NURS 8210 HIT Projects and Decision Makers

In a good functioning organization, many systems, including health information technologies (HIT), require constant maintenance, revision, and evaluation. So, depending on what phase a HIT system is, it might require analysis, re/design, implementation, or a replacement with a new system. This process is made easier because of the system development life cycle (SDLC). In addition, getting key stakeholders and decision-makers involved when planning a new HIT project can help avoid some risks or failures. In this Discussion, we describe an example of a HIT project implemented at our organizations and evaluate the impact of key decision-makers on implementing HIT Projects.

Description an Example of a HIT Project Implemented

Hospitals and healthcare facilities face patient falls, with about 2 to 3% of hospitalized patients fall each year. Unobserved falls require hospitals to rule out and/or diagnose and treat injuries by conducting imaging studies, performing costly procedures, which are not reimbursed by the Centers for Medicare and Medicaid (CMS) (Kramer et al., 2020). The civilian hospital where I work is not excluded from these fall events. As a result, the Director of my nursing unit identified video monitoring systems as means to reduce falls at another hospital. At first, the Director brought the idea during staff meetings, including all the stakeholders. She asked if anyone knew about this monitoring system, and we discussed its benefits and drawbacks. Next, she proposed the project for approval to the Chief nurse officer (CNO) along with all the fall statistics and costs to the hospital as support to her case during budgeting. Finally, the project was approved, and a systems analyst came to analyze and implement the system. This HIT project followed the four major stages of the systems development life cycle (SDLC): planning, design, implementation, and maintenance and evaluation stages (Laureate Education, 2011).

Evaluating the Impact of key Decision Makers on Implementing HIT Projects

During the process of this HIT project, key decision-makers and key stakeholders were part of the planning. Stakeholders had their questions and concerns answers, and the analyst provided solutions to anticipated incidences. Before complete implementation, they used one hospital unit as a pilot project to test the viability and effectiveness of the monitoring camera with a technician constantly watching the screen and alerting the staff in case of any attempt to fall and a runner available to intervene. This project was a great one, and the evaluation showed that it eliminated/reduced falls at the hospital for several months. But with time, the hospital did not maintain the system as it was designed. They did not have enough staff to be the runners, and the fall rate increased again. So, the leaders did a great job involving the key decision-makers and stakeholders, but the organization failed to maintain the usage of the system as designed.

Reference

Kramer, J. B., Sabalka, L., Rush, B., Jones, K., & Nolte, T. (2020). Automated depth video monitoring for fall reduction: A case study. 2020 IEEE/CVF Conference on Computer Vision and Pattern Recognition Workshops (CVPRW), Computer Vision and Pattern Recognition Workshops (CVPRW),2020 IEEE/CVF Conference On, 1188–1196. https://doi-org.ezp.waldenulibrary.org/10.1109/CVPRW50498.2020.00155

Laureate Education, Inc. (Executive Producer). (2011). Transforming nursing and healthcare through technology: Systems analysis. Author.

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I do agree with you that the organizational culture and nature of the management of a healthcare facility has an impact on the implementation of projects (Mathieson et al., 2018). Health Information Technologies are a panacea to quality care and making it easy for the health systems to work best. Successful project implementation requires adequate planning and multidisciplinary teams’ approach. Involving nurses who work at the point of care in all phases of introducing a new technology helps to ensure a smooth transition to using the new technology and increases nurses’ buy-in to the system (Huter et al., 2020). Through research, it has been observed that nurses will and do adopt new technologies if they have had the opportunity to provide input into the planning and implementation processes by conducting trials of various types of equipment in different clinical settings, as well as the evaluation process by which they can be confident. For example, in a study on nurses’ efforts to promote early nurse involvement when introducing a new technology, the Bar Code Medication Administration (BCMA) system was used. After describing the context in which they worked to introduce this technology and the BCMA system, they will share their early attempts to introduce a BCMA system and then describe how active nurse involvement in the later planning phase, as well as the implementation and evaluation phases, facilitated this implementation process (Knox, 2019).

References

Huter, K., Krick, T., Domhoff, D., Seibert, K., Wolf-Ostermann, K., & Rothgang, H. (2020, December 9). Effectiveness of Digital Technologies to Support Nursing Care: Results of a Scoping Review. Journal of Multidisciplinary Healthcare. https://www.dovepress.com/effectiveness-of-digital-technologies-to-support-nursing-care-results–peer-reviewed-fulltext-article-JMDH

Knox, A. (2019, April 5). Informatics in Nursing Leadership: Leading in the Age of Technology | Canadian Journal of Nursing Informatics. Canadian Journal of Nursing Informatics. https://cjni.net/journal/?p=5979

Mathieson, A., Grande, G., & Luker, K. (2018). Strategies, facilitators and barriers to implementation of evidence-based practice in community nursing: a systematic mixed-studies review and qualitative synthesis. Primary Health Care Research & Development, 20(20). https://doi.org/10.1017/s1463423618000488

In order to have more affordable and quality healthcare, disruptive innovations need to take place. It involves using technologies to become more efficient (Townsend, 2013). For healthcare systems to implement new health information technology (HIT) the use of the systems development life cycle is used. The system development life cycle includes five stages, planning, design, implementation, maintenance, and evaluation (Laureate Education, 2011).

