System Design Life Cycle Flashcards
Describe the term: automated documentation.
The field of nursing informatics has taken the traditional system of paper documentation and transformed it into a paperless environment using the computer system. The advantages of automated documentation include increased productivity due to:
- Decreases in cost, errors, and omissions
- Improved care and communications
- Easier access to patient information
Paper documentation has been transformed in several different ways on a computer system including narrative charting, charting by exception, flow sheet charting, and standardized nursing languages. Narrative charting is very similar to traditional nursing documentation. It uses menu selections or text entry fields. Charting by exception allows the nurse to view normal values and change only those values for which the patient does not conform to the norm. Flow sheet charting makes use of a graphical user interface to allow the nurse to enter information from a selection of menus. Finally, standardized nursing languages use nationally and internationally defined codes to enter information free from ambiguity.
Discuss the characteristics that should be taken into account when choosing an information system trainer.
The following characteristics should be taken into account when selecting a trainer for information systems:
- Experience: Has the trainer worked with hospital information systems (HIS) previously? How knowledgeable are they regarding the newly installed system?
- Style: How does the trainer work in group situations? Are they good at the communication and coaching aspects of the training session?
- Organizational fit: Is the individual familiar with the training approach and philosophy that the organization prefers?
- Working with upper management: Will the individual be able to train users on the specialized departmental level?
Describe the advantages and disadvantages of computer based training (CBT) for information systems.
Computer Based Training (CBT) is a more popular and efficient type of training for information systems. Advantages and disadvantages of computer-based training include:
Advantages
- Self-paced: The trainee can go through the materials as fast (or slow) as they choose.
- Interactive: There is instant feedback regarding correct/incorrect responses to exercises.
- Availability: The training is available per the trainee’s schedule.
- Modules: The training can be broken up into easily completed modules.
Disadvantages
- Construction: It takes a lot of time and labor to develop and maintain a good CBT system.
- Lack of coaching: Trainees must learn without the help of knowledgeable coaches.
Describe the advantages and disadvantages of e-mail and video methods of training.
The following advantages and disadvantages of the e-mail and video methods of training include:
Advantages
- Trainees receive training materials electronically.
- E-mail messages are easy to assemble and send to targeted trainees.
Disadvantages
- Trainees must open the mail and follow the instructions for completing.
- Reponses might be slow or non-existent without stringent follow-up procedures.
Video
Advantages
- Videos are available 24 hours a day, 7 days a week.
- Exposes many trainees to a single point of training material.
- Easy to distribute and can be shared by trainees within uniform functional areas.
Disadvantages
- Requires expensive cameras and production techniques.
- The instructor must be familiar with presenting the training material through the video medium.
Explain training requirements for the troubleshooting of system problems.
Basic troubleshooting should be taught to all users of the system. This would include re-boot procedures (for a frozen screen), changing passwords, how to properly edit data entries, and when to contact the support desk. Because every system is unique, users must learn the proper procedures to follow when problems arise. Also, learning when to report system performance (i.e., when the system is running slow or oddly) to the system administrator may help avoid a much larger problem.
Describe the strategy of scheduling user-training sessions.
It can be challenging to train the staff of an organization that runs 24 hours a day, 7 days a week (such as a hospital). Finding the best time to train staff members will depend on their overall availability. People may often have to come in late (and be too tired to concentrate) if they are scheduled for a training session after their shift ends. The best strategy may be to allow individuals an entire day for training purposes It may also be necessary to offer training during all three shifts (i.e., 24 hours a day) in order to accommodate shift personnel. Trainees should be given materials to review in advance of the training session so that they will be fully prepared. Training should also be timed to occur as close to the go-live date as possible so that the new information will be remembered.
Describe four factors to consider when choosing a training method for a new information system.
The following four factors should be considered when choosing a training method for a new information system:
- Time: Different training methods take various amounts of time to prepare and perform (e.g., in-person or self-taught)
- Cost: This includes the cost of trainers, equipment, and the amount of hours that employees will need to spend away from their job.
- Learning styles: It is important to consider the predominant successful training style for the organization (what works best for the majority of trainees). This may be determined by the demographics (age, gender, education) of the trainee pool.
- Learning retention: Retention of training concepts may be much higher if the training is “hands-on” (or in-person) rather that self-taught.
Explain the concept of disaster recovery training
Disaster recovery procedures should be taught to users in the event the system “crashes” or goes down for a period of time. It is important to have a back up plan because all information systems are subject to service failures (e.g., power outages or networking problems). The backup procedures should allow the users to continue to perform their assigned tasks in another independent manner (such as paper-based) while the system is down. During training, users should be taken through the backup procedures for the entire organization and for their own department or unit. Additionally, the users should be taught how to backfill the data that was captured while the system was down (once it comes back up).
List the factors to consider when choosing a training site.
The following is a list of factors to consider when choosing a site for information system training:
- Is there space available to conduct the training on-site or will an off-site facility be needed?
- Is the training budget adequate to allow for the option of offsite training?
- Are their enough computer terminals for all of the trainees or will they have to share a terminal?
- Is the site properly configured with power outlets and network connections?
