Clinical Information Clinical Information Systems at a GlanceSystems at a Glance

By: Evie DevlinBy: Evie Devlin Christina JarvisChristina Jarvis Danielle RitzDanielle Ritz Lacy PhillipsLacy Phillips Angie MessnerAngie Messner

Team SOL2-01Team SOL2-01

Angie MessnerAngie Messner: : Introduction slides and a brief Introduction slides and a brief overview of a CIS and what key players are involved.overview of a CIS and what key players are involved.

Danielle RitzDanielle Ritz: : The EHR component.The EHR component.

Evie DevlinEvie Devlin: : The clinical decision making system in a The clinical decision making system in a CIS and reference slides.CIS and reference slides.

Lacy PhillipsLacy Phillips: : Safety and cost of a CIS.Safety and cost of a CIS.

Christina JarvisChristina Jarvis: : Education about a CIS and Education about a CIS and conclusion slide.conclusion slide.

Clinical Information Clinical Information Systems at a GlanceSystems at a Glance

A broad overview of a clinical information A broad overview of a clinical information system and an electronic health record system and an electronic health record will be discussed in this presentation.will be discussed in this presentation.

Additionally, factors such as safety, cost, Additionally, factors such as safety, cost, and education related to clinical and education related to clinical information systems will be evaluated.information systems will be evaluated.

The CISThe CIS

Presented By: Angie MessnerPresented By: Angie Messner

What is a Clinical What is a Clinical Information System?Information System?

““A clinical information system is a A clinical information system is a technology-based system that is applied technology-based system that is applied at the point of care and is designed to at the point of care and is designed to support the acquisition and processing of support the acquisition and processing of information as well as providing storage information as well as providing storage and processing capabilities” and processing capabilities” (McGonigle & (McGonigle &

Mastrian, 2009, p. 193)Mastrian, 2009, p. 193)..

Clinical Information Clinical Information SystemsSystems

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

2009)2009)..

Various Types of Various Types of Information Systems in Information Systems in HealthcareHealthcare

Communication Communication SystemsSystems

Core Business Core Business SystemsSystems

Case Management Case Management Information SystemsInformation Systems

Order Entry SystemsOrder Entry Systems Patient Care Patient Care

Information SystemsInformation Systems

Patient Care Support Patient Care Support SystemsSystems

Clinical Clinical Documentation Documentation SystemsSystems

Electronic Medical Electronic Medical RecordsRecords

Pharmacy Pharmacy Information SystemsInformation Systems(McGonigle & Mastrian, 2009).(McGonigle & Mastrian, 2009).

Contributors to Developing, Contributors to Developing, Revising, & Implementing a Clinical Revising, & Implementing a Clinical Information SystemInformation System

The people at the administrative level who The people at the administrative level who contribute are known as the stakeholders contribute are known as the stakeholders (McGonigle & Mastrian, 2009)(McGonigle & Mastrian, 2009)..

Groups of information technologists and Groups of information technologists and technology support services contribute as well technology support services contribute as well (McGonigle & Mastrian, 2009)(McGonigle & Mastrian, 2009)..

Specific areas of the healthcare organization Specific areas of the healthcare organization help develop the different systems as well, for help develop the different systems as well, for example, nursing managers and staff nurses example, nursing managers and staff nurses help in development of what pertains to their help in development of what pertains to their field of work field of work (McGonigle & Mastrian, 2009)(McGonigle & Mastrian, 2009). .

The EHRThe EHR8 Basic Components8 Basic Components

Presented By: Danielle RitzPresented By: Danielle Ritz

Health Information and Health Information and DataData

Health information and data is the patient Health information and data is the patient data required to make sound clinical data required to make sound clinical decisions including demographics, medical decisions including demographics, medical and nursing diagnoses, medication lists, and nursing diagnoses, medication lists, allergies, and test results.allergies, and test results.

The people that are going to be looking at The people that are going to be looking at this will be physicians, nurses, and other this will be physicians, nurses, and other members of the healthcare team.members of the healthcare team.

Results ManagementResults Management

This is the ability to manage results of all This is the ability to manage results of all types electronically, including laboratory types electronically, including laboratory and radiology procedure reports, both and radiology procedure reports, both current and historical. current and historical.

