This power point presentation provides an overview of a clinical information system (CIS). It discusses what a CIS is, how CIS have evolved, and the key players involved in designing CIS. It also examines the electronic health record component of a CIS and discusses the eight basic components that make up an EHR. Additional topics covered include clinical decision making systems, safety, costs, and education regarding CIS. The presentation was created by four students with each student covering specific slides and aspects of the topic.

1. EVALUATION OF A CLINICAL
INFORMATION SYSTEM (CIS)
Krystena Bowen Slides 1-5; 17
Nikita Macias Slides 11-15;
References
Tedra Estis Slides 6-10;
18, 22
Samantha Patton Slides 18-21

2. INTRODUCTION
After viewing this power point you will know
about the CIS, clinical information system.
Topics covered will include an overview of CIS,
the HER component, clinical decision making,
safety, cost, and education regarding CIS.
To begin lets look at what exactly the CIS is…

3. WHAT IS CIS?
 CIS stands for clinical information system
 Defined by TheInformatician.com “An
information system used to collect, integrate
and distribute information to the appropriate
areas of responsibility. Serves clinical, billing,
inventory management, research,
scheduling, and planning purposes.”

4. EVOLVING CIS
 Current CIS programs have come a long way
from early systems which included only lab
results and medication administration. Now
the goal is to expand to systems that also
provide support in clinical decision making
and an electronic patient record. Also, some
look to add professional development
training tools into their systems (McGonigle,
2009). As the system has evolved we now
see an interdisciplinary display of patient
education, care plans, and exchanges of
information between different providers.

5. WHO ARE THE KEY PLAYERS?
 Who is involved in the design of the system used directly by
nurses?
 Staff nurses
 Nurse managers
 Support staff
 Performance improvement analysts
 Ancillary staff
 Having all these different people collaborate when designing,
implementing, and revising the system allows consistency in
charting and accessing information by different clinicians
(McGonigle, 2009). Involving more people will help when
implementing new systems and feedback from hands-on
experiences is part of revising and creating a more user
friendly system.

6. THE ELECTRONIC HEALTH RECORD?
The Eight Basic Components of the EHR
All electronic health records need to incorporate these eight basic
components. Without all eight components the health record would be
incomplete.
 Health Information and Data
 This includes the patient’s history, co-morbids, a list of current
medications, current illness, family history, allergies, previous
doctors’ visits and all medical personnel who has cared for the
patient currently or in the past.
 Also includes physician notes, nursing communications,
diagnosis, lab values.
 Doctors, nurses, and all collaborative care personnel should be
allowed access to the patient’s health information and data.
Without this information the medical team would not know what
they were treating or why.

7. The Eight Basic Components of the EHR (Cont.)
 Results Management
 This is where all lab values including WBC, blood glucose, INR, PT
& PTT, and RB,C just to name a few, can be found. All electrolyte
values drawn can also be found.
 Also found are results from tests including MRI, CT, x-ray, and
echoes.
 All clinical personnel including lab, physicians, nurses, pharmacy
and any other clinician attending to the patient should have
access to this information. Lab values are critical and this
information always needs to be accessed by those caring for the
patient. Patient safety is a number one concern.
 Order Entry Management
 “Is the ability of a clinician to enter medication and other care
orders, including
laboratory, microbiology, pathology, radiology, nursing, supply
orders, ancillary services, and consultations directly into a
computer” (McGonigle & Mastrian, 2009, p. 222).
 Doctors, nurses, the lab, and other clinicians should be allowed
access to this patient’s information. There cannot be collaborative

8. The Eight Basic Components of the EHR (Cont.)
 Decision Support
 These are screens, reminders and flags that provide information
concerning medication and the 5 rights of medication. The five
rights include right time, right dose, right patient, right
medication, and right route
(http://www.wapc.org/pdf/newsletters/yukReport_Spring06.pdf).
 Routine vaccines and other preventive measures that the patient
needs is also a part of the decision support reminders.
 Doctors and nurses are the main medical personnel that need
access to this information. The MAR is a very important tool in the
EHR. This component is important to maintain patient medication
schedules.
 Electronic Communication and Connectivity
 This is the means in which all disciplines communicate through the
electronic health record. It is online and includes email and access
to the health record.
 All disciplines need access to provide collaborative care to the
patient. Without communication between disciplines, collaboration
can be slowed down and patient’s needs may be unnecessarily
delayed.

