Discussion - Week 9
The Inclusion of Nurses in the Systems Development Life Cycle
In the media introduction to this module, it was suggested that you as a nurse have an important role in the Systems Development Life Cycle (SDLC). With a focus on patient care and outcomes, nurses may not always see themselves as contributors to the development of new systems. However, as you may have observed in your own experience, exclusion of nurse contributions when implementing systems can have dire consequences.
In this Discussion, you will consider the role you might play in systems development and the ramifications of not being an active participant in systems development.
To Prepare:
- Review the steps of the Systems Development Life Cycle (SDLC) as presented in the Resources.
- Reflect on your own healthcare organization and consider any steps your healthcare organization goes through when purchasing and implementing a new health information technology system.
- Consider what a nurse might contribute to decisions made at each stage of the SDLC when planning for new health information technology.
By Day 3 of Week 9
Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.
By Day 6 of Week 9
Respond to at least two of your colleagues* on two different days, by offering additional thoughts regarding the examples shared, SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.
Click on the Reply button below to reveal the textbox for entering your message. Then click on the Submit button to post your message.
*Note: Throughout this program, your fellow students are referred to as colleagues.
REPLY QUOTE
5 months ago
Marisa Buffa
RE: Discussion - Week 9
Nursing & SDLC
SDLC or systems development life cycle is a method similar to the nursing process for creating high-quality software. SDLC is a way to deliver efficient information systems that fit with the strategic business plan of a healthcare facility (McGonigle & Mastrian, 2022). Since nurses are experts in the skills of assessing, diagnosing, planning, implementing, and evaluating, they are the perfect asset to any organizational team involving software and systems development.
The Consequences of a Healthcare Organization not Involving Nurses
When purchasing and implementing a new health information technology system, nurses are crucial in the analysis and design phase as they are the main collectors of healthcare data. Nursing experience can uncover flaws in the data collection processes and guide the organization to design a more user-friendly system. Flaws in process analysis and design can be avoided with nursing input and guidance. One example of the oversight of not utilizing nursing contributions involves mistakes made during medication administration. Bar code medication administration had increased nursing compliance and decreased workarounds when nurses were involved in the design process (Weckman & Janzen, 2009). The inclusion of nurses in analysis and design also decreases technology-related stress when learning a new system, thereby providing a safer patient environment. Healthcare organizations that lack nursing input in implementation and testing phases may also have negative consequences. Testing a new process without nursing involvement may decrease its acceptability by nursing staff. On the contrary, encouraging “superusers” or “champions” of a new process can increase acceptability, confidence, and involvement in the new technology (Verma & Gupta, 2017). One example of this includes nurses in alarm management technology. Alarm fatigue occurs when healthcare workers become desensitized to the many alarms going off on the unit, resulting in missed alarms that actually require medical attention. Involving nursing in smart alarm technology can decrease alarm fatigue and increase patient safety simultaneously (Webicina, 2021).
Input in Healthcare Systems in my Practice
Last year my facility transitioned from Allscripts desktop to Epic. I am not aware of any nursing input into this new charting system. Nurses did not teach the Epic training course; instead, it was taught by Epic IT staff. This made training difficult as there was a definite disconnect between nursing and IT. This translated into a stressful Go Live when Epic was rolled out. It took some time to get used to the new layout, which did not flow well from an Emergency Room perspective. One example of an Epic flaw is having to log out of the system to see the pediatric patients, even though they are in the same ED as the adult patients. This waste of time adds to an already stressful environment. Including nursing staff in this decision-making could have increased morale and strengthened confidence around this new system.
References
McGonigle, D., & Mastrian, K. (2022). Nursing Informatics and the foundation of knowledge. Amazon. Retrieved October 17, 2021, from https://www.amazon.com/Nursing-Informatics-Foundation-Knowledge-McGonigle/dp/1284043517.
Verma, M. P., & Gupta, S. (2017, May 19). Software development for nursing: Role of Nursing Informatics. International Journal of Nursing Education and Research. Retrieved October 20, 2021, from https://ijneronline.com/HTMLPaper.aspx?Journal=International%2BJournal%2Bof%2BNursing%2BEducation%2Band%2BResearch%3BPID%3D2017-5-2-19.
Webicina. (2021, January 21). 8 Digital Health Technologies transforming the future of Nurses. The Medical Futurist. Retrieved October 21, 2021, from https://medicalfuturist.com/the-future-of-nurses-superheros-aided-by-technology/.
Weckman, H., & Janzen, S. (2009, April). The Critical Nature of Early Nursing Involvement for Introducing New Technologies. The critical nature of early nursing involvement for introducing new technologies. Retrieved October 20, 2021, from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No2May09/Nursing-Involvement-and-Technology.html.
REPLY QUOTE EMAIL AUTHOR
4 months ago
Robin Moyers WALDEN INSTRUCTOR MANAGER
RE: Discussion - Week 9
Good response Miranda. Thank you for getting us started in out LAST discussion thread!
Class:
Welcome to Week 9, Module 5.
Don't forget to submit your main post by 11:59 pm MT Wednesday, and respond to two posts on two more dates during the week. Make sure to post three separate days (dates) by Saturday, day 6. If you don't know how to see the date of your post, hover over the time stamp and the date and time will appear. Remember, post on three different dates out of the week---regardless of your individual time zone.
Also, make sure to include at least three citations and references in your main post and at least two references in each participation post.
Remember, every citation must have a reference and every reference must have a citation.
Dr. Moyers
REPLY QUOTE EMAIL AUTHOR
4 months ago
Amy Birkenstamm
RE: Discussion - Week 9
Systems Development Life Cycle (SDLC) is a method similar to the nursing process for creating high-quality software. SDLC is a way to deliver efficient information systems that fit with the strategic business plan of a healthcare facility (McGonigle & Mastrian, 2022). Since nurses are experts in the skills of assessing, diagnosing, planning, implementing, and evaluating, they are the perfect asset to any organizational team involving software and systems development. The SDLC is an extremely useful tool throughout healthcare organizations.
Nurses are typically at the core and forefront of patient care and implementation of systems within a healthcare organization. In theory, nurses should have adequate involvement and input when it comes to applying SDLC within their organization. Nurses are also trained to gather data and synthesize all pieces of information in order to understand bigger picture concerns and content that coincides with patients. An example regarding patient safety regulations includes the use of barcode medication administration. The barcode medication process had increased nursing compliance and decreased workarounds when nurses were involved in the design process (Weckman & Janzen, 2009). The inclusion of nurses in analysis and design also decreases technology-related stress when learning a new system, thereby providing a safer patient environment.
Within the past year, my business transitioned to a medical aesthetics specific EMR. The company that I introduced to my practice was a relatively new company that was also open to input from medical aesthetics providers using the system. This was completely helpful with being able to contribute feedback and offer ideas as to what our needs were to better use the computerized program better. Technology is always evolving and the more opportunities that consumers and nurses specifically can have within an organization, the better chance a SDLC, especially for a startup company will be effective.
McGonigle, D., & Mastrian, K. (2022). Nursing Informatics and the foundation of knowledge. Amazon. Retrieved October 17, 2021, from https://www.amazon.com/Nursing-Informatics-Foundation-Knowledge-McGonigle/dp/1284043517.
Weckman, H., & Janzen, S. (2009, April). The Critical Nature of Early Nursing Involvement for Introducing New Technologies. The critical nature of early nursing involvement for introducing new technologies. Retrieved October 20, 2021, from https://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No2May09/Nursing-Involvement-and-Technology.html.
REPLY QUOTE EMAIL AUTHOR
4 months ago
Tina Alino
RE: Discussion - Week 9
Hey Amy,
I totally enjoyed reading your post. Nurses' involvement in any IT new development is highly important. Hence, they are the front liners and the ones to use the implemented system. As you correctly stated, the implementation of the medication barcode has significantly decreased the burden of nurses. It has also reduced the number of pharmaceutical errors noticed in the healthcare system. According to studies, about half of all hospitalized patients, if not more, experience adverse drug events (ADEs) (Truitt et al., 2016). By electronically confirming the '5 rights of medication administration (right patient, right dose, right drug, right time, and right route), barcode medication administration (BCMA) systems eliminate medication errors (Shah et al., 2016).
