Our Southwest Baptist BSN nursing course assigned this project. This project covers modern Computer Information Systems that are specially designed for healthcare. The purpose of the project is to promote a knowledgable selection

2. Contributors
 Slides 25-29: Arnold, Lori
 Slides 6-10: Estes, Rachel
 Slides 1-2, 5,13-24, 30-39: McHugh, Robyn
 Slides 3-4, 11-12: Pellegren, Leigha

3. Technology-based systems applied at the point
of care, designed to support the acquisition
and processing of information as well as
providing storage and processing
capabilities
 Goal
 To become a comprehensive system that
provides clinical decision support, an
electronic patient record, and professional
development training tools
(McGonigle & Mastrian, 2009)

4.  Advantages
 Easy access to patient data, increase the
amount of data available for clinical
use, reduce medical errors, and patient safety
 Disadvantages
 Computer literacy is required and there could
be a breach in confidentiality, privacy and
security if a computer screen is left open or
unattended.
(McGonigle & Mastrian, 2009)

5. Staff
nurses &
Nurse
managers Who should be involved in
choosing, implementing, and revising
the CIS?
.
Performance
improvement
analysts
Support staff
End users
(McGonigle & Mastrian, 2009)

6. Education
“The most important participants in the health care
delivery system are the patients and their families
who receive the care and the clinicians who
provide the care.”
(Sittig et al., 2002)

7. Education
Problems
 Volume of information
 Can make it difficult to implement certain education
pieces
 Ever changing and dynamic
 Just like technology!
 Maintenance is difficult – re-education is key
(McGonigle & Mastrian, 2009)

8. Education
 Educators, and users, should be well trained in
order to provide the best care for the patient and
patient’s family!
 Educators should be specifically qualified and
knowledgeable in the healthcare field in order to
instruct more effectively.
 Information continually provided establishes
compliance.
(Sittig et al., 2002; McGonigle & Mastrian, 2009)

9. Education
Goals
 Should not take RN away from bedside to
classroom
 Needs to be convenient – computerized
 Needs to be interactive
 Repetition and frequent re-education
(McGonigle & Mastrian, 2009)

10. Education
Example of interactive
education
Joy Hilty, RN
Those documenting If answered
Developed a “prompt”
on the computer see They can answer them correctly, they receive
system on
pop-up boxes with a with an e-mail a vacation from the
computerized charting
question pop-up boxes
Encourages
Pop-ups are colorful
interaction, especially
and eye catching!
between peers
(McGonigle & Mastrian, 2009)

11.  Initial costs
 License fees for databases and interfaces
 External services: process consulting, user
training, customizing, etc.
 Internal implementation expenditure: for
initial user training and intensive support
activities during implementation phase
(Cost benefit study of ORBIS)

12.  Operating costs
 Personnel costs: for system
administration, workstation maintenance, user
helpdesk, etc.
 Depreciations on workstation and server
hardware and infrastructure
 Costs for maintenance and care of hardware
and software
(Cost benefit study of ORBIS)

13. Electronic Health Record
A compiled electronic record of patient
health information generated via one or more
encounters of care provision including:
Patient demographics Problems
Medical history Medications
Laboratory data Vital signs
Immunization Radiology Patient drug
history reports allergies
(mitre.org)

14. Electronic Health Record
Longitudinal
collection of
health
information
Immediate Provides
access to patient knowledge and
info. by decisional
authorized user support
Supports
efficient
processes for
health care
delivery
(http://www.openclinical.org/emr.html#benefits)

15. Promotes greater
quality/
efficiency in
healthcare
Promotes greater
US IOM report
safety in
is key!
healthcare
Eight core
care
delivery
functions
(openclinical.org)

16. 1. Health Information & Data
• All patient data included
• Benefits:
• Immediate access to key information
• Provides ability to make timely, sound
clinical decisions
(McGonigle & Mastrian, 2009; mitre.org)

17. 2. Results Management
• Manages all results, from all departments
• Benefits:
• Integrates all patient results between
departments
• Enables providers to participate in patient
care in multiple settings
(McGonigle & Mastrian, 2009; mitre.org)

18. 3. Order Management
• Enters and stores orders for
tests, prescriptions, and other services.
• Benefits:
• Enhances legibility
• Reduces duplication and speeds execution
(McGonigle & Mastrian, 2009; mitre.org)

19. 4. Decision Support
• Uses two or more items of patient data to
generate case specific advice
• Benefits:
• Improves compliance with evidence based
practice
• Ensures regular screenings and preventative
services
• Facilitates diagnoses and treatments
(McGonigle & Mastrian, 2009; mitre.org)

20. 5. Communications & Connectivity
• Networking between other care providers
and patients through Web. 2.0 applications
• Benefits:
• Improves continuity of care
• Increases timeliness of diagnoses and
treatments
• Reduces frequency of adverse events
(McGonigle & Mastrian, 2009; mitre.org)

21. 6. Patient Support
• Tools provided to patient including access to
health records, patient
education, monitoring, and tele-health
• Benefits:
• Improves control of chronic conditions
• Allows provision of patient care in patient’s
own home
(McGonigle & Mastrian, 2009; mitre.org)

22. 7. Administrative Processes
• Computerized administration in such areas as
scheduling, billing, and out-patient services
• Benefits:
• Improves hospital/clinic efficiency
• Provides more timely service to patients
• Reduces lost charges
(McGonigle & Mastrian, 2009; mitre.org)

