Evaluation of a clinical information system (cis)

EVALUATION OF A CLINICAL INFORMATION SYSTEM (CIS)

Krystena Bowen Slides 1-5; 17

Nikita Macias Slides 11-15; References

Tedra Estis Slides 6-10; 18, 22

Samantha Patton Slides 18-21

INTRODUCTION

After viewing this power point you will know about the CIS, clinical information system.

Topics covered will include an overview of CIS, the HER component, clinical decision making, safety, cost, and education regarding CIS.

To begin lets look at what exactly the CIS is…

WHAT IS CIS?

CIS stands for clinical information system

Defined by TheInformatician.com “An information system used to collect, integrate and distribute information to the appropriate areas of responsibility. Serves clinical, billing, inventory management, research, scheduling, and planning purposes.”

EVOLVING CIS Current CIS programs have come a long way

from early systems which included only lab results and medication administration. Now the goal is to expand to systems that also provide support in clinical decision making and an electronic patient record. Also, some look to add professional development training tools into their systems (McGonigle, 2009). As the system has evolved we now see an interdisciplinary display of patient education, care plans, and exchanges of information between different providers.

WHO ARE THE KEY PLAYERS? Who is involved in the design of the system used

directly by nurses? Staff nurses Nurse managers Support staff Performance improvement analysts Ancillary staff

Having all these different people collaborate when designing, implementing, and revising the system allows consistency in charting and accessing information by different clinicians (McGonigle, 2009). Involving more people will help when implementing new systems and feedback from hands-on experiences is part of revising and creating a more user friendly system.

THE ELECTRONIC HEALTH RECORD?The Eight Basic Components of the EHR

All electronic health records need to incorporate these eight basic components. Without all eight components the health record

would be incomplete.

Health Information and Data This includes the patient’s history, co-morbids, a list of

current medications, current illness, family history, allergies, previous doctors’ visits and all medical personnel who has cared for the patient currently or in the past.

Also includes physician notes, nursing communications, diagnosis, lab values.

Doctors, nurses, and all collaborative care personnel should be allowed access to the patient’s health information and data. Without this information the medical team would not know what they were treating or why.

The Eight Basic Components of the EHR (Cont.)

Results Management This is where all lab values including WBC, blood glucose,

INR, PT & PTT, and RB,C just to name a few, can be found. All electrolyte values drawn can also be found.

Also found are results from tests including MRI, CT, x-ray, and echoes.

All clinical personnel including lab, physicians, nurses, pharmacy and any other clinician attending to the patient should have access to this information. Lab values are critical and this information always needs to be accessed by those caring for the patient. Patient safety is a number one concern. Order Entry Management

“Is the ability of a clinician to enter medication and other care orders, including laboratory, microbiology, pathology, radiology, nursing, supply orders, ancillary services, and consultations directly into a computer” (McGonigle & Mastrian, 2009, p. 222).

Doctors, nurses, the lab, and other clinicians should be allowed access to this patient’s information. There cannot be collaborative care without it.

The Eight Basic Components of the EHR (Cont.) Decision Support

These are screens, reminders and flags that provide information concerning medication and the 5 rights of medication. The five rights include right time, right dose, right patient, right medication, and right route (http://www.wapc.org/pdf/newsletters/yukReport_Spring06.pdf).

Routine vaccines and other preventive measures that the patient needs is also a part of the decision support reminders.

Doctors and nurses are the main medical personnel that need access to this information. The MAR is a very important tool in the EHR. This component is important to maintain patient medication schedules.

Electronic Communication and Connectivity This is the means in which all disciplines communicate

through the electronic health record. It is online and includes email and access to the health record.

All disciplines need access to provide collaborative care to the patient. Without communication between disciplines, collaboration can be slowed down and patient’s needs may be unnecessarily delayed.

The Eight Basic Components of the EHR (Cont.)

Patient Support “Is the patient education and self monitoring tools,

including interactive computer-based patient education, home telemonitoring, and telehealth systems” (McGonigle & Mastrian, 2009, p. 222).

All disciplines need access to the patient education.

Administrative Processes This is where the billing takes place, the claims are filed

and reviewed, and scheduling is done. Scheduling includes: medical bills and claims, patient follow

up appointments including lab draws and doctor’s appointments. Follow ups can be inpatient or in an outpatient setting. Procedures such as x-rays and CT’s are also scheduled.

The administrative staff are the ones that will use this feature the most. It should be available to the disciplines who are charging for the services.

The Eight Basic Components of the EHR (Cont.)

Reporting and Population Health Management When working in a hospital setting and a clinical setting, the

needs in the two different setting can be different. This group mets the needs of both settings.

A cardiac floor will have different needs than the NICU. This team can provide the various templates needed to met the different needs of the different specialty areas.

