Chapter 3
Electronic Health Information Systems
EIM Team Questions
How do we investigate St. Rita’s applications?
Does St. Rita’s have an application inventory?
Where do we start?
St. Rita’s has hundreds of applications
Narrow scope to most commonly used
Clinical applications
Administrative applications
Clinical information systems
Clinical Information Systems (CIS)
Definition
Information systems dedicated to collecting, storing, manipulating, and making available clinical information important to the delivery of patient care
There is no one specified inventory of a CIS that fits all organizations
Clinical Information Systems (CIS)
CIS benefits
Providing access to organized, complete, and legible patient information in a timely way
Improves patient safety and outcomes
Can reduce costs
Improves operations and efficiency
Anesthesia Information Management System (AIMS)
Purpose and functions
Automate the capture, storage, and presentation of data during the intraoperative period
Functions may include
Electronic history taking
Intraoperative charting including manual input and output from monitoring devices
Decision support capabilities
Automated Patient Identification and Bar Coding
Purpose and functions
Also referred to as bar code point of care (BPOC)
Enables use of bar code technology for identifying any individual or object
Used for medication administration, transfusions, specimen collection and diagnostics, point-of-care testing, and patient charges
Clinical Data Repository (CDR)
Purpose and functions
Consolidates data from different clinical source systems (for example, laboratory, pharmacy, and radiology) within an organization to present a unified view of a single patient’s data
Real-time database that updates data immediately when it is entered by a person, directly from a device, or in another manner
Backbone of the electronic medical record (EMR)
Computerized Physician/Provider Order Entry (CPOE)
Purpose and functions
Allows those with ordering privileges to directly enter medical orders such as medications, tests, and treatment
Routes orders to the appropriate departments and individuals for completion
Includes decision support capabilities such as alerts for drug-drug contraindications, drug overdoses, or patient allergies
Critical Care Information System (CCIS)
Purpose and functions
Provides intensive care units (ICU) with automated documentation for collection, management, and display of patient information
Integrates with monitoring
Decision support capabilities
Dietary Department and Management System
Purpose and functions
Supports patient nutritional assessment and management, processing diet meal orders, cancellations and reorders, menu development, patient menu choice, and meal tracking and delivery
Integrates with other systems such as Registration-Admission, Discharge, Transfer (R-ADT) System
Supports departmental administrative functions
Electronic Document Management Systems (EDM)
Purpose and functions
Often called an EHR bridge technology
Electronically scans paper documents, creating a digital image which can be indexed and stored by the system for retrieval and viewing by end users
May include workflow technology that automatically identifies tasks to be performed for preparing and scanning documents
Emergency Department Information System (EDIS)
Purpose and functions
Provides management and operational tools to improve emergency department (ED) performance
May include patient registration, central visualization screen for patient management, management of patient flow, monitoring patient movement throughout the ED, reporting ED room status, managing requests, and notifications for patient beds and resources
Laboratory Information System (LIS)
Purpose and functions
Support administrative and operational functions of anatomical pathology and clinical laboratory
Provides workflow automation, financial and management reporting, and quality assurance
Supports patient and specimen identification, specimen tracking, results reporting, quality control, and inventory control
Includes instrument interfaces
Medication Administration System (MAS)
Purpose and functions
Supports administration of medication to patients
Uses bar code technology
Provides decision support features checking for patient allergies, drug-drug, and drug-lab interactions
Automatically documents medication administration
Interfaces with CPOE, MPI, and other subsystems
Medication Reconciliation Systems
Purpose and functions
Helps manage the coordination of drugs for a patient across the continuum of care to avoid medication discrepancies
May incorporate e-prescribing systems so post-discharge medications orders are electronically transferred to a pharmacy of the patient’s choice
Monitoring Systems
Purpose and functions
Provide periodic or continuous observation of the patient or physiological functions in guiding decisions of therapeutic interventions
Store patient data, provide data electronically to life-support equipment, perform complex data analysis, and provide noise and text alerts to potentially life-threatening conditions to caregivers
Usually associated with critical care units
Nursing Information System
Purpose and functions
Supports nursing documentation for patient assessment, development of patient care plans, and documenting patient care delivery
May include decision support such as prompts and reminders, guides to disease linkages between signs or symptoms, and access to online medical resources
Usually interface with CPOE and other subsystems
Operating Room Management System
Purpose and functions
Provide coordination of human and material resources during pre-operative, intra-operative, and post-operative phases of care
Support clinical documentation, tracking patient status, staffing management, equipment allocation and tracking, scheduling operating room suites, and coordinating patient flow during perioperative period
Usually interface with other subsystems
Patient Care Pathways
Purpose and functions
Multidisciplinary structured care plans that healthcare professionals use to implement clinical guidelines and protocols for a specific patient group, usually based on diagnosis or surgical procedure
Pharmacy Information System
Purpose and functions
Provide verification work lists allowing pharmacists to review, verify, and fill incoming drug orders
Decision support capabilities for contraindication information
May integrate with automated dispensing stations
Perform administrative functions such as inventory management and stock requisition
Real Time Locator System
Purpose and functions
Identifies, determines, and tracks the location of equipment, materials, and personnel, and in the case of healthcare patients, throughout a building or healthcare complex using wireless technology
Radiology Information System (RIS)
Purpose and functions
Support workflow of departmental functions and communication within and outside the radiology department
Includes patient scheduling, patient tracking, and results reporting, digital transcription