The people that can read this information The people that can read this information will be most of the members of the will be most of the members of the healthcare team and the patient.healthcare team and the patient.

Order Entry ManagementOrder Entry Management

This is the ability of a clinician to enter This is the ability of a clinician to enter medication and other care orders, including medication and other care orders, including laboratory, microbiology, pathology, laboratory, microbiology, pathology, radiology, nursing, supply orders, ancillary radiology, nursing, supply orders, ancillary services, and consultations directly into a services, and consultations directly into a computer.computer.

The people that will be responsible for this The people that will be responsible for this information will be the physicians and information will be the physicians and nurses, when they get orders by phone.nurses, when they get orders by phone.

Decision SupportDecision Support This is computer reminders and alerts to This is computer reminders and alerts to

improve the diagnosis and care of a patient improve the diagnosis and care of a patient including screening for correct drug selection including screening for correct drug selection and dosing, medication interactions with other and dosing, medication interactions with other medications, preventative health reminders in medications, preventative health reminders in areas such as vaccinations, health risk areas such as vaccinations, health risk screening and detection, and clinical screening and detection, and clinical guidelines for patient disease treatment.guidelines for patient disease treatment.

The people that will use this information the The people that will use this information the most are the physicians, nurses, and most are the physicians, nurses, and pharmacy.pharmacy.

Electronic Communication Electronic Communication and Connectivityand Connectivity

This is the online communication among This is the online communication among the healthcare team members, their care the healthcare team members, their care partners, and patients including email, partners, and patients including email, Web messaging, and an integrated Web messaging, and an integrated health record within and across settings, health record within and across settings, institutions, and telemedicine.institutions, and telemedicine.

The whole healthcare team will use this The whole healthcare team will use this along with our patients.along with our patients.

Patient SupportPatient Support

This is patient education and self-This is patient education and self-monitoring tools, including interactive monitoring tools, including interactive computer-based patient education, home computer-based patient education, home telemonitoring, and telehealth systems.telemonitoring, and telehealth systems.

The person that will have access to this The person that will have access to this would be the patient.would be the patient.

Administrative ProcessesAdministrative Processes This is the electronic scheduling, billing, and This is the electronic scheduling, billing, and

claims management systems including claims management systems including electronic scheduling for inpatient and electronic scheduling for inpatient and outpatient visits and procedures, electronic outpatient visits and procedures, electronic insurance eligibility validation, claim insurance eligibility validation, claim authorization, and prior approval, identification authorization, and prior approval, identification of possible research study participants, and of possible research study participants, and drug recall support.drug recall support.

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

Reporting and Population Reporting and Population Health ManagementHealth Management

This is data collection tools to support This is data collection tools to support public and private reporting requirements public and private reporting requirements including data representing in a including data representing in a standardized terminology and machine-standardized terminology and machine-readable format.readable format.

This information is meant for the public This information is meant for the public and our patients.and our patients.

Clinical Decision Clinical Decision Making SystemMaking System(DCMS)(DCMS)

A significant domain of the Clinical A significant domain of the Clinical Information System (CIS)Information System (CIS)

Presented by:Presented by:Evie W. DevlinEvie W. Devlin

Clinical Decision Making SystemClinical Decision Making System(DCMS)(DCMS)

Definitions:Definitions: ““Tools that provide the clinicians, staff, patients, or other Tools that provide the clinicians, staff, patients, or other

individuals with knowledge & person-specific information, individuals with knowledge & person-specific information, intelligently filtered or presented at appropriate times to enhance intelligently filtered or presented at appropriate times to enhance health & healthcare.” (health & healthcare.” (Osheroff & colleagues, 2007 as mentioned by Osheroff & colleagues, 2007 as mentioned by McGonigle & Mastrian, 2009)McGonigle & Mastrian, 2009)

““Active knowledge systems which use two or more items of Active knowledge systems which use two or more items of patient data to generate case-specific advice.” patient data to generate case-specific advice.” (Wyatt & Spiegelhalter, (Wyatt & Spiegelhalter, 1991) 1991)

““Interactive computer programs designed to assist physicians & Interactive computer programs designed to assist physicians & health professionals with decision making tasks. health professionals with decision making tasks. (Wikipedia, 2010)(Wikipedia, 2010)

““The greatest tool to increase the standardization of care, The greatest tool to increase the standardization of care, reduction of practice pattern variation, successful and effective reduction of practice pattern variation, successful and effective diagnosis, and correct care path choice.”diagnosis, and correct care path choice.”

