Software Development for Nursing: Role of Nursing Informatics
Medha Piplani Verma1*, Dr. Sandhya Gupta2
1Nurse Educator, Bodhi Health Education Pvt. Ltd., Gurugram, Haryana
2Faculty, College of Nursing, All India Institute of Medical Sciences, New Delhi
*Corresponding Author Email: medha.aiims@gmail.com
ABSTRACT:
Health IT has transformed healthcare in a way that it would be difficult for any healthcare organization to sustain if it fails to adapt to such developments. Nurses have welcomed this change and continue to contribute to its successful implementation. Nevertheless, the true participation in system development remains an unmarked zone where nurses have not been engaged. Nurses are key professionals who should participate during implementation process. However, their role in software development has never been highlighted. To penetrate the healthcare sector in a coherent manner and to achieve the desirable goals in clinical setting, participation of nurses throughout the inception process is imperative. This article would highlight the need for role definition of nurses through different phases of software development in healthcare.
KEYWORDS: Health IT, Nursing informatics, Nurse informaticists, Software development in Health, Software development cycle.
INTRODUCTION:
Nurses are at forefront to change the face of healthcare as they take a step forward in successful implementation of Health IT. It has been observed that with digitalization, adoption of IT in healthcare has followed the same pattern as in other fields. It was during 1950s that the new technology was utilized to automate standardized and repetitive tasks like accounting and payroll. Healthcare also used IT to process statistical data. After twenty years, similar IT revolution took over the world. It did affect the health care with the introduction of electronic health care. Though biotechnology has continued to advance in terms of disease management, the IT application in terms of health care management is still in its infancy.
Some healthcare institutions have moved beyond and have gone to stage of full digitalization, incorporating IT in services sector, channels, and processes, as well as advanced analytics that enable entirely new operating models. Nursing informatics is emerging as promising field with a challenge being thrown at the professionals to understand and participate in the field of Health IT with efficient training and leadership. The facilities provided by digitalization are enormous. It has opened many avenues for the patients to utilize healthcare facilities proficiently. A patient can now access an application to look for a disease related information, seek opinion from any specialist globally, manage appointments and access electronic health record for previous disease history. However, it has been observed that the patients can have reservations about sharing health related information with professionals online and may not be comfortable about their health-related information being available on the internet. To strengthen this, collaborative effort towards e-health, it is obligatory to improve the standards in health care information and digitalization. This adoption of electronic interaction between patients and professionals, demands an active involvement of healthcare professionals in the development process as well as implementation of quality clinical applications. Nurses are eager to improve clinical processes through adoption of Health IT. Measurement of essential quality improvement standards like patient safety, strategic development, monitoring and efficient reporting involve more prompt systems like well-defined clinical decision support systems and integrated patient care records where active engagement of clinical professionals is indispensable. Digitalization has immensely benefited all, by providing the opportunity to have access to patient care information through user-centered electronic medical records. On a macro level, information management systems have opened doors of research, monitoring and pivotal public health. Nursing is the central component to efficient patient care. Electronic health record (EHR) must be maintained by the nurses, being the connecting link between professionals. As per HIMSS the role of nurse has grown beyond helping the IT folks design electronic medical record (EMR) screens and choose equipment. It is now an integral part of the healthcare delivery and a differentiating factor in the selection, implementation, and evaluation of health IT in order to support safe, high quality, patient-centric care.
Nursing and Information System Management:
The information systems used by healthcare organizations like admission, discharge, order entry, clinical documentation, communication system and critical pathways require professional guidance as the data collected is utilized in variant clinical systems. The current focus areas in nursing informatics are standardizing terminologies, clinical decision support, patient safety, data exchange and interoperability, and clinical quality measures. It has been emphasized that standard nursing terminologies can be used in patient care systems as it would make documentation process more understandable. The basic principles for successful implementation of any software are the same. One word to define a good software would be ‘user friendly’. User friendly software in healthcare would be the one which would have the following features:
· Easy to understand
· Requires minimal effort at the user end
· Is clinically relevant
· Provides easily retrievable information
Nurse informaticists are required to be part of the development process of software as they understand clinical flow and patient care processes better. This becomes more relevant as EHR are now looked upon as not only a source of convenience, but a mode to enhance patient care processes and quality improvement. Nurses working in clinical setting are in a better position to judge whether a software is useful and facilitates patient care, or just adds to the burden of formality for the healthcare professionals. Involvement of nurses could also address common problems that may arise due to ill-designed software, as well as ensure better allocation of healthcare resources. The need of nurses to be a part of the software development process has long being recognized. It is important that nurses be involved in selection, development and implementation of any system. (Glancey TS, Brooks GM, Vaughan VS, 1990).
