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Clinical Information Systems

August 17, 2009
By

Healthcare is a complex and highly regulated industry. Until recent years, the industry was dominated by paper—paper records, paper prescriptions, paper charts, paper x-rays, paper supply orders, paper updates to patient records, paper lab test results, etc. Paper is still a big part of healthcare, but the advent of clinical information systems (CIS) has reduced the industry’s dependence on paper substantially and has provided numerous benefits as well.

In this article, I’ll review the breadth of the problem created by too much paperwork. Then, I will demonstrate how information technology, especially CIS, has transformed the industry, made it less paper dependent, and addressed concerns over safety and accuracy.

Patient Information: Anywhere, Anytime

One of the greatest challenges physicians face is obtaining the most complete and accurate patient information at the right time. A person needing medical care might go to the emergency room, a hospital, an outpatient facility or somewhere else if he or she happens to be out of state. A non-digital file can only be at one physical location. Add to that the patient consent forms, legal forms, compliance forms and insurance, and it’s not hard to see how that can present multiple challenges to healthcare providers. The longer the physician doesn’t have the correct information to make a diagnosis, the longer the patient must wait for the appropriate healthcare solution.

Healthcare providers are increasingly turning towards an enterprise-wide CIS that can provide specific medical information whenever and wherever it’s needed. The CIS encapsulate everything from “nursing documentation and physician order entry systems to laboratory and pharmacy systems.” (Rogoski, “Clinical,” 1) This server-based system enables the clinician to access data from home through a Virtual Private Network (VPN) or within any touch point of the health system such as bed-side, off-site, or back office. (Rogoski, “Clinical,” 2)

Effective Care in a More Efficient Workplace

Clinicians don’t just treat patients; they answer telephone calls, check insurance eligibility, order supplies, update patient charts, schedule appointments, reference audit trails for follow up care and hunt down valuable physical file space for patient data storage. The CIS simplifies this task by creating a “single repository” (Rogoski, 2), whereby every component is linked and accessible from virtually any location within the system at any time.

Healthcare facilities that have implemented comprehensive CIS have experienced significant improvements in efficiency, quality of care, cost savings, and security. Regarding enhanced efficiency, Baptist Medical Center South in Jacksonville, Florida, “reduced time from physician order to medication delivery from two hours to 16 minutes.” (All Digital, 2) Somerset Medical Center in Somerset, New Jersey, was able to decrease registration time by 50%, redundant x-ray costs by $104,000 annually, and administrative nursing costs by $1.2M over six months. (HIT, 2)

With more time to treat patients and less time spent tracking down clinical information, even the doctors are happier. Baptist South reports improved employee retention as a result of the CIS-enhanced work environment with “physicians vying to round at the hospital.” (All Digital, 2) By reviewing and accessing patient information at home, they show up fully prepared to see their patients. CIS also improves HIPAA compliance by streamlining the clinician’s time-consuming responsibilities in this process. (Heise) Integration is the key.

It goes without saying that if a doctor has the clinical information faster, he or she can make quicker, more informed decisions. Overall care quality is improved and the risk of medical errors decreases. Margaret Reed, an RN from Altru Health confirms, “It is less likely that patient information will fall through the cracks.” (Rogoski, “Clinical,” 2) One facility dropped chart pull durations, a very time consuming and expensive process, from 20 minutes down to seven. (Rogoski, “Clinical,” 7)

A good CIS also plays a role in forwarding important documents like lab test results, referrals to specialists, and billing instructions, documents that often got misplaced in the past because they changed hands so much. The CIS closes the loop on these issues and others dealing with what’s known as the five rights—right medication, dose, patient, time, and route. (Rogoski, “Banking,” 2)

Enhanced Security and Safety

Enhanced patient data security is an additional advantage of the CIS. Reed’s system at Altru Health prevents physicians from accessing patient data on other physicians’ patients by using a password protection protocol. (Rogoski, “Clinical,” 2) The Baptist South CIS uses a trusted ID and digital time stamping mechanism to track documentation updates and alert security when records have been breached by unauthorized personnel. (All Digital, 2) Other features of the CIS provide safeguards against fraud and identity theft at the facility or pharmacy level.

