Nursing Informatics Terminology Self Study: Systems Development Life Cycle, Needs Assessment, Analysis Phase, Gap Analysis, Risk Analysis, Risk ManagementAll about nursing

A systems development life cycle (SDLC) is a frame work for describing the phases of developing information systems.

nursing informatics is the nursing specialty practice that “integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice” (ANA 2008).
the standards of nursing informatics practice:
- assessment
- problem identification
- outcomes identification
- planning
- implementation (coordination of activities, teaching/ promotion/ education, consultation)
- evaluation
The SDLC contains:
- initiation, analysis, design, implementation, and continuous improvement of support
- The nurse informatician working on tasks in the design phase of the Systems Development Life Cycle uses the findings of the –Analysis phase as a blue print– the findings and plans developed in the analysis phase provide the guide for the design phase of the SDLC

The informatics specialist is in a unique position to promote the integration of consumer informatics into the mainstream of health care delivery. true statement about the nurse informatics clinical specialist? –the nurse informatics clinical specialist can be part of the life cycle process. — with the increase in health care technology, the incorporation of a nurse informatics specialist can help to provide patients and nurses the tools to understand the use of technology and promote the widespread adoption of consumer informatics.

Planning — Needs assessment is the first step/ phase of the information system life cycle. organizational goals are set based upon a needs assessment. The first step is for management to agree on the upcoming needs of the organization. These needs may be long term, short term, or a combination of both. once the needs have been determined, performance goals for individuals and teams should be set to meet the organization’s needs. It is important that the individual goals are specific, measureable, and time based. The goals should be distributed across the organization to align efforts in meeting the core needs. Regular milestones should also be set to assure that progress is being made.
- identification of an organization’s goals and objectives is a critical factor in fulfilling the mission.
- the goals and objectives explain how the mission will be realized
  - a goal is an open-ended statement that describes in general terms what is to be accomplished
    - the ability to achieve defined goals is especially important in the rapidly changing healthcare environment as hospitals merge into large enterprises and services evolve to meet changing needs. Prior to writing goals and objectives, administrators need to communicate the vision and mission to employees in a manner that elicits understanding and buy-in.
  - objectives state how and when an organization will meet its goals.
- Planning:
  - The strategic planning teams first identified, then actual planning process can begin. Identifying the goals and scope is the second step in strategic planning.
  - the goals of the project must meet the needs of the users as well as support the mission and goals of the institution.
  - Scanning the external and Internal environments–needs assessment.
  - after data have been collected during the needs assessment, the project implementation team must perform analysis, identifying trends in the current operations as well as future needs and expectations, and determine feasibility from technical, financial, time, and resource perspectives.
    - a feasibility study will help to define the problems that the new information system is expected to address. It will also answer questions regarding cost, goals, and specific outcomes. Some specific questions may include
      - how will the outcome be measured?
      - what research has been done to back up the proposal?
      - what are the risks in terms of people, money, and time?
      - how long will the implementation take and what will be involved?
      - will the project require dedicated staff members, contractors, or a combination of both?
      - Your unit is in the process of making a major change in patient care delivery. Data has been collected; the driving and restraining forces, including costs, desirability, and feasibility, have been examined. which issue related to change has the unit addressed? –structural issue–
        
        structural issues include the costs, desirability, and feasibility of the change project
        
        political issues include the power groups in favor of or against the proposed change.
        
        technology issues may include new, up-to-date equipment
        
        people issues include the commitment of the staff, their level of education and training, and their interest in the project.
The nurse informaticist is aware that the analysis phase answers the question of what the system will do, while the design phase addresses: how will it work?
- Gap analysis–examines the space between where the organization is and where it wants to be (is the different between the ideal and real situations), an assessment of the differences between the expected magnet requirements and the organization’s current performance on these requirements. Performance gap assessment is a strategy of demonstrating an opportunity for improvement at baseline outlining current practice related to specific indicators. This is helpful in encouraging commitment for practice changes.
- gap analysis is a method used to determine the steps required to move from a current state or actual performance or situation to a new one or potential performance or situation and the “gap” between the two that requires action or resources.
- Essentially gap analysis answers the questions “What is our current situation?” and “What do we want it to become?” “Gap analysis includes the determination of the resources and time required to achieve the target goal. Steps to gap analysis include:
  - assessing the current situation and listing important factors, such as performance levels, costs, staffing, and satisfaction, and all procedures
  - identifying the current outcomes of the processes in place
  - identifying the target outcomes for projected processes
  - outlining the process required to achieve target outcomes
  - identifying the gaps that are present between the current process and goal
  - identifying resources and methods to close the gaps.
    - Which of the following questions should be considered in the hospital gap analysis survey of safety and security readiness in the event of a disaster?
      - does the facility have a lockdown plan in case of emergency?
      - do you have a plan for allowing staff entry into the facility during an emergency?
      - dose the facility have emergency powered phones in case of a disaster?
      - assessing the clinical operations readiness in the gap analysis survey can be answered by asking some of the following questions:
        
