EVALUATION OF A CISTiffany Smith 2, 8-11, 31-33

Holly Palazza 19-26Cooper Walsworth 3-7

Misty Glenn 27-30Kurt Harter 12-18

Introduction

Technology is vastly changing in today’s society. There are several areas of technology and information systems that are important and should be understood. These include:

Overview of a CIS Education Cost Safety EHR Component Decision Making System

Clinical Information System

According to Nursing Informatics and the Foundation of Knowledge a CIS 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” (Mastrian & McGonigle, 2009, pp. 193)

Basis of CIS

Friedman and Wyatt concluded that there are five categories that an organization needs to review before they decide on a CIS: Need (the depth of problems) Development (methodology) Structure ( the way the different parts function) Functionality (how easy is it to use?) Impact (how it effects those that use it)

Friedman CP, Wyatt JC. Evaluation methods in medical informatics. New York: Springer-Verlag; 1997. p 42.

An Example CISHTTP://HEALTHNETCONSULTING.COM/ACIS/INDEX.HTML

The example model at the right is a depiction called an Apex model designed by HealthNET

This Apex was designed to help healthcare institutions process and integrate their information more effectively and more clearly

Key Persons in a CIS

The development team is the first to establish a basis for the CIS (the development team can consist of nurses, managers, analysts, insurance companies, and ancillary staff (Mastrain & McGonigle, 2009, pp. 194)

The people that implement the CIS include patients/families, doctors, nurses, therapists, aides, chaplains, and many other health care staff

Those that revise the CIS are often research teams that have found more beneficial ways to implement the information for the use of those that actively use the CIS daily

The Health Information and the CIS

http://www.ilink-systems.com/industries/healthcare/healthinformationexchange.aspx

The Health Information system shown at the left would help define the structure and function of the CIS; the way the different parts function and how simple it is to use the information of the CIS

Overview of Education

Technology is constantly and rapidly changing in the medical field

It is vital that staff are kept up to date on the changes in order to use it correctly and effectively.

Users should be properly educated initially. Users should be properly re-educated when

changes occur. There should be an education team assigned to

educate staff members. This needs to be done to ensure that it is getting done properly and the team is not distracted by other tasks.

Educating Users

Problems arise in the work place from a lack of communication and education.

The most successful organizations are those where management/leadership takes proactive steps to identify and solve potential problems before they even occur.

Steps: Make a list of issues and problems that need to be addressed. Make a list of potential areas for problems. Make a master list of potential or current issues, identifying the underlying

problems. Work with other management/leadership to create realistic goals or solutions

for the problems identified. This could include lack of staff training, lack of clear expectations, and lack of

communication Implement the changes and train staff.

Communicate with staff the reasons for the decisions that were made. Allow them to understand why you are training them which is to provide them with better information and

support.

Re-Educating

Staff needs to be reminded how important security is for themselves as well as their patients.

Rules: Not to take shortcuts to get things done faster.

This puts security at risk. Don’t share badges for access. Don’t share passwords for access. Only put in accurate and truthful information

into the technology.

Continuing Education

Continuing education can include workshops, conferences, classes, and presentations within your specific area.

Education is starting to become on-line based.

This allows for easier access to be included at home to better accommodate staff members and fit their lifestyle better.

COST

Cost is incorporated in many different aspects of a CIS or EHR project.

Cost aspects to be considered: Initial purchase price of program Licensing fees Purchase of hardware Maintenance of hardware and software Educating personnel Staff dollars to research and support

program(s) Space for equipment to store information

Breakdown of Cost

Initial cost for a CIS / EHR program for a 500 bed hospital can be $10 million to $70 million http://www.healthcaretechnologyonline.com/article.mvc/How-Much-Will-An-EHR-System-Cost-You-0001

Licensing cost based on the number of users that will be using the program. Need a license for each user.

Hardware costs vary greatly due to amount of hardware available prior to software purchase. Recommended replacement every 3-5 years (Bailiff interview 3-31-11).

Maintenance costs are 17-30% of initial purchase price (Bailiff interview 3-31-11). Therefore maintenance costs would be $1.7-$21 million annually for 500 bed hospital purchasing a $10-$70 million EHR program.

Cost Breakdown cont’d

Education costs include time staff spent learning new CIS program. Also includes loss of production while staff learning as well as drop in production after new process(s) implemented.

