The document discusses key components of a Clinical Information System (CIS) including the Electronic Health Record (EHR). It describes the 8 components of an EHR, how clinical decision making systems work, considerations for safety, cost, and education. Clinical decision making systems use evidence-based practices and hierarchical approaches to determine diagnoses and treatment plans. Safety involves backing up data, protecting files from threats, and complying with privacy laws like HIPAA. Costs include purchasing, maintenance, training staff, and ongoing security and upgrades. Education of staff is important both initially and continuously as systems evolve.

1. The Clinical Information System (CIS) Brittney N. Teresa H. Greg D. Stephanie J.

2. Overview of CIS: slides 4-7 by Teresa H. EHR Component: slides 8-10 by Stephanie J. Clinical decision making system in a CIS: slides 11-13 by Greg D. Safety: slides 14-18 by Teresa H. Cost: slides 19-21 by Brittney N. Education: slides 22-23 by Brittney N.

3. Intro into CIS & EHR The Clinical Information System (CIS) and Electronic Health Record (EHR) are key components to giving quality care to clients. It allows health care professionals to come together and deliver care, and without the organization of such software, information could possibly get lost in translation.

4. Clinical Information Systems Definition of CIS Computer-based system designed to compile & store patient health records Provides centralized repository of information based technology applications Provides historical data of patient health decisions & treatment plans

5. Allows navigation and integration of information from different entities (billing, compliance,wellness activities) Encodes knowledge to drive clinical decision making process Captures clinical data to support more efficient & effective decision making that is evidenced based Provides for interdisciplinary exchange of information to streamline workflow

6. Benefits of CIS

7. Key Stakeholders Choosing, implementing or upgrading a CIS should include a broad spectrum of people including: - Clinicians (Nursing & Physician) -IT Dept. -Quality/ PI Division -Administration -Ancillary Dept.'s (Pharmacy, Radiology, Lab)

9. Health care professionals use this to document a patient’s health status

10. Information can be stored, processed, entered, and accessed

13. Decision Making SystemStructure Decisions : Diagnosis, alternative diagnosis Ie. – red sore throat+white patches on throat+fever= Strep throat may be = pharyngitis, tonsillitis Actions: Interventions or care to be administered Strep throat = antibiotics, Tylenol, contact precautions Process: Hierchial approach to delineate the importance of each step of care and what order they should be in. 1) 10 day antibiotics immediately 2) contact precautions/Tylenol

14. Decision Making SystemImplementing EBP “If clinical research is to improve clinical care, it must be relevant, of high quality, and accessible” (Sim, Gorman, Greenes, Haynes, & Kaplan, 2001) The goal of researchers is to “Develop shareable, machine-readable repositories of executable guidelines that are linked to up-to-date evidence repositories” (Sim, Gorman, Greenes, Haynes, & Kaplan, 2001) A good decision making system for a CIS is continually evolving and updating

15. Decision Making SystemsCompanies Companies that are involved in developing decision making systems are: HBOC, IBM, Siemens Medical Systems, and Health VISION Siemens Medical Systems - http://www.medical.siemens.com/siemens/en_GLOBAL/gg_diag_FBAs/files/Informatics/Protis/0701021-Protis_Mappe_LO_38456275_1.pdf Different decision making systems make different decisions!!! Example – Siemens Medical Systems Protis system : Delivers a comprehensive overview of results for each patient Integrates test data from multiple instruments into one report Supports a broad range of assessment modules: iron and anemia, nutrition, cardiac risk, kidney, and CSF Provides doctors with an easy-to-review graphical readout Simplifies organization of test data, saving time (Siemens Medical Systems, 2011)

16. Safety Considerations Backup/Storage of Data Data Warehouses act as repositories for an organization’s data; allows its later retrieval (Often located off-site) By digitizing & centralizing information, it becomes more accessible Minimizing downtime increases functionality of system

17. Safety cont. Protection of Files (viruses, hacker, & worms) Safeguards: Develop a System Map to identify all computers connected to internal network, virus scanning software, intrusion detection systems Develop a Security Policy defining authorized users, password policy & accessibility Harden the Software by checking for updates & patches