May include materials management, charge capture, and management reporting
Interfaces with other subsystems such as CPOE, MPI
Radiology Picture Archiving and Communication System (PACS)
Purpose and functions
Provides storage and access to images from various modalities such as x-ray computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), mammograms, and digital radiography
Usually integrates with other subsystems such as MPI
Results Reporting, Retrieval, and Management
Purpose and functions
Provides the functionality to retrieve patient data such as laboratory reports and diagnostic studies such as radiology reports
May allow results management which is manipulation of data for graphing or comparison purposes of data from multiple source systems
Administrative information systems
Administrative Information Systems
A suite of applications that support organizational strategic and operational management
Many of these systems could be referred to as dual purpose because they provide support for both administrative and clinical functions
Registration-Admission, Discharge, Transfer (R-ADT) Systems
Purpose and functions
One of the backbone applications of a health information system
Captures patient demographic, insurance, and other administrative data at registration or admission
Tracks a patient when there is an intra-facility transfer from one care area to another and identifies the date and time the physician discharges the patient
Automated Diagnostic Coding
Purpose and functions
Automated tools to help assign diagnostic and procedures codes such as ICD codes
May included a series of edit checks based on classification rules to help ensure that code assignment is correct
Use heuristic logic to assign a diagnostic-related-group (DRG)
May include national language processing to interpret digital reports
Bed Management System
Purpose and functions
Automates the process of assigning a patient to a specific hospital care unit
Includes tracking bed inventory, categorizing bed requests, managing patient queues, and managing environmental services for room preparation
Business Intelligence (BI) Management
Purpose and functions
Collects data from various subsystems, both clinical and administrative, and uses sophisticated analysis programs to analyze performance against key indicators or measures
Used for clinical performance management, financial analysis, cost accounting and budgeting, and process performance management
Data warehouse used for data storage and retrieval
Financial Information Systems
Purpose and functions
An umbrella of financial systems that rely on data from both clinical and administrative information systems
Includes patient and payer billing, claims management, accounts payable and receivable, collection monitoring, staff scheduling, budgeting, accounting, revenue cycle management, and facility maintenance
Inpatient Scheduling Systems
Purpose and functions
Support care coordination and manage inpatient scheduling for diagnostic exams, tests, and treatments
Sometimes referred to as inpatient flow management systems
Master Patient Index
Purpose and functions
Automatically assigns a unique patient identifier (medical or health record number) to a patient and is a permanent identifier for each patient who receives services at a healthcare facility
Contains a subset of information that identifies the patient such as name, date of birth, gender, and address, and is considered the “ system of record” for patient identification
Master Patient Index (MPI)
Purpose and functions
The unique identifier maps to other source systems and is a key to identifying data about a patient’s multiple hospitalizations or encounters
When an MPI is developed for an entire enterprise that has multiple facilities or groups, it is usually referred to an enterprise master patient index (EMPI)
Example of MPI Screen
Record Completion Management System
Purpose and functions
Automates managing workflow for documentation deficiency analysis, routing deficiency notices to the correct clinician for completion, and tracking record deficiencies and their completion
Data from the system supports administrative analysis of record deficiencies and workflow
Request for and Release of Health Information Management System
Purpose and functions
Supports the capture of data that tracks disclosure of health information and monitors and tracks requests from patients for their own information
May integrate with a document management system so scanned copies of requests and other correspondence can be captured and stored within the system
Workforce Management System
Purpose and functions
Support staffing needs assessments and workforce balance, capacity planning, and clinical staff scheduling
Generates various administrative reports to determine future appropriate staffing levels
System interoperability
Interoperability
Definition
The ability of different information technology systems to exchange data with each other and to use that data
Difference between data exchange and interoperability
Essential for EHRs and HIEs
Levels of Interoperability
Foundational interoperability
Lowest level of interoperability
Allows one system to exchange data with another
The target system cannot interpret the data
Levels of Interoperability
Structural interoperability
Intermediate level of interoperability
Allows one system to exchange data with another system in a common data format and structure
Retains the identification of the data
Levels of Interoperability
Semantic interoperability
Highest level of interoperability
Exchanges data in standard format and preserves its meaning by adding metadata and linking each data element to a controlled vocabulary
Allows target system to interpret and use the exchanged data
Computer Interfaces
Specialized software that allows computer systems to communicate with each other
Required to achieve interoperability
Point-to-point interface development
Interface engine
Computer Networks
A communication network consisting of
A transmitter that sends data,
A receiver that receives data, and
A medium that connects the transmitter and receiver and provides the pathway for the transmission of the data
Essential for interoperability
Computer Networks
Network computers
Client computer accesses shared resources
Server computer provides a variety of shared resources
Computer Networks
Network types
Bus topology
Star topology
Ring topology
Mesh topology
St. rita’s EIM team Conclusions and Next Steps
EIM Team Conclusions
The variety of clinical and administrative applications required for organization operations makes management of these complex
There is interdependency among clinical and administrative applications
Lack of standards makes interoperability among systems difficult
An inventory of applications should be a top priority for St. Rita’s
EIM Team Next Steps
Armed with knowledge about the history of information systems development in healthcare and an understanding of the clinical and administrative applications that make these systems, the team is ready to explore the components and what constitutes an EIM program.