Protecting the health and safety of patients is in my opinion the most important function of the CIS. Saving time and money is one thing, but protecting human life is pre-eminent. The pharmacy is one place where the advantages of the CIS are highly visible. “More than 7,000 Americans are killed each year through preventable medication errors, most often illegible prescriptions written by physicians.” (Dart) In that same article Newt Gingrich declared, “Paper kills. It is clear that a paper prescription is dangerous.”

To reduce these errors, technology firms have partnered with healthcare entities to form the National ePrescribing Patient Initiative. The initiative has created a website,  www.nationaleRx.com, where physicians can prescribe their medications electronically. The system has features in place that guard against erroneous prescription choices and dosages. (Dart)

Other providers use a CIS with a pharmacy component that has additional patient safety features. Detroit Medical Center, for example, developed a set of “standard orders [they] believe are best practice for a specific disease.” (Rogoski, “Banking,” 2) The company PAR3 offers RFID chips that change the color of the bottle cap when it’s time to take your meds and notifies your doctor if you don’t. (Schwartz) SureScripts’ system is able to suggest alternatives if a drug isn’t covered by insurance and evaluate how multiple drugs will interact with each other. (Schwartz)

Another way to view just how far CIS has impacted healthcare is to visit the high-risk prenatal room of the local hospital. You might find fetal monitors connected to the CIS providing real-time vital signs to the attending OB. Nurses come and go and make notations in a wireless tablet PC, adding detail and continuity to the growing “electronic” patient chart. A paperless audit trail keeps track of who did what and when, and the OB walks across the street for a burger, occasionally checking his own tablet PC for any significant changes, always ready to rush back if necessary. (Rogoski, “Clinical”, 6-7)

Conclusion

The advances in CIS technology have made healthcare delivery safer, more efficient, and more cost effective. Certainly not every hospital or facility has adopted CIS. Those that do will have a distinct competitive advantage in this rapidly changing industry. CIS technology is reliable, secure, and easy to use. It will impact healthcare for many generations to come in ways that stretch the boundaries of our imagination. A nurse at Baptist South said it best … this technology “has encouraged staff to step forward and be part of something new and exciting in the medical world.”

References

  1. Rogoski, Richard R. “Clinical Systems Are a “Go” in Real Life.” Health Management Technology. January 2007. http://www.healthmgttech.com/.
  2. “All Digital Hospital Transforms Patient Care.” Cerner Corporation Case Studies. http://www.cerner.com/public/Cerner_3.asp?id=27400.
  3. “HIT Transforms Community Care.” Cerner Corporation Case Study PDF. http://www.cerner.com/public/search/default.aspx?ip_text=somerset&ip_server=schqryprd.northamerica.cerner.net%3A8500&ip_searchWithin=off.
  4. Heise, Rick (September 2006). “Overcoming Financial Barriers to Healthcare Technology.” Cerner Corporation, PowerWorks in the News PDF. http://www.cerner.com/public/Cerner_2.asp?id=26328.
  5. Rogoski, Richard R. “Banking on Safety: Detroit Medical Center Fast Tracks Adoption of CPOE, EMR and Other Allied Systems.”Health Management Technology November 2006, Vol 27 Iss 11. ABI/INFORM Global. ProQuest. Evans Library, Melbourne, FL. 29 January 2007 <http://www.proquest.com/>
  6. Dart, Bob. “Web site replaces doctors’ scrawl: Online prescription service should cut down on drug errors.” The Atlanta Journal – Constitution. Atlanta, Ga.: Jan 17, 2007.  pg. A.8. ProQuest Newsstand. ProQuest. Evans Library, Melbourne, FL. 29 January 2007 <http://www.proquest.com/>
  7. Schwartz, Ephraim. “Healthcare and IT.” InfoWorld. San Mateo: Dec 4, 2006. Vol. 28, Iss. 49;  pg. 10, 1 pgs. ABI/INFORM Global. ProQuest. Evans Library, Melbourne, FL. 29 January 2007 <http://www.proquest.com/>

Other Links

For our readers who are interested in a career in nursing, OnlineNursePractitionerPrograms.com provides the “Definitive List of Government Nursing Resources on the Web”.  http://onlinenursepractitionerprograms.com/governmental-resources/

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