Discussion: The Inclusion of Nurses in the Systems Development Life Cycle

Post a description of what you believe to be the consequences of a healthcare organization not involving nurses in each stage of the SDLC when purchasing and implementing a new health information technology system. Provide specific examples of potential issues at each stage of the SDLC and explain how the inclusion of nurses may help address these issues. Then, explain whether you had any input in the selection and planning of new health information technology systems in your nursing practice or healthcare organization and explain potential impacts of being included or not in the decision-making process. Be specific and provide examples.

The systems development life cycle (SDLC) “is a way to deliver efficient and effective information systems that fit with the strategic business plan of an organization” (McGonigle & Mastrian, 2018, p. 175). There are many stages and models used within SDLC. These models include the waterfall model, rapid prototyping, object-oriented systems development, and dynamic system development (McGonigle & Mastrian, 2018). The model is used for nursing isn’t crucial as involvement. SDLC focuses on a needs assessment in a medical setting and should include shared partnerships from the entire organization (McGonigle & Mastrian, 2018). Nurses, as end product users, play an essential role in procuring these new technologies. Without nurse’s involvement early and often in the SDLC process, the consequences could be a complete failure of the technology.

While technology specialties may understand new technology, they have no idea how patient care flows or the impact these new technologies may have on patient care. This is where nursing experts come in. In an article from The Online Journal of Issues in Nursing, Weckman and Janzen (2009) state nurses “understand the dynamic flow of patient care and the frequent interaction needed between numerous healthcare providers while providing their care.” Involving nurses early and often can facilitate a smooth transition, as well as end-user buy-in. Having a nurse engaged throughout the process lends the technology to having credibility and buy-in. This buy-in is one of the essential success factors in any new technology introduced in a medical setting (Weckman & Janzen, 2009). I believe it is also important to note here the nurse and patient relationship. It cannot be overlooked that the patients trust nurses, and if the nurses are not happy, there is a great chance the patients will not be satisfied (Singletary & Baker, 2019).

If we take the Waterfall model, for example, you can look at how important it is to have a nurse involved early in the process. The first step is feasibility. Feasibility tells us whether the new technology could and should work. A nurse will know right away if a new technology will work on their floor, and it is essential to understand what may work on one floor may not work on another. Not involving a nurse in this step could lead to wasted time and money on a project that isn’t going to work. In the next phase, design, users look at how the new technology will work and interact with current technologies. There could be mockups or prototypes made (McGonigle & Mastrian, 2018). This could be necessary trial runs on less critical patients. Finally, we get into implement, test, and maintain. If this is the first time a nurse has seen this product, the chances of success are limited.

I have had the opportunity to provide input into a new medication entry system. We currently utilize a completely separate system to chart our medications. It cannot connect to our health records in any manner. However, late last year, we did a 30-day test on a new portion of our current electronic medical records system, which would link all medications into the patient’s records. Our facility was selected as one of two test sites. The new system worked well. It even gave us the ability to chart medication refusals for patients who did not attend medline, which we have never been able to do in the past. It also allowed providers to place orders into one system and be done, unlike before, where medication orders must be entered into two completely different approaches. However, there was one big issue. When we ordered patient refills, the pharmacy never got the orders, so no medication refills were ever called. This was in November 2020, and this still hasn’t been fixed. No one could explain where the disconnect occurred, but the new system has just gone away. No one even talks about it anymore. Luckily, we provided out inputs, but it makes one wonder how it got that far into development, and a big problem like this wasn’t discovered. If this system was not tested and just been put into place, I can’t imagine the hardships it would have caused. In just a little facility, with 500 offenders, it was chaos waiting for refills that were never coming. The answer we continued to get was to wait to see if the refills go through. We had patients on so many critical meds that went weeks without. To say the offenders and nurses were ready to riot is not an understatement. Putting this into place with 10,000 state offenders would have been a disaster. Thank goodness it was tested, and this didn’t happen.

References

McGonigle, D., & Mastrian, K. (2017). Nursing informatics and the foundation of knowledge (4th ed.). Jones & Bartlett Learning.

Singletary, V. & Baker, E. L. (2019). Building informatics-savvy health departments: The systems development life cycle. Journal of Public Health Management & Practice, (25)6, 610-611. doi: 10.1097/PHH.0000000000001086

Weckman, H. N. & Janzen, S. K. (2009). The critical nature of early nursing involvement for introducing new technologies. The Online Journal of Issues in Nursing, (14)2. doi: 10.3912/OJIN.Vol14No02Man02

Respond to at least two of your colleagues* on two different days, by offering additional thoughts regarding the examples shared, SDLC-related issues, and ideas on how the inclusion of nurses might have impacted the example described by your colleagues.