Clinical information system

Clinical Information System

By: Ashlee Rossner slides 1-8, 13, 21, 27-32, 37-38Jenna George slides 8-12,13, 21, 27, 32 & 38 Kelsey Smith slides14-21, 8, 13, 27, 32 & 38

Rachel Hiebert slides 22-27, 8, 13, 21, 32 & 38Steven Barksdale slides 32-36, 8, 13, 21 27 & 38

Ashlee Rossner : Discussing what a CIS is , key players that are involved in choosing, implementing and revising a CIS. Also discussing cost of a CIS. What should be considered, purchasing, IT support personnel, and continuing education.

Jenna George: Discussing EHR component: Should it have the 8 basic components, who has access to this particular information, and why is this particular information needed within the CIS

Kelsey Smith: Discussing the clinical decision making system in a CIS. How should it be structured, how often should it be update with new EBP guidelines, Any companies out there that design clinical decision making systems for the CIS.

Rachel Hiebert: Discussing about safety issues. Backup, storage of data, protection of files from viruses/worms/hackers, who has access, how users gain access, HIPAA considerations, &ethical considerations in design.

Steven Barksdale: Discussing education. How often should re-education and updates take place, who should do the educating and why, what type of formats should be used for learning.

Introduction

◦ What is a CIS? “CIS is an array or collection of applications and

functionality; amalgamation of systems, medical equipment, and technologies working together that are committed or dedicated to collecting, storing, and manipulating healthcare data and information and providing secure access to interdisciplinary clinicians navigating the continuum of client care. Designed to collect patient data in real time to enhance care by providing data at the clinician’s fingertips and enabling decision making where it needs to occur-at the bedside” (McGonigle, & Mastrian, 2009, pp 443).

Giving healthcare providers patient date with a click of button!

Overview of CIS

Confused

Some areas addressed by CIS are:

“Clinical decision support: This provides users with the tools to acquire, manipulate, apply and display appropriate information to aid in the making of correct, timely and evidence-based clinical decisions.

Electronic medical records (EMR): this contains information about the patient, from their personal details, such as their name, age, address and sex to details of every aspect of care given by the hospital (from routine visits to major operations)

Training and Research: Patient information can be made available to physicians for the purpose of training and research. Data mining of the information stored in databases could provide insights into disease states and how best to manage them”

(Biohealthmatic.com, 2010).

Overview of CIS

Nurses

Nurse managers

Support staff

Performance improvement analysts

Physicians

Administration

(McGonigle, & Mastrian, 2009).

Key Players in Choosing a CIS

Key players that choose the CIS are usually involved in implementing & revising the system (McGonigle, & Mastrain, 2009).

◦ “Getting input from both the clinicians who will be using the system and the staff who will be using the output information is critical to the success of system design and implementation” (McGonigle, & Mastrain, 2009, pp 195).

◦ “…critical need for the end users to be intimately involved in choosing and/or developing the CIS” (MCGonigle, & Mastrain, 2009, pp 194).

Healthland is just one of many companies that provide tech support throughout the implementations and revising process (Healthland, 2011).

Implementing & Revising the CIS

Hope you aren’t day dreaming!

Health information and data

Results management

Order entry management

Decision support

Electronic communication and connectivity

Patient support

Administrative processes

Reporting and population health management

(McGonigle & Mastrian, 2009, pp 219-224)

Components of an EHR

EHR’s should contain all pertinent information in regards to a patient’s health.

This includes all disciplines such as physicians, nurses, PT/OT, pastoral services, rehab, etc.

Enables all information to be compiled into one location for easy access and accurate updates regarding patient’s condition/status

(CMS, 2011).

Why So Detailed?

Physicians and Licensed Personnel: should be granted full access to all 8 components.

UAPs: access to health information and data

Pastoral services: access to decision support and patient support.

(McGonigle, & Mastrain, 2009)

Who Should Have Access?

This is personal/protected health information, treat it as such.

Do not grant access just because asked, remember patient privacy.

Access should not be abused, only access the information needed to complete your job and provide quality care.

Key Points to Remember

Mind wandering? Come back!

Definitions:

• “Tools that provide the clinicians, staff, patients, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times to enhance health and healthcare.” (McGonigle & Mastrian, 2009)

• “Interactive computer programs designed to assist physicians and healthcare professionals with decision making tasks.” (Wikipedia, 2010)

• “The greatest tool to increase the standardization of care, reduction of practice variation, successful and effective diagnosis, and correct care path choice.” (Farukhi, 2009)

Clinical Decision Making

Provide physician with a guideline model

Reduce overall cost of healthcare

Receive patient data and utilize data to process a series of possible diagnoses and course of action

Recognize drug-drug interaction and patient complications that would otherwise be unrecognized by the physician to provide a valid, efficient, and “best practice” solution to the patient diagnosis process

(Faruhki. (2009)

Why is clinical decision making important?

