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.
List the items that need to be evaluated when performing system selection in the system development life cycle.
The following items need to be evaluated when performing the system selection portion of the system development life cycle:
- Costs related to the hardware, software and network for the new system
- Facts about the vendor (e.g., reputation, knowledgeable staff, and financial stability)
- System capabilities in regards to ease of use, user friendly interface, ability to meet the organization’s needs, security, expandability, and ability to interface with other systems
List the items that should be included in a request for proposal (RFP).
The following information should be included in a request for proposal (RFP):
- A description of the organization
- The organization’s mission statement, goals, and objectives
- The organizational structure
- The type of healthcare facility
- The proportion of clients in each pay type
- The patient and facility statistics
- The overall system requirements
- The criteria for evaluating responses to the RFP
- The deadline for submission of the requested information
Describe the overall steps in the formation of a steering committee.
The following are the overall steps in the formation of a steering committee:
Step 1: Form a steering committee to evaluate the current information system and begin the research process for the new system.
Step 2: Staff the steering committee with representatives from all levels of the organization that will use the new system.
Step 3: Establish a leader of the steering committee that will own the process and report progress.
Step 4: Establish the steering committee’s goals and objectives.
Step 5: Determine if an experienced outside consultant is needed to handle complex technical issues, and/or save time.
List the vendor attributes that are important for a successful purchase and implementation experience.
The following is a list of important attributes to consider when selecting a vendor:
- What is the company’s history and financial stability?
- Do they invest in the development of new technologies?
- How many sites currently use the company’s systems?
- What other organizations use the system being evaluated?
- What hardware/networking is required for the system architecture?
- Is the company’s technology state of the art?
- What other systems and software are compatible with the system?
- What methods of user support are available (phone, internet, etc.) and what is the average response time to a user support request?
- Does the organization have any large upcoming changes for the system to adapt?
- How (and how often) does the company distribute software updates?
Describe the information that should be gathered when conducting a site visit.
The following information should be gathered when conducting a site visit:
- The site’s experience regarding the information system’s reliability and vendor support services
- The amount of downtime that has occurred and the primary causes
- System backup procedures User experiences with the various interfaces to the system
- Narratives regarding any customizations to the system
- A log of the amount of hours of training that were required
- System security performance
- Overall satisfaction with the system
Describe the tasks of a steering committee in researching a new information system.
The following tasks should be carried out by the steering committee when researching a new information system:
- Verify that the project fits into the organization’s goals and objectives as stated in the mission statement
- Reach a consensus on the business requirements that the new information system needs to satisfy
- Scan the internal environment within the organization to assess where the current information system is not adequate
- Look to the future to assess the longevity of the new system and how it can evolve to meet the organization’s needs for the next three to five years
Describe the advantages and disadvantages of expert systems.
The following is a list of programmed expert systems advantages:
- Consistency in decision-making. Given a set input, the returned answer is always the same.
- A central knowledge depository. Expert systems can manage a larger database of information than most human experts. Additionally, the knowledge survives staffing changes (e.g., the loss of subject matter experts). • Ability to review answers and generate reports. This allows decision makers unfettered access to information they need at any given time.
The following is a list of programmed expert systems disadvantages:
- The software lacks “common sense”. It may sometimes provide answers that are not accurate.
- The logic is “locked down”. The user is unable to deviate from the program in order to be more creative.
- Programming difficulties. Programming these types of programs can be difficult due to the need to incorporate high- powered business integrators.
- Not adaptable. Once the program has been completed, it is not adaptable to change without major effort.
Describe the terms: Open system and closed system.
There are two types of systems: open and closed. They are defined as follows:
- Open systems do not have fixed or permanent boundaries but are instead constantly being re-defmed as they interact with the environment. An open system may be a subsystem (e.g., a nurse within a hospital) and can overlap other systems. In computing, an open source program allows access to the source code. This allows customizations and updates from users and programmers in an open environment.
- Closed systems are self-contained and isolated from the environment (including other systems). The boundaries of a closed system are distinct and fixed. With the exception of an external energy source, closed systems do not receive input from the environment and all output is contained within the system. A saline IV pump is an example of a closed system. In computing, when the source code is locked (by the vendor) the program acts as a closed system. All adaptations must originate from the vendor.
Describe the four phases of the system development life cycle.
The system development life cycle is divided up into the following four phases:
- Needs Assessment: The phase where business requirements are collected from the future users of the system.
- System Selection: The phase where an information system is selected that can meet all of the gathered business requirements.
- Implementation: The phase in which the system is scaled up and performance tested.
- Maintenance: The phase where a help desk is set up (for troubleshooting user problems) and the system is regularly backed-up and updated.
Describe the term: Expert systems.
