the patient, healthcare facilities have implemented the remote monitoring systems.
Promoting the remote health monitoring is one of the most prevalent factors, that provides more enough outcomes for the heart failure patient. Remote patient monitoring can improve patient results by improving to their responsiveness in the instances of emergency. Remote patient monitoring intensifies medical specialists to assist in following the patient biometric real-time and offer solutions immediately (Emani, 2017). Remote patient monitoring boosts suitable escalation mainly with the nervous patients who are very responsive. By surging quickly, the patient may suffer large medical bills that may negatively impact their quality of life. Furthermore, taking responsibility in monitoring is vital in adequately ensuring the patient has soaring results. Appropriate medication is an essential part of treatment regimens, though it is challenging to understand with certainty if the patient id complying with the prescription (Emani, 2017). The remote health monitoring system is arranged to give patients a reminder on the appropriate time to take their medicines. This system also alerts the physician, if the patient isn’t compliant with treatment.
While the remote patient monitoring is designed for patients with heart problems, this system is key in accessing health care services, appropriate care, and regulation, the program must meet a certain legal and regulatory compliance especially with the privacy and data security.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Team 3: CIS Presentation
1. Team Members
Tina Fulbright – Slides #2 – 12
Christy Smith – Slides #13 – 23
Jali Jackson – Slides # 24 – 35
Todd MacDonald – Slides #36 - 51
2. As you will see in the following
compilation of research,
Clinical Information Systems
are multifaceted with the
ultimate goal of providing
clinical decision information
to the clinician. This
information allows the
clinician to make decisions
about patient care and can
enhance patient outcome.
3. CIS Overview
CIS refers to a Clinical Information System. The
system requires multiple technology applications
which are used at the point of care. The CIS is capable
of acquiring, processing, retaining, and retrieving
information related to patient care.
(McGonigle & Mastrian, 2009)
4. Choosing, Implementing, Revising
the CIS
The choice of systems is one made between multiple
departments. A collaborative effort is required in
order to ensure that the needs of all departments are
met by the system chosen for the facility. Various
committees are formed to gather information in an
effort to focus the goals of the system, to oversee
clinical quality as well as evaluate design of the system
and hardware.
(Al Mallah, Guelpa, Marsh & van Rooij, 2010)
5. Choosing, Implementing, Revising
the CIS (Cont)
Some of the team players would include
administration and executive staff as well as
representatives from clinical specialty areas, support
services, and the information technology department.
Software vendors are also called upon for their input
and recommendations.
(Al Mallah, Guelpa, Marsh, & van Rooij, 2010)
6. Some of the team players would include administration and
executive staff as well as representatives from clinical specialty
areas, support services, and the information technology
department. Software vendors are also called upon for their
input and recommendations. After implementation of the
CIS, revisions are made based upon the needs and input of the
users.
(Al Mallah, Guelpa, Marsh, & van Rooij, 2010)
7. Clinical Decision Support
Clinical decision support (CDS) is a program which is
computer-based. It is intended to help clinicians make
clinical decision. Large amounts of information are
integrated or filtered during this process and give clinicians
suggestions in regard to clinical intervention. (The
Design, 2001)
8. CDS Infrastructure
• A quality infrastructure would include a depository of medical
knowledge that would require “standardization of CDS and genomic
medicine information”. This information would need to be computer-
processable;
• In order for it to be computer interpretable, there must be a standard
format of patient data. An example would be Health Level (HL) 7 and
extensible markup language (XML);
• The approach used to acquire medical knowledge and find and
recapture patient data in order to form patient-specific guidance by
bringing together both the personal data of the patient and medical
knowledge.
(Al Mallah, Guelpa, Marsh & van Rooij, 2010)
9. The American National Standard Institute HIT
Standards Panel (HITSP) champions “the
standardization of health information technology
through the American Health Information
Community.”
(Al Mallah, Guelpa, Marsh & van Rooij, 2010)
10. Structure and Updates
The design of the CDS should be easy to use for the
clinician. It should contain quality up-to-date medical
information that will help the clinician make the best
decision for each individual patient. The system
should be updated as new information becomes
available.
11. Clinical Decision Support Systems
There are multiple systems available on the market.
Listed below are just a few of the CDS systems
available and their design companies.
