The document discusses clinical information systems and their components. It provides an overview of electronic health records and describes key parts of a clinical information system including health information, order entry, decision support, and clinical documentation. It also discusses clinical decision making systems and their importance in reducing variation, costs, and improving diagnosis. Safety, education and costs related to clinical information systems are also evaluated.

1. Clinical Information Systems at a Glance By: Evie Devlin Christina Jarvis Danielle Ritz Lacy Phillips Angie Messner

2. Team SOL2-01 Angie Messner : Introduction slides and a brief overview of a CIS and what key players are involved. Danielle Ritz : The EHR component. Evie Devlin : The clinical decision making system in a CIS and reference slides. Lacy Phillips : Safety and cost of a CIS. Christina Jarvis : Education about a CIS and conclusion slide.

3. Clinical Information Systems at a Glance A broad overview of a clinical information system and an electronic health record will be discussed in this presentation. Additionally, factors such as safety, cost, and education related to clinical information systems will be evaluated.

4. The CIS Presented By: Angie Messner

5. What is a Clinical Information System? “A clinical information system 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” (McGonigle & Mastrian, 2009, p. 193) .

6. Clinical Information Systems The purpose of clinical information systems today is to encompass various aspects such as electronic health records, support for clinical staff, and a training environment for professionals into one collective entity (McGonigle & Mastrian, 2009) .

7. Various Types of Information Systems in Healthcare Communication Systems Core Business Systems Case Management Information Systems Order Entry Systems Patient Care Information Systems Patient Care Support Systems Clinical Documentation Systems Electronic Medical Records Pharmacy Information Systems (McGonigle & Mastrian, 2009).

8. Contributors to Developing, Revising, & Implementing a Clinical Information System The people at the administrative level who contribute are known as the stakeholders (McGonigle & Mastrian, 2009) . Groups of information technologists and technology support services contribute as well (McGonigle & Mastrian, 2009) . Specific areas of the healthcare organization help develop the different systems as well, for example, nursing managers and staff nurses help in development of what pertains to their field of work (McGonigle & Mastrian, 2009) .

9. The EHR 8 Basic Components Presented By: Danielle Ritz

10. Health Information and Data Health information and data is the patient data required to make sound clinical decisions including demographics, medical and nursing diagnoses, medication lists, allergies, and test results. The people that are going to be looking at this will be physicians, nurses, and other members of the healthcare team.

11. Results Management This is the ability to manage results of all types electronically, including laboratory and radiology procedure reports, both current and historical. The people that can read this information will be most of the members of the healthcare team and the patient.

12. Order Entry Management This is 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. The people that will be responsible for this information will be the physicians and nurses, when they get orders by phone.

13. Decision Support This is 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 screening and detection, and clinical guidelines for patient disease treatment. The people that will use this information the most are the physicians, nurses, and pharmacy.

14. Electronic Communication and Connectivity This is the online communication among the healthcare team members, their care partners, and patients including email, Web messaging, and an integrated health record within and across settings, institutions, and telemedicine. The whole healthcare team will use this along with our patients.

15. Patient Support This is patient education and self-monitoring tools, including interactive computer-based patient education, home telemonitoring, and telehealth systems. The person that will have access to this would be the patient.

16. Administrative Processes This is 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. The people that will have this information will be the patients and the people that are in charge of the scheduling, billing, and claims.

17. Reporting and Population Health Management This is data collection tools to support public and private reporting requirements including data representing in a standardized terminology and machine-readable format. This information is meant for the public and our patients.

18. Clinical Decision Making System (DCMS) A significant domain of the Clinical Information System (CIS) Presented by: Evie W. Devlin

19. Clinical Decision Making System (DCMS) Definitions: “ Tools that provide the clinicians, staff, patients, or other individuals with knowledge & person-specific information, intelligently filtered or presented at appropriate times to enhance health & healthcare.” ( Osheroff & colleagues, 2007 as mentioned by McGonigle & Mastrian, 2009) “ Active knowledge systems which use two or more items of patient data to generate case-specific advice.” (Wyatt & Spiegelhalter, 1991) “ Interactive computer programs designed to assist physicians & health professionals with decision making tasks. (Wikipedia, 2010) “ The greatest tool to increase the standardization of care, reduction of practice pattern variation, successful and effective diagnosis, and correct care path choice.” Source: Farukhi, 2009 @ http://www.cwru.edu/med/epidbio/mphp439/Clinical_Decision.htm