Source: Farukhi, 2009 @ http://www.cwru.edu/med/epidbio/mphp439/Clinical_Decision.htm

Key functionsKey functions

AdministrativeAdministrative Supporting clinical coding and documentation, authorization Supporting clinical coding and documentation, authorization

of procedures, and referrals. of procedures, and referrals. Managing clinical complexity and detailsManaging clinical complexity and details

Keeping patients on research and chemotherapy protocols; Keeping patients on research and chemotherapy protocols; tracking orders, referrals follow-up, and preventive care. tracking orders, referrals follow-up, and preventive care.

Cost controlCost control Monitoring medication orders; avoiding duplicate or Monitoring medication orders; avoiding duplicate or

unnecessary tests. unnecessary tests. Decision supportDecision support

Supporting clinical diagnosis and treatment plan processes; Supporting clinical diagnosis and treatment plan processes; and promoting use of best practices, condition-specific and promoting use of best practices, condition-specific guidelines, and population-based management. guidelines, and population-based management.

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

Why is CDS important?Why is CDS important? Receive patient data & utilize data to propose a series Receive patient data & utilize data to propose a series

of possible diagnoses & course of actionof possible diagnoses & course of action Provide physicians with a guideline model their Provide physicians with a guideline model their

decision decision Lead to a reduction of the practice pattern variation Lead to a reduction of the practice pattern variation

that plagues the health care delivery process that plagues the health care delivery process Reduce overall cost of healthcare Reduce overall cost of healthcare Recognize drug-drug interaction & patient Recognize drug-drug interaction & patient

complications that would otherwise be unrecognized complications that would otherwise be unrecognized by the physician to provide a valid, efficient, & “best by the physician to provide a valid, efficient, & “best practice” solution to the patient diagnosis processpractice” solution to the patient diagnosis process

Source: Farukhi, 2009 @ http://www.cwru.edu/med/epidbio/mphp439/Clinical_Decision.htm

Key Features of CDSKey Features of CDS Tools & interventionsTools & interventions

Computerized alerts and Computerized alerts and remindersreminders

Clinical guidelinesClinical guidelines Order setsOrder sets Patient data reportsPatient data reports DashboardsDashboards Documentation templatesDocumentation templates Diagnostic supportDiagnostic support Clinical workflow toolsClinical workflow tools

ApplicationsApplications Electronically available clinical Electronically available clinical

data data e.g., information from a e.g., information from a

clinical laboratory system or clinical laboratory system or information from a disease information from a disease registryregistry

Electronic full-text journal & Electronic full-text journal & textbook accesstextbook access

evidence-based clinical evidence-based clinical guidelinesguidelines

systems that provide patient systems that provide patient and situation-specific advice and situation-specific advice

e.g., EKG interpretation & e.g., EKG interpretation & drug-drug interaction drug-drug interaction checking checking

Source: Agency for Health Research & Quality, U.S. Dep’t. of Health & Human Services@ http://healthit.ahrq.gov

Examples of CDS interventions Examples of CDS interventions by target area of careby target area of care

Target Area of CareTarget Area of Care ExampleExample

Preventive carePreventive care Immunization, screening, disease management Immunization, screening, disease management guidelines for secondary preventionguidelines for secondary prevention

Diagnosis Diagnosis Suggestions for possible diagnoses that match a Suggestions for possible diagnoses that match a patient’s signs and symptomspatient’s signs and symptoms

Planning or implementing Planning or implementing treatmenttreatment

Treatment guidelines for specific diagnoses, drug Treatment guidelines for specific diagnoses, drug dosage recommendations, alerts for drug-drug dosage recommendations, alerts for drug-drug interactionsinteractions

