This power point discusses many aspects of Clinical information system and electronic health records. Enjoy! NUR3563 (Nursing informatics class)

1. By: Ashlee Rossner slides 1-8, 13, 21, 27-32, 37-38
Jenna George slides 8-12,13, 21, 27, 32 & 38
Kelsey Smith slides14-21, 8, 13, 27, 32 & 38
Rachel Hiebert slides 22-27, 8, 13, 21, 32 & 38
Steven Barksdale slides 32-36, 8, 13, 21 27 & 38

2.  Ashlee Rossner : Discussing what a CIS is , key players that are
involved in choosing, implementing and revising a CIS. Also discussing cost
of a CIS. What should be considered, purchasing, IT support personnel, and
continuing education.
 Jenna George: Discussing EHR component: Should it have the 8 basic
components, who has access to this particular information, and why is this
particular information needed within the CIS
 Kelsey Smith: Discussing the clinical decision making system in a CIS.
How should it be structured, how often should it be update with new EBP
guidelines, Any companies out there that design clinical decision making
systems for the CIS.
 Rachel Hiebert: Discussing about safety issues. Backup, storage of
data, protection of files from viruses/worms/hackers, who has access, how
users gain access, HIPAA considerations, &ethical considerations in design.
 Steven Barksdale: Discussing education. How often should re-
education and updates take place, who should do the educating and
why, what type of formats should be used for learning.

3. ◦ What is a CIS?
 “CIS is an array or collection of applications and
functionality; amalgamation of systems, medical
equipment, and technologies working together that are
committed or dedicated to collecting, storing, and
manipulating healthcare data and information and
providing secure access to interdisciplinary clinicians
navigating the continuum of client care. Designed to
collect patient data in real time to enhance care by
providing data at the clinician’s fingertips and enabling
decision making where it needs to occur-at the
bedside” (McGonigle, & Mastrian, 2009, pp 443).
Giving healthcare providers patient date with a click of button!

5.  Some areas addressed by CIS are:
 “Clinical decision support: This provides users with the tools to
acquire, manipulate, apply and display appropriate information to
aid in the making of correct, timely and evidence-based clinical
decisions.
 Electronic medical records (EMR): this contains information
about the patient, from their personal details, such as their name,
age, address and sex to details of every aspect of care given by the
hospital (from routine visits to major operations)
 Training and Research: Patient information can be made
available to physicians for the purpose of training and research. Data
mining of the information stored in databases could provide insights
into disease states and how best to manage them”
(Biohealthmatic.com, 2010).

6.  Nurses
 Nurse managers
 Support staff
 Performance improvement analysts
 Physicians
 Administration
(McGonigle, & Mastrian, 2009).

7.  Key players that choose the CIS are usually
involved in implementing & revising the system
(McGonigle, & Mastrain, 2009).
◦ “Getting input from both the clinicians who will be using the
system and the staff who will be using the output information
is critical to the success of system design and implementation”
(McGonigle, & Mastrain, 2009, pp 195).
◦ “…critical need for the end users to be intimately involved in
choosing and/or developing the CIS” (MCGonigle, & Mastrain, 2009, pp 194).
 Healthland is just one of many companies that
provide tech support throughout the
implementations and revising process (Healthland, 2011).

9.  Health information and data
 Results management
 Order entry management
 Decision support
 Electronic communication and connectivity
 Patient support
 Administrative processes
 Reporting and population health management
(McGonigle & Mastrian, 2009, pp 219-224)

10.  EHR’s should contain all pertinent
information in regards to a patient’s health.
 This includes all disciplines such as
physicians, nurses, PT/OT, pastoral services,
rehab, etc.
 Enables all information to be compiled into
one location for easy access and accurate
updates regarding patient’s condition/status
(CMS, 2011).

11.  Physicians and Licensed Personnel: should be
granted full access to all 8 components.
 UAPs: access to health information and data
 Pastoral services: access to decision support
and patient support.
(McGonigle, & Mastrain, 2009)

12.  This is personal/protected health
information, treat it as such.
 Do not grant access just because asked,
remember patient privacy.
 Access should not be abused, only access the
information needed to complete your job and
provide quality care.

14.  Definitions:
• “Tools that provide the clinicians, staff, patients, or other
individuals with knowledge and person-specific information,
intelligently filtered or presented at appropriate times to
enhance health and healthcare.” (McGonigle & Mastrian, 2009)
• “Interactive computer programs designed to assist physicians
and healthcare professionals with decision making tasks.”
(Wikipedia, 2010)
• “The greatest tool to increase the standardization of care,
reduction of practice variation, successful and effective
diagnosis, and correct care path choice.” (Farukhi, 2009)

15.  Provide physician with a guideline model
 Reduce overall cost of healthcare
 Receive patient data and utilize data to process a
series of possible diagnoses and course of action
 Recognize drug-drug interaction and patient
complications that would otherwise be
unrecognized by the physician to provide a
valid, efficient, and “best practice” solution to the
patient diagnosis process
(Faruhki. (2009)

16.  Tools and Interventions:
◦ Computerized alerts and reminders
 Medications that are due, patient has an allergy to a
medication, lab levels
◦ Order sets
◦ Patient data reports
◦ Diagnostic support
◦ Documentation templates
◦ Clinical guidelines
 Best practice for prevention of skin breakdown
(Agency for health research and quality, n.d.)