Software Development Phases:
Software development is a step wise process, which is targeted to plan and develop a software. System development life cycle is a term used to define the various phases in development of a software. Following are the phases of software development (Fig 1):
Fig 1: System development cycle
1. Understanding the Problem:
Before a product is developed for healthcare professionals, the software developers need to understand the need of the users. The users in healthcare involve frontline nurses in majority as nurses coordinate and conduct a lot of patient care related activities. Clinical nurse leaders and managers can contribute significantly in explaining and putting the requirement in a coherent manner so that the product that comes out is not redundant. Involvement of nurses in initial phases of software development would ensure a better product which is different and more relevant clinically (Plochg and Hamer, 2012). Nurses need to participate in initial stages to identify improvement areas for quality patient care, where IT can contribute. For example, development of standard operating procedures to prevent medication errors, antibiotic resistance etc. engagement of nurses here, will be helpful in tracking such important areas. Nurses can take up roles of project and operation manager to supervise the project plan and provide strategic guidance towards product development.
2. Coding Planned Solution:
The next step in software development cycle is to code the program i.e. translating it into the program language. A software developer can understand the requirements but there are many terminologies that may require the guidance of a healthcare professionals for example use of medical terminology or patient care data relevant to acuity system which can create a false clinical picture if not put aptly. A standardized nursing language used in patient care systems must be defined in order to be able to communicate patient care information accurately among nurses and other healthcare providers. Nurses must work closely with the IT team for defining standardized nursing terminology to outline and define the nursing scope in patient care and hence reflect on the healthcare software. As we know that the terminology used by medical professionals and nurses may vary in terms of patient care and expected outcome, hence it is necessary to have clear language instructions in healthcare software. Nurse informaticist can learn coding and take up the role of a coder. It would enhance collaboration and understanding between the software team and healthcare professionals. It would also ensure effective integration of technology into practice.
3. Testing actual program:
Clinical nurses are the best judge to assess the positive aspects and to identify the challenges that may hinder the functioning of software created for patient care. It is important for the decision makers to involve nurses before a system or software is adopted as nurses remain important link to many clinical processes in healthcare (O'Cathain A, Sampson FC, Munro JF, Thomas KJ, Nicholl JP, 2004). Testing is an important phase as a system’s design can greatly influence its acceptability by the users. An example is the use of learning management system for online learning (Table 1). The sections defined are essential fields under any e-learning platform that need to be organized well. When such platforms are used for healthcare professionals, that role of nurse becomes more important as they would be able to contribute highly to identification of innovative strategies for making it successful. Nurse informatics can take up role of a test analyst or a tester to check the credibility of software. Nurses conventionally are involved in beta testing of software which means that they test the software as users. Now is the time that the nursing professionals take up primary roles as they can participate in alpha testing when the product is tested before it is available for implementation.
4. Deployment and Maintenance of Product:
The last step is to implement the solution in the clinical setting. This phase is the most interesting and challenging part of the process. The software is adopted and used by many users. Usually, at this stage, the system encounters unthinkable problems as the IT goes live. The system may or may not produce desired results as expected. A well-designed system can be exploited to extract information in multiple dimension and various clinical processes. The guidance at this point cannot be ignored in order to smart track data using checklists, nursing alerts and clinical guidelines that promote evidence-based practices. Data can be structured systematically to check performance through dashboards and compliance records. At this point, the system is utilized to understand the information obtained as multiple users use the system. The system can track progress of individual user and identify problems faced by them in using the system. For example, a software is developed with an intent to save nursing time, but the data indicates otherwise as the nurses are not comfortable using the system and find it difficult to access. Such problems can be identified when the software is put in action in the clinical setting. Nurses can not only identify such issues but would be in better position to suggest an alternative that is more practical and clinically relevant. Nurses can work as solution architects to guide the team about development of software as per client’s requirement and improvise it with time.
