Transcript Slide 1

Chapter 5
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Clinical Information Systems
◦ Electronic health record/Electronic
medical record
◦ Computerized provider order entry
◦ Medication Administration
◦ Telehealth and Telemedicine
Definition and Functions
Current Use of Systems
Factors Influencing Adoption
Value of Systems
Barriers to Diffusion
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Meaningful Use of Electronic Health Records,
April 2011 through May 2012.
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MRI Five Levels of Computerization
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Level
Level
Level
Level
Level
1:
2:
3:
4:
5:
Automated Medical Record
Computerized Medical Record System
Electronic Medical Record
Electronic Patient Record
Electronic Health Record
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Improved quality, outcomes and safety
◦ Computerized reminders and alerts
◦ Improved compliance with practice guidelines
◦ Reduction in medical errors
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Improved efficiency, productivity, and cost
reduction
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Improved service and satisfaction
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Patient satisfaction
User satisfaction
Less stress
Improved job satisfaction
Quality of documentation
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Computerized provider order entry (CPOE)
Medication administration using barcoding
Telemedicine
Telehealth—for our purposes, we will focus
on online communication (e.g. email)
between patients and providers
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Computerized 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.
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Electronic entry of physician orders and
instructions for treatment
Order entry at point-of-care or off site
Communication over a network to medical
staff
Integration of various departments
(radiology, laboratory, etc..)
(Wikipedia, 2010)
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Replacer of hand-written orders
Immediate alerting of allergies or
contraindications at point of entry
Real-time clinical decision support
Supports access to patient data
(Open Clinical, 2006)
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Desktop Computer
Laptop
Computer on Wheels
PDA (Personal Digital Assistant)
PALM Pilot
Provider Order System
 Multiple manufacturers
• Cerner
• McKesson
• Eclipsys
• Siemens
• Quadramed
• HMS
• Meditech
 May be coupled with Clinical Decision Support
Systems (CDSS)
(MedicExchange, 2010)
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Offers single solution to automate workflow
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Capabilities:
 Enter orders
 Check orders
 Document
 Communicate
 Evaluate patient status
(Cerner Corporation, 2010)
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Benefits with Cerner:
 Improve patient safety
 Save time
 Save money
 Enhance communication
 Reduce errors
 Easy-to-use
(Cerner Corporation, 2010)
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Evaluated with indicators:
 Ease of use
 Ease of learning
 Satisfaction
 Efficiency of use
 Error tolerance
 Fit of system to task
(McGonigle, D. & Mastrian, K., 2009)
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Most often implemented in large academic
medical centers
 25-27% of U.S. hospitals over 200 beds using
CPOE
 11.3% of U.S. hospitals actively using CPOE
(physicians entering >50% of orders)
 Currently 291 hospitals that use CPOE at the
100% level
 Most CPOE sites also using barcode scanning
(Hess, J., 2010)
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Ensures standardized and complete orders
Increases patient safety by reducing errors
Automates workflow
Supports ready access to patient data and
assessment
Improves efficiency by integrating multiple
departments
Provides order sets for easier use
(Open Clinical, 2006)
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Direct entry of orders into EMR
Replaces handwritten orders
Cross reference for potential druginteractions or allergies
Reduces wait times for patients
Improves compliance with best practices
Ready access to patient data
(Open Clinical, 2006)
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Improves patient safety
Potential to improve efficiency
Cost saving benefits by:
 Reducing number of duplicate tests
 Reducing errors
(Open Clinical, 2006)
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Cost
User resistance
Personalization for individual hospitals
Potential for integration issues with other
systems
Disruption of workflow with employee
training
(Open Clinical, 2006)
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Basic knowledge of computer usage
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Three levels of competencies:
 Technical
 Utility
 Leadership
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Technical:
 Web
 Expert data systems
 Nursing and Hospital information systems
 Multimedia
 Telecommunication devices
(Kaminski, 2009)
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Utility:
 Process of using computers and other technology
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Leadership:
 Ethical issues with using computers
 Management issues with using computers
(Kaminski, 2009)
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Physician entry an issue
Takes longer to place order; many systems
are ‘cumbersome’, take too many steps
Incentives may not be aligned with use
Lack of confidence in system reliability
Insufficient training
Mandating use – should you?
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Use of barcoding
becoming more
widespread
Aids in correctly
identifying patient,
drug, dose, etc.
HIMSS implementation
guide—good resource
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More widely
accepted
Has been used
successfully by
many health care
organizations
Again, has potential
to aid in making
sure the right meds,
get to the right
patient, at the right
dose…
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Financial (acquisition and support)
Organizational or Behavioral (user
acceptance)
Technical (need for standards, integration)
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What strategies are being employed to help
overcome—
◦ Financial barriers?
◦ Behavioral barriers?
◦ Technical barriers?
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Examined 5 different clinical information
systems—their current use, status, and value
Discussed the three major barriers to
adoption of these systems—financial,
behavioral and technical and strategies to
overcome them