Clinical Information Systems: Connecting Clinical Information across the enterprise

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Patient care and safety took center stage at HIMSS ’07. Vendors rolled out an array of systems designed to meet the dual (and sometime competing) goals of boosting productivity and increasing patient safety. New solutions provide caregivers with a streamlined and comprehensive view of the patient and patient history to allow them to provide the right care at the right time to the right patient. Automated bar-coding and CPOE were evident as were an array of state-of-the-art department systems such as laboratory information systems and emergency department information systems.
   
Cardiology figured prominently on the show floor as well. New solutions connect data from disparate sources such as imaging modalities, bedside devices and lab systems to meet that elusive dual objective of improving patient care and accelerating productivity. Many of the new systems offer customizable and configurable user portals to provide appropriate clinical information to the array of cardiac caregivers.
   
Other new technologies recognize the trend toward consumer-directed care, providing patients with the tools to create personal health, determine financial responsibility and pay bills. 
 



Agfa HealthCare unveiled ORBIS and ORBIS CARE.

ORBIS is designed to collect real-time clinical and administrative data as well as images along specific clinical paths to enhance the quality of care while reducing costs. It provides an intelligent solution to deliver patient 'flow' through the appropriate clinical path as efficiently as possible with high quality results. The system enables the implicit clinical knowledge through process automation to handle dynamic clinical pathways that trigger multiple clinical interventions per individual care episode.
   
The company shared its vision of an integrated EMR. “Agfa plans to take a multi-year phased approach to delivering a full product portfolio to connect the enterprise,” explained Stuart Long, executive director, enterprise solutions. The Agfa approach includes Clinical Paths, Enterprise Clinical Portal, Enterprise Scheduling and Clinical Data Center.
   
Clinical and operational paths need to be maintained and streamlined if the institution is to advance and provide high levels of patient care, said Agfa. This requires automation throughout the ancillary clinical disciplines such as Radiology, Pharmacy, Laboratory, Therapy Services, Nursing Management and Critical Care. ORBIS provides over 80 separate modules to address needs across the continuum and create patient-centric Clinical Paths.
    
Agfa’s Enterprise Clinical Portal simplifies physician and nurse access through a unified view to relevant patient information, relieving the clinical care team of the need to manage multiple log-on IDs and passwords across various patient information databases. The Enterprise Clinical Portal also incorporates user authentication, authorization and audit control options to address security requirements and streamlines workflow when integrated with a clinical information system.
    
Enterprise Scheduling lets staff schedule appointments with ease to reduce training time, optimize process workflow and help foster better patient relationships.
    
Clinical Data Center (CDC) is a real-time database of structured and unstructured data collected from disparate clinical sources. It enables management of large data volumes (beyond terabytes to petabytes) to satisfy permanently growing archives long term while allowing sites to fully take advantage of existing disparate legacy enterprise systems. Agfa's CDC offers the capability to leverage clients' current Clinical Informatics solutions by providing a single ubiquitous view of all clinically relevant data, results, assessments and images across the patient's continuum of care.
   
ORBIS Care is a clinical module for point of care documentation, flow sheet charting and care planning. It enables the community hospital to manage clinical data and patient flow through all departments. Agfa is signing pilot sites for ORBIS Care, which is the first component its ORBIS EMR solution. “The goal,” said Long, “is to help customers drive down the price of healthcare by removing inefficiencies and connecting data and users.”
 


Cerner launched the “Smart Room.”
   
Cerner’s Smart Room is powered by the CareAware architecture, which integrates multiple devices with the EMR while maintaining a patient-centric focus. The Smart Room is the intersection of a variety of technologies including radio frequency identification (RFID), patient beds, medical bedside devices, patient communication, information and entertainment.
   
The Smart Room features an interactive TV system, which combines popular off-the-shelf hardware components and custom-developed applications that provide comprehensive communication, education and entertainment for patients and their families.
   
The Smart Room allows care providers to create remote intensive care unit (ICU) access using video/audio conferencing technology to support quality audio and video image and help physicians monitor patient progress in various locations. Two-way communication into each patient’s room, along with high-resolution video and audio, provides the remote site with real time “eyes and ears.” Cerner’s virtual solution allows a physician to monitor multiple patients from multiple hospitals.
   
The “dashboard” securely displays up-to-date and accurate information needed by authorized care providers treating the patient at the bedside. Cerner is working with industry leading tablet and PDA manufacturers to enhance Cerner Millennium on different form factors while allowing these devices to communicate on the CareAware medical device architecture in real time. 
   
The Smart Room is powered by the CareAware architecture, which bridges the gap between medical devices and patient information, allowing healthcare organizations to connect the provider community to medical devices to eliminate errors and improve effectiveness; connect the devices to the clinician workflow to improve outcomes and connect device information to the EMR to provide one source of truth.



