Handbook of Informatics for Nurses and Healthcare Professionals

Handbook of Informatics for Nurses and Healthcare Professionals Chapter 5 Health Care Information Systems Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Information System • Use of computer hardware and software to • process data into information Healthcare information system (and hospital information system)—a group of systems used to support and enhance health care Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Types of Information Systems • Clinical information • Administrative systems (CISs) – Directly support care – Individual systems may be stand alone – Goal: data exchange among systems – Indirectly support patient care – Individual systems may stand alone – Goal: data exchange among systems Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Clinical Information Systems (CISs) • • • Nursing Multidisciplinary Monitoring Laboratory Pharmacy Radiology • Emergency • • • department Physician practice management systems Longterm Homecare Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Administrative Systems • • Client management (registration) Financial Payroll Human resources Quality assurance Contract management Risk management systems Materials management Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Nursing Information System (NIS) Supports the use and documentation of nursing activities and provides tools for managing the delivery of nursing care – Access to online databases Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Nursing Information System Advantages • • • Improved access to information Better documentation Improved quality of care Improved productivity and communications Tracking capability Enhanced regulatory compliance Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

NIS Status Despite advantages information systems that are used by all clinicians are seen more commonly Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Documentation • Nursing process—based on traditional • • documents with nursing diagnosis as organizing framework, may use standardized nursing languages Critical pathway—often used for multidisciplinary documentation, may incorporate physician orders Flowsheets, charting by exception Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Standardized Nursing Languages • Provide a common language for all nurses • • • in all locations Important to the development of the electronic health record Measure nursing’s contributions Contribute to the body of nursing knowledge Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Clinical Information Systems Support provider order entry, results retrieval, documentation, evidence-based practice, and decision support across distributed locations and by different disciplines Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Monitoring • Comprised of devices that monitor • temperature, pulse, respirations, blood pressures, oxygen saturation, or other measures automatically feeding the input into a clinical information system Alarms notify caregivers of readings that are outside the range of “normal” Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Order Entry Systems • Orders entered into the computer are • transmitted to the appropriate areas such as the pharmacy, laboratory, radiology, social service Direct entry of orders by the physician, nurse practitioner, physical therapist, or other provider is preferred (CPOE) Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

CPOE • Computerized provider order entry • Initiative by the Institute of Medicine and Leapfrog Group to improve the quality of care and reduce medication errors – Eliminates transcription error – Expedites treatment – Encourages more accurate, complete orders Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Laboratory Information Systems • ↓ Turnaround time, duplicate testing, errors • Can – Alert providers when new or stat tests results are back or values are critical – Send results to clinical system for view – Accept input from bedside devices – Generate labels for specimen collection – Use rules to order additional tests when indicated Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Radiology • Allows direct order entry or accepts orders • • • from other systems Provides scheduling of diagnostic tests Generates client instructions Permits transcription of results Provides picture archiving and transmission of images and tracking of film Generates charges once procedures done Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Pharmacy Information Systems • Provide checks in order and administration • • • process using evidence-based guidelines ↓ Errors when used with bar code technology Use lab results, allergy, and interaction information from clinical systems Track medication use, costs, billing information Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Pharmacy • May include more than one system – In pharmacy dispensing systems (robots) – Unit-based dispensing cabinets in care areas – Barcode and RFID Medication Administration • E-prescribing – Process that allows the physician to enter a prescription which is then electronically sent to the pharmacy from computers, PDAs Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Barcode and RFID Medication Administration • Quality initiative identified by the Leapfrog • Group and the Veterans Administration’s National Center for Patient Safety Uses barcode on the unit-dose medication package and patient bracelet to ensure right patient, right drug, right dose, right time, right route Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

E-prescribing Benefits • Provides a longitudinal prescription record • Checks formulary compliance and • • • reimbursement Provides alerts about drug interactions Generates reminders to order home meds for the discharged client Eliminates phone authorization for refills Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Physician Practice Management Systems • Features include capture of demographic • and insurance data, scheduling, billing, outcome tracking, and report capability May, or may not, connect to hospital electronic patient records or maintain separate patient records Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Home Healthcare • May communicate with hospital systems to • • exchange data Support demands for excessive documentation Improve payment for services because it is easier and quicker to fin information needed for billing Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Longterm Healthcare Systems • Slow to come to this area • Needed for the improved quality of care • • • and efficiency Critical to business survival Integration with other systems needed to best serve patients Can include all features seen in other clinical information systems Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Decision Support and Expert Systems …aid in and strengthen the selection of viable options using the information of an organization to facilitate decision-making and overall efficiency Decision support software organizes information to fit new environments Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Registration Systems • Admission/discharge/transfer(ADT) • • systems Collect and store demographic and insurance data that are verified and updated at the time of each visit Critical to operations to ensure correct patient identification and reimbursement for charges Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Impact of Mobile Computing • Allows access to data at the point of care to facilitate treatment decisions – Test results – Evidence-based practice guidelines • Facilitates documentation at the point of care for improved accuracy Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

Future Directions The adoption and refine of healthcare information systems will continue driven by demands for safety, quality, efficiency, and retention of the workforce Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Copyright © 2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.