CLINICAL INFORMATION SYSTEMS (CIS)

Contributors

Slides 25-29: Arnold, Lori Slides 6-10: Estes, Rachel Slides 1-2, 5,13-24, 30-39: McHugh, Robyn Slides 3-4, 11-12: Pellegren, Leigha

Clinical InformationSystems

Technology-based systems applied at the point of care, designed to support the acquisition and processing of information as well as providing storage and processing capabilities

GoalTo become a comprehensive system that

provides clinical decision support, an electronic patient record, and professional development training tools

(McGonigle & Mastrian, 2009)

Clinical InformationSystems

AdvantagesEasy access to patient data, increase the

amount of data available for clinical use, reduce medical errors, and patient safety

DisadvantagesComputer literacy is required and there could

be a breach in confidentiality, privacy and security if a computer screen is left open or unattended.

(McGonigle & Mastrian, 2009)

Key PlayersStaff

nurses &Nurse

managers

End users

Support staff

Who should be involved in choosing, implementing, and revising

the CIS?

.

Performance improvement

analysts

(McGonigle & Mastrian, 2009)

“The most important participants in the health care delivery system are the patients and their families who receive the care and the clinicians who provide the care.”

(Sittig et al., 2002)

Education

Education

Volume of information Can make it difficult to implement certain education

pieces

Ever changing and dynamic Just like technology! Maintenance is difficult – re-education is key

Problems

(McGonigle & Mastrian, 2009)

Education

Educators, and users, should be well trained in order to provide the best care for the patient and patient’s family! Educators should be specifically qualified and

knowledgeable in the healthcare field in order to instruct more effectively.

Information continually provided establishes compliance.

(Sittig et al., 2002; McGonigle & Mastrian, 2009)

Education

Should not take RN away from bedside to classroom

Needs to be convenient – computerized Needs to be interactive Repetition and frequent re-education

Goals

(McGonigle & Mastrian, 2009)

Education

Example of interactive education

Joy Hilty, RN

Developed a “prompt” system on

computerized charting

Those documenting on the computer see pop-

up boxes with a question

Pop-ups are colorful and eye catching!

They can answer them with an e-mail

If answered correctly, they receive a

vacation from the pop-up boxes

Encourages interaction, especially

between peers

(McGonigle & Mastrian, 2009)

Cost

Initial costsLicense fees for databases and interfacesExternal services: process consulting, user

training, customizing, etc.Internal implementation expenditure: for

initial user training and intensive support activities during implementation phase

(Cost benefit study of ORBIS)

Cost

Operating costsPersonnel costs: for system administration,

workstation maintenance, user helpdesk, etc.Depreciations on workstation and server

hardware and infrastructureCosts for maintenance and care of hardware

and software

(Cost benefit study of ORBIS)

A compiled electronic record of patient health information generated via one or more

encounters of care provision including:

Patient demographicsMedical historyLaboratory data

Radiology reports

ProblemsMedicationsVital signs

Patient drug allergies

Electronic Health Record

(mitre.org)

Electronic Health RecordLongitudinal

collection of health information

Provides knowledge and

decisional support

Supports efficient processes for health care

delivery

Immediate access to patient info. by

authorized user

(http://www.openclinical.org/emr.html#benefits)

Components of an EHR

Eight core care delivery

functions

Promotes greater safety in healthcare

Promotes greater quality/

efficiency in healthcare

US IOM report is key!

(openclinical.org)

1. Health Information & Data

• All patient data included• Benefits:

• Immediate access to key information• Provides ability to make timely, sound

clinical decisions

Electronic Health Record(EHR)

(McGonigle & Mastrian, 2009; mitre.org)

2. Results Management

• Manages all results, from all departments• Benefits:

• Integrates all patient results between departments

• Enables providers to participate in patient care in multiple settings

Electronic Health Record(EHR)

(McGonigle & Mastrian, 2009; mitre.org)

3. Order Management

• Enters and stores orders for tests, prescriptions, and other services.• Benefits:

• Enhances legibility• Reduces duplication and speeds execution

Electronic Health Record(EHR)

(McGonigle & Mastrian, 2009; mitre.org)

4. Decision Support

• Uses two or more items of patient data to generate case specific advice• Benefits:

• Improves compliance with evidence based practice

• Ensures regular screenings and preventative services

• Facilitates diagnoses and treatments

Electronic Health Record(EHR)

(McGonigle & Mastrian, 2009; mitre.org)

5. Communications & Connectivity

• Networking between other care providers and patients through Web. 2.0 applications• Benefits:

• Improves continuity of care• Increases timeliness of diagnoses and

treatments• Reduces frequency of adverse events

Electronic Health Record(EHR)

(McGonigle & Mastrian, 2009; mitre.org)

6. Patient Support

• Tools provided to patient including access to health records, patient education, monitoring, and tele-health• Benefits:

• Improves control of chronic conditions• Allows provision of patient care in patient’s

own home

Electronic Health Record(EHR)

(McGonigle & Mastrian, 2009; mitre.org)

7. Administrative Processes

• Computerized administration in such areas as scheduling, billing, and out-patient services• Benefits:

• Improves hospital/clinic efficiency• Provides more timely service to patients• Reduces lost charges

Electronic Health Record(EHR)

(McGonigle & Mastrian, 2009; mitre.org)

8. Reporting

• Provides data collection capabilities, specific to institution, to support reporting requirements to federal, state, & private entities• Benefits:

• Allows healthcare agencies to respond more quickly to required reporting mandates

Electronic Health Record(EHR)

(McGonigle & Mastrian, 2009; mitre.org)

Who Should Have Access?

