Evaluation of a Clinical Information

System Southwest Baptist University NUR 3563

Team 7Caitlin Robertson: Slides 3-10

Song Lee: Slides 11-17, referencesLauren Underwood: Slides 1-2, 18-23

Janna Keller: Slides 24-28

What you will learn about the CIS:

• Overview of the CIS • Persons Involved• EHR Component• Clinical Decision Making for the EHR• Education and Training

Introduction

Caitlin Robertson:Covers the first bullet point on the instructions: “Brief overview of what a CIS is and what key players (persons) should be involved in choosing, implementing, and revising a CIS?

Create the Title and Introduction PagesSong Lee:Covers the second bullet point: “The EHR component: Should it have the 8 basic components from your text/lecture? With each of the components also address who should have access to the information and why that information is needed within the CIS. Bring up specifics if needed.” Compile references from others and create reference slide. Post final project in Discussion BoardLauren Underwood:Covers Bullet third bullet point: “The clinical decision making system in a CIS – How should it be structured? How often should it be updated with new EBP guidelines? Any companies out there that design clinical decision making systems for the CIS?”Compiles & puts together all power points at end of project and emails to all members to review Janna Keller:Covers bullet point six: “Education- how should users be educated on the system and updates? (formats for learning, how often should re-education and updates take place, who should do the educating and why…)” Makes conclusion slides.

Introduction• The quality of care that we provide goes hand-in-hand with the

information that is accessible to healthcare providers. Obtaining information, sharing that information within an information system and managing that information are key aspects to providing optimal care (Oroviogoioechea, Elliott & Watson, 2007, p. 568; Kelley, Brandon & Docherty, 2011, p.154-155).

• Oroviogoicoechea, Elliott, & Watson describe the current standard in health care as a “multi-disciplinary approach” and believe that information systems play a central role in patient care, documentation and communication between providers (2007, p. 568).

• Since nurses are a key role in patient care, they are seen as the main “collectors, generators and users of patient/client information”, the safety of the patients we care for directly correlates with the information put in to the CIS (Oroviogoioechea, Elliott & Watson, 2007, p. 568).

What is a CIS?• A clinical information system (CIS) is a technology-based collection

of information. This includes a patient’s history of illnesses, pertinent information and also provides means of communication between providers to help make a decision about the patient’s condition, plans for treatment and patient wellness plans (as cited in McGonigle & Mastrian, 2009, p. 193).

• Goals for many computer information systems are to “expand the scope of the CIS to a comprehensive system that provides clinical decision support, an electronic patient record, and…professional development training tools” (McGonigle & Mastrian, 2009, p. 193).

• Benefits of a CIS include “accessibility, readability, completeness, decision-support and access to knowledge bases” that are acknowledged and increasingly being used as a health care organizational tools (Oroviogoicoechea, Elliott & Watson, 2011, p. 569).

Requirements of a CIS• It is necessary for an “integrated patient record” that

permits health care professionals to access patient information from different places simultaneously. This will result in optimal patient care.

• User involvement is key to the implementation of the information system.

• “The importance of organizational issues such as culture, innovation and leadership for effective implementation process” (Oroviogoicoechea, Elliott & Watson, 2011, p. 569)

Persons Involved in Choosing the CISPeople who use the CIS are

the people who design the CIS

Staff nurses, nurse managers, and support staff are involved in the process of designing the CIS (McGonigle & Mastrian, 2009, p. 194).

Persons Involved in Revising the CIS

Performance improvement analysts: Analyze the “performance improvement initiatives.” This person is directly involved with the design of the information system for nurses (McGonigle & Mastrian, 2009, p. 466).

This position helps provide consistent charting among different clinicians, while still catering to their “specific needs”

“Reports are created for quality assurance and reporting” (McGonigle & Mastrian, 2009, p. 194).

The performance improvement department helps with the ability to make changes to the CIS, develop reports and presentations based on user needs (McGonigle & Mastrian, 2009, p. 195).

Looks at charting from a different view point: clinicians like to look at specific charting elements relevant to their patient that is easy to access and the improvement department looks at charting based on “safety indicators and regulatory requirements” (McGonigle & Mastrian, 2009, p. 195).

Persons Involved in Implementing the CIS

• Clinical analysis receive daily reports to review assessment data, confirm that the data is accurate and ensure that new admissions have information entered within a timely manner (McGonigle & Mastrian, 2009, p.194).

• Nursing informatics specialist (NIS) work alongside program developers to confirm the use of a universal language within a information system (as cited in McGonigle & Mastrian, 2009, p.198).