Staff production also drops during the research and development on new CIS program.

Implementation Cost Example: 5 physician office spent $162,047 (1st 60 days), and $85,500 per year in yearly maintenance. Maintenance costs included licensing, hosting , technical support, and networking http://www.ihealthbeat.org/articles/2011/3/9/study-assesses-costs-of-implementing-ehrs-in-primary-care-practices.aspx .

Safety

Safety is protection of all of the patient health record, hardware and software equipment, personal information (patients and staff), and organizational information.

Patient health record is protected by password access usually. Staff is allowed to access the record for documentation by password then the employees are to sign off.

If the employee does not sign off, the record can be tampered with and the employee could receive disciplinary action.

Safety Cont’d

Some programs allow staff to sign in with a password one time at the beginning of the shift. Then the employee can use their badge or biometrics (fingerprint or retinal scan) the rest of the shift. This allows for faster sign on each time.

Firewalls are used to keep outside threats (usually viruses) from getting into organization and damaging information.

Safety Cont’d

Catastrophic Safety Issues: Fire, Water Damage, Overheating of Data Storage Devices, Viruses or Hackers

Data can be stored on site or off site. Redundancy of data storage is essential.

CoxHealth stores data on site as well as at the Springfield Underground (R. Bailiff, personal communication 3-31-11)

Some data stored as multiple copies ex: 3 copies of patient images (x-rays, CT’s) (R. Bailiff, personal communication, 3-31-11)

Safety Cont’d

Information should be encrypted especially e-mails because it is so prevalent http://www.aafp.org/fpm/2005/0400/p43.html.

Ensure vendors are aware of importance of HIPAA security standards. http://www.aafp.org/fpm/2005/0400/p43.html.

Increased safety measure increase the cost of a CIS, but safety can also save an organization money due to security breaches and disasters.

EHR Component

The EHR (electronic health record) is a computer based patient chart. It is a comprehensive electronic system which includes many aspects. There are eight basic components which are beneficial for any electronic health record system to include.

http://chiroblog.borah.net/wp-content/uploads/2011/02/Electronic_Health_Records-01.jpg

8 Basic Components

1. Health information and data• Electronic compilation of patient data including:

demographics, medical and nursing diagnoses, medication lists, allergies, and test results

2. Results management• Management of various forms of results electronically

including: laboratory, microbiology, pathology, radiology, nursing, supply orders, ancillary services, and consultations

3. Order entry management• The ability for a clinician to enter medication and other

orders into a computer

8 Basic Components

4. Decision support• Best practice reminders and alerts the computer can support

clinicians diagnoses, medication selections, and disease treatments

5. Electronic communication and connectivity

• Online aspect which allows communication between healthcare team members and for an integrated health record between all parts of the healthcare system

6. Patient support• Patient education and self-monitoring that is accomplished

via computer based teaching programs and home monitoring systems

8 Basic Components

7. Administrative process• Electronic means of scheduling, billing, and claims including

scheduling of both inpatient and outpatient visits, insurance eligibility confirmation, and claim approvals.

8. Reporting and population health management

• Data collection tools for reporting and documentation

http://www.technicaljones.com/EHR_June%202010.jpg

http://www.citytowninfo.com/images/education-news/switch-to-electronic-health-records-will-create-jobs-10020302.jpg

Access

Who should have access to each of the 8 components?

1. Health information and data: All healthcare employees with direct patient contact need access to this information.

Some positions that would be included in this are: Physicians, Physician assistants, nurse practitioners, nurses, nurse assistants, respiratory, physical, occupational, and speech therapists, social workers and case managers.

Each position should not have access to all information, though the level of access should be based on need for example a nurse assistant does not need access to all the medications a patient is on because they will not be administering medications or assessing for effectiveness or side effects.

Access

2. Results management: Physicians, physician assistants, nurse practitioners and nurses need access to the results. Lab technicians also need access to input the information.

3. Order entry management: Physicians and nurses need access to this aspect of the EHR.

4. Decision support: All members of the health care team need access to this part of the system, but it needs to be tailored to each positions specific needs. For example: a nurse should get best practice results involving patient care such as skin care tips and skin breakdown prevention methods for high risk patients. Alternatively, a dietician should get alerts of patients needing specialized diet needs such as diabetics, patients who are undernourished, and cardiac patients.

