CHAPTER 19IMPLEMENTING AND UPGRADING CLINICAL INFORMATION SYSTEM

CLINICAL INFORMATION SYSTEMCIS assist clinicians with the data necessary for decision making and problem solving.Major CIS Requirement for NursingAdminister a nursing department2. Assist the management of nursing practice.3.Assist nursing education4.Support nursing research

THE PLANNING PHASE8 Phases of Design,I mplementation and UpgradingPlanningSystem AnalysisSystem Design/System CollectionTestingTrainingImplementationEvaluation

CLINICAL INFORMATION SYSTEM COMMITTEE STRUCTURE AND PROJECT STAFFThe Nursing administrator in conjunction with the information system management team works to develop a committee structure and participation to best guarantee success of the project.Transition Management- is a series of ..deliberate planned intervention undertaken to assure successful adaptation/assimilation of a desired outcome into organization. (Douglas and Wright)

CLINICAL INFORMATION SYSTEM STEERING COMMITTEEThe CIS steering committee generally includes representatives from the following areas.Hospital administration/hospital financeNursing AdministrationMedical StaffInformation system departments at manager/director levelMajor ancillary departments (lab,radiology,pharmacy,dietary,records,accountiing)

CLINICAL INFORMATION SYSTEM STEERING COMMITTEE6. Health Information management (medical records)7. Legal affairs8. Outside consultants (as needed)9. Other appointed membersThe Steering committee is charged with providing oversight guidance to the selection and integration of a new CIS into the organization.

PLANNING PHASEProject Team- it is led by an appointed project manager and includes a designated team leader for each of the major departments affected by the system selection, implementation, or upgrade proposed.The Objectives of the project team are:Understand the technology and technology restrictions if any of a proposed system.Understand the impact of intradepartmental decisions.Make decisions at the intradepartmental level for the overall good of the CIS within the organization.Become the key resource for their application.

THE PLANNING PHASEProject Manager-is responsible in managing all aspect of the project. It includes software application development, hardware, and networks as well as oversight management of the interfacing and conversion task.

THE PLANNING PHASEDepartmental TeamsTo thoroughly understand the departments information needs.To gain a full understanding of the software features and functions.To merge the new systems capabilities with the departments operationsTo assist in the system testing effort.Participate in developing and conducting end-user education.Provide high level support during initial activation.

THE PLANNING PHASEThe Planning steps involves:Definition of the ProblemFeasibility studyDocumentation and negotiation of project scope agreement.Allocation of resources

PLANNING PHASEA. Definition of the Problem-essential to it is the precise statement of the goal and outcomeEx. Unfair nurse staff assignments may relate to invalid patient classification tool (inaccurate grouping of patients)

PLANNING PHASEB. Feasibility study helps identify the information needs, objectives and scope of the project. Helps analyzing multiple parameters and by presenting possible solutions whether the proposed system outweigh the cost.It seeks to answer..Ex. Whats the real problem to be solved or goal to meet? What are the estimated cost? What are the known limitations and risk to the project?

PLANNING PHASE- FEASIBILITY STUDYStatement of the Objectives- outcome oriented and stated in measurable terms.Environmental Assessment- project is evaluated relative to organizations competitions. The impact of legal, regulatory and ethical considerations is reviewed.Determination of information needs- needs assessment and outlines the high level information required by the users.Determination of Scope-the scope of the proposed system.

PLANNING PHASE- FEASIBILITY..5. Development of Project Timeline- the project workplan, the steps required for each phase are outlined in sufficient detail.6. Recommendations- based on the finding of the feasibility study.

PLANNING PHASE- DOCUMENTAITON.C. Documentation and Negotiation of a Project Scope AgreementThe project scope agreement is drafted by the project team and submitted to theprojects steering committee.D. Allocation of Resources It considers the following when planning for reources:1. Present staff workload

PLANNING PHASE2. Human resources3. Cost of operation4. Relationship of implementation events with non-project events ( ex. JCAHO reviews)5.Anticipated training cost.6. Space availability7. Current and anticipated equipment requirements for the project team.

THE KEY ROLE OF THE NURSE ADMINISTRATORNurse executive involvement plays a critical role in the success of CIS implementation or upgrade. Business plan features the following..An executive summaryAn introductionAn environmental assessment of the CIS iin use by similar hospital.An analysis of nsg depatment culture, policies and information needs.An overview of the design and implementation plan describing the objectives, strategy, equipment needs, staffing projections etc.

THE KEY ROLE OF THE NURSE ADMINISTRATOR6. Financial plan projecting staffing, budget, expenses, capital expenditures and miscellaneoous expenditures.

SYSTEM ANALYSIS PHASEit is the second phase of developing a CIS is a fact finding phaseAll 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, how it is used and what is needed in the new system.

SYSTEM ANALYSIS PHASE5 StepsData collectionData AnalysisData ReviewBenefits identificationSystem Proposal Development

SYSTEM ANALYSIS PHASEData -collecting of data reflecting the existing problem or goal as the first step in system analysis phase. -as a result of data collection two documents were created. 1.1Workflow Document-data collected into logical sequencing of task and subtask performed by end user. includes the following; 1.1.1 List of assumptions about the process or work effort. 1.1.2 A list of the major task performed by the user. 1.1.3 A list of subtask and steps the user accomplishes and outlines.

