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Handbook of Informatics for Nurses
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.oni /ee Hebda and Patricia Car
Chapter 8
System Implementation
and Maintenance
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#ystem Implementation
.hird phase of the life cycle
1egins &ith purchase of the system
$euires planning before purchase Entails selection of the implementation
committee
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Implementation Committee
Pro3ect leader4needs to be in%ol%ed in theentire process
.echnical staff
Informatics representati%es
Clinical representati%es
5anagers &ho understand day6to6day
operations and ho& those processes mightbe impro%ed
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#teering Committee membership and
organiational issues are as important as
the technology &hen implementing a ne&
system
Pro3ect leader must ha%e strong
leadership and communication skills
Implementation Committee
7continued8
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Implementation Committee .asks
e%elop plan 7&ork breakdo&n structure8
#chedule tasks for implementation
efine the scope of each task
Identify timelines and :go6li%e; date
Identify resources and constraints
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?n6site training by the %endor
> @endor training at corporate headuarters
> Consultants may pro%ide training #hould re%isit issues eAamined during
selection
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Issues to $e6%isit
Is technology currentB "pgradableB
-inancial stability of %endorB
@endor compliance &ith regulationsB
Interoperability &ith other systemsB
#upport inpatient outpatient and E %isitsB
#upport for the electronic medical recordB
$emote accessB oes it support patient careB
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1ase #ystem %s! Custom
.his decision impacts implementation
Customiation reuires time and
resources Customiation may also ha%e ripple
effects on other systems and
interoperability
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-unction
, task performed manually or automated
5ust identify information pertinent to
completion of each function EAamples
> ?rder entry
> $esults reporting> ocumentation
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#ystem ?utput
5aterial generated by the system
EAamples of output include
> $euisitions produced in other departments> $eports
> iagnostic results
> Dorklists> Charges
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etermining ?utput
,nalysis of the current and desired
&orkflo&s pro%ide this information
#pecifications must be agreed to or:signed off; by managers in the areas that
&ill be impacted
Constant changes to specifications delaythe pro3ect and costs
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.est En%ironment
Copy of the information system soft&are
that is used to make changes from the off6
the6shelf %ersion from the %endor
Programmed changes are tested to
ensure that they &ork as designed
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.est Plan
Identifies long6range goals and test items
#cript that follo&s a series of transactions
from beginning to end for all associatedfunctions
$euires input and participation from
users from all areas of the facility E%aluation4eAamine output
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Hard&are $euirements
,nalysis of needs must be done early in
the implementation phase
Considerations> Net&ork infrastructure
> Dorkstations and 5obile de%ices
>Placement of &orkstations
> Printer needs
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Net&ork Infrastructure
#hould be determined early4later
changes increase costs
> Net&ork configuration reuirements
> #er%er specifications4memory processing
po&er consider future needs
> .echnical standards
> Cabling and po&er
> Direless access
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Dorkstations and 5obile e%ices
5ust determine ad%antages and
disad%antages of each type of de%ice
etermine the number of de%ices needed In%estigate technology and support for
access by P,s and handheld de%ices for
pro%iders etermine &here de%ices &ill be located
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Procedures and ocumentation
etermine ho& the system &ill be used
before end user training starts
E%aluateFre%ise policies and proceduresfor system use and include in training
e%elop "ser guides
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#ystem ocumentation
e%elop a dictionary of terms and map
terms from one system to another
ictionaries and mapping help to ensurehigh uality data
-inalie path&ays and screens before the
test plan is &ritten and training starts
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"ser #ystem .raining
o not start until changes are complete
.raining en%ironment4separate copy of
the information system soft&are that&orks the same &ay as the actual system
and is populated by fictitious patients
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Implementation Pitfalls
"nderestimate for time and resources
?ngoing addition of changes and more
features 7scope creep and feature creep8 -ailure to consider costs for annual
maintenance and other eApenses
Problems &ith testing or training
/ack of system :o&nership; by users
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5aintenance
"ser feedback analyed and appropriate
changes made
"ser support4resource staff a%ailableduring go6li%e on units and %ia help6desk
at all times
5ust apply updates to all G en%ironments4test training and production 7li%e8
.echnical
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.he $ole of Nursing
,ll users should ha%e input into the
systems that they use
Nurse informaticists pro%ide :credibility; forinformation system pro3ects
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Nurse Informaticist $esponsibilities
#ystems de%elopment and implementation
/iaison
uality initiati%es
#trategic planning
Education
@endor communication
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.he Chief Nursing ?fficer 7CN?8 must
&ork &ith key figures to de%elop
strategies to transform care prioritiesystem design to maAimie the %alue
and benefits of a clinical information
system and re6allocating time sa%ed in
documentation and other efficiencies to
impro%e patient care ser%ices!
Nurse Informaticist $esponsibilities