NSG Module IV Discussion 1 Wilkes University

Name and describe an information system you use in your clinical setting. Discuss how the information system enables you to apply healthcare informatics in providing increased quality of care to your patients. Present an analysis on any changes using the SDLC [Planning, Analysis, Design, Testing and Implementation, and Post-Implementation (Maintenance)] stages which would be beneficial to the operations of this information system. Describe the process you would implement to improve this system by applying this week’s theory. Describe barriers you anticipate encountering.

Post your initial response by Wednesday at 11:59 PM EST. Respond to two students by Saturday at 11:59pm EST. The initial discussion post and discussion responses occur on three different calendar days of each electronic week. All responses should be a minimum of 300 words, scholarly written, APA formatted (with some exceptions due to limitations in the D2L editor) and referenced.  A minimum of 2 references are required (other than the course textbook). These are not the complete guidelines for participating in discussions. Please refer to the Grading Rubric for Online Discussion found in the Course Resource module. 

Module IV/Initial Post

                                                            Discussion Board

Information System: SIMS Charting

            The purpose of this discussion post is to discuss the systems development life cycle and how it is used in clinical practice. While this model is used differently, in nursing, it is defined as a unidirectional cycle focused on planning, analysis, design, implementation, and maintenance in informatics (Wang et al., 2019). 

            In my clinical practice, the organization uses a system called SIMS charting. In SIMS charting, the students can chart a patient using a simulated electronic health record. A benefit of using this charting system is that it provides a simulated care plan creator to help students plan care and begin to understand the nursing process, thus being able to put the pieces together. Kleib et al. (2021) report that using an electronic health record in academics helps promote practice, knowledge, and skills as it relates to informatics so that the user is able to provide care in a safe environment.

The Systems Development Life Cycle Model

Until recently, the students have not used the SIMS program due to no assigned clinical site, and as a result, some students forgot their usernames and passwords. In contrast, others forgot how to use the SIMS, while others did not express any interest in using the product. not note any interest in using it. In addition, the organization is always hiring new staff, however, some of the staff are not educated on how to utilize this software, therefore posing difficulty while at the clinical site. For example, the instructor has the clinical group out at the site and plans a SIMS assignment on a patient. When the student asks for assistance, the instructor is not sure how to provide assistance, which then results in both parties being angry; therefore, for these situations, the stages of change that would prove to be effective include the planning phase, design phase, as well as testing and implementation, and evaluation phase.

Analyzing for Change Using the Theory

            The first phase of planning should be initiated by addressing changes in the organization to make SIMS more user-friendly. During this phase, it is essential to determine the software’s primary goal: In order to determine the goal, I would propose questions such as who will use the software, how often, and what is the anticipated time frame. In their work, McBride and Tietze (2018) point out that a part of this phase is to have a goal in mind. To determine the goal, I would meet with my Director of Nursing and members of the teaching staff and assess who will be implementing this SIMS software in their curriculum. McBride and Tietze (2018) report that one of the responsibilities in this phase is to determine what the end users need; therefore, gathering all users’ information and their needs, will help the organization be successful in promoting student success. According to Wang et al. (2018), the end users include the nursing faculty and students.

            Secondly, the next phase that would provide change is the design phase. During this phase, McBride and Tietze (2018) found that it is essential to focus on security. For example, once the student is enrolled in the program, they receive a scratch-off card that shows their username with a temporary password, and to better protect the student’s and staff’s information, I would work with the vendor and propose a plan to update passwords at least every six months.

The following testing and implementation phases could also be applied to this analysis. For example, the question is whether the software will support the end users involved. Therefore, to answer that, I would ensure proper education is provided to all users, and while teaching how to use the product, assess all of the user’s knowledge.  For example, I would have the students use a SIMS chart for every clinical; even if they did not go to a site, they would have a lab day on campus and would be given a patient scenario or case study, thereby utilizing and having practice with the software. In addition, I would provide the same instruction for staff, and instruct them to chart in SIMS using a patient case study as well.  Lastly, I would enforce communication between all users to inform me of what is working or what is not working. Therefore, if the staff or students are experiencing difficulties, I can address them if needed. (McBride & Tietze, 2018).   

