The Clinical Information System (CIS)

Brittney N.Teresa H.

Greg D.Stephanie J.

Overview of CIS: slides 4-7 by Teresa H. EHR Component: slides 8-10 by

Stephanie J. Clinical decision making system in a

CIS: slides 11-13 by Greg D. Safety: slides 14-18 by Teresa H. Cost: slides 19-21 by Brittney N. Education: slides 22-23 by Brittney N.

Intro into CIS & EHR

The Clinical Information System (CIS) and Electronic Health Record (EHR) are key components to giving quality care to clients. It allows health care professionals to come together and deliver care, and without the organization of such software, information could possibly get lost in translation.

Clinical Information Systems

Definition of CIS Computer-based system designed to

compile & store patient health records Provides centralized repository

of information based technology applications

Provides historical data of patient health decisions & treatment plans

Allows navigation and integration of information from different entities (billing, compliance,wellness activities)

Encodes knowledge to drive clinical decision making process

Captures clinical data to support more efficient & effective decision making that is evidenced based

Provides for interdisciplinary exchange of information to streamline workflow

Benefits of CIS

Easy access to Patient Data enhancing

continuity of care

Structured Information that is well organized &

legible

Improved Drug/Patient Safety

through safeguarding

measures incorporated into

system

Key Stakeholders

Choosing, implementing or upgrading a CIS should include a broad spectrum of people including:

- Clinicians (Nursing & Physician) -IT Dept.

-Quality/ PI Division-Administration

-Ancillary Dept.'s (Pharmacy, Radiology, Lab)

Electronic Health Record (EHR)What is EHR? • It is a digital collection of patient data.

•Health care professionals use this to document a patient’s health status

•Information can be stored, processed, entered, and accessed

• This provides quality care for patients

8 Components of the EHR1. Health Information and Data

• Patient data that helps to make clinical decisions such as results, diagnoses, medications, etc. Patients supply the core information so health care professionals can gather more data.

2. Results Management• Health care professionals can use this area to manage patients’

current and historical results including labs, tests, and procedures

3. Order Entry Management• Allows health care providers to enter patient orders such as

medications, labs, and nursing.

4. Decision Support• Alerts and reminders can be used by professionals to improve

quality of patient care. This can include medication time reminders, allergy alerts, and new results alert.

(McGonigle & Mastrian, 2009)

5. Electronic Communication and Connectivity• Communication between health care personnel through e-

mail and recording digital messages.

6. Patient Support• Programs for patient education and monitoring tools. This is

for patients to access and become more knowledgeable over health topics.

7. Administrative Processes• This is for health facilities and insurance companies for filing

claims, scheduling appointments, and billing clients.

8. Reporting and Population Health Management• This component is a part of data collection tools that help to

create support for public and private reporting requirements. (McGonigle & Mastrian, 2009)

8 Components Cont’d.

Decision Making SystemStructure

Decisions : Diagnosis, alternative diagnosis› Ie. – red sore throat+white patches on throat+fever= Strep throat

may be = pharyngitis, tonsillitis

Actions: Interventions or care to be administered› Strep throat = antibiotics, Tylenol, contact precautions

Process: Hierchial approach to delineate the importance of each step of care and what order they should be in.› 1) 10 day antibiotics immediately 2) contact

precautions/Tylenol

Decision Making SystemImplementing EBP

“If clinical research is to improve clinical care, it must be relevant, of high quality, and accessible” (Sim, Gorman, Greenes, Haynes, & Kaplan, 2001)

The goal of researchers is to “Develop shareable, machine-readable repositories of executable guidelines that are linked to up-to-date evidence repositories” (Sim, Gorman, Greenes, Haynes, & Kaplan, 2001)

A good decision making system for a CIS is continually evolving and updating

Decision Making SystemsCompanies

Companies that are involved in developing decision making systems are: HBOC, IBM, Siemens Medical Systems, and Health VISION

Siemens Medical Systems - http://www.medical.siemens.com/siemens/en_GLOBAL/gg_diag_FBAs/files/Informatics/Protis/0701021-Protis_Mappe_LO_38456275_1.pdf› Different decision making systems make different decisions!!!

Example – Siemens Medical Systems Protis system :› Delivers a comprehensive overview of results for each patient › Integrates test data from multiple instruments into one report › Supports a broad range of assessment modules: iron and

anemia, nutrition, cardiac risk, kidney, and CSF › Provides doctors with an easy-to-review graphical readout › Simplifies organization of test data, saving time

(Siemens Medical Systems, 2011)

Safety Considerations

Backup/Storage of Data Data Warehouses act as repositories for

an organization’s data; allows its later retrieval (Often located off-site)

By digitizing & centralizing information, it becomes more accessible

Minimizing downtime increases functionality of system

Safety cont.

Protection of Files (viruses, hacker, & worms)

Safeguards: 1. Develop a System Map to identify

all computers connected to internal network, virus scanning software, intrusion detection systems

2. Develop a Security Policy defining authorized users, password policy & accessibility

3. Harden the Software by checking for updates & patches

Safety cont.