Dairyland Healthcare Solutions launched Surgery Management and a web-based Personal Health Record solution.
       
Designed specifically for the surgical departments of community hospitals and specialized surgical centers, the application enables surgical departments to effectively manage their surgery department’s operations, resources and schedules. It helps departments improve and optimize resource management, enhance flexibility and adaptability to surgeon preferences, increase charge capture and billing accuracy, and simplify inventory management.
   
Surgery Management provides the flexibility to define procedures by organizational standards and/or by surgeon preferences through the Preference Card functionality. Preference Cards identify the resources and preferences for specific procedures including surgical materials, equipment, instructions and setup. They also simplify billing through the creation of charge lists for performed procedures. Upon completion of a procedure, the charge list can be reviewed and modified as needed prior to posting the procedure charges to the patient account. Further, inventory items are depleted based on charge entry.
    
The web-based Personal Health Record solution complements Dairyland’s HIS. It enables users to easily manage their health information in a secure and confidential online website. Personal Health Records may include personal identification, health insurance information, current medications and dosages, immunizations and dates, allergies, important test results, eye and dental records, and miscellaneous information users may want to include about their health.



Eclipsys Corporation highlighted Sunrise Clinical Manager, Sunrise Pharmacy and Sunrise Patient Financials and Sunrise Access Management.
   
Sunrise Clinical Manager provides computerized physician order entry (CPOE), evidence-based order sets and automated dosing to support safe and efficient medication ordering processes and workflows. The solution can improve productivity and process efficiencies by providing clinicians immediate access to patient results and medication orders, Eclipsys said. “The Sunrise experience lets users maintain their context without launching a web viewer or moving to a separate workstation,” explained Product Director Mike Valente. An imaging tab uses knowledge like orders and results in Sunrise Clinical Manager to provide thumbnail images that allow users to launch the viewer. In addition, Sunrise maintains study knowledge whether or not images are in the PACS, so users can read reports of studies outside of the PACS.
       
Sunrise Pharmacy helps sites automate pharmacy distribution workflow. It includes advanced clinical decision support capabilities to ensure the safe ordering and administration of medications and improve pharmacy revenue.
   
Sunrise Patient Financials and Sunrise Access Management consolidates medical records, patient access, and patient accounting in one system to enhance revenue cycle management and financial reporting in order to improve financial performance and support revenue stream optimization. The systems streamline billing processes, maximize reimbursements, improve cash flow and enhance patient satisfaction. Sunrise Patient Financials and Sunrise Access Management can reduce duplicate efforts on profile changes, regulatory requirements, patient inquiries and streamline the claims editing process through implementation of front-end edits.



GE Healthcare launched Centricity Laboratory Information System (LIS) and showed Centricity Practice Solution and Centricity Business Solution.
   
Centricity Laboratory provides a robust LIS designed to handle the high-volume test-processing needs of mid-to large-sized labs and multi-hospital facilities. It is available with a Transfusion Medicine (TM) module, a new QC module, and additional security features. The fully integrated TM module provides full inventory management, patient and donor testing and electronic documentation for all blood bank activities. Technologists can track the testing of units and chart compatibility of blood types. Additionally, Centricity Laboratory offers advanced security features, providing users with the tools necessary to meet regulatory requirements including HIPAA Security. Enhanced flexibility in report formatting is available and can increase ease of use while providing clinicians with the information they need when they need it.
   
Centricity Practice Solution is a single clinical and financial practice management solution aimed at helping to improve practice efficiency and patient care. GE’s Centricity Electronic Medical Record (EMR) enables ambulatory care physicians and clinical staff to document patient encounters, streamline clinical workflow and securely exchange data with other providers, patients and information systems. GE’s Centricity Practice Management solution provides patient and financial management, document management, decision support and connectivity tools that improve business performance and patient service. Certified by the Certification Committee for Health Information Technology (CCHIT) and by the National Consortium for Quality Outcomes (NCQA), Centricity Practice Solution is focused on delivering real-time clinician decision support through nationally accepted, evidence-based clinical guidelines. By providing new tracking, measuring and reporting capabilities practices will be better equipped to measure quality outcomes against national standards and keep up with increasing pay for performance programs.
   
Centricity Business Solution maximizes business performance for hospitals, integrated delivery networks and large physician organizations. Robust financial and administrative capabilities improve and accelerate the revenue cycle from the first point of patient contact to final payment for services. The results are fewer denials, faster payments and a decreased cost of collections. Automated revenue cycle processes increase efficiency. The integrated solution leverages Centricity EMR but allows sites with an existing EMR to choose the clinical solution that best fits their needs. Centricity Business Advantage is a fully outsourced revenue cycle management (RCM) service that supports business and administrative functions within healthcare organizations while maximizing revenue cycle efficiencies. The solution, hosted by GE, eliminates large capital requirements, IT staffing infrastructure and long installation times while helping to reduce operating costs and allowing investment in other critical needs.
   