- If the training is at an off-site location, is it convenient to the trainees in terms of parking and proximity to work?
- Is the site prepared with all of the required training materials?
Explain the training materials and proficiency testing involved in information system training.
Choosing the appropriate materials (both those supplied by the vendor and supplementary) for information system training is a key aspect of the learning process. The materials should reflect and support the operation of the live information system. The materials should be clear, concise, and targeted at the comprehension level of the trainees. In addition to the training materials, job aids should be available at the trainee workstation. These job aids should be step-by-step instructions as to how to work with the new system. In addition, of critical importance in training is proficiency testing. The degree to which the trainees have absorbed the knowledge should be evaluated. There are two types of proficiency examinations: criterion referenced or norm referenced. Criterion referenced measures assess each test taker against a set correct value (this measure is the most commonly used). Norm referenced exams grade individuals directly against one another.
Describe the final stages of a go-live implementation.
The final stages of a go-live implementation are:
- Establish a user support structure and its format (phone, webbased, etc.).
- Develop a procedure for change control regarding changes to the system and future upgrades/maintenance.
- The go-live period is a very labor-intensive period for project personnel. A work schedule (including any necessary overtime) should be created in anticipation of this expected workload.
- An implementation feedback loop for users should be created. This may consist of paper questionnaires, a dedicated phone number/e-mail address, or a web site.
- A permanent committee should be established to review requests and implement changes.
Discuss conversion and go-live: Data conversion/migration.
Data conversion/migration occurs when data are translated from one format to another. During implementation of a new system, data migration must occur for the new system to use legacy data but may also occur during system hardware/software upgrades. Migration usually requires software (commercial or in-house) as well as manual effort. The primary stages to migration of data include;
- Planning stage: This includes inventorying the system, reviewing the types and amounts of data to be migrated and the source and destination formats, determining the most cost-effective method, making a specific plan for conversion, performing mapping, and creating conversion scripts and specification documents.
- Performance stage: This includes generating baseline backup of all data, extracting data from the source, normalizing data, performing trial and test conversions, and completing data migration.
- Validation stage: This includes checking to ensure data were converted accurately and completely with all data elements formatted correctly, eliminating duplicate data, and resolving problems.
Explain the procedure that should be followed when planning the “go-Ilve” process.
Set the date when the system is anticipated to go-live and whether the system will be scaled up in a staggered (according to certain client types), modular (according to facility or department) or an all at once manner.
Create an overall implementation strategy that includes:
- Transfer of data from the old system to the new system
- Establish a user and system support system
- Develop the various short- and long-term evaluation procedures to monitor the new system
- Develop a change control procedure to assure that all changes to the new system are documented and carried out properly
Discuss implementation strategies: Pilot implementation.
Pilot implementation is often used in large organizations or those with multiple locations to “try out” the new system before it is implemented further. This is similar to phased implementation except that it is usually limited to one or few units, and extensive evaluation is usually completed during the pilot program. This evaluation includes interviews with users to determine what faults exist and assessment of end-user acceptance so that any alterations or modifications can be completed before further implementation. With pilot implementation, initial training may be restricted to those in the pilot program. The early adopters may be used as trainers and mentors in later implementation. Pilot programs are often easiest to assess in stand-alone units that do not require a lot of data transmission to and from other units.
Discuss system implementation strategies: Overview.
System implementation begins early by preparing staff and users for changes. An implementation committee should be formed before purchase of a system to assess needs and ensure that changes meet the mission of the organization. Nurses should have an active role in the implementation committee, which must develop a project plan and timetable. Project planning software is available to develop a work breakdown structure, which is a plan with a timeline and breakdown of specific tasks. Committee members must be educated about the system so they can serve as resources during the extensive training that needs to occur before implementation. Factors to consider during selection of an information system include the currency of the technology, the ability to upgrade, and issues related to obsolescence, vendor history, vendor compliance with regulations, ability to integrate with existing or other systems, flexibility, support of electronic health records, and the computer data source. Hardware analysis includes network infrastructure, types of workstations/devices, hardware locations, and printing capabilities and locations.
Discuss conversion and go-live: Interoperability
Interoperability is the ability to two systems to exchange and use data while maintaining the same meaning, and this is an important element in the conversion of data. Types of interoperability include the following:
- Technical interoperability refers to the ability of two systems or equipment from different manufacturers to exchange data. This usually refers to hardware/software or equipment that allows machine-to-machine communication.
- Syntactical interoperability refers to the transfer of data formats without necessarily ensuring that meaning is intact.
- Semantic interoperability refers to the transfer of meaning so that people recognize that the content transferred is the same.
- Process interoperability refers to processes and specifications that facilitate exchange of data from one organization to another.
Noninteroperability may result from lack of adequate system review, changes in standards that interfere with the application to another system, and varying levels of technical quality from one system to another.
List some anticipated problems that may occur during implementation of a new system
The following problems may occur when introducing a new information system into a healthcare facility:
- Failing to allocate adequate time for system implementation.
- Scope creep: allowing the project to exceed the original scope (e.g., adding extra features or functions without paying attention to timeline or budget). This tends to occur slowly during the conduct of the project and ultimately results in exceeding the budget and/or timeline.
