1. CHAPTER 19 Implementing and Upgrading Clinical Information Systems

2. OBJECTIVES Describe the eight phases in developing,implementing,or upgrading a clinical information Describe the personal requirements for implementing or upgrading a CIS Describe the roles and responsibilities of nursing for implementing, and upgrading a CIS Identify the various tools of the trade used in developing,implementing, and upgrading a CIS Describe the methods of evaluating a CIS Describe new challenges in implementing and upgrading CISs.

3. KEY WORDS INFORMATION SYSTEMS INFORMATION TECHNOLOGY INTEGRATED SYSTEM ADVANCES INFORMATION MANAGEMENT SYSTEMS HOSPITAL INFORMATION SYSTEM CLINICAL INFORMATION SYSTEM

4. Composition of the CIS management team: CIS Steering Committee Project Team Departmental Team

5. FAILURE IN IMPLEMENTING OR UPGRADING A SYSTEM CIS does not meet the stated goals of the project There is failure to gain end user acceptance Expenditures exceed budget Anticipated benefits are unrealized

7. Planning Identification of the composition of the CIS management team Definition of the Problem Feasibility Study Environmental Assessment Development of a Project Timeline Giving of Recommendations Documentation and Negotiation of a Project Scope Agreement Allocation of Resources

8. CIS STRUCTURE AND PROJECT STAFF The nursing administrator involvement in the establishment of a CIS committee structure is paramount to the project. Transition management as the process is sometimes called, is a series of … deliberate planned interventions undertaken to assure successful adaptation / assimilation of a desired outcome into an organization A

9. CIS Steering Committee MAIN MANAGERS OF CIS composted of representatives from the different areas (hospital administration, nursing administration, medical staff, information systems, major ancillary departments, health information management, legal affairs, consultants, and appointed members) in charge of providing oversight GUIDANCE to the selection and integration of a new CIS into the organization

10. Project Team: DESIGN AND UPGRADING MANAGERS OF CIS composed by the project manager and team leaders from each of the major departments; Objectives: To understand the technology, including restrictions of a proposed system To understand the impact of intradepartmental decisions To make decisions at the interdepartmental level for the overall good of the CIS within the organization To become key resource for application *Project Manager - has significant implementation experience, is responsible for managing the software application development, hardware and networks and all aspects of the healthcare project implementation.

11. Departmental Team : KEY IMPLEMENTORS OF CIS has the task of understanding the department’s information needs and the software features and functions, merging system’s capabilities with department’s operations, participating in developing and conducting end- user education, and providing high level of support in utilization of the system

13. PLANNING During planning phase,the information requirements necessary to solve the problem or accomplishment the goal are assessed. The information needs in selecting, implementing or upgrading a CIS, including their implications for nursing services, nursing practices, and quality care,must also be identified STEPS IN PLANNING PHASE  Definition of the problem and /or stated  Feasibility study  Documentation and negotiation of project scope agreement  Allocation of resources

14. Definition of the Problem : includes statements of the problem identified in the institution requiring CIS development or utilization, key goals after the project implementation, and evaluation techniques if upgrading a system, it may also include identification of equipment available, age, degree of amortization, and need for upgrades

15. Feasibility Study: Study BENEFITS and PRODUCTS vs. RISKS and ISSUES; TO BE OR NOT TO BE a preliminary analysis to determine if the proposed problem can be solved by the implementation of CIS; with identified objectives *Issues may be legal, operational, or technical in nature

16. TOPICS AREAS IN FEASIBILITY STUDY Statement of objectives Environmental assessment Determination of information needs Determination of scope Development of a project timeline Recommendation

17. Documentation and Negotiation of Project Scope Agreement: A project scope agreement is drafted by the project team and submitted to the project’s steering committee for acceptance The project scope agreement becomes the internal organizational contract for the project

18. Allocation of Resources: Considerations: - staffing workload - human resources - present cost of operation - relationship of implementation events with non project events - training costs - space availability - current and anticipated equipment requirements The last step in planning phase is determining what resources are acquired to successful complete the project scope agreement

19. SYSTEMS ANALYSIS During this phase, all data requirements related to the problem defined in the project scope agreement are collected and analyzed to gain a sound understanding of the current system the importance of this phase should not be underestimated. Design changes made during the analysis stages often add minimal costs to the project. 5 step of Data collection,Data analysis, Data review, Benefits identification, System proposal development

