1. Handbook of Informatics for Nurses and Healthcare Professionals Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Chapter 8 System Implementation and Maintenance

2. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar System Implementation Third phase of the life cycle Begins with purchase of the system Requires planning before purchase Entails selection of the implementation committee

3. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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

4. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Steering Committee membership and organizational issues are as important as the technology when implementing a new system Project leader must have strong leadership and communication skills Implementation Committee (continued)

5. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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, how used

6. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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

7. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Issues to Re-visit Is technology current? Upgradable? Financial stability of vendor? Vendor compliance with regulations? Interoperability with other systems? Support inpatient, outpatient, and ED visits? Support for the electronic medical record? Remote access? Does it support patient care?

8. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Base System vs. Custom This decision impacts implementation Customization requires time and resources Customization may also have ripple effects on other systems and interoperability

9. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Function A task performed manually or automated Must identify information pertinent to completion of each function Examples –Order entry –Results reporting –Documentation

10. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar System Output Material generated by the system Examples of output include: –Requisitions produced in other departments –Reports –Diagnostic results –Worklists –Charges

11. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Determining Output Analysis 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 ↑ costs

12. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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

13. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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

14. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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

15. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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

16. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Workstations and Mobile Devices Must 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

17. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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

18. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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

19. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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 patients

20. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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

21. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Implementation Pitfalls Underestimate for time and resources 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

22. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Maintenance User feedback analyzed and appropriate changes made User support—resource staff available during go-live on units and via help-desk at all times Must apply updates to all 3 environments —test, training, and production (live) Technical

23. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar The Role of Nursing All users should have input into the systems that they use Nurse informaticists provide “credibility” for information system projects

24. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Nurse Informaticist Responsibilities Systems development and implementation Liaison Quality initiatives Strategic planning Education Vendor communication

25. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar 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 re-allocating time saved in documentation and other efficiencies to improve patient care services. Nurse Informaticist Responsibilities