18. Safety cont. Reduce the number of access points Install a gateway or firewall to shield your internal network from the Internet; install anti-virus software Require data encryption for information sent over unsecured networks or on portable devices Conduct periodic security audits

19. Safety cont. Health Insurance Portability & Accountability Act became law in1996; established to provide privacy, confidentiality, & security to patients Health care entities must insure all coworkers have received HIPAA education Collaboration with external sites & entities to insure knowledge of policies Establish disciplinary action for violations Ensure protocol to identify, authenticate, & properly respond to individual request for records.

21. Demonstrates the vigilance necessary to maintain patient privacySource: U.S. Department of Health and Human Services (Cortes, 2009)

23. Depends on size of facility, implementation process, & current legacy (operating) system.

25. IT Personnel

26. With the additional technology, additional support staff is needed.

27. Some EHR companies will charge you extra for after hour support.

29. Cost to train staff.

30. EPIC training for new RN staff at St.Johns consist of 5 eight hour days. (32 hours x $17/hr = $544 per RN)

31. Continued Education- every time a new or updated feature is introduced, some form of training/education has to be provided.

32. Miscellaneous

33. Cost for added online security

34. Potential cost to update systems to support EMR/EHR

36. Educators Initial education should be provided by either Educators from the company of the EHR/EMR or by staff members who have attended some form of educator training. (These people will have the most knowledge about the system allowing them to further help others.) Re-education and updates should be taught by the education department, whom should also have a form of educator training, before teaching it to others.

37. Summary All this information can at times be overwhelming, but the main thing to remember is that the CIS brings all aspects of the health record together. When researching CIS the eight components of the EHR, comparing decision making systems, safety of the data, adequate cost, and educating software users are all important.

38. References Congdon, K. (2009, september 14). How much will an ehr system cost you?. Retrieved from http://www.healthcaretechnologyonline.com/article.mvc/How- Much-Will-An-EHR- System-Cost-You-0001 Cortes, S. (2009, May 11). Understanding the risk of penalties for violating privacy laws. Posted to IT Knowledge Exchange @http://itknowledgeexchange.techtarget. com/it- compliance/tag/ftc/ Farukhi, F. (2010). Public health management & policy [11th ed.]. Retrieved from http://www.cwru.edu/med/epidbio/mphp439/Clinical_Decision.htm Hoffman, S, & Podgurski, A. (2008, October 30). Case western reserve university professors call for regulation of electronic health records. Retrieved from http://blog.case.edu/casenews/2008/10/30/ehrregulation McGonigle, D, & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury,MA: Jones and Bartlett Publishers.

39. References MSI Systems Integrators. (2010). Case study: Sanford health integrated clinical information systems to enhance health operations from the inside out. Retrieved March 16, 2010, from http://www.msiinet.com/casestudies/storage/sanford-health Siemens Medical Systems, Initials. (2011). Overview: protis system. Retrieved from http://www.medical.siemens.com/webapp/wcs/stores/servlet/ProductDisplay~q_catalogId~e_-111~a_catTree~e_100001,1023066,1032316~a_langId~e_-111~a_productId~e_182194~a_storeId~e_10001.htm Sim, I., Gorman, P., Greenes, R.A., Haynes, B., & Kaplan, B. (2001). Clinical decision support system for the practice of evidence-based medicine. Journal of the American medical Informatics Association, 8(6), Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC130063 Sittig, D., Hazelhurst, B., Palen, T., Hsu, J., Jimison, H., & Hornbrook, M. (2002). A clinical information system research landscape. The Permanente Journal, 6(2). Retrieved March 20, 2011, from http://xnet.kp.org/permanentejournal/spring02/landscape.html U.S. Department of Health & Human Services.(n.d.). Health information privacy: health information technology. Retrieved March 20, 2011 from http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/index.html Zaroukian, M.H. (2004). Emr cost-benefit analysis. Retrieved from http://www.himss.org/content/files/EMRCost-BenefitReality.pdf