Shah, K., Lo, C., Babich, M., Tsao, N. W., & Bansback, N. J. (2016). Bar Code Medication Administration Technology: A Systematic Review of Impact on Patient Safety When Used with Computerized Prescriber Order Entry and Automated Dispensing Devices. The Canadian journal of hospital pharmacy, 69(5), 394–402. https://doi.org/10.4212/cjhp.v69i5.1594
Truitt, E., Thompson, R., Blazey-Martin, D., NiSai, D., & Salem, D. (2016). Effect of the Implementation of Barcode Technology and an Electronic Medication Administration Record on Adverse Drug Events. Hospital pharmacy, 51(6), 474–483. https://doi.org/10.1310/hpj5106-474
REPLY QUOTE EMAIL AUTHOR
4 months ago
Tiffany Turner
RE: Discussion - Week 9
Thank you for your post. The lack of health insurance is the number reason why people don’t seek medical attention and thus it results in unnecessary morbidity. The US healthcare system lacks nurse ran clinics which would greatly benefit those that lack health care resources (Andrea, n.d.). Starting clinics like the one you’ve stated with have a lasting impact on the community you intend to service. Socioeconomic status often divide healthcare. However, with more nurse ran clinics patients are likely to get the same care no matter what their disparities are. More government funding should be allocated for nurse ran clinics to bridge the gap in healthcare (Young, et al.2020)
Andera, S. (n.d.) Meeting the Needs of the Underserved: A Nurse-run Free Clinic Projecthttps://canpweb.org/canp/assets/File/2015%20Conference%20Presentations/Underseved%20Health-free%20clinic.pdf
Young, H., McNeal, G., Reinhard, S. (11/18/2020). Modernization of California Nurse Practitioner Practice is Overdue: Implications for Nurse-Led Clinics https://campaignforaction.org/implications-for-nurse-led-clinics/
REPLY QUOTE EMAIL AUTHOR
4 months ago
Ivo Ngosong
RE: Discussion - Week 9
Amy, The nurses in a healthcare organization are, as you say, generally in the forefront of patient care and system implementation. The following video shows what would happen if there was no nurse involvement at any step of the SDLC. a total lack of communication and the creation of a product that will be of no benefit to us or to patient care. Throughout the day, the relationship between the nurse and the patient, as well as the technology, changes. Watson et al. have been measuring efficiency and time since 2009, after the passage of the American Recovery and Reinvestment Act of 2009, which required the adoption of electronic health records (EHRs) in all health care systems (Watson, 2021). Those of us who work in healthcare are well aware of how much time is spent on documentation. We'll have snags that waste time and money if we don't incorporate the nurses in every phase of the SDLC (Scope and Practice Standards, 2015).
References
Nursing Informatics: Scope and Standards of Practice. (2015). American Nurses Association, 186.
Watson, M. D. (2021). Electronic health record usage among nurse practitioners, physician assistants, and junior residents. Journal of the American Association of Nurse Practitioners, 200-204. https://doi-org.ezp.waldenulibrary.org/10.1097/JXX.0000000000000466
REPLY QUOTE EMAIL AUTHOR
4 months ago
Sophie Enjema Ndumbe
RE: Discussion - Week 9
Hello Amy,
I enjoyed reading your post. System development life cycle is necessary in every healthcare setting. This will make it easy for the facility to run smoothly especially if everybody has been trained on how to use the system well. All the phases of system development life cycle must be recognized and followed the right way. According to Laureate Education (2018) the most essential part of the system development life cycle is to follow and recognize all parts of the cycle so that solutions can be implemented if issues arise. I agree with you that nurses are the lead in patient’s care and so they need to be trained on how to use essential technologies to take care of patients. Nurses need to know how to work and manage information technology services Laureate Education (Producer, 2018).
References
Laureate Education (Producer). (2018). Interoperability, Standards, and Security [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2018). Managing Health Information Technology [Video file]. Baltimore, MD: Author.
REPLY QUOTE EMAIL AUTHOR
4 months ago
Tiffany Turner
RE: Discussion - Week 9
I agree with your post, Systems Development Life Cycle (SDLC) is an project management that drastically improve the information systems with the healthcare system. Like your post, I agree that SDLC improves quality outcomes and can be integrated to equally improve healthcare. The increase demands for data management require today’s healthcare to place great investment into IT (Innovation Architect, 2019). Around the world nurses are providing safe care to patients and families through changes in IT standards with providers that are ever changing. Many disagreements among healthcare staff exist due to how to allocate nursing resources (Mc Bride, 2020). However, like your post states forefront of patient care and implementation of systems within a healthcare organization is key to improving patient outcomes.
References
Innovation Architect. (2019, June). Benefits of applying sdlc to the healthcare industry. https://www.innovativearchitects.com/KnowledgeCenter/industry-specific/healthcare-industry-sdlc.aspx
McBride, S. (n.d.). Systems Development Life Cycle for Achieving Meaningful Use. Retrieved October 20, 2020, from
REPLY QUOTE EMAIL AUTHOR
4 months ago
Kirsi Hoselton
RE: Discussion - Week 9
Transforming Nursing and Healthcare Through Technology
Week 9 Discussion: The Inclusion of Nurses in the Systems Development Life Cycle
Second Post
Marisa, thank you for sharing! I enjoyed reading your post. I agree with you that the implementation of health professionals is crucial during the planning stages of new technology. When creating a technology system, it is crucial to address security concerns and ensure that patients' medical records and pertinent information are protected. Therefore, nursing staff should be included during the planning stages to provide essential input and education throughout the process (McGonigle & Mastrian, 2018).
Several designs are utilized in software design, whereas the Waterfall model is considered the oldest SDLC approach utilized for software development (McGonigle & Mastrian, 2018). There are six phases included in the Waterfall approach that is broken down into small through medium sizes for better utilization (McGonigle & Mastrian, 2018). Since the development of the nursing informatics role has increased the possibility for all nurses throughout healthcare to be utilized to the process of systems to evolution, allowing to maintain aspects of nursing care. Initiating feasibility determines the support and needs using cost-benefit analysis of the type of project being completed. Nursing plays an essential role in the utilization portion related to equipment design flaws that can have legal ramifications due to the lack of nurse involvement (Harington, 2015). The design and analysis phase is essential to a healthcare organization because this phase deciphers how the system design will integrate into the new system. During this stage, nurse feedback is helpful due to providing personal input that will assist the organization with how to design the system to be user-friendly and allow a smooth transition of system change (Weckman, 2009). The implementation and testing phase will assist nurses with an opportunity to use the equipment before purchasing. To make the process safer and more superficial, nurses need to increase the efficiency of the system design.
The organization, the writer of this discussion, works for implements the use of EPIC for patient care. It is essential to include nurses, nurse managers, project managers, and organizational leaders to create a technology system that works for everyone. Particular strategies were implemented to evaluate the system process.
References
Harrington, L. (2015). American Nurses Association Releases New Scope and Standards of
Nursing Informatics Practice. AACN Advanced Critical Care, 28(2), 93-96.
file:///D:/Walden/Nursing%20informatics-ANA.pdf
McGonigle, D., & Mastrian, K. (2018). Nursing informatics and the foundations of knowledge
(Fourth ed.). Burlington, MA: Jones & Bartlett Learning.
