1. Ronnie Breig, Kassidi Bremer, Anna Hicks,
Marcia Howard & Reynel Walden
Southwest Baptist University
2. • Ronnie Breig—introduction, overview, reference
pages
• Kassidi Bremer—EHR component
• Anna Hicks—safety & cost
• Marcia Howard—clinical decision making &
conclusion
• Reynel Walden—education
3. • “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” (McGonigle, D., &
Mastrian, K., 2009, p. 443)."
• Allows patient data to be available when and
where it is needed…with the click of a button.
4. “The use of health information
technology should lead to more efficient,
safer, and higher quality care” (Jha et al.,
2009, p. 1628)
If utilized correctly, the CIS makes our
jobs easier!
5. • Nurses HAVE to be involved
in choosing a good CIS
• “It behooves nurses to be
engaged in the acquisition,
design, implementation, and
evaluation of CIS to assure
the realization of benefits for
clinical care and outcomes”
(McGonigle, D., & Mastrian,
K., 2009, p. 141).
6. • Administration = $$$
• Nurse Managers
• Support staff
• Performance improvement analysts
• Ancillary staff
(McGonigle, D. & Mastrian, K., 2009)
After all, all of these people will have to use
the system!
7. • Health Information and Data
• Results Management
• Order Entry Management
• Decision Support
• Electronic Communication and Connectivity
• Patient Support
• Administrative Processes
• Reporting and Population Health management
8. • Health Care team
• Organizations monitoring reports of specific
diseases
• Administrative persons (i.e. billing and
claims)
• Laboratory, radiology, etc. within the
hospital
9. • Increased delivery of guideline-based care
• Enhance capacity to perform surveillance
and monitoring for disease conditions
• Reduction in medication errors
• Decreased utilization of care
• Reduced turnaround time for lab results
10. • Information management tools to help us
• Net benefits for safer care and
improved clinical outcomes
• Acquire, manipulate, apply, distribute
and display appropriate clinical
knowledge to clinicians and patients
11. “Provides clinicians, staff, patients, or other
individuals with knowledge and person-
specific information, intelligently filtered or
presented at appropriate times to enhance
health and health care” (McGonigle, D. &
Mastrian, K., 2009, p.)
12. • Computerized alerts and reminders
o Medications due, patient has an allergy, K+ level
• Clinical guidelines
o Best practice for prevention of skin breakdown
• Online information retrieval
o CINAHL, drug information
• Clinical order sets and protocols
• Online access to organizational policies and
procedures
13. • athenahealth, Inc.SM
• Cerner Corporation: PowerWorks EMR
• Criterions LLC: The Criterions Medical Suite
(TCMS)
• e-MDs: e-MDs Solution Series
• GE Healthcare: Centricity Electronic Medical
Record
• EHS Inc.: EHS CareRevolution
• NextGen Healthcare Information Systems,
Inc.: NextGen
• Ambulatory Electronic Health Records
14. • Health clinicians (users) can access information
o username and password (policies include changing
password every 30 or 60 days)
o ID cards
o biometrics (include thumb prints, retina patterns, or
facial patterns)
• Limit authorization to write files to a device (cd/dvd
burners, jump drives, flash drives, or thumb drives
are devices with potential security risks)
15. • Security tools and Backup Storage data
• Antivirus Software (that updates daily or
weekly)
• Firewalls(to examine all incoming
messages)
• Proxy servers
• Intrusion detection system (to monitor
who is using the network and what files
are being accessed)
16. The Health Insurance Portability and
Accountability Act (HIPPA)
• “HIPAA is a collection of federal laws and regulations
has wide-ranging impacts for healthcare providers,
health plans, and businesses related to the healthcare
industry and is administered by the U.S. Health and
Human Services Department” (Health Insurance
Portability and Accountability Act, 2006).
• HIPPA protects patient information by prohibiting
hospital employees such as physicians and nurses from
disclosing the information in the chart to anyone outside
of that patient’s healthcare providers.
17. • There are penalties for violation of the law such as:
Wrongful Disclosure of Individually Identifiable Health
Information:
• Wrongful disclosure offense: $50,000, imprisonment
of not more than one year or both
• Offense under false pretenses: $100,000,
imprisonment or not more than 5 years, or both
• Offense with intent to sell information: $250,000,
imprisonment of not more than 10 years, or both “
(Health Insurance Portability and Accountability Act,
2006)
18. • The cost of implementing a CIS system can be a big
deciding factor for health systems.
• “Implementation costs have been estimated to exceed
$700,000 per hospital (15% of capital expenses),and
hospital IEHR operating costs exceed 2% of operating
expenses (about $ 1.7 million). Physician expenses are
around $30,000 per doctor for implementation and
$1,000 per year for operating costs”(Lockwood, 2009).