Expert systems were designed by individuals working in the field of artificial intelligence. These systems are programmed with information that a human expert would use to handle a particular problem, use set rules to analyze the problem, and in some cases provide the user with a list of recommendations. Expert systems are widely used in healthcare to help diagnose and treat patients. The knowledge bases for expert systems are created by a group of individuals who are asked to give guidelines on how they solve very specifically defined problems. Next, the system is created and test cases are used to verify the accuracy of the outcomes. Expert systems may use simple true/false logic or more advanced fuzzy logic. Simple true/false logic design generally asks the user a series of questions to which they answer yes or no. Fuzzy logic attempts to include common uncertainties, but is generally not as accurate as systems designed on true/false logic.
Describe the six elements of a system.
There are six elements necessary in the formation of a system. They are:
- Interdependency: There must be multiple components that interact with each other in a concerted way.
- Inputs: Data that is placed (input] into the system from an external source (e.g., system users].
- Process: The overall functionality that the system contributes its various components towards achieving.
- Output: The product of the system. The end result of the various interdependent components of the system. This is usually a distinct product that can only be achieved if the system is operating correctly.
- Control: Operation that works to prevent or correct problems as they occur throughout the process. This is usually initiated through a feedback mechanism.
- Feedback: An internal control mechanism that allows for the detection and correction of processing problems. This can also include the monitoring of the external environment for an open system.
Describe the term: network systems.
A network system is a group of computers linked together to increase efficiency or distribute computing power. One key reason to use a network system in a healthcare facility is related to data. Patient data must be stored for long periods and accessed by different functional areas within the same facility. By storing patient data in a central server (accessible to all computers connected to the network), the process is made far more efficient and reliable. Another advantage of network systems is that all users share the same software making it easier for the users to share information. In addition, network software licenses are more affordable for the company to purchase. The network software packages are easier to upgrade since only one upgrade to the server is required. Finally, individuals can use the network connection to perform patient consults, proofread each other’s work, and send electronic mail (e-mail).
Explain the role of the informatics nurse (business integrator) in the implementation of information systems.
When a new information system is going to be implemented, the informatics nurse (or business integrator) is in a particularly important position to support the process. For this role, the following items should be included in the implementation plan:
- A statement of support from the upper management of the company.
- An assessment on how the new system will impact the various jobs that will be within the scope of the implementation.
- A complete overview of the implementation plan and the methods being used.
- An assessment on how the new system will affect the company culture (particularly nursing).
- A budget that includes where the money will come from and how this will affect finances.
Discuss the project scope and project plan.
Project scope defines the goals of an information systems project, describing those elements to be automated and outlining both the content and the complexity. As part of the project scope, alternate solutions should be identified and feasibility considered. The project scope statement, which outlines the project plan, is usually done in the later stages of development as a guide for the user or consumer. The project plan should include the following:
- Objectives of the project and characteristics
- Requirements (in terms of services and products as well as deliverables)
- Acceptance criteria
- Limitations, boundaries, and constraints
- Assumptions
- Initial organization and preliminary timetable and schedule, taking into consideration the people assigned to different tasks and their skill levels
- Identification of risks and methods to attenuate risks
- Initial work breakdown structure, dividing the project into organized sequential steps, such as with a Gantt chart
- Estimated costs and resources and creating a resource plan
- Management requirements
- Approval processes and requirements
Discuss collaborative tools: Social media.
Social media are Web-based programs/technology that allow users to interact with others online. Social media sites, such as Twitter, Facebook, YouTube, and Linkedin, allow user-generated content (UGC), such as blogs, images, videos, and audio files, which are accessible by the public; however, many social media sites, such as Facebook, allow users to control access through privacy settings. PatientsLikeMe.com is a health-related website with interactivity. Web tools used for health related social media sites are often referred to as Health 2.0 or Medicine 2.0 and can include blogs, wikis, search functions, videocasts, and podcasts. Web tools are increasingly used for medical education, especially in nursing curricula. Facebook is increasingly used for promotion and education by medical practitioners and other health care providers. For example, Healthcare.gov provides links to other government organizations and articles and allows users to subscribe and comment.
Discuss collaborative tools: Wikis.
Wikis are open databases that allow the user to access, edit, delete, or add material. Wikipedia, the online encyclopedia, is a well-known example of a wiki that is open to the public. Wikis can be open to anyone or can be restricted to specific groups of people; for example, a class may have a wiki to which students post information about a particular topic. Wikis may be designed for a narrow intent, such as for one class, or to manage content for a broad purpose, such as a program. Wikis may be designed with different levels of access so, for example, only certain people are allowed to delete or edit material. Wikis use simplified markup language (HTML, XML) or an online rich-text editor that allows WYSIWYG editing. Wikis support hyperlinks, and many wikis can include photos, videos, and audio files.
Discuss collaborative tools: SharePoint.
