CIS Innovations in Healthcare
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Transcript of CIS Innovations in Healthcare
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#