TheraDoc, Inc/Hospira
VisualDx/Logical Images
QMR/First Data Bank
(Clinical Decision, 2003)
12. Conclusion
Obviously, when considering a CIS, one must look at
multiple factors. There must be a team assembled to
determine what is needed by that particular facility.
The HER, CDS, safety of the system, cost and the
education for staff must all be considered in great
detail before one can begin to work towards
implementing a successful system into their facility.
13.
14. The EHR Component
The HIMSS(Healthcare Information and
Management Systems Society, 2006)
defines an EHR as a “longitudinal
electronic record of patient information
produced by encounters in one or more
care setting” (McGonigle & Mastrian,
2009).
The IOM(Institute of Medicine) defines
the EHR as “health information and
data that is the patient data required to
make sound clinical decisions including
demographics, medical and nursing
diagnoses, medication lists, allergies
and test results” (McGonigle &
Mastrian, 2009).
15. Eight Components to the EHR
Health
Information and
Data
Results
Management
Order Entry
Management
Decision Support
Electronic
Communication
and Connectivity
Patient Support
Administrative
Processes
Reporting and
Population
Health
Management
16. Health Information and Data
The patient data required to make sound clinical
decisions including demographics, medical and
nursing diagnoses, medication lists, allergies and test
results(IOM,2003) (McGonigle & Mastrian, 2009).
All personnel that have a sign on, password and
credentials(for most facilities) have access to this
information. Doctors, nurses, PA’s, NP’s, etc… There
is a demographic view available for admission staff.
17. Results Management
The ability to manage results of all types
electronically including laboratory and radiology
procedure reports both current and historical(IOM,
2003)((McGonigle & Mastrian, 2009).
Laboratory and radiology personnel have the ability
to view and enter results here. Authorized staff have
the ability to view results here. Any personnel with
the credentials to view patient records has access to
this information. Without this component, results
are delayed and hard to compare with archived
records.
18. Order Entry Management
The ability of a clinician to enter medication and
other care orders, including laboratory, microbiology,
pathology, radiology, nursing, supply orders, ancillary
services, and consultations directly into a
computer(IOM,2003) (McGonigle &Mastrian, 2009).
Personnel are given rights according to their
credentials. Orders and medications are signed by
physicians electronically when needed. Without this
component, there are several extra steps that must be
taken to complete the task of placing an order for a
patient.
19. Decision Support
The computer reminders and alerts to improve the diagnosis
and care of a patient including screening for correct drug
selection and dosing, medication interactions with other
medications, preventative health reminders in areas such as
vaccinations, health risk screenings and detection, and clinical
guidelines for patient disease treatment(IOM,2003)(Mcgonigle
& Mastrian, 2009)
This component helps us to monitor what the patient has and
has not had completed according to their medical record. It
also aids in the faster prescribing of medications for physicians
and keeping patients safe from possible deadly interactions
from their medications. This is a powerful tool for both the
healthcare team and patient satisfaction.
20. Electronic Communication and
Connectivity
The online communication among healthcare team
members, their care partners, and patients including
E-mail, Web messaging, and an integrated health
record within and across settings, institutions, and
telemedicine (IOM, 2003) (McGonigle & Mastrian,
2009).
This component is important for access to patients
records when they are being seen by a physician other
than their primary care and history can be easily
accessed. Not all parts of this system are utilized by
all healthcare facilities, but they are available and
helpful tools for accurate patient care.
21. Patient Support
The patient education and self-monitoring tools,
including interactive computer-based patient education,
home telemonitoring and telehealth systems(IOM,2003)
(Mcgonigle & Mastrian, 2009).
These are very helpful for patients to be taken care of on
an out-patient basis. Blood pressure monitoring for home
health that reports immediately if there are any problems
is a good example of one system used through a patient’s
phone line. The report of the patient’s vitals is sent to the
agency and they can call if something is not right or if the
patient doesn’t respond to the machine telling them it is
time for their vital signs to be checked.
22. Administrative Processes
The electronic scheduling, billing, and claims
management systems including electronic scheduling for
inpatient and outpatient visits and procedures, electronic
insurance eligibility validation, claim authorization and
prior approval, identification of possible research study
participants and drug recall support (IOM, 2003)
(McGonigle & Mastrian, 2009).
