NI Handouts (last day)

8/7/2019 NI Handouts (last day)

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Dependability and Healthcare Quality and Safety

Ethical obligations drive requirements for system reliability, availability, confidentiality, dataintegrity, responsiveness and safety attributes to collectively refer to as dependability.Dependability is a measure of the extent to which a system can justifiably be relied on to deliver the services expected from it. Dependability comprises the following six (6) attributes:

System Reliability ± the system consistently behaves the same way. Service Availability ± required services are present and usable when they are needed. Confidentiality ± sensitive information is disclosed only to those who authorized to see

it. Data Integrity ± data are not corrupted or destroyed. Responsiveness ± the system responds to user input within an expected and

acceptable time period. Safety ± the system does not cause harm.

Remember CARDS: Confidentiality, Availability, Reliability, Responsiveness, Data

Integrity, Safety

5 Guidelines

Architect f or Dependability ± an enterprise system architecture should be developedfrom the bottom up so that no critical component is dependent on a component lesstrustworthy that itself.

Anticipate Failures ± features that are transparent to software applications should beimplemented to detect faults, to fail over to redundant components when faults aredetected, and to recover from failures before they become catastrophic.

Anticipate Success ± the systems planning process should anticipate businesssuccess and the consequential need for larger networks, more systems, newapplications and additional integration

Hire Meticulous Managers ± good system administrators should meticulously monitor and manage system and network performance.

Don¶t be Adventur ous ± an organization must use only proven methods, tools,

technologies and products that have been in production, under conditions, at a scalesimilar to the intended environment.

Design, Implementation and Upgrading Clinical Inf ormation Systems

There are eight (8) phases of designing, implementing or upgrading a nursing informationsystem:

The Planning Phase

The planning phase of the project begins once an organization has determined that anexisting need or problem may be filled or solved by the development or implementation of a CISor application. Establishing the committee framework to research and make recommendations

for the project is an important first step and is variable based on the needs of the organization.The planning phase involves the following steps:

Definition of the Pr oblem ± the project definition includes a description of the how thesystem will be evaluated. Establishing the evaluation criteria early in the processsupports the successful management philosophy of beginning with the end in mind. Theresults and improvements expected from implementing the system are described by therealistic goals for the system. When updating or expanding the CIS, the project definitionincludes the identification of equipment currently available, its age, the degree of



amortization, and the need for hardware or operating system software upgrade prior totaking an upgrade project.

Feasibility Study ± is a preliminary analysis to determine if the proposed problem can besolved by the implementation of a CIS or component application. The feasibility study notonly clarifies the problem and/or stated goal but also helps to identify the informationneeds, objectives and scope of the project. It includes the following project areas:

Statement of Objectives Environmental Assessment Determination of Information Needs Determination of Scope

Documentation and Negotiation of Pr oject Scope Agreement ± A project scopeagreement is drafted by the project team and submitted to the project¶s steeringcommittee for acceptance. The agreement includes the scope of the project, theapplication level management requirements, the proposed activation strategy for implementing CIS or application, and the technical management and personnel who willmaintain the equipment.

Allocation of Resources ± A firm commitment of resources for development of theentire CIS project scope agreement is needed before the system can fulfill its statedobjectives. The following points should be considered:

Present staffing workload

Human resources Present cost of operation Relationship of implementation events with non-project events Anticipated training cost Space availability Current and anticipated equipment requirements of a project team

The System Analysis Phase

The system analysis phase is considered the fact-finding phase. All data requirementsrelated to the problem defined in the project scope agreement are collected and analyzed to gaina sound understanding of the current system, how it is used, and what is needed for the currentsystem. It consist of the following five steps:

Data Collection ± the collection of data reflecting the existing problem or goal is the firststep in the system analysis phase. As a result of thorough data collection, refinements tothe project scope agreement may occur. Added benefits to the organization may berealized through the small refinements. Two important documents are created as a resultof data collection:

Workflow document ± assimilates the data collected into logical sequencing of tasks and subtasks perform by the end users for each goal or problem area. Itincludes a list of assumptions about the process of work efforts; major tasksperformed by the user and subtasks and steps the user accomplishes andoutlines whether.

Functional design ± is the overview of the statement of how the new system willwork. It uses the workflow documents as its base, adding the criticaldocumentation of the integration of each of the workflow documents to create a

new system, implement a commercial software application or upgrade a system. Data Analysis ± the analysis provides the data for development of an overview of the

nursing problem and/or stated goal defined in the project scope agreement. Severaltools can be used in the development of the workflow and functional design documents:

Data flowchart Grid chart Decision table Organizational chart Model



Data Review ± the review focuses on resolving the problems and/or attaining the goalsdefined in the feasibility study based on the methods or pathways derived from theworkflow documents and the functional design. Recommendations for streamliningworkflow are suggested.

Benefits Identification ± should reflect the resolution of the identified problem,formulated and stated in quantifiable terms. The proposed benefits statements becomethe criteria for measuring the success of the problem.

System pr oposal development ± it includes submission to the project¶s steeringcommittee for review and approval. The format of the final system proposal includes thefollowing information:

A concise statement of the problem and/or goals Background information related to the problem Environmental factors related to the problem

(a) Competition(b) Economics(c) Politics(d) Ethics

Anticipated benefits Proposed solutions Budgetary and resource requirements

Project timetable

The System Design Phase

In the system design phase, 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 the system. Acceptance of system proposal by the committee heralds the beginning of thesystem design phase. There are three (3) major steps in the design system phase:

Functional Specifications ± use the functional design document developed in thesystem analysis phase of a CIS and builds on the design by formulating a detaileddescription of all system inputs, outputs and processing logic required to complete thescope of the project.

Technical Specifications ± Dedicated technical manager is required. Each area

requires that a detailed technical specification be developed. The four major areasincludes:

Hardware Application Software Interface Software Conversions

Implementation Planning ± includes establishment of a detailed workplan. Theworkplan identifies a responsible party and a beginning date and end date of each phase,step, task and subtask.

The Development Phase

If the project steering committee decides to develop its own system programs, the projectstaff must proceed with the development phase which includes hardware selection, softwaredevelopment, test system and document system.

The Testing Phase

The system, whether newly developed or commercially available, must be tested to ensureall data are processed correctly and the desired outputs are generated. Testing verifies that thecomputer programs are written correctly and ensures that when implemented in the production(live) environment, the system will function as planned.



The Training Phase

It is essential to train the end users on how to use the system properly. A CIS will functiononly as well as its users understand its operation and the operation streamline the work.

All users of the new system or application must receive training. Training on a new systemshould occur no more than six (6) weeks prior to the activation of the new system. Training takesplace before and during the activation of a new system.

The Implementation Phase

The implementation phase organizes all steps into a detailed plan describing the series of events required to begin using the system or application in the production or live environment anddetails the necessary computer and software maintenance operations required to keep thesystem running. This phase ensures that once the system is installed in the live environment, thesystem and the delivery of healthcare in the organization will run smoothly.

The Evaluation Phase

The evaluation phase describes and assesses, in detail, the new system¶s performance.Using the criteria established in the planning and system design phases, the evaluation processsummarizes the entire system, identifying both the strengths and weaknesses of theimplementation process. An evaluation study often leads to system revisions and, ultimately, abetter system. Approaches to evaluating the functional performance of the system exist.

Documents

NI Handouts (last day)