As part of the new solution, GE will offer single sign-on capabilities to provide quicker access to the information healthcare providers need at the point of care. Additionally, because Centricity Practice Solution is offered on Microsoft’s SQL Server technology clinicians can now have access to clinical decision support tools that also help reduce costs and increase profitability across a broad range of practice specialties. 

Also part of the Centricity product portfolio is the Centricity Electronic Data Interchange solution, which can be used in conjunction with the Centricity Practice Solution. Centricity Electronic Data Interchange is an extensive web-based payer claims management solution that allows practices to verify patient eligibility, submit claims electronically, and proactively monitor business transactions.



McKesson Corporation launched the Horizon Nursing Portal and interactive consumer-facing solutions at HIMSS ’07.
   
The Nursing Portal serves as a “command center,” giving nurses access to the information most relevant to them including clinical and medication histories, flowsheets, images and results as well as charting, medication administration, order management – even fetal strip monitoring and nursing-specific census management. Nurses can better manage the complexity of patient care with review tools such as on-the-fly graphing to quickly identify trends, a variety of options for customizing flowsheets, and critical alerts that help prioritize patient needs.
   
According to ongoing research by Ascension Health and Kaiser Permanente, the typical medical-surgical nurse walks six miles per shift and spends only 10 seconds in one spot, challenging health IT vendors to design solutions that create more efficient workflows for nurses, helping them achieve higher levels of quality and safety and giving them more time with patients. The new portal improves patient safety in several ways. For example, it provides a longitudinal view of encounter data, including medication histories and clinical summaries, from multiple settings such as the emergency or surgery departments. It also helps providers address key National Patient Safety Goals from the Joint Commission on Accreditation of Healthcare Organizations, with a special module for medication reconciliation and customized tools for improving handoff communications such as an electronic Situation/Background/Assessment/Recommendation (SBAR) form.
   
McKesson’s consumer-facing solutions provide patients with online out-of-pocket cost estimates of planned procedures to gain immediate and upfront access to their personal financial obligations for healthcare services, such as co-payments, deductibles and payment options. Prior to service, the interactive tools enable providers to determine the ability of patients to pay their portion of the service charge. In the case of financial hardship, providers can offer a standardized, non-discriminatory assessment for either Medicaid or charity program eligibility.
   
At point-of-service, McKesson’s Horizon Patient Kiosk allows patients to self-check in electronically and “swipe” a credit card for pre-service payments. In the home, Patient Compass, powered by the RelayHealth Network, creates the ability for providers to offer patients a convenient online business office. By consolidating bills from the health system’s physician and hospital systems and intelligently turning them into consumer-friendly communication, patients are more likely to understand and pay their financial obligations, which they can do online. In combination, the package of services creates more informed “consumer payors” and sets the stage to greatly reduce the cost of recouping consumer dollars, estimated to cost up to three times as much for every dollar that it costs to collect insurance payments.



Picis launched three new features available in ED PulseCheck, its comprehensive and integrated emergency department information system (EDIS).

The native web-based software combines triage, patient tracking, physician and nursing documentation, risk management, charge management, integrated voice recognition, prescription writing and other features. New features — Aerial View, Automated Bar Code Medication Administration and Administrative Department Rules — further improve productivity and operational efficiency in the ED. Aerial View allows patient tracking and management throughout their stay using ED PulseCheck’s aerial view tracking board, which provides a central control view at a glance.

Automated Bar Code Medication Administration leverages bar code technology to provide additional information aimed at optimizing efficiency. Medical personnel can scan the wristband of the patient and then scan the packaging of the medication about to be delivered.

Administrative Department Rules allows hospitals to define parameters for decision making. For example, a rule can be established that when the number of patients in the waiting room exceeds a defined number, an administrator will be paged.



Philips Medical Systems demonstrated IntelliVue Clinical Information Portfolio (ICIP) Critical Care and HeartStart MRx monitor/defibrillator. The company also previewed Xcelera Cardiovascular Information Solution and Xper Information Management as works-in-progress.
   