This helps the organization not double book patients for
appointments and to get authorization for procedures and
admits almost immediately. Of coarse not everything is
automatic but it helps speed the process for both the
institution and the patient. If your sign on has the
credentials needed for this process, you have access to
work in these sections.
23. Reporting and Population Health
Management
The data collection tools to support public and
private reporting requirements including data
represented in a standardized terminology and
machine-readable format (IOM, 2003) (Mcgonigle &
Mastrian, 2009).
This is part of every healthcare system and is required
by law. The reporting is done to evaluate EHR
systems for functionality, security, and
interoperability. This is regulated by the Certification
Commission for Healthcare Information Technology
or CCHIT.
24. The EMR/EHR was created to limit mistakes, cut down
expenses, and improve care.
EMR/EHR’s provide direct access to patient records, improve
order legibility, have built in safety features, and use of
standardized nomenclature.
Like with anything new, there is a need for protection and
education.
The following slides will show how safety and education will
be implemented regarding the EMR/HER.
(Buppert, 2010)
25. Backup
Due to private and sensitive patient information, it is necessary to back-up the
EMR/EHR frequently (Buppert, 2010).
Not only does the system need to be backed up, but the method in which the
system is backed up needs to be assessed frequently to ensure that a back up is
taking place (Buppert, 2010).
It is necessary to ensure that the network storage or hard drive is efficient in
terms of space and function (Buppert, 2010)
Common back up programs include Legato and Net-backup software
(Rosenfeld, 2006).
A cheaper, yet slower, option is hierarchical storage management software
(Rosenfeld, 2006).
26. Storage
“The key driver leading to the need for healthcare
institutions to pay attention to storage and archival
resources is the dramatic growth in healthcare digital
information” (Rosenfeld, 2006)
A cost efficient choice for storage management are
enterprisewide storage architectures.
This architecture “…expedite[s] management of storage
resources, enhance[s] the ability to share application
data with other systems, and facilitate[s] automated
data backup and redundancy/continuity” (Rosenfeld,
2006)
27. EMR/EHR
Access
Implement password protected log-ins.
Automatic log out if no activity after 2
minutes.
Have designated staff to handle breaches
in security.
Have staff change their password every 6
months to ensure only employees have access to
sensitive records.
(Buppert, 2010)
28. HIPAA Considerations
The HIPAA rule book is 1,500 pages long. Although this is a
massive amount of information, “…it is a well-thought-out, clear
set of rules about the accepted use of protected health
information” (McDonald, 2009).
HIPAA requires all organizations using EMR/EHR to maintain an
audit trail.
Other rules implemented by HIPAA regarding the EMR/EHR
took effect April 14, 2003.
These rules are to help maintain each and every patients privacy.
(Medscape, 2010)
29. Protection of Files
It is important to protect the privacy of sensitive patient information.
With EMR/EHR comes the increased opportunity for security breaches
and viruses.
Because of this, there needs to be increased security and awareness
when charts are pulled up on the computer.
Built in automatic shut off and password protected screen savers are
a must have.
Antivirus and malware programs also need to be installed on all
computers to ensure that privacy is maintained
(Fetter, 2009)
30. Protection of Files (cont…)
Due to the frequent occurrence of power surges, there is a chance for
disruptions in computer systems and network damage.
This risk can cause a loss of patient information and aggravated staff members.
Uninterruptible power supplies (UPS) can be installed to prevent this from
occurring.
A great option to use because it is generator friendly and removes the problems
associated with generator frequency synchronization problems.
(Reisz, et al., 2010)
31. Education
Anyone who will be operating or charting in the EMR/EHR needs to be
properly educated on the proper way of doing so.
IT workers who are familiar with the program and all that it entails are
great resources to the facility and it employees.
An important aspect of EMR/EHR education is developing a plan that
will enhance computer literacy and competency of the staff.
It is “…critical to assess, develop, and maintain staff competency to
ensure quality of care in all nursing areas” (Miller & Arquiza, 1999).
32. Education
Strategies
Select members from each unit to be
trained in a way that they would be able
to train others- “Super users”
Structure classes based on position/level
(i.e. Nurses, doctors, CNA would be in
three different classes)
Conduct annual competency checks to
evaluate if more training is needed.