- Allowing programmers to customize a system beyond what is necessary.
- Not allowing enough funds for maintenance.
- Failing to provide dedicated staff to work on the project.
- Encountering organizational resistance to change that causes roadblocks or delays.
- Not allowing enough time to adequately test the system.
- Not allowing enough time to train relevant staff.
Discuss implementation strategies: Parallel implementation.
In parallel implementation, both the existing (legacy) system and new system are used concurrently; for example, when moving from paper charting to computerized record keeping, both systems are used. A timetable is usually established for phasing out the legacy system. Parallel implementation allows end-users to learn the new system while still using the old system to record data. This method is usually faster than phased implementation but slower than big bang and tends to be the rnost costly both in terms of finances and time, as users must enter data in two systems, increasing the risks of errors. However, this format does allow for evaluation of the accuracy of use of the new system, as comparison data are available in the legacy system. Parallel implementation is also less risky in terms of System failure than big bang implementation because a backup system is essentially in place.
Describe the steps involved in the back loading of existing data into a new information system.
The following steps are involved in the back loading of data into a new information system:
- Decide what information needs to be migrated to the new system
- Establish who is responsible for entering the existing data into the new system
- Set a schedule for the timing of the data transfer
- Establish the time frame for migration of historical data
- Implement controls to assure that all back loaded information is accurate
- Verify that the system is working properly
Discuss implementation strategies: Big-bang implementation.
Big-bang implementation occurs when a complete system goes live across an organization on a designated date and time. For example, if the prior system involved paper documentation, this stops, and all entries are done on the new computerized system. The big-bang approach is best in small organizations where people have been well trained in the new system, have competent computer skills, or have mentors readily available. A phased approach may be better for a large organization because inevitable problems arise during transition. Lists of those who are trained and can assist others should be published, and training should be a staffing consideration so that all units have mentors available. All data must be converted from the old system into the new system before implementation, and the validity of the data must be verified because errors can occur during conversion. Advantages are rapid change, less updating of documentation, and focused training. Disadvantages include confusion, lost data, learning curve, and startup problems. Fallback plans should be in place in the event of system failure.
Discuss testing methods: Automated testing.
Automated testing involves using software tools specifically designed to test features of an information system, such as the graphical user interface (GUI). Automated testingdoes not require manual intervention. The software may include tools to provide comparison data regarding expected and actual outcomes and well as other reports. Automated testing often mimics the actions of users, but automated testing must include adequate testing scripts to be used effectively. Applications may include program monitors, debugging tools, GUI testing tools, profiling tools (to generate reports), and benchmarks. Metrics (standards of measurement) must be developed to address performance issues, and the goals and expected outcomes of automated testing should be clearly defined. Automated testing is especially valuable in the types of testing that may not be practical to do manually, such as stress testing in which a system is tested with large numbers of simulated users.
Discuss the steps of the system implementation plan.
The following steps are involved in administering the system implementation process:
Step 1: Develop a schedule (with strategic milestones) that will be used to install the new system. This is sometimes referred to as the work breakdown structure (WBS) of the project.
Step 2: Assign tasks. These tasks should be specific, assigned to capable persons, and tracked (for completion).
Step 3: Establish a communications plan that covers the methods and timing of all communication within and outside of the implementation team.
Step 4: Test the system (in a controlled test environment) before going live. This gives the users and a support staff opportunity to stress the system and assure that it is operating properly.
Discuss system elements to be tested: Screens.
Screens, such as those on computer monitors, smartphones, or tablets, display both text and graphic images. Early computer screens used cathode ray technology (CRT], but this has been almost completely replaced by liquid crystal display (LCD) technology, used for flat panel displays. LCDs have a lower power demand than CRTs or plasma displays (used primarily for large screen televisions); additionally, they are more lightweight and smaller. LCDs have two sheets of polarizing material with a liquid crystal solution between the sheets. For touch screen capabilities or use of a stylus, an electromagnetic field is added.
Considerations include:
- Refresh rate: This is the speed at which the screen reprints from top to bottom. Slow refresh rates on CRTs can cause flickering, but this does not occur with LCDs, which have a frame rate (the rate at which consecutive images or frames appear] expressed in frames per second, usually about 60.
- Resolution: This is the number of horizontal pixels by vertical, such as 1440 X 900. The higher the resolution, the clearer (but smaller) the image.
Discuss validating data integration across disparate systems.
Validating data integration across disparate systems is essential because incorrect data can lead to serious problems with the system and provide false information. Validating every item of data is virtually impossible, but doing spot checks of representative data may miss faults. Validation should include assessing the size of data, including the number of files or records, before and after data transfer to a disparate system to ensure it is the same and that the data source is completely transferred correctly. Data should be complete, accurate, and formatted correctly, and duplicate elements should be eliminated. Important elements of validation include:
- Validating across all levels of data, determining frequency, duration, and areas of applications.
- Validating at high granularity (degree of breakdown into smaller units/parts) rather than low.
- Validating data that are especially critical.
- Automating validation.
- Thoroughly understanding the source of data as well as its input and storage.
