NURSING INFORMATICS Chapter 6 clinical applications of health informatics

Introduction Healthcare organizations integrate a variety of clinical and administrative types of information systems. These systems collect, process and distribute patient-centered data to aid in managing and providing care. An understanding of how each of these types of systems works within healthcare organizations is fundamental in the study of Nursing Informatics.

CLINICAL INFORMATION SYSTEMS Electronic Health Records (her) system Electronic Health Record (EHR) is data storehouse of information regarding the health status of patients, replacing the former paper-based medical record.

It is the systematic documentation of a client’s health status and healthcare in a secured digital format, meaning that it can be processed, stored, transmitted and accessed by authorized interdisciplinary professionals for the purpose of supporting efficient, high quality healthcare across the client’s healthcare continuum;

Also known as an Electronic Medical Record:  An electronic health or medical record is a computer-based patient medical record that can be used to collect and look up patient data by physicians or health professionals at various locations such as doctor’s offices or hospitals. The record includes information such as patient problems, medications, allergies, laboratory results, etc.

****Advantages of the EHR No more long interpretation of poor penmanship and handwritten orders Reduced turn-around-time for lab results in an emergency department Long wait for the administration of the first dose of antibiotics in an inpatient nursing unit. In the ambulatory care setting evidence of improved management of cardiac related risk factors in patients with diabetes Effective patient notification of medication recalls have been demonstrated

Acuity System Calculates the nursing care requirements for individual patients based on severity of illness, specialized equipment and technology needed, and intensity of nursing interventions; determines the amount of daily nursing care needed for each patient in a nursing unit.

Admission, Discharge and Transfer (ADT) System Provides the backbone structure for the other types of clinical and business systems. It contains the groundwork for the other types of healthcare information systems since it includes:

The patient’s name, medical record number, visit or account number and demographic information such as age, sex, home address and contact information; they are the central source for collecting this type of patient information and communicating it to the other types of healthcare information systems including clinical and business.

Case Management Information System (CMIS) An information system, or group of components that interact to produce information, "designed to facilitate the practice of case management by supporting the information needs of case managers"

Clinical Documentation System 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; 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 information systems (CIS).

Communication System Collection of individual communications networks and transmission systems; in healthcare, it includes call light systems, wireless phones, pagers, email, instant messaging and any other devices or networks that clinicians use to communicate with patients, families, other professionals, internal and external resources.

Computerized Physician Order Entry System (CPOE) A system that automates the way that orders have traditionally been initiated for patients.  Clinicians place orders within these systems instead of traditional handwritten transcription onto paper; provide major safeguards by ensuring that physician orders are legible and complete thereby providing a level of patient safety that was historically missing with paper-based orders. 

These systems provide decision support and automated alert functionality that was previously unavailable with paper-based orders.

Core Business Systems Enhance administrative tasks within healthcare organizations. Unlike clinical information systems whose aim is to provide direct patient care, these systems support the management of healthcare within an organization. Core business systems provide the framework for reimbursement, support of best practices, quality control, and resource allocation.

There are four common core business systems: 1) admission, discharge and transfer (ADT), 2) financial, 3) acuity, and 4) scheduling systems.

Laboratory Information System Report on blood, body fluid and tissue samples along with biological specimens that are collected at the bedside and received in a central laboratory. These systems provide clinicians with reference ranges for tests indicating high, low or normal values in order to make care decisions. Often the laboratory system provides result information directing clinicians towards the next course of action within a treatment regime.

Order Entry System A system that automates the way that orders have traditionally been initiated for patients.  Clinicians place orders within these systems instead of traditional handwritten transcription onto paper; provide major safeguards by ensuring that physician orders are legible and complete thereby providing a level of patient safety that was historically missing with paper-based orders. 

These systems provide decision support and automated alert functionality that was previously unavailable with paper-based orders.

Patient Care Information System (PCIS) Patient-centered information systems focused on collecting data and disseminating information related to direct care.  System of components that make up each of the specialty disciplines within healthcare and their associated patient care information systems. Several of these systems have become mainstream types of systems used in healthcare.  The four systems most commonly found include:

Clinical documentation systems. Pharmacy information systems. Laboratory information systems. Radiology information systems.

Pharmacy Information System Information systems that facilitate the ordering, managing and dispensing of medications for a facility. They also commonly incorporate allergies and  height and weight information for effective medication management; streamline the order entry, dispensing, verification and authorization process for medication administration while they often interface with clinical documentation and order entry systems so that clinicians can order

and document the administration of medications and prescriptions to patients while having the benefits of decision support alerting and interaction checking.

Picture and Archiving Communication System (PACS) Systems that are designed to collect, store and distribute medical images such as computed tomography (CT) scans, magnetic resonance imaging (MRI) and X-rays; replace traditional hard copy films with digital media that is easy to store, retrieve and present to clinicians.

