Clinical Information Systems in Critical Care

Clinical Information Systems in Critical Care

CORE CRITICAL CARE Series Editor Dr Alain Vuylsteke Papworth Hospital Cambridge, UK Assistant Editor Jo-anne Fowles Papworth Hospital Cambridge, UK Other titles in the series Delirium in Critical Care Valerie Page and E. Wesley Ely ISBN 9780521132534 Intra-Abdominal Hypertension Manu Malbrain and Jan De Waele ISBN 9780521149396 Forthcoming titles in the series Renal Replacement Therapy in Critical Care Patrick Honoré and Oliver Joannes-Boyau ISBN 9780521145404

Clinical Information Systems in Critical Care Cecily Morrison Researcher in Health and Information Systems University of Cambridge, UK Matthew R. Jones University Lecturer in Information Systems Judge Business School University of Cambridge, UK Julie Bracken Critical Care Matron Papworth Hospital Cambridge, UK

University Printing House, Cambridge CB2 8BS, United Kingdom Cambridge University Press is part of the University of Cambridge. It furthers the University s mission by disseminating knowledge in the pursuit of education, learning and research at the highest international levels of excellence. Information on this title: /9780521156745 C 2014 This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of Cambridge University Press. First published 2014 Reprinted 2014 Printed in the United Kingdom by CPI Group Ltd, Croydon CR0 4YY A catalogue record for this publication is available from the British Library Library of Congress Cataloguing in Publication data Morrison, Cecily, author. Clinical information systems in critical care / Cecily Morrison, Matthew R. Jones, Julie Bracken. p. ; cm. (Core critical care) Includes bibliographical references and index. ISBN 978-0-521-15674-5 (paperback) I. Jones, Matthew R. (Matthew Russell), 1958 author. II. Bracken, Julie, author. III. Title. IV. Series: Core critical care. [DNLM: 1. Critical Care. 2. Health Information Systems. WX 218] RC86.7 616.02 80285 dc23 2013026159 ISBN 978-0-521-15674-5 Paperback Cambridge University Press has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate.... Every effort has been made in preparing this book to provide accurate and up-to-date information which is in accord with accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors and publishers can make no warranties that the information contained herein is totally free from error, not least because clinical standards are constantly changing through research and regulation. The authors, editors and publishers therefore disclaim all liability for direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.

CONTENTS Foreword Don E. Detmar page vii 1 Introduction 1 2 Deciding to purchase a CIS 9 3 Making the case 25 4 Choosing a CIS 38 5 Planning for success 66 6 Training 84 7 Customizing a CIS 96 8 Leadership 116 9 Impact on clinical workflow 132 10 Research and audit 158 11 CIS of the future 165 Index 175

FOREWORD Using a computer-based clinical information system (CIS) is, as the late informatics pioneer Homer Warner noted, 80% sociology and 20% technology. Today, the growth in use of these systems as well as their ever-widening applications have convinced me that clinicians who live for things to get back to normal should just get over it since this isn t likely to happen any time soon. Instead, health information and communications technology keeps developing alongside an exponential growth in the science base of the healing professions as genomics is augmented by burgeoning chronic illness calling for activated patients if good outcomes are to be expected. For those clinicians who are originators or early adopters, they re truly blessed to live in such compelling times, while for those clinicians who are either pragmatists or conservers, it can seem well beyond disruptive. It is hardly any wonder then, that the American Board of Medical Specialties recently added a Clinical Informatics certificate to its list of specialties and that chief clinical information officers are becoming the norm in larger US hospitals. Their roles are to assure that these systems can address those issues raised in the latter chapters of this volume.

viii Foreword As Sir Cyril Chantler noted, Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective and potentially dangerous. When one is choosing and implementing clinical information systems for 24/7 critical care units characterized by complex life support equipment and decidedly constrained time windows for critical decision-making, one needs reasoned and seasoned advice. This concise volume serves that purpose well. In short, Morrison, Jones and Bracken did us all a favour by clearly laying out the most critical facets of this challenge whether one is a happy volunteer or the most reluctant conscript. Implementing clinical information systems has been described accurately as a contact sport. The descriptions of relevant issues in the initial chapters are clear, honest, candid, and carry the message of experienced users that these systems are both works in progress and genuine challenges but with much to offer to those willing to make the personal and financial investment. Despite the utility of CIS some issues remain with a stubborn consistency, including interoperability, clunky user-interfaces and system security. Yet training can make a difference. Convincing clinicians to undertake three or more hours of training can offset weeks of complaints from those who limit themselves to one hour. The well-written section on documentation deserves particular commendation since often this effort is seen as somehow redundant. Since the focus is on critical care, patient engagement through CISs gets little attention. With the rise of chronic illness in aging populations, connectivity with patients to manage their care becomes a key factor for future success,

Foreword ix for example adding the patient and perhaps even a key loved one to the clinical team. Also, relating to governance may become a significant part of the business case negotiations and may prove to be problematic if taken for granted in some settings. The reader will want to keep this handy guide available for ongoing reference since it is filled with hard earned wisdom. My compliments go to the authors for contributing a very useful addition to the clinical informatics literature. And my hopes and best wishes go to those who undertake the clinical transformation that CIS involves. Remember to celebrate your successes along the way; you ve earned them. Don Eugene Detmer, MD, MA University of Virginia