17.  Evidence based clinical guidelines
 Systems that provide patient and situation
specific advice
◦ Example: EKG interpretations or drug-drug
interaction look up
 Electronic full text journals and textbook
access
 Electronically available clinical data
◦ Example: information from clinical laboratory system
(Agency for health research and quality, n.d.)

18.  Target Area of Care:  Example:
1. Immunization, screening,
1. Preventive care disease management guidelines
for secondary prevention
2. Diagnosis 2. Suggestions for possible
3. Planning or implementing diagnoses that match a
treatment patient’s signs and symptoms
3. Treatment guidelines for
4. Follow-up management specific diagnoses, drug
5. Hospital, provider dosage recommendations,
alerts for drug-drug
efficiency interactions
6. Cost reductions and 4. Corollary orders, reminders for
improved patient drug adverse event monitoring
5. Care plans to minimize length
convenience of stay, order sets
6. Duplicate testing alerts, drug
formulary guidelines
(Berner, 2009) (Berner, 2009)

19.  Workflow
◦ Assessment of workflow & how CDS fits within it
◦ Proper integration
 Data Entry and Output
◦ Who enters the data and who receives the advice
 Standards and Transferability
◦ Must adapt to universal needs as well as unique needs of the end users
◦ Need for national standards for the specific evidenced based guidelines
 Knowledge Maintenance
◦ Accuracy of data and frequency of updates of data (new medications, new
diagnoses, or new evidence based guidelines)
◦ Investigate source of knowledge and frequency of updates before
purchasing CDS program and/or initiate a knowledge management
process internally
 Clinician motivation to use CDS
◦ Patients safety
◦ Concern of physician autonomy
◦ Legal and ethic ramifications
◦ Busy schedule of clinicians
(Berner, 2009)

20.  Epic (www.Epic.com)
 Infermed (www.infermed.com)
 Cerner Corporation
 Lifecom
 Theradoc
 Metavision by iMDsoft

22.  HIPAA
◦ Stands for Health Insurance Portability and
Accountability Act
◦ signed into law in 1996 by President Bill Clinton
◦ provides privacy of health information
◦ “require(s) the covered entities to put safeguards that
protect the confidentiality, integrity, and availability of
protected health information when stored and
transmitted electronically into place”(McGonigle, &
Mastrian, 2009, pp 172).
(McGonigle, & Mastrain, 2009)

23.  Securing Network Information
◦ “healthcare organization(s) will have computers linked
together to facilitate communication and operations within
and outside the facility”= network
◦ 3 areas of secure network information: confidentiality,
availability, integrity
◦ confidentiality policy to “clearly define what data is
confidential and how the data should be handled”(McGonigle, &
Mastrian, 2009, pp 185).
◦ protection also comes with an “acceptable use policy”
which determines what “activities” are acceptable to use on
the network.
(McGonigle, & Mastrain, 2009)

24.  Threats to Security
◦ unawareness of computer monitor visibility, shoulder
surfing, removal of computer hardware (McGonigle, &
Mastrian, 2009, pp 187).
◦ Removable storage devices: jump drives, flash
drives, CDs, DVDs, thumb drives (McGonigle, &
Mastrian, 2009, pp 187-188).
◦ spyware, viruses, worms, Trojan horses (see next
slide)
(McGonigle, & Mastrain, 2009)

25.  Viruses and Antivirus Software
◦ protection from viruses can be achieved by installing
“antivirus software or a hardware tool such as a proxy server”
(McGonigle, & Mastrian, 2009, pp 189).
◦ firewalls: “hardware or software […] examines all incoming
messages or traffic to the network” (McGonigle, & Mastrian, 2009, pp
189-190).
◦ proxy servers prevent users from “directly accessing the
internet” (McGonigle, & Mastrian, 2009, pp 190).
◦ intrusion detection systems “allow an organization to monitor
who is using the network and what files that user has
accessed” (McGonigle, & Mastrian, 2009, pp 190).

