Clinical Information System Transforming Health Care Delivery

November 21 2003–A clinical information system implemented at Cincinnati Children’s Hospital Medical Center (http://www.cincinnatichildrens.org/default.htm) has resulted in a 35 percent reduction in medication errors and a 52 percent improvement between the time medicines are ordered and the time they are ready to be given to patients. X-ray images are delivered electronically, eliminating the need for films, and urgent X-rays arrive much quicker than before.

Doctors and nurses have information available at their fingertips, allowing them to make quicker and more accurate clinical decisions. Patients with chronic illnesses can access their health records over a secure internet connection from anywhere in the world.

The system has also helped Cincinnati Children’s become the first pediatric hospital in the nation to earn the prestigious Nicholas E. Davies Award of Excellence for 2003 from the Healthcare Information and Management Systems Society (HIMSS). “Cincinnati Children’s has taken computerized patient record systems to new dimensions of influence, usage and effectiveness,” says Asif Ahmad, chair of the Davies Award committee.

The system is called the Integrating Clinical Information System, or ICIS, and it’s transforming health care. ICIS, in combination with broad-based hospital performance improvement programs, has resulted in significant improvements in patient safety, efficiency, regulatory compliance and patient satisfaction.

“I want you to know that this type of integration of information system into medical care instills real confidence in the parents of patients,” wrote David Wehrle in a letter to Cincinnati Children’s. Mr. Wehrle’s son, Gabriel, came to Cincinnati Children’s from New Jersey earlier this year for airway reconstruction surgery.

“So many mistakes are often due to the lack of information or a quick and convenient way to access information. You are truly thinking in terms of the hospital as one integrated system. I like that! When an aide came to my son’s room regularly with a wifi networked notebook to record his vital signs, I had to pick my jaw up off the floor. Kudos to you. You are doing it.”

ICIS refers to the entire clinical information system at Cincinnati Children’s. Central to ICIS, and a major reason for earning the Davies Award, are clinical order entry (COE) and clinical documentation components.

“COE provides complete, unambiguous and legible orders,” says Brian Jacobs, MD (http://www.cincinnatichildrens.org/svc/staff/j/brian-jacobs.htm), who led implementation of several ICIS components, including COE. “Clinical decisions are better informed, with numerous information resources readily available at their fingertips.”

Decision support includes more than 250 disease and diagnosis-based standardized care order sets; links to medication formularies, policies and procedures; internet search capability; help and feedback screens; and evidence-based clinical guidelines and pathways. COE also has built-in safety checks to minimize dosage errors due to improper weight entries, medication under- or overdosing, medication allergies or interactions and duplicate orders. Orders are routed to pages, printers or electronic interfaces throughout the hospital so that clinicians can initiate care immediately.

COE is integrated with the clinical documentation system and medication administration record. This can be thought of as electronic charting: The system allows nurses to document electronically, rather than on multiple paper forms, essential clinical information such as vital signs, allergies, heights, weights, fluid balance and pain assessments.

It also includes an electronic medication administration record, formerly transcribed onto a piece of paper by a health unit coordinator and a nurse.

“Supporting patient safety and increasing efficiency in care delivery is the goal of clinical documentation,” says Terri Price, RN, a director in the Department of Patient Services who has led the implementation of the clinical documentation part of the system with the nursing staff. “Studies have demonstrated that as much as 40 minutes per shift can be gained by using electronic charting systems. That’s 40 minutes more per shift that a nurse can spend with a patient and family. Overall, clinical documentation facilitates a family-centered approach to care by improving efficiency in care delivery, improving outcomes and reducing length of stay.”

Cincinnati Children’s first major clinical ICIS implementation came in 1999, with an electronic medical imaging Picture Archiving and Communication System, or PACS, according to Neil Johnson, MD, medical director, Information Services (http://www.cincinnatichildrens.org/svc/staff/j/neil-johnson.htm). PACS sends medical images, such as X-rays, CT and MRI scans, and ultrasound, as well as radiology reports, electronically to wherever clinicians need them.

Next, Cincinnati Children’s implemented an electronic discharge summary, which enabled physicians for the first time to enter important information directly into a computer system and increased their comfort with using computers for direct patient care. Then, before COE and clinical documentation cam online, Cincinnati Children’s established a web-based, patient results system, which provides secure access to patient test results from anywhere in the system.

ICIS is now expanding to include chronic care portals — web-based applications to help families whose children have chronic diseases manage their own care — often from distances far from Cincinnati. The first operational portal is the liver transplant portal. The portal graphically depicts test results, trends and other medical information, and provides secure communication between patients and clinicians. Patients and their families can access the online, browser-based system from anywhere in the world.

In addition, Cincinnati Children’s is implementing a new perioperative, anesthesia and intensive care electronic information system. This system will serve as “mission control” for these critical patient-care areas — tracking a child’s progress at every step of the way — from surgery registration to recovery to critical care. Doctors and nurses will be able to view a child’s status at any given moment, see exactly what happened at previous steps and gain access to the patient’s complete medical history.

HIMSS bestows the Nicholas E. Davies Award of Excellence each year for use of electronic health record (EHR) systems in health care organizations. HIMSS provides leadership in health care for the advancement and management of information technology and provides services to more than 13,000 members, including IT health care corporations, firms and professionals from around the globe. HIMSS directs and shapes the health care industry, encourages emerging technology and promotes public policies that will improve health care delivery.