SharePoint, a Microsoft product, is a Web-application platform that is integrated with Microsoft Office tools (e.g.. Word, Excel, PowerPoint, Outlook) and can be used for content and document management, collaboration, social media, and development of websites and Intranets. SharePoint provides centralized storage of documents, which can be accessed through password-protected portals. SharePoint sites can store lists (e.g., a list of links or other similar items) and libraries (collections of documents). The SharePoint “wheel,” or outcomes that SharePoint can facilitate include the following:
- Creation of sites or work environments
- Establishment of communities, such as for sharing information or collaborating
- Management of documents, including storing, tracking, updating, allowing collaboration, and archiving
- Inclusion of search functions, based on keywords as well as analysis of content
- Provision of information and insights to promote effective workflow
- Allowance of composites and data integration
- Templates are available for the creation of sites and subsites, and navigation is similar to that of Office products.
Discuss collaborative tools: Weblogs/blogs.
Weblogs/blogs are essentially online diaries or documents that are laid out in reverse chronological order (last entry viewed first) to which a blogger can add information as desired. A blog may be maintained by one person or a group of persons with shared interests. Multiauthor blogs (MABs) are becoming common. Blogs allow people to register to view the blog and to comment on entries, although they are not able to edit the blog. Blogs may contain only text, but most also have images and videos as well as links to other sites (e.g., YouTube). Blogs typically focus on one primary topic of interest, such as exercise, and some serve primarily as advertisement for companies or products. Blog-hosting services are available, although blogs can also be maintained on regular Web-hosting sites with blog software.
Discuss collaborative tools: WebEx.
WebEx, a Cisco company, provides applications that allow for Web-based videoconferencing and collaboration. WebEx products include the Cisco WebEx Meeting Center, Training Center, Support Center, and Event Center. WebEx provides a number of services, depending on the product used, including the following:
- Face-to-face meetings via Web in real time
- Notifications
- Training for users: interactive Internet training with videos and a variety of interactive tools to allow learners to participate actively in learning, including chat rooms and question and answer threads
- Live-streaming
- Consultation
- Business management
- Instant messaging
- E-mail management
WebEx allows participants in Web conferencing to share content, such as images and videos, in real time; thus, it allows people to collaborate at any time and from any distance, reducing the need to travel and allowing immediate consultation and videoconferencing, such as during surgery. WebEx is used for both business and education, especially for delivery of online courses or supplementary material for more traditional classes.
Discuss process diagrams: Data-flow diagrams.
Data-flow diagrams show how data flow into a system and from one process to another, presenting a graphic representation of a-system and its processes. The diagram is a simplified flow chart that uses only four symbols, which are labeled during diagramming:
- Square: external entity or sources of data or external destinations. An entity is named.
- Rounded rectangle: process in inputting and outputting data. This is named with verb and object (but does not include word “process,” and there is no subject). Data flow is from left to right and top to bottom. Each rounded rectangle represents only one process (so “and” is not used). Arrow (line with arrowhead): direction of data flow.
- Arrows are named (but do not include the word “data”).
- Three-sided open rectangle (electronic or physical data storage): Open rectangles are named and numbered (but do not include the word “file.”) If more than one system shares a data store, then a solid stripe is placed on the left side of the rectangle to indicate this.
Discuss process diagrams: Gantt chart.
A Gantt chart is used for developing improvement projects to manage schedules and estimate time needed to complete tasks. It is a bar chart with a horizontal time scale that presents a visual representation of the beginning and end points of time when different steps in a process should be completed. Gantt charts are a component of project management software programs. The Gantt chart is usually created after initial brainstorming and creation of a time line and action plans. Steps to create a Gantt chart include the following:
- List the name of the process at the top.
- Create a chart with a timeline of days, weeks, or months (as appropriate for process) horizontally across the top.
- List tasks vertically on the left of the chart.
Draw horizontal lines or bars from the expected beginning point to the expected end point for each task. These may be color-coded to indicate which individual or team is responsible for completing the task.
Discuss process diagrams: Clinical flow chart.
A clinical flow chart is a schematic representation of a process and is often used to analyze quality improvement, particularly when looking for solutions to a problem. Typically, the following symbols are used:
- Parallelogram: input and output (start/end)
- Arrow: direction of flow
- Diamond: conditional decision (yes/no or true/false)
- Circle: connectors with diverging paths with multiple arrows coming in but only one going out
A variety of other symbols may be used to indicate different functions. Flow goes from top to bottom and left to right. Flow charts help people visualize how a process is carried out and to examine a process for problems. Flow charts may also be used to plan a process before it is used. Flow charts may demonstrate critical pathways to outline treatment options or paths related to findings.
List several ways to alleviate the detrimental effects of prolonged mouse use and prolonged sitting.
Prolonged mouse usage can lead to pain and nerve damage in the wrist, hand, and fingers. Solutions known to help include:
- Adhere to a break schedule that allows you to stretch and rest your hands and arms.