9. The Eight Basic Components of the EHR (Cont.)
 Patient Support
 “Is the patient education and self monitoring tools, including
interactive computer-based patient education, home
telemonitoring, and telehealth systems” (McGonigle & Mastrian,
2009, p. 222).
 All disciplines need access to the patient education.
 Administrative Processes
 This is where the billing takes place, the claims are filed and
reviewed, and scheduling is done.
 Scheduling includes: medical bills and claims, patient follow up
appointments including lab draws and doctor’s appointments. Follow
ups can be inpatient or in an outpatient setting. Procedures such as
x-rays and CT’s are also scheduled.
 The administrative staff are the ones that will use this feature the
most. It should be available to the disciplines who are charging for
the services.

10. The Eight Basic Components of the EHR (Cont.)
 Reporting and Population Health Management
 When working in a hospital setting and a clinical setting, the needs
in the two different setting can be different. This group mets the
needs of both settings.
 A cardiac floor will have different needs than the NICU. This team
can provide the various templates needed to met the different needs
of the different specialty areas.
 The computer programmers will use this aspect of the EHR. The
different medical disciplines need access to the templates they need
to use.

11. CLINICAL DECISION MAKING SYSTEMS IN A CIS

12. CLINICAL DECISION MAKING SYSTEMS IN A CIS
 Structural Considerations
 Integration of patient data / Standardized systems (e.g. ICD Codes)
 Functional, point-of-care capabilities
 Medication Safety
 Integration with medical devices
 Ease of workflow with charting
 Ability to address standards of care and regulatory requirements
 Prompt Physician/Nurse Access to the system
 Updates with new EBP guidelines
New guidelines and research take place daily. The CIS
can alert the user when updates are available. The EBP research
sites can be linked directly to the CIS. Two common sites are:
http://www.guideline.gov/ National Guideline Clearinghouse
http://www.cochrane.org/ The Cochrane Collaboration

13. CLINICAL DECISION MAKING SYSTEMS IN A CIS
 Companies that design clinical
decision making systems
• HBOC
• IBM
• Siemens Medical Systems
• Health VISION

14. CLINICAL DECISION MAKING SYSTEMS IN A CIS
 Information systems technical standard
for security
1. The identification (e.g. passwords) and authentication
(e.g. digital signatures) of health information.
2. The provision of audit trails or records of access activity
relating to health information
3. The protection from unauthorized access (e.g. firewall)
to health information

15. CLINICAL DECISION MAKING SYSTEMS IN A CIS
 HIPAA and Ethical Considerations
HIPAA Security Rule: Sets national standards for
the security of electronic protected health information
HIPAA Patient Safety Rule: Confidentiality provisions
which protect identifiable information being used to analyze
patient safety events and improve patient safety.
Any type of EHR system must maintain respect for
patient autonomy, and decisions must be made about the
access, content, and ownership of the records.

16. COST
 Many costs should be taken into consideration. These include:
 Hardware, including computers, desks, chairs, printers, fax
machines, copiers, and the mouse.
 Software, which is the program itself such as EPIC or Cerner.
 Training:
 The amount of time it takes to initially train personnel in the use
of the new software.
 The staffing that will be in place to fill the gap of the people
being trained.
 Continuing education.
http://www.himss.org/content/files/Amb_EHR_Implemention081507.pdf
http://cio-chime.org/advocacy/CIOsGuideBook/CIO_Guide_Final.pdf

17. EDUCATION ON CIS
 Users of CIS should be educated on their hospital’s or
clinic’s, etc, current system. Typically your employer will
provide classes as a part of new co-worker orientation, that
give on hand training of the CIS they use.
 With interactive training modes a
nurse, physician, PT, etc., can practice using the system
without being in someone’s actual record.
 In addition to initial training, when updates occur in the
CIS notifications should be sent out addressing what the
changes will be and how it will effect the user. A brief
class could be given to show the new changes to the users
if they require in-depth explaining.
 Education on CIS should be taught by certified individuals
at the hospital who specialize in the system and to
teaching it.