- Customizing validation approaches, according to the needs of the organization.
Discuss system elements to be tested: Devices.
Devices include input devices, such as keyboards, mouse, microphone, stylus, webcams, and output devices, such as terminals, printers, projectors, and screens. The informatics nurse specialist must understand the system architecture and how all of the devices are interconnected as well as how the operating system interfaces with the devices. Other necessary information includes the configuration of the individual devices and software access as well as the manner in which to add individual devices to an existing system. Different operating systems use different naming protocols for similar devices and display information about devices in different manners. Devices can be in four different states when connected to a system:
- Undefined: The system does not recognize the device.
- Defined: Information about a specific device is present in the database but not available to the system.
- Available: Information about a device is present in the database and configured to the operating system.
- Not available/stopped: Information about the device is present in its driver, but the device is not available.
Discuss testing methods: System integration testing.
System integration testing (SIT), part of software/hardware testing, determines if hardware or software applications can work together. Integration testing is done after unit testing and before system and acceptance testing and involves testing how all the units function together. This is a type of black box testing that should not require knowledge of code or inner product design. The purpose of the testing is to identify problems or faults within the component parts (assemblages) or within the entire information system that affects performance. SIT may include load, volume, and usability testing. SIT involves development of an integration test plan that outlines what will be tested and how the tests will be conducted as well as pass/fail criteria. Test cases may be developed to identify transitions and present end-user scenarios. Test data should be developed to use in the test cases. Approaches to integration testing include big bang (includes all components), top down (higher level components before lower level), and bottom up (lower level components before higher level).
Discuss testing methods: Systems environment.
The systems environment is assessed through analysis of the internal environment (e.g., staff, physicians, board) and external environment (e.g., vendors, patients, agencies). A needs assessment may be required to determine the type of data required. Data may be derived from the following:
- Published materials (e.g., journal articles, reports)
- Vendor materials (e.g., pamphlets, specifications)
- Organizational input
- Regulatory requirements
- Accreditation requirements
- Marketing t rends
- Interviews and questionnaires
- Technological trends
Data are analyzed to identify trends, needs, and expectations. Once potential actions or solutions to problems are identified, they must be further analyzed and comparisons made, considering the needs of endusers. After implementation of a system, ongoing testing, analysis, and feedback are necessary to ensure that needs are met and that the system functions effectively.
Discuss testing methods: Load, or volume testing.
Load, or volume testing, is a type of nonfunctional reliability testing that evaluates the system’s ability to function under different loads, such as during normal use times and peak times with multiple users to determine maximum capacity and problems that might be encountered. This test involves evaluating the effect of volume on the system to determine limits. Testing tries to determine at which exact point problems arise. This can include static and dynamic testing of the system at the safe working load (SWL) and above the SWL. Volume testing may include testing the ability of an application to handle a certain volume of data, such as in a database. Volume testing should always be concluded before a system becomes live to prevent crashes and loss of data if limits are exceeded.
Discuss system elements to be tested: Reports.
Information systems provide a number of different types of reports, and these should be assessed for accuracy. Some reports are generated automatically, and others require manual input to define the type of report and information needed. Types of reports that may be available include:
- Configuration: These reports contain data about the system itself, including hardware and software, as well as workstations and servers. Configuration reports may be generated by systems or data sets.
- Informational: Often informational reports include built-in templates and provide fact-finding to glean information from databases.
- Change: Usually change reports are automated, showing changes that occur in the system over a period of time.
- Baseline: Usually baseline reports are automated to show how the system or elements of the system compare to a baseline.
- Summary/management: These reports show summaries of actions, processes, and data.
- Periodic: Periodic reports are issued at predetermined periods, such as monthly claims reports.
- Error/exception: Error or exception reports are issued when faults occur or data are outside of normal parameters.
Discuss testing methods: Functional testing.
Functional testing verifies that a code is functioning properly and determines if users are able to carry out certain functions or whether features in the software work as expected. Functional testing may include manipulating data, conducting searches, using user commands, and accessing user screens. Integration testing is also conducted as part of functional testing. Functional testing should be completed on units during development and on the system as a whole after integration. Functional testing should also be conducted from the perspective of the end-user, so functional tests should always be designed to correspond to end-user requirements. Functional testing may include both manual and automated testing components. Functional tests should be able to identify system level faults and problems.
Discuss system elements to be tested: Links.
Links (i.e., highlighted words, icons, images) allow access of information at one point from a different point. For example, a link may allow the user to jump from one part of a document to another or one document to another. In some cases, links may be external, such as links to Internet websites. When the user clicks on a link, a transmission control protocol/Internet protocol connection is established between the user and server, resulting in a hypertext transfer protocol request of information. All links must be tested individually to ensure they function properly. Links may open in different ways, such as in a popup window or by replacing the content of the original window. Links may be generated automatically, such as with alerts, or accessed manually.
Discuss testing methods: Unit/component (suitability testing methods).
Unit/component suitability testing methods:
Black box - This is a form of functional testing that determines if an input results in the correct output, using test cases focused on the system’s operational profile. This type of testing does not require knowledge of code or inner product design. Testing may not include activation of all codes, so it may not detect all faults.