- Alternate the hand that uses the mouse (e.g., if you are left handed, switch the mouse to your right hand).
- Perform a wider variety of work that involves more than sitting behind a desk.
- Use an ergonomically designed alternative to a mouse (such as a track ball).
- Use keystroke substitutes to avoid repetitive motion.
Prolonged sitting can place strain on the back that may lead to pain and nerve damage. The following is a list of solutions that are known to help:
- Adhere to a schedule that allows you to stand up, walk, and stretch.
- Use an adjustable chair to maintain a good posture.
- Place equipment (such as a phone or printer) so that it forces you to get out of your chair.
- Consider a workstation that allows you the flexibility to sit or stand and perform your work.
Discuss process diagrams: Storyboard.
A storyboard is a visual representation of the actions of a team, including data analysis and decisions, during the performance improvement process. It is usually done on a firm poster board and may be 3-4 feet square. It is somewhat like a giant flow chart with arrows or lines connecting one piece of information to the next The storyboard may be used to present summary reports and is also a tool used in continuous quality improvement. The storyboard may include a variety of items or information, such as the following:
- Charts
- Diagrams
- Pictures
- Text
- Illustrations
- Statistics
Because the storyboard is meant to provide easy access to information about team activities, text is usually minimal.
Discuss disability accommondations: Americans with Disabilities Act.
The 1992 Americans with Disabilities Act (ADA) is civil rights legislation that provides the disabled, including those with mental impairment, access to employment and the community. The ADA prevents discrimination against employees or potential employees for organizations with fifteen or more employees because of disabilities. The Equal Employment Opportunity Commission enforces these provisions. Employers are only allowed to ask applicants if they need accommodations, not if they have disabilities, and individual accommodations must be made. Accommodations can include the following:
- Alterations in workstation
- Speech recognition software
- Screen magnifying software
- Optical character recognition systems
- Video captioning
- Braille readers and screen readers
- Adapted keyboards and on-screen keyboard
- Teletypewriter or text display device
- Amplification systems
People who are disabled are entitled to assistive technology that will allow them to function but are not entitled to jobs that they are unable to do even with assistive devices or accommodations. Most computer operating systems now incorporate assistive technology (e.g., screen readers).
Describe supportive, scooped key, minimum motion, and straight column keyboards.
There are a number of alternative keyboards on the market:
- Supportive keyboards. These keyboards have a built in wrist rest. While the wrist rest may help the individual user sit with a more comfortable posture, it may also allow fluid to build up in the carpal tunnel causing wrist pain.
- Scooped key arrangement keyboards. These keyboards are designed in bowl-like shapes. This type of design has the keys set closer together which allows for an extra row of keys. The intent is to reduce reach fatigue.
- Minimum-motion keyboards. These keyboards were developed to change the way the individual keys are operated. Rather than pushing the keys down flat (as is the case with traditional keyboards), the user only has to lightly touch them. This is meant to reduce muscle tension and finger pain.
- Straight column keyboards. This keyboard places keys running straight up and down instead of in diagonally offset rows (as is the case for traditional keyboards). This arrangement helps to lessen stress on the left hand with little effect on the right hand.
Describe the findings of current ergonomics research.
The user of the ergonomic device has to be evaluated along with the equipment and setting. All humans are different and have different ergonomic needs. The best ergonomic solution for one individual may not necessarily work for another. It should also be noted that the workstation may not appear to be configured in the best way to the supervisor (or casual observer), but may indeed be the best for the user. There is no such thing as a true ergonomic chair. Chairs are manufactured with many adjustable features. Some of these are effective and some are not. Chairs should be chosen that would accommodate the widest variety of users (body types) that will be sitting on them. Additionally, chair parts and padding wear out very quickly. What may have once begun as a very suitable ergonomic chair could deteriorate into a poor choice in a relatively short amount of time. Used chairs should be refurbished or disposed.
Describe the different types of ergonomically designed keyboards.
There are three major types of ergonomically designed keyboards:
- Split keyboard: This type of keyboard was designed to minimize the occurrence of the hand and wrist position that places pressure on the major nerves in the wrist. There are two types of split keyboard designs; one directs each keyboard half out toward the elbows while the other completely separates the keyboard so that the halves can be located in-line with the elbows.
- Tented keyboards are similarly split into two halves; however, they also allow the typist to angle their palms toward one another reducing the joint posture known as pronation.
- Negative-slope keyboards were developed to reduce wrist extension by allowing the user to tilt the keyboard to a flat or backward slope opposite of the more traditional positive slope keyboard.
Ergonomic research results for these keyboards are mixed, with individuals who already have ulnar nerve damage receiving the most benefit.
Explain the terms: repetitive stress injury and carpal tunnel syndrome.
