CIS and Electronic Health Record

1. C LINICAL I NFORMATION S YSTEMS
Developed By: Rachelle G. (slides 3-9)
Jessica M. (slides 10-14)
Rachel S. (slides 15-19, 25-27)
Ragean W. (slides 20-24)

2. TABLE O F C ONTENTS
 Slide 3-9:Brief overview of CIS and key players
involved in implementing it.
 Slide 10-14: The eight basic components of EHR
 Slides 15-19: The clinical decision making system in a
CIS
 Slide 20-22: Safety/Security
 Slide 23-24: Cost
 Slide 25-27: Education

3. W HAT IS C LINICAL
I NFORMATION S YSTEMS
 Clinical Information System (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.
 A collection of various information technology
applications that provides central repository of
information related to patient care across
distributed locations
 (McGonigle & Mastrian, 2009 p193)

4. CONT … W HAT IS C LINICAL
I NFORMATION S YSTEMS
 CIS is also known as Clinical documentation
systems and is the most commonly used type of
patient care support system within healthcare
organizations.
 CIS is designed to collect patient data in real
time.
 CIS is patient centered including observations,
interventions, and outcomes noted by patient
care team.
 (McGonigle & Mastrian, 2009, p 209)

5. T EN C OMMANDMENTS OF
C LINICAL I NFORMATION
S YSTEMS
 1. Speed is everything.
 2. Realize doctors won’t wait for the computer’s pearls.
 3. Delivers “just-in-time” information
 4. Fits into user’s workflow.
 5. Respect physicians sense of autonomy
 6. Monitor implementation in real time and respond “right now”.
 7. Be aware of unintended consequences.
 8. Be wary of uncovering long standing process flaws.
 9. Don’t disrupt “magic nursing glue”.
 10. Speed is everything.
(Shabot, M., 2004)

6. K EY P LAYERS IN C HOOSING
CIS
 When choosing key players to help select a CIS it depends on
where the CIS is located.
• Nursing
• Laboratory
• Pharmacy
• Monitoring
• Order Entry
• Billing
• Information Technology (IT) Department
• Executive leaders/ CEO
• Additional Ancillary systems to meet institution needs
(McGonigle & Mastrian, 2009, p 148)

7. K EY P LAYERS FOR
I MPLEMENTATION OF CIS
 Executive leadership: The single most critical element of
success of implementing a CIS is the sponsorship by a
senior executive within the organization.
 CEO- Critical role in implementation and is imperative
that the CEO:
• Communicate the vision
• Communicate the value of CIS project
• Allocate resources necessary in accordance with
budgetary cycle
• Arbitrate any major conflicts between physicians and
various hospital disciplines
(Page, C., 2011)

8. K EY P LAYERS FOR
I MPLEMENTATION OF CIS
 Information Technology Department
 When implementing a CIS you have your key
players that are involved in helping choose what
types of system may be needed, but it would be
important to develop committees to develop
short and long term goals for CIS with
measureable outcomes.
 These committees would also be accountable for
outcomes of decisions.

9. K EY P LAYERS IN R EVISING A
CIS
 Executive Leadership
 CEO
 IT Department
 Original Committees
 Staff Leaders
 Department Heads

10. E IGHT C OMPONENTS OF THE
E LECTRONIC H EALTH R ECORD (HRE)…
 Health Information and Data
 Patient data, including demographics, diagnosis,
medication lists, allergies, test results, etc.
 Results Management
 Manages current and historical results/reports of all
types.
 Order Entry Management
 Enables clinicians to order medications and other care
orders, including consultations, laboratory, nursing, etc.
McGongile, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers.

11. E IGHT C OMPONENTS OF THE
E LECTRONIC H EALTH R ECORD (HRE)…
 Decision Support
 Alerts used to improve patient care, such as screening for
correct medication selection and dosing, medication
interactions, vaccinations, health risk screening, etc.
 Electronic Communication & Connectivity
 Online communication between healthcare team
members, colleagues and patients, allowing for collaboration
within and across settings and institutions.
 Patient Support
 Patient access to education and self-monitoring tools from
other settings, such as home!
McGongile, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers.