20. Data Collection: HARDWARE, PROCEDURES, SOFTWARE, PROCESSING, OUTPUT, INTENDED REPORTS creation of workflow documents and functional design document * Workflow document – assimilates the data collected into logical sequencing of tasks and subtasks performed by the end users for the goal or problem area * Functional design document – overview statement of how the new system will work; uses the workflow document as its basis in creating a new system, or upgrading a previously existing system Data Analysis: provides overview of the nursing problem and/or stated goal; use tools to analyze data (data flowchart, grid chart, decision table, organizational chart, model) Data Review: review data gathered thru feasibility study, workflow document, and functional documents, and provide recommendations Benefits Identification: Benefits Identification basis for measuring the success of the project, the benefits reflect the resolution of the identified problem, formulated and stated in quantifiable terms Systems Proposal Development: proposal is submitted to the project’s steering committee for review and approval, identifying the problems and/or goals and requirements for the new system’s overall design

21. SYSTEMS DESIGN  The design details of the system and the detailed plans for implementing the system are developed for both the functional and the technical components of a system. THREE MAJOR STEPS IN SYSTEM DESIGN PHASE  FUNCTIONAL SPECIFICATION Used functional design documentation developed in the system analysis phase of a CIS and builds on the design by formulating a detailed description.

22.  DATA MANIPULATION AND OUTPUT Consideration for handling data manipulation and output The departmental teams and users determine what the actual data will looks like in its output form and gain consensus from the departmental teams for the proposed design. The functional specification matures and major design decisions (e.g., selection of the underlying application technology and datdbase structures have occurred,a design “freeze point “ is establish.  TECHNICAL SPECIFICATIONS Technical personnel work closely with the project and departmental teams to ensure the technical components of the proposed system in concert with technology and end user needs and to assist in the development of the implementation plan.

23.  HARDWARE Technical specifications describing the recommended equipment are developed and tested in development laboratory The types of devices to be used ( pc vs. handheld vs. bedside devices) require dialog and testing with team leaders and department team  INTERFACE SYSTEM Defines those programs and processes required to transmit data between two disparate systems  CONVERSIONS the conversions of data from legacy systems to the new system is fourth major area of coordination for the project technical team

24. Implementation Planning: development of a detailed implementation plan Contents of the Plan: Personnel Timeframes Costs and budgets Facilities and equipment required Development or implementation tasks Operational considerations Human- computer interactions (interfaces) System test plan IMPLEMINTATION WORKPLAN  Personnel  Timeframes  Costs and budgets  Facilities and equipment required  Development or implementing tasks  Operational consideration  Human computer interactions  System test plan

25. Select software Selecting the correct hardware for the system depends on its design, applications,and software requirements. Computer hardware were is obtained in several different ways. Microcomputers is the most economical for some applicatons Input, ooutput, and processing media including secondary storage is selected and all hardware must be installed and enable to test the computer programs.

26. Development software Becomes an interative process of programing sections of the design established in the functional specifications, testing the design with the informatics nurse or design team, evaluating options suggested as a result of testing and refining / reevaulation the functioning specification.

27. DEVELOPMENT Software development of the software iterative process of programming sections of the design determination of product packaging and marketing materials, establishment of product pricing, development of system/application documentation, and establishment of a marketing plan

28. TESTING alpha test vs. beta test verifies that computer programs are written correctly and ensures that when implemented, the system will function as planned **Document system TRAINING includes the databases, processing logic, and outputs of the system’s features and functions Levels: 1. project team and selected members of the departmental team receive training from the developers or vendor 2. end-user training -done no more than 6 weeks prior to activation of the new system Important Notes: Training should take place before and during activation of a new system Training is most effective when it is interactive and hands-on

29. DOCUMENTATION DESCRIBE THE SYSTEM FOR ALL USERS IS AN ONGOING ACTIVITY WITH DEVELOPMENT OF THE DOCUMENTATION OCCURING AS THE VARIOUS SYSTEM PHASES AND STEPS ARE COMPLETED

30. USERS MANUAL HIGHLIGHTS HOW TO USE THE SYSTEM AND DESCRIBE AND DESCRIBE WHAT OUTPUTS THE SYSTEM CAN PRODUCE Reference manual Used by the projects team members to understand how the system works

31. Training phase It is essential to train the end users on how to use the system properly. Training takes place before and during the activation of new system Training is the most effective when hands on, interactive instruction is provided Evaluation the system is the final and ongoing step in implementing process.

32. IMPLEMENTATION IMPLEMENTATION + COLLABORATION materialization of the implementation plan 4 Approaches: Parallel Pilot Phased-in Big Bang

33. EVALUATION Describe and assess,in detail the new system’s performance The system is evaluated to determine whether it has accomplished the stated objectives.

34. STEPS IN PLANNING PHASE  Definition of the problem and/ stated goal  Feasibility  Documentation and negotiation of the project scope agreement  Allocation of resources

35. Thank you for listening Reported by Hazel Mae Estrada