Presentation on theme: "Current and Emerging Use of Clinical Information Systems"— Presentation transcript:
1 Current and Emerging Use of Clinical Information Systems Chapter 5
2 Outline Clinical Information Systems Definition and Functions Electronic health record/Electronic medical recordComputerized provider order entryMedication AdministrationTelehealth and TelemedicineDefinition and FunctionsCurrent Use of SystemsFactors Influencing AdoptionValue of SystemsBarriers to Diffusion
10 Electronic Medical Record MRI Five Levels of ComputerizationLevel 1: Automated Medical RecordLevel 2: Computerized Medical Record SystemLevel 3: Electronic Medical RecordLevel 4: Electronic Patient RecordLevel 5: Electronic Health Record
13 Value of EMR Improved quality, outcomes and safety Computerized reminders and alertsImproved compliance with practice guidelinesReduction in medical errorsImproved efficiency, productivity, and cost reduction
14 Value of EMR continued Improved service and satisfaction Patient satisfactionUser satisfactionLess stressImproved job satisfactionQuality of documentation
15 Other major types of CIS Computerized provider order entry (CPOE)Medication administration using barcodingTelemedicineTelehealth—for our purposes, we will focus on online communication (e.g. ) between patients and providers
16 CPOEComputerized Provider Order Entry, at its most basic level, is a computer application that accepts physicians orders electronically, replacing handwritten or verbal orders and prescriptions. Most CPOE systems provide physicians with decision-support capabilities at the point of ordering.
17 What is CPOE?Electronic entry of physician orders and instructions for treatmentOrder entry at point-of-care or off siteCommunication over a network to medical staffIntegration of various departments (radiology, laboratory, etc..)A trend that is being implemented and used in hospitals and facilities in increasing numbers today. It is the process of entering orders and treatment instructions by the physician for patients under their care. It can be done in the hospital or facility in which the patient is admitted but also provides the ability for MD’s to enter orders off site in places such as their home. It links the various departments of the hospital when orders are entered, such as triggering the lab about lab work that was ordered and radiology departments on tests ordered and schedule times. In a sense the department responsible for filling or carrying out the order that was entered is informed via the computer network.(Wikipedia, 2010)
18 What is CPOE, continued Replacer of hand-written orders Immediate alerting of allergies or contraindications at point of entryReal-time clinical decision supportSupports access to patient dataCPOE eliminates the need for hand-written orders. As an order is entered in to the system, allergies or possible contraindications for the patient are immediately alerted to the physician before final submission. The real-time support also provides duplicate therapy warnings, alternate dosage and/or alternate medication suggestions. Allows the physician access to patient data and assessment information potentially needed for the decision making.(Open Clinical, 2006)
19 CPOE Hardware Desktop Computer Laptop Computer on Wheels PDA (Personal Digital Assistant)PALM PilotCPOE software can be placed and utilized on many different types of hardware. Typically placed on desktop computers for use. It can also be utilized mobilely on laptops and PDA’s or PALM handheld computers.
20 CPOE Software Provider Order System Multiple manufacturersCernerMcKessonEclipsysSiemensQuadramedHMSMeditechMay be coupled with Clinical Decision Support Systems (CDSS)Many companies manufacture types of Computer Provider Order Entry systems. Most CPOE systems are combined with Clinical Decision Support Systems that reduce errors and decrease costs.(MedicExchange, 2010)
21 Cerner CPOE Offers single solution to automate workflow Capabilities: Enter ordersCheck ordersDocumentCommunicateEvaluate patient status(Cerner Corporation, 2010)
22 Cerner CPOE, continued Benefits with Cerner: Improve patient safety Save timeSave moneyEnhance communicationReduce errorsEasy-to-use(Cerner Corporation, 2010)
23 CPOE Usability Evaluated with indicators: Ease of use Ease of learning SatisfactionEfficiency of useError toleranceFit of system to task(McGonigle, D. & Mastrian, K., 2009)
24 CPOE Usability, continued Most often implemented in large academic medical centers25-27% of U.S. hospitals over 200 beds using CPOE11.3% of U.S. hospitals actively using CPOE (physicians entering >50% of orders)Currently 291 hospitals that use CPOE at the 100% levelMost CPOE sites also using barcode scanning(Hess, J., 2010)
25 CPOE System Ensures standardized and complete orders Increases patient safety by reducing errorsAutomates workflowSupports ready access to patient data and assessmentImproves efficiency by integrating multiple departmentsProvides order sets for easier use(Open Clinical, 2006)
26 CPOE Advantages Direct entry of orders into EMR Replaces handwritten ordersCross reference for potential drug- interactions or allergiesReduces wait times for patientsImproves compliance with best practicesReady access to patient dataCPOE has more documented advantages than disadvantages. CPOE allows for many positive results not only for the staff that utilize it but patients as well.(Open Clinical, 2006)
27 Advantages, continued Improves patient safety Potential to improve efficiencyCost saving benefits by:Reducing number of duplicate testsReducing errors(Open Clinical, 2006)
28 CPOE Disadvantages Cost User resistance Personalization for individual hospitalsPotential for integration issues with other systemsDisruption of workflow with employee trainingCPOE is expensive to implement and maintain.(Open Clinical, 2006)
29 Informatics Competencies Basic knowledge of computer usageThree levels of competencies:TechnicalUtilityLeadership
30 Informatics Competencies, continued Technical:WebExpert data systemsNursing and Hospital information systemsMultimediaTelecommunication devices(Kaminski, 2009)
31 Competencies, continued Utility:Process of using computers and other technologyLeadership:Ethical issues with using computersManagement issues with using computers(Kaminski, 2009)
33 Barriers to CPOE use Physician entry an issue Takes longer to place order; many systems are ‘cumbersome’, take too many stepsIncentives may not be aligned with useLack of confidence in system reliabilityInsufficient trainingMandating use – should you?
34 Medication administration Use of barcoding becoming more widespreadAids in correctly identifying patient, drug, dose, etc.HIMSS implementation guide—good resourceMore widely acceptedHas been used successfully by many health care organizationsAgain, has potential to aid in making sure the right meds, get to the right patient, at the right dose…
36 Barriers to Adoption Financial (acquisition and support) Organizational or Behavioral (user acceptance)Technical (need for standards, integration)
37 Strategies for Overcoming Barriers What strategies are being employed to help overcome—Financial barriers?Behavioral barriers?Technical barriers?
38 SummaryExamined 5 different clinical information systems—their current use, status, and valueDiscussed the three major barriers to adoption of these systems—financial, behavioral and technical and strategies to overcome them