Health Care Information Systems

Module 7: Patient Care Applications

The following objectives should be met by the end of this module:

1. Identify the specific benefits of clinical applications for the HSOs
2. Define the most common applications of IS in the clinical setting
3. Discuss the potential role of clinical decision-support systems
4. Explain the role of information systems in ambulatory care
5. Define telemedicine and list the major limitations to its expansion
6. Describe IS in the long-term care and home health care settings.

These notes are intended only to supplement your readings. The best way to ensure each module is absorbed is to complete all the readings prior to reviewing these lecture notes. I will try to highlight what I believe to be the most important topics from your module readings. If you have any questions or concerns or there is something you do not understand, please ask me. You can either post on the web board the question you have (that way others can benefit from the response), or you can e-mail me if you want a more private response. Either way it is extremely important that you have a complete and thorough understanding of the material for the module.

The goal of any clinical IS is to provide on-line, real-time patient information to the members of a health care team. Implementation of a clinical IS should be based upon ease of use, standardization of terms, area of data repository and access by clinicians to the system. Clinical IS can do a variety of tasks in the health care setting. First and foremost, it provides direct support for patient care. It can also assist in ensuring quality of care by comparing treatment plans to known outcomes as well as keeping track of population statistics. Clinical IS can aide in controlling costs in the patient care setting by developing protocols for plans of care that are effective and cost efficient based on past data collected. In 1996, a leadership survey of respondents in the health care setting stated the top three application priorities for IS in their organization, they were:

1. implement a clinical data repository
2. implement new clinical systems
3. implement an electronic medical record

These priorities continue to hold true as many healthcare organizations are implementing systems to continue to compete in the industry. With the penetration of managed care as well as the growth of large integrated healthcare systems, IS in the clinical setting is not just a luxury but a necessity.

The Computerized Patient Record (CPR) will be discussed in much more detail in the next module. National standards for the CPR are currently under development by the "Computer-based Patient Record Institute". Other clinical applications include order entry, results reporting, and department specific IS. More common IS in healthcare are found in the laboratory, pharmacy, radiology, as well as the ER and many, many other departments.

So far, we have discussed the acute care system and the IS that is associated with this specific organization. Many of you are focusing on ambulatory care for your final paper, so let's see what clinical applications are associated with ambulatory care. Physicians, dentists as well as other health care professionals are turning more and more to the use of IS in their ambulatory care services. The availability of relatively inexpensive, but powerful microcomputers have opened the doors of IS to the smaller health care organization. Typical computer applications include:

• patient scheduling and appointment systems
• computerized patient record and medical management systems
• patient and third-party billing
• managed care contract management
• electronic communications with other providers in an integrated system

The IS in a private practice can be linked to other organizations to speed up access of medical information, physician orders, or results from diagnostic procedures. The systems can also be linked to insurance companies as well as financial institutions to improve the efficiency of the payment process.

Point-of-care systems, a system where the care is brought as close to the patient as possible, is an important trend in nursing IS. Point-of-care systems have a variety of advantages in healthcare that range from reduction in healthcare costs to improved quality of care. It is important to note that point-of-care technology is not strictly part of the IS, but can also be the equipment and the technology itself. For example, the bedside qlucometer is a type of point-of-care device. The nurse, or other health care professional, can now get an accurate, quick reading on a patient's individual serum glucose without waiting on someone to come and take the blood, take it back to the lab, have the lab analyze it, then have the results forwarded back to the ward. There are strict regulations and restrictions on point-of-care technology, but.... that is another class.

Clinical decision-support systems can be defined as either passive or active. Clinical decision-support systems (CDSS) are computer-based information systems designed to assist health care professionals in diagnosis and treatment planning. A passive CDSS only collects information and organizes it to display for analysis. The CPR is an examples of a passive CDSS. An active CDSS utilizes stored data and provides suggestions as to the diagnosis and treatment of the patient. Three types of active CDSS are the expert, those that use probabilistic algorithms, and reminder/alert systems.

Telemedicine is a clinical application whose use is becoming widespread. Telemedicine (or some may call "telehealth") is the "application of computer and communications technologies to support healthcare provided to patients at remote locations". Online communication in coordination with digital transfer of medical information can bring the physician to locations never seen before. Telemedicine is becoming most useful to date in the area of diagnostics. For example, a patient can get an x-ray taken at a remote site and have the digital image sent to a specialist in the field for review. Prior to telemedicine, this patient would have had to wait for a diagnosis or had to travel far away to get that diagnosis. Legal issues concerning reimbursement and licensure are still to be defined for telemedicine, but the potential for this technology is tremendous.