Weckman, H., Janzen, S., (May 31, 2009) "The Critical Nature of Early Nursing Involvement for Introducing New Technologies" OJIN: The Online Journal of Issues in Nursing, Vol. 14, No. 2, Manuscript 2.10.3912/OJIN.Vol14No02Man02
REPLY QUOTE EMAIL AUTHOR
4 months ago
Tanaka Ruzvidzo
RE: Discussion - Week 9 - Response #1
Dear Marisa, thank you for your insightful discussion post. Nurses play such a crucial role, not only in patient care, but also as patient advocates. In my experience, most nurses are nurturers and will spend an extra minute or two attending to patients' needs versus charting. Therefore, when it comes to implementing new software for instance they may not be involved and mostly do not have the time to do so, however, being that they are the ones that have to use the said software it is important that they be a part of the process. If this does not happen it may result in a redundant or failed project as the nurses, who are the end users are not able to use the software efficiently. (Kushniruk & Borycki, 2017) described this in their text “in addition to successes there have been a growing number of failed projects and a range of issues have been identified, many related to the adoption and usability of systems in this complex domain (Kushniruk & Borycki, 2017, p. 33).
Nurses also like to be in control and so granting them a certain level of autonomy in the design, implementation and evaluation of a software or project can go a long way in ensuring it is a success. A study was done that concluded that “health care organizations should devote energy and resources to enhance professional autonomy to affect multiple dimensions of meaningful work through which workers can experience meaningful work and its associated positive work outcomes (Both-Nwabuwe et al., 2020, p. 113). This would be a win-win situation for the healthcare organization, whereby the nurses are satisfied and know that their input is useful and valued and will therefore help ensure success of software and systems development.
References
Both-Nwabuwe, J. M., Lips-Wiersma, M., Dijkstra, M. T., & Beersma, B. (2020). Understanding the autonomy–meaningful work relationship in nursing: A theoretical framework. Nursing Outlook, 68(1), 104-113. https://doi.org/10.1016/j.outlook.2019.05.008
Kushniruk, A. W., & Borycki,, E. M. (2017). Usability of Healthcare Information Technology: Barrier to the Exchange of Health Information in the Two-Sided E-Health Market. In E- Health two-side markets: Implementation and business models (p. 33-41). Academic Press.
REPLY QUOTE EMAIL AUTHOR
4 months ago
salome ugwu
RE: Discussion - Week 9
Marisa,
McGonigle and Mastrian (2017) explain that hours of education on new technology stresses employees out. Furthermore, has impact on job performance. As you said Rahma, nurse is the largest component in healthcare and play a huge role in bedside patient care. From that reason alone nurses should be stakeholders.
Stakeholders disagreement “describes the conflict between the Needs, Wants and Desires (NWDs) of different stakeholders, which if left unresolved, can result in dissatisfaction, workarounds, errors, and threats to patient safety” (Soares et al, 2012). Soares et al (2012) looks at three different studies, moreover, all articles come to same conclusion is that stakeholders and nurse must work together for patient safety. Examples were giving throughout article on how the patient lives were at risk if nurse where not involved in new technology programs.
Reference
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning
Soares, M. M., Jacobs, K., Samaras, E. A., Real, S. D., Curtis, A. M., & Meunier, T. S. (2012). Recognizing nurse stakeholder dissonance as a critical determinant of patient safety in new healthcare information technologies. Work, 41, 1904–1910. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=rzh&AN=104523018&site=eds-live&scope=site
REPLY QUOTE
4 months ago
Ivo Ngosong
RE: Discussion - Week 9
Marisa, I completely agree that medical caretakers are critical in the examination and configuration stages since they are the primary collectors of medical care data. Medical attendants are the cornerstone of medical care, according to Hamer and Cipriano (2013), and when they are not linked to the plan and dynamic cycles of the Systems Development Life Cycle, the results may be devastating. Since the acceptance of new technologies by medical care organizations, there has been a significant development in silent contemplation. Involvement of medical caregivers throughout the interaction, including the planning, organizing, executing, and evaluating phases, is critical to success in implementing these innovations (Weckman and Janzen 2019). Medical attendants are in the finest position to separate the bits of facts required to discover hidden underlying concerns and give ideas for possible goals, so paying close attention to their comments and advice is critical. It empowers and improves wellness when medical caregivers are acknowledged for their innovative plans. The author of a 2009 study on early nurse involvement during the execution of a Bar Code Medication Administration (BCMA) framework depicted how attendants participated in the BCMA's early planning, arranging, execution, and evaluation phases. The analysis revealed that the benefits of early nurse participation in each era of BCMA innovation outweighed the difficulties that might arise from early nursing participation (Weckman and Jansen, 2019). This investigation discovered that in order to achieve success while implementing new advancements, medical attendants must be present at all times during the interaction, as comments and input from medical caretakers provide critical information that can help identify hidden foundational issues and provide potential goals (Weckman and Jansen, 2019).
References
Hamer, S., & Cipriano, P. (2013). Involving nurses in developing new technology. Nursing times, 109(47), 18–19. Retrieved July 24, 2021
Weckman, H. N., & Janzen, S. K., (2019). The critical nature of early nursing involvement for introducing new technologies. Online Journal of Issues
in Nursing, 14(2), 1-11
REPLY QUOTE EMAIL AUTHOR
4 months ago
Amy Birkenstamm
RE: Discussion - Week 9
Marisa,
I enjoyed reading your post and agree that it is imperative for nurses to be actively involved with the training and implementation of health care tech systems. Since nurses are primarily the ones with the most direct interaction and with patients, this can help improve accuracy of patient charting , continuity of care, safety and improved patient outcomes. Nursing staff should be included during the planning stages to provide essential input and education throughout the process (McGonigle & Mastrian, 2018). A study that was done that concluded that "health care organizations should devote energy and resources to enhance professional autonomy to affect multiple dimensions of meaningful work and its associated positive work outcomes (Both-Nwabuwe et al, 2020). Collectively, including nurses with the process of health care technology within their organizations is helpful for the entire health care system.
McGonigle, D., & Mastrian, K. (2018). Nursing informatics and the foundations of knowledge (Fourth ed.). Burlington, MA: Jones & Bartlett Learning.
Both-Nwabuwe, J. M., Lips-Wiersma, M., Dijkstra, M. T., & Beersma, B. (2020). Understanding the autonomy–meaningful work relationship in nursing: A theoretical framework. Nursing Outlook, 68(1), 104-113. https://doi.org/10.1016/j.outlook.2019.05.008
REPLY QUOTE EMAIL AUTHOR
4 months ago
Kirsi Hoselton
RE: Discussion - Week 9
Transforming Nursing and Healthcare Through Technology
Week 9 Discussion: The Inclusion of Nurses in the Systems Development Life Cycle
Initial Post
According to the textbook Nursing Informatics and the Foundation of Knowledge, the system development life cycle (SDLC) is comparable to the nursing process (McGonigle & Mastrian, 2018). The nursing process is an outline utilized by nurses to assess, utilize nursing diagnosis, planning, implementation, then evaluate patients (McGonigle & Mastrian, 2018). In comparison, the SDLC is a process that utilizes system planning, design, implementation and development, testing, integration, maintenance of software or hardware throughout healthcare. The utilization of the SDLC is an essential tool implemented throughout healthcare.
Nurses play a vital role in various areas throughout healthcare. Therefore, any technological system should be implemented when considering user requirements, including nurses' involvement when developing any technology system. When creating a technology system, it is crucial to address security concerns and ensure that patients' medical records and pertinent information are protected. Therefore, nursing staff should be included during the planning stages to provide essential input and education throughout the process (McGonigle & Mastrian, 2018).
Several designs are utilized in software design, whereas the Waterfall model is considered the oldest SDLC approach utilized for software development (McGonigle & Mastrian, 2018). There are six phases included in the Waterfall approach that is broken down into small through medium sizes for better utilization (McGonigle & Mastrian, 2018). Since the development of the nursing informatics role has increased the possibility for all nurses throughout healthcare to be utilized to the process of systems to evolution, allowing to maintain aspects of nursing care. Initiating feasibility determines the support and needs using cost-benefit analysis of the type of project being completed. Nursing plays an essential role in the utilization portion related to equipment design flaws that can have legal ramifications due to the lack of nurse involvement (Harington, 2015). The design and analysis phase is essential to a healthcare organization because this phase deciphers how the system design will integrate into the new system. During this stage, nurse feedback is helpful due to providing personal input that will assist the organization with how to design the system to be user-friendly and allow a smooth transition of system change (Weckman, 2009). The implementation and testing phase will assist nurses with an opportunity to use the equipment before purchasing. To make the process safer and more superficial, nurses need to increase the efficiency of the system design.
