Discussion: The Inclusion of Nurses in the Systems Development Life Cycle NURS 6051 Discussion

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Discussion: The Inclusion of Nurses in the Systems Development Life Cycle NURS 6051 Discussion

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.

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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. Discussion: The Inclusion of Nurses in the Systems Development Life Cycle NURS 6051 Discussion

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. Discussion: The Inclusion of Nurses in the Systems Development Life Cycle NURS 6051 Discussion

RE: Discussion – Week 9

Systems Development Life Cycle

Systems Development Life Cycle is defined by McGonigle and Mastrian (2018) as “a way to deliver efficient and effective information systems that fit with the strategic business plan of an organization” (p.175). Each Health care organization have their own platform which usually patterned on their health care team’s workflow to achieve quality patient care.  Each Organization has their own assessment team and sometimes their own IT department with their own Electronic Health Record Software such as PROTOUCH for Kindred Hospital Organization and MEDITECH for Hospital Corporation of America. Most Healthcare Organization works with third party Software Companies such as EPIC and CERNER.  Each Software is uniquely designed for each Healthcare Organization to fit their vision and mission.  SDLC is a big project which involve a process of Feasibility, Analysis, Design, Implement, Test and Maintain. 

 

Nurses are the largest healthcare workforce that is affected by any systems change in a healthcare organization besides the patient. SDLC first step is the feasibility study which is planning and developed a prioritized requirement list. These are the MosCow which stands for “Must have, Should have, Could have and Would Have. We as bedside nurses take least participation in feasibility studies which is very early on the project discussion of budget and timelines.  Analysis is a part of SDLC that nurses are involved because detailed system workflow is discussed and if we as bedside nurses take part in this process. The team will be able to have an insight on our needs that caters our patient care. Design is a vital step that we should be involve. Each nursing department in a healthcare facility has their unique workflow that will create a better continuity of patient care, hence quality healthcare. Implementation is a step of SDLC that software engineers write / program in certain software language to bring the design to life (McGonigle and Mastrian, 2018, p179). Test is a part of SDLC that nurses can participate in to perform quality checks on the system before integrating in current EMR system.  Nurse’s participation in this stage will benefit the whole team in addressing user errors, duplication of charting or any confusion that may arises due to user’s technological limitation. Maintain is the last stage of SDLC which is the support systems offered to the whole healthcare facility during the live implementation of the systems.  This is also a very important stage that nurses specially those who are included from the beginning. They are considered super-users in each nursing unit.  These nurses are usually the first person anyone will approach before anybody from the IT team. They are the one that will help these unit achieved the goals determined from the beginning of this new system development. 

 

 I have been fortunate to be included in my previous hospital’s IT team. We held meetings and discussed issues in our electronic patient chart.  We also discussed suggestions for the issues encountered in our unit.  During those times, our unit nurses are having issues in documenting certain description specially in wound care. The documentation only offered specific description which we all know that is limited and there are no wounds alike.  The IT team were able to give us nurses the option to describe the wounds in our own words/description. This made every nurse in my unit happy and also helped our wound care nurses identify and prioritize consultation. This alone created a better workflow for us by lesser documentation and created a better understanding on difference between Hospital Acquired Pressure Injury and Wounds acquired prior to hospitalization whether it is a chronic wound, trauma acquired and, surgical wounds.

 

Reference:

Laureate Education (Producer). (2018). Systems Implementation [Video file]. Baltimore, MD: Author

 

Mastrian, K. & McGonigle, D. (2018). Systems Development Life Cycle: Nursing Informatics and Organizational Decision Making. In D. McGonigle & K.G. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (4th ed., pp. 175-187,  245-261). Jones and Bartlett Learning.

 

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.

*Note: Throughout this program, your fellow students are referred to as colleagues.

According to McGonigle and Mastrian (2017), “SDLC is a way to deliver efficient and effective information systems that fit with the strategic business plan of an organization” (p. 175). The stages of the SDLC follow the waterfall model and include feasibility, analysis, design, implement, test and maintain. Consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system may include delays, unmet needs, costly decision making, waste of resources or inefficient decision making (Laureate Education, 2018b).

Interoperability is described as the ability of computer systems to exchange information with another system which needs to be phased in overtime (Laureate Education, 2018a).  When looking at the high volume of different workflows seen in different systems one can imagine there are multiple challenges faced in implementing a new health information technology system. These challenges may be overcome by using technical standards (Laureate Education, 2018a).

