discussion 2

| November 30, 2016

Respond to your colleagues using one or more of the following approaches:

Ask a probing question, substantiated with additional background information, evidence or research.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own research in the Walden Library.
Validate an idea with your own experience and additional research.
Make a suggestion based on additional evidence drawn from readings or after synthesizing multiple postings.
Expand on your colleagues’ postings by providing additional insights or contrasting perspectives based on readings and evidence.

Successful Implementation of Electronic Health Information Technology

Since the inception of the HITECH Act, health organizations have faced increased pressure to update their health information technology (HIT) resources. As discussed last week, many believe that the increased use of electronic health records and the quick and efficient communication afforded by HIT can lead to improved quality of patient care. Yet there are significant costs associated with implementing such systems. What can organizations do to ensure that the correct system is selected and that the system will be appropriate for those required to use it? Who should be involved in those decisions?

This week introduces the systems development life cycle and discusses how it can guide an organization through the complexities of adopting a new HIT system. In this Discussion, you are asked to consider the role of nurses in the SDLC process.

To prepare:

Review the steps of the systems development life cycle.
Think about your own organization, or one with which you are familiar, and the steps the organization goes through when purchasing and implementing a new HIT system.
Consider what a nurse could contribute to decisions made at each stage when planning for new health information technology. What might be the consequences of not involving nurses?
Reflect on your own experiences with your organization selecting and implementing new technology. As an end user, do you feel you had any input in the selection or and planning of the new HIT system?

DISCUSSION 1- Successful Implementation of Electronic Health Information Technology

Organizations are constantly updating their systems and resources. It is imperative that nurses are incorporated with the decision in making the healthy information technology decisions. According to Nurse leaders discussion the nurse’s role in driving technology decisions (2010), nurses’ decisions about clinical technologies should be guided by two overarching goals, establishing safe and efficient care, and measuring nurses’ impact in keep patients safe (p. 8). Having the nurses review and support and idea of a new technology helps the organization make the right investment for its patients.

The dynamic system development method has three phases, the pre-project, the pro-life life cycle, and post project (McGonigle & Mastrian, 2015, p. 179). According to McGonigle & Mastrian (2015), the systems development life cycle has five steps feasibility, business studies, functional model iteration, design and build iteration, and implementation (p. 180).

In the first step, the feasibility is brought together with the potential risks. “In step one, the deliverables are a feasibilities report, project plan, and a risk log” (McGonigle & Mastrian, 2015, p. 179). Nurses should be involved with this step of the process because they will know if this project, or technology, is even worth the effort. According to Nurse leaders discussion the nurse’s role in driving technology decisions (2010), “clinicians must help drive the selection of clinical technologies (p. 8). Nurses will be able to know if something will be useful in everyday use or if it will cause more of a hassle. Not involving nurses can cause the waste of resources and money spent on the organization.

In step two, the business side begins. The business side of this process brings together the stakeholders and the processes that are needed for this new HIT system. Having the nurses involved in this to use the MoSCoW approach. According to McGonigle & Mastrian (2015), MoSCoW stands for “Must have, Should Have, Could Have, and Would Have” (p. 180). Nurses should be able to answer each of the MoSCoW approach sections and prioritize between the “must have” and the “should have” requirements. Nurse leaders discussion the nurse’s role in driving technology decisions (2010) stated, that nurses should take part in site visits to hospitals using the proposed technology and should be prepared to critique a system. The nurses should be able to recognize and appreciate the money being spent for the organization to help the workflow for nurses. Acknowledging the cost of the new program with help nurses be more appreciative. Not having nurses involved in this stage could waste time and money on issues and priorities that are not important to the organization.

The third step is the most important step for nurses to be involved in. The third step is known as functional model iteration (McGonigle & Mastrian, 2015, p. 181). This step involves translating the requirements into a functional model with a functioning prototype that can be evaluated by its users (McGonigle & Mastrian, 2015, p. 181). It is important for the nurses to be able to use and test out the new technology to see if it meets the requirements for the organization. “Some of the greatest success stories occur when staff nurses are given great latitude in driving technology decisions” (Nurse leaders discussion the nurse’s role in driving technology decisions, 2010, p. 9). Not having nurses included in this stage could potentially have requirements that are not necessary tested. Thus, continuing to waste time and money to bring a new technology to an organization that will not help the nursing staff.

The final step is also known as the implementation, deliverables are the system, documentation, and trained users (McGonigle & Mastrian, 2015, p. 181). This step includes training the users of the newly approved system and all of its satisfied requirements. This step stresses the importance of its impact on the business and organization. Having nursing involved in all of the systems development life cycles promotes nurses awareness to its implementation. If nurses help design and enhance the technology being purchased they will be less reluctant to the change. “Nurse leaders are clear about selecting technologies based on their ability to enable practice, not help clinicians accomplish tasks” (Nurse leaders discussion the nurse’s role in driving technology decisions, 2010, p. 9). Not having the nurses involved in this step will lead to a miss communication and reluctant learners. The “post project” phase is when the team verifies that the system is working properly (McGonigle & Mastrian, 2015, p. 182). Having nurses involved in this phase will help recognize any glitches or system errors that need to be fixed. Not performing audits or survey by the nurses will only have nurse become more reluctant and defiant to the new system. The goal of the system is to help promote an easier workflow.