• There are financial programs available for the
implementation costs of a CIS system.
19. • “The American Recovery and Reinvestment Act of
2009 (i.e., the Stimulus Act) has made implementation
of health system IT a priority, authorizing
approximately $19 billion in incentives between 2009
and 2019” (Lockwood, 2009).
• This program will help increase the number of
hospitals using a CIS.
Although the implementation costs are high,
the system will save money in the long term!
20. “Evidence suggests that an IEHR system could reduce
aggregate healthcare costs. A cost-benefit study of IEHR use
in primary care practice settings estimated a net savings over
5 years of $86,400 per clinician,' and a recent study estimated
that the United States could save $77 billion per year in
healthcare costs when IEHR use reaches 90% of providers”
(Lockwood, 2009).
“Implementing IEHRs should decrease administrative costs to
payers and providers by generating complete and accurate
billing data exchanges. The reduction in healthcare insurance
premiums could reduce expenses for employers who provide
medical insurance and increase the number of firms offering
such benefits. It would also reduce Medicaid and Medicare
costs” (Lockwood, 2009).
21. "Implementation of systems within health
care team is the responsibility of many
people and department systems require a
collaboration and knowledge sharing to
successfully implement and maintain
successful standards of care" (McGonigle,
D., & Mastrian, K., 2009, p. 214).
22. How should users be educated on the
system and updates?
• Implementing a new system can take some time and
should be introduced gradually.
• Institution should evaluate missions and goals as to
why a new system is needed.
-efficiency and easier access to patient data
-structure legibility of information standardization
-reducing cost
-improve safety and quality care
23. Team from clinical specialty areas and
support service.
• Healthcare Clinician
o NURSES!! Nurses must be involved with design,
development, education, and the implementation
process to ensure that the system meets the needs
of staff. This will result in user satisfaction and will
help determine when more education is needed.
24. • Customization or configuration to CIS is required
when errors are identified
• Creation of a template is often made specific to
various units’ workflow.
"Maintenance of the systems requires ongoing efforts
to keep them up to date as operational
and clinical requirements and process change"
(Shortliffe and Camino p. 261)
How often should a CIS
be updated?
25. Clinical Information Systems (CIS)
may represent one of
the most important roles in delivery and
management of healthcare…
“The integration of technology within
healthcare organizations has limitless
possibilities…success will be achieved when
health care incorporates technology systems
in a way that they are not viewed as separate
tools to support healthcare practices, but
necessary instruments to provide healthcare”
(McGonigle, D., & Mastrian, K., 2009, p. 215).
26. Health Insurance Portability and Accountability Act
(2006,August 9). Retrieved October 15, 2010 from
http://www.biohealthmatics.com/
technologies/his/cis.aspx
Jha, A., BesRoches, C., Campbell, E., Donelan, K.,
Rao,S.,Ferris, T., Shields, A., Rosenbaum, S.,
Blumethal, D. (2009). Use of electronic health
records in U.S. Hospitals. New England Journal
of Medicine, 360:1628-38.
27. Lockwood, C. (2009). A national integrated electronic
health record system would benefit everyone.
Contemporary OB/GYN, 54(12), 8. Retrieved from
CINAHL Plus with Full Text database
McDonnell C., Werner K., Wendel L. (May 2010).
Electronic health record usability: Vendor
practices and perspectives. AHRQ
Publication No. 09(10) 0091-3-EF. Rockville, MD:
Agency for Healthcare Research and Quality.
28. McGonigle, D., Mastrain, K. (2009). Nursing informatics and
the foundation of knowledge. Sudbury, Massachusetts:
Jones and Bartlett Publishers.
Shortliffe, E. H., & Camino, J. J. (Eds.). (2006). Biomedical
Informatics: Computer Applications in Health and
Biomedicine (3rd ed., ). New York: Springer
Science+Business Media, LLC. Retrieved October 19,
2010, from http://books.google.com/books?id=Wn-
fFVuUguMC&pg=PA571&lpg=PA571&dq=shortliffe+and+
camino&source=bl&ots=UbImBXl_5g&sig=4yD8dvr2sQn
rC6NyN6TJbbplvTU&hl=en&ei=30O-
TK_mKIWZnAfR1vSwAg&sa=X&oi=book_result&c
29. Sittig, D., Hazelhurst, B., Palen, T., Hsu, J., Jimison,
H., Hornbrook, M. (n.d.). A clinical information
system research agenda for Kaiser
Permanente. Retrieved from Xnet.kp.org/
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