The organization, the writer of this discussion, works for implements the use of EPIC for patient care. It is essential to include nurses, nurse managers, project managers, and organizational leaders to create a technology system that works for everyone. Particular strategies were implemented to evaluate the system process.
References
Harrington, L. (2015). American Nurses Association Releases New Scope and Standards of
Nursing Informatics Practice. AACN Advanced Critical Care, 28(2), 93-96.
file:///D:/Walden/Nursing%20informatics-ANA.pdf
McGonigle, D., & Mastrian, K. (2018). Nursing informatics and the foundations of knowledge
(Fourth ed.). Burlington, MA: Jones & Bartlett Learning.
Weckman, H., Janzen, S., (May 31, 2009) "The Critical Nature of Early Nursing Involvement for Introducing New Technologies" OJIN: The Online Journal of Issues in Nursing, Vol. 14, No. 2, Manuscript 2.10.3912/OJIN.Vol14No02Man02
REPLY QUOTE EMAIL AUTHOR
4 months ago
Robin Moyers WALDEN INSTRUCTOR MANAGER
RE: Discussion - Week 9
Good information Kirsi. Thank you. Let's examine the test portion....
Class
Do you think a new charting system should be install organization-wide, at the same time, or should an organization start with one unit. What is your rationale for your selection?
REPLY QUOTE EMAIL AUTHOR
4 months ago
Kirsi Hoselton
RE: Discussion - Week 9
Dr.Moyer,
Thank you for your feedback.
I personally feel that a new charting system would be beneficial starting with one unit at a time. The rationale behind this idea is to ease everyone into a new system. However, in the clinical setting where I work any new updates or systems are installed oragnization-wide.
REPLY QUOTE EMAIL AUTHOR
4 months ago
Federica Clay
RE: Discussion - Week 9
Kirsi,
I agree that nurses absolutely need to be a part of any new technology system design since they are some of the main ones using it to find information on their patients and documenting their findings. Nurses could be beneficial in the high- and low-level design phases by exploring how the program will work within the health system (McGonigle & Mastrian, 2017). Another way nurses are vital in the upbringing of a new technology system is that they can truly assess “usability” or evaluate if a system is easy to use and “user friendly” (Agency for Healthcare Research and Quality, n.d.). As mentioned previously, nurses are at the helm of patient care and need to be able to chart quickly and effectively in certain situations so they can move on to their next task. Having a user-friendly technology system can make that go a long way.
Resources
Agency for Healthcare Research and Quality. (n.d.). Workflow assessment for health IT toolkit. Retrieved 10/26/21, from https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/usability
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 9, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making” (p. 183).
REPLY QUOTE EMAIL AUTHOR
4 months ago
Tae Kim
RE: Discussion - Week 9
Kirsi, thank you for your great post. Although nurses should be involved in the SDLC process, sometimes their role may seem overwhelming or beyond their skills. After all, how many nurses know how to build systems or write software code like Java? The nurse informaticist, however, can play a key role in bridging the gap between the nurse and the developers. The informaticist should address workflows from all users to find touchpoints which occur between EHR, the clinician, and the patient. This allows the Information System (IS) team to identify opportunities for improvements, the resources needed, and training needs for the users (Johnson, 2020, p. 24).
The need for a healthcare provider’s involvement, not just nurses, in the SDLC is critical. This is especially true with the EHR. It is estimated that for every hour a healthcare provider spends on direct patient care, we spend another two with the EHR. Even when interacting directly with patients, it is estimated that the provider’s focus is on computer screens up to 80% of the time. Therefore, EHR influences physician and other providers’ behavior and not always in a positive way. A poorly designed EHR can, for example, result in the overuse of low-value medical care, ordering unnecessary tests, using brand name drugs instead of less expensive but still effective drugs (Vaughn & Linder, 2018, p. 583).
References
Johnson, C. B. (2020). The day in the life of an informatics nurse: The informatics nurse's role in creating a patient-centered virtual experience. Journal of Informatics Nursing, 5(3), 24-26, 29. Retrieved October 26, 2021, from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Fday-life-informatics-nurse-nurses-role-creating%2Fdocview%2F2479483404%2Fse-2%3Faccountid%3D14872
Vaughn, V. M., & Linder, J. A. (2018). Thoughtless design of the electronic health record drives overuse, but purposeful design can nudge improved patient care. BMJ Quality & Safety, 27(8), 583 - 586. Retrieved October 26, 2021, from http://dx.doi.org.ezp.waldenulibrary.org/10.1136/bmjqs-2017-007578
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4 months ago
Alexis Liggett
RE: Discussion - Week 9 Peer Response 2
Kirsi,
Great post! I had never thought about the idea that the system development life cycle (SDLC) was comparable to the nursing process. Like the nursing process, they entail a lot of the same phases. “System development life cycle phases include planning, system analysis, system design, development, implementation, integration and testing, and operations and maintenance” (Veracode, n.d.).
A healthcare organization not involving its nurses when purchasing and implementing new health information technology (HIT) system can be detrimental. Nurses are crucial in the design and analysis of SDLC due to being a main source of data collection in the healthcare industry. Technology specialists are masters in in the technology field, while nurses are experts in their field. “It is important both for nurses to understand a new technology, and for technology engineers to understand how the equipment and software will need to interface with the facility’s existing systems” (Weckman & Janzen, 2009).
References
Veracode. (n.d.). Systems Development Life Cycle. Retrieved October 27, 2021, from https://www.veracode.com/security/what-systems-development-life-cycle
Weckman, H., & Janzen, S. (2009). The Critical Nature of Early Nursing Involvement for Introducing New Technologies. The Journal of Issues in Nursing, 14(2).
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4 months ago
Federica Clay
RE: Discussion - Week 9
Consequences of no nurse involvement
There are some consequences when it comes to healthcare organizations making decisions on patient care without first consulting with nurses or involving them in each stage of the systems development life cycle (SDLC) when a new information technology system has been purchased. According to Laureate Education (2018), the 5 steps of the SDLC are planning, analysis, design, implementation, and maintenance and nurses play a crucial role in each of those steps. Nurses may have something to contribute to the new technology that may benefit all other nurses, but without their expertise, this opportunity may be missed if they are not included in the planning phase. In the analysis phase, nurses can determine if the technology is feasible and relevant to their nursing practice. This could help in the design of accessibility of certain pages being able to be accessed one right after the other to help make charting faster. In the design phase, nurses could contribute their input on how they chart each day and in what sequence. Because nurses and other staff will be the main users of this new technology system, another consequence could include nurses feeling like they are not important or being heard in their opinions about changing to a new system, therefore they may be reluctant to try to learn it when in the implementation stage. They must be trained, willing, and ready to use the new documentation system to be able to see the full effect of the new changes (McGonigle & Mastrian, 2017). In the maintenance phase, nurses would be able to contribute their experiences with the new technology system as they’ve used it in their practice. They would be able to say what is working well and what could be changed.
Inclusion of myself in new health information technology system
I have never experienced a major system change, only small changes within the existing system. I have not been included in the selection or planning of any changes within the technology system. I have always been on the receiving end of trying out a new system after it’s been implemented. I have been asked about what I think about the new changes in the documentation system and have given my input, but it has always been in the maintenance phase of the SDLC where changes are often made due to nurses not agreeing with how some things were implemented or changed. I along with some other nurses have felt that our voice is not important at times when new changes come up. This affects staff morale where a connection could have been made between staff nurses and management or those implementing the new changes in the system. One way that nurses have been able to participate in the maintenance of a new system is by performing surveys or interviews to collect information on opinions from staff using the new system (Agency for Healthcare Research and Quality, n.d.).