Nurses Need to be Involved in Software Development:
In the current scenario, nurses are a part of the process only when the software is tested and at later stages when the software is ready to be deployed throughout the organization. The issues like interaoperability are already producing a glitch for healthcare. Nurse informaticists has listed it as one of the key areas of research in near future. But the question remains that if the nurses are not involved in software development process, how would such issues be addressed. Another problem commonly encountered as highlighted earlier is the system being not user friendly. The argument here is, who is the best to suggest what suits the users? The answer is ‘the user’; someone who will be using it in the clinical setting for the patient care. Clinical nursing leaders do participate in earlier stages and provide consultation to vendors. Nurses must be involved in the earlier stages of software development cycle in order to have an efficient system which literally translates the language of health into the software being used. Implementation and adoption of such systems require identification of champions or problem solvers. Yet nurses are still portrayed as professionals who are not willing to adopt technology readily, which causes another hurdle for their involvement in this process. The responsibility to break this stereotype remains not only with leaders but also with the frontline nurses. Frontline nurses can coherently put forward requirements such as recording of content, format of content, linkage with other systems, reporting capabilities of the system, access and training implementation.
Table 1: Tool try out for online learning portal
|
Pre-assessment
It identifies the existing knowledge of the learner. Nurses can decide the correct assessment methodology for the topic. Assessment format that can be utilized on a LMS: • Case based method • Multiple choice questions • True/false • Short answer • Essay type • Calculation type • Audio/video recording based questions |
Desired outcome and Learning material • To ensure effective learning, defining the key outcomes is important. • Learning material must be formatted in a way to communicate the outcomes efficiently. • Nurses being familiar with training strategies can help device learning activities with the content. |
Assessment
• Assessment would follow a similar format as that of Pre-assessment. • Different assessment formats can be used based on the desired outcomes. |
Evaluation
• Once the learners have used the system, evaluation of various parameters can be done. |
|
Cardiopulmonary resuscitation (CPR) You are posted in OPD. Suddenly a patient collapses in front of you. • What would be the initial assessment steps? • What initial care will you provide to the victim?
|
Course objectives need to outlined and content needs to be effective enough to achieve the desired outcomes.
Objectives The learner should be able to: • Describe the components of CPR. • Understand the sequence of managing a cardiac arrest victim.
Content: • Presentation explaining the steps of CPR. • Video demonstration of CPR management of a cardiac arrest victim. |
• Which of the following represents the correct sequence of steps to perform CPR? • The location for checking pulse for an infant is/are?
|
• Number of learners who completed the course (with desired %). • Average time taken per user to finish the course.
|
CONCLUSION:
An important goal of nursing is information management to provide quality patient care. It would require working on aspects of preventive care and choosing apt interventions for patient care. This would be achieved by using different technologies like smart phone applications, tele-nursing, hospital information systems to address patient care in different settings; whether the patient is at the hospital, community or outpatient department. Nurses can play important an role in successful implementation of community level projects where the patients’ understanding of technology may be limited. Healthcare information system necessitates participation of nurses for its sustainability. To have quality information system in place and for diverse use of technology in patient care, nurses’ role is eventful and a difficult void to fill. Quality care in healthcare cannot be successful unless nurses take the lead. It is time that healthcare leaders realize and delegate nurses to ‘prepare for the future e-healthcare’ as quality management can be revolutionized with intelligent use of information technology.
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Received on 12.02.2017 Modified on 28.04.2017
Accepted on 15.05.2016 © A&V Publications all right reserved
Int. J. Nur. Edu. and Research. 2017; 5(2): 203-207.
DOI: 10.5958/2454-2660.2017.00044.8