Legal requirements restrict access to the patient and those providing patient care only.

HIPPA defines who should have access:Joint commission IM 2.10.7 provides protection

from unauthorized access, corruption or damage.

(Walsh, T. & Miaoulis, W., 2011)

SAFETY

HIPAAIt is a way to protect and maintain patient’s health informationIt is the health care professional’s responsibility Data should be backed up dailyMissouri’s Medical Retention Laws on storage of data

Missouri 5 years Skilled nursing, intermediate care, andresidential care facilities must maintain medical records for five years after the resident leaves the facility, or until the resident reaches the age of 26, whichever is longer.

RS Mo. Section 198.052.7(1983)

(LTC Consortium, 2004)

Who has access? Access can be gained by policies and job titles Policies help with who can access and what type of

activities are permitted

Access and Authentication

(McGonigle & Mastrian, 2009)

Access and Authentication

(McGonigle & Mastrian, 2009)

How do users gain access? Access through passwords, identification cards, and

biometrics Biometrics are

Devices that recognize thumb prints, retina patterns, or facial patterns.

“The most common threats a corporate network faces are hackers, malicious code

(spyware, viruses, worms, Trojan horses) and the malicious insider.”

Security Threats

(McGonigle & Mastrian, 2009)

Firewalls: Examine all incoming and outgoing network

information Proxy servers:

Acts as a filter to block users from the Internet Intrusion detection systems:

Monitors who is using network and what is being accessed

Security Tools

(McGonigle & Mastrian, 2009)

Who Should Have Access?

Access should be based on role-based definitions.

Tasks associated with care provision roles:Should be tied to corresponding access

necessary to perform care provision role

(Walsh, T. & Miaoulis, W., 2011)

Who Should Have Access?

Evaluate each employee to ensure appropriate level of access

System administrator should be identified in order to Authorize new roles and staffVerify employee statusTerminate access when employee leavesMonitor accessDevelop policy & exceptions to policy

(Walsh, T. & Miaoulis, W., 2011)

Active knowledge systems

Use two or more items of patient data

Generate case specific advice

Designed to integrate medical knowledge with patient data

Decisional Support Systems

(http://www.openclinical.org/dss.html#definition)

Administrative(Clinical coding)

Clinical Detail Management(Referrals, follow-up)

Cost control(Monitor medication orders)

Decision Support(Best treatment options)

Decisional Support SystemsFunction

(http://www.openclinical.org/dss)

Automatic prompts rather than user activation Integrated decisional support into clinical work

flow Decisional support provided at time/location of care

provision Provides active voice recommendations for care

provision Uses a computer to generate this support

These support structures improve clinical practice based on Evidence-based practice

These structures all make it easier for care providers to use decisional support systems

Decisional Support SystemsStructure

(Kawamoto, K., Houlihan, C. A. , Balas,E. A., & Lobach, D. F. 2005)

Should provide periodic performance feedback

Request documentation for reasons when system recommendations are not followed

Share decision support results with patients

Decisional Support SystemsStructure

(Kawamoto, K., et al., 2005)

Continuous maintenance and updating of system necessary

Maintenance alarms should be in place Notification of current system performance

should be in place Provision for support & maintenance of

systems should be in place

Decisional Support SystemsWhen to Update

(http://www.openclinical.org/dss)

Clinical InformationSystems

Companies that design clinical decision making systems for the CISAnvita Health www.anvitahealth.com

Capterra www.capterra.com

Plante-moran www.plantemoran.com

Active Health www.activehealth.com

Med Assets www.medassets.com

References

AHIMA, (2011.). Retrieved Oct 25, 2011, from AHIMA: http://campus.ahima.org/audio/2007/RB112007

Kawamoto, K ., Houlihan, C. A. , Balas,E. A., & Lobach, D. F. (2005). Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. BMJ, 1-8. Retrieved Oct. 25, 2011, from BMJ Online First: http://www.bmj.com/content/330/7494/765.full.pdf doi:10.1136/bmj.38398.500764.8F

LTC Consortium. (2004). State by State Medical Record Retention Laws: Nursing Facilities. Retrieved October 25, 2011, from http://www.ahcancal.org/facility_operations/hipaa/Documents/State%20by%20State%20Medical%20Record%20Retention%20Laws-Nursing%20Facilities%202004.pdf

MITRE, (2011). Retrieved Oct. 25, 2011, from MITRE: http://www.mitre.org/Electronic medical records. (2011, Sept. 14). Retrieved Oct. 25, 2011, from Open Clinical: http://www.openclinical.org/emr.html#benefits

McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett.

References

Open Clinical (2006). Decision support systems. Retrieved Oct. 25, 2011, from OpenClinical: http://www.openclinical.org/dss

Open Clinical (2006). Decision support systems. Retrieved Oct. 25, 2011, from Open Clinical: http://www.openclinical.org/dss.html#definition

McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett.

Sittig, D. F., Hazlehurst, B. L., Palen, T., Hsu, J., Jimison, H., & Hornbrook, M. C. (2002). A clinical information system research landscape. The Permanente Journal, 6(2). Retrieved from http://xnet.kp.org/permanentejournal/spring02/landscape.html#