Fault injection — This introduces faults into the system to show what happens to the system when the component fails to function properly.
Operational system - This tests the ability of the system to function after introduction of a component. However, this may require a huge amount of testing to determine how the system will deal with component failures or problems.
Defense building - Wrappers are used to limit the component software in some way; that is, the wrapper may check or limit input into the component or check or limit output to the system. Wrappers are often employed when commercial software is purchased that only partially meets requirements.
Discuss resistance to organizational change.
Performance improvement processes cannot occur without organizational change, and resistance to change is common for many people, so coordinating collaborative processes requires anticipating resistance and taking steps to achieve cooperation. Resistance often relates to concerns about job loss, increased responsibilities, and general denial or lack of understanding and frustration. Leaders can prepare others involved in the process of change by taking these steps:
- Be honest, informative, and tactful, giving people thorough information about anticipated changes and how the changes will affect them, including positives.
- Be patient in allowing people the time they need to contemplate changes and express anger or disagreement.
- Be empathetic in listening carefully to the concerns of others.
- Encourage participation, allowing staff to propose methods of implementing change, so they feel some sense of ownership.
- Establish a climate in which all staff members are encouraged to identify the need for change on an ongoing basis.
- Present further ideas for change to management.is common for many people, so coordinating collaborative processes requires anticipating resistance and taking steps to achieve cooperation.
Discuss system elements to be tested: User interface.
A user interface (human-computer/machine interface) allows interaction between the user and the machine (e.g., computer, other electronic devices), permitting the user to make input and to see output as a result. The design of this interface must consider the needs of the user and ease of use. Types of current and new interfaces include the following:
- Touch screens and touch user: Often used in simulations, the device has a combined use of input and output.
- Graphical user: This allows an interface between devices, such as the keyboard and computer. It includes object-oriented user interfaces as well as application-oriented interfaces.
- Gesture: This allows input from gestures and mouse/stylus movements.
- Zooming: This allows changes in scale of output.
- Voice user: Input is by keystrokes or voice commands, and output is by voice commands.
- Natural language: This allows input by keystrokes in natural language (e.g., questions), and output is the response.
- Zero-input: Input derives from sensors.
Describe the steps necessary for upgrading or implementing information systems.
The following steps are necessary whenever an organization is upgrading or implementing an information system:
- Planning and administration of the project: Establish the planning and project teams, and set the key milestones for the project
- Delivery of hardware and software: Select the vendor and purchase the hardware and software.
- Program installation: Provide time for installation and perform a qualification (system testing, interfaces to databases, etc.) of the newly installed components.
- Policies and procedures: Develop and approve the relevant polices and procedures.
- Training: Provide training for all relevant personnel.
- Maintenance and support: Set up a maintenance and user support procedure.
Discuss system elements to be tested: Features.
Features are parts of a component with predictable properties. Systems have become increasingly complex because of the expansion in features. Feature creep is the term used to describe the addition of more and more features to a program. Features may relate to data, hardware, software, end-users, and telecommunications and facilitate the four primary functions of an information system: allowing input, providing storage, processing data, and providing output. Features may include the following:
- Management of database (e.g., storage, retrieval, import, export)
- Ability to generate reports
- Ability to integrate with other components of a system and scalability
- E-mail and other customizable alerts
- Time keeping/login and logout times
- Communication among different levels and multisite capabilities
- Real-time processing
- Ability to establish uniform procedures
- Ability to provide feedback
Describe the creation of standard operating procedures (SOPs) and user manuals for an information system.
The following steps should be followed when developing the documentation that will be used to operate the new information system:
Step 1: The standard operating procedures and user documentation should be prepared and used to train users before the system goes live.
Step 2: The documentation that was used to operate the old system should be evaluated for applicability (via editing) to operate the new system.
Step 3: Disaster recovery documents should be prepared in the event the system “crashes” or goes down. A paper-based system should be readily available.
Step 4: The vendor’s user guides and support documentation should be reviewed to determine if the information could be incorporated in the organization’s user documentation.
Explain the aspects of system testing during the implementation process.
Before going live with a hospital information system, the system should be thoroughly tested to assure that it is operating properly. This is accomplished by performing a system test plan. The system test plan consists of the following four steps:
Step 1: Develop the overall test plan. This includes the installation, operation, and validation of the new system.
Step 2: Create the test scripts. These are the scripts that actual users of the system will use to “stress” the system to determine if it is working according to specifications. They should reflect real use as closely as possible.
Step 3: Carry out the testing and troubleshoot and system’s failings as soon as possible.
Discuss making recommendations for programming changes.
Programming changes are common with information systems because of updates, upgrades, and the addition of new features. Technolog,’ is constantly changing along with user needs and regulatory requirements, so programming must accommodate these changes. Typically, software upgrades are released on an 18-month schedule, and often one upgrade can be skipped without a significant impact on productivity; however, by the third year, obsolescence is an issue, and upgrading and making necessary programming changes are usually necessary, so management must carefully assess the value of upgrades, needs of the organization, and associated time and costs in implementation when making recommendations. Changes in regulatory requirements may occur every year or 2, so monitoring requirements and making necessary programming changes are essential.
