Healthcare InformaticsClinical Information System

A. MartinS. Tipton

K. RowlettA. Warnecke

What is a CIS?

• A Clinical Information System (CIS) is a computer based system that is designed for collecting, storing, manipulating and making available clinical information important to the healthcare delivery process. (biohealthmatics.com)

• Clinical Information Systems may be limited in extent to a single area (e.g. laboratory systems, ECG management systems) or they may be more widespread and include virtually all aspects of clinical information (e.g. electronic medical records). (biohealthmatics.com)

What is a CIS?

• Clinical Information Systems provide a clinical data repository that stores clinical data such as the patient’s history of illness and the interactions with care providers. The repository encodes information capable of helping physicians decide about the patient’s condition, treatment options, and wellness activities as well as the status of decisions, actions undertaken and other relevant information that could help in performing those actions. (biohealthmatics.com)

Who Should be involved?

Key leaders in the choosing, implementing, and revising the CIS should be ……

Clinical StaffAdministration Staff

Information technology staff

Clinical Staff

• Nurses• Physicians• X-ray technologist• Pharmacy• Disciplines in direct patient care

Administrative Staff

• Medical Director • Administrative Coordinator• CFO• CEO• Director of Nursing Services

Computer Staff

• Chief information Officer• Nursing Information Officer• Programmer/Analyst

(facilities and healthcare centers may differ on titles of computer information staff)

Costs of an EHR

• Calculations of costs are very difficult to obtain due to the varying type and size of the healthcare institutions and the variety of different IT systems that may be chosen to be implemented.

• The costs to consider that we will look further into are:o     Purchase/Implementationo     Equipment needso     IT supporto     Continuing Education

Estimated Costs of EHR/EMR • A 2003 and 2006 study were

carried out at a teaching hospital to obtain an average figure. o    On average, implementation

costs for the health IT system amounted to about $14,500 per bed, and annual operating costs were about 19 percent of those one-time costs, or $2,700 per bed.

• Hoffmann and Podgurski's scholarly study estimate the cost of purchasing is $33,000 per physician. 

• RAND Corporation researchers estimated for a larger grouping of teaching hospitals for costs considerably highero    nearly $63,000 per bed. The

RAND researchers estimated that annual costs for maintaining and updating the system would equal 30 percent of acquisition costs—a figure that is higher than the corresponding proportion in other estimates and that adds $18,900 per bed per year. 

Additional costs to consider

• Additionally there are other common costs to consider:o Other training costs (computer-based tutorials, hired trainers…)o Office staff back fill costs (while staff are in training, assisting with design,

development and/or implementation)o Temporary labor (initial EMR data entry, scanning the paper-based medical records)o Self-service kiosks including software and services o Temporarily reduced income (reduced schedule at EMR go-live; amount is variable

and dependent primarily on the practice and EMR functionalities installed)o Office construction and furniture (shelves, counters, wall mounts, power outlets,

chairs, carts, tables…)o Technical upgrade of office infrastructure (i.e. wireless network, upgraded network

connectivity)o Additional hardware and devices including networking devices, scanners, printers or

kiosk deviceso Consultants or project manager to facilitate the implementation (large practices in

particular should strongly consider using a consultant to help manage the EMR selection, implementation and post-implementation phases

Equipment for Implementation• A basic statement would be that everyone who needs access to the

EHR needs to have it available.•  

o This means that they must have a Windows computer available wherever and whenever they need to see the record. For the most part this will mean computer access in every examination room, at every provider's desk, at all nursing work areas, and at all other points of patient care or consultation. This might be accomplished by fixed desktop computers or by mobile workstations.

o Computers will have to retrieve RPMS patient data, the facility needs to have a reliable network connecting all of the above locations. This network should also have a high-speed Internet connection, to facilitate the clinical decision support functions of EHR

IT support/costs• Information Technology is a huge part of the healthcare practice.  It

includes hardware, software, networks, internet, and problem solving.  These all need to be integrated to work effectively and efficiently.

