chapter 5. clinical information systems ◦ electronic health record/electronic medical record ◦...
TRANSCRIPT
Current and Emerging Use of Clinical Information
SystemsChapter 5
Outline 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
EMR Adoption in Hospitals
Adoption of EHR Meaningful Use of Electronic Health
Records, April 2011 through May 2012.
Electronic Medical Record MRI Five Levels of Computerization
◦ Level 1: Automated Medical Record◦ Level 2: Computerized Medical Record System◦ Level 3: Electronic Medical Record◦ Level 4: Electronic Patient Record◦ Level 5: Electronic Health Record
Five Levels of Computerization (Figure 5.1)
Value of EMR Improved quality, outcomes and safety
◦ Computerized reminders and alerts◦ Improved compliance with practice guidelines◦ Reduction in medical errors
Improved efficiency, productivity, and cost reduction
Value of EMR continued Improved service and satisfaction
◦ Patient satisfaction ◦ User satisfaction◦ Less stress◦ Improved job satisfaction◦ Quality of documentation
Other major types of CIS 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
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.
CPOE
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..)
What is CPOE?
(Wikipedia, 2010)
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
What is CPOE, continued
(Open Clinical, 2006)
Desktop Computer Laptop Computer on Wheels PDA (Personal Digital Assistant) PALM Pilot
CPOE Hardware
Provider Order System Multiple manufacturers• Cerner • McKesson• Eclipsys• Siemens• Quadramed• HMS• Meditech
May be coupled with Clinical Decision Support Systems (CDSS)
CPOE Software
(MedicExchange, 2010)
Offers single solution to automate workflow
Capabilities: Enter orders Check orders Document Communicate Evaluate patient status
Cerner CPOE
(Cerner Corporation, 2010)
Benefits with Cerner: Improve patient safety Save time Save money Enhance communication Reduce errors Easy-to-use
Cerner CPOE, continued
(Cerner Corporation, 2010)
Evaluated with indicators: Ease of use Ease of learning Satisfaction Efficiency of use Error tolerance Fit of system to task
CPOE Usability
(McGonigle, D. & Mastrian, K., 2009)
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
CPOE Usability, continued
(Hess, J., 2010)
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
CPOE System
(Open Clinical, 2006)
Direct entry of orders into EMR Replaces handwritten orders Cross reference for potential drug-
interactions or allergies Reduces wait times for patients Improves compliance with best practices Ready access to patient data
CPOE Advantages
(Open Clinical, 2006)
Improves patient safety Potential to improve efficiency Cost saving benefits by:
Reducing number of duplicate tests Reducing errors
Advantages, continued
(Open Clinical, 2006)
Cost User resistance Personalization for individual hospitals Potential for integration issues with other
systems Disruption of workflow with employee
training
CPOE Disadvantages
(Open Clinical, 2006)
Basic knowledge of computer usage
Three levels of competencies: Technical Utility Leadership
Informatics Competencies
Technical: Web Expert data systems Nursing and Hospital information systems Multimedia Telecommunication devices
Informatics Competencies, continued
(Kaminski, 2009)
Utility: Process of using computers and other
technology
Leadership: Ethical issues with using computers Management issues with using computers
Competencies, continued
(Kaminski, 2009)
Barriers to CPOE use 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?
Medication administration
Use of barcoding becoming more widespread
Aids in correctly identifying patient, drug, dose, etc.
HIMSS implementation guide—good resource
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…
Fitting Pieces Together(Figure 5.9)
Barriers to Adoption Financial (acquisition and support) Organizational or Behavioral (user
acceptance) Technical (need for standards, integration)
Strategies for Overcoming Barriers What strategies are being employed to help
overcome—◦ Financial barriers?◦ Behavioral barriers?◦ Technical barriers?
Summary 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