The healthcare system had five regional cancer centers all using the same electronic health record (EHR). The system had been implemented in 2005, and had undergone two upgrades to the system. The maintenance phase in the system development life cycle includes be aware of the new business needs, and refining the system to meet those needs (Dennis, Wixom, & Roth, 2012). The physicians were proficient in CPOE and all orders were entered electronically. The cancer center had an outpatient clinic, surgery, infusion center, and inpatient settings all using the EHR. Patients moved between levels of care frequently between levels of care, and the need became apparent that electronic reconciliation of medications needed to be implemented. In the Institute of Medicine’s Report, To Err is Human, recommendations were made for organizations to use CPOE, bar code medication administration and medication reconciliation to increase patient safety and reduce medication errors (To Err Is Human: Building a Safer Health System, 2000). The healthcare system had also implemented bar coded medication administration, but had never moved on to medication reconciliation using the EHR. The project was identified by the physicians within the cancer center. Patient due to their changes of condition were moving from the outpatient to inpatient units. The manual reconciliation for a patient at discharge from inpatient status was taking a physician at least two hours and mistakes were being made due to the manual process. I was director of clinical informatics for the hospital, and the chief hospitalist brought it to my attention. Together we coordinated a meeting with the chief hospitalists and informatics directors at the other four hospitals to gain consensus. The group created an enhancement request to take to the governance committee for information systems. The request was initially denied due to other projects currently prioritized.

In this situation, the physician and nursing leaders brought the new business need to the information systems (IS) department were willing to support the HIT project, but the IS department felt there was a shortage of resources to implement the medication reconciliation project (Szydlowski & Smith, 2009). To make change in an environment it is necessary to have support of by stakeholders who can influence the project outcome. It can be done through formal influence such at the executive team, and by informal influence of key stakeholders who may have influence conferred by their peers (Coplan & Masuda, 2011). The physicians supported their chief hospitalist and as a part of the medical leadership committee voted for the implementation of medication reconciliation. The chief hospitalist, the chief medical officer, and the chief surgeon aligned with the directors of clinical informatics to address the executive team at each hospital. Statistics had been gathered to show the waste of physician hours to manually reconcile the medications and the potential safety errors. The chief operating officer at each hospital sits on the IS governance board. Each hospital executive team agreed and voted that the medication reconciliation module needed to be the top priority for the organization, and trumped other projects. There was a meeting of the IS governance committee the next month, and the medication reconciliation was prioritized to be the next implementation. It then took six months to go through the system development life cycle to get to the go-love of the HIT.

Before implementing new HIT, the need for the new technology must be recognized. HIT that is in the maintenance phase should be evaluated to see if there are new business needs and is it meeting those needs (Laureate Education, 2011). The hospitalist recognized they were not using the HIT efficiently, when the patients were moving to different levels of care. And in this instance, it was the influence and perseverance of the key stakeholders, the physicians, that impacted the implementation of the medication reconciliation module.

References

Coplan, S., & Masuda, D. (2011). Change mangement Project management for healthcare information technology (pp. 193-237). New York, NY: McGrawHill Companies.

Dennis, A., Wixom, B. H., & Roth, R. M. (2012). Transition to the new system Systems Analysis & Design (5th ed., pp. 471-501). Hoboken, NJ: John Wiley& Sons, Inc.

Laureate Education, I. (Producer). (2011). Transforming nursing and healthcare through technology: Systems analysis.

Szydlowski, S., & Smith, C. (2009). Perspectives From Nurse Leaders and Chief Information Officers on Health Information Technology Implementation.Hospital Topics, 87(1), 3-9. doi:10.3200/HTPS.87.1.3-9

To Err Is Human: Building a Safer Health System. (2000). Washington, DC: The National Academies Press.

Townsend, J. C. (2013). Disruptive innovation: A prescription for better healthcare. Forbes, 5. Retrieved from Forbes website: http://www.forbes.com/

I agree with you that it is imperative to adopt disruptive innovations in healthcare in order to promote quality care and patient satisfaction (Alotaibi & Federico, 2017). Modern technological advancement in the care practices have ensured reduced procedures of admission, easy and safe access to patients’ medical history and smooth transition from one level of care to the next hence saves time and resources. Cancer morbidity and mortality are rapidly increasing globally as a result of population growth and aging, reflecting changes in the prevalence and distribution of major cancer risk factors. These global trends have resulted in an increase in the number of people living with or beyond cancer. As a result, there is an increased need to improve and optimize cancer care services from diagnosis to treatment, rehabilitation, and end-of-life care (Sullivan et al., 2017). Modern technologies, which are frequently enabled by the availability of big data and advanced analytics, have demonstrated the potential to improve the current level of cancer care quality, for example, by improving information access, informing and sharing clinical decision making with patients, and facilitating communication and support for living with the illness (Kondylakis et al., 2020).

References

Kondylakis, H., Axenie, C., Bastola, D. (Kiran), Katehakis, D. G., Kouroubali, A., Kurz, D., Larburu, N., Macía, I., Maguire, R., Maramis, C., Marias, K., Morrow, P., Muro, N., Núñez-Benjumea, F. J., Rampun, A., Rivera-Romero, O., Scotney, B., Signorelli, G., Wang, H., & Tsiknakis, M. (2020). Status and Recommendations of Technological and Data-Driven Innovations in Cancer Care: Focus Group Study. Journal of Medical Internet Research, 22(12), e22034. https://doi.org/10.2196/22034

Sullivan, R., Pramesh, C. S., & Booth, C. M. (2017). Cancer patients need better care, not just more technology. Nature, 549(7672), 325–328. https://doi.org/10.1038/549325a

NURS 8210 HIT Projects and Decision Makers