This document discusses components and considerations for clinical information systems (CIS). It describes the common components of a CIS including electronic medical records, clinical data repositories, clinical guidelines, and decision support tools. It outlines important factors to consider when implementing a CIS such as cost, safety, security, education and training for staff. Selection of a CIS requires involvement from clinical and administrative staff and should be based on how it improves patient care and integrates with existing systems while protecting privacy. Ongoing support is also essential during and after implementation.

1. Clinical Information System Jamie Renfro Becky Sigrest Danielle Russell

2. Overview of a CIS Clinical Information Systems (CIS) consists of information technology that is used at the point of patient care. Included in the decision making is electronic medical records, clinical data repositories, clinical care guidelines, medication interactions and others per program(University of Medicine and Dentistry of New Jersey 2009).

3. Overview of a CIS There are many components to the repository in a CIS. The patients’ medical history including prior hospitalizations, progress notes, surgical notes, nurses charting, vital signs and lab results. The patients current and past medications are also listed with patient allergies to assist in medication administration. This information is available to help decide the plan of care for patients. Clinical guidelines are also incorporated.

4. Who picks the CIS? The entire healthcare team from people involved in direct patient care to the persons controlling the budget and current medical records. A CIS has to work for the facility it is placed in and has to be changed and improved as the healthcare facility changes. Hospital management should pick a program based on the financial aspect, how it will improve patient care, how well it will meld into already established systems and how secure it will be for patient privacy. Many companies provide tech support and follow-up education before during and after CIS implementation Healthland is one company that continuous to provide support to hospital staff during the entire implementation process and beyond(Healthland 2010)

5. EHR Components The common denominator of the eight basic components of a successful electronic health record must be : Patient Safety (McGonigle, & Mastrian, 2009)

6. EHR Components Should include: Health Information and Data Results Management Order Entry Management Decision Support Electronic Communication and Connectivity Patient Support Administration Reporting and Population Health Management (McGonigle, & Mastrian, 2009)

7. EHR Components Administrative Components: Patient Name, Demographics, Chief complaint, Patient disposition, etc. The registration portion of an EHR contains a unique patient identifier, usually consisting of a numeric or alphanumeric sequence ("Mitre center for," 2006)

8. EHR Components Lab systems to integrate orders, results from laboratory , schedules, billing, and other administrative information .

9. EHR Components Radiology The system should tie together radiology data (e.g., orders, interpretations, patient identification information) and images. They are usually used in conjunction with picture archiving communications systems. ("Mitre center for," 2006)

10. Clinical Decision Making Should Include Accessibility and Use for: Nurses Administrative Staff Lab Personnel Pharmacy Physicians All disciplines need to be able to use and update information.(Farukhi)

11. Clinical Decision Making Designed to assist health care professionals in the areas of : Information Management Access (e.g., reference ranges for lab values ). Electronic Resources (e.g., bibliographic databases and pharmacy knowledge bases). Tools for focusing attention to things that might be overlooked (e.g., abnormal labs). (Bakken, Currie, Lee, Roberts, & Cimino, 2008)

12. Clinical Decision Making Tools for Patient Specific Consultation : Custom Tailored Assessments Advice Based on Set of Patient Specific Data Decision Analysis Diagnostic Decision Support Protocol Eligibility Treatment Recommendations All should be focused on Evidence Based Practice (Bakken, Currie, Lee, Roberts, & Cimino, 2008)

13. ("Mitre center for," 2006)

14. Decision Making Software www.infermed.com www.isabelhealthcare.com www.epic.com

15. Safety YouTube - electronic medical records security The above video highlights some of the concerns of safety with patient information that is contained in electronic format.

17. Spyware

18. Antivirus software

19. Firewalls

20. Intrusion detection systems

21. Data Security

22. Passwords

23. Biometrics

24. Radio Frequency Identity Chip (RFID)

25. Physical Security

26. Shoulder surfing

28. Cost Considerations V. Ciotti (2009) stated that EPIC a very popular CIS is overly expensive. He mentioned there are other providers that are more reasonable . Analyst S.Gunasekaran(2009) stated that Epic only brings in a fraction of the Billion dollar price tag hospitals advertise. The processes of picking a CIS is challenging and has many facets.

29. Cost Considerations Sanyal (2009) Stated to choose a program within budget that can be upgraded and changed with the changing of the hospital. The cost for these changes and upgrades including storage and safety need to be considered.

30. Education Training should include anyone who has any contact with EMR….which is everyone!

31. Nursing Informatics Methods of training Online Hands on Blended Modalities of training Video Webcasts Tutorials Simulations

32. References: University of Medicine and Dentistry of New Jersey. (2009). Clinical Information Systems. Retrieved April 7, 2010, from http://informatics.umdnj.edu/clinical/information_systems.htm Healthland. (2010). Support. Retrieved April 7, 2010, from http://www.healthland.com/services/ Ciotti, V. (2009, February 16). EPIC costs. Retrieved April 7, 2010, from http://www.healthcare-informatics.com/ME2/dirmod.asp?sid=&nm=&type=Blog&mod=View+Topic&mid=67D6564029914AD3B204AD35D8F5F780&tier=7&id=AE67FD3F7317442B96C91EF2D7921181 Gunasekaran, S. (2009, February 17). Top 10 Misconceptions about IT Project Pricetags. Retrieved April 7, 2010 Sanjay, S. (2009). Picking a CIS. Retrieved April 6, 2010, from http://mua.academia.edu/SanjoySanyal http://www.linkedin.com/in/sanyalsanjoy8

33. References Mitre center for enterprise modernization. (2006). [Web]. Retrieved from http://www.ncrr.nih.gov/publications/informatics/EHR.pdf McGonigle, D., & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MS: Jones and Barlett. Farukhi, F. (n.d.). Clinical dicision support systems. Retrieved from http://www.cwru.edu/med/epidbio/mphp439/Clinical_Decision.htm Bakken, S., Currie, L., Lee, N., Roberts, D., & Cimino, J. (2008). Integrating evidence into clinical information systems for nursing decision support. International Journal of Medical Informatics, 77(6), Retrieved from http://www.ijmijournal.com/article/S1386-5056(07)00162-1 doi: 10.1016/j.ijmedinf.2007.08.006