Evaluation of a Clinical Evaluation of a Clinical Information SystemInformation System

Betsy Mullings – Decision Making SystemKati Ewing – Safety-BackupKatie Daniel – CIS OverviewTanya Leyva – Cost and EducationTraci Cheney – EHR Component

Introduction

• This presentation gives a brief overview of clinical information system (CIS) highlighting areas such as basic components of electronic health record (EHR), clinical decision making process within CIS, safety-backup, cost, and education.

• The aim of this presentation is to build a framework of aspects others should know about CIS

What is a Clinical information system? (CIS)

• A CIS is defined as a computer based system designed for collecting, storing, manipulating, and making available clinical information important to the healthcare delivery process.– It can be …

limited to a single area such as laboratory systems and ECG management

or could be widespread and include all areas of clinical information such as the whole EMR.

Some areas addressed by CIS

• 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 (EMRs): this contain information about the patient, from their personal details, such as their name, address and sex to details of every aspect of care given by the hospital (from routine visits to surgeries).

• 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 to best manage them.

Who should choose, implement, manage and revise the CIS?

• Executive leadership/CEO– Important because they communicate the vision & value– Allocate resources and make time for decision making– Mediator between the physician community and other

hospital disciplines.• Key stakeholders

– their “buy-in” is crucial b/c all decisions made will affect their daily workflow

• Medical staff and clinicians– They know better than anyone because they access patient

charts everyday.– They can give a better idea of what works and what doesn’t

Who should choose, implement, manage, and revise the CIS? cont’d

• System administrator– This person is the “project manager” and is in charge of communication

of any changes in the CIS etc, handle conflict resolution with tech support, and they must prioritize and make decisions at the same time.

• Tech Support– This part of the team is important all the time, but more so in the

beginning when everyone is learning how to use it and while the system gets the “kinks” worked out

• Education team-– These people are in charge on educating everyone who comes in

contact with a patients chart. – They will also be implement any new

changes to the system.

EHR Component

• McGonigle and Mastrian (2009) claims the Institute of Medicine has the most widely used definitions of the eight components used in an EHR.

– Health Information and Data “is the patient data required to make sound clinical decisions” .

– Results Management “is the ability to manage results of all types electronically . . . both current and historical”.

– Order Entry Management “ is the ability of the clinician to enter . . . orders . . . and consultations directly into the computer”.

– Decision Support “is the computer reminders and alerts . . .”.– Electronic Communication and Connectivity “is the online communication between

health team members . . . and patients . . .”.– Patient Support “is [] patient education and self-monitoring tools . . .”– Administrative Processes are the electronic scheduling, billing, and claims

management systems . . .”.– Reporting and Population Health Management “are the data collection tools to

support public and private reporting requirements . . .“. (McGonigle and Mastrian, 2009, 222)

EHR Component cont.

• The components of an EHR allows care providers the ability to evaluate recent and past test results, radiology results, medication list, and historical data to find health trends. It also requires a common language to be used system wide which standaridizes care and also assists with scheduling and billing.

• The system also allows for health care providers to standardize pressure ulcer care or determine fall risk (Bakken, 223).

• Bar coding medications and blood products and scanning patient armbands before administration has been proven to reduce patient administration errors (Bakken, 226). The process of scanning patient armbands before administration “increased by 30% the risk of finding a misidentification event in any stage of the process (Bakkan, 226).

• The EHR needs to be accessed only by patient care givers. Care givers can range from the nurses aid to the person in charge of patient billing. Restricted parameters can be set within the confines of the record to limit the access a specialty has to documenting on a patient’s chart. A respiratory tech cannot schedule a patient for a procedure. They do not have the access.

• Limited access to a patient chart can be frustrating but can also be broadened once a caregiver has established their legitimate claim to documenting in a certain part of a patient’s chart.

EHR cont.

• CIS availability online has allowed patients to be more involved in their own diagnosis and treatment possibilities. Patients are able to research information on the internet and will arrive for a doctors appointment with many questions regarding new treatments. Many patients will arrive with written questions.

• The Comprehensive Health Enhancement Support System (CHESS) is a computer base education system that has had proven success “in underserved populations (black, low socioeconomic) demonstrated

more use of information and analysis services . . . (Bakkan, 234).