Discuss system elements to be tested: Interface.
Interface is a computer program that allows two or more programs to exchange information. If the connection is direct, the interface is point-to-point and allows transfer of data only between two programs. Interface engine software allows information to transfer from one system to a number of different systems. In this case, translation tables move data from the clinical data repository (collective database) to each system. Because terms may vary from one system to another, mapping is required to associate terms in one system with comparable terms in other systems. The serial peripheral interface bus (SPI) is a de facto industry standard, although different vendors have different configurations. SPI allows master/slave communication from the master device to single or multiple slave devices. SPI is full duplex and facilitates communication in both directions simultaneously. Half duplex interfaces facilitate communication in both directions but only in one direction at a time. SPI is used to communicate with a variety of peripheral devices, such as sensors, clocks, liquid-crystal displays, universal serial bus ports, and communications (e.g., Ethernet, handheld devices).
Describe the purpose of conducting a feasibility study before implementing an information system.
A feasibility study will help to define the problem(s) that the new information system is expected to address. It will also answer questions regarding cost, goals, and specific outcomes. Some specific questions may include:
- How will the outcome (e.g., meeting the pre-defined business requirements) be measured?
- What research has been done to back up the proposal?
- What are the risks in terms of people, money, and time?
- How long will the implementation take and what will be involved?
- Will the project require dedicated staff members, contractors, or a combination of both?
Discuss system elements to be tested: Components.
Components are software applications, such as those commercially available or prepared by third parties, which need to be integrated into the other software of the information system. Testing is completed to determine if the software meets specifications and functions properly and whether it meets interaction requirements of the system. Tests verify if specific areas of code work correctly. Factors to consider include the ease with which the software’s functions can be observed, behavior traceability, the difficulty or ease of functions and operations, and the method the component uses to provide or present information. Components may be tested by the developer and by the user, but the user may lack the source codes necessary for effective testing. In some cases, if software is functioning well, further testing may not be indicated. In general, those components that should be tested include reusable and domain components. Commercial components are often reusable and should be tested and evaluated for liability issues. When possible, reusable testing strategies should be developed.
Explain issues related to instructing and advising staff on changes in policies, procedures, or working standards.
Changes in policies, procedures, or working standards are common, and the quality professional is responsible for educating the staff about changes related to processes, which should be communicated in an effective and timely manner.
- Policies are usually changed after a period of discussion and review by administration and staff, so all staff should be made aware of policies under discussion. Preliminary information should be disseminated to staff regarding the issue during meetings or through printed notices.
- Procedures may be changed to increase efficiency or improve patient safety often as the result of surveillance and outcome data. Procedural changes are best communicated in workshops with demonstrations. Posters and handouts should be available as well.
- Working standards are often changed because of regulatory or accrediting requirements; this information should be covered extensively in a variety of ways: discussions, workshops, and handouts so that the implications are clearly understood.
Describe the hardware infrastructure analysis that occurs during system implementation.
The following hardware infrastructure requirements should be evaluated and satisfied before the new system is installed:
- Network infrastructure: cable/wireless local area network (LAN) installation, available access points, and overall compatibility with the new system
- The type(s) of user workstation interfaces (desktop computer, laptop computer, terminals, etc.)
- The location of the workstations (portable or permanent)
- The physical location of the hardware (servers)
- The connectivity and location of printers and/or other output devices
Discuss planning, directing, and leading resources: System enhancements.
The availability of system enhancements, such as software upgrades, new software, and new hardware, is almost constant, but constant changes to a system can result in changes in functionality and a need for increased resources and training. A committee that reviews requests for enhancements can help to determine which are needed by the organization and which are unnecessary. Enhancements should be evaluated in terms of impact on efficiency and cost-effectiveness. Introducing enhancements to a system that change functionality requires advance notice to staff and sometimes additional training, so holding the introduction of enhancements to a schedule, such as every 6 weeks, may be less disruptive than routinely updating software and equipment as updates become available. Testing the enhancement should be completed, when possible, before wide dissemination.
List the individuals who should be included on the steering committee of an information system implementation.
It is important when implementing a new information system into the clinical environment to have representatives from all areas of the organization that will be affected by the new system, including those listed below:
- Hospital Administration: In order to assure that business processes are maintained
- Finance: To assure that billing and patient records are maintained, in addition to establishing a budget.
- Nurse administrator: To facilitate that nursing procedures are compatible with the new system.
- Director of the Information Systems department: To oversee that the system is installed properly.
- Medical records: To assure that record keeping is accurate and follows all regulatory requirements (e.g., HIPAA)
Describe the necessary steps for the formation of an implementaiton team.
The following steps are needed to form an effective implementation team:
Step 1: Select a leader who will own the implementation process.
Step 2: Form the team with representation from the various users of the system (e.g., IT staff, executives, and nurses)
Step 3: To assure success, look for the following team member characteristics:
- Good communication skills
- Can multi-task effectively
- Good cooperation in the team environment
Step 4: Keep the team focused on the final goal of implementing an effective system.