Tools and Interventions:

◦ Computerized alerts and reminders Medications that are due, patient has an allergy to a

medication, lab levels ◦ Order sets◦ Patient data reports◦ Diagnostic support◦ Documentation templates◦ Clinical guidelines

Best practice for prevention of skin breakdown

(Agency for health research and quality, n.d.)

Key Features and Tools available

Evidence based clinical guidelines Systems that provide patient and situation

specific advice◦ Example: EKG interpretations or drug-drug

interaction look up Electronic full text journals and textbook

access Electronically available clinical data

◦ Example: information from clinical laboratory system

(Agency for health research and quality, n.d.)

Applications of a Clinical Decision Making System

Examples of CDS interventions by target area of care

(Berner, 2009) (Berner, 2009)

Target Area of Care:

1. Preventive care2. Diagnosis 3. Planning or implementing

treatment4. Follow-up management5. Hospital, provider

efficiency6. Cost reductions and

improved patient convenience

Example:

1. Immunization, screening, disease management guidelines for secondary prevention

2. Suggestions for possible diagnoses that match a patient’s signs and symptoms

3. Treatment guidelines for specific diagnoses, drug dosage recommendations, alerts for drug-drug interactions

4. Corollary orders, reminders for drug adverse event monitoring

5. Care plans to minimize length of stay, order sets

6. Duplicate testing alerts, drug formulary guidelines

Workflow ◦ Assessment of workflow & how CDS fits within it◦ Proper integration

Data Entry and Output◦ Who enters the data and who receives the advice

Standards and Transferability◦ Must adapt to universal needs as well as unique needs of the end users ◦ Need for national standards for the specific evidenced based guidelines

Knowledge Maintenance ◦ Accuracy of data and frequency of updates of data (new medications, new

diagnoses, or new evidence based guidelines)◦ Investigate source of knowledge and frequency of updates before purchasing

CDS program and/or initiate a knowledge management process internally Clinician motivation to use CDS

◦ Patients safety◦ Concern of physician autonomy◦ Legal and ethic ramifications◦ Busy schedule of clinicians

(Berner, 2009)

Design and Implementation of Clinical Decision Making System

Epic (www.Epic.com)

Infermed (www.infermed.com)

Cerner Corporation

Lifecom

Theradoc

Metavision by iMDsoft

Decision Making Software

Wishing you were some place else?

HIPAA

◦ Stands for Health Insurance Portability and Accountability Act

◦ signed into law in 1996 by President Bill Clinton

◦ provides privacy of health information

◦ “require(s) the covered entities to put safeguards that protect the confidentiality, integrity, and availability of protected health information when stored and transmitted electronically into place”(McGonigle, & Mastrian, 2009, pp 172).

(McGonigle, & Mastrain, 2009)

Safety regarding CIS

Securing Network Information

◦ “healthcare organization(s) will have computers linked together to facilitate communication and operations within and outside the facility”= network

◦ 3 areas of secure network information: confidentiality, availability, integrity

◦ confidentiality policy to “clearly define what data is confidential and how the data should be handled”(McGonigle, & Mastrian, 2009, pp 185).

◦ protection also comes with an “acceptable use policy” which determines what “activities” are acceptable to use on the network.

(McGonigle, & Mastrain, 2009)

Safety (cont’d)

Threats to Security

◦ unawareness of computer monitor visibility, shoulder surfing, removal of computer hardware (McGonigle, & Mastrian, 2009, pp 187).

◦ Removable storage devices: jump drives, flash drives, CDs, DVDs, thumb drives (McGonigle, & Mastrian, 2009, pp 187-188).

◦ spyware, viruses, worms, Trojan horses (see next slide)

(McGonigle, & Mastrain, 2009)

Safety (cont’d)

Viruses and Antivirus Software

◦ protection from viruses can be achieved by installing “antivirus software or a hardware tool such as a proxy server” (McGonigle, & Mastrian, 2009, pp 189).

◦ firewalls: “hardware or software […] examines all incoming messages or traffic to the network” (McGonigle, & Mastrian, 2009, pp 189-190).

◦ proxy servers prevent users from “directly accessing the internet” (McGonigle, & Mastrian, 2009, pp 190).

◦ intrusion detection systems “allow an organization to monitor who is using the network and what files that user has accessed” (McGonigle, & Mastrian, 2009, pp 190).

Safety (cont’d)

Authentication of Users (Access)

◦ “ways to authenticate users: ID badge, weak vs. strong passwords, finger scanners” (McGonigle, & Mastrian, 2009, pp 186).

