1. Handbook of Informatics for Nurses and Healthcare Professionals Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Chapter 5 Health Care Information Systems

2. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Information System Use of computer hardware and software to process data into information Healthcare information system (and hospital information system)—a group of systems used to support and enhance health care

3. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Types of Information Systems Clinical information systems (CISs) –Directly support care –Individual systems may be stand alone –Goal: data exchange among systems Administrative systems –Indirectly support patient care –Individual systems may stand alone –Goal: data exchange among systems

4. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Clinical Information Systems (CISs) Nursing Multidisciplinary Monitoring Laboratory Pharmacy Radiology Emergency department Physician practice management systems Longterm Homecare

5. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Administrative Systems Client management (registration) Financial Payroll Human resources Quality assurance Contract management Risk management systems Materials management

6. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Nursing Information System (NIS) Supports the use and documentation of nursing activities and provides tools for managing the delivery of nursing care –Access to online databases

7. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Nursing Information System Advantages Improved access to information Better documentation Improved quality of care Improved productivity and communications Tracking capability Enhanced regulatory compliance

8. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Despite advantages information systems that are used by all clinicians are seen more commonly NIS Status

9. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Documentation Nursing process—based on traditional documents with nursing diagnosis as organizing framework, may use standardized nursing languages Critical pathway—often used for multidisciplinary documentation, may incorporate physician orders Flowsheets, charting by exception

10. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Standardized Nursing Languages Provide a common language for all nurses in all locations Important to the development of the electronic health record Measure nursing’s contributions Contribute to the body of nursing knowledge

11. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Clinical Information Systems Support provider order entry, results retrieval, documentation, evidence-based practice, and decision support across distributed locations and by different disciplines

12. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Monitoring Comprised of devices that monitor temperature, pulse, respirations, blood pressures, oxygen saturation, or other measures automatically feeding the input into a clinical information system Alarms notify caregivers of readings that are outside the range of “normal”

13. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Order Entry Systems Orders entered into the computer are transmitted to the appropriate areas such as the pharmacy, laboratory, radiology, social service Direct entry of orders by the physician, nurse practitioner, physical therapist, or other provider is preferred (CPOE)

14. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar CPOE Computerized provider order entry Initiative by the Institute of Medicine and Leapfrog Group to improve the quality of care and reduce medication errors –Eliminates transcription error –Expedites treatment –Encourages more accurate, complete orders

15. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Laboratory Information Systems ↓ Turnaround time, duplicate testing, errors Can –Alert providers when new or stat tests results are back or values are critical –Send results to clinical system for view –Accept input from bedside devices –Generate labels for specimen collection –Use rules to order additional tests when indicated

16. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Radiology Allows direct order entry or accepts orders from other systems Provides scheduling of diagnostic tests Generates client instructions Permits transcription of results Provides picture archiving and transmission of images and tracking of film Generates charges once procedures done

17. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Pharmacy Information Systems Provide checks in order and administration process using evidence-based guidelines ↓ Errors when used with bar code technology Use lab results, allergy, and interaction information from clinical systems Track medication use, costs, billing information

18. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Pharmacy May include more than one system –In pharmacy dispensing systems (robots) –Unit-based dispensing cabinets in care areas –Barcode and RFID Medication Administration E-prescribing –Process that allows the physician to enter a prescription which is then electronically sent to the pharmacy from computers, PDAs

19. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Barcode and RFID Medication Administration Quality initiative identified by the Leapfrog Group and the Veterans Administration’s National Center for Patient Safety Uses barcode on the unit-dose medication package and patient bracelet to ensure right patient, right drug, right dose, right time, right route

20. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar E-prescribing Benefits Provides a longitudinal prescription record Checks formulary compliance and reimbursement Provides alerts about drug interactions Generates reminders to order home meds for the discharged client Eliminates phone authorization for refills

21. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Physician Practice Management Systems Features include capture of demographic and insurance data, scheduling, billing, outcome tracking, and report capability May, or may not, connect to hospital electronic patient records or maintain separate patient records

22. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Home Healthcare May communicate with hospital systems to exchange data Support demands for excessive documentation Improve payment for services because it is easier and quicker to fin information needed for billing

23. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Longterm Healthcare Systems Slow to come to this area Needed for the improved quality of care and efficiency Critical to business survival Integration with other systems needed to best serve patients Can include all features seen in other clinical information systems

24. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Decision Support and Expert Systems …aid in and strengthen the selection of viable options using the information of an organization to facilitate decision-making and overall efficiency Decision support software organizes information to fit new environments

25. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Registration Systems Admission/discharge/transfer(ADT) systems Collect and store demographic and insurance data that are verified and updated at the time of each visit Critical to operations to ensure correct patient identification and reimbursement for charges

26. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Impact of Mobile Computing Allows access to data at the point of care to facilitate treatment decisions –Test results –Evidence-based practice guidelines Facilitates documentation at the point of care for improved accuracy

27. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Future Directions The adoption and refine of healthcare information systems will continue driven by demands for safety, quality, efficiency, and retention of the workforce