The computer programmers will use this aspect of the EHR. The different medical disciplines need access to the templates they need to use.

CLINICAL DECISION MAKING SYSTEMS IN A CIS

CLINICAL DECISION MAKING SYSTEMS IN A CIS

Structural Considerations Integration of patient data / Standardized systems (e.g. ICD

Codes) Functional, point-of-care capabilities Medication Safety Integration with medical devices Ease of workflow with charting Ability to address standards of care and regulatory

requirements Prompt Physician/Nurse Access to the system

Updates with new EBP guidelinesNew guidelines and research take place daily. The

CIS can alert the user when updates are available. The EBP research sites can be linked directly to the CIS. Two common sites are:http://www.guideline.gov/ National Guideline Clearinghousehttp://www.cochrane.org/ The Cochrane Collaboration

CLINICAL DECISION MAKING SYSTEMS IN A CIS

Companies that design clinical decision making systems

• HBOC• IBM• Siemens Medical Systems• Health VISION

CLINICAL DECISION MAKING SYSTEMS IN A CIS

Information systems technical standard for security

1. The identification (e.g. passwords) and authentication (e.g. digital signatures) of health information.

2. The provision of audit trails or records of access activity relating to health information

3. The protection from unauthorized access (e.g. firewall) to health information

CLINICAL DECISION MAKING SYSTEMS IN A CIS

HIPAA and Ethical Considerations

HIPAA Security Rule: Sets national standards for the security of electronic protected health information

HIPAA Patient Safety Rule: Confidentiality provisions which protect identifiable information being used to analyze patient safety events and improve patient safety. 

Any type of EHR system must maintain respect for patient autonomy, and decisions must be made about the access, content, and ownership of the records.

COST

Many costs should be taken into consideration. These

include:

Hardware, including computers, desks, chairs, printers, fax machines, copiers, and the mouse.

Software, which is the program itself such as EPIC or Cerner.

Training: The amount of time it takes to initially train personnel in

the use of the new software. The staffing that will be in place to fill the gap of the

people being trained. Continuing education.

http://www.himss.org/content/files/Amb_EHR_Implemention081507.pdf

http://cio-chime.org/advocacy/CIOsGuideBook/CIO_Guide_Final.pdf

EDUCATION ON CIS Users of CIS should be educated on their hospital’s

or clinic’s, etc, current system. Typically your employer will provide classes as a part of new co-worker orientation, that give on hand training of the CIS they use.

With interactive training modes a nurse, physician, PT, etc., can practice using the system without being in someone’s actual record.

In addition to initial training, when updates occur in the CIS notifications should be sent out addressing what the changes will be and how it will effect the user. A brief class could be given to show the new changes to the users if they require in-depth explaining.

Education on CIS should be taught by certified individuals at the hospital who specialize in the system and to teaching it.

EDUCATION ON CIS Implementing an EHR is a “process, not

an event”(Grant, 2010). Education and training will be a continuous process.

Conducting an in house assessment to gauge the staff members strengths and weaknesses can be beneficial to a successful EHR software launch.

Consider the amount of training that will be required prior to implementation of the EHR and the costs associated with the training (Jain, 2010).

EDUCATION ON CIS

Practice sessions simulating patient encounters are useful to the learning process and allow for the recognition of problem areas.

Jeffrey Grant (2010) states that any organization that has made the transition to the EHR has met challenges along the way. “Not enough training and not enough time for training” are the two pitfalls that can be avoided with the proper training.

EDUCATION ON CIS

Grant (2010) The benefits of bringing in the EHR vendor to train staff with considerations being made for employee numbers and facility size.

“Power Users” are people who display exceptional knowledge in the EHR and have additional training with the vendor.

The advanced users can be available to train and assist other basic users.

EDUCATION ON CIS

Having power users and project managers present during the “Go Live” will help the transition go smoothly.

Practice computers should be available to the Doctors and other health care works during the tutorial training.

After training is complete a mock program can be used before a “Go Live” takes place to assess the needs for improvements.

A computer information system is a combination of information science, computer science, and library science integrated with hardware and software to facilitate electronic data processing, system analysis, and computer programing. In the medical field the CIS is used by all disciplines. Doctors, nurses, lab techs, physical therapy, respiratory therapy, the billing department, and all other disciplines use the CIS in a collaborative effort to provide excellent patient care.

Eight basic components are used in the CIS to form the electronic health record. Together these elements integrate all aspects of a patient’s care and makes it accessible to a variety of medical personnel.

Many other aspects of the computer information system include clinical decision making, safety issues, costs, and education. Many different disciplines come together to make decisions about these issues that will most benefit the facility using the CIS.

CONCLUSION

REFERENCES

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Jain, V. (2010). Evaluating EHR Systems. Health Management Technology,

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