Clinical Information Systems

Presented by Jennifer Ames, Jessica Blaha, Lee-Amy Choate, David Houzenga, and Windsor Lake

Introduction

Nursing has changed so much in the last 100 years. From new medicines, new procedures, new diseases and to new forms of information sharing and storing. In the past ten years there has been a shift on the way patients health information has been stored and shared. With the creation of EHR (Electronic Health Records) patients health information is now permanently stored and ready to be shared to better care for that patient. The slides to follow discuss what a Clinical Information System is and different aspects of its creation and maintenance.

Clinical Information Systems

A 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. (McGonigle & Mastrian, 2009)

CIS cont.•A CIS includes electronic media records, clinical data repositories, decision support programs (such as clinical guidelines and drug interaction checking), handheld devices for collecting data and viewing reference material, imaging modalities and communication tools such as electronic messaging systems.(Clinical information Systems, 2010)•This technology allows for the use of long-term data containing clinical data that are used to assist in patient care. (Blum, 1986 )

Implementation of a CIS

• CIS are being used in both the clinical setting and administrative applications. (Blum,1986)

• All involved in the use of the CIS need to have representation in the implementation process. Implementation is a term used to describe the process of choosing to system, implementing, and revising the CIS.

• This includes administrative representation to do cost/benefit analysis of the CIS, to those directly involved in patient care.

Implementation of a CIS cont.• A study done on implementations of CIS and outcomes for the system, users,

management and patients was looked at.• The study looked at 18 systems and the leaders involved in the

implementation of the CIS. Some of those involved included:– Nurse project coordinators– Full time RNs– Clinical nurses with IT knowledge and experience – Nurse educators – Physicians– VP’s of operations and IS leadership

• The study emphasized that members from all areas of the health care system need to be involved in the implementation of a CIS to ensures the success.

(Gruber, Leblanc, Smith, 2009)

The Components of an EHR• Health Information and Data: diagnoses, medications, allergies, and test results.• Results Management: both current and historical radiology and laboratory

reports.• Order Entry Management: available for the clinician to enter medications and all

other care orders.• Decision Support: the computer alert system designed to protect and improve

patient care.• Electronic Communication and Connectivity: the online communication system

between the healthcare team, patient and institutions.• Patient Support: the patient education and self-monitoring tool.• Administrative Processes: the electronic scheduling , billing, and claims

management system.• Reporting and Population Health Management: the data collection tools to

support public and private reporting requirements.

Accessibility to the EHR

• The healthcare team should have access to all components of the EHR to help ensure patient safety and cost management for both the institution and patient.

• The billing department should have limited access to the EHR, which includes minimum information pertinent for job performance only.

• The patient should have slightly limited access including their HI, electronic communication and connectivity, patient support and administrative processes.

Necessity of the EHR• These eight components cover essential items directed towards

patient safety.• Additional components can be added for more specialized

practice such as pediatrics or women’s health.• The EHR reduces medication errors, the capacity to perform

surveillance and monitoring for disease conditions, increased use of guideline-based care, and a decreased utilization of care.

• It helps identify patients who qualify for research studies or prescription drug benefits offered by pharmaceutical companies.

• The EHR helps identify patients taking medications that have been recalled.

Clinical Decision Making

Clinical decision making or support systems are interactive computer programs to assist clinicians with decision making tasks. It uses two or

more items from patient data to generate advice. There are two types of CDSS:

Knowledge Based and Non knowledge based.

Methodologies of CDSS• Bayesian Network- knowledge

based, shows set of variables, their probabilistic reactions between disease and symptoms.

• Artificial Neural Networks- non- knowledge based adaptive CDSS, machine learning from past experiences/ examples and recognizes patterns in clinical information

• Genetic Algorithms- From MIT 1950’s, non- knowledge based using Darwin's evolutionary theory of survival of the fittest.

• Rule based system- capture knowledge of domain experts and forms expressions that can be evaluated as a known rule.

• Logical condition- given a variable and a bound. Then it checks to see if the variables are with in the bounds and take action based on the results.

• Casual Probabilistic Network- cause and effect. Will trace a pathway from symptom nodes all the way to disease classification nodes using probability to determine which path is the best fit.

(Wikipedia, 2010)

Clinical Decision Systems for RN

• Alerts and reminders• Clinical guidelines, best practice• Online information retrieval• Clinical order sets and protocols• Online access to organization policies and

procedures • (McGonigle & Mastrian,2009)

EVIDENCE BASED MEDICINE SYSTEMS USES PATIENT SYMPTOMS, MEDICAL HISTORY, FAMILY HISTORY, GENETICS AS WELL AS HISTORICAL DATA GEOGRAPHIC TRENDS OF DISEASE OCCURRENCE.

Effectiveness of clinical decision support systems have improved practitioner performance.

Clinical Decision Making systems-Metavision by iMDsoftTheradocLifecomInternist- IVisual DXEach program is different and some are involved in specialty areas.