12. E IGHT C OMPONENTS OF THE
E LECTRONIC H EALTH R ECORD (HRE)…
 Administrative Process
 Electronic scheduling, billing, claims, etc.
 Reporting & Population Health Management
 Data collection tools to support public and private reporting
requirements.
The following slide illustrates how data is
collected by many members of the health-
care team and how it all fits together to
create the EHR…
McGongile, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers.

13. National Institutes of Health National Center for Research. (2006). Electronic health records overview. Retrieved from http://www.ncrr.nih.gov/publications/informatics/ehr.pdf.

14. T HE EHR IS AN IMPORTANT PIECE OF
THE C OMPUTER I NFORMATION S YSTEM
 The most common benefits include:
(CIS)
 Increased delivery of guideline-based care.
 Enhanced capacity to perform surveillance and monitoring for
disease conditions.
 Reduction in medication errors.
 Other potential benefits include:
 Reduction in cost.
 Improved quality and outcomes.
McGongile, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers.

15. C LINICAL D ECISION S UPPORT
S YSTEM
 Clinical decision support systems are “computer
programs designed to help health care
professionals make clinical decisions” (Bakken)
 A clinical decision making system within a CIS is
the perfect way to make sure evidence based
practice is being followed
 Can improve clinical performance for drug
dosage and preventive care (Hunt)

16. D IFFERENT TOOLS FOR CDSS
 Infobuttons are a great system instituted because
it allows content-specific information to be
accessed (Bakken)
 Require up to date evidence supplied by the
content providers (Bakken)
 Computer-based alerts to grab providers’
attention also provide valuable information
(Bakken)
 Used for such things as drug-drug and drug-lab
interactions

17. S TRUCTURE OF THE CDSS
 Structure of the clinical decision support system
needs to involve a few separate aspects (Bakken)
 Data acquisition
 data is gathered from other systems in the CIS
than can be accessed through a user interface
 Health care standards
 Specific guidelines set for the institution

18. S TRUCTURE ( CON ’ T )
 Data Repositories
 Data can be stored and later retrieved during use of
the system
 Digital Sources of Evidence
 Many internal and external sources of evidence that
are linked to specific content
 Research is evolving best care practices at such a fast
rate
 evidence should be updated frequently to allow the
best care to be implemented

19. C OMPANIES WHO DESIGN
CDSS
 Medic Exchange provides a comprehensive list of
companies that design CDSS
 Some of these companies are:
 McKesson
 Thomson Reuters
 GE Healthcare
 Sanovia
 Amirsys
o (MedicExchange, 2011)

20. S ECURITY !!!!
 Security is a major issue for EHR.
 Back-up of data must be continuous and automatic
(every hour, day, or week)
 Storage of all of the data is essential and usually
sent off campus. It also must be able to last for the
length of the patients life and digital signatures
must stay relevant.
 Security must also include protection for viruses
and worms. This can be accomplished through
firewalls, anti-virus software, and limiting the use
of each computer to only do what is needed (no
web surfing in unknown sites.)
 (Wainer, 2008)

21. S ECURITY
 “Confidentiality: The patient’s records are private and
confidential; no unauthorized person may inspect the
contents of the patient’s records.”
 “Control: The patient controls the access to his or her
records. A patient may grant access to an HP and revoke
such access rights when the treatment is over.”
 “Integrity: The patient’s life may depend on the data
contained in the records, and therefore only authorized
people can enter or change the data.”
 “Legal Value: The patient’s records are the
unadulterated, complete record of all actions taken by
the HPs on behalf of that patient and should be the
definitive source of information about said actions.”
• (Wainer, 2008)