Repetitive stress injury: Any injury resulting from performing a similar motion repeatedly. In the late 1990’s, there was a large increase in repetitive stress (motion) injuries reported by healthcare workers due to the increased use of computers and other electronic devices.
Carpal tunnel syndrome: This is the most well-known repetitive stress injury. It involves the compression of the median nerve located in the wrist. It is usually seen in individuals who spend many hours in front of a computer screen typing. Ergonomic keyboards and wrist rests have not been shown to significantly decrease the chance of developing carpal tunnel syndrome. Many sufferers do report relief when using wrist splints at night to rest their affected hand(s). One of the best ways to keep from developing carpal tunnel syndrome is to take frequent breaks from the keyboard or mouse and perform simple exercises designed to alleviate pressure on the median nerve. Once carpal tunnel syndrome has been diagnosed, it can be treated with steroid injections, anti- inflammatory medications, or (less commonly) surgery.
List some of the devices that can be used to enhance the ergonomics of a user workstation.
Due to the danger of repetitive motion stress injuries and other hazards of working with computers, designers have developed a number of ergonomic enhancement products to be used in the computer work environment. They are:
- Glare filter: This helps reduce eyestrain from light reflecting from a user’s monitor.
- Negative keyboard angles: This allows the keyboard to be situated below the elbows and allows the wrists to be held at a straighten more natural angle.
- Document holder: This holds documents at eye level so that the user may type and enter information without moving their neck up and down.
- Lumbar support: This helps support the back more comfortably, and helps position the back with a proper curvature to alleviate stress.
- Footrest: This helps to improve posture, increase blood flow to the feet, and prevent lower back pain.
Define the three different types of ergonomics.
Ergonomics is the study of the work environment and its effect on humans. There are three types of ergonomics:
- Physical: Physical ergonomics deals with the interaction between a person’s body and a machine.
- Cognitive: Cognitive ergonomics (also known as engineering psycholow) deals with the interaction between the human mind and work.
- Organized: Organized ergonomics (also known as macro ergonomics) deals with the culture of work including issues of safety and ethics.
When implementing a new information system in a medical facility, it is important to consider all three types of ergonomics. First, the interactive devices (e.g., computer screens and keyboards) must be physically easy to work with and have a low risk of physical injury. Second, the staff must be psychologically willing to value the new computer system and use it effectively. Finally, the ethical use of the system must be defined and written standards put in place to assure consistency.
Describe the main features of ergonomic chairs.
The following are main features of a good ergonomic chair:
- The ability to adjust the height of the seat. Preferably, this should include a pneumatic adjuster that allows a customized setting rather than a ratcheting mechanism. The user should be able to adjust the chair so that their thighs are parallel to the floor (with both feet flat on the floor).
- The ability to adjust seat pad front-to-back. This will allow individuals of different heights to support their legs and feel comfortable.
- The chair should have padded armrests that are adjustable for both height and width. This will prevent arm strain by providing passive support of the elbows. The forearms and hands will then be in the correct neutral position for typing.
- The chair should be able to recline to transfer some upper body weight to the backrest.
- The chair should have an adjustable back support to prevent lumbar compression.
List some important factors of ergonomically designed computer workstations.
The following are some important ergonomic factors in regards to the design of computer workstations:
- Deciding how it will be used: How will the user interface with the information system?
- Finding out how long the user will be in place: How many hours will the user be stationed at the interface? Is the time continuous?
- Configured based on the equipment to be used: Does the user have to turn or reach for various components of the information system during their routine operations?
- Located in areas of low noise: Is the noise environment conducive to the tasks the user needs to perform?
- Located in areas of good ventilation: Are environmental conditions appropriate for the users and equipment?
- Use stable workstation furniture: Is the workstation furniture suitable for the equipment that it supports?
- Educate users on proper usage: Do the users follow the proper ergonomic procedures for performing their job?
- Choose chairs with proper back support: Is the user’s chair appropriate for the user in terms of adjustability and back support?
Discuss issues related to biomedical device interfaces.
Biomedical devices, such as physiological monitors (heart rate, blood pressure) and smart pumps, must interface between the patient and the device and then in digital form from the device to the information system, which must aggregate the data, which are then sent to an interface that converts the data to HL7 for transmission to the electronic health record. While standardization is occurring, there are at present many communication standards, and interfacing with older systems or modified systems poses problems. Additionally, interface requirements vary among devices. Elements that must be considered in determining interoperability of biomedical devices include the following:
- Type of device, including manufacturer and specifications
- Network connectivity capabilities and whether the device is part of the same or a different network
- Wired (specifications) or wireless (Bluetooth, 802.11, others)
- Transport, data, messaging, and certifications (Continua, ICE)
- Type of data transmitted by the device
- Extra equipment required, such as a dongle, for connection or cables
- Security of data
Discuss user-modeling studies: Assessing types of errors.