IntelliVue Clinical Information Portfolio (ICIP) Critical Care, a clinical decision support tool used by clinicians to support patient care, is designed to address the challenge of connecting data from disparate systems. A platform built to support future applications beyond critical care, ICIP is the evolution of CareVue Chart. It centralizes patient data from the bedside and core hospital information systems so clinicians have access, anywhere, to the information they need to make crucial care decisions. Vital signs, bedside device data, labs, pathology reports, medication orders and planned interventions, among other data, are included in the patient flowsheet, helping to eliminate transcription errors and time lost recording and re-recording data by hand. Clinical advisories—algorithms that combine critical clinical information from all sources of information—are intended to enable clinicians to increase patient safety, reduce medical errors and increase compliance with evidence-based care guidelines.  ICIP’s reporting tools merge flexibility and ease of use with a comprehensive built-in library that allows the entire hospital staff to generate regulatory and compliance reports with a few mouse clicks. The ICIP front-end user interface is highly customizable for hospitals’ and individual units’ unique workflow.  Meanwhile, the back-end architecture was built on Microsoft .NET framework to enable seamless interfacing with other hospital applications, including computerized physician order entry (CPOE).
   
The HeartStart MRx monitor/defibrillator combines two devices into one, for wireless transport, emergency department overflow and cardiac departmental needs. The HeartStart MRx streams the patient’s waveforms and vitals information in real-time to Philips IntelliVue Information Center, leveraging the IntelliVue Clinical Network’s wired and wireless capabilities. The monitor/defibrillator connects to a hospital’s real-time clinical network and can include remote surveillance and automatic logging of patient data for hospitals requiring a defibrillator for transport, which is more cost effective than two separate devices. And since the HeartStart MRx is integrated into the IntelliVue Clinical Network, it can take advantage of the network’s HL7 messaging capability outbound and ADT (Admit/Discharge/Transfer) information flow inbound, which means that patient physiologic data collected by the HeartStart MRx can move with the patient and that data can flow to the patient chart for review by clinical staff.
    
Xcelera Cardiovascular Information Solution is an integrated software suite that unites information from all cardiology-imaging modalities such as interventional cardiology, cardiovascular ultrasound, cardiac CT, cardiac MR, nuclear cardiology and electrophysiology.
   
Xper Information Management provides a personalized cardiovascular workflow solution for the catheterization (cath) lab. The integrated Xper Information Management system includes Physiomonitoring 5, the latest evolution of the Philips Series IV Physiomonitoring & Information system.  Plus, it delivers innovations for reporting, scheduling, inventory and intelligent data management. Xper offers user-centric navigation and tools to enhance efficiency on multiple levels and speed and simplify workflow for all cardiovascular professionals. The system manages the entire care cycle from pre-holding to the procedure to charting and filing and recovery, Philips said. Reports are auto-populated and electronic signature-enabled. A built-in scheduler allows sites to effectively schedule staff, resources and inventory. Inventory is tied into billing for streamlined processes, and a portal builder creates and customizes roles for various users so the technology revolves around workflow.



Siemens Medical Solutions showcased Soarian Cardiology 2.0 multimodality cardiovascular information system and Soarian Cardiovascular Enterprise.

Soarian Cardiology 2.0 is a comprehensive solution that addresses the entire cardiovascular continuum of care. It helps physicians deliver effective cardiac care from admission to discharge and follow-up by providing secure access to images via syngo Dynamics and patient data to give healthcare providers anywhere and anytime access to complete clinical information. Soarian Cardiology 2.0 is a highly scalable solution, applicable for offices, imaging clinics, hospitals and multi-facility enterprise health systems. Using a web-based architecture, Siemens is able to combine medical devices, imaging modalities, PACS and IT into the cardiology workflow, streamlining patient care and helping to improve clinical, operational and financial outcomes.

Soarian Cardiovascular Enterprise, which comprises Soarian Cardiology and syngo Dynamics, a multi-modality, dynamic image review PACS, enables evidence-based reporting to help improve the efficiency of clinical procedures for cardiology, as well as applications in general imaging and OB/GYN. Its reporting tools enable clinicians to produce and distribute reports more quickly and with fewer manual steps.
   
Soarian-driven workflows are being deployed globally to support key quality and regulatory initiatives such as those defined by Centers for Medicare and Medicaid Services (CMS), the Joint Commission (JC) Core Measures, the six key objectives of the Institute for
Healthcare Improvement's (IHI) 100,000 Lives Campaign, and providers' own internal quality measures. Currently, more than 50 Soarian-enabled workflows demonstrate the ability to seamlessly connect clinical, operational, and financial processes in support of patient-centered care. Examples include workflows to identify patients at risk for deep vein thrombosis (DVT); better manage patients on heparin therapy; better manage bed utilization; identify early and manage patients with isolation-requiring infections; deliver evidence-based care to Acute Myocardial Infarction (AMI), chronic heart failure (CHF), Diabetes and Community-Acquired Pneumonia patients; reduce risk of negative drug interactions by reconciling medications on transfer patients; coordinate care of IV site management, according to hospital best practice guidelines and better manage patients at risk for falling in the hospital.