During the final phase of evaluation, I would investigate this software’s use and determine if the students are finding it helpful. McBride and Tietze (2018) share that we need to determine if this phase promotes steady growth and information. In deciding this, I would send out student surveys and assess what they feel they learned, whether are they finding the system easy to use, and if not, what can be changed, and then review data from completed surveys. I also would ensure that students have access to user support systems or IT. In providing these resources for the students and faculty, this product will be user-friendly for all involved. In closing, I believe one of the perceived barriers to the implementation and use of SIMS includes the staff and students not wanting to participate in the education to learn how to use the system. In this case, the next plan of action includes meeting with the President of the campus, the Director of nursing and student, and any Instructors involved in hopes to address and rectify the issue.

                                                References

Kleib, M., Jackman, D., Wisnesky, U. D., & Ali, S. (2021). Academic electronic health records in undergraduate nursing education: Mixed methods pilot study. JMIR Nursing, 4(2). https://doi.org/10.2196/26944

McBride, S., & Tietze, M. (2018). Nursing informatics for the advanced practice nurse: patient

safety, quality, outcomes, and interprofessional. Springer Publishing Company

Wang, J., Gephart, S. M., Mallow, J., & Bakken, S. (2019). Models of collaboration and dissemination for nursing informatics innovations in the 21st Century. Nursing outlook, 67(4), 419. https://doi.org/10.1016/j.outlook.2019.02.003

The red warning signs are always visible from far from any powered computer cart that every nurse on the unit is using to document, store meds and utilities and administer medications during the very hectic twelve hours shift on the Spine floor. 10am is usually the time where morning medications are administered. The rush hour of nursing.

Hence when a specific medication is not administered within the specific period a red alert pops up and does not go away unless the medication is either administered, put on hold or documented as not given.

This alert is red and can be easily seen from far and hence when passing by a nurse’s computer It unwillingly tells if the nurse is on time or not on medication administration.

Epic is an information system that we use at the clinical setting I sometimes moonlight for a weekend. The system is vast, and all different parts of the hospital actively participate in it. For instance, it has all the tools that I need to safely assess my patient in the morning, administer medications safely on time, teach my patient, make a care plan and communicate with different providers throughs messaging, get an update on the plan of care of the patient…

It consists of nonclinical items. I could see if a bed is ready I another unit before transferring my patient or giving report on the latter. I could communicate with pharmacy at any given point. I could see the result of my patient out before even the latter could come back on the floor from a procedure.

The system also has the dual checking system where both the medication and the patient are scanned. This by itself is an excellent system of checks and balances. It is an excellent tool in preventing medication errors as the latter is cause to thousands of errors every year.

Another HIS that we use in the hospital is a device called Vocera. This device is directly connected to the call bell at the patient’s bedside and alerts the nurse and the PCA if the latter is calling.

Vocera also helps as a translator phone. One can quickly find another team member via call. It helps to send messages for the whole floor. During emergencies, Vocera is an excellent tool to bring the available nurses to the site of emergency very hastily.

Moreover, Vocera is also very anxiety causing device. It constantly calls the nurse, sometimes makes the latter repeat the answer numerous times when it fails to catch the answer. I have witnessed many nurses being burnt out and taking the battery out of the device for a short break just to get a quick relief from the incessant calls of the Vocera device.

One change I would implement would be to sync the vocera device to EPIC screen the messages into urgent, to the nurse and to the PCP. Adding an advanced voice recognition software could let the Vocera machine distinguish and screen information and send it to the specific person. For instance if the patient wants ice, instead of Vocera calling both the nurses and the PCA at the same time, it could direct it to the PCA and save the most important questions to the RN who is normally busy making more critical decisions.

Also synchronizing Vocera with EPIC and sending messages via EPIC like the current message platform that EPIC has and is used by the collaborative team would be excellent. The latter is seldom cause for anxiety and is addressed on time as the nurse is mostly on EPIC for any specific task.

The design would necessitate the input of both the Vocera and the EPIC team to work together to sync both devices.