Resources
Agency for Healthcare Research and Quality. (n.d.). Workflow assessment for health IT toolkit. Retrieved 10/25/21, from https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit
Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 9, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making” (p. 183).
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4 months ago
Robin Moyers WALDEN INSTRUCTOR MANAGER
RE: Discussion - Week 9
Good insights Frederica. The staff is definitely the crux in a new implementation, which leads me to another question...
If you were a nurse manager and your organization was getting readying to implement a new EHR, how would you go about motivating your staff to embrace this upcoming change?
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4 months ago
Tina Alino
RE: Discussion - Week 9
Hello Federica,
Your article was well-written and to the point. I agree that nurses are sometimes overlooked at the most essential stage of the SDLC, the planning stage. The ability to include nursing staff in the planning stage allows nurses to use technology to bring in their opinion and knowledge, which is critical to a new system's success. It is well recognized that the use of technology can help to improve the quality of care (McGonigle & Mastrian, 2017). It's intriguing to learn that bedside nurses aren't involved in the development of new technology, despite the fact that they are the ones who will be utilizing it. Nurses are in the best position to detect any concerns that need to be addressed with new technologies, according to an article by Weckman and Janzen (2009), therefore hearing their views and opinions is critical.
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Weckman, H. N., & Janzen, S. K. (2009). The critical nature of early nursing involvement for introducing new technologies. Online Journal of Issues in Nursing, 14(2), 1-11. https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx? direct=true&db=rzh&AN=105264473&site=eds-live&scope=site
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4 months ago
jennifer girgis
RE: Discussion - Week 9
Response 2.
Thank you for your very informative post, Federica.
I agree with the consequences you provided.
The SDLC is a loop that needs to be revisited multiple times, doing the same evaluation process to improve its accuracy. (McGonigle & Mastrian, 2018) Healthcare technology evolves continuously and is the need for efficient EHR and technology systems. The last step of SDLC is destruction. New approaches are broken down and repurposed. In this step, nurses can provide input on what works or not based on nursing practice and experiences.
To answer Dr. Moyers's question, if I am a manager and trying to implement change or a new EHR, I would be there in the go-live training process. By becoming an example and showing eagerness to learn, others can follow, observe, and maybe realize that they are not struggling alone. Then when I think that employees are getting the hang of it, I will start to back out littile by little to let them take the initiative to evaluate if the new system is beneficial or need revisions. According to Laureate Education (2018), active participants (e.g., nurses) and stakeholders (e.g., clinicians, educators, nurse managers) must be part of the process occurring for any potential end-user or new system to work.
References
Laureate Education (Producer). (2018). Systems Implementation [Video File]. Baltimore, MD: Author.
McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
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4 months ago
salome ugwu
RE: Discussion - Week 9
Hi Federica!
Good Post
According to McGonigle & Mastrian (2017), SDLC is a way to deliver efficient and effective information systems (ISs) that fit with the strategic business plan of an organization. The program must identify the needs of the organization as a whole and propose solutions to meet those needs or a way to address the issue (McGonigle and Mastrian, 2017). Once the healthcare system decides to integrate a new beneficial method for nurses, it is essential to use nurses in the process to evaluate the efficacy of the system. Therefore health IT can suggest a new project to increase patient safety by creating new protocols for nurses benefit is vital that the nurse was involved in the process. However, new technologies brought a concern to time management changes affected impact patient care. The nurses adopt the new system, technology, or protocol as long as beneficial and useful for them. The new system is designed to improve patient outcomes and avoid delays in treatment.
References
AHRQ. (2019). Health IT Evaluation Toolkit and Evaluation Measures Quick Reference Guides. https://healthit.ahrq.gov/health-it-tools-and-resources/evaluation-resources/health-it-evaluation-toolkit-and-evaluation-measures-quick-reference
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning
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4 months ago
Miguel Rodrigo Estrera
RE: Discussion - Week 9- Initial Post
Not involving nursing in purchasing or implementing a health information technology system could lead to poor patient outcomes. For an efficient system that transfers the language of health into the software being used, nurses must be included in the software development cycle from the first stages. The identification of champions or issue solvers is essential for the successful implementation and adoption of such systems (Verma, Medha Piplani & Gupta, Sandhya, 2017). Suppose a technology purchased by an organization is appealing from an information technology standpoint, but needs an end-user to complete a large number of steps. In that case, the patient experience may be compromised as a result of the acquisition (Denham, Nicole & Matthews, Bonnie, 2018).
SDLC is analogous to the nursing process, in which the nurse should assess, diagnose, plan, implement, and evaluate (McGonicgle & Mastrian, Kathleen, 2018). Nurse leaders must be active in every stage of the process in order to ensure that the system delivers optimal outcomes to both healthcare systems and their respective patient populations. Design specialists require an understanding of the actual usage context, and workers need an account of the various technology solutions available. It is through active collaboration between workers and designers that these sorts of skills are produced most successfully in the context of specific design projects (Qin, Yanhong, et al., 2017).
Recently, I was offered the opportunity to participate in the selection process for a discharge planning program that will be used to improve the efficiency of our discharge procedure at my healthcare system. Because of my previous expertise as a case manager and my knowledge of our healthcare population, I provided input on which software would be most advantageous to our healthcare organization by assessing the software and pinpointing different advantages and disadvantages each software had to offer.
References
Denham, Nicole, & Matthews, Bonnie. (2018, January/February ). Nurses Underscore Value of Collaboration when Implementing Health Technology. Biomedical Instrumentation & Technology, 52(1), 32-36. doi:10.2345/0899-8205-52.1.32
McGonicgle, D., & Mastrian, Kathleen. (2018). System Development Life Cycle, Nursing Informatics and Organizational Decision Making. In D. McGonicgle, & K. Mastrian, Nursing Informatics and the Foundation of Knowledge (pp. 176-177). Burlington, Massachusetts: Jones & Bartlett Learning.
Qin, Yanhong, Zhou, Ranyun, Wu, Qiong, Huang, Xiaodi, Chen, Xinli, Wang, Weiwi, . . . Yu, Ping. (2017, December 6). The effect of nursing participation in the design of a critical care information system: a case study in a Chinese hospital. BMC Medical Informatics and Decision Making, 17(1), 1-12. doi:10.1186/s12911-017-0569-3
Verma, Medha Piplani, & Gupta, Sandhya. (2017, December 2). Software Development for Nursing: Role of Nursing Informatics. International Journal of Nursing Education and Research, 5(2), 203-207. doi:10.5958/2454-2660.2017.00044.8
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4 months ago
Robin Moyers WALDEN INSTRUCTOR MANAGER
RE: Discussion - Week 9- Initial Post
Thank you Miguel. Let's explore stakeholders being involved in the development process...
Class:
If your organization was going to implement an EHR, who are the stakeholders?
Dr. Moyers
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4 months ago
Miguel Rodrigo Estrera
RE: Discussion - Week 9- Initial Post
Hello Dr. Moyers, Thank you for taking the time to respond to my discussion post. An electronic health record (EHR) keeps a continuous record of information on a person's health state throughout all duration. The electronic health record (EHR) allows healthcare professionals (HCPs) to access patient data more efficiently, spend more time with patients, minimize duplication of tests and work, and improve the safety and quality of care offered (Fennely, et al., 2020).
In the design of EHR, stakeholders should include A multidisciplinary panel of experts and knowledge users that include Healthcare professionals such as Nurses, doctors, administrators, process change champions, trainers, and end-users. These interdisciplinary team experts can all benefit from feedback since it allows them to learn, speak up, and make adjustments to processes and the functioning of the electronic health record. End-users, such as healthcare practitioners, nursing staff, and administrative staff, typically possess unique expertise and insights to optimize procedures that simplify system updates and patches, promoting continuous improvement (Woody, 2020). End-users must understand precisely how the updated system will favorably impact the care they provide to their patients, as well as how the new system will affect their capacity to do their job obligations.
