Introduction to Information Systems

in Healthcare Part II

Lynn M. Nagle, PhD, RN, FAAN National Institute on Nursing Informatics

Objec'ves:

•  To identify commonly used functional components of electronic health records

•  To identify the optimal system characteristics to most effectively support clinical care

•  To identify the benefits to be derived from electronic health records 2

What’sinaname?

•  eHealth–ElectronicHealth• mHealth–MobileHealth•  vHealth–VirtualHealth

•  EHR–ElectronicHealthRecord-Jurisdic>on•  EPR–ElectronicPa>entRecord-Ins>tu>onal•  EMR–ElectronicMedicalRecord-Physician•  PHR–PersonalHealthRecord-Personal

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Hospitals

PrimaryCare

HomeCare

Rehabilita'on

MentalHealth

Long-TermCare

PublicHealth

Pharmacies

Diagnos'cCenters

ElectronicHealthRecord

ClientRegistry

ProviderRegistry

Loca'onRegistry

ClinicalEventDataRepositories

DiagnosesTreatmentsDrugProfileAllergies

Diagnos'csLabResultsDIResults

Immuniza'onsSurveillance

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Enterprise-wide Patient Scheduling

Mas

ter

Patie

nt

Inde

x

In

Pat

ient

s

Out

P

atie

nts

ER

P

atie

nts

Day

S

urge

ry

Registration

Nutrition Info System

Radiology Information System

Laboratory Info System

Picture Archiving Communication System (PACS)

Pharmacy Info System

Dictated/Transcribed Notes

Enterprise-Wide Results Review

Clinical Documentation

Hospitals

MDs

HC

LTC

CCC

MH

Portals Clinician Patient

Clinician Order Entry

Core functional Components of a Clinical Information System

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Clinical Provider Order Entry (CPOE)

Diagnostics Lab DI

Cardiology Neurology

Therapeutics

Nursing Medications

OT PT SW

Nutrition Other ancillary

Referrals

Supported by…

Wired & Wireless Networks Fixed Workstations Computers on Wheels (COWs) Workstations on Wheels (WOWs) “Thin” client – “Fat” client Point of Care Technologies

•  Tablets •  PDAs

Decision Support/Evidence

•  Best Practice Guidelines (BPGs) •  Clinical Pathways/Care Maps •  Clinical Reference Tools

•  eCPS

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Clinical Documentation

Assessments Admission/Discharge

NCP

Kardex Critical Pathways/Care Maps

Flow Sheets

(Vitals/I & O)

Narrative Notes

Medication Administration Record (eMAR)

Referrals

Consult Notes

Supported by…

Wired & Wireless Networks Fixed Workstations Computers on Wheels (COWs) Workstations on Wheels (WOWs) “Thin” client – “Fat” client Point of Care Technologies

•  Tablets •  PDAs •  Barcode Readers •  Integrated devices (monitors)

Decision Support/Evidence

•  Best Practice Guidelines (BPGs) •  Clinical Reference Tools

•  eCPS, PEPID, ePocrates

Nursing Orders/Task List

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Access to detailed data

Results and images Patient information

Medical alerts

Medication history

Encounters

Immunizations Problem list 8

ThePortalConcept…

A solution/architecture for dynamically consolidating access to individual health information from multiple sources into a single view…

Eventually to include interactive functions

including order entry, documentation etc.

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Site A Site C Site D Site B Site E

Silos of Information

Local MPI Local MPI Local MPI Local MPI Local MPI

Site Specific Information Systems

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Patient Centric vs Site Centric Solution

Clinical Portal

Clinical Data Repositories

Primary Care

Enterprise MPI

Other External

Site Specific Information Systems

Community

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•  Seamless integration •  Paperless - Reliable •  Responsive - Connected •  Accessible - remote, portable •  Integrated Decision Support •  Interoperable

Optimal Characteristics of Electronic Record Management Systems

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What are the benefits to be derived from electronic health records?

Benefitstoberealized…

•  Health System –  Improved co-ordination of service planning

and delivery –  Increased delivery of services to remote

communities – More cost-effective service delivery –  Improved population health and protection

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•  Providers –  Improved access and sharing of clinical data/

information – Streamlined requests and referrals – Decreased duplication of diagnostics & drugs – Enhanced access to results –  Improved co-ordination of care – Enhanced access to evidence and best practices – Dynamic creation of new knowledge

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•  Public and Patients-Clients/Families –  Improved access to health services &

information –  Improved self-management – Safer care – Consistent, evidence-based quality care –  Improved overall health care experience

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KeyLearnings

•  Commonly used functional components of electronic health records

•  Optimal system characteristics to most effectively support clinical care

•  Benefits to be derived from electronic health record systems

SuggestedReadings:•  Karsh,B-T.,Weinger,M.B.,Abbott,P.A.,&Wears,R.L.(2010).Healthinformationtechnology:Fallaciesandsoberingrealities.JournaloftheAmericanMedicalInformaticsAssociation,17(6),617-623.

•  Lau,F.,Kuziemsky,C.,Price,M.,&Gardner,J.(2010).Areviewonsystematicreviewsofhealthinformationsystemstudies.JournaloftheAmericanMedicalInformaticsAssociation,17(6),637-645.

•  Staggers,N.,Thompson,C.B.,Snyder-Halpern,R.(2001).HistoryandtrendsinclinicalinformationsystemsintheUnitedStates.JournalofNursingScholarship,33(1),75-81.

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