Introduction
Driving a car does not require knowledge of how the engine, suspension, or gearbox work. Mastering profession-related IT is quite similar: one can obtain the benefits without knowing how the technology works (Silva et al., 2011). The implementation of HIT (Healthcare Information Technology) allows to enhance and streamline multiple processes of healthcare organizations: from improving patient’s care to reducing chances of medical error (Szydlowski & Smith, 2009). Electronic Health Records (EHR), also known as Electronic Medical Records (EMR), represent one of the common HITs, which serves to improve the overall quality of medical services. However, implementing any HIT requires strong, capable leadership from nursing leaders and decision-makers (Laukka et al., 2020). This paper explores the implementation and development cycle of EHR in a single healthcare organization.
Project Identification and Development
Similar to a human being, a HIT project such as EHR has its life stages. However, while the identification and development can be compared to birth, childhood, and adolescence, respectively, the EHR is not expected to die. Instead, the nursing personnel is supposed to deliver user feedback so that the EHR system could be improved and continue to function. Therefore, the SDLC (Systems Development Life Cycle) of the EHR can be viewed as a closed-loop, not a straight line.
A successful HIT project implementation requires a well-structured SDLC, in which healthcare workers must fulfill specific roles from identification to completion. In that regard, the EHR implementation has much in common with programming, except that nursing personnel does not complete coding tasks. Achimugu et al. (2010) provided a hierarchical architecture of project management and development progress, which consists of three schemas:
- Manager’s schema: in the nursing department, that schema solely consisted of CNO, who planned, led, and supervised the EHR implementation;
- Actor’s schema: that level consisted of informatics nurses — the leaders among them identified the necessity to implement the EHR system. Those nursing leaders approached the CNO, who agreed with their arguments;
- User’s schema: that schema represented nursing personnel who worked with the EHR system and provided necessary feedback to informatics nurses.
Overall, the middle-level leaders — the informatics nurses, had the most impact on EHR implementation. According to their standards of practice, they provided an assessment of the situation, identified the issue, and shared their knowledge with colleagues (American Nurses Association, [ANA], 2008). The hospital CNO provided the necessary top-level leadership for the project, and the line nursing personnel showed important support and understanding of the changes. Therefore, a duly involvement of all three SDLC schemas determined a successful EHR implementation.
The Impact of Decision-makers
A precise evaluation of the decision-makers’ impact on successful EHR implementation is a challenging task, which requires complex research. However, Laukka et al. (2020) provided a classification of healthcare leader’s roles and their impact on HIT implementation. According to it, the most common and important part of decision-makers is supporters (Laukka et al., 2020). Supporters form a chain on all healthcare organization levels, thus creating a welcoming environment for the changes. The second-most important role play change managers, who oversee the process of implementation and prevent setbacks. Finally, the third-place role belongs to the project manager, the head of the whole initiative. That person is essential, but it is difficult to succeed alone when everyone else does not show support.
Conclusion
An implementation of the complex HIT such as EHR requires the creation of the well-structured SDLC. All three schemas — manager, actors, and users must be involved. In fact, the support of the middle and bottom level schemas is even more critical for the eventual success. The crucial role belongs to specialist nursing leaders: the informatics nurses. Those leaders act as links between the CNO and healthcare workers, starting from the identification stage and finishing with implementation and subsequent development.
References
American Nurses Association. (2008). Nursing informatics: Scope and standards of practice. American Nurses Association.
Laukka, E., Huhtakangas, M., Heponiemi, T., & Kanste, O. (2020). Identifying the roles of healthcare leaders in HIT implementation: A scoping review of the quantitative and qualitative evidence.International Journal of Environmental Research and Public Health, 17(8), 2865. Web.
Silva, J. S., Seybold, N., & Ball, M.J. (2011). Disruptive innovation: Point of care. In M. J. Ball, J.V. Douglas & P. H. Walker (Eds.), Nursing informatics: Where technology and caring meet (4th ed, pp. 291-303). Springer.
Szydlowski, S., & Smith, C. (2009). Perspectives from nurse leaders and chief information officers on health information technology implementation.Hospital Topics, 87(1), 3-9. Web.