CISComputer

Information System

CIS

• Julia Cruzan – Overview and Reference Slide• Amy Strickland – EHR Components and Cost• Cassondra Bowman – Clinical Decision

Making and Safety• Victoria Blankenship – Education

Southwest Baptist University

Clinical Information System• Computer based system designed to collect,

store, and make available clinical data• Can be limited to a single area (ie: laboratory

systems) or may include all aspects of clinical information (ie: electronic medical records)

• Also stores information like the patient’s history and interactions with other health care providers.

(McGonigle & Mastrian, 2009)

Areas addressed by CIS

• Specific areas that are addressed by the CIS are:–Clinical decision support–Electronic medial records (EMRs–Training and research

(Biohealthmatics, 2010)

Benefits vs. BarriersBenefits

• Easy access to patient information• Structure• Improved drug

safety

Barriers• Initial cost• Privacy and

security issues• Clinician resistance • Integration of

legacy systems

(Biohealthmatics, 2010)

Who is important in this process?

• Staff nurses• Nurse managers• Support staff• Performance improvement analysts

(Mcgonigle & Mastrian, 2009)

Components of the EHR• There are 8 basic components necessary in

the EHR.• They are Health Information and Data,

Results Management, Order Entry Management, Decision Support, Electronic Communication and Connectivity, Patient Support, Administrative Processes, and Reporting and Population Health Management.

Why each component is essential

• Each of these components play a unique role in adequately incorporating all aspects of the health care record electronically.

• All health care providers involved with direct patient care and support management would need access to the all of these components.

• Most common benefits are an increased delivery of guideline-based care, enhanced capacity to perform surveillance and monitoring for disease conditions, reduction in medication errors, and decreased utilization of care.

Importance of each component

• Health information and Data – All patient data required to make sound clinical decisions.

• Results Management – Manage Electronic results (ie. Lab and Radiology).

• Oder Entry – Initiate any order ranging from medications, consults, to ancillary services.

• Decision Support – Reminders and alerts to help improve patient care.

Importance of each component (cont.)

• Electronic Communication – Connect providers and patients on line.

• Patient Support – Patient education and self monitoring.

• Administrative Processes – Scheduling, billing and claims management.

• Reporting and Population Health – Public and private reporting.

Clinical Decision Making System in a CIS

• Clinical decision making systems (CDMS) are set up to help clinicians, nurses, and patients to gain knowledge, and person specific information to help guide the care of the patients.

• The CDMS is set up to include tools such as:– Computerized alerts and reminders– clinical guidelines such as evidence based practice

concepts– Online information retrieval – Clinical order sets and protocols– Online access to policies and procedures

Clinical Decision Making System in a CIS

How often should the evidence based practice guidelines be updated?

The guidelines should be updated when new information or evidence based information becomes available. Keeping this information updated is not only important but needed to help clinicians and nurses get up to date care and information regarding a disease or any other service rendered to a patient.

Clinical Decision Making System in a CIS

• Companies that develop CDMS for CIS

– There are companies that are working on developing CDMS for CIS they are using guide lines to help develop a good system.

– There are online based resources to use as well.

Safety

• Safety is an important factor when it comes to CIS. There is the issues of backup, storage, protection, access, HIPPA regulations, and ethical issues.

• Backup of the CIS– It is important to backup all files, when computers are hooked

up to a network many people have access and many things can go wrong and information can be lost.

– There are many ways to backup files:• On a DVD• A zip drive• Or other device that can be stored away from the network

in a safe place

Safety (cont.)Storage of data

Data is stored in files in the network and is accessible to everyone who is able to access the system.This is the main reason not only should a backup be made just in case the system crashes but also in case someone corrupts the system.

Protection of filesThere are many ways that the files in a network are protected:Antivirus software is used Firewalls are used for internet accessProxy servers are used to keep people form accessing the internet without proper permission Intrusion detection systems are used to monitor who is accessing information in the network

Safety (cont.)• Access–Who has access to the system?• User authentication is important the only persons

that should have access are the people that work in that environment and they should not give out any of their information. • User names and passwords are used by people who

have access to the network (these should not be given out for any reason)• Identification cards are used in some areas to gain

access to the network• Biometrics is also used these can be finger prints,

retina scans, or facial scans

Safety (cont.)

-HIPPA and EthicsWe must be aware of shoulder surfing (people standing behind you that can read the information on your screen)Integrity and confidentiality are very important training classes should be given to stress these issues and to teach the importance on these concepts.

Costs Associated with a CIS

• The initial costs of installing a clinical information system can seem astronomical as many factors must be considered

• After initial installation and training is completed then costs associated with maintenance and updates along with continuing education must be maintained

Associated Cost

• Initial hardware and software installation• Wireless network that will support the entire

entity• Workstations for all users• Initial Training on system• Support Personnel• Updates• Maintenance• Continuing Education

Benefits of Cost

• Improved quality and patient care• More efficient tracking of patient costs• Benefits to the business of healthcare• Better documentation and improved audit

capabilities• Avoidance of repeating expensive tests and

more time spent with patients(National Center for Research Resources, 2006)

(McGonigle, D., Mastrian, K., 2009)

Approach to Education

• Old Standby – Paper-based flyer• Brochure outdated at release• Today – More dynamic• e-brochures• e-newsletters• call-center tie-ins• continually updated

(McGonigle, D., Mastrian, K., 2009)

Supporting Use of the Internet

• Nurses and other healthcare providers• Embrace internet • Source of health information • Weblog – online journal• Blog – interactive online weblog

• Finding trusted health care sites•Health on the Net (HON).• Trust-e

References• Biohealthmatics. Clinical Information System

(2010, August 6). Retrieved October 17, 2010, from http://www.biohealthmatics.com/technologies/his/cis.aspx

• Mastrian, K., McGonigle, D. (2009). Nursing Informatics and the Foundation of Knowledge. Sudbury, MA.: Jones and Bartlett Publishers

References con’t

• McGonigle, D., & Mastrian, K. (2009). Nursing Informatics and the Foundation of Knowledge (pp. 193-195). Sudbury, MA: Jones and Bartlett Publishers.

• National Center for Research Resources. (2006, April). Retrieved October 16, 2010, from Electronic Health Records Overview: http://www.ncrr.nih.gov/publications/informatics/ehr.pdf

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