Once that is done the next step would be to choose a floor for a pilot study and see if the system works.

Discuss the pros and cons of the system in regular huddle that involves all the personnel involved in patient care and using the device.

Assess the responsiveness of the team to the new change and make changes if need be.

Once adequate positive input threshold that was previously determined is reached the change could now be implemented on a wider scale in other units.

Maintenance of the change could be reassessed on a time set period. One way of assessing would be to look at the anxiety level of nurses and PCAs both pre and post implementation of the change.

We could also look at patient satisfaction both pre and post implementation of the change and compare results. 

We should also look at the technical aspect of it if the sync is working or if it needed troubleshooting.

References:

Krishna1, P., Reddy, G. S., & Madhav, M. V. (2021). Component Based Software Development (SDLC) [Review of Component Based Software Development (SDLC)]. Component Based Software Development (.

Cao, Y., & Ball, M. J. (2016). A Hospital Nursing Adverse Events Reporting System Project: An Approach Based on the Systems Development Life Cycle. Studies in Health Technology and Informatics, 245, 1351.

In my psychotherapy practice, telemedicine was a needed information system during the pandemic. Telemedicine is a form of healthcare informatics that employs digital information and communication technologies to permit health providers to deliver services remotely  (Mayo Clinic, 2022). When it was impossible to physically meet in person with patients who needed mental health treatment, we elected to use a telemedicine informatics application that we did not specifically plan, analyze, or design. At that time, implementation and evaluation were the only phases of the systems development life cycle (SDLC) important to us. Staff trained in how to use the telemedicine application and evaluated while my practice used it. The important thing was that the telemedicine application allowed us to meet with our patients, collect and update patient data, and provide patients with needed treatment. My practice’s mission is to provide patients with quality mental healthcare. The telemedicine application allowed us to do this seamlessly.

Since the pandemic is in a transition phase, my practice must decide on the next stage for telemedicine. Using SDLC will enable us to determine the best future use for telemedicine for our practice. During the planning phase, the first step is defining the project, which includes its scope, how it aligns with our vision and goals, timeframe, resources identified, and stakeholders. 

 In the analysis phase, we will examine whether telemedicine has a negative or positive effect on our practice; how it affects patients, mental health treatment, staff, workflow, and culture; and is in-person treatment better for patients.

The design phase will determine whether the existing telemedicine platform meets our needs or do we need to use another platform. In addition, do we need to add new interface elements? One problem was the telemedicine platform we used was somewhat complicated for patients because they had to apply a few steps to connect to their therapist. We will consider using a platform with fewer steps.

For the implementation phase, we will provide training and instruction as necessary to staff and patients. We also want to ensure that we follow HIPAA regulations strictly. One thing we do not want to do is take any shortcuts. Shortcuts can invite hackers to compromise patient data. In 2022, healthcare organizations in the United States suffered an average of 1,410 weekly cyberattacks per organization, 86% higher than in 2021 (Pollack, 2023).

During the maintenance phase, we will constantly review whether the telemedicine system is meeting our needs and is error-free. If the system should stop meeting our needs or an error arises, we will perform the SDLC process to find a solution.

Most of the barriers we face with telemedicine are related to the unknown. For instance, state and government regulations relaxed regarding telemedicine during the pandemic. We are not sure how it will affect our use of telemedicine if guidelines are stricter in the future. Another unknown concern is telehealth usage by patients. Telemedicine protected people from being infected with the COVID-19 virus, and usage surged. As the COVID-19 threat diminishes, whether telemedicine will remain a popular option for medical care is unknown. Although many of our patients still meet through telemedicine, more patients have requested in-person psychotherapy sessions in recent months. Has telemedicine been just a trend born out of necessity, or is it here to stay?

References

Pollack, R. (2023, February 3). Keeping hospitals and patients safe against cyberattacks.    American Hospital Association. Keeping Hospitals and Patients Safe againstCyber             attacks | AHA News

Mayo Clinic. (2022, June 18). Telehealth: Technology meets health care.  https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/telehealth/art-            20044878