References
Fennely, O., Cunningham, C., Grogan, L., Cronin, H., O'Shea, C., Roche, M., . . . O'Hare, N. (2020, December ). Successfully implementing a national electronic health record: a rapid umbrella review. International Journal of Medical Informatics, 144, 1-17. doi:https://doi.org/10.1016/j.ijmedinf.2020.104281
Woody, C. E. (2020, September-October ). MHS Genesis Implementation: Strategies in Support of. Military Medicine, 185(9-10), e1520-e1527. Retrieved from https://web-p-ebscohost-com.ezp.waldenulibrary.org/ehost/pdfviewer/pdfviewer?vid=34&sid=7f4641d1-3b29-44c2-8e03-481bb658922c%40redis
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4 months ago
Kirsi Hoselton
RE: Discussion - Week 9- Initial Post
Transforming Nursing and Healthcare Through Technology
Week 9 Discussion: The Inclusion of Nurses in the Systems Development Life Cycle
First Post
Miquel, thank you for your response. I enjoyed reading your post.
According to the textbook Nursing Informatics and the Foundation of Knowledge, the system development life cycle (SDLC) is comparable to the nursing process (McGonigle & Mastrian, 2018). The nursing process is an outline utilized by nurses to assess, utilize nursing diagnosis, planning, implementation, then evaluate patients (McGonigle & Mastrian, 2018). In comparison, the SDLC is a process that utilizes system planning, design, implementation and development, testing, integration, maintenance of software or hardware throughout healthcare. The utilization of the SDLC is an essential tool implemented throughout healthcare.
Nurses play a vital role in various areas throughout healthcare. Therefore, any technological system should be implemented when considering user requirements, including nurses' involvement when developing any technology system. When creating a technology system, it is crucial to address security concerns and ensure that patients' medical records and pertinent information are protected. Therefore, nursing staff should be included during the planning stages to provide essential input and education throughout the process (McGonigle & Mastrian, 2018).
Reference
McGonigle, D., & Mastrian, K. (2018). Nursing informatics and the foundations of knowledge
(Fourth ed.). Burlington, MA: Jones & Bartlett Learning.
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4 months ago
Tae Kim
RE: Discussion - Week 9- Initial Post
Miguel, thank you for sharing your insightful post. As the professionals who provide direct care, nurses are in a good position to identify the needs of a system. A nurse informaticist should have a critical leadership role in ensuring nurses’ inputs are part of the process. However, informatics is a complex skill for which nurse informaticists should have formal training. This course is a good start but a nurse informaticist should have at least a graduate-level degree and be well educated in project management, process improvement, and the principles of business (Lloyd & Ferguson, 2017, p. 211).
A qualified informaticist will probably understand the different SDLC models. You mentioned the waterfall model which is one of the oldest models. Another model that has gained popularity in systems development is the agile model. The agile model involves the identification and review of key requirements (e.g., needs, preferences, user expectations, etc.,) and continuous partial deliveries for stakeholders and end-users. Users and stakeholders are included at every stage of development. Decisions and changes to the product are discussed among a multidisciplinary team to arrive at the best solution (Lawrence et al., 2021, “Methods” section).
References
Lawrence, K., Rodriguez, D. V., Feldthouse, D. M., Shelley, D., Yu, J. L., Belli, H. M., . . . Mann, D. M. (2021, February). Effectiveness of an integrated engagement support system to facilitate patient use of digital diabetes prevention programs: Protocol for a randomized controlled trial. JMIR Research Protocols, 10(2). Retrieved October 26, 2021, from http://dx.doi.org.ezp.waldenulibrary.org/10.2196/26750
Lloyd, J., & Ferguson, S. L. (2017, July / August). Innovative information technology solutions: Addressing current and emerging nurse shortages and staffing challenges worldwide. Nursing Economics, 35(4), 211 - 212. Retrieved October 26, 2021, from https://ezp.waldenulibrary.org/login?qurl=https%3A%2F%2Fwww.proquest.com%2Fscholarly-journals%2Finnovative-information-technology-solutions%2Fdocview%2F1929680573%2Fse-2%3Faccountid%3D14872
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4 months ago
Federica Clay
RE: Discussion - Week 9- Initial Post
Miguel,
The end-user in the case of a new technology system would be nurses and all other healthcare staff that uses the system to find relevant patient information as well as document. Nurses are crucial in all steps of the SDLC. As end-users, nurses are often the ones implementing the new program, testing, and requesting changes in the maintenance phase of the SDLC. Nurses are often involved in the operational feasibility of the process. “Operational feasibility determines how effective the project will be in meeting the needs and expectations of the organization and actually achieving the goals of the project or addressing and solving the business problem” (McGonigle & Mastrian, 2017). They help determine the effectiveness of the system.
Another way nurses are vital in the upbringing of a new technology system is that they can truly assess “usability” or evaluate if a system is easy to use and “user friendly” (Agency for Healthcare Research and Quality, n.d.). This is because nurses are constantly using the technology system and assessing what they like about the system or what could be better. Nurses need to be able to chart quickly and effectively so that they can move on to their next task.
Resources
Agency for Healthcare Research and Quality. (n.d.). Workflow assessment for health IT toolkit. Retrieved 10/26/21, from https://digital.ahrq.gov/health-it-tools-and-resources/evaluation-resources/workflow-assessment-health-it-toolkit/all-workflow-tools/usability
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning. Chapter 9, “Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making” (p. 183).
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4 months ago
Tanaka Ruzvidzo
RE: Discussion - Week 9- Initial Post
Dear Miguel, Thank you for great discussion points. You made an excellent point about the identification of champions, or super-users. These would ideally be those that are nurses and directly involved in patient care. It would benefit management to identify these super-users and include them in the process from the beginning. This ensures buy-in and at the same time they can help co-workers address any issues they may experience as well as assist in end-user training. “To solve the challenge of ambiguity of requirements and difficulty in understanding the viewpoint of each other, the engineers and the nurses really collaborated to understand each other” (Qin et al., 2017, p. 4). Constant communication and collaboration between the super-users, end users and designers is key to ensuring that everyone is on the same page. This makes for a better work environment with increased morale and nurse satisfaction knowing that their input is valued.
Improved patient outcomes, and shorter hospital stays are an achievable goal, and nurses play a critical role in helping meet this goal. Their involvement in implementation of a health information technology system has several benefits. “Nurse leaders will inevitably model how to foster an innovative culture while addressing opportunities to improve the safety, efficiency, timeliness, patient-centeredness, effectiveness, or equity of care not previously available” (Kelley, 2019, p. 534). This is a win-win situation for the healthcare organization, and they should therefore make it a point to include nurses in their decision-making process.
References
Kelley, T. (2019). Emergence of nursing innovation influenced by advances in informatics and health IT. Nurse Leader, 17(6), 531-536. https://doi.org/10.1016/j.mnl.2019.09.012
Qin, Y., Zhou, R., Wu, Q., Huang, X., Chen, X., Wang, W., Wang, X., Xu, H., Zheng, J., Qian, S., Bai, C., & Yu, P. (2017). The effect of nursing participation in the design of a critical care information system: A case study in a Chinese hospital. BMC Medical Informatics and Decision Making, 17(1). https://doi.org/10.1186/s12911-017-0569-3
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4 months ago
Kene Fall
RE: Discussion - Week 9- Initial Post
Hello Miguel, great post. I agree with you that not involving nursing in purchasing or implementing a health information technology system could lead to poor patient outcomes. The Systems Development Life Cycle is a process utilized to develop and implement information systems designed to support a company's goals and objectives (Mcgonigle & Mastrian, 2018). Nurses play an essential role in the healthcare workforce, and they should be allowed to develop their skills in the areas of strategic planning and implementation of programs that promote continuous improvement (Collins et al., 2015)
References:
Collins, S. A., Alexander, D., & Moss, J. (2015). The nursing domain of CI governance: recommendations for health IT adoption and optimization. Journal of the American Medical Informatics Association, 22(3), 697-706.