Clinical Analytics “promote medical care outcomes research”• Create standardized tools to ease analysis of data• Develop clinical guidelines (aka: best practice guidelines) for

implementation• Using a comprehensive CIS allows analysis of nursing outcomes• Analytics back the use of acquiring “required data reporting functions”(McGonigle & Mastrian, 2009, p.196)

Implementation and Continual Education for the CIS

• Staff development gives opportunity for “professional growth and skills development.” The CIS can be utilized for “ongoing education and development of nursing staff members since the medium can embed prompts, information, and related questions in the nursing documentation system with a link to an appropriate clinical protocol” (McGonigle & Mastrian, 2009, p. 474).

• “Education material has improved the compliance” for the CIS (McGonigle & Mastrian, 2009, p. 202).

• Companies are developing software applications (i.e. Uptodate and Micromedex) and using them in clinical information systems to offer links with the most current information available (McGonigle & Mastrian, 2009, p. 201; Thomson Reuters, 2011; Uptodate Inc., 2011).

Electronic Health Record (EHR)

“A computer-based data warehouse or

repository of information regarding the health status of a client, replacing the former

paper-based medical record”

(McGonigle & Mastrian, 2009, p. 450).

Benefits of an EHR

Our CIS will contain an EHR component

Benefits include:• “Increased delivery of guideline-based care.”• “Enhanced capacity to perform surveillance and

monitoring for disease conditions.• “Reduction of medical errors”.• “Decreased utilization of care.”

(McGonigle & Mastrian, 2009, p. 224).

The Basic Components8 key factors that work together to “promote patient safety…” (McGonigle & Mastrian, 2009, p. 221).

1. Health information & Data:•main bulk of information needed to compile enough data to make appropriate health care decisions for the client•includes medical history, medication lists, allergies, lab results, etc.

2. Results Management:•allows for seeing and using a different array of results from the past as well as current results•needed to maintain current information on client, comparisons can be made to monitor for any health changes• Granted access to: Primary healthcare providers such as Doctors, PA, NP, RN, etc. Limited info allowed to be seen for other caregivers.• Patient will have proper access when requested.

The Basic Components

3. Order Entry Management:• place for orders pertaining to patient care to be entered• needed for uniform way of entering & finding orders• Granted access to: Those licensed to put orders in (Doctors, PA, NP) and those allowed to take orders (RN).

4. Decision Support:•“computer reminders & alerts” (McGonigle & Mastrian, 2009, p. 222). • needed as an extra line of defense in catching errors• Granted access to: all who provide care – starter prompt to relay safe patient care.

The Basic Components5. Electronic Communication & Connectivity:• communication online for “health care team members, care partners, and patients” (McGonigle & Mastrian, 2009, p. 222).• needed for more ways of contact & patient involvement in care • “Communication with other nurses and providers is a major part of delivering patient care” (Kelly, Brandon, & Docherty, 2011).• Granted access to: health care team & patients

6. Patient Support:• “patient education and self-monitoring tools” (McGonigle & Mastrian, 2009, p. 222).• gives patients initiative in taking good care of themselves as well as autonomy• Granted access to: PATIENTS! And providers of that information.

The Basic Components

7. Administrative Processes:• “scheduling, billing, and claims” for the many interactions with patients (McGonigle & Mastrian, 2009, p. 222).• needed for one place to confine these duties

8. Reporting and Population Health Management:• allows for a universal language when representing data and finding different formats of programs compatible with system• Granted access to: Administrative positions, IT department, and other technical support positions.

EHR

“The national agenda assumes that the use of electronic sources, such as nursing documentation, will greatly improve the quality of care provided to hospitalized patients. The majority of hospitals across the United States are expected to convert to electronic health records in the next few years…”(Kelly, Brandon, & Docherty, 2011).

“Electronic health records have come to the forefront and will remain central in shaping the future of healthcare” (McGonigle & Mastrian, 2009, p. 231).

Clinical Decision Making for the EHR

Components of the EHR need to be

clinically-based and supported by

evidenced-based practice (EBP)

What is Clinical Decision Making for the EHR?

• It provides a basic clinical guideline for health-care providers.

• Stores and processes patient data and information.

• Quality measures of the EHR are helpful for reaching quality goals including effective, safe, efficient, patient-centered, equitably, and timely care (Centers for Medicare & Medicaid Services, 2011, para 2).

• According to the Department of Human and Health Services, 2010, “Using that information to track key clinical conditions and communicating that information for care coordination purposes (whether that information is structured or unstructured, but in structured format whenever feasible); consistent with other provisions of Medicare and Medicaid law, implementing clinical decision support tools to facilitate disease and medication management; and reporting clinical quality measures and public health information” (p 1852).

Why do we need clinical decision making in the EHR?

• Clinical decision making helps protect patient safety.

• “Clinical decision support can take many forms. The simplest form it can take is alerting a physician about drug-drug and drug-allergy interactions at the time of creating prescriptions. Though simple, this kind of alerting can be very important and can have a significant impact on quality of care” (Rowley, 201, para 4).

