Handbook of Informatics for Nurses and Healthcare Professionals Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Chapter 7 Selecting a Healthcare Information System

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar The competitive advantages associated with health information systems are contingent upon the technology, the degree to which technology meets the organization’s needs, the strength of the information services staff, and the speed and method by which the system is implemented. Some Thoughts

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Some Thoughts Some benefits of a new system are immediate but economic benefits may not be evident for years Awareness of the mistakes made by others can be used to guide decisions The staggering costs associated with purchase and implementation make a wise choice critical

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar There is no “right” choice but the best place to start when selecting a healthcare information system with the strategic plan because it sets goals and determines technology needs Some Thoughts

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Life Cycle The process for the selection and implementation of an information Ongoing process of developing and maintaining an information system 4 main phases that cover the life span of information systems

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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Life Cycle Phases 1. Needs assessment 2. System selection 3. Implementation 4. Maintenance

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Needs Assessment Initiated by someone with a vision of the future Analyzes the organization needs Looks at segments in the organization Identifies deficits and issues The selection committee uses data to generate a list of possible solutions

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Steering Committee Members Key to process Membership –Board members (ensure congruence with organizational strategic plan) –Representatives from all departments impacted (↓possibility of missing potential problems) –Must include end-users –Chair should be a member of administration

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Steering Committee Structure Large enough to make a good decision but small enough to be effective and efficient Who will make the final decisions? –Multilevel committee  Upper level makes final decisions  Lower level makes recommendations

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Committee Considerations Steering Committee members must receive release time from other responsibilities Want users with functional expertise, good communication, and ideally a computing background May use input from consultants

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Consultants May be used for any part of the selection or implementation processes Effective use requires clear definition of the contractual relationship and expected outcomes May be used to analyze all available information and make recommendations

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Analysis of Current System Thorough understanding is essential Must determine what information is used, who uses it, and how it is used May use questionnaires, observation, and interviews Must weigh strengths and weaknesses

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar System Requirements User needs—“Musts” and “Wants” Technical criteria Administrative criteria Registration criteria Medical Records Criteria Order Entry/Results Reporting Accounting Criteria

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar “Musts” and “Wants” Determination of system requirements from what end users identify as essential or “nice” to have to do their work Selection committee develops and uses a weighting system to rank criteria identified by workers

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Technical Criteria Hardware and software needed for the desired level of system performance Type of architecture (does it work with other systems) Response time Downtime Test and training environments Support for other technology

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Administrative Criteria Compliance with regulatory and legal requirements Report capabilities Ease of use Purging and restoring data

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar System Selection Second phase of the Life Cycle Phase begins once decision made to purchase a new system Critical to the success of the project Requires the collection of additional information and awareness of funds available for the project

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Sources of Information Trade shows and conferences Publications –Professional organizations –Trade journals –User groups Internet and World Wide Web Site visits Request for information/proposal/quote

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Request for Information (RFI) Brief document sent to vendors that states plans to purchase and install a system Asks the vendor for a description of the system, its capabilities, and perhaps: –About the company –Number of installed sites –Technical capabilities –Updates

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Request for Proposal (RFP) Formal document sent to vendors that describes system requirements sought Detailed Solicits proposals from vendors that describe their capabilities to meet the “wants” and “needs Responses are used to narrow the choices

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Analysis of RFP Responses Receipt of RFP Responses is the beginning of the “Evaluation” phase Consider –Was it submitted by the deadline date? –Is it a professional effort? –Were the vendor representatives responsive? –Does the proposal address the RFP or is it a standard bid?

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Request for Quote (RFQ) Statement of need that focuses upon pricing, service levels, and contract terms Skips marketing hype often received in response to RFP

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar After the system selection and recommendations negotiations are done through legal and purchasing representatives Request for Quote (RFQ)

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey All rights reserved. Handbook of Informatics for Nurses and Healthcare Professionals, Fourth Edition Toni Lee Hebda and Patricia Czar Future Directions The system life cycle is ongoing Each repetition of the system life cycle process increases the body of knowledge that will help organizations with future choices Increased knowledge will also help to shorten the selection process

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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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)

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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?

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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

Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 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