Have employees perform self
assessments and compare with
comments made by “super-users”
(Miller & Arquiza, 1999)
33. Education Strategies (cont…)
Depending on whether weekly or monthly training sessions
are needed, there needs to be an adequate number of IT
personnel available to “…answer questions and give
impromptu training on [various units], and receive
feedback on…problems in return” (Transitioning to, 2006).
Organizational planning and shared resources combined
with a well thought out mission, vision, and yearly
objectives can help advance knowledge and competency
(Fetter, 2009).
Provide refreshments and support to facilitate
participation.
34. Principles to Improve Effectiveness
Assess training needs
Don’t rush training time
Have a low student-to-instructor ratio
Allow staff to practice their new knowledge in the
classroom before use on real charts.
(Fetter, 2009)
35. Principles (cont…)
Have paper versions of screen shots available to aid in
learning how to navigate through the EMR/EHR.
Allow extra practice time
Have extra trainers available to answer individual
questions.
Technical support needs to be available for each unit.
(Fetter, 2009)
36.
37. Taking into consideration all aspects of implementing
a CIS is a daunting task. Genesis, the joint initiative
task force from St. Johns, has been responsible for the
research and implementation of EPIC at St. Johns.
The total installation cost, Mercy-wide, has been
approximately $500,000,000.
The following presentation discusses where the costs
were incurred.
Micki Struckhoff, RN – VP Systems Integration, St. Johns Springfield.
38. What Is A Computer Network?
Simply stated, a computer network “is two or more
computers connected so that they can communicate
with each other and share information, software,
peripheral devices, and/or processing power.” The
most common of which is called a LAN (local area
network) and a WAN (wide area network).
highered.mcgraw-
hill.com/sites/0072464011/student_view0/chapter6/glossary.html
39. Hardware and Software
Hardware & software for a computer network involves
several components. Keep in mind, when a large
network is installed, the hardware & software needs
can increase significantly.
An upgrade to existing computer networks typically
accompanies the addition of a CIS package.
40. Components
Hardware
Robust computer
workstation
Network Cables
Router with firewall
Servers & Backups
Repeater (if signal
attenuation an issue)
Peripheral Equipment
Fiber optic connection to
internet
Software
Compatible OS (operating
system & license)
CIS Software & license for
each server (usually based
on size of network
involved)
Internet access
Software firewall
Antivirus
41. Classic Network
Bandwidth &
Hardware Map
The picture on the left is a great depiction of what a typical wide area networks
bandwidth looks like without hardware. The right is a very basic map of a LAN.
42. Support Personnel
Relevant to the discussion is the number of support
technicians available and their associated salaries.
According to indeed.com, the average salary for a
computer technician in Springfield, MO is $33,000 per
year. Depending on the size of network, this cost could
multiply very quickly. The network manager will
average $66,000.
43. Support Personnel Continued
As is the case with EPIC, there are groups of IT
Technicians within the IT Department that strictly
support the CIS, according to Micki Struckhoff, RN.
Anyone supporting the software must be certified
through EpicCare, the company that supplies St.
Johns’ CIS software.
Micki Struckhoff, RN. – VP Systems Integration for St. Johns Springfield.
44. Multiple redundancies are required for this
type of market. Several ISPs are involved in
making this system as failsafe as possible to
achieve maximum stability.
45. Workstations
Workstations are the PCs that everyone does their
work.
St. John’s needed to upgrade each PC that the hospital
had to support the new software.
46. Part of the purchase of any CIS will be to train
those utilizing the system. With EPIC,
Certified Trainers were sent to Wisconsin for
training by the company, EpicCare. As it was
during the CIS implementation at St. John’s,
those who would help the remainder of the
system to become trained were the
“Credential Trainers” for the next site for
training, which included retired teachers.
47. Implementation
Prior to implementing a CIS, a committee known as
Genesis at St. John’s, gathered information from all
aspects from the hospital end-users. This committee
represented a cross-section of all areas of the system.
The needs from the end-user was translated into what
the software was going to accomplish for our
healthcare system. Going “live” would be done in
phases as to eliminate potential unforeseen issues.
48. Implementation
Other aspects needing to be considered is the
“transitional time and problems associated with
switching over to a new clinical software.”
http://informatics.umdnj.edu/clinical/information_systems.htm
49. Challenge To Implementation
Mercy wanted to standardize all areas to reduce the
cost of building software. Most common challenge was
to standardize all order sets collaboratively across all
regions.