Followup managementFollowup management Corollary orders, reminders for drug adverse event Corollary orders, reminders for drug adverse event monitoringmonitoring

Hospital, provider efficiencyHospital, provider efficiency Care plans to minimize length of stay, order setsCare plans to minimize length of stay, order sets

Cost reductions and improved Cost reductions and improved patient convenience patient convenience

Duplicate testing alerts, drug formulary guidelinesDuplicate testing alerts, drug formulary guidelines

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

Design and Design and ImplementationImplementation WorkflowWorkflow

Assessment of workflow & how CDS fits in it (not otherwise)Assessment of workflow & how CDS fits in it (not otherwise) Proper integration of CDS into the workflowProper integration of CDS into the workflow

Data Entry & OutputData Entry & Output Who enters the data & who receives the advice; who can change or modify the Who enters the data & who receives the advice; who can change or modify the

data or entrydata or entry Standards & TransferabilityStandards & Transferability

CDS must adapt to universal needs as well to the unique needs of the end usersCDS 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 There is a need for national standards for the specific evidence-based guidelines

Knowledge MaintenanceKnowledge Maintenance Accuracy of data & frequent updates of data (e.g. new drugs, new diagnoses, new Accuracy of data & frequent updates of data (e.g. new drugs, new diagnoses, new

evidence-based guidelines)evidence-based guidelines) Investigate source of knowledge and frequency of updates before purchasing Investigate source of knowledge and frequency of updates before purchasing

CDS program and/or initiate a knowledge management process internallyCDS program and/or initiate a knowledge management process internally Experts on healthcare IT advocate a “national repository of knowledge” to be Experts on healthcare IT advocate a “national repository of knowledge” to be

incorporated in the CDSincorporated in the CDS Clinician Motivation to use CDSClinician Motivation to use CDS

Concerns on physicians’ autonomyConcerns on physicians’ autonomy Legal & ethical ramificationsLegal & ethical ramifications Patient safetyPatient safety Busy schedule of clinicians 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

Safety & Cost of a Safety & Cost of a CISCIS

Presented By: Lacy PhillipsPresented By: Lacy Phillips

Clinical Information Clinical Information System: SafetySystem: Safety

Storage of DataStorage of Data

The system is mainly The system is mainly online with disc backuponline with disc backup

Recovery systemRecovery system Quick rebooting software Quick rebooting software

that brings up most recent that brings up most recent changes in informationchanges in information

All information integrated All information integrated to make it help simpler to make it help simpler

Set limits to prevent Set limits to prevent overloading the serveroverloading the server

Iron Mountain, 2010

SafeguardSafeguardss

Frequent monitoring of IT Frequent monitoring of IT environmentenvironment

Involved training for all Involved training for all individuals using CISindividuals using CIS

Protocols set for those Protocols set for those who can view electronic who can view electronic health information as well health information as well as how information can be as how information can be sharedshared

Standards for reporting Standards for reporting and punishment of and punishment of information breachesinformation breaches

Clinical Information System: Safety

State of Oregon, 2010

Clinical Information Clinical Information System: SafetySystem: Safety

The Role of HIPAA in Clinical Information SystemsThe Role of HIPAA in Clinical Information Systems

It is important to make patient’s aware that EHR’s are It is important to make patient’s aware that EHR’s are safe and secure.safe and secure.

There is less potential for loss and stolen information as There is less potential for loss and stolen information as there was with paper records.there was with paper records.

As discussed with safeguards, information should be As discussed with safeguards, information should be protected from being seen by individuals who are not protected from being seen by individuals who are not directly caring for the patient.directly caring for the patient.

