The CIS-Clinical Information System

Ronnie Breig, Kassidi Bremer, Anna Hicks, Marcia Howard & Reynel Walden

Southwest Baptist University

• Ronnie Breig—introduction, overview, reference pages

• Kassidi Bremer—EHR component

• Anna Hicks—safety & cost

• Marcia Howard—clinical decision making & conclusion

• Reynel Walden—education

Putting it all together…

What is the CIS? • “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.

“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!  

Why a CIS? 

• 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).

Who should be involved in picking a  CIS?

• 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!

Other Key Players 

• Health Information and Data• Results Management• Order Entry Management• Decision Support• Electronic Communication and Connectivity• Patient Support• Administrative Processes• Reporting and Population Health management

 

 Electronic Health Records 

Components

Who can access?

• Health Care team• Organizations monitoring reports of

specific diseases• Administrative persons (i.e. billing and

claims)• Laboratory, radiology, etc. within the

hospital

• 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

Benefits of a CIS

 • 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

Clinical Decision Making

“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.)

Decision Making cont...

 

• Computerized alerts and reminderso Medications due, patient has an allergy, K+ level

• Clinical guidelineso Best practice for prevention of skin breakdown

• Online information retrievalo CINAHL, drug information

• Clinical order sets and protocols

• Online access to organizational policies and procedures

 

Decision Making Tools

• 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

Various Vendors and EHR systems 

• Health clinicians (users) can access information o username and password (policies include changing

password every 30 or 60 days)o ID cardso 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)

Securing Information and Network Security

• 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)

Securing Information and Network Security cont.

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.

HIPAA

• 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)

HIPAA cont…

• 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.

Cost

• “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!

Cost cont…

“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).

Cost cont...

"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).

Educational Tools

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

 

Education cont..

 Team from clinical specialty areas and support service. 

• Healthcare Cliniciano 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. 

Who should be doing the education? 

   • 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? 

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).

Conclusion

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.

References

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.

References

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=4yD8dvr2sQnrC6NyN6TJbbplvTU&hl=en&ei=30O-TK_mKIWZnAfR1vSwAg&sa=X&oi=book_result&c

References

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/ permanentejournal/springo2/landscape.html

References