Nursing InformaticsAmanda

Amber

Cindi

Tish

Southwest Baptist University

Team Members:

Amanda (Slides 1-6) Tish (Slides 7-12) Amber (Slides 13-16) Cindi (Slides 17-23)

Clinical Information System (CIS)

According to McGonigle & Mastrain (2009), “a CIS is a technology based system that is applied at the point of care and is designed to support the acquisition and the processing of information as well as providing storage and processing capabilities” (p.193).

A CIS is a complete, comprehensive electronic health record system (EHR).

McGonigle, D. & Mastrian, K., 2009

What are some benefits of a CIS?

Ease of obtaining patient data at the point of care

Ability to search patient data easily There is no concern with legibility of

charting Ability to analyze data easily Enhanced patient safety

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

Who are the key players to a CIS?

Administration Physicians Patient care assistants Social workers  Therapy staff Nurses and many others!

McGonigle, D. & Mastrian, K., 2009

Key players continued:

You need to include everyone from those who will run reports, to most importantly, the end users.

Ensuring everyone is involved, will provide “a consistency in the charting done by different clinicians, while enabling their pathways to be designed according to their specific needs” (McGonigle & Mastrian. 2009, p.194).

What are the components of the EHR?

health information and data order entry management results management decision support electronic communication and connectivity patient support administrative processes reporting and population health management The entire health care team should have access

to the EHR.McGonigle, D. & Mastrian, K.

(2009).

What is a CDS?

CDS is an abbreviation for the Clinical Decision System. A software program that

allows health care professionals with many tasks related to health care. Diagnoses Course of treatment Statistics related to disease And much more!

What are the functions of a CDS?

There are four functions of an electronic clinical decision support systems: Administrative: Supporting clinical coding and

documentation, authorization of procedures, and referrals. Managing clinical complexity and details: Keeping patients

on research and chemotherapy protocols; tracking orders, referrals follow-up, and preventive care.

Cost control: Monitoring medication orders; avoiding duplicate or unnecessary tests.

Decision support: Supporting clinical diagnosis and treatment plan processes; and promoting use of best practices, condition-specific guidelines, and population-based management. "

[Perreault & Metzger, 1999]

Comparing the two types of CDS:How should it be structured?

Knowledge-BasedNon Knowledge-Based

Provide clinicians with accurate data such as Drugs Drug Interactions Patient Data

Also known as machine learning

This allows clinicians to use data from past experiences Symptoms of diseases Algorithms Solutions to problems Results in more narrow

results

Incorporating EBP (Evidence Based Practice) in a CDS

“EBP should be embedded in computerized documentation of a CIS, providing both

prompts for intervention and/or different questions based on a charted assessment…

references supporting EBP should be available for review at the click of a mouse or by a few keystrokes…the CIS prompting capabilities

will reinforce the practice of looking for evidence to support nursing interventions…”

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

Interested in a CDS for your Health System?

Check out these companies!!!

DiagnosisOne Diagnosisone.com

DSS www.vxvista.org

Eclipsys Allscripts.com

Zynx Health Zynxhealth.com

AND MANY MORE…@MEDICEXCHANGE.COM

http://medicexchange.com/

Safety and Security

The safety and security of a CIS is one of the most important things to keep in mind when evaluating an EHR system.

The main areas of safety and security in a CIS are:

Confidentiality Availability Integrity

(McGonigle & Mastrian 2009)

Safety and Security: Confidentiality

Shoulder Surfing is the most common problem in the confidentiality of an EHR (McGonigle & Mastrian 2009).

Shoulder surfing is defined as: using direct observation

techniques, such as looking over someone's shoulder, to get information (TechTarget, February 2002).

Be sure to observe employees and note any shoulder surfing by not only employees, but patients and visitors as well.

http://techteachtoo.com/wp-content/uploads/2010/12/shouldersurfing.jpg

Safety and Security: Availability

One way for organizations to protect the availability of their network is to institute an acceptable use policy. This policy outlines what employees can and cannot do on the hospital network.

For example: Are employees allowed to download personal pictures or music?

Limiting downloads limits the chances for downloading a virus, which could potentially compromise the information on the CIS (McGonigle & Mastrian 2009).

When evaluating a CIS, read the hospitals acceptable use policy and note any areas that could use improvement.

Safety and Security: Integrity

Integrity: firm adherence to a code of especially moral or artistic values (Merriam-Webster 2011)

Because employees rely on the information on an EHR, the integrity of the content is crucial.

When evaluating a CIS, make sure there are references for information, and that they can be verified as truthful or factual.

http://i.dailymail.co.uk/i/pix/2010/03/25/article-1260760-08DDFB31000005DC-84_233x317.jpg

Costs Involved in Implementing an EHR

“…federal health information technology spending will grow from $3.2 billion in 2008 to over $4.5 billion in 2013” (McGonigle, D. & Mastrian, K., 2009)

2 Categories of costs involved System Costs Induced Costs

System Costs

Vary markedly depending on software, institution,needs, contracts.

Software and Hardware TrainingImplementationOngoing Maintenance and Support

Induced Costs

Costs involved in transitioning from a paper to an electronic system, such as the temporary decrease in productivity during the implementation phase

Cost Savings

Decreased Labor Decreased billing errors Increased capture of charges Decreased medical errors Increased productivity,

information sharing, and patient satisfaction

Medicare and Medicaid incentives if qualify

Educating Staff

Federal initiatives are pushing the adoption of electronic health records (EHRs) throughout all health care institutions by the year 2014.

Staff must have the knowledge and skills to practice in a technology-rich environment.

Information technology competencies must be mandatory for staff to ensure patient safety and quality of data input.

Education

Who Should provide Education? Should be managed by a Nursing

Informatics Specialist, defined as:“A specialist with training in

Nursing science and the study/application of technology and the relationship between the technology and its use in real-world settings.” (University of California, Irvine)

Education Goals

Staff training and orientation throughout institution according to department standards

Staff training related to privacy and HIPAA compliance; initial as well as yearly and/or PRN refresher training

Provide education and guidance to staff transitioning to the EHR

ReferencesBerner, Eta S., ed. Clinical Decision Support Systems. New York, NY: Springer, 2007

Cavolo, D. Electronic medical record systems: Know the total cost of ownership. Nursing Homes. Jul 2007; 56(7): 17-20.

Colpas, P. Digital Dilemma. Health Management Technology. June 2010;31(6):12. Online. Accessed October 31, 2011.

"Decision support systems ." 26 July 2005. 17 Feb. 2009 <http://www.openclinical.org/dss.html

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

Merriam-Webster Dictionary (2011) Definition of Integrity Retreived on Nov. 27, 2011 from http://www.merriam-webster.com/dictionary/integrity?show=0&t=1320272169

TechTarget (2002) Definition Shoulder Surfing Retrieved on Nov. 22, 2011 from http://searchsecurity.techtarget.com/definition/shoulder-surfing

National League of Nursing. “Preparing the next generation of Nurses”. April 23, 2009. Retrieved from http://www.newsweekshowcase.com/Health/venues/pring/Next .

Perreault L, Metzger J. A pragmatic framework for understanding clinical decision support. Journal of Healthcare Information Management. 1999;13(2):5-21.

Wang, S., Blackford, M., Prosser, L., Bardon, C., Spurr, C., Carchidi, P. & Kittler, A. A cost benefit analysis of electronic medical records in primary care. The American Journal of Medicine. 2003; 114: 397-403.