Handbook of Informatics for Nurses & Healthcare Professionals                                          Fifth Edition      ...
Learning Outcomes1. Discuss the significance of change in a   culture.2. Understand the barriers to   implementation.3. De...
Learning Outcomes5. Explain the differences between the   test, training, and production   environments.6. List the decisi...
Learning Outcomes8. Discuss the factors that contribute to   effective training.9. Discuss the “go-live” process and   ide...
Learning Outcomes12.Explain the significance of providing  ongoing system and technical  maintenance.13.Recognize that the...
System Implementation•   Third phase of the life cycle•   Begins with purchase of the system•   Requires planning before p...
Implementation Committee• Project leader—needs to be involved in  the entire process• Technical staff• Informatics represe...
Implementation Committee• Steering Committee membership and  organizational issues are as important  as the technology whe...
Implementation Committee Tasks • Develop plan (work breakdown   structure). • Schedule tasks for implementation. • Define ...
Getting to Know the System• “Base” system—supplied by vendor  without any changes• Training for committee  – On-site train...
Issues to Revisit•   Is technology current? Upgradable?•   Financial stability of vendor?•   Vendor compliance with regula...
Issues to Revisit• Support for the electronic medical  record?• Remote access?• Does it support client care?     Handbook ...
Base System vs. Custom• This decision impacts implementation.• Customization requires time and  resources.• Customization ...
Function• A task performed manually or  automated• Must identify information pertinent to  completion of each function• Ex...
System Output• Material generated by the system• Examples  – Requisitions produced in other    departments  – Reports  – D...
Determining Output• Analyses of the current and desired  workflows provide this information.• Specifications must be agree...
Test Environment• Copy of the information system  software that is used to make changes  from the off-the-shelf version fr...
Test Plan• Identifies long-range goals and test  items• Script that follows a series of  transactions from beginning to en...
Hardware Requirements• Analysis of needs must be done early in  the implementation phase• Considerations  – Network infras...
Network Infrastructure• Should be determined early—later  changes increase costs  – Network configuration requirements  – ...
Workstations and Mobile Devices• Determine advantages and  disadvantages of each type of device.• Determine the number of ...
Procedures and Documentation• Determine how the system will be used  before end user training starts.• Evaluate/revise pol...
System Documentation• Develop a dictionary of terms and map  terms from one system to another.• Dictionaries and mapping h...
User System Training• Do not start until changes are complete• Training environment—separate copy of  the information syst...
Go-Live Planning• Go-live—system running and used to  collect and process actual client data• Implementation strategy—stag...
Implementation Pitfalls• Underestimation of time and resources  needed• Ongoing addition of changes and more  features (sc...
Maintenance• User feedback analyzed and  appropriate changes made to identify  problems• User support—resource staff avail...
Maintenance• Must apply updates to all three  environments—testing, training, and  production (live)• Technical     Handbo...
The Role of Nursing• All users should have input into the  systems that they use.• Nurse informaticists provide  “credibil...
Nurse Informaticist             Responsibilities• Systems development and  implementation• Liaison• Quality initiatives• S...
Nurse Informaticist              Responsibilities• The Chief Nursing Officer (CNO) must  work with key figures to develop ...
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Issues and Trends in HBI Ch10 pp

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Issues and Trends in HBI Ch10 pp