McGonigle, D., & Mastrian, K. (2018). Nursing Informatics and the Foundation of Knowledge ( 4th ed.). Burlington, MA: Jones & Barlett Learning.
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4 months ago
Tae Kim
RE: Discussion - Week 9
Consequences of a Healthcare Organization Not Involving Nurses in Each Stage of the System Development Life Cycle (SDLC) when Purchasing and implementing a New HIT System
The system development life cycle (SDLC) is divided into four primary stages: planning, design, implementation, and maintenance and evaluation (Laureate, 2018). Certain models may subdivide the SDLC into additional phases. The waterfall model, for example, has stages for feasibility, analysis, design, implementation, testing, and maintenance (McConigle & Mastrian, 2018, pp. 178 – 180). It is vital to include the appropriate individuals at each step. Nurses are critical leaders in system improvement and redesign because they have the majority of daily encounters with patients and are aware of whether processes are functioning or not (Castner et al., 2016, p. 300).
Plan Stage - This stage establishes the need of a system (Laureate, 2018). Nurses identify issues with the system they are presently using and recommend fixes as they use it. They have an idea of what the healthcare system is capable of doing for the patient. Nurses engage in this step to ensure a patient-centered solution to an issue. Without nurses and other direct patient care professionals, the system risks being poorly designed and failing to satisfy the provider's or patient's requirements. If this is the case, the system may be operated inefficiently or not at all (Castner et al., 2016, pp. 302 – 303). A badly conceived EHR system, for example, would almost certainly result in suboptimal outcomes in subsequent phases of the SDLC.
The design process includes both high- and low-level designs, as well as interface and data design. A high-level design establishes which programs are required and their interaction. A low-level phase establishes the operational parameters for the different programs. The interfaces define the system's appearance and feel. The team validates whether data are necessary or vital via data design (McConigle & Mastrian, 2018, p. 179). Nurses may influence the design to ensure that it best meets their requirements for delivering critical patient care. Without the wisdom and experience of the healthcare professional, the design may fall short of meeting their expectations. Vaughn and Linder (2018) illustrate the influence of a poorly constructed EHR order set on pneumonia therapy. Antibiotics were arranged alphabetically in their example, which meant that amikacin was always the first choice. Thus, when an antibiotic was chosen, the mode of administration was automatically intravenous. Due to the EHR's poor design, its order set became a barrier to prudent decision-making, resulting in increased misuse and expense (p. 584).
Implementation Stage — The implementation stage is concerned with transforming a well-designed system into a usable state for all stakeholders. Implementation will comprise the installation of the actual software and hardware, as well as testing to guarantee network functionality is working properly. Healthcare practitioners are unlikely to be involved in developing and implementing the systems' hardware or authoring the software code. However, providers, as end users, should be included in an implementation team that is responsible for testing and deciding the appropriate degree of performance. If nurses do not give the essential leadership, ownership, and sponsorship throughout implementation, delays and waste, inefficient decision-making, and costly decision-making nearly invariably occur (Laureate, 2018).
After a system is authorized and made operational for all end users, it must be utilized and maintained (McConigle & Mastrian, 2018, p. 180). Healthcare practitioners, as end users, are uniquely qualified to review and offer input on the system. They may offer suggestions about how to improve the system. If proposals are approved, they might be sent to developers for small or even large system improvements. Without user input, improvements may not be implemented or may result in changes that do not improve the system. For example, an EHR system may be unintuitive, leading in more effort or even mistakes. Only by raising awareness of the concerns can suggestions be incorporated in the scheduled revisions.
Input that I had in the Selection and Planning of New HIT Systems in My Nursing Practice or Healthcare Organization
I was not engaged in the selection or development of new health information technology systems. In my institution, registered nurses are mainly involved in the maintenance and evaluation stage of a system. RNs collaborate with nurse informaticists on a variety of topics, most notably those involving our EHR system and its recommendations. When we have suggestions for improving the EHR system, we communicate them to our leadership and informatics. They will next work with our information technology department to organize the implementation of these recommendations. When an upgrade occurs, we are told by pop-up alerts when we log into the Epic system, as well as via E-mails with tip sheets.
References
Castner, J., Sullivan, S. S., Titus, A. H., & Klingman, K. J. (2016, July / August). Strengthening the role of nurses in medical device development. Journal of Professional Nursing, 32(4), 300 – 305. https://doi.org/10.1016/j.profnurs.2016.01.002
Laureate Education (Producer). (2018). Managing Health Information Technology [Video file]. Baltimore, MD: Author
McGonigle, D., & Mastrian, K. G. (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, Ma: Jones & Bartlett Learning.
Vaughn, V. M., & Linder, J. A. (2018). Thoughtless design of the electronic health record drives overuse, but purposeful design can nudge improved patient care. BMJ Quality & Safety, 27(8), 583 - 586. Retrieved October 25, 2021, from http://dx.doi.org.ezp.waldenulibrary.org/10.1136/bmjqs-2017-007578
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4 months ago
Robin Moyers WALDEN INSTRUCTOR MANAGER
RE: Discussion - Week 9
Thank you Tae. Excellent explanation of the SDLC!
REPLY QUOTE EMAIL AUTHOR
4 months ago
Tanaka Ruzvidzo
RE: Discussion - Week 9, Initial Discussion Post
The Systems Development Life Cycle, or SDLC is a “process which requires phases of Planning, Analysis, Design, Implementation, and Maintenance” (Laureate Education (Producer), 2018). The involvement of nurses at each stage of development helps ensure success and they may act as change champions to help bring others on board. “SDLC is a way to deliver efficient and effective information systems that fit with the strategic business plan of an organization” (McGonigle & Mastrian, 2017, p. 204). This is necessary to ensure that the company grows, remains relevant and competitive and continues to meet its goals in the process.
The planning/assessing needs phase is important to determine what and how many resources are needed to carry out the project. This is an important step whereby nurses need to agree, and their input considered. A potential issue may arise whereby nurses are not included in the planning stage and because of this they may not avail themselves as the project develops, as their input was not valued from the beginning.
The analysis phase involves fact-finding to ascertain requirements and the best place to obtain information would be from the end-user. A potential issue at this stage is bypassing the end-user instead of acquiring feedback from them as far as the usefulness of the project. Design, develop and test - this is the actual design of a system, and a potential issue may be a design that does not fit the needs of the end user, or that may be redundant. Involving nursing may bring out gaps that are missing and hash out any gray areas. Implementation - this phase is characterized by change, because this is where the new system replaces the old. Nursing input is vital at this stage to act as change champions so that resistance is lessened by staff members that are required to use the new system. Maintenance - this phase requires ongoing system support that includes technical support for users and maintenance to address errors and issues that arise. This phase lasts a long time and as such nurse input is needed to ensure that problems are reported so that they can be corrected in a timely manner. Evaluation - the best source for evaluation would be the end user, which is typically the nurse. Encouraging feedback from them during this phase may give them a sense of empowerment as they may feel that their input is valued.
I did not have any input in the selection and planning of the new health information technology systems in my nursing practice or healthcare organization. A potential impact of being included in the decision-making process is improved quality of care. In a study done on reporting adverse events in a hospital, the nurses were able to share and respond to adverse events in a timely and efficient manner. “The reporting system has brought an enormous change in how the nurses report, analyze and respond to the adverse events” (Cao & Ball, 2017, p. 1351). Inclusion of nurses at each step of the project may help things move smoothly and quickly. Additionally, nurses will feel that their opinion matters which will encourage them to speak up.
References
Cao, Y., & Ball, M. (2017). A Hospital Nursing Adverse Events Reporting System Project: An Approach Based on the Systems Development Life Cycle. Precision Healthcare through Informatics, 245, 1351. https://doi.org/10.3233/978-1-61499-830-3-1351
Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.