◦ ID cards can be used for authentication

◦ create a strong password, using letters, numbers and characters (i.e #, @, +)

◦ never write down passwords in an obvious place (under your keyboard)

(McGonigle, & Mastrain, 2009)

Safety (cont’d)

Keep your heads on, we are almost done!

Cost

Implementing a CIS is a very expensive task that continues to grow as hospitals continue to grow.

◦ “…implementation of such a comprehensive system will cost the organization both dollars and losses in clinician productivity during development and implementation” (McGonigle, & Mastrian, 2009, pp194).

◦ “The high cost of basic infrastructure of clinical information technology is a substantial hurdle for many health care organizations, many of whose income margins have deteriorated after years of decreasing reimbursement (from Medicare and other sources) and whose access to capital for new medical technology is extremely scarce” (Crane, & Raymond, 2003).

The Cost also depends on what CIS is purchased, and IT program hospitals go through.

“The cost of health information technology should be shared among those who benefit from it. Public investment is needed to encourage adoption of important technologic applications” ( Crane, & Raymond, 2003).

Remember: Have a budget and a CIS that can progress as hospitals continue to grow!

Cost

Data security and patient privacy

Time and cost required to choose, buy, and implement or build a health informatics system. (Don’t forget hidden costs!)

Integration of legacy systems (Challenge for organizations to abandon their large IT investment)

Clinician resistance

Lack of industry standards and interoperability (outpatient verses inpatient system)

Risk aversion (Shrinking income margins)

Inability to transfer (IT personals have differences in care delivery models, leadership factors, and organizational culture).

(Crane, & Raymond 2003).

Cost Considerations

Which CIS to Purchase? Four phases of decision making for a CIS

◦ Preparatory phase: (detailed explanation of content, scope, requirement and analytical methods that they want from a CIS)

◦ Screening phase: (selection of alternatives; existence of some functions or interfaces or cost limits)

◦ Evaluating phase: (comparison of alternatives; narrow it down to 6 products to be evaluated in detail)

◦ Decisions phase: (Key players make a recommendation to the board of the hospital)

(Graeber, 2001).

Don’t Jump, its just education

Where does it start?

First- A hospital decides to implement a CIS.

Second- “Key Players”, users of all levels, are chosen to evaluate the potential CIS programs.

Third- Different agencies show a sample of what their program can do for the hospital to the “Key Players”.

Fourth- The chosen provider will build a base program, upload it to the hospital system, and send educators to the “Key Players” beginning the three education stages.

(McGonigle, & Mastrian, 2009)

Education

Who needs it?Everyone-

Stage 1: The “Key Players” are used to find any flaws in the base program as well as figuring out what is working and what is not. This helps the facility to fine tune the program before full implementation.

Stage 2: Any flaws found in Stage 1 are examined and the program is adjusted to fix the flaws. Then the training starts with the educated employees (Key Players) training other future educators.

Stage 3: The trained educators are utilized in the education of the hospital. The users that will be educated in the hospital include everyone, from doctors to volunteer personnel prior to installation of the new program.

(McGonigle, & Mastrian, 2009)

Education

How often?

Education is an ongoing process that never stops!!!

The more the system is used, the more the users are able to see what needs to be added or changed.

Updates and continued education are done as often as needed. Some education can be done via email, while other education may require in-person training.

(McGonigle, & Mastrian, 2009)

Education

What style learning works best?

When teaching the new program all types of learning are used.

Audio- Question/Answer format with Educators

Visual- Show and Tell format with Educators

Kinesthetic- Tactile format with Educators incorporating physical activity into the learning process.

(McGonigle, & Mastrian, 2009)

Education

The End

Agency for Health Research and Quality. (n.d.). US Department of Health and Human Services. Retrieved from http://healthit.ahrq.gov

Biohealthmatics.com. (2010). Clinical information system. Retrieved from http://www.biohealthmatics.com/technologies/his/cis.aspx

Berner, 2009. Published for the Agency for Healthcare Research and Quality for the US Department of Health and Human Resources. http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html

CMS. (2011, June 13). Overview of Electronic Health Records. In U.S. Department of Health and Human Services.

Crane, R. M., & Raymond, B. (2003). health systems: fulfilling the potential of clinical information systems. . The Permanente Journal, 7(1), Retrieved from http://xnet.kp.org/permanentejournal/winter03/cis.html

Faruhki. (2009). http://cwru.edu/med/epidbio/mphp430/clinical_decision.htm

Graeber, S. (2001). How to select a clinical Information system. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2243333/pdf/procamiasymp00002-0258.pdf

Healthland. (2011). Implementation services. Retrieved from http://www.healthland.com/services/

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

2010. Wikipedia. Clinical Decision Support System. Retrieved from http://en.wikipedia.org/wiki/Clinical_decision_support_system

References