CLINICAL INFORMATION SYSTEM

Jamie RenfroBecky SigrestDanielle Russell

Overview of a CIS

Clinical Information Systems (CIS) consists of information technology that is used at the point of patient care. Included in the decision making is electronic medical records, clinical data repositories, clinical care guidelines, medication interactions and others per program(University of Medicine and Dentistry of New Jersey 2009).

Overview of a CIS

There are many components to the repository in a CIS. The patients’ medical history including prior hospitalizations, progress notes, surgical notes, nurses charting, vital signs and lab results. The patients current and past medications are also listed with patient allergies to assist in medication administration. This information is available to help decide the plan of care for patients. Clinical guidelines are also incorporated.

Who picks the CIS?

The entire healthcare team from people involved in direct patient care to the persons controlling the budget and current medical records.

A CIS has to work for the facility it is placed in and has to be changed and improved as the healthcare facility changes.

Hospital management should pick a program based on the financial aspect, how it will improve patient care, how well it will meld into already established systems and how secure it will be for patient privacy.

Many companies provide tech support and follow-up education before during and after CIS implementation Healthland is one company that continuous to provide support to hospital staff during the entire implementation process and beyond(Healthland 2010)

EHR Components

The common denominator of the eight basic components of a successful electronic health record must be :

Patient Safety

(McGonigle, & Mastrian, 2009)

EHR Components

Should include:1. Health Information and Data2. Results Management3. Order Entry Management4. Decision Support5. Electronic Communication and Connectivity6. Patient Support7. Administration8. Reporting and Population Health

Management(McGonigle, & Mastrian, 2009)

EHR Components

Administrative Components:Patient Name, Demographics, Chief

complaint, Patient disposition, etc. The registration portion of an EHR

contains a unique patient identifier, usually consisting of a numeric or alphanumeric sequence ("Mitre center for," 2006)

EHR Components

Lab systems to integrate orders, results from laboratory , schedules, billing, and other administrative information .

EHR Components

Radiology The system should tie together

radiology data (e.g., orders, interpretations, patient identification information) and images. They are usually used in conjunction with picture archiving communications systems. ("Mitre center for," 2006)

Clinical Decision Making

Should Include Accessibility and Use for:

1. Nurses2. Administrative Staff3. Lab Personnel4. Pharmacy5. PhysiciansAll disciplines need to be able to use

and update information.(Farukhi)

Clinical Decision Making

Designed to assist health care professionals in the areas of :

Information Management Access (e.g., reference ranges for lab values ).

Electronic Resources (e.g., bibliographic databases and pharmacy knowledge bases).

Tools for focusing attention to things that might be overlooked (e.g., abnormal labs).

(Bakken, Currie, Lee, Roberts, & Cimino, 2008)

Clinical Decision Making

Tools for Patient Specific Consultation : Custom Tailored Assessments Advice Based on Set of Patient Specific Data Decision Analysis Diagnostic Decision Support Protocol Eligibility Treatment RecommendationsAll should be focused on Evidence Based

Practice (Bakken, Currie, Lee, Roberts, & Cimino, 2008)

("Mitre center for," 2006)

Decision Making Software

www.infermed.com

www.isabelhealthcare.comwww.epic.com

Safety

YouTube - electronic medical records security

The above video highlights some of the concerns of safety with patient information that is contained in

electronic format.

Elements of Security

Virtual SecuritySpywareAntivirus softwareFirewalls Intrusion detection

systems Data Security

PasswordsBiometricsRadio Frequency

Identity Chip (RFID)

Physical Security Shoulder surfing Screen protector

Cost Considerations

Implementing a CIS is a very expensive task that grows with the size of the hospital

The following are a few of the main Cost considerations for implementing a CIS: initial programming, initial incorporation into hospital, maintaining, revising, securing, storing, IT personnel needed, additional computers and equipment

Cost Considerations

V. Ciotti (2009) stated that EPIC a very popular CIS is overly expensive. He mentioned there are other providers that are more reasonable .

Analyst S.Gunasekaran(2009) stated that Epic only brings in a fraction of the Billion dollar price tag hospitals advertise.

The processes of picking a CIS is challenging and has many facets.

Cost Considerations

Sanyal (2009) Stated to choose a program within budget that can be upgraded and changed with the changing of the hospital.

The cost for these changes and upgrades including storage and safety need to be considered.

Education

Training should include anyone who has any contact with EMR….which is

everyone!

Nursing Informatics

Methods of training Online Hands on Blended

Modalities of training Video Webcasts Tutorials Simulations

References:

University of Medicine and Dentistry of New Jersey. (2009). Clinical Information Systems. Retrieved April 7, 2010, from http://informatics.umdnj.edu/clinical/information_systems.htm

Healthland. (2010). Support. Retrieved April 7, 2010, from http://www.healthland.com/services/

Ciotti, V. (2009, February 16). EPIC costs. Retrieved April 7, 2010, from http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Blog&mod=View+Topic&mid=67D6564029914AD3B204AD35D8F5F780&tier=7&id=AE67FD3F7317442B96C91EF2D7921181

Gunasekaran, S. (2009, February 17). Top 10 Misconceptions about IT Project Pricetags. Retrieved April 7, 2010

Sanjay, S. (2009). Picking a CIS. Retrieved April 6, 2010, from http://mua.academia.edu/SanjoySanyal http://www.linkedin.com/in/sanyalsanjoy8

References

Mitre center for enterprise modernization. (2006). [Web]. Retrieved from http://www.ncrr.nih.gov/publications/informatics/EHR.pdf

McGonigle, D., & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MS: Jones and Barlett.

Farukhi, F. (n.d.). Clinical dicision support systems. Retrieved from http://www.cwru.edu/med/epidbio/mphp439/Clinical_Decision.htm

Bakken, S., Currie, L., Lee, N., Roberts, D., & Cimino, J. (2008). Integrating evidence into clinical information systems for nursing decision support. International Journal of Medical Informatics, 77(6), Retrieved from http://www.ijmijournal.com/article/S1386-5056(07)00162-1 doi: 10.1016/j.ijmedinf.2007.08.006