When performing modeling studies to determine the number of errors that occur in human-computer interactions, the types of errors should also be considered. With input, errors may occur during intention to carry out actions, the sequence, or the execution. With output, errors may occur in perception, interpretation, or evaluation:
- Low level: Errors in execution of steps interfere with outcomes, and misunderstanding of outcomes interferes with perception.
- Moderate level: The sequence of actions results in input that is not compatible with the computer or the mode results in misinterpretation of input. Output is misunderstood or misinterpreted because of a lack of training or education.
- High level: Interference with intention occurs because of an inability to make a decision regarding a correct action or an inability to evaluate and interpret outcomes correctly.
Discuss barcode medication administration.
Barcode medication administration (BCMA) uses wireless mobile units at the point of care to scan the barcode on each unit of medication or blood component before it is dispensed. Scanning ensures the correct medication and dosage is given to the correct patient, eliminating most point of administration medication errors. The BCMA system can also be used for specimen collection. This system requires monitoring and input from the pharmacy, as each new barcode must be entered into the system. Additionally, some medications are received in bulk, so when they are dispensed in unit doses, barcodes must be individually attached. Staff must be trained to ensure that BCMA is used properly and consistently. The Food and Drug Administration has required that drug suppliers provide barcodes on the labels of medications and other biological product. BCMA increases safety for patients, integrates with the medication administration record, and the information system of the organization, providing data for assessment.
Discuss user-modeling studies: Cognitive walkthrough and ease of learning.
Cognitive walkthrough is one method to determine ease of learning of new technology or applications. A study to determine each step in a process to complete a task is completed. Cognitive walkthrough is one method to assess the user’s ability to understand the model and its purpose, to produce the desired actions, and to determine if users understand which is the right action and system feedback. The ‘think aloud” procedure is used while participants use a product and carry out the steps in a process, noting any usability problems, such as the ability to learn the process without formal training. Sessions may be audiotaped or videotaped for later evaluation. Cognitive walkthroughs are particularly useful with prototypes or early in a system to identify problems with design or usability. Users may also be assessed for knowledge retention over a period of time and their comprehension of the system.
Discuss user-modeling studies: Performance testing to assess for errors.
Performance testing to assess for errors includes the following:
- Time needed to complete tasks, including both the speed and reaction time
- Percentage of completed and incomplete tasks and the percentage completed correctly
- Number of errors and types of errors
- Time spent in each component/option as well as frequency
- Time spent in training
- Overall quality of completed tests
- Time needed for system setup or installation and ease or complexity
- Users descriptions of problems encountered and “think aloud” comment during tasks
- Degree of application usage in real work environment as opposed to testing
- Observations of user responses and behavior, including facial expressions, actions, and eye tracking
- Amount of time spent on the Web and the number of hits
Discuss user-modeling studies: Usability or ease of use.
An important aspect of human-computer interaction (HCI) is usability or ease of use, which may encompass a variety of elements, such as screen layout and navigation. The three primary goals of usability are effectiveness, efficiency, and satisfaction. Usability studies should address all of these goals. There are many different approaches to usability studies, but studies have indicated that large-scale studies can often be replaced with small-scale studies with five to eight participants. Practice with prototypes, even on paper, can yield valuable insights. Participants using the prototypes are encouraged to “think aloud” and talk through the procedures, while observers write down the observations. This can help to determine the ease of use of equipment or software and the amount of training needed for effective use. Evaluation by trained experts can also effectively highlight usability problems. Heuristic (rule of thumb) evaluation or inspection methods have been developed to help guide the evaluation process. Measures of user perceptions include asking participants to assign usability ratings, noting comments during use, and administering questionnaires about satisfaction and workload.
Discuss gap analysis.
Gap analysis is a method used to determine the steps required to move from a current state or actual performance or situation to a new one or potential performance or situation and the “gap” between the two that requires action or resources: Essentially gap analysis answers the questions “What is our current situation?” and “What do we want it to become?” Gap analysis includes the determination of the resources and time required to achieve the target goal. Steps to gap analysis include:
- Assessing the current situation and listing important factors, such as performance levels, costs, staffing, and satisfaction, and all processes.
- Identifying the current outcomes of the processes in place.
- Identifying the target outcomes for projected processes.
- Outlining the process required to achieve target outcomes.
- Identifying the gaps that are present between the current process and goal.
- Identifying resources and methods to close the gaps.
Discuss the three factors that contribute to software usability.
There are three different factors that contribute to software usability. They are:
- Learnability: The amount of time it takes to learn and figure out how to use the software program. This can be enhanced by the program’s help features, documentation, and interface design.
- Memorability (or efficiency): The amount of time it takes the user to perform tasks without having to stop and look up the instructions or use the help feature. Software that has been intuitively designed will enhance memorability.