18. EDUCATION ON CIS
 Implementing an EHR is a “process, not an
event”(Grant, 2010). Education and training
will be a continuous process.
 Conducting an in house assessment to gauge
the staff members strengths and weaknesses
can be beneficial to a successful EHR software
launch.
 Consider the amount of training that will be
required prior to implementation of the EHR and
the costs associated with the training
(Jain, 2010).

19. EDUCATION ON CIS
 Practice sessions simulating patient encounters
are useful to the learning process and allow for
the recognition of problem areas.
 Jeffrey Grant (2010) states that any
organization that has made the transition to the
EHR has met challenges along the way. “Not
enough training and not enough time for
training” are the two pitfalls that can be avoided
with the proper training.

20. EDUCATION ON CIS
 Grant (2010) The benefits of bringing in the
EHR vendor to train staff with considerations
being made for employee numbers and facility
size.
 “Power Users” are people who display
exceptional knowledge in the EHR and have
additional training with the vendor.
 The advanced users can be available to train
and assist other basic users.

21. EDUCATION ON CIS
 Having power users and project managers
present during the “Go Live” will help the
transition go smoothly.
 Practice computers should be available to the
Doctors and other health care works during the
tutorial training.
 After training is complete a mock program can
be used before a “Go Live” takes place to assess
the needs for improvements.

22. CONCLUSION
A computer information system is a combination of
information science, computer science, and library science
integrated with hardware and software to facilitate electronic data
processing, system analysis, and computer programing. In the
medical field the CIS is used by all disciplines. Doctors, nurses, lab
techs, physical therapy, respiratory therapy, the billing department,
and all other disciplines use the CIS in a collaborative effort to
provide excellent patient care.
Eight basic components are used in the CIS to form the
electronic health record. Together these elements integrate all
aspects of a patient’s care and makes it accessible to a variety of
medical personnel.
Many other aspects of the computer information system
include clinical decision making, safety issues, costs, and
education. Many different disciplines come together to make
decisions about these issues that will most benefit the facility using
the CIS.

23. REFERENCES
Banner, K., Hardin, P., Johnson, J., Murphy, J., & Sornberger, L. (2008). Your
strategies for improving patient registration processes. Hfm (Healthcare
Financial Management), 62(7), 1-4.
Buggey, T. (2007, Summer). Storyboard for Ivan's morning routine. Diagram.
Journal
of Positive Behavior Interventions, 9(3), 151. Retrieved December 14,
2007, from Academic Search Premier database.
CHIME. (2010). The cio’s guide to implementing ehr in the hitech era. Retrieved
October 27, 2011 from
http://cio-chime.org/advocacy/CIOsGuideBook/CIO_Guide_Final.pdf

24. Clinical Information System. (n.d.). Retrieved October 2011, from
TheInformatician.com:
http://hayajneh.org/glossary/vocabulary/g/ClinicalInformationSystem.html
Grant, J.T. (2010, March). EHR : from paper to electronic. Opthamology
Times;
35(6), 44-46.
Grant, J.T. (2010, April). Allow time to implement EHR. Opthamology Times,
35(7),
54-56.
HIMSS. (2007). EHR implementation in ambulatory care. Retrieved on
October 28, 2011 from

25. REFERENCES
Jain, V. (2010). Evaluating EHR Systems. Health Management Technology,
31(8), 22-24.
McLean, V. (2006, April). Electronic Health Records Overview. National
Institutes of Health National Center for Research Resources.
Retrieved on October 21, 2011 from
http://www.ncrr.nih.gov/publications/informatics/ehr.pdf
McGongile, D. & Mastrain, K. (2009). Nursing Informatics and the Foundation of
Knowledge. Jones and Bartlett; Sudbury, MA.

26. REFERENCES
Washington Poison Center, The Yuck Report. (2006). The five rights of
medication
safety. Retrieved on October 28 from
http://www.wapc.org/pdf/newsletters/yukReport_Spring06.pdf