  1. 1. Handbook of Informatics for Nurses & Healthcare Professionals Fifth Edition CHAPTER 10 System Implementation and Maintenance Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  2. 2. Learning Outcomes1. Discuss the significance of change in a culture.2. Understand the barriers to implementation.3. Describe how implementation committee members are selected.4. Discuss the importance of establishing a project timeline or schedule. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  3. 3. Learning Outcomes5. Explain the differences between the test, training, and production environments.6. List the decisions that must be addressed when performing an analysis of hardware requirements.7. Review the issues that must be addressed when developing procedures and documentation for users. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  4. 4. Learning Outcomes8. Discuss the factors that contribute to effective training.9. Discuss the “go-live” process and identify the components involved in planning for it.10.Recognize several common implementation pitfalls.11.Name several common forms of user feedback and support. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  5. 5. Learning Outcomes12.Explain the significance of providing ongoing system and technical maintenance.13.Recognize that the life cycle of an information system is an ongoing cyclical process. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  6. 6. System Implementation• Third phase of the life cycle• Begins with purchase of the system• Requires planning before purchase• Entails selection of the implementation committee Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  7. 7. Implementation Committee• Project leader—needs to be involved in the entire process• Technical staff• Informatics representatives• Clinical representatives• Managers who understand day-to-day operations and how those processes might be improved Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  8. 8. Implementation Committee• Steering Committee membership and organizational issues are as important as the technology when implementing a new system.• The project leader must have strong leadership and communication skills. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  9. 9. Implementation Committee Tasks • Develop plan (work breakdown structure). • Schedule tasks for implementation. • Define the scope of each task. • Identify timelines and “go-live” date. • Identify resources and constraints. • Get to know the system. • Research what data is needed and how it is used. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  10. 10. Getting to Know the System• “Base” system—supplied by vendor without any changes• Training for committee – On-site training by the vendor – Vendor training at corporate headquarters – Consultants may provide training• Should revisit issues examined during selection Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  11. 11. Issues to Revisit• Is technology current? Upgradable?• Financial stability of vendor?• Vendor compliance with regulations?• Interoperability with other systems?• Support inpatient, outpatient, and ED visits? Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  12. 12. Issues to Revisit• Support for the electronic medical record?• Remote access?• Does it support client care? Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  13. 13. Base System vs. Custom• This decision impacts implementation.• Customization requires time and resources.• Customization may also have ripple effects on other systems and interoperability. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  14. 14. Function• A task performed manually or automated• Must identify information pertinent to completion of each function• Examples – Order entry – Results reporting – Documentation Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  15. 15. System Output• Material generated by the system• Examples – Requisitions produced in other departments – Reports – Diagnostic results – Worklists – Charges Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  16. 16. Determining Output• Analyses of the current and desired workflows provide this information.• Specifications must be agreed to, or “signed off” by, managers in the areas that will be impacted.• Constant changes to specifications delay the project and increase costs. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  17. 17. Test Environment• Copy of the information system software that is used to make changes from the off-the-shelf version from the vendor• Programmed changes are tested to ensure that they work as designed Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  18. 18. Test Plan• Identifies long-range goals and test items• Script that follows a series of transactions from beginning to end for all associated functions• Requires input and participation from users from all areas of the facility• Evaluation—examine output Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  19. 19. Hardware Requirements• Analysis of needs must be done early in the implementation phase• Considerations – Network infrastructure – Workstations and mobile devices – Placement of workstations – Printer needs Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  20. 20. Network Infrastructure• Should be determined early—later changes increase costs – Network configuration requirements – Server specifications—memory, processing power, consider future needs – Technical standards – Cabling and power – Wireless access Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  21. 21. Workstations and Mobile Devices• Determine advantages and disadvantages of each type of device.• Determine the number of devices needed.• Investigate technology and support for access by PDAs and handheld devices for providers.• Determine where devices will be located. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  22. 22. Procedures and Documentation• Determine how the system will be used before end user training starts.• Evaluate/revise policies and procedures for system use and include in training.• Develop user guides. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  23. 23. System Documentation• Develop a dictionary of terms and map terms from one system to another.• Dictionaries and mapping help to ensure high-quality data.• Finalize pathways and screens before the test plan is written and training starts. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  24. 24. User System Training• Do not start until changes are complete• Training environment—separate copy of the information system software that works the same way as the actual system and is populated by fictitious clients Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  25. 25. Go-Live Planning• Go-live—system running and used to collect and process actual client data• Implementation strategy—staggered/all• Conversion—bring in old data• Develop the support schedule• Develop evaluation procedures• Develop a procedure to request post go-live changes Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  26. 26. Implementation Pitfalls• Underestimation of time and resources needed• Ongoing addition of changes and more features (scope creep and feature creep)• Failure to consider costs for annual maintenance and other expenses• Problems with testing or training• Lack of system “ownership” by users Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  27. 27. Maintenance• User feedback analyzed and appropriate changes made to identify problems• User support—resource staff available during go-live on units and via help desk at all times Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  28. 28. Maintenance• Must apply updates to all three environments—testing, training, and production (live)• Technical Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  29. 29. The Role of Nursing• All users should have input into the systems that they use.• Nurse informaticists provide “credibility” for information system projects. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  30. 30. Nurse Informaticist Responsibilities• Systems development and implementation• Liaison• Quality initiatives• Strategic planning• Education• Vendor communication Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  31. 31. Nurse Informaticist Responsibilities• The Chief Nursing Officer (CNO) must work with key figures to develop strategies to transform care, prioritize system design to maximize the value and benefits of a clinical information system, and reallocate time saved in documentation and other efficiencies to improve client care services. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar

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