        Does the facility have procedures in place to maximize staff safety in a disaster?
        
        Does the facility have procedures in place for use of PPE?
        
        Can the facility track patients until discharge or death while maintaining confidentiality?
- Risk analysis: needs to be done at the beginning of the project and continue throughout the process. This is similar to an assessment –what are the real and potential risks and problems, and what is the plan to prevent them?–
  - Proactive risk mitigation rather than reactive recovery efforts:
    - 24/7 operation and performance with redundances throughout the system, failovers, and tested high reliability
    - tools to assist in monitoring and managing the IT environment, monitor system use, and identify technology issues before system failure occurs
    - scalable IT solutions as more clinical applications come online
    - solutions that IT departments can manage without in-depth technology expertise
    - implementation of health information exchanges (HIEs) to facilitate the sharing of patient information
  - David Hillson managing project risk:
    - “…management of overall project risk becomes a shared duty of both project sponsor and project manager, acting in partnership to ensure that the project has the optimal chance of achieving its objectives within the allowable risk threshold. Successful management of risk at this whole-project level therefore depends largely on the effectiveness of the working relationship between these two key players. “
    - bridging the strategy and tactics gap to ensure that project delivery is tied to organizational needs and vision
    - focusing projects on the benefits they exist to support, rather than producing a set of deliverables
    - managing opportunities proactively as an integral part of business process at both strategic and tactical levels
    - providing useful information to decision makers at all levels when the environment is uncertain
    - allowing an appropriate level of risk to be taken intelligently with full awareness of the degree of uncertainty and its potential effects on objectives
  - Planning risk management: the process of deciding how to approach risk management activities and plan for them in a project
    - output–Risk management plan: documents the procedures for managing risk throughout the project. — it is important to clarify roles and responsibilities, prepare budget and schedule estimate for risk-related work, and identify risk categories for consideration. it is also important to describe how risk management will be done, including assessment of risk probabilities and impacts as well as the creation of risk-related documentation.
      - contingency plans
      - fallback plans
      - contingency reserves
      - management reserves
    - Common sources of risk on IT projects: Business, Technical, Organizational, Project management.
  - Identifying risks: the process of understanding what potential events might hurt or enhance a particular project.
    - brainstorming
    - delphi technique
    - interviewing
    - SWOT analysis (Strengths, Weaknesses, Opportunities, and Threats)
    - checklists
    - assumptions
    - diagrams
    - Output–risks identified / risk register : is a document that contains results of various risk management processes; it is often displayed in a table or spreadsheet format.
      - an identification number for each risk event
      - a rank for each risk event
      - the name of the risk event
      - a description of the risk event
      - the category under which the risk even falls
      - the root cause of the risk
      - triggers for each risk
      - potential responses to each risk
      - the risk owner or person who will take responsibility for the risk
      - the probability of the risk occurring
      - the impact to the project if the risk occurs
      - the status of the risk
  - Performing qualitative risk analysis: assessing the likelyhood and impact of identified risks to determined their magnitude and priority.
  - Performing quantitative risk analysis
  - Planning risk responses
    - risk avoidance: eliminating a specific threat, usually by eliminating its causes
    - risk acceptance: accepting the consequences if a risk occurs (having contingency or backup plan)
    - risk transference: shifting the consequence of a risk and responsibility for its management to a third party
    - risk mitigation: reducing the impact of the risk event by reducing the probability of its occurrence
    - Four basic response strategies for positive risks:
      - risk exploitation: doing whatever you can to make sure the positive risk happens
      - risk sharing: allocating ownership of the risk to another party
      - risk enhancement: changing the size of the opportunity by identifying and maximizing key drivers of the positive risk.
      - risk acceptance
  - Controlling risks
    - workarounds – unplanned responses to risk events, when they do not have contingency plans in place
    - Using software to assist in project risk management