• New positions are recommended by the EHR program since the point of a clinical system is to work during all hours of patient care, there also needs to be someone there to perform clinical support duties at all hours of patient care. 

• Projections for jobs available to IT technical support/health information support shows employment in 2008 as 172, 500 and projected employment for 2018 to be 207, 600.

• Earnings to these employers and costs to our healthcare systemso Federal Executive Branch  - $42,760o General medical and surgical hospitals  - $32,600o Nursing care facilities  - $30,660o Outpatient care centers  - $29,160o Offices of physicians  - $26,210

Continuing Education   • Just like any profession or network there is a learning curve

that is constantly changing.  This ranges from social networks and email to the EMR system and medical advances in technology.

• The training to implement a EHR system is costly:o Training costs such as computer-based tutorials and hired trainerso Office staff back fill costs for while staff are in training to cover there

originally positions

• So when the basic training is done, the technology is still evolving and will need someone to continue to implement and teach the changes as they come.  The costs will be less then the implementation but there will still be a cost if your system is to be successful. 

Education for the CIS

HOW ?Hands on for first time users

Verbal instruction during live computer lab sessions

Updates-interactive computer tutorials with quick reference guide handouts.

A.Martin-AAMrtin-11

Education for CIS

Formats of Learning:

Amartin-2http://www.arrowhead.lib.mn.us/renewal/formats.htm

                                                                        

Touch-classroom based activities and practice skills

See- demonstration & observation,  handouts and resource guides

Hear- verbal instruction provides increased comprehension

Education for CIS

          TIME Periodic updates should be given every few months as people become more familiar with the initial training. (ex: show one way to perform a task at the initial education then a month

later show another way or a short cut method to help with user speed)

Annual re-education- cover any upgrades to the software that users may not be familiar with.

Amartin-3

Education for CIS

     WhoEducation should be done by nurses that are currently practicing and have an extensive computer background. A clinical informatics specialist team would be the most desirable educators.

Amartin-4 http://my.clevelandclinic.org/nursing/informatics. aspx

The Electronic Health Record (EHR)

  

Definition 

The EHR is a computer-based data warehouse or repository of information regarding the health status of a client, replacing the former paper-based medical record; it is the systematic documentation of a client's health status and health care in a secured digital format, meaning that it can be processed, stored, transmitted, and accessed by authorized interdisciplinary professionals for the purpose of supporting efficient, high quality health care across the client's healthcare continuum. (Mastrian & McGonigle, 2009)   

The Electronic Health Record

The  possible features of the EHR have  been divided into eight essential components. EHR Components1. Health information and data2. Results management3. Order entry management4. Decision support5. Electronic communication and connectivity6. Patient support7. Administrative processes8. Reporting and population health management

The Electronic Health RecordComponents:

 1. Health Information and data     This is patient data required to make sound clinical decisions.  Includes: Demographics              Medical and Nursing Diagnoses              Medication Lists              Allergies              Test Results Access: The patient and all health care professionals involved in             that patients care should have access to this component.  Importance:  To have data readily available to make                     clinical decisions.                    

The Electronic Health RecordComponents: 

2. Results Management     The ability to manage all types of results electronically.

    This includes current and historical results.  Includes: Laboratory              Radiology Procedure Reports

Access: Patient and all health care professional involved in care.

 Importance: Allows health care professionals to tie patient data together. Includes patient tracking, scheduling, results reporting, and image tracking.

The Electronic Health Record

Components 

3. Order Entry Management    The ability of a clinician to enter care orders.

 Includes: Medications               Laboratory               Microbiology               Pathology               Radiology               Nursing               Supply orders               Consultations, etc..

The Electronic Health Record

3. Order Entry Management Continued Access:  Patient may view their orders. Physicians and proper licensed personal may enter orders.  Importance: Permits proper clinical  providers to electronically enter orders. This system offers a range of functionality, from pharmacy ordering to more sophisticated systems such as complete ancillary service  ordering, alerting, customized order sets, and result reporting.

