1.  Clinical information systems in nursing homes: an evaluation of initial implementation strategies

Author(s): Alexander GL, Rantz M, Flesner M, Diekemper M, Siem C

Source: Comput Inform Nurs 2007 Jul-Aug;25(4):189-97.

Summary: This article presents qualitative results collected 6 months after implementation of a clinical information system in four nursing homes in the Midwestern USA. Researchers explored initial implementation strategies, discussed employee experiences and analyzed employee satisfaction. Transcript-based analysis and axial coding were completed to illustrate recurring phenomena. Common attributes were identified by two gerontological nurse experts and a researcher with human factors expertise. Common themes emerging from 22 focus groups and direct observation of more than 120 nursing home staff were perception and cognition, change, workable systems, competence, and connectedness. Implementation strategies associated with lower satisfaction were availability of equipment, training resources, and the presence of information technology professionals. Initial clinical information system implementation strategies and employee satisfaction could be enhanced by the inclusion of a system life cycle charter plan, emphasizing change management procedures, improving start-up projections, hiring adequately trained information technology staff, and providing a system support plan. Findings will be useful to administrators and policy makers who are contemplating implementation of a clinical information system.

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2.  Evidence-based practice: how nursing administration makes IT happen

Author(s): Simpson RL

Source: Nurs Adm Q 2006 Jul-Sep;30(3):291-4.

Summary: As the voice of and advocate for nurses, nursing administration should assume the leadership position in the development of evidence-based practice models. One of its most important tasks is to advocate for ubiquitous information technology (IT) to support these models. This article examines evidence-based nursing and the importance of IT to its development and growth. It explains the role of nursing administration in guiding IT implementation, as well as key issues that must be examined in system selection and development.

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3.  Information technology: changing nursing processes at the point-of-care

Author(s): Courtney KL, Demiris G, Alexander GL

Source: Nurs Adm Q 2005 Oct-Dec;29(4):315-22.

Summary: Changing societal demographics, increasing complexity in healthcare knowledge, and increasing nursing shortages have led healthcare strategists to call for a redesign of the healthcare system. Embedded within most redesign recommendations is the increased use of technology to make nursing practice more efficient. However, information technology (IT) has the potential to go beyond simple efficiency increases. If IT is perceived truly as a part of the redesign of healthcare delivery rather than simply the automation of existing processes, then it can change nursing processes within institutions and furthermore change the point-of-care between nurses and patients. Nursing adoption of technology within the workplace is a result of the interactions between technical skills, social acceptance, and workplace culture. Nursing needs for information not only influence their adoption of particular technologies but also shape their design. The objective of this article is to illustrate how IT can change not only nursing practice and processes but also the point-of-care. A case study of the use of IT by nurses in telehomecare is presented and administrative implications are discussed.

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4.  Nurses' experiences using a nursing information system: early stage of technology implementation

Author(s): Lee TT

Source: Comput Inform Nurs 2007 Sep-Oct;25(5):294-300.

Summary: Adoption of information technology in nursing practice has become a trend in healthcare. The impact of this technology on users has been widely studied, but little attention has been given to its influence at the beginning stage of implementation. Knowing the barriers to adopting technology could shorten this transition stage and minimize its negative influences. The purpose of this study was to explore nurses' experiences in the early stage of implementing a nursing information system. Focus groups were used to collect data at a medical center in Taiwan. The results showed that nurses had problems with the system's content design, had insufficient training, were concerned about data security, were stressed by added work, and experienced poor interdisciplinary cooperation. To smooth this beginning stage, the author recommends involving nurses early in the system design, providing sufficient training in keyboard entry skills, redesigning workflow, and improving interdisciplinary communication.

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5.  Outcomes assessment of clinical information system implementation: A practical guide

Author(s): Nahm ES, Vaydia V, Ho D, Scharf B, Seagull J.

Source: Nurs Outlook 2007 Nov-Dec;55(6):282-288.

Summary: Healthcare information systems (HIS) play a vital role in quality of care and the organization's daily operations. Consequently, increasing numbers of clinicians have been involved in HIS implementation, particularly for clinical information systems (CIS). Implementation of these systems is a major organizational investment, and its outcomes must be assessed. The purpose of this article is to provide clinicians and frontline informaticians with a practical guide to assess these outcomes, focusing on outcome variables, assessment methods, and timing of assessment. Based on in-depth literature reviews and their empirical experiences, the authors identified 3 frequently used outcomes: user satisfaction, clinical outcomes, and financial impact. These outcomes have been assessed employing various methods, including randomized controlled trials, pre- and post-test studies, time and motion studies, surveys, and user testing. The timing for outcomes assessments varied depending on several factors, such as learning curves or patients conditions. In conclusion, outcomes assessment is essential for the success of healthcare information technology, and the CIS implementation team members must be prepared to conduct and/or facilitate these studies.

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6.  Patient and nurse safety: how information technology makes a difference

Author(s): Simpson RL

Source: Nurs Adm Q 2005 Jan-Mar;29(1):97-101.

Summary: The Institute of Medicine's landmark report asserted medical error is seldom the fault of individuals, but the result of faulty healthcare policy/procedure systems. Numerous studies have shown that information technology can shore up weak systems. For nursing, information technology plays a key role in protecting patients by eliminating nursing mistakes and protecting nurses by reducing their negative exposure. However, managing information technology is a function of managing the people who use it. This article examines critical issues that impact patient and nurse safety, both physical and professional. It discusses the importance of eliminating the culture of blame, the requirements of process change, how to implement technology in harmony with the organization and the significance of vision.