4. Reduce the number of access points

5. Install a gateway or firewall to shield your internal network from the Internet; install anti-virus software

6. Require data encryption for information sent over unsecured networks or on portable devices

7. Conduct periodic security audits

Safety cont.

Health Insurance Portability & Accountability Act became law in1996; established to provide privacy, confidentiality, & security to patients

Health care entities must insure all coworkers have received HIPAA education

Collaboration with external sites & entities to insure knowledge of policies

Establish disciplinary action for violations Ensure protocol to identify, authenticate, &

properly respond to individual request for records.

HIPAA HIPAA ENFORCEMENT RESULTS BY YEAR

• Increasing use of electronic health records raises the concern for greater opportunity for violating patient confidentiality either unintentionally or purposefully.

• Demonstrates the vigilance necessary to maintain patient privacy

Source: U.S. Department of Health and Human Services(Cortes, 2009)

CO$TSeveral things should be considered in the

total cost of implementing an EHR/EMR: purchase price, IT personnel, maintenance,

system capable of handling the software, staff education, & more.

• Purchase Price • Depends on size of facility, implementation

process, & current legacy (operating) system. • Health Information Technology Act of 2007

and the Wired for Health Care Quality Act of 2007 help provide financial support and incentives to implement and EHR/EMR.

• It is estimated that the purchasing cost is $33,000 for each physician, with an additional $1,500 per doctor per month for maintenance.

• IT Personnel• With the additional technology, additional support

staff is needed. • Some EHR companies will charge you extra for

after hour support. • For a 36 provider facility the annual support cost

(software maintenance & upgrade, IT support, and depreciation) were an average $55,000.

• Education• Cost to train staff.• EPIC training for new RN staff at St.Johns consist of

5 eight hour days. (32 hours x $17/hr = $544 per RN)

• Continued Education- every time a new or updated feature is introduced, some form of training/education has to be provided.

• Miscellaneous• Cost for added online security• Potential cost to update systems to support

EMR/EHR• Upgrades

EDUCATION Types of Education

Initial education should be done hands on, led by an instructor that knows the system.

I think it would be helpful to establish different class that are at taught at different paces, depending on ones computer knowledge and comfortability with learning new technology.

Additional learning materials would also be helpful: handouts, online learning modules, videos.

Continuing Education I think re-education should be available

2-4 times a year for those who need refreshers. It would be nice if updates were all implemented together

or in like two segments, but it seems like they happen in spurts.

Educators Initial education should be provided by either

Educators from the company of the EHR/EMR or by staff members who have attended some form of educator training. (These people will have the most knowledge about the system allowing them to further help others.)

Re-education and updates should be taught by the education department, whom should also have a form of educator training, before teaching it to others.

Summary

All this information can at times be overwhelming, but the main thing to remember is that the CIS brings all aspects of the health record together. When researching CIS the eight components of the EHR, comparing decision making systems, safety of the data, adequate cost, and educating software users are all important.

References

Congdon, K. (2009, september 14). How much will an ehr system cost you?. Retrieved from http://www.healthcaretechnologyonline.com/article.mvc/How- Much-Will-An-EHR- System-Cost-You-0001

Cortes, S. (2009, May 11). Understanding the risk of penalties for violating privacy laws. Posted to IT Knowledge Exchange @

http://itknowledgeexchange.techtarget. com/it- compliance/tag/ftc/ Farukhi, F. (2010). Public health management & policy [11th ed.]. Retrieved from

http://www.cwru.edu/med/epidbio/mphp439/Clinical_Decision.htm

Hoffman, S, & Podgurski, A. (2008, October 30). Case western reserve university professors call for regulation of electronic health records. Retrieved from http://blog.case.edu/casenews/2008/10/30/ehrregulation

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

References MSI Systems Integrators. (2010). Case study: Sanford health integrated clinical information systems to enhance health operations from the inside out. Retrieved March 16, 2010, from http://www.msiinet.com/casestudies/storage/sanford-health

Siemens Medical Systems, Initials. (2011). Overview: protis system. Retrieved from http://www.medical.siemens.com/webapp/wcs/stores/servlet/ProductDisplay~q_catalogId~e_-111~a_catTree~e_100001,1023066,1032316~a_langId~e_-111~a_productId~e_182194~a_storeId~e_10001.htm

Sim, I., Gorman, P., Greenes, R.A., Haynes, B., & Kaplan, B. (2001). Clinical decision support system for the practice of evidence-based medicine. Journal of the American medical Informatics Association, 8(6), Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC130063

Sittig, D., Hazelhurst, B., Palen, T., Hsu, J., Jimison, H., & Hornbrook, M. (2002). A clinical information system research landscape. The Permanente Journal, 6(2). Retrieved March 20, 2011, from http://xnet.kp.org/permanentejournal/spring02/landscape.html

U.S. Department of Health & Human Services.(n.d.). Health information privacy: health information technology. Retrieved March 20, 2011 from http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/index.html

Zaroukian, M.H. (2004). Emr cost-benefit analysis. Retrieved from http://www.himss.org/content/files/EMRCost-BenefitReality.pdf