Current and Emerging Use of Clinical Information Systems

1. Current and Emerging Use of Clinical Information Systems Chapter 5

2. 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

3. Electronic Medical Record Definitions Institute of Medicine Medical Records Institute 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

4. Five Levels of Computerization (Figure 5.1)

5. EMR attributes Longitudinal (institution level vs. across institution) Complete, accurate, timely Available to multiple users Provides decision support capabilities Provides access to knowledge aids Facilitates the care process Improves efficiency and effectiveness

6. Where are we today?

7. Sample Drug Alert Screen(Figure 5.2)

8. Sample EMR Screen (figure 5.3)

9. 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

10. Value of EMR continued Improved service and satisfaction Patient satisfaction User satisfaction Less stress Improved job satisfaction Quality of documentation

11. 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

12. CPOE Driven by need to improve patient safety Automates the ordering process Accepts orders electronically, provides decision support, may aid in diagnosis and treatment

13. Use and Status of CPOE Estimates vary from 3-13%; higher estimates usually indicate that physicians are not direct ordering Many organizations are in planning or early implementation stages Looking to advice from others � Cedars Sinai case

14. 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?

15. 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�

16. Telemedicine Use of telecommunciations for the direct provision of care to patients at a distance Over 200 telemedicine programs in nation Store and forward Two-way interactive TV Funding an issue Cost effectiveness not fully known

17. Telehealth Using telecommunications to communicate with patients and deliver services Email communication Refilling prescriptions Registering patient Scheduling appointments

18. Telehealth Current use of email communication between patients and physicians Value to patients and providers Issues Complexity of infrastructure Degree of integration Message structure Cost Security Reimbursement

19. Fitting Pieces Together(Figure 5.9)

20. Barriers to Adoption Financial (acquisition and support) Organizational or Behavioral (user acceptance) Technical (need for standards, integration)

21. Strategies for Overcoming Barriers What strategies are being employed to help overcome� Financial barriers? Behavioral barriers? Technical barriers?

22. 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