SYSTEM ANALYSIS PHASE Multiple Sources of Data for completing a workflow document.Written documents, forms, and flow sheetsPolicy and procedure manualsQuestionnairesInterviewsObservations

SYSTEM ANALYSIS PHASEFunctional Design Document is the overview statement of how the new system will work. It outlines the human and machine procedures, the input points, the processing requirement, output from the data entry and major reports generated from the system.Functional design- is a concise description of the functions required from the proposed computerized system and describes how the application performs its task. Then database structure will be determined.

SYSTEM ANALYSIS PHASE2. Data analysis- provides data for development of an overview of the nursing problem and or stated goal defined in the project scope agreement.3. Data Review- The third step in the analysis phase is to review the data collected in the feasibility study, the workflow documents, and the functional specification and provide recommendations to the project steering committee for the new system.

SYSTEM ANALYSIS PHASEThe review focuses on resolving the problems and attaining the goals defined in the feasibility study based on the best methods or pathways derived from the workflow documents and the functional design.4. System Proposal Development- the final step in the system analysis stage is to create a system proposal document.It sets forth the problems and/or goals and the requirements for the new systems overall design.It outlines the standards, documentation, and procedures for management control of the project, and it defines the information required, the necessary resources, anticipated benefits, a detailed workplan, and projected costs for the new system.

SYSTEM ANALYSIS PHASEThe system proposal document answers four questions:What are the major problems and goals under consideration?How will the proposed CIS solution correct or eliminate the problems and/or accomplish the stated goals?What are the anticipated costs?How long will it take?

SYSTEM ANALYSIS PHASEthe system proposal describes the project in sufficient detail to provide a management level understanding of the system or application without miring in minutiae.The format of the final system proposal includes the following information:A concise statement of the problems and/0r goalsBackground information related to the problem

SYSTEM ANALYSIS PHASE3. Environmental factors related to the problemCompetitionEconomicsPoliticsEthics4. Anticipated benefits5. Proposed solutions6. Budgetary and resource requirements7. Project timetable

THE SYSTEM DESIGN PHASEThe design detail of the system and the detailed plans for implementing the system are developed for both the functional and the technical components of the system.Three major steps in the system design phase:Functional specificationsTechnical specificationsImplementation planning

THE SYSTEM DESIGN PHASEFunctional specificationsUse the functional design document developed in the system analysis phase of a CIS and builds on the design by formulating a detailed description of all system inputs, outputs, and processing logic required to complete the scope of the project. It further refines what the proposed system will encompass and provides the framework for its operation.

SYSTEM DESIGN PHASECommercial software vendors provides manuals, usually application-specific, include an introduction, a section for each pathway, and technical section.The hospitals departmental and project teams produce the organizations functional specification by evaluating the available commercial softwares functions with the workflow documents and making decisions on the pathways and functions to be used by the institution.

SYSTEM DESIGN PHASE2. Data Manipulation and OutputThe design team creating the new application often works closely with the programmers, making adjustments in the design and specification based on new perspectives, programming logic, and technologies.

SYSTEM DESIGN PHASE3. Technical SpecificationTechnical manager works on the four major areas 1. Hardwarethe ability to operate the new application on multiple hardware platforms is often desired.Ex. terminals., handheld devices, printers, upgrade a network, building computer rooms

SYSTEM DESIGN PHASE2. Application Softwareestablishing technical specifications outlining the operational requirements for the new system.specifications detail the procedures required to maintain the application software

3. Interface Systemdefines those programs and processes required to transmit data between two disparate system.

SYSTEM DESIGN PHASE4. Conversionsconversion of data from legacy system to the new systemdetermining the conversion requirements and developing and testing the conversion programs

SYSTEM DESIGN PHASE4. IMPLEMENTATION PLANNINGlast step in system design to establish detailed implementation workplan.workplan identifies a responsible party, and a beginning date and end date for each phase, step, task and subtask.this plan coordinates all task necessary to complete the development of new software, implement a new system and upgrade a current system.

THE TESTING PHASEthe new system or commercially available must be tested to ensure that all data are processed correctly and the desired outputs are generated. To ensure if programs are written correctly, the ff are done.Unit testing- conducted by individual programmersAlpha testing-done by system assurance group within the development organization Beta testing- occurs at the first client site

THE TESTING PHASEWhen commercially available software, the ff are recommended.1. Functional test-departmental teams test and verify databases.2. Integrated system test- total system is tested; this includes interfaces between systems as well as interplay between applications within the same system.3. Final testing- is within the end user training

DOCUMENT SYSTEM documentation begins with the final system proposalseveral manuals are prepared like users manual, a reference manual, and operators maintenance manual.

TRAINING PHASEtraining takes place before and during the activation of the new system.two training takes place; project team and selected members of the departmental team and the end user trainng

IMPLEMENTATION PHASEdescribes series of events required to begin using the system or application in the production or live environment and details the necessary computer and software maintenance operations required to keep the system running.Activation approaches Parallel PilotPhased-inBig bang theory

EVALUATION PHASEdescribes and assesses, in detail the new system performance identifying the strenght and weaknesses of the implementation process.determine whether it has accomplished the stated goalif it continuously meet the need of the users.

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