- Discovery: The time it takes a user to find specific product features in response to the need for that particular feature. This may be enhanced by the similarity of a software product to one that was previously used.
All three of these factors should be evaluated when determining whether to purchase a software program for an information system.
Discuss types of programming language: Structured query language.
Structured query language (SQL) is a fourth-generation programming language (4GL) that differs from 3GLs, such as Java, in that SQL uses syntax similar to human language to access, manipulate, and retrieve data from relational database management systems, which store data in tables. Both the American National Standards Institute (ANSI) and the International Organization for Standardization have adopted SQL; however, because the language is complex, many vendors do not use the complete standard, and this limits portability between vendors without modifications. Despite many available versions, ANSI standards require that basic commands (e.g., UPDATE, DELETE, SELECT) be supported. Language elements of SQL include the following:
- Clauses: from, where, group by, having, and order by
- Expressions: produce scales and tables
- Predicates: three-valued logic (null, true, false) and Boolean truth values
- Queries: require a SELECT statement
- Statements: includes the semicolon (to terminate a statement)
Discuss user-modeling studies: Conducting usability studies.
There are five steps for conducting a usability study:
- Defining Purpose - The purpose, which guides the choice of usability tests, should be clearly defined.
- Evaluating constraints - The constraints (e.g., time, staff, resources) may influence the type of testing and the design of the test.
- Refining components based on evaluation of human—computer interaction (HCI) framework - The HCI framework must be evaluated to determine each component and to whom or what it applies. This includes choosing the most appropriate staff, determining the most important step in a process, and choosing the setting. If testing involves comparison with older or more traditional practices, then measures of equivalency must be determined.
- Determining emphasis - Usability testing may focus on one or more aspects, depending on the overall purpose.
- Select methods - Methods must match purpose and take into account constraints and HCI evaluation.
When choosing software, explain the terms: Likeability and utility.
Likeability of software programs is not the same as usability or utility. Usability is the ease of which a human uses a software program. Likeability is defined as how much an individual enjoys using the program. Products that rank high in usability tend to also get high marks for likeability. While it is difficult to pinpoint exactly why users prefer one software program to another, likeability is a leading factor in determining how much a person wants to use the software.
Utility is the usefulness of the program. Utility does play a role in the likeability of a product. If the user perceives that the software will perform correctly, they are more likely to use it They may also be attracted to the cost saving potential of the software program. Both of these factors should be considered when purchasing system software.
Explain the term: Usability when choosing software.
A key factor in choosing software for a computer system is the software’s usability. Overall, usability is based on “user-centric” design that incorporates the interaction of the human user from the start of the design process. The success (or failure} of the design is based upon measurements such as focus groups, interviews, or questionnaires with the targeted potential users of the software. For software developers, it is important to remember to balance usability with utility. The software must be able to collect the proper inputs and perform its primary designed function in addition to having the best possible human interface (in terms of usability). Once the software is installed, the targeted users should also test it for usability. This should include a variety of individuals from all areas of the organization. The data collected should then be shared with the software developer for usability enhancements in future versions.
Describe the five logical steps of computer programming.
There are five logical steps involved in computer programming:
- Problem definition: also called function specification. The problem (or function) must be defined in detail. All contributing information necessary for solving the problem must be outlined.
- Program design: Provide the functional specification: Identify what the program will do (inputs/outputs). Provide design specifications: Specific instructions for the programmer to follow.
- Program preparation: The code is written in a programming language. Documents (including instructions for the user) are prepared.
- Program testing: Alpha testing (also known as disk checking) is carried out by the programmers and system analyst. Beta testing (real world user testing) is carried out to check for accuracy and sufficiency.
- Program implementation: Trained users test the full program (including all logical sub-routines). Programmers troubleshoot uncovered problems before the program is released.
Describe the classification of programming algorithms by their design.
The following is a classification of programming algorithms by the way they are designed.
- Divide and Conquer: Separates the problem into smaller and smaller sub-problems until each sub-problem can be solved easily.
- Dynamic Programming: Breaks the problem down into problems that have already been solved in order to find the answer more quickly.
- Greedy Method: Makes sure of approximate answers to sub-problems and can be the fastest way to find solutions.
- Linear Programming: Inputs are restricted based on a predetermined construct.
- Reduction: Changes the problem into a simpler problem.
- Search and Enumeration: Specifies rules in the form of a graph.
Human-computer interaction framework developed by Nancy Staggers.