In conlcusion, having nurses included in the implementation of any new system within the organizaiton will help the organization as whole. Nurses will be using the system the most to help with patient care and documenting appropriately. Continuing to help support the nurses and having their best interest within the organization will develop and implement the best system.

References:

McGonigle, D., & Mastrian, K. (2015). Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making. In D.McGonigle, & K. Mastrian, Nursing Informatics and the foundation of knowledge (3rd ed., pp. 173-185). Burlington, MA: Jones and Bartlett Learning.

Nurse leaders discussion the nurse’s role in driving technology decisions. (2010). Virginia Nu

Discussion 2: Successful Implementation of Electronic Health Information Technology

An organization should never underestimate the importance of the involvement of all key stakeholders from beginning to the end of the system development life cycle (SDLC) (McGonigle & Mastrian, 2012). Nurses play a vital role in the success of an implementation of a new Health Information Technology (HIT) system, and efforts should be made to maintain their involvement throughout the process. The majority of nurses have positive attitudes towards HIT, and most negative attitudes come from poor system design or a slow or malfunctioning system (Huryk, 2010). Nurse leaders set the stage for a successful implementation by providing a positive and nurturing environment for the staff (Huryk, 2010).

For successful adoption of a new HIT system the nurse must feel that the system has value and will be helpful in their daily workflow (Hsiao, Chang, & Chen, 2011). Countless aspects influence this perceived usefulness including management support, compatibility, and information quality (Hsiao et al., 2011). The role of nurses is critical as the providers of bedside care and managers of patient health information. Sustainment may fail without the initial buy-in, continued support, and involvement of nurses in the adoption process. Nursing feedback is essential to consider when conducting all stages of the SDLC process, to improve training, functionality, and adoption by all staff members. Although the process is trying, most nurses prefer the electronic system to paper after time and are willing to get involved with the process and promote usage.

The first step of assessing the systems needs carries the obligation of identifying all the needs of the facility; no one knows this better than the nurse providing care for the patients. In this phase, an analysis of every area of the hospital, clinical and non-clinical, is completed to assess the services they provide and identify gaps that may exist in the current system as compared to the planned system. The nurses give invaluable information and can help avoid costly errors and potential change requests in the future. This process also addresses step two, analyzing specifications for the system. If the facility has a need for a particular system, program or interface that exists or needs to be built, these should be identified at this point.

Designing, developing, and testing the system is the next step in the SDLC process. Although some electronic health records (EHRs) have more flexibility than others, the nurse can help identify any issue that may exist in the present system to ensure prevention in the new system. A good example is in the system we are presently implementing. The ADT system does not allow for a transfer to another facility within our system and to move a patient to another campus, a discharge must occur. This process will create a new encounter number, requiring duplication of all documentation (i.e., admission history). If it was not for the workflow process review and the help of our nursing and ancillary staff this issue may not have been addressed.

During the implementation process the nurses are invaluable. Nurses are our trainers for both physician and staff and our super users. Without the assistance of the nursing staff and their support, the implementation process would not be successful. This process also encompasses the next SDLC step which is support the system operations and users. The nurses work closely with the physicians, staff members, and the informatics department to support one another during and after the implementation process. One potential issue that could occur without the assistance of the nursing staff is the participation of computerized physician order entry (CPOE) by the physicians. The nursing staff support will assist the physicians in this process as they do today in many other areas.

Evaluating the system is the last step and we do this process prior to and after the implementation. The subject matter experts, nurses from specialized areas, run test scripts after the interfaces are built to ensure they are working correctly. These nurses become experts on the system and excellent resources for their coworkers and the implementation team. These nurses continue the role of the super user and assist with maintaining the system with upgrades and changes in the future. Problems, issues, and questions arise at every point in an implementation process and the nurse is frequently our first resource for reliable information.

References

Hsiao, J., Chang, H., & Chen, R. (2011). A study of factors affecting acceptance of hospital information systems: A nursing perspective. Journal of Nursing Research, 19(2), 150-160. http://dx.doi.org/10.1097/JNR.0b013e31821cbb25

Huryk, L. A. (2010). Factors influencing nurses’ attitudes towards healthcare information technology. Journal of Nursing Management, 18(5), 606-612. http://dx.doi.org/10.1111/j.1365-2834.2010.01084.x

McGonigle, D., & Mastrian, K. (2015). Systems development life cycle: Nursing informatics and organizational decision making. In D. McGonigle & K. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (3rd ed., pp. 173-185). Burlington, MA: Jones & Bartlett Learning.

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