Handbook of Informatics for Nurses and Healthcare Professionals Copyright ©2009 by Pearson...

Handbook of Informatics for Nurses and Healthcare Professionals

Copyright ©2009 by Pearson Education, Inc.Upper Saddle River, New Jersey 07458

All rights reserved.

Handbook of Informatics for Nurses and Healthcare Professionals, Fourth EditionToni Lee Hebda and Patricia Czar

Chapter 5

Health Care Information Systems




Information System

• Use of computer hardware and software to process data into information

• Healthcare information system (and hospital information system)—a group of systems used to support and enhance health care




Types of Information Systems

• Clinical information systems (CISs)– Directly support

care– Individual systems

may be stand alone– Goal: data

exchange among systems

• Administrative systems– Indirectly support

patient care– Individual systems

may stand alone – Goal: data

exchange among systems




Clinical Information Systems (CISs)

• Nursing

• Multidisciplinary

• Monitoring

• Laboratory

• Pharmacy

• Radiology

• Emergency department

• Physician practice management systems

• Longterm

• Homecare




Administrative Systems

• Client management (registration)

• Financial

• Payroll

• Human resources

• Quality assurance

• Contract management

• Risk management systems

• Materials management




Nursing Information System (NIS)

Supports the use and documentation of nursing activities and provides tools for managing the delivery of nursing care– Access to online databases




Nursing Information SystemAdvantages

• Improved access to information

• Better documentation

• Improved quality of care

• Improved productivity and communications

• Tracking capability

• Enhanced regulatory compliance




Despite advantages information systems that are used by all clinicians are seen more commonly

NIS Status




Documentation

• Nursing process—based on traditional documents with nursing diagnosis as organizing framework, may use standardized nursing languages

• Critical pathway—often used for multidisciplinary documentation, may incorporate physician orders

• Flowsheets, charting by exception




Standardized Nursing Languages

• Provide a common language for all nurses in all locations

• Important to the development of the electronic health record

• Measure nursing’s contributions

• Contribute to the body of nursing knowledge




Clinical Information Systems

Support provider order entry, results retrieval, documentation, evidence-based practice, and decision support across distributed locations and by different disciplines




Monitoring

• Comprised of devices that monitor temperature, pulse, respirations, blood pressures, oxygen saturation, or other measures automatically feeding the input into a clinical information system

• Alarms notify caregivers of readings that are outside the range of “normal”




Order Entry Systems

• Orders entered into the computer are transmitted to the appropriate areas such as the pharmacy, laboratory, radiology, social service

• Direct entry of orders by the physician, nurse practitioner, physical therapist, or other provider is preferred (CPOE)




CPOE

• Computerized provider order entry

• Initiative by the Institute of Medicine and Leapfrog Group to improve the quality of care and reduce medication errors – Eliminates transcription error– Expedites treatment– Encourages more accurate, complete orders




Laboratory Information Systems

• ↓ Turnaround time, duplicate testing, errors

• Can – Alert providers when new or stat tests results are

back or values are critical– Send results to clinical system for view– Accept input from bedside devices– Generate labels for specimen collection– Use rules to order additional tests when indicated




Radiology

• Allows direct order entry or accepts orders from other systems

• Provides scheduling of diagnostic tests

• Generates client instructions

• Permits transcription of results

• Provides picture archiving and transmission of images and tracking of film

• Generates charges once procedures done




Pharmacy Information Systems

• Provide checks in order and administration process using evidence-based guidelines

• ↓ Errors when used with bar code technology

• Use lab results, allergy, and interaction information from clinical systems

• Track medication use, costs, billing information




Pharmacy

• May include more than one system– In pharmacy dispensing systems (robots)– Unit-based dispensing cabinets in care areas– Barcode and RFID Medication Administration

• E-prescribing – Process that allows the physician to enter a

prescription which is then electronically sent to the pharmacy from computers, PDAs




Barcode and RFID Medication Administration

• Quality initiative identified by the Leapfrog Group and the Veterans Administration’s National Center for Patient Safety

• Uses barcode on the unit-dose medication package and patient bracelet to ensure right patient, right drug, right dose, right time, right route




E-prescribing Benefits

• Provides a longitudinal prescription record

• Checks formulary compliance and reimbursement

• Provides alerts about drug interactions

• Generates reminders to order home meds for the discharged client

• Eliminates phone authorization for refills




Physician Practice Management Systems

• Features include capture of demographic and insurance data, scheduling, billing, outcome tracking, and report capability

• May, or may not, connect to hospital electronic patient records or maintain separate patient records




Home Healthcare

• May communicate with hospital systems to exchange data

• Support demands for excessive documentation

• Improve payment for services because it is easier and quicker to fin information needed for billing




Longterm Healthcare Systems

• Slow to come to this area

• Needed for the improved quality of care and efficiency

• Critical to business survival

• Integration with other systems needed to best serve patients

• Can include all features seen in other clinical information systems




Decision Support and Expert Systems

…aid in and strengthen the selection of viable options using the information of an organization to facilitate decision-making and overall efficiency

Decision support software organizes information to fit new environments




Registration Systems

• Admission/discharge/transfer(ADT) systems

• Collect and store demographic and insurance data that are verified and updated at the time of each visit

• Critical to operations to ensure correct patient identification and reimbursement for charges




Impact of Mobile Computing

• Allows access to data at the point of care to facilitate treatment decisions– Test results– Evidence-based practice guidelines

• Facilitates documentation at the point of care for improved accuracy




Future Directions

The adoption and refine of healthcare information systems will continue driven by demands for safety, quality, efficiency, and retention of the workforce

Handbook of Informatics for Nurses and Healthcare Professionals Copyright ©2009 by Pearson...

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