The human-computer interaction (HCI) framework developed by Nancy Staggers in 2001, applies concepts related to psychology and technology to explain human interactions with computers over a period of time in different contexts. The different contexts include the following:
- Providers
- Patients
- Interactions between patients and providers
Communication is the basic exchange of human-computer interactions. The basic tasks to accomplish this exchange include initiating interaction, responding, providing information, and exchanging information. The primary focus of HCI is usability related to human performance during interactions with computers in different contexts, such as overall ease of use, difficulty in learning, efficiency, satisfaction, the ability to carry out error-free interactions, and the ability of the computer system to match the tasks. Another focus is the mental model of users, the idea that the response of users to computers is based on previous knowledge and experience. In order to be successful in tackling complex computer tasks, the mental model should be consistent with the concept or design of the computer programs; thus, the goal is to find a design that promotes an effective mental model.
Explain the term: programming languages.
All computer software is written in a specific programming language. Programming languages have been divided into five separate generations based on how close they mimic human language. The first generation is binary. Binary is machine language made up of two symbols that signify off (0) and on (1). Assembler language is the second generation. Assembler language uses English letters and symbols but relates them directly to binary. For this reason, assembler language can be difficult to learn. FORTRAN, COBOL, Java, and Visual BASIC are examples of third generation programming languages. FORTRAN and COBOL are procedural languages that require the user to specify both the exact procedure to be carried out as well as the data involved. Third generation programming languages also include Java and Visual BASIC. Java is used for internet content and Visual BASIC is a visual programming language. Most people interact with computers today through fourth generation languages that allow users to choose procedures from a menu instead of having to specify them with code. In the future, it is hoped that people will be able to speak directly to computers and have them carry out the verbal commands. This will be the fifth generation of programming languages.
Describe programming algorithms and how they are applied to Information Systems.
There are a number of algorithms that are used in programming information systems. The following is a list of common algorithms and how they are applied:
- Recursion: Calls on itself repeatedly until a match is made. This type of algorithm is often used in functional programming.
- Iterative: Uses constructs that repeat themselves many times with the possible addition of other information to find a solution.
- Logical: Uses the controlled dedication of axioms. Algorithm = logic + control.
- Serial: One instruction is performed after another.
- Parallel and Distributive: Breaks up the algorithm into parts that can be solved on different machines and then brings the separate answers together for the results.
- Deterministic/Non-Deterministic: Uses precise decisions or uses a heuristically designed system of guessing.
- Exact/Approximate: Determines a concrete answer or determines an answer that is close enough.
Discuss developing screens for consistency and ease of use: Text.
Text is more tiring for the eyes on the screen than on the printed page because of the illumination of the screen, and some fonts may blur in browsers, so fonts especially designed for the web, such as Verdana and Lucida Sans/Grande, should be used for text that will be accessed by a browser. Using a variety of fonts and multiple sizes on one screen can be very distracting. Long paragraphs should be avoided, and information should be presented in small paragraphs with adequate white space to rest the eyes. Font size should be 12-14 for standard text with larger sizes for headings. Text against a colored background, especially a deep color, is difficult to read. When highlighting text, underlining is more evident than italicizing and holding because screens have different lighting and resolution. Colored fonts may be used sparingly to highlight different types of information. For example, a question or heading may be in a blue font and an explanation in a black font.
List the items that need to be evaluated when performing needs assessment in the system development life cycle.
The following items need to be evaluated when performing the needs assessment portion of the system development life cycle:
- Compatibility and connectivity of the hardware and software that will be incorporated into the system
- Aniount of downtime required for system testing and installation
- Set up of the test and live environments
- System response time and number of concurrent users
- User support system
- Administration of the system
- Security parameters of the system
- Disaster recovery contingency plans
- User interface and ability to retrieve reports
- System routines used for business processes such as hospital registration, records, and billing
Outline the steps needed for human-centered design.
The following steps are required for human-centered design:
- Define and understand the organization’s requirements and the requirements of the individual users.
- Define and understand the logistics of how and where the system will be used.
- Perform a functionality analysis. Specific system tasks should be broken down by priority, duration, frequency, and probability of completion.
- Define the key system functions. The system functions should be logical and intuitive to the end users.
- Perform an analysis of the most common potential errors that could occur during tasks. Minimize the likelihood of committing errors by optimizing processes.
- Design interfaces and workstations so that they will work best with the users.
- Perform system testing with actual users. Depending on the results of these tests, the system should be adjusted to create the best system for the users.
Discuss developing screens for consistency and ease of use: Layout.
Developing screens for consistency and ease of use requires an understanding of the basic layout and text guidelines. Headings should be placed uppermost and in the same place on subsequent screens. The eye should move in a continuous line (usually top to bottom], so images and text should not be scattered about a page but arranged in an orderly vertical display. Bright colors are distracting, and red and green should be avoided because some people may be color blind to those colors. Complex images and illustrations are difficult to view on the screen, so simple designs are preferable. Menu and status bars should be in the same place on each screen (usually top or bottom] and should contain only essential items. Icons should be easily recognizable and consistent. Unnecessary lines on the screen, such as borders, should be avoided.
