Archive for March 10th, 2009

Roles of the Healthcare Informatics Professional

March 10, 2009

I found the information on the history of health care informatics and future roles of informatics professionals very interesting.

We have become so immersed in technology in such a short time. My husband and I were discussing last evening how when he decided to replace his computer 4 years ago we were keeping the old computer for the sole purpose of using it for games since that was pretty much the only reason I used the computer. He used his only to track his business on a very basic spreadsheet. We have since that time expanded to 2 PC’s, 2 laptops, a notebook and computer access on our cell phones. We use computers daily for business, communication, computation, finances and bill paying and of course computer games.
In reading the history of the evolution of computers it was surprising in many ways. We often forget that computer technology has been used for several decades, crude and massive as those first computers were. Few of the general public was even aware of their existence or use. We have since evolved to smaller, faster and more sophisticated computers. It is rare to talk with people who do not use computers in some capacity in their daily life. My father first began using email at 60 years old and enjoyed using the Internet until his death 6 years later. My mother refused to learn and at 77 years old is still fighting use of computers. She is constantly amazed at how common place the use of computers is in everyday life and does on occasion use them in the grocery store and doctors offices.  Computers are not only used in all aspects of my job but I use them continuously in my daily life. I can no longer imagine a life without them.

I found it interesting in reading these chapters how they talked about the eventual realization of Internet access on cell phones. In the 7 years since this book (Health Care Informatics, An Interdisciplinary Approach, 2002) was published Internet access on cell phones has become common place. As noted in Moore’s law the processing power of the transistor chip doubles every 18 months. Computer technology is advancing at an alarming rate making it difficult at times to keep up with these advances.

Of course all of this advancement has greatly changed to roles of the healthcare informatics professional. I have been at my hospital for 27 years. When I first came to the hospital we had an IS staff of 2, one for hardware and one for software. We now have an IS staff of over 50 with analyst, programmers, hardware implementation and maintenance and software developers as well as integration specialist.  Not only have the number of roles increased but the responsibilities included in each of these roles have greatly expanded.

In reading the information on standards as well as educational changes it is evident how these roles have expanded. The healthcare informatics professional must understand the needs of clinicians, patients and support staff. They must also be aware of the standards affecting all of the aspects of healthcare and keep up to date on these standards. There has been a great shift in the education of all healthcare professionals to incorporate the use of computers in the delivery of healthcare. In working on implementations not only with clinicians but with support staff I am often surprised at the capacity for staff to adapt and learn new systems. Even those who are resistant to change are able to adapt and make these changes.
The role of the healthcare informatics professional is constantly changing. This can be daunting at times however I find it also exciting. We are in the midst of a revolution of change and I enjoy being in the thick of things.

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Lessons Learned: The completion of a new installation

March 10, 2009

It is said that life imitates art. I have found that for me recently life has paralleled my studies. I have recently completed a project that I followed from inception to completion. It has been an interesting journey.

I began this journey in October of 2006. I was new to healthcare informatics and project management having just taken a new position a month earlier. I was asked by the CNO who I report to directly, to coordinate the demos of three companies who were to show us their vital sign solutions for a system that would integrate with our Meditech EMR. This was a bit of a challenge at first as I had not done anything like this in my nursing career; however my family owned several retail stores so I was familiar with salesmen and felt confident in my ability to deal with them.

After having arranged the demonstrations and gone through the process of narrowing it down to 2 vendors we had many discussions between IS and nursing about which vendor we would choose.  The CIO moved ahead and approved purchase from a vendor who would also supply us carts on wheels. After receiving the carts it was found that the vital signs equipment they had shown us in the demo was not what was on the carts. The equipment did not work and there was not a previous interface with Meditech as they had told us.

First lesson, communication is of utmost importance in selecting a vendor and implementing a new system. The CIO had made this decision without the approval of the CNO and had not talked with me about this also. Therefore the system did not meet the needs of the clinical staff though the IS staff felt it was the best choice. This was the second lesson which has been discussed in these chapters of Health Care Informatics, An Interdisciplinary Approach, the need for the healthcare informatics professional to understand the needs of the clinicians.

After more discussion and deliberation another vendor was chosen and we began the task of assessing and deciding how much equipment to buy, getting board approval and going through with the purchasing process.  At this time the CNO officially appointed me as the project manager.

I began setting up the acceptance of the products and working with the implementation team to coordinate not only training of the end users but working with the IS staff on the integration with Meditech. This provides the 3rd lesson which is also discussed in this module of my educational program. Never underestimate how many different entities are involved in a project. Not only were IS and the nursing staff effected but so were the bioengineering, purchasing, physicians, of course patients as well as safety and quality assurance departments.

One of the issues that are discussed in this module is the need to meet standards set by many agencies that the hospital answers to from JCAHO and OSHA to IEEE and AHRQ. It was interesting to see how this project required attention to many of these standards.

We came across many “bumps in the road” on this project. There was a previously unplanned upgrade to Meditech which delayed implementation. There then was a problem with Meditech not accepting messages from the PDA’s used to download vitals into the Meditech module which required a “special build” from Meditech. There were wireless assessments, training to both the IS and the bioengineering staff for support and maintenance of the system. There were builds needed both in Meditech and in the software on the PDA’s for the integration and then there was the issue of a lost shipment of PDA’s.
 At times I doubted the project would ever come to fruition. However, with much communication, organization and attention to detail we were able to complete implementation of the project with the final go live on March 4th. We are live on 5 inpatient units and are now looking to expand this to the outpatient arena. The staff loves the new processes and feels it has improved safety with positive patient ID and real time documentation of the vital signs. The team worked together, IS, bioengineering, and nursing as well as the other involved entities as well as the implementation team from our vendor, making the actual go live was a very smooth and positive process for all involved.

The final lessons learned, timing is everything, expect the unexpected, communication is essential and there are no small projects!

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