Handbook of Informatics for Nurses
and Healthcare Professionals
Sixth Edition
Chapter 8
Healthcare Information
Systems
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Learning Objectives (1 of 2)
8.1 Differentiate between clinical information systems
(CIS) and administrative information systems (AIS).
8.2 Describe two or more applications for each type of
system: CIS and AIS.
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Learning Objectives (2 of 2)
8.3 State one format for representing healthcare
knowledge.
8.4 Discuss the definition and potential benefits for
practitioners or patients of smart technology.
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Introduction (1 of 2)
• An information system is a combination of computer
hardware and software that can process data into
information to solve a problem.
• The terms “healthcare information system” and “hospital
information system (HIS)” both refer to an information
system used in a healthcare enterprise.
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Introduction (2 of 2)
• An HIS typically comprises two major types of information
systems:
– Clinical information systems (CISs)
– Administrative information systems (AISs)
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Figure 8-1
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Clinical Information Systems (1 of 11)
• These focus on management of clinical (patient) data and
information (as compared to administrative information
systems).
• Computerized provider (or practitioner) order entry
(CPOE)
– Facilitates process of selecting scripted orders
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Clinical Information Systems (2 of 11)
• Results-reporting applications
– Share laboratory values and diagnostic test results
• Electronic documentation
– Provided through EHRSs and other applications listed
here
• Laboratory-information systems (LISs)
– Receive requests, schedule tests, and track specimen
collection and trajectory
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Clinical Information Systems (3 of 11)
• Radiology-information systems (RISs)
– Receive requests, schedule imaging, provide patient-
focused information, manage image storage, and
store and report radiologists’ interpretations
• Picture archiving and communication system (PACS)
– Designed to store, retrieve, present, and share digital
imaging from x-rays, magnetic resonance imaging
(MRI), computed tomography, and ultrasound
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Clinical Information Systems (4 of 11)
• Pharmacy information systems (PISs)
– Combine administrative and patient-care functions
– Administrative: Inventory control, billing,
documentation
– Clinical: Order entry, tracking of drug dispensing,
alerting practitioners and pharmacists of prescription
errors and potential interactions, patient education,
and providing assess to clinical information
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Clinical Information Systems (5 of 11)
• Physiological monitoring systems
– Store real-time data about various physiological
aspects of a patient
– Track changes in the monitored parameter from a
baseline
– Aspects that can be monitored today include
▪Vital signs
▪Arterial blood pressure
▪Intracranial pressures
▪Cardiac rhythm and waveform trends
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Clinical Information Systems (6 of 11)
• Physiological monitoring systems
– Aspects that can be monitored today
▪Fetal heart rate
▪Pulse oximetry
▪Continuous video EEG monitoring
▪Electromyography
▪Phonocardiography
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Clinical Information Systems (7 of 11)
• Operating room information systems (ORISs)
– Also known as surgical-information systems (SISs) or
perioperative information systems
– Functions provided:
▪Surgical scheduling
▪Patient tracking
▪Perioperative nursing and anesthesia
documentation
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Clinical Information Systems (8 of 11)
• Operating room information systems (ORISs)
– Functions provided :
▪Tissue tracking
▪Integration of medical devices
▪Revenue and materials management
▪Real-time displays of ongoing OR activity
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Clinical Information Systems (9 of 11)
• Anesthesia information management systems
– Connected to physiological monitors, anesthesia
machines, and ideally to the clinical information
system
– Anesthesia personnel can enter data into online
anesthesia record
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Clinical Information Systems (10 of 11)
• Critical care information systems (CCISs)
– These incorporate or integrate most of the prior
applications
– In addition, they interface with bedside devices,
facilitate calculation of clinical indices, and help
organize and manage the large volume of data
assessments
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Clinical Information Systems (11 of 11)
• Clinical decision support systems (CDSSs)
– Support healthcare practitioners in making patient-
care decisions
• Knowledge representation
– Formal process
– Includes clinical experts representing specialties and
healthcare professionals who understand the science,
research evidence, and how to present information
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Administrative Information Systems
• Registration and scheduling systems
• Patient acuity/staff scheduling systems
• Financial systems
• Risk-management systems
• Payroll and human-resources systems
• Quality assurance systems
• Contract-management systems
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Administrative Information Systems
Used in the Healthcare Setting (1 of 3)
• Financial systems provide the facility with accounting
functions. Accurate tracking of financial data is critical for
enabling the organization to receive reimbursement for
services.
