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    Handbook of Informatics for Nurses

    and Healthcare Professionals

    Copyright 2009 by Pearson Education Inc!"pper #addle $i%er Ne& 'ersey 0()*+

    ,ll rights reser%ed!

    Handbook of Informatics for Nurses and Healthcare Professionals -ourth Edition

    .oni /ee Hebda and Patricia Car

    Chapter 8

    System Implementation

    and Maintenance

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    Handbook of Informatics for Nurses and Healthcare Professionals -ourth Edition

    .oni /ee Hebda and Patricia Car

    #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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    .oni /ee Hebda and Patricia Car

    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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    Handbook of Informatics for Nurses and Healthcare Professionals -ourth Edition

    .oni /ee Hebda and Patricia Car

    #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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    .oni /ee Hebda and Patricia Car

    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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    .oni /ee Hebda and Patricia Car

    ?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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    Handbook of Informatics for Nurses and Healthcare Professionals -ourth Edition

    .oni /ee Hebda and Patricia Car

    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