In 2018 I had the chance to help test a new interoperability coming to the hospital I work at. We were connecting our MARs to our IV pumps. The thought was to be able to scan a medication, scan the pump and then the information would flow over to the pump so that the RN does not have to manually program the pump. I attended two testing dates. At these dates there were bedside nurses from across the ministry all in one room to test every single medication in the system. The goal was to make sure all of the medication were working in the system, however pretty quickly the nurse started noticing failures. The two days ended up being a time when nurses were able to give their opinion on smooth transition and implementation. It became very evident that the team setting all of this up had not consulted any bedside nurses. We were scheduled to go live with our Epic/Alaris Interop in January of 2019 but we did not go live until March.

References

Laureate Education (Producer). (2018a). Interoperability, Standards, and Security [Video file]. Baltimore, MD: Author

Laureate Education (Producer). (2018b). Managing Health Information Technology [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.

Submission and Grading Information

Rubric Detail

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Name: NURS_5051_Module05_Week09_Discussion_Rubric
Grid View
List View
Excellent Good Fair Poor
Main Posting
45 (45%) – 50 (50%)
Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
40 (40%) – 44 (44%)
Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.
35 (35%) – 39 (39%)
Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.
0 (0%) – 34 (34%)
Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.
Main Post: Timeliness
10 (10%) – 10 (10%)
Posts main post by day 3.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not post by day 3.
First Response
17 (17%) – 18 (18%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
15 (15%) – 16 (16%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
13 (13%) – 14 (14%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 12 (12%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Second Response
16 (16%) – 17 (17%)
Response exhibits synthesis, critical thinking, and application to practice settings.

Responds fully to questions posed by faculty.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Response is effectively written in standard, edited English.
14 (14%) – 15 (15%)
Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.
12 (12%) – 13 (13%)
Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.
0 (0%) – 11 (11%)
Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.
Participation
5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
Name: NURS_5051_Module05_Week09_Discussion_Rubric

Good Morning Melissa and Jessica,

I really enjoyed reading your posts and your discussion of the need to involve nurses in all aspects of the SDLC, especially the design phase. It reminded me of the critical need to involve nurses in the design and to continually evaluate the design of Health IT systems to make sure they fit the workflow and are easy to navigate and use. Horsky and Ramelson (2016) developed a cognitive framework and prototype to review a summary of a patient record using open card sorting, walk through think aloud and in-person interviews. They reported, “Excellent usability characteristics allow electronic health record (EHR) systems to more effectively support clinicians providing care and contribute to better quality and safety. The Office of the National Coordinator for Health IT (ONC) therefore requires all vendors to follow a User-Centered Design (UCD) process to increase the usability of their products in order to meet certification criteria for the Safety-Enhanced Design part of the Meaningful Use (stage 2) EHR incentive program. This report describes the initial stage of a UCD process in which foundational design concepts were formulated. We designed a functional prototype of an EHR module intended to help clinicians to efficiently complete a summary review of an electronic patient record before an ambulatory visit. Cognitively-based studies were performed and the results used to develop a cognitive framework that subsequently guided design of a prototype. Results showed that clinicians categorized and reasoned with patient data in distinct patterns; they preferred to review relevant history in the assessment and plan section of the most recent note, to search for changes in health and for new episodes of care since the last visit and to look up current-day data such as vital signs. These basic concepts were represented in the design, for instance, by screen division into vertical thirds that had historical content to the left and most recent data to the right. Other characteristics such as visual association of contextual information or direct, one-click access to the assessment and plan section of visit notes were directly informed by our findings and refined in a series of UCD-specific iterative testing. Understanding of tasks and cognitive demands early in the UCD process was critically important for developing a tool optimized for reasoning and workflow preferences of clinicians”.

I think this was a great study that demonstrated how providers interact with a system and took this information to design screens that aligned with how providers used the system to locate information. Well designed systems involve providers that use these systems, resulting in systems that are user friendly, meet the needs of nurses and their workflow, and facilitate efficient retrieval of patient data. Thanks for your thoughtful posts and sharing your experiences.  Dr. Reilly

Horsky, J., & Ramelson, H. Z. (2016). Development of a cognitive framework of patient record summary review in the formative phase of user-centered design .Journal of Biomedical Informatics, 64, 147-157.  https://doi.org/10.1016/j.jbi.2016.10.004

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