2. 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
3. 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)
4. 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)
5. Benefits vs. Barriers
Benefits
• Easy access to
patient
information
• Structure
• Improved drug
safety
Barriers
• Initial cost
• Privacy and
security issues
• Clinician resistance
• Integration of
legacy systems
(Biohealthmatics, 2010)
6. Who is important in this process?
• Staff nurses
• Nurse managers
• Support staff
• Performance improvement analysts
(Mcgonigle & Mastrian, 2009)
7. 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.
8. 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.
9. 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.
10. 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.
11. 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
12. 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.
13. 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.
14. 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
15. 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 files
There are many ways that the files in a network are protected:
Antivirus software is used
Firewalls are used for internet access
Proxy 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
16. 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
17. Safety (cont.)
-HIPPA and Ethics
We 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.
18. 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
19. 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
20. 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)
21. 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)
22. 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 (McGonigle, D., Mastrian, K., 2009)
23. References
• Biohealthmatics. Clinical Information System
(2010, August 6). Retrieved October 17,
2010, from
http://www.biohealthmatics.com/technolog
ies/his/cis.aspx
• Mastrian, K., McGonigle, D. (2009).
Nursing Informatics and the
Foundation of Knowledge. Sudbury,
MA.: Jones and Bartlett Publishers
24. 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/informatic
s/ehr.pdf
•
Editor's Notes
A Clinical information system (CIS) is an important part of the health world today. This is a computer based system that is designed to collect, store, and make available clinical data about a patient. This data then becomes available to health care providers. The system can be specific to a single, such as laboratory. It can also include all aspects of clinical information, such as electronic medical records. With the use of a CIS clinical data can be combined with patient history thus providing easier access to patient records.
There are many areas that a CIS can address. The clinical decision support area is one that provides the users access to tools that aid in making evidenced-based clinical decisions. This improves patient care by providing clinical decisions that are tailored specifically to an individual patient. Electronic medical records contains information about the patient, such as name, gender, age, address, etc. It also includes information about routine visits, examinations, procedures, etc. The training and research area makes a patient’s information available to health care providers for the purpose of training and research.
There are many benefits as well as barriers to implementing a CIS into a hospital system. I believe that having easy access to patient information is the number one benefit of this system. Being able to access a patient’s information from one office to the other reduced the hassle. Having a solid structure within the system provides a more organized way of keeping track of data. The more organized the data, the easier it is to read a patient’s chart correctly. The system also provides improved drug safety by improving drug dosing and leading to reduced adverse drug interactions.
Cost of the system falls on the barrier side. Privacy and security becomes an issue because of the risk of someone ‘shoulder spying’. Shoulder spying occurs when a person who is not authorized to see patient charts some how visualizes them. This can happen by charts being left open around the nurse’s station or left open in a patient’s room. Other problems can include clinician resistance and integration of legacy systems. CIS programs can take a while to chart on, thus taking up more time than usual and creating some resistance from clinicians.
There are many people who are key in making the CIS effective. Staff nurses, nurse managers, support staff, as well as performance improvement analysts are all crucial to the process of expanding the scope of a CIS. This establishes a consistency within charting, even when done by different clinicians. These people can also help create pathways that are designed to fit specific needs. Changes are also put into place as the system matures and as staff become more comfortable charting within the system. These changes enhance the system and increase the quality assurance of the CIS.
The unique patient identifier referred to as the medical record number is the core of the EHR and links all clinical observations, tests, procedures, complaints, evaluations, and diagnosis to the patient. (National Center for Research Resources, 2006)
A recent American Hospital Association survey found that “the median annual capital investment on IT was over $700,000 and represented 15 percent of all capital expenses. Operating expenses were much higher—$1.7 million, or 2 percent of all operating expenses. Those with more advanced systems—and especially advanced CPOE systems—spend even more.” (National Center for Research Resources, 2006)