20. Key functions 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. Source: Perreault & Metzger, 1999 courtesy of Open Clinical.org @

21. Why is CDS important? Receive patient data & utilize data to propose a series of possible diagnoses & course of action Provide physicians with a guideline model their decision Lead to a reduction of the practice pattern variation that plagues the health care delivery process Reduce overall cost of healthcare Recognize drug-drug interaction & patient complications that would otherwise be unrecognized by the physician to provide a valid, efficient, & “best practice” solution to the patient diagnosis process Source: Farukhi, 2009 @ http://www.cwru.edu/med/epidbio/mphp439/Clinical_Decision.htm

22. Key Features of CDS Tools & interventions Computerized alerts and reminders Clinical guidelines Order sets Patient data reports Dashboards Documentation templates Diagnostic support Clinical workflow tools Applications Electronically available clinical data e.g., information from a clinical laboratory system or information from a disease registry Electronic full-text journal & textbook access evidence-based clinical guidelines systems that provide patient and situation-specific advice e.g., EKG interpretation & drug-drug interaction checking Source: Agency for Health Research & Quality, U.S. Dep’t. of Health & Human Services @ http://healthit.ahrq.gov

23. Examples of CDS interventions by target area of care Source: Berner, 2009, Published for the Agency for Healthcare Research and Quality for the U.S. Department of Health and Human Services @ http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html Target Area of Care Example Preventive care Immunization, screening, disease management guidelines for secondary prevention Diagnosis Suggestions for possible diagnoses that match a patient’s signs and symptoms Planning or implementing treatment Treatment guidelines for specific diagnoses, drug dosage recommendations, alerts for drug-drug interactions Followup management Corollary orders, reminders for drug adverse event monitoring Hospital, provider efficiency Care plans to minimize length of stay, order sets Cost reductions and improved patient convenience Duplicate testing alerts, drug formulary guidelines

24. Design and Implementation Workflow Assessment of workflow & how CDS fits in it (not otherwise) Proper integration of CDS into the workflow Data Entry & Output Who enters the data & who receives the advice; who can change or modify the data or entry Standards & Transferability CDS must adapt to universal needs as well to the unique needs of the end users There is a need for national standards for the specific evidence-based guidelines Knowledge Maintenance Accuracy of data & frequent updates of data (e.g. new drugs, new diagnoses, new evidence-based guidelines) Investigate source of knowledge and frequency of updates before purchasing CDS program and/or initiate a knowledge management process internally Experts on healthcare IT advocate a “national repository of knowledge” to be incorporated in the CDS Clinician Motivation to use CDS Concerns on physicians’ autonomy Legal & ethical ramifications Patient safety Busy schedule of clinicians Source: Berner, 2009, Published for the Agency for Healthcare Research and Quality for the U.S. Department of Health and Human Services @ http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html

25. Safety & Cost of a CIS Presented By: Lacy Phillips

26. Clinical Information System: Safety Storage of Data The system is mainly online with disc backup Recovery system Quick rebooting software that brings up most recent changes in information All information integrated to make it help simpler Set limits to prevent overloading the server Iron Mountain, 2010

27. Safeguards Frequent monitoring of IT environment Involved training for all individuals using CIS Protocols set for those who can view electronic health information as well as how information can be shared Standards for reporting and punishment of information breaches Clinical Information System: Safety State of Oregon, 2010

28. Clinical Information System: Safety The Role of HIPAA in Clinical Information Systems It is important to make patient’s aware that EHR’s are safe and secure. There is less potential for loss and stolen information as there was with paper records. As discussed with safeguards, information should be protected from being seen by individuals who are not directly caring for the patient. Privacy Rights Clearinghouse, 2010

29. Clinical Information System: Cost Study on Annual Cost by the American Hospital Association $700,000 per year is the median amount spent on IT Operating expenses had a median cost of $1.7 million annually National Institutes of Health National Center for Research Resources, 2006

30. Clinical Information System: Cost Better quality of patient care Easy tracking of costs and charges during hospital stays and office visits Improved documentation May lead to fewer lawsuits due to easy auditing Ability to see results from previous tests Cuts cost to patients from diagnostic tests that are repeated National Institutes of Health National Center for Research Resources, 2006 Potential Financial Benefits of CIS

31. Clinical Information System: Cost Technology is constantly changing and continuing education will be needed Wages paid to staff that are not productive work hours Continued need for IT personnel for updates Cost of Maintaining System National Institutes of Health National Center for Research Resources, 2006

32. Education Presented By: Christina Jarvis

33. Education Implementing and maintaining a CIS system requires training and education of all users of the system..”education and in-service training are necessary to provide the knowledge and skills to understand how computerized equipment functions, what it measures, and interpretation of data”(O’Connel,O’Loughlin, Reid, 2004).