McGonigle, D., & Mastrian, K. (2017). Nursing informatics and the foundation of knowledge. Jones & Bartlett Learning.
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4 months ago
Robin Moyers WALDEN INSTRUCTOR MANAGER
RE: Discussion - Week 9, Initial Discussion Post
4 months ago
Tanaka Ruzvidzo
RE: Discussion - Week 9, Initial Discussion Post
4 months ago
jennifer girgis
RE: Discussion - Week 9, Initial Discussion Post
4 months ago
Sophie Enjema Ndumbe
RE: Discussion - Week 9, Initial Discussion Post
Hello Tanaka,
Nice discussion, Nurses play very important role in the healthcare setting. Nurses must be involved in all the stages SDLC for any planned project to move on smoothly. They cannot miss any of the stages for system development life cycle. I agree with you that system development cycle is made up of planning, analysis, design, implementation and maintenance. The system development cycles make it easy for facilities to train their workers well to prepare them for any new system in place. Healthcare workers and nurses need to be trained before a software is installed in their facility (Laureate Education, 2018).
When nurses are not involved in system development life, it becomes a problem to the facility or health care institution, most of the workers might want to quit their jobs because of lack of knowledge and skills using the new software. According Laureate Education (2018) facilities must address challenges getting any new software, nurses and healthcare workers should recognize each phase of the SDLS and work on it efficiently to be successful.
References
Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author.
Laureate Education (Producer). (2018). Managing Health Information Technology [Video file]. Baltimore, MD: Author.
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4 months ago
Dorothy Chudi-Agbaku
RE: Discussion - Week 9, Initial Discussion Post
Hi Tanaka,
Good post. According to McGonigle & Mastrian (2017), the analysis and design phases which are very vital phases in the development cycle according and during these phases, nurses’ input as the end users are needed to ensure that the software’s overall configuration is properly defined. Also at the maintenance phase, and as changes occur during the SDLC and the project is not static, supports from the nurses are needed from the nurses and are necessitated through their use or time of use (McGonigle & Mastrian, 2017).
This being said, there is a lot of consequences when nurses are not included during SDLC in any organization. A study showed that active participation by the nurses in SDLC development would lead to their full usage of the system resulting in significant improvement in medication order transmission, administration, and in quality and efficiency in nursing documentation (Qin et al., 2017). This also led to nursing performance improvement.
Dorothy.
References
McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Qin, Y., Zhou, R., Wu, Q., Huang, X., Chen, X., Wang, W., Wang, X., Xu, H., Zheng, J., Qian, S., Bai, C., & Yu, P. (2017). The effect of nursing participation in the design of a critical care information system: A case study in a Chinese hospital. BioMed Central, 17(165). https://doi.org/10.1186/s12911-017-0569-3
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4 months ago
ZULFIQAR ABBAS
RE: Discussion - Week 9
Hello colleagues,
System Development Life Cycle (SDLC) has a lot of similarities with the nursing process includes planning, designing, analysis, implementation, and testing, and ongoing maintenance (McGonigle & Mastrian (2018). The process of system development helps in organizing and administration of information of technology to manage the challenges during the operation of the facility. SDLC is also the predictor of the success of a project analysis to evolution (Mustaquim, & Nyström, 2015).
Nurses’ contribution is very high in any healthcare setup. They work both on the front and back end during the delivery of high-quality care. Nurses must be a part of any new process, technology, or new protocol before coming on board. If nurses are not part of any new policy, procedure, or change in practice there is a very high chance of system failure because they are the one who executes the system. For example, if any healthcare facility is trying to lounge a new Electronic Health Record (EHR), nurses should be the part of entire new EHR lounge process. Nurses should not be ignored to ensure the maintenance of normal workflow. Nurses are the one who has to test, execute, maintain, and operate the EHR to provide the quality of care. Nursing staff should make sure the EHR is user-friendly, has less chance of errors or glitches, and has easy access to the system. As stated above nurses are first and end-user of the system, they should have adequate knowledge of the system. Nurses' ability to adopt positive deviance as they experience unintended consequences offers opportunities for organizations to engage nursing perspectives in improving the EHR and engineer it to be more resilient to nursing work (Bristol, et al; 2018). If nurses’ knowledge and wisdom are not used properly any new EHR would be only informative not serving the purpose required.
One of the primary care I had worked with 4 years ago lounged a new EHR and completely ignored the nurses and other staff involved in care. Nursing staff struggled hard to work with the new EHR but could not succeed. Eventually, management arranged extensive in-person training for nurses’ staff for a week which cost a lot of money and interrupted the facility operation. With this approach, the facility learned a lesson of not being involved with nurses in the new software and ended up paying a higher cost.
Nurses can support each other in this process who are not properly aware of IT. If nurses are not the part of new EHR the transition would be more difficult and costly. Expert IT nurses can provide feedback and constantly monitor the correct operation to maintain the normal flow. The SDLC models help to deliver a cost-effective way to provide EHR properly and promptly. It has been proven that using nurses’ knowledge and wisdom in every stage of the process had shown to improve quality and safety for the health of our community.
References
Bristol, A. A., Nibbelink, C. W., Gephart, S. M., & Carrington, J. M. (2018). Nurses' use of positive deviance when encountering electronic health records-related unintended consequences. Nursing administration quarterly, 42(1), E1-E11.
McGonigle & Mastrian (2018). Nursing informatics and the foundation of knowledge (4th ed.). Burlington, MA: Jones & Bartlett Learning.
Mustaquim, M. M., & Nyström, T. (2015, June). A system development life cycle for persuasive design for sustainability. In International Conference on Persuasive Technology (pp. 217-228). Springer, Cham.
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4 months ago
Robin Moyers WALDEN INSTRUCTOR MANAGER
RE: Discussion - Week 9
Thank you Zulfiqar. Good notation of possible ramifications of excluding nurses.
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4 months ago
ZULFIQAR ABBAS
RE: Discussion - Week 9
Hi Dr Moyers,
Thank you for the feedback.
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4 months ago
Miguel Rodrigo Estrera
RE: Discussion - Week 9
Hello Zulfiqar, You have a solid point on the importance of Nurse’s Contribution to implementing new processes, technologies, or protocols. Instead of perceiving stakeholders as passive users of the functionality supplied by EHRs, the service design approach views stakeholders as active co-creators in the service design process and the utilization of these systems. With its comprehensive and systemic approach, service design may involve and support a wide range of stakeholders in complex environments such as healthcare, enabling them to carry out their activities and achieve their objectives more effectively. Several studies have demonstrated how inadequate user and organizational participation during the creation of such systems resulted in the underutilization of HIS in general and EHRs in particular (Teixeira, Jorge, de Pinho, Nelson , & Patricio, Lia, 2019). Because of the widespread use of electronic health records (EHRs) to facilitate clinical procedures, even minor inefficiencies or design defects in EHRs can significantly influence clinical workload. In the case of documentation of care, what was once a straightforward process of handwriting or typing a few lines of free text is now complicated by computer clicks, dropdown menus, check-boxes, and multiple steps of selecting from structured terminologies lists and entering information into specific fields, among other things (Lopez, Karen, et al., 2021).
References
Lopez, Karen, Chin, Chieh, Ferrerira, Renato, Azevedo, Leitao, Kaushik, Varsha, Roy, Bidisha, . . . Morrow, Daniel. (2021, May). Electronic health record usability and workload changes over time for provider and nursing staff following transition to new EHR. Applied Ergonomics, 93, 1-9. doi:https://doi.org/10.1016/j.apergo.2021.103359
Teixeira, Jorge, de Pinho, Nelson , & Patricio, Lia. (2019, December ). International Journal of Medical Informatics. Bringing service design to the development of health information systems: The case of the Portuguese national electronic health record, 132. doi:doi-org.ezp.waldenulibrary.org/10.1016/j.ijmedinf.2019.08.002