
Clinical Information Systems



CIS is the means to an end Jon Elion, Chartwise Systems

Whether selecting and adapting an inpatient or an outpatient clinical in

information system, a little homework c

ease the pains of adoption:

can go a long way towards helping to e

• Start by carefully defining your c

current information environment, fol- lo

lowed by a complete description of the

functionality that you want (now and in the future). List all systems that create information and all stakeholders that use it. Then you can start looking at vendors, making sure that their systems meet your scenario.

• As you move to the all-electronic medical record, decide how you will handle the components that are still paper based.

• Decided if (and how) you need to migrate or access legacy data.

• Defi ne the interfacing and data needs of each external component in the system, remembering that there are several possible strategies: Standalone (no integration); fi le-based uploads of patient demographics information; data delivered by HL7 messages; unstructured data (for example, displayable reports) returned via HL7 or other means; structured data returned via HL7; and direct ap- plication integration (patient-synchronized applications, portal-savvy applets, direct application plug-ins).

• Identify the information that needs to fl ow between the inpatient and outpatient settings and how that will hap- pen. This includes connectivity with referring physicians and acquiring data from outside testing facilities. Do not count on the CIS to magically give you the desired information and workfl ow; it is just a means to the end. Identify thoroughly where you are headed, then make sure that the software will get you there.

Must engage clinicians in selection process

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Steve Claypool, M.D., VP of clinical development and informatics, Wolters Kluwer Health

When deploying clinical information systems, the best way to minimize pain is through early clinician engagement. Understanding how these technologies will impact clinical workfl ows, as well

as any expectations and concerns that may affect users’ will- ingness to adopt, is crucial to developing a comprehensive plan that minimizes disruptions and maximizes satisfaction. This process will also uncover any gaps that must be fi lled before the new system can meet administrative objectives and clinical expectations. For example, it is imperative that a suffi cient number

14 September 2011

In the midst of implementation, it pays to connect devices Dave Dyell, CEO and founder, iSirona Implementing a new clinical in- formation system (CIS) is a large undertaking. In fact, as Johns Hopkins Medicine stands at the precipice of such an endeavor, it plans to hire more than 60 new strategic positions to en- sure a smooth implementation. True, every hospital is unique; no two implementa- tions are exactly alike. But any hospital in the midst of a CIS implementation has an incredible opportunity for a quick win that delivers immediate results: device connectivity.

Device connectivity automates, or channels, medical de- vice data directly into the CIS or electronic medical record (EMR). The result is a more robust, or “meaningful,” EMR. That said, meaningful-use dollars go a long way in improving the ROI on the CIS investment. Federal monies aside, it still pays to bring devices online.

For one, nursing documentation responsibilities are greatly reduced when hospitals automate data fl ows. This gives clini- cians more time to deliver direct care. Similarly, data accuracy improves with device connectiv-

ity, as human transcription is inherently problematic; it’s also quite slow. Automation solidifi es the data chain, leading to timely, accurate data in the EMR.

Because automation funnels patient data to the EMR

faster, clinicians (as well as clinical decision-support systems and next-generation alarm-management systems) have access to more up-to-date patient information. This, in turn, leads to better patient care.

In short, if you’re already under the hood implementing a new CIS, it pays to integrate the devices that will, ultimately, populate your system.

of evidence-based order sets be available within a CPOE system at go-live or physicians will likely fi nd it to be too cumbersome. Thus, it is important that a sizable order-set library be built and integrated with CPOE in a timely manner. This gap can typically be closed by investing in an electronic order-set solution to accelerate authoring and integration. A revamp of processes governing order-set development may also be necessary. Keeping pain to a minimum also requires engaging clini- cians in the evaluation and selection process. Encourage their participation in vendor demonstrations and solicit input – positive and negative – on the features and functionality of each system. While it likely isn’t feasible to have every member of the clinical staff actively involved in the evalu- ation, it is important that each department be represented to ensure their voices are heard and that there is a sense of ownership of the new system.

