Utility of a Clinical Information System

Clinical Information System (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 inter-disciplinary clinicians navigating the continuum of client care

Clinical Information System (CIS)

• designed to collect patient data in real time to enhance care by providing data at the clinician's fingertips and enabling decision making where it needs to occur, at the bedside

• also known as clinical documentation systems.

Overview

• A clinical information system (CIS) is a technology based system that is applied at the point of care and is designed to support the acquisition and processing of information as well as providing storage and processing capabilities.

• Early CISs were limited in scope and provided information such as laboratory results, or medication administration and drug interaction information.

Overview

• Paying attention to the Human-Computer Interface elements of the system is essential.

• Adequate testing prior to implementation can prevent problems for users.

• Inadequate testing can result in a negative attitude and a lack of trust in the system.

Overview

• One glitch that remains with many CISs is the quality of the printed document generated by the system.

• Since the systems are designed for “virtual use” their display when printed can produce volumes of paper that is difficult to follow.

Clinical Outcomes and Quality Assurance

Supported by the CIS

• The ability to measure outcomes can be enhanced or impeded by the way an information system is designed and used.

• Integrating standardized nursing terminologies into computerized nursing documentation systems enhances the ability to use the data for reporting and further research.

Clinical Outcomes and Quality Assurance

Supported by the CIS

• The ability to refine the CIS to create different reports and displays based on the need of the user is very helpful.

• With the implementation of a comprehensive CIS, similar analyses of nursing outcomes could also be performed and shared.

Clinical Outcomes and Quality Assurance

Supported by the CIS

• Quality assurance (QA) in the electronic world deals not only with quality indicators in regards to the care provided but also applies to the way the information is captured, displayed and reported.

• Making sure that the system design and linking are done so that the discrete data elements are easy to identify whether the data is reviewed on-line or being used for research, measurement is now important.

Evidence Based Practice and the

CIS• Evidence Based Practice (EBP) can be thought

of as the integration of clinical expertise and best practices based on systematic research to enhance decision-making and improve patient care.

• EBP should be imbedded in computerized documentation of a CIS, providing both prompts for interventions and/or different questions based on the charted assessment.

Evidence Based Practice and the

CIS• References supporting EBP should be available

for review at the click of a mouse or a few keystrokes.

• Preparing staff involved in bedside care to effectively communicate what they are doing can be a challenge.

• Some institutions rely on standardized clinical practice guidelines that can be modified for application to individual patients.

Evidence Based Practice and the

CIS• In order to incorporate EBP into the

practice of clinical nursing the information needs to be imbedded in the computerized documentation system so that it is part of the workflow.

• Balancing a consistency in formatting with creativity can be difficult, but worth the effort to stimulate an atmosphere for learning.

Evidence Based Practice and the

CIS• EBP is supported by translational

research. • The use of translational research to

support EBP may help to close the gap between what we know (research) and what we do (practice).

The CIS as a Staff Development Tool

• Joy Hilty, RN from Kaweah Delta came up with a creative way to provide staff education, without taking staff away from the bedside to a classroom setting.

• She created “pop-up boxes: on the opening charting screens for all staff who chart on the computer.

The CIS as a Staff Development Tool

• The ‘pop-up box education format has encouraged staff to share the “answers”, thus creating interaction, dissemination of information and reinforcement of the education provided.

• This same logic can be utilized to reinforce new standards of care based on current evidence.

The CIS as a Staff Development Tool• Embedding EBP into nursing documentation

can also increase the compliance with Joint Commission Core measures, such as providing information on Influenza and Pneumovac vaccinations to at-risk patients.

• Creating an environment that encourages and expects professional development and learning needs to be a consistent expectation across all levels of an organization.

The CIS as a Staff Development Tool

• By imbedding a standard language into the computerized documentation, the data can be used for instruction, as well as facilitating the sharing of information for research.

• Many institutions have implemented Nursing Practice Councils that use the information generated by the CIS to design clinical education programs.

Summary• The clinical information system (CIS) is a

technology based system that is applied at the point of care and is designed to support the acquisition and processing of information as well as providing storage and processing capabilities.

• CISs are becoming more robust in and assuming increasing roles in the healthcare delivery system.

Thought Provoking Questions

1. You have been asked to prioritize the requirements of a clinical documentation system. It has already been determined that ease, usability and dependability are priorities, what else would you include in the system requirements?

Thought Provoking Questions

2. You have been asked to design a test scenario for a new CIS. What are some of the details you would test? Who would you involve?

3. You are asked about a diagnosis that you are unfamiliar with. Where would you start looking for information? How would you determine the validity of the information?