Discuss planning, directing, and leading resources: Assigning resources.
Assigning resources involves understanding the types of resources available—educational, personnel, financial, and equipment—as each must be allocated, using different priorities; therefore, establishing a list of priorities for each category of resources is essential. Prioritizing may be done by the informatics nurse specialist alone or with guidance from an advisory committee. For example, educational resources, such as computerized modules, videos, and texts, may first be assigned to those in a particular unit where training is essential. Personnel should be assigned, according to need, in terms of actual number of staff, work time, and duration of time. Financial allocation includes ongoing costs of maintaining a system, costs of updates and enhancements, and contingency costs (e.g., when problems arise or equipment malfunctions). Equipment resources, such as handheld devices and biometric monitoring devices, are allocated according to need, which is often determined by an advisory committee.
Discuss system planning concepts and considerations: Return on investement.
Return on investment (ROl) refers to an accounting calculation used to determine the value and cost of an investment. A typical ROI calculation includes:
- The yearly cost for an employee who will use equipment (in dollars), for example, $80,000 (A).
- The percentage of time (in decimals) the employee will use equipment, for example, 25% = 0.2S (B).
- The percentage of estimated increased efficiency over prior system (in decimals), for example, 30% = 0.30 (C).
- Multiplying the three figures above (A x B x C) yields the productivity advantage in dollars, for example:
$80,000 X 0.25 X 0.30 = $6000 (D).
- Equipment (including software and training time) costs in dollars, for example, $20,000 (E).
- Dividing E by D and multiplying by 12 (E/D x 12) yields the time in months needed for the new equipment to pay for itself, for example:
$20,000/$6000 = 3.33 x 12 = 39.96 months
While this is simplified and does not account for depreciation, upgrades, and other changes, this approximates the procedure.
Discuss system planning concepts and considerations: External customer-supplier relationships.
External customer-supplier relationships are critical to an organization because these customers receive products or services supplied by the organization. External customers include patients and their families (although inpatients are sometimes considered internal customers), private physicians, vendors, insurance companies, government regulatory agencies, lawyers, and others in the community. As with internal customers, each external customer is both a receiver of products or goods and a supplier. For example, a regulatory agency provides regulations and guidelines as a supplier and then receives reports in return as a customer. This symbiotic relationship must be clearly understood because the external customer-supplier relationship is one over which the organization often has less direct control, so identification of the customers’ needs through surveys, interviews, focus groups, research, and brainstorming can help to clarify and improve these relationships.
Describe the process of examining the external and internal environments for strategic planning.
Both the external and internal environments should be examined when performing strategic planning. In terms of the external environment, the major item of interest would be the state of technology. Some questions to ask include:
- Has the hardware and/or software been updated by the suppliers?
- Do we as an organization need to move up to the new level?
- What are our competitors or peers up to?
- Would an update in technology become a competitive advantage?
In terms of internal environment, this information should be readily available through feedback from the users of the current informatics systems. In addition, any changes in business processes that require new capabilities should also be examined.
Discuss system planning concepts and considerations: Internal customer-supplier relationships.
Internal customer-supplier relationships in an organization must be identified and understood. Internal customers are those directly involved in product or health care delivery, such as those on the Board of Directors, clerical staff, administrative personnel, nursing personnel, medical support staff, physicians, human resources personnel, plant managers, pharmacists, and volunteer staff. In-patients may be considered internal customers. A customer is, by definition, a receiver. Internal customers need others in the work environment to provide some type of product or service so that they may function, and they, in turn, provide a product or service to others, so each internal customer is also a supplier. Vertical customer-supplier relationships, such as between administration and nursing staff, are sometimes more obvious than the equally important horizontal relationships, such as between floor nurses, which can involve cooperative measures to ensure that quality care is provided. Identifying customer-supplier relationships should be part of strategic planning to increase internal awareness and improve methods of meeting the various customers’ needs.
Discuss system planning concepts and considerations: Cost-utility analysis.
Cost-utility analysis (CUA) is a subtype of cost-effective analysis; however, the results are more difficult to quantify and use to justify expense because a CUA measures the benefit to society (e.g., decreasing teen pregnancy). Often the standards used to quantify a CUA are somewhat subjective. A CUA compares a variety of outcomes (e.g., increased life expectancy, decreased suffering) in relation to the quality- adjusted-life-year. A scale is used with 1 being normal health and O being death. A health condition is assigned a number on this scale, which is referred to as its “utility.” When calculating outcomes with a CUA, an intervention is evaluated on whether or not it increases the utility score and thereby increases life expectancy or improves life circumstances by x number of years. Thus, the results of this type of analysis are not expressed as monetary values but rather societal values.
Discuss request for information.
Request for information (RFI) is used early in system analysis to gather information from vendors, often in conjunction with requests for proposal and requests for quote. The RFI is often done by letter, although some vendors now use e-mail or:accept RFI on websites. The person requesting should outline the type of information needed and give an overview of plans to purchase and install an information system. Many companies have brochures or websites that provide general information about their systems, so sending a list of specific questions may elicit better information. The primary purpose in sending a RFI to a variety of vendors is to help in the elimination and selection process. Topics for questions may include the following:
- History and financial status of company
- Lists of current users of company’s product and numbers of sites
- Information about system architecture
- Hardware and software requirements
- User support
- Equipment support/maintenance
- Ability of equipment to integrate with other systems
Discuss system planning concepts and considerations: Resource use.