Micki Struckhoff, RN – VP Systems Integration, St. Johns Springfield
50. Updates for the software are twice per
year. This year will be a full system
upgrade in December. Those wishing to
improve their skills have the opportunity
to work in a computer lab setting prior to
utilizing the upgraded software.
51. Summary
While the costs associated with this CIS were
considerable, a massive upgrade to the network
backbone was the costliest portion. Thousands of due
diligence and man hours went into the
implementation of the CIS to ensure the most stable,
reliable and user-friendly software would run
seamlessly in our health care system.
52. ReferencesAl Mallah, A., Guelpa, P., Marsh, S & van Rooij, T., (2010). Integrating genomic-based clinical
decision support into electronic health records. Personalized Medicine. 7(2), 163-170.
Barey, E.B.,(2009). The Electronic Health Record and Clinical Informatics. In McGonigle, D., &
Mastrian, K.(Eds.), Nursing Informatics and the Foundation of Knowledge(pp.219-237).
Boston: Jones and Bartlett Publishers.
Buppert, C. (2010, January 13). Medscape. Retrieved October 1, 2010, from Authors and
Disclosures: http://www.medscape.com/viewarticle/714812
Clinical Decision Support Systems. (2003). Retrieved October 6, 2010, from http://www.informatics-
review.com/decision-support/index.html
Fetter, M. (2009). Improving information technology competencies: implications for psychiatric
mental health nursing. Issues in Mental Health Nursing, 30(1), 3-13. Retrieved from CINAHL
Plus with Full Text database.
53. References Continued
Indeed.com. Salaries for computer technicians in Springfield, MO. Retrieved
October 23, 2010.
http://www.indeed.com/salary?q1=Computer+Technician&l1=springf
ield%2C+mo
Institute of Medicine. (2003). Key capabilities of an electronic health
system: Letter report. Washington, DC: National Academics Press.
Informatics Institute: University of Medicine & Dentistry of New Jersey .
Retrieved October 20, 2010
http://informatics.umdnj.edu/clinical/information_systems.htm
54. References Continued
McDonald, C. (2009). Protecting patients in health information exchange: A defense of the HIPAA privacy rule. Health
Affairs , 447-449.
McGonigle, D. & Mastrian, K. (2009). Nursing Informatics: and the foundation of knowledge ( pp. 193). Massachusetts:
Jones and Bartlett Publishers, LLC.
McGraw-Hill Online Learning Center. Retrieved October, 21, 2010. http://highered.mcgraw-
hill.com/sites/0072464011/student_view0/chapter6/glossary.html
Medscape. (2010, September 10). Retrieved October 1, 2010, from OJIN: The Online Journal of Issues in Nursing:
http://www.medscape.com/viewarticle/723608
Miller, E., & Arquiza, E. (1999). Improving computer skills to support hospital restructing. Journal of Nursing Care Quality,
13(5), 44-56. Retrieved from CINAHL Plus with Full Text database.
55. References Continued
Reisz, T., Denny, J., Nguyen, D., Braun, D., Merkel, R., Kuhn, P., et al. (2010). 2010:
change & progress: our panel of experts offers readers their take on what to
look for in healthcare technology in the year ahead. Health Management
Technology, 31(1), 12. Retrieved from CINAHL Plus with Full Text database.
Rosenfeld, K. (2006). What is application-attached storage costing your facility?
As electronic healthcare databases grow, traditional backup systems may
become inadequate. Is information lifecycle management the future of data
storage? Health Management Technology, 27(8), 22-25. Retrieved from
CINAHL Plus with Full Text database.
56. References Continued
Struckhoff, Micki RN – VP Systems Integration, St. John’s Springfield.
Personal interview October 25, 2010.
Ten commandments for implementing clinical information systems
Proc (Bayl Univ Med Cent). 2004 July; 17(3): 265–269. Retrieved October 23, 2010
www.ncbi.nlm.nih.gov/pmc/articles/PMC1200662/
Transitioning to electronic medical records: the move to electronic records presents opportunities
and challenges for physicians. (2006). AMIA Annu Symp Proc , 629-633.
University of California, Irvine, Donald Bren School of Information and Computer Sciences.
Retrieved October 22, 2010. http://www.ics.uci.edu/.../Tech-EC/EC-EB/index.html
The design and implementation of a computerized patient record at the Ohio State University
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