1. Next Generation Clinical Systems: Is It Time to Jump?
Elaine Remmlinger
Principal and National Service Director
Kurt Salmon Associates
New York, NY
Stacy Melvin
Consultant

2. CIS Development
No longitudinal history—information was retained for the current episode only and purged at final billing leaving little in the way of an easily accessible historical patient record.
Character-based screens—the user interface was unfriendly and oriented to data entry, not clinical
functionality.
Point to point interfaces—there were few interfaces other then laboratory and possibly radiology.
Interfaces were custom developed for each situation and required significant maintenance.
No clinical depth—for the most part, systems were really not clinically oriented at all. The focus was
on charge capture with orders, order status, charges, limited results, and little clinical information.
Not physician oriented—physicians did not use these systems, except in selected academic medical centers that required residents to perform order entry.
No alerts or reminders—clinical decision support was largely non-existent; few systems had the ability to check for duplicates.

3. Impetus for next generation systems
Major technology breakthroughs and medical science innovation.
The Internet, which enables providers and patients to instantly connect to volumes of information,
including reference materials and test results, has provided opportunities to alter the processes
involved in providing health care significantly.
The Institute of Medicine Reports that focus on the use of clinical information systems and the
CPR to reduce preventable adverse events; improve coordination and communication in the treatment
of chronic illnesses; and improve the overall effectiveness, timeliness, efficiency, and quality
of care.
Leapfrog Group Initiatives, which recognize and reward health care providers for major advances
in protecting patients from preventable medical errors and has put forth the use of Computer
Physician Order Entry (CPOE) as one of its benchmarks.
Development of coalitions with representation from agencies with responsibility for licensure
and oversight interested in patient safety and CPOE
Adoption of patient safety program mandate by JCAHO
Passage of state legislation mandating “patient safety programs” that may include CPOE and
advanced clinical information systems beginning (e.g., CA)
Consumerism, which hinges on the expectations of an informed public with increased expectations regarding patient safety, availability of information, ease of access, and outcomes.

4. The Future Vision

5. The Next Generation Fully replace the paper-based chart
Contain patient-centric health status information over time
Integrate multi-media information from multiple sources
Facilitate timely, accurate, and comprehensive communication of clinical information throughout the continuum of care
Meet clinical, legal, and administrative requirements
Provide ready access to clinical knowledge bases and decision support tools
Enhance the quality, productivity, and efficiency of the organization
Reduce medical errors through the use of clinical decision support and Computer Physician
Order Entry
Ensure confidentiality and integrity of patient information
Appear seamless and user-friendly to end-users.

6. See Appendix for additional slides explaining the model.
CDO - clinical delivery organization
CPOE - Computerized provider order entry
CDSS - Clinical decision support systems
IM COUNCIL Dec 8, 2008

7. Vendor marektplace
Historically, CIS products focused on the inpatient environment and ambulatory function was not integrated with these inpatient systems.
Vendor consolidations continue, but products are still not integrated.
Larger “core” clinical information systems often do not provide adequate functionality for specific departments (e.g., Emergency Department, cardiac services, oncology, etc.)
Mature, outdated legacy products continue to be supported, giving many health care organizations less incentive to move to newer platforms
The proliferation of e-Health products with many dot.com failures leaves vendors and providers
unsure of what direction to take even though the functionality available through e-Health is desirable.

8. Focus on caregiver utilization

9. Potential Benefits and Advanced Clinical Information Systems

10. Barriers Financial: acquisition, implementation and maintenance costs
Cultural – resistance to change
Product status – no one fits all

11. Potential CIS strategies

12. The organizational impact of implementing any system must also be considered:
What changes in workflow will be required?
How should the facility be designed to optimize workflow (e.g., device placement) and encourage use of clinical information systems?
What policy and procedure changes will result?
What is the Total Cost of Ownership of alternative strategies?
What are the potential benefits?
How do alternative strategies impact relationships with affiliates?
What are the resource requirements for implementation/conversion by strategy?

13. Due Dilligence

14. Drivers for the future Paperless Clinical Environment
Filmless: Picture Archive and Communication System (PACS)
Patient Access to Information
Client Services Integration: Direct patient access via the Internet and other sources to scheduling
Telehealth: Specialty care available to rural or remote areas and homebound individuals