Resource use refers to the consideration of all factors related to the planning and delivery of quality products and activities. Resources may be allotted to the physical environment for building or remodeling, staffing, equipment, literature, training, and outreach programs. Use review requires consideration of individual safety, program effectiveness, and cost. Interventions should be safe, effective, and affordable for each individual. Decisions should take into consideration rising health care costs and how to maximize the use of resources while continuing to provide quality professional development activities. The goal of resource use is to provide quality, cost-effective programs while using the best-qualified staff and appropriate resources.
Discuss system planning concepts and considerations: Staffing management.
Staffing management involves both clinical staff (e.g., nurses) and nonclinical staff (e.g., housekeeping staff, office personnel). Important issues include the following:
- Workforce size and distribution, including full-time equivalent staff members, needed
- Educational resources, such as training programs, and availability of trained personnel, including professional staff and support staff
- Staff training, ongoing need for staff development, and opportunities for certification or advancement
- Demographics (e.g., age, economic levels, ethnic backgrounds, lifestyles)
- Incentives for career advancement, including increases in income, promotion, and certification
- Staff turnover, burnout, and an ongoing need for recruitment
- Organizational structure
- Financial resources available
- Cost-effective staffing and billable provision of care
- Reimbursement (e.g.. Medicare, Medicaid, health insurance, private pay)
- Supervision/ feedback
- Organization-wide strategies for staffing
Discuss system planning concepts and considerations: Cost-effective analysis, efficacy studies, and incremental cost-effectiveness ratio.
A cost-effective analysis measures the effectiveness of an intervention rather than the monetary savings. For example, each year, about 2 million nosocomial infections result in 90,000 deaths and an estimated $6.7 billion in additional health costs. From that perspective, decreasing infections should reduce costs, but there are human savings in suffering as well, on which it is difficult to place a dollar value. If each infection adds about 12 days to hospitalization, then a reduction in infection by 5 days would be calculated as follows:
5 X 12 = 60 fewer patient infection days.
Efficacy studies may compare a series of cost-benefit analyses to determine the intervention with the best cost-benefit. They may also be used for process or product evaluation. For example, a study might be done to determine the effective use of four different types of computers to determine which type resulted in the fewest errors that resulted in added costs, thus saving the most money.
Incremental cost-effectiveness ratio is the ratio of cost change to outcome change.
Describe the components of the system selection process.
System selection is the second phase of the system development life cycle.
The following are the three components of the system selection process:
- Needs Assessment: This first action takes place after the decision has been made to purchase a new system or upgrade an existing system. Information is gathered regarding the current state of the art and how the offerings in the marketplace meet the current defined needs of the organization, as well as future needs. Typically, a selection committee attends trade shows and sales meetings that are set up by the potential vendors of the systems.
- Request for proposal (RFP): Once the pool of potential vendors has been narrowed down (typically to three), RFPs are sent out. The resulting proposals are then evaluated, references are checked, and the system is evaluated in action (wherever possible).
- Contract negotiation: The winning system is then selected and a contract is negotiated with the vendor. Once the contract is approved, implementation plans may proceed.
Discuss system planning concepts and considerations: Inventory.
Inventory describes the amount of material or equipment on hand, which should be reviewed at least once a year. In many cases, reordering is done when the amount of a particular item drops to a certain pre- established level. Just-in-time ordering is done when stock is almost depleted. Automatic reordering of supplies is easy when inventories are computerized. In some cases, departments have open accounts that can be used for small purchases without bidding. For large purchases (especially in public institutions), the nurse should state exactly (i.e., include brand names when appropriate) which items are to be purchased on a bid form. The bids are then sent to prospective bidders (at least three) in a competitive bid process. Organizations vary in what bids are acceptable. Some only accept the lowest bid, while others accept the best bid (e.g., those supplying brand names rather than substituting with generics). Many organizations have private purchase plans that allow them to purchase directly without bids or lease equipment, which is less expensive initially.
Discuss system planning concepts and considerations: Cost-benefit analysis.
A cost-benefit analysis uses the average cost of an event and the cost of intervention to demonstrate savings. Examples follow:
- Computer repair overtime costs related to improper computer use are $125/hour. If the institution averages 20 hours of overtime a month ($125 x 20 = $2500) x 12 months ($2500 x 12), the annual cost equals $30,000.
- If the intervention included staff training materials ($400), instructor costs ($2000), and staff costs ($10,000), then the total intervention cost is $400 + $2000 + 10,000 for a total of $12,400.
- If the goal were to decrease overtime costs by 80% to 4 overtime hours a month, then savings would be calculated as 4 x $125 = $500 monthly costs x 12 = $6000 subtracted from the current annual cost of $30,000 = $24,000 savings.
- Subtracting the intervention costs from the savings gives the annual cost-benefit: $24,000 - $12,400 = $11,600 annual cost-benefit.