23. 8. Reporting
• Provides data collection capabilities, specific
to institution, to support reporting
requirements to federal, state, & private
entities
• Benefits:
• Allows healthcare agencies to respond more
quickly to required reporting mandates
(McGonigle & Mastrian, 2009; mitre.org)

24.  Legal requirements restrict access to the patient
and those providing patient care only.
 HIPPA defines who should have access:
 Joint commission IM 2.10.7 provides protection
from unauthorized access, corruption or damage.
(Walsh, T. & Miaoulis, W., 2011)

25. HIPAA
It is a way to protect and maintain patient’s health information
It is the health care professional’s responsibility
Data should be backed up daily
Missouri’s Medical Retention Laws on storage of data
Missouri 5 years Skilled nursing, intermediate care, and RS Mo. Section
residential care facilities must maintain
medical records for five years after the
198.052.7
resident leaves the facility, or until the resident (1983)
reaches the age of 26, whichever is longer.
(LTC Consortium, 2004)

26. Access and Authentication
Who has access?
 Access can be gained by policies and job titles
 Policies help with who can access and what type of
activities are permitted
(McGonigle & Mastrian, 2009)

27. Access and Authentication
How do users gain access?
 Access through passwords, identification cards, and
biometrics
 Biometrics are
 Devices that recognize thumb prints, retina patterns, or facial
patterns.
(McGonigle & Mastrian, 2009)

28. Security Threats
“The most common threats a corporate network faces
are hackers, malicious code
(spyware, viruses, worms, Trojan horses) and the
malicious insider.”
(McGonigle & Mastrian, 2009)

29. Security Tools
 Firewalls:
 Examine all incoming and outgoing network information
 Proxy servers:
 Acts as a filter to block users from the Internet
 Intrusion detection systems:
 Monitors who is using network and what is being accessed
(McGonigle & Mastrian, 2009)

30.  Access should be based on role-based
definitions.
 Tasks associated with care provision roles:
Should be tied to corresponding access
necessary to perform care provision role
(Walsh, T. & Miaoulis, W., 2011)

31.  Evaluate each employee to ensure appropriate
level of access
 System administrator should be identified in
order to
 Authorize new roles and staff
 Verify employee status
 Terminate access when employee leaves
 Monitor access
 Develop policy & exceptions to policy
(Walsh, T. & Miaoulis, W., 2011)

32. Active knowledge systems
Use two or more items of patient data
Generate case specific advice
Designed to integrate medical
knowledge with patient data
(http://www.openclinical.org/dss.html#definition)

33.  Administrative
(Clinical coding)
 Clinical Detail Management
(Referrals, follow-up)
 Cost control
(Monitor medication orders)
 Decision Support
(Best treatment options)
(http://www.openclinical.org/dss)

34.  Automatic prompts rather than user activation
 Integrated decisional support into clinical work
flow
 Decisional support provided at time/location of
care provision
 Provides active voice recommendations for care
provision
 Uses a computer to generate this support
 These support structures improve clinical practice
based on Evidence-based practice
 These structures all make it easier for care providers
to use decisional support systems
(Kawamoto, K., Houlihan, C. A. , Balas,E. A., & Lobach, D. F. 2005)

35.  Should provide periodic performance
feedback
 Request documentation for reasons when
system recommendations are not followed
 Share decision support results with patients
(Kawamoto, K., et al., 2005)

36.  Continuous maintenance and updating of
system necessary
 Maintenance alarms should be in place
 Notification of current system performance
should be in place
 Provision for support & maintenance of
systems should be in place
(http://www.openclinical.org/dss)

37. Companies that design clinical decision
making systems for the CIS
Anvita Health www.anvitahealth.com
Capterra www.capterra.com
Plante-moran www.plantemoran.com
Active Health www.activehealth.com
Med Assets www.medassets.com

38. AHIMA, (2011.). Retrieved Oct 25, 2011, from AHIMA:
http://campus.ahima.org/audio/2007/RB112007
Kawamoto, K ., Houlihan, C. A. , Balas,E. A., & Lobach, D. F. (2005). Improving clinical
practice using clinical decision support systems: a systematic review of trials to identify
features critical to success. BMJ, 1-8. Retrieved Oct. 25, 2011, from BMJ Online First:
http://www.bmj.com/content/330/7494/765.full.pdf doi:10.1136/bmj.38398.500764.8F
LTC Consortium. (2004). State by State Medical Record Retention Laws: Nursing Facilities.
Retrieved October 25, 2011, from
http://www.ahcancal.org/facility_operations/hipaa/Documents/State%20by%20State%20M
edical%20Record%20Retention%20Laws-Nursing%20Facilities%202004.pdf
MITRE, (2011). Retrieved Oct. 25, 2011, from MITRE: http://www.mitre.org/Electronic
medical records. (2011, Sept. 14). Retrieved Oct. 25, 2011, from Open Clinical:
http://www.openclinical.org/emr.html#benefits
McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge.
Sudbury, MA: Jones and Bartlett.

39. Open Clinical (2006). Decision support systems. Retrieved Oct. 25, 2011, from
OpenClinical: http://www.openclinical.org/dss
Open Clinical (2006). Decision support systems. Retrieved Oct. 25, 2011, from Open
Clinical: http://www.openclinical.org/dss.html#definition
McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation of
knowledge. Sudbury, MA: Jones and Bartlett.
Sittig, D. F., Hazlehurst, B. L., Palen, T., Hsu, J., Jimison, H., & Hornbrook, M. C.
(2002). A clinical information system research landscape. The Permanente
Journal, 6(2). Retrieved from
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