Critically evaluate the role of a Clinical Information System (CIS) in intensive care
CIS refers to a computerized system for managing the clinical record often within geographically designated areas within the hospital such as ICU, ED or OR.
Potential benefits of CIS include:
a) Recording of bedside observations – automated, minimal transcription errors
b) Legible record
c) Electronic record of drug prescription
d) Access to additional clinical information at the bedside – pathology, XRays
e) Access to decision support systems – online databases, clinical pathways,algorithms
f) Medicolegal – archiving, good audit trail
g) Ease of collection of data for research.
Limitations of CIS
a) Financial cost
b) Rapidly changing nature of technology
c) Lack of computer literacy amongst clinicians and the need for training prior to commencing work in the ICU
d) No evidence that CIS decreases workloads or save expenditure on salaries e) Data archiving and storage is a problem.
f) No evidence that implementation of CIS results in improved patient outcomes.
g) Interface with other computer systems
h) Legality of drug prescription
i) Other clinician entry
These are computerised databases which store and retrieve the ICU medical records. They may integrate diagnostic test review, test ordering, prescription/administration of drugs, and storage/retrieval of imaging studies. LITFL has an excellent summary.
Whatever the public opinion of these things, at the time of writing (mid 2014) the inevitable invasion of ICCIS is coming to NSW and there is nowhere to hide.
The answer below is essentially a direct copy and paste effort from the summary of administrative topics.
Evidence in support of CIS use
Evidence against the use of CIS
Hammond, Jeffrey, et al. "A qualitative comparison of paper flowsheets vs a computer-based clinical information system." CHEST Journal 99.1 (1991): 155-157.
Wong, David H., et al. "Changes in intensive care unit nurse task activity after installation of a third-generation intensive care unit information system." Critical care medicine 31.10 (2003): 2488-2494.
Marasovic, Caroline, et al. "Attitudes of Australian nurses toward the implementation of a clinical information system." Computers in Nursing 15.2 (1996): 91-98.
Mador, Rebecca L., and Nicola T. Shaw. "The impact of a Critical Care Information System (CCIS) on time spent charting and in direct patient care by staff in the ICU: a review of the literature." International journal of medical informatics 78.7 (2009): 435-445.
Levesque, Eric, et al. "The implementation of an Intensive Care Information System allows shortening the ICU length of stay." Journal of clinical monitoring and computing (2014): 1-7.
Levesque, Eric, et al. "The positive financial impact of using an Intensive Care Information System in a tertiary Intensive Care Unit." International journal of medical informatics 82.3 (2013): 177-184.
Lapinsky, Stephen E. "Computers in Intensive Care." The Organization of Critical Care. Springer New York, 2014. 53-69.
Ehteshami, Asghar, et al. "Intensive care information system impacts." Acta Informatica Medica 21.3 (2013): 185.
Amarasingham, Ruben, et al. "Clinical information technologies and inpatient outcomes: a multiple hospital study." Archives of Internal Medicine 169.2 (2009): 108-114.
Hunt, Dereck L., et al. "Effects of computer-based clinical decision support systems on physician performance and patient outcomes: a systematic review." Jama 280.15 (1998): 1339-1346.
Bures, Sergio, et al. "Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit." American journal of infection control 28.6 (2000): 465-471.