All programs will need to be updated periodically due to changing research and new EBP concepts that are presented. The Information system needs

Excellent article about Canada and their health care system. This talks about who the CDSS is working for and the perception of how it works.

www.cche.net/about/files/clinical_decision_support_tools.pdf

CIS Safety

Computers are linked together in what is called a network. They can all

be housed in one building or across the United States. Because of the

multiple number of users, safety of patients information is extremely

important.

Secure medical data networks include 3 main aspects. The use and understanding of HIPPA needs to be in place to keep information confidential.

The information needs to be available at all times. That includes having an emergency back up electrical system to power the computers as needed. Data should also be stored in more than one area in case of a disaster. Our local hospital store data off campus in town as well as a server in St. Louis.

Last, the users need to know that the information they are using is accurate or the data has integrity. This is accomplished by a strict way of data being entered, changed, and tracked.

(McGonigle, 2009)

To help secure who can use the network of information all users should be given an individual identification and password. The password is confidential and should never be shared. Users need to be encourage to make a strong password with letters, numbers, and signs.

The CIS should have a way to monitor for hackers, worms, and viruses. This can be done by the use of firewalls and intrusion detection devices.

Networks are a way for sharing and storing data as well as a way for coworkers to communicate with each other via email.

Emails from within the organization but especially personal emails from outside the organization can harm the network.

Networks have to be monitored for viruses, worms and spyware. Antivirus software needs to be installed and updated on a regular basis to prevent harm to the network.

In a time of portable devices (such as laptops, PDA’s, USB memory sticks, and smartphones) the ability for information to be lost or stolen has grown.

“Provisions in the federal stimulus package have tightened HIPPA notification and enforcement regulations and have made HIPPA violations more costly. For example, the maximum civil penalty from the Dept. of Health and Human Services for a data breach occurring after Feb 18, 2009, rose from $25,000 to $1.5 million.” (Dolan, 2010)

Therefore, the use of encrypting is very important. Encrypting allows only the identified user to access the data. If the device is lost or stolen, others would not be able to view the stored data. Using encryption decreases the risk of a HIPPA violation.

Education

• Educating nurses for implementation of electronic healthcare charting should include the following;

• Nurses should be involved in making the basic system, designing and development.

• Attitude adjustments, nursing staff will need to openly communicate about the reason why a healthcare provider would switch to an EHR.

• User satisfaction. Nurses need to be involved in the product evaluation. user friendliness and appropriate needs.

(McGonigle and Mastrian, 2009)• A designated space for training would enhance the learning experience.

Nursing staff should be available to help other nurses learn the EHR. (Gruber, 2010)

Additional points to consider

• Computer use may be difficult for the older nurse. Pre education on computer usage maybe necessary.

• Voice reorganization can be an option for the nurse that find it difficult to communicate on a computer by typing.

• Additional time will be needed to help nursing staff learn a new work flow. Low patient census can helpful for a month after implementation.

(McGonigle and Mastrian, 2009)

Methods of learning.• The majority of nurses learn from hands on demonstrations. One

example of this would be the drug reps coming into the hospital to demonstrate the administration of a new medication.

• Nurses also need reference material because many nurses are independent learners and require reference resources.

• Verbal communication is an additional assets for nurses to learn. Nurses use these skills daily in patient care.

(Lee-Amy, 2010)

Conclusion

There are many different aspects to computer information systems but ,for most EHR’s, the components are the same. Health Care changes on a daily basis and with new computer programs being developed the systems we know now will change and grow to fit the needs of the clients better.

References Blum, B. (1986). Clinical information systems. Western journal of medicine.vol. 145(6). (pp 791-797). Retrieved April 8,

2010, from http://www.ncbi.nlm.nih.gov/pmc/articles/pmc1307152/

Clinical information systems. From the University of Medicine and Dentistry website. Retrieved April 8, 2010, from http://informatics.umdnj.edu/clinical/information_systems.htm

Dolan, P. (2010 ). Data security breaches often triggered by carelessness. Amednews.com. Retrieved from

http://www.ama-assn.org/amednews/2010/02/22/bil20222.htm.

Gruber N. (2010, Jan).Embracing change to improve performance: implementation of an electronic health record system. Long-term living: for the continuing care professional. 59. 28-31.

Gurber, G., Leblanc, L., Smith, D. (2009). Factors influencing outcomes of clinical information systems implementation. CIN: Computers, informatics, Nursing.(27.3)(pp 151-163). Retrieved April 9, 2010, from http://www.nursingcenter.com/pdf.asp?AID=859442

Hayward, R. Clinical Decision Support Tools: Do they support the clinicians?. Future Practice. 2004. Pg 66-68.

References, cont. McGonigle, D., Mastian, K. (2009). A insider’s view of the utility of a clinical information system. Nursing informatics and the

foundation of knowledge. (pp 193-195). Sudbury, MA: Jones and Bartlett Publishers.

Wikipedia. en.wikipedia.org/wiki/Clinical_decision_support_system. Clinical Decision Making, retrieved April 9, 2010.