Access

All healthcare team members need to work together to implement an EHR successfully. They need to be aware that access to certain aspects of the chart may be limited and dependent upon position. As team members work with each other through communication, patient continuity of care and safety will be ensured.

http://www.practiceone.com/pics/page-div.box-div.image-EHR.jpg

Clinical Decision Making

The structure of a CIS should: Be easily accessible and

user friendly. Ease and access to more information will gain trust and understanding with the user.

Contain standardized language which allows for more effective tracking methods and less confusion among providers.

Be formatted for rapid scanning with the ability to expand information when more detail is required.

(Mastrian & McGonigle, 2009, pp. 199-202)

Clinical Decision Making con’t

Evidence-Based Practice (EBP) Guidelines “Evidence-based” implies that the document or

recommendation has been created using an unbiased and transparent process of systematically reviewing, appraising, and using the best clinical research findings of the highest value to aid in the delivery of optimum clinical care to patients (Watters III, 2008).

According to the Agency for Healthcare Research and Quality, they developed the National Guideline Clearinghouse (NGC). The NGC updates their EBP guidelines yearly. Thus a CIS should be updated and reviewed twice annually looking for any additions, deletions or changes (National Guideline Clearinghouse, 2011).

Clinical Decision Making Systems for the CIS

Who designs clinical decision making systems? An online company, Open Clinical “provides

an increasingly comprehensive set of resources on advanced knowledge management methods, technologies and applications for healthcare” (Open Clinical, 2011). According to this company, there are over 280 suppliers which provide clinical decision making systems for clinical information systems.

Clinical Decision Making Providers

A few popular examples of these companies who develop clinical decision making systems include: Cerner Corporation, 3M Health Information Systems, EPIC Systems Corporation, Epocrates, Micromedex and MedPlus just to name a few. A more extensive list of suppliers may be found on the Open Clinical website, http://www.openclinical.org/suppliers.html

Conclusion

As we have all learned, there are many components to technology, CIS, EHR, etc. There is much more that we have’nt even learned about that is out there. What we have learned is how to be safe when using it, the basics of CIS, components, structure, HIPAA considerations, costs, continuing education, and more. The clinical information system is a multi-faceted structure that requires knowledge and respect from users.

References Congdon, K. (2009). How Much Will an EHR System Cost You? Healthcare

Technology Online. Retrieved 3/31/2011 from http://www.healthcaretechnologyonline.com/article.mvc/How-Much-Will-An-EHR-System-Cost-You-0001

Friedman CP, Wyatt JC. Evaluation Methods in Medical Informatics. New York: Springer-Verlag; 1997. p42. Retrieved from http://xnet.kp.org/permanentejournal/spring02/landscape.html.

Jackson, S. (2011). Start Educating Staff on Security Now. Fierce EMR. Retrieved on 4/1/2011 from: http://www.fierceemr.com/story/start-educating-staff-security-now/2011-01-13

Kibbe, D. C. (2005, April). Ten Steps to HIPAA Security Compliance. In Family Practice Management. Retrieved April 1, 2011, from http://www.aafp.org/fpm/2005/0400/p43.html

Lutmer-Paulson, J. (2010). How to Use a Proactive Approach in Educating Staff. Retrieved on 4/1/2011 from: http://www.ehow.com/how_7475670_use-proactive-approach-educating-staff.html.

McGongile, D. & Mastrain, K. (2009). Nursing Informatics and the Foundation of Knowledge. Jones and Bartlett; Sudbury, MA. Pp. 193-94.

References

National Guideline Clearinghouse. (2011). National guideline clearinghouse. Retrieved March 23, 2011, from National Guideline Clearinghouse Web site, http://www.guideline.gov/faq.aspx

Open Clinical. (2010). Suppliers of clinical knowledge management products. Retrieved April 1, 2011 from http://www.openclinical.org/suppliers.html

Study Assesses Costs of Implementing EHR's in Primary Care Practices. (2011, March 9). In iHealthbeat. Retrieved March 31, 2011, from http://www.ihealthbeat.org/articles/2011/3/9/study-assesses-costs-of-implementing-ehrs-in-primary-care-practices.aspx#ixzz1IKHWg3tU

Watters III, W.C. (2008). Defining evidence-based clinical practice guidelines. American Association of Orthopaedic Surgeons. Retrieved from http://www.aaos.org/news/aaosnow/jul08/research2.asp