34. Education Typically training begins prior to implementing a new system via: group training, one-on-one training, distance learning or on-the-job training. Each type of system has it’s benefits but most prefer group training. According to a study of nurses in Australia 52.4% preferred this type of format (Buikstra,Eley,Fallon,Hegney,Soar, 2008). Some nurses report that on-the-job experiences was more beneficial in their training (O,Connell,O’Loughlin,Reid, 2004).

35. Education Training for CIS systems and upgrades is handled by various members such as company representatives, clinical nurse educators, data managers, project team members, and on-the-job experiences. Training doesn’t end when a system is implemented for there are constant changes such as updates, revisions, medical knowledge changes, treatment option changes, hardware upgrades and loss of knowledge from initial training (Chin, 2004). “Ongoing and continual evaluation, education, and training are necessary to optimize clinical efficiency and effectiveness (Chin, 2004 ).

36. Education Company representatives are a good source of training for the fact that they are very knowledgeable of the system and they can easily troubleshoot problems. Project team members are also invaluable for their in-depth training as well as the fact that they are end users and can be a link for continual training on updates and changes. On-the-job experiences are beneficial to trial and error learning.

37. Conclusion In conclusion, CIS systems and Electronic Health Records involved within these systems hold many changes in the future. As with any technology changes occur rapidly and new advances to streamline the systems in use are continually being implemented. Electronic Health Records will be transformed to allow clinicians at any location the ability to access information about health history, labs, etc. Patients can transfer between physicians nationwide and not have lost information. Additionally we will see advances to support systems that help with diagnosis and plan of care of patients.

38. Conclusion Continued Along with new advances to CIS systems comes increased costs to facilitate these changes such and education, maintenance, software and hardware upgrades. Privacy issues will be another area that will see increased regulations to coincide with an increase in accessibility of patient information. To ensure best practice for our patients we must stay engaged in these advancements and continue to look to the future.

39. References Berner, 2009. Clinical decision support systems: State of the art. Retrieved April 1, 2010 from http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html Chin, H. (2004). The Reality of EMR Implementation: Lessons from the field . Retrieved April 11, 2010, from http://xnet.kp.org/permanentejournal/fall04/reality.html Eley, R., Fallon, T., Soar, J., Buikstra, E., & Hegney, D. (2008). The status of training and education in information & computer technology of Australian nurses: A national survey. Journal of Clinical Nursing, 17, 2758-2767. Retrieved April 11, 2010, from CINAHL Plus with Full Text database. doi:10.1111/j.1365-2702.2008.02285.x Farukhi, n.d. Development of decision support system. Retrieved April 1, 2010 from http://www.cwru.edu/med/epidbio/mphp439/Clinical_Decision.htm Iron Mountain. (2010). Server Backup Solutions, Online Serve Backup, Server Protection & Recovery. Retrieved April 8, 2010 from http://www.ironmountain.com/health-information/health-server-backup.html

40. References McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge . Sudbury, MA: Jones & Bartlett. National Institutes of Health National Center for Research Resources. (2006). Electronic Health Records Overview. Retrieved April 8, 2010 from http://www.ncrr.nih.gov/publications/informatics/EHR.pdf O'Connell, M., Reid, B., & O'Loughlin, K. (2008). An exploration of the education and training experiences of ICU nurses in using computerised equipment. Australian Journal of Advanced Nursing, 25 (2), 46-52. Retrieved April 11, 2010, from CINAHL Plus with Full Text database. Privacy Rights Clearinghouse. (2010). HIPAA Basics: Medical Privacy in the Electronic Age. Retrieved April 8, 2010 from http://www.privacyrights.org/fs/fs8a-hipaa.htm#12 State of Oregon. (2010). Reassessing Your Security Practices in a Health IT Environment: A Guide for Small Health Care Practices. Retrieved April 8, 2010 from http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10731_848086_0_0_18/SmallPractice SecurityGuide-1.pdf