Structuring a CIS

• Patient Demographics/Identification Information

• Progress Notes• Doctor’s Orders• Nurse’s Notes• Vital Signs• Medications• Allergies• Laboratory Data

Structuring Continued:

• All “Ologies”– Radiology– Cardiology– GI– Pulmonology

• Past Medical History• Immunizations• Problem Lists• Visits

Companies Who Design CIS

McKESSON Empowering Healthcare

SIEMENS

Evidence-Based Practice (EBP)

• EBP should be embedded in the EHR as prompts, pop-ups, links, reminders and text messages.

• The information needs to be easy to retrieve.

• iphone has apps that can be downloaded with the updated EBP information.

Back Up Look for these incentives when choosing the electronic health record for

your healthcare organization

• A fault-tolerant disk, external power supply

• Battery incase of power outage

• An off-site location for back up disks.

• Set times to back up information- such as once a day, week, month, year.

http://www.medscape.com/viewarticle/579131_sidebar2

Storage

• Maintain logs of all back ups and where the disks are stored.

• Mark all disks with specifics about what is stored on the disks.

How Users Gain Access

• Experience with EHRs has shown that the confidentiality of personal health information can be maintained with properly designed security system

• To gain access- users must have individual user identifications numbers and passwords.

• Having individual login information allows the system to track what the users are doing and what information they are looking up

• http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2047325/

HIPAA

• The HIPAA regulations restrict users (healthcare personnel) to look at the EHRs of other heatlhcare personnel and/or family members or acquaintances.

• Allowing patients access to their records- a request form on the site, patient fills out request and sends it in to the company- who grants or denies them access.

Importance of Involved Staff

• Before even beginning to count the cost the organization must ensure that two essential elements are in place through the implementation process– Strong IT involvement—to

improve the effectiveness of the process

– Clinicians support and involvement—to avoid an outright revolt or a passive aggressive non-use of the system

http://www.sleep-net.com/sleep_apnea_mask/support_clinician.jpg

Counting the Cost

• There are two methods of counting the cost– Top down (ABC) method

• Starts at the top by looking at the organizations complete budget, and distributing the cost to various activities

• Total budget ÷ cost activities= cost

– Bottom-up (Unit costs) method

• Begins from bottom up, by calculating the total cost of an activity, by multiplying the unit price by quantities consumed

• Activity × quantity consumed = Cost

http://www.viralblog.com/wp-content/uploads/2008/10/budget.jpg

• Activities – into which the total cost of operation will be allocated

• Personnel – Salaries of all personnel involved excluding management.

• Executive management – salaries of executive managers, which is about 3% of the revenue.

• Human resources and finance – estimated to be 5% of the revenue of the clinic

• Building – cost for rent by square footage of the building times the market price.

• Supplies

• Electronic Health Record – Cost of the software and hardware required.

• Other operating expenses – licensing fee and impact on productivity.

Is it Cost Worthy?

• The following equation is used to determine the percentage change in the total cost before and after the implementation of EHR:– (Cost After – Cost Before)

÷ (Cost before) × 100%• If the percentage change is

negative, the organization is more productive with the EHR.

• If the percentage change is positive, the organization is less productive with the EHR.

http://www.ci.sparks.nv.us/governing/budget101/images/money_scale.jpg

Education

• Purpose– Teaching end users to successfully navigate and utilize

the technology and consistently supporting them as they gain EHR proficiency.

• Method– Nurses, doctors, and ancillary staff received training

separately, because each uses different clinical pathways, and each is accustomed to viewing patient information in different ways.

Hours of Training

– Physicians received three hours of training

– Registered nurses received 12 hours of training in order entry results reporting and medical administration documentation, and were instructed how to order emergency verbal orders for physicians

– Ancillary staff –including everyone from patient care technicians to information specialists—received seven hours of training

http://www.harrisonlifelonglearning.com/images/computer%20ed%20pic.jpg

Pain Free Education

• It helps convince physicians to adopt the EHR when training is worked around physicians' schedules, rather than trying to force doctors to work their schedules around training

• Trainers may go as far as scheduling classes in the middle of the night in order to accommodate doctors' schedules

• Classes could be done in four hour increments with groups of 20 people receiving training from several instructors in classroom settings

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Feedback and Ongoing Education

• Listen to users and creators of clinical information to understand what is essential and what wastes time

• Typically information systems have “updates” on a routine basis. When an update occurs, system users must be informed about the changes and re-trained if required.

Conclusion

• As it is evident CIS, and more specifically EHR, are beneficial to the healthcare facility, but it requires finances and a lot of hard work of those involved.

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