22. S ECURITY
 HIPPA- The Health Information Portability and
Accountability Act was signed into law by
President Bill Clinton in 1996 which addresses
the need for standards to regulate and
safeguard health information and making
provisions for health insurance coverage for
employed persons who change jobs.
 This law basically requires that all measures
must be taken to insure that no one is able to
see the patients medical records that are not
supposed to (limiting access), and those that
see the records can not talk about it.
 (McGonigle, 2009)

23. C OST
 The CBO recently conducted a study and reported that, on
average, EHR implementation costs for hospitals amount
to approximately $14,500 per bed for implementation.
 Annual operating costs amount to $2,700 per bed per
year.
 Annual net savings to the healthcare sector of about $80
billion (in 2005 dollars), relative to total spending for
health care of about $2 trillion per year if all providers and
hospitals appropriately implement EHRs.
 (Electronic Health Record Implementation: Cost and
Benefits, 2010)

24. B ENEFITS OF EHR THAT
LOWER THE COST
 Remind physicians about appropriate preventive care
 Identify harmful drug interactions or possible allergic
reactions to prescribed medicines
 Eliminate problems associated with illegible
medication orders
 Maximize/standardize both data and quality of
patient care
 Increase compliance with JCAHO
standards, decreasing fines.
 Reduce the duplication of diagnostic test
 (Electronic Health Record Implementation: Cost and Benefits, 2010)

25. E DUCATION
 “Nurses need to be appropriately equipped with
the tools to effectively and efficiently manage
data, information, and knowledge” (McGonigle,
2009, pg 136)
 Computer education is best done in a classroom
setting to promote hands-on learning
• (McGonigle, 2009)

26. E DUCATION (C ON ’ T )
 Re-education should take place any time there
are major system updates
 With minor updates, memos can be sent out
 Updates shouldn’t just take place at specific
times, but only when there are significant
changes that better the system
• (McGonigle, 2009)

27. E DUCATION ( CON ’ T )
 Education for the computer information systems
should be done by employees from the company
that created the system
 They know all the ins and outs
 Hospital IT members will not have enough time to
become proficient enough to thoroughly teach
 If a hospital IT member was trained from the
company and then trains hospital
employees, some things can be lost in translation
o (McGonigle, 2009)

28. R EFERENCES
 Bakken, S., Currie, L. M., Lee, N., Roberts, W. D., Collins, S. A., Cimino, J. J.
(2008). Integrating evidence into clinical information systems for nursing
decision support. Int J Med Inform 77(6). 413-420.
 Electronic Health Record Implementation: Cost and Benefits. (2010). Retrieved
November 2, 2011, from Perotsystems:
http://www.perotsystems.com/mediaroom/library/ServiceOverviews/Service
Overview_CostsAndBenefits.pdf
 Hunt, D. L., Haynes, R. B., Hanna, S. E., Smith, K. (1998). Effects of computer-
based clinical decision support system on physician performance and patient
outcomes. The Journal of the American Medical Association 280 (15). 1339-
1346.
 McGonigle, D. & Mastrian, K. (2009). Nursing informatics and the foundation
of knowledge. Jones and Bartlett; Sudbury, MA.

29. R EFERENCES
 MedicExchange (2011). http://www.medicexchange.com/CDSS-
Companies.html
 National Institutes of Health National Center for Research. (2006).
Electronic health records overview. Retrieved from
http://www.ncrr.nih.gov/publications/informatics/ehr.pdf.
 Page, C. (2011). Critical factors for implementing a clinical information
system. Life and Health Library. Retrieved 10-2011 from
2http://findarticles.com/p/articles/mi_m0FSW/is_5_18/ai_n18610
516/
 Shabot, M., (2004).Ten commandments for implementing clinical
information systems. July; 17(3): 265-269. Baylor Unversity Medical
Center http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1200662/
 Wainer, J. (2008, December 24). Security Requirements for a Lifelong
Electronic Health Record System: An Opinion. Retrieved Nov 2, 2011,
from The Open Medical Informatics Journal:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2669643/