• Payroll and human resource systems track employee
time and attendance, credentials, performance
evaluations, and payroll-compensation information.
• Contract-management systems manage contracts with
third-party payers.
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Administrative Information Systems
Used in the Healthcare Setting (2 of 3)
• Risk-management systems track and plan prevention of
unusual occurrences or incidents.
• Quality-assurance systems monitor outcomes and
produce reports that are used to guide quality
improvement initiatives.
• Physician-management systems support patient
registration, scheduling, coding, and billing in the
physician’s office and may support results retrieval.
These systems also provide better protection of patient
privacy than paper records.
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Administrative Information Systems
Used in the Healthcare Setting (3 of 3)
• Executive-information systems provide administrators
with easy access to summarized information related to
the financial and clinical operations of the organization.
• Materials-management systems facilitate inventory
control and charging of supplies.
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Smart Technology (1 of 5)
• Functionality behind the scenes
• Sends real-time messages to all of the areas required
during patient visit
• Used by providers to documents visits, order medications
while checking alerts for errors, schedule appointments,
and generate bills
• All possible because the different systems are tied or
interfaced together
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Smart Technology (2 of 5)
• Benefits for clinicians
– Increases efficiency
– Increases communication between providers
– Handles alerts
– Permits documenting tasks in the mobile computer
system in the patient’s room
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Smart Technology (3 of 5)
• Benefits for clinicians
– Barcode-scanning capability to see if patient’s
armband matches barcode on medication pulled from
the medication cart
– Alert fatigue, from a system that generates too many
alerts, can be avoided by eliminating some
functionality
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Smart Technology (4 of 5)
• Benefits for patients and families
– Decreased wait-times
– In the hospital, patients can use tablet computers in
their rooms to order meals, extra blankets, water, or
other items
– Patients can send and receive messages from family
members
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Smart Technology (5 of 5)
• Benefits for patients and families
– Patients can select educational materials
– A plan of care may be posted
– Patients can be monitored electronically for vital signs
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Current Topics in Healthcare
Information Systems (1 of 3)
• Big data
– At present, huge amounts of data frequently resides
in various unstructured databases.
– Frequently it cannot be retrieved and analyzed
because it is not categorized in ways understood by
current systems.
– Implementation of structured data management
systems is now a priority for many organizations.
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Current Topics in Healthcare
Information Systems (2 of 3)
• Obstacles and Risks
– With older, overloaded systems, down time is a
possibility.
▪The system is then inaccessible.
▪It may be necessary to revert to documenting on
paper until the system comes back up.
▪When the system does come back, there may be
duplicate orders and documentation (on paper, and
within the system).
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Current Topics in Healthcare
Information Systems (3 of 3)
• Costs
– Implementing and maintaining computer systems is
very expensive.
– They must be upgraded every two to three years with
new software and hardware.
– Functionality will need to be added and interfaced
with the current system.
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Future Directions (1 of 3)
• Advanced decision support tools
• Analysis of big data
• Display and communication of health data
• Use of health IT to support distributed care models and
improve efficiency
• Health IT safety monitoring and testing
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Future Directions (2 of 3)
• Advancement of smart technology
– Smart wearable devices: wristbands, bras, contact
lenses, braces, clothes with smart buttons, T-shirts
with embedded sensors that capture cardiac and
respiratory signs
– Data captured can have analysis capabilities based
on cloud computing technology
– Lab-on-a-chip
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Future Directions (3 of 3)
• Wireless body area network (WBAN) for aging population
– Miniature sensors in the body to enable remote
monitoring of vital signs, pacemaker function, EKG
data, and other information
• Wrist wearable unit (WWU) to measure activity levels in
people older than 60
• Improved accuracy of continuous glucose monitoring
(CGM) sensors
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