Clinical Decision Making Model

Clinical Decision Making Tools and Functions

• Computerized alerts and reminders.• Clinical guidelines.• Order sets.• Patient data reports and dashboards.• Documentation templates.• Diagnostic support.• Clinical workflow tools.(Downing, 2009, p. 4)

Use of EBP in the EHR• Using the EHR properly may develop guidelines to evidence-based

practice (Downing, 2009, p. 8).• Data that can be used for the EBP from the EHR are:

– Evidence obtained from at least one properly designed randomized controlled trial.

– Evidence obtained from well-designed controlled trials without randomization.

– Evidence obtained from well-designed cohort or case- control analytic studies, preferably from more than one center or research group.

– Evidence obtained from multiple time series with or without the intervention. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.

– Opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees.

(Downing, 2009, p. 9)

Education

What kind of education and training will you expect to need when an EHR is involved?

Initial Training• As a general rule people are best taught one on one but that

is not always financially possible.

• Small group classes are a good solution to train the masses

– Try to make each person feel like they are being spoken too directly

– Make eye contact with each person in the group

• Try to use Desktop computers because most healthcare workers are already familiar with them.

• BABY STEPS!!

– Implement one thing at a time, try not to overwhelm your trainees

(John, 2009)

Steps for TrainingAssess your practice readiness

• Assess your employees skills• Upgrade the skills of those who need help

Plan your approach• Decide your approach- grass roots movement or start

with the leaders and work your way down the ranksChoose the right EHR for your needs

• Make sure you have the appropriate technology for your needs

Conduct TRAINING• Once you know everyone is on the same skill level train

them in small groups and expect some resistance for the older population.

(HealthIT.gov, 2011)

Re-Education Needs

• Re-education will be required because we are still working on setting up best practice standards.

- A recent stimulus package, The American Recovery and Reinvestment Act of 2009, includes $17 billion in incentives for health providers to switch to EHRs. The package also includes $2 billion for the development of EHR standards and best-practice guidelines (Peled, 2099)

• EHRs are constantly needing upgrades for software and system needs, with upgrades come new needs

• According to Health Leaders Media (2007), re-education is suggested about once every two to three years depending on the amount of upgrades and changes utilized.

Why Invest Time to be Educated

• According to the US Department of Labor, Healthcare Information Technicians have one of the most in-demand future careers (Occupational Outlook Handbook, 2011).

• The bottom line is this: It’s not a matter of "if" an organization will need to deploy EHR, it’s "when," and CHCA has spent considerable effort on behalf of its members to develop the potential of success for all (Community Health Centers, 2010).

ReferencesDiamond, J. N. (2007). Health Leaders Media. Electronic health records briefing. Retrieved from:

http://www.healthleadersmedia.com

Downing, G. (2009). Decision support tools for practice. Retrieved at http://www.cdc.gov/genomics/translation/GAPPNet/meeting/file/print/slides/Downing.pdf

John. (2009). EMR and HIPPA. EMR implementation training and computer training. Retrieved from: http://www.emrandhipaa.com

Kelley, T., Brandon, D. & Docherty, S. (2011). Electronic nursing documentation as a strategy to improve quality of patient care. Journal of Nursing Scholarship, 43(2). Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=60732670&site=ehost-live

McGongile, D. & Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Bartlett.

Oroviogoioechea, C., Elliott, B. & Watson, R. (2007). Review: Evaluating information systems in nursing. Journal of Clinical Nursing, 17(5). Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=29361277&site=ehost-live

Peled, J. U., Sagher, O., Morrow, J. B., & Dobbie A. E. (2009). Do electronic health records help or hinder medical education? PLoS Med 6(5): e1000069. doi:10.1371/journal.pmed.1000069. Retrieved from: http://www.ebscohost.com

References

Rowley, R. (2011). EHRs and clinical decision support. Retrieved at http://www.practicefusion.com/ehrbloggers/2011/02/ehrs-and-clinical-decision-support.html

Thomson Reuters. (2011). Micromedex 2.0. Retrieved from www.micromedex.com/evidence/

Uptodate Inc. (2011). A unique resource for clinicians and patients. Retrieved from www.uptodate.com/home/about/index.html

(2011). Centers for Medicare & Medicaid Services. Quality measures overview. Retrieved from http://www.cms.gov/QualityMeasures/01_Overview.asp#TopOfPage

(2010). Community Health Centers. Why EHR?. Retrieved from: http://www.chcalliance.org

(2010). Department of Health and Human Services: Centers for Medicare & Medicaid Services. Retrieved at http://edocket.access.gpo.gov/2010/pdf/E9-31217.pdf

(2011). HeathIT. How to Implement EHRs. Retrieved from: http://www.healthit.gov

(2011). US Department of Labor. [Electronic Version]Occupational Outlook Handbook, 2010-11 Edition. Retrieved from: http://www.bls.gov/oco