These systems may also be stand-alone systems, separate from the main radiology system, or they can be integrated with radiology information systems (RIS) and computer information systems (CIS). The benefit of RIS and PACS systems is their ability to assist in diagnosing and storing vital patient care support data.

Radiology Information System (RIS) Information systems designed to schedule, result, and store information as it relates to diagnostic radiology procedures.  One common feature found in most radiology systems is a Picture Archiving and Communication System (PACS).  These systems may also be stand-alone systems, separate from the main radiology system, or they can be integrated with RIS and computer information systems (CIS).

These systems collect, store and distribute medical images such as computed tomography (CT) scans, magnetic resonance imaging (MRI) and X-rays.  PACS replace traditional hard copy films with digital media that is easy to store, retrieve and present to clinicians. The benefit of RIS and PACS systems is their ability to assist in diagnosing and storing vital patient care support data.

Scheduling System Designed to coordinate staff, services, equipment, and allocation of patient beds. These systems frequently integrate with the other types of core business systems.  By closely monitoring staff and physical resources, these systems provide data to the financial systems. 

For example, resource-scheduling systems provide information about operating room utilization, and distribution of those resources or availability of intensive care unit beds and regular nursing unit beds. These systems also serve as a great asset to the financial systems when they are used to track medical equipment within a facility.  Procedures and care are planned when the tools and resources are available; help to track resources within a facility while managing the frequency and distribution of those resources.  

Case Management Information Systems (CMIS) Case management information systems (CMIS) identify resources, patterns and variances in care to prevent costly complications related to chronic conditions and enhance the overall outcomes for patients. Once a trend is identified case management systems provide decision support promoting preventative care.

A care plan is a set of care guidelines that outline the course of treatment and the recommended interventions that should be implemented to achieve optimal results. CMIS are especially beneficial for patient populations with a high cost of care and complex health needs such as the elderly or patients with chronic disease conditions.

Case management systems assimilate massive amounts of information obtained over a patient’s lifetime by reaching far beyond the walls of the hospital and track care from one medical visit to the next. Information collected by case management systems is processed in a way that helps to reduce risks, ensures quality, and decrease costs.

Communication Systems Communication systems promote the interaction between healthcare providers and patients. Communication systems have historically been separate from other types of health information systems and from one another. Examples of communication systems include call light systems, wireless phones, pagers, email, and instant messaging, which have traditionally been forms of communication targeted at the clinicians.

Integrating communication systems with clinical applications provides a real-time approach that will facilitate care among the entire healthcare team, patients and their families.

Core Business Systems Core Business Systems enhance administrative tasks within healthcare organizations. Core business systems provide the framework for reimbursement, support of best practices, quality control, and resource allocation. There are four common core business systems: Admission, discharge and transfer (ADT), Financial, Acuity, Scheduling systems.

ADT systems provide the backbone structure for the other types of clinical and business systems. Financial systems manage the expenses and revenue for providing healthcare. Acuity systems monitor the range of patient types within a healthcare organization using specific indicators. Scheduling systems coordinate staff, services, equipment, and allocation of patient beds.

Scheduling systems help to track resources within a facility while managing the frequency and distribution of those resources.

Order Entry Systems Order entry systems are one of the most important systems in use today. These systems automate the way that orders have traditionally been initiated for patients. Order entry systems provide major safeguards by ensuring that physician orders are legible and complete thereby providing a level of patient safety that was historically missing with paper-based orders.

Patient Care Support Systems Most specialty disciplines within healthcare have an associated patient care information system. These patient-centered systems focus on collecting data and disseminating information related to direct care. Clinical Documentation Systems also known as Clinical Information Systems (CIS) are the most commonly used type of patient care support system within healthcare organizations.

Clinical information systems are designed to collect patient data in real time. Pharmacy information systems have also become a mainstream patient care support system. These systems typically allow pharmacists to order, manage and dispense medications for a facility. Laboratory Information Systems were perhaps some of the first systems ever used in healthcare.

Laboratory information systems report on blood, body fluid and tissue samples along with biological specimens that are collected at the bedside and received in a central laboratory. Radiology Information System (RIS) are systems schedule, result, and store information as it relates to diagnostic radiology procedures. The benefit of RIS and PACS systems is their ability to assist in diagnosing and storing vital patient care support data.

Departmental Collaboration and Knowledge/Information Exchange The implementation of systems within healthcare is the responsibility of many people and departments. Knowledge exchange is the product of collaboration when sharing an understanding of information promotes learning from past experiences to make better decisions in the future.

At an administrative level, collaboration among key stakeholders is critical to the success of any project. Collaboration also occurs among the various departments impacted by the system. From collaboration comes the exchange of information and ideas through knowledge sharing. A multidisciplinary approach assures that systems will work in the complex environment of healthcare organizations with diverse and complex patient populations.