Privacy Rights Clearinghouse, 2010

Clinical Information Clinical Information System: CostSystem: Cost

Study on Annual Cost by the American Hospital Study on Annual Cost by the American Hospital AssociationAssociation

$700,000 per year is $700,000 per year is the median amount the median amount spent on ITspent on IT

Operating expenses Operating expenses had a median cost of had a median cost of $1.7 million annually$1.7 million annually

National Institutes of Health National Center for Research Resources, 2006

Clinical Information Clinical Information System: CostSystem: Cost Better quality of patient careBetter quality of patient care Easy tracking of costs and Easy tracking of costs and

charges during hospital stays charges during hospital stays and office visitsand office visits

Improved documentationImproved documentation May lead to fewer lawsuits due May lead to fewer lawsuits due

to easy auditingto easy auditing Ability to see results from Ability to see results from

previous testsprevious tests Cuts cost to patients from Cuts cost to patients from

diagnostic tests that are diagnostic tests that are repeatedrepeated

National Institutes of Health National Center for Research Resources, 2006

Potential Financial Benefits of CIS

Clinical Information Clinical Information System: CostSystem: Cost

Technology is constantly changing and Technology is constantly changing and continuing education will be neededcontinuing education will be needed Wages paid to staff that are not productive work Wages paid to staff that are not productive work

hourshours

Continued need for IT personnel for updatesContinued need for IT personnel for updates

Cost of Maintaining System

National Institutes of Health National Center for Research Resources, 2006

EducationEducation

Presented By: Christina JarvisPresented By: Christina Jarvis

EducationEducation

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

EducationEducation

Typically training begins prior to implementing a Typically training begins prior to implementing a new system via: group training, one-on-one new system via: group training, one-on-one training, distance learning or on-the-job training.training, distance learning or on-the-job training.

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

EducationEducation

Training for CIS systems and upgrades is handled by Training for CIS systems and upgrades is handled by various members such as company representatives, various members such as company representatives, clinical nurse educators, data managers, project team clinical nurse educators, data managers, project team members, and on-the-job experiences.members, and on-the-job experiences.

Training doesn’t end when a system is implemented for Training doesn’t end when a system is implemented for there are constant changes such as updates, revisions, there are constant changes such as updates, revisions, medical knowledge changes, treatment option medical knowledge changes, treatment option changes, hardware upgrades and loss of knowledge changes, hardware upgrades and loss of knowledge from initial training (Chin, 2004). “Ongoing and from initial training (Chin, 2004). “Ongoing and continual evaluation, education, and training are continual evaluation, education, and training are necessary to optimize clinical efficiency and necessary to optimize clinical efficiency and effectiveness (Chin, 2004 ).effectiveness (Chin, 2004 ).

EducationEducation

Company representatives are a good source of Company representatives are a good source of training for the fact that they are very training for the fact that they are very knowledgeable of the system and they can knowledgeable of the system and they can easily troubleshoot problems.easily troubleshoot problems.

Project team members are also invaluable for Project team members are also invaluable for their in-depth training as well as the fact that their in-depth training as well as the fact that they are end users and can be a link for they are end users and can be a link for continual training on updates and changes.continual training on updates and changes.

On-the-job experiences are beneficial to trial On-the-job experiences are beneficial to trial and error learning.and error learning.

ConclusionConclusion

In conclusion, CIS systems and Electronic Health In conclusion, CIS systems and Electronic Health Records involved within these systems hold many Records involved within these systems hold many changes in the future.changes in the future.

As with any technology changes occur rapidly and new As with any technology changes occur rapidly and new advances to streamline the systems in use are advances to streamline the systems in use are continually being implemented.continually being implemented.

Electronic Health Records will be transformed to allow Electronic Health Records will be transformed to allow clinicians at any location the ability to access clinicians at any location the ability to access information about health history, labs, etc. Patients information about health history, labs, etc. Patients can transfer between physicians nationwide and not can transfer between physicians nationwide and not have lost information.have lost information.

Additionally we will see advances to support systems Additionally we will see advances to support systems that help with diagnosis and plan of care of patients.that help with diagnosis and plan of care of patients.

Conclusion ContinuedConclusion Continued

Along with new advances to CIS systems Along with new advances to CIS systems comes increased costs to facilitate these comes increased costs to facilitate these changes such and education, maintenance, changes such and education, maintenance, software and hardware upgrades. software and hardware upgrades.

Privacy issues will be another area that will see Privacy issues will be another area that will see increased regulations to coincide with an increased regulations to coincide with an increase in accessibility of patient information.increase in accessibility of patient information.

To ensure best practice for our patients we To ensure best practice for our patients we must stay engaged in these advancements and must stay engaged in these advancements and continue to look to the future. continue to look to the future.

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