26.  Authentication of Users (Access)
◦ “ways to authenticate users: ID badge, weak vs. strong
passwords, finger scanners” (McGonigle, & Mastrian, 2009, pp
186).
◦ ID cards can be used for authentication
◦ create a strong password, using letters, numbers and
characters (i.e #, @, +)
◦ never write down passwords in an obvious place
(under your keyboard)
(McGonigle, & Mastrain, 2009)

28.  Implementing a CIS is a very expensive task that continues to
grow as hospitals continue to grow.
◦ “…implementation of such a comprehensive system will cost the
organization both dollars and losses in clinician productivity
during development and implementation” (McGonigle, &
Mastrian, 2009, pp194).
◦ “The high cost of basic infrastructure of clinical information
technology is a substantial hurdle for many health care
organizations, many of whose income margins have deteriorated
after years of decreasing reimbursement (from Medicare and other
sources) and whose access to capital for new medical technology
is extremely scarce” (Crane, & Raymond, 2003).
 The Cost also depends on what CIS is purchased, and IT
program hospitals go through.

29.  “The cost of health information technology should
be shared among those who benefit from it. Public
investment is needed to encourage adoption of
important technologic applications” ( Crane, & Raymond, 2003).
 Remember: Have a budget and a CIS that can
progress as hospitals continue to grow!

30.  Data security and patient privacy
 Time and cost required to choose, buy, and implement or
build a health informatics system. (Don’t forget hidden costs!)
 Integration of legacy systems (Challenge for organizations to abandon their
large IT investment)
 Clinician resistance
 Lack of industry standards and interoperability (outpatient verses
inpatient system)
 Risk aversion (Shrinking income margins)
 Inability to transfer (IT personals have differences in care delivery models,
leadership factors, and organizational culture).
(Crane, & Raymond 2003).

31.  Four phases of decision making for a CIS
◦ Preparatory phase: (detailed explanation of content, scope,
requirement and analytical methods that they want from a CIS)
◦ Screening phase: (selection of alternatives; existence of some
functions or interfaces or cost limits)
◦ Evaluating phase: (comparison of alternatives; narrow it down
to 6 products to be evaluated in detail)
◦ Decisions phase: (Key players make a recommendation to the
board of the hospital)
(Graeber, 2001).

33. Where does it start?
First- A hospital decides to implement a CIS.
Second- “Key Players”, users of all levels, are chosen to
evaluate the potential CIS programs.
Third- Different agencies show a sample of what their program
can do for the hospital to the “Key Players”.
Fourth- The chosen provider will build a base program, upload
it to the hospital system, and send educators to the “Key
Players” beginning the three education stages.
(McGonigle, & Mastrian, 2009)

34. Who needs it?
Everyone-
Stage 1: The “Key Players” are used to find any flaws in the base
program as well as figuring out what is working and what is not. This
helps the facility to fine tune the program before full implementation.
Stage 2: Any flaws found in Stage 1 are examined and the program
is adjusted to fix the flaws. Then the training starts with the educated
employees (Key Players) training other future educators.
Stage 3: The trained educators are utilized in the education of the
hospital. The users that will be educated in the hospital include
everyone, from doctors to volunteer personnel prior to installation of
the new program.
(McGonigle, & Mastrian, 2009)

35. How often?
Education is an ongoing process that never stops!!!
The more the system is used, the more the users are
able to see what needs to be added or changed.
Updates and continued education are done as often
as needed. Some education can be done via
email, while other education may require in-person
training.
(McGonigle, & Mastrian, 2009)

36. What style learning works best?
When teaching the new program all types of learning are used.
Audio- Question/Answer format with Educators
Visual- Show and Tell format with Educators
Kinesthetic- Tactile format with Educators incorporating
physical activity into the learning process.
(McGonigle, & Mastrian, 2009)

38.  Agency for Health Research and Quality. (n.d.). US Department of Health and Human Services. Retrieved from
http://healthit.ahrq.gov
 Biohealthmatics.com. (2010). Clinical information system. Retrieved from
http://www.biohealthmatics.com/technologies/his/cis.aspx
 Berner, 2009. Published for the Agency for Healthcare Research and Quality for the US Department of Health
and Human Resources. http://healthit.ahrq.gov/images/jun09cdsreview/09_0069_ef.html
 CMS. (2011, June 13). Overview of Electronic Health Records. In U.S. Department of Health and Human Services.
 Crane, R. M., & Raymond, B. (2003). health systems: fulfilling the potential of clinical information systems. . The
Permanente Journal, 7(1), Retrieved from http://xnet.kp.org/permanentejournal/winter03/cis.html
 Faruhki. (2009). http://cwru.edu/med/epidbio/mphp430/clinical_decision.htm
 Graeber, S. (2001). How to select a clinical Information system. Retrieved from
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2243333/pdf/procamiasymp00002-0258.pdf
 Healthland. (2011). Implementation services. Retrieved from http://www.healthland.com/services/
 McGongile, D. & Mastrain, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones
and Bartlett Publishers.
 2010. Wikipedia. Clinical Decision Support System. Retrieved from
http://en.wikipedia.org/wiki/Clinical_decision_support_system