The Electronic Health Record

Component 

4. Decision Support    This is computer reminders and alerts used to improve the      care and diagnosis of a patient.

 Includes: Screening for.. Correct drug and dosing                                     Medication interactions                                     Preventive health reminders (vaccinations)                                     Clinical guidelines                                     Health risk screening & detection                                     Patient allergies

 

The Electronic Health Record

4. Decision Support Continued Access: Patient may view this component. All health care              professionals involved in direct patient care may use this              component. Importance: To better protect the patient and make the appropriate                    decisions.

The Electronic Health RecordComponent 

5. Electronic Comminucation & Connectivity     Online communication among healthcare team members and      patients. Includes: E-mail              Web messaging              Integrated health record Access: Patient and healthcare team involved in direct care. Importance: Allows connection & comminication across settings                    & institutions.

The Electronic Health RecordC om po ne nt 

6 . Patien t Support    Pa tie nt ed uc a tion an d s e lf- m on ito rin g too l.

 In c lu de s : C om pu te r-ba s e d pa tien t e du ca tio n                  H om e te lem on ito ring (m o nitorin g pa tien t from a dis ta nc e )                  Te le he a lth (te le co mm u nic a tion )

 A cc es s :  Pa tien t a nd he a lth c a re p rov ide rs in volve d in d ire c t pa tien t

                                                 Im po rta nc e : To inc rea s e e ffic ien cy , q ua lity of he a lth c a re , s e rvic e ,                        ed uc a tion , s urv e illan ce , a nd re s e a rc h.c C cc c

The Electronic Health RecordComponent 

7. Administrative Processes     Electronic scheduling, billing, admission, transfer, discharge,       claims management, etc...

 Includes: Inpatient/Outpatient visits & procedures

              Personal patient identifier (numerical or alphanumeric)              Insurance eligibility validation Access: Patient and healthcare team involved in direct patient care. Importance: Allows patient information to be organized and used for                   clinical analysis and research.

The Electronic Health RecordComponent 

8. Reporting & Population Health Management    Data collection tools to support public and private reporting      requirements.

 Includes: Standardized terminology               Machine- readable format               Care delivery functions

 Access: Patient and healthcare professionals involved in direct             patient care.

 Importance: To promote the ability to share patient information                   and to assure users that these technology systems work.

 

Conclusion of CIS

When evaluating for an EMR/EHR system points to consider are: 

•  Knowing what a Clinical Information System is and who the                    decision makers should be

• A full understanding of the EHR and all of the components contained within the system

• The cost factors of implementation, equipment, IT support and education

• Education requirements for staff and how to deliver education in order to meet users needs

                                                                                                                           AMartin

References

• Biohealthmatics (2010) Clinical Information System. http://www.biohealthmatics.com/technologies/his/cis.aspx. Retrieved April 1, 2010

• Electronic health record. (n.d.). Retrieved from http://www.ihs.gov/CIO/EHR/index.cfm?module=faq#top

• Glaser, J. (2009) Success Factors for Clinical Information System Inplementation. http://www.usafp.org/CHCS//-Files. Retrieved April 1, 2010

• Hagen, S, & Richmond, P. (2008, May). Evidence on the costs and benefits of health information technology. Retrieved from http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm

References

• Hoffmann, S, & Podgurski, A. (2008, October 30). Case western reserve university professors call for regulation of electronic health records. Retrieved from http://blog.case.edu/case-news/2008/10/30/ehrregulation

• Mastrian, K., & McGonigle, D. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett Publishers, LLC.

• Occupational outlook handbook, 2010-11 edition. (2009, Dec 17). Retrieved from http://www.stats.bls.gov/oco/ocos103.htm

• Zytkowski, M, & Oblack, M. (n.d.). Nursing informatics. Retrieved from http://my.clevelandclinic.org/nursing